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Bisong E, Jibril N, Premnath P, Buligwa E, Oboh G, Chukwuma A. Predicting high blood pressure using machine learning models in low- and middle-income countries. BMC Med Inform Decis Mak 2024; 24:234. [PMID: 39180117 PMCID: PMC11342471 DOI: 10.1186/s12911-024-02634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
Responding to the rising global prevalence of noncommunicable diseases (NCDs) requires improvements in the management of high blood pressure. Therefore, this study aims to develop an explainable machine learning model for predicting high blood pressure, a key NCD risk factor, using data from the STEPwise approach to NCD risk factor surveillance (STEPS) surveys. Nationally representative samples of adults aged 18-69 years were acquired from 57 countries spanning six World Health Organization (WHO) regions. Data harmonization and processing were performed to standardize the selected predictors and synchronize features across countries, yielding 41 variables, including demographic, behavioural, physical, and biochemical factors. Five machine learning models - logistic regression, k-nearest neighbours, random forest, XGBoost, and a fully connected neural network - were trained and evaluated at global, regional, and country-specific levels using an 80/20 train-test split. The models' performance was assessed using accuracy, precision, recall, and F1 score. Feature importance analysis identified age, weight, heart rate, waist circumference, and height as key predictors of blood pressure. Across the 57 countries studied, model performances varied considerably, with accuracy ranging from as low as 58.96% in some models for specific countries to as high as 81.41% in others, underscoring the need for region and country-specific adaptations in modelling approaches. The explainable model offers an opportunity for population-level screening and continuous risk assessment in resource-limited settings.
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Affiliation(s)
| | | | - Preethi Premnath
- Department of Government Enablement, Abu Dhabi, United Arab Emirates
| | | | | | - Adanna Chukwuma
- World Bank, Washington, DC, 20433, USA.
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, 20433, USA.
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Lamprou S, Koletsos N, Zografou I, Lazaridis A, Mintziori G, Trakatelli CM, Kotsis V, Gkaliagkousi E, Doumas M, Triantafyllou A. Skin Microvascular Dysfunction in Type 2 Diabetes Mellitus Using Laser Speckle Contrast Analysis and Association with Carotid Intima-Media Thickness. J Clin Med 2024; 13:4957. [PMID: 39201096 PMCID: PMC11355809 DOI: 10.3390/jcm13164957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Background: It is established that diabetes mellitus (DM) is characterized by increased cardiovascular risk associated with subclinical atherosclerosis as well as microvascular alterations. Laser speckle contrast analysis (LASCA) is an innovative, non-invasive method for assessing skin microvascular function. Objectives: We sought to assess skin microvascular function in patients with type 2 DM and matched controls. Methods: Consecutive patients with DM and individuals matched for age, sex and BMI were included in the study. Skin microvascular perfusion was assessed, using LASCA, during baseline, a 5 min occlusion period and a 5 min reperfusion period. Carotid intima-media thickness (cIMT) was measured as a surrogate marker of macrocirculation. Results: In total, 18 patients with DM and 22 in the control group were enrolled. No statistically significant differences were observed in baseline flux, peak flux and percentage decrease during arterial occlusion. During reperfusion, individuals with DM exhibited a smaller peak magnitude compared to controls (147.0 ± 64.7% vs. 189.4 ± 46.0%, respectively; p < 0.05). Moreover, cIMT was higher in patients with DM compared to controls (0.68 ± 0.09 mm vs. 0.60 ± 0.08 mm, respectively, p < 0.01) and was negatively correlated with skin microvascular reactivity in the univariate analysis. In the multivariate analysis, glucose and office systolic blood pressure levels remained significant predictors of microvascular reactivity. Conclusions: Our study shows that patients with type 2 DM exhibit impaired skin microvascular function compared to controls. Furthermore, glucose levels and blood pressure play a key role in microvascular dysfunction. However, additional studies are needed to address the clinical significance of early microvascular changes in DM.
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Affiliation(s)
- Stamatina Lamprou
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Nikolaos Koletsos
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Ioanna Zografou
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (I.Z.); (M.D.)
| | - Antonios Lazaridis
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Christina Maria Trakatelli
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Vasilios Kotsis
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Eugenia Gkaliagkousi
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (I.Z.); (M.D.)
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (S.L.); (A.L.); (C.M.T.); (V.K.); (E.G.); (A.T.)
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Alsharairi NA. A Review of Experimental Studies on Natural Chalcone-Based Therapeutic Targeting of Genes and Signaling Pathways in Type 2 Diabetes Complications. Genes (Basel) 2024; 15:942. [PMID: 39062722 PMCID: PMC11276432 DOI: 10.3390/genes15070942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetes mellitus type 2 (T2DM) is a common chronic condition that presents as unsettled hyperglycemia (HG) and results from insulin resistance (IR) and β-cell dysfunction. T2DM is marked by an increased risk of microvascular and macrovascular complications, all of which can be the cause of increasing mortality. Diabetic nephropathy (DNE), neuropathy (DNU), and retinopathy (DR) are the most common complications of diabetic microangiopathy, while diabetic cardiomyopathy (DCM) and peripheral vascular diseases are the major diabetic macroangiopathy complications. Chalcones (CHs) are in the flavonoid family and are commonly found in certain plant species as intermediate metabolites in the biosynthesis of flavonoids and their derivatives. Natural CHs with different substituents exert diverse therapeutic activities, including antidiabetic ones. However, the therapeutic mechanisms of natural CHs through influencing genes and/or signaling pathways in T2DM complications remain unknown. Therefore, this review summarizes the existing results from experimental models which highlight the mechanisms of natural CHs as therapeutic agents for T2DM complications.
