Epidemiology of and Risk Factors for Type 2 Diabetes in Egypt

Association between adiponectin single nucleotide polymorphisms and the risk of diabetic polyneuropathy

Genetic factors play a significant role in the occurrence and clinical course of diabetic peripheral neuropathy (DPN). This research aimed to search the influence of adiponectin single nucleotide polymorphisms (SNPs) on the risk of developing and the severity of DPN in Egyptian patients. Adiponectin SNPs were genotype in 360 participants comprising diabetic sufferers with and without peripheral neuropathy and healthy volunteers via the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach. Regarding the + 45 T/G SNP, the TG/ and GG genotypes and the G allele were linked to an rised risk of DPN by comparing the DPN group with both the control and diabetic patients without peripheral neuropathy (DWPN) groups, and when comparing the DWPN group with the control group. Concerning + 276 G/T SNP, the GT genotype and T allele were linked to a declined risk of occuring DPN when comparing the DPN group with both other groups. Patients with DPN had greater frequencies of the GA genotype of the - 11,391 G/A SNP than individuals in the control group, while patients with DPN had greater frequencies of the AA genotype than patients in the DWPN group. Regarding clinic-pathological features, a meaningful rise in the mean values of fasting blood glucose (FBG), duration of the disease, and Toronto Clinical Neuropathy Severity Score (TCSS) were noted in the + 45 GG genotype and G allele carriers. Contrariwise, the + 276 TT genotype carriers had lower mean values for the same clinic-pathological features. For the T allele carriers, the same results were observed in case of duration of the disease and TCSS value. Our results concluded that adiponectin + 45 T/G SNP could be a risk factor considering DPN and the severity of the disease. The - 11391G/A SNP might be associated with DPN. In addition, + 276 G/T SNP could be a protective factor regarding DPN and the severity of the disease.

Citronellal Alleviates Insulin Resistance in High-Fat Diet/Streptozocin Model: Role of Asprosin/Olfactory Receptor Axis

Ectopic olfactory receptors are expressed in nonolfactory tissues and perform diverse roles including regulation of glucose homeostasis. We explored the effect of citronellal treatment on olfactory receptor 4M1 subtype (OR4M1) signaling in insulin resistance and Type II diabetes in rats. We aimed to validate the anti-diabetic effect of citronellal through Asprosin/OR4M1 modulation. Exploring new antidiabetics and pharmacological targets is important to improve quality of life and limit complications. The model was established in Sprague-Dawley rats by a high-fat diet for 4 weeks followed by a single low-dose streptozotocin (STZ) (35 mg/kg/ip). One week after STZ injection, oral citronellal (100 mg/kg) was administered for 4 weeks. Citronellal lowered serum glucose and triglycerides and ameliorated OGTT and HOMA-IR results. Docking results revealed that citronellal blocked the Asprosin binding site at OR4M1. The hepatic expression of OR4M1 and Asprosin was reduced. Citronellal lowered cAMP levels causing attenuated levels of protein kinase A and downstream gluconeogenic enzymes: glucose-6-phosphatase and phosphoenolpyruvate carboxykinase. Citronellal also inhibited the expression of hepatic TLR-4 and inhibited JNK phosphorylation. Citronellal attenuated hepatic levels of NF-κB, p-NF-κB, and downstream proteins MCP-1 and TNF-α. These results suggest that citronellal alleviates insulin resistance by mitigating Asprosin/OR4M1 and Asprosin/TLR4/JNK signaling.

Brain-derived Neurotrophic Factor Level and Gene Polymorphism as Risk Factors for Depression in Patients with type 2 Diabetes Mellitus- A Case-Controlled Study

BACKGROUND

Diabetes mellitus and depression are comorbidities that can be caused by each other. Brain-derived neurotrophic factor (BDNF) functions as a neuronal growth factor. It maintains the functional integrity of the nervous system.

AIM

To study the possible association between BDNF levels and gene polymorphism with depression in patients diagnosed with type 2 diabetes mellitus.

METHODS

The Elisa technique measured BDNF, and rs6265 gene polymorphism was detected using real-time PCR. Depression was assessed utilizing a clinical interview tool designed to establish the diagnosis of depression and differentiate it from other psychiatric diseases.

RESULTS

BDNF levels were significantly lower in patients with type 2 diabetes mellitus and symptoms of depression than in patients with type 2 diabetes mellitus and no symptoms of depression (82.6±16.1. vs. 122± 17.47, P< 0.001). There was a statistically significant difference in BDNF levels in patients with diabetes among the three genotypes of the BDNF gene (P-value < 0.001). Val/ Val carriers had the highest serum BDNF levels, and Met/ Met carriers had the lowest serum BDNF levels. Subgroup analysis showed statistically significant genotype-related differences in serum BDNF levels among the three subgroups in the Depression group. Val/ Val carriers had the highest serum BDNF levels, and Met/ Met carriers had the lowest serum BDNF levels. BDNF Val66Met polymorphism had no significant association with the presence of depression, yet there was a trend towards significance (p = 0.05).

CONCLUSION

In this pilot, Low levels of BDNF were associated with depression in patients with type 2 diabetes. Carriers of the Met/ Met allele have the lowest serum BDNF levels. Multicenter studies with more participants are required.

Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care

BACKGROUND

Diabetes is one of the most common chronic diseases that severely reduce a patient's quality of life. Effective self-care and management are critical for maintaining blood glucose levels and preventing complications.

AIM

This study evaluates the effectiveness of a structured diabetes self-management education program on patients' self-management behaviors, empowerment, and activation levels.

METHODS

This study employed a quasi-experimental design involving 100 participants aged 30-65 to improve diabetes self-management and empowerment. Over 16 weeks, the program included three phases: a two-week pre-test phase for recruitment and baseline assessments using the Diabetes Self-Management Questionnaire (DSMQ), Diabetes Empowerment Scale (DES), and Patient Activation Measure (PAM); a 12-week intervention phase featuring weekly 90-minute educational sessions on topics such as diet, exercise, medication adherence, stress management, and self-empowerment; and a two-week post-test phase for follow-up assessments using the same tools. Data were analyzed using descriptive statistics, chi-square tests for PAM levels, and paired t-tests for DSMQ and DES scores, with statistical significance set at p < 0.05.

RESULTS

The study demonstrated significant improvements in participants' self-management, empowerment, and activation levels after the intervention. DSMQ scores increased from 64.5 to 68.6 (p < 0.001), DES scores rose from 65.4 to 70.0 (p = 0.001), and the number of participants at the highest PAM activation level (Level 4) grew from 30 to 50 (p = 0.016). Positive correlations among DSMQ, DES, and PAM scores suggest these improvements are interrelated.

CONCLUSION

The structured diabetes self-management education programme significantly impacted participants' self-management behaviors, empowerment, and activation levels. The findings underscore healthcare professionals' need to implement targeted interventions that facilitate patient engagement in diabetes care.

RECOMMENDATION

Future interventions should be designed to address the specific needs of diverse populations, paying attention to those facing socio-economic challenges. It is vital to facilitate greater access to diabetes self-management education to enhance health outcomes for these demographic groups.

Antidiabetic potential of thiazolidinedione derivatives with efficient design, molecular docking, structural activity relationship, and biological activity: an update review (2021-2023)

Thiazolidinedione has been used successfully by medicinal chemists all over the world in the development of potent antidiabetic derivatives. The few compounds with excellent antidiabetic potency that we have identified in this review could be used as a lead for further research into additional antidiabetic mechanisms. The information provided in this review regarding the design, biological activity, structure-activity relationships, and docking studies may be useful for scientists who wish to further explore this scaffold in order to fully utilize its biological potential and develop antidiabetic agents that would overcome the limitations of currently available medications for the treatment of diabetes. This review outlines the antidiabetic potential of Thiazolidinedione-based derivatives that have been published in the year 2021- till date.

Decoding the synergy: unveiling gradient boosting regression model for multivariate quantitation of pioglitazone, alogliptin and glimepiride in pure and tablet dosage forms

This study represents a comparison among the performances of four multivariate procedures: partial least square (PLS) and artificial neural networks (ANN) in addition to support vector regression (SVR) and extreme gradient boosting (XG Boost) algorithm for the determination of the anti-diabetic mixture of pioglitazone (PIO), alogliptin (ALG) and glimepiride (GLM) in pharmaceutical formulations with aid of UV spectrometry. Key wavelengths were selected using knowledge-based variable selection and various preprocessing methods (e.g., mean centering, orthogonal scatter correction, and principal component analysis) to minimize noise and improve model precision. XG Boost effectively enhanced computing speed and accuracy by focusing on specific spectral features rather than the entire spectrum, demonstrating its advantages in resolving complex, overlapping spectral data. The independent test results of different models demonstrated that XG Boost outperformed other methods. XG Boost achieved the lowest root mean squared error of prediction (RMSEP) and standard deviation (SD) values across all compounds, indicating minimal prediction error and variability. For PIO, XG Boost recorded an RMSEP of 0.100 and SD of 0.369, significantly better than PLS and ANN. For ALG, XG Boost showed near-perfect performance with an RMSEP of 0.001 and SD of 0.005, outperforming SVR and PLS, which had higher error rates. In the case of GLM, XG Boost also excelled with an RMSEP of 0.001 and SD of 0.018, demonstrating superior precision compared to the much higher errors seen in PLS and ANN. These results highlight XG Boost's exceptional ability to handle complex, overlapping spectral data, making it the most reliable and accurate model in this study.

