Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends

Effect of combined aerobic exercise and resistance training on postmenopausal women with type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

There is no strong evidence demonstrating whether or not aerobic exercise in conjunction with resistance exercise improves metabolic diabetes markers in postmenopausal women.

OBJECTIVE

To evaluate the effect of aerobic exercise and resistance training on metabolic markers in postmenopausal women with type 2 diabetes mellitus (T2DM) by means of a systematic review and meta-analysis.

METHODS

The searches were completed using EMBASE, MEDLINE/PubMed, Scopus and Web of Science databases. This study included non-blinded, single or double-blinded randomized control trials and postmenopausal women diagnosed with T2DM. The imposed intervention was aerobic exercise plus any training protocol to strengthen muscle groups for resistance intervention. The outcomes of interest were the blood glucose levels, insulin secretion, homeostasis model assessment-insulin resistance index (HOMA-IR) and glycated hemoglobin (HbA1c). Risk of Bias tools and GRADE were obligatory.

RESULTS

Three studies were included (83 participants). Exercise intervention ranged between two to four days per week. Compared to the control group, in the group submitted to aerobic exercise + resistance training, no significant change was noted for HbA1c (subtotal = mean difference - 0.35 [95% CI: -0.85, 0.15], p = .17, and heterogeneity = 0%) (GRADE: very low), nevertheless, HOMA-IR index was significantly improved (subtotal = mean difference -0.52 [95% CI: -0.99, -0.05], p = .03, and heterogeneity = 0%) (GRADE: very low).

CONCLUSION

Despite the very low certainty found in the quality of evidences, our analysis showed that aerobic exercise along with strength exercise seems to improve some metabolic diabetes markers in postmenopausal women with T2DM. There is a need for further studies to support our preliminary findings.

Understanding the link between type 2 diabetes mellitus and Parkinson's disease: role of brain insulin resistance

Type 2 diabetes mellitus and Parkinson's disease are chronic diseases linked to a growing pandemic that affects older adults and causes significant socio-economic burden. Epidemiological data supporting a close relationship between these two aging-related diseases have resulted in the investigation of shared pathophysiological molecular mechanisms. Impaired insulin signaling in the brain has gained increasing attention during the last decade and has been suggested to contribute to the development of Parkinson's disease through the dysregulation of several pathological processes. The contribution of type 2 diabetes mellitus and insulin resistance in neurodegeneration in Parkinson's disease, with emphasis on brain insulin resistance, is extensively discussed in this article and new therapeutic strategies targeting this pathological link are presented and reviewed.

Effect of metabolic disorders on reactive gliosis and glial scarring at the early subacute phase of stroke in a mouse model of diabetes and obesity

It is well recognized that type II Diabetes (T2D) and overweight/obesity are established risk factors for stroke, worsening also their consequences. However, the underlying mechanisms by which these disorders aggravate outcomes are not yet clear limiting the therapeutic opportunities. To fill this gap, we characterized, for the first time, the effects of T2D and obesity on the brain repair mechanisms occurring 7 days after stroke, notably glial scarring. In the present study, by performing a 30-minute middle cerebral artery occlusion (MCAO) on db/db (obese diabetics mice) and db/+ (controls) mice, we demonstrated that obese and diabetic mice displayed larger lesions (i.e. increased infarct volume, ischemic core, apoptotic cell number) and worsened neurological outcomes compared to their control littermates. We then investigated the formation of the glial scar in control and db/db mice 7 days post-stroke. Our observations argue in favor of a stronger and more persistent activation of astrocytes and microglia in db/db mice. Furthermore, an increased deposition of extracellular matrix (ECM) was observed in db/db vs control mice (i.e. chondroitin sulfate proteoglycan and collagen type IV). Consequently, we demonstrated for the first time that the db/db status is associated with increased astrocytic and microglial activation 7 days after stroke and resulted in higher deposition of ECM within the damaged area. Interestingly, the injury-induced neurogenesis appeared stronger in db/db as shown by the labeling of migrating neuroblast. This increase appeared correlated to the larger size of lesion. It nevertheless raises the question of the functional integration of the new neurons in db/db mice given the observed dense ECM, known to be repulsive for neuronal migration. Carefully limiting glial scar formation after stroke represents a promising area of research for reducing neuronal loss and limiting disability in diabetic/obese patients.

Development and validation of a machine learning model for prediction of type 2 diabetes in patients with mental illness

BACKGROUND

Type 2 diabetes (T2D) is approximately twice as common among individuals with mental illness compared with the background population, but may be prevented by early intervention on lifestyle, diet, or pharmacologically. Such prevention relies on identification of those at elevated risk (prediction). The aim of this study was to develop and validate a machine learning model for prediction of T2D among patients with mental illness.

METHODS

The study was based on routine clinical data from electronic health records from the psychiatric services of the Central Denmark Region. A total of 74,880 patients with 1.59 million psychiatric service contacts were included in the analyses. We created 1343 potential predictors from 51 source variables, covering patient-level information on demographics, diagnoses, pharmacological treatment, and laboratory results. T2D was operationalised as HbA1c ≥48 mmol/mol, fasting plasma glucose ≥7.0 mmol/mol, oral glucose tolerance test ≥11.1 mmol/mol or random plasma glucose ≥11.1 mmol/mol. Two machine learning models (XGBoost and regularised logistic regression) were trained to predict T2D based on 85% of the included contacts. The predictive performance of the best performing model was tested on the remaining 15% of the contacts.

RESULTS

The XGBoost model detected patients at high risk 2.7 years before T2D, achieving an area under the receiver operating characteristic curve of 0.84. Of the 996 patients developing T2D in the test set, the model issued at least one positive prediction for 305 (31%).

CONCLUSION

A machine learning model can accurately predict development of T2D among patients with mental illness based on routine clinical data from electronic health records. A decision support system based on such a model may inform measures to prevent development of T2D in this high-risk population.

Trends in Alzheimer's-Related Mortality Among Type 2 Diabetes Patients in the United States: 1999-2019

BACKGROUND

Recent research has shown that type 2 diabetes mellitus (T2DM) has increased the burden of Alzheimer's disease (AD) in the US aging population. However, trends in mortality from this comorbidity among adults aged ≥ 65 years have not been investigated.

OBJECTIVES

This study examined trends and disparities in AD-related mortality among older US adults with T2DM from 1999 to 2019.

METHODS

Data from the CDC WONDER database were analysed to assess AD-related mortality in patients with T2DM aged ≥ 65 between 1999 and 2019. Age-adjusted mortality rates (AAMRs) per 100,000 people and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, age, urbanisation and geographical region.

RESULTS

From 1999 to 2019, there were 71,550 deaths with T2DM and AD among adults aged ≥ 65. AAMRs rose from 4.12 in 1999 to 11.65 in 2019, with the sharpest increase between 2014 and 2017 (APC: 10.81; 95% CI: -3.20 to 13.43). Women had slightly higher AAMRs than men, with rates increasing from 4.71 in 1999 to 11.61 in 2019 for women, and from 4.08 to 11.70 for men. Hispanic individuals saw the highest increase in AAMR (11.15), followed by non-Hispanic Black (9.30) and White populations (7.92). AAMRs were highest in the West (10.91) and the Midwest (9.62), while the Northeast (4.70) had the lowest. Nonmetropolitan areas had consistently higher AAMRs (10.74) than large metropolitan areas (6.68) and small/medium metropolitan areas (9.25). States in the top 90th percentile for T2DM-AD mortality included California, South Dakota and Kentucky, where rates were approximately eight times higher than in states in the lowest 10th percentile.

CONCLUSIONS

This study reveals a significant rise in T2DM-AD comorbidity-related mortality among older adults, especially among Hispanics, women and rural residents. These findings underscore the need for targeted interventions to reduce the burden in vulnerable populations.

SGLT2 inhibition improves endothelium-independent vasodilatory function in type 2 diabetes: A double-blind, randomized, placebo-controlled crossover trial

AIMS

The objective of this study was to examine the effects of empagliflozin on endothelium-dependent and endothelium-independent vasodilatation and systemic hemodynamic parameters and to assess the role of the nitric oxide (NO) system in patients with type 2 diabetes (T2DM).

MATERIALS AND METHODS

In this double-blind, placebo-controlled cross over trial, patients with T2DM were treated with either empagliflozin 10 mg or matching placebo for 4 weeks. Following a 2-week washout, participants were crossed over to 4 weeks of the opposite treatment. Forearm blood flow (FBF) was measured after each treatment period using venous occlusion plethysmography. Acetylcholine and sodium nitroprusside (SNP) were infused into the brachial artery to assess endothelium-dependent and endothelium-independent vasodilatory function, respectively. Total peripheral resistance, 24-h blood pressure (BP) and biochemical markers of NO activity were measured as well.

RESULTS

Sixteen participants completed the trial. The mean age was 68 ± 8 years, and 69% were male. The SNP response increased by 21% (geometric mean ratio 1.21, 95% CI: 1.09; 1.33) during treatment with empagliflozin compared to placebo (p ≤ 0.001), but not during acetylcholine infusion (p = 0.290). Empagliflozin decreased 24-h systolic BP by 5 mmHg (95% CI: -9; -1 mmHg) (p = 0.015), diastolic BP by 2 mmHg (95% CI: -5; 0 mmHg) (p = 0.029) and systemic vascular resistance by 48 dyn×s/m5 (95% CI: -94; -1 dyn×s/m5) (p = 0.044). Furthermore, empagliflozin reduced plasma levels of nitrite and urinary levels of NOx.

