Characterization of Anti-Insulin Antibodies in Type 1 and Type 2 Diabetes Mellitus: Clinical Relevance

The administration of insulin as a treatment for diabetes frequently leads to the formation of anti-insulin antibodies (IAs). The influence of these antibodies on the efficacy and safety of insulin therapy remains incompletely understood. This study presents a systematic, exploratory, cross-sectional analysis of the quantitative and qualitative properties of IAs in 101 patients with type 1 diabetes (T1D) and 101 patients with type 2 diabetes (T2D). The goal was to identify subpopulations of IAs that might impact glycemic control. We assessed the presence, titer, isotype, subclass, avidity, and in vitro neutralizing capacities of IAs, using glycated hemoglobin A1c (HbA1c) levels as an indicator of the clinical effectiveness of insulin. Our findings showed that 72% of individuals with T1D and 32% with T2D developed IAs, with IgG being the predominant isotype in both groups. Despite the presence of IAs, no in vitro neutralizing effect against insulin was observed, and there was no significant correlation between IA titer or avidity and HbA1c levels in either group. The results from this study demonstrate that while IAs are prevalent in both T1D and T2D, they do not have a significant clinical impact on the outcomes of insulin therapy in our study populations.

Honey, Gellan Gum, and Hyaluronic Acid as Therapeutic Approaches for Skin Regeneration

Background/Objectives: Chronic wounds pose a significant health concern, with their prevalence increasing due to various etiologies. The global aging population further contributes to this rise, placing a substantial burden on healthcare systems in developed countries. This work aimed to develop new therapeutic options in the form of creams and dressings based on honey, gellan gum, and hyaluronic acid for preventing and treating chronic wounds across all stages. Methods: To address this, after the formulations were developed, in vitro cytocompatibility was determined. To confirm biocompatibility, an ovine wound model was used: full-thickness excisional wounds were treated with three formulations, namely gellan gum and honey sponges (GG-HNY), gellan gum, honey and hyaluronic acid sponges (GG-HA-HNY) and a honey-based cream (cream FB002). Daily assessments, including visual evaluation and wound scoring, were conducted for 30 days. Following the study period, tissues were collected for histological analyses. Results: The macroscopic examination revealed that all therapeutic groups facilitated lesion closure. Lesion size reduction, granulation tissue disappearance, and scar tissue development were consistent across all groups, with the group receiving cream demonstrating an advanced stage of healing. All groups achieved substantial wound closure by day 30, with no significant differences. Histopathological analysis following ISO standards revealed that GG-HA-HNY had the lowest ISO score, indicating minimal reactivity and inflammation, which corroborated the cytocompatibility. Conclusions: Combining these insights with previous findings enhances our understanding of wound regeneration dynamics and contributes to refining therapeutic strategies for chronic wounds. The formulations were designed to balance therapeutic efficacy with cost-effectiveness, leveraging low-cost raw materials and straightforward production methods.

Obesity and Atherosclerotic Cardiovascular Disease: A Review of Social and Biobehavioral Pathways

In the United States, two out of every five adults have obesity. The obesity epidemic is a significant public health concern and a major risk factor for atherosclerotic cardiovascular disease (ASCVD), contributing to its development through a complex interplay of social, biologic and behavioral mechanisms. It exacerbates traditional cardiovascular risk factors such as dyslipidemia, hypertension, and type 2 diabetes, while visceral and epicardial fat deposition promotes inflammation and insulin resistance, thereby accelerating atherosclerosis. Beyond traditional pathophysiologic pathways, social determinants of health (SDoH) significantly contribute to obesity-related disparities, particularly among racial and ethnic minorities. SDoH factors such as socioeconomic status, access to health care, and limited availability of nutritious food and safe spaces for physical activity not only increase obesity prevalence but also exacerbate its psychological toll, including stress and anxiety, which further elevate cardiovascular risk. Environmental factors, such as limited green spaces and air pollution, further promote obesogenic behaviors and worsen cardiovascular outcomes. In this review, we explore the association between obesity and ASCVD and key mediating pathways including the role of SDoH and environmental risk factors. We also discuss potential strategies-including patient education, community engagement to address SDoH, and establishment of dedicated cardiometabolic and cardiovascular prevention clinics-to mitigate the population burden of obesity and improve downstream cardiovascular outcomes.

Brain activity in different brain areas of patients with diabetic vitreous hemorrhage according to voxel-based morphometry

AIM

To elucidate the neuropathological mechanisms underlying diabetic vitreous hemorrhage (DVH) and its correlation with clinical characteristics.

METHODS

Twenty-one individuals with DVH (male/female 12/9; mean age 52.29±11.66y) were selected, alongside 21 appropriately matched controls with diabetes mellitus (DM). Voxel-based morphometry (VBM) techniques were employed to identify aberrant functional regions in the brain. Receiver operating characteristic (ROC) curves were utilized for classification based on the average VBM values of the two groups, and Pearson correlation analysis was conducted to assess the relationship between average VBM values in distinct brain regions and clinical manifestations.

RESULTS

Relative to the DM controls, DVH patients exhibited reduced VBM values in the right superior temporal pole, the right superior temporal gyrus, the right medial orbital frontal gyrus, and the left superior frontal gyrus. Furthermore, ROC curve analysis of these four brain regions in DVH patients demonstrated a high degree of accuracy, as indicated by the area under the curve. The average VBM value in each of these regions exhibited a negative correlation with both the duration of DVH and the score on the Hospital Anxiety and Depression Scale (HADS).

CONCLUSION

Pathological alterations in four distinct brain regions are observed in patients with DVH, potentially reflecting neuropathological changes associated with this condition.

Effect of intensive nutrition training, education and support versus standard therapy in reducing the need for insulin therapy in gestational diabetes (INTENSE-GDM): a protocol for a randomised controlled single-centre trial in Denmark

INTRODUCTION

Gestational diabetes mellitus (GDM) poses health risks due to hyperglycaemia, which can lead to clinical complications for mother and child. While dietary therapy serves as first-line treatment, approximately one-third of women with GDM require insulin to obtain glycaemic control. However, insulin therapy amplifies hospital care expenses and personal burdens. Intensive nutrition education, training and support may improve dietary intake leading to glycaemic control and reducing the need for insulin therapy. This study investigates the effectiveness of intensified dietary therapy versus standard dietary therapy in reducing the need for insulin and consequently lowering hospital care costs among women with GDM at high risk of requiring insulin therapy. Responses to the dietary interventions will also be examined within ethnic subgroups.

METHODS AND ANALYSIS

This study is a randomised controlled parallel-group trial involving women with GDM randomised in a 1:1 ratio to receive either intensive dietary therapy (intensive group) or standard dietary therapy with only one educational consultation (control group). The educational content of the first consultation is according to routine care and similar in both groups. The intensive group receives two additional dietitian consultations and two additional consultations on request to facilitate training and support in addition to education. Assessments are conducted at baseline and 2-3 weeks before planned delivery, with additional data gathered from medical records. The primary outcome is the difference in the proportion of women requiring insulin therapy. Maternal outcomes, neonatal outcomes, patient-reported outcomes, health behaviour and cost-saving aspects of hospital care will also be assessed. Recruitment began in January 2024 and ends in December 2025, with a target enrolment of 214 women.

ETHICS AND DISSEMINATION

The study received approval from the Ethics Committee of the Capital Region of Denmark (H-23055674). Results will be disseminated through peer-reviewed journals, and detailed presentations to key stakeholders.

TRIAL REGISTRATION NUMBER

NCT06127823.

The TANGO-DM randomized controlled trial study protocol: treatment outcomes for gestational diabetes diagnosed according to WHO 2013 or WHO 1999 thresholds

INTRODUCTION

Gestational diabetes mellitus (GDM), or hyperglycemia first diagnosed in pregnancy, affects 7-10% of all pregnancies worldwide. Perinatal risk rises with increasing glycemia at oral glucose tolerance test (OGTT). The new (2013) WHO criteria recommend a lower fasting, and a higher post-load threshold for GDM diagnosis in comparison to the old (1999) WHO criteria. To date, however, outcomes of GDM treatment for those affected by the altered diagnostic criteria, has not been well investigated. We hypothesized that intensive GDM treatment according to the new (2013) GDM criteria would result in a reduction in infants with birth weight > 90th centile (large for gestational age, LGA), in comparison to treatment according to the old criteria (1999).

METHODS

The TANGO-DM trial is an open label, multicenter randomized controlled trial. Participants are pregnant with a gestational age between 16 + 0 and 32 + 0 weeks, who underwent a 1-step venous 2- or 3-point 75-gram oral OGTT, were eligible if they had glucose concentrations discordant between the old (1999) and the new (2013) criteria. After informed consent, women are randomized to either intensive GDM treatment, consisting of dietary advice and glucose monitoring and, if euglycemia is not reached, antihyperglycemic agents, or normal obstetric care without GDM treatment. The primary outcome is large-for-gestational-age infants (birth weight > 90th percentile). Secondary outcome measures include maternal complications, obstetric complications, neonatal complications, obstetric interventions, quality of life, and healthcare and societal costs. Outcomes will be analyzed according to the intention-to-treat principle. The study is powered to detect a reduction in LGA from 16% in the untreated to 10% in the treated group, which requires 1032 participants (516 per arm; alpha-error 5% for 80% power).

DISCUSSION

The TANGO-DM trial will provide high-level evidence to support or refute the use of the new 2013 WHO diagnostic criteria in terms of their ability to lower the number of large for gestational age infants and/or improve maternal and perinatal outcomes and/or costs in women with gestational diabetes.