Predictive value of optical coherence tomography angiography in management of diabetic macular edema

BACKGROUND

Optical coherence tomography angiography (OCTA) is a relatively new extension of Optical coherence tomography (OCT) that generates non-invasive, depth-resolved images of the retinal microvasculature which allows for the detection of various features of diabetic retinopathy.

OBJECTIVES

This study aimed to detect biomarkers that may predict an early anatomical response to the treatment of diabetic macular edema (DME) with intravitreal ranibizumab (IVR) by means of OCTA.

PATIENTS AND METHODS

This prospective interventional study was undertaken on 111 eyes of 102 naïve participants who had diabetic macular edema; enrolled patients were evaluated by taking a complete ophthalmologic history, examination and investigations by use of a pre-designed checklist involving Optical Coherence Tomography Angiography.

RESULTS

Regarding the best corrected visual acuity (BCVA) the Mean ± SD was 0.704 ± 0.158 preoperatively and 0.305 ± 0.131 postoperatively in good responder patients; and was 0.661 ± 0.164 preoperatively and 0.54 ± 0.178 postoperatively in poor responders. The central macular thickness (CMT) was 436.22 ± 54.66 μm preoperatively and 308.12 ± 33.09 μm postoperatively in good responder patients; and was 387.74 ± 44.05 μm preoperatively and 372.09 ± 52.86 μm postoperatively in poor responders. By comparing the pre injection size of the foveal avascular zone area (FAZ-A) in both groups, it found that the mean ± SD of FAZ-A was 0.297 ± 0.038 mm in good responder patients compared to 0.407 ± 0.05 mm in non-responder patients. The preoperative superficial capillary plexus (SCP) foveal vascular density (VD) was 24.02 ± 3.01% in good responder patients versus 17.89 ± 3.19% um in poor responders. The preoperative SCP parafoveal VD was 43.06 ± 2.67% in good responder patients versus 37.96 ± 1.82% um in poor responders. The preoperative deep capillary plexus (DCP) foveal VD was 30.58 ± 2.89% in good responder patients versus 25.45 ± 3.14% in poor responders. The preoperative DCP parafoveal VD was 45.66 ± 2.21% in good responder patients versus 43.26 ± 2.35% um in poor responders, this was statistically significant.

CONCLUSION

OCTA offers an accurate measurement for VD in the macula as well as the FAZ-A which could be used to predict an early anatomical response of anti-VEGF treatment in DME.

Eggshell membrane and green seaweed (Ulva lactuca) micronized powders for in vivo diabetic wound healing in albino rats: a comparative study

BACKGROUND

Nonhealing diabetic wounds are a serious complication associated with extremely lethargic wound closure and a high risk of infection, leading to amputation or limb loss, as well as substantial health care costs and a poor quality of life for the patient. The effects of either eggshell membrane (ESM) and green seaweed (Ulva lactuca) extracts alone or in combination were evaluated for in vivo skin wound healing in a rat model of induced diabetes.

METHODS

Micronized powders of waste hen ESM, Ulva lactuca, and their 1:1 mixture were prepared using regular procedures. The mechanical, electrical, and surface morphology characteristics of powders were examined using direct compression, LCR-impedancemetry, and scanning electron microscopy. The effect of ESM, Ulva lactuca, and their mixture as compared to standard Dermazin treatments were evaluated on wounds inflicted on male Wistar Albino rats with induced diabetes. Quantitative wound healing rates at baseline and at 3, 7, 14, and 21 days of treatments among all rat groups were conducted using ANOVA. Qualitative histological analysis of epidermal re-epithelization, keratinocytes, basement membrane, infiltrating lymphocytes, collagen fibrines, and blood vessels at day 21 were performed using Image J processing program.

RESULTS

Compressive strength measurements of tablets showed a Young's modulus of 44.14 and 27.17 MPa for the ESM and ESM + Ulva lactuca mixture, respectively. Moreover, both samples exhibited relatively low relative permittivity values of 6.62 and 6.95 at 1 MHz, respectively, due to the porous surface morphology of ESM shown by scanning electron microscopy. On day 21, rats treated with ESM had a complete diabetic wound closure, hair regrowth, and a healing rate of 99.49%, compared to 96.79% for Dermazin, 87.05% for Ulva lactuca, 90.23% for the mixture, and only 36.44% for the negative controls. A well-formed basement membrane, well-differentiated epithelial cells, and regular thick keratinocytes lining the surface of the epidermal cells accompanied wound healing in rats treated with ESM, which was significantly better than in control rats.

CONCLUSION

Ground hen ESM powder, a low-cost effective biomaterial, is better than Ulva lactuca or their mixture for preventing tissue damage and promoting diabetic wound healing, in addition to various biomedical applications.

Renoprotective effect of a novel combination of 6-gingerol and metformin in high-fat diet/streptozotocin-induced diabetic nephropathy in rats via targeting miRNA-146a, miRNA-223, TLR4/TRAF6/NLRP3 inflammasome pathway and HIF-1α

BACKGROUND

MiRNA-146a and miRNA-223 are key epigenetic regulators of toll-like receptor 4 (TLR4)/tumor necrosis factor-receptor-associated factor 6 (TRAF6)/NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome pathway, which is involved in diabetic nephropathy (DN) pathogenesis. The currently available oral anti-diabetic treatments have been insufficient to halt DN development and progression. Therefore, this work aimed to assess the renoprotective effect of the natural compound 6-gingerol (GR) either alone or in combination with metformin (MET) in high-fat diet/streptozotocin-induced DN in rats. The proposed molecular mechanisms were also investigated.

METHODS

Oral gavage of 6-gingerol (100 mg/kg) and metformin (300 mg/kg) were administered to rats daily for eight weeks. MiRNA-146a, miRNA-223, TLR4, TRAF6, nuclear factor-kappa B (NF-κB) (p65), NLRP3, caspase-1, and hypoxia-inducible factor-1 alpha (HIF-1α) mRNA expressions were measured using real-time PCR. ELISA was used to measure TLR4, TRAF6, NLRP3, caspase-1, tumor necrosis factor-alpha (TNF-α), and interleukin-1-beta (IL-1β) renal tissue levels. Renal tissue histopathology and immunohistochemical examination of fibronectin and NF-κB (p65) were performed.

RESULTS

6-Gingerol treatment significantly reduced kidney tissue damage and fibrosis. 6-Gingerol up-regulated miRNA-146a and miRNA-223 and reduced TLR4, TRAF6, NF-κB (p65), NLRP3, caspase-1, TNF-α, IL-1β, HIF-1α and fibronectin renal expressions. 6-Gingerol improved lipid profile and renal functions, attenuated renal hypertrophy, increased reduced glutathione, and decreased blood glucose and malondialdehyde levels. 6-Gingerol and metformin combination showed superior renoprotective effects than either alone.

CONCLUSION

6-Gingerol demonstrated a key protective role in DN by induction of miRNA-146a and miRNA-223 expression and inhibition of TLR4/TRAF6/NLRP3 inflammasome signaling. 6-Gingerol, a safe, affordable, and abundant natural compound, holds promise for use as an adjuvant therapy with metformin in diabetic patients to attenuate renal damage and stop the progression of DN.

Comorbidity of depression and type 2 diabetes in Egypt results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study

BACKGROUND

Diabetes mellitus and depression are serious common diseases, and the number of people with both conditions is rising steadily. Depression in people with diabetes mellitus results in poorer prognosis through different mechanisms. On the other hand, the presence of diabetes in individuals with depression increases functional impairment that is associated with depression.

AIMS

The study aimed to assess the prevalence and factors associated with depression among adults with type 2 diabetes mellitus attending a diabetes clinic in Cairo, Egypt.

METHODS

A cross-sectional study was conducted among adult patients with diabetes type 2 attending a diabetes clinic in the endocrinology department in Ain Shams University Teaching Hospital, Cairo, Egypt. Data were collected through face-to-face interviews by trained psychiatrists and from patients' records.

RESULTS

The prevalence of depression among diabetic patients was 21.8% (95% CI [15.6%, 29.1%]). Depression was more common among younger age groups and those with a higher level of education. There was no significant difference between those with lifetime depression compared to those without depression regarding physical health complications.

CONCLUSIONS

The prevalence of depression among patients with type 2 diabetes is high. Given the impact of co-morbid diabetes and depression, diabetic patients should be routinely screened for the latter condition.

