Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections

Visit-to-visit glucose variability is associated with echocardiographic variables in people with type 2 diabetes: epidemiological and mendelian randomization approaches

BACKGROUND

This study aimed to examine the associations between visit-to-visit variability in fasting plasma glucose (FPG) and HbA1c with echocardiographic variables in patients with type 2 diabetes using epidemiologic and Mendelian randomization (MR) methods.

METHODS

From January 2001 to December 2020, 2,326 (1,233 men and 1,093 women) subjects with type 2 diabetes who underwent echocardiography assessment were enrolled in the diabetes care management program of a medical center in Taiwan. The echocardiographic variables included those for cardiac structural, cardiac systolic, and diastolic function. Variability in FPG and HbA1c within one-year prior echocardiographic measurements was calculated using coefficient of variation (CV). A two-stage multivariable regression analysis was used to assess the causal relationship among FPG-CV, HbA1c-CV, and echocardiographic variables using 22 SNPs for FPG and 14 SNPs for HbA1c as instrumental variables.

RESULTS

A total of 2,326 participants were included, with a mean age of 64.5 years and 53.0% were men. Epidemiologic and MR analyses show the significant associations between left atrium diameter (LAD), left ventricular systolic diameter (LVSd), left ventricular mass (LVM), left ventricular ejection fraction (LVEF), E, and E/e' ratio with FPG variability. Significant associations between HbA1c variability and echocardiographic variables including LAD, E/e', and deceleration time identified in the epidemiologic approach became non-significant in the MR analysis when controlling for covariates.

CONCLUSIONS

Our epidemiologic and MR studies demonstrated that visit-to-visit variability of FPG in patients with type 2 diabetes was independently associated with the left cardiac structure as well as systolic and diastolic function.

Comparative study of intraocular pressure variation among healthy and diabetic individuals

Background

Diabetes and glaucoma share several common risk factors and pathophysiological similarities. Elevated intraocular pressure, a key pathogenic feature of glaucoma and its progression, has been found to be influenced in diabetic patients. Furthermore, a link between poor glycemic control and increased intraocular pressure has been documented. Given the rising prevalence of diabetes mellitus and its emergence as a new pandemic with widespread effects, it is crucial to thoroughly study its impact on various body systems and implement measures to reduce these adverse effects. Therefore, this study aims to investigate the variation in intraocular pressure and its relationship with different pathogenic risk factors in diabetes mellitus patients to develop effective prevention strategies.

Aim

To study the variation in intraocular pressure among the subjects with Type II Diabetes Mellitus Settings and Study Design: This analytical cross-sectional study conducted at KGMU, Ophthalmology OPD.

Methods and Materials

Study has been conducted on a total of 140 participants, comprising of 70 Type II DM cases and 70 age, gender-matched controls in 1year duration. Type II DM was confirmed by diagnosis while controls were selected to match in age & gender without diabetes. IOP measurement was done using non-contact tonometry and central corneal thickness was measured by non-contact method using NIDEK CEM-530 specular microscope. Regression analysis was used to assess association between Type II DM and IOP variation. Statistical analysis of the data was done using IBM SPSS Stats 25.0 version with Student t-test, Chi-square test, ANOVA, and Pearson's correlation with 95% CI is used. P <0.05 is considered significant.

Result

Significant distinction in IOP between the between cases and control group is observed. And, also more the duration of diabetes with poor glycemic control may lead to raised IOP.

Conclusion

The study rules out the risk factors for raised IOP in general & diabetic population. Thus, emphasizing the need for meticulous ocular care in diabetic individuals.

Glycaemic sugar metabolism and the gut microbiota: past, present and future

Non-communicable diseases (NCDs), such as type 2 diabetes (T2D) and metabolic dysfunction-associated fatty liver disease, have reached epidemic proportions worldwide. The global increase in dietary sugar consumption, which is largely attributed to the production and widespread use of cheap alternatives such as high-fructose corn syrup, is a major driving factor of NCDs. Therefore, a comprehensive understanding of sugar metabolism and its impact on host health is imperative to rise to the challenge of reducing NCDs. Notably, fructose appears to exert more pronounced deleterious effects than glucose, as hepatic fructose metabolism induces de novo lipogenesis and insulin resistance through distinct mechanisms. Furthermore, recent studies have demonstrated an intricate relationship between sugar metabolism and the small intestinal microbiota (SIM). In contrast to the beneficial role of colonic microbiota in complex carbohydrate metabolism, sugar metabolism by the SIM appears to be less beneficial to the host as it can generate toxic metabolites. These fermentation products can serve as a substrate for fatty acid synthesis, imposing negative health effects on the host. Nevertheless, due to the challenging accessibility of the small intestine, our knowledge of the SIM and its involvement in sugar metabolism remains limited. This review presents an overview of the current knowledge in this field along with implications for future research, ultimately offering potential therapeutic avenues for addressing NCDs.

Effectiveness of Roux-en-Y Gastric Bypass in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

This meta-analysis aimed to evaluate the effectiveness of Roux-en-Y gastric bypass (RYGB) in people living with type 2 diabetes mellitus (T2DM). A comprehensive search was conducted in the PubMed database up to January 2024. A random-effects model was used to calculate the pooled standard mean differences (SMDs) and odds ratios (ORs). Ten studies were included in our review. The RYGB group demonstrated significantly better outcomes compared to the non-surgical group in multiple measures. These included higher triple criteria compliance rates (OR 9.04, 95% CI 3.22-25.36), complete T2DM remission (OR 15.37, 95% CI 4.42-53.41), and partial T2DM remission (OR 11.49, 95% CI 3.57-37.03). Additionally, improvements were observed in glycated hemoglobin A1c (HbA1c) levels (SMD - 1.41, 95% CI - 2.22 to - 0.61), with HbA1c < 6.0% (OR 8.54, 95% CI 3.38-21.62) and HbA1c < 7.0% (OR 5.62, 95% CI 3.20-9.86). Fasting blood glucose (FBG) levels also showed improvement (SMD - 0.43, 95% CI - 0.71 to - 0.14), with a higher proportion achieving FBG < 100 mg/dl (OR 11.83, 95% CI 4.75-29.43). Other notable outcomes included significant percentage of total weight loss (%TWL: SMD 1.88, 95% CI 1.39-2.37), reductions in body mass index (BMI: SMD - 2.28, 95% CI - 3.52 to - 1.04), and improvements in lipid profiles, including low-density lipoprotein (LDL) levels (SMD - 1.01, 95% CI - 1.91 to - 0.11) and LDL < 2.59 mmol/L (OR 3.65, 95% CI 1.94-6.87). In addition, high-density lipoprotein (HDL) levels increased (SMD 1.30, 95% CI 0.55-2.05), while triglycerides (SMD - 1.11, 95% CI - 1.70 to - 0.52), systolic blood pressure (SBP: SMD - 0.38, 95% CI - 0.70 to - 0.06), and diastolic blood pressure (DBP: SMD - 0.41, 95% CI - 0.63 to - 0.18) decreased. A greater proportion of patients in the RYGB group achieved SBP < 130 mmHg (OR 3.15, 95% CI 1.61-6.13). Moreover, reductions were noted in insulin use (OR 0.25, 95% CI 0.14-0.46), diabetes medication use (SMD - 1.95, 95% CI - 3.32 to - 0.57), and peripheral neuropathy (OR 0.13, 95% CI 0.02-0.79). However, no significant differences were observed in hypertension medication use or retinopathy between the two groups. RYGB was found to be effective in improving glycemic control, promoting weight loss, enhancing lipid profiles, and managing blood pressure. It also significantly reduced the need for postoperative diabetes medications and the incidence of diabetic peripheral neuropathy in people living with T2DM.

ALTERATION OF TREATMENT CHOICES AND THE VISUAL PROGNOSIS FOR DIABETIC MACULAR EDEMA IN THE ERA OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR DRUGS: Analysis of the STREAT-DME 2 Study

PURPOSE

To assess the real-world outcome of best-corrected visual acuity after 2-year intervention for treatment-naive diabetic macular edema since the approval of anti-vascular endothelial growth factor therapy.

METHODS

A total of 1,780 treatment-naive eyes with diabetic macular edema for which intervention was initiated between 2015 and 2019, and which were followed for 2 years, were extracted from the longitudinal medical records of 37 retinal disease institutions in Japan. Interventions included anti-VEGF therapy, topical corticosteroid therapy, macular photocoagulation, and vitrectomy. The baseline and final best-corrected visual acuity, and the number and timing of interventions were recorded. Eyes were classified according to the year in which intervention was initiated.

RESULTS

Over a 2-year period, best-corrected visual acuity improved annually, finally reaching seven letters. The proportion of eyes in which good vision was maintained (best-corrected visual acuity >20/40) increased to 73.3% in the latest period. The administration of anti-VEGF therapy remained stable, accounting for approximately 90% of eyes. Notably, the proportion of eyes receiving anti-VEGF drugs as first-line treatment increased dramatically to approximately 80%.

CONCLUSION

Anti-VEGF therapy has become the first-line treatment since the approval of anti-VEGF drugs for diabetic macular edema. These findings reflect the evolution of diabetic macular edema treatment and highlight the superiority of anti-VEGF therapy and its increased uptake over time.

Delayed Immune Response Upon Injury in Diabetic Wounds Impedes Healing

BACKGROUND

Chronic wounds are a severe complication of diabetes. Dysregulated inflammatory signalling is thought to underly the poor healing outcomes. Yet, there is little information available on the acute response following injury and its impact on healing.

METHODS

Using a murine full thickness excisional wound model, the current study therefore assessed the expression of pro-inflammatory and pro-resolving lipid mediators during the early stages post injury in acute and diabetic wounds and compared the timeframe for transitioning through the phases of healing. Tissue eicosanoid (LTB4, PGE2, TxA2, MaR1, RvE1, RvD1, PD) and MMP-9 levels were assessed at 6 h post wounding using ELISAs. Wound closure, healing dynamics (histology), cellular infiltration and MPO, TNF-α expression (IHC) were assessed at 6 h, day2, day7 post wounding.