TRIAL REGISTRATION

Central Committee on Research Involving Human Subjects (CCMO) (NL63013.018.18). Registered on 22 September 2018.

Clinical Role of Epicardial Adipose Tissue

While the epidemic of atherosclerosis has slowed down in industrialized nations, it has increased in speed and severity in developing countries. The worldwide expanding incidence and prevalence of obesity, insulin resistance and diabetes mellitus may be among the most important drivers of this trend, and the role of visceral adipose tissue as a promoter of atherosclerosis has come under intense scrutiny. Epicardial adipose tissue (EAT) is embryologically similar to the visceral fat in the intra-peritoneal space. Both adipose compartments are capable of secreting numerous pro-atherosclerotic cytokines and have been shown to promote inflammation in patients with dysmetabolic syndromes and in patients with established coronary artery disease. The adverse cardiovascular effects of EAT extend to influencing the development of atrial fibrillation and heart failure, mostly with preserved ejection fraction, through a combination of inflammatory, pro-fibrotic and pro-arrhythmogenic pathways. We provide an overview of the current understanding of the role of EAT in the development of several cardiovascular conditions and some of the therapeutic advances in the field.

Nursing consultation and diabetes: an educational and transformative process for primary health care

OBJECTIVE

METHOD

convergent care research carried out with 12 nurses. Participant observation, semi-structured individual interviews and convergence groups were used to collect data, which were treated by participatory analysis, with an interpretative approach.

RESULTS

the promotion of self-care, the bond between professionals and users, and the support for lifestyle changes for people with diabetes were aligned with the proposed Care Model. On the other hand, attitudes, values and knowledge that weaken care were identified as divergent. The theoretical and practical deepening of the care model, diabetes, dealing with work overload, and the implementation of a guide and a protocol for the development of the nursing consultation were points of convergence for improving the quality of the consultation. It was also observed that nurses' autonomy was strengthened, critical thinking was awakened, and the search for improvement and redefinition of the relationship with the user was sought.

CONCLUSION

the nursing consultation was enhanced through the active participation of nurses in an educational, reflective and dialogical process.

BACKGROUND

(1) The Nursing Consultation for people with DM by nurses consisted of elements that are similar to and different from the MACC. (2) Elements that align with the MACC: as establishing a bond with users, accountability, longitudinal care, and the social and family approach. (3) Elements diverged from the assumptions of MACC: a limited understanding of the care model, the professional attitude of blaming the user and the weaknesses in the application of the nursing process. (4) The nursing consultation was enhanced through the active participation of nurses in an educational, reflective and dialogical process.

The Impact of Virtual Consultations on Quality of Care for Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Virtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity).

METHODS

A systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models.

RESULTS

In total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12).

CONCLUSION

VCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.

Medicinal and edible homologous poly/oligo-saccharides: Structural features, effect on intestinal flora and preventing and treating type 2 diabetes, and their applications: A review

Type 2 diabetes mellitus (T2DM) is the third most common chronic metabolic disorder worldwide and seriously dangerous. Novel therapeutics are sought due to the paucity of safe and effective metabolic disorder-related diabetes medicines. Intestinal flora impacts glucose and lipid balance, making it a unique T2DM therapeutic target. Due to gut fermentation, poly/oligo-saccharides are highly beneficial prebiotic carbohydrates for intestinal health. Moreover, supplementation with naturally occurring medicinal and edible homologous traditional Chinese medicines (MEHTCM) poly/oligo-saccharides has significant antidiabetic effects with few side effects. Now, a comprehensive review of research developments of MEHTCM poly/oligo-saccharides was presented to explore their prospects. We outlined the structural characteristics, structure classification, and structure-activity relationships. Notably, structure-activity relationships illustrated that molecular weight, monosaccharide composition, and glycosidic bond type could influence the hypoglycemic activity and prebiotic effect of MEHTCM poly/oligo-saccharides. Additionally, the review systematically summarized the effect and potential mechanism of MEHTCM poly/oligo-saccharide on T2DM, focusing on gut microbiota. The potential applications in formulations for special medical purposes, common food, health care product, agriculture and other fields have also been summarized. This review emphasizes MEHTCM poly/oligo-saccharides' potential as prebiotics for T2DM treatment. This information provides new insights and a theoretical foundation for MEHTCM poly/oligo-saccharide nutritional and medicinal research.

Synthesis and biological activity, photophysical, photochemical properties of tetra substituted magnesium phthalocyanine

The compound 4-(2-((1H-benzo[d]imidazol-2-yl) thio) phenoxy) phthalonitrile was obtained from the reaction of 2-nitrophenol, 4-nitrophthalonitrile and 2-mercaptobenzimidazole. This compound was reacted with magnesium Chloride (MgCl2) to yield tetrakis-[(2-((1H-benzo[d]imidazol-2-yl) thio) phenoxy) phthalocyaninato] magnesium II. New compounds were characterized by UV-vis, 1H NMR, 13C NMR, FTIR and Mass spectra. Electronic spectra aggregation study of magnesium phthalocyanine compound in various concentrations and diverse solvents was performed. Photoluminescence spectra of magnesium phthalocyanine in different solvents were investigated. The biological activities of 3 and 4 compounds were investigated. The results showed that 4 had excellent antioxidant and antidiabetic activities as 75.71% and 81.83%, respectively. 3 and 4 had deoxyribonucleic acid (DNA) cleavage ability and 4 caused a double-strand fracture in plasmid DNA at 100 and 200 mg/L. Both compounds showed antimicrobial activity and also 4 was more effective against pathogenic microorganisms than 3. Photodynamic antimicrobial therapy of test compound was also more effective than without irradiation. The highest biofilm inhibition of 3 and 4 was 78.28% and 98.49% for S. aureus and also 73.95% and 91.13% for P. aeruginosa, respectively. Finally, both compounds demonstrated %100 microbial cell viability inhibition at 100 mg/L. Overall, the study suggests that both 3 and 4 have potential for further development as therapeutic agents.

Bariatric surgery significantly reduces progression from prediabetes to diabetes compared with the general population: 15-year single-institution data

BACKGROUND

There is a paucity of literature on the impact for bariatric surgery on the progression from prediabetes (PDM) to type II diabetes mellitus (T2DM).

OBJECTIVES

To evaluate the progression from PDM to T2DM in bariatric surgery compared with a nonsurgical cohort.

SETTING

Single academic institution, Center of Bariatric Excellence.

METHODS

This retrospective study of patients with morbid obesity with patients with PDM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2001 and 2022. Nonsurgical controls from a primary care cohort were directly matched by hemoglobin A1c, age, sex, and body mass index. DM was defined as a clinical diagnosis of type II diabetes or hemoglobin A1c ≥6.5%. Kaplan-Meier analysis was used to estimate time until T2DM. Cox regression was used to compare time until T2DM in RYGB versus sleeve gastrectomy and in bariatric surgery versus nonsurgical controls.

RESULTS

A total of 1326 bariatric cases with PDM (n = 1154 RYGB, n = 172 SG) were identified. The cohort was 83% female, mean age = 45.3 years, mean body mass index 46.9 kg/m2, and follow-up was 65% over 15 years. In bariatric cases, PDM progression to T2DM at 5, 10, and 15 years after surgery was 1.8%, 3.3%, and 6.7%, respectively. PDM progression to T2DM was almost 20 times greater in matched nonsurgical controls at 5, 10, and 15 years 31.1%, 51.4%, and 68.7%, respectively (hazard ratio 19.8, 95% confidence interval 13.9-28.4, P < .0001). When stratifying by bariatric surgery type, those with SG were 4 times more likely to progress to T2DM versus RYGB (hazard ratio 4.01, 95% confidence interval 1.71-9.39, P = .0014).

CONCLUSIONS

Bariatric surgery significantly decreases the conversion from PDM to T2DM. The impact was significantly greater for RYGB compared with SG.

Microglia aggregates define distinct immune and neurodegenerative niches in Alzheimer's disease hippocampus

In Alzheimer's disease (AD), microglia form distinct cellular aggregates that play critical roles in disease progression, including Aβ plaque-associated microglia (PaM) and the newly identified coffin-like microglia (CoM). PaM are closely associated with amyloid-β (Aβ) plaques, while CoM are enriched in the pyramidal layer of the CA2/CA1 hippocampal subfields, where they frequently engulf neurons and associate with tau-positive tangles and phosphorylated α-synuclein. To elucidate the role of these microglial subtypes, we employed high-content neuropathology, integrating Deep Spatial Profiling (DSP), multiplex chromogenic immunohistochemistry and confocal microscopy, to comprehensively map and characterise their morphological and molecular signatures, as well as their neuropathological and astrocytic microenvironments, in AD and control post-mortem samples. PaM and PaM-associated astrocytes exhibited signatures related to complement system pathways, ErbB signalling, and metabolic and neurodegenerative processes. In contrast, CoM displayed markers associated with protein degradation and immune signalling pathways, including STING, TGF-β, and NF-κB. While no direct association between CD8 + T cells and either microglial type was observed, CD163 + perivascular macrophages were frequently incorporated into PaM. These findings provide novel insights into the heterogeneity of microglial responses, in particular their distinct interactions with astrocytes and infiltrating immune cells, and shed light on specific neurodegenerative hotspots and their implications for hippocampal deterioration in AD.