Knowledge, attitude, and practice of insulin among diabetic patients and pharmacists in Egypt: "cross-sectional observational study"

BACKGROUND

Diabetes recently has been identified as a growing epidemic. Although insulin's vital role in both types of diabetes, it is considered one of the harmful medications if used incorrectly. In Egypt, effective usage of insulin remains a challenge due to insufficient knowledge of insulin and diabetes management, leading to errors in insulin therapy. As pharmacists are experts in pharmacological knowledge, they are uniquely situated to assess adherence to treatment regimens, the effect of drug therapy, or potential alterations in drug therapy to meet patient goals. To provide effective patient education and counseling, community pharmacists in Egypt should be efficiently knowledgeable about diabetes and insulin.

OBJECTIVE

To identify the knowledge, attitude, and practice of pharmacists and patients about insulin. To identify pharmacists' educational preparedness and confidence in counseling diabetic patients.

METHODS

A descriptive, cross-sectional study was conducted with two knowledge, attitude, and practice surveys. This study was carried out from September 2016 to February 2023. Face-to-face interviews were conducted with patients, and a paper-based questionnaire was administered to pharmacists. The two questionnaires were adapted from previous studies.

RESULTS

A total of 492 patients and 465 pharmacists participated in this study. The mean knowledge score of correct answers among patients and pharmacists was 10.67 ± 1.9 and 15 ± 3.6. Most of the patients and pharmacists had a positive attitude regarding insulin's role in improving health and to better control blood glucose. On the negative side, around half of the patients reported that they believe that regular use of insulin leads to addiction, while only 14.5% of the pharmacists believed that insulin could cause addiction. Self-confidence scores for pharmacists differed statistically with sex, years of experience, and pharmacist's direct exposure to diabetic patients.

CONCLUSIONS

This study uncovers considerable deficiencies in patients' and pharmacists' knowledge about insulin therapy. This study also strongly recommends higher education and a more structured pharmacist training schedule.

Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis

Introduction

Prior primary studies have examined the prevalence and factors associated with glycaemic control among patients with type 2 diabetes mellitus, but studies with evidence-based synthesis of the primary data remained unknown. Hence, we aimed to determine the prevalence of poor glycemic control and identify determinants of poor glycemic control in patients with type 2 diabetes in Ethiopia.

Methods

We performed searches in the online databases of PubMed, Google Scholar, Scopus, Science Direct, and the Cochrane Library. Microsoft Excel was used to extract data, and STATA statistical software (v. 16) was used for analysis. Publication bias was explored by forest plots, Begg's rank test, and Egger's regression test. To check for heterogeneity, I2 was computed. Subgroup analysis was conducted based on region and publication year. In addition, the pooled odds ratio for associated factors was calculated.

Results

Out of 1,045 studies assessed, 23 studies were included fulfilling our inclusion criteria. In all, 6,643 individuals were enrolled in the study. It was estimated that 61.11% of type 2 diabetes patients had poor glycemic control (95% CI, 57.14-65.19). The subgroup analysis by study region and publication year revealed that the highest prevalence was observed in the Addis Ababa region (68.57%) and studies published before 2019 (61.76%), respectively. Poor glycemic control was associated with older age > 50 years (AOR = 2.12; 95% CI: 1.27-2.97), not attending formal education (AOR = 3.60; 95% CI: 2.75, 4.46), having diabetes for longer duration (10 years; AOR = 2.57; 95% CI: 1.65-3.49), having comorbidity (AOR = 2.43; 95% CI: 2.05-2.80), and low adherence to diabetes management (AOR = 3.67; 95% CI: 2.41-4.92).

Conclusion

Our findings indicate a high prevalence of poor glycemic control among people with type 2 diabetes in Ethiopia. Being older, not attending formal education, having a longer duration of diabetes, having comorbidity, and having low adherence to diabetes management were all associated. Therefore, we recommend health organizations implement measures to monitor and control patients' blood glucose levels. Patient education and training of healthcare professionals could serve as a short-term strategy to achieve adequate glycemic control.

Systematic review registration

PROSPERO, identifier CRD42022349792, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349792.

Simultaneous estimation of two anti-diabetic drugs; Linagliptin and empagliflozin in their tablet by chemometric spectrophotometry

Four spectrophotometric approaches had been established and optimized for the simultaneous estimation of two anti-diabetic drugs; linagliptin (LIN) and empagliflozin (EMP) in their bulk and tablet dosage form. LIN concentration could be first determined from the zero order spectra at its λmax (293 nm) without interference from EMP as at this wavelength EMP showed zero absorbance. The LIN and EMP zero order absorption spectra displayed considerable overlap which hindered the direct determination of EMP. Thus, four indirect spectrophotometric approaches were established and optimized for the determination and quantification of EMP concentrations in presence of LIN. Method (I) was ratio difference method (RD) which depended on the determination of difference amplitudes in the ratio spectra (ΔP) at 236 nm and 227 nm; ΔP(236-227) was directly proportional to EMP concentration. Method (II) was ratio derivative method (1DD) based on the measuring of the amplitude of first derivative of ratio spectra at 243 nm which was directly proportional to EMP concentration. For determination of EMP concentration using both method (I) and (II); LIN 7 µg/mL was used as the divisor. Method (III) was area under curve method (AUC) which depended on the measurement of area confined between 220 and 230 nm and 273-290 nm. Method (IV) was dual wavelength method (DWL) which based on measurement of absorbance difference (ΔA) in zero order spectra between 239.8 and 282.6 nm which was directly proportional to EMP concentration. The four developed methods were optimized and entirely validated regarding to ICH guidelines. The proposed spectrophotometric approaches were used for the quantification of LIN and EMP simultaneously in their tablet dosage form. F-test and t-test were applied for statistical comparison between the results obtained by the proposed approaches and that obtained by the reported method. There was no significant difference concerning to precision and accuracy.

Antioxidant and antidiabetic flavonoids from the leaves of Dypsis pembana (H.E.Moore) Beentje & J.Dransf., Arecaceae: in vitro and molecular docking studies

BACKGROUND

Oxidative stress and diabetes are medical conditions that have a growing prevalence worldwide, significantly impacting our bodies. Thus, it is essential to develop new natural antioxidant and antidiabetic agents. Dypsis pembana (H.E.Moore) Beentje & J.Dransf (DP) is an ornamental palm of the family Arecaceae. This study aimed to broaden the understanding of this plant's biological properties by evaluating its in vitro antioxidant and antidiabetic activities.

METHODS

The in vitro antioxidant activities of the crude extract, fractions, and selected isolates were evaluated by DPPH method. While the in vitro antidiabetic activities of these samples were evaluated by assessing the degree of inhibition of α-glucosidase. Additionally, molecular docking analysis was performed to investigate the interactions of tested compounds with two potential targets, the cytochrome c peroxidase and alpha glucosidase.

RESULTS

The crude extract displayed the highest antioxidant activity (IC50 of 11.56 µg/ml), whereas among the fractions, the EtOAc fraction was the most potent (IC50 of 14.20 µg/ml). Among tested compounds, isoquercetrin (10) demonstrated the highest potency, with an IC50 value of 3.30 µg/ml, followed by rutin (8) (IC50 of 3.61 µg/ml). Regarding antidiabetic activity, the EtOAc (IC50 of 60.4 µg/ml) and CH2Cl2 fractions (IC50 of 214.9 µg/ml) showed activity, while the other fractions did not demonstrate significant antidiabetic effects. Among tested compounds, kaempferol-3-O-neohesperidoside (9) showed the highest antidiabetic activity, with an IC50 value of 18.38 µg/ml, followed by kaempferol (4) (IC50 of 37.19 µg/ml). These experimental findings were further supported by molecular docking analysis, which revealed that isoquercetrin and kaempferol-3-O-neohesperidoside exhibited strong enzyme-binding affinities to the studied enzyme targets. This analysis provided insights into the structure-activity relationships among the investigated flavonol-O-glycosides.

CONCLUSION

The biological and computational findings revealed that isoquercetrin and kaempferol-3-O-neohesperidoside have potential as lead compounds for inhibiting cytochrome c peroxidase and alpha glucosidase enzymes, respectively.

Evaluation of the corneal thickness and endothelial changes following uncomplicated phacoemulsification in diabetic and non-diabetic patients with pseudo-exfoliation syndrome by specular microscopy

PURPOSE

To evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX.

METHODS

This prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT.

RESULTS

By the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction.

CONCLUSION

Patients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications.

STUDY REGISTRATION NUMBER

The study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168).

Comorbidities among Egyptian systemic lupus erythematosus: The COMOSLE-EGYPT study

OBJECTIVE

To study the prevalence and impact of comorbidities among a cohort of patients with systemic lupus erythematosus (SLE).

METHODS

This study is retrospective, multicenter including 902 Egyptian patients with SLE. Medical records were reviewed for demographic data, clinical characteristics, routine laboratory findings, immunological profile, and medications. Moreover, SLE Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College Rheumatology Damage Index scores were calculated.