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Affiliation(s)
- Naser A Alsharairi
- Heart, Mind and Body Research Group, Griffith University, Gold Coast, QLD 4222, Australia
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Jeddi S, Bahadoran Z, Mirmiran P, Kashfi K, Ghasemi A. Impaired vascular relaxation in type 2 diabetes: A systematic review and meta-analysis. EXCLI JOURNAL 2024; 23:937-959. [PMID: 39253535 PMCID: PMC11382252 DOI: 10.17179/excli2024-7330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/01/2024] [Indexed: 09/11/2024]
Abstract
Type 2 diabetes (T2D) significantly increases the risk of vascular complications (12-32 %), which are a major cause of death (over 50 %) in T2D patients. In T2D, both endothelial (ET) and vascular smooth muscle (VSM) cells are impaired, which act as independent risk factors for cardiovascular disease. Thus, the question of this systematic review and meta-analysis is: Do ET-dependent and -independent VSM relaxation impair in T2D? We systematically searched PubMed and Scopus databases until March 2024; 44 eligible clinical trial studies (68, 16, 30, and 50 study arms for acetylcholine (ACh), methacholine (MTH), sodium nitroprusside (SNP), and glyceryl trinitrate (GTN)) published were included. ET-dependent VSM relaxation in response to ACh (overall ES = -28.9 %, 95 % CI: -35.2, -22.7; p<0.001) and MTH (overall ES = -55.3 %, 95 % CI: -63.6, -47.1; p<0.001) decreased in T2D patients compared to controls. ET-independent VSM relaxation in response to SNP (overall ES = -17.2 %, 95 % CI: -35.2, -22.7; p<0.001) and GTN (overall ES = -63.2 %, 95 % CI: -81.0, -45.5; p<0.001) decreased in T2D patients compared to controls. Our meta-analysis showed reductions in both ET-dependent (~40 %) and ET-independent (~25 %) VSM relaxation. The decrease was more pronounced for MTH (~55 %) compared to ACh (~30 %) and for GTN (~63 %) compared to SNP (~17 %). These findings suggest that dysfunction of both ET and VSM contributes to impaired VSM relaxation in T2D patients. See also the graphical abstract(Fig. 1).
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Affiliation(s)
- Sajad Jeddi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences,Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences,Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosrow Kashfi
- Department of Molecular, Cellular, and Biomedical Sciences, Sophie Davis School of Biomedical Education, City University of New York School of Medicine, NY, USA
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Singhal K, Taywade M, Patro BK, Pal D, Behera P, Mishra AK. Effectiveness of "Rule of Seven" intervention in improving control status in diabetes mellitus protocol of a randomized controlled trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:180. [PMID: 39268440 PMCID: PMC11392247 DOI: 10.4103/jehp.jehp_1249_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/03/2023] [Indexed: 09/15/2024]
Abstract
BACKGROUND We developed the "rule of seven" intervention because different targets related to diabetes control can somehow be calculated by multiplication of seven. This study aimed to evaluate the effectiveness of the "rule of seven" in improving glycemic control in patients diagnosed with diabetes by measuring fasting plasma glucose and 2 hours postprandial plasma glucose. MATERIALS AND METHODS This two-arm randomized controlled trial will compare the effectiveness of the "rule of seven" intervention in achieving glycemic control in diabetes mellitus patients. The patients in the control arm will receive routine patient counseling related to diabetes mellitus. Patients registered with the noncommunicable disease (NCD) clinics of All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Community Health Center (CHC) Tangi, and CHC Mendhasala will be recruited consecutively during clinic hours after fulfilling eligibility criteria and obtaining written informed consent. The sample size was estimated as 426 in each group. The ethical permission was obtained from the Institutional Ethics Committee (IEC) and prospectively registered in the Clinical Trial Registry of India (CTRI/2023/07/055522). DISCUSSION After the intervention, we will find out the change in knowledge regarding parameters related to glycemic status; discover the change in biochemical parameters after 1, 3, and 6 months; and conclude whether those changes are statistically significant or not.
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Affiliation(s)
- Kritika Singhal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manish Taywade
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Binod K Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debkumar Pal
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Priyamadhaba Behera
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Abhisek K Mishra
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Thomson AM, Rioux BV, Hrubeniuk TJ, Bouchard DR, Sénéchal M. Does type 2 diabetes duration influence the effectiveness of an aerobic exercise intervention: Results from the INTENSITY study. PLoS One 2024; 19:e0304341. [PMID: 38843234 PMCID: PMC11156316 DOI: 10.1371/journal.pone.0304341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Studies suggest that longer durations of T2DM increase the risk of T2DM complications and premature mortality. However, whether T2DM duration impacts the efficacy of an aerobic exercise intervention is unclear. OBJECTIVE The purpose of this study was: 1) to compare changes in body composition, cardiorespiratory fitness, and glycemia between individuals with short- and long-duration T2DM after aerobic exercise and 2) to determine whether these changes were associated with changes in glycemia by T2DM duration. METHODS A secondary analysis of the INTENSITY study (NCT03787836), including thirty-four adults (≥19 years) with T2DM who participated in 28 weeks of aerobic exercise training for 150 minutes per week at a moderate-to-vigorous intensity (4.5 to 6.0 metabolic equivalents (METs)). Using pre-established cut-points, participants were categorized into two groups 1) short-duration T2DM (<5 years) or 2) long-duration T2DM (≥5 years). Glycemia was measured by glycated hemoglobin (HbA1c), body composition by BodPod, and cardiorespiratory fitness by a measure of peak oxygen consumption (VO2peak). All measurements were performed at baseline, 16 weeks, and 28 weeks. RESULTS Participants in the short-duration T2DM group experienced decreases in fat mass (kg) (p = 0.03), HbA1c (p = 0.05), and an increased relative VO2peak (p = 0.01). Those with long-duration T2DM experienced decreases in fat mass (kg) (p = 0.02) and HbA1c (p <0.001) and increased fat-free mass (p = 0.02). No significant differences were observed between groups in any outcomes. Changes in fat mass (r = 0.54, p = 0.02), and body fat percentage (r = 0.50, p = 0.02) were significantly associated with the change in HbA1c in those with a long-duration T2DM only. CONCLUSION Our results suggest T2DM duration did not differently impact the efficacy of a 28-week aerobic exercise intervention. However, changes in body composition were associated with better glycemia in individuals with longer T2DM duration only.