CONCLUSIONS

Empagliflozin improves endothelium-independent vasodilation, reduces vascular resistance and lowers 24-h BP in patients with T2DM, whereas no change in endothelial-dependent vasodilation was observed.

TRIAL REGISTRATION

EU Clinical Trials Register number: 2019-004303-12 (https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-004303-12/DK).

Efficacy of imeglimin treatment versus metformin dose escalation on glycemic control in subjects with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor plus low-dose metformin: A multicenter, prospective, randomized, open-label, parallel-group comparison study (MEGMI study)

AIMS

To compare the efficacy of adding imeglimin versus that of metformin dose escalation on glycemic control in subjects with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor plus low-dose metformin (500-1000 mg/day).

MATERIALS AND METHODS

In this multicentre, open-labelled, prospective, randomized, parallel-group comparison study, the addition of imeglimin (2000 mg/day) or metformin escalation was applied for 24 weeks in eligible subjects. The primary endpoint was the mean change in glycated haemoglobin (HbA1c) over 24 weeks. As the secondary endpoints, the occurrence of adverse events, changes in metabolic parameters, biomarkers and factors associated with HbA1c improvement were analysed.

RESULTS

Seventy-three eligible subjects were enrolled. Of them, 65 participants comprised the full analysis set. At 24 weeks, the addition of imeglimin (n = 33) resulted in greater improvement in HbA1c compared with metformin dose escalation (n = 32) (from 7.61 ± 0.48% to 6.93 ± 0.49% in imeglimin and from 7.56 ± 0.61% to 7.09 ± 0.56% in metformin escalation; change difference: -0.21% [95% confidence interval: -0.41%, -0.01%] [p = 0.038]); however, seven subjects in the imeglimin group discontinued imeglimin because of serious adverse events on gastrointestinal tract. In intra-group pre/post comparisons, imeglimin treatment significantly reduced body weight and improved liver enzyme elevation. There was a significant correlation between improvement levels of HbA1c and indicators of fatty liver disease in the imeglimin group.

CONCLUSIONS

Imeglimin in combination with a dipeptidyl peptidase-4 inhibitor and low-dose metformin improved HbA1c compared with metformin dose escalation.

A preliminary randomized trial of a brief dissonance-based type 2 diabetes prevention programme for adults with pre-diabetes

OBJECTIVE

Conduct a preliminary randomized trial that compared a 6-week type 2 diabetes (T2D) prevention programme to an educational video control for adults with pre-diabetes.

METHODS

Adults (N = 62) with pre-diabetes were randomized to the group-delivered Project Health T2D or an educational video control, completing measures at pre-test, post-test and 3-month follow-up.

RESULTS

Participants randomized to the intervention versus control condition showed significantly greater reductions in body fat (d = 0.76, p = 0.002; d = 1.07, p < 0.001), weight (d = 0.59, p = 0.030; 0.65, p = 0.017) and body mass index (BMI = kg/m2; d = 0.60, p = 0.030; 0.67, p = 0.014), significantly greater increases in lean mass (d = 0.80, p = 0.003; 0.93, p = 0.001) at post-test and 3-month follow-up, respectively, and marginally greater reductions in glycated haemoglobin (HbA1c) (d = 0.54, p = 0.056), but not fasting plasma glucose at 3-month follow-up (d = 0.25, p = 0.364). Project Health T2D also produced a marginally greater 75% reduction in future onset of type 2 diabetes compared with educational controls, reducing incidence over the total 5-month observation period from 15% to 4% (odds ratio = 4.52, p = 0.096).

CONCLUSIONS

Project Health T2D produced encouraging reductions in body fat, weight and T2D incidence, and increases in lean mass, and is less intensive than other lifestyle modification T2D prevention programme, suggesting that it might be useful to evaluate in a fully powered efficacy trial with a longer follow-up.

Ethnicity, Skin Tones, and Cultural Considerations in Wound Care: Challenges and Solutions

Wound care patients often have a variety of chronic medical conditions that result in poor outcomes, such as delayed healing and nontraumatic limb loss. Many of these suboptimal patient outcomes result from healthcare disparities linked to social determinants of health (SDOH). Race and ethnicity influence SDOH by impacting patients' access to consistent quality healthcare. Understanding and addressing why and how ethnic and cultural factors influence SDOH is crucial for making substantial changes.

The obesity pandemic and its impact on non-communicable disease burden

The rising prevalence of overweight and obesity across the globe is a major threat both to public health and economic development. This is mainly due to the link of obesity with the development and outcomes of non-communicable diseases (NCDs). NCDs are a leading cause of global death and disability, and reducing the burden of NCDs on patients and healthcare systems is of critical importance to improve public health. Obesity is projected to be the number one preventable risk factor for NCDs by 2035, and there is an urgent need to tackle the growing obesity rates in order to reduce NCD incidence and severity. Here, we review the current understanding of the impact of obesity on NCD burden in general, as well as the epidemiological and mechanistic relationship between obesity and some of the most common classes of NCDs. By literature review, we found that over 70% of NCDs have a documented association with obesity, highlighting the importance of a better understanding of the pathophysiologies underlying obesity/overweight as well as the interaction between obesity and NCDs in order to reduce global disease burden.

Safety and Effectiveness of MiniMed™ 780G Advanced Hybrid Closed-Loop Insulin Intensification in Adults with Insulin-Requiring Type 2 Diabetes

Background: Early feasibility studies have demonstrated safe and effective automated insulin delivery use in individuals with suboptimally controlled type 2 diabetes (T2D). The present study investigated MiniMed™ 780G advanced hybrid closed-loop (AHCL) therapy safety and effectiveness in adults with insulin-requiring T2D. Materials and Methods: This 13-site, single-arm, open-label study included 95 adults (mean ± standard deviation [SD] age of 60.3 ± 10.8 years and T2D duration of 18.6 ± 8.6 years) using basal-bolus insulin therapy. Participants underwent a run-in period (∼21 days) of open-loop or HCL followed by a study period (∼90 days) of AHCL. The primary safety end point was mean change in glycosylated hemoglobin (HbA1c) from baseline to the end of the 3-month study period. The primary and secondary effectiveness end points were noninferiority and superiority in the percentage of time in range (%TIR 70-180 mg/dL) during the last 6 weeks of the study period (computed by the Hodges-Lehmann method). Safety metrics, including the rates of severe hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS), were summarized. Results: HbA1c was reduced from 7.9% ± 1.0% (62.4 ± 10.4 mmol/mol) at baseline to 7.2 ± 0.7% (54.7 ± 8.0 mmol/mol) (P < 0.001). The %TIR estimate was 80.9% (95% confidence interval: 78.4%, 83.1%), and the significance criteria for both the primary and secondary effectiveness end points were met (P < 0.001). While total daily insulin dose was increased from run-in to the end of the study (77.4 ± 38.5 U vs. 91.8 ± 49.3 U, P < 0.0001), announced carbohydrates were unchanged, and the number of daily user-initiated boluses was reduced (3.9 ± 1.9 vs. 3.2 ± 1.8, P < 0.0001). There was no significant change in participant weight or body mass index, no severe hypoglycemia, DKA, or HHS, and no serious or unanticipated adverse device effects. Conclusions: These findings show that MiniMed 780G AHCL use provides safe insulin intensification in type 2 diabetes and significantly improves mean HbA1c and %TIR.

Medicare Part D Glaucoma Drug Prescribing Patterns by Ophthalmologists from 2018 to 2022

Background: Glaucoma is a chronic, progressive disease of visual loss and blindness that is often managed pharmacologically. The objective of this study was to evaluate glaucoma drug prescribing trends by ophthalmologists in the United States from 2018 to 2022. Methods: Data on ophthalmologist prescribers were abstracted from Medicare Part D Prescriber Public Use Files to identify the total number of claims for each drug. Drugs were classified by type (generic or brand-name) and by drug class (carbonic anhydrase inhibitors, alpha-2 agonists, beta-blockers, prostaglandin analogs, rho kinase inhibitors, parasympathomimetic drugs, and mixed-mechanism drugs). The types of drugs prescribed were compared longitudinally. Results: Forty glaucoma drugs were prescribed under Medicare Part D from July 1st, 2018, to June 30th, 2022. A dip in total claims and claims by drug class was observed from 2018-2019 to 2019-2020. This was followed by increases to the greater number of claims in 2021-2022. Prostaglandin analogues were the most frequently prescribed class, and the most commonly prescribed drugs were latanoprost, timolol, and the dorzolamide/timolol combination. The majority of claims consisted of generics, and this value increased longitudinally as well. The most rapidly growing class prescribed by physicians was rho kinase inhibitors. Conclusion: Longitudinal differences in Medicare Part D glaucoma drug claims may reflect changing practice patterns and preferences among providers. An increasing number of claims annually, with the exception of the COVID-19 pandemic onset, reflects the growing prevalence of glaucoma. The utilization of new glaucoma agents, such as rho kinase inhibitors, is rapidly increasing as a new therapeutic option.