RESULTS

Comorbidities were found in 75.5% of the studied group with hypertension and dyslipidemia as the most frequent comorbidities (43.1% and 40.1%, respectively), followed by sicca features, avascular necrosis, diabetes, osteoporosis and renal failure (11.5%,9%, 9%,8.9%, and 7.1%, respectively). Multivariate regression model showed statistically significant relation between the presence of comorbid condition and each of age (P = 0.006), disease duration (P = 0.041), SLEDAI at onset (P < 0.001), cyclophosphamide intake (P = 0.001), and cumulative pulse intravenous methylprednisone (P < 0.001). Also, when adjusted to age and sex, those with multiple comorbid conditions had 18.5 increased odds of mortality compared to those without comorbidities (odds ratio (OR), 95% confidence interval (CI) = 18.5 (6.65-51.69)].

CONCLUSION

Patients with SLE suffer from several comorbidities, with an increasing risk with age, longer disease duration, higher SLEDAI at onset, cyclophosphamide intake and cumulative pulse intravenous methylprednisone. Risk of mortality is exponentiated with multiple comorbidities.

A comprehensive analysis of genetic risk for metabolic syndrome in the Egyptian population via allele frequency investigation and Missense3D predictions

Diabetes mellitus (DM) represents a major health problem in Egypt and worldwide, with increasing numbers of patients with prediabetes every year. Numerous factors, such as obesity, hyperlipidemia, and hypertension, which have recently become serious concerns, affect the complex pathophysiology of diabetes. These metabolic syndrome diseases are highly linked to genetic variability that drives certain populations, such as Egypt, to be more susceptible to developing DM. Here we conduct a comprehensive analysis to pinpoint the similarities and uniqueness among the Egyptian genome reference and the 1000-genome subpopulations (Europeans, Ad-Mixed Americans, South Asians, East Asians, and Africans), aiming at defining the potential genetic risk of metabolic syndromes. Selected approaches incorporated the analysis of the allele frequency of the different populations' variations, supported by genotypes' principal component analysis. Results show that the Egyptian's reference metabolic genes were clustered together with the Europeans', Ad-Mixed Americans', and South-Asians'. Additionally, 8563 variants were uniquely identified in the Egyptian cohort, from those, two were predicted to cause structural damage, namely, CDKAL1: 6_21065070 (A > T) and PPARG: 3_12351660 (C > T) utilizing the Missense3D database. The former is a protein coding gene associated with Type 2 DM while the latter is a key regulator of adipocyte differentiation and glucose homeostasis. Both variants were detected heterozygous in two different Egyptian individuals from overall 110 sample. This analysis sheds light on the unique genetic traits of the Egyptian population that play a role in the DM high prevalence in Egypt. The proposed analysis pipeline -available through GitHub- could be used to conduct similar analysis for other diseases across populations.

Renoprotective Potency of Sitagliptin versus Pioglitazone in Type 2 Diabetic Patients: Impact on LncMIAT

Background: Diabetes mellitus (DM) represents one of the most important reasons for chronic kidney diseases due to the high level of blood glucose that destructs blood vessels. Objective: The present study focused on investigating the protective impact of sitagliptin on kidney complication in type 2 diabetes mellitus (T2DM) patients in comparison to pioglitazone to examine which has the superior effect against the nephritic complication of DM. Methods: Eighty adult subjects were classified into four groups: control group, pioglitazone-treated T2DM patients (P group), sitagliptin-treated T2DM patients for less than one year (SL group), and sitagliptin-treated T2DM patients for more than one year (SM group). Blood samples were withdrawn from all subjects for analysis of neutrophil gelatinase-associated lipocalin (NGAL), vanin-1, kidney injury molecule-1 (KIM-1), glyoxalase-1 (Glo-1), methylglyoxal (MG), cystatin-C, and interleukin-18 (IL-18) using competitive ELISA kits. Also, long noncoding myocardial infarction associated transcript (lncMIAT) was measured in whole blood using qRT-PCR. Results: The present study revealed that the lncMIAT expression level was significantly higher in the P group as compared to the SL group, SM group, or healthy control group. Additionally, serum NGAL, vanin-1, KIM-1, Glo-1, MG, and cystatin-C were significantly higher in the P group and SL group as compared to the SM group and healthy control group. Conclusion: Sitagliptin protected the kidney through downregulation of lncMIAT besides amelioration of kidney injury marker levels, which was more preferable than in pioglitazone therapy.

Diabetes Mellitus across the Arabo-Islamic World: A Revolution

Background

Mankind continues to suffer from the ever-growing diabetes epidemic and the rapid rise of type 2 diabetes mellitus (T2DM). This metabolic disease has been studied since ancient civilizations. The Arabo-Islamic civilization excelled in establishing some of the most notable discoveries and teachings that remained the blueprint for years to come in the field of diabetology.

Aim

This article aimed to review the ancient history of diabetes mellitus, with its main focus on the Arabo-Islamic civilization, and to report our subjective views and analysis of some of the past recommendations based on modern-day findings. Discussion. It is natural to have the teachings of medicine dynamically inspired by one civilization to another, as various fields continue to expand and evolve. This also applies to diabetology as the Arabo-Islamic world used the outlines of prior civilizations to revolutionize the understanding of the disease. Al-Razi and Ibn Sina are probably two of the most renowned polymaths in history, and their contributions to diabetology are well documented. Ibn Maymun's postulation about the higher prevalence of diabetes in Egypt as compared to Andalusia is something to be carefully studied. It could be that diabetes mellitus' underdiagnosis and late-stage detection are some of the major reasons for the disparity between the two mentioned regions. Modern-day Arabo-Islamic scholars continue to excel in revolutionizing diabetology.

Conclusion

The Arabo-Islamic world houses an impressive bout of scholars who have contributed since the ancient times to diabetology. This scientific locomotion shows no signs of stopping, as it continues to shine during the present day, and likely in the future.

Orbital blood vessels changes on color duplex imaging in diabetics with and without diabetic retinopathy

To compare changes in ophthalmic artery (OA) and its branches in diabetics with and without diabetic retinopathy (DR) using color duplex imaging (CDI), and to correlate these changes with the disease variables. 60 eyes of 60 diabetic patients were enrolled, divided into 3 groups: without DR (Group A), with Non-Proliferative DR (Group B) and with Proliferative DR (PDR) (Group C). Laboratory testing including HbA1c was done. Patients underwent CDI, by which OA, Central Retinal Artery (CRA) and Ciliary Arteries were identified; for each of them we measured Peak systolic velocity (PSV), End Diastolic velocity (EDV) and Resistivity Index (RI). Results were compared to clinical, laboratory and fundus examination. OA EDV was significantly lower and OA RI was found to be significantly higher in Group C (p = 0.027 and 0.025 respectively). CRA PSV and EDV were significantly lower in Group C (p = 0.017 and 0.001 respectively). PCA RI was significantly higher in Group C (p = 0.008). HbA1c was negatively correlated with CRA PSV (p = 0.041), also it was negatively correlated with CRA EDV (p = 0.0001), as well as with PCA EDV (p = 0.002). There was direct significant correlation between HbA1c and PCA RI (p = 0.012). Duration since diagnosis was negatively correlated with CRA EDV (p = 0.004). Multivariate linear regression showed that DR is an independent predictor for low OA EDV, high OA RI, low CRA EDV and high PCA RI. DR is an independent risk factor for orbital and ocular vessels flow alteration, thus can be used as a prognostic tool in diabetic patients. CDI can be reliably used in diabetics to predict early changes or progression of DR.

Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage

Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD -ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender (P > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD (P < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; P < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation (P < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.

Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015

BACKGROUND

There is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic.

METHODS

This study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference.

RESULTS

Diabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06).

CONCLUSION

Diabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.

The Correlation Between C-Peptide and Severity of Peripheral Atherosclerosis in Type 2 Diabetes Mellitus

Background

One of the major issues affecting global health is Diabetes mellitus (DM), not only in terms of the disease itself but also its complications. Macrovascular complications are both common and serious, affecting many patients. This study aimed to assess fasting C-peptide levels and correlate them with the severity of the peripheral arterial disease complicating type 2 DM (T2DM).

Patients and Methods

This study included 200 participants who were categorized into two groups: Group I (n=100, patients with T2DM complicated by femoropopliteal arterial atherosclerosis) and Group II (n=100, healthy age- and sex-matched individuals serving as controls). Fasting C-peptide levels were estimated using an immunochemiluminometric assay.

Results

Fasting C-peptide levels were significantly higher in Group I than in the control group. Fasting C-peptide levels were positively correlated with the severity of atherosclerosis. In addition, the receiver operating characteristic (ROC) curve analysis revealed that fasting C-peptide levels served as a specific and sensitive marker for detecting the severity of this disease.

Conclusion

Fasting C-peptide levels can be used as a sensitive and specific indicator of the severity of femoropopliteal arteriosclerosis that complicates T2DM.

Real-World Effectiveness and Safety of Hydrogen Inhalation in Chinese Patients with Type 2 Diabetes: A Single-Arm, Retrospective Study

Aim

To evaluate the real-life effectiveness and safety of Chinese patients with type 2 diabetes mellitus (T2DM) receiving hydrogen inhalation (HI) treatment as a supplementary treatment.

