Treating prediabetes: why and how should we do it?

Habitual coffee drinking and the chance of prediabetes remission: findings from a population with low coffee consumption

Introduction

We aimed to investigate the association between coffee drinking and total caffeine intakes with the chance of prediabetes (Pre-DM) regression and progression over 9-years of follow-up.

Research design and methods

This cohort study included 334 Pre-DM individuals (mean age of 49.4 ± 12.8 years and 51.5% men) who participated in the third phase of the Tehran Lipid and Glucose Study (2006-2008). A validated food frequency questionnaire at baseline assessed habitual coffee consumption. All measurements were done at baseline and all subsequent examinations with 3-year follow-up intervals. The odds ratios (OR) and 95% confidence intervals (CIs) of Pre-DM regression to normal glycemia or progression to type 2 diabetes (T2D) in coffee drinkers/non-drinkers were estimated using multinomial logistic regression analysis.

Results

During the study follow-up 39.8% of the study participants were progressed to T2D and 39.8% returned to normal glycemia. Coffee consumption nearly doubled the chance of returning to normal (OR = 2.26, 95% CI = 1.03-4.97). Total caffeine intake was not related to Pre-DM progression and regression. Compared to non-drinkers, coffee drinkers had significantly lower 2-hour serum glucose concentrations over time (152, 95% CI = 144-159 vs. 162, 95% CI = 155-169 mg/dL, P = 0.05).

Conclusions

Habitual coffee drinking may increase the chance of returning to normal glycemia in Pre-DM subjects.

Vitamin D inhibits ferroptosis and mitigates the kidney injury of prediabetic mice by activating the Klotho/p53 signaling pathway

Diabetic nephropathy (DN) is a serious public health problem worldwide, and ferroptosis is deeply involved in the pathogenesis of DN. Prediabetes is a critical period in the prevention and control of diabetes and its complications, in which kidney injury occurs. This study aimed to explore whether ferroptosis would induce kidney injury in prediabetic mice, and whether vitamin D (VD) supplementation is capable of preventing kidney injury by inhibiting ferroptosis, while discussing the potential mechanisms. High-fat diet (HFD) fed KKAy mice and high glucose (HG) treated HK-2 cells were used as experimental subjects in the current study. Our results revealed that serious injury and ferroptosis take place in the kidney tissue of prediabetic mice; furthermore, VD intervention significantly improved the kidney structure and function in prediabetic mice and inhibited ferroptosis, showing ameliorated iron deposition, enhanced antioxidant capability, reduced reactive oxygen species (ROS) and lipid peroxidation accumulation. Meanwhile, VD up-regulated Klotho, solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) expression, and down-regulated p53, transferrin receptor 1 (TFR1) and Acyl-Coenzyme A synthetase long-chain family member 4 (ACSL4) expression. Moreover, we demonstrated that HG-induced ferroptosis is antagonized by treatment of VD and knockdown of Klotho attenuates the protective effect of VD on ferroptosis in vitro. In conclusion, ferroptosis occurs in the kidney of prediabetic mice and VD owns a protective effect on prediabetic kidney injury, possibly by via the Klotho/p53 pathway, thus inhibiting hyperglycemia-induced ferroptosis.

Combined association of abdominal obesity and depressive symptoms with risk of type 2 diabetes: A cohort study

OBJECTIVE

To explore the combined effect of abdominal obesity and depressive symptoms on the risk to type 2 diabetes, while also assessing the potential influence of various glycemic states and gender on this combined relationship.

METHODS

Data is acquired from the China Health and Retirement Longitudinal Study, and 5949 participants were included for analysis. Participants were divided into four groups: neither have abdominal obesity nor depressive symptoms (AO-/DS-), only have depressive symptoms (AO-/DS+), only have abdominal obesity (AO+/DS-), and have both abdominal obesity and depressive symptoms (AO+/DS+). Stratified analyses differentiating the glycemic statuses and sex of the participants were also carried out.

RESULTS

After adjusting for the confounders, the AO-/DS+, AO+/DS- and AO+/DS+ phenotypes were all discovered to be risk factors for type 2 diabetes (OR = 1.38, 95%CI: 1.06-1.79; OR = 2.07, 95%CI: 1.63-2.63; OR = 2.38, 95%CI: 1.83-3.11, respectively) compared with the AO-/DS- phenotype in the overall population. In further stratified analyses, we arrived at the same conclusion for normoglycemic individuals, especially in females. For prediabetes and males, the AO+/DS- and AO+/DS+ phenotypes are risk factors for type 2 diabetes compared with the AO-/DS- phenotype, but not with AO-/DS+.