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Affiliation(s)
- Amy M. Thomson
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Brittany V. Rioux
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Travis J. Hrubeniuk
- CancerCare Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Danielle R. Bouchard
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Feng X, Yang X, Zhong Y, Cheng X. The role of ncRNAs-mediated pyroptosis in diabetes and its vascular complications. Cell Biochem Funct 2024; 42:e3968. [PMID: 38439590 DOI: 10.1002/cbf.3968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Abstract
Over the past decade, the prevalence of diabetes has increased significantly worldwide, leading to an increase in vascular complications of diabetes (VCD), such as diabetic cardiomyopathy (DCM), diabetic nephropathy (DN), and diabetic retinopathy (DR). Noncoding RNAs (ncRNAs), such as microRNAs (miRNAs), long Noncoding RNAs (lncRNAs), and circular RNAs (circRNAs), play a key role in cellular processes, including the pathophysiology of diabetes and VCD via pyroptosis. ncRNAs (e.g., miR-17, lnc-MEG3, and lnc-KCNQ1OT1) can regulate pyroptosis in pancreatic β cells. Some ncRNAs are involved in VCD progression. For example, miR-21, lnc-KCNQ1OT1, lnc-GAS5, and lnc-MALAT1 were reported in DN and DCM, and lnc-MIAT was identified in DCM and DR. Herein, this review aimed to summarize recent research findings related to ncRNAs-mediated pyroptosis at the onset and progression of diabetes and VCD.
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Affiliation(s)
- Xinyao Feng
- Hunan Key laboratory of Vascular Biology and Translational Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoxu Yang
- Hunan Key laboratory of Vascular Biology and Translational Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Yancheng Zhong
- Hunan Key laboratory of Vascular Biology and Translational Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Xihua Cheng
- Hunan Key laboratory of Vascular Biology and Translational Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China
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Rabbani N, Thornalley PJ. Hexokinase-linked glycolytic overload and unscheduled glycolysis in hyperglycemia-induced pathogenesis of insulin resistance, beta-cell glucotoxicity, and diabetic vascular complications. Front Endocrinol (Lausanne) 2024; 14:1268308. [PMID: 38292764 PMCID: PMC10824962 DOI: 10.3389/fendo.2023.1268308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024] Open
Abstract
Hyperglycemia is a risk factor for the development of insulin resistance, beta-cell glucotoxicity, and vascular complications of diabetes. We propose the hypothesis, hexokinase-linked glycolytic overload and unscheduled glycolysis, in explanation. Hexokinases (HKs) catalyze the first step of glucose metabolism. Increased flux of glucose metabolism through glycolysis gated by HKs, when occurring without concomitant increased activity of glycolytic enzymes-unscheduled glycolysis-produces increased levels of glycolytic intermediates with overspill into effector pathways of cell dysfunction and pathogenesis. HK1 is saturated with glucose in euglycemia and, where it is the major HK, provides for basal glycolytic flux without glycolytic overload. HK2 has similar saturation characteristics, except that, in persistent hyperglycemia, it is stabilized to proteolysis by high intracellular glucose concentration, increasing HK activity and initiating glycolytic overload and unscheduled glycolysis. This drives the development of vascular complications of diabetes. Similar HK2-linked unscheduled glycolysis in skeletal muscle and adipose tissue in impaired fasting glucose drives the development of peripheral insulin resistance. Glucokinase (GCK or HK4)-linked glycolytic overload and unscheduled glycolysis occurs in persistent hyperglycemia in hepatocytes and beta-cells, contributing to hepatic insulin resistance and beta-cell glucotoxicity, leading to the development of type 2 diabetes. Downstream effector pathways of HK-linked unscheduled glycolysis are mitochondrial dysfunction and increased reactive oxygen species (ROS) formation; activation of hexosamine, protein kinase c, and dicarbonyl stress pathways; and increased Mlx/Mondo A signaling. Mitochondrial dysfunction and increased ROS was proposed as the initiator of metabolic dysfunction in hyperglycemia, but it is rather one of the multiple downstream effector pathways. Correction of HK2 dysregulation is proposed as a novel therapeutic target. Pharmacotherapy addressing it corrected insulin resistance in overweight and obese subjects in clinical trial. Overall, the damaging effects of hyperglycemia are a consequence of HK-gated increased flux of glucose metabolism without increased glycolytic enzyme activities to accommodate it.
