Impact of glycemic control over cardiac autonomic neuropathy

Effects of Home-Based Exercise Training on Cardiac Autonomic Neuropathy and Metabolic Profile in Diabetic Hemodialysis Patients

Background: This study aimed to investigate the effects of a home-based exercise training program on Cardiac Autonomic Neuropathy (CAN) and metabolic profile in Diabetic Kidney Disease (DKD) patients undergoing maintenance hemodialysis (HD). Method: Twenty-eight DKD patients undergoing hemodialysis were randomly assigned into two groups. The exercise (EX) group followed a 6-month combined exercise training program at home, while the control (CO) group remained untrained. All participants at baseline and the end of the study underwent cardiopulmonary exercise testing (CPET), biochemical tests for glucose and lipid profile, and 24-h electrocardiographic monitoring for heart rate variability (HRV) analysis and heart rate turbulence (HRT). Results: At the end of the study, compared to the CO, the EX group showed a significant increase in serum high-density lipoprotein (HDL) by 27.7% (p = 0.01), peak oxygen uptake (VO2peak) by 9.3% (p < 0.05), the standard deviation of R-R intervals (SDNN) by 34.3% (p = 0.03), percentage of successive RR intervals higher than 50ms (pNN50) by 51.1% (p = 0.02), turbulence slope (TS) index by 18.4% (p = 0.01), and decrease in (glycated hemoglobin) HbA1c by 12.5% (p = 0.04) and low-frequency power LF (ms2) by 29.7% (p = 0.01). Linear regression analysis after training showed that VO2peak was correlated with SDNN (r = 0.55, p = 0.03) and HF (r = 0.72, p = 0.02). Multiple regression analysis indicated that the improvement of sympathovagal balance and aerobic capacity depended on patients’ participation in exercise training. Conclusion: In conclusion, a 6-month home-based mixed-type exercise program can improve cardiac autonomic function and metabolic profile in DKD patients on HD.

High HbA1c Levels Are Associated With Development of Trigger Finger in Type 1 and Type 2 Diabetes: An Observational Register-Based Study From Sweden

OBJECTIVE

Trigger finger (TF) is a hand disorder causing the fingers to painfully lock in flexion. Diabetes is a known risk factor; however, whether strict glycemic control effectively lowers risk of TF is unknown. Our aim was to examine whether high HbA1c was associated with increased risk of TF among individuals with diabetes.

RESEARCH DESIGN AND METHODS

The Swedish National Diabetes Register (NDR) was cross-linked with the health care register of the Region of Skåne in southern Sweden. In total, 9,682 individuals with type 1 diabetes (T1D) and 85,755 individuals with type 2 diabetes (T2D) aged ≥18 years were included from 2004 to 2019. Associations between HbA1c and TF were calculated with sex-stratified, multivariate logistic regression models with 95% CIs, with adjustment for age, duration of diabetes, BMI, and systolic blood pressure.

RESULTS

In total, 486 women and 271 men with T1D and 1,143 women and 1,009 men with T2D were diagnosed with TF. Increased levels of HbA1c were associated with TF among individuals with T1D (women OR 1.26 [95% CI 1.1-1.4], P = 0.001, and men 1.4 [1.2-1.7], P < 0.001) and T2D (women 1.14 [95% CI 1.2-1.2], P < 0.001, and men 1.12 [95% CI 1.0-1.2], P = 0.003).

CONCLUSIONS

Hyperglycemia increases the risk of developing TF among individuals with T1D and T2D. Optimal treatment of diabetes seems to be of importance for prevention of diabetic hand complications such as TF.

Controlled synthesis of in-situ gold nanoparticles onto chitosan functionalized PLGA nanoparticles for oral insulin delivery

Chitosan-based nanoparticles (chitosan nanoparticles (ChNps), chitosan gold Nps (ChAuNps), and chitosan gold Nps functionalized with poly lactic-co-glycolic acid (PLGA) (ChAuNps/PLGA)) were prepared as nanocarriers for insulin to improve its oral uptake. The emulsion solvent diffusion method was employed to functionalize the Nps with PLGA. TEM, SEM, DLS, and zeta potential were conducted to characterize the Nps. The morphological analysis confirmed the formation of spherical Nps with hydrodynamic particle sizes of 138±23, 16±2.2, and 50±9.3 nm for ChNps, ChAuNps, and ChAuNps/PLGA, respectively. Zeta potential measurements indicated two types of Nps, regardless of insulin entrapment, positively charged, (ChNps (+36 ± 4.2, +31 ± 2.2mv)) and ChAuNps (+37 ± 4.3, +33 ± 2.5mv) and negatively charged (ChAuNps/PLGA (-31 ± 2.7, -26 ± 2.1 mv)). The in vitro studies were assessed by measuring the entrapment efficiencies (EE%) and the release profiles of insulin at different pH values. EE% for ChNps, ChAuNps, and ChAuNps/PLGA were 97 ± 1.5, 98.4 ± 1.9, and 99 ± 1.2%, respectively. At an acidic medium, a significant level of insulin retention was observed (96 ± 0.08%) for ChAuNps/PLGA. While a high amount was released at higher pH values over an extended period of time. In vivo studies, diabetic rats treated with insulin-loaded Nps had reduced blood glucose level (BGL) (38 ± 2.8, 35 ± 6.5, and 27 ± 5.6%) for ChNps ChAuNps and ChAuNps/PLGA, respectively. The pharmacological availability (PA%) and bioavailability (FR%) for insulin-loaded ChAuNps/PLGA were 15.8 ± 0.71% and 7.7 ± 0.93%, respectively. Altogether, emphasize the role of biocompatible Nps and their efficiency in the convenient delivery of insulin, thus lowering the BGL in a safe condition.

Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Regular exercise is important for a healthy pregnancy and can lower the risk of developing GDM. For women with GDM, exercise is safe and can affect the pregnancy outcomes beneficially. A single exercise bout increases skeletal muscle glucose uptake, minimizing hyperglycemia. Regular exercise training promotes mitochondrial biogenesis, improves oxidative capacity, enhances insulin sensitivity and vascular function, and reduces systemic inflammation. Exercise may also aid in lowering the insulin dose in insulin-treated pregnant women. Despite these benefits, women with GDM are usually inactive or have poor participation in exercise training. Attractive individualized exercise programs that will increase adherence and result in optimal maternal and offspring benefits are needed. However, as women with GDM have a unique physiology, more attention is required during exercise prescription. This review (i) summarizes the cardiovascular and metabolic adaptations due to pregnancy and outlines the mechanisms through which exercise can improve glycemic control and overall health in insulin resistance states, (ii) presents the pathophysiological alterations induced by GDM that affect exercise responses, and (iii) highlights cardinal points of an exercise program for women with GDM.