Hyperglycaemia per se does not affect erythrocyte glucose-6-phosphate dehydrogenase activity in ketosis-prone diabetes

Acquired Glucose-6-Phosphate Dehydrogenase Deficiency

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a hereditary condition caused by mutations on chromosome X and is transmitted by a sex-linked inheritance. However, impairment of G6PD activity may result from biochemical mechanisms that are able to inhibit the enzyme in specific clinical conditions in the absence of a structural gene-level defect. In this narrative review, a number of clinical settings associated with an "acquired" G6PD deficiency, phenotypically undistinguishable from the primary deficiency, as well as the mechanisms involved, were examined. Hyperaldosteronism and diabetes are the most common culprits of acquired G6PD deficiency. Additional endocrine and metabolic conditions may cause G6PD deficiency in both hospitalized and outpatients. Contrary to the inherited defect, acquired G6PD deficiency is a condition that is potentially curable by removing the factor responsible for enzyme inhibition. Awareness regarding acquired G6PD deficiency by physicians might result in improved recognition and treatment.

Antidiabetic and antihyperlipidemic effects of crude fractions and isolated compound from Striga orobanchioides Benth on streptozotocin induced diabetic rats

Background

Striga orobanchioides Benth is a traditionally used Ayurvedic medicinal plant for the treatment of diabetes. Scientific validation of the claim is studied in this research. The significant bioactivity of the plant components is obligatory for its use in medicine.

Objective

The present work is to extract bioactive fractions and chemicals, biological activity of the chemicals and to identify potentially bioactive compound(s) from ethanolic extract of the plant.

Materials and methods

Ethanolic extract of the authenticated plant was fractionated and subjected to in vitro and in vivo antidiabetic and antihyperlipidemic activity. In vitro α-amylase and α-glucosidase enzyme activity was carried out on digestive enzyme. Streptozotocin (STZ) induced diabetes mellitus in rats model was preferred for in vivo activity where antidiabetic parameters body weight, urine volume, blood glucose level, glycosylated hemoglobin, serum insulin, liver glycogen and lipid profile as an antihypertensive parameters were assessed. Isolation of bioactive compounds was carried out by chromatographic techniques and identification of the compound was done by FTIR, Mass spectrometry and NMR spectroscopy. The molecular docking study with α-amylase, α-glucosidase, dipeptidyl peptidase-IV (DPP-IV), glucokinase (GK) as diabetic markers and on 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) and Niemann-Pick C1-Like 1 (NPC1L1) was carried out.

Results

Ethyl acetate-methanol fraction of the ethanol extract showed presence of pentacyclic triterpenoids (81.5% w/w) in GC-HRMS study. Spectroscopic analysis of the isolated compound revealed presence betulin. In vitro antidiabetic activity pointed out robust inhibition of the digestive enzymes by the fractions known as bioactive fraction and betulin. Betulin at a dose of 40 mg/kg treated group showed significant improvement of diabetic conditions. The gene expression studies revealed that betulin in 40 mg/kg dose has positive effects for carbohydrate metabolism in liver, lowers the hepatic inflammation and increases insulin secretion. The plant compound demonstrated significant inhibitory potential on α-amylase, α-glucosidase, DPP-IV and GK enzymes in silico.

Conclusion

The biological study reveals that betulin could dominate the succession of diabetes in dose dependent manner. The plant and specifically Betulin exerts a significant antidiabetic and antihyperlipidemic effects that are more possibly through stimulation of insulin secretion, increase in PPAR-α level with an increase in GRIA2 mRNA expression.

Erythrocyte glucose-6-phosphate dehydrogenase activity and risk of gestational diabetes

Purpose

Glucose-6-phosphate dehydrogenase (G6PD) is the regulating enzyme in the pentose phosphate pathway. A link between the activity of G6PD and diabetes mellitus has previously been reported. The association of G6PD activity with the pathogenesis of gestational diabetes mellitus (GDM) has not yet been investigated. The aim of the present study was to investigate the association of erythrocyte G6PD activity with major characteristics of GDM.

Methods

This case-control study was conducted at Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from March to November 2017. Eighty-four age-matched pregnant women including GDM (n = 33), impaired glucose tolerance (IGT; n = 7), and normal glucose tolerance (NGT; n = 44) subjects were enrolled in this study. The levels of erythrocyte G6PD activity, fasting plasma glucose (FPG), insulin, malondialdehyde (MDA), and ferric reducing power (FRAP) of serum were measured. The level of homeostasis model for the assessment of insulin resistance (HOMA-IR) was calculated. The data were analyzed using SPSS software. P < 0.05 was considered statistically significant.