CONCLUSION

Regardless of glycemic status and sex, the coexistence of abdominal obesity and depressive symptoms were associated with an increased risk of type 2 diabetes. Depressive symptoms were independent risk factors for type 2 diabetes only in normoglycemic individuals and females.

Importance of timing optimization for closed-loop applications of vagus nerve stimulation

In recent decades, vagus nerve stimulation (VNS) therapy has become widely used for clinical applications including epilepsy, depression, and enhancing the effects of rehabilitation. However, several questions remain regarding optimization of this therapy to maximize clinical outcomes. Although stimulation parameters such as pulse width, amplitude, and frequency are well studied, the timing of stimulation delivery both acutely (with respect to disease events) and chronically (over the timeline of a disease's progression) has generally received less attention. Leveraging such information would provide a framework for the implementation of next generation closed-loop VNS therapies. In this mini-review, we summarize a number of VNS therapies and discuss (1) general timing considerations for these applications and (2) open questions that could lead to further therapy optimization.

Multimodal testing reveals subclinical neurovascular dysfunction in prediabetes, challenging the diagnostic threshold of diabetes

AIM

To explore if novel non-invasive diagnostic technologies identify early small nerve fibre and retinal neurovascular pathology in prediabetes.

METHODS

Participants with normoglycaemia, prediabetes or type 2 diabetes underwent an exploratory cross-sectional analysis with optical coherence tomography angiography (OCT-A), handheld electroretinography (ERG), corneal confocal microscopy (CCM) and evaluation of electrochemical skin conductance (ESC).

RESULTS

Seventy-five participants with normoglycaemia (n = 20), prediabetes (n = 29) and type 2 diabetes (n = 26) were studied. Compared with normoglycaemia, mean peak ERG amplitudes of retinal responses at low (16-Td·s: 4.05 μV, 95% confidence interval [95% CI] 0.96-7.13) and high (32-Td·s: 5·20 μV, 95% CI 1.54-8.86) retinal illuminance were lower in prediabetes, as were OCT-A parafoveal vessel densities in superficial (0.051 pixels/mm² , 95% CI 0.005-0.095) and deep (0.048 pixels/mm² , 95% CI 0.003-0.093) retinal layers. There were no differences in CCM or ESC measurements between these two groups. Correlations between HbA_1c and peak ERG amplitude at 32-Td·s (r = -0.256, p = 0.028), implicit time at 32-Td·s (r = 0.422, p < 0.001) and 16-Td·s (r = 0.327, p = 0.005), OCT parafoveal vessel density in the superficial (r = -0.238, p = 0.049) and deep (r = -0.3, p = 0.017) retinal layers, corneal nerve fibre length (CNFL) (r = -0.293, p = 0.017), and ESC-hands (r = -0.244, p = 0.035) were observed. HOMA-IR was a predictor of CNFD (β = -0.94, 95% CI -1.66 to -0.21, p = 0.012) and CNBD (β = -5.02, 95% CI -10.01 to -0.05, p = 0.048).

CONCLUSIONS

The glucose threshold for the diagnosis of diabetes is based on emergent retinopathy on fundus examination. We show that both abnormal retinal neurovascular structure (OCT-A) and function (ERG) may precede retinopathy in prediabetes, which require confirmation in larger, adequately powered studies.

Genetic Variants of HNF4A, WFS1, DUSP9, FTO, and ZFAND6 Genes Are Associated with Prediabetes Susceptibility and Inflammatory Markers in the Saudi Arabian Population

Prediabetes is a reversible, intermediate stage of type 2 diabetes mellitus (T2DM). Lifestyle changes that include healthy diet and exercise can substantially reduce progression to T2DM. The present study explored the association of 37 T2DM- and obesity-linked single nucleotide polymorphisms (SNPs) with prediabetes risk in a homogenous Saudi Arabian population. A total of 1129 Saudi adults [332 with prediabetes (29%) and 797 normoglycemic controls] were randomly selected and genotyped using the KASPar SNP genotyping method. Anthropometric and various serological parameters were measured following standard procedures. Heterozygous GA of HNF4A-rs4812829 (0.64; 95% CI 0.47–0.86; p < 0.01), heterozygous TC of WFS1-rs1801214 (0.60; 95% confidence interval (CI) 0.44–0.80; p < 0.01), heterozygous GA of DUSP9-rs5945326 (0.60; 95% CI 0.39–0.92; p = 0.01), heterozygous GA of ZFAND6-rs11634397 (0.75; 95% CI 0.56–1.01; p = 0.05), and homozygous AA of FTO-rs11642841 (1.50; 95% CI 0.8–1.45; p = 0.03) were significantly associated with prediabetes, independent of age and body mass index (BMI). Additionally, C-reactive protein (CRP) levels in rs11634397 (AA) with a median of 5389.0 (2767.4–7412.8) were significantly higher than in the heterozygous GA genotype with a median of 1736.3 (1024.4–4452.0) (p < 0.01). In conclusion, only five of the 37 genetic variants previously linked to T2DM and obesity in the Saudi Arabian population [HNF4A-rs4812829, WFS1-rs1801214, DUSP9-rs5945326, ZFAND6-rs11634397, FTO-rs11642841] were associated with prediabetes susceptibility. Prospective studies are needed to confirm the potential clinical value of the studied genetic variants of interest.