Angiotensin II: A novel biomarker in vascular diseases

The renin-angiotensin system (RAS), composed mainly of renin, angiotensin, and aldosterone, is a key endocrine pathway involved in cardiovascular activity regulation. Under physiological conditions, the RAS plays a vital role in water and salt metabolism, blood pressure regulation, and electrolyte balance. Angiotensin II (Ang II) is the most important active component of the RAS, and its receptors are concentrated in vascular, pulmonary, cardiac, and renal tissues in vivo. Moreover, Ang II is closely associated with the development of vascular lesions. Ang II expression is closely associated with atherosclerosis, aortic aneurysm/dissection, ischemic stroke, hypertension, pulmonary hypertension, and type 2 diabetes mellitus. Given the significant pathophysiological role of Ang II in vascular diseases and the availability of advanced detection methods, Ang II holds promise as a reliable biomarker and therapeutic target in clinical settings. This review summarizes the mechanisms through which Ang II contributes to different vascular diseases and discusses its potential application as a biomarker for disease diagnosis.

Investigation and study on the epidemiology of gestational diabetes mellitus in Guizhou

BACKGROUND

Gestational diabetes mellitus (GDM) is a growing public health concern, particularly in regions with diverse ethnic populations. Understanding the incidence and risk factors of GDM is crucial for early prevention and management, especially in underrepresented areas like Guizhou Province, China, where geographic and ethnic diversity may influence the disease's prevalence and risk profiles.

AIM

To investigate the incidence of GDM and identify its associated risk and protective factors among different ethnic groups in Guizhou Province, providing essential data for early prevention strategies.

METHODS

A multi-center retrospective study was conducted, dividing participants into GDM and non-GDM groups according to standardized diagnostic criteria. Data were collected from 103629 deliveries across 40 hospitals in Guizhou. Various demographic, clinical, and laboratory parameters were analyzed using logistic regression to identify risk and protective factors for GDM.

RESULTS

Among the 103629 deliveries, 18957 cases of GDM were identified, with an incidence of approximately 18.3%. The risk of GDM was higher in the Han ethnic group compared to minority ethnic groups. The Dong ethnic group had the lowest incidence among the minorities. Key risk factors identified included older age (especially > 35 years), higher pre-pregnancy body mass index (BMI), light physical activity, gravidity, family history of diabetes, hemoglobin, aspartate aminotransferase, alanine aminotransferase, and direct bilirubin. Protective factors included higher education level, total protein, and albumin. There were also differences based on blood type, with type A associated with higher risk.

CONCLUSION

The incidence rate in Guizhou is 18.3%. Older age (especially > 35 years), Han ethnicity, lower education level, higher pre-pregnancy BMI, light physical activity, and higher gravidity are the main risk factors for GDM. Laboratory findings indicate that higher hemoglobin, higher liver function parameters (alanine aminotransferase, aspartate aminotransferase, and direct bilirubin), and lower total protein and albumin are associated with a higher risk of GDM. Blood type A has a higher risk of GDM compared to blood types AB and O.

Evaluating the effectiveness of ultrasound-assisted wound debridement in managing diabetic foot ulcers: A systematic review and meta-analysis

BACKGROUND

Diabetic foot ulcers (DFUs) present a significant clinical challenge due to their high prevalence and profound impact on morbidity. Ultrasound-assisted wound debridement (UAWD) has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.

AIM

To evaluate the efficacy of UAWD in treating DFUs on wound closure rates, treatment duration, and quality of life outcomes.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines, systematically searching PubMed, Embase, Web of Science, and the Cochrane Library with no date restrictions. Randomized controlled trials (RCTs) that evaluated the efficacy of UAWD in DFU treatment were included. Data were independently extracted by two reviewers, with discrepancies resolved through consensus or third-party consultation. The risk of bias was assessed using the Cochrane tool. χ 2 and I 2 statistics assessed heterogeneity, informing the use of fixed or random-effects models for meta-analysis, supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.

RESULTS

From 1255 articles, seven RCTs met the inclusion criteria. The studies demonstrated that UAWD significantly reduced DFU healing time (standardized mean difference = -0.78, 95%CI: -0.97 to -0.60, P < 0.001) and increased healing rates (odds ratio = 9.96, 95%CI: 5.99 to 16.56, P < 0.001) compared to standard care. Sensitivity analysis confirmed the stability of these results, and no significant publication bias was detected.

CONCLUSION

UAWD is a promising adjunctive treatment for DFUs, significantly reducing healing times and increasing healing rates. These findings advocate for the integration of UAWD into standard DFU care protocols.

Neuroprotective effects of traditional Chinese medicine Naofucong on diabetic cognitive impairment: Mechanisms involving insulin-degrading enzyme-mediated degradation of Amyloid-β and inhibition of ERK/JNK/p38 MAPK signaling pathway

The increasing prevalence of diabetes and its related cognitive impairments is a significant public health concern. With limited clinical treatment options and an incomplete understanding of the underlying mechanisms, traditional Chinese medicine (TCM) Naofucong is proposed as a potential neuroprotective agent against diabetic cognitive impairment (DCI). This study aims to investigate the therapeutic mechanisms of Naofucong in DCI. We hypothesize that Naofucong may improve cognitive function in diabetic rats by modulating the extracellular regulated protein kinases (ERK)/c-Jun N-terminal kinase (JNK)/p38 mitogen-activated protein kinases (MAPK) signaling pathway, enhancing insulin-degrading enzyme (IDE) expression, reducing amyloid-beta (Aβ) deposition, decreasing phosphorylated Tau (p-Tau) levels, and alleviating oxidative stress. Diabetes was induced in specific-pathogen-free male Sprague-Dawley rats using streptozotocin, and the rats were treated with oral Naofucong for 12 weeks. We assessed cognitive function and measured neuronal damage, oxidative stress injury, and the expression levels of IDE, Aβ, amyloid precursor protein (APP), p-Tau, and components of the ERK/JNK/p38 MAPK pathway. Diabetic rats showed significant declines in cognitive function, neuronal damage, oxidative stress, low IDE expression, Aβ accumulation, high APP expression, abnormal Tau phosphorylation, and overactivation of the ERK/JNK/p38 MAPK pathway. Naofucong treatment significantly reversed these symptoms. Our findings suggest that Naofucong improves cognitive impairment in diabetic rats by inhibiting the ERK/JNK/p38 MAPK pathway, upregulating IDE, reducing Aβ deposition, suppressing APP and p-Tau expression, and alleviating neuronal damage and oxidative stress. This research provides a reference for the clinical prevention and treatment of DCI using TCM Naofucong.

Non-linear relationship between arteriosclerosis index and diabetes risk in non-obese east Asian adults

Previous studies have shown a positive association between the arteriosclerosis index (AI) and future diabetes risk. However, evidence in non-obese populations is limited. This study investigates the relationship between AI and future diabetes risk in non-obese East Asian adults. This retrospective cohort study enrolled 95,402 non-obese adults from China and Japan. Participants had a mean age of 42.92 ± 12.24 years, with 51,295 (53.77%) being male. Median follow-up was 3.01 years. Cox proportional hazards models assessed the association between baseline AI and diabetes risk. Non-linear associations were explored using cubic splines and smoothed curves in Cox models. Sensitivity analyses were performed. After adjusting for covariates, a positive association was found between AI and diabetes risk in non-obese adults (HR 1.09, 95% CI 1.03-1.15, P = 0.0017). A non-linear relationship was identified, with an inflection point at 1.47. Below this point, HR was 5.87 (95% CI 1.20-28.63, P = 0.0287); above, it was 1.07 (95% CI 1.02-1.13, P = 0.0115). Sensitivity analyses affirmed the robustness of these results. This study identifies a positive, non-linear association between the AI and diabetes risk in non-obese adults. Interventions targeting AI reduction could significantly lower the risk of future diabetes in this population.

Glucagon-like peptide-1 and impaired counterregulatory responses to hypoglycemia in type 1 diabetes

This letter comments on a study by Jin et al, published recently in the World Journal of Diabetes. Hypoglycemia is a significant complication of diabetes, with primary defense mechanisms involving the stimulation of glucagon secretion in α-cells and the inhibition of insulin secretion in pancreatic β-cells, which are often compromised in type 1 diabetes mellitus (T1DM) and advanced type 2 diabetes mellitus. Recurrent hypoglycemia predisposes the development of impaired hypoglycemia awareness, a condition underpinned by complex pathophysiological processes, encompassing central nervous system adaptations and several hormonal interactions, including a potential role for glucagon-like peptide-1 (GLP-1) in paracrine and endocrine vias. Experimental evidence indicates that GLP-1 may impair hypoglycemic counterregulation by disrupting the sympathoadrenal system and promoting somatostatin release in pancreatic δ-cells, which inhibits glucagon secretion from neighboring α-cells. However, current trials evaluating GLP-1 receptor agonists (GLP-1 RAs) in T1DM patients have shown promising benefits in reducing insulin requirements and body weight, without increasing the risk of hypoglycemia. Further research is essential to elucidate the specific roles of GLP-1 and GLP-1 RAs in modulating glucagon secretion and the sympathetic-adrenal reflex, and their impact on hypoglycemia unawareness in T1DM patients.

Non-pharmacological management strategies for type 2 diabetes in children and young adults: A systematic review

PURPOSE

The evidence for effective non-pharmacological management of type 2 diabetes in children and young adults is scarce. This systematic review aims to identify the available evidence for non-pharmacological interventions in managing type 2 diabetes in children and young adults.

METHODS

A systematic search of OVID MEDLINE, Ovid Emcare, EMBASE, CINAHL, Cochrane, APA PsycINFO, Joanna Briggs, ACP Journal Club, Global Health, Scopus databases, INFORMIT, Circumpolar Health, Native Health Database, Indigenous Studies Portal, OpenGrey and Clinicaltrials.gov was performed up to March 2024. Information on author, year, study design, setting and population, intervention characteristics, and results were extracted by three reviewers independently.

