Type 2 diabetes mellitus and inflammation: Prospects for biomarkers of risk and nutritional intervention

Screening type 2 Diabetes mellitus among Indians using inflammatory biomarkers

Diabetes is a metabolic disorder associated with chronic inflammation; pre-diabetes phase promotes to inflammatory mechanism then finally progress to diabetes and its associated complications. Therefore, it is of interest to investigate the changes in inflammatory biomarkers Evidence that inflammatory markers play a role in the development as well as severity of Type 2 diabetes mellitus (T2DM). This study has been designed to decipher the involvement of Tumor Necrosis Factor (TNFα), Interleukin-6 (IL-6), Nesfatin-1 and Blood sugar in the etiopathogenesis of T2DM. This retrospective observational study analyzed patient records from our hospital, focusing on those with diabetes or pre-diabetes. Glycosylated hemoglobin, inflammatory biomarkers, Fasting Blood Glucose, and Post-Prandial Blood Glucose were assessed. SPSS 28 facilitated statistical analysis; utilizing Bivariate Correlation assessed the relationship between inflammatory biomarkers and diabetes status (glycosylated hemoglobin). In the pre-diabetic vs. diabetic groups, significant differences exist in IL-6 (p=0.0344), TNF-α (p=0.041), Nesfatin-1 (p=0.0485), fasting blood glucose (p=0.036), and 2h post-prandial blood glucose (p=0.048). IL6 (AUC=0.729, p<0.001), TNF (AUC=0.761, p<0.001), and Nesfatin1 (AUC=0.892, p<0.001) show moderate discriminative power. PP (AUC=0.992, p<0.001) and hbA1c (AUC=0.993, p<0.001) exhibit excellent discriminatory ability. Correlations: IL6 with TNF (r=0.672, p<0.001) and Nesfatin1 (r=0.542, p<0.001); TNF with Nesfatin1 (r=0.591, p<0.001), hbA1c (r=0.683, p<0.001), and PP (r=0.367, p<0.001); Nesfatin1 with PP (r=0.594, p<0.001) and hbA1c (r=0.800, p<0.001). Age has a negative correlation with hbA1c (r=-0.119, p=0.086). Thus, data shows a significant association between inflammatory markers, blood glucose levels, and the progression from pre-diabetes to diabetes.

Inflammation on the Waiting List Is a Risk Factor for New-Onset Prediabetes and Post-Transplant Diabetes Mellitus: A Prospective Study

INTRODUCTION

Inflammation is a risk factor for diabetes in the general population. The role of inflammation in prediabetes or post-transplant diabetes mellitus (PTDM) is not clear. We evaluated the association between inflammatory markers in patients on the waiting list for renal transplantation and the onset of prediabetes and PTDM 12 months after transplantation.

METHODS

This is a post hoc analysis of a prospective study that included nondiabetic patients on the waiting list for kidney transplantation who underwent an oral glucose tolerance test (OGTT) and were followed up to 12 months after transplantation. At this time, those patients without PTDM underwent another OGTT. At pre-transplantation, five cytokines: TNFα, IL6, IL1β, CRP, MCP1 were determined. The association between inflammation and prediabetes/PTDM was evaluated using multiple regression models.

RESULTS

110 patients on the waiting list were enrolled: 74 had normal glucose metabolism and 36 had prediabetes or occult diabetes. At 12 months, 53 patients had normal glucose metabolism, 25 prediabetes, and 32 PTDM. In multiple regression analysis, pre-transplant inflammation was not a risk factor for prediabetes or PTDM. This was attributed to the high interrelation between obesity, prediabetes, and inflammation: about 75% of the cases had these conditions. In a sub-analysis, we analyzed only patients without prediabetes and occult diabetes on the waiting list and found that TNFα levels and BMI at pre-transplantation were independently associated with the onset of prediabetes or PTDM 1 year after transplantation.

CONCLUSIONS

Pre-transplant inflammation and BMI are risk factors for prediabetes and PTDM in patients without glucose metabolism alterations.

Prefrontal oxygenation and working memory in patients with type 2 diabetes mellitus following integrated yoga: a randomized controlled trial

AIMS

Type 2 diabetes mellitus (T2DM) alters brain functional and structural connectivity leading to cognitive dysfunction. This study examined the effect of a 12-week yoga intervention on prefrontal cortex (PFC) oxygenation and working memory in patients with T2DM.

METHODS

Fifty participants were randomized into yoga and waitlist control groups. The yoga protocol specific to T2DM was followed. The pre- (day 1), mid- (6 weeks) and post-intervention (12 weeks) assessments included measurement of PFC oxygenation while performing working memory tasks (n-back) using functional near-infrared spectroscopy.

RESULTS

Following a 12-week intervention, the yoga group showed improved performance in working memory [accuracy (geometric mean difference of 3.15%, 95% CI [2.33,3.96], p = 0.001) and reaction time (mean difference of 100.8 milliseconds,95% CI [- 166.6, - 35.1], p = 0.002] in the high task load (2-back) associated with higher oxygenation in dorsolateral PFC (β coefficient mean difference of 95.6, 95% CI [0.23,191], p = 0.049) and ventrolateral PFC (β coefficient mean difference of 53.4, 95% CI [7.8,98.9], p = 0.018) regions. Higher oxygenation in dorsolateral PFC during 2-back task was positively correlated with accuracy (r(23) = 0.65, p < 0.001) and negatively correlated with reaction time (r(23) =  - 0.47,p = 0.017).

CONCLUSION

Integrated yoga practice may improve working memory performance associated with higher PFC oxygenation in patients with T2DM. As 12 weeks of yoga intervention improved working memory performance, the regular practice of yoga may have the potential to prevent decline of cognitive functions in clinical conditions.

Profiling Inflammatory Biomarkers following Curcumin Supplementation: An Umbrella Meta-Analysis of Randomized Clinical Trials

Objective

Several meta-analyses have shown that curcumin can reduce inflammatory biomarkers, but the findings are inconsistent. The objective of the present umbrella meta-analysis was to provide a more accurate estimate of the overall effects of curcumin on inflammatory biomarkers.

Methods

The following international databases were systematically searched until March 20, 2022: PubMed, Scopus, Embase, Web of Science, and Google Scholar. A random-effects model was applied to evaluate the effects of curcumin on inflammatory biomarkers. Meta-analysis studies investigating the effects of curcumin supplementation on inflammatory biomarkers with corresponding effect sizes (ES) and confidence intervals (CI) were included in the umbrella meta-analysis. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the certainty of evidence.

Results

A meta-analyses of ten studies with 5,870 participants indicated a significant decrease in C-reactive protein (CRP) (ES = -0.74; 95% CI: -1.11, -0.37, p < 0.001; I² = 62.1%, p=0.015), interleukin 6 (IL-6) (ES = -1.07; 95% CI: -1.71, -0.44, p < 0.001; I² = 75.6%, p < 0.001), and tumour necrosis factor α (TNF-α) levels (ES: -1.92, 95% CI: -2.64, -1.19, p < 0.0; I² = 18.1%, p=0.296) following curcumin supplementation. Greater effects on CRP and TNF-α were evident in trials with a mean age >45 years and a sample size >300 participants.

Conclusion

The umbrella of meta-analysis suggests curcumin as a promising agent in reducing inflammation as an adjunctive therapeutic approach in diseases whose pathogenesis is related to a higher level of inflammatory biomarkers.

Prevalence of Pulmonary Tuberculosis in Diabetic Patients: Epidemiology, Immunological Basis, and Its Amalgamated Management

Tuberculosis (TB) is one of the most widespread and infectious diseases in the world, which is brought on by Mycobacterium tuberculosis (MTB). Most infection lacks traditional signs. Latent TB is the name given to this ailment. Of these latent infections, 10% become active and cause illness. Fever, night sweats, a prolonged cough with blood-containing mucus, and weight loss are common signs of active TB infection. Diabetes, on the other hand, is a group of metabolic illnesses characterized by elevated serum glucose levels. It is a chronic metabolic condition brought on by a deficiency in insulin secretion or resistance. It is of two types, that is, type 1 and type 2. Among all the cases of diabetes, the occurrence of type 2 is more common and less fatal than type 1. The prevalence of diabetes is currently increasing in low- and middle-income nations. As both diabetes and TB come under the most widespread chronic condition; therefore, their combined effect is evaluated. In recent years, the higher occurrence of TB in patients with hyperglycemia has come to light. People with elevated blood glucose levels exhibit several risk factors that make them more vulnerable to contracting TB. This review provides information on epidemiological data about the prevalence of TB in patients with hyperglycemia. In addition, this paper discusses the immunological underpinnings of TB development in patients with diabetes mellitus and how glycemic management reduces the risk of TB infection. It illustrates how the clinical signs and radiographic evidence of TB differ between people with diabetes and healthy people and mentions diabetes and TB combined management.

Clinical and biological risk factors associated with inflammation in patients with type 2 diabetes mellitus

BACKGROUND

Chronic inflammation has been associated with insulin resistance and related metabolic dysregulation, including type 2 diabetes mellitus (T2DM). Several non modifiable (i.e. genetic predisposition) and modifiable (i.e. sedentary lifestyle, energy-dense food) risk factors were suggested to explain the mechanisms involved in the development of inflammation, but are difficult to assess in clinical routine. The present study aimed to identify easy to asses clinical and biological risk factors associated with inflammation in patients with T2DM.

