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

IGFBP2 and IGFBP4 interact to activate complement pathway in diabetic kidney disease

BACKGROUND

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease globally. Recent research has identified insulin-like growth factor-binding proteins 2 (IGFBP2) and 4 (IGFBP4) as potential biomarkers for DKD. Overactivation of the complement pathway in DKD remains poorly understood.

METHODS

Blood samples were collected from patients for proteomic analysis, complemented by both in vitro and in vivo experiments to investigate the roles of IGFBP2, IGFBP4, and the complement pathway in DKD.

RESULTS

Elevated levels of IGFBP2 and IGFBP4 were observed in DKD patients. The levels of IGFBP2 and IGFBP4 increased in DKD mice, accompanied by the activation of the complement pathway, and a deterioration in renal function. High glucose and serum from DKD mice stimulated an increase in the levels of IGFBP2 and IGFBP4 in HK-2 cells. The supernatant from HK-2 cells was used to culture THP-1 cells, resulted in an increase in the M1 type of THP-1 cells, a decrease in the M2 type, and activation of the complement pathway. The supernatant from THP-1 cells affected the growth of primary human renal podocytes. The exogenous addition of IGFBP2 and IGFBP4 proteins to primary human renal podocytes did not affect their growth. However, when human renal podocytes were cultured with the supernatant from THP-1 cells, the growth of the podocytes was affected.

CONCLUSIONS

IGFBP2 and IGFBP4 interact to stimulate the activation of the complement pathway in macrophages, which induces podocyte apoptosis and subsequently promotes the development of DKD.

Perceptions and knowledge of diabetes in poor urban communities in Accra, Ghana

Diabetes is a major public health concern, leading to costly and life-threating complications while significantly impacting quality of life. However, limited evidence exists on how diabetes is understood in poor urban communities in Africa, including Ghana. Evidence suggests that community beliefs about disease can shape health outcomes and influence intervention strategies. This cross-sectional qualitative study assessed perceptions and knowledge of diabetes in two poor urban communities in Accra, Ghana. Thirteen focus group discussions were conducted, involving ninety-four participants segmented by sex, age, and diabetes status. Participants frequently cited unhealthy diets, alcohol consumption, and smoking as primary causes of diabetes. Knowledge of prevention was primarily focused on maintaining a healthy diet and engaging in physical activity. Managing diabetes was associated with adopting healthy lifestyles and seeking care at a health facility. Additionally, covert diabetes-related stigma was observed in the communities, with implications for illness disclosure and overall quality of life. Community-wide interventions are needed to increase awareness on the causes and consequences of diabetes, address negative social norms, and expand screening programmes to facilitate early detection and guidance for effective disease management.

Comparison of the cardioprotective effects of liraglutide, dapagliflozin and their combination in a rat model of diabetes induced by streptozotocin

BACKGROUND

Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists positively affect diabetic cardiac complications.

AIM

To evaluate and compare the impact of liraglutide, dapagliflozin, and their combination on cardiac biomarkers of inflammation, oxidative stress, and fibrosis in a rat model of streptozotocin (STZ)-induced diabetes.

METHODS

Adult male Wistar rats were assigned into five groups (15-17 rats/group): control rats, diabetic rats (DM, single 50 mg/kg STZ intraperitoneally (IP)), diabetic rats treated with dapagliflozin (Dapa, 1 mg/kg by oral gavage), diabetic rats treated with liraglutide (Lira), 0.4 mg/kg subcutaneously (SC), and diabetic rats treated with both medications (Dapa+Lira) for 8 weeks. Cardiac biomarkers of inflammation, oxidative stress, and fibrosis were evaluated.

RESULTS

Dapagliflozin and/or liraglutide treatment lowered glucose levels, mostly in the combination group. Diabetes increased heart/body weight ratio, which was normalized by all treatments. DM increased cardiac inflammatory and oxidant markers, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), endothelin-1 (ET-1), myeloperoxidase (1), plasminogen activator inhibitor-2 (PAI-2), total nitrite, and thiobarbituric acid reactive substances (TBARS). Dapagliflozin normalized inflammatory markers levels, but combination with Lira added no benefit, except for PAI-2. Dapagliflozin normalized total nitrite and TBARS levels. Combining treatments further decreased nitrite and TBARS levels and normalized cardiac SOD activity. Both dapagliflozin and the combination normalized cardiac fibrosis and platelet-derived growth factor-BB (PDGF-BB) levels.

CONCLUSION

Dapagliflozin reduced cardiac fibrosis, and attenuated oxidative stress, and inflammation more effectively than liraglutide. Combining treatments improved oxidative status. Our findings support using dapagliflozin to prevent cardiovascular diseases more than liraglutide.

Antidiabetic constituents of Kaempferiae rhizoma: Previously undescribed O-linked diarylheptanoid dimers promoting GLP-1 secretion via PKA-CREB pathway

Glucagon-like peptide-1 (GLP-1) is a fascinating target for the treatment of diabetes to avoid hypoglycemia. Kaempferiae Rhizoma (KR), the dried rhizomes of Kaempferia galanga, is a famous pungent medicine used for activating Qi, warming interior, removing digestion and relieving pain in China. In order to characterize the antidiabetic effects of KR, 21 previously undescribed O-linked diarylheptanoid dimers, kaemgalangins A1-A4 (1-4), B1-B13 (5-17) and C1-C4 (18-21), were isolated from the ethyl acetate fraction. Their structures were determined by extensive spectroscopic analyses, quantum computation and chemical methods. All compounds were tested for their GLP-1 stimulating effects on NCI-H716 cells, most of which showed obvious activity representing a new type of antidiabetic constituents. Especially, compounds 1, 2 and 16 showed spectacular GLP-1 stimulation with promoting rates of 146.6 ± 31.1 %, 159.0 ± 16.6 % and 142.9 ± 2.7 %, more potent than the positive control. Mechanism study manifested that kaemgalangin A1 (1) promoted GLP-1 secretion through up-regulating the mRNA expression of Gcg and Pc1/3, and the phosphorylation of PKA and CREB, but independent on TGR5 and GPR119 receptors. Furthermore, network pharmacology analysis suggested that the GLP-1 secretion induced by 1 was closely related to MAPK and PI3K-Akt signaling pathways. This investigation first revealed that KR was rich in diarylheptanoid dimers with GLP-1 promoting effects, which provides scientific basis for the antidiabetic application of K. galanga.

Selenium-containing polyurethane nanofibers with MnO2 nanoparticles and gelsevirine promote diabetic wound healing by modulation of ROS and inflammation

Reactive oxygen species (ROS) and subsequent inflammatory cascades hinder the healing of diabetic wounds, which should be tackled simultaneously when designing wound dressings. In this study, ROS-responsive di‑selenium-containing polyurethane nanofibers (PUF) loaded with manganese dioxide nanoparticles (MnO2 NPs) and gelsevirine (GSV) with an average diameter of 0.6 ± 10 μm, were prepared to specifically target ROS and inflammation control, thereby enhancing healing in diabetic wounds. The resulting nanofibers exhibited a porous architecture and enhanced drug delivery capability. The MnO2/GSV/PUF dressing showed negligible cytotoxicity with cell viability over 80 %, effective ROS-scavenging ability of 87 %, and inhibition of pro-inflammatory cytokine expression. This dual mechanism of ROS-scavenging and inflammation modulation accelerated the healing of diabetic wounds up to 92 % in 14 d in a full-thickness diabetic wound model, as evidenced by reduced cytokine levels, enhanced epithelialization, and uniform collagen deposition with the highest percentage of 60 %.

Continuous glucose monitoring: Minimally and non-invasive technologies

This paper highlights technological advancements in non-invasive blood glucose monitoring against the backdrop of increasing global prevalence of diabetes. Traditional monitoring methods, primarily invasive methods face limitations in providing continuous glucose level data, which is essential for effective and timely diagnosis of disease stage and for determining the optimal therapeutic strategy. Recent non-invasive technologies encompass optical, acoustic, electromagnetic, and chemical approaches. These technologies exploit the intrinsic properties of glucose, such as its optical absorption coefficients, to offer promising avenues for less intrusive blood glucose monitoring. Despite these advancements, challenges in achieving high accuracy persist due to interference from substances like water and other blood components. This underlines the need for sophisticated algorithms and sensor designs for accurate glucose estimation. Further research is required to integrate various sensing techniques and advanced data processing to enhance accuracy and user-friendliness. In conclusion, while significant progress has been made, developing a reliable, convenient, and accessible method for non-invasive glucose monitoring is crucial for transforming diabetes management and improving patients' quality of life.