Rural-urban disparities in the associations of residential greenness with diabetes and prediabetes among adults in southeastern China

AIMS

Greenness offers health benefits to prevent diabetes in urban areas. However, urban-rural disparities in this association have not been explored, with the underlying pathways understudied as well. We aimed to investigate and compare the associations and potential pathways between residential greenness and the risks for diabetes and prediabetes in urban and rural areas.

METHODS

Diabetes and prediabetes were diagnosed by fasting blood glucose (FBG). The participants' residential greenness exposure was estimated by the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). The association of residential greenness with the risks for diabetes and prediabetes was estimated by logistic regression and the generalized additive model. The potential mediation effects of air pollution, body mass index (BMI), and physical activity (PA) were examined by causal mediation analysis.

RESULTS

Of the 50,593 included participants, and the prevalence of prediabetes and diabetes were 21.22 % and 5.63 %, respectively. Each 0.1-unit increase in EVI_500m and NDVI_500m for healthy people reduced the risk for prediabetes by 12 % and 8 %, respectively, and substantially reduced the risk for diabetes by 23 % and 19 %, respectively. For those with prediabetes, each 0.1-unit increase in EVI_500m and NDVI_500m reduced the diabetes risk by 14 % and 12 %, respectively. Compared to the risks for diabetes at the 25th percentile of EVI_500m/NDVI_500m, such risks significantly reduced when EVI_500m (NDVI_500m) increased over 0.43 (0.48) and 0.28 (0.39) in urban and rural areas, respectively. The residential greenness-prediabetes/diabetes associations were mediated by air pollution and PA in urban areas and by air pollution and BMI in rural areas.

CONCLUSIONS

Exposure to residential greenness was associated with a lower risk for prediabetes and diabetes in urban areas and, more strongly, in rural areas, which were partly mediated by air pollution, PA, and BMI.

Construction and Validation of a Model for Predicting Impaired Fasting Glucose Based on More Than 4000 General Population

Purpose

Impaired fasting glucose (IFG) is associated with an increased risk of multiple diseases. Therefore, the early identification and intervention of IFG are particularly significant. Our study aims to construct and validate a clinical and laboratory-based nomogram (CLN) model for predicting IFG risk.

Patients and Methods

This cross-sectional study collected information on health check-up subjects. Risk predictors were screened mainly by the LASSO regression analysis and were applied to construct the CLN model. Furthermore, we showed examples of applications. Then, the accuracy of the CLN model was evaluated by the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC) values, and the calibration curve of the CLN model in the training set and validation set, respectively. The decision curve analysis (DCA) was used to estimate the level of clinical benefit. Furthermore, the performance of the CLN model was evaluated in the independent validation dataset.

Results

In the model development dataset, 2340 subjects were randomly assigned to the training set (N = 1638) and validation set (N = 702). Six predictors significantly associated with IFG were screened and used in the construction of the CLN model, a subject was randomly selected, and the risk of developing IFG was predicted to be 83.6% by using the CLN model. The AUC values of the CLN model were 0.783 in the training set and 0.789 in the validation set. The calibration curve demonstrated good concordance. DCA showed that the CLN model has good clinical application. We further performed independent validation (N = 1875), showed an AUC of 0.801, with the good agreement and clinical diagnostic value.

Conclusion

We developed and validated the CLN model that could predict the risk of IFG in the general population. It not only facilitates the diagnosis and treatment of IFG but also helps to reduce the medical and economic burdens of IFG-related diseases.

Association between body mass index and reversion to normoglycemia from impaired fasting glucose among Chinese adults: a 5-year cohort study

Objective

Evidence regarding the relationship between body mass index (BMI) and reversion to normoglycemia from prediabetes is still limited. The purpose of our study is to survey the link of BMI on reversion to normoglycemia among patients with impaired fasting glucose (IFG).