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Affiliation(s)
| | - Paul J. Thornalley
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Raut SS, Acharya S, Deolikar V, Mahajan S. Navigating the Frontier: Emerging Techniques for Detecting Microvascular Complications in Type 2 Diabetes Mellitus: A Comprehensive Review. Cureus 2024; 16:e53279. [PMID: 38435878 PMCID: PMC10905308 DOI: 10.7759/cureus.53279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This review comprehensively explores emerging techniques for detecting microvascular complications in Type 2 Diabetes Mellitus (T2DM), addressing the critical need for advancements in early detection and management. As T2DM continues to rise globally, microvascular complications, including retinopathy, nephropathy, and neuropathy, contribute significantly to the morbidity and mortality associated with the condition. The review synthesizes key findings, revealing various emerging technologies, from advanced imaging modalities to genomic and proteomic approaches. It underscores the potential for personalized medicine, emphasizing the importance of tailoring diagnostic strategies to individual patient profiles. Challenges, including the lack of standardized criteria and issues related to patient adherence, highlight the necessity for collaborative efforts. The conclusion issues a call to action, advocating for enhanced collaboration, increased research investment, patient empowerment through education, and seamless integration of emerging diagnostic techniques into routine clinical care. The review envisions a transformative shift in detecting and managing microvascular complications in T2DM, ultimately improving patient outcomes and contributing to a healthier future for individuals affected by this prevalent metabolic disorder.
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Affiliation(s)
- Sarang S Raut
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vinit Deolikar
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Satish Mahajan
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Firima E, Gonzalez L, Khan MA, Manthabiseng M, Sematle MP, Bane M, Khomolishoele M, Leisa I, Retselisitsoe L, Burkard T, Seelig E, Lee T, Chammartin F, Gupta R, Leigh B, Weisser M, Amstutz A, Labhardt ND. High Rates of Undiagnosed Target Organ Damage Among Adults with Elevated Blood Pressure or Diabetes Mellitus in a Community-Based Survey in Lesotho. J Epidemiol Glob Health 2023; 13:857-869. [PMID: 37883005 PMCID: PMC10686968 DOI: 10.1007/s44197-023-00158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Prevalence of elevated blood pressure (BP) and diabetes mellitus (DM) is increasing in sub-Saharan Africa. Data on target organ damage such as retinopathy, left ventricular hypertrophy (LVH), renal impairment and peripheral neuropathy (PN) among persons with elevated BP and/or DM in sub-Saharan Africa remain scarce. AIM To determine at community-level the prevalence of retinopathy, LVH, renal impairment, and PN among adults with elevated BP and/or DM, and assess the association of elevated BP and/or DM with target organ damage in Lesotho. METHODS During a household-based survey, a sub-sample of adults with elevated BP (≥ 140/90 mmHg) and/or DM (glycosylated hemoglobin ≥ 6.5%), as well as comparators (BP < 140/90 mmHg, HbA1c < 6.5%) were screened for retinopathy, LVH, renal impairment, and PN. We used multivariable logistic regression for inferential analysis. RESULTS Out of 6108 participants screened during the survey, 420 with elevated BP only, 80 with DM only, 61 with elevated BP and DM, and 360 comparators were assessed for target organ damage. Among those with elevated BP, and among those with DM with or without elevated BP, prevalence of retinopathy was 34.6% (89/257) and 14.4% (15/104); renal impairment was 45.0% (156/347) and 42.4% (56/132), respectively. Among those with elevated BP, 2.3% (7/300) and 65.7% (224/341) had LVH and left ventricular concentric remodeling, respectively. PN, only assessed among those with DM, was present in 32.6% (42/129). Elevated BP was associated with increased odds of retinopathy (aOR, 19.13; 95% CI, 8.52-42.94; P < 0.001) and renal impairment (aOR, 1.80; 95% CI, 1.27-2.55; P = 0.001). Presence of both elevated BP and DM was associated with an increased odds of retinopathy (aOR, 16.30; 95%CI, 5.69-46.68; P < 0.001), renal impairment (aOR, 2.55; 95% CI, 1.35-4.81; P = 0.004), and PN (aOR, 2.13; 95% CI, 1.04-4.38; P = 0.040). CONCLUSION We found a high prevalence of undiagnosed target organ damage among adults with elevated BP and/or DM during community-based screening. These findings emphasize the importance of regular prevention and screening activities in this setting.
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Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Lucia Gonzalez
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | | | | | | | | | | | - Thilo Burkard
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Eleonara Seelig
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Tristan Lee
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Bailah Leigh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Maja Weisser
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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11
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Anson M, Zhao SS, Essa H, Austin P, Ibarburu GH, Lip GYH, Alam U. Metformin and SGLT2i as First-line Combination Therapy in Type 2 Diabetes: A Real-world Study With a Focus on Ethnicity. Clin Ther 2023; 45:1259-1265. [PMID: 37648574 DOI: 10.1016/j.clinthera.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Suboptimal glucose control early in the diagnosis of type 2 diabetes (T2D) is strongly associated with subsequent morbidity and mortality, termed the 'glycaemic legacy'. Additionally, it is known that Asian and Black individuals are at increased risk of T2D, and its associated complications compared to their White counterparts. However, ethnicity does not currently feature in the treatment algorithm of T2D, unlike in other cardiovascular disease states such as hypertension. We therefore sought to evaluate the real-world impact of early intensive treatment with combination therapy on cardiorenal outcomes compared to standard treatment in T2D, with a focus on ethnicity. METHODS We performed a retrospective cohort study of all patients aged 18 or over with T2D using the TriNetX platform. TriNetX is a global collaborative network providing access to real time, anonymised medical records. We included patients who were initiated with Metformin and an SGLT2i within one month of diagnosis of T2D and compared this cohort with individuals who received Metformin only for a period of at least 1 year. We evaluated cardiovascular and renal outcomes at three years and stratified by ethnicity. We excluded individuals with a personal history of an outcome of interest. FINDINGS We identified 49,651 individuals with T2D who were treated with Metformin and an SGLT2i and 1,028,806 patients with T2D who were treated with Metformin alone. A total of 98,094 individuals were included in the core analysis. The Metformin only group had a greater risk of mortality (RR 1.44, [95% CI 1.34-1.55], P<0.0001), CKD (RR 1.10, [95% CI 1.04-1.16], P = 0.0004), diabetic nephropathy (RR 1.06, [95% CI 1.01-1.12], P = 0.0239), heart failure (RR 1.13, [95% CI 1.07-1.21], P < 0.0001) and hospitalisation (RR 1.24, [95% CI 1.21-1.27], P < 0.0001) compared to individuals treated with Metformin and SGLT2i. Black individuals had a reduced risk of mortality (RR 0.71, [95% CI 0.55-0.92], P = 0.0099) and IHD (RR 0.73, [95% CI 0.64-0.84], P < 0.0001) compared to White individuals. Asian individuals had a reduced risk of heart failure (RR 0.61, [95% CI 0.41-0.91], P = 0.0134) and hospitalisation (RR 0.76, [95% CI 0.66-0.87], P = 0.0001) compared to White individuals. IMPLICATIONS Initial combination treatment within the first year of T2D diagnosis confers favourable cardio-metabolic outcomes when compared to standard therapy, even in patients without established cardiovascular disease. Black and Asian individuals in particular demonstrate a greater degree of benefit compared to White individuals. Further prospective studies with a focus on ethnicity are now required to validate these findings.