RESULTS

Seven studies met criteria for inclusion. Very low-energy diet (VLED) was associated with reduction in hemoglobin A1c (HbA1c), weight, and body mass index (BMI). No other interventions (intensive group-based lifestyle program, occupational-therapist conducted support program or peer support program) improved HbA1c. Interventions positively impacted well-being, mental health and cardiometabolic outcomes.

DISCUSSION

Evidence for non-pharmacological management of youth onset type 2 diabetes is scarce. Available evidence demonstrated that VLED is associated with improved glycemia and weight loss. The role of social support from peers, family, and health professionals shows mixed results.

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

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

Aspirin-triggered lipoxin A4 reduces neuropathic pain and anxiety-like behaviours in male diabetic rats: antinociceptive enhancement by cannabinoid receptor agonists

Neuropathy is the most common complication of diabetes, leading to painful symptoms like hyperalgesia. Current treatments for diabetic painful neuropathy often prove inadequate, necessitating the exploration of new pharmacological approaches. Therefore, this study aimed to investigate the potential antinociceptive effect of aspirin-triggered lipoxin A4 (ATL), a specialized pro-resolving lipid mediator, when administered alone or in combination with cannabinoid agonists, to alleviate diabetic neuropathic pain. Mechanical hyperalgesia in the hindpaws of streptozotocin (STZ)-induced diabetic (DBT) rats was assessed using the electronic Von Frey test (VFT), before diabetes induction and for up to 32 days after STZ administration and intraperitoneal ATL (0.3, 1, 3, 10, or 30 ng/rat) treatment, alone or in combination with intrathecal CB1 or CB2 receptor agonists (ACEA or JWH-133, respectively; 10 or 30 μg/rat). The effect of ATL treatment on locomotor activity and anxious or depressive-like behaviors was also evaluated. In comparison to control normoglycemic rats, control DBT rats developed: 1) mechanical hyperalgesia; 2) increase in anxious and depressive-like behaviors. ATL treatment attenuated mechanical hyperalgesia in DBT rats both acutely (at 30 ng) and cumulatively (at doses of 1, 3, 10, or 30 ng), without compromising locomotor activity. The antinociceptive effect of ATL (at 1 or 3 ng) was augmented when combined with ACEA or JWH-133 treatments (only at a dose of 30 μg/rat). While ATL treatment alone reduced anxious-like behavior in DBT rats, it did not affect depressive-like behavior. These findings underscore the therapeutic potential of ATL, in diabetic complications, suggesting a possible interaction with the endocannabinoid system.

Pelvic floor dysfunction in patients with gestational diabetes mellitus

In this editorial, we comment on an article by Wang et al. Recent literature shows an increase in research on pelvic organ prolapse (POP). Although the true incidence of POP remains uncertain, its impact on quality of life is substantial. Anatomical studies report high incidence rates, surpassing those observed in symptom-based surveys. Weakness of the endopelvic fascia is a primary anatomical risk factor for POP. Additionally, gestational diabetes mellitus (GDM) has emerged as a growing concern, as poor glycemic control increases complications for both mother and fetus. GDM and POP are interconnected, with factors like maternal obesity, macrosomia, and hormonal changes exacerbating pelvic floor dysfunction. Modifiable risk factors, such as obesity and chronic hyperglycemia, along with multiparity, instrumental deliveries, and obstetric trauma, further increase susceptibility. For patients with GDM, gynecological exams, Pelvic Organ Prolapse Quantification staging, and pelvic floor ultrasonography are valuable diagnostics, with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses. Imaging, though uncomfortable during pregnancy, is safe in the early postpartum period. This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.

Glucagon-like peptide 1 receptor agonists and renal outcomes in kidney transplant recipients with diabetes mellitus

AIMS

Glucagon-like peptide-1 receptor agonists (GLP1-RAs) show reno-protective effects in type 2 diabetes. Limited data is available on their use in post-transplant diabetes mellitus. We aimed to explore the effect of GLP1-RAs on renal outcomes in diabetic kidney transplant recipients (KTR).

METHODS

We conducted a cohort retrospective study on adult KTR with diabetes mellitus. KTR treated with GLP1-RAs were matched with non-users. The primary outcome was the first occurrence of graft rejection, start of dialysis, re-transplantation or all-cause mortality. Other outcomes included a composite of the first occurrence of a genitourinary infection or all-cause mortality, and all-cause mortality. Metabolic effects of GLP1-RA treatment and risk for biliopancreatic adverse events were also explored.

RESULTS

We included 272 patients (69 % males, average age 58.3 ± 11.0 years) with a 3.1-year median follow-up. The use of GLP1-RAs lowered the incidence of the composite renal outcome after adjustment for independent risk factors (114 versus 68 events per 1000-patient years in controls versus GLP1-RA users, HR 0.489, 95 % CI 0.271-0.883). GLP-RA users had improved glycemic control, lipid profile and a decrease in body mass index. The treatment was safe without increased genitourinary infections or biliopancreatic events.

CONCLUSION

The use of GLP1-RAs decreased the risk of a composite outcome of renal dysfunction and mortality, improved metabolic control and showed safety of use in a large cohort of diabetic KTR, suggesting reno-protective effects in this high-risk population. Prospective data is further needed in KTR who are excluded from large RCTs.

Fruit Carbohydrates and Their Impact on the Glycemic Index: A Study of Key Determinants

Background: Fruits are a convenient and natural source of carbohydrates that can rapidly affect blood sugar levels and the glycemic index (GI). The GI plays a crucial role in the management of chronic diseases, including diabetes, obesity, hyperglycemia, and diet-related illnesses. Despite there being several health benefits linked with consuming fruits, it remains unclear which specific components of fruits are the key determinants that significantly influence the GI. Methods: This study retrospectively examined the relationship between different types of carbohydrates and the GI of various fruits to determine their correlation. The fruits' sugar and fiber contents were identified from available public databases, the U.S. Department of Agriculture (USDA), FooDB, PubMed, and published sources. Results: Previously, the GI was determined by the available carbohydrates, which include different types of sugar. In this study, individual hexose sugars, along with the total carbohydrates and dietary fiber, were examined. The results indicated a strong correlation between fructose and the GI, whereas glucose and total glucose did not exhibit such a correlation. The total carbohydrate-to-fiber ratio displayed a stronger correlation (R = 0.57 and p > 0.0001) with the GI compared to glucose alone (R = 0.37; p = 0.01) or the total glucose (R = 0.45; p = 0.0009) with the consideration of fiber, while the scattering of data points around the regression line suggested that factors beyond the total carbohydrate and fiber also contribute to determining the GI. Conclusions: This study demonstrated that individual hexose sugars, especially fructose, significantly influence the GI. These findings suggest that the carbohydrate-to-fiber ratio may offer a more accurate and reliable metric for determining the GI than traditional methods. Further research is warranted to investigate the specific contribution of dietary fiber components, fruit texture, micronutrients, vitamins, genetic predispositions, gut microbiota, and the body's physiological status to gain a deeper understanding of GI regulation.

Diabetes mellitus, metformin's target gene AMPK, and inflammatory bowel disease: A Mendelian randomization study

The causal relationship between inflammatory bowel disease (IBD) and diabetes mellitus remains unclear. The aim of this study was to delve into this association and investigate the correlation between AMP-activated protein kinase (AMPK), a target gene of metformin, and the risk of developing IBD. Researchers conducted a bidirectional two-sample Mendelian randomization analysis to examine causal relationships between IBD, including ulcerative colitis and Crohn disease (CD), and diabetes mellitus, encompassing both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Additionally, this study utilized AMPK-related variants associated with HbA1c (%) as instrumental variables for the metformin target gene AMPK to further investigate their association with the risk of IBD. The inverse variance weighted method was used as the primary analytical approach. Mendelian randomization analysis revealed a suggestive association between IBD and T1DM (P = .024). CD was associated with an increased risk of T1DM (P = .011). In the reverse analysis, T1DM also increased the risk of IBD (P = .043). No causal relationship was found between IBD and T2DM in either the forward or reverse analyses. In addition, this study did not find any significant effect of AMPK on IBD. In conclusion, this study suggests a bidirectional association between IBD and T1DM, in which CD may increase the risk of T1DM. However, no causal relationship was found between IBD and T2DM. Furthermore, our findings revealed that the metformin's target gene AMPK had no significant effect on the onset of IBD.

Bioinformatics analysis and validation of novel biomarkers and competitive endogenous RNA networks involved in pyroptosis in diabetic nephropathy

Diabetic nephropathy (DN) is one of the major complications of diabetes mellitus. Pyroptosis is a type of programmed cell death that is closely related to the development of DN, however the molecular mechanism of pyroptosis in the development of DN is still unclear. The aim of this study is to identify pyroptosis-related potential biomarkers and competing endogenous RNA (ceRNA) networks in DN. The differentially expressed pyroptosis-related genes (DEPRGs) were identified using R software from Gene Expression Omnibus (GEO) database. In total, 4 significantly upregulated hub DEPRGs (CASP1, TXNIP, IRF9, and TRAF3) were selected and verified by machine learning techniques. Receiver Operating Curve (ROC) to assess the diagnostic value of pivotal DEPRGs. Immune infiltration was analysed using the CIBERSORT algorithm in R software. Then, differentially expressed miRNAs (DEmiRNAs) and lncRNAs (DElncRNAs) were obtained from the GEO database, respectively. The hub DEPRGs-associated ceRNA network was constructed. Finally, DN rats were induced by high-sugar and high-fat diet combined with an intraperitoneal injection of STZ. The expression of pyroptosis-related proteins and 4 hub DEPRGs were detected in rats' kidney tissues using Western blotting. The DN pyroptosis-related ceRNA networks constructed by hub genes were validated both in clinical samples and DN rat model using real-time PCR (qRT-PCR). Our results indicated that the ceRNA network consisting of key genes might be a potential regulatory axis for pyroptosis in DN.