Deleterious impacts of Western diet on jejunum function and health are reversible

The goal of this study was to determine whether the influence of a high-fat high-sugar diet (Western diet) on intestinal function and health was reversible. We measured transepithelial short circuit current (Isc), across freshly isolated segments of jejunum from male C57Bl/6J mice randomly assigned to one of the following groups for the study duration: high-fat high-sugar diet for 24 wk (HFHS), HFHS diet for 12 wk then switched to standard chow and water for a further 12 wk (Std), and lean controls (standard chow and water for 24 wk). At the completion of the study, segments of jejunum were frozen for Western blot determination of key proteins involved in secretory and absorptive functions, as well as senescence. Intestinal morphology was assessed. Serum and tissue assays were performed. Basal Isc was significantly decreased (by 42%, P < 0.05) in HFHS versus leans. This decrease in Isc was fully reversed by switching to Std diet. The HFHS-induced decrease in Isc was attributed to a significant loss of calcium-activated chloride channel (ClC2) expression. Changes in inflammatory state (TNF-α) and intestinal health [myeloperoxidase (MPO) activity] were associated with body weight changes. Our data suggests that the reduced basal jejunal Isc in HFHS mice is reversible. Better understanding of Western diet-mediated intestinal disturbances may permit for improved treatment options for gastrointestinal abnormalities in obese individuals.NEW & NOTEWORTHY Our data suggests that the reduced basal jejunal Isc (decreased secretory function) in Western diet-fed mice is reversible. A better understanding of Western diet-mediated intestinal disturbances may permit improved treatment options for gastrointestinal abnormalities in obese individuals.

Targeting senescence to prevent diabetic kidney disease: Exploring molecular mechanisms and potential therapeutic targets for disease management

BACKGROUND/AIMS

As a microvascular complication, diabetic kidney disease is the leading cause of chronic kidney disease and end-stage renal disease worldwide. While the underlying pathophysiology driving transition of diabetic kidney disease to renal failure is yet to be fully understood, recent studies suggest that cellular senescence is central in disease development and progression. Consequently, understanding the molecular mechanisms which initiate and drive senescence in response to the diabetic milieu is crucial in developing targeted therapies that halt progression of renal disease.

METHODS

To understand the mechanistic pathways underpinning cellular senescence in the context of diabetic kidney disease, we reviewed the literature using PubMed for English language articles that contained key words related to senescence, inflammation, fibrosis, senescence-associated secretory phenotype (SASP), autophagy, and diabetes.

RESULTS

Aberrant accumulation of metabolically active senescent cells is a notable event in the progression of diabetic kidney disease. Through autocrine- and paracrine-mediated mechanisms, resident senescent cells potentiate inflammation and fibrosis through increased expression and secretion of pro-inflammatory cytokines, chemoattractants, recruitment of immune cells, myofibroblast activation, and extracellular matrix remodelling. Compounds that eliminate senescent cells and/or target the SASP - including senolytic and senomorphics drugs - demonstrate promising results in reducing the senescent cell burden and associated pro-inflammatory effect.

CONCLUSIONS

Here we evidence the link between senescence and diabetic kidney disease and highlight underlying molecular mechanisms and potential therapeutic targets that could be exploited to delay disease progression and improve outcomes for individuals with the disease. Trials are now required to translate their therapeutic potential to a clinical setting.

Meal replacements on obesity and leptin: a systematic review and meta-analysis

The global prevalence of obesity and overweight is a significant concern in the field of public health. Numerous interventional studies have been conducted to assess the possible meal replacements (MRs) effect on anthropometric indicators and indices and laboratory test that reflect obesity. However, there are no comprehensive results in this field. The study aim was to understand the possible effects of MRs on body weight, body mass index (BMI), fat mass, waist circumferences (WC), and leptin levels. A systematic search was conducted in five electronic databases in order to find randomized clinical trials (RCTs) that examined the possible MRs effect on obesity. Analyses were performed in R software, version 4.2.1. The random-effects model analysis was used to provide pooled mean difference and 95% confidence intervals (95% CI). Seventy studies were included. Body weight (WMD: -3.35 kg, 95% CI: -4.28 to -2.42), BMI (WMD: -1.12 kg/m2, 95% CI: -1.51 to -0.72), fat mass (WMD: -2.77 kg, 95% CI: -3.59 to -1.6), WC (WMD: -2.82 cm, 95% CI: -3.51 to -2.12) were significantly reduced after MRs compared to control. No significant effect was observed on leptin (WMD: -3.37 ng/ml, 95% CI: -8.23 to 1.49). Subgroup analyses indicated that impact of total MRs on anthropometric factors was greater in comparison to partial MRs. Considering other lifestyle factors, MRs can lead to anthropometric indicators and indices reduction.

The Effects of Glucagon-Like Peptide-1 Receptor Agonists on Mitochondrial Function Within Skeletal Muscle: A Systematic Review

BACKGROUND

Obesity is a chronic disease associated with increased risk of multiple metabolic and mental health-related comorbidities. Recent advances in obesity pharmacotherapy, particularly with glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), have the potential to transform obesity and type 2 diabetes mellitus (T2DM) care by promoting marked weight loss, improving glycaemic control and addressing multiple obesity-related comorbidities, with added cardio-renal benefits. Dual agonists combining GLP-1 with other enteropancreatic hormones such as glucose-dependent insulinotropic polypeptide (GIP) have also been developed in recent years, leading to greater weight loss than using GLP-1 RAs alone. However, up to 40% of the weight lost with GLP-1 RAs comes from lean body mass, raising concerns about potential adverse effects on skeletal muscle function. Mitochondrial dysfunction, characterized by reduced mitochondrial size and activity, is prevalent in individuals with obesity and T2DM and is a known contributor to muscle wasting in ageing and some chronic diseases. This systematic review investigates the impact of GLP-1-based therapies on skeletal muscle mitochondrial function in individuals with obesity and T2DM or in related animal and cell models.

METHODS

A comprehensive search of MEDLINE, Scopus, CINAHL and clinicaltrials.gov was conducted. Inclusion criteria included randomized controlled trials, randomized crossover trials, cluster randomized control trials and basic science studies involving any GLP-1 RA or GLP-1/GIP dual agonist. Outcomes of interest were skeletal muscle respiratory function either in the form of measurements of mass, number, content, oxidative capacity/respiratory function, mitochondrial dynamics, mitochondrial biogenesis and mitophagy.

RESULTS

Eight studies were eligible for analysis; no human studies were identified. All of the included studies used GLP-1 RAs (single agonists) as intervention. The emerging evidence suggests that GLP-1 RAs increase mitochondrial area, number and morphology (i.e., reduces swelling). Data are conflicting on the effect of GLP-1 RAs upon mitochondrial mass, respiration and the expression of uncoupling proteins and PGC-1α. Data also demonstrate muscle specific (i.e., soleus vs. extensor digitorum longus) responses to GLP-1 RAs.

CONCLUSION

GLP-1 RAs appear to have a positive effect upon mitochondria area, number and morphology, but effects upon other aspects of mitochondrial health remain inconclusive. Data are very limited and solely presented in animal and in vitro models. Future studies should be conducted in human populations in order to begin to understand the effect of GLP-1 RAs and GLP-1-based therapies on human skeletal muscle mitochondria.

Exploring synergistic inhibitory mechanisms of flavonoid mixtures on α-glucosidase by experimental analysis and molecular dynamics simulation

The study was the first to evaluate the synergistic interaction of luteolin + quercetin, luteolin + 3-O-methylquercetin, and quercetin + 3-O-methylquercetin mixtures on α-glucosidase and the binding mechanisms were explored using both experimental and theoretical approaches. The results showed that three flavonoid mixtures exhibited a mixed type of inhibition and demonstrated the most potent synergistic effects on α-glucosidase inhibition at 6:4 ratio, with interaction index (γ) of 0.85, 0.78 and 0.73, respectively. The three mixtures had a great influence on α-glucosidase secondary structures. Molecular simulation further demonstrated that three flavonoid mixtures formed hydrophobic interactions and hydrogen bonds with amino acid residues at different sites of α-glucosidase. Collectively, luteolin + quercetin, luteolin + 3-O-methylquercetin and quercetin + 3-O-methylquercetin were found to inhibit α-glucosidase in a synergistic manner and can be potentially used for the development of hypoglycemic food products.

Multiple pesticide exposure and impaired glucose regulation in U.S. non-diabetic population

Prediabetes is a serious metabolic disorder that is often overlooked and 70% of individuals with prediabetes would eventually develop type 2 diabetes. The diabetogenic effects of pesticides have been reported in toxicological studies but their association with prediabetes is rarely investigated. We aimed to evaluate the association between pesticide exposure and impaired glucose regulation (IGR), including prediabetes (defined as impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]) and insulin resistance, in a general U.S. non-diabetic population. Three classes of urinary pesticides, including organophosphorus pesticides (OPs), pyrethroid, and herbicides were measured. Generalized linear regression, restricted cubic spline, and Bayesian kernel machine regression (BKMR) models were combined to evaluate their associations. 3,5,6-trichloropyridinol (TCPY) was positively associated with prediabetes and IGT (highest vs lowest TCPY quartile: prediabetes: OR: 1.97, 95% CI: 1.18, 3.31; IGT: OR: 2.03, 95% CI: 1.14, 3.66) in a linear dose-response manner (P for nonlinear<0.05). Another two metabolites of OPs, malathion dicarboxylic acid (MDCA) diacid and para-nitrophenol (PNP), were found to increase the odds ratio of insulin resistance (PNP: OR: 1.22, 95% CI: 1.05, 1.42; MDCA: OR: 1.36, 95% CI: 1.08, 1.70) with linear dose-response curves (P for nonlinear<0.05). Considering mutual exposure to multiple pesticides, TCPY, MDCA, and PNP made the most contributions in the mixture exposure and IGR. No obvious interactions among pesticides were found in the multiple exposure settings. The odds ratio of TCPY exposure and prediabetes was increased with advancing age but not related to body mass index (BMI). The results remained robust in sensitivity analysis with restricted participants without abnormal urinary creatinine and unsteady glucose or insulin levels. Our findings suggested the close relationship between OPs and impaired glucose regulation, especially in older adults, which provides insights into the prevention of diabetes at the earlier stage.