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Affiliation(s)
- Matthew Anson
- Diabetes & Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Hani Essa
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | | | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; Danish Centre for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Uazman Alam
- Diabetes & Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
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12
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Shakya P, Shrestha A, Bajracharya M, Shrestha A, Kulseng BE, Karmacharya BM, Shrestha S, Das S, Shrestha IB, Barun K, Shrestha N, Skovlund E, Sen A. Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal. BMJ Nutr Prev Health 2023; 6:253-263. [PMID: 38264365 PMCID: PMC10800278 DOI: 10.1136/bmjnph-2023-000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024] Open
Abstract
Background Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes. Method A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure. Results In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI -0.074 to 0.104) between the intervention arm and the control arm, while it was -0.077 (95% CI -0.152 to -0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was -1.6 kg (95% CI -3.1 to -0.1). A significantly lower grain consumption was found in intervention arm (-39 g/day, 95% CI -65 to -14) compared with the control arm at postintervention assessment. Conclusion Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention. Trial registration number NCT04074148.
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Affiliation(s)
- Pushpanjali Shakya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute for Implementation Science and Health, Kathmandu, Bagmati Province, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Monish Bajracharya
- Department of Business and IT, University of South-Eastern Norway, Bo, Norway
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati Province, Nepal
| | - Bård Erik Kulseng
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Biraj Man Karmacharya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Smriti Shrestha
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
- ECA College of Health Sciences, Sydney, New South Wales, Australia
| | - Seema Das
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Ishwori Byanju Shrestha
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
| | - Krishnaa Barun
- Research and Development Division/Department of Community Programs, Dhulikhel Hospital, Dhulikhel, Bagmati Province, Nepal
- Department of Public Health, Nobel College, Pokhara University, Kathmandu, Bagmati Province, Nepal
| | - Nistha Shrestha
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati Province, Nepal
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal Ministry of Health and Population, Kathmandu, Bagmati Province, Nepal
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Centre for Oral Health Services and Research (TkMidt), Trondheim, Norway
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13
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Li C, Shen J, Jing X, Zhang K, Liu L, Wang Y, Zhang H, Sun J. Mechanism of action of Huangbaichen Sanwei formulation in treating T2DM based on network pharmacology and molecular docking. Medicine (Baltimore) 2023; 102:e36146. [PMID: 37986298 PMCID: PMC10659618 DOI: 10.1097/md.0000000000036146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
Huangbaichen Sanwei formulation (HBCS) has been reported to have a good hypoglycemic effect, but its pharmacological mechanism of action remains unclear. We used network pharmacology and molecular docking to explore the potential mechanism of action of HBCS against type-2 diabetes mellitus (T2DM). Fifty-five active components from HBCS interfered with T2DM. Twenty-five core targets, such as AKT1, INS, INSR, MAPK1 were identified. Enrichment analyses showed that HBCS was involved mainly including insulin receptor signaling pathway, extracellular region, and insulin-like growth factor receptor binding and other biological processes; common targets had roles in treating T2DM by regulating diabetic cardiomyopathy and insulin resistance. Molecular docking verified that components combined with core targets. HBCS play a part in treating T2DM through multiple components and targets at the molecular level, which lays a theoretical foundation for research using HBCS to treat T2DM. The components, predicted targets, and T2DM targets of HBCS were searched through databases, and common targets were determined. Further screening of the core targets was conducted through the establishment of a protein -protein interaction network. The core targets were analyzed by Gene Ontology (GO) annotation utilizing the DAVID platform. And the enrichment of signaling pathways was explored by employing the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Cytoscape 3.9.1 was employed to construct a "TCM-components-core target-pathway" network. Autodock Vina was used to dock molecules to compare the binding activity of active molecules with targets.
