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

The role of the farnesoid X receptor in diabetes and its complications

Diabetes is a metabolic disease in which tissues and organs are exposed to a hyperglycemic environment for a prolonged period. Long-term hyperglycemia can cause dysfunction of multiple organs and tissues in the body, leading to diabetic complications such as diabetic cardiomyopathy and diabetic nephropathy. Diabetes and its complications have become one of the key issues that seriously threaten the health of people worldwide. Farnesoid X receptor (FXR), as a metabolic regulator, has multiple functions in regulating insulin synthesis and secretion, insulin resistance, lipid metabolism, oxidative stress, inflammatory response, and fibrosis. It plays a key role in alleviating diabetes and its complications. In this review, we discuss the latest findings of FXR related to diabetes and its complications, focusing on its role in diabetes, diabetic nephropathy, diabetic cardiomyopathy, and diabetic liver injury. The aim is to better understand the role of FXR in diabetes and its complications and to provide new perspectives on the treatment of diabetes and its complications.

Multifunctional Conductive Nanofibers for Self-Powered Glucose Biosensors

Electrochemical glucose biosensors are essential for diabetes management, and self-powered systems present an eco-friendly and innovative alternative. Traditional biosensors face several limitations including limited sensitivity, enzyme instability, and dependency on external power sources. Addressing these issues, the study develops a novel multifunctional nanofiber integrating biosensor for glucose detection and a self-powered motion sensor, utilizing an innovative triboelectric nanogenerator (TENG) system. Electrospun nanofibers, composed of graphene oxide (GO), porous graphene (PG), graphene foam (GF), polypyrrole (PPy), and polycaprolactone (PCL), demonstrate enhanced electrical conductivity, triboelectric efficiency, and mechanical strength. Among these, dip-coated nanofibers exhibited the highest conductivity of 4.9 × 10⁻⁵ S/cm, attributed to superior surface electrical properties of GO. PCL/PPy/GO nanofibers achieved the highest glucose detection performance in cyclic voltammetry and differential pulse voltammetry due to efficient electron transfer mechanisms of GO and PPy. Additionally, triboelectric tests revealed peak voltages of 63V with PCL/PPy/GO and polyvinylidene fluoride nanofibers containing glucose oxidase enzyme. Core-sheath and dip-coated nanofibers also demonstrated significant mechanical resilience (∼0.9 N force, ∼350 s durability). These findings highlight PCL/PPy/GO nanofibers as a multifunctional, efficient, and scalable solution, offering highly sensitive glucose detection and non-invasive sweat analysis along with robust energy harvesting for environmentally friendly and advanced diabetes management systems.

Proximal tubular deletion of superoxide dismutase-2 reveals disparate effects on kidney function in diabetes

There is a large body of evidence implicating mitochondrial reactive oxygen species (ROS) overproduction and oxidative stress in the development of diabetic kidney disease and the deficiency of mitochondrial antioxidant systems in the kidney, such as manganese superoxide dismutase (MnSOD/SOD2) have been identified. The proximal tubules of the kidney are densely packed with mitochondria thereby providing energy via oxidative phosphorylation in order to drive active transport for proximal tubular reabsorption of solutes from the glomerular filtrate. We hypothesized that maintenance of MnSOD function in the proximal tubules would be critical to maintain kidney health in diabetes. Here, we induced targeted deletion of SOD2 in the proximal tubules of the kidney in Ins2Akita diabetic mice (SODptKO mice) and show that 20 weeks of SOD2 deletion leads to no major impairment of kidney function and structure, despite these mice displaying enhanced albuminuria and kidney lipid peroxidation (8-isoprostanes). Plasma cystatin C, which is a surrogate marker of glomerular filtration was not altered in SODptKO diabetic mice and histological assessment of the kidney cortex revealed no change in kidney fibrosis. Thus, our findings suggest that deletion of SOD2 in the proximal tubular compartment of the kidney induces a more subtle phenotype than expected, shedding light on the involvement of SOD2 and the proximal tubular compartment in the pathogenesis of diabetic kidney disease.

Effects and Mechanisms of Steviol Glycosides on Glucose Metabolism: Evidence From Preclinical Studies

The natural sweeteners of steviol glycosides (SGs) have been widely used as a substitute for sugar due to their high sweetness, low-calorie properties, and potential health benefits. Some studies reported that SGs could regulate glucose metabolism and prevent Type 2 diabetes mellitus (T2DM); however, the detailed mechanisms remained further elucidated. Therefore, in this review, we aimed to systematically summarize the effects and mechanisms of SGs on glucose metabolism based on evidence from preclinical studies. We searched PubMed and Web of Science (up to March 31, 2024), and included a total of 40 animal and 5 cell studies for review. Results showed that SGs could improve glucose metabolism by enhancing insulin secretion, simulating insulin effects, improving insulin resistance, advancing key enzyme activities, or regulating gut microbiota. To conclude, if further validated in clinical trials and population studies, the sugar substitute of SGs may serve as a potential nutritional strategy for effective prevention and treatment of T2DM.

Effectiveness of a low-intensity nurse-led lifestyle intervention on glycaemic control in individuals with prediabetes: The PREDIPHONE randomized controlled clinical trial

BACKGROUND

Lifestyle changes can effectively prevent diabetes onset in individuals with prediabetes. Although nurse-led interventions have proven to be cost-effective and feasible in the management of diabetes and hypertension in primary care, low-intensity lifestyle interventions for people with prediabetes led by nurses remain poorly evaluated.

OBJECTIVE

To assess whether a low-intensity nurse-led telephone lifestyle intervention is effective in reducing fasting plasma glucose levels in individuals with prediabetes.

DESIGN

A two-arm, parallel, randomized controlled clinical.

SETTINGS

Five Primary Care Centres in the Balearic Islands, Spain.

PARTICIPANTS

A total of 206 participants were enrolled, 103 in each group.

METHODS

Consenting participants aged 25-75 years, with fasting plasma glucose levels of 100-125 mg/dL, and body mass index ≥27 and < 40 kg/m2 were randomly assigned (1:1) to either a 9-month nurse-led telephone lifestyle intervention (intervention) or short text messages with general lifestyle advice (control). Research staff and the statistician were masked to group allocation. The primary outcome was fasting plasma glucose at 9-month follow-up, analyzed per protocol and by intention-to-treat.

RESULTS

Among the 206 participants (103 in each group), 189 (91·8 %; n = 91 in the intervention group, n = 98 in the control group) completed the 4-month follow-up and 181 (87·9 %; n = 87 in the intervention group, n = 94 in the control group) completed the 9-month follow-up. Among the 206 randomized participants, 52.9 % were women, 73.8 % were obese, and 69.4 % were of Spanish nationality. Differences in fasting plasma glucose between groups at 9-months were not statistically significant (Intervention group n = 85 mean 103·4 mg/dL [SD 9·6] vs Control group n = 91 mean 104·8 mg/dL [SD 9·7]; adjusted mean difference 1·1 mg/dL [95 % CI -1·6 to 3·8]; p-value = 0·43). Difference in waist circumference at 9 months were statistically significant (Intervention group n = 85 mean 100.6 cm [SD 10.2] vs Control group n = 91 mean 104.0 cm [SD 10.2]; adjusted mean difference 1.9 cm [95 % CI 0.6 to 3.3]; p-value <0.01). At 9-month follow-up, diet quality improved in the intervention group (intervention group n = 86 mean 8.4 points [SD 2.0] vs control group n = 93 mean 7.5 points [SD 2.1], adjusted mean difference - 1.3 points [95 CI -1.7 to -0.7]; p-value <0.01). Likewise, sedentary behavior presented statistically significant differences at 9-month follow-up (intervention group n = 86 mean 5.4 H/d [SD 1.8] vs control group n = 93 mean 6.3 H/d [SD 1.9], adjusted mean difference 1.0 H/d [95 CI 0.5 to 1.4]; p-value <0.01).

CONCLUSIONS

These results do not support the effectiveness of a low-intensity nurse-led telephone lifestyle intervention in reducing fasting plasma glucose in individuals with prediabetes, although changes in diet quality and sedentary behavior were observed.

REGISTRATION

https://clinicaltrials.gov/study/NCT04735640?term=prediphone&rank=1NCT04735640. Registered 03/02/2021, first recruitment 13/04/2021.

TWEETABLE ABSTRACT

A nurse-led phone intervention had no significant benefits on glucose levels in patients with prediabetes. @GlobalHealth_rg.

Ultrasound super-resolution imaging and shear wave elastography for the non-invasive diagnosis of non-proliferative diabetic retinopathy: a pilot study

Background

Diabetic retinopathy (DR), characterized by retinal microvascular and neuroglial network damage, results from prolonged hyperglycemia. Non-proliferative DR (NPDR) frequently presents asymptomatically, complicating its early detection. This pilot study explored the use of advanced ultrasound techniques, specifically super-resolution imaging (SRI) and shear wave elastography (SWE), to non-invasively diagnose NPDR.

Methods

A total of 34 patients with NPDR and 32 patients with non-DR (NDR) underwent routine, two-dimensional (2D) ultrasound to measure eye axial length and structure. Color Doppler was used to assess the posterior eye blood flow. SWE was used to measure the optic nerve stiffness. SRI was used to image the fundus microcirculation. Lastly, the parameters were compared between groups.

Results

The NPDR group had greater optic nerve stiffness and lower microvascular density at the optic disc (both P<0.05). Receiver operating characteristic (ROC) analysis revealed that optic nerve elastic Young's modulus mean (Emean) >7.33 kPa and microvascular density <42.99% suggest NPDR, with microvascular density having the highest diagnostic value. The microvascular density was significantly negatively correlated with the Emean (R=-0.83; P<0.001).

Conclusions

SRI and SWE were used in this pilot study to quantify vascular and optic nerve abnormalities in patients with NPDR. The detection of early microcirculatory changes and increased optic nerve stiffness has introduced innovative, non-invasive methods for the early diagnosis of NPDR.

