Type 2 diabetes - An unresolved disease across centuries contributing to a public health emergency

High-Intensity Interval Versus Moderate-Intensity Continuous Exercise Training on Glycemic Control, Beta Cell Function, and Aerobic Fitness in Women with Type 2 Diabetes

Objective: This study aimed to compare the effects of High-Intensity Interval Training (HIIT) and Moderate-Intensity Continuous Training (MICT) on glycemic control, beta-cell function, and aerobic fitness in women with Type 2 Diabetes Mellitus (T2DM). Methods: Thirty-six women with T2DM were assigned equally to HIIT, MICT, and control (CON) groups. Participants in the exercise cohorts underwent a 12-week training regimen (three sessions per week), while the CON group maintained an inactive lifestyle. Glycaemia variables, beta-cell function, maximal oxygen uptake (VO2max), lipid profiles, and body composition were assessed at baseline and post-intervention. Results: Both HIIT and MICT interventions led to significant improvements in glucose, insulin, HbA1c, and insulin resistance index. Moreover, visceral adiposity index (VAI), lipid accumulation product (LAP), total cholesterol (TC), and low-density lipoprotein (LDL) levels significantly decreased in the HIIT and MICT groups after 12 weeks. Triglyceride (TG) levels decreased only after MICT, while high-density lipoprotein (HDL) levels increased after both interventions. Maximal oxygen uptake (VO2max), body mass, body mass index (BMI), and waist circumference (WC) significantly improved in all exercise groups. Notably, the HIIT group showed greater reductions in body mass compared to MICT. Nevertheless, beta-cell function remained unaltered after these two exercise regimens. Conclusion: Both HIIT and MICT interventions effectively managed T2DM in women, regardless of exercise intensity. The HIIT regimen can be considered for time-efficient lifestyle interventions in people with T2DM.

Does Pre-existing Diabetes Correlate with Long COVID-19 in Europe? Evidence from the Analysis of the Survey of Health, Ageing and Retirement in Europe's Corona Surveys

Background

A substantial proportion of those infected with COVID-19 are presenting with persistent symptoms, referred to as long COVID-19. Emerging evidence suggests that the presence of pre-existing chronic conditions, such as diabetes, may increase the risk of long COVID-19.

Objectives

To investigate whether having pre-existing diabetes increases the risk of developing long COVID-19 in the population of middle-aged and older adults (≥50 years old) in Europe, while assessing if this relationship can be accounted for or is modified by the known long COVID-19 and diabetes risk factors (age, sex, hospitalization, pre-existing hypertension, and weight status).

Methods

A population-based longitudinal prospective study involving a sample of respondents aged 50 years and older (n = 4,004) with probable or confirmed COVID-19 infection from 27 countries that participated in both waves 7 and 8 of the Survey of Health, Ageing and Retirement in Europe and its 2020 and 2021 Corona Surveys. Logistic regression modeling was performed.

Results

Overall, 66.8% of the respondents affected by COVID-19 infection reported at least one long COVID-19 symptom; 55.2% were female, and the average age was 64.6 years; 13.2% had pre-existing diabetes. Respondents with pre-existing diabetes had significantly higher odds of developing long COVID-19, compared to those without diabetes (OR = 1.37; 95% CI = 1.12, 1.68). This relationship remained significant (OR = 2.00; 98% CI = 0.25, 1.14) after adjusting for sex (OR = 1.64 for females; 95% CI = 1.43, 1.88), hospitalization for COVID-19 illness (OR = 3.19; 95% CI = 2.41, 4.23), pre-existing hypertension (OR = 1.17; 95% CI = 1.01, 1.36), and overweight (OR = 1.31; 95% CI = 1.11, 1.56) and obese (OR = 1.77; 95% CI = 1.44, 2.19) weight status. The effect of pre-existing diabetes on the risk of long COVID-19 is moderated by age; it was highest at the age of 50 (OR = 2.00; 95% CI = 1.28, 3.14), and then, it declined with age.

Conclusions

There is a relationship between pre-existing diabetes and long COVID-19, even after controlling for literature-based confounding factors, with age having a moderating effect on this relationship.