Autophagy and the peroxisome proliferator-activated receptor signaling pathway: A molecular ballet in lipid metabolism and homeostasis

Lipids, which are indispensable for cellular architecture and energy storage, predominantly consist of triglycerides (TGs), phospholipids, cholesterol, and their derivatives. These hydrophobic entities are housed within dynamic lipid droplets (LDs), which expand and contract in response to nutrient availability. Historically perceived as a cellular waste disposal mechanism, autophagy has now been recognized as a crucial regulator of metabolism. Within this framework, lipophagy, the selective degradation of LDs, plays a fundamental role in maintaining lipid homeostasis. Dysregulated lipid metabolism and autophagy are frequently associated with metabolic disorders such as obesity and atherosclerosis. In this context, peroxisome proliferator-activated receptors (PPARs), particularly PPAR-γ, serve as intracellular lipid sensors and master regulators of gene expression. Their regulatory influence extends to both autophagy and lipid metabolism, indicating a complex interplay between these processes. This review explores the hypothesis that PPARs may directly modulate autophagy within the realm of lipid metabolism, thereby contributing to the pathogenesis of metabolic diseases. By elucidating the underlying molecular mechanisms, we aim to provide a comprehensive understanding of the intricate regulatory network that connects PPARs, autophagy, and lipid homeostasis. The crosstalk between PPARs and other signaling pathways underscores the complexity of their regulatory functions and the potential for therapeutic interventions targeting these pathways. The intricate relationships among PPARs, autophagy, and lipid metabolism represent a pivotal area of research with significant implications for understanding and treating metabolic disorders.

Oral Health-Related Knowledge, Attitudes, and Practices of Diabetic Patients in Tanzania

AIM

To assess oral health-related knowledge, attitude, and practices (KAP) of patients with diabetes mellitus (DM) attending public diabetic clinics in Dar es Salaam, Tanzania.

METHODOLOGY

This study involved adult patients diagnosed with DM. A questionnaire with questions related to oral health KAP was used. Data analysis was done using SPSS software v26. Multivariate regression analysis was utilized for response analysis. An alpha of less than 0.05 was considered to indicate statistical significance.

RESULTS

Participants with good levels of KAP related to oral health comprised 51.0%, 82.3%, and 20.6%, respectively. The odds of good oral health knowledge among participants were almost 2 folds higher in participants with high education levels and 7 folds higher in those who had been referred to a dentist by a physician. Participants with good oral health knowledge had 5.5 times higher odds of having a good attitude. The participants with high education levels were almost 3 times more likely to have good practice.

CONCLUSION

About half of the patients with DM have good oral health-related knowledge. A majority have good compliance towards oral health, but only a limited number have good oral health-related practices. The level of education and previous referrals to dental professionals were found to be predictors of good knowledge regarding dental health.

Physical frailty, genetic predisposition, and type 2 diabetes mellitus

AIM

To examine the association between frailty and incident type 2 diabetes mellitus (T2DM), considering the joint effect of multimorbidity and genetic risk.

METHODS

The study included 429,022 individuals in the UK Biobank. We used Cox regression with hazard ratio (HR) and 95 % confidence interval (CI) to 1) evaluate the associations of frailty with incident T2DM, 2) explore whether frailty and multimorbidity would have a joint effect, and 3) assess whether the associations were modified by genetic risk.

RESULTS

Compared with non-frail individuals, prefrail and frail individuals were at higher risk of T2DM: HR[95 %CI] = 1.42 [1.38;1.47] for prefrailty and 1.81[1.70;1.92] for frailty. Five frailty components were associated with increased risk of T2DM: HR[95 %CI] = 1.21[1.17;1.26] for weight loss, 1.35[1.30;1.40] for exhaustion, 1.31[1.26;1.37] for low physical activity, 1.27[1.20;1.33] for low grip strength, and 1.47[1.41;1.52] for slow gait speed. The increased risks were more pronounced among frail individuals with more than three morbidities: HR[95 %CI] = 4.10[3.76;4.46]. Frail individuals at high genetic risk had a four and a half-fold greater risk of T2DM compared with non-frail individuals at low genetic risk: HR[95 %CI] = 4.54[4.14;4.97].

CONCLUSION

Frailty was associated with increased risk of T2DM, especially in individuals with higher number of morbidities and high genetic risk. Frailty may be an independent risk factor for T2DM and targeted strategies to prevent and manage frailty would contribute to reducing the risk of T2DM.

An in-depth understanding of the role and mechanisms of T cells in immune organ aging and age-related diseases

T cells play a critical and irreplaceable role in maintaining overall health. However, their functions undergo alterations as individuals age. It is of utmost importance to comprehend the specific characteristics of T-cell aging, as this knowledge is crucial for gaining deeper insights into the pathogenesis of aging-related diseases and developing effective therapeutic strategies. In this review, we have thoroughly examined the existing studies on the characteristics of immune organ aging. Furthermore, we elucidated the changes and potential mechanisms that occur in T cells during the aging process. Additionally, we have discussed the latest research advancements pertaining to T-cell aging-related diseases. These findings provide a fresh perspective for the study of T cells in the context of aging.

Influencing factors of exercise behavior in older patients with type 2 diabetes mellitus combined with frailty: A qualitative study

BACKGROUND

Frailty is the third major complication of older patients with diabetes mellitus. Exercise plays an irreplaceable role in improving the frailty and physical function of older patients with type 2 diabetes (T2DM), but the compliance of exercise is not high. At present, there is little research on the influencing factors of exercise behavior in older diabetes patients with frailty.

OBJECTIVE

The aim of this study is to analyze the obstacles and promoting factors that affect exercise behavior from the perspective of patients, providing a basis for developing personalized exercise intervention strategies.

METHODS

A semi-structured face-to-face in-depth interview was conducted on older T2DM patients combined with frailty in the endocrinology department of a tertiary hospital using phenomenological research methods. Analyze data and extract topics based on COM-B system and Colaizzi seven step analysis method.

RESULTS

The themes were identified containing: capability (restriction of physical function, exercise psychology, shortage of exercise knowledge); motivation (importance recognition of exercise, exercise self-efficacy, exercise habit); opportunity (multiple external support, prescription and guidance of exercise, environment and social resources). Most sub-themes had the potential as barriers and facilitators, with the exception of capability which were highlighted as barriers.

DISCUSSION

The factors influencing the exercise behavior of older patients with T2DM combined with frailty are complex and diverse. Healthcare professionals should take targeted measures to develop personalized exercise prescriptions to improve patients' participation in exercise, maximize the benefits of exercise therapy.

A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial

AIMS/HYPOTHESIS

We conducted the largest and longest clinical trial comparing a whole-food, plant-based intervention with standard medical care (SMC) in individuals with type 2 diabetes.

METHODS

We randomised (parallel-arm; computerised 1:1 randomisation ratio) 169 adults aged 18-75 years with type 2 diabetes in the Marshall Islands to an intensive whole-food, plant-based intervention with moderate exercise (PB+Ex) or SMC for 24 weeks. The PB+Ex intervention included 12 weeks of meals, exercise sessions and group classes. Primary outcomes were glycaemic control (HbA1c, glucose, insulin and HOMA-IR) and glucose-lowering medication use. Secondary outcomes included lipids, blood pressure, heart rate and C-reactive protein. Only lab analysts were blinded.

RESULTS

Compared with SMC (n=90 randomised; n=70 analysed), the PB+Ex (n=79 randomised; n=66 analysed) intervention decreased HbA1c by an additional 14 mmol/mol (1.3%) at week 12 (-22 vs -7 mmol/mol [-2.0% vs -0.7%]; p<0.0001) and 8 mmol/mol (0.7%) at week 24 (-16 vs -8 mmol/mol [-1.4% vs -0.7%]; p=0.01). Concomitantly, 63% of medicated PB+Ex participants reduced their glucose-lowering medications (vs 24%; p=0.006), and 23% of PB+Ex participants with a baseline HbA1c <75 mmol/mol (<9%) achieved remission. Additionally, the PB+Ex intervention reduced weight (-2.7 kg; p<0.0001), C-reactive protein (-11 nmol/l; p=0.005) and cardiovascular medication use compared with SMC. At intermediate timepoints, it improved glucose, insulin, HOMA-IR, cholesterol, triglycerides and heart rate, but not at week 24.