New perspectives on the treatment of diabetic nephropathy: Challenges and prospects of mesenchymal stem cell therapy

Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes mellitus. Traditional treatment methods have certain limitations and it is difficult to effectively delay the disease progression. Mesenchymal stem cells (MSCs), owing to their potential for self-renewal, multidirectional differentiation, and immunomodulatory abilities, can regulate the renal immune microenvironment and repair damaged tissues, providing a new strategy for the treatment of DN. However, MSCs face problems such as immune rejection, cell inactivation, challenges in directed differentiation, insufficient homing ability, and low cell retention rate after delivery. These issues limit their clinical application in patients with DN. This review aims to propose optimization strategies targeting DN pathological features to improve MSC effectiveness and reduce their side effects. Specifically, it involves optimizing cell culture systems and cryopreservation protocols, along with pre-transplantation pharmacological conditioning to boost the functionality and viability of MSCs. Additionally, the exploration of synergistic drug-MSC combination therapies was carried out, taking advantage of diverse mechanisms of action to improve therapeutic outcomes. The integration of biomaterials and gene editing technologies to significantly enhance cell survival, target specificity, and tissue engraftment was also pursued. Concurrently, the determination of optimal therapeutic dosages and administration routes remained crucial. These multifaceted strategies not only provide a theoretical framework for overcoming existing technical limitations but also lay a robust foundation for accelerating the clinical translation of MSC-based therapies.

Methylglyoxal-induced neuronal dysfunction: Linking diabetes to Alzheimer's disease through cytoskeletal disruption

This study investigates how methylglyoxal affects Alzheimer's disease, which is common in patients with diabetes mellitus. Using SH-SY5Y cells as a model of AD, we investigated the effects of MGO on cell viability, morphology, inflammation, and stress responses. Exposure to MGO induces cytotoxicity, inflammation and oxidative stress that contribute to AD in diabetic patients. We analyzed how MGO (150-900 μM) affects SH-SY5Y cells and its effects on cell survival, gene expression, cytoskeletal integrity, stress indicators, and Aβ42 accumulation (dose- and time-dependent). MGO dramatically affected cell viability depending on the dose and exposure time. Cell death occurred via intrinsic (BAX, CASP9) and extrinsic (FAS, FASLG) apoptotic pathways. Markers related to insulin signaling such as INSR, IRS1, IRS2, SLC2A4, etc. were downregulated, whereas markers of inflammation such as TNF-α, IL-6 and oxidative markers such as HMOX1, G6PD, etc. were upregulated with MGO (P < 0.001). Changes in MAP2 and TUBB3 expression were associated with cytoskeletal damage (P < 0.01). High levels of Aβ42 and low SOD activity confirmed that oxidative stress was induced. LPS treatment exacerbated these effects (P < 0.01). The results highlight the possible role of MGO in cognitive decline associated with diabetes and suggest the need for novel treatment against MGO-related neurotoxicity.

Coffee intake, plasma caffeine levels, and diabetic microvascular complications: A Mendelian randomization study

BACKGROUND AND AIM

Diabetic microvascular complications pose significant health challenges for individuals. The influence of modifiable lifestyle factors, such as coffee intake, on these complications has not been conclusively determined, highlighting the need for a causality assessment.

METHODS AND RESULTS

Utilizing Mendelian randomization (MR), this study explored the causal links between coffee intake, plasma caffeine levels, and diabetic microvascular complications using data from FinnGen. Single nucleotide polymorphisms associated with coffee intake and plasma caffeine levels were identified through genome-wide association study meta-analyses. The univariable MR analysis indicated a slightly increased risk for diabetic retinopathy (OR 1.006; 95 % CI: 1.002-1.010; P = 0.003) and a suggestively elevated risk for nephropathy (OR 1.011; 95 % CI: 1.001-1.022; P = 0.036) associated with genetically predicted higher coffee intake, while no significant effect on neuropathy was observed. Multivariable MR analysis, adjusted for smoking, revealed a significant protective effect of coffee intake on diabetic retinopathy (OR 0.895; 95 % CI: 0.856-0.936; P = 9.468 × 10-7) and a suggestive reduction in risk for diabetic nephropathy (OR 0.828; 95 % CI: 0.712-0.963; P = 0.014). Higher plasma caffeine levels were also suggestively protective against these complications.

CONCLUSIONS

Our findings suggest that genetically predicted higher coffee intake and plasma caffeine levels are protective for diabetic retinopathy and nephropathy. Further research is necessary to substantiate these findings and to investigate their potential impact on diabetes management strategies.

Fasting-mimicking diet in type 2 diabetes reduces myocardial triglyceride content: A 12-month randomised controlled trial

BACKGROUND AND AIMS

Type 2 diabetes is associated with a heightened risk of cardiovascular complications, including myocardial steatosis. Fasting-mimicking diets (FMDs) may mimic the metabolic benefits of fasting, while being less intensive than fasting. This study aims to investigate the effect of following an FMD program on myocardial triglyceride content (MTGC), as assessed by Magnetic Resonance Spectroscopy (MRS), in patients with type 2 diabetes.

METHODS AND RESULTS

100 patients with type 2 diabetes, who used metformin as the only glucose-lowering drug or no medication were randomly assigned to either an FMD group or a control group. The FMD group received the FMD program for 5 consecutive days a month alongside usual care, while the control group received usual care only. Both groups underwent baseline, 6-months and 12-months examinations, including single voxel cardiac 1H-MRS to assess MTGC. N = 13 participants of the FMD and n = 13 of the control group had complete data at baseline and twelve month follow-up. The FMD group exhibited a significant reduction in MTGC over the twelve month period (-0.235 % MTGC, p = 0.027), while the control group saw no significant change (0.143 % MTGC, p = 0.236). The decrease of MTGC in the FMD group was statistically different (p = 0.018) from control.

CONCLUSION

Following an FMD program reduces MTGC, which indicates a favorable effect on cardiac metabolism and thereby may be an effective strategy to reduce the cardiovascular risk in patients with type 2 diabetes.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03811587.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT03811587, submitted January 13th, 2019.

Synthesis and profiling (in vitro and in silico) of the 6-methoxy/hydroxy substituted 7-acetyl-2-aryl-5-bromobenzofurans for antihyperglycemic, cytotoxic and antioxidant properties

A small library of the 7-acetyl-2-aryl-5-bromo-6-methoxybenzo[b]furans 2a-f was synthesized and transformed into the corresponding ortho-(hydroxyacetyl) substituted 2-arylbenzo[b]furan derivatives 3a-f. The structures of both series of compounds were characterized using a combination of spectroscopic techniques complemented with single crystal X-ray diffraction (XRD) analysis of a representative example from each category. Both series of compounds were evaluated through enzymatic assays in vitro for potential to inhibit α-glucosidase, α-amylase and/or protein tyrosine phosphatase 1 beta (PTP1B) all of which are associated with the pathogenesis and progression of type 2 diabetes mellitus (T2DM). The test compounds exhibited moderate to significant antigrowth effect against the breast cancer (MCF-7) cell line and reduced cytotoxicity against the human embryonic kidney derived (Hek293-T) cell line compared to the anticancer drug, doxorubicin. The anti-oxidation potential of the test compounds was evaluated spectrophotometrically using the nitric oxide (NO) radical scavenging assay. A cell-based antioxidant activity assay involving lipopolysaccharide (LPS) induced reactive oxygen species production in the MCF-7 and Hek293-T cells revealed their potential to mitigate against oxidative stress. Molecular docking analysis revealed hydrogen bonding, hydrophobic and π-π stacking interactions to play a significant role in the binding affinity and interactions of the test compounds with amino acid residues in the active sites of the test enzymes.