METHODS

One hundred nine patients (51 men, 58 women), 28-60 years old, from seven primary healthcare centers in Gaza City, Palestine, took part to the cross-sectional study (November 2013-May 2014). Study participants had T2DM with no history of inflammatory diseases, cardiovascular diseases, medication and/or any health condition that might affect the inflammatory markers, interleukin 6 (IL-6) and C-reactive protein (CRP). Inflammation was defined for IL-6 ≥ 2 pg/mL and CRP ≥ 6 mg/L. Multivariable logistic regressions were used to identify the relationship between inflammation and clinical and biological risk factors.

RESULTS

After adjustment for age and gender, inflammation seems to increase with increased body mass index (BMI) (OR: 1.427 [1.055-1.931]), increased fasting blood glucose (OR: 1.029 [1.007-1.052]) and decreased adiponectin values (OR: 0.571 [0.361-0.903]). There were also significant relationships between inflammation and BMI (OR: 1.432 [1.042-1.968]), fasting blood glucose (OR: 1.029 [1.006-1.052]) and adiponectin (OR: 0.569 [0.359-0.902]), after adjustment for smoking habits and physical activity.

CONCLUSION

Managing obesity and associated complications (i.e. hyperglycemia, high adiponectin levels) might help decreasing inflammation in individuals with T2DM.

Triglyceride: A mediator of the association between waist-to-height ratio and non-alcoholic fatty liver disease: A second analysis of a population-based study

OBJECTIVE

Increasing evidence suggests that an increased waist-to-height ratio (WHtR) may increase the risk of non-alcoholic fatty liver disease (NAFLD). Whether this association is due to WHtR itself or mediated by WHtR-associated increases in triglyceride (TG) is uncertain. On that account, our research aims to disentangle these relationships.

METHODS

In this cross-sectional study, 14251 participants who participated in the medical examination program were consecutively and non-selectively collected in Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables were WHtR and NAFLD, respectively. Triglyceride was the mediating factor. The correlation between WHtR, TG, and NAFLD risk factors was examined using spearman correlation analysis. The association between WHtR or TG and NAFLD was examined using multiple logistic regression. In order to determine whether TG mediated the association between WHtR and NAFLD, a mediation analysis was performed.

RESULTS

The mean age of the included individuals was 43.53 ± 8.89 years old, and 7411 (52.00%) were male. The mean WHtR and TG were 0.46 ± 0.05, 0.89 ± 0.63, respectively. The prevalence rate of NAFLD was 2507 (17.59%). Individuals with NAFLD had significantly higher levels of WHtR and TG than those without NAFLD (P&lt;0.05). After adjusting covariates, the multivariate linear regression analysis showed that WHtR was positively associated with TG. That was, for every 0.1 increase in WHtR, TG increased by 0.226mmol/L (β=0.226, 95%CI: 0.206, 0.247). Multiple logistic regression analysis indicated that WHtR (OR=8.743, 95%CI: 7.528, 10.153) and TG (OR=1.897, 95%CI: 1.732, 2.078) were positively associated with NAFLD. The mediation analysis showed that WHtR had a direct, significant effect on NAFLD (β=0.139, 95%CI: 0.126, 0.148), and TG partially mediated the indirect effect of WHtR on NAFLD (β=0.016, 95% CI: 0.013-0.019). TG contributed to 10.41% of WHtR-related NAFLD development.

CONCLUSION

Findings suggest a mediation link between WHtR and TG and the risk of NAFLD. The significance of TG as a mediator deserves recognition and consideration.

Effects of Probiotic Supplementation on Inflammatory Markers and Glucose Homeostasis in Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background: Several studies have revealed the effect of probiotic supplementation in patients with type 2 diabetes (T2DM) on the amelioration of low-grade inflammation, which plays an important role in the pathogenesis of T2DM. However, the effects of the clinical application of probiotics on inflammation in individuals with T2DM remain inconsistent. This study aims to investigate the comprehensive effects of probiotics on inflammatory markers in adults with T2DM.

Methods: PubMed, Embase, Cochrane Library, and the Web of Science were searched to identify randomized controlled trials (RCTs) exploring the effect of probiotic supplementation on inflammatory markers in individuals with T2DM through March 11, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. We used a random-effects model to calculate the standardized mean difference (SMD) between the probiotic supplementation and control groups.

Results: Seventeen eligible studies were selected with a total of 836 participants, including 423 participants in probiotic supplementation groups and 413 participants in control groups. Our study demonstrated that compared with the control condition, probiotic intake produced a beneficial effect in reducing the levels of plasma inflammation markers, including tumour necrosis factor-α (TNF-α) (SMD [95% CI]; −0.37 [−0.56, −0.19], p < 0.0001) and C-reactive protein (CRP) (SMD [95% CI]; −0.21 [−0.42, −0.01], p = 0.040), while it had no effect on the plasma interleukin-6 (IL-6) level (SMD [95% CI]; −0.07 [−0.27, 0.13], p = 0.520). In addition, our results support the notion that probiotic supplementation improves glycaemic control, as evidenced by a significant reduction in fasting blood glucose (FPG), HbA1c and HOMA-IR (SMD [95% CI]: −0.24 [−0.42, −0.05], p = 0.010; −0.19 [−0.37, −0.00], p = 0.040; −0.36 [−0.62, −0.10], p = 0.006, respectively).

Conclusion: Our study revealed some beneficial effects of probiotic supplementation on improving inflammatory markers and glucose homeostasis in individuals with T2DM. Probiotics might be a potential adjuvant therapeutic approach for T2DM.

Glycoprotein Profile Measured by a 1H-Nuclear Magnetic Resonance Based on Approach in Patients with Diabetes: A New Robust Method to Assess Inflammation

Patients with type 2 diabetes mellitus (T2DM) and atherogenic dyslipidemia (AD) are at higher risk of developing cardiovascular diseases (CVDs), so an interest in discovering inflammation biomarkers as indicators of processes related to CVD progression is increasing. This study aims (a) to characterize the plasma glycoprotein profile of a cohort of 504 participants, including patients with and without T2DM and/or AD and controls, and (b) to study the associations between the glycoprotein profile and other lipid and clinical variables in these populations. We characterized the plasma glycoprotein profiles by using ¹H-NMR. We quantified the two peaks associated with the concentration of plasma glycoproteins (GlycA and GlycB) and their height/width ratios (H/W GlycA and H/W GlycB), as higher and narrower signals have been related to inflammation. We also quantified GlycF, the signal of which is proportional to the concentration of the acetyl groups of free N-acetylglucosamine, N-acetylgalactosamine, and N-acetylneuraminic in the samples. The lipoprotein profile was also determined (Liposcale^®). Standard clinical and anthropometric measurements were taken. Multivariate classification models were developed to study the differences between the study groups. Reduced HDL-C levels, increased small dense LDL and HDL particles, and elevated TG levels were significantly associated with glycoprotein variables. Glycoprotein values in the diagnostic groups were significantly different from those in the CT groups. AD and DM conditions together contribute to a positive and significant synergetic effect on the GlycA area (<0.05) and the H/W ratios of GlycA (<0.01) and GlycB (<0.05). By adding the new glycoprotein variables to the traditionally used marker of inflammation C-reactive protein (CRP), the AUC increased sharply for classification models between the CT group and the rest (0.68 to 0.84), patients with and without dyslipidemia (0.54 to 0.86), and between patients with and without diabetes (0.55 to 0.75). ¹H-NMR-derived glycoproteins can be used as possible markers of the degree of inflammation associated with T2DM and AD.

Dietary quality indices modify the effects of apolipoprotein B polymorphisms on biochemical and anthropometric factors in type 2 diabetes mellitus

We tried to identify the interaction between dietary quality indices and apolipoprotein B Ins/Del and EcoR1 polymorphisms on biochemical and anthropometric factors in patients with type 2 diabetes mellitus (T2DM). This cross-sectional study recruited 700 adults with T2DM in Tehran. The genotypes of Ins/Del and EcoR1 single nucleotide polymorphisms (SNP) were explored via polymerase chain reaction (PCR). Dietary quality index-international (DQI-I), healthy eating index-2015 (HEI-2015) and dietary phytochemical index (DPI) were calculated by semi-quantitative food frequency questionnaire (FFQ). In both crude and adjusted model for confounding factors, we observed significant interactions between DQI-I and Ins/Del SNP on leptin in and 8-iso-prostaglandin F2 α (8-iso-PGF2α), DPI and EcoR1 SNP on total cholesterol (TC) and between Ins/Del SNP and HEI-2015 on interleukin-18 (IL-18). Furthermore, in crude model there were close to meaningful interactions between EcoR1 SNP and DQI-I on total antioxidant capacity (TAC) and between EcoR1 SNP and HEI-2015 on serum leptin and superoxide dismutase (SOD) levels. Our finding indicated that the association between DQI-I, HEI-2015 and DPI with IL-18, TC, leptin and 8-iso-PGF2α in patients with T2DM might be dependent on Ins/Del and EcoR1 variants in ApoB gene.

Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers in the 10-year diabetes mellitus risk: the ATTICA epidemiological study

Purpose

To investigate the combined role of irrational beliefs, anxiety and depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors.

Methods

Within the context of the ATTICA cohort study (2002-2012), 853 participants without evidence of CVD [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI) (range 0-88), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI). Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association (ADA).

Results

Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). Participants with high irrational beliefs who also had anxiety symptoms had a 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with high levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations.

Conclusion

Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions.