TRIM21 ameliorates hepatic glucose and lipid metabolic disorders in type 2 diabetes mellitus by ubiquitination of PEPCK1 and FASN

Hepatic glucose and lipid metabolism disorders promote the development and progression of type 2 diabetes mellitus (T2DM), yet the underlying mechanisms are not fully understood. Here, we identify tripartite motif-containing protein 21 (TRIM21), a class IV TRIM family member, as a pivotal regulator of hepatic metabolism in T2DM for the first time. Bioinformatic analysis suggests that TRIM21 expression is significantly reduced in T2DM patients. Intriguingly, in a mouse model of obese diabetes, TRIM21 expression is predominantly reduced in the liver rather than in other metabolic organs. It is further demonstrated that hepatic overexpression of TRIM21 significantly ameliorates glucose intolerance, insulin resistance, hepatic steatosis, and dyslipidemia in obese diabetic mice. In contrast, the knockdown of TRIM21 promotes glucose intolerance, insulin resistance, and triglyceride accumulation. Mechanistically, both phosphoenolpyruvate carboxykinase 1 (PEPCK1) and fatty acid synthase (FASN) are the hepatic targets of TRIM21. We revealed that TRIM21 promotes the degradation of PEPCK1 and FASN through a direct protein-protein interaction mediated K48-linked ubiquitination. Notably, overexpression of PEPCK1 and FASN essentially abolished the beneficial effects achieved by TRIM21 overexpression in obese diabetic mice. Overall, our data demonstrate that TRIM21 is a novel regulator of hepatic metabolic disorder, and suggest TRIM21 as a promising therapeutic target for T2DM.

Effects of Exercise Training on Inflammatory and Cardiometabolic Risk Biomarkers in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The interaction between type 2 diabetes mellitus (T2DM) and cardiometabolic morbidity and mortality stems from the progressive nature of inflammation underpinning both diseases. Exercise training is considered an effective treatment strategy for T2DM and cardiometabolic diseases.

OBJECTIVE

The current systematic review and meta-analysis investigated the effects of exercise training on inflammatory and cardiometabolic risk biomarkers in patients with T2DM.

DATA SOURCES

Electronic databases (PubMed/Medline, Embase, Cochrane Library, CINAHL, Google Scholar, Scopus, and Web of Science) were searched for randomized controlled trials (RCTs) from inception to January 2022. We used random effects models to estimate weighted mean differences with 95% confidence intervals.

STUDY SELECTION

Twenty-five RCTs were included (N = 1257 participants; mean age = 52 years). Included studies had moderate to good overall methodological quality (TESTEX = 9 (range 7-13).

RESULTS

Meta-analysis indicated that exercise training significantly increased adiponectin and decreased fasting insulin, homeostatic model assessment for insulin resistance, tumor necrosis factor-α, interleukin-6, and C-reactive protein (ps ≤ 0.05). Subgroup analysis by type of training indicated that aerobic exercise had the most consistent beneficial effects as compared to other types of exercise training; however, there was high heterogeneity among studies.

CONCLUSION

Different types of exercise training increase adiponectin levels and decrease pro-inflammatory cytokines such as TNF-α, IL-6, and CRP, as well as fasting insulin and insulin resistance markers in patients with T2DM. However, these effects were not beneficial for more commonly measured cardiometabolic risk factors (i.e., lipid profiles). Additional relevant clinical trials are required to confirm these results.

TRIAL REGISTRATION

This systematic review and meta-analysis was prospectively registered in the PROSPERO database (CRD42022307396).