RESULTS

Eicosanoid expression did not differ between groups (LTB4 24-125 pg/mL, PGE2 63-177 pg/mL, TxA2 529-1184 pg/mL, MaR1 365-2052 pg/mL, RvE1 43-1157 pg/mL, RvD1 1.5-69 pg/mL, PD1 11.5-4.9 ng/mL). An inverse relationship (p < 0.05) between MMP-9 and eicosanoids were however only evident in acute and not in diabetic wounds. Diminished cellular infiltration (x5 fold) (p < 0.05) in diabetic wounds coincided with a significant delay in the expression of TNF-α (pro-inflammatory cytokine) and MPO (neutrophil marker). A significant difference in the expression of TNF-α (C 1.8 ± 0.6; DM 0.7 ± 0.1 MFI) and MPO (C 4.9 ± 1.9; DM 0.9 ± 0.4 MFI) (p < 0.05) was observed as early as 6 h post wounding, with histology parameters supporting the notion that the onset of the acute inflammatory response is delayed in diabetic wounds.

CONCLUSION

These observations imply that the immune cells are unresponsive to the initial eicosanoid expression in the diabetic wound tissue.

Deciphering the ameliorative effect of Aloe vera (L.) burm. F. extract on histopathological alterations in Streptozotocin-induced WNIN/GR-ob rats

ETHNOPHARMACOLOGICAL RELEVANCE

Natural products have emerged as a novel source in the management of non-communicable diseases, more so in diabetes mellitus and its comorbidities. Aloe vera is widely recognized for its anti-hyperglycemic and anti-hyperlipidemic properties and numerous researchers have identified component (s) from Aloe vera attributing to these therapeutic effects.

AIM OF THE STUDY

The current work was undertaken to gain insight into the protective effect of Aloe vera (L.) Burm. f. extract to study the cytoarchitecture/histopathological alterations in the target organs in mutant Obese WNIN/GR-Ob rats that were made frank diabetic with streptozotocin.

MATERIALS AND METHODS

Rats were divided into five groups. 1)WNIN-GR-Ob/control group 2)WNIN-GR-Ob treated with STZ 3)WNIN-GR-Ob + STZ + Sitagliptin 4)WNIN-GR-Ob + STZ + Aloe vera 5)WNIN-GR-Ob/control group + Aloe vera. Histopathological analysis of the pancreas, kidney, liver, and adipocytes was done after 4 weeks of treatment.

RESULTS

The histopathological examination of STZ-induced diabetic rats revealed significant changes in all the vital organs including cell infiltration, degeneration, and necrosis. Treatment with A. vera negated most of the histopathological changes seen in STZ induced rats. Sitagliptin-which served as a positive control in the present study-reversed the alterations seen in streptozotocin rats.

CONCLUSION

Considering the hypoglycaemic and hypolipidemic activities of Aloe vera that have been previously demonstrated by us, the present study further re-instates the therapeutic efficacy of Aloe vera towards vital organs. It was able to restore islet cells and reduce β-cell damage. In addition, it was also able to aid in kidney tubular regeneration and reverse the degenerative changes brought on by streptozotocin on liver. Further, Aloe vera treated group exhibited moderate hyperplasia with decreased size of adipocytes and reduced macrophage infiltration. Thus, our findings advocate its application as an important nutraceutical in the therapeutic management of diabetes mellitus and associated complications.

Changes in Cardiovascular Health at Midlife and Subsequent Cardiovascular Outcomes in Individuals With Diabetes

Background

Whether improvements in cardiovascular health (CVH) in midlife mitigate cardiovascular disease (CVD) risk in patients with diabetes remains underexplored.

Objectives

The aim of the study was to examine the relationships between changes in CVH during midlife and subsequent risks of CVD events and all-cause mortality among individuals with and without diabetes.

Methods

The study utilized data from the Atherosclerosis Risk in Communities Study. CVH data were collected during visits 1 and 3 and the median follow-up was 23 years. CVH was based on ideal Life's Simple 7 metrics and categorized as low (0-2 metrics), moderate (3 or 4 metrics), and favorable CVH (5-7 metrics). Cox proportional hazards regression models were used to determine the association between changes in CVH and CVD outcomes.

Results

Among the final sample (N = 8,741), 806 had diabetes (9.2%). Of those with diabetes, 62.3% had low CVH at both visits, 12.0% maintained moderate CVH, 15.0% showed improvement, and 10.3% experienced a decline in CVH. Only 0.4% maintained favorable CVH. Those with improved CVH had lower CVD event risks (HR: 0.69; 95% CI: 0.50-0.93), as did those who maintained moderate CVH (HR: 0.68; 95% CI: 0.50-0.94) or shifted from moderate to low CVH (HR: 0.60; 95% CI: 0.41-0.88). Similar patterns were observed for all-cause mortality. In comparison to participants without diabetes who maintained a favorable CVH trajectory at midlife, those with diabetes consistently displayed higher risks of CVD events and mortality, regardless of their CVH trajectory.

Conclusions

For patients with diabetes, achieving or maintaining ideal CVH levels at midlife may help improve outcome; however, CVD risk is not completely mitigated by favorable CVH trajectories.

Differentiation, reduction, and proliferation of pancreatic β-cells and their regulatory factors

The prevalence of diabetes has increased rapidly in recent years, and many types of therapeutic agents have been developed. However, the main purpose of these drugs is to lower blood glucose levels, and they are not fundamental solutions. In contrast, our research has been aimed at stimulating and inducing β-cell proliferation in vivo and replenishing β-cells. We demonstrated that pancreatic ductal cells are a source of β-cells both after birth and during regeneration after partial duct ligation: cell lineage tracing showed that 39% of growing islets and 50% of adult islets during tissue regeneration contained β-cells differentiated from duct cells. We also examined the factors contributing to β-cell depletion. Insulin and cyclin A genes are tightly regulated by transcriptional activators and repressors, and we found that imbalanced and excessive levels of repressors result in a drastic reduction of insulin and β-cell numbers, leading to severe diabetes. Thus, we searched for factors that induce β-cell proliferation in vivo. In our transgenic (Tg) mice, there was a sex difference in the progression of diabetes and sex steroid hormones were shown to contribute to this. Surprisingly, in diabetic male Tg mice, modulation of sex steroid hormones under certain conditions resulted in a marked increase of β-cells. We identified Greb1 as a factor inducing β-cell proliferation in response to a rapid elevation of E2 levels. This series of studies has demonstrated that islet cells exhibit plasticity and indicates that changes of islet cell mass and function are dynamic and recoverable.

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

On the role of the glycosylation of type I collagen in bone

Glycan-protein interactions play a crucial role in biology, providing additional functions capable of inducing biochemical and cellular responses. In the extracellular matrix of bone, this type of interactions is ubiquitous. During the synthesis of the collagen molecule, glycans are post-translationally added to specific lysine residues through an enzymatically catalysed hydroxylation and subsequent glycosylation. During and after fibril assembly, proteoglycans are essential for maintaining tissue structure, porosity, and integrity. Glycosaminoglycans (GAGs), the carbohydrate chains attached to interstitial proteoglycans, are known to be involved in mineralization. They can attract and retain water, which is critical for the mechanical properties of bone. In addition, like other long-lived proteins, collagen is susceptible to glycation. Prolonged exposure of the amine group to glucose eventually leads to the formation of advanced glycation end-products (AGEs). Changes in the degree of glycosylation and glycation have been identified in bone pathologies such as osteogenesis imperfecta and diabetes and appear to be associated with a reduction in bone quality. However, how these changes affect mineralization is not well understood. Based on the literature review, we hypothesize that the covalently attached carbohydrates may have a water-attracting function similar to that of GAGs, but at different lengths and timescales in the bone formation process. Glycosylation potentially increases the hydration around the collagen triple helix, leading to increased mineralization (hypermineralization) after water has been replaced by mineral. Meanwhile, glycation leads to the formation of crosslinking AGEs, which are associated with a decrease in hydration levels, reducing the mechanical properties of bone.

Prevalence and assessment of diabetic retinopathy in a densely populated suburban area of Tianjin, China - The Beichen Eye Study

PURPOSE

The aim of this study is to explore the prevalence, associated risk factors, and the influence of urbanization on the epidemiology of diabetic retinopathy (DR) and diabetic macular edema (DME).

METHODS

This study utilized a cross-sectional design to survey residents aged 50 and older in the Beichen community, Tianjin. Participants underwent thorough examinations, including questionnaire surveys, laboratory blood tests, eye assessments, fundus photography, and optical coherence tomography (OCT) scans. DR was diagnosed using the retinopathy severity scale from fundus photographs based on the Early Treatment Diabetic Retinopathy Study (ETDRS) classification system. DME was identified through medical history records and OCT evaluations. In this study, we analyzed and assessed the prevalence and risk factors associated with DR and DME.

RESULTS

The study included 5,648 participants, and 1,182 of these were diagnosed with diabetes. Among the diabetic individuals, the prevalence of DR was 28.8%. Among the eyes of those diagnosed with DR, 37.12% had mild non-proliferative DR (NPDR), 54.81% had moderate NPDR, 6.35% (33 eyes) showed severe NPDR, and 1.73% had proliferative DR (PDR). The prevalence of DME among diabetic patients was 14.13%. Age was negatively correlated with DR (OR, 0.924), while blood glucose levels (OR, 1.123) and the duration of diabetes (OR, 1.090) were positively correlated. Additionally, blood glucose levels (OR, 1.121) and the duration of diabetes (OR, 1.070) were positively associated with DME.