Revolutionizing drug delivery strategies with probucol to combat oxidative stress in retinal degeneration: A comprehensive review

Localized oxidative stress plays a key role in the development of retinal degenerative diseases, with diabetic retinopathy (DR) being one of them, contributing significantly to this vision-threatening complication of diabetes. Increased oxidative burden leads to dysfunction across various retinal cell types, including vascular endothelial cells, neurons, glial cells and pericytes. Importantly, even after achieving normalized glycemia, the detrimental effects of oxidative stress persist. Nonetheless, growing data highlights the therapeutic potential of antioxidants in safeguarding vision. However, extensive clinical trials using traditional antioxidants have produced mixed results. Therefore, probucol, known for its ability to limit vascular oxidative stress, decrease superoxide generation, and improve endogenous antioxidant activity, is a promising candidate explored in this review. In addition to describing probucol, this review will explore novel therapeutic formulation strategies by incorporating bile acid into probucol-loaded nanoparticles to enhance drug delivery to the posterior segment of the eye for more effective management of DR. The integration of bio-nanotechnology with probucol and bile acids represents a promising avenue for developing effective therapies for DR, addressing the limitations of traditional antioxidant treatments.

Experimental validation of the molecular mechanism of phlorizin in the treatment of diabetic retinopathy

This study conducted an experiment to scrutinize the effect of phlorizin (Phl) on diabetic retinopathy (DR) and to delve into the related molecular mechanisms. Within this investigation, DR was induced in rats with diabetes mellitus (DM) by subjecting them to a regimen involving a high-fat and high-sugar diet, coupled with intraperitoneal administration of streptozotocin (STZ) at a dosage of 45 mg/kg. Retinal damage in DR rats was assessed by means of hematoxylin and eosin (HE) staining. The serum levels of inflammatory and angiogenic factors were also measured. Additionally, the levels of tight junction proteins, angiogenic proteins, and inflammatory proteins in the retinas of DR model rats were assessed using Western blot (WB),immunohistochemistry(IHC) and immunofluorescence(IF). Moreover, bioinformatics and network pharmacology methodologies were utilized to pinpoint intersecting genes linked to DR and to elucidate the mechanism of action of Phl. This involved screening with Venny, conducting Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG)analyses, constructing a Protein-Protein Interaction (PPI) network, and performing molecular docking analysis. The results of this study demonstrated that Phl significantly normalized fasting glucose levels and reduced body weight, thereby alleviating obesity in DR rats after 12 weeks. Furthermore, the serum levels of inflammatory and angiogenic factors were considerably reduced in the drug-treated rats. WB, IHC and IF revealed increased expression of the tight junction proteins zonula occludens-1(ZO-1) and occludin in the retinas of drug-treated DR rats, validating the observed findings. Molecular biology validation experiments based on the predictions by network pharmacology indicated a substantial decrease in the expression levels of vascular endothelial growth factor (VEGF), notch homolog 1 (Notch1), and hypoxia inducible factor-1 (HIF-1α) in the retina upon treatment with Phl. This reduction resulted in the inhibition of neovascularization. Furthermore, Phl exhibited inhibitory effects on inflammatory pathways, leading to a decrease in cytokine release. The overexpression of VEGF was identified as a factor diminishing brain-derived neurotrophic factor(BDNF) expression while increasing the expression levels of inflammatory proteins. Therefore, the results of this research demonstrate that Phl has the potential to protect the retina of DR rats by inhibiting VEGF expression. This protective effect may be associated with the modulation of the VEGF/BDNF/NF-κB signaling pathway.

Lung Function Impairment and Risks of Incident Cardiovascular Diseases and Mortality Among People With Type 2 Diabetes: A Prospective Cohort Study

OBJECTIVE

Individuals with type 2 diabetes (T2D) frequently exhibit impaired lung function, potentially accelerating the onset of cardiovascular disease (CVD), although prospective studies remain limited. We aimed to explore the relationship between lung function impairment and risk of CVD and mortality within this high-risk population.

RESEARCH DESIGN AND METHODS

This prospective study included 16,242 participants with T2D and free of CVD from the UK Biobank. Obstructive physiology (OP), restrictive physiology (RP), and preserved ratio impaired spirometry (PRISm) were defined using spirometry, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Fine-Gray subdistribution hazards models and Cox proportional hazards models were used to estimate risks of CVD and all-cause mortality, respectively.

RESULTS

During a median follow-up of 13.9 years, 2,825 incident cases of CVD and 2,811 deaths were documented. Lower FEV1, FVC, FEV1/FVC ratio, FEV1 percent predicted, and FVC percent predicted were related to higher risks of CVD and all-cause mortality. Compared with preserved lung function, the adjusted subdistribution hazard ratios (HRs) for CVD were 1.19 (95% CI 1.05-1.35) for OP and 1.47 (95% CI 1.33-1.65) for RP. Compared with the control group, the subdistribution HRs for CVD were 1.20 (95% CI 1.06-1.36) for OP and 1.43 (95% CI 1.29-1.59) for PRISm. These associations were consistent across subgroups and sensitivity analyses. Adding lung function measurements significantly enhanced the performance of CVD prediction beyond the SCORE2-Diabetes model.

CONCLUSIONS

Lung function impairment was associated with increased risks of CVD and all-cause mortality among individuals with T2D.

Association of depression, traditional risk factor control and genetic risk with incident cardiovascular disease among individuals with prediabetes: A population-based prospective study from UK biobank

BACKGROUND

The relationship between depression and cardiovascular disease (CVD) in individuals with prediabetes, its relative importance compared with traditional risk factors and whether genetic risk modifies this association remain unclear.

AIMS

To explore the potential interactive effects of controlling traditional risk factors and depression on CVD, and to assess how depression compares with traditional risk factors in terms of its relative contribution to CVD risk in individuals with prediabetes.

MATERIALS AND METHODS

We analysed a prospective cohort of 42,020 individuals from the UK Biobank, all free of prevalent CVD. Depression was determined using multiple sources to accurately assess the exposure. The five traditional risk factors considered were sleep duration, smoking, blood pressure (BP), low-density lipoprotein (LDL) cholesterol and renal function. We used Cox proportional hazards regression models to examine the associations between depression, risk factor control and CVD events.

RESULTS

Over a median follow-up of 13.1 years, 5865 individuals developed CVD, including 4764 cases of coronary heart disease and 1415 strokes. Compared with controlling 4-5 risk factors, both depression and controlling 0-1 risk factor significantly increased the risk of CVD in individuals with prediabetes. The corresponding multivariable-adjusted hazard ratios (95% CI) for CVD were 1.18 (1.09-1.28) and 1.44 (1.29-1.60), respectively. Depression ranked second in predicting CVD among the selected risk factors. A synergistic effect between depression and risk factor control was observed for CVD, with a relative excess risk due to interaction of 0.16 (0.06-0.26). Furthermore, these associations were independent of the genetic susceptibility to CVD.

CONCLUSIONS

Among individuals with prediabetes, both depression and suboptimal control of traditional risk factors are associated with an increased risk of CVD, independent of genetic susceptibility.

Insulin fibrillation under physicochemical parameters of bioprocessing and intervention by peptides and surface-active agents

Even after the centenary celebration of insulin discovery, there prevail challenges concerning insulin aggregation, not only after repeated administration but also during industrial production, storage, transport, and delivery, significantly impacting protein quality, efficacy, and effectiveness. The aggregation reduces insulin bioavailability, increasing the risk of heightened immunogenicity, posing a threat to patient health, and creating a dent in the golden success story of insulin therapy. Insulin experiences various physicochemical and mechanical stresses due to modulations in pH, temperature, ionic strength, agitation, shear, and surface chemistry, during the upstream and downstream bioprocessing, resulting in insulin unfolding and subsequent fibrillation. This has fueled research in the pharmaceutical industry and academia to unveil the mechanistic insights of insulin aggregation in an attempt to devise rational strategies to regulate this unwanted phenomenon. The present review briefly describes the impacts of environmental factors of bioprocessing on the stability of insulin and correlates with various intermolecular interactions, particularly hydrophobic and electrostatic forces. The aggregation-prone regions of insulin are identified and interrelated with biophysical changes during stress conditions. The quest for novel additives, surface-active agents, and bioderived peptides in decelerating insulin aggregation, which results in overall structural stability, is described. We hope this review will help tackle the real-world challenges of insulin aggregation encountered during bioprocessing, ensuring safer, stable, and globally accessible insulin for efficient management of diabetes.

Multifunctional coaxial gelatin/polylactic acid three-dimensional nanofibrous scaffolds for diabetic wounds

Diabetes, characterized by hyperglycemia, poses a significant threat to human health. Diabetic wounds exhibit heightened levels of excessive reactive oxygen species (ROS), bacterial infection, hypoxia, and substantial exudate. These factors accelerate the inflammatory phase and impede wound healing, often leading to chronicity. Inadequate wound healing is a common chronic complication of diabetes. In this study, we fabricated three-dimensional (3D) curcumin@(manganese dioxide (MnO2)@(gelatin/polylactic acid (PLA)@ε-polylysine (ε-pl))) (GPPMC) nanofibrous scaffolds dressing using coaxial electrospinning, homogenization, freeze-drying, glutaraldehyde crosslinking, and impregnation techniques. The presented gelatin-based 3D nanofibrous dressing demonstrated superior water absorption capacity, hemostatic proficiency, enhanced cell adhesion and tissue infiltration compared to two-dimensional (2D) counterparts. It also exhibited exceptional compressibility, biocompatibility, prolonged curcumin and ε-pl drug release, as well as scavenging capabilities against ROS, antibacterial efficacy and oxygen generation in vitro. Additionally, this dressing exhibited remarkable wound healing efficacy and anti-inflammatory in vivo. These findings suggested that the developed multifunctional gelatin-based 3D nanofibrous scaffold is a promising candidate for the treatment of diabetic wounds.

An overview of the FreeStyle Libre monitoring system for individuals with type 1 and type 2 diabetes

INTRODUCTION

Diabetes is a chronic disease with high prevalence, necessitating advanced technology to achieve glycemic targets and reduce complications. Continuous glucose monitoring (CGM) has become a cornerstone in diabetes management, with the Freestyle Libre (FSL) systems being some of the most widely used devices.

AREAS COVERED

This review focuses on FSL systems, each including an all-in-one sensor and transmitter, a handheld reader and a Mobile Medical App (MMA). Glucose data are uploaded to a dedicated cloud-based platform for analysis. Over the years, FSL has evolved with new features offering valuable support for individuals with diabetes, caregivers, and healthcare providers. Clinical trials and real-world studies have demonstrated efficacy and safety across diverse populations, including individuals with type 1 and type 2 diabetes, adolescents, and pregnant women with diabetes.