Results

The values of FPG, insulin, HOMA-IR, G6PD activity, and FRAP were significantly higher in GDM patients compared to NGT subjects. G6PD activity was correlated with FPG ((r = 0.224; P = 0.041). Binary logistic regression analysis revealed independent association of body mass index >25.88 [OR = 3.23, 95% CI 1.071-9.75, P = 0.037], HOMA- IR >2.33 [OR = 7.15, 95% CI 2.26-22.56, P < 0.001], and G6PD activity>21.17 U/g Hb [OR = 4.63, 95% CI 1.49-14.38, P = 0.008] with an increased risk of GDM. No significant change was observed among serum MDA levels in the three groups.

Conclusion

The findings demonstrate that increased G6PD activity is positively associated with the risk of GDM.

Antihyperglycemic effect of hesperetin, a citrus flavonoid, extenuates hyperglycemia and exploring the potential role in antioxidant and antihyperlipidemic in streptozotocin-induced diabetic rats

Diabetes is the major health problem in modern civilization which occurs due to inadequate metabolism of carbohydrate and lipid could cause tremendous changes in the metabolic activities of liver. In this study, we investigated the antihyperglycemic, antioxidant and antihyperlipidemic effects of hesperetin, a citrus flavonoid against streptozotocin (STZ)-induced experimental rats. To stimulate diabetes mellitus, rats were injected with STZ intraperitoneally at a single dose of 45mg/kg. STZ induced rats showed marked increase in the level of plasma glucose and significant reduction in the level of plasma insulin. The activities of carbohydrate metabolic enzymes, hepatic glycogen, lipid profiles, enzymic antioxidants in circulatory system and pancreas, hepatic and renal functional markers were explored. Supplementation with hesperetin (40mg/kg b.w) to STZ-induced experimental rats for 45days established a significant decline in plasma glucose and a marked improvement in plasma insulin and glycogen levels in STZ-induced rats. The altered activities of hepatic glucose metabolic enzymes, lipid profiles, enzymic antioxidants and serum biomarkers of liver and kidney toxicity were restored to almost normal. The acquired outcome were compared with glibenclamide (1mg/kg b.w), a standard oral hypoglycemic drug. Hesperetin treatment was found to be efficient in protecting the normal histological manifestation of hepatic, renal and insulin positive β-cells in STZ induced rats. On the basis of current experimental findings, we concluded that administration of hesperetin attenuates the hyperglycemia and dyslipidemia through ameliorating antioxidant competence in STZ-induced experimental rats.

DIABETIC KETOACIDOSIS: A COMMON DEBUT OF DIABETES AMONG AFRICAN AMERICANS WITH TYPE 2 DIABETES

OBJECTIVE

More than half of African Americans (AA) with a new diagnosis of diabetic ketoacidosis have clinical and metabolic features of type 2 diabetes during follow-up. This particular presentation of diabetes has been termed as ketosis-prone type 2 diabetes (KPDM) or atypical diabetes.

METHODS

We review the epidemiology, diagnosis, pathophysiology, and acute and long-term management of AA with KPDM and compare these similarities to patients with type 2 diabetes.

RESULTS

In contrast to the long-term insulin requirement of auto-immune type 1 diabetes, patients with KPDM are able to discontinue insulin after a few months of therapy and maintain acceptable glycemic control for many years on either diet or oral agents. Patients with KPDM have significant impairment of both insulin secretion and insulin action at presentation; however, at the time of near-normoglycemia remission, insulin secretion and action improve to levels similar to hyperglycemic patients with ketosis-resistant type 2 diabetes. In the long term, however, patients with KPDM have a decline in β-cell function similar to patients with type 2 diabetes. Recent studies indicate that treatment with metformin and dipeptidyl peptidase-4 inhibitors can prolong the period of near-normoglycemia remission for several years compared to placebo therapy.

CONCLUSION

KPDM is a unique but common presentation of newly diagnosed African Americans with type 2 diabetes.

ABBREVIATIONS

A(+/-) = auto-antibody positive/negative AA = African Americans DKA = diabetic ketoacidosis FFA = free fatty acids G6PD = glucose-6-phosphate dehydrogenase GAD-65 = 65-kDA glutamic acid decarboxylase HBA1c = glycated hemoglobin A1c HHV8 = human herpes virus 8 HLA = human leukocyte antigen KPDM = ketosis-prone type 2 diabetes.