Methods

This retrospective, multicenter, observational 6-months clinical study included T2DM patients maintaining HI, visited at 4 time points. The primary outcome is the mean change in glycated hemoglobin (HbA1c) at the end of the study compared to baseline. The secondary outcome is analyzing the mean change of fasting plasma glucose (FPG), weight, lipid profile, insulin dose and homeostasis model assessment. Linear regression and logistics regression are applied to evaluate the effect of HI after the treatment.

Results

Of the 431 patients comprised, it is observed a significant decrease in HbA1c level (9.04±0.82% at baseline to 8.30±0.99% and 8.00±0.80% at the end, p<0.001), FPG (165.6±40.2 mg/dL at baseline to 157.1±36.3mg/dL and 143.6±32.3mg/dL at the end, p<0.001), weight (74.7±7.1kg at baseline to 74.8±10.0kg and 73.6±8.1kg at the end, p<0.001), insulin dose (49.3±10.8U/d at baseline to 46.7±8.0U/d and 45.2±8.7U/d, p<0.001). The individuals in subgroup with higher baseline HbA1c and longer daily HI time duration gain greater HbA1c decrease after 6 months. Linear regression shows that higher baseline HbA1c level and shorter diabetes duration are significantly in relation to greater HbA1c reduction. Logistics regression reveals that lower weight is associated with a higher possibility of reaching HbA1c<7%. The most common adverse event is hypoglycemia.

Conclusion

HI therapy significantly improves glycemic control, weight, insulin dose, lipid metabolism, β-cell function and insulin resistance of patients with type 2 diabetes after 6 months. Higher baseline HbA1c level and shorter diabetes duration is related to greater clinical response to HI.

Type-1 diabetes mellitus down-regulated local cerebral glial fibrillary acidic protein expression in experimental toxoplasmosis

Cerebral toxoplasmosis is an opportunistic infection, occurring mostly in immunosuppressed patients due to the reactivation of latent Toxoplasma cysts. The cerebral comorbidity in diabetic patients tends to intensify the burden of pathogenic infection within the brain. The aim of this work was to study the effect of cerebral toxoplasmosis in experimentally infected hyperglycemic mice, on histopathology and glial fibrillary acidic protein (GFAP) expression, compared to normoglycemic mice at different time intervals. Vasculopathy was exclusively observed in diabetic groups, with features of increased severity during Toxoplasma infection. Gliosis was observed in diabetic groups, while hyperactive astroglial activity was detected in normoglycemic groups, especially at 6 weeks of infection. GFAP expression showed significant up-regulation in normoglycemic mice at 6 weeks of infection (40.03 ± 1.41) afterwards, it decreased to 22.22 ± 3.14 at 12 weeks which was statistically insignificant to the normal level, possibly indicating the successful Toxoplasma stage transformation (to bradyzoite), thereby limiting the infection within the brain. In hyperglycemic infected groups, GFAP was significantly down-regulated, in both acute and chronic phases of infection, most likely indicating failure of stage transformation and infection limitation. This may expose those vulnerable groups to the risk of dissemination, resulting in life-threatening diffuse encephalitis. The current study emphasized the importance of rapid diagnosis of Toxoplasma infection in diabetic subjects, and highlighted the value of using GFAP as a neurological indicator of disease progression in those comorbid cases.

Chrysin loaded nanovesicles ameliorated diabetic peripheral neuropathy. Role of NGF/AKT/GSK-3β pathway

Diabetic peripheral neuropathy (DPN) is a common diabetic complication. Chrysin (CHY) has many biological properties but poor oral bioavailability. This study investigates the effect of CHY and CHY-loaded nanovesicles (CHY-NVs) on streptozotocin (STZ)-induced DPN in rats. CHY-NVs were prepared by using film hydration method. The formula with the best entrapment efficiency%, lowest particle size, highest zeta potential, and highest in vitro CHY released profile was selected, characterized by Differential scanning calorimetry, Fourier transformation infrared spectroscopy analysis, and examined by Transmission electron microscope. Acute toxicity test, pharmacokinetic study and experimental model of diabetes mellitus were performed on the selected formulation. Wistar rats were considered diabetic by administration of a single intraperitoneal dose of STZ (50 mg/kg). 48 h after STZ administration, hyperglycemic rats were randomly assigned into four groups, one group of untreated hyperglycemic rats and the other three groups received daily oral doses of unloaded NVs, CHY-NVs (25 mg/kg), and CHY-NVs (50 mg/kg), respectively for 21 days. Moreover, five additional groups of healthy rats received: distilled water (control), free CHY, unloaded NVs, and CHY-NVs respectively for 21 days. CHY and CHY-NVs maintained body weight and reduced STZ-induced behavioral changes in rotarod, hind paw cold allodynia, tail cold allodynia, tail flick, and hot plate tests. CHY and CHY-NVs lowered blood glucose, glycated hemoglobin, elevated serum reduced glutathione (GSH), and reduced plasma malondialdehyde (MDA) levels. CHY-NVs elevated phosphatidylinositol 3-kinase (Pi3k), phosphorylated protein kinase B (p-AKT), and reduced nuclear factor kappa B (NF-κB), interleukin-6 (IL-6) in sciatic nerve homogenate. CHY and CHY-NVs increased nerve growth factor (NGF) and decreased glycogen synthase kinase-3β (GSK-3β) gene expressions in the sciatic nerve. In conclusion, CHY and CHY-NVs ameliorated STZ-induced DPN behavioral and histopathological changes via attenuating hyperglycemia, exerting anti-oxidant, anti-inflammatory effects, activating NGF/p-AKT/GSK-3β pathway, and its anti-apoptotic effect. The best pharmacokinetic profile and therapeutic effect was observed in rats treated with CHY-loaded NVs.

Study of serum bisphenol-A and the mRNA of galactosidase beta 1 and tumor necrosis factor alpha in Egyptian patients with type 2 diabetes mellitus

Background

The pathogenesis of type 2 diabetes mellitus (T2DM) originates from multiple tissue defects. Environmental pollutants such like endocrine-disrupting chemicals (EDCs) have lately gotten special attention in triggering the metabolic abnormalities in relation to insulin resistance and T2DM. Bisphenol-A (BPA), which is one of the EDCs and simulates natural endogenous estrogens, has been implicated in the pathogenesis of several diseases, and, over the last decade, it has been revealed to have probable diabetogenic and obesogenic actions.

Aim

To study the environmental exposure of BPA by measuring its serum level together with the relative expression level of galactosidase beta 1 (GLB1), tumor necrosis alpha (TNF-α) mRNAs and malondialdehyde (MDA) as an oxidative stress marker determine the association of these markers with the glycemic control of Egyptian patients having T2DM.

Patients and methods

The present study was conducted on 90 participants categorized into group 1: 60 patients with T2DM and group 2: 30 subjects with normal glucose tolerance. Serum BPA levels were measured by enzyme-linked immunosorbent assay (ELISA) kit, and biochemical determinations were done by standard protocols. Because of the pro-oxidizing role of BPA, we measured serum level of malondialdehyde (MDA) as an oxidative stress marker. Peripheral blood mononuclear cells (PBMCs) were used for detecting the gene expression changes in GLB1 mRNA, a major marker of cellular senescence, and the mRNA of the proinflammatory cytokine, TNF-α.

Results

Serum levels of BPA in T2DM patients were significantly higher compared to their control group, and they were significantly and positively correlated to poor glycemic control and insulin resistance. T2DM patients showed significantly high serum MDA, mRNA levels of GLB1, and TNF-α. There was positive correlation between serum BPA levels and oxidative stress marker, senescence indicator, and inflammatory marker; however, there was no statistical significance for this correlation.

Conclusion

Our study demonstrates that there is a link between increased serum BPA levels, poor glycemic control, and insulin resistance in Egyptian patients with T2DM.

Serum fatty acid-binding protein 4 as a biomarker for early detection of diabetic nephropathy in type 2 diabetes

Background

Diabetic nephropathy (DN) is one of the major causes of ESKD, and its complications are characterized by proteinuria, decreased glomerular filtration, and renal fibrosis resulting in the deterioration of renal functions, so early detection of nephropathy is essential to slow down and prevent the progression of the disease. Fatty acid-binding protein 4 (FABP4) is expressed in renal proximal tubule cells and released in response to hypoxia caused by decreased peritubular capillary blood flow, so serum FABP 4 is one of the promising biomarkers for early prediction of diabetic nephropathy in patients with type 2 diabetes.

Methods

This was a case–control study that included 120 patients with type-2 diabetes mellitus selected from Kasr Alainy Hospital, Cairo University Hospital, who were divided into 2 groups: the first group comprised 60 diabetic patients divided into 3 sub-groups according to their urinary albumin/creatinine ratio (normo-, micro-, and macroalbuminuria). The second group included 60 apparently healthy individuals. All patients were subjected to history, clinical examination, laboratory investigations, and serum FABP4 by ELISA.