EXPERT OPINION

FSL is a user-friendly system that meets the needs of patients and healthcare providers. The MMA allows a review of glucose metrics and pattern identification, and supports educational strategies and patient-tailored treatment. Future advancements, including ketone monitoring, integration with wearables and other devices, and telemedicine applications, will further optimize diabetes care and prevention.

The association between stress hyperglycemia ratio and nonalcoholic fatty liver disease among U.S. adults: A population-based study

BACKGROUND AND AIM

The stress hyperglycemia ratio (SHR) offers a more nuanced understanding of glucose metabolism by factoring in the background glycemia through the component of Hemoglobin A1c. The association of SHR with cardiovascular and cerebrovascular diseases has been established, but the relationship between SHR and the risk of nonalcoholic fatty liver disease (NAFLD) remains unexplored. This study aimed to elucidate the relationship between the two among U.S. adults with diabetes or prediabetes.

METHODS AND RESULTS

A total of 1409 participants diagnosed with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 were included in this study. Multiple logistic regression models (ranging from unadjusted to fully adjusted), restricted cubic splines, and subgroup analyses were employed to determine the relationship between SHR and NAFLD risk and to assess the stability of this relationship across different populations. The average age of all participants was 54.65 years, with males accounting for 47.91 %, and the prevalence of NAFLD being 68.77 %. A fully adjusted logistic regression model indicated a positive association between SHR levels and the risk of NAFLD. Specifically, for each one standard deviation increase in SHR, the risk of NAFLD increased by 20 % (OR, 1.2; 95 % CI, 1.0-1.4). Both the trend test and the restricted cubic splines suggested a linear relationship between the two variables (p for trend <0.05, p for nonlinear = 0.390). Subgroup analysis demonstrated that this positive association remained consistent across most subgroups.

CONCLUSIONS

SHR was identified as a valuable index for predicting the risk of NAFLD among U.S. adults with diabetes or prediabetes.

Real-Time AI-Assisted Insulin Titration System for Glucose Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial

Importance

Type 2 diabetes (T2D) is one of the most prevalent chronic diseases in the world. Insulin titration for glycemic control in T2D is crucial but limited by the lack of personalized and real-time tools.

Objective

To examine whether an artificial intelligence-based insulin clinical decision support system (iNCDSS) for glycemic control in hospitalized patients with T2D is noninferior to standard insulin therapy administered by senior physicians.

Design, Setting, and Participants

This multicenter, single-blind, parallel randomized clinical trial (RCT) was conducted between October 1, 2021, and September 8, 2022, in endocrinology wards of 3 medical centers. Eligible participants were adults (aged ≥18 years) with glycated hemoglobin levels between 7.0% and 11.0% who had received antidiabetic treatments in the previous 3 months.

Interventions

Participants were randomized in a 1:1 ratio to receive insulin dosage titration by iNCDSS or senior endocrinology physicians for 5 consecutive days.

Main Outcomes and Measures

The primary outcome was the proportion of time in the target glucose range (70-180 mg/dL) during the 5-day study period; the noninferiority margin was 6 percentage points. Secondary outcomes included other glycemic control measurements and adverse events.

Results

A total of 149 participants (mean [SD] age, 64.2 [12.0] years; 84 male [56.4%]) were enrolled and randomized to the iNCDSS group (n = 75) or physician group (n = 74). The mean (SD) target glucose range (primary outcome) was 76.4% (16.4%) in the iNCDSS group and 73.6% (16.8%) in the physician group, which achieved the prespecified noninferiority criterion (estimated treatment difference, 2.7%; 95% CI, -2.7% to 8.0%). There were no significant differences in adverse events between the 2 groups. Most physicians were satisfied with the iNCDSS for its clear, time-saving, effective, and safe clinical support.

Conclusions and Relevance

In this RCT of an iNCDSS, the system demonstrated noninferiority to senior endocrinology physicians in insulin titration in an inpatient setting, indicating its potential as a favorable tool for insulin titration in patients with T2D.

Trial Registration

ClinicalTrials.gov Identifier: NCT04642378.

The role of dietary inflammatory index in metabolic diseases: the associations, mechanisms, and treatments

In recent years, the prevalence of metabolic diseases has increased significantly, posing a serious threat to global health. Chronic low-grade inflammation is implicated in the development of most metabolic diseases, such as type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, and cardiovascular disease, serving as a link between diet and these conditions. Increasing attention has been directly toward dietary inflammatory patterns that may prevent or ameliorate metabolic diseases. The Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of dietary intake. Consequently, a growing body of research has examined the associations between the DII and the risk of several metabolic diseases. In this review, we explore the current scientific literature on the relationships between the DII, T2DM, obesity, and dyslipidemia. It summarizes recent findings and explore potential underlying mechanisms from two aspects: the interaction between diet and inflammation, and the link between inflammation and metabolic diseases. Furthermore, this review discusses the therapeutic strategies, including dietary modifications, prebiotics, and probiotics, and discusses the application of the DII in metabolic diseases, as well as future research directions.

Syntaxin 17 Translocation Mediated Mitophagy Switching Drives Hyperglycemia-Induced Vascular Injury

The risk of diabetic cardiovascular complications is closely linked to the length of hyperglycemia exposure. Mitophagy plays a significant role in vascular endothelial injury. However, the specific mechanisms by which mitophagy contributes to endothelial injury during sustained hyperglycemia remain unclear. In diabetic ApoE-/- mice and human umbilical vein endothelial cell (HUVEC) models, mitophagy is enhanced following short-term and long-term high-glucose exposure. Short-term high-glucose exposure promotes Parkin-mediated mitophagy and upregulates mitochondrial fission protein 1 (Fis1) expression, whereas long-term high-glucose exposure suppresses Parkin-mediated mitophagy and downregulates Fis1. With prolonged high-glucose exposure, Syntaxin 17 (STX17) translocates from the endoplasmic reticulum to the mitochondria, activating STX17-mediated mitophagy. Silencing STX17 alleviates mitochondrial degradation, decreases reactive oxygen species (ROS) levels, enhances endothelial nitric oxide synthase (eNOS) phosphorylation, and reduces apoptosis. Silencing Fis1 accelerates the switching to STX17-mediated mitophagy, worsening endothelial dysfunction, whereas Fis1 overexpression prevents this switching, reducing ROS and apoptosis and enhancing eNOS phosphorylation. In summary, these findings suggest that the switching from Parkin-mediated to STX17-mediated mitophagy drives vascular endothelial injury following long-term hyperglycemic exposure, providing valuable insights into therapeutic strategies for diabetic cardiovascular complications.

Continuous Exposure of Nonobese Adult Male Rats to a Soft-Textured, Readily Absorbable Diet Induces Insulin Resistance and Derangements in Hepatic Glucose and Lipid Metabolism

BACKGROUND

Type 2 diabetes (T2D) is characterized by insulin resistance and defective insulin secretion. Previously, we found that rats fed soft pellets (SPs) on a 3-h restricted schedule over 14 wk demonstrated glucose intolerance and insulin resistance with disruption of insulin signaling.

OBJECTIVES

This study aims to determine 1) the time required for an SP diet to induce insulin resistance, and 2) whether the metabolic derangements in rats fed SPs can be reversed by changing to a standard control diet.

METHODS

We performed glucose tolerance tests and calculated the homeostasis model assessment of insulin resistance (HOMA-IR) to evaluate the insulinemic response to glucose and assess insulin resistance in nonobese male rats fed control pellets (CPs) or SPs on a 3-h restricted schedule (10:00-13:00) for 4 and 9 wk. At 11 wk, we switched half of the insulin-resistant SP group to CPs [soft-to-control pellets (SCPs)] and after an additional 11 wk evaluated changes in glucose and lipid metabolism across the 3 groups.

RESULTS

The glucose tolerance test results in the SP and CP rats did not differ at 4 or 9 wk. The insulin levels in the SP group were higher than in the CP group at both time points (P < 0.05). The HOMA-IR was significantly higher in the SP rats at 9 wk compared with the controls (P < 0.05). At 22 wk, the HOMA-IR, blood glucose levels at 30 min after initiating feeding, hepatic glucose metabolism, and lipid synthesis in rats fed SPs continuously were significantly greater than in those fed CPs (P < 0.05); however, these values in the SCP rats did not differ from those in the CP rats.

CONCLUSIONS

A continuous diet of soft-textured, readily absorbable food may be an important and reversible underlying driver in T2D pathogenesis.

Exploring the prevalence of hyperglycemia and the link to physical fitness in young Danish women with overweight - A cross-sectional study

BACKGROUND

Diagnosis of type 2 diabetes (T2D) at 20 years of age is associated with a reduction in life expectancy of 17.9 years. With an increasing prevalence of overweight among young people, we aimed to assess the prevalence of T2D and intermediate hyperglycaemia among young Danish women with overweight or obesity, who had not been previously diagnosed with T2D. Furthermore, we aimed to examine associations between markers of hyperglycaemia (glucose tolerance, fasting glucose, insulin, and HOMA-IR), body composition, physical fitness, and other lifestyle factors.

METHODS

In this multicentre, cross-sectional study, we included 111 women aged 18-30 years with BMI> 25 kg/m2 who engaged in little or no regular physical activity. Participants underwent an oral glucose tolerance test and fasting blood samples were obtained and analysed for fasting glucose, insulin, and lipids. Other outcomes included measurements of anthropometry and body composition (DXA), physical activity level (PAL), physical fitness (Aastrand's bike test), hand grip strength, and countermovement jump. Dietary intake was estimated through 4-day dietary records, and calcium intake was estimated through food frequency questionnaires.

RESULTS

Among women (24 ± 3 years) with a BMI of 30.9 ± 4.8 kg·m-2, 19.8 % were classified with intermediate hyperglycaemia and 2.7 % with T2D, despite no previous diabetes diagnosis. Markers of hyperglycaemia were inversely associated with PAL and physical fitness and positively associated with BMI and fat mass.

CONCLUSION

In a cohort of young women with overweight or obesity, not previously diagnosed with T2D, every fifth exhibited intermediate hyperglycaemia, which was linked to low physical fitness and high BMI.