Construction of CeO2/Ti3C2Tx heterojunction with antibacterial and antioxidant capabilities for diabetic wound healing

Diabetic wounds are highly prone to persistent pathogenic infections due to the complex nature of their microenvironment, which significantly hinders the healing process under hyperglycemic conditions. In this study, we developed a bio-heterojunction enzyme system consisting of hollow CeO2/Ti3C2Tx MXene quantum dots (CeO2@MQD) integrated with glucose oxidase (GOx-CeO2@MQD). The GOx-CeO2@MQD system exhibits multifunctional enzymatic activities, including peroxidase (POD) and catalase (CAT)-like activity, resulting in the production of •OH and O2, alongside the consumption of glucose and glutathione (GSH). The incorporation of GOx effectively mitigates the hyperglycemic microenvironment by catalyzing glucose, leading to a significant increase in H2O2 production, which is subsequently converted into bactericidal •OH through POD activity. Furthermore, H2O2 can be catalyzed into H2O and O2 via the CAT pathway, thereby alleviating inflammation caused by the excessive accumulation of reactive oxygen species. In vitro antibacterial assays demonstrated that the GOx-CeO2@MQD system achieved remarkable bactericidal efficiencies of 99.99% against E. coli and S. aureus at concentrations of 12.5 ppm and 2.0 ppm, respectively. In vivo experiments further revealed that GOx-CeO2@MQD significantly promoted angiogenesis, accelerated wound epithelialization, and induced a strong anti-inflammatory response, thus facilitating the regeneration of infected diabetic skin. This study proposes a novel approach for diabetic wound treatment by harnessing the synergistic effects of multiple enzyme-like activities.

Immunomodulatory effect of allium sativum in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a metabolic disorder marked by chronic hyperglycemia and low-grade inflammation, contributing to various complications. Natural agents with immunomodulatory and antioxidant properties have gained attention as adjunct therapies. To review the effects of Allium sativum on inflammatory pathways and metabolic alterations associated with T2DM. A narrative review was performed using PubMed/MEDLINE, EMBASE, and Scielo databases. The search included terms such as “allium sativum”, “inflammation", “oxidative stress”, and “diabetes mellitus”. Studies in English and Spanish - ranging from clinical trials to meta-analyses - were selected based on relevance. Bioactive compounds such as allicin, S-allyl cysteine, and diallyl disulfide exhibit anti-inflammatory, antioxidant, hypoglycemic, and lipid-lowering actions. Preclinical studies show improved glucose metabolism, insulin sensitivity, and organ function. Moreover, clinical evidence supports reductions in fasting glucose, hemoglobin A1c, blood pressure, and oxidative stress, with good safety profiles. Allium sativum appears to be a promising adjuvant in T2DM management, offering metabolic and anti-inflammatory benefits. Nonetheless, further high-quality clinical trials are needed to confirm its long-term efficacy and standardize its therapeutic use.

Effects of a protein kinase C epsilon inhibitor on insulin signalling in lipid-treated HepG2 hepatocytes and glucose tolerance in fat-fed mice

AIMS

Protein kinase C epsilon (PKCε) plays a causative role in the development of glucose intolerance, and is a potential target for the treatment of type 2 diabetes. Here, we examined the effects of the PKCε inhibitor CIDD-0150612 (CP612) on insulin action in palmitate-treated HepG2 hepatocytes in vitro and on glucose homeostasis in fat-fed mice in vivo.

METHODS

HepG2 cells were treated with palmitate and CP612 and stimulated with insulin. Insulin signalling was examined by immunoblotting and glucose incorporation into glycogen was measured using glucose tracer. Mice were fed a high-fat diet and treated with CP612 prior to glucose tolerance tests and tissue harvest. Proteomic analysis of liver was carried out by mass spectrometry.

RESULTS

CP612 promoted Akt phosphorylation in a highly insulin-dependent manner and reversed the inhibition of insulin-stimulated Akt phosphorylation and glucose incorporation into glycogen by palmitate. Fat-fed mice treated with CP612 had reduced fat mass, but not lean mass, compared with vehicle-treated littermates. Mice treated acutely with CP612 exhibited elevated fasting blood glucose. However, mice studied 24h after the last dose had lower fasting glucose and improved glucose tolerance with a lower insulin excursion. Proteomic analysis of liver from CP612-treated fat-fed mice indicated a reduction in gluconeogenic gene expression and decreased phosphorylation of the transcription factor Foxk1.

CONCLUSIONS

The PKCε inhibitor CP612 had beneficial effects on insulin action in hepatocytes and on fat mass and glucose homeostasis in mice. Because certain effects were not previously observed in genetically PKCε-deficient mice, off-target effects may be partly responsible.

Associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with type 2 diabetes mellitus

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) face a heightened risk of future cardiovascular events. It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis. Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters. However, further evidence is required for widespread clinical application.

AIM

To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.

METHODS

This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants. To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events, including major adverse cardiovascular events (MACEs) and congestive heart failure (CHF). We employed univariable and multivariable-adjusted Cox proportional hazards regression models. Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models. Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.

RESULTS

After adjustment for confounding factors, all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM. In comparison with patients in the lowest quartile, the hazard ratios (95% confidence intervals) of those in the highest quartile were 1.50 (1.29-1.73), 1.51 (1.30-1.74), 1.50 (1.29-1.73), and 1.30 (1.12-1.50) for total cholesterol/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol/HDL-C, non-HDL-C/HDL-C, and remnant cholesterol/HDL-C, respectively. Similar findings were noted for CHF. Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed, with threshold values of 7.29, 6.29, and 2.15 for total cholesterol/HDL-C, non-HDL-C/HDL-C, and remnant cholesterol/HDL-C, respectively. However, no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.

CONCLUSION

Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.

Is there a role for platelet indices in predicting poor glucoregulation in type 2 diabetes mellitus?

In this editorial, we discuss the recent article by Regassa et al, published in the World Journal of Diabetes, which highlights the potential role of platelet indices (PI) in predicting poor glucoregulation in patients with type 2 diabetes mellitus (T2DM). Given the high morbidity and mortality associated with T2DM, there is a constant need to find new and accessible methods for predicting and treating individuals with this condition. The pathophysiology of T2DM involves systemic inflammation, metabolic dysfunction, and an increased risk of vascular injury, which are commonly associated with the development of microvascular and macrovascular complications, such as cardiovascular diseases and neuropathies. The link between these complications and T2DM requires further elucidation but may be explained by prolonged exposure to high glycemic levels and increased advanced glycation end products. PI might play an important role in determining whether some individuals are prone to poor glucoregulation. Recent evidence encourages the scientific efforts to demonstrate the consistency of this role and its applicability in monitoring glucoregulation, underscoring the importance of the study by Regassa et al.

Mechanism of trypsin-mediated differentiation of pancreatic progenitor cells into functional islet-like clusters

BACKGROUND

Endogenous regeneration of pancreatic islet β-cells is a path to cure both type 1 and advanced type 2 diabetes. Pancreatic cancer cell line-1 (PANC-1), a human pancreatic islet progenitor cell line, can be induced by trypsin to differentiate into insulin-secreting islet-like aggregates (ILAs). However, the underlying mechanism has not been explored.

AIM

To explore the mechanism and signaling pathway of trypsin-induced differentiation of islet progenitor cells into insulin-secreting cells.

METHODS

PANC-1 cells were induced by trypsin to form ILAs and differentiate into insulin-secreting cells. Clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 knockout and small interfering RNA knockdown techniques were used to investigate membrane proteins and downstream signaling pathways involved in the process.

RESULTS

The extracellular domain of membrane receptor E-cadherin hydrolyzed by trypsin induced the aggregation of PANC-1 cells and stimulated E-cadherin-recruited casein kinase-1γ3, which specifically phosphorylated the Ser655/Thr658 site of α-catenin in the cadherin-catenin complex, participating in the process of PANC-1 differentiation and affecting the maturation of differentiated ILAs.

CONCLUSION

The current study reveals the mechanism by which trypsin promotes PANC-1 cell differentiation into islet-like cells, providing a novel approach for endogenous islet β-cell regeneration.