CONCLUSION

In this study, the prevalence of DR and DME was high in the Beichen District of Tianjin than in other parts of China. Maintaining effective glycemic control is the most important modifiable factor in reducing the risk of DR and DME progression and minimizing the risk of vision loss.

Availability, price, and affordability of diabetes mellitus and thyroid dysfunction medicines in South Wollo zone, Northeast Ethiopia

BACKGROUND

Diabetes mellitus and thyroid dysfunction are prevalent endocrine disorders that impose enormous burdens on patients and countries. However, access to essential medicines remains inadequate in many low-income countries. This study evaluated medications' availability, price, and affordability for these conditions.

METHODS

A cross-sectional study was conducted at health facilities in the South Wollo zone in 2022. Following World Health Organization (WHO)/Health Action International (HAI) guidelines, 34 medicines were evaluated across 60 medicine outlets. Data were collected using a standardized tool adapted from WHO/HAI. Availability was measured by the percentage of facilities where the medicines were in stock. Prices were reported as median prices and median price ratios (MPR). Affordability was assessed based on the number of days' wages required for the lowest-paid government workers to cover the full course of therapy.

RESULTS

The availability of lowest-priced generic (LPG) diabetes and thyroid dysfunction medicines in the public sector was 24.4% and 28.7%, respectively. In private pharmacies, availability was 26.3% for diabetes and 21% for thyroid dysfunction medicines. Median prices for LPG medicines were higher in private pharmacies than in public health facilities, with 81.81% showing a statistically significant difference (p < 0.05). In private pharmacies, the prices of LPG diabetes (5, 71.43%) and thyroid dysfunction medicines (5, 83.33%) exceeded the reference price. None of the LPG diabetes and thyroid dysfunction medicines were affordable in either setting.

CONCLUSIONS

The study revealed a very low availability of medicines and a financial burden on patients. Therefore, the government should improve the availability of these essential medicines and regulate their prices.

Research progress and application of pectin: A review

Pectin, an acidic polysaccharide, is naturally present primarily in the cell walls and inner layers of higher plants. Pectin is extensively used in food, pharmaceutical, cosmetic, and other industries owing to its exceptional attributes encompassing superior gelation, emulsification, antioxidant activity, stability, biocompatibility, and nontoxicity. Due to the increasing demand for pectin, there is a short supply in the domestic pectin market. Currently, the domestic production of pectin is heavily reliant on imports, thus emphasizing the urgent need to enhance its local manufacturing capabilities. Due to the diverse sources of pectin and variations in extraction and purification methods, its content, physicochemical properties, and biological activity are influenced, consequently impacting the market application of pectin. Therefore, this paper comprehensively reviews the extraction and purification process of pectin, in vivo metabolism, and biological activities (including antitumor, immunomodulatory, anti-inflammatory, antioxidant, hypoglycemic and hypolipidemic effects, antimicrobial properties, accelerated wound healing potential, promotion of gastrointestinal peristalsis, and alleviation of constipation as well as cholesterol-lowering effect). Furthermore, it explores the diverse applications of pectin in food science, biomedicine, and other interdisciplinary fields. This review serves as a valuable resource for enhancing the efficiency of pectin content improvement and exploring the potential value and application of pectin in a more scholarly and scientifically rigorous manner.

Nationwide prevalence of type 2 diabetes mellitus and pre-diabetes in Pakistan: A systematic review and meta-analysis

Type 2 diabetes mellitus (T2DM) and pre-diabetes (pre-DM) are significant health concerns in Pakistan. This systematic review and meta-analysis estimate the prevalence of T2DM and pre-DM, assessing regional, gender, and urban-rural differences. We searched PubMed, Scopus, Cochrane, and PakMediNet databases, identifying 3478 articles. After screening, 17 studies from 1995 to 2018 were included. The pooled prevalence of T2DM and pre-DM in Pakistan was found to be 10.0 % and 11.0 %, respectively. This equates to approximately 24 million individuals with T2DM and 26 million with pre-DM, totaling 50 million affected. Rural areas showed higher T2DM prevalence post-2000, with an odds ratio (OR) of 1.25 (95 % CI: 0.73 to 2.14). Gender analysis revealed a slightly higher, though statistically insignificant, prevalence of T2DM in females and a significantly higher prevalence of pre-DM in males (OR: 0.79, 95 % CI: 0.63 to 0.98). Regionally, Punjab had the highest T2DM prevalence (16 %), followed by Baluchistan (15 %), Sindh (14 %), and Khyber Pakhtunkhwa (KPK) (11 %). There is a substantial burden of T2DM and pre-DM in Pakistan, with significant regional and gender differences. Targeted interventions and resource allocation are needed to address the rising prevalence of diabetes, focusing on early detection and lifestyle modifications.

Effect of the Time Interval of Functional Loading on the Periapical Healing of Endodontically Treated Mandibular Molar Teeth with Pulp Necrosis and Asymptomatic Apical Periodontitis: A Split-mouth Randomized Clinical Study

INTRODUCTION

This prospective study evaluated the effect of immediate functional loading (IFL) of a full-coverage prosthesis on the clinical and radiographic outcome of nonsurgical endodontic therapy (NSET) performed on mandibular molar teeth with pulp necrosis and asymptomatic apical periodontitis.

METHODS

In 20 subjects, standardized 2-visit NSET was performed in bilateral mandibular first molar teeth (split-mouth model) with a diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting a radiographic periapical index (PAI) score ≥3. In each subject, the nonvital bilateral mandibular first molar teeth were randomized to 1 of 2 groups: the IFL group or the functional loading after a time interval of 6 months group. Provisional full-coverage prostheses were provided within 7 days after the completion of endodontic therapy. The cases were followed up clinically and radiographically at 6 and 12 months. Radiographs were assessed for periapical healing based on PAI scores, which were dichotomized as healed (PAI score ≤2) or nonhealed (PAI score ≥3). The data were compared using chi-square and Fisher exact tests.

RESULTS

A recall rate of 100% was achieved at the end of 12 months. All teeth in the IFL group and the functional loading after a time interval of 6 months group were clinically asymptomatic. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was a significant difference (P < .05).

CONCLUSIONS

IFL of a full-coverage prosthesis in endodontically treated mandibular molar teeth with pulp necrosis and asymptomatic apical periodontitis delayed periapical healing.

Machine Learning-Based Hyperglycemia Prediction: Enhancing Risk Assessment in a Cohort of Undiagnosed Individuals

Background

Noncommunicable diseases continue to pose a substantial health challenge globally, with hyperglycemia serving as a prominent indicator of diabetes.

Objective

This study employed machine learning algorithms to predict hyperglycemia in a cohort of individuals who were asymptomatic and unraveled crucial predictors contributing to early risk identification.

Methods

This dataset included an extensive array of clinical and demographic data obtained from 195 adults who were asymptomatic and residing in a suburban community in Nigeria. The study conducted a thorough comparison of multiple machine learning algorithms to ascertain the most effective model for predicting hyperglycemia. Moreover, we explored feature importance to pinpoint correlates of high blood glucose levels within the cohort.

Results

Elevated blood pressure and prehypertension were recorded in 8 (4.1%) and 18 (9.2%) of the 195 participants, respectively. A total of 41 (21%) participants presented with hypertension, of which 34 (83%) were female. However, sex adjustment showed that 34 of 118 (28.8%) female participants and 7 of 77 (9%) male participants had hypertension. Age-based analysis revealed an inverse relationship between normotension and age (r=-0.88; P=.02). Conversely, hypertension increased with age (r=0.53; P=.27), peaking between 50-59 years. Of the 195 participants, isolated systolic hypertension and isolated diastolic hypertension were recorded in 16 (8.2%) and 15 (7.7%) participants, respectively, with female participants recording a higher prevalence of isolated systolic hypertension (11/16, 69%) and male participants reporting a higher prevalence of isolated diastolic hypertension (11/15, 73%). Following class rebalancing, the random forest classifier gave the best performance (accuracy score 0.89; receiver operating characteristic-area under the curve score 0.89; F1-score 0.89) of the 26 model classifiers. The feature selection model identified uric acid and age as important variables associated with hyperglycemia.

Conclusions

The random forest classifier identified significant clinical correlates associated with hyperglycemia, offering valuable insights for the early detection of diabetes and informing the design and deployment of therapeutic interventions. However, to achieve a more comprehensive understanding of each feature's contribution to blood glucose levels, modeling additional relevant clinical features in larger datasets could be beneficial.

Self-care behaviors, medication adherence status, and associated factors among elderly individuals with type 2 diabetes

Elderly individuals face an increased likelihood of developing chronic diseases such as diabetes. Self-care practices and medication adherence play crucial roles in preventing complications and adverse effects of this condition. Therefore, this study aimed to determine self-care behaviors, medication adherence status, and related factors among elderly patients with type 2 diabetes. This descriptive-analytical study was conducted on 374 elderly patients with type 2 diabetes who visited educational healthcare centers in Qazvin, Iran, during 2023 (March-September). Sampling was performed using the convenience method. Data collection instruments included a demographic characteristics checklist, the summary of diabetes self-care activities questionnaire, and the Morisky medication adherence scale. Data analysis was conducted using SPSS-22 software, employing the Kolmogorov-Smirnov test, mean, standard deviation, univariate and multivariate regression analyses. The significance level was set at p ≤ 0.05. The mean age of participants was 67.56 ± 5.93 years. In the self-care questionnaire, the highest score pertained to adherence to the diet recommended by the treating physician (3.16 ± 1.87). In contrast, the lowest scores were related to the frequency of checking inside shoes (0.17 ± 0.93) and foot examination (0.31 ± 1.07), respectively. Furthermore, results in self-care behaviors indicated that with increasing education levels, self-monitoring of blood glucose (SMBG) significantly decreased (P = 0.048). This variable was considerably higher in rural residents than in urban dwellers (P = 0.016). Additionally, the frequency of blood glucose measurements was significantly higher in urban residents than in rural inhabitants (p = 0.006). Based on the results, the mean score for medication adherence among patients was 5.53 ± 1.65. Based on our findings, the level of self-care in physical activity, SMBG, and foot care among the elderly is below average. Furthermore, medication adherence in these patients is poor. We expect that managers and policymakers take steps to reduce complications and improve these two variables by developing educational programs on self-care and emphasizing the importance of treatment adherence for these patients.