Salivary inflammatory biomarkers and glycated haemoglobin among patients with type 2 diabetic mellitus

Background

Type 2 diabetes mellitus has reached epidemic proportions worldwide and improved detection techniques and biomarkers are urgently needed across the spectrum of diabetes initiation and progression. Inflammatory biomarkers play a role in the development of the condition and blood is the gold standard body fluid for the diagnosis of diabetes mellitus. Serum glycated haemoglobin is a widely used marker of chronic hyperglycemia, and it is currently used to diagnose type 2 diabetes mellitus and it is the standard biomarker for the adequacy of management. However, saliva offers an alternative to serum as a biological fluid for diagnostic purposes. Non-invasive measures of inflammatory biomarkers (such as saliva diagnostics) are increasingly being investigated due to significant similarities between salivary and serum proteome. The role of saliva diagnostics in diabetes mellitus has not been explored in our study population.

Objectives

This study investigated the association of selected salivary inflammatory biomarkers (Interleukin 6 [IL-6], C-reactive protein [CRP], and Tumour necrosis factor α [TNF-α]) to glycated haemoglobin (HbA1C) in type 2 diabetics.

Materials and methods

Seventy-five participants, 39 type 2 diabetics (52%) and 36 (48%) healthy controls were recruited. Saliva and blood samples were collected for each participant. The levels of selected salivary inflammatory biomarkers (IL-6, CRP and TNF-α) were estimated by Enzyme Linked Immunosorbent Assay (ELISA) method and glycated haemogloin (HbA1C) was estimated using the liquid chromatography method. Periodontal status of the participants were determined using the Basic Periodontal Examination (BPE).

Results

The mean salivary levels of CRP was significantly higher in diabetics, 0.05 ± 0.04 µg/ml than in controls, 0.02 ± 0.02 µg/ml (p < 0.001). Mean TNF-α was also significantly higher in diabetics, 5.39 ± 12.10 pg/ml than in controls, 1.51 ± 3.66 pg/ml (p = 0.036). Mean salivary IL-6 was also higher in diabetics compared with controls (47.20 ± 18.49 versus 41.94 ± 16.88 pg/ml), but the difference was not statistically significant, p = 0.204. In the multivariate analysis adjusting for age and periodontal status, only the mean salivary CRP was significantly higher in diabetics, 0.034 higher than controls (95% CI 0.009, 0.059 and p = 0.01). There was a positive correlation between salivary CRP and HbA1C levels, which was moderate with r-value 0.4929 and p-value < 0.0001.

Conclusions

Salivary inflammatory biomarkers especially CRP are higher in diabetics compared with controls and CRP is positively correlated with serum HbA1C levels. The biomarkers show potentials as non-invasive alternative method to evaluate glycaemic control in diabetes.

Serum cytokine dependent hematopoietic cell linker (CLNK) as a predictor for the duration of illness in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is an endocrine illness associated with various changes in the immune system and adaptor protein levels. Cytokine dependent hematopoietic cell linker (CLNK) is an adapter protein that regulates immune receptor signaling and acts as a regulator of the receptor signaling of T-cells and natural killer cells. The role of CLNK in T2DM is not studied previously. In the present study, serum CLNK level was measured and correlated with some sociodemographic and insulin resistance (IR) parameters. To achieve these goals, we measured CLNK level and insulin parameters (glucose, insulin, HbA1c, in addition to the calculation of the functions of IR (HOMA2IR), insulin sensitivity (HOMA%S), and beta-cell function (HOMA%B)) in 60 T2DM patients and 30 controls. The results indicated a significant increase (p < 0.05) in serum CLNK in patients group in comparison with the controls. Multivariate generalized linear model (GLM) analysis revealed no significant effect of age, BMI, and sex on the CLNK level. The results of tests for between-subjects showed that the CLNK affects diagnosis significantly (F = 7.445, p = 0.008, partial η² = 0.081) and its effect is approximately the same as the effect of insulin (F = 8.107, p = 0.006, partial η² = 0.087). The correlation study showed a highly significant positive correlation between CLNK and the duration of disease (rho = 0.420, p < 0.001). It can be concluded that the increase CLNK in T2DM revealing the role of the adaptor proteins level in the progression of the disease and may act as a predictor for diabetes complications, which deserves more investigations.

Co-administration of berberine/gypenosides/bifendate ameliorates metabolic disturbance but not memory impairment in type 2 diabetic mice

Cognitive impairment is a well-known complication of Type 2 diabetes mellitus (T2DM) characterized by cellular insulin resistance, chronic inflammation, and metabolic disturbances. Berberine, gypenosides and bifendate are traditional Chinese herbal medicines with multiple pharmacological activities including anti-inflammation, anti-oxidant, metabolism improvement and memory improvement. To investigate whether they have synergistic effect on T2DM metabolic syndrome and associated memory impairment, we measured in this study the effect of a low dose of berberine/gypenosides/bifendate (BGB) co-administration on metabolism and memory performance of T2DM model mice. We found that BGB co-administration ameliorated metabolic abnormalities of both high-fat diet/streptozotocin (STZ)-induced T2DM mice and db/db mice. However, it did not alleviate memory impairment in either type of T2DM model mice. Since neither berberine, gypenosides nor bifendate alone at the low dose is effective, we presume that BGB co-administration has synergistic action on T2DM metabolic syndrome. In addition, our findings suggest that higher doses of BGB might be required to ameliorate memory impairment than metabolic disturbance associated with T2DM.

Effect of Metformin on Circulating Levels of Inflammatory Markers in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Emerging evidence indicates that metformin has anti-inflammatory effect; however, the results differ concerning randomized controlled trails of the effect of metformin on inflammatory markers in type 2 diabetes (T2D) patients.

OBJECTIVE

This study reassessed the data on the effect of metformin treatment on inflammatory markers in T2D patients through a systematic review and meta-analysis.

METHODS

A systematic search was performed in the PubMed, ISI Web of Science, EMBASE, Cochrane Library and Scopus databases to collect relevant published data up to September 2020. Data of each study was combined using random-effects model. Subgroup analysis was performed based on subgroups of the treatment duration, dose and target population.

RESULTS

Thirteen RCTs including 1776 participants with T2D were analyzed. Although CRP levels significantly decreased [SMD: -0.76 mg/L; 95% CI (-1.48, -0.049); P = 0.036] in patients with T2D following metformin treatment, circulating levels of TNF-α [SMD: -0.17 pg/mL; 95% CI (-0.55, 0.20); P = 0.37] and IL-6 [SMD: -0.06 pg/mL; 95% CI (-0.38, 0.25); P = 0.69] were insignificant after metformin treatment. Compared to treatment duration of less than 24 weeks, longer treatment duration (more than 24 weeks) was associated with reduced level of CRP.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Based on available evidence from RCTs in this meta-analysis, metformin decreased CRP level. However, strategies for the treatment of inflammation should focus on metformin in patients with T2D.

CONCLUSION

The present study evidences that therapy with metformin can reduce CRP level significantly in T2D patients compared to other inflammatory markers.

Triglycerides Mediate Body Mass Index and Nonalcoholic Fatty Liver Disease: A Population-Based Study

INTRODUCTION

Nonalcoholic fatty liver disease (NAFLD) is defined by the accumulation of triglycerides (TG). The body mass index (BMI) is associated with NAFLD. This large-scale cohort study was performed to evaluate and quantify the mediating effect of TG on the association between BMI and NAFLD.

METHODS

In total, 15,943 participants in the Kailuan Group were recruited between 2010 and 2014. The impact of TG on the association between BMI and NAFLD was determined through a mediation analysis.

RESULTS

BMI was an independent risk factor for incident NAFLD, with OR of 1.416 (95% CI 1.338-1.499) and 1.187 (95% CI 1.137-1.240) in the low-BMI and high-BMI groups, respectively (p < 0.001). The TG level was a risk factor for NAFLD in the high-BMI group, with an OR of 2.775 (95% CI 1.488-5.177; p = 0.001). Positive associations between BMI and the TG level remained in the 2 above mentioned groups after adjusting for confounders (β = 0.072 and 0.032; p < 0.001). The mediation analysis revealed that TG contributed to 26.050% of incident NAFLD in the high-BMI group (p = 0.01).

CONCLUSION

A high BMI was an independent risk factor for incident NAFLD, and a high TG level was a risk factor in the high-BMI group (BMI ≥24). TG contributes about 25% to incident NAFLD in people with obesity.

Effects of Exercise on Inflammatory Cytokines in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

OBJECTIVE

Inflammation is involved in the pathogenesis of type 2 diabetes (T2DM) and the occurrence of insulin resistance. The purpose of this study was to investigate the effects of exercise on inflammatory factors in patients with T2DM.

METHODS

A systematic review was conducted on five databases, Cochrane, Embase, Pubmed, Web of Science, and EBSCO. All randomized controlled trials (RCTs) published between establishment of the database and November 2020 without restrictions on language were included. Studies evaluated the effects of exercise intervention on inflammatory cytokines in patients with T2DM were selected.

RESULTS

Twenty-three randomized controlled trials (1350 patients) were included in our meta-analysis. Exercise can significantly reduce the level of C-reactive protein (CRP) (MD: -0.79, 95% CI: -1.26 to -0.33, p = 0.0008), tumor necrosis factor-α (TNF-α) (MD: -2.33, 95% CI: -3.39 to -1.27, p < 0.0001), and interleukin-6 (IL-6) (MD: -0.42, 95% CI: -0.60 to -0.24, p < 0.0001) in T2DM patients.

CONCLUSION

The findings of this review suggest that exercise reduces inflammatory cytokines (CRP, TNF-α, and IL-6) in T2DM patients. More studies with high methodological qualities and large sample sizes need to be done to confirm which forms of exercise are most effective.