Sleeve Gastrectomy Improves Hepatic Glucose Metabolism by Downregulating FBXO2 and Activating the PI3K-AKT Pathway

Type 2 diabetes mellitus (T2DM), a chronic metabolic disease, is a public health concern that seriously endangers human health. Sleeve gastrectomy (SG) can relieve T2DM by improving glucose homeostasis and enhancing insulin sensitivity. However, its specific underlying mechanism remains elusive. SG and sham surgery were performed on mice fed a high-fat diet (HFD) for 16 weeks. Lipid metabolism was evaluated via histology and serum lipid analysis. Glucose metabolism was evaluated using the oral glucose tolerance test (OGTT) and insulin tolerance test (ITT). Compared with the sham group, the SG group displayed a reduction in liver lipid accumulation and glucose intolerance, and western blot analysis revealed that the AMPK and PI3K-AKT pathways were activated. Furthermore, transcription and translation levels of FBXO2 were reduced after SG. After liver-specific overexpression of FBXO2, the improvement in glucose metabolism observed following SG was blunted; however, the remission of fatty liver was not influenced by the over expression of FBXO2. Our study explores the mechanism of SG in relieving T2DM, indicating that FBXO2 is a noninvasive therapeutic target that warrants further investigation.

The influence of SLC22A3 rs543159 and rs1317652 genetic variants on metformin therapeutic efficacy in newly diagnosed patients with type 2 diabetes mellitus: 25 weeks follow-up study

BACKGROUND AND AIMS

Among anti-diabetic medications, metformin has been proven to be the preferred initial pharmacologic agent for type 2 diabetes mellitus (T2DM) treatment. Despite its safety and efficacy, the response to metformin varies between individuals. Genetic variations, especially within genes involved in pharmacokinetics and pharmacodynamics of metformin (e.g SLC22A3), have been suggested to be responsible for the observed inter-individual differences. By considering the undeniable role of organic cation transporter 3 in hepatic uptake of metformin, this study was aimed to investigate the association of rs543159 and rs1317652 variants in SLC22A3 gene with response to metformin monotherapy in newly diagnosed patients with T2DM.

METHODS

The study included 200 T2DM patients who received metformin monotherapy for 25 weeks. The patients were classified into 2 groups according to their HbA1c values: the responders (reduction in HbA1c levels by at least 1% after 25 weeks treatment with metformin) and non-responders (less than 1% reduction in HbA1c levels after 25 weeks treatment with metformin). We used tetra ARMS-PCR method to determine genotypes of the target variants.

RESULTS

For the rs543159, CA and AA genotypes were more frequent in responders as compared to non-responders (OR = 2.48; 95% CI = 1.28-4.78, P-value = 0.0057) under the dominant model. In case of rs1317652 CC and CT genotypes were more frequent in metformin responders as compared to non-responder group (OR = 2.49; 95% CI = 1.32-4.70, P-value = 0.0043) under the dominant model. Parameters such as fasting blood sugar (FBS), HbA1c, and total cholesterol (TC) levels were significantly lower in the responder group after 25 weeks of metformin monotherapy. Moreover, according to the result of multiple linear regression rs543159 and base line HbA1c values are significantly associated with response to metformin monotherapy.

CONCLUSION

Our results suggested that rs543159 and rs1317652 in SLC22A3 gene might be associated with variability in response to metformin therapy in T2DM patients.

Anti-hyperglycemic effects of Eryngium billardierei F. Delaroche extract on insulin-resistance HepG2 cells in vitro

BACKGROUND

Insulin resistance as a major problem is associated with type 2 diabetes mellitus. This study investigated the effect of Eryngium billardierei on insulin-resistance induced HepG2 cells.

METHODS AND RESULTS

MTT method was used to evaluate the viability of HepG2 cells treated with various doses of E. billardierei extract. An insulin-resistance model was established in HepG2 cells. Next, MTT assay and Acridine orange staining were performed to investigate the viability of cells in the vicinity of different concentrations of insulin, pioglitazone, and E. billardierei extract in an insulin-resistance media. The glucose uptake test was performed to select the optimal insulin concentration. Expression levels of IR, G6Pase, and PEPCK genes were assessed by real-time RT-PCR. According to obtained data, E. billardierei at concentrations of 0.5 and 1 mg/mL show no toxicity on cells. Furthermore, based on MTT assay and glucose uptake test 10^-5 mol/L insulin was chosen as the model group to induce insulin-resistance in HepG2 cells for gene expression analysis. Finally, 1 mg/mL E. billardierei not only induced no cytotoxicity but also showed an increase in the expression of IR as well as a reduction in G6Pase and PEPCK level compared to the control and model groups.