Exendin-4 blockade of T1R2/T1R3 activation improves Pseudomonas aeruginosa-related pneumonia in an animal model of chemically induced diabetes

OBJECTIVE

Poorly controlled diabetes frequently exacerbates lung infection, thereby complicating treatment strategies. Recent studies have shown that exendin-4 exhibits not only hypoglycemic but also anti-inflammatory properties. This study aimed to explore the role of exendin-4 in lung infection with diabetes, as well as its association with NOD1/NF-κB and the T1R2/T1R3 sweet taste receptor.

METHODS

16HBE human bronchial epithelial cells cultured with 20 mM glucose were stimulated with lipopolysaccharide (LPS) isolated from Pseudomonas aeruginosa (PA). Furthermore, Sprague‒Dawley rats were fed a high-fat diet, followed by intraperitoneal injection of streptozotocin and intratracheal instillation of PA. The levels of TNF-α, IL-1β and IL-6 were evaluated using ELISAs and RT‒qPCR. The expression of T1R2, T1R3, NOD1 and NF-κB p65 was assayed using western blotting and immunofluorescence staining. Pathological changes in the lungs of the rats were observed using hematoxylin and eosin (H&E) staining.

RESULTS

At the same dose of LPS, the 20 mM glucose group produced more proinflammatory cytokines (TNF-α, IL-1β and IL-6) and had higher levels of T1R2, T1R3, NOD1 and NF-κB p65 than the normal control group (with 5.6 mM glucose). However, preintervention with exendin-4 significantly reduced the levels of the aforementioned proinflammatory cytokines and signaling molecules. Similarly, diabetic rats infected with PA exhibited increased levels of proinflammatory cytokines in their lungs and increased expression of T1R2, T1R3, NOD1 and NF-κB p65, and these effects were reversed by exendin-4.

CONCLUSIONS

Diabetic hyperglycemia can exacerbate inflammation during lung infection, promote the increase in NOD1/NF-κB, and promote T1R2/T1R3. Exendin-4 can ameliorate PA-related pneumonia with diabetes and overexpression of NOD1/NF-κB. Additionally, exendin-4 suppresses T1R2/T1R3, potentially through its hypoglycemic effect or through a direct mechanism. The correlation between heightened expression of T1R2/T1R3 and an intensified inflammatory response in lung infection with diabetes requires further investigation.

Artificial sweeteners and their implications in diabetes: a review

Diabetes is a significant global health concern, highlighting the critical role of dietary strategies in its management and prevention. Artificial sweeteners (ASs), due to their capacity to provide sweetness without contributing to caloric intake, have emerged as a potential tool in diabetes management. This review thoroughly examines the nuanced relationship between artificial sweeteners and diabetes, addressing their benefits and potential risks. ASs have been shown to aid in weight management, a key factor in reducing diabetes risk, and do not impact immediate blood glucose levels, offering improved glucose control for individuals with diabetes. Beyond these benefits, however, artificial sweeteners may interact complexly with gut microbiota, potentially altering its composition and affecting metabolic health. This interaction introduces concerns regarding insulin sensitivity and the risk of insulin resistance, with studies reporting conflicting findings. This comprehensive review highlights the importance of a nuanced approach to understanding the implications of artificial sweeteners in diabetes management. Given the mixed evidence on their health effects, there is a clear need for further research to fully elucidate the role of artificial sweeteners in metabolic health and their suitability as part of dietary interventions for diabetes.

Global prevalence of hypomagnesemia in type 2 diabetes mellitus - a comprehensive systematic review and meta-analysis of observational studies

PURPOSE

Hypomagnesemia, characterized by low magnesium levels, has been implicated in the pathophysiology of Type 2 Diabetes Mellitus (T2DM). This meta-analysis aims to provide a comprehensive assessment of hypomagnesemia prevalence in individuals with T2DM as well as its potential implications for diabetes management and complications.

METHODS

We conducted a comprehensive systematic review and meta-analysis using databases like PubMed, Google Scholar, Science Direct, and Research Gate to identify relevant studies between January 2008 and August 2023. We focused on observational studies related to serum magnesium levels and Type 2 Diabetes in individuals aged 19 and older. Newcastle Ottawa tool was used for quality assessment. A random effect meta-analysis was performed to calculate the prevalence of hypomagnesemia in T2DM.

RESULTS

We identified a total of 671 studies, and after screening 383 abstracts and full texts by two independent reviewers, we identified 19 eligible studies encompassing 4192 patients diagnosed with T2DM. The mean age was 55.4 (SD, 4.39) years with a mean HbA1C level of 8.01. The pooled prevalence of hypomagnesemia in T2DM was 32% (95% CI: 22-36%) out of 4192 cases. On subgroup analysis, the prevalence of hypomagnesemia in male and female were 19.8% and 20.1%, respectively. Geographically, Asia had the highest prevalence of hypomagnesemia with 31.9% (95% CI: 24-41.1%).

CONCLUSION

This meta-analysis highlights a significant prevalence of hypomagnesemia in individuals with T2DM, emphasizing the need for further investigation due to the intricate nature of the association between serum magnesium levels and T2DM.

Comparison of the efficacy and safety of rapid-acting insulin analogs, lispro versus aspart, in the treatment of diabetes: a systematic review of randomized controlled trials

INTRODUCTION

We evaluated a potential move from one rapid-acting insulin analog to another, or their biosimilars, to aid better and faster decisions for diabetes management.

METHODS

A systematic literature review was performed according to PRISMA reporting guidelines. The MEDLINE/EMBASE/COCHRANE databases were searched for randomized control trials (RCTs) comparing aspart/lispro in type-1 (T1D) and type-2 (T2D) diabetes. The methodological quality of the included studies was assessed using the Cochrane Collaboration's risk of bias assessment criteria.

RESULTS

Of the 753 records retrieved, the six selected efficacy/safety RCTs and the additional three hand-searched pharmacokinetics/pharmacodynamics RCTs showed some heterogeneity in the presentation of the continuous variables; however, collectively, the outcomes demonstrated that lispro and aspart had comparable efficacy and safety in adult patients with T1D and T2D. Both treatments yielded a similar decrease in glycated hemoglobin (HbA1c) and had similar dosing and weight changes, with similar treatment-emergent adverse events (TEAE) and serious adverse event (SAE) reporting, similar hypoglycemic episodes in both T1D and T2D populations, and no clinically significant differences for hyperglycemia, occlusions or other infusion site/set complications.

CONCLUSIONS

Aspart and lispro demonstrate comparative safety and efficacy in patients with T1D/T2D. Since both are deemed equally suitable for controlling prandial glycemic excursions and both have similar safety attributes, they may be used interchangeably in clinical practice.

PROSPERO REGISTRATION NUMBER

CRD42023376793.

Comorbidity of depression and type 2 diabetes in Egypt results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study

BACKGROUND

Diabetes mellitus and depression are serious common diseases, and the number of people with both conditions is rising steadily. Depression in people with diabetes mellitus results in poorer prognosis through different mechanisms. On the other hand, the presence of diabetes in individuals with depression increases functional impairment that is associated with depression.

AIMS

The study aimed to assess the prevalence and factors associated with depression among adults with type 2 diabetes mellitus attending a diabetes clinic in Cairo, Egypt.

METHODS

A cross-sectional study was conducted among adult patients with diabetes type 2 attending a diabetes clinic in the endocrinology department in Ain Shams University Teaching Hospital, Cairo, Egypt. Data were collected through face-to-face interviews by trained psychiatrists and from patients' records.

RESULTS

The prevalence of depression among diabetic patients was 21.8% (95% CI [15.6%, 29.1%]). Depression was more common among younger age groups and those with a higher level of education. There was no significant difference between those with lifetime depression compared to those without depression regarding physical health complications.

CONCLUSIONS

The prevalence of depression among patients with type 2 diabetes is high. Given the impact of co-morbid diabetes and depression, diabetic patients should be routinely screened for the latter condition.

Drug repurposing for metabolic disorders: Scientific, technological and economic issues

Obesity, diabetes, and other metabolic disorders place a huge burden on both the physical health and financial well-being of the community. While the need for effective treatment of metabolic disorders remains urgent and the reality is that traditional drug development involves high costs and a very long time with many pre-clinical and clinical trials, the need for drug repurposing has emerged as a potential alternative. Scientific evidence has shown the anti-diabetic and anti-obesity effects of old drugs, which were initially utilized for the treatment of inflammation, depression, infections, and even cancers. The drug library used modern technological methods to conduct drug screening. Computational molecular docking, genome-wide association studies, or omics data mining are advantageous and unavoidable methods for drug repurposing. Drug repurposing offers a promising avenue for economic efficiency in healthcare, especially for less common metabolic diseases, despite the need for rigorous research and validation. In this chapter, we aim to explore the scientific, technological, and economic issues surrounding drug repurposing for metabolic disorders. We hope to shed light on the potential of this approach and the challenges that need to be addressed to make it a viable option in the treatment of metabolic disorders, especially in the future fight against metabolic disorders.

Clinical characteristics of new-onset diabetes after liver transplantation and outcomes

Background

We aimed to identify the characteristics of new-onset diabetes after liver transplantation (LT) (NODAT) and investigate its impacts on post-transplant outcomes.

Methods

Adult LT patients between 2014 and 2020 who used tacrolimus as initial immunosuppression and survived 3 months at least were evaluated. Patients who developed NODAT within 3 months after LT were classified as NODAT group. Also, patients were further classified as history of diabetes before LT (PHDBT) and non-diabetes (ND) groups. Patient characteristics, post-LT outcomes, and cardiovascular and/or pulmonary complications were compared.