Results

There was a significant increase in serum FABP4 in the macroalbuminuria group, followed by the microalbuminuria group, then the normoalbuminuria group, in comparison to the normal control group. There was a significant positive correlation between serum FABP 4 level and the duration of diabetes and HBA1c. There was a significantly negative correlation between serum FABP4 and serum albumin in the macroalbuminuria group. Receiver operating characteristic curve analysis found that serum FABP 4 discriminate micro- and macroalbuminuric patients with diabetes from controls with 96.6% and 98.3% diagnostic specificity and 100% diagnostic sensitivity respectively.

Conclusion

Serum FABP 4 can be used as a biomarker for the early detection of diabetic nephropathy.

Deduction of the operable design space of RP-HPLC technique for the simultaneous estimation of metformin, pioglitazone, and glimepiride

A reversed-phase RP-HPLC method was developed for the simultaneous determination of metformin hydrochloride (MET), pioglitazone (PIO), and glimepiride (GLM) in their combined dosage forms and spiked human plasma. Quality risk management principles for determining the critical method parameters (CMPs) and fractional factorial design were made to screen CMPs and subsequently, the Box-Behnken design was employed. The analytical Quality by Design (AQbD) paradigm was used to establish the method operable design region (MODR) for the developed method depended on understanding the quality target product profile (QTPP), analytical target profile (ATP), and risk assessment for different factors that affect the method performance to develop an accurate, precise, cost-effective, and environmentally benign method. The separation was carried out using a mobile phase composed of methanol: 0.05 M potassium dihydrogen phosphate buffer pH 3.7 with 0.05% TEA (78:22, v/v). The flow rate was 1.2 mL/min. DAD detector was set at 227 nm. Linagliptin (LIN) was used as an internal standard. The proposed method was validated according to The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH). The assay results obtained by using the developed method were statistically compared to those obtained by the reported HPLC method, and a satisfying agreement was observed.

Chemical and Biological Review of Endophytic Fungi Associated with Morus sp. (Moraceae) and In Silico Study of Their Antidiabetic Potential

The chronic nature of diabetes mellitus motivates the quest for novel agents to improve its management. The scarcity and prior uncontrolled utilization of medicinal plants have encouraged researchers to seek new sources of promising compounds. Recently, endophytes have presented as eco-friendly leading sources for bioactive metabolites. This article reviewed the endophytic fungi associated with Morus species and their isolated compounds, in addition to the biological activities tested on their extracts and chemical constituents. The relevant literature was collected from the years 2008-2022 from PubMed and Web of Science databases. Notably, no antidiabetic activity was reported for any of the Morus-associated endophytic fungal extracts or their twenty-one previously isolated compounds. This encouraged us to perform an in silico study on the previously isolated compounds to explore their possible antidiabetic potential. Furthermore, pharmacokinetic and dynamic stability studies were performed on these compounds. Upon molecular docking, Colletotrichalactone A (14) showed a promising antidiabetic activity due to the inhibition of the α-amylase local target and the human sodium-glucose cotransporter 2 (hSGT2) systemic target with safe pharmacokinetic features. These results provide an in silico interpretation of the possible anti-diabetic potential of Morus endophytic metabolites, yet further study is required.

Green Coffee Bean Extract Potentially Ameliorates Liver Injury due to HFD/STZ-Induced Diabetes in Rats

The goal of the current study was to examine the therapeutic potential of green coffee bean extract (GCBE) in the treatment of diabetic hepatic damage induced by high-fat diet (HFD) and streptozotocin (STZ) administration. The novelty of this study lies in constructing a newly stabilized in vivo obese diabetic animal model in rats using HFD/STZ for investigating the dose-dependent effect of two commonly used doses of GCBE in hepatoprotection against oxidative stress-induced hepatic damage by measuring many parameters that have not been carried out previously in other studies. GCBE that was used in this study was a hot water extract of green coffee beans with a concentration of 0.1 g ml−1. Male albino rats were given a single dose of STZ (35 mg kg−1), and HFD to induce diabetes mellitus (DM). For 28 days, two separate doses of GCBE 50 mg kg−1 and 100 mg kg−1 were administered orally to diabetic animals. Leptin, liver enzymes, oxidative stress parameters, inflammatory parameters, fasting plasma glucose (FPG), fasting plasma insulin (FPI), and lipid profile levels were examined. Real-time PCR and ELISA were used to quantitatively detect the mRNAs of the genes involved in the insulin signaling pathway, the genes involved in glucose metabolism, and the amounts of proteins. The levels of FPG, lipid profile, liver enzymes, inflammatory markers, and leptin in the HFD/STZ diabetic group revealed a considerable spike, while they considerably decreased after GCBE treatment in a dose-dependent manner. After GCBE treatment, the diabetic group showed a significant rise in the antioxidant markers glutathione, superoxide dismutase, and catalase, as well as a decrease in malondialdehyde and nitric oxide levels. The liver changes caused by HFD/STZ were entirely reversed by GCBE, and most intriguingly, in a dose-dependent manner. We concluded that GCBE can repair the hepatic oxidative damage caused by HFD and STZ by reversing all the previously measured parameters and improving the insulin signaling pathways. GCBE demonstrated strong antifree radical activity and significantly protected cells from oxidative damage caused by HFD/STZ.

Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review

Sinusitis is a common condition with various forms and different etiologies. In the era of COVID-19, a large number of studies covered the association between sinusitis and COVID-19, while others reported the impact of COVID-19 on the development of acute invasive fungal rhinosinusitis (AIFR), together with the most commonly associated predisposing factors. Fungal sinusitis, particularly AIFR, can be life-threatening. It is important to dissect this association and improve current evidence and management. Therefore, we conducted this literature review to highlight the association between COVID-19 and sinusitis based on evidence from the available studies in the literature. Evidence shows that chronic sinusitis might have a negative impact on COVID-19 outcomes. However, current results are conflicting, and further studies are needed. On the other hand, COVID-19 can also cause olfactory dysfunction, which is usually temporary. In addition, we found several studies that indicated the association between COVID-19 and AIFR. The condition is usually associated with severe morbidities, as affected patients are usually immunocompromised, including those with uncontrolled diabetes, malignancy, immunosuppression, AIDS, the administration of chemotherapy and other immunosuppressive drugs, and COVID-19.

Using of eosin Y as a facile fluorescence probe in alogliptin estimation: Application to tablet dosage forms and content uniformity testing

New simple sensitive and reliable spectrofluorimetric approach was established for the determination of the antidiabetic drug; Alogliptin (ALG) in its pure and tablet forms. The developed approach is depended on the suppressive action of ALG on the eosin Y native fluorescence. The quenching action of ALG on the eosin Y native fluorescence was measured at acidic medium pH: 3.5, emission wavelength 541 nm (λ_ex. 260 nm). The relative fluorescence intensity (RFI) was measured, and it was directly proportional to ALG concentration in the concentration range of (15-110) μg/mL. The developed and optimized approach was entirely validated regarding to ICH guidelines. The developed method application was successfully extended for ALG content uniformity test (CU). The distribution fraction (DF), rate constants (K), and free energy changes (ΔG°) were calculated. The results obtained were compared to that of the published spectrophotometric one.

Type 2 diabetes mellitus stimulated pulmonary vascular inflammation and exosome biogenesis in rats

It has been shown that type 2 Diabetes Mellitus (T2DM) changes the paracrine activity of several cell types. Whether the biogenesis of exosomes is changed during diabetic conditions is the subject of debate. Here, we investigated the effect of T2M on exosome biogenesis in rat pulmonary tissue. Rats received a high-fat diet regime and a single low dose of Streptozocin to mimic the T2DM-like condition. A total of 8 weeks after induction of T2DM, rats were subjected to several analyses. Besides histological examination, vascular cell adhesion molecule 1 (VCAM-1) levels were detected using immunohistochemistry (IHC) staining. Transcription of several genes such as IL-1β, Alix, and Rab27b was calculated by real-time polymerase chain reaction assay. Using western blot analysis, intracellular CD63 levels were measured. The morphology and exosome secretion activity were assessed using acetylcholinesterase (AChE) assay and scanning electron microscopy, respectively. Histological results exhibited a moderate-to-high rate of interstitial pneumonia with emphysematous changes. IHC staining showed an increased VCAM-1 expression in the diabetic lungs compared with the normal conditions (p < .05). Likewise, we found the induction of IL-1β, and exosome-related genes Alix and Rab27b under diabetic conditions compared with the control group (p < .05). Along with these changes, protein levels of CD63 and AChE activity were induced upon the initiation of T2DM, indicating accelerated exosome biogenesis. Taken together, current data indicated the induction of exosome biogenesis in rat pulmonary tissue affected by T2DM. It seems that the induction of inflammatory niche is touted as a stimulatory factor to accelerate exosome secretion.