Structural insights and therapeutic potential of plant-based pectin as novel therapeutic for type 2 diabetes mellitus: A review

Type 2 diabetes mellitus (T2DM) is a global health challenge with limited efficacy of current treatments, necessitating alternative therapies. Plant-derived pectin, composed of galacturonic acid and structural domains such as homogalacturonan, has shown promise as an anti-diabetic agent. Pectin exerts its therapeutic effects through multiple mechanisms, including enhancing β-cell function, regulating glucose metabolism, improving insulin sensitivity, inhibiting digestive enzymes, and restoring gut microbiota balance. Its bioactivity is influenced by physicochemical properties like molecular weight, degree of methylation, and structural complexity. This review explores the anti-diabetic potential of pectin, its structure-activity relationships, and mechanisms of action, providing insights for its development as a novel therapeutic agent in T2DM management.

Associations between the timing of 24 h physical activity and diabetes mellitus: results from a nationally representative sample of the US population

AIMS/HYPOTHESIS

Growing evidence suggests that timing may be an important aspect of physical activity that influences cardiometabolic health. However, the current literature is inconclusive regarding the time of day that physical activity offers the greatest metabolic advantages. We investigated associations between hourly physical activity levels and diabetes mellitus and glycaemic biomarkers in a cross-sectional and nationally representative sample of US adults.

METHODS

We studied 7074 adults (mean age 48 years; 52% women) from the National Health and Nutrition Examination Survey (2011-2014). Physical activity was measured by actigraphy. A monitor-independent movement summary (MIMS) unit was used to derive the total activity level (divided into quintiles) for hourly windows that were defined relative to sleep timing and according to clock time. The primary outcome was prevalent diabetes, and secondary outcomes included fasting glucose, fasting insulin, HOMA-IR and 2 h OGTT results.

RESULTS

Physical activity levels in late morning and late afternoon were associated with lower adjusted odds of diabetes. Specifically, in late morning (8:01-9:00 h after the sleep midpoint), the highest quintile of activity was associated with a 35% decrease (OR 0.65; 95% CI 0.44, 0.96) in the odds of diabetes when compared with the lowest quintile, while in late afternoon (11:01-17:00 h after the sleep midpoint), the highest quintiles were associated with 56% and 36% lower odds (OR 0.44; 95% CI 0.29, 0.69 and OR 0.64; 95% CI 0.43, 0.95). Higher night-time activity was associated with higher odds of diabetes. Similar patterns of results were observed with OGTT data and across subgroups of age, gender, race/ethnicity, chronotype and sleep duration.

CONCLUSIONS/INTERPRETATION

Our findings suggest that the timing of physical activity may modulate its metabolic effects.

An equity audit on program completion among women with a history of gestational diabetes in a state-funded diabetes and cardiovascular risk reduction program

PURPOSE

To assess the completion of the type 2 diabetes, heart disease and stroke prevention program (the Life!) among women with a history of gestational diabetes mellitus (GDM) according to participants' characteristics.

METHODS

Data from women with a history of GDM enrolled in the Life! program in Victoria, Australia, between 2014 and 2022 were analysed. Completion rates were assessed using the PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital Plus age and smoking) framework. Multivariable logistic regression model was fitted.

RESULTS

A total of 2399 women with a history of GDM were enrolled in the program, of which 55 % completed it. Characteristics associated with higher completion rates included being from metropolitan areas (AOR = 1.52, 95 % CI: 1.14-2.01) compared with being from regional areas, having a body mass index in a normal range (AOR = 1.50, 95 % CI: 1.06-2.15) compared with having overweight or obesity, having middle income (AOR = 1.41, 95 % CI: 1.01-1.98) compared with having low- or high-income, and enrolment after 2019 (AOR = 2.3, 95 % CI:1.80-3.06) compared with enrolment in 2019 or earlier. Conversely, having a South or Central Asian background (AOR = 0.65, 95 % CI: 0.46-0.92) is associated with a lower completion rate compared with being from Australia.

CONCLUSION

Characteristics associated with lower completion rates among women with prior GDM in a cardiometabolic risk reduction program included residing in rural and remote areas, having an elevated BMI (in the overweight or obesity range), low or high income, enrolment in 2019 or earlier and being of South or Central Asian background.

The relationship between longitudinal changes in triglyceride-glucose-body mass index and new-onset diabetes in middle-aged and elderly adults: Evidence from a nationwide Chinese cohort study

OBJECTIVE

This study investigates the association between changes in TyG-BMI and the risk of diabetes mellitus (DM) in middle-aged and elderly adults in China, as prior research has mainly focused on single baseline measurements.

METHODS

Data were obtained from CHARLS, a nationwide prospective cohort study. TyG-BMI changes (2011-2015) were analyzed using K-means clustering. Cox proportional hazards regression models assessed the relationship between TyG-BMI changes, cumulative TyG-BMI, and DM risk, with sensitivity and subgroup analyses ensuring robustness.

RESULTS

Compared to individuals with consistently low TyG-BMI (class 1), hazard ratios (HRs) for DM were 1.474, 2.250, and 3.142 for participants with moderately sustained and slowly increasing TyG-BMI (class 2), slowly increasing high level of TyG-BMI (class 3), and the highest and increasing TyG-BMI levels (class 4), respectively. △TyG-BMI2015-2011 (per 10-unit) yielded HRs of 1.064 for class 2, 1.108 for class 3, and 1.079 for class 4. Cumulative TyG-BMI (per 10-unit) had an HR of 1.029.

CONCLUSION

TyG-BMI changes and sustained exposure to high TyG-BMI levels are independently linked to increased DM risk. Monitoring long-term fluctuations in TyG-BMI could be an important strategy for preventing DM, and effectively controlling high TyG-BMI through various interventions may significantly reduce DM risk.

Kidney function-related protection of polysaccharides from red kidney bean and small black soybean via urine metabolomics in type 2 diabetic rats

Diabetic nephropathy is a significant microvascular complication of diabetes mellitus. Crude polysaccharides extracted from red kidney beans and small black soybeans (RK, SB) have demonstrated promising antidiabetic effects in type 2 diabetic rats. This study evaluated the protective effects of RK and SB on kidney function in diabetic rats by examining kidney markers and urine metabolism. It also investigated the impact of pure polysaccharides (RKP, SBP) to pinpoint the active component of RK and SB. Findings indicated that RK and SB influenced kidney function by affecting the kidney index and key urine metabolites, like citric acid and cis-aconitic acid, linked to the TCA cycle and phenylalanine metabolism. Furthermore, a higher dose (400 mg/kg) of RKP and SBP was more effective in treating kidney damage in diabetic models than the optimal 200 mg/kg dose of RK and SB. This was shown by better regulation of urea nitrogen and uric acid levels, improved kidney tissue health seen in HE staining, and fewer red-stained lipid droplets in the kidney, as indicated by Oil Red O staining. Overall, this study provided additional evidence to support RKP and SBP as a functional ingredients production in the food industry.

Free tissue transfer for limb salvage following acute diabetes-related foot infections: A multicentre outcome study of success and failure

BACKGROUND

In cases of limb-threatening diabetes-related foot infections (DFIs), the primary goal of treatment is to control the infection while maintaining as much functional limb as possible. Aggressive surgical debridement is one of the cornerstones of treatment. Once the infection is controlled, extensive soft tissue defects with exposed vital structures such as bone or joint may remain, limiting the mobility of the patient and posing a risk for the development of new (deep) infections. One possible treatment option for these soft tissue defects is free tissue transfer (FTT). Although reported FTT success rates in diabetic foot ulcers are over 90%, patient selection and indications for FTT in diabetic foot disease vary widely in the literature, and little has been described about FTT after limb-threatening DFI.

METHODS

This multicentre, retrospective study included patients that underwent FTT after a limb-threatening DFI between 01-01-2017 and 01-03-2024 in four Dutch hospitals. The primary outcome was flap success rate within 30 days. Secondary outcomes included limb salvage within 90 days, incidence of major amputation during follow-up, ulcer recurrence, and ambulation.

RESULTS

Fourteen patients with a limb-threatening DFIs were included. The flap survival rate within 30 days was 78.6% (11/14). Limb salvage within 90 days was 92.9% (13/14). The total incidence of major amputations during follow-up was 28.6% (4/14), performed after flap failure in one and ulcer recurrence in three patients.

CONCLUSION

Our results suggest that FTT following acute limb-threatening DFI is technically feasible and may increase the chance of limb salvage.

Effects of Lifestyle Interventions to Promote Physical Activity on Physical Activity and Glycated Hemoglobin in Patients with Type 2 Diabetes: a Systematic Review and Meta-Analysis

BACKGROUND

Numerous studies have explored the impact of controlled exercise interventions in type 2 diabetes, as physical activity can positively influence its progression. However, our understanding of how broader lifestyle interventions can effectively promote physical activity in practical real-world scenarios remains limited.

OBJECTIVE

This systematic review and meta-analysis aimed to investigate the potential of lifestyle interventions targeting the promotion of physical activity on physical activity outcomes and glycated hemoglobin (HbA1c), providing a comprehensive understanding of both behavioral and clinical impacts.

METHODS

We performed a systematic review and meta-analysis, searching three databases and examined the study design, structure, and content of the lifestyle interventions. We assessed physical activity and HbA1c as endpoints and performed a multivariate meta-regression to explore physical activity's impact on HbA1c.

RESULTS

This review incorporated 13 studies (n = 5301 patients), with heterogeneity in intervention designs, components, and durations. Lifestyle interventions showed a slight increase in physical activity, equivalent to an average of 9.0 min more total physical activity per day (95% confidence interval 5.8, 12.2) and 1.7 min more moderate-to-vigorous physical activity per day (95% confidence interval 1.1, 2.3), irrespective of objective (e.g., accelerometers) or subjective measurement (e.g., questionnaires) method. However, HbA1c reduction through these interventions was minimal 0.09% (95% confidence interval - 0.20, 0.03). The effect of physical activity was - 0.04 (standard error = 0.05, 95% confidence interval - 0.15, 0.06), suggesting that physical activity does not act as a moderator for changes in HbA1c.

CONCLUSIONS

Lifestyle interventions effectively increase physical activity but have limited impact on HbA1c compared to controls. The role of physical activity as a moderator for changes in HbA1c remains uncertain. Further research is needed to enhance the efficacy of these interventions in reducing HbA1c in individuals with type 2 diabetes.