CONCLUSIONS/INTERPRETATION

A whole-food, plant-based lifestyle intervention was more effective for improving glycaemic control than SMC. It also reduced the need for diabetes and cardiovascular medications and induced diabetes remission in some participants. Therefore, it is an effective, evidence-based lifestyle option for individuals with type 2 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03862963 FUNDING: This research was funded by the Department of the Army (W81XWH-05-1-0547). CJH received support through a National Institutes of Health Predoctoral T32 Obesity Fellowship (T32 HL105349).

Modulation of inflammatory markers in type 2 diabetes mellitus through gut microbiome-targeted interventions: An umbrella review on meta-analyses

BACKGROUND & AIMS

Type 2 diabetes mellitus (T2DM) poses a significant global health challenge due to various lifestyle factors contributing to its prevalence and associated complications. Chronic low-grade inflammation, characterized by elevated levels of inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), plays a pivotal role in the pathogenesis of T2DM. Modulation of the gut microbiota through microbiome-targeted therapy (MTT), including probiotics, prebiotics, and synbiotics, has emerged as a potential strategy to mitigate inflammation and improve metabolic outcomes in T2DM.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the impact of MTT on inflammatory markers in patients with T2DM. Searches were performed in PubMed, Scopus, and Web of Science databases up to June 2024, with inclusion criteria limited to English-language meta-analyses of randomized controlled trials (RCTs) assessing the effects of probiotics, prebiotics, or synbiotics on inflammatory markers in T2DM patients.

RESULTS

Ten meta-analyses met the inclusion criteria, comprising studies investigating the effects of various MTT interventions on CRP, IL-6, and TNF-α levels in T2DM patients. Meta-analysis results indicated significant reductions in CRP (SMD: -0.070; 95 % CI: -0.119 to -0.020) and TNF-α (SMD: -0.370; 95 % CI: -0.554 to -0.186) levels following MTT, while IL-6 reductions (SMD: -0.070; 95 % CI: -0.269 to 0.129) did not reach statistical significance. However, heterogeneity in study quality, intervention protocols, and participant demographics posed challenges in interpretation.

CONCLUSIONS

While improvements in inflammatory markers with MTT have been observed, significant limitations-such as heterogeneity in study quality and variation in intervention protocols-highlight the need for further research to confirm its efficacy and clarify underlying mechanisms. Future studies should aim to address these limitations by exploring variations in dosage, supplement formulations, and bacterial strains, which are crucial for improving the reliability and broader applicability of MTT in the management of T2DM.

The Association of Physical Activity With Overweight/Obesity and Type 2 Diabetes in Nepalese Adults: Evidence From a Nationwide Non-Communicable Disease Risk Factor Survey

Background

The rising prevalence of obesity and type 2 diabetes (T2DM) is a significant public health concern, particularly in low- and middle-income countries. This study aimed to explore the association between physical activity levels, overweight/obesity, and T2DM in a nationwide survey of Nepalese adults.

Methods

This was a secondary analysis of the 2019 non-communicable diseases (NCD) risk factors STEPS survey conducted in Nepal. Demographic and anthropometric data, body mass index (BMI) and T2DM status were collected along with assessment of physical activity using Global Physical Activity Questionnaire (GPAQ). A two-stage data analysis was conducted, first using descriptive statistics to summarize participant characteristics and differences across BMI and T2DM status, and then applying multivariate analyses to assess associations between physical activity levels, BMI and T2DM.

Results

Of the 5284 participants included, 28.0% had overweight/obesity, 5.8% had obesity, and 6.5% had T2DM. The mean age of the participants was 40.1 years (95% CI: 39.8-40.6), and 63.9% were female. The overall physical activity energy expenditure was higher in the lean group (BMI < 25 kg/m2) compared to the those with overweight/obesity, and among participants without T2DM compared to those with T2DM. Sedentary behavior was more common among individuals with overweight/obesity and T2DM. A higher proportion of participants with low physical activity was observed in the overweight/obesity group compared to the lean group (8.9% vs. 6.3%) and the T2DM group compared to the non-T2DM group (11.7% vs. 6.7%). Low physical activity was associated with overweight/obesity (OR:1.4; 95% CI:1.1-1.8), obesity (OR:2.1; 95% CI:1.5-2.3), T2DM (OR:1.6; 95% CI:1.1-2.3) and T2DM in the presence of obesity (OR:3.6; 95% CI:1.7-7.8).

Conclusion

This study highlights the low rates of physical activity and higher rates of sedentary behavior among adults with overweight/obesity and T2DM in Nepal. Public health interventions promoting physical activity and reducing sedentary behavior may help reduce the burden of these NCDs.

Management of diabetes in people with advanced chronic kidney disease

Diabetes is the commonest cause of end stage kidney disease globally, accounting for almost 40% of new cases requiring renal replacement therapy. Management of diabetes in people with advanced kidney disease on renal replacement therapy is challenging due to some unique aspects of assessment and treatment in this group of patients. Standard glycaemic assessment using glycated haemoglobin may not be valid in such patients due to altered red blood cell turnover or iron/erythropoietin deficiency, leading to changed red blood cell longevity. Therefore, use of continuous glucose monitoring may be beneficial to enable more focussed glycaemic assessment and improved adjustment of therapy. People with advanced kidney disease may be at higher risk of hypoglycaemia due to a number of physiological mechanisms, and in addition, therapeutic options are limited in such patients due to lack of experience or license. Insulin therapy is the basis of treatment of people with diabetes with advanced kidney disease due to many other drugs classes being contraindicated. Targets for glycaemic control should be adjusted according to co-morbidity and frailty, and continuous glucose monitoring should be used in people on dialysis to ensure low risk of hypoglycaemia. Post-transplant diabetes is common amongst people undergoing solid organ transplantation and confers a greater risk of mortality and morbidity in kidney transplant recipients. It should be actively screened for and managed in the post-transplant setting.

Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study

BACKGROUND

People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.

METHODS

We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.

RESULTS

Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.

CONCLUSION

Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels.

Burden of type 2 diabetes and its relationship with human development index in Asian countries: Global Burden of Disease Study in 2019

BACKGROUND

The mounting burden of type 2 diabetes is a major concern in healthcare systems worldwide. The purpose of this study is to investigate Burden of type 2 diabetes and its relationship with human development index in Asian countries.

METHODS

All accessible data from the 2019 Global Burden of Disease study were used to estimate the diabetes mellitus type 2 prevalence, mortality and disability-adjusted life years and diabetes mellitus type 2 in Asia from 1990 to 2019. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs) and attributable risk.

RESULTS

The results indicated that the human development index (HID) was positively and significantly correlated with the incidence of type 2 diabetes in men (r = 0.481, P < 0.05) and women (r = 0.414, P < 0.05, but the correlation between death and the HDI was not significant in men and women (P > 0.05). The highest share of DALY risk factors in men (12093.2 per 100000) and in women (7122.4 per 100000) was related to behavioral factors. According to the results, air pollution, high fasting plasma glucose, and dietary risks are the main risk factors associated with the burden of type 2 diabetes in women and men, respectively.

CONCLUSION

Given that the burden of type 2 diabetes is escalating in Asia and the burden of disease can be largely controlled by managing its risk factors, the disease management program in different countries, especially in countries with high prevalence and high burden could be reduced by making policies.

Prevalence and associated factors of diabetes among adult populations of Hawassa town, southern Ethiopia: A community based cross-sectional study

INTRODUCTION

Knowing the magnitude and preventable risk factors of diabetes has a significant contribution in targeted prevention intervention which ultimately ensures the existence of healthier and productive individuals in a country. Diabetes has untoward impact on health, social and economic consequences. Exploring preventable risk factors are extremely important because of their potential association and interaction with diabetes. Therefore, the aim of this study was to investigate the magnitude and modifiable risk factors of diabetes among adult populations in Hawassa town, southern Ethiopia.

METHODS

A community based cross-sectional study was conducted from September, 2023 to November, 2023 among adult populations. A multi-stage sampling technique was employed to select 1,113 study participants between the ages of 20-69 years. An interviewer-administered questionnaire was used to collect data. Additionally, participants were also instructed to fast overnight, after which the standard fasting blood glucose test was conducted. A binary logistic regression model was fitted to identify independent predictors of diabetes.

RESULTS

The overall prevalence of diabetes was 14.4% (95% Confidence Interval (CI): 12.4%, 16.4%). Being male (Adjusted Odds Ratio (AOR):2.10; 95% CI: 1.34, 3.29), being unable to read and write (AOR: 3.38; 95% CI: 1.09, 10.47), read and write (AOR: 3.38; 95% CI: 1.09, 10.47) and medium cycle (AOR 2.79; 95% CI: 1.02, 7.63) compared to college and above, consume less than 5 servings of fruits on daily base (AOR: 2.80; 95% CI: 1.18, 6.62), having ever chewed khat (AOR 6.50; 95% CI: 4.07, 10.39) and being overweight and obese (AOR: 2.43; 95% CI: 1.54, 3.83) were independently associated with diabetes mellitus (DM).

CONCLUSION

This study identified a high prevalence of diabetes among adults in Hawassa, driven by various risk factors. This presents an opportunity to mitigate diabetes risk through public health measures, including avoiding khat chewing, promoting healthy diets, managing overweight and obesity, implementing community-based screening, enhancing health literacy, and integrating health information into daily life.