Results

A total of 83, 225, and 263 patients were classified into NODAT, PHDBT, and ND groups. The proportion of cholestatic liver disease and rejection within 90 days were higher in NODAT group. Mean serum tacrolimus concentration trough level in the first week after LT was 7.12, 6.12, and 6.12 ng/mL (p < 0.001). Duration of corticosteroids was significantly longer in NODAT compared to PHDBD or ND (416, 289, and 228 days, p < 0.001). Three-year graft and patient survival were significantly worse in NODAT than ND (80.5% vs. 95.0%, p < 0.001: 82.0% vs. 95.4%, p < 0.001) but similar to PHDBT. Adjusted risks of 3-year graft loss and patient death using Cox regression analysis were significantly higher in NODAT compared to ND (adjusted hazard ratio [aHR] 3.41, p = 0.004; aHR 3.61, p = 0.004). Incidence rates of cardiovascular or pulmonary complications after LT in NODAT were significantly higher than ND but similar to PHDBT.

Conclusion

Higher initial tacrolimus concentration and early rejection might be risk factors for NODAT. NODAT was associated with worse post-transplant outcomes.

Correlations between insulin-degrading enzyme and metabolic markers in patients diagnosed with type 2 diabetes, Alzheimer's disease, and healthy controls: a comparative study

PURPOSE

This study aimed to explore correlations between insulin-degrading enzyme (IDE) and markers of metabolic function in a group of patients diagnosed with type 2 diabetes mellitus (T2DM) or Alzheimer's disease (AD) and metabolically healthy volunteers.

METHOD

We included 120 individuals (47 with T2DM, 9 with AD, and 64 healthy controls). Serum levels of IDE were measured with commercial kits for ELISA. Differences in IDE levels between groups were analyzed with non-parametric ANCOVA, and correlations were analyzed with Spearman's rank correlations. We also investigated the influence of age, sex, and the use of insulin on the correlation using a non-parametric version of partial correlation.

RESULTS

Patients diagnosed with T2DM had higher IDE levels than patients diagnosed with AD and healthy controls after adjustment for age and sex. IDE was increasingly associated with body mass index (BMI), fasting blood glucose, C-peptide, hemoglobin A1c (HbA1c), insulin resistance, and triglycerides. In stratified analyses, we found a decreasing partial correlation between IDE and HbA1c in patients diagnosed with AD and a decreasing partial correlation between IDE and C-peptide in healthy controls. In patients diagnosed with T2DM, we found no partial correlations.

CONCLUSION

These results indicate that IDE is essential in metabolic function and might reflect metabolic status, although it is not yet a biomarker that can be utilized in clinical practice. Further research on IDE in human blood may provide crucial insights into the full function of the enzyme.

Diabetic patients with chronic hepatitis C virus response compared to non diabetics when treated with directly acting antiviral therapy

BACKGROUND AND STUDY AIMS

Hepatitis C virus (HCV) impairs glucose homoestasis, thus influences its clinical picture and prognosis. This study aimed at evaluating Diabetes mellitus (DM) on Egyptian patients with chronic hepatitis C (CHC), and its impact on their virologic response when treated with directly acting antiviral (DAA) medications.

PATIENTS AND METHODS

Adult patients with CHC were divided into 2 groups; Diabetic patients, and Non diabetic patients serving as control group. All patients were subjected to thorough clinical evaluation, basic biochemical laboratory tests including fasting blood glucose/glycosylated haemoglobin (HbA1C), and virologic assay. They were treated with various combined DAAs, and were monitored during, at and after end of treatment.

RESULTS

Diabetic patients constituted 9.85 % of CHC, and had generally worse laboratory tests (significantly higher transaminases, platelet count, Fib4 and hepatic steatosis) than non diabetic patients, and a less sustained virologic response (SVR) (significantly in Sofosbuvir (SOF) + pegylated interferon (PegIFN) + ribavirin (RBV), SOF + RBV, SOF + daclatasvir (DAC)). Although DM did not play a significant influence on SVR, yet Fib4 and SOF + RBV + PEG-IFN were significant factors affecting SVR among diabetics, while female gender and viraemia were significant factors affecting SVR among non diabetics. Hepatic fibrosis and SOF/RBV significantly influenced SVR in both groups.

CONCLUSIONS

Diabetic patients with CHC have worse liver biochemical profile, yet DM per se did not influence the virologic response to DAAs, however, some factors played roles in affecting SVR among them.

Photocoagulation or sham laser in addition to conventional anti-VEGF therapy in macular edema associated with TelCaps due to diabetic macular edema or retinal vein occlusion (TalaDME): a study protocol for a multicentric, French, two-group, non-commercial, active-control, observer-masked, non-inferiority, randomized controlled clinical trial

BACKGROUND

Macular edema (ME) results from hyperpermeability of retinal vessels, leading to chronic extravasation of plasma components into the retina and hence potentially severe visual acuity loss. Current standard of care consists in using intravitreal injections (IVI), which results in a significant medical and economic burden. During diabetic retinopathy (DR) or retinal vein occlusion (RVO), it has recently been shown that focal vascular anomalies (capillary macro-aneurysms, also termed TelCaps) for telangiectatic capillaries may play a central role in the onset, early recurrence, and/or persistence of ME. Since targeted photocoagulation of TelCaps may improve vision, identification, and photocoagulation of TelCaps, it may represent a way to improve management of ME.

OBJECTIVE

The Targeted Laser in (Diabetic) Macular Edema (TalaDME) study aims to evaluate whether ICG-guided targeted laser (IGTL), in association with standard of care by IVI, allows reducing the number of injections during the first year of treatment compared with IVI only, while remaining non-inferior for visual acuity.

METHODS

TalaDME is a French, multicentric, two-arms, randomized, sham laser-controlled, double-masked trial evaluating the effect of photocoagulation of TelCaps combined to IVI in patients with ME associated with TelCaps. Patients with vision loss related to center involved ME secondary to RVO or DR and presenting TelCaps are eligible. Two hundred and seventy eyes of 270 patients are randomized in a 1:1 ratio to standard care, i.e., IVI of anti-VEGF solely (control group) or combined with IGTL therapy (experimental group). Stratification is done on the cause of ME (i.e., RVO versus diabetes). Anti-VEGF IVI are administered to both groups monthly for 3 months (loading dose) and then with a pro re nata regimen with a monthly follow-up for 12 months. The primary endpoint will be the number of IVI and the change in visual acuity from baseline to 12 months. Secondary endpoints will be the changes in central macular thickness, impact on quality of life, cost of treatment, and incremental cost-utility ratio in each groups.

KEY SAFETY

Rare but severe AE linked to the use of IVI and laser, and previously described, are expected. In the sham group, rescue laser photocoagulation may be administered by the unmasked investigator if deemed necessary at month 3.

DISCUSSION

The best management of ME associated with TelCaps is debated, and there have been no randomized study designed to answer this question. Given the fact that TelCaps may affect 30 to 60% of patients with chronic ME due to DR or RVO, a large number of patients could benefit from a specific management of TelCaps. TalaDME aims to establish the clinical and medico-economic benefits of additional targeted laser. The results of TalaDME may raise new recommendations for managing ME and impact healthcare costs.

TRIAL REGISTRATION

EudraCT: 2018-A00800-55/ NCT03751501. Registration date: Nov. 23, 2018.

High-Resolution Imaging of Cones and Retinal Arteries in Patients with Diabetes Mellitus Type 1 Using Adaptive Optics (rtx1)

(1) Background. Diabetes mellitus (DM), called the first non-infectious epidemic of the modern era, has long-term health consequences leading to a reduced quality of life, long-term disabilities, and high mortality. Diabetic retinopathy (DR) is a neurovascular complication of diabetes and accounts for about 80% cases of vision loss in the diabetic population. The adaptive optics (AO) technique allows for a non-invasive in vivo assessment of retinal cones. Changes in number or morphology of retinal cones may be one of the first indicators of DR. (2) Methods. This study included 68 DM1 patients (17 women) aged 42.11 ± 9.69 years with a mean duration of diabetes of 22.07 ± 10.28 years, and 41 healthy volunteers (20 women) aged 41.02 ± 9.84 years. Blood pressure, BMI, waist circumference, and metabolic control measures were analysed. Cones' morphological parameters were examined with a retinal camera with Imagine Eyes adaptive optics (rtx1). Statistical analysis was carried out with IMB SPSS version 23 software. (3) Results. Neither study group differed significantly in age, BMI, blood pressure, or eyeball length. Intraocular pressure (IOP) was statistically significantly higher in DM1 patients but remained within physiological range in both groups. Analysis of cone parameters showed a statistically significant lower mean regularity of cones (Rmean) in the DM1 group compared to control group (p = 0.01), with the lowest value in the group with DM1 and hypertension (p = 0.014). In addition, DM1 patients tended to have fewer cones. (4) Conclusions. Our study revealed abnormalities in cone and vessel parameters and these abnormalities should be considered as risk factors for the development of DR. Complementing an eye examination with AO facilitates non-invasive in vivo cellular imaging of the retina. Lesions like those detected in the eye may occur in the brain and certainly require further investigation.

Gender Differences With Ibutilide Effectiveness and Safety in Cardioversion of Atrial Fibrillation

INTRODUCTION

Few studies have examined the use of ibutilide in noncardiac surgical populations. Our study considered the effectiveness and safety of ibutilide in cardioversion of atrial fibrillation (AF) in medical and surgical intensive care patients.

METHODS

A retrospective chart review was performed for patients with a confirmed diagnosis of AF who were hemodynamically stable and received ibutilide after the initial diagnosis. Patients were administered 1 mg of ibutilide fumarate intravenous for 10 min with a second dose administered if AF persisted after 30 min. Patients were pretreated with intravenous magnesium sulfate if their blood magnesium level was <2 mg/dL.