The Prevalence and Predictors of Improper Sharps Collection Practices Among People With Diabetes in Saudi Arabia

BACKGROUND

Diabetes treatment requires the use of medical sharps for glycemic control. Improper sharps collection and disposal poses substantial threats to people with diabetes (PWD), health care professionals, the environment, and public health.

OBJECTIVES

To identify the prevalence and predictors of improper sharps collection practices among PWD in Saudi Arabia.

METHODS

We surveyed 288 PWD at King Saud University Diabetes Center in Riyadh, Saudi Arabia, from September to October 2021. We asked questions about demographics, diabetes history, sharps collection practices, and prior education on proper sharps collection practices. We defined "proper sharps collection" as: using a designated sharps disposal container or homemade sealed container to collect sharps.

RESULTS

Of the PWD surveyed, 60% were women, 54% were ≥35 years old, and 53% had type 1 diabetes. Most respondents (80% and 72%) reported improper collection of needles and lancets, respectively. Approximately, 56% of needle users and 61% of lancet users reported that they had never received instructions on safe sharps disposal. Receiving education on safe sharps disposal practices was associated with a 66% reduction in the risk of improper sharps collection practices (odds ratio (OR) [95% confidence interval (CI)]: 0.34 [0.16-0.68]) after adjusting for age, gender, type and duration of diabetes, income, education, and nationality of the study participants. Among those who improperly dispose their needles, 67% thought their sharps collection practices were appropriate.

CONCLUSIONS

Our findings highlight the high prevalence of unsafe sharps collection practices among PWD in Saudi Arabia, and how prior education on safe sharps collection practices can help address this environmental and public health threat. Policies to reduce diabetes-related waste, unify the approach to proper sharps collection and disposal, and promote safe disposal education are needed to achieve a sustainable and safe waste management system.

Protective effects of phenolic phytochemicals on male fertility: a narrative review

Infertility is a global health issue and is closely related to oxidative stress, which occurs when high concentrations of free radicals surpass the protective effects of antioxidant molecules and enzymes. Such imbalance causes damage to DNA, as well as cellular proteins and lipids, ultimately leading to the destruction of the blood-testis barrier. This, in turn, hinders spermatogenesis. Various plants and compounds have been employed in an attempt to reverse these damages, such as phenolic compounds. Therefore, this review aims to identify the main phytochemical phenolic compounds and their respective effects when used in the treatment of male infertility. Related information concerning phenolic phytochemical compounds was gathered from studies selected from PubMed, Scopus, and Web of Science databases. The search was conducted using the combination of six terms: "phenolic compounds", "male infertility", "testis", "spermatozoa", "testosterone" and "male fertility". These compounds can raise testosterone levels, reduce lipid peroxidation, and improve tubular histoarchitecture in cases of subfertility associated with diabetes mellitus. They can also mitigate the damage caused by obesity by increasing serum testosterone, antioxidant activity, and sperm motility. When it comes to fertility problems caused by inorganic and organic pollutants, these compounds effectively restore the structure of the seminiferous tubules, increase testosterone levels, and improve sperm quality. Furthermore, phenolic phytochemical compounds have shown beneficial effects in countering the adverse impacts of certain drugs on testicular physiology by reducing apoptosis in testicular tissue, increasing the number of Leydig cells, and promoting spermatocyte production. However, while these compounds may have protective effects on sperm cryopreservation for in vitro fertilization, caution is needed as certain dosages can cause irreversible damage to sperm quality. Overall, plant extracts containing phenolic phytochemical compounds hold promise as a therapeutic avenue for treating infertility and subfertility caused by metabolic disorders and environmental pollutants.

Cardiac autonomic neuropathy is associated with ectopic fat distribution in autoimmune but not in type 2 diabetes

BACKGROUND

Cardiac autonomic neuropathy (CAN) is a life-threatening complication of diabetes. While obesity is a well-known risk factor of dysautonomia, the association between CAN and body fat distribution has not been fully clarified, especially in autoimmune diabetes (AD).

AIM

To evaluate if the association between CAN and body fat distribution differs between AD and type 2 diabetes (T2D).

METHODS

Body fat distribution was evaluated by Dual X-Ray Absorptiometry in 143 people with diabetes (44 with ADand 99 with T2D) undergoing clinical screening for CAN. The association of CAN with markers of ectopic fat distribution was evaluated in multivariate regression models adjusting for confounders and testing for the interaction between diabetes type and CAN.

RESULTS

A significant interaction between CAN and diabetes type was found with respect to markers of ectopic fat distribution. Specifically, people with CAN had significantly higher amount of visceral adipose tissue (530 [376-665]g versus 251[189-360]g, p = 0.001), total fat mass (22708[20200-27845]g versus 15434[12981-21879]g, p = 0,016), and trunk-to-leg ratio (0.88 [0.75-1.04] versus 0.70 [0.56-0.78], p = 0,023) compared to those without CAN only in participants with AD, but not in T2D (p-values for interaction < 0.05 for all comparisons).

CONCLUSION

Ectopic fat distribution is more strongly associated with CAN in AD than in T2D. This highlights the distinct role of fat distribution in the cardiometabolic health of people with AD, suggesting the need for further studies to better understand the pathophysiology and implications of overweight in this population.

The emerging role and therapeutical implications of ferroptosis in wound healing

Wound healing is a complex biological process involving multiple steps, including hemostasis, inflammation, proliferation, and remodeling. A novel form of regulated cell death, ferroptosis, has garnered attention because of its involvement in these processes. Ferroptosis is characterized by the accumulation of lipid peroxides and is tightly regulated by lipid metabolism, iron metabolism, and the lipid-peroxide repair network, all of which exert a significant influence on wound healing. This review highlights the current findings and emerging concepts regarding the multifaceted roles of ferroptosis throughout the stages of normal and chronic wound healing. Additionally, the potential of targeted interventions aimed at modulating ferroptosis to improve wound-healing outcomes is discussed.

Metabolomic Signatures in Adults with Metabolic Syndrome Indicate Preclinical Disruptions in Pathways Associated with High-Density Lipoprotein Cholesterol, Sugar Alcohols

Background

Metabolic syndrome is a pressing public health issue and risk factor for the development of type 2 diabetes (T2D) and cardiovascular disease (CVD), yet clinical practice is lacking in biomarkers that represent pre-clinical perturbations of the heterogenous subtypes of risk. This study aimed to characterize the baseline metabolome in relation to known clinical characteristics of risk in a sample of obese adults.

Methods

Untargeted metabolome data from N = 126 plasma samples with baseline data from a previously completed study including obese adults with metabolic syndrome. Metabolites were acquired using validated liquid chromatography mass spectrometry methods with 15-25 internal standards quantified by peak heights. Pearson's correlations were used to determine relationships between baseline metabolites, sample characteristics (e.g., age, body mass index (BMI)), and atherosclerotic clinical characteristics (e.g., high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides), adjusting for multiple comparisons using the Benjamini-Hochberg False Discovery Rate (FDR) method. Differences in metabolite levels between clinical classifications of dysglycemia (e.g., normal, prediabetes, diabetes) at baseline were assessed using ANOVA and adjusted for multiple comparisons and adjusted for covariates.

Results

The sample consisted primarily of female (74%) participants, predominantly white (70%), with an average age of 56 years. After FDR adjustment, two baseline metabolites were significantly associated with age (xylose, threitol), two with BMI (shikimic acid, propane-1,3-diol), one with LDL (tocopherol-alpha), and 42 with HDL cholesterol. Three metabolites were significantly associated with fasting blood glucose (FBG) levels at baseline (glucose, gluconic acid lactone, pelargonic acid).

Conclusions

This study identified novel metabolite associations with known markers of T2D and CVD risk. Specific metabolites, such as alpha-tocopherol, branched-chain amino acids (BCAAs), and sugar-derived metabolites like mannose and xylose, were significantly associated with age, BMI, lipid profiles, and glucose measures. Although most sample participants had normal HDL cholesterol at baseline, 42 metabolites including branched chain amino acids were significantly associated with HDL, suggesting pre-clinical perturbations in biological pathways associated with both diabetes and cardiovascular comorbidities. Metabolomic signatures Specific to prediabetes and metabolic syndrome can enhance risk stratification and enable targeted prevention strategies for T2D. Longitudinal studies are needed to understand how these associations change over time in at-risk individuals compared with controls.

Association between the GMI/HbA1c ratio and preclinical carotid atherosclerosis in type 1 diabetes: impact of the fast-glycator phenotype across age groups

BACKGROUND

Since the arrival of continuous glucose monitoring (CGM), the relationship between the glucose management indicator (GMI) and HbA1c has been a topic of considerable interest in diabetes research. This study aims to explore the association between the GMI/HbA1c ratio and the presence of preclinical carotid atherosclerosis in type 1 diabetes (T1D).

METHODS

Individuals with T1D and no prior history of cardiovascular disease were recruited from two centers. Carotid ultrasonography was performed using a standardized protocol and carotid plaques were defined as intima-media thickness ≥ 1.5 mm. CGM-derived data were collected from a 14-day report. A GMI/HbA1c ratio < 0.90 was selected to identify "fast-glycator" phenotype.