CUN-BAE adiposity index prediction of incident type 2 diabetes: the Seguimiento Universidad de Navarra prospective cohort

BACKGROUND

Obesity is currently a pandemic and a cardinal risk factor for incident diabetes, a parallel growing pandemic. Measures commonly used to define obesity, i.e., BMI and waist circumference, do not accurately reflect body fatness.

METHODS

We examined the prognostic value of body fatness assessed with the 'Clínica Universidad de Navarra-Body Adiposity Estimator' (CUN-BAE, range: 18.4-65.0 %) in 18,594 participants of the "Seguimiento Universidad de Navarra" prospective longitudinal cohort (60.5% women) without diabetes at baseline. Participants were followed-up with biennial questionnaires and multivariable-adjusted Cox models were used to estimate incident diabetes.

RESULTS

During 13.7 years of median follow-up, 209 participants developed diabetes. Progressively ascending quartiles of CUN-BAE were significantly associated with incident diabetes in multivariable-adjusted models, even after adjusting for BMI > 30 kg/m2. For each 2-unit increment in the CUN-BAE index, diabetes risk relatively increased by 46% in men and women (95% CI: 33%-62%). When comparing ROC AUC for CUN-BAE and BMI the association was stronger for CUN-BAE (p < 0.001).

CONCLUSIONS

CUN-BAE index, an easy equation that can be used in any clinical setting, predicted better the risk of incident diabetes compared to BMI. Our results emphasize the importance of reducing and maintaining a low adiposity in order to prevent diabetes.

The effects of type 1 and type 2 diabetes mellitus on bone health in chronic kidney disease

Fracture is an under-recognized but common complication of diabetes mellitus, with an incidence approaching twofold in type 2 diabetes mellitus (T2DM) and up to sevenfold in type 1 diabetes mellitus (T1DM) compared with that in the general population. Both T1DM and T2DM induce chronic hyperglycaemia, leading to the accumulation of advanced glycosylation end products that affect osteoblast function, increased collagen crosslinking and a senescence phenotype promoting inflammation. Together with an increased incidence of microvascular disease and an increased risk of vitamin D deficiency, these factors reduce bone quality, thereby increasing bone fragility. In T1DM, reduced anabolic stimuli as well as the presence of autoimmune conditions might also contribute to reduced bone mass and increased fragility. Diabetes mellitus is the most common cause of kidney failure, and fracture risk is exacerbated when chronic kidney disease (CKD)-related mineral and bone disorders are superimposed on diabetic changes. Microvascular pathology, cortical thinning and trabecular deterioration are particularly prominent in patients with T1DM and CKD, who suffer more fragility fractures than do other patients with CKD. This Review explores the pathophysiology of bone fragility in patients with diabetes mellitus and CKD and discusses techniques to predict fracture and pharmacotherapy that might reduce fracture risk.

Construction of a metabolic-immune model for predicting the risk of diabetic nephropathy and study of gut microbiota

AIMS

This study conducts a comprehensive analysis of the relative impact of risk factors for diabetic nephropathy (DN) during disease progression, with a particular emphasis on the role of gut microbiota. We developed multiple predictive models trying to enhance the early identification of high-risk patients in clinical practice.

MATERIALS AND METHODS

We collected data from type 2 diabetes mellitus patients, categorizing them by renal function for comparison. Logistic regression identified risk factors for DN, and we developed nomogram and random forest risk prediction models. Finally, we analyzed the correlations among these factors.

RESULTS

Compared to patients with diabetes alone, those with DN have a longer disease duration, characterized by abdominal obesity, hypertension, chronic inflammation, activation of the complement system, and declining renal function, along with a significant reduction in Bifidobacterium and Enterobacterium. Patients with macroalbuminuria exhibit a higher male prevalence, as well as elevated blood pressure and lipid levels, and poorer renal function. Increased waist-to-hip ratio, systolic blood pressure, urea, neutrophil-to-lymphocyte ratio, and complement C3, along with decreased Enterobacterium and albumin, have been identified as significant risk factors for DN. The nomogram model developed based on these findings demonstrates good predictive capacity. And the establishment of the random forest model further underscores the importance of the aforementioned indicators. Additionally, significant correlations were observed among obesity, inflammation, blood pressure, lipid levels, and gut microbiota.

CONCLUSIONS

Dysbiosis, metabolic disorders, and chronic inflammation play key roles in the progression of DN and may serve as new targets for future prevention and treatment strategies.

Steam explosion improved the physicochemical properties, hypoglycemic effects of polysaccharides from Clerodendranthus spicatus leaf via regulating IRS1/PI3K/AKT/GSK-3β signaling pathway in IR-HepG2 cells

Clerodendranthus spicatus (C. spicatus) leaf is a kind of functional tea and traditional Chinese folk medicine and it is famous for hypoglycemic value. The effects of steam explosion (SE) pretreatment on structural characteristics, α-glucosidase inhibition activity and hypoglycemic effects of C. spicatus leaf polysaccharides (CSP) were investigated. Two polysaccharides fractions from the untreated C. spicatus leaf (NTCSP-A) and SE treated C. spicatus leaf (SECSP-C) were obtained after the purification by DEAE Sepharose Fast Flow column chromatography. Results showed that SE pretreatment obviously increased the yields of CSP from 10.17 % to 13.43 % and decreased the molecular weight distribution. Monosaccharide composition analysis indicated that the main compositional modification by SE pretreatment was the increase in the proportion of mannose, glucuronic acid and arabinose. And SE pretreatment changed the inhibition type against α-glucosidase from competitive inhibition (NTCSP-A) to uncompetitive inhibition (SECSP-C). In addition, SE pretreatment increased the anti-diabetic activity on IR-HepG2 cells by increasing the glucose consumption and glycogen synthesis and regulating IRS1/PI3K/AKT/GSK-3β signaling pathway. This study indicated that SE technology modified the physiochemical properties and increased the hypoglycemic activity of CSP. It also provided helpful information on the application of SE in the efficient preparation and utilization of bioactive polysaccharides.

Ginsenoside Rb1 and berberine synergistically protect against type 2 diabetes mellitus via GDF15/HAMP pathway throughout the liver lobules: Insights from spatial transcriptomics analysis

Type 2 diabetes mellitus (T2DM) is a significant public health issue with high morbidity and mortality. Ginsenoside Rb1 (Rb1) and berberine (BBR), the main bioactive compounds of Panax ginseng and Coptis chinensis, respectively, are known for their hypoglycemic effects. Nevertheless, the synergistic effects and underlying mechanism of Rb1 and BBR on T2DM remain unclear. In this study, we utilized a leptin receptor-deficient (db/db) mouse model to investigate the protective effects of their combination treatment. Our findings demonstrated that the combined use of Rb1 and BBR at a 1:4 ratio had more pronounced effects than the first-line anti-diabetic drug metformin on reducing the weight ratio of white adipose tissue, ameliorating insulin resistance, and improving glucose and lipid metabolism. Using spatial transcriptomics, we revealed that metformin treatment improved gluconeogenesis and lipogenesis only in the periportal zone, while the combination treatment induced improvements throughout the liver lobule, with distinct key targets across different zones, thus underscoring a more comprehensive modulation of hepatic metabolism. This may be the key reason why this combination therapy demonstrated superior protective effects against T2DM. Additionally, the reversed expression of the key callback gene hepcidin (HAMP) and its regulator growth differentiation factor 15 (GDF15) following the combination therapy across all zones, along with validation experiments, further suggested that GDF15/HAMP pathway might be a key mechanism underlying the beneficial effects of Rb1 and BBR against T2DM. This study also indicates a path toward innovative drug cocktails for treating T2DM, offering a holistic approach to regulate the entire liver lobule metabolism.

Biomedical outcomes and cardiovascular risks in Chinese adults with type 2 diabetes in the metabolic management center program: A longitudinal comparative study

AIMS

To assess the extent to which biomedical outcomes and cardiovascular risk profile were improved in the management of Chinese patients with type 2 diabetes enrolled in the metabolic management center (MMC) program.

MATERIALS AND METHODS

We performed propensity score matching of diabetic patients in the MMC program for at least 12 months to those with diabetes under usual primary care, based on age, sex, fasting plasma glucose (FPG) level, and diabetes duration. Difference-in-difference analysis was conducted to compare changes in biomedical outcomes, attainment of treatment targets, and cardiovascular disease (CVD) risk reduction.

RESULTS

Of 557 pairs of diabetic patients matched 1:1 (n = 1,114), the MMC cohort exhibited greater improvements in FPG (-0.84 mmol/L, 95% confidence interval [CI] -1.22 to -0.46, P < 0.001), diastolic blood pressure [BP] (-2.08 mmHg, 95%CI -3.21 to -0.94, P < 0.001), body mass index [BMI] (-0.29 kg/m2, 95%CI -0.51 to -0.07, P = 0.009), low-density lipoprotein cholesterol (0.13 mmol/L, 95%CI 0.04-0.23, P = 0.008), high-density lipoprotein cholesterol (0.05 mmol/L, 95%CI 0.01-0.08, P = 0.017), and 10-year CVD risk (Framingham CVD risk, -0.94%, 95%CI -1.71 to -0.17, P = 0.017; atherosclerotic CVD risk, -0.77%, 95%CI -1.34 to -0.20, P = 0.009) when compared to the usual primary care cohort after adjustment for confounders. More patients in the MMC cohort achieved treatment targets with lifestyle modifications than their counterparts under primary care.

CONCLUSIONS

Enrolment in the MMC program appears promising in the management of FPG, BP, BMI, lifestyle, and CVD risk in diabetic patients, suggesting the necessity of incorporating the MMC program into routine primary care.

Effectiveness of different traditional Chinese medicine injections in patients with diabetic lower extremity arterial disease: A Bayesian network meta-analysis

BACKGROUND AND PURPOSE

Numerous studies have demonstrated the effectiveness of Chinese medicine injections (CMIs) in treating diabetic lower extremity arterial disease (Dia-LEAD). However, with the variety of CMIs available, it has become challenging to determine the optimal choice for Dia-LEAD patients. This study aims to compare and rank the efficacy of CMIs for Dia-LEAD to provide references and evidence for clinicians in optimising drug selection.