CONCLUSIONS

The obtained data indicated that 1 mg/mL E. billardierei might have an anti-insulin resistance effect on insulin-resistance HepG2 cells in vitro and could be a promising candidate with anti-hyperglycemic properties for diabetes treatments.

Treatment of Peripheral Arterial Occlusive Disease around the Globe: Malta

INTRODUCTION

Malta is a small island in the middle of the Mediterranean with a population of 514,564 inhabitants and is served by one public tertiary hospital, Mater Dei Hospital. The Vascular unit was set up in 2007. The aim of this review is to analyse the work related to peripheral arterial occlusive disease (PAOD) in Malta with an in-depth focus on amputations and revascularisation procedures since the introduction of the Vascular unit.

METHOD

Various sources of data have been interrogated to address this subject. Population and prevalence data on obesity and type II diabetes mellitus from 2003 to 2019 was obtained from the National Statistics Office, the World Health Organization, and the International Diabetes Federation, respectively. The Maltese Vascular Register (MaltaVasc), and in-hospital reports from 2003 to 2019 was used to obtain data on revascularisation procedures, major amputations and minor amputation rates in Malta.

RESULTS

Malta has one of the highest rates of obesity in Europe. In 2015, the prevalence rate was 30.6%. Similarly, data from the International Diabetes Federation Atlas showed that the prevalence rate of T2DM among adults was 14% in 2017. There was a mean of 33 open/hybrid procedures per 100,000 population (28-38, 95% confidence interval) between 2005 and 2009 and a mean of 57 endovascular procedures per 100,000 population (46-68, 95% confidence interval) during the same time-period. From 2009 to 2019, there was a mean of 16 major amputations and 78 minor amputations per 100,000 population.

CONCLUSION

A significant reduction in major amputation rates with an increase in minor amputation rates and revascularisation rates has been noted since the establishment of the vascular unit in Malta. During this period, there has been an increase in prevalence in obesity and T2DM together with an aging population.

Synergy between the pay-for-performance scheme and better physician-patient relationship might reduce the risk of retinopathy in patients with type 2 diabetes

AIMS/INTRODUCTION

This study investigated whether participation by patients with type 2 diabetes in Taiwan's pay-for-performance (P4P) program and maintaining good continuity of care (COC) with their healthcare provider reduced the likelihood of future complications, such as retinopathy.

MATERIALS AND METHODS

The analysis used longitudinal panel data for newly diagnosed type 2 diabetes from the National Health Insurance claims database in Taiwan. COC was measured annually from 2003 to 2013, and was used to allocate the patients to low, medium and high groups. Cox regression analysis was used with time-dependent (time-varying) covariates in a reduced model (with only P4P or COC), and the full model was adjusted with other covariates.

RESULTS

Despite the same significant effects of treatment at primary care, the Diabetes Complications Severity Index scores were significantly associated with the development of retinopathy. After adjusting for these, the hazard ratios for developing retinopathy among P4P participants in the low, medium and high COC groups were 0.594 (95% confidence interval [CI] 0.398-0.898, P = 0.012), 0.676 (95% CI 0.520-0.867, P = 0.0026) and 0.802 (95% CI 0.603-1.030, P = 0.1062), respectively. Thus, patients with low or median COC who participated in the P4P program had a significantly lower risk of retinopathy than those who did not.

CONCLUSIONS

Diabetes care requires a long-term relationship between patients and their care providers. Besides encouraging patients to participate in P4P programs, health authorities should provide more incentives for providers or patients to regularly survey patients' lipid profiles and glucose levels, and reward the better interpersonal relationship to prevent retinopathy.

The interaction between diabetes and climate change - A review on the dual global phenomena

INTRODUCTION

Type 2 diabetes and climate change are forefront global challenges of the 21st century. Both are on a progressive incline with intergenerational effects on the wellbeing, health and security of the population. The aim of this review was to explore the interconnection relationship between type 2 diabetes and climate change.