Identification and validation of serum amino acids as diagnostic biomarkers for diabetic peripheral neuropathy

BACKGROUND

Diabetic peripheral neuropathy (DPN) is the most prevalent complication of type 2 diabetes mellitus (T2DM). Due to a lack of specific biomarkers, the early diagnosis of this disorder is limited.

AIM

To identify and validate serum amino acids that could discriminate T2DM patients with DPN from those without DPN.

METHODS

T2DM patients with DPN, T2DM patients without DPN, and healthy controls were recruited for this study. The participants comprised two nonoverlapping cohorts: A training cohort (DPN = 84 participants, T2DM = 82 participants, normal = 50 participants) and a validation cohort (DPN = 112 participants, T2DM = 93 participants, normal = 58 participants). A prediction model of the ability of serum amino acids to distinguish DPN from T2DM was established using a logistic regression model, and area under the curve (AUC) analysis was used to evaluate the diagnostic ability of the model. In addition, the serum amino acid levels of 13 DPN patients were also detected before treatment and after 3 months of treatment.

RESULTS

A clinical detection method for the diagnosis of DPN based on a biomarker panel of three serum amino acids and diabetes duration was developed. The diagnostic model demonstrated AUC values of 0.805 (95%CI: 0.739-0.871) and 0.810 (95%CI: 0.750-0.870) in the training and verification cohorts, respectively. In the identification of T2DM patients and normal controls, the AUC values were 0.891 (95%CI: 0.836-0.945) and 0.883 (95%CI: 0.832-0.934) in the training and validation cohorts, respectively. Arginine and tyrosine levels were increased after treatment, whereas aspartic acid levels were decreased after treatment.

CONCLUSION

This study successfully identified and validated the metabolomic significance of arginine, tyrosine, and glutamic acid as potential biomarkers for diagnosing DPN. These findings are particularly valuable, as they establish a foundational step toward developing the first routine laboratory test for DPN. Moreover, the diagnostic model that was constructed in this study effectively distinguishes DPN patients from those with T2DM without neuropathy, thereby potentially facilitating early diagnosis and intervention.

Mechanisms of Inonotus obliquus (Fr.) Pilát polysaccharides in ameliorating lipid-induced skeletal muscle insulin resistance via PI3K/AKT and AMPK/ACC1/CPT1 signaling pathways

ETHNOPHARMACOLOGICAL RELEVANCE

Inonotus obliquus (Fr.) Pilát, a traditional medicinal fungi, has been used to treat diabetes in China and Russia since the 16th century. Recent studies show Inonotus obliquus (Fr.) Pilát polysaccharides (IOP) have hypoglycemic and lipid-lowering effects in type 2 diabetes mellitus (T2DM) mice and can recover liver insulin resistance.

AIM OF THE STUDY

This study aims to assess the effect of IOP and its mechanisms in ameliorating insulin resistance and lipid metabolism disorders in T2DM.

MATERIALS AND METHODS

The potential targets of IOP for T2DM were identified by network pharmacology and molecular docking. In vitro, an insulin resistance model in C2C12 cells was induced, and IOP's effects on glucose uptake, glycogen, lipid content, and lipid metabolism-related mRNAs were assessed. In vivo, a T2DM mice model was established. Blood glucose, lipids, glucose tolerance, and insulin sensitivity were evaluated. Histopathology was used to assess morphological changes in mice skeletal muscle. Western blotting was utilized to evaluate the expression levels of PI3K/AKT and AMPK/ACC1/CPT1 signaling pathway proteins both in vivo and in vitro.

RESULTS

Network pharmacology results showed IOP and T2DM targets were enriched in PI3K/AKT, insulin resistance, and lipid metabolism pathways. Cell experiments showed IOP enhanced glucose uptake and glycogen content, reduced lipid content, and improved lipid deposition in insulin-resistant C2C12 cells. Animal experiments showed IOP improved hyperglycemia and hyperlipidemia, enhanced glucose tolerance and insulin sensitivity, and reduced insulin resistance in T2DM mice. Western blot showed IOP activated PI3K/AKT and AMPK/ACC1/CPT1 pathways, promoting GLUT4 expression and translocation, and GSK3β phosphorylation.

CONCLUSIONS

In summary, the results indicated that IOP was able to ameliorate lipid-induced skeletal muscle insulin resistance in T2DM. The mechanism may be related to the PI3K/AKT and AMPK/ACC1/CPT1 signaling pathways.

Multi-strain probiotics attenuate carbohydrate-lipid metabolic dysregulation in type 2 diabetic rats via gut-liver axis modulation

Type 2 diabetes mellitus (T2DM) is a pervasive chronic metabolic disorder characterized by dysregulation of carbohydrate, protein, and lipid metabolism. The objective of this study was to elucidate the impact of multi-strain probiotic supplementation on the metabolism of carbohydrates and lipids and the interplay between the gut and liver in a T2DM rat model. A total of 32 rats were randomly assigned to four experimental groups: a control group, a T2DM model group, a low-dose probiotics group, and a high-dose probiotics group. The impact of probiotic intervention on glycemic and lipid profiles was evaluated, with a specific emphasis on the high-dose cohort. The treatment with multi-strain probiotics, consisting of three Lacticaseibacillus species and one Bifidobacterium species, resulted in a significant improvement in blood glucose and lipid profiles in T2DM rats, with the highest dosage demonstrating the most pronounced effects. Probiotic administration modulated gut microbiota composition and diversity, enriching potentially beneficial bacterial species and altering gut metabolic modules and carbohydrate-active enzyme profiles. Multi-omics analyses indicated that alterations in fecal short-chain fatty acids and serum bile acids may serve as pivotal mediators for crosstalk between hepatic and gut transcriptomic pathways. This study offers novel insights into the role of probiotics in managing T2DM via the gut-liver axis, emphasizing the potential of probiotic therapy in modulating key metabolic pathways.IMPORTANCEType 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia, caused by defects in insulin secretion, insulin action, or both. For individuals diagnosed with T2DM, managing diabetes-related complications is often the most challenging aspect. Exogenous probiotics have the potential to serve as a promising therapeutic strategy to improve diabetes-related symptoms. We conducted a 64-day animal experiment to investigate the effects of probiotics on T2DM-related metabolic disorders and dyslipidemia by feeding four mixed probiotics to T2DM rats. The results showed that probiotics exerted beneficial effects on glucose- and lipid-related homeostasis indices in diabetic rats to some extent and modulated the gut microbiota to manage T2DM via the gut-liver axis.

Stimulus-responsive hydrogels for diabetic wound management via microenvironment modulation

Diabetic wounds, a major complication of diabetes mellitus, pose a significant clinical challenge. The treatment of diabetic wounds requires comprehensive interventions tailored to their pathophysiological characteristics, such as recurring bacterial infection, persistent inflammation, excessive oxidative stress, and impaired angiogenesis. The development of stimulus-responsive hydrogel dressings offers new strategies for diabetic wound treatment. By responding to various physical and biochemical signals, these smart hydrogels enable real-time monitoring and precise modulation of the wound microenvironment to accelerate diabetic wound healing. In this review, we provide an overview of the disease characteristics of chronic diabetic wounds and introduce the current clinical treatment approaches. We summarize the cutting-edge applications of physical and biochemical signal-responsive hydrogels for diabetic wound treatment by modulating the wound microenvironment.

Circulating miR-4454 as a potential biomarker for the diagnosis of T2DM and the prediction value of comorbidity and complications in T2DM

OBJECTIVE

T2DM (type 2 diabetes mellitus) is a chronic metabolic disease that seriously affects human health. Abnormal expression of microRNAs has been reported to play an important role in disease diagnosis. This study aimed to investigate the predictive value of miR-4454 for T2DM and possible risk factors for comorbidity and complications (CC) of T2DM.

METHODS

Baseline information was collected from a total of 206 subjects including 109 T2DM patients (T2DM group) and 97 healthy individuals (healthy control group), and miR-4454 expression levels were assessed by qRT-PCR. A chi-squared test and a t-test were used to assess the difference in miR-4454 expression of T2DM and healthy subjects. The predictive value of miR-4454 on T2DM was evaluated by receiver operating characteristic (ROC). Potential risk factors for CC of T2DM were predicted by multivariate logistic regression analysis.