METHODS

We conducted a comprehensive search for randomised controlled trials (RCTs) of CMIs for treating Dia-LEAD, which included the China National Knowledge Infrastructure (CNKI), Wanfang, China Weipu Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, the Cochrane Library, Embase, and Web of Science, covering inception to 15 October 2023. We used the Cochrane Risk of Bias Tool 2.0 to assess bias risk, and RevMan 5.4.1, GeMTC, STATA 13.0, and R 4.2.1 for statistical analysis and visualization of the network meta-analysis.

RESULTS

We analysed 38 studies with 12 CMIs. Compared with other interventions, Shuxuening injection (SXN) + conventional treatment (CT) was superior in terms of the total effective rate (surface under the cumulative ranking (SUCRA) 86.2 %). Danshen injection (DS) + CT ranked first in improving the ankle-brachial index (ABI) (SUCRA 95.1 %) and dorsalis pedis artery blood flow (DPABF) (SUCRA 88.8 %). Danhong injection (DH) + CT showed the highest probability of effectiveness in improving the plasma viscosity (SUCRA 91.6 %). Chuanxiongqin injection (CXQ) + CT yielded favourable results in regulating fibrinogen levels (SUCRA 77.1 %). Furthermore, no significant differences in adverse reactions were detected between the treatment and control groups.

CONCLUSION

The study demonstrated that CMIs have potential as a complementary therapy for treating Dia-LEAD, and it supports the positive effects of combining CMIs with CT on a number of outcome indicators. Especially when it comes to improving the haemodynamics indices and the haemorheology indices, DS in combination with CT may be a more effective intervention. However, further confirmation in more rigorous, high-quality, and multicentre RCTs is needed to strengthen the validity and generalisability of the results.

Beneficial effects of cell-derived exosomes on diabetic nephropathy: a systematic review and meta-analysis of preclinical evidence

AIMS

Recent studies indicate that cell-derived exosomes are effective in treating diabetic renal injury, though their precise mechanisms remain unclear. This meta-analysis evaluates the therapeutic efficacy of exosomes in diabetic nephropathy.

METHODS

In addition to reviewing references and consulting experts, we systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science for studies on exosome therapy for diabetic nephropathy. Seven outcome measures were selected to evaluate efficacy: blood glucose [(fasting blood glucose (FBG) and random blood glucose (RBG)], renal function parameters [serum creatinine (SCR), blood urea nitrogen (BUN), 24-hour urinary protein (24 h UP) and albumin-to-creatinine ratio (UACR)], and inflammatory factors. Study quality was assessed using the SYRCLE risk of bias tool, and data were analyzed using RevMan (version 5.3) software.

RESULTS

We included 17 studies involving 288 animals, with follow-up durations ranging from 2 to 14 weeks. Pooled analysis demonstrated that exosome treatment significantly improved GLU (FBG: SMD - 1.39, 95% CI -2.70 to -0.08, P = 0.04; RBG: SMD - 1.29, 95% CI -2.25 to -0.34, P < 0.008), SCR (SMD - 1.45, 95% CI -2.14 to -0.76, P < 0.0001), BUN (SMD - 2.06, 95% CI -3.01 to -1.11, P < 0.0001), 24 UP (SMD - 2.88, 95% CI -3.97 to -1.78, P < 0.00001), and UACR (SMD - 2.00, 95% CI -3.15 to -0.85, P = 0.0007) compared to the diabetic model group. Qualitative analysis revealed that exosomes increased anti-inflammatory factors while reducing pro-inflammatory factors (P < 0.05). No adverse effects of exosomes were reported in any of the included studies.

CONCLUSIONS

Current evidence indicates that exosomes attenuate diabetic nephropathy progression through anti-inflammatory, anti-fibrotic, anti-apoptotic, and autophagy-inducing mechanisms. To demonstrate the most efficient exosomes and therapeutic parameters for the treatment of diabetic nephropathy, future studies should conduct sizable, randomized, double-blind trials with high-quality, long-term follow-ups.

Clinical Impact of Personalized Physician's Education and Remote Feedback Via a Digital Platform on Glycemic Control: Pilot Randomized Controlled Trial

BACKGROUND

The digital education platform Doctorvice (iKooB Inc.) offers face-to-face physician-patient education during outpatient clinic visits, remote glucose monitoring, and the delivery of educational messages, and is expected to be effective for personalized diabetes care.

OBJECTIVE

This study aims to evaluate the effectiveness of the digital education platform for diabetes care by comparing cases that included both face-to-face education and remote monitoring with those that included only face-to-face education.

METHODS

This was a randomized clinical study conducted at the Diabetes Center of Seoul St. Mary's Hospital. Participants were aged ≥19 years and had glycated hemoglobin (HbA1c) levels between 7.5% and 9.5%. In the intervention group, physicians used the digital education platform to provide face-to-face education at enrollment and at the 3- and 6-month visits, along with remote monitoring during the first 3 months of the 6-month study period. The control group received conventional outpatient education. Both groups completed questionnaires-assessing satisfaction with diabetes treatment, diabetes-related stress, and adherence to diabetes medication-at the beginning and end of the study. The primary endpoint was the change in HbA1c levels.

RESULTS

A total of 66 participants were enrolled between August 1, 2022, and August 31, 2023. Of these, 26 in the intervention group and 30 in the control group were analyzed, excluding 10 participants who dropped out of the study. The mean baseline HbA1c levels were 8.3% (SD 0.6%) in the intervention group and 8.0% (SD 0.5%) in the control group. At the 3-month follow-up, mean HbA1c decreased by 0.5%-7.8% (SD 0.9%; P=.01) in the intervention group and by 0.2%-7.8% (SD 0.7%) in the control group. HbA1c levels substantially improved during the first 3 months with both face-to-face education and remote glucose monitoring. However, HbA1c tended to increase during the 3- to 6-month follow-up in the intervention group without the remote monitoring service. Satisfaction with diabetes treatment significantly improved at the end of the study compared with baseline in the intervention group (mean change +3.6 points; P=.006). Medication adherence improved in both groups, with no significant difference at 6 months (P=.59), although the intervention group showed a greater increase from baseline. Subgroup analysis indicated that the reduction in HbA1c was greater for patients with baseline HbA1c levels ≥8.0%, those aged ≥65 years, smokers, drinkers, and those with obesity in the intervention group.

CONCLUSIONS

The digital education platform for personalized diabetes management may be beneficial for glycemic control in type 2 diabetes mellitus. Its effectiveness appears to be enhanced when physicians provide personalized face-to-face education combined with remote feedback.

TRIAL REGISTRATION

Clinical Research Information Service (CRiS) of Republic of Korea KCT0007953; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23507&search_page=L.

Changing the triglyceride diagnostic criteria of metabolic syndrome for African Americans

The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular disease and type 2 diabetes mellitus. Studies show that there is a paradoxical relationship in African Americans however, as they experience a higher rate of cardiovascular disease and type 2 diabetes mellitus despite having a lower prevalence of metabolic syndrome when compared to whites. The triglyceride paradox, an unusual phenomenon in which African Americans consistently express a more normal triglyceride status even when having conditions known to be characterized by high triglyceride levels, is believed to account for this paradoxical relationship. In this manuscript, we review the history and pathophysiology of metabolic syndrome while also discussing the importance of the triglyceride paradox in explaining the inverse relationship that exists between metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus in African Americans. In addition, we advocate for decreasing the triglyceride cutoff value when diagnosing metabolic syndrome in this population to more precisely determine who is at risk for developing type 2 diabetes mellitus and cardiovascular disease.

The Impact of Cardiometabolic Index on Cardiovascular Disease Risk Among Diabetic Patients: Evidence From Two National Cohorts

BACKGROUND

This study investigates the relationship between the Cardiometabolic Index (CMI) and cardiovascular disease (CVD) risk in diabetic populations using data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). Understanding the predictive role of CMI in assessing CVD risk is essential for enhancing preventive strategies in diabetic patients.

METHODS

A cross-sectional analysis was conducted on diabetic participants from NHANES (2005-2018) and CHARLS (2011). CMI was calculated based on the waist-to-height ratio and the triglyceride-to-HDL-C ratio. Multivariable logistic regression models and restricted cubic spline analyses were utilised to evaluate the associations between CMI and CVD risk, adjusting for demographic and clinical covariates.

RESULTS

In the NHANES cohort (n = 2044), a higher CMI was significantly associated with an increased risk of CVD after adjusting for confounding factors (OR = 2.01, p = 0.0074). Similarly, in the CHARLS cohort (n = 3964), a higher CMI was linked to an elevated CVD risk (OR = 1.45, p = 0.009). Subgroup analyses demonstrated consistent results across various age, gender and health status subgroups. The restricted cubic spline analysis revealed significant non-linear trends between CMI and CVD risk in both cohorts (p < 0.05).

CONCLUSION

CMI is a robust and independent predictor of CVD risk among diabetic individuals across different populations. These findings highlight the potential clinical value of incorporating CMI into routine assessments to identify high-risk diabetic patients. Future longitudinal studies are needed to further validate these findings and explore the underlying mechanisms.

Identification and characterization of two novel dipeptidyl peptidase-IV inhibitory peptides from the simulated gastrointestinal digestion of Tartary buckwheat proteins

This study analyzed dipeptidyl peptidase-IV (DPP-IV) inhibitory peptides from Tartary buckwheat (Fagopyrum tataricum) protein hydrolysates, known for managing chronic diseases. Simulated gastrointestinal digestion enhanced the inhibitory activity of DPP-IV. Using anion-exchange resin DEAE-52, reverse high-performance liquid chromatography, and LC-MS/MS, eight novel peptides were identified. Among them, the peptides LAGQS (LA5) and LREIDDADK (LR9) exhibited the strongest inhibition in both competitive and noncompetitive modes. Molecular docking revealed electrostatic, hydrogen bond, and hydrophobic interactions for both peptides, with LR9 also engaging in π-cation interactions. Based on the Caco-2 model, the in situ DPP-IV inhibitory effect of LR9 was superior to that of LA5, likely because of LR9's greater stability during hydrolysis. Moreover, LA5 could not be transported through the Caco-2 monolayer, and LR9 demonstrated moderate transportability. These findings highlight Tartary buckwheat protein's potential for application in high-value plant-based products, including functional foods and pharmaceuticals targeting blood glucose regulation using DPP-IV inhibitory peptides.