Sex, Sleep, Steroids, and Lifestyle: Unraveling the Coronavirus Disease 2019 Conundrum

Coronavirus disease 2019 (COVID-19) has wreaked havoc and distressed economies worldwide. Countries have gone on lockdown of their economies to prevent the spread of the disease. This obviously led to collateral damage in the form of worsening healthcare for non-COVID-related conditions and is playing havoc with the world economy. Herein, we suggest novel strategies to prevent COVID-19 related complications, keeping in view the pathophysiology of the disease.

Hyperglycemia is a strong predictor of poor prognosis in COVID-19

AIMS

The objective of this study is to explore the association between documented diabetes, fasting plasma glucose (FPG), and the clinical outcomes of Coronavirus disease 2019 (COVID-19).

METHODS

This retrospective study included 255 patients with COVID-19. Of these, 214 were admitted to isolation wards and 41were admitted to intensive care units (ICUs). Demographic, clinical, treatment, and laboratory data were collected and compared between ICU and non-ICU patients. Multivariable logistic regression models were used to explore the risk factors associated with poor clinical outcomes (ICU admission or death).

RESULTS

There were significant changes in several clinical parameters in ICU patients (leukopenia, lymphopenia, elevated D-dimer, as well as higher levels of FPG, cardiac troponin, serum ferritin, IL-6, and high-sensitivity C-reactive protein)compared with non-ICU patients. The prevalence of known diabetes was substantially higher in ICU than non-ICU patients (31.7% vs. 17.8%, P = 0.0408). Multivariable regression analysis showed that a history of diabetes [odds ratio (OR), 0.099; 95% confidence interval (CI), 0.016-0.627; P = 0.014], high FPG at admission (OR, 1.587; 95% CI, 1.299-1.939, P < 0.001), high IL-6 (OR, 1.01; 95% CI, 1.002-1.018, P = 0.013), and D-dimer higher than 1 mg/L at admission (OR, 4.341; 95% CI, 1.139-16.547, P = 0.032) were independent predictors of poor outcomes. Cox proportional hazards analysis showed that compared with FPG < 7 mmol/L, FPG levels of 7.0-11.1 mmol/L and ≥ 11.1 mmol/L were associated with an increased hazard ratio (HR) for poor outcome (HR, 5.538 [95% CI, 2.269-13.51] and HR, 11.55 [95% CI, 4.45-29.99], respectively).

CONCLUSION

Hyperglycemia and a history of diabetes on admission predicted poor clinical outcomes in COVID-19.

Serum adropin levels are reduced in patients with inflammatory bowel diseases

Adropin is a novel peptide mostly associated with energy homeostasis and vascular protection. To our knowledge, there are no studies that investigated its relationship with inflammatory bowel diseases (IBD). The aim of this study was to compare serum adropin levels between 55 patients with IBD (30 Ulcerative colitis (UC) patients, 25 Crohn’s disease (CD) patients) and 50 age/gender matched controls. Furthermore, we explored adropin correlations with IBD severity scores, hsCRP, fecal calprotectin, fasting glucose and insulin levels. Serum adropin levels were significantly lower in patients with IBD in comparison with the control group (2.89 ± 0.94 vs 3.37 ± 0.60 ng/mL, P = 0.002), while there was no significant difference in comparison of UC patients with CD patients (P = 0.585). Furthermore, there was a negative correlation between adropin and fecal calprotectin (r = −0.303, P = 0.025), whereas in the total study population, we found a significant negative correlation with fasting glucose levels (r = −0.222, P = 0.023). A multivariable logistic regression showed that serum adropin was a significant predictor of positive IBD status when enumerated along with baseline characteristics (OR 0.455, 95% CI 0.251–0.823, P = 0.009). Our findings imply that adropin could be involved in complex pathophysiology of IBD, but further larger scale studies are needed to address these findings.

Pulmonary Complications Secondary to Immune Checkpoint Inhibitors

Background

Immune checkpoint inhibitors (ICI) have changed the landscape in the treatment of a number of cancers. Immune-related adverse events (irAEs) have emerged as a serious clinical problem with the use of ICI.

Methods

All oncology patients diagnosed with pulmonary complications secondary to ICI at Mayo Clinic Rochester from January 1, 2012 to December 31, 2018 were reviewed. Demographics, comorbidities, smoking, and oncologic history were analyzed.

Results

A total of 10 patients developed pulmonary complications secondary to ICI. Seven patients were men (70%), and the median age at diagnosis was 61.5 (IQR 55.8-69.3) years. All patients had stage IV disease. Melanoma was the most common malignancy. Seven (70%) patients had a positive smoking history, and 6 (60%) were obese (BMI > 30). Most cases were grade 2 pneumonitis (70%). One patient with grade 4 pneumonitis required endotracheal intubation and a prolonged course of systemic corticosteroids (>30 days). Eight (80%) patients received prior radiation therapy. The median time from initiation of ICI to pneumonitis diagnosis was 3.5 months.

Conclusion

Melanoma was the most common malignancy, the majority of patients had grade 2 pneumonitis and required treatment with steroids, and all patients affected by ICI-related pneumonitis had stage IV malignancy. Potential risk factors included smoking history, prior radiotherapy, obesity, and advance stage at the time of ICI initiation. Extrapulmonary irAEs are common in patients with pneumonitis.

Clopidogrel Resistance in a Murine Model of Diet-Induced Obesity Is Mediated by the Interleukin-1 Receptor and Overcome With DT-678

OBJECTIVE

Clopidogrel is a commonly used P2Y₁₂ inhibitor to treat and prevent arterial thrombotic events. Clopidogrel is a prodrug that requires bioactivation by CYP (cytochrome P450) enzymes to exert antiplatelet activity. Diabetes mellitus is associated with an increased risk of ischemic events, and impaired ability to generate the active metabolite (AM) from clopidogrel. The objective of this study is to identify the mechanism of clopidogrel resistance in a murine model of diet-induced obesity (DIO). Approach and Results: C57BL/6J mice and IL-1R^-/- mice were given high-fat diet for 10 weeks to generate a murine model of diet-induced obesity. Platelet aggregation and carotid arterial thrombosis were assessed in response to clopidogrel treatment. Wild-type DIO mice exhibited resistance to antiplatelet and antithrombotic effects of clopidogrel that was associated with reduced hepatic expression of CYP genes and reduced generation of the AM. IL (Interleukin)-1 receptor-deficient DIO (IL1R^-/- DIO) mice showed no resistance to clopidogrel. Lack of resistance was accompanied by increased exposure of the clopidogrel AM. This resistance was also absent when wild-type DIO mice were treated with the conjugate of the clopidogrel AM, DT-678.

CONCLUSIONS

These findings indicate that antiplatelet effects of clopidogrel may be impaired in the setting of diabetes mellitus due to reduced prodrug bioactivation related to IL-1 receptor signaling. Therapeutic targeting of P2Y₁₂ in patients with diabetes mellitus using the conjugate of clopidogrel AM may lead to improved outcomes.

Title: Human Serum/Plasma Glycoprotein Analysis by 1H-NMR, an Emerging Method of Inflammatory Assessment

Several studies suggest that variations in the concentration of plasma glycoproteins can influence cellular changes in a large number of diseases. In recent years, proton nuclear magnetic resonance (1H-NMR) has played a major role as an analytical tool for serum and plasma samples. In recent years, there is an increasing interest in the characterization of glycoproteins through 1H-NMR in order to search for reliable and robust biomarkers of disease. The objective of this review was to examine the existing studies in the literature related to the study of glycoproteins from an analytical and clinical point of view. There are currently several techniques to characterize circulating glycoproteins in serum or plasma, but in this review, we focus on 1H-NMR due to its great robustness and recent interest in its translation to the clinical setting. In fact, there is already a marker in H-NMR representing the acetyl groups of the glycoproteins, GlycA, which has been increasingly studied in clinical studies. A broad search of the literature was performed showing a general consensus that GlycA is a robust marker of systemic inflammation. The results also suggested that GlycA better captures systemic inflammation even more than C-reactive protein (CRP), a widely used classical inflammatory marker. The applications reviewed here demonstrated that GlycA was potentially a key biomarker in a wide range of diseases such as cancer, metabolic diseases, cardiovascular risk, and chronic inflammatory diseases among others. The profiling of glycoproteins through 1H-NMR launches an encouraging new paradigm for its future incorporation in clinical diagnosis.

Twelve Weeks of Combined Resistance and Aerobic Exercise Improves Cardiometabolic Biomarkers and Enhances Red Blood Cell Hemorheological Function in Obese Older Men: A Randomized Controlled Trial

The present study examined the effect of a 12-week combined resistance and aerobic exercise training program on cardiometabolic biomarkers and red blood cell (RBC) hemorheological function in 20 obese older men (mean age: 68.8 ± 0.9 years). Subjects were randomly divided into two groups (exercise intervention [EXP; n = 10] and control [CON; n = 10]). The EXP subjects performed resistance and aerobic exercise training program three times per week for 12 weeks, and the CON subjects maintained their regular lifestyle during the intervention period. Body composition was estimated using bioelectrical impedance analysis equipment. Cardiometabolic biomarkers (glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), HOMA β-cell function, and leptin) and RBC hemorheological parameters (RBC deformability and aggregation) were analyzed. Percent body fat decreased significantly in the EXP group during the intervention period but increased significantly in the CON group. Insulin increased significantly in the CON group over the 12-week period and both insulin and HOMA-IR were significantly higher in the CON group than in the EXP group at post-test. RBC deformability (RBC EI_3Pa) and aggregation (RBC AI_3Pa) improved significantly only in the EXP group. The present study suggests that combined exercise training can be useful for improving cardiometabolic biomarkers and RBC hemorheological parameters in obese older men and may help prevent metabolic syndrome and cardiovascular diseases.