RESULTS

Significant downregulation of miR-4454 was observed in the T2DM group. The predictive value of miR-4454 for T2DM was verified by the ROC curve. MiR-4454 expression in the T2DM group was negatively correlated with fasting blood glucose (FBG), glycated hemoglobin (HbA1c), homeostasis model-insulin resistance index (HOMA-IR), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C), and positively correlated with the levels of adiponectin (ADI) and peroxisome proliferator-activated receptor gamma (PPAR-γ). Multivariate logistic regression analysis suggested that miR-4454, FBG, HbA1c, HOMA-IR, TC, TG, and LDL-C could be considered risk factors for CC of T2DM.

CONCLUSIONS

The expression level of miR-4454 showed a diagnostic value for T2DM and could serve as a risk factor for the occurrence of CC in T2DM.

CLINICAL TRIAL NUMBER

Not applicable.

Intangible cost and its associated factors among caregivers of individuals with Type 2 Diabetes Mellitus managed at primary healthcare settings: a scoping review

BACKGROUND

The chronic and debilitating nature of Type 2 Diabetes Mellitus (T2DM) not only places a significant burden on patients but also imposes high intangible costs on their caregivers. This review aimed to critically assess the intangible costs and their associated factors among caregivers of people with T2DM treated in primary healthcare settings.

METHOD

A systematic search using several combinations of keywords was conducted in Scopus, WoS, and PubMed databases. The primary outcome was the score or levels of intangible costs, while the secondary outcome was the factors associated with such burden.

RESULT

The review included seven cross-sectional designs (six employing a quantitative approach and one a mixed-methods approach) that adopted the Zarit Burden Interview or Zarit Caregiver Burden Scale, with four reporting a mild level, two reporting a high level, and one reporting a moderate level. Associated factors identified were characteristics of the caregiver (e.g., female, housewife, and no or low income), caregiving characteristics (longer duration and time spent in taking care of the individual with T2DM), and clinical characteristics of individuals with T2DM (i.e., presence of complication and their health status).

CONCLUSION

It was found that T2DM caregivers in primary healthcare settings experienced moderate to high levels of intangible costs. The identified vulnerable subgroup should be regularly screened for their levels of intangible costs to prevent poor outcomes in T2DM caregiving. Furthermore, the implementation of targeted support interventions for these caregivers could improve their well-being and the quality of care provided to individuals with T2DM, ultimately enhancing patient outcomes and reducing their intangible costs.

The research of dapagliflozin on cognitive function in middle-aged and older patients with type 2 diabetes mellitus and mild cognitive impairment: a 36-week prospective parallel control study

Sodium-glucose co-transporter 2 inhibitors have demonstrated potential for improving cognitive function in preclinical studies; however, robust clinical evidence supporting this effect in humans remains limited. We conducted a prospective trial to assess the effect of dapagliflozin on cognitive function in middle-aged and older patients with type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI). Ninety participants were randomly assigned to either the dapagliflozin or control group for 36 weeks. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Eight participants from each group underwent resting-state functional magnetic resonance imaging to assess region homogeneity (ReHo). After 36 weeks, the dapagliflozin group demonstrated significant improvements in MoCA and MMSE scores compared to the control group. Additionally, the dapagliflozin group exhibited reductions in diastolic blood pressure, glycated haemoglobin, fasting plasma glucose, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and ReHo values in the left superior temporal gyrus were significantly reduced (p < 0.05). Spearman's correlation analysis revealed that improvements in MOCA scores before and after treatment were negatively correlated with HOMA-IR (r=-0.653, p=0.006), TC (r=-0.619, p=0.011), and ReHo values in the left superior temporal gyrus (r=-0.710, p=0.002) in both groups. These findings suggest that dapagliflozin may improve cognitive function and modulate ReHo values in the left superior temporal gyrus in middle-aged and older adults with T2DM. These effects may be linked to improvements in insulin sensitivity and reductions in TC.

Antioxidant proteins can be potential targets in ameliorating ferroptosis in diabetic cardiomyopathy: a literature review

Diabetic cardiomyopathy (DCM) is one of the cardiovascular complications of diabetes mellitus, which is different from myocardial damage caused by coronary ischemia, hypertension, and valvular disease. DCM lacks distinct clinical manifestations in its early stages, and current therapeutic approaches primarily focus on symptomatic management. Emerging evidence indicates that even with optimized glycemic regulation, the pathophysiological progression of DCM remains unmitigated. Exploring the pathogenic mechanism of DCM is the focus and hotspot of current research. Ferroptosis, an iron-dependent form of regulatory cell death, is crucial in DCM myocardial damage. Dysfunctional antioxidant defense system, increased oxidative stress, and elevated reactive oxygen species are the key mechanisms of ferroptosis in DCM. Thus, this review innovatively takes antioxidant proteins as the entry point, and for the first time systematically summarizes the molecular mechanism of antioxidant proteins to improve DCM by regulating the ferroptosis pathway, and summarizes the therapeutic strategy of medications to enhance ferroptosis in DCM by targeting the expression of antioxidant proteins, to explore the potential targets to improve ferroptosis in DCM, to provide a new perspective for the study of delaying the progression of DCM.

A J-shaped association between the atherogenic index of plasma and diabetes risk in a Japanese population: a large-scale retrospective cohort study

BACKGROUND

Atherosclerotic dyslipidemia has been linked to an increased risk of type 2 diabetes (T2D). While previous studies have established an association between the atherogenic index of plasma (AIP) and insulin resistance, there is a notable lack of large-scale cohort studies examining the relationship between AIP and the risk of T2D in the general population. Therefore, the present longitudinal study aims to examine the association between AIP and the risk of T2D in a cohort of Japanese adults.

METHODS

This retrospective cohort study included a total of 15,453 adults. To evaluate the association between the AIP and the risk of developing T2D, hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression models. Furthermore, potential nonlinear relationships were explored through Cox proportional hazards regression combined with smooth curve fitting techniques.

RESULTS

During a mean follow-up period of 6.05 years, 373 adults developed T2D. Elevated AIP was independently associated with a significantly higher risk of T2D after adjusting for potential confounding factors (HR: 2.23, 95% CI: 1.55-3.20, P < 0.0001). Furthermore, a J-shaped relationship between AIP and the incidence of T2D was observed. When AIP levels were below - 0.45, no statistically significant association was found between AIP and T2D risk (HR: 0.35, 95% CI: 0.06-1.95, P = 0.2298). In contrast, AIP levels exceeding this threshold were positively associated with an increased risk of T2D (HR: 2.61, 95% CI: 1.77-3.85, P < 0.0001).

CONCLUSION

The AIP demonstrates a J-shaped relationship with the risk of developing T2D in Japanese adults. Consequently, maintaining AIP levels below the identified threshold (-0.45) may help reduce their chances of developing diabetes.

CLINICAL TRIAL NUMBER

Not applicable.

Association Between the Hemoglobin Glycation Index (HGI) and Risk of Diabetic Nephropathy: A Retrospective Cohort Study

Background

The Hemoglobin Glycation Index (HGI) quantifies the difference between observed and predicted glycated hemoglobin (HbA1c) values, and has connections to multiple adverse outcomes. However, the relationship between HGI and the risk of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) remains underexplored. The objective of this study was to examine the relationship between baseline HGI and the risk of DN development among patients with T2DM through a retrospective cohort study.

Methods

A single-center retrospective study was conducted on 1050 newly diagnosed T2DM patients with normal renal function at baseline. Participants were categorized into quartiles based on HGI values. The primary outcome was DN development, defined as persistent proteinuria or reduced estimated glomerular filtration rate (eGFR). Multivariable logistic regression, restricted cubic spline (RCS) analysis, and threshold effect models were employed to assess the association between HGI and DN risk. Subgroup and sensitivity analyses were conducted to validate the robustness of our findings, while mediation analysis was employed to explore potential underlying mechanisms.