RESULTS

Fifty seven total female patients and 99 male patients received ibutilide. Females had an 88% conversion rate to normal sinus rhythm (NSR) compared to 68% in males (P = 0.008). A 70% successful return to NSR was observed in patients from all groups pretreated with magnesium sulfate (P = 0.045). One year after discharge, 74% of the patients stayed in the NSR.

CONCLUSIONS

Within our population, pretreatment with magnesium sulfate followed by ibutilide was associated with increased conversion to NSR. Additionally, we noted that females had a higher conversion rate to NSR compared to males, regardless of whether they were pretreated with magnesium sulfate.

Epidemiology of diabetes mellitus in Pakistan: a systematic review protocol

INTRODUCTION

Diabetes mellitus (DM) is a chronic metabolic disorder characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. As a major global health concern, its prevalence has been steadily increasing. Pakistan, is no exception to this trend, facing a growing burden of non-communicable diseases including DM. This research aims to comprehensively assess the prevalence of DM, and disparities between rural and urban populations as well as between men and women in Pakistan.

METHODS AND ANALYSIS

The systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will aim to assess DM prevalence in Pakistan. A comprehensive search strategy will be applied to databases like PubMed, Scopus, Cochrane, PakMediNet and CINAHL from inception up to 1st April 2024. We will include studies that focus on diabetes prevalence in the general population, employing WHO or American Diabetes Association criteria for diagnosis of DM. Cross-sectional studies, cohort studies and population-based surveys with a sample size ≥500, in English will be considered. Data extraction will be done as per a predefined proforma which will include study details such as demographics, prevalence data and methodology. A meta-analysis will be performed using a random effect model with an inverse variance weighted method. I2 statistics will be used to examine heterogeneity, and subgroup analyses will be performed.

ETHICS AND DISSEMINATION

The findings from the systematic review will be shared by publishing them in a peer-reviewed journal and showcasing them at pertinent conferences. Our analysis will be based on aggregated data and will not involve individual patient information, thus eliminating the need for ethical clearance.

PROSPERO REGISTRATION NUMBER

CRD42023453085.

Deliverables from Metabolomics in Kidney Disease: Adenine, New Insights, and Implication for Clinical Decision-Making

BACKGROUND

Chronic kidney disease (CKD) presents a persistent global health challenge, characterized by complex pathophysiology and diverse progression patterns. Metabolomics has emerged as a valuable tool in unraveling the intricate molecular mechanisms driving CKD progression.

SUMMARY

This comprehensive review provides a summary of recent progress in the field of metabolomics in kidney disease with a focus on spatial metabolomics to shed important insights to enhancing our understanding of CKD progression, emphasizing its transformative potential in early disease detection, refined risk assessment, and the development of targeted interventions to improve patient outcomes.

KEY MESSAGE

Through an extensive analysis of metabolic pathways and small-molecule fluctuations, bulk and spatial metabolomics offers unique insights spanning the entire spectrum of CKD, from early stages to advanced disease states. Recent advances in metabolomics technology have enabled spatial identification of biomarkers to provide breakthrough discoveries in predicting CKD trajectory and enabling personalized risk assessment. Furthermore, metabolomics can help decipher the complex molecular intricacies associated with kidney diseases for exciting novel therapeutic approaches. A recent example is the identification of adenine as a key marker of kidney fibrosis for diabetic kidney disease using both untargeted and targeted bulk and spatial metabolomics. The metabolomics studies were critical to identify a new biomarker for kidney failure and to guide new therapeutics for diabetic kidney disease. Similar approaches are being pursued for acute kidney injury and other kidney diseases to enhance precision medicine decision-making.

Retinal nerve fiber layer and ganglion cell complex thickness in diabetic smokers without diabetic retinopathy

PURPOSE

To compare the thickness of the retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL) in smoker and nonsmoker diabetics without diabetic retinopathy.

MATERIALS AND METHODS

Patients with diabetes were divided into two groups according to their smoking status: Group 1 consisted of 38 smoker diabetics who had chronically smoked more than 20 cigarettes per day for more than five years; Group 2 consisted of 38 nonsmoker diabetics. After a detailed ophthalmologic examination, the mean and regional (superior, supratemporal, inferior, inferotemporal, temporal, nasal, superonasal, and inferonasal) RNFL and GC-IPL thicknesses were measured with spectral-domain optic coherence tomography (SD-OCT) and compared between groups.

RESULTS

The mean age was 54.7 ± 10.5 and 51.2 ± 9.7 years in the smoker and nonsmoker groups, respectively (p = 0.14). Gender, duration of diabetes, and the mean axial length were similar between groups (p:0.43, p:0.54, p: 0.52, respectively). Mean RNFL thickness was 89.1 ± 8.0 µm in the smoker group and 93.4 ± 7.0 µm in the nonsmoker group, and it was significantly thinner in the smoker group (p = 0.01). The temporal RNFL thickness in the smoker group was thinner than in the nonsmoker group (p = 0.02). There was no difference in superior, inferior, and nasal RNFL thicknesses between the groups (p = 0.31, p = 0.12, p = 0.39, respectively). The mean macular GC-IPL thickness of the smoker and nonsmoker groups was 78.53 ± 15.74 µm and 83.08 ± 5.85 µm, respectively (p = 0.09). Superior, superonasal, inferonasal, inferior, inferotemporal, and superotemporal quadrant GC-IPL thicknesses were similar between the groups (p = 0.07, p = 0.60, p = 0.55, p = 0.77, p = 0.71, p = 0.08, respectively). The groups showed no difference in minimum GC-IPL thickness (p = 0.43). There was a significant negative correlation between smoking exposure and mean, inferior quadrant RNFL thicknesses in the smoker group (p = 0.04, r= -0.32, and p = 0.01, r= -0.39, respectively).

CONCLUSION

Mean RNFL thickness was significantly thinner in smoker diabetics. Although not statistically significant, especially mean, superior, and superotemporal GC-IPL was thinner in smoker diabetics. The results suggest a potential association between the coexistence of diabetes and smoking with alterations in RNFL and GC-IPL thickness.

Candida Variety in the Oral Cavity of Mexican Subjects with Type 2 Diabetes Mellitus and TLR2 Gene Expression

BACKGROUND

The aim was to diagnose Candida in the oral cavity of subjects with type 2 diabetes mellitus (T2DM) using a genotyping technique and compare the results with those from conventional diagnosis by Papanicolaou (Pap) staining.

METHODS

Palatal mucosa smears were performed on 18 dental care patients diagnosed with T2DM and grade I, II, and III prosthetic stomatitis who met the inclusion criteria; 18 healthy control subjects were also included in the study. Hemoglobin A1c (HbA1c) levels were determined from total blood. Using exfoliative cytology, the Pap staining technique was used to diagnose candidiasis. Exfoliative cytology was also used for molecular diagnosis; DNA was obtained for Candida genotyping, and RNA was used for gene expression studies.

RESULTS

Clinical patterns indicated that all subjects were positive for Candida; however, Pap analysis revealed only three positive subjects, whereas end-point polymerase chain reaction (PCR) analysis revealed 15 subjects with some type of Candida. The most common Candida species found were Candida guilliermondii (38.8%), Candida krusei (33.3%), Candida tropicalis, and Candida lusitaniae (22.2%). Interestingly, the coexpression of different species of Candida was found in various patients. In all patients, HbA1c levels were increased. Gene expression analysis showed a significant decrease (p ≤ 0.05) in TLR2 expression in positive subjects, whereas TLR4 expression did not differ significantly among patients.

CONCLUSIONS

The end-point PCR technique showed better sensitivity for the diagnosis of Candida when compared with the diagnosis by Pap staining. T2DM subjects showed an increased presence of C. guilliermondii that was correlated with decreased TLR2 expression.

Associations between dietary magnesium intake and hypertension, diabetes, and hyperlipidemia

Hypertension, diabetes, and hyperlipidemia significantly impact chronic diseases and mortality. Magnesium is an essential nutrient for maintaining critical physiological functions, and magnesium deficiency is often associated with adverse health outcomes. In a cross-sectional study of US adults, we aimed to explore dietary magnesium intake and its association with the prevalence of hypertension, diabetes, and hyperlipidemia in US adults over 20 years of age in NHANES 2007-2018. We obtained data on 24,171 samples of hypertension, 9950 samples of diabetes, and 12,149 samples of hyperlipidemia. We used multivariable logistic regression models adjusted for multiple sociodemographic, anthropometric, and lifestyle factors, with participants subdivided into five groups based on quintiles of daily dietary magnesium. After adjusting for the major lifestyle and dietary variables, an independent and significant inverse relationship between dietary magnesium and hypertension, diabetes, and hyperlipidemia was observed. Compared with the lowest quintile of magnesium intake, the prevalence of hypertension, diabetes, and hyperlipidemia was significantly reduced in the highest magnesium quintile. The OR of hypertension in the highest quintile was 0.66 (95% CI: 0.51-0.87; P trend < 0.001), the OR of diabetes was 0.56 (95% CI: 0.39-0.81; P trend < 0.001), and the OR of hyperlipidemia was 0.68 (95% confidence interval: 0.53-0.86; P trend = 0.007). In the subgroup analysis, most of the inverse relationships persisted. Our findings highlight the potential of magnesium-rich foods to prevent hypertension, diabetes, and hyperlipidemia in US adults. This article summarizes and discuss recent findings on: 1) A high dietary magnesium intake was associated with a lower prevalence of hypertension; 2) An inverse relationship between dietary magnesium with diabetes hyperlipidemia; 3) Monitoring and management of magnesium was important.