Effect of Individualized Dietary Intervention on Oxidative Stress in Patients with Type 2 Diabetes Complicated by Tuberculosis in Xinjiang, China

INTRODUCTION

This study aimed to examine the effect of individual dietary intervention on nutrition and oxidative stress of patients with type 2 diabetes mellitus (T2DM) complicated by pulmonary tuberculosis (PTB) in Xinjiang.

METHODS

A total of 164 patients with T2DM and PTB from January 2018 to December 2018 in the Chest Hospital of Xinjiang Uyghur Autonomous Region were included. According to the random number table method, the patients were divided into an experimental group (n = 82) and control group (n = 82). The original treatments of PTB and T2DM were maintained. The control group was treated with a self-controlled diet, while the experimental group was treated with an individual quantitative dietary intervention. All patients included in our study were closely followed up for 3 months and the serum levels of variables related to nutrition, oxidative stress, and blood glucose were measured to compare each patient's nutritional and oxidative stress after the intervention. Proportions of patients with sputum testing positive for bacteria before and after the intervention were also recorded and compared between the two groups.

RESULTS

There were no significant differences between the two groups with regard to age, sex, labor intensity, marital status, course and treatment of diabetes, and proportion of patients with sputum positive for bacteria before the intervention (P > 0.05). There were statistically significant differences between the two groups in variables to related nutrition and oxidative stress, especially SOD which was increased by 13.2% in the experimental group and 2.5% in the control group after intervention (P < 0.05). The proportion of patients with sputum positive for bacteria in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05).

CONCLUSION

A combination of individual quantitative dietary interventions can improve the nutritional status of patients with T2DM-PTB and adjust the oxidative stress. This method provides a theoretical basis for a reasonable diet in patients with T2DM-PTB.

TRIAL REGISTRATION

ChiCTR900025477 (Retrospectively registered).

Isoquercetin regulates SREBP-1C via AMPK pathway in skeletal muscle to exert antihyperlipidemic and anti-inflammatory effects in STZ induced diabetic rats

Diabetes mellitus (DM) is a cluster of metabolic diseases that exhibits high blood glucose levels accompanied by hyperlipidemia and inflammation. DM is the primary risk factor contributes majorly to cardiovascular disease (CVD) mediated morbidity and mortality. The incidence of dyslipidemia seems to attribute considerably to the initiation of CVDs. The beneficial action of isoquercetin on hyperlipidemia and related signaling pathways are not documented yet, hence we decide to carry out this study. The experimental rats were divided into five groups: Group 1, control rats; group 2, isoquercetin control (40 mg/kg b.w); group 3, diabetic rats (STZ-40 mg/kg b.w); group 4, diabetic + isoquercetin (40 mg/kg b.w); and group 5, diabetic + glibenclamide (600 µg/kg b.w). The animals were sacrificed at the end of the experimental duration of 45 days. Results of our analysis reveal that isoquercetin have a major impact on the tissue lipid profile, isoquercetin strongly regulates the expression of various lipid-metabolizing enzymes, C-reactive protein, expression of various inflammatory genes, SREBP-1C genes and proteins and AMP-activated protein kinase-α (AMPK) signaling pathway genes and proteins. Results recommend that isoquercetin can be effective in mitigating the consequences of hyperlipidemia and DM.

Targeting Inflammation by Flavonoids: Novel Therapeutic Strategy for Metabolic Disorders

A balanced metabolic profile is essential for normal human physiological activities. Disproportions in nutrition give rise to imbalances in metabolism that are associated with aberrant immune function and an elevated risk for inflammatory-associated disorders. Inflammation is a complex process, and numerous mediators affect inflammation-mediated disorders. The available clinical modalities do not effectively address the underlying diseases but rather relieve the symptoms. Therefore, novel targeted agents have the potential to normalize the metabolic system and, thus, provide meaningful therapy to the underlying disorder. In this connection, polyphenols, the well-known and extensively studied phytochemical moieties, were evaluated for their effective role in the restoration of metabolism via various mechanistic signaling pathways. The various flavonoids that we observed in this comprehensive review interfere with the metabolic events that induce inflammation. The mechanisms via which the polyphenols, in particular flavonoids, act provide a promising treatment option for inflammatory disorders. However, detailed clinical studies of such molecules are required to decide their clinical fate.

Immunological Impacts of Diabetes on the Susceptibility of Mycobacterium tuberculosis

The interaction between diabetes and major world infections like TB is a major public health concern because of rapidly rising levels of diabetes. The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a major global public health problem. Diabetes mellitus is a major risk factor for the development of active and latent tuberculosis. Immune mechanisms contributing to the increased susceptibility of diabetic patients to TB are due to the defects in bacterial recognition, phagocytic activity, and cellular activation which results in impaired production of chemokines and cytokines. The initiation of adaptive immunity is delayed by impaired antigen-presenting cell (APC) recruitment and function in hyperglycemic host, which results in reduced frequencies of Th1, Th2, and Th17 cells and its secretion of cytokines having a great role in activation of macrophage and inflammatory response of tuberculosis. In addition, impaired immune response and killing of intracellular bacteria potentially increase bacterial load, chronic inflammation, and central necrosis that facilitate bacterial dissemination and miliary tuberculosis. Understanding of the immunological and biochemical basis of TB susceptibility in diabetic patients will tell us the rational development of implementation and therapeutic strategies to alleviate the dual burden of the diseases. Therefore, the aim of this review was focused on the association between diabetes and tuberculosis, focusing on epidemiology, pathogenesis, and immune dysfunction in diabetes mellitus, and its association with susceptibility, severity, and treatment outcome failure to tuberculosis.

C-Reactive Protein Gene Variants and Their Serum Levels in Early Adult-onset Type 2 Diabetes Mellitus

BACKGROUND/AIM

C-Reactive protein (CRP) is a common marker of inflammation. Elevated CRP levels have been associated with increased risk of development of type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association of CRP gene polymorphisms with early-onset T2DM and the effect of genetic variants on CRP level.

MATERIALS AND METHODS

In total, 948 individuals with early-onset (n=271) or late-onset (n=677) T2DM were enrolled in the study. Five single-nucleotide polymorphisms (SNPs) in the CRP gene, namely rs3093077, rs2808630, rs1800947, rs11265263, and rs11265265, were selected for genotyping, and CRP levels were measured.

RESULTS

Genotypic, allelic, and haplotype frequencies of these five SNPs were not significantly different between patients with early- and those with late-onset. T2DM Higher serum CRP levels were independently associated with the C-allele of rs3093077 and T-allele of rs11265265 (p<0.001). Furthermore, the C-allele of rs3093077 was associated with higher CRP level in both early- (p=0.016) and late-onset (p<0.001) T2DM.

CONCLUSION

CRP gene variants may contribute to the risk of early-onset T2DM by affecting the serum CRP level.

Predictors of isolated systolic hypertension among type 2 diabetes mellitus patients in Jimma University Specialized Hospital, Southwest Ethiopia

OBJECTIVES

Systolic blood pressure rise among T2DM patients was main risk factor for cardiovascular disease. Objective of this study was to identify predictors of isolated systolic hypertension among T2DM patients at Jimma University Specialized Hospital, 2016. We conducted cross sectional study using simple random sampling and interviewer administered questionnaire. Isolated systolic hypertension is SBP ≥ 140 mmHg and < 90 mmHg. Data entered and analyzed using Epi Data and SPSS respectively. Predictor factor was declared at p < 0.05.

RESULTS

A total of 315 T2DM took part. Prevalence of ISH was 27.6% [95% CI (22.7, 32.5%)]. One hundred sixty and two (51.4%) patients were males with mean age of 54.1 from 22 to 87 years. Male sex [AOR = 2.4, 95% CI 1.21-4.72, p = 0.012], unemployment [AOR = 3.22, 95% CI 1.48-7.03, p = 0.003], age of 47-55 [AOR = 2.63, 95% CI 1.03-6.70, p = 0.044], single [AOR = 2.26, 95% CI 1.13-4.51, p = 0.021], ≤ Grade 8 [AOR = 2.94, 95% CI 1.10-7.85, p = 0.03] and income (ETB) 501-800 [AOR = 21.9, 95% CI 7.62-63.1, p < 0.001], 801-1500 [AOR = 5.78, 95% CI 2.55-13.1, p < 0.001] and > 1500 [AOR = 4.23, 95% CI 1.74-10.30, p = 0.001] were significant factors of ISH. The health sector has to establish preventive strategies for ISH among T2DM patients by giving special attention to predictor factors.

Anti-inflammatory effects of vitamin D and resistance training in men with type 2 diabetes mellitus and vitamin D deficiency: a randomized, double-blinded, placebo-controlled clinical trial

Objectives

The present study aimed to investigate the anti-inflammatory effects of vitamin D and resistance training in men with type 2 diabetes mellitus and vitamin D deficiency.

Design

This study was a randomized, placebo-controlled, double-blinded clinical trial.Trial registration code: IRCT20190204042621N1.

Participants

Forty-eight patients with type 2 diabetes aged 40-65 (from a total of 52 volunteers in Ardabil diabetes clinic) were randomly assigned to either the vitamin D supplementation with resistance training group (VD + RT: n = 12), the resistance training group (RT: n = 12), the vitamin D supplementation group (VD: n = 12), or the control group (CON: n = 12).