Results

The study revealed a U-shaped relationship between HGI and DN risk. Both excessively low and high HGI levels were associated with an increased risk of DN, with the lowest risk observed at an HGI threshold of -0.648. In fully adjusted models, the highest HGI quartile (Q4) demonstrated a significantly increased risk of DN (OR = 1.54, 95% CI: 1.03-2.30, P = 0.036), while the lowest HGI quartile (Q1) also showed a trend toward higher risk (OR = 1.40, 95% CI: 0.92-2.14, P = 0.115). However, fasting plasma glucose (FPG) (P for overall = 0.217) and glycated hemoglobin (HbA1c) (P for overall = 0.529) did not show an association with the risk of DN. Subgroup and sensitive analyses confirmed the consistency of this U-shaped association across different patient demographics. Mediation analysis indicated that C-reactive protein (CRP) mediated 11.1% of the effect of |HGI| on DN.

Conclusion

In T2DM patients, baseline HGI exhibits a U-shaped association with DN risk, serving as a potential indicator for assessing DN risk.

Duration of antibiotherapy for patients with diabetic foot osteomyelitis without amputation: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Diabetic foot osteomyelitis (DFO) poses a serious threat to the quality of life and survival of patients, and systemic antibiotic therapy is effective and plays a pivotal role in the management of patients with DFO without amputation. However, the optimal duration of systemic antibiotic therapy is not clear. We aim to perform a network meta-analysis (NMA) to assess the efficacy and safety of different durations of antibiotic therapy for patients with DFO without amputation.

METHODS AND ANALYSIS

We will search multiple databases, including the China National Knowledge Infrastructure, VIP database, Wanfang Data, ScienceDirect, EBSCO, EMBASE, Web of Science, Cochrane Library, and PubMed. The outcome indicators are remission rate, time needed for complete wound healing, major amputation rates and the rate of antibiotic-related adverse events. Risk of bias will be evaluated using the Cochrane risk-of-bias tool. NMA will be performed using STATA/MP V.15.0. The surface under the cumulative ranking area will be calculated to rank each treatment.

ETHICS AND DISSEMINATION

This study is a systematic review protocol collecting data from published literature and does not require approval from an institutional review board. Results from this systematic review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023486089.

Cultural Influences, Experiences and Interventions Targeting Self-Management Behaviours for Prediabetes or Type 2 Diabetes in First-Generation Immigrants: A Scoping Review

AIM

To map the existing evidence and identify research gaps regarding the self-management of prediabetes or type 2 diabetes among first-generation immigrants ≥ 18 years.

DESIGN

A scoping review followed the JBI guidelines and was in accordance with the PRISMA extension for Scoping Reviews.

METHODS

A systematic search of CINAHL, Cochrane, EMBASE, MEDLINE, PsycINFO, ProQuest, SCOPUS and the Web of Science was conducted. Grey literature and reference lists of included studies were searched for additional citations. Articles published in English from the database inception to February 2023 were included.

RESULTS

We included 96 studies, of which 28.1% were published within the last 5 years. Most studies (71.9%) were conducted in the United States. Study participants were recruited mainly from community settings and English was their second language. The most common study methodologies used were cross-sectional surveys and phenomenological interviews. Only two studies specifically focussed on individuals with prediabetes. Multiple factors, such as age, gender, country of origin and other societal, linguistic, cultural and resource barriers or facilitators, as well as patient's cultural unique experiences, were of particular significance for self-management behaviours. Although several studies reported that culturally tailored interventions were feasible and acceptable among first-generation immigrants living with type 2 diabetes but not prediabetes, the duration and intensity of these interventions varied.

CONCLUSION

Health professionals should consider various demographic, societal, linguistic and cultural factors, such as participants' low English language proficiency, and provide appropriate support for this group to ensure better self-management behaviours. Tailoring interventions to individual and cultural preferences in collaboration with key stakeholders is crucial for adult immigrants with prediabetes and type 2 diabetes across diverse cultural and ethnic groups.

IMPACT

Developing and applying culturally tailored self-management interventions for the targeted population, particularly those with prediabetes, should be an important direction for future research. No Patient or Public Contribution.

Association of early-onset diabetes with socioeconomic, and health factors: a matched case-control study controlling for age, gender, and BMI

Objectives

This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020).

Methods

A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression.

Results

The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704).

Conclusion

The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study

The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.

MATERIAL AND METHODS

Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.

RESULTS

A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.

CONCLUSIONS

The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.

A bibliometric analysis of research trends on left ventricular dysfunction and exercise among individuals with type 2 diabetes mellitus

BACKGROUND

Diabetic cardiomyopathy (DCM) is a severe outcome of type 2 diabetes mellitus (T2DM) and a major global health concern. The overall impact of T2DM on the heart is demonstrated by echocardiographic measurements. Exercise helps reduce cardiovascular disease risk and improves glycemic management in T2DM. The objective of the present bibliometric study was to map the research trends on left ventricular dysfunction and exercise among T2DM.

MATERIALS AND METHODS

The comprehensive search was conducted in the SCOPUS database, with the keywords "type 2 diabetes", "diabetic cardiomyopathy", "exercise," and "left ventricular function", with BOOLEAN Operators AND, OR. The search period ranged from 1984 to November 2023. The data was exported to VOS Viewer(1.6.20) for analysis.

RESULTS

Sixty-nine documents were retrieved from the database search. A steady rise was observed in the number of documents per year, between 1 and 5. The following countries published the maximum number of documents: the USA, Italy, Australia, and the UK. 79.7% of documents were original articles, 18.8% were reviews, and 1.4% were editorials. Most studies belonged to categories, namely medicine(69.9%), biochemistry(15.1%), pharmacology (8.6%) and health professions (2.2%). The network analysis was performed to explore the association between the studies based on co-authorship, citation analysis, and co-occurrence.

CONCLUSION

The bibliometric analysis showed the maximum number of publications belonged to high-income countries, with smaller contributions from low-middle-income countries (LMICs), including the Indian subcontinent. There is a need to explore the area of exercise and left ventricular dysfunction in T2DM as exercise can act as a valuable tool in LMICs where the burden of T2DM is increasing.

Preoperative glycemic control and postoperative clinical outcomes in patients with type 2 diabetes mellitus undergoing bariatric surgery

BACKGROUND

The preoperative glycated hemoglobin (HbA1c) cutoff point for elective surgery in patients with type 2 diabetes mellitus (T2DM) remains unclear, as does its association with postoperative outcomes, especially in patients undergoing bariatric surgery.

METHODS

We conducted a retrospective cohort study including patients with T2DM and an electronic record of HbA1c within the four months prior to surgery who underwent Roux-en-Y gastric bypass (RYGB) from August 2010 to May 2019. The primary outcome was postoperative hospital length of stay (LOS), and secondary outcomes included need for intensive care, clinical outcomes (pulmonary, cardiovascular, septic), and surgical wound complications. These outcomes were assessed using an HbA1c cutoff value of 7 %. Comparisons were made using the Mann-Whitney U test and a general linear model adjusting the primary outcome for confounders and for differences in baseline characteristics between groups.

RESULTS

A total of 114 individuals were divided into two groups according to HbA1c: ≤7 % (N = 63) or > 7 % (N = 51). No differences were observed between the groups in terms of LOS (4 vs 5 days, p = 0.28) and clinical or operative wound complication rates. Alternative HbA1c cutoff points (7.5 %, 8 %, and 8.5 %) were also evaluated for LOS, with no change in results.

CONCLUSION

Bariatric surgery should not be postponed in patients with T2DM based on an HbA1c greater than 7 %, as LOS, clinical outcomes and operative wound complication rates are not worse in patients with poorer glucose control based on this criterion.

The association between dietary diversity score and food insecurity and novel cardiovascular risk factors in type 2 diabetes mellitus patients: a cross-sectional study

Objectives

An efficient approach to monitor the risks associated with chronic diseases is to use a dietary diversity score (DDS). To our knowledge, there has been no study conducted on the correlation between DDS and cardiovascular risk factors in individuals with diabetes. Hence, the objective of this study is to ascertain the correlation between these traits.

Methods

In this cross-sectional investigation, 490 individuals with type 2 diabetes were included. The patients' food consumption was assessed using a 168-item food frequency questionnaire (FFQ), and a dietary diversity score (DDS) was computed. Traditional CVD risk variables were used to evaluate cardiovascular risk factors, including Castelli risk index 1 and 2 (CRI-I and II), atherogenic index of plasma (AIP), lipid accumulation product (LAP), and cholesterol index (CI). We evaluated the anthropometric indicators that predict CVD, including the abdominal volume index (AVI), body roundness index (BRI), and body shape index (ABSI).