Methods

This study, a retrospective cohort, covered 32 regions and 11 cities in China and collected 258,74 IFG patients who underwent a health check from 2010 to 2016. We investigated the association between baseline BMI and reversion to normoglycemia in patients with IFG using the Cox proportional-hazards regression model. The nonlinear relationship between BMI and reversion to normoglycemia was determined using a Cox proportional hazards regression with cubic spline functions and smooth curve fitting. In addition, we also performed a series of sensitivity analyses and subgroup analyses. A competing risk multivariate Cox regression was performed using progression to diabetes as a competing risk for reversal of normoglycemic events.

Results

After adjusting covariates, the results showed that BMI was negatively related to the probability of reversion to normoglycemia (HR=0.977, 95%CI:0.971-0.984). Compared with participants with normal BMI(<24kg/m²), overweight (BMI:24-28kg/m²) participants with IFG had a 9.9% lower probability of returning to normoglycemia (HR=0.901,95%CI:0.863-0.939), while obese patients (BMI ≥ 28kg/m²) had a 16.9% decreased probability of reverting from IFG to normoglycemia (HR=0.831,95%CI:0.780-0.886). There was also a nonlinear relationship between them, and the inflection point of BMI was 21.7kg/m². The effect sizes (HR) on the left sides of the inflection point were 0.972(95%CI:0.964-0.980). The competing risks multivariate Cox's regression and sensitivity analysis demonstrated the robustness of our results.

Conclusion

This study demonstrates a negative and nonlinear relationship between BMI and reversion to normoglycemia in Chinese patients with IFG. Minimizing BMI to 21.7 kg/m² in patients with IFG through aggressive intervention may significantly increase the probability of returning to normoglycemia.

Worldwide trends in prediabetes from 1985 to 2022: A bibliometric analysis using bibliometrix R-tool

Background

Prediabetes is a widespread condition that represents the state between normal serum glucose and diabetes. Older individuals and individuals with obesity experience a higher rate of prediabetes. Prediabetes is not only a risk factor for type 2 diabetes mellitus (t2dm) but is also closely related to microvascular and macrovascular complications. Despite its importance, a bibliometric analysis of prediabetes is missing. The purpose of this study is to provide a comprehensive and visually appealing overview of prediabetes research.

Methods

First, the Web of Science (WOS) database was searched to collect all articles related to prediabetes that were published from 1985 to 2022. Second, R language was used to analyze the year of publication, author, country/region, institution, keywords, and citations. Finally, network analysis was conducted using the R package bibliometrix to evaluate the hotspots and development trends of prediabetes.

Results

A total of 9,714 research articles published from 1985 to 2022 were retrieved from WOS. The number of articles showed sustained growth. Rathmann W was the most prolific author with 71 articles. Diabetes Care was the journal that published the highest number of articles on prediabetes (234 articles), and Harvard University (290 articles) was the most active institution in this field. The United States contributed the most articles (2,962 articles), followed by China (893 articles). The top five clusters of the keyword co-appearance network were "prediabetes", "diabetes mellitus", "glucose", "insulin exercise", and "oxidative stress". The top three clusters of the reference co-citation network were "Knowler. WC 2002", "Tabak AG 2012", and "Matthews DR1985".

Conclusions

The combined use of WOS and the R package bibliometrix enabled a robust bibliometric analysis of prediabetes papers, including evaluation of emerging trends, hotspots, and collaboration. This study also allowed us to validate our methodology, which can be used to better understand the field of prediabetes and promote international collaboration.

Acupuncture-related techniques for prevention of type 2 diabetes mellitus in people with pre-diabetes: Protocol for a systematic review and meta-analysis

BACKGROUND

In modern society, the incidence of diabetes is increasing year by year. Most individuals pass through a phase of prediabetes before developing full blown diabetes. Acupuncture-related has been widely used in the treatment of diabetes, but there is no systematic review of acupuncture-related on the control of blood glucose in prediabetes. Therefore, this study aims to conduct a meta-analysis of the clinical efficacy of acupuncutre-related therapy in preventing the development of diabetes in patients with prediabetes.

METHODS

We will search Web of Science, The Cochrane Library, PubMed, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wan-Fang Database, Chinese Scientific Journal Database (VIP Database) from their respective inception dates to September 1, 2022 to identify potentially eligible studies. We will use the Review Manager 5.4 software provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures.

RESULTS

This meta-analysis further elucidates the protective effects of acupuncture-related techniques on patients with prediabetes.

CONCLUSION

The purpose of this meta-analysis was to investigate the effect of acupuncture- related techniques on blood glucose in patients with prediabetes, and to provide more methods for clinical prevention of conversion from prediabetes to diabetes.