Protective effect of Astragalus polysaccharide on diabetic nephropathy: A systematic review and meta‑analysis reveals the efficacy and potential mechanisms

Astragali radix is widely used to treat diabetes and Astragalus polysaccharides (APS) is a primary bioactive compound. Previous evidence has demonstrated that APS, when administered, is an effective monomer in the treatment of diabetic nephropathy (DN). In the present systematic review and meta-analysis, the effects and potential underlying mechanisms of APS in the treatment of DN were evaluated. PubMed, Embase, EBSCO, Web of Science and OVID databases were employed to obtain the published studies included in the present meta-analysis up to April 2024. Each article's quality was assessed using the Jadad score assessment scale. The odds ratios of risk factors were pooled using a random-effects meta-analysis model. Heterogeneity was assessed using the Cochrane Q statistics and I-Square (I2) tests, and publication bias was detected using the funnel plot and/or Egger's test. If necessary, the authors of the identified papers were contacted for more information. The primary outcomes were analyzed, including the parameters of creatinine, kidney-to-urine protein, blood urea nitrogen, urine protein and fasting blood glucose. Additionally, APS was found to reduce known risk factors, including kidney weight and total cholesterol levels. Furthermore, it was revealed that the therapeutic effects of APS in DN may be associated with antifibrotic, anti-inflammatory and anti-oxidative stress processes. The findings of the present study have validated the anti-DN effects of APS, and the safety of its use; however, further rigorously designed and well-performed preclinical trials are required in order to fully evaluate the anti-DN effects and safety of APS, and to verify these findings prior to its possible clinical application.

Hyperglycaemia and Its Risk Factors Among Adults Living With HIV on Follow-Up at the Hawassa City Administration, Southern Ethiopia: A Cross-Sectional Study

BACKGROUND

Ethiopia implemented the universal test and treat in 2017 and later adopted dolutegravir-based regimens for people living with HIV (PLWH). However, the impact of these changes on glucose metabolism in Ethiopia remains unclear, highlighting the need for further investigation.

METHODS

A cross-sectional study was conducted in southern Ethiopia from 5 January 2023 to 30 May 2024. We included 443 adult PLWH using systematic random sampling. American Diabetes Association criteria was used to define hyperglycaemia. To identify factors associated with hyperglycaemia, binary logistic regression was used with adjusted odds ratio (AOR) and 95% confidence interval (CI).

RESULTS

Overall prevalence of hyperglycaemia was 24.4% (16.7% prediabetes and 7.7% diabetes mellitus [DM]). Of the participants with DM, 82.3% were newly diagnosed. Significant predictors of hyperglycaemia were age > 50 years (AOR 2.1; 95% CI 1.1-3.9), alcohol intake (AOR 2.1; 95% CI 1.02-4.2), obesity (AOR 3.2; 95% CI 1.3-7.9), high waist-hip ratio (AOR 2.6; 95% CI 1.4-5.05) and LDL-cholesterol (AOR 2.2; 95% CI 1.02-4.6). While significant predictors of DM were alcohol intake (AOR 3.0; 95% CI 1.1-8.4), co-morbidity (AOR 2.6; 95% CI 1.1-6.05), high waist circumference (AOR 7.5; 95% CI 1.3-43.3), high waist-hip ratio (AOR 4.1; 95% CI 1.02-16.2) and high triglycerides (AOR 3.2; 95% CI 1.3-7.7). Dolutegravir-based regimen was not associated with hyperglycaemia.

CONCLUSION

Hyperglycaemia prevalence among adult PLWH on antiretroviral therapy in southern Ethiopia is rising, with most diabetes cases newly identified. This emphasises the critical need for routine screening to enable early detection, prevention and management.

Newer Glucagon-Like Peptide-1 Receptor Agonists Are Associated With Improved Glycemic Control in US Adults With Type 2 Diabetes: A Population-Level Time Series Analysis

OBJECTIVES

The population-level impact of newer glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatments on patients with type 2 diabetes remains unclear. Therefore, this study investigated the association of newer GLP-1 RAs with population-level diabetes-related outcomes in US adults with type 2 diabetes.

METHODS

This was a noninterventional, retrospective analysis of administrative insurance claims data obtained from Optum's deidentified Clinformatics® Data Mart Database between January 2004 and December 2022. Individual patient data were aggregated into monthly time series at the population level. Associations between the proportion of patients on newer GLP-1 RAs of interest (dulaglutide, once-weekly or oral semaglutide, and tirzepatide) and average hemoglobin A1c (HbA1c), HbA1c <7.0%, and HbA1c <8.0% were assessed using time series regressions. Time-based trends in population-level outcomes were assessed using interrupted time series analyses. All analyses were adjusted for potential confounders.

RESULTS

Time series regression analyses demonstrated that a higher proportion of patients taking newer GLP-1 RAs was associated with a lower average HbA1c and a higher proportion of patients with HbA1c <7.0% (after 5 months of treatment) and <8.0% (after 2 months of treatment). Results from the interrupted time series analyses demonstrated that population-level glycemic control has been improving since the first newer GLP-1 RA (dulaglutide) was approved. This trend has persisted, even after the COVID-19 emergency declaration.

CONCLUSIONS

A higher percentage of patients receiving newer GLP-1 RAs was associated with significantly improved population-level glycemic control. The newer GLP-1 RA period displayed improved population-level glycemic control compared with the older GLP-1 RA period.

Inhibitory mechanism of lithospermic acid on the fibrillation of type 2 diabetes associated islet amyloid polypeptide

The abnormal fibrillation of a 37-residue peptide hormone human islet amyloid polypeptide (hIAPP) is linked with type 2 diabetes (T2D). Pang et al. depicted a prominent role of lithospermic acid (LA) in blocking hIAPP fibrillation and alleviating the hIAPP aggregates-induced cytotoxicity. LA is a polyphenolic compound present in extra virgin olive oil with therapeutic properties. Despite its notable inhibitory effect on hIAPP fibrillation, the inhibition mechanism remains unclear. Here, molecular dynamics (MD) simulations have been utilized to shed light on the putative binding mechanism and inhibitory mechanism of LA against hIAPP fibrillation. The molecular docking predicted favourable binding (-7.1 kcal/mol) of LA with hIAPP. Interestingly, LA increases the helix content in hIAPP and blocks the conformational transition to the aggregation-competent conformations. The conformational clustering and hydrogen bond analyses depicted that LA formed hydrogen bonds with Asn21 of hIAPP, which play an important role in hIAPP aggregation. LA binds favourably to hIAPP (ΔGbinding = -49.62 ± 3.34 kcal/mol) with a major contribution from the van der Waals interactions. The MD simulations highlighted that LA dramatically interfered with the intrapeptide interactions and inhibited sampling of aggregation-competent β-sheet conformations in hIAPP via hydrogen bonds through its hydroxyl groups, van der Waals interactions with hIAPP residues, thus blocking hIAPP aggregation to β-sheet rich cytotoxic fibrillar aggregates. The MD simulations illuminated specific interactions between hIAPP and LA, which will benefit in developing new chemical entities against hIAPP fibrillation.

The association between the AST/ALT ratio and osteopenia or osteoporosis in patients with type 2 diabetes mellitus

Introduction

The aim of this study was to investigate the relationship between the AST/ALT ratio and osteopenia or osteoporosis in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 589 patients with T2DM were divided into two groups based on T-score: T-score ≥ -1.0 group, normal bone mineral density and T-score < -1.0 group, osteopenia or osteoporosis (OP). The association between the AST/ALT ratio and osteopenia/OP was evaluated by multivariate analyses. The receiver operating characteristic (ROC) curves were used to estimate the diagnostic performance according to the area under the ROC curve (AUC).

Results

The patients in the T-score < -1.0 group showed significantly higher AST/ALT level than those in the T-score ≥ -1.0 group (0.93 ± 0.16 vs 1.17 ± 0.24, P < 0.001). According to the interquartile range of the AST/ALT ratio, the participants were divided into four groups: Q1 (0.650, 0.874), Q2 (0.875, 0.999), Q3 (1.000, 1.173) and Q4 (1.174, 1.917). After adjustment for confounding factors, compared with Q1 of the AST/ALT level, subjects in Q3 and Q4 remained more likely to have osteopenia or osteoporosis (Q3, OR 3.478, 95% CI 1.641-7.411; Q4, OR 15.278, 95% CI 6.377-36.837). The AST/ALT ratio provided an AUC value of 0.81 (95% CI 0.77-0.84) for osteopenia or osteoporosis in patients with T2DM.

Conclusion

An elevated AST/ALT ratio is associated with the evaluated risk of osteopenia/OP in patients with T2DM. The AST/ALT ratio, a practical and cost-effective biomarker, may be a potential predictor of osteopenia/OP in patients with T2DM.

Connection between Impaired Fasting Glucose or Type 2 Diabetes Mellitus and Sepsis: A 10-Year Observational Data from the National Health Screening Cohort

BACKGRUOUND

The mortality of sepsis without direct drugs is high. The association between prediabetes, based on a single fasting glucose (FG), or long-term type 2 diabetes mellitus (T2DM) and sepsis remains unclear.

METHODS

Of the adults aged ≥20 years who were included in the National Health Screening Program (NHSP) in 2009, 40% were randomly sampled. After excluding patients with type 1 diabetes mellitus, with missing information, and who were diagnosed with sepsis during the wash-out (between 2001 and the NHSP) or 1-year lag period, a cohort comprised of 3,863,323 examinees. Body mass index (BMI) measurements, FG tests, and self-reported questionnaires on health-related behaviors were conducted. Individual information was followed up until 2020 and censored upon the first occurrence of sepsis or death. The incidence of sepsis was compared using a multivariable regression adjusted for age, sex, income, BMI, smoking, drinking, physical activity levels, and chronic diseases.

RESULTS

The cohort was divided into those with normal FG (n=2,675,476), impaired fasting glucose (IFG) (n=890,402, 23.0%), T2DM <5 years (n=212,391, 5.5%), or T2DM for ≥5 years (n=85,054, 2.2%). The groups with IFG (adjusted hazard ratio [aHR], 1.03; 95% confidence interval [CI], 1.01 to 1.05), T2DM <5 years (aHR, 1.43; 95% CI, 1.40 to 1.47), and T2DM for ≥5 years (aHR, 1.82; 95% CI, 1.77 to 1.87) exhibited significantly higher incidence of sepsis (P<0.001), with the greatest risk in patients with T2DM aged <40 years (aHR, 1.96; 95% CI, 1.71 to 2.25).