Intervention

The subjects in VD group took vitamin D supplements at 50000 IU per 2 weeks for 3 months; the subjects in RT group exercised 3 times per week for 12 weeks; and the subjects in VD + RT group participated in both treatments. Subjects in CON group were asked to maintain normal daily life pattern for the duration of the study.

Measurements

Serum Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α) and C-reactive protein (CRP) levels were determined at pre and post-test and the data were compared among the four groups and between two tests (4 × 2) using two-way ANOVA with repeated measures.

Results

IL-6 decreased significantly (P = 0.001) in all groups (VD + RT = % -71.73, RT = % -65.85, VD = % -61.70). TNF-α decreased significantly (P = 0.001) in VD + RT (% -44.90) and RT (% -40) groups. CRP showed no significant change in any group (P > 0.05).

Conclusion

Results demonstrated that vitamin D supplementation in addition to resistance training had positive effects on some inflammatory markers in T2D and vitamin D deficient men. Vitamin D supplementation was especially effective when it was complemented with exercise training.

Type 2 diabetes mellitus, oxidative stress and inflammation: examining the links

Diabetes mellitus has been recognised as one of the four major non-communicable diseases that demands urgent attention from all key shareholders globally in an effort to address its prevalence and associated complications. It is considered as a top 10 cause of death globally, killing about 1.6 million people worldwide and is seen as the third highest risk factor for worldwide premature mortality due to hyperglycaemia and hyperglycaemic-induced oxidative stress and inflammation. There is a strong link between hyperglycaemia, hyperglycaemic-induced oxidative stress, inflammation and the development and progression of type 2 diabetes mellitus. Various reports have shown that chronic low-grade inflammation is associated with the risk of developing type 2 diabetes and that sub-clinical inflammation contributes to insulin resistance and is linked to the characteristics of metabolic syndrome which include hyperglycaemia. Oxidative stress stimulates the generation of inflammatory mediators and inflammation in turn enhances the production of reactive oxygen species. This interaction between diabetes, oxidative stress and inflammation is the primary motivation for the compilation of this review. Based on previous studies, the review examines the interaction between diabetes, oxidative stress and inflammation, factors promoting prevalence of diabetes mellitus, mechanisms involved in hyperglycaemia-induced oxidative stress with particular focus on type 2 diabetes and selected diabetic complications.

Tau underlies synaptic and cognitive deficits for type 1, but not type 2 diabetes mouse models

Diabetes mellitus (DM) is one of the most devastating diseases that currently affects the aging population. Recent evidence indicates that DM is a risk factor for many brain disorders, due to its direct effects on cognition. New findings have shown that the microtubule-associated protein tau is pathologically processed in DM; however, it remains unknown whether pathological tau modifications play a central role in the cognitive deficits associated with DM. To address this question, we used a gain-of-function and loss-of-function approach to modulate tau levels in type 1 diabetes (T1DM) and type 2 diabetes (T2DM) mouse models. Our study demonstrates that tau differentially contributes to cognitive and synaptic deficits induced by DM. On one hand, overexpressing wild-type human tau further exacerbates cognitive and synaptic impairments induced by T1DM, as human tau mice treated under T1DM conditions show robust deficits in learning and memory processes. On the other hand, neither a reduction nor increase in tau levels affects cognition in T2DM mice. Together, these results shine new light onto the different molecular mechanisms that underlie the cognitive and synaptic impairments associated with T1DM and T2DM.

Astroglia in Sepsis Associated Encephalopathy

Cellular pathophysiology of sepsis associated encephalopathy (SAE) remains poorly characterised. Brain pathology in SAE, which is manifested by impaired perception, consciousness and cognition, results from multifactorial events, including high levels of systemic cytokines, microbial components and endotoxins, which all damage the brain barriers, instigate neuroinflammation and cause homeostatic failure. Astrocytes, being the principal homeostatic cells of the central nervous system contribute to the brain defence against infection. Forming multifunctional anatomical barriers, astroglial cells maintain brain-systemic interfaces and restrict the damage to the nervous tissue. Astrocytes detect, produce and integrate inflammatory signals between immune cells and cells of brain parenchyma, thus regulating brain immune response. In SAE astrocytes are present in both reactive and astrogliopathic states; balance between these states define evolution of pathology and neurological outcomes. In humans pathophysiology of SAE is complicated by frequent presence of comorbidities, as well as age-related remodelling of the brain tissue with senescence of astroglia; these confounding factors further impact upon SAE progression and neurological deficits.

THE ROLE OF ADIPONECTIN AND TOLL-LIKE RECEPTOR 4 GENE POLYMORPHISMS ON NON-PROLIFERATIVE RETINOPATHY IN TYPE 2 DIABETES MELLITUS PATIENTS. A CASE-CONTROL STUDY IN ROMANIAN CAUCASIANS PATIENTS

Context

Persistent inflammation and impaired neovascularization are important contributors to the development of diabetic retinopathy (DR). Gene polymorphisms of adiponectin (APN) were demonstrated to have an important role on the plasma level and activity of adiponectin. APN has anti-inflammatory, anti-diabetic and anti-atherogenic properties. Toll-Like Receptor 4 (TLR4) is a critical mediator of innate immunity. Polymorphisms in TLR-4 gene were shown to be associated with impaired inflammatory response in diabetes.

Objective

The aim of the study was to analyze the association of +276G>T variant of APN gene and Asp299Gly and Thr399Ile of TLR-4 gene variants in relationship with T2DM and DR in an Eastern European population group.

Design

The distribution of the mutant alleles in 198 T2DM patients with DR and 200 non-T2DM controls was examined. Genomic DNA from T2DM patients and healthy controls genotyped through the use of PCR-RFPL assay.

Results

Genotype and allele frequencies of the Asp299Gly and Thr399Ile polymorphisms differed between T2DM patients and non diabetic subjects (P<0.001). Moreover, the presence of the minor alleles of these polymorphisms were significantly identified as protective factors against T2DM, under a dominant model of Fisher's exact test (χ2=4.988, phi=0.745, OR=0.767, 95% CI=0.602-0.867, P<0.001; respectively χ2=5.254, phi=0.820, OR=0.487, 95% CI=0.211-0.648, P<0.001). Genotype analysis for the adiponectin 276G>T gene polymorphism yielded no significant association with T2DM, but revealed a borderline significance for the association with DR (χ2=5.632, phi=0.423, OR =1.101, 95% CI=0.887-1.203, P=0.009).

Conclusions

We found an association between the TLR4 Asp299Gly and Thr399Ile polymorphisms and protection for DR. The APN genetic polymorphism is not associated with T2DM.

Decreased GlycA after lifestyle intervention among obese, prediabetic adolescent Latinos

BACKGROUND

Obese youth with prediabetes are at increased risk for premature morbidity and mortality through multiple mechanisms, including increased systemic inflammation. GlycA is a novel measure of systemic inflammation that predicts type II diabetes, cardiovascular events, and all-cause mortality in adults.

OBJECTIVE

The purpose of the present study was to examine changes in GlycA after lifestyle intervention among obese, prediabetic Latino youth.

METHODS

Obese, prediabetic Latino youth (n = 27; 15.5 ± 1.1 years, 13 males/14 females) completed a 12-week lifestyle intervention that included weekly nutrition education and 3 d/wk of moderate to vigorous physical activity. Prediabetes was characterized by an expanded definition of impaired glucose tolerance, using 2-hour glucose ≥120 mg/dL after an oral glucose tolerance test. GlycA was assessed at baseline and 12 weeks using nuclear magnetic resonance spectroscopy.

RESULTS

After the lifestyle intervention, GlycA was significantly reduced (445.3 ± 51.3 μmol/L to 419.0 ± 50.0 μmol/L, P = .01) (mean ± standard deviation). Additional improvements were observed in multiple cardiovascular risk factors, including body mass index (BMI; 34.8 ± 5.0 kg/m² to 34.0 ± 5.1 kg/m², P < .001), total cholesterol (154.1 ± 30.3 mg/dL to 143.3 ± 29.1 mg/dL, P = .003), and 2-hour glucose (141.0 ± 13.2 mg/dL to 115.9 ± 31.4 mg/dL, P < .001). Decreases in GlycA were associated with decreases in 2-hour glucose (r = 0.49, P = .008) and BMI (r = 0.41, P = .03).

CONCLUSION

These data are consistent with the hypothesis that lifestyle intervention might improve GlycA levels in obese, prediabetic adolescent Latinos, but randomized trial evidence is needed. Healthy lifestyle modifications among high-risk youth may decrease future risk of cardiometabolic disease through reducing systemic inflammation, in addition to improving traditional cardiovascular risk factors.

Prevalence of chronic comorbidities in dengue fever and West Nile virus: A systematic review and meta-analysis

Background

Flavivirus diseases such as dengue fever (DENV), West Nile virus (WNV), Zika and yellow fever represent a substantial global public health concern. Preexisting chronic conditions such as cardiovascular diseases, diabetes, obesity, and asthma were thought to predict risk of progression to severe infections.

Objective

We aimed to quantify the frequency of chronic comorbidities in flavivirus diseases to provide an estimate for their prevalence in severe and non-severe infections and examine whether chronic diseases contribute to the increased risk of severe viral expression.

Methods

We conducted a comprehensive search in PubMed, Ovid MEDLINE(R), Embase and Embase Classic and grey literature databases to identify studies reporting prevalence estimates of comorbidities in flavivirus diseases. Study quality was assessed with the risk of bias tool. Age-adjusted odds ratios (ORs) were estimated for severe infection in the presence of chronic comorbidities.