Continuous Glucose Monitoring and Physical Activity

Continuous glucose monitoring (CGM) use has several potential positive effects on diabetes management. These benefits are, e.g., increased time in range (TIR), optimized therapy, and developed documentation. Physical activity is a recommended intervention tool in diabetes management, especially for people with type 2 diabetes (T2D). The benefits of physical activity for people with diabetes can be seen as an improvement of glycemic control, glycemic variability, and the reduction of insulin resistance. In relation to the physical activity of people with T2D, the benefits of CGM use can even be increased, and CGM can be a helpful tool to prevent adverse events due to physical activity of people with diabetes, such as hypoglycemic events and nocturnal hypoglycemia after sports. This narrative review aims to provide solid recommendations for the use of CGM in everyday life physical activities based on the noted benefits and to give a general overview of the guidelines on physical activity and CGM use for people with diabetes.

A Review of National Level Guidelines for Risk Management of Cardiovascular and Diabetic Disease

Cardiovascular diseases and diabetes are among the leading preventable causes of morbidity and mortality. Cardiovascular disease risk reduction aimed to address the significant modifiable risk factors, including lifestyle-related risk factors, hypertension, hyperlipidemia, and diabetes. Given the severity and disease burden, many insurances, including Medicare, cover the annual counseling for risk reduction of cardiovascular disease. Although numerous national-level guidelines are available for managing these conditions, most of them focus on disease management. Given the broad areas covered in these recommendations, a concise review summarizing the measures addressing the preventive approach in these conditions is not readily available. Herewith, we review and outline the currently available guidelines from national-level publications with principal attention to the primary prevention measures to provide a broad overview and assist providers with the risk reduction counseling.

Association of body mass index with risk of prediabetes in Chinese adults: a population-based cohort study

Aims/Introduction

Overweight and obesity in adults are strongly associated with an increased risk of prediabetes, and this study set out to gain a better understanding of the optimal body mass index (BMI) range for assessing the risk of prediabetes in the Chinese population.

Materials and Methods

The cohort study included 100,309 Chinese adults who underwent health screening. Participants were divided into six groups based on the cut‐off point for BMI recommended by the World Health Organization (underweight: <18.5 kg/m², normal‐weight: 18.5–24.9 kg/m², pre‐obese: 25.0–29.9 kg/m², obese class I: 30.0–34.9 kg/m², obese class II: 35.0–39.9 kg/m², and obese class III ≥40 kg/m²). The association of BMI with prediabetes and the shape of the correlation were modeled using multivariate Cox regression and restricted cubic spline regression, respectively.

Results

In the multivariate Cox regression model, with normal weight as the control group, underweight people had a lower risk of developing prediabetes, whereas obese and pre‐obese people had a higher risk of prediabetes. Additionally, in the restricted cubic spline model, we found that the association of BMI with prediabetes follows a positive dose–response relationship, but does not conform to the pattern of obesity paradox. Among the general population in China, a BMI of 23.03 kg/m² might be a potential intervention threshold for prediabetes.

Conclusions

The national cohort study found that the association of BMI with prediabetes follows a positive dose–response relationship, rather than a pattern of obesity paradox. For Chinese people with normal weight, more attention should be paid to glucose metabolism when BMI exceeds 23.03 kg/m².

Engineered mesoporous silica reduces long-term blood glucose, HbA1c, and improves metabolic parameters in prediabetics

Aim: To investigate the effect of oral consumption of engineered mesoporous silica particles, SiPore15^®, on long-term blood glucose levels and other metabolic parameters in individuals with prediabetes and newly diagnosed Type 2 diabetes. Method: An open-label, single-arm, multicenter trial was conducted in which SiPore15 was consumed three times daily for 12 weeks. Hemoglobin A1c (HbA1c, primary end point) and an array of metabolic parameters were measured at baseline and throughout the trial. Result: SiPore15 treatment significantly reduced HbA1c by a clinically meaningful degree and improved several disease-associated parameters with minimal side effects. Conclusion: The results from this study demonstrate the potential use of SiPore15 as a treatment for prediabetes that may also delay or prevent the onset of Type 2 diabetes.