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Affiliation(s)
- Chunnan Li
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Jiaming Shen
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Xiaolong Jing
- College of pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kaiyue Zhang
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Lu Liu
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Yuelong Wang
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Hui Zhang
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Jiaming Sun
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
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14
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Gerber F, Gupta R, Lejone TI, Tahirsylaj T, Lee T, Kohler M, Haldemann MI, Räber F, Chitja M, Manthabiseng M, Khomolishoele M, Mota M, Bane M, Sematle PM, Makabateng R, Mphunyane M, Phaaroe S, Basler D, Kindler K, Seelig E, Briel M, Chammartin F, Labhardt ND, Amstutz A. Community-based type 2 diabetes care by lay village health workers in rural Lesotho: protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC). Trials 2023; 24:688. [PMID: 37875943 PMCID: PMC10598965 DOI: 10.1186/s13063-023-07729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) poses a growing public health burden, especially in low- and middle-income countries (LMICs). Task-shifting to lay village health workers (VHWs) and the use of digital clinical decision support systems (CDSS) are promising approaches to tackle the current T2D care gap in LMICs. However, evidence on the effectiveness of lay worker-led T2D care models, in which VHWs initiate and monitor drug treatment in addition to community-based screening and referral services, is lacking. METHODS We are conducting a cluster-randomized trial nested within the Community-Based Chronic Disease Care Lesotho (ComBaCaL) cohort study (NCT05596773) using the trial within cohort (TwiC) design to assess the effectiveness of a VHW-led, CDSS-assisted T2D care model in rural Lesotho. Participants are non-pregnant members of the ComBaCaL cohort study with T2D. The ComBaCaL cohort study is conducted in approximately 100 villages in two rural districts in Lesotho and is managed by trained and supervised VHWs. In intervention villages, VHWs offer a community-based T2D care package including lifestyle counselling, first-line oral antidiabetic, lipid-lowering, and antiplatelet treatment guided by a tablet-based CDSS to participants who are clinically eligible, as well as treatment support to participants who prefer or clinically require facility-based T2D care. In control clusters, all participants will be referred to a health facility for T2D management. The primary endpoint is the mean glycosylated haemoglobin (HbA1c) 12 months after enrolment. Secondary endpoints include the 10-year risk for cardiovascular events estimated using the World Health Organization risk prediction tool. DISCUSSION The trial was launched on May 13, 2023, and has enrolled 226 participants at the date of submission (October 6, 2023). To our knowledge, the trial is the first to assess task-shifting of T2D care to VHWs at the community level, including the prescription of first-line antidiabetic, lipid-lowering, and antiplatelet medication in sub-Saharan Africa, and will thus provide the missing evidence on the effectiveness of such a T2D care model in this setting. The study is operating within the established Lesotho VHW programme. Similar community health worker programmes which exist across sub-Saharan Africa may benefit from the findings. TRIAL REGISTRATION ClinicalTrials.gov NCT05743387. Registered on February 24 2023.
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Affiliation(s)
- Felix Gerber
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
| | | | - Thabo Ishmael Lejone
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thesar Tahirsylaj
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Tristan Lee
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Maurus Kohler
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria Ines Haldemann
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabian Räber
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | - Dave Basler
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Business, Economics and Informatics, University of Zurich, Zürich, Switzerland
| | - Kevin Kindler
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Business, Economics and Informatics, University of Zurich, Zürich, Switzerland
| | - Eleonora Seelig
- University of Basel, Basel, Switzerland
- Clinic of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Frédérique Chammartin
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alain Amstutz
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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15
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Tawhari MH, Aldahash RA, Almutairi FM, Albogami MS, Rokon AE, Alsomali FA, Alanazi KH, Alshehri AA, Almutairi TH, Alharbi AD, Alghamdi RM, Tawhari IH, Salih SAB. Impact of sodium-glucose cotransporter-2 inhibitors on kidney outcomes in type 2 diabetes: A tertiary center experience. J Family Community Med 2023; 30:267-272. [PMID: 38044971 PMCID: PMC10688587 DOI: 10.4103/jfcm.jfcm_111_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is a complication of chronic hyperglycemia associated with diabetes mellitus (DM). Several studies have demonstrated the positive impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on kidney outcomes. The objective of the study was to evaluate the effects of dapagliflozin, an SGLT2 inhibitor, on kidney outcomes in Saudi patients with type 2 DM. MATERIALS AND METHODS Study included all Saudi patients with type 2 DM who visited our center from August 1, 2021, to July 31, 2022, and had been on dapagliflozin for at least 3 months. Data was abstracted through chart review for all patients included in the study. Paired t-test or Wilcoxon signed-rank test were used to compare the results before and after treatment for continuous variables and the McNemar test was used to compare the results for categorical data. RESULTS Study included 184 Saudi patients with type 2 diabetes with a mean age of 61.32 years (SD=9.37). Dapagliflozin 10 mg/day significantly reduced hemoglobin A1C (HbA1C) from a mean (SD) of 9.00 to 8.40 (P < 0.001). Among a subgroup of patients with significant proteinuria (n = 83), dapagliflozin significantly reduced ACR from a median of 93.1 to 64.9 mg/g (P = 0.001). Following treatment, the estimated glomerular filtration rate improved from a mean of 69.83 to 71.68 mL/min and the mean arterial pressure (MAP) fell from 90.03 to 89.06 mmHg, both were not statistically significant. Despite a statistically insignificant increase in the episodes of urinary tract infections (UTIs), the hospitalization rate declined. No episodes of amputations or ketoacidosis occurred during the study period. CONCLUSION SGLT2 inhibitors had beneficial effects among Saudi patients with type 2 diabetes by improving diabetic control and lowering proteinuria. Dapagliflozin did not result in significant harm, including UTIs, amputations, and ketoacidosis.