RESULTS

A total of 584 participants were included (319 women, 54.6%), with a mean age of 48.8 ± 10.7 years and a mean diabetes duration of 27.5 ± 11.4 years. Carotid plaques were present in 231 subjects (39.6%). Approximately 43.7% and 13.4% of participants showed absolute differences of ≥ 0.5 and ≥ 1.0 between 14-day GMI and HbA1c, respectively. Among patients ≥ 48 years, the fast-glycator phenotype was independently associated with presence of plaques (OR 2.27, 95%CI: 1.06-4.87), even after adjusting for non-specific and T1D-specific risk factors and statin treatment. No significant association was observed in younger subjects (p for interaction < 0.05).

CONCLUSIONS

Fast-glycator phenotype is independently associated with atherosclerosis in T1D individuals aged ≥ 48 years, suggesting an age-related increase in the glycation risk. These findings highlight the potential of the GMI/HbA1c ratio for cardiovascular risk stratification in this population.

Identification of potential diagnostic targets and therapeutic strategies for anoikis-related biomarkers in lung squamous cell carcinoma using machine learning and computational virtual screening

Objective

Lung squamous cell carcinoma (LUSC) is a common subtype of non-small cell lung cancer (NSCLC) characterized by high invasiveness, high metastatic potential, and drug resistance, resulting in poor patient prognosis. Anoikis, a specific form of apoptosis triggered by cell detachment from the extracellular matrix (ECM), plays a crucial role in tumor metastasis. Resistance to anoikis is a key mechanism by which cancer cells acquire metastatic potential. Although several studies have identified biomarkers related to LUSC, the role of anoikis-related genes (ARGs) remains largely unexplored.

Methods

Anoikis-related genes were obtained from the Harmonizome and GeneCards databases, and 222 differentially expressed genes (DEGs) in LUSC were identified via differential expression analysis. Univariate Cox regression analysis identified 74 ARGs significantly associated with survival, and a prognostic model comprising 8 ARGs was developed using LASSO and multivariate Cox regression analyses. The model was internally validated using receiver operating characteristic (ROC) curves and Kaplan-Meier (K-M) survival curves. Differences in immune cell infiltration and gene expression between high- and low-risk groups were analyzed. Virtual drug screening and molecular dynamics simulations were performed to evaluate the therapeutic potential of CSNK2A1, a key gene in the model. Finally, in vitro experiments were conducted to validate the therapeutic effects of the identified drug on LUSC.

Results

The 8-gene prognostic model demonstrated excellent predictive performance and stability. Significant differences in immune cell infiltration and immune microenvironment characteristics were observed between the high- and low-risk groups, suggesting the critical role of ARGs in shaping the immune landscape of LUSC. Virtual drug screening identified Dihydroergotamine as having the highest binding affinity for CSNK2A1. Molecular dynamics simulations confirmed that the CSNK2A1-Dihydroergotamine complex exhibited strong binding stability. Further in vitro experiments demonstrated that Dihydroergotamine significantly inhibited LUSC cell viability, migration, and invasion, and downregulated CSNK2A1 expression.

Conclusion

This study is the first to construct an anoikis-related prognostic model for LUSC, highlighting its role in the tumor immune microenvironment and providing insights into personalized therapy. Dihydroergotamine exhibited significant anti-LUSC activity and holds promise as a potential therapeutic agent. CSNK2A1 emerged as a robust candidate for early diagnosis and a therapeutic target in LUSC.

Scoping review protocol: The chrononutrition factors in association with glycemic outcomes in adult population

Chrononutrition, which examines the relationship between circadian rhythms and nutrition, has been associated with glycemic outcomes in adults. However, published data on delayed meal timing, increased meal frequency and frequent breakfast skipping have shown inconsistent glycemic outcomes due to variations in methodologies and populations studied. This review presents the scoping review protocol designed to map the evidence on the association between chrononutrition factors and glycemic outcomes in adults. The methodology framework from Arksey and O'Malley will be adapted for this scoping review. Relevant publications will be searched on databases including PubMed, EBSCO Host, ProQuest Central, MEDLINE & Ovid, Scopus and Web of Science. This review focuses on original articles published from January 2014 to 2024, involving participants aged 18 years and older, published in English, and encompassing experimental and observational studies. A comprehensive keyword search strategy will be developed to identify relevant articles. Two reviewers will independently screen the abstracts and titles to determine the eligibility. Subsequently, the full text of potentially eligible articles will be reviewed by additional independent reviewer for final inclusion, with full text screening being verified by two reviewers, and interrater reliability will be conducted. Data from the included articles will be extracted, collated and charted to summarize the relevant methods, outcomes and key findings. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist will be used to guide the development of protocol. This scoping review represents a novel approach to summarize the association between chrononutrition factors and glycemic outcomes among adults. We anticipate the findings of the review will provide stakeholder with crucial evidence-based information for development of effective intervention to manage glycemic outcome in adults. This protocol has been prospectively registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PA9BU).

Loss of RIP3 alleviates insulin resistance and inflammation in gestational diabetes mellitus mice via TLR4/MyD88/NF-κB signaling pathway

BACKGROUND

Gestational diabetes mellitus (GDM) is diabetes with reduced glucose tolerance that is found or diagnosed during pregnancy, which seriously affects the health of mothers and infants, and its incidence is increasing year by year. The necroptotic apoptosis regulator RIP3 has been proposed to be active in managing pancreatic islet cell survival and inflammatory response. Still, its role and mechanism in GDM have not yet been clarified.

METHOD

The effect of high glucose induction and RIP3 on the viability of Pancreatic β-cells and insulin secretion was observed in vitro experiments. C57BL/6J mice were used to establish the GDM model. Weight, serum glucose levels, and insulin levels were measured to evaluate the improvement of diabetes symptoms in GDM mice by sh-RIP3. The levels of IL-1β, IL-6, and TNF-α were determined by ELISA and qRT-PCR assays. Hematoxylin and Eosin (HE) staining assay was applied to detect islet cell morphology and inflammatory damage in pancreatic tissue. Progeny weight and litter size were also recorded to evaluate reproductive function in GDM mice. Western blot was performed to express TLR4/MyD88/NF-κB signal-related proteins.

RESULTS

Knockdown of RIP3 ameliorated GDM symptoms, improved glucose tolerance and insulin sensitivity, suppressed inflammation, and enhanced fetal outcomes, possibly by TLR4/MyD88/NF-κB signaling pathway activation in GDM mice.

CONCLUSION

The present study provided evidence that the downregulation of RIP3 alleviates insulin resistance and inflammation in GDM mice by mediating the TLR4/MyD88/NF-κB signaling pathway, which made RIP3 a new potential therapeutic target for GDM treatment in the future.

Biomarkers to predict or measure steroid resistance in idiopathic nephrotic syndrome: A systematic review

In this systematic review we have sought to summarise the current knowledge concerning biomarkers that can distinguish between steroid-resistant nephrotic syndrome and steroid-sensitive nephrotic syndrome. Additionally, we aim to select biomarkers that have the best evidence-base and should be prioritised for further research. Pub med and web of science databases were searched using "steroid resistant nephrotic syndrome AND biomarker". Papers published between 01/01/2012 and 10/05/2022 were included. Papers that did not compare steroid resistant and steroid sensitive nephrotic syndrome, did not report sensitivity/specificity or area under curve and reviews/letters were excluded. The selected papers were then assessed for bias using the QUADAS-2 tool. The source of the biomarker, cut off, sensitivity/specificity, area under curve and sample size were all extracted. Quality assessment was performed using the BIOCROSS tool. 17 studies were included, comprising 15 case-control studies and 2 cross-sectional studies. Given the rarity of nephrotic syndrome and difficulty in recruiting large cohorts, case-control studies were accepted despite their limitations. We present a range of candidate biomarkers along with scores relating to the quality of the original publications and the risk of bias to inform future investigations. None of the selected papers stated whether the authors were blinded to the patient's disease when assessing the index test in the cohort. Highlighting a key problem in the field that needs to be addressed. These candidate biomarkers must now be tested with much larger sample sizes. Using new biobanks such as the one built by the NURTuRE-INS team will be very helpful in this regard.

The role of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers - A literature review

Diabetic Foot Ulcers (DFUs) are chronic foot wounds, in a person with diabetes, which are associated with peripheral arterial insufficiency and/or peripheral neuropathy of the lower limb. Recent UK audit figures report that approximately 50-60 % of DFUs remain unhealed after 12 weeks. Previous research has suggested that ischaemia plays a key role in the pathophysiology of many chronic wounds, including DFUs. For this reason, hyperbaric oxygen therapy (HOT) has been investigated. The study aimed to investigate 1) Current understanding of the physiology of normal wound healing and the pathological mechanisms that occur in DFUs to interrupt these processes; 2) Effectiveness of current DFU treatment approaches; 3) Effectiveness from clinical trials and meta-analyses for any demonstrated therapeutic benefits of HOT in the treatment of DFUs, 4) Patient selection criteria for HOT, and patients who stand to benefit most from treatment. The review found that wound healing is a complex process, involving many cells and signalling molecules, and it remains incompletely understood. However, current evidence suggests that hyperglycaemia, hypoxia, chronic inflammation (due to infection, immune-cell dysfunction or other causes), peripheral neuropathy, and macro- and micro-vascular dysfunction may all adversely affect DFU healing. The review found that current NICE guidelines do not approve HOT therapy in the UK for DFU's, despite encouraging clinical research findings. HOT shows theoretical promise and has been successfully used in the treatment of individual DFUs for several decades. Despite this, there remains a lack of strong clinical evidence of benefits to encourage HOT's wider use. The review found that there were four important patient selection criteria for HOT treatment, including glycaemic control, possible contraindications and complications associated with treatment, ulcer severity and resistance to first and second line treatments. The review concluded that further high-quality clinical research is needed to improve the evidence base.