Effect of cinnamon on blood sugar and anthropometric measurement in type two diabetes patients

There is some emerging evidence that suggests certain supplements help lower blood sugar levels. One of these is cinnamon, which exhibits characteristics that mimic insulin, such as the activity of biologically active substances to activate insulin receptor kinase, increasing glucose uptake, autophosphorylation of the insulin receptor, and glycogen synthase activity. To assess the effect of the cinnamon substance on lowering fasting blood sugar, modifying body weight, body mass index (B.M.I.), and waist circumference in type two diabetics. A randomized controlled intervention clinical trial. The study was conducted on 60 patients with type II diabetes mellitus; the study followed both gender patients for four weeks. The contributors were allocated randomly into a group that receives 2 g/d cinnamon substance (intervention group), and a group without cinnamon substance is given (control group). Fasting plasma glucose (F.P.G.) and anthropometrics measurement at the beginning (beforehand cinnamon supplementation and 4week at the end of the study duration). After 4 weeks of cinnamon taken, serum F.P.G. levels significantly improved (P≤0.0001). Anthropometric measurements (weight, height, B.M.I.) were reduced significantly (change mean ≤ P=0.001) for all. The Present study disclosed that supplementation of 2 gm cinnamon improves F.P.G. and has a good role in anthropometric indices (weight, waist circumference, B.M.I.).

Vitamin D3 deficiency is associated with more severe insulin resistance and metformin use in patients with type 2 diabetes

BACKGROUND

Vitamin D3 (vit. D3) deficiency is considered as one of the main factors involved in the development of type 2 diabetes (T2D). We assessed insulin resistance (IR), β-cell functional activity and metabolic profile according to 25(OH) vit. D3 status in patients with T2D.

METHODS

The study included 109 patients with T2D, divided in 3 groups: group 1 (N.=11) with normal levels of vit. D3 (>30 ng/mL); group 2 (N.=38) with vit. D3 insufficiency (21-29 ng/mL); and group 3 (N.=60) with vit. D3 deficiency (<20 ng/mL). IR and β-cell functional activity were assessed as change in C-peptide concentration and homeostasis model assessment-estimated (HOMA) β-cell function which was calculated using HOMA2 calculator.

RESULTS

Patients with vit. D3 deficiency presented significantly higher C-peptide concentration compared to other groups. HOMA2 (3.29±1.89 vs. 2.12±0.71; P=0.049) and hemoglobin (H8b)A1c (9.11±1.63 vs. 7.75±1.06; P=0.016) levels changed significantly only in patients with vit. D3 deficiency compared to diabetics with normal vit. D3 levels. Furthermore, in univariate Pearson's correlation analysis, we observed significant association between vit. D3 levels and C-peptide, insulin sensitivity, HOMA2, triglyceride-glucose index, HbA1c and Body Mass Index, only in the vit. D3 deficiency group. In multivariate logistic regression analysis, poor glycemic control, as defined by HbA1c levels, was independent from metformin use while high density lipoprotein-cholesterol levels were associated with vit. D3 deficiency.

CONCLUSIONS

Our study demonstrated that vit. D3 deficiency in patients with T2D was associated with more severe IR, poor glycemic control and obesity compared to normal status or vit. D3 insufficiency.

Diabetes Care in India: A Descriptive Study

CONTEXT

Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent and reduce the risk of long-term complications. It requires an array of investigations to provide an accurate picture of the condition and its management accordingly by a qualified doctor.

AIMS

This study was conducted to understand the treatment received by type 2 diabetes (T2DM) patients from various categories of health care professionals and awareness about diabetes reversal by lifestyle modification and prevention of complications.

SETTINGS AND DESIGN

This was a community-based cross-sectional study.

SUBJECTS AND METHODS

The link of the semi-structured questionnaire in Google form with e-consent was sent to all members in the selected groups of "World free of obesity and diabetes" campaign on their personal WhatsApp account.

STATISTICAL ANALYSIS USED

A total of 3082 participants were included, and the data obtained were analyzed using SPSS v26.

RESULTS

The mean age of the participants was 50.26 ± 9.78 years ranging from 18 to 81 years. A total of 35.8% of the study population was diabetic for 1-5 years. A total of 54.9% were started with antidiabetic medication on the same day of diagnosis. Only 1.5% of the patients had complete investigation profile for T2DM, 50.2% of the patients were briefed about hypoglycemia, and only 15.8% of the patients were checked for retinopathy.

CONCLUSIONS

Most doctors, qualified as well as nonqualified, did not follow the standard guidelines for diagnosis, treatment, and patient education regarding T2DM; therefore, it is necessary to train all medical practitioners regarding these guidelines. Diabetes reversal by lifestyle modification must be prescribed as the first line of treatment in patients with T2DM.