Effectiveness of Different Intervention Modes in Lifestyle Intervention for the Prevention of Type 2 Diabetes and the Reversion to Normoglycemia in Adults With Prediabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Lifestyle interventions have been acknowledged as effective strategies for preventing type 2 diabetes mellitus (T2DM). However, the accessibility of conventional face-to-face interventions is often limited. Digital health intervention has been suggested as a potential solution to overcome the limitation. Despite this, there remains a significant gap in understanding the effectiveness of digital health for individuals with prediabetes, particularly in reducing T2DM incidence and reverting to normoglycemia.

OBJECTIVE

This study aimed to assess the effectiveness of different intervention modes of digital health, face-to-face, and blended interventions, particularly the benefits of digital health intervention, in reducing T2DM incidence and facilitating the reversion to normoglycemia in adults with prediabetes compared to the usual care.

METHODS

We conducted a comprehensive search in 9 electronic databases, namely MEDLINE, Embase, ACP Journal Club, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Clinical Answers, Cochrane Methodology Register, Health Technology Assessment, and NHS Economic Evaluation Database through Ovid, from the inception to October 2024. This review included randomized controlled trials (RCTs) that studied the effectiveness of lifestyle interventions in adults with prediabetes. The overall intervention effect was synthesized using a random-effects model. The I² statistic was used to assess heterogeneity across the RCTs. We performed a subgroup analysis to explore the effectiveness of digital health, face-to-face, and blended interventions compared with the control group, which received usual care.

RESULTS

From an initial 7868 records retrieved from 9 databases, we identified 54 articles from 31 RCTs. Our analysis showed that face-to-face interventions demonstrated a significant 46% risk reduction in T2DM incidence (risk ratio [RR] 0.54, 95% CI 0.47-0.63; I²=43%; P<.001), and a 46% increase in the reversion to normoglycemia (RR 1.46, 95% CI 1.11-1.91; I²=82%; P=.006), when compared with the control group. On the other hand, digital health interventions, compared with the control group, were associated with a 12% risk reduction in T2DM incidence (RR 0.88, 95% CI 0.77-1.01; I²=0.6%; P=.06). Moreover, the blended interventions combining digital and face-to-face interventions suggested a 37% risk reduction in T2DM incidence (RR 0.63, 95% CI 0.49-0.81;I²<0.01%; P<.001) and an 87% increase in the reversion to normoglycemia (RR 1.87, 95% CI 1.30-2.69; I²=23%; P=.001). However, no significant effect on the reversal of prediabetes to normoglycemia was observed from the digital health interventions.

CONCLUSIONS

Face-to-face interventions have consistently demonstrated promising effectiveness in both reductions in T2DM incidence and reversion to normoglycemia in adults with prediabetes. However, the effectiveness of digital health interventions in these areas has not been sufficiently proven. Given these results, further research is required to provide more definitive evidence of digital health and blended interventions in T2DM prevention in the future.

TRIAL REGISTRATION

PROSPERO CRD42023414313; https://tinyurl.com/55ac4j4n.

Quality of life among Indonesian family caregivers caring for dependent older persons with type 2 diabetes mellitus in the community: A cross-sectional, correlational study

Background

The global prevalence of older adults with diabetes has increased, and family caregivers in Indonesia play a critical role in managing diabetes and providing personal care. However, caregiving can be complex and challenging, often negatively affecting caregivers' quality of life (QoL).

Objective

This study aimed to develop and test a hypothesized causal model of QoL among Indonesian family caregivers who care for dependent older persons with type 2 diabetes mellitus (T2DM) in 2024.

Methods

A cross-sectional, correlational study was conducted with 270 family caregivers recruited from five Community Health Centers. Data were collected using various scales: the Center for Epidemiologic Studies Depression Scale, the Zarit Burden Interview, the Duke University Religion Index, the Perceived Knowledge on T2DM Care Scale, the Family-Carer Diabetes Management Self-Efficacy Scale, the Multidimensional Scale of Perceived Social Support, and the Quality-of-Life Index. Descriptive statistics and Partial Least Squares Structural Equation Modeling (PLS-SEM) were used for analysis.

Results

The final model explained 89.1% of the variance in the quality of life (QoL) of family caregivers (R2 = 0.893, Adjusted R2 = 0.891), with 66% predictive relevance. Depression symptoms had the strongest negative direct effect on QoL, followed by caregiver burden. Self-efficacy and perceived knowledge had positive direct effects, while social support showed no significant direct effect. Indirect effects revealed that social support and self-efficacy positively influenced QoL through depression symptoms. The total effect (TE) analysis confirmed that depression symptoms had the strongest negative effect on QoL (TE = -0.744, p <0.001), while social support (TE = 0.443, p <0.001) and self-efficacy (TE = 0.413, p <0.001) had positive effects.

Conclusion

Reducing depression symptoms and caregiver burden, strengthening social support, and promoting self-efficacy could significantly improve the QoL of family caregivers who care for older persons with T2DM. Nursing practice should address caregivers' physical and emotional needs, provide education, foster social support, and support caregiver mental health.

Milk-derived bioactive peptides in insulin resistance and type 2 diabetes

Diabetes is a global health issue affecting over 6% of the world and 11 % of the US population. It is closely linked to insulin resistance, a pivotal factor in Type 2 diabetes development. This review explores a promising avenue for addressing insulin resistance through the lens of Milk-Derived Bioactive Peptides (MBAPs). Taken from casein or whey fractions of various milks, MBAPs exhibit diverse health-promoting properties. Specific interactions between these peptides and enzymes involved in glucose digestion and metabolism have been examined, leading to the identification of some key peptides exerting the effects. This review emphasizes the positive impact of MBAPs on glycemic control through various mechanisms. Different cell lines have been used to investigate MBAPs' effects on insulin signaling, inflammation, and oxidative stress. Preclinical in vivo studies have also shown that MBAPs lower glucose, stimulate insulin, and reduce inflammation. Human trials further substantiate these findings and suggest the potential utility of milk protein hydrolysates containing MBAPs in individuals with insulin resistance or T2D to improve insulin action and glucose homeostasis.

Exploring the dynamics of self-efficacy, resilience, and self-management on quality of life in type 2 diabetes patients: A moderated mediation approach from a positive psychology perspective

OBJECTIVES

Type 2 diabetes mellitus (T2DM) significantly deteriorates patients' quality of life (QOL). This study examined the dynamic interplay of factors that influence QOL in patients with T2DM, utilizing concepts from positive psychology and intrinsic mechanisms, to lay the groundwork for improving patient outcomes. Improving self-management behaviors is essential for effective disease management.

METHODS

Using a cross-sectional design, this study incorporated 408 patients with T2DM from the endocrinology department of a public hospital in Urumqi, who were selected through convenience sampling from December 29, 2023 to June 30, 2024. Data collection tools included the General Data Questionnaire, Summary of Diabetes Self-Care Activities, Self-Efficacy for Diabetes Questionnaire, Connor-Davidson Resilience Scale, and Diabetes-Specific Quality of Life Scale. Structural equation modeling and Model 15 of Hayes' SPSS-Process program facilitated the moderated mediation analysis.

RESULTS

The findings demonstrated that self-efficacy significantly enhanced the QOL (β = -0.8557, p < 0.01), with resilience serving as a partial mediator, accounting for 43.1% of this effect. Interactions between self-efficacy and self-management, and resilience and self-management, were also significant predictors of QOL (β = -0.0751, p < 0.01 and β = -0.0073, p < 0.05, respectively).

CONCLUSION

These findings introduce a novel theoretical framework for T2DM from the perspective of positive psychology, which will be beneficial for intervention development. This study underscores the importance of promoting diabetes self-management as an effective strategy to enhance QOL. Additionally, healthcare providers must focus on fostering patients' positive psychological traits and reliable self-management behaviors.

Global, regional, and national burden of type 2 diabetes mellitus caused by high BMI from 1990 to 2021, and forecasts to 2045: analysis from the global burden of disease study 2021

Objective

To produce estimates of the global burden of type 2 diabetes mellitus (T2DM) caused by high body mass index (high BMI) and its impact for 2021 and projections for 2045.

Methods

We downloaded data from the Global Burden of Disease Study 2021(GBD 2021) to estimate the disease burden of T2DM caused by high BMI. Secondary analyses were performed by year, age, gender, region, and socio-demographic index (SDI).

Results

Globally, the all-ages number of T2DM-related deaths has increased significantly from 238.1 thousand to 723.7 thousand, representing a 203.9% increase since 1990. And the all-ages number of T2DM-raleted DALYs has raised from 10.4 million to 39.3 million, increased by 276.7% from 1990. The burden was expected to continue to increase to 1296.7 thousand by 2045 for all-ages number of deaths, and 85.5 million by 2045 for all-ages number of DALYs. The curves of T2DM-related burden showed an intersection for different genders around the age of 60, beyond which women exhibit a higher burden, compared to men. The disease burden of T2DM caused by high BMI shows a significant upward trend across all SDI groups, with a heavier burden on women, especially in the postmenopausal female population. In 2021, among the 204 countries and territories, the top 3 largest number of T2DM-related burden caused by high BMI occurred in China, India, and United States. The top three countries with highest T2DM-related rate caused by high BMI were Fiji, Marshall Islands, and Kiribati.