Agreement and disagreement between diagnostic criteria for gestational diabetes and implications for clinical practice: A retrospective observational study

AIMS

To evaluate agreement/disagreement between eleven gestational diabetes (GDM) diagnostic criteria, including five used in current clinical practice globally.

METHODS

Records of 353 pregnant women with oral glucose tolerance test performed after 20 weeks of gestation were retrospectively reviewed. The diagnosis of GDM was compared using the IADPSG, DIPSI, WHO 1999, CDA 2003 and 2013, NICE 2015, JSOG 1984, ADIPS 1998, ADA 2004, NZSSD 2004 and EASD 1996 criteria. The agreement between criteria was expressed as Cohen's kappa coefficient (k; 0.4-0.6, moderate; 0.6-0.8, good; 0.8-1.0, very good) and disagreement as percentage (d). IADPSG criteria were used as a reference for comparison.

RESULTS

The prevalence of GDM varied from 7.4 % (95 % CI, 4.9-10.4 %) by CDA 2003 criteria to 23.8 % (95 % CI, 19.5-28.4 %) by IADPSG criteria. Of the 55 pair-wise criteria comparisons, 29 (52.7 %) showed moderate, 16 (29.1 %) good, and 10 (18.2 %) very good agreement. Among the currently used criteria, the CDA 2013 (k = 0.811; d = 6.2 %) agreed the most, the DIPSI/WHO 1999 (k = 0.456) agreed the least, and the NICE 2015 (k = 0.580) criteria showed an intermediate agreement with the IADPSG criteria.

CONCLUSIONS

There is a marked variation in the prevalence of GDM, with a significant degree of disagreement between different diagnostic criteria. The study findings should be interpreted in the context of its retrospective nature and non-consecutive recruitment, which introduce a potential for selection bias.

Hereditary transthyretin amyloidosis (ATTRv)

Hereditary transthyretin (TTR) amyloidosis (ATTRv amyloidosis) is a devastating disease characterized by broad range of clinical manifestations, including predominantly neurological, predominantly cardiac, and mixed phenotypes. This wide phenotypic variability hindered timely disease diagnosis and risk stratification in the past, especially in individuals with absent or uncharted family history. However, recent advances in noninvasive testing have led to greater awareness and earlier diagnosis. Further, medications have been discovered which proved effective in controlling the disease and improving outcomes including stabilizing TTR, silencing TTR variants, and removing TTR amyloid from affected tissues. Importantly, CRISPR gene editing, a groundbreaking technology, offers the unique potential to cure ATTRv amyloidosis, transforming lives and opening new doors in medical science. This review provides an update on ATTRv amyloidosis mechanisms, diagnosis, and management emphasizing the importance of early diagnosis as the steadfast underpinning for the capitalization of the advances in medical treatment to the benefit of the patients.

Methylglyoxal Formation-Metabolic Routes and Consequences

Methylglyoxal (MGO), a by-product of glycolysis, plays a significant role in cellular metabolism, particularly under stress conditions. However, MGO is a potent glycotoxin, and its accumulation has been linked to the development of several pathological conditions due to oxidative stress, including diabetes mellitus and neurodegenerative diseases. This paper focuses on the biochemical mechanisms by which MGO contributes to oxidative stress, particularly through the formation of advanced glycation end products (AGEs), its interactions with antioxidant systems, and its involvement in chronic diseases like diabetes, neurodegeneration, and cardiovascular disorders. MGO exerts its effects through multiple signaling pathways, including NF-κB, MAPK, and Nrf2, which induce oxidative stress. Additionally, MGO triggers apoptosis primarily via intrinsic and extrinsic pathways, while endoplasmic reticulum (ER) stress is mediated through PERK-eIF2α and IRE1-JNK signaling. Moreover, the activation of inflammatory pathways, particularly through RAGE and NF-κB, plays a crucial role in the pathogenesis of these conditions. This study points out the connection between oxidative and carbonyl stress due to increased MGO formation, and it should be an incentive to search for a marker that could have prognostic significance or could be a targeted therapeutic intervention in various diseases.

Metabolomic study of Polygonum posumbu Buch. Ham. Ex D. Don integrating with anti-diabetic potential - a mechanistic approach

The present investigation aimed to evaluate the anti-diabetic effect of the well-known food plant Polygonum posumbu along with the mechanism of combining its in-vitro, in-vivo effects and UHPLC-QTOF-MS based phytochemical profiling linked with the network pharmacology. In-vitro anti-diabetic potential of the extract was determined by testing against α-amylase and α-glucosidase enzymes. The in-vivo anti-diabetic effect of the extract was investigated in STZ-induced diabetic mice. Tissue and blood samples were taken for the assessment of tissue antioxidant capacity, biochemical markers and HbAc1 level estimation. Pancreas was subjected to histopathology examination. The anti-diabetic mechanism was further explored using UHPLC-QTOF-MS based metabolomic analysis combined with network pharmacology. The in-vitro findings showed that the extract has more selectivity towards α-amylase as compared to α-glucosidase. Administration of extract found to stimulate glucose utilization in OGTT study. Extract treated group also showed significant reduction in blood glucose level on 14th day. HbA1c, AST/GOT, ALP, creatinine, and urea level were also normalized in extract treated group. This is further evident by histopathology observation of pancreatic islets cells morphology. Moreover UHPLC-QTOF-MS based metabolomic study combined with network pharmacology analysis identified EGFR, SRC, IGF1R, MET, MMP9, ESR1, KDR, MMP2, ESR2, and SMAD3 as key targets for showing anti-diabetic activity. The findings integrating the phytochemical and therapeutic potential through the in-vitro, in-vivo and network pharmacology analysis of P. posumbu extract against diabetes suggested that the herb could be a good source for further development of functional food for the management of diabetic complications.

Association of Myo-Inositol and Microlipodispersed Magnesium in Androgen-Dependent Dermatological Diseases: A Retrospective Study

Background: Acne is a pathology of the pilosebaceous unit. It is characterized by a highly complex etiopathology which includes inflammation, hyperkeratinization, increased sebum production, colonization of Cutibacterium acne, hyperandrogenemia, and hyperinsulinemia. This condition, together with hirsutism, androgenic alopecia, and acanthosis nigricans, are highly prevalent cutaneous manifestations of the polycystic ovary syndrome (PCOS). While conventional therapies represent effective treatment options, they are not free from side effects which may reduce compliance. In this context, considerable attention has been directed toward nutraceutical supplements, which include different molecules with great potential to reduce inflammation, hyperkeratinization, hyperseborrhea, and hyperinsulinemia. Myo-inositol has been shown to be effective in improving some of the signs and symptoms of patients with microcystic ovaries: reducing body mass index (BMI), testosterone free levels, dehydroepiandrosterone sulfate (DHEAS) levels, and improving ovarian function and insulin sensitivity. Methods: The authors conducted a retrospective study that included 200 patients suffering from PCOS. Over 6 months, they analyzed the effects of the supplementation of LEVIGON™ (Sanitpharma; Milan, Italy)-a specific nutraceutical formulation containing myo-inositol, microlipodispersed magnesium, and folic acid-on the clinical picture of acne and hirsutism. Results: The supplementation of LEVIGON™ showed a significant reduction of BMI, testosterone, testosterone free, and DHEAS levels, thus improving the clinical picture of acne and hirsutism. Moreover, the impact of acne on the quality of life, assessed using the Cardiff Acne Disability Index (CADI) and Dermatology Life Quality Index (DLQI) scale, improved significantly after 3 and 6 months. Women with hirsutism benefited also from a significant improvement of the Ferriman-Gallwey score after both 3 and 6 months (p < 0.0001; p < 0.0001 respectively compared to the baseline). Conclusions: Myo-inositol supplementation, associated with microlipodispersed magnesium in a bioaccessible form, proved to be extremely useful in reducing acne and hirsutism in patients suffering from microcystic ovaries. In addition, there were no side effects, thus confirming excellent compliance. Further long-term randomized clinical trials are needed to confirm this preliminary evidence.

Optimizing a 5-factor cocktail to prepare reparative macrophages for wound healing

The treatment of nonhealing wounds, such as diabetic ulcers, remains a critical clinical challenge. Recent breakthroughs in cell therapy have shown great promise, with one primary focus on preparing cells with comprehensive reparative functions and foreseeable safety. In our previous study, we recapitulated the proregenerative and immunosuppressive functions of tumor-associated macrophages in non-tumor-derived macrophages, endowing the latter with characteristics for promoting diabetic wound healing-termed tumor-associated macrophage-educated macrophages. To eliminate the use of tumor-derived sources and devise a more controllable method to prepare tumor-associated macrophage-educated macrophage-like cells, in this study, we identify a cocktail comprising 5 recombinant proteins as an essential condition to induce nonpolarized macrophages into therapeutic cells with prohealing functions. The screened 5 factors are osteopontin, macrophage inflammatory protein 2, chemokine (C-C motif) ligand 8, vascular endothelial growth factor B, and macrophage colony-stimulating factor. We demonstrate the rationale for screening these factors and the phenotype of the 5 factor-induced tumor-associated macrophage-educated macrophage-like macrophages prepared from murine bone marrow-derived macrophages, which exhibit angiogenic and immunomodulatory effects in vitro. Then, we induce primary human monocytes from periphery blood into the 5 factor-induced tumor-associated macrophage-educated macrophage-like macrophages, which show prohealing effects in a human primary cell-based ex vivo model (T-Skin™). Our study demonstrates a simple, effective, and controllable approach to induce primary macrophages to possess repairing activities, which may provide insights for developing cell-based therapeutics for nonhealing wounds clinically.