Compartmentally scavenging hepatic oxidants through AMPK/SIRT3-PGC1α axis improves mitochondrial biogenesis and glucose catabolism

Early treatment can prevent the occurrence of diabetes; however, there are few pharmacological treatment strategies to date. The liver is a major metabolic organ, and hepatic glucose homeostasis is dysregulated in type 1 and type 2 diabetes mellitus. However, the potential of specifically targeting the liver to prevent diabetes has not been fully exploited. In this study, we found that compartmentally inhibiting hepatic oxidants by nano-MitoPBN, a liver mitochondrial-targeting ROS scavenger, could effectively prevent diabetes. Our results demonstrated that nano-MitoPBN reversed the downregulation of PGC-1α and the enhanced gluconeogenesis in the livers of diabetic mice. PGC-1α, through an AMPK- and SIRT3-mediated mechanism, promoted mitochondrial biogenesis, increased the number of mitochondria, and enhanced the rate of aerobic oxidation, leading to decreased glucose levels in the blood by increasing glucose uptake and catabolism in the liver. Moreover, the increase in PGC-1α activity did not promote the activation of gluconeogenesis. Our study demonstrated that by regulating the redox balance of liver mitochondria in the early stage of diabetes, PGC-1α could selectively inhibit gluconeogenesis in the liver and promote hepatic mitochondrial function, which accelerated the catabolism of hepatic glucose and reduced blood glucose. Thus, glucose tolerance can be normalized through only three weeks of intervention. Our results showed that nano-MitoPBN could effectively prevent diabetes in a short period of time, highlighting the effectiveness and importance of early intervention for diabetes and suggesting the potential advantages of hepatic mitochondrial targeting oxidants nano-inhibitors in the prevention and early treatment of diabetes.

The Mechanisms of the Development of Atherosclerosis in Prediabetes

Lifestyle changes, such as overeating and underexercising, can increase the risk of prediabetes. Diabetes is one of the leading causes of atherosclerosis, and recently it became clear that the pathophysiology of atherosclerosis progresses even before the onset of diabetic symptoms. In addition to changes in platelets and leukocytes in the hyperglycemic state and damage to vascular endothelial cells, extracellular vesicles and microRNAs were found to be involved in the progression of prediabetes atherosclerosis. This review discusses the cellular and molecular mechanisms of these processes, with an intention to enable a comprehensive understanding of the pathophysiology of prediabetes and atherosclerosis.

Anti-obesity Medications in Cancer Therapy: A Comprehensive Insight

The interplay between cancer and obesity is multifactorial and complex with the increased risk of cancer development in obese individuals posing a significant threat. Obesity leads to the upregulation or hyperactivation of several oncogenic pathways in cancer cells, which drives them towards a deleterious phenotype. The cross-talk between cancer and obesity is considered a large contributing factor in the development of chemotherapeutic drug resistance and the resistance to radiotherapy. The link between obesity and the development of cancer is so strong that a medication that demonstrates effectiveness against both conditions would serve as an essential step. In this context, anti-obesity medications provide a worthy list of candidates based on their chemo-preventive potential and chemotherapeutic properties. The current study focuses on exploring the potential of anti-obesity medicines as dual anticancer drugs. These medications target several key signaling pathways (e.g., AMPK, PI3K/Akt/mTOR, MAPK, NF-κB, JNK/ERK), which prove to be crucial for both cancer growth and metastases. Some of these drugs also play an important role in attenuating the signaling and cellular events which incite cancer-obesity cross-talk and demonstrate efficient counteraction of neoplastic transformation. Thus, this review highlights a comprehensive view of the potential use of anti-obesity medicines to treat both cancer and obesity for patients exhibiting both comorbities.

Serum IRAP, a Novel Direct Biomarker of Prediabetes and Type 2 Diabetes?

Insulin resistance (IR), currently called prediabetes (PD), affects more than half of the adult population worldwide. Type 2 diabetes (T2D), which often follows in the absence of treatment, affects more than 475 million people and represents 10–20% of the health budget in industrialized countries. A preventive public health policy is urgently needed in order to stop this constantly progressing epidemic. Indeed, early management of prediabetes does not only strongly reduce its evolution toward T2D but also strongly reduces the appearance of cardiovascular comorbidity as well as that of associated cancers. There is however currently no simple and reliable test available for the diagnosis or screening of prediabetes and it is generally estimated that 20–60% of diabetics are not diagnosed. We therefore developed an ELISA for the quantitative determination of serum Insulin-Regulated AminoPeptidase (IRAP). IRAP is associated with and translocated in a stoechiometric fashion to the plasma membrane together with GLUT4 in response to insulin in skeletal muscle and adipose tissue which are the two major glucose storage sites. Its extracellular domain (IRAPs) is subsequently cleaved and secreted in the blood stream. In T2D, IRAP translocation in response to insulin is strongly decreased. Our patented sandwich ELISA is highly sensitive (≥10.000-fold “normal” fasting concentrations) and specific, robust and very cost-effective. Dispersion of fasting plasma concentration values in a healthy population is very low (101.4 ± 15.9 μg/ml) as compared to those of insulin (21–181 pmol/l) and C-peptide (0.4–1.7 nmol/l). Results of pilot studies indicate a clear correlation between IRAPs levels and insulin sensitivity. We therefore think that plasma IRAPs may be a direct marker of insulin sensitivity and that the quantitative determination of its plasma levels should allow large-scale screening of populations at risk for PD and T2D, thereby allow the enforcement of a preventive health policy aiming at efficiently reducing this epidemic.