Protein Hydrolysates and Bioactive Peptides as Mediators of Blood Glucose-A Systematic Review and Meta-Analysis of Acute and Long-Term Studies

Type 2 diabetes mellitus (T2DM) is a major public health concern associated with high mortality and reduced life expectancy. Since diabetes is closely linked with lifestyle, not surprisingly, nutritional intervention and increased physical activity could play a vital role in attenuating the problems related to diabetes. Protein hydrolysates (PHs) and their bioactive peptides (BP) have been shown to exert a wide range of biological effects, including antioxidative, antihypertensive, and in particular, hypoglycaemic activities. To better understand the efficacy of such interventions, a systematic review and meta-analysis of randomised controlled trials (RCTs) were performed concerning the influence of protein hydrolysates on glycaemic biomarkers in subjects with and without hyperglycaemia. Five different databases were used to search for RCTs. In total, 37 RCTs were included in the systematic review and 29 RCTs in the meta-analysis. The meta-analysis revealed a significant reduction in postprandial blood glucose response (PPGR) in normoglycaemic (-0.22 mmol/L; 95% CI -0.43, -0.01; p ≤ 0.05) and in hyperglycaemic adults (-0.88 mmol/L; 95% CI -1.37, -0.39; p ≤ 0.001) compared with the respective control groups. A meta-regression analysis revealed a dose-dependent response for PPGR following PH consumption in normoglycaemic adults, specifically for doses ≤ 30 g. The postprandial blood insulin responses (PPIR) were significantly higher after the ingestion of PHs in both the group with and the group without hyperglycaemia, respectively (23.05 mIU/L; 95% CI 7.53, 38.57; p ≤ 0.01 and 12.57 mIU/L; 95% CI 2.72, 22.41; p ≤ 0.01), compared with controls. In terms of long-term responses, there was a small but significant reduction in both fasting blood glucose (FBG) and fasting glycated haemoglobin (HbA1c) in response to PH compared with the control group (p < 0.05). The PHs significantly improved the parameters of glycaemia in adults and, hence, it may contribute to the management and regulation of the future risk of developing T2DM.

A Narrative Review of Retinopathy in Diabetic Patients

Patients with diabetes may be at risk of ocular diseases, like retinopathy due to diabetes and oedema of the eye. Patients with retinopathy due to diabetes experience constant injury to the retina and the posterior end of the eye, which is light-sensitive. It is a prominent complication faced by diabetics that threatens a patient's vision. Diabetes can inhibit the body's potential to ingest and maintain blood glycemic levels, resulting in several health problems. Excessive glucose in the blood can affect the eyes and other organs of the body. Diabetes has an effect on the blood supply system of the retina over a prolonged period of time. Diabetes-related retinopathy can lead to blindness as fluid can flow into the macula, which is essential for maintaining a clear visual field. The macula, despite its small size, is the region that enables us to comprehend colours and fine peculiarities well. The fluid swells the macula, leading to an impaired visual field. The weak, irregular blood vessels formed during neovascularization can potentially haemorrhage into the posterior end of the eye, obstructing the visual field. Blood vessels of the eye leak blood and other fluids, causing retinal tissue enlargement and eyesight clouding. Typically, the illness affects both eyes. Diabetes retinopathy is more likely to develop as a person's diabetes progresses. If untreated, retinopathy due to diabetes can result in blindness.

Mitochondrial Dysfunction and Imeglimin: A New Ray of Hope for the Treatment of Type-2 Diabetes Mellitus

Diabetes is a rapidly growing health challenge and epidemic in many developing countries, including India. India, being the diabetes capital of the world, has the dubious dual distinction of being the leading nations for both undernutrition and overnutrition. Diabetes prevalence has increased in both rural and urban areas, affected the younger population and increased the risk of complications and economic burden. These alarming statistics ring an alarm bell to achieve glycemic targets in the affected population in order to decrease diabetes-related morbidity and mortality. In the recent years, diabetes pathophysiology has been extended from an ominous triad through octet and dirty dozen etc. There is a new scope to target multiple pathways at the molecular level to achieve a better glycemic target and further prevent micro- and macrovascular complications. Mitochondrial dysfunction has a pivotal role in both β-cell failure and insulin resistance. Hence, targeting this molecular pathway may help with both insulin secretion and peripheral tissue sensitization to insulin. Imeglimin is the latest addition to our anti-diabetic armamentarium. As imeglimin targets, this root cause of defective energy metabolism and insulin resistance makes it a new add-on therapy in different diabetic regimes to achieve the proper glycemic targets. Its good tolerability and efficacy profiles in recent studies shows a new ray of hope in the journey to curtail diabetes-related morbidity.

Hepatoprotective Mechanisms Induced by Spinach Methanolic Extract in Rats with Hyperglycemia-An Immunohistochemical Analysis

Spinach methanolic extract (SME) has a hepatoprotective effect due to its polyphenolic antioxidants; however, its action in parenchymal (PQ) and non-parenchymal (nPQ) cells remains unknown. This study investigates the hepatoprotective effect of SME on streptozotocin-induced hyperglycemic rats (STZ), focusing on immunohistochemical analyses. Methods: The extract was prepared, and the total polyphenols and antioxidant activity were quantified. Adult male Wistar rats were divided into four groups (n = 8): normoglycemic rats (NG), STZ-induced hyperglycemic (STZ), STZ treated with 400 mg/kg SME (STZ-SME), and NG treated with SME (SME) for 12 weeks. Serum liver transaminases and lipid peroxidation levels in tissue were determined. The distribution pattern and relative levels of markers related to oxidative stress [reactive oxygen species (ROS), superoxide dismutase-1, catalase, and glutathione peroxidase-1], of cytoprotective molecules [nuclear NRF2 and heme oxygenase-1 (HO-1)], of inflammatory mediators [nuclear NF-κB, TNF-α], proliferation (PCNA), and of fibrogenesis markers [TGF-β, Smad2/3, MMP-9, and TIMP1] were evaluated. Results: SME had antioxidant capacity, and it lowered serum transaminase levels in STZ-SME compared to STZ. It reduced NOX4 staining, and lipid peroxidation levels were related to low formation of ROS. In STZ-SME, the immunostaining for antioxidant enzymes increased in nPQ cells compared to STZ. However, enzymes were also localized in extra and intracellular vesicles in STZ. Nuclear NRF2 staining and HO-1 expression in PQ and nPQ were higher in STZ-SME than in STZ. Inflammatory factors were decreased in STZ-SME and were related to the percentage decrease in NF-κB nuclear staining in nPQ cells. Similarly, TGF-β (in the sinusoids) and MMP-9 (in nPQ) were increased in the STZ-SME group compared to the other groups; however, staining for CTGF, TIMP1, and Smad2/3 was lower. Conclusions: SME treatment in hyperglycemic rats induced by STZ may have hepatoprotective properties due to its scavenger capacity and the regulation of differential expression of antioxidant enzymes between the PQ and nPQ cells, reducing inflammatory and fibrogenic biomarkers in liver tissue.

[Exploring facilitators and barriers to implementing expanded nursing roles in MexicoEstudo de facilitadores e barreiras para a implementação de funções ampliadas de enfermagem no México]

Objective

To explore the perceptions of nursing professionals regarding facilitators and barriers to the implementation of expanded nursing functions in a state in central Mexico.

Methods

Qualitative descriptive phenomenological study. During 2022, 18 semi-structured interviews were conducted with three types of informants: a) head nurses at state-level facilities; b) head nurses at local-level facilities; and c) heads of health units and operational nursing staff who have direct contact with patients.

Results

The following facilitators were identified: willingness to adopt the strategy (seen as favorable by managers and acceptable by nursing staff); reorganization of functions (simplification of processes and analysis of the situation of health units); access to training; and characteristics of nursing staff (professionalization, work experience, and favorable attitude). Barriers included: conditions at the first level of care (personnel shortages, too many administrative activities, lack of physical space, materials, supplies, and consumables), resistance to change (professional jealousy of other disciplines and duplication of tasks), staff salaries, lack of training, not trusted with expanded duties, and attitude of patients (resistance to nursing care).

Conclusions

By understanding the perceptions of nursing professionals, we can identify key elements for the successful expansion of nursing functions through expansion of the competencies of operational staff. Reorganization and proper management at different levels of decision-making will be necessary.

Real-World Persistence and Treatment Interval in Patients with Diabetic Macular Edema Treated with Anti-Vascular Endothelial Growth Factors in the USA

INTRODUCTION

There is little understanding of long-term treatment persistence in patients receiving anti-vascular endothelial growth factor (anti-VEGF) injections for diabetic macular edema (DME), particularly relating to treatment intervals. The aim of this study was to investigate the association between treatment interval and discontinuation rate after 24 months of unilateral anti-VEGF treatment in patients with DME under routine clinical care in the USA.

METHODS

This was a non-interventional, retrospective cohort study to review the health insurance claims of adults with DME linked with the IBM MarketScan® Commercial and Medicare Supplemental databases, who were continuously enrolled in a health plan for at least 6 months prior to their first anti-VEGF treatment and for a duration of at least 24 months between July 2011 and June 2017. Patients were grouped on the basis of the injection interval they achieved at 24 months of treatment. Discontinuation rate beyond 24 months and its association with treatment intervals at 24 months was estimated using the Kaplan-Meier method and Cox proportional hazards models.

RESULTS

The overall discontinuation rate among the 1702 eligible patients from 24 to 60 months after treatment initiation was 30%. At 60 months, patients were more likely to remain on treatment in shorter (75.3% [4-week interval group]) versus longer treatment interval groups (62.1% [> 12-week interval group], difference = 13.2%, [95% confidence interval (CI) 1.06, 2.06], p = 0.01). Patients on a > 12-week interval were twice as likely to discontinue treatment compared with those on an 8-week interval (hazard ratio = 2.01 [95% CI 1.43, 2.82], p < 0.001).