In Vitro Antidiabetic, Antioxidant, and Prebiotic Activities of the Chemical Compounds Isolated from Guizotia abyssinica

India and Ethiopia employ Guizotia abyssinica (niger plant) as a source of edible vegetable oil. Previous studies have documented the niger plant's antioxidant properties and dietary benefits. Here, G. abyssinica extract was obtained and ten known bioactive components (1-10) were isolated. The antioxidant, antidiabetic, and prebiotic properties of whole extract and isolated components of niger and the plant's ability to cooperate symbiotically with probiotic strains were examined. Compound 10, myricetin-3-O-L-rhamnoside, had the highest antioxidant capacity measured in the 2,2-diphenylpicrylhydrazyl (DPPH, 4629.76 ± 6.02 µmol Trolox equivalent/g compound) and ferric-reducing antioxidant power (FRAP, 2667.62 ± 7.5 mol Trolox equivalent/g compound) assays. The lowest α-amylase and glycogen phosphorylase activities and glucose diffusion were obtained with whole G. abyssinica extracts, whereas compounds 8-10 had moderate inhibitory effects. G. abyssinica extract also induced the highest glucose absorption by yeast cells in the presence of 5 mM of glucose. Moreover, Lactobacillus plantarum and L. rhamnosus incubated with β-sitosterol 3-O-D-glucoside (compound 7) showed the highest prebiotic activity score. The levels of L-(+)-lactic acid isomer in the probiotic strains were the highest in presence of the whole extract and decreased progressively in the presence of flavonoid glycosides (compounds 8-10) and β-sitosterol 3-O-D-glucoside. The enzymatic profile of the probiotic strains was unaffected by the niger extract and compounds 7-10. The findings revealed that the biological activities of G. abyssinica extract are mediated by the compounds 1-10, and it may be considered as a promising plant for the treatment of diabetes mellitus.

Albuminuria as a predictor of mortality in type II diabetic patients after living-donor liver transplantation

PURPOSE

Diabetes mellitus (DM) increases the risk of morbidity and mortality after liver resection. Albuminuria is associated with a higher risk for all-cause and cardiovascular mortality. This study evaluated albuminuria as a predictor of the outcome of living donor liver transplantation (LDLT) in patients with pre-existing DM.

METHODS

This retrospective study involved 103 type II diabetic patients with end-stage liver disease who received LDLT. Preoperative spot urine albumin: creatinine ratio was used to determine the degree of albuminuria. The primary outcome measure was the impact of urinary albumin excretion on the 3-year mortality rate after LDLT in this diabetic cohort.

RESULTS

Hepatitis C virus infection was the main cause of cirrhosis. Albuminuria was detected in 41 patients (39.8%); 15 had macroalbuminuria, while 26 had microalbuminuria. Patients with microalbuminuria were significantly older than those with macroalbuminuria and normal albumin in urine. After 3 years, twenty-four patients (23.3%) died within 3 years after LT. Myocardial infarction was the leading cause of death (25%). Albuminuria was an independent factor affecting 3-year mortality with an odds ratio of 5.17 (95% CI: 1.86-14.35).

CONCLUSION

Preoperative albuminuria is an independent factor affecting mortality within 3 years after LDLT in type II diabetic patients. Myocardial infarction was the leading cause of death in 25% of cases, followed by hepatocellular carcinoma recurrence, sepsis, and graft failure.KEY MESSAGESDiabetes mellitus (DM) increases the risk of morbidity and mortality after liver resection.Albuminuria is associated with a higher risk for all-cause and cardiovascular mortality.Preoperative albuminuria is a significant predictor of mortality within 3 years after LDLT in diabetic patients.

An Overview of Diabetes Mellitus in Egypt and the Significance of Integrating Preventive Cardiology in Diabetes Management

In Egypt, diabetes mellitus (DM) is a significant public health concern, and the disease is considered a modern pandemic throughout the world. The incidence of diabetes is steadily climbing, which is causing grave concern. As a result, it is essential to take into consideration the risk factors that are pervasive in Egyptian society and have led to the worsening of this problem. These risk factors include sedentary lifestyles, obesity, hepatitis C infections, pesticides, smoking, and bad cultural habits. In this review, we aim to demonstrate the possible solutions to fight diabetes mellitus and overcome its serious health and socioeconomic burdens in Egypt. A multidisciplinary, team-based approach is highly recommended in diabetes management. Primary care physicians, endocrinologists, nephrologists, and preventive cardiologists all play a crucial role in providing the highest possible level of care to diabetic patients by collaborating closely with one another. The assessment of cardiovascular risk and the prevention of life-threatening cardiovascular events, common among diabetic patients, warrant the introduction of preventive cardiology, a new and significant concept in diabetes care that demands adoption. The integration of preventive cardiology into the treatment of diabetic patients is expected to significantly cut down the morbidity and mortality rates associated with diabetes mellitus and provide them with a better quality of life.

Isolation and biological activities of compounds from Rumex vesicarius L. and their use as a component of a synbiotic preparation

The study evaluated prebiotic potential and the enzyme inhibition of extracts and isolated compounds of Rumex vesicarius (ruby dock), family Polygonaceae. Eight known compounds were identified in the roots of R. vesicarius. Extracts and compounds (1-8) increased the growth rate of Escherichia coli Nissle 1917 differentially compared to controls. The highest prebiotic index (PI) and activity score was recorded for EcN in the presence of compound 4, followed by, in descending order, petroleum ether, ethyl acetate, and total methanol extracts. The compounds and extracts reduced protease, α-amylase, and angiotensin-converting enzyme activities. This inhibitory activity was positively correlated with PI, P_score, µ_u, and Y_max. These findings suggest that R. vesicarius is a good source of potential prebiotic and can boost beneficial bacteria. It may also be considered promising for treatment of diabetes mellitus, controlling weight, and regulating blood pressure.

Glycemic Control for Type 2 Diabetes Mellitus Patients: A Systematic Review

Diabetes mellitus is a chronic metabolic disorder resulting in hyperglycemia and microvascular and macrovascular complications in individuals globally. Type 2 diabetes mellitus (T2DM) is highly prevalent and accounts for 90% of patients. Maintaining blood glucose concentration is essential to avoid severe complications.

Glycemic control is the optimal serum glucose concentration in diabetic patients. It is necessary to identify factors affecting the glycemic control of patients to prevent control and complications. We conducted this systematic review to assess the factors affecting glycemic control among type 2 diabetes mellitus patients.

Published literature between the years 2020 to 2022 was retrieved from PubMed, Science Direct, and Google Scholar using different combinations of keywords: T2DM, Glycemic control, Poor, Good, Adequate, Inadequate, Factors, Association, and Determinants. All original articles written in the English language with full-text available and the value of glycemic control defined were included. A total of 1866 studies were retrieved. After the title, abstract, screening, and full-text screening, 12 studies were eligible.

The prevalence of poor glycemic control was high, and it ranged between 45.2% and 93% among the studies. The factors associated with glycemic control were stratified into four categories: personal or body-related, clinical, medication-related, and behavioral factors. There was a high prevalence of poor glycemic control in all included studies. The glycemic control was associated with various factors; some were related to the patient or medical conditions while others were related to the behavior of the patients or the medication administrated.

Molecular Study of Lactobacilli Species in Patients with Type 2 Diabetes Mellitus

Background:

Diabetes mellitus type 2 (T2DM) is a metabolic disorder of multiple etiologies due to disturbances in carbohydrate, protein, and fat metabolism. Egypt is among the top 10 countries with a high prevalence of T2DM (15.56% of adults). There are studies that show a link between the diversity of the gut microbiota and the development of T2DM. There are species of Lactobacilli that inhabit the gut that might differ in patients with T2DM compared to healthy subjects.

Objective:

The aim of the present research is to study the presence of Lactobacilli species in gut microbiota by multiplex PCR in patients with T2DM compared to healthy controls as a preliminary approach to open the way for future treatment with the help of probiotics or diet modulation.

Methods:

A retrograde case-control study was conducted on 79 patients with T2DM and 100 healthy controls cross-matched with age and sex. All patients were subjected to full clinical examination and laboratory tests, including identification of stool Lactobacillus species by multiplex polymerase chain reaction (PCR).

Results:

Certain species of L. acidophilus, and L. rhamnosus were found to be significantly increased in patients with T2DM (67.1%, 50.6% respectively) compared to control subjects (35%, P=0.001, OR 3.8, 95% CI:2.1-7.1, 25%, P=0.001, OR 3.1, 95% CI:1.64-5.8 respectively). Other species as determined by multiplex PCR, namely, L. gasseri, (70%, P=0.001, OR 0.16, 95% CI: 0.1-0.3), L. reuteri (74%, P=0.001, OR 0.28, 95% CI: 0.5-0.53), and L. plantarum (69%, P=0.003, OR 0.4, 95% CI: 0.073-0.22) were significantly higher in prevalence in control compared to patients with T2DM.