Oral glucose tolerance test does not affect degree of hemoglobin glycation as measured by routine assay

BACKGROUND

Hemoglobin A1c (HbA1c) is an accurate index of fluctuation in glycemia over the 2-3 months prior to quantitative assessment. During this time, hemoglobin (Hb) slowly glycates until it shows the properties of advanced glycation end-products. Glycation kinetics is intensified by prolonged glucose exposure. In subjects undergoing oral glucose tolerance testing (OGTT), immediately after ingestion, glucose is ostensibly transported by the glucose transporter 1 (GLUT1) to erythrocyte corpuscular hemoglobin. The earliest significant measurable level of hemoglobin glycation associated with this transportation is still not clear.

SUBJECTS AND METHODS

We attempted to explore the early impact of short-term glucose load on HbA1c levels, because it is now known that transmembrane GLUT1-mediated glucose transport occurs immediately. A total of 88 participants (46 patients and 42 clinically healthy controls) underwent fasting plasma glucose quantitation during an OGTT. HbA1c, revealed by a monoclonal anti-glycation epitope antibody and adiponectin, was quantitated before (T0) and 2 hours (T120) after 80 g glucose ingestion.

RESULTS

Wilcoxon test revealed that the HbA1c values did not significantly vary (P=0.15) during the OGTT, whereas glucose concentration varied strongly between T0 and T120.

DISCUSSION

It is well known that quantitative estimation of HbA1c is informative for clinical care, independently of glucose level. The molecular mechanisms and dynamics by which glucose enters/exits red blood cells are incompletely known and may differ between individuals. We here show, for the first time, that HbA1c levels do not significantly increase during OGTT, supporting the view that non-enzymatic glycation of hemoglobin occurs slowly and that glycation during the 2 hours of an OGTT is insignificant.

Dietary Patterns and the Risk of Prediabetes in Taiwan: A Cross-Sectional Study

Background: prediabetes prevention and management are the main methods used to combat the prevalence of diabetes. Exploratory factor analysis is an upcoming method that is successful in identifying dietary patterns that correlate with healthy or unhealthy outcomes. Aim: this study aims to identify dietary patterns in Taiwan that are associated with the risk of prediabetes. Methods: anthropometric, blood glucose, 3 d/24 h dietary records, and food frequency questionnaire data were collected from subjects recruited at Taipei Tzu-Chi Hospital. The following five dietary patterns were identified using factor analysis: Western, prudent, convenience, Asian traditional, and continental. This cross-sectional study compares tertiles of dietary patterns and analyzes the significance of the characteristics. Results: the Western and the prudent patterns are the major dietary patterns found in other studies. A higher factor loading in the Western pattern is significantly related to a higher risk of prediabetes. A higher factor loading in the continental pattern is significantly related to a lower risk of prediabetes. Conclusion: decreasing meat and seafood consumption while increasing egg, coffee, and milk consumption may be associated with a decreased risk for prediabetes.

Prediabetes Deserves More Attention: A Review

Evidence increasingly demonstrates that prediabetes is a toxic state, as well as a risk factor for diabetes, and is associated with pathophysiological changes in several tissues and organs. Unfortunately, use of available evidence-based treatments for prediabetes is low. This review seeks to explain why prediabetes must be viewed and treated as a serious pathological entity in its own right. It offers an overview of the pathophysiology and complications of prediabetes and describes how this condition can be reversed if all treatment avenues are deployed early in its course.

Sugar-Lowering Drugs for Type 2 Diabetes Mellitus and Metabolic Syndrome-Review of Classical and New Compounds: Part-I

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia together with disturbances in the metabolism of carbohydrates, proteins and fat, which in general results from an insulin availability and need imbalance. In a great number of patients, marketed anti-glycemic agents have shown poor effectiveness in maintaining a long-term glycemic control, thus being associated with severe adverse effects and leading to an emerging interest in natural compounds (e.g., essential oils and other secondary plant metabolites, namely, flavonoid-rich compounds) as a novel approach for prevention, management and/or treatment of either non-insulin-dependent diabetes mellitus (T2DM, type 2 DM) and/or Metabolic Syndrome (MS). In this review, some of these promising glucose-lowering agents will be comprehensively discussed.