Conclusion

Our study reveals that the disease burden of T2DM caused by high BMI is significantly increasing and is expected to continue rising in the future. Women bear a heavier burden, particularly postmenopausal women, and there are significant differences in the disease burden across different geographical regions, and socioeconomic statuses. Targeted considerations and specific strategies are essential to address these disparities, thereby improving public health and reducing the burden.

Global bibliometric analysis of traditional Chinese medicine regulating gut microbiota in the treatment of diabetes from 2004 to 2024

Objectives

The therapeutic efficacy of Traditional Chinese Medicine (TCM) in modulating gut microbiota for diabetes treatment has garnered increasing scholarly attention. This study aims to meticulously examine current research trajectories and focal areas from 2004 to 2024, providing a foundational framework for future inquiries.

Methods

A comprehensive search of documents published between 2004 and 2024 was conducted using the Web of Science database. The resulting data were analyzed and visualized using R software, VOSviewer, and CiteSpace.

Results

The study included a total of 751 documents. From 2004 to 2022, the number of annual publications showed a continuous upward trend (2004: n = 1 to 2022: n = 159), and the number of publications in 2023 (n = 141) decreased slightly from the previous year. China emerged as the leading country in terms of article publications (n = 430). Additionally, the United States played a prominent role in international research collaborations. Frontiers in Pharmacology (n = 31) was the most frequently published journal, while Nature (n = 1,147) achieved the highest citation count. Key identified keywords included obesity, insulin resistance, inflammation, and oxidative stress.

Conclusion

Three key research focuses in this domain include: the therapeutic effects of active constituents in TCM on diabetes via gut microbiota modulation, the underlying mechanisms through which TCM influences gut microbiota in diabetes management, and the targeted regulation of specific gut bacterial populations by TCM in the treatment of diabetes.

A legume-enriched diet improves metabolic health in prediabetes mediated through gut microbiome: a randomized controlled trial

Healthy dietary patterns rich in legumes can improve metabolic health, although their additional benefits in conjunction with calorie restriction have not been well-established. We investigated effects of a calorie-restricted, legume-enriched, multicomponent intervention diet compared with a calorie-restricted control diet in 127 Chinese prediabetes participants, living in Singapore. The study was a 16-week, single-blind, parallel-design, randomized controlled trial (n = 63 intervention group (IG), n = 64 control group (CG); mean ± SD age 62.2 ± 6.3 years, BMI 23.8 ± 2.6 kg/m2). Primary outcomes were markers of glycemia and all measurements were taken at 2 or 4-weekly intervals. At the end of 16 weeks, both groups had significantly lower BMI (q(Time) = 1.92 ×10-42, β  = -0.02) compared with baseline, with minimal difference between groups. The IG had significantly greater reductions in LDL cholesterol (q(Treatment×Time) = 0.01, β  = -0.16), total cholesterol (q(Treatment×Time) = 0.02, β  = -0.3) and HbA1c (q(Treatment×Time) = 0.04, β  = -0.004) compared with CG, alongside increases in fiber degrading species in IG, mediated through metabolites such as bile acids and amino acids. A legume-enriched, multicomponent intervention diet can improve metabolic health in a prediabetes population, in addition to benefits obtained from calorie restriction alone, partially mediated through changes in gut microbial composition and function. Trial registration: Clinical Trials NCT04745702.

The human genetic variant rs6190 unveils Foxc1 and Arid5a as novel pro-metabolic targets of the glucocorticoid receptor in muscle

The genetic determinants of the glucocorticoid receptor (GR) metabolic action remain largely unelucidated. This is a compelling gap in knowledge for the GR single nucleotide polymorphism (SNP) rs6190 (p.R23K), which has been associated in humans with enhanced metabolic health but whose mechanism of action remains completely unknown. We generated transgenic knock-in mice genocopying this polymorphism to elucidate how the mutant GR impacts metabolism. Compared to non-mutant littermates, mutant mice showed increased insulin sensitivity on regular chow and high-fat diet, blunting the diet-induced adverse effects on adiposity and exercise intolerance. Overlay of RNA-seq and ChIP-seq profiling in skeletal muscle revealed increased transactivation of Foxc1 and Arid5A genes by the mutant GR. Using myotropic adeno-associated viruses for in vivo overexpression or knockdown in muscle, we found that Foxc1 was required and sufficient for normal expression levels of insulin response pathway genes Insr and Irs1 , promoting muscle insulin sensitivity. In parallel, Arid5a was required and sufficient to transcriptionally repress the lipid uptake genes C 36 and Fabp4 , reducing muscle triacylglycerol accumulation. Moreover, the Foxc1 and Arid5a programs in muscle were divergently changed by glucocorticoid regimens with opposite metabolic outcomes in muscle. Finally, we found a direct human relevance for our mechanism of SNP action in the UK Biobank and All of Us datasets, where the rs6190 SNP correlated with pro-metabolic changes in BMI, lean mass, strength and glucose control according to zygosity. Collectively, our study leveraged a human nuclear receptor coding variant to unveil novel epigenetic regulators of muscle metabolism.

Graphical abstract

Patterns of Sleep Duration and Metabolic Biomarkers Across the Menstrual Cycle

CONTEXT

Along the menstrual cycle, associations between inconsistent sleep duration and levels of metabolic biomarkers are uncertain and could involve fluctuations in estrogen concentrations.

OBJECTIVE

To examine associations between patterns of sleep duration and metabolic biomarkers across 2 menstrual cycles within a cohort of premenopausal women.

METHODS

The BioCycle Study was conducted in New York between 2005 and 2007, enrolling 259 premenopausal women over 2 menstrual cycles. This microlongitudinal cohort study involved intensive data collection including daily sleep diaries and biomarker assessments of leptin, insulin, and glucose at 16 key points timed to menstrual cycle phases. We considered dynamic sleep duration as hours slept 1 night or as mean hours slept during the 2 nights before each biomarker assessment. Variability in habitual sleep duration (ie, reported daily sleep duration) was summarized across both menstrual cycles. Variation in habitual sleep duration was computed using L-moments, a robust version of dispersion, skewness, and kurtosis. To examine associations between patterns of sleep duration and metabolic biomarkers, we fitted a series of linear mixed models with random intercepts and inverse probability weighting. These models were adjusted for potential demographic, lifestyle, health confounders, and menstrual cycle phase.

RESULTS

Sleep duration 1 night or 2 nights before clinic visits were not associated with metabolic biomarker measures. However, overall variability (dispersion) in habitual sleep duration was associated with lower mean insulin Homeostatic Model Assessment for Insulin Resistance levels, but not glucose. Moreover, extremely short or long bouts of sleep duration were associated with higher mean levels of leptin, insulin, and Homeostatic Model Assessment for Insulin Resistance.

CONCLUSION

These data suggest that variation in habitual sleep duration along the menstrual cycle may be associated with metabolic function.

Health literacy and medication adherence in adults from ethnic minority backgrounds with Type 2 Diabetes Mellitus: a systematic review

BACKGROUND

For people living with Type 2 Diabetes Mellitus (T2DM), achieving optimal health outcomes requires optimal self-management and adherence to medical treatment. While some studies suggest an association between poor medication adherence and lower levels of health literacy, the evidence for this association remains inconclusive. This systematic review aimed to synthesise the evidence on the association between health literacy and medication adherence among adults from ethnic minority backgrounds living with T2DM.

METHODS

Medline (Ovid), The Cochrane Library, Embase (Ovid), PsycInfo (EBSCO), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) were searched systematically for peer-reviewed literature, published until January 2024. Studies were included in this review if they assessed health literacy and medication adherence among ethnic minority people with T2DM. Two reviewers independently screened and selected the studies, extracted data from the included articles, and assessed the methodological quality of the studies. The methodological quality and bias in designing, conducting, and analysis of each study were evaluated using a standardised JBI critical appraisal tool.

RESULTS

Of the total 6,318 identified studies, seven studies were included in the review. The total participant sample sizes across these studies varied from 53 to 408 participants. All included studies incorporated cross-sectional design for the research, with the majority conducted in the USA. Of the seven unique studies, only one study observed a significant association between health literacy and medication adherence among people from an ethnic minority background.

CONCLUSIONS

Evidence on the association between health literacy and medication adherence in ethnic minority adults with T2DM is weak and inconsistent. To understand this association more clearly in ethnic minority populations and to address the disparities in cultural and linguistic considerations, well-designed studies are required.

TRIAL REGISTRATION

This review is registered with PROSPERO (CRD42022328346).

Burden of type 2 diabetes due to high body mass index in different SDI regions and projections of future trends: insights from the Global Burden of Disease 2021 study

AIM

The aim of our study was to assess the impact of high body mass index (BMI) on type 2 diabetes mellitus (T2DM) in different Socio-Demographic Development Index (SDI) regions using data from the Global Burden of Disease (GBD) 2021 study.

METHODS

Using data from the GBD study, the burden of disease for T2DM was measured by analyzing the age-standardized disability-adjusted life year rate (ASDR) and age-standardized mortality rate (ASMR) for type 2 diabetes due to high BMI and the associated estimated annual percentage change (EAPC). Decomposition analyses, frontier analyses, and predictive models were used to analyze changes and influencing factors for each metric.