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Affiliation(s)
- Mohammed H. Tawhari
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Medicine, Division of Nephrology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Raed A. Aldahash
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Medicine, Division of Endocrinology, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal M. Almutairi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mahdi S. Albogami
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmad E. Rokon
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal A. Alsomali
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khaled H. Alanazi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman A. Alshehri
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Talal H. Almutairi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman D. Alharbi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rayan M. Alghamdi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ibrahim H. Tawhari
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Salih A. Bin Salih
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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16
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Islam MS, Cai L, Horowitz M. Recent therapeutic targets for the prevention and management of diabetic complications. World J Diabetes 2023; 14:1330-1333. [PMID: 37771330 PMCID: PMC10523234 DOI: 10.4239/wjd.v14.i9.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
Diabetes and associated complications represent major global public health issues which are associated with impaired quality of life and premature death. Although some diabetic complications have decreased in the developed world, the majority are still prevalent, with an increasing trend in the developing world. Currently used therapies are mainly 'glucocentric', focusing on the optimization of glycemic control to prevent, delay or manage diabetes-associated complications- other common comorbidities, such as dyslipidemia and hypertension are often underestimated. Although a number of novel therapeutic approaches have been reported recently, some of them have not received comparable attention in relation to either further studies or potential clinical implementation. This editorial briefly discusses some recent therapeutic approaches to the prevention and management of diabetes and its associated complications, as well as potential directions for future research and development in this area.
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Affiliation(s)
- Md Shahidul Islam
- Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Durban 4000, KwaZulu-Natal, South Africa
| | - Lu Cai
- Pediatric Research Institute, University of Louisville, Louisville, KY 40202, United States
| | - Michael Horowitz
- Department of Medicine, University of Adelaide, Adelaide 5005, Australia
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Luo X, Sun J, Pan H, Zhou D, Huang P, Tang J, Shi R, Ye H, Zhao Y, Zhang A. Establishment and health management application of a prediction model for high-risk complication combination of type 2 diabetes mellitus based on data mining. PLoS One 2023; 18:e0289749. [PMID: 37552706 PMCID: PMC10409378 DOI: 10.1371/journal.pone.0289749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
In recent years, the prevalence of T2DM has been increasing annually, in particular, the personal and socioeconomic burden caused by multiple complications has become increasingly serious. This study aimed to screen out the high-risk complication combination of T2DM through various data mining methods, establish and evaluate a risk prediction model of the complication combination in patients with T2DM. Questionnaire surveys, physical examinations, and biochemical tests were conducted on 4,937 patients with T2DM, and 810 cases of sample data with complications were retained. The high-risk complication combination was screened by association rules based on the Apriori algorithm. Risk factors were screened using the LASSO regression model, random forest model, and support vector machine. A risk prediction model was established using logistic regression analysis, and a dynamic nomogram was constructed. Receiver operating characteristic (ROC) curves, harrell's concordance index (C-Index), calibration curves, decision curve analysis (DCA), and internal validation were used to evaluate the differentiation, calibration, and clinical applicability of the models. This study found that patients with T2DM had a high-risk combination of lower extremity vasculopathy, diabetic foot, and diabetic retinopathy. Based on this, body mass index, diastolic blood pressure, total cholesterol, triglyceride, 2-hour postprandial blood glucose and blood urea nitrogen levels were screened and used for the modeling analysis. The area under the ROC curves of the internal and external validations were 0.768 (95% CI, 0.744-0.792) and 0.745 (95% CI, 0.669-0.820), respectively, and the C-index and AUC value were consistent. The calibration plots showed good calibration, and the risk threshold for DCA was 30-54%. In this study, we developed and evaluated a predictive model for the development of a high-risk complication combination while uncovering the pattern of complications in patients with T2DM. This model has a practical guiding effect on the health management of patients with T2DM in community settings.
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Affiliation(s)
- Xin Luo
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jijia Sun
- Department of Mathematics and Physics, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong Pan
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dian Zhou
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Huang
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingjing Tang
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Shi
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong Ye
- Department of Mathematics and Physics, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Zhao
- Department of Mathematics and Physics, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - An Zhang
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Bahadoran Z, Mirmiran P, Kashfi K, Ghasemi A. Vascular nitric oxide resistance in type 2 diabetes. Cell Death Dis 2023; 14:410. [PMID: 37433795 PMCID: PMC10336063 DOI: 10.1038/s41419-023-05935-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
Vascular nitric oxide (NO•) resistance, manifested by an impaired vasodilator function of NO• in both the macro- and microvessels, is a common state in type 2 diabetes (T2D) associated with developing cardiovascular events and death. Here, we summarize experimental and human evidence of vascular NO• resistance in T2D and discuss its underlying mechanisms. Human studies indicate a ~ 13-94% decrease in the endothelium (ET)-dependent vascular smooth muscle (VSM) relaxation and a 6-42% reduced response to NO• donors, i.e., sodium nitroprusside (SNP) and glyceryl trinitrate (GTN), in patients with T2D. A decreased vascular NO• production, NO• inactivation, and impaired responsiveness of VSM to NO• [occurred due to quenching NO• activity, desensitization of its receptor soluble guanylate cyclase (sGC), and/or impairment of its downstream pathway, cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG)] are the known mechanisms underlying the vascular NO• resistance in T2D. Hyperglycemia-induced overproduction of reactive oxygen species (ROS) and vascular insulin resistance are key players in this state. Therefore, upregulating vascular NO• availability, re-sensitizing or bypassing the non-responsive pathways to NO•, and targeting key vascular sources of ROS production may be clinically relevant pharmacological approaches to circumvent T2D-induced vascular NO• resistance.