Results

In the final model adjusted for all the considered confounders, there was a significant association between DDS and LAP (OR: 1.33; 95% CI: 0.61, 0.82; p-trend = 0.03). Moreover, there was a significant association between DDS and AVI (OR: 1.99; 95% CI: 1.17,3.35; p-trend = 0.04). We could not find any association between food security and DDS among the participants of the current study.

Conclusions

In the present study, it was found that DDS may result in higher LAP and AVI which are markers of abdominal obesity and cardiovascular diseases. Therefore, despite the probable positive effect of having a diverse diet on cardiovascular health and wide recommendations for that, using healthier food groups should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01557-0.

Altered cerebellar activity and cognitive deficits in Type 2 diabetes: Insights from resting-state fMRI

OBJECTIVE

To investigate alterations in brain activity in patients with Type 2 Diabetes and explore the relationship between altered regions and neuropsychological performances.

METHODS

A total of 36 patients with Type 2 Diabetes and 40 age- and education-matched healthy controls were recruited for this case-control study. All participants underwent resting-state functional magnetic resonance imaging (Resting-state fMRI) and neuropsychological tests. The neuropsychological scales included the Auditory Verbal Learning Test (AVLT), Shape Trajectory Test B (STT-B), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Boston Naming Test (BNT), Symbol Digit Modality Test (SDMT), Regional homogeneity (ReHo) and the amplitude of low-frequency fluctuations (ALFF) were used to assess differences in spontaneous regional brain activity. For functional connectivity (FC) analyses, the differences identified among the groups were selected as seed regions. Then, the correlations between neuropsychological scale scores (AVLT, HAMA, HAMD, STT-B, BNT, and SDMT) and ALFF/ReHo values were specifically analyzed in the focal regions that exhibited significant alterations between the T2DM and control groups, as detailed in Tables 2 and 3.

RESULTS

Patients with Type 2 Diabetes exhibited significantly higher ALFF values in the superior lobe of the cerebellum, specifically in the left cerebellar crus I (Cerebellum_Crus I_L), left cerebellar lobule VI (Cerebellum_6_L), and left cerebellar lobule IV-V (Cerebellum_4_5_L). Additionally, they exhibited elevated ReHo values in the Cerebellum_Crus I_L and Cerebellum_6_L. The findings were statistically significant with a family-wise error-corrected, cluster-level p-value of less than 0.05. However, the FC analysis was not significant. AVLT scores were significantly lower in the diabetes group. The correlation analysis demonstrated a negative association between ALFF values of the Cerebellum_6_L and AVLT scores (R2 = 0.1375, P < 0.001). The ReHo values within the Cerebellum_6_L also exhibited a negative association with AVLT scores (R2 = 0.0937, P = 0.007).

CONCLUSION

Patients with Type 2 Diabetes showed abnormal neural activities in diverse cerebellar regions mainly related to cognitive functions. This provides supplementary information to deepen our insight into the neural mechanisms by which Type 2 Diabetes affects the functional activity of the brain's posterior circulation, as well as the potential association of these changes with cognitive impairment.

A simple and accessible diabetic retinopathy risk prediction model: Establishment and validation in a hospital-based cohort of type 2 diabetes patients

AIMS

Diabetic retinopathy (DR) is a leading cause of vision loss, with early detection challenging due to asymptomatic progression and limited predictive tools. To address this, we aimed to develop and validate a risk nomogram for DR prediction in type 2 diabetes patients.

METHODS

In this retrospective cohort study of 70,073 patients with type 2 diabetes admitted from 2013 to 2019, 2,585 patients were included after exclusions. Patients were randomly assigned to derivation (2/3) and validation (1/3) sets. The prediction model was derived using Cox proportional hazards regression. A nomogram was developed and evaluated for discriminatory capacity and calibration accuracy.

RESULTS

Among 2585 participants (mean age 59 years), 220 (8.5 %) developed retinopathy over a median follow-up of 34 months. We identified key predictors: glycated haemoglobin A1c, serum urea, and diabetes duration. Predictive models for 1-, 3-, and 5-year retinopathy-free survival were constructed and presented as a nomogram, demonstrating good discriminatory power (AUC: 0.941, 0.886, 0.594 in derivation; 0.747, 0.736, 0.670 in validation). Calibration plots further corroborated the improved fit for 3- and 5-year models.

CONCLUSIONS

The proposed model shows promise for guiding early interventions and improving outcomes. Further external validation is needed to confirm its applicability across diverse populations.

The PI3K/Akt pathway: a target for curcumin's therapeutic effects

Purpose

The purpose of this review study is to investigate the effect of curcumin on the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in various diseases. Curcumin, the main compound found in turmeric, has attracted a lot of attention for its diverse pharmacological properties. These properties have increased the therapeutic potential of curcumin in chronic diseases such as cardiovascular disease, Type 2 diabetes, obesity, non-alcoholic fatty liver disease, kidney disease, and neurodegenerative diseases. One of the main mechanisms of the effect of curcumin on health is its ability to modulate the PI3K/Akt signaling pathway. This pathway plays an important role in regulating vital cellular processes such as growth, cell survival, metabolism, and apoptosis. Disruption of the PI3K/Akt signaling pathway is associated with the incidence of several diseases.

Methods

Electronic databases including PubMed, Google Scholar, and Scopus were searched with the keywords "phosphoinositide 3-kinase" AND "protein kinase B "AND "curcumin" in the title/abstract. Also, following keywords "non-alcoholic fatty liver disease" AND "diabetes" AND "obesity" AND "kidney disease" and "neurodegenerative diseases" was searched in the whole text.

Results

Research indicates that curcumin offers potential benefits for several health conditions. Studies have shown it can help regulate blood sugar, reduce inflammation, and protect the heart, kidneys, and brain.

Conclusion

This protective effect is partially achieved by regulating the PI3K-Akt survival pathway, which helps improve metabolic disorders and oxidative stress. By examining how curcumin affects this vital cell pathway, researchers can discover new treatment strategies for a range of diseases.

The intervention effect of comprehensive precision nursing in elderly patients with type 2 diabetes

OBJECTIVE

This study evaluated the impact of precision nursing on blood sugar levels, psychological health and quality of life in ageing type 2 diabetes patients.

METHODS

A prospective cohort study involving 100 older patients was carried out at a tertiary hospital located in Sichuan Province, China. The patients were categorised into two groups: a control group that received standard nursing care and an observation group that received tailored nursing interventions.

RESULTS

The outcomes for the observation group were considerably more favourable, featuring decreased levels of fasting blood glucose (FPG), 2-h postprandial blood glucose (2hPG) and glycosylated haemoglobin (HbA1c). Additionally, this group reported lower levels of anxiety and depression, along with a better quality of life relative to the control group. Furthermore, the occurrence of hypoglycaemia was notably less in the observation group.

CONCLUSIONS

Precision nursing significantly improves glucose management, mental health and overall quality of life, while also lowering the risk of hypoglycaemia in older patients with type 2 diabetes. This research highlighted the efficacy of precision nursing in the care of ageing adults, promoting its integration as a common approach for managing chronic illnesses.

In silico and in vitro evidence on the anti-diabetic effect of grandidentatin from Salix acmophylla Boiss

Current pharmacological treatments against diabetes do not reach optimal results in many conditions, and the attention of medicinal chemists is currently dedicated to multi-target compounds with antioxidant, anti-inflammatory and anti-diabetic properties. In this connection, medicinal plants represent valuable sources. Grandidentatin is a phenolic glycoside isolated from the leaves of Salix acmophylla Boiss., and in the current study its anti-inflammatory activity was investigated in vitro through red blood cells membrane stabilization and protein denaturation assays, and it was comparable to that of the positive control diclofenac sodium. Additionally grandidentatin was effective in the glucose uptake assay, used to assess the blood sugar lowering action, in the same concentration range of metformin. Computational studies were also enrolled to investigate the physico-chemical properties and the mechanism of action, showing that the molecule possesses the features to be defined as a "drug-like" compound, and that it may target aldose reductase as observed by docking studies.