Results

We identified 65 studies as eligible for inclusion for DENV (47 studies) and WNV (18 studies). Obesity and overweight (i.e., BMI> 25 kg/m², prevalence: 24.5%, 95% CI: 18.6–31.6%), hypertension (17.1%, 13.3–21.8%) and diabetes (13.3%, 9.3–18.8%) were the most prevalent comorbidities in DENV. However, hypertension (45.0%, 39.1–51.0%), diabetes (24.7%, 20.2–29.8%) and heart diseases (25.6%, 19.5–32.7%) were the most prevalent in WNV. ORs of severe flavivirus diseases were about 2 to 4 in infected patients with comorbidities such as diabetes, hypertension and heart diseases. The small number of studies in JEV, YFV and Zika did not permit estimating the prevalence of comorbidities in these infections.

Conclusion

Higher prevalence of chronic comorbidities was found in severe cases of flavivirus diseases compared to non-severe cases. Findings of the present study may guide public health practitioners and clinicians to evaluate infection severity based on the presence of comorbidity, a critical public health measure that may avert severe disease outcome given the current dearth of clear prevention practices for some flavivirus diseases.

Nutrition Therapy in Managing Pregnant Women With Gestational Diabetes Mellitus: A Literature Review

Objective: Gestational diabetes mellitus is the most common metabolic and endocrine perinatal complication and is a growing health problem worldwide. Considering the fetal programming and its contribution as one of the evolutionary origins of human diseases, it is very important to improve the glucose metabolism in pregnant women, determination of other nutrients, preventing excessive accumulation of fetal fats, emphasis on weight loss measures before pregnancy, dietary intake with low-fat healthy food and prevention of abundant weight loss. In this paper, we have provided a brief review on dietary intake and dietary interventions in GDM from the perspective of nutrition science attending the physiopathology and etiology of the disease. Materials and methods: Electronic search for English and Persian articles has been perform in databases, including Google Scholar, PubMed ,Scopus, Cochrane central ,Science direct, ISC, SID, Magiran, Iran Medex, and Med Libby key words: gestational diabetes, gestational diabetes mellitus, nutrition, macronutrient, micronutrient, Diabetes. All available articles (cross-sectional, descriptive-analytic, and clinical studies with desirable design and review quality studies were used. Reference books including Krause's Food and the Nutrition Care, The Williams Obstetrics editions of the 14th (2017) and the 24th edition (2014) were also reviewed. Results: Nutrition therapy and physical activity are the initial treatment of GDM. Proper and flexible methods of nutrition therapy that successfully regulate maternal glycaemia while improving expected fetal growth have extensive concepts. Meanwhile, dietary supplements with proven beneficial effects can play an important role in improving deficiencies and improving the metabolic profile of patients. Conclusion: Nutritional management is the main treatment for gestational diabetes mellitus and overweight/obesity is the principal contest in patient counseling and interventions during pregnancy. Despite extensive researches carried out, this field is an active research area and requires more clinical research to minimize maternal and fetal complications.

Regular Use of Aspirin or Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs Is Not Associated With Risk of Incident Pancreatic Cancer in Two Large Cohort Studies

BACKGROUND & AIMS

Use of aspirin and/or non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) reduces the risk of several cancers, but it is not clear if use of these drugs is associated with risk of pancreatic cancer.

METHODS

We evaluated aspirin and non-aspirin NSAID use and risk of pancreatic adenocarcinoma in 141,940 participants from the Health Professionals Follow-up Study and Nurses' Health Study using multivariable-adjusted Cox proportional hazards regression. We considered several exposure classifications to model differing lag times between NSAID exposure and cancer development. We also conducted a nested case-control study of participants from 3 prospective cohorts using conditional logistic regression to evaluate pre-diagnosis levels of plasma salicylurate, a major metabolite of aspirin, in 396 pancreatic cancer cases and 784 matched individuals without pancreatic cancer (controls).

RESULTS

In the prospective cohort study, 1122 participants developed pancreatic adenocarcinoma over 4.2 million person-years. Use of aspirin or non-aspirin NSAIDs was not associated with pancreatic cancer risk, even after considering several latency exposure classifications. In a pre-planned subgroup analysis, regular aspirin use was associated with reduced pancreatic cancer risk among participants with diabetes (relative risk, 0.71; 95% CI, 0.54-0.94). In the nested case-control study, pre-diagnosis levels of salicylurate were not associated with pancreatic cancer risk (odds ratio, 1.08; 95% CI, 0.72-1.61; Ptrend 0.81; comparing participants in the highest quintile with those in the lowest quintile of plasma salicylurate).

CONCLUSIONS

Regular aspirin or non-aspirin NSAID use was not associated with future risk of pancreatic cancer in participants from several large prospective cohort studies. A possible reduction in risk for pancreatic cancer among people with diabetes who regularly use aspirin should be further examined in preclinical and human studies.

Impact of vitamin D supplementation on C-reactive protein; a systematic review and meta-analysis of randomized controlled trials

Background

To evaluate the effect of vitamin D supplementation on C-reactive protein (CRP) through a systematic review and meta-analysis of randomized control trials (RCTs).

Methods

PubMed-Medline, SCOPUS, Google Scholar and Web of Science databases were searched (up until April 2016) to identify RCTs evaluating the impact of vitamin D supplementation on CRP. We used random effects models (using DerSimonian-Laird method) as well as the generic inverse variance methods for quantitative data synthesis. For sensitivity analysis, we applied leave-one-out approach. To examine the heterogeneity we used I2 index. Registration code: CRD42016036932.

Results

Among 1274 search items, 24 studies met the inclusion criteria in the final evaluation. Pooling the data together indicated a non-significant decrease in CRP level following administration of vitamin D (weighted mean difference [WMD] -0.26(mg/l), (95% CI -0.75 to 0.22, N = 26 arms, heterogeneity p = 0.042; I² 54.2%). The WMDs for IL6 was 0.67 pg/ml, (95% CI 0.29 to 1.06, N = 16 arms, heterogeneity p = 0.234; I² 19.1%), 0.43 pg/ml, (95% CI 0.08 to 1.05, N = 26 arms, heterogeneity p = 0.120; I² 42.1%), for IL10, and −0.11 pg/ml, (95% CI -0.53 to 0.30, N = 12 arms, heterogeneity p = 0.423; I² 9.2%) for TNF-α, 4.03 pg/ml, (95% CI 3.50 to 4.57, N = 3 arms, heterogeneity p = 0.752; I² 8.1%) for adiponectin. Sensitivity analyses confirmed the robustness of the findings.

Conclusions

This study provided evidence that vitamin D supplementation had no impact on serum CRP, IL10, and TNF-α, while significantly increased serum IL6. We recommend RCTs with longer period of follow-up time (12 months) for future studies to provide explicit results.

Electronic supplementary material

The online version of this article (10.1186/s40795-017-0207-6) contains supplementary material, which is available to authorized users.

Genomic determinants of long-term cardiometabolic complications in childhood acute lymphoblastic leukemia survivors

BACKGROUND

While cure rates for childhood acute lymphoblastic leukemia (cALL) now exceed 80%, over 60% of survivors will face treatment-related long-term sequelae, including cardiometabolic complications such as obesity, insulin resistance, dyslipidemia and hypertension. Although genetic susceptibility contributes to the development of these problems, there are very few studies that have so far addressed this issue in a cALL survivorship context.

METHODS

In this study, we aimed at evaluating the associations between common and rare genetic variants and long-term cardiometabolic complications in survivors of cALL. We examined the cardiometabolic profile and performed whole-exome sequencing in 209 cALL survivors from the PETALE cohort. Variants associated with cardiometabolic outcomes were identified using PLINK (common) or SKAT (common and rare) and a logistic regression was used to evaluate their impact in multivariate models.

RESULTS

Our results showed that rare and common variants in the BAD and FCRL3 genes were associated (p<0.05) with an extreme cardiometabolic phenotype (3 or more cardiometabolic risk factors). Common variants in OGFOD3 and APOB as well as rare and common BAD variants were significantly (p<0.05) associated with dyslipidemia. Common BAD and SERPINA6 variants were associated (p<0.05) with obesity and insulin resistance, respectively.

CONCLUSIONS

In summary, we identified genetic susceptibility loci as contributing factors to the development of late treatment-related cardiometabolic complications in cALL survivors. These biomarkers could be used as early detection strategies to identify susceptible individuals and implement appropriate measures and follow-up to prevent the development of risk factors in this high-risk population.

d-Ribose as a Contributor to Glycated Haemoglobin

Glycated haemoglobin (HbA1c) is the most important marker of hyperglycaemia in diabetes mellitus. We show that d-ribose reacts with haemoglobin, thus yielding HbA1c. Using mass spectrometry, we detected glycation of haemoglobin with d-ribose produces 10 carboxylmethyllysines (CMLs). The first-order rate constant of fructosamine formation for d-ribose was approximately 60 times higher than that for d-glucose at the initial stage. Zucker Diabetic Fatty (ZDF) rat, a common model for type 2 diabetes mellitus (T2DM), had high levels of d-ribose and HbA1c, accompanied by a decrease of transketolase (TK) in the liver. The administration of benfotiamine, an activator of TK, significantly decreased d-ribose followed by a decline in HbA1c. In clinical investigation, T2DM patients with high HbA1c had a high level of urine d-ribose, though the level of their urine d-glucose was low. That is, d-ribose contributes to HbA1c, which prompts future studies to further explore whether d-ribose plays a role in the pathophysiological mechanism of T2DM.