Support Vector Machine for Stratification of Cognitive Impairment Using 3D T1WI in Patients with Type 2 Diabetes Mellitus

Purpose

To explore the potential of MRI-based radiomics in predicting cognitive dysfunction in patients with diagnosed type 2 diabetes mellitus (T2DM).

Patients and Methods

In this study, data on 158 patients with T2DM were retrospectively collected between September 2019 and December 2020. The participants were categorized into a normal cognitive function (N) group (n=30), a mild cognitive impairment (MCI) group (n=90), and a dementia (DM) group (n=38) according to the Chinese version of the Montréal Cognitive Assessment Scale-B (MoCA-B). Radiomics features were extracted from the brain tissue except ventricles and sulci in the 3D T1WI images, support vector machine (SVM) model was then established to identify the CI and N groups, and the MCI and DM groups, respectively. The models were evaluated based on their area under the receiver operating characteristic curve (AUC), Precision (P), Recall rate (Recall, R), F1-score, and Support. Finally, ROC curves were plotted for each model.

Results

The study consisted of 68 cases in the N and CI group, with 54 cases in the training set and 14 in the verification set, and 128 cases were included in the MCI and DM groups, with 90 training sets and 38 verification sets. The consistency for inter-group and intra-group of radiomics features in two physicians were 0.86 and 0.90, respectively. After features selection, there were 11 optimal features to distinguish N and CI and 12 optimal features to MCI and DM. In the test set, the AUC for the SVM classifier was 0.857 and the accuracy was 0.830 in distinguishing CI and N, while AUC was 0.821 and the accuracy was 0.830 in distinguishing MCI and DM.

Conclusion

The SVM model based on MRI radiomics exhibits high efficacy in the diagnosis of cognitive dysfunction and evaluation of its severity among patients with T2DM.

Functionally characterizing obesity-susceptibility genes using CRISPR/Cas9, in vivo imaging and deep learning

Hundreds of loci have been robustly associated with obesity-related traits, but functional characterization of candidate genes remains a bottleneck. Aiming to systematically characterize candidate genes for a role in accumulation of lipids in adipocytes and other cardiometabolic traits, we developed a pipeline using CRISPR/Cas9, non-invasive, semi-automated fluorescence imaging and deep learning-based image analysis in live zebrafish larvae. Results from a dietary intervention show that 5 days of overfeeding is sufficient to increase the odds of lipid accumulation in adipocytes by 10 days post-fertilization (dpf, n = 275). However, subsequent experiments show that across 12 to 16 established obesity genes, 10 dpf is too early to detect an effect of CRISPR/Cas9-induced mutations on lipid accumulation in adipocytes (n = 1014), and effects on food intake at 8 dpf (n = 1127) are inconsistent with earlier results from mammals. Despite this, we observe effects of CRISPR/Cas9-induced mutations on ectopic accumulation of lipids in the vasculature (sh2b1 and sim1b) and liver (bdnf); as well as on body size (pcsk1, pomca, irs1); whole-body LDLc and/or total cholesterol content (irs2b and sh2b1); and pancreatic beta cell traits and/or glucose content (pcsk1, pomca, and sim1a). Taken together, our results illustrate that CRISPR/Cas9- and image-based experiments in zebrafish larvae can highlight direct effects of obesity genes on cardiometabolic traits, unconfounded by their - not yet apparent - effect on excess adiposity.

Exploring the Role of Hypoxia and HIF-1α in the Intersection of Type 2 Diabetes Mellitus and Endometrial Cancer

Diabetes and Cancer are the most complex chronic diseases, accounting for significant global mortality and morbidity. The association between Type 2 DM (T2DM) and endometrial cancer (EC) is multifaced, sharing numerous risk factors, including insulin resistance, obesity, hypoxia, and oxidative stress. Hypoxia plays a vital role in T2DM pathogenesis by altering the insulin level and pancreatic β-cell failure through an imbalance between antioxidant enzymes and cellular oxidative levels, while chronic inflammation contributes to EC malignancy. HIF-1α is a potent transcription factor involved in modulating cellular responses to hypoxia within the disease environment. Targeting the HIF-1α signaling cascade, a major metabolic regulator may contribute to advanced therapeutic advances. This review focuses on the association between T2DM and EC, especially focusing on hypoxia and HIF signaling pathways. These intersect with key pathways involved in T2DM and EC pathology, such as insulin signaling, PI3K/AKT, mTOR pathway, MUC1/HIF-1α pathway, and hormonal imbalance. Understanding this complex relationship paves the way for future researchers to develop HIF-1α-targeted therapies that could lead to novel combination therapies to treat these comorbid conditions.

Uncovering the role of prokineticin pathway on Epicardial Adipose Tissue (EAT) development and EAT-associated cardiomyopathy

Epicardial adipose tissue (EAT), a unique fat depot surrounding the heart, plays a multifaceted role in glucose and lipid metabolism, thermogenesis, and the secretion of bioactive molecules that influence cardiac structure and function. Its proximity to the myocardium allows it to contribute directly to CVDs, including coronary artery disease, arrhythmias, and heart failure. In particular, excessive EAT has emerged as a significant factor in heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure, especially in individuals with obesity and diabetes. Traditional metrics like body mass index (BMI) fail to capture the complexities of visceral fat, as patients with similar BMIs can exhibit varying CVD risks. EAT accumulation induces mechanical stress and fosters a pro-inflammatory and fibrotic environment, driving cardiac remodeling and dysfunction. Pharmacological modulation of EAT has shown promise in delivering cardiometabolic benefits. Recent advancements in diabetes therapies, such as SGLT2 inhibitors and GLP-1 receptor agonists, and antilipidemic drugs have demonstrated their potential in reducing pro-inflammatory cytokine production and improving glucose regulation, which directly influences EAT. These discoveries suggest that EAT could be a significant therapeutic target, though further investigation is necessary to elucidate its role in HFpEF and other CVDs. Recent advances have identified the prokineticin/PKR1 signaling pathway as pivotal in EAT development and remodeling. This pathway regulates epicardial progenitor cells (EPDCs), promoting angiogenesis while reducing EAT accumulation and metabolic stress on the heart, particularly under high-calorie conditions. Prokineticin, acting through its receptor PKR1, limits visceral adipose tissue growth, enhances insulin sensitivity, and offers cardioprotection by reducing oxidative stress and activating cellular survival pathways. In this review, we provide a comprehensive analysis of EAT's role in CVDs, explore novel therapeutic strategies targeting EAT, and highlight the potential of prokineticin signaling as a promising treatment for HFpEF, obesity, and diabetes.

Effect of dietary glycemic index on insulin resistance in adults without diabetes mellitus: a systematic review and meta-analysis

Low glycemic index (LoGI) diets are associated with decreased insulin resistance and are an effective strategy for patients with diabetes mellitus to control postprandial glucose levels. However, whether these effects on insulin resistance and glucose levels are also observable in those without diabetes mellitus is poorly understood. The present study examined the influence of LoGI diets compared with that of high glycemic index (HiGI) diets on insulin resistance in adults without diabetes mellitus. This meta-analysis included six randomized controlled trials involving 192 participants with a mean age of 52.5 years. A homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated for each trial, and differences in HOMA-IR before and after each dietary intervention were calculated independently. The primary outcome was variations in insulin resistance, which was assessed by proxy as the difference between HOMA-IR scores at the beginning and end of the trials. The results suggested that LoGI diets decrease HOMA-IR scores to a greater extent than HiGI diets (estimate: 0.31; 95% confidence interval [CI], 0.01-0.61; p < 0.001) in individuals without diabetes mellitus. This association remained significant (estimate: 0.16; 95% CI, 0.01-0.31) after excluding one study with a short follow-up time (7 days). In conclusion, LoGI diets lower HOMA-IR scores to a greater extent than HiGI diets in adults without diabetes mellitus.

Systematic review registration

(https://www.crd.york.ac.uk/PROSPERO/).

Effect of different incisions on dry eye symptoms after cataract surgery in diabetic patients

AIM

Diabetic patients suffer from severe dry eye after cataract surgery, and the aim of this study was to investigate the effect of 2.2 mm and 3.0 mm clear corneal incisions on dry eye after phacoemulsification in patients with type 2 diabetes mellitus (T2DM).

METHODS

Clinical data of 104 patients with T2DM who underwent phacoemulsification in the Department of Ophthalmology of The People's Hospital of Yingshang from January 2022 to November 2023 were retrospectively collected. The patients were categorized into 2.2 mm and 3.0 mm groups according to the surgical incision, and their preoperative and postoperative Ocular surface disease index (OSDI), Schirmer I test (SIt), and Fluorescein breakup time (FBUT), as well as anxiety and depression levels, were analyzed.

RESULTS

Before surgery, mild anxiety and depression were present in both groups. At 7 days and 1 month postoperatively, OSDI was significantly higher and SIt and FBUT were substantially lower in both groups, but the above indexes were milder in the 2.2 mm group. Meanwhile, the psychological status of both groups significantly improved at 1 month after surgery, and the improvement was more significant in the 2.2 mm group. At 3 months postoperatively, the dry eye of the two groups was relieved, and the psychological status was also improved.

CONCLUSION

Compared with 3.0 mm, a 2.2 mm clear corneal incision effectively reduced dry eye after phacoemulsification in T2DM patients.