CONCLUSION

Patients with DME on longer anti-VEGF treatment intervals at 24 months consistently had higher discontinuation rates in the following years than those on shorter treatment intervals.

The role of sRAGE in cardiovascular diseases

Advanced glycation end products (AGEs), by-products of glucose metabolism, have been linked to the emergence of cardiovascular disorders (CVD). AGEs can cause tissue damage in four different ways: (1) by altering protein function, (2) by crosslinking proteins, which makes tissue stiffer, (3) by causing the generation of free radicals, and (4) by activating an inflammatory response after binding particular AGE receptors, such as the receptor for advanced glycation end products (RAGE). It is suggested that the soluble form of RAGE (sRAGE) blocks ligand-mediated pro-inflammatory and oxidant activities by serving as a decoy. Therefore, several studies have investigated the possible anti-inflammatory and anti-oxidant characteristics of sRAGE, which may help lower the risk of CVD. According to the results of various studies, the relationship between circulating sRAGE, cRAGE, and esRAGE and CVD is inconsistent. To establish the potential function of sRAGE as a therapeutic target in the treatment of cardiovascular illnesses, additional studies are required to better understand the relationship between sRAGE and CVD. In this review, we explored the potential function of sRAGE in different CVD, highlighting unanswered concerns and outlining the possibilities for further investigation.

Different responses of the MIO‑M1 Mueller cell line to angiotensin II under hyperglycemic or hypoxic conditions

Members of the renin-angiotensin aldosterone system (RAAS) are expressed by various retinal tissues including Mueller glial cells. As the RAAS is hypothesized to play an important role in the pathogenesis of diseases that threaten vision, such as diabetic macular edema or retinal vein occlusion, the possible changes induced by exposure of the human cell line MIO-M1, an established model of Mueller cells, to angiotensin II or aldosterone for 6 h under hypoxic and/or hyperglycemic conditions were investigated. The mRNA expression levels of the members of the RAAS were assessed by reverse transcription-quantitative PCR, and the secretion of cytokines was assessed by ELISA. Under hyperglycemic conditions, the mRNA expression levels of the angiotensin-converting enzyme 2 (ACE2), angiotensin II receptors, AT1 and AT2, and the receptor of angiotensin (1-7) MAS1 were significantly higher after exposure to angiotensin II, and the expression of ACE2, AT2, and IL-6 (a marker of inflammation) was significantly increased after treatment with aldosterone; the expression of the other targets investigated remained unchanged. Significantly more IL-6 was secreted by MIO-M1 cells exposed to hyperglycemia and angiotensin. When cells were cultured in a hypoxic environment, additional treatment with aldosterone significantly increased the mRNA expression levels of ACE, but significantly more ACE2 mRNA was expressed in the presence of angiotensin II. Under hypoxic plus hyperglycemic conditions, significantly less ACE but more AT2 was expressed after treatment with angiotensin II, which also led to strongly elevated expression of IL-6. The mRNA expression levels of the angiogenic growth factor VEGF-A and secretion of the encoded protein were notably increased under hypoxic and hypoxic plus hyperglycemic conditions, irrespective of additional treatment with angiotensin II or aldosterone. These findings suggest that angiotensin II induces a pro-inflammatory response in MIO-M1 cells under hyperglycemic conditions despite activation of the counteracting ACE2/MAS1 signaling cascade. However, hypoxia results in an increased expression of angiogenic VEGF-A by these cells, which is not altered by angiotensin II or aldosterone.

Analysis of Trauma Characteristics Between the Older and Younger Adult Patient from the Pan Asian Trauma Outcome Study Registry (PATOS)

OBJECTIVE

Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries.

METHODS

This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays.

RESULTS

Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02-1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04-2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06-5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48-5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40-5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30-7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02-4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23-3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95-22.48, p < 0.001) were significant predictors of hospital mortality.

CONCLUSIONS

Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors.

Oxidative Stress and Its Regulation in Diabetic Retinopathy

Diabetic retinopathy is the retinal disease associated with hyperglycemia in patients who suffer from type 1 or type 2 diabetes. It includes maculopathy, involving the central retina and characterized by ischemia and/or edema, and peripheral retinopathy that progresses to a proliferative stage with neovascularization. Approximately 10% of the global population is estimated to suffer from diabetes, and around one in 5 of these individuals have diabetic retinopathy. One of the major effects of hyperglycemia is oxidative stress, the pathological state in which elevated production of reactive oxygen species damages tissues, cells, and macromolecules. The retina is relatively prone to oxidative stress due to its high metabolic activity. This review provides a summary of the role of oxidative stress in diabetic retinopathy, including a description of the retinal cell players and the molecular mechanisms. It discusses pathological processes, including the formation and effects of advanced glycation end-products, the impact of metabolic memory, and involvements of non-coding RNA. The opportunities for the therapeutic blockade of oxidative stress in diabetic retinopathy are also considered.

Greb1 Transiently Accelerates Pancreatic β-Cell Proliferation in Diabetic Mice Exposed to Estradiol

Decrease of pancreatic β cells leads to diabetes. In an inducible cAMP early suppressor (ICER-Iγ) transgenic mouse model of severe type 2 diabetes with reduced insulin production and depleted β cells, supplementation with high concentrations of 17β-estradiol (E2) markedly enhances β-cell proliferation and normalizes glucose levels. The current study explored the underlying mechanisms leading to a dynamic increase of β cells and pathologic changes in diabetic mice exposed to E2. Gene expression profiling of pancreatic islets of 6-month-old ICER-transgenic mice recovering from diabetes due to elevated E2 levels identified growth regulation by estrogen in breast cancer 1 (Greb1) as a gene significantly up-regulated during the recovery phase. To substantiate this, β-cell-specific Greb1-deficient mice were generated, and Greb1 was shown to be essential for recovery of depleted β cells in diabetic mice. Graft growth and glucose lowering were observed in 50 islets with increased Greb1 expression transplanted adjacent to E2 pellets beneath the kidney capsule of streptozotocin-induced diabetic mice. Greb1 expression due to a drastic increase in exogenous or endogenous E2 was transient and closely correlated with changes in E2-related and some cell cycle-related genes. These findings provide new insights into in vivo proliferation of deficient β cells and suggest the possibility of new therapeutic approaches targeting pancreatic β cells that could revolutionize the concept of diabetes treatment, which has been considered difficult to cure completely.

Associations between eating speed and food temperature and type 2 diabetes mellitus: a cross-sectional study

OBJECTIVE

This study aimed to evaluate the relationship between eating speed and food temperature and type 2 diabetes mellitus (T2DM) in the Chinese population.

METHODS

A cross-sectional survey was conducted between December 2020 to March 2022 from the department of Endocrinology at the Shandong Provincial Hospital. All recruited participants were asked to complete structured questionnaires on their eating behaviors at the time of recruitment. Clinical demographic data such as gender, age, height, weight, familial history of T2DM, prevalence of T2DM and various eating behaviors were collected. Univariate and multivariate logistic regression analyses were used to analyze the associations between eating behaviors and T2DM.

RESULTS

A total of 1,040 Chinese adults were included in the study, including 344 people with T2DM and 696 people without T2DM. Multivariate logistic regression analysis of the general population showed that gender (OR = 2.255, 95% CI: 1.559-3.260, p < 0.001), age (OR = 1.091, 95% CI: 1.075-1.107, p < 0.001), BMI (OR = 1.238, 95% CI: 1.034-1.483, p = 0.020), familial history of T2DM (OR = 5.709, 95% CI: 3.963-8.224, p < 0.001), consumption of hot food (OR = 4.132, 95% CI: 2.899-5.888, p < 0.001), consumption of snacks (OR = 1.745, 95% CI: 1.222-2.492, p = 0.002), and eating speed (OR = 1.292, 95% CI:1.048-1.591, p = 0.016) were risk factors for T2DM.

CONCLUSION

In addition to traditional risk factors such as gender, age, BMI, familial history of T2DM, eating behaviors associated with Chinese culture, including consumption of hot food, consumption of snacks, and fast eating have shown to be probable risk factors for T2DM.

Functional and structural outcomes and complications after pars plana vitrectomy for severe features of proliferative diabetic retinopathy in type 1 and type 2 diabetes mellitus

PURPOSE

To evaluate the functional and structural outcomes as well as postoperative complications after pars plana vitrectomy (PPV) for severe features of proliferative diabetic retinopathy (PDR) in type 1 and type 2 diabetes mellitus (DM) patients.

METHODS

Twenty two eyes of type 1 diabetics (DM1 group) and 27 eyes of type 2 diabetics (DM2 group) were included. Best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative structural changes in optical coherence tomography (OCT) and postoperative complications such as recurrent vitreous haemorrhage, diabetic macular oedema, secondary glaucoma and persistent tractional retinal detachment (TRD) were assessed and compared between the two groups.

RESULTS

Complete reattachment of retina was achieved in 88.9% from the DM1 group and in 95.5% from the DM2 group and remained attached in follow-up. BCVA in DM2 group was significantly lower preoperatively (p = 0.04). Mean postoperative BCVA significantly improved in both studied groups, but it was more evident in eyes of type 2 diabetics compared to type 1 diabetics. In eyes in the DM1 group there was perceptible stabilisation of BCVA. Poor visual acuity or lack of improvement in BCVA in the DM1 group was related to preoperative subretinal haemorrhage in macular region, and TRD involving macula, whereas in the DM2 group-to preoperative subretinal haemorrhage and neovascular glaucoma. The postoperative structural changes (disruption of EZ and ELM) were observed more often in DM2 group, but had the greatest impact on BCVA in eyes of type 1 DM. Complications after PPV for PDR were rare and hadn't a significant influence on the final functional outcomes in both groups.

CONCLUSIONS

Functional improvement after PPV for severe features of proliferative diabetic retinopathy were more noticeable in patients with type 2 DM. Postoperative structural changes had more negative impact on BCVA in type 1 diabetics.