METHODS

A literature review search of MEDLINE publications from 2010 to March 2020 was performed. English-language articles using terms "diabetes" AND "climate change" OR "temperature change" OR "temperature rise" OR "hot temperature" OR "extreme heat" were reviewed.

RESULTS

Climate change and diabetes are interconnected through a direct and indirect pathway. Temperature changes can trigger a person's susceptibility to develop diabetes as well as impose adverse effects on those diagnosed with diabetes (such as increased incidence of hospitalization, dehydration and mortality). Both temperature extremes have been reported to lead to negative effects on diabetes. Concurrently, both phenomena have shared predisposing vectors (such as sedentary lifestyle, urbanisation, unhealthy diets) that lead to their progressive development.

CONCLUSION

A bidirectional relationship exists between type 2 diabetes and climate change. This relationship originates through a multifactorial pathway involving biological, social, environmental, geophysical and economic factors. An integrated action plan targeting the common predisposing vectors should be set up. This should support a low environmental impact while promoting equity and wellbeing.

Mapping the burden of diabetes in five small countries in Europe and setting the agenda for health policy and strategic action

BACKGROUND

Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems' reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level.

METHODS

We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies.

RESULTS

Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population.

CONCLUSIONS

Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level.

Integrative transcriptomic analysis of pancreatic islets from patients with prediabetes/type 2 diabetes

AIM

To identify new transcriptomic alterations in pancreatic islets associated with metabolic dysfunctions in people with prediabetes (PD)/type 2 diabetes (T2D).

MATERIALS AND METHODS

We collected information from public data repositories T2D related microarray datasets from pancreatic islets. We identified Differential Expressed Genes (DEGs) in non-diabetic (ND) vs people with T2D in each study. To identify relevant DEGs in T2D, we selected those that varied consistently in the different studies for further meta-analysis and functional enrichment analysis. DEGs were also evaluated at the PD stage.

RESULTS

A total of seven microarray datasets were collected and analysed to find the DEGs in each study and meta-analysis was performed with 245 ND and 96 T2D cases. We identified 55 transcriptional alterations potentially associated with specific metabolic dysfunctions in T2D. Meta-analysis showed that 87% of transcripts identified as DEGs (48 out of 55) were confirmed as having statistically significant up- or down-modulation in T2D compared to ND. Notably, nine of these DEGs have not been previously reported as dysregulated in pancreatic islets from people with T2D. Consistently, the most significantly enriched pathways were related to the metabolism and/or development/maintenance of β-cells. Eighteen of the 48 selected DEGs (38%) showed an altered expression in islets from people with PD.

CONCLUSIONS

These results provide new evidence to interpret the pathogenesis of T2D and the transition from PD to T2D. Further studies are necessary to validate its potential use for the development/implementation of efficient new strategies for the prevention, diagnosis/prognosis and treatment of T2D.

The burden of type 2 diabetes pre-and during the COVID-19 pandemic - a review

Introduction

Diabetes Mellitus is a chronic disease and a global epidemic. It is a known fact that co-morbidities, including Diabetes Mellitus, pose a higher risk of infection by COVID-19. Additionally, the outcomes following infection are far worse than in people without such co-morbities.Factors contributing to the development of type 2 diabetes mellitus (T2DM) have long been established, yet this disease still bestows a substantial global burden. The aim was to provide a comprehensive review of the burden of diabetes pre-COVID-19 and the additional impact sustained by the diabetes population and healthcare systems during the COVID-19 pandemic, while providing recommendations of how this burden can be subsided.

Methodology

Literature searches were carried out on 'Google Scholar' and 'PubMed' to identify relevant articles for the scope of this review. Information was also collected from reliable sources such as the World Health Organisation and the International Diabetes Federation.

Results

T2DM presented with economic, social and health burdens prior to COVID-19 with an significant 'Disability Adjusted Life Years' impact. Whilst people with diabetes are more susceptible to COVID-19, enforcing lockdown regulations set by the Public Health department to reduce risk of infection brought about its own challenges to T2DM management. Through recommendations and adapting to new methods of management such as telehealth, these challenges and potential consequences of mismanagement are kept to a minimum whilst safeguarding the healthcare system.