Obesity and inflammation: the linking mechanism and the complications

Obesity is the accumulation of abnormal or excessive fat that may interfere with the maintenance of an optimal state of health. The excess of macronutrients in the adipose tissues stimulates them to release inflammatory mediators such as tumor necrosis factor α and interleukin 6, and reduces production of adiponectin, predisposing to a pro-inflammatory state and oxidative stress. The increased level of interleukin 6 stimulates the liver to synthesize and secrete C-reactive protein. As a risk factor, inflammation is an imbedded mechanism of developed cardiovascular diseases including coagulation, atherosclerosis, metabolic syndrome, insulin resistance, and diabetes mellitus. It is also associated with development of non-cardiovascular diseases such as psoriasis, depression, cancer, and renal diseases. On the other hand, a reduced level of adiponectin, a significant predictor of cardiovascular mortality, is associated with impaired fasting glucose, leading to type-2 diabetes development, metabolic abnormalities, coronary artery calcification, and stroke. Finally, managing obesity can help reduce the risks of cardiovascular diseases and poor outcome via inhibiting inflammatory mechanisms.

Obesity, cardiovascular disease, and role of vitamin C on inflammation: a review of facts and underlying mechanisms

Obesity means the accumulation of excessive fat that may interfere with the maintenance of optimal state of health. Obesity causes cardiac and vascular disease through well-known mediators such as hypertension, type-2 diabetes mellitus, and dyslipidemia, but there are evidences for other mediators such as chronic inflammation, oxidative stress, and thrombosis. The decreased levels of antioxidants factors and nitric oxide predispose to further cardiovascular adverse events. To reduce the risks, antioxidants can help by neutralizing the free radicals and protecting from damage by donating electrons. Having the capacity, vitamin C protects from oxidative stress, prevention of non-enzymatic glycosylation of proteins, and enhances arterial dilation through its effect on nitric oxide release. It also decreases lipid peroxidation, and alleviates inflammation. The anti-inflammatory property of vitamin C could be attributed to ability to modulate the NF-_kB DNA binding activity and down-regulation in the hepatic mRNA expression for the interleukins and tumor factors.

Prevalence of Diabetes in the 2009 Influenza A (H1N1) and the Middle East Respiratory Syndrome Coronavirus: A Systematic Review and Meta-Analysis

Over the past two decades a number of severe acute respiratory infection outbreaks such as the 2009 influenza A (H1N1) and the Middle East respiratory syndrome coronavirus (MERS-CoV) have emerged and presented a considerable global public health threat. Epidemiologic evidence suggests that diabetic subjects are more susceptible to these conditions. However, the prevalence of diabetes in H1N1 and MERS-CoV has not been systematically described. The aim of this study is to conduct a systematic review and meta-analysis of published reports documenting the prevalence of diabetes in H1N1 and MERS-CoV and compare its frequency in the two viral conditions. Meta-analysis for the proportions of subjects with diabetes was carried out in 29 studies for H1N1 (n=92,948) and 9 for MERS-CoV (n=308). Average age of H1N1 patients (36.2±6.0 years) was significantly younger than that of subjects with MERS-CoV (54.3±7.4 years, P<0.05). Compared to MERS-CoV patients, subjects with H1N1 exhibited 3-fold lower frequency of cardiovascular diseases and 2- and 4-fold higher prevalence of obesity and immunosuppression, respectively. The overall prevalence of diabetes in H1N1 was 14.6% (95% CI: 12.3-17.0%; P<0.001), a 3.6-fold lower than in MERS-CoV (54.4%; 95% CI: 29.4-79.5; P<0.001). The prevalence of diabetes among H1N1 cases from Asia and North America was ~two-fold higher than those from South America and Europe. The prevalence of diabetes in MERS-CoV cases is higher than in H1N1. Regional comparisons suggest that an etiologic role of diabetes in MERS-CoV may exist distinctive from that in H1N1.

Incidence of prediabetes and risk of developing cardiovascular disease in women with polycystic ovary syndrome

Our aim was to determine the incidence of prediabetes and risk of developing cardiovascular disease (CVD) in women with polycystic ovary syndrome (PCOS). This prospective, observational study included 148 women with PCOS, without Type 2 diabetes mellitus (T2DM) and CVD present at baseline. In the fasting blood samples, we measured lipids, glucose, and insulin levels during oral glucose tolerance test, levels of C-reactive protein (CRP), steroids, 25-hydroxyvitamin D (25-OHD), prolactin, thyroid-stimulating hormone, and parathyroid hormone. The follow-up period was 3 years. At baseline, prevalent prediabetes was present in 18 (12%) of PCOS cases and it progressed to T2DM in 5 (3%) of the cases. Incident prediabetes during the follow-up was noted in 47 (32%) women or 4.7 per 1000 persons/year. Prediabetes was associated with elevated body mass index (BMI) (odds ratio [OR] = 1.089, confidence interval [CI]: 1.010; 1.174, p = 0.026), high baseline levels of CRP (OR = 3.286, CI: 1.299; 8.312, p = 0.012), homeostatic model assessment - insulin resistance (IR) (OR = 2.628, CI: 1.535; 4.498, p < 0.001), and high lipid accumulation product (LAP) (OR = 1.009, CI: 1.003; 1.016, p = 0.005). Furthermore, prediabetes was associated with low 25-OHD (OR = 0.795, CI: 0.724; 0.880, p ≤ 0.05). In addition, cardiovascular risk in PCOS women with prediabetes was high (hazard ratio = 1.092, CI: 1.036; 1.128, p < 0.001). We showed association of prediabetes with high BMI, IR, markers of inflammation, LAP, and low serum 25-OHD concentration. IR appears to be more relevant than the other predictors of prediabetes risk in this study. PCOS women are considered as a high-risk population for prediabetes.

Natural Phyto-Bioactive Compounds for the Treatment of Type 2 Diabetes: Inflammation as a Target

Diabetes is a metabolic, endocrine disorder which is characterized by hyperglycemia and glucose intolerance due to insulin resistance. Extensive research has confirmed that inflammation is closely involved in the pathogenesis of diabetes and its complications. Patients with diabetes display typical features of an inflammatory process characterized by the presence of cytokines, immune cell infiltration, impaired function and tissue destruction. Numerous anti-diabetic drugs are often prescribed to diabetic patients, to reduce the risk of diabetes through modulation of inflammation. However, those anti-diabetic drugs are often not successful as a result of side effects; therefore, researchers are searching for efficient natural therapeutic targets with less or no side effects. Natural products' derived bioactive molecules have been proven to improve insulin resistance and associated complications through suppression of inflammatory signaling pathways. In this review article, we described the extraction, isolation and identification of bioactive compounds and its molecular mechanisms in the prevention of diabetes associated complications.

High Levels of C-Reactive Protein Are Positively Associated with Isolated Postchallenge Hyperglycemia in Postmenopausal Women

BACKGROUND

Isolated postchallenge hyperglycemia (IPH) is an early form of type 2 diabetes with fasting glucose <126 mg/dL and 2-hr postchallenge glucose ≥200 mg/dL. The purpose of this study was to explore the relationships of high-sensitivity C-reactive protein (hsCRP) with IPH.

METHODS

We recruited 476 naturally postmenopausal women without a history of diabetes mellitus for the study. Fasting blood samples were collected for the measurements of hsCRP and biochemistry. All participants received a 75 g oral glucose tolerance test to examine if they had IPH. The relative contributions of body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR) to the association of hsCRP with IPH were evaluated by logistic regression.

RESULTS

There was an increasing trend in prevalence of IPH with increasing quartiles of hsCRP (2.9%, 3.6%, 5.9%, and 7.6% in quartile 1-4, respectively) (P = 0.001). BMI and HOMA-IR were the most important determinants of hsCRP in this cohort. We observed a significant and positive association between high hsCRP levels and IPH in our subjects. Compared with subjects in the lowest quartile group, individuals with high levels of hsCRP (the 3rd and the 4th quartiles) were 2-2.5 times more likely associated with IPH, before and after adjustments for BMI and HOMA-IR values (all P < 0.05).

CONCLUSION

Our results demonstrated that chronic inflammation, measured by elevated serum hsCRP levels, was positively associated with IPH in postmenopausal women. This finding was independent of obesity and insulin resistance.

Withaferin A protects against palmitic acid-induced endothelial insulin resistance and dysfunction through suppression of oxidative stress and inflammation

Activation of inflammatory pathways via reactive oxygen species (ROS) by free fatty acids (FFA) in obesity gives rise to insulin resistance and endothelial dysfunction. Withaferin A (WA), possesses both antioxidant and anti-inflammatory properties and therefore would be a good strategy to suppress palmitic acid (PA)-induced oxidative stress and inflammation and hence, insulin resistance and dysfunction in the endothelium. Effect of WA on PA-induced insulin resistance in human umbilical vein endothelial cells (HUVECs) was determined by evaluating insulin signaling mechanisms whilst effect of this drug on PA-induced endothelial dysfunction was determined in acetylcholine-mediated relaxation in isolated rat aortic preparations. WA significantly inhibited ROS production and inflammation induced by PA. Furthermore, WA significantly decreased TNF-α and IL-6 production in endothelial cells by specifically suppressing IKKβ/NF-κβ phosphorylation. WA inhibited inflammation-stimulated IRS-1 serine phosphorylation and improved the impaired insulin PI3-K signaling, and restored the decreased nitric oxide (NO) production triggered by PA. WA also decreased endothelin-1 and plasminogen activator inhibitor type-1 levels, and restored the impaired endothelium-mediated vasodilation in isolated aortic preparations. These findings suggest that WA inhibited both ROS production and inflammation to restore impaired insulin resistance in cultured endothelial cells and improve endothelial dysfunction in rat aortic rings.