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Affiliation(s)
- Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosrow Kashfi
- Department of Molecular, Cellular, and Biomedical Sciences, Sophie Davis School of Biomedical Education, City University of New York School of Medicine, New York, NY, 10031, USA
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Martiniakova M, Kovacova V, Mondockova V, Svik K, Londzin P, Folwarczna J, Soltesova Prnova M, Stefek M, Omelka R. The Effects of Prolonged Treatment with Cemtirestat on Bone Parameters Reflecting Bone Quality in Non-Diabetic and Streptozotocin-Induced Diabetic Rats. Pharmaceuticals (Basel) 2023; 16:ph16040628. [PMID: 37111385 PMCID: PMC10145951 DOI: 10.3390/ph16040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Cemtirestat, a bifunctional drug acting as an aldose reductase inhibitor with antioxidant ability, is considered a promising candidate for the treatment of diabetic neuropathy. Our study firstly examined the effects of prolonged cemtirestat treatment on bone parameters reflecting bone quality in non-diabetic rats and rats with streptozotocin (STZ)-induced diabetes. Experimental animals were assigned to four groups: non-diabetic rats, non-diabetic rats treated with cemtirestat, diabetic rats, and diabetic rats treated with cemtirestat. Higher levels of plasma glucose, triglycerides, cholesterol, glycated hemoglobin, magnesium, reduced femoral weight and length, bone mineral density and content, parameters characterizing trabecular bone mass and microarchitecture, cortical microarchitecture and geometry, and bone mechanical properties were determined in STZ-induced diabetic versus non-diabetic rats. Treatment with cemtirestat did not affect all aforementioned parameters in non-diabetic animals, suggesting that this drug is safe. In diabetic rats, cemtirestat supplementation reduced plasma triglyceride levels, increased the Haversian canal area and slightly, but insignificantly, improved bone mineral content. Nevertheless, the insufficient effect of cemtirestat treatment on diabetic bone disease does not support its use in the therapy of this complication of type 1 diabetes mellitus.
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Affiliation(s)
- Monika Martiniakova
- Department of Zoology and Anthropology, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Veronika Kovacova
- Department of Zoology and Anthropology, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Vladimira Mondockova
- Department of Botany and Genetics, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Karol Svik
- Centre of Experimental Medicine, Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia
| | - Piotr Londzin
- Department of Pharmacology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
| | - Joanna Folwarczna
- Department of Pharmacology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
| | - Marta Soltesova Prnova
- Centre of Experimental Medicine, Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia
- Faculty of Informatics and Information Technologies, Slovak University of Technology in Bratislava, 842 16 Bratislava, Slovakia
| | - Milan Stefek
- Centre of Experimental Medicine, Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia
| | - Radoslav Omelka
- Department of Botany and Genetics, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
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Ahmed YM, Orfali R, Abdelwahab NS, Hassan HM, Rateb ME, AboulMagd AM. Partial Synthetic PPARƳ Derivative Ameliorates Aorta Injury in Experimental Diabetic Rats Mediated by Activation of miR-126-5p Pi3k/AKT/PDK 1/mTOR Expression. Pharmaceuticals (Basel) 2022; 15:1175. [PMID: 36297290 PMCID: PMC9607084 DOI: 10.3390/ph15101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2D) is a world wild health care issue marked by insulin resistance, a risk factor for the metabolic disorder that exaggerates endothelial dysfunction, increasing the risk of cardiovascular complications. Peroxisome proliferator-activated receptor PPAR) agonists have therapeutically mitigated hyperlipidemia and hyperglycemia in T2D patients. Therefore, we aimed to experimentally investigate the efficacy of newly designed synthetic PPARα/Ƴ partial agonists on a High-Fat Diet (HFD)/streptozotocin (STZ)-induced T2D. Female Wistar rats (200 ± 25 g body weight) were divided into four groups. The experimental groups were fed the HFD for three consecutive weeks before STZ injection (45 mg/kg/i.p) to induce T2D. Standard reference PPARƳ agonist pioglitazone and the partial synthetic PPARƳ (PIO; 20 mg/kg/BW, orally) were administered orally for 2 weeks after 72 h of STZ injection. The aorta tissue was isolated for biological ELISA, qRT-PCR, and Western blotting investigations for vascular inflammatory endothelial mediators endothelin-1 (ET-1), intracellular adhesion molecule 1 (ICAM-1), E-selectin, and anti-inflammatory vasoactive intestinal polypeptide (VIP), as well as microRNA126-5p and p-AKT/p-Pi3k/p-PDK-1/p-mTOR, endothelial Nitric Oxide Synthase (eNOS) immunohistochemical staining all are coupled with and histopathological examination. Our results revealed that HFD/STZ-induced T2D increased fasting blood glucose, ET-1, ICAM-1, E-selectin, and VIP levels, while decreasing the expression of both microRNA126-5p and p-AKT/p-Pi3k/p-PDK-1/p-mTOR phosphorylation. In contrast, the partial synthetic PPARƳ derivative evidenced a vascular alteration significantly more than reference PIO via decreasing (ET-1), ICAM-1, E-selectin, and VIP, along with increased expression of microRNA126-5p and p-AKT/p-Pi3k/p-PDK-1/p-mTOR. In conclusion, the partial synthetic PPARƳ derivative significantly affected HFD/STZ-induced T2D with vascular complications in the rat aorta.
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Affiliation(s)
- Yasmin M. Ahmed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Nahda University, Beni-Suef 62521, Egypt
| | - Raha Orfali
- Department of Pharmacognosy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Nada S. Abdelwahab
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Nahda University, Beni-Suef 62521, Egypt
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Hossam M. Hassan
- Department of Pharmacognosy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt
| | - Mostafa E. Rateb
- School of Computing, Engineering & Physical Sciences, University of the West of Scotland, Paisley PA1 2BE, UK
| | - Asmaa M. AboulMagd
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Nahda University, Beni-Suef 62521, Egypt
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