Conclusion

By understanding the challenges and burdens faced by this population both evident pre-covid and during, targeted healthcare can be provided during the COVID-19 pandemic. Furthermore, implementation of targeted action plans and recommendations ensures the care provided is done in a safe and effective environment.

Obesity population at risk of COVID-19 complications

Introduction

Global public health is challenged by two concurrent epidemics; COVID-19 and obesity. Considering the global prevalence of obesity, exploring relationships with COVID-19 are of clinical importance. The aim was to provide a comprehensive summary and recommendations on this relationship between COVID-19 and obesity.

Method

A literature search was performed to prepare a narrative review of COVID-19 and obesity.

Results

An obesity state promotes chronic inflammation, vitamin D deficiency, hinders immunity and causes mechanical lung compression. These increase susceptibilities to COVID-19 infection, complications including the requirement of invasive ventilation. Existing co-morbidities enhances these complications. Preventive measures of social distancing and self-isolation may increase stigmatisation and psychological deterrents. Hence, special recommendations targeting this vulnerable population are required.

Conclusion

The obese population is a COVID-19 vulnerable group, requiring special attention during this pandemic to avoid complications and healthcare systems burden. Lacking COVID-19 vaccination, regular physical activity and a healthy diet are recommended with attention to mental health. A prolonged quarantine duration and administration of prophylactic vitamin D may be considered.

Comparing the renoprotective effects of the antioxidants melatonin, vitamin D and vitamin E in diabetic rats

Objectives

Diabetes mellitus is associated with oxidative stress that leads to inflammation and diabetic nephropathy. This study aimed to determine the possible renoprotective effects of the antioxidants melatonin, vitamin D and vitamin E in diabetic rats.

Methods

We divided 108 albino rats into 12 groups. G1 group was fed a normal diet and did not receive any medication. G2 to G4 consisted of non-diabetic rats that were treated as follows: G2 with melatonin; G3 with vitamin E; G4 with vitamin D. Groups G5 to G12 consisted of diabetic rats that were treated as follows: G5 received no medication; G6 treated with insulin; G7 treated with melatonin; G8 treated with melatonin and insulin; G9 treated with vitamin E; G10 treated with vitamin E and insulin; G11 treated with vitamin D and G12 treated with vitamin D and insulin. Two months after treatment commenced, histological and biochemical examinations of glucose profile, oxidative stress status, renal function, homocysteine and TNF-α were performed.

Results

Total antioxidant capacity (TAC) increased significantly in groups G2, 7, 8, 10 and 11. TNF-α significantly increased in G2, but decreased in all other groups. Creatinine increased significantly in groups G5, 6, 7, 8, 9, 11 and 12. In the kidneys of the diabetic rats, thickened capillary basement membrane, diffuse mesangial sclerosis and nodular glomerulosclerosis was observed. Rats treated with melatonin showed marked improvement in these symptoms. However, in those treated with vitamin D and E, thickened capillary basement membrane and mesangial sclerosis was still present.

Conclusions

Melatonin, administered either with or without insulin had a significant biochemical antioxidant effect and histological renoprotective effect. Conversely, vitamin D and E did not appear to have any effects on the parameters measured.

A Translational In Vivo and In Vitro Metabolomic Study Reveals Altered Metabolic Pathways in Red Blood Cells of Type 2 Diabetes

Clinical parameters used in type 2 diabetes mellitus (T2D) diagnosis and monitoring such as glycosylated haemoglobin (HbA1c) are often unable to capture important information related to diabetic control and chronic complications. In order to search for additional biomarkers, we performed a pilot study comparing T2D patients with healthy controls matched by age, gender, and weight. By using ¹H-nuclear magnetic resonance (NMR) based metabolomics profiling of red blood cells (RBCs), we found that the metabolic signature of RBCs in T2D subjects differed significantly from non-diabetic controls. Affected metabolites included glutathione, 2,3-bisphophoglycerate, inosinic acid, lactate, 6-phosphogluconate, creatine and adenosine triphosphate (ATP) and several amino acids such as leucine, glycine, alanine, lysine, aspartate, phenylalanine and tyrosine. These results were validated by an independent cohort of T2D and control patients. An analysis of the pathways in which these metabolites were involved showed that energetic and redox metabolism in RBCs were altered in T2D, as well as metabolites transported by RBCs. Taken together, our results revealed that the metabolic profile of RBCs can discriminate healthy controls from T2D patients. Further research is needed to determine whether metabolic fingerprint in RBC could be useful to complement the information obtained from HbA1c and glycemic variability as well as its potential role in the diabetes management.