Conclusion:

The present study highlights the significant prevalence of certain species of Lactobacilli in gut as determined by multiplex PCR, namely L. gasseri, L. reuteri and L. plantarum in controls compared to patients with T2DM. These species may have a role in the reduction of certain risk factors associated with the development of T2DM. Moreover, certain species of L. acidophilus, L. delbrueckii and L. rhamnosus were significantly increased in prevalence in patients with T2DM. The findings of this preliminary study need further verification by a larger longitudinal study.

The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version

Diabetes prevalence is on the rise in the Middle East. In countries of the Gulf region-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-prevalence rates are among the highest in the world. Further, Egypt now ranks as one of the top 10 countries in the world for high number of people with diabetes. Medical nutrition therapy is key to optimal management of diabetes. Patient adherence to nutritional guidance depends on advice that is tailored to regional foods and cultural practices. In 2012, international experts created a transcultural Diabetes Nutrition Algorithm (tDNA) for broad applicability. The objective of this current project was to adapt the algorithm and supportive materials to the Middle East region. A Task Force of regional and global experts in the fields of diabetes, obesity, and metabolic disorders met to achieve consensus on Middle East-specific adaptations to the tDNA. Recommendations, position statements, figures, and tables are presented here, representing conclusions of the tDNA-Middle Eastern (tDNA-ME) Task Force. Educational materials can be used to help healthcare professionals optimize nutritional care for patients with type 2 diabetes. The tDNA-ME version provides evidence-based guidance on how to meet patients' nutritional needs while following customs of people living in the Middle Eastern region.

Analytical quality by design based on design space in reversed-phase-high performance liquid chromatography analysis for simultaneous estimation of metformin, linagliptin and empagliflozin

Employing the Quality by Design paradigm through this work helped conclude the method operable design region for optimizing the high performance liquid chromatography (HPLC) assay using Design of Experiments and response surface methodology to obtain a good resolution and determination of all analysed compounds and to achieve a suitable analysis time. A deep understanding of the quality target product profile, analytical target profile and risk assessment for parameters that affect the method performance led to developing an accurate, precise and cost-effective method. Quality risk management principles were applied for determining the critical method parameters affecting the simultaneous determination of metformin hydrochloride (MET), linagliptin (LIN) and empagliflozin (EMP) by reversed-phase HPLC . The ternary mixture was successfully resolved in 5 min with a linearity range of (0.1-600) µg ml^-1 for MET and (0.05-50) µg ml^-1 for LIN and EMP. The newly developed method was validated according to the International Council for Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use guidelines. Good agreement was observed with the assay results of the reported UPLC one. To evaluate the greenness of the proposed method, an analytical Eco-Scale method was used.

Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review

OBJECTIVES

The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

PARTICIPANTS AND SETTING

African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM).

OUTCOME

All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs.

DATA SOURCES

Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020.

RESULTS

Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications.

CONCLUSIONS

Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research.

PROSPERO REGISTRATION NUMBER

CRD42019122785.

Diabetes Mellitus and Its Risk Factors among Migrant Workers in Kuwait

The prevalence of diabetes mellitus (DM) is growing enormously worldwide, and actions need to be taken in order to minimize the burden of diabetes mellitus and reduce its complications. Since two-thirds of Kuwait's population are expatriates, the prevalence of and factors associated with diabetes among migrant workers was assessed as it has a significant impact on migrant workers' quality of life, health, and productivity. The data used in this study was for all migrant workers who attended Shuaiba Industrial Medical Center (SIMC) for physical examination in the year 2018. Univariate and multivariate regression were used to assess the relationship between diabetes mellitus and the other independent factors where odds ratios with confidence intervals were delineated. Information for a total of 3477 participants was recorded in the dataset for 2018. Of the total participants, 10.1% had diabetes mellitus. About 49% of the participants were overweight. The largest age group of participants was between 31 and 40 years of age. A small percentage of the participants were diagnosed with hypertension at 11.8%. Additionally, 76.1% of the participants reported themselves as non-smokers. Diabetes was positively associated with age, hypertension, and nationalities. However, no association was found between BMI and smoking tobacco. This is the first study in SIMC to assess DM and its associated risk factor among migrants, since migrant workers are neglected subpopulations that need our focus and attention to achieve justice and fairness. The findings revealed that the prevalence of DM among our study population was considerably lower. However, a healthy lifestyle, including a healthy diet and being physically active, need to be introduced to prevent any further damage.

Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region

There are 22 countries in the Eastern Mediterranean Region (EMR) expanding from Morocco in the west to Pakistan and Afghanistan in the east, containing a population of 725,721 million in 2020. In the previous 30 years, the illness burden in the EMR has transmitted from communicable diseases to non-communicable diseases such as diabetes, cardiovascular diseases, and cancer. In 2019, cardiovascular mortality in the EMR was mostly attributed to ischemic heart disease, the first reason for mortality in 19 countries in the region. Stroke was the second reason for death in nine countries followed by diabetes, which was ranked as the second reason for death in two countries. The prominent nutrition-related NCDs risk factors in EMR include obesity, hypertension, high fasting plasma glucose, and upregulated unhealthy diet consumption. Most of the EMR population are unaware of their NCDs risk factor status. These risk factors, even if treated, are often poorly controlled, therefore, inhibiting their existence by changing the lifestyle to proper dietary habits and sufficient physical activity is mandatory. In this review, the epidemiology and nutrition-related risk factors of NCDs in the EMR will be discussed and illustrated, aiming to scale up action and support decision-makers in implementing cost effective strategies to address obesity and NCDs prevention and management in the region.

Screening for identification of patients at high risk for diabetes-related foot ulcers: a cross-sectional study

OBJECTIVE

Diabetes affected 463 million people globally in 2019, and this number is anticipated to reach 700 million by 2045. Diabetes results in lower limb amputation every 30 seconds. Egypt has a high prevalence of diabetic foot disease among patients with type 2 diabetes mellitus (T2DM). We aimed to identify high-risk patients for diabetic foot ulcers (DFUs) in Egypt.

METHODS

We designed a cross-sectional study among adult patients with diabetes at Asyut University Hospital. Inlow's 60-second diabetic foot screening tool was used to assess the risk of DFU. Neuropathy was assessed using the 10g monofilament test, and laboratory testing was performed to assess glycosylated hemoglobin (HbA1c) and diabetes control levels.

RESULTS

Participants were aged 46.11 ± 9.18 years; 56% had T2DM and HbA1c levels >7%. In total, 47.9% of participants were at risk for DFUs. This risk was higher in patients who were older, male, widowed, working, illiterate, living in rural areas, and patients with diabetes duration >10 years, body mass index >32 kg/m2, uncontrolled blood glucose levels, on an insulin regimen, and smokers.

CONCLUSIONS

Increasing health care providers' awareness and ability to identify high-risk patients is critical to prevent DFUs and reduce the risk of amputation.

Impact of a Clinical Pharmacist Intervention Program on the Follow-up of Type-2 Diabetic Patients

Aims

The primary aim of this current study was to investigate the impact of the clinical pharmacist interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes in Egypt.

Methods

A prospective trial was conducted on 100 patients with uncontrolled type 2 diabetes admitted in the diabetes outpatient's clinics. Patients were randomly allocated into the clinical pharmacist intervention group and usual care group. In the intervention group, the clinical pharmacist, in collaboration with the physician had their patients receive pharmaceutical care interventions. In contrast, the usual care group patients received routine care without clinical pharmacist's interference.

Results

After 6-month of follow-up, of the average HbA1c and FBG values of the patients in the clinical pharmacist intervention group (HbA1c % from 8.6 to 7.0; FBG (mg/dL) from 167.5 to 121.5) decreased significantly compared to the usual care group patients (HbA1c % from 8.1 to 7.8; FBG (mg/dL) from 157.3 to 155.9) (P < .05). Additionally, the results indicated that mean scores of patients 'diabetes knowledge, medication adherence, and diabetes self-care activities of the patients in the clinical pharmacist group increased significantly compared to the control group (P < .05).

Conclusions

The study demonstrated an improvement in HbA1c, FBG, and lipid profile, in addition to self-reported medication adherence, diabetes knowledge, and diabetes self-care activities in patients with type 2 diabetes who received pharmaceutical care interventions. The study outcomes support the benefits and the need to integrate clinical pharmacist interventions in the multidisciplinary healthcare team in Egypt.

A budget impact analysis of substituting sitagliptin with liraglutide in type 2 diabetes from a private health insurance perspective in Egypt

Introduction

Type 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view. This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose-lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon.

Methods

Two budget impact models were compared with the standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin) administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose-lowering drugs were provided and validated by the Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed.

Results

The estimated target population of 120,574 type 2 diabetic adult patients was associated with cardio vascular risk. The budget impact per patient per month for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the 1st, 2nd, and 3rd years, respectively. The budget impact per patient per month for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the 1st, 2nd, and 3rd years, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer cardiovascular-related events, avoided mortality and avoided hospitalizations over 3 years.

Conclusion

Adding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer cardiovascular-related complications and deaths avoided compared to the standard of care. Sitagliptin resulted in a small budget impact but was associated with increased deaths and fewer hospitalizations avoided.