CONCLUSION

Patients with long-standing and young-onset T2DM show a substantially high risk of sepsis, emphasizing the need for infection prevention and vaccination.

Citral: Bioactivity, Metabolism, Delivery Systems, and Food Preservation Applications

Citral is a monoterpene aldehyde with a lemon flavor, comprising two isomers: geranyl aldehyde and neura. Citral's unique biological activities and lemonlike aroma have contributed to its widespread use in the food preservation industry. However, citral exhibits instability under various conditions, necessitating the development of several delivery systems to enhance its physicochemical stability and retard degradation. This article provides a comprehensive review of citral's structure, biological activities (including antimicrobial, antioxidant, anti-inflammatory, diabetes prevention, anticancer, and insect repellent properties), metabolism, stability, and delivery systems (such as spray drying, Pickering emulsions, nano-emulsions, and self-assembly), as well as its applications in food preservation. The advantages and limitations of these delivery systems are also discussed. Future research should explore opportunities to develop biopackaging films by integrating advanced technologies to achieve better monitoring and regulation of food freshness.

Systematic Literature Review of the Impact of Type 2 Diabetes and Heart Failure Guideline Adherence on Clinical and Economic Outcomes

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is associated with comorbidities, particularly in the cardiovascular, renal, and metabolic (CVRM) spectrum. Given the complexity of CVRM spectrum diseases and the treatment landscape, treatment guidelines have been established to assist physicians in selecting the most appropriate treatment based on not only patients' primary disease but also their comorbidities. However, the impact of adherence to treatment guidelines on associated outcomes remains unclear.

METHODS

A systematic literature review was conducted to evaluate the impact of guideline-based treatment on clinical, economic, and quality-of-life (QoL) outcomes and related comorbidities in the CVRM spectrum or heart failure (HF) alone in individuals with T2DM. The MEDLINE, MEDLINE In-Process, Embase, Cochrane Central Register of Controlled Trials, and EconLit electronic databases were searched to identify relevant peer-reviewed studies published in the United States, Canada, or Germany. The studies were screened and selected for inclusion or exclusion based on populations, interventions, comparators, and study design (PICOS) criteria.

RESULTS

Of the 622 records identified, 28 publications met the inclusion criteria. In total, 11 and 16 studies reported adherence to clinical guidelines for T2DM and HF management, respectively. Adherence to T2DM and HF treatment guidelines decreased all-cause mortality and all-cause hospitalizations; furthermore, adherence to T2DM guidelines decreased hospitalizations due to HF, myocardial infarction, and stroke, and reduced T2DM-related long-term complications, while adherence to HF guidelines reduced hospitalizations due to HF. Evidence gaps were identified, including the need to assess the impact of guideline adherence on economic outcomes, the impact of adherence to diagnosis and monitoring guidelines, and the impact of guideline adherence on QoL outcomes.

CONCLUSIONS

Adherence to disease management guidelines improves the outcomes of patients with T2DM or HF and reduces disease-related complications and hospitalizations; however, key evidence gaps exist, particularly regarding patients with T2DM along with comorbidities in the CVRM spectrum.

Challenges to Lifestyle Medicine for Type 2 Diabetes in Iran: A Synoptic Review

Type 2 diabetes (T2D) is a major public health issue in Iran. The principal context for T2D management is the prevention of cardiovascular disease development and progression. These preventive strategies can be enhanced with routine implementation of comprehensive lifestyle modification, guideline-directed medical therapies, and creation of infrastructure that considers social determinants of health, ethnocultural variables, and financial challenges. In this synoptic review, scientific evidence sourced from Iran is analyzed to identify tactics to optimize the lifestyle medicine component of T2D care in Iran. Important evidence-based factors gleaned from the literature were curated into 9 categories: self-care, dietary adherence, mental health, self-comparison, transcultural adaptation, family support and community engagement, physical activity, the global pandemic, and service delivery. These categories were then assigned to 1 of 4 a priori aspects challenging diabetes care in Iran: behavioral factors, belief system, drivers, and implementation. By codifying discussion points and individual tactics, the improvement and optimization of T2D care in Iran can be facilitated. This reductionist model of approaching lifestyle medicine and complex chronic disease such as T2D can be applied to other ethnocultural populations.

Patient-centered care and satisfaction of patients with diabetes: insights from a survey among patients at primary healthcare centers in Saudi Arabia

BACKGROUND AND OBJECTIVE

Patient-centered care (PCC) and patient satisfaction are pivotal in healthcare provision for patients with diabetes. This study investigates the link between perceived PCC and satisfaction with care among patients with diabetes in Saudi Arabia.

METHODS

A cross-sectional study was conducted at 47 primary healthcare centers affiliated with general hospitals, including King Abdullah Medical Complex, King Abdulaziz Hospital, East Jeddah Hospital, King Fahd General Hospital, and Al Thagr General Hospital, operated by the Ministry of Health in Jeddah City, Saudi Arabia, between July and August 2023. Over 800 patients with diabetes were approached through a random sampling technique at the reception areas of these centers. These patients were directed to designated private rooms for further engagement, where they completed a face-to-face questionnaire administered by an interviewer. Data analysis was conducted using the software package SPSS version 28 and AMOS version 28.

RESULTS

Of the 594 patients who participated in the study (response rate 73.4%), the results indicated that the perceived level of PCC, including physical comfort (β = 0.200, p = 0.000), continuity in care transition (β = 0.114, p = 0.031), access to care (β = 0.203, p = 0.000), information and education (β = 0.169, p = 0.001), and family and friends involvement (β = 0.082, p = 0.023), were significantly related to patient satisfaction. However, other perceived PCC components, like patient preferences (β = 0.052, p = 0.233), care coordination (β = 0.078, p = 0.123), and emotional support (β=-0.080, p = 0.066), did not appear to have a significant relationship with patient satisfaction. Income and level of education substantially impacted the perception of PCC and satisfaction with care. One notable finding was that the perceived level of PCC had a strong positive relationship with patient satisfaction (β = 0.762, p = 0.002).

CONCLUSION

This study highlights the significant positive relationship between PCC and patient satisfaction in diabetes care in Saudi Arabia. It emphasizes the need for healthcare tailored to individual needs and demographic factors. This provide advocates the broader integration of PCC principles in health systems, particularly in Saudi Arabia, to improve patient experience and satisfaction. Policymakers should integrate patient-centered care into healthcare policies to improve service quality and health outcomes.

Rapid screening and identification of novel dipeptidyl peptidase IV inhibitory peptides from buffalo milk

BACKGROUND

Peptidomics combined with molecular docking is an effective alternative method for rapid screening of novel bioactive peptides in food. Buffalo milk as a potential source of dipeptidyl peptidase-IV (DPP-IV) inhibitory peptides has been less studied. Peptidomics and molecular docking methods were employed to rapidly screen new DPP-IV inhibitory peptides from buffalo milk. The screened DPP-IV inhibitory peptides were further verified using an in vitro inhibition assay and a Caco-2 cell assay.

RESULTS

The DPP-IV inhibition rate of buffalo milk was increased from 73.40 ± 6.01% to 97.23 ± 3.18% in an in vitro digestion assay, suggesting that buffalo milk could be a promising source of DPP-IV inhibitory peptides. Subsequently, two novel peptides (GPFPIIV and FPQYL) with potential DPP-IV inhibitory activity were screened using peptidomics, molecular docking and an in vitro inhibitory assay. The IC50 values for GPFPIIV and FPQYL were 0.2998 ± 0.03 and 0.1407 ± 0.01 mg mL-1, respectively. During simulated gastrointestinal digestion in vitro, FPQYL had an excellent digestive stability of 92.13 ± 1.03%, whereas that of GPFPIIV was 59.52 ± 2.56%. In addition, GPFPIIV and FPQYL (1.00 mg mL-1) showed significant DPP-IV inhibitory effects in a Caco-2 cell assay, with the inhibition rate increasing to 32% and 36%, respectively.

CONCLUSION

In summary, two new DPP-IV inhibitory peptides were screened from buffalo milk through a combination of peptidomics and molecular docking, both of which exhibited significant DPP-IV inhibitory activities. The identified peptides, GPFPIIV and FPQYL, have promising applications in diabetes management. © 2025 Society of Chemical Industry.

Exploring glycemic variability and time in range: Emerging indicators of at-risk pregnancy in type 2 diabetes mellitus

OBJECTIVE

This study compares ambulatory glycemic profile and glycemic variability between pregnant women diagnosed with type 2 diabetes mellitus (T2DM) receiving pharmacotherapy and healthy pregnant women without diabetes and assesses their correlation with fetal outcome.

METHOD

This was a case-control study involving 60 pregnant women (40 with T2DM and 20 healthy controls) in the third trimester of pregnancy. A flash glucose monitor device was applied over the upper arm to obtain the ambulatory glucose profile. Various glycemic parameters were analyzed and correlated with fetal outcomes among the two groups.

RESULTS

A total of 720 days of glucose data, comprising 69 120 data points, were analyzed. This included 46 080 glucose values from the T2DM group and 23 040 from the healthy control group. Mean glucose levels in the T2DM group were 23.75% higher compared to the controls. All measures of glycemic variability were significantly elevated in the T2DM group, including mean amplitude of glycemic excursions (MAGE) (52.85 mg/dL vs. 35.72 mg/dL, P = 0.036) and standard deviation (22.84 mg/dL vs. 14.00 mg/dL, P = 0.029). A MAGE >55 mg/dL was associated with adverse fetal outcomes, such as large-for-gestational-age (LGA) infants, neonatal hypoglycemia, and stillbirth. In the T2DM group, poor outcomes were also linked to a higher time above range (TAR) (13.39% vs. 2.5%, P = 0.0001). The LGA subgroup exhibited an elevated TAR (15.2%) compared to those with normal outcomes.

CONCLUSION

Pregnant women with T2DM exhibit higher glycemic variability compared to healthy pregnant women. A MAGE >55 mg/dL was associated with adverse fetal outcomes, and elevated TAR significantly influenced these outcomes.