[The treatment of diabetes mellitus: myths and evidence]

For more than 3500 years, metabolic disorders were recognized by symptoms similar to those indicating diabetes mellitus today. Over centuries, explanations remained elusive and shed sparse light on the origin of the disease and any treatments. The poor prognosis triggered myths and misconceptions, some even lasting until today. Two hundred years ago, major advances were made in the understanding of the pathophysiology, which has led to more successful treatments. Presently, useful preventive, diagnostic, and therapeutic procedures exist. However, old myths and misconceptions still influence the treatments. This article reviews ongoing myths dealing with the genesis and treatment of diabetes and the growing evidence for improved therapies.Increasingly more studies focus on cardiovascular endpoints while considering more realistic therapeutic goals. This paves the way to polyvalent treatment concepts reaching beyond the classic glucocentric treatment concept of type 2 diabetes. The introduction of molecular medicine, the current opportunities and future prospects of new drugs, personalized medicine, and technical innovations prompt hopes and expectations for a change of paradigms in therapeutic concepts. It is quite possible that traditional and newly generated myths will accompany this development. This has to be kept in mind when developing new concepts for treatment.

Effect of herbal tea on glycemic control in patients with type 2 diabetes: Protocol for a systematic review and meta-analysis

BACKGROUND

Type 2 diabetes (T2D) is a significant health concern worldwide, and good glycemic control is the basis of avoiding disease progression. Herbal tea, as a convenient and effective medication method, has gained popularity among many diabetic patients. However, there are no systematic reviews or meta-analyses to evaluate the clinical efficacy of herbal tea on T2D.

METHODS

Four English electronic databases and 4 Chinese electronic databases were searched for randomized controlled trials (RCTs) meeting inclusion criteria; Clinical trials were searched to explore the relevant unpublished data. Fasting blood glucose and glycated hemoglobin will be measured as primary outcomes. Secondary outcomes include 2-hour postprandial blood glucose, fasting insulin, and homeostasis model assessment-insulin resistance. The heterogeneity of data will be investigated by Chi-square and I test; subgroup analysis and sensitivity analysis will be conducted to explore the sources of heterogeneity; funnel plot will be used to evaluate publication bias; finally, we will use grading of recommendations assessment, development, and evaluate system method to evaluate the quality of evidence. Merging analysis of data will be performed using Rev Man 5.3 software.

RESULTS

The results will be published in a peer-reviewed journal.

CONCLUSIONS

The systematic review will confirm whether herbal tea consumption is benefit to the glycemic control in patients with T2D.

PROSPERO REGISTRATION NUMBER

CRD42019129863.

Among Commercially Available Fruit Juices, Pomegranate Is the Most Effective Inhibitor of PMS-Trypsin Amyloid-Like Fibrils Formation

The formation of amyloid fibrils is associated with many human illnesses, such as Alzheimer’s, Huntington’s, and Parkinson’s diseases, amyotrophic lateral sclerosis, spongiform encephalitis, type 2 diabetes, and primary and secondary systemic amyloidosis. Nutrition contributes to the prevention of these diseases. The aim of our work was to look for commercially available fruit juices that can inhibit the formation of amyloid fibrils. Of the fruit juices that we examined, that of pomegranate was found to be the most effective inhibitory agent using turbidity measurements and Congo red binding assay. According to our experiments, pomegranate juice reduced the amount of PMS-trypsin amyloid-like fibrils to 3.7% at 5-fold dilution compared with the sample without pomegranate. The inhibitory effect of the pomegranate juice was concentration dependent.