Evaluation of hearing function in patients with type 2 diabetes mellitus and investigation of its relationship with stages of diabetic retinopathy

Background

Diabetes mellitus is a serious, chronic metabolic disorder associated with microvascular and macrovascular complications that affect the cardiac, renal, ophthalmic, cerebral, and peripheral systems. Similar complications can also occur in the structures of the inner ear.

Objectives

This study aimed to assess the hearing function of patients diagnosed with T2DM and to investigate the relationship between hearing function and the stage of diabetic retinopathy.

Methods

This prospective, single-center, cross-sectional, and case-control study included 30 healthy controls (Group 1) and 90 patients with T2DM [30 without retinopathy (Group 2), 30 with non-proliferative diabetic retinopathy (Group 3), and 30 with proliferative diabetic retinopathy (Group 4)] aged 40 to 60 years. The best-corrected visual acuity and audiological tests, including pure tone audiometry (PTA) and high frequency audiometry (HFA), were performed.

Results

A statistically significant difference was observed at all frequencies (for all, p < 0.001), except for 125 Hz (for 125 Hz, p = 0.075). The median PTA values were 13.75 (min-max: 5-31.2) in Group 1, 20 (min-max: 10-37.5) in Group 2, 16.87 (min-max: 8.7-42.5) in Group 3, and 24.37 (min-max: 12.5-56.25) in Group 4. A multiple comparisons analysis for PTA showed a statistically significant difference between Group 1 and Group 4 (p < 0.001). The mean HFA values were 32.23 ± 12.27 in Group 1, 50.23 ± 12.80 in Group 2, 53.47 ± 10.75 in Group 3, and 62.63 ± 12.52 in Group 4. The HFA values were significantly lower in Group 1 compared to the other groups (p < 0.001). In pairwise comparisons, p = 0.730 for Group 2 vs. Group 3, p = 0.001 for Group 2 vs. Group 4, and p = 0.021 for Group 3 vs. Group 4.

Conclusions

It was observed that T2DM patients were at risk for developing hearing impairment, and sensorineural hearing impairment increased as the DR stage progressed, particularly in high frequencies. These results suggest a hearing evaluation in the screening of DR patients.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

Relationship between glycaemic control and frailty in older Chinese patients: The mediating role of diabetes distress

PURPOSE

This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty.

DESIGN

This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022.

METHODS

A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1).

RESULTS

The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty.

CONCLUSIONS

The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes.

RELEVANCE TO CLINICAL PRACTICE

This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings.

PATIENT OR PUBLIC CONTRIBUTION

This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.

Exploration of novel dipeptidyl peptidase-IV inhibitory tetrapeptide from walnut (Juglans sigillata) protein and its effect on diabetes-like phenotypes induced by high-sugar diet in Drosophila melanogaster

Walnut protein was hydrolyzed by different enzymes, and bromelain protein hydrolysate (W-Bromelain) showed the highest dipeptidyl peptidase-IV (DPP-IV) inhibitory activity. W-Bromelain was fractionated, and three novel tetrapeptides (LPQF, LPSF, and VPFP) were identified. In vitro evaluation showed that LPQF exhibited the highest DPP-IV inhibitory activity with an IC50 value of 99.34 μM. Evaluation of the absorption, distribution, metabolism, excretion, and toxic properties of LPQF showed high absorption and nontoxicity. Molecular docking showed that LPQF could interact with the active residues of DPP-IV through seven hydrogen bonds and five hydrophobic interactions. Molecular dynamics simulation further confirmed the stability of the LPQF-DPP-IV complex. LPQF showed high stability in in vitro gastrointestinal digestion. LPQF ameliorated the type 2 diabetes mellitus-like phenotype and reduced the degree of oxidative stress and intestinal barrier damage in a Drosophila melanogaster model of insulin resistance. Furthermore, the RNA-seq analysis showed that LPQF may exert hypoglycemic effects by regulating the Wnt, MAPK, and FoxO pathways.

Diabetes Mellitus and Associated Vascular Disease: Pathogenesis, Complications, and Evolving Treatments

Diabetes mellitus is a metabolic disorder, characterized by elevated blood sugar levels (hyperglycemia) and insulin dysregulation. This disease is associated with morbidity and mortality, including significant potential vascular complications. High levels of hyperglycemia lead to not only elevated levels of reactive oxygen species but also advanced glycation end products, which are detrimental to the vascular endothelium and reduce protective compounds such as nitric oxide and prostacyclin. This damage contributes to the development of both macrovascular and microvascular complications. The present investigation explores the pathophysiological mechanisms of diabetic vascular complications and evaluates current management strategies, including lifestyle modifications, pharmacological treatments, and emerging therapies. The review underscores the importance of ongoing progress in diabetes management and patient education to lead to optimal patient-health outcomes and quality of life for individuals with diabetes mellitus.

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears Yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus

PURPOSE

To compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM).

METHODS

Patients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients' characteristics. Only patients with glycosylated hemoglobin <8% were eligible. The visual analog scale for shoulder pain, American Shoulder and Elbow Surgeons and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications that required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson χ2 test and Fisher exact test were used for categorical variables. The interaction between the postoperative period and ROM was analyzed by the Friedman test and Wilcoxon rank-sum test with the Holm-Sidak post hoc test.

RESULTS

We studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P < .05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences in visual analog scale and American Shoulder and Elbow Surgeons scores between the groups (P = .10 to ≥.999). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P ≥ .999).

CONCLUSIONS

SCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the 2 groups.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Produce prescription to improve health among adults with type 2 diabetes in Australia: Protocol for a randomised controlled trial

BACKGROUND

'Food is medicine' programs such as Produce Prescription (PRx) aim to integrate food-based nutrition programs into healthcare, for the prevention, management and treatment of diet-related diseases, typically for those experiencing food insecurity. However, the impact of PRx on health indicators in Australia has never been tested in a randomised trial.

OBJECTIVES

To determine the effect of PRx on blood glucose control and other health indicators in adults with type 2 diabetes experiencing hyperglycaemia and food insecurity and/or financial hardship in Australia.

METHODS

Using a parallel design randomised controlled trial, n = 224 participants will be randomised (1:1) to PRx or usual care. Over 26 weeks, the intervention group will receive a weekly delivery of fruits, vegetables, wholegrains and nuts, and up to 3 sessions with an accredited dietitian. Controls will receive usual care. The primary outcome is change in mean HbA1c over 26 weeks, comparing the intervention and control group. Secondary outcomes include between-group differences at 26 weeks in change in blood pressure, body weight, blood lipids, food and nutrition insecurity, person-reported outcome measures, medication use, and diet quality. Implementation outcomes assessed will include feasibility, acceptability, scalability and cost effectiveness.

DISCUSSION

This Australia-first PRx trial will provide novel and rigorous data for an intervention that may be feasible to improve health and health equity as part of the Australian healthcare system. We anticipate PRx will lead to a clinically meaningful reduction in HbA1c, contribute to improved health equity and long-term health benefits for adults with type 2 diabetes and food insecurity.

HG043, a potent thienopyrimidine GPR119 agonist, demonstrates enhanced anti-diabetic and anti-obesity effects in preclinical models

GPR119 is a promising therapeutic target for type 2 diabetes because of its role in enhancing glucose-stimulated insulin secretion and GLP-1 release. We investigated the anti-diabetic and anti-obesity effects of HG043, a novel and potent thienopyrimidine-based GPR119 agonist, by comparing its pharmacological activities to those of MBX-2982 (a known GPR119 agonist) and sibutramine (an appetite suppressant) in both in vitro and in vivo models. HG043 exhibited potent agonistic activity for human GPR119 and demonstrated enhanced efficacy compared to MBX-2982 in stimulating incretin secretion in pancreatic β-cell lines. Single and long-term treatment with HG043 resulted in significant improvements in diabetic and obesity parameters compared to both MBX-2982 and sibutramine in both healthy and disease models. Furthermore, HG043 demonstrated synergistic glucose-lowering effects when combined with metformin or sitagliptin. These findings suggest that HG043 may serve as a promising therapeutic option for the treatment of type 2 diabetes with obesity patients.