RESULTS

The study revealed the significant global health burden of T2DM induced by high BMI, which EAPC of 1.82 with confidence intervals (CI) ranging from 1.78 to 1.87 for disability-adjusted life years (DALYs) and 0.85 with CIs ranging from 0.77 to 0.93 for mortality. The results of the analysis emphasized the geographic variability of T2DM disease burden associated with SDI Within the area covered by the study, a decreasing trend in ASMR for T2DM was observed in high SDI areas, with an EAPC value of - 1.07 and a confidence interval ranging from - 1.39 to - 0.76. At the same time, in the other SDI areas, the ASMR and ASDR for T2DM showed an increasing trend. In addition, the study noted that individuals in the 65- to 75-year-old age group accounted for a higher proportion of T2DM-related deaths and DALYs, with females affected at a greater rate than males. Projections for future trends indicate that the ASDR and ASMR for T2DM are expected to continue an upward trajectory over the next decade.

CONCLUSION

This study investigates the variation in T2DM burden attributable to high BMI across regions with different SDI levels. The analysis reveals that, in high-SDI regions, the ASMR decreased from 1990 to 2021 and stabilized around 4.4 deaths per 100,000 people, while the ASDR increased, reaching approximately 416 cases per 100,000 people in 2021. Conversely, both ASDR and ASMR exhibited an upward trend in other SDI regions over the same period.

Short-Term and Long-Term Effects of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review

Background and Objectives: Diabetic retinopathy (DR) is a common diabetes complication and a leading cause of blindness. Although bariatric surgery (BS) is well studied for diabetes management, its effects on DR onset and progression, particularly long-term outcomes, remain underexplored. This review seeks to evaluate the short- and long-term retinal outcomes of BS in diabetic patients. Materials and Methods: A systematic search of PubMed, Web of Science, and Cochrane Library was conducted following PRISMA 2020 guidelines, including the use of the PRISMA checklist and flow diagram. The search included English-language articles (2014-2024) using keywords like "diabetic retinopathy" and "bariatric surgery". The review excluded studies published in languages other than English, as well as reviews, case reports, and those lacking adequate data or relevance. The risk of bias was determined by using the Downs and Black checklist. A systematic review of the literature was conducted, and the results were organized and displayed in tables to summarize and compare the main findings. Results: After screening 158 articles, 13 studies involving 17,903 patients were selected, focusing on the effects of BS on DR progression and regression. Short-term data suggest that BS may stabilize or improve DR but poses risks of worsening in advanced cases, requiring careful monitoring. However, long-term findings are inconsistent, with evidence of both DR regression and progression. These variations highlight the need for further research. Discussion: BS generally improves DR progression, but its effect depends on preoperative severity and glycemic control. Further studies should explore additional risk factors to better predict DR outcomes post-surgery. Conclusions: BS improves weight management, blood pressure, and diabetes control, potentially benefiting DR. However, the long-term effects remain uncertain due to conflicting findings. Rapid glycemic changes after surgery may pose risks of DR progression. Large-scale, longitudinal studies are needed to clarify the role of BS in DR progression and regression.

Terminalia catappa aqueous extract reduces hyperglycaemia and oxidative stress in diabetic-hypercholesterolemic rats

BACKGROUND

Terminalia catappa is an important medicinal plant. Plants from the genus Terminalia have been reported for antidiabetic effects.

OBJECTIVE

To study effect of Terminalia catappa leaves aqueous extract in type 2 diabetic rats.

MATERIALS AND METHODS

High-fat diet (HFD) and a low dose of streptozotocin (35 mg/kg, i.p.) were used for inducing type 2 diabetes in rats; streptozotocin was injected after two weeks of dietary modification with HFD. HFD was continued throughout the study. Doses of 500 and 1000 mg/kg of aqueous extract of Terminalia catappa were used as a treatment for six weeks. At the end of the study, biochemical and oxidative stress parameters were estimated. Histopathology and immunohistochemistry of pancreatic tissue were performed.

RESULTS

Significant decrease (p < 0.01, p < 0.001) was observed in glucose levels of diabetic animals treated with T. catappa extract at both dose levels when compared with diabetic control group. Treatment with aqueous extract reduced cholesterol levels significantly (p < 0.05). After receiving 1000 mg/kg of extract, the triglyceride level was significantly lowered (p < 0.01) in the diabetic rats. Extract treatment enhanced the insulin sensitivity index (ISI), while insulin levels and HOMA-IR were markedly reduced. Treatment with 1000 mg/kg of extract significantly enhanced the levels of GSH and catalase. Histopathological analysis of the pancreas showed that damage caused by hyperglycemia was prevented in the extract-treated groups. Pancreatic tissue showed an increased expression of SIRT1 in extract-treated animals.

CONCLUSION

The current study's findings prove that the extract has remarkable antidiabetic effects.

Comparison of the effectiveness and safety of GLP-1 receptor agonists for type 2 diabetes mellitus patients with overweight/obesity: A systematic review and network meta-analysis

OBJECTIVE

To evaluate the effectiveness and safety of different Glucagon-like peptide-1 receptor agonists (GLP-1RAs) in treating type 2 diabetes mellitus (T2DM) with overweight/obesity using a systematic review and network meta-analysis.

METHODS

We searched PubMed, Embase, Cochrane Library, and Web of Science up to December 20, 2024, for randomized controlled trials (RCTs) involving T2DM patients with overweight/obesity treated with GLP-1RAs, with the control group receiving either a placebo or another GLP-1RA. We conducted a network meta-analysis assessed evidence using CINeMA.

RESULTS

A total of 4548 articles were retrieved, and 41 RCTs were included, comprising 15,126 patients and 13 different GLP-1RAs. Tirzepatide showed superior effects in lowering blood glucose (Compared with placebo, increased glycated hemoglobin: -1.64 (-1.94, -1.35), increased fasting blood glucose: -2.10 (-2.95, -1.25)) and weight loss (Compared with placebo, increased weight: -9.89 (-11.29, -8.49), rincreased BMI: -3.85 (-4.71, -2.99)). However, clinical efficacy of GLP-1RAs in lipid levels, blood pressure, and pancreatic function was not widely observed. Adverse reactions were significant with GLP-1RAs, but overall acceptable.

CONCLUSION

GLP-1RAs demonstrate efficacy and safety in T2DM patients with overweight/obesity, with certain advantages over other drugs. However, due to limitations in the number and quality of included studies, conclusions should be interpreted with caution.

A systematic review on gut microbiota in type 2 diabetes mellitus

Aims/hypothesis

The gut microbiota play crucial roles in the digestion and degradation of nutrients, synthesis of biological agents, development of the immune system, and maintenance of gastrointestinal integrity. Gut dysbiosis is thought to be associated with type 2 diabetes mellitus (T2DM), one of the world's fastest growing diseases. The aim of this systematic review is to identify differences in the composition and diversity of the gut microbiota in individuals with T2DM.

Methods

A systematic search was conducted to identify studies reporting on the difference in gut microbiota composition between individuals with T2DM and healthy controls. Relevant studies were evaluated, and their characteristics and results were extracted using a standardized data extraction form. The studies were assessed for risk of bias and their findings were reported narratively.

Results

58 observational studies published between 2010 and 2024 were included. Beta diversity was commonly reported to be different between individuals with T2DM and healthy individuals. Genera Lactobacillus, Escherichia-Shigella, Enterococcus, Subdoligranulum and Fusobacteria were found to be positively associated; while Akkermansia, Bifidobacterium, Bacteroides, Roseburia, Faecalibacteirum and Prevotella were found to be negatively associated with T2DM.

Conclusions

This systematic review demonstrates a strong association between T2DM and gut dysbiosis, as evidenced by differential microbial abundances and altered diversity indices. Among these taxa, Escherichia-Shigella is consistently associated with T2DM, whereas Faecalibacterium prausnitzii appears to offer a protective effect against T2DM. However, the heterogeneity and observational nature of these studies preclude the establishment of causative relationships. Future research should incorporate age, diet and medication-matched controls, and include functional analysis of these gut microbes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023459937.

Relationship Between Depression and Decreased Activity Level and Cognitive Impairment in Patients with Diabetes Mellitus Type 2 and/or Atrial Fibrillation

Background: The interdependence between type 2 diabetes mellitus (DM-2), atrial fibrillation (AF), and cognitive decline (CD)/dementia is a debated topic. In this study, we highlighted the influence of DM-2 and FA individually and in association on the severity of CD/dementia. Methods: This study comprises 248 patients with very high cardiovascular risk (VHCVR) according to Systematic Coronary Risk Evaluation (SCORE2), of whom 184 had DM-2 and/or AF, and 64 were age-matched controls (without DM-2/AF), admitted to the Municipal Hospital Timisoara. Results: Mini-Mental-State-Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living Score (ADL), and Instrumental Activities of Daily Living Score (IADL) were significantly decreased, and Geriatric Depression Scale (GDS-15) increased in patients with DM-2 and AF in comparison to controls (p < 0.05), with the subjects with DM-2 and AF having more severe CD compared to those with only one of these two pathologies. The logistic regression model showed that the risk of CD (MMSE < 27) or dementia (MMSE < 24) increased significantly in patients with DM-2 and/or AF depending on the SCORE2 values, ADL, and GDS-15. In DM-2 and/or AF patients, an increase of 1% in SCORE2 was associated with an elevation of 2.40% in the odds of CD and of 4.30% of dementia. In these patients, depression (GDS score) increased the risk of CD by 36.3%, and if ADL improved, the risk of CD decreased by 44.0%. Conclusions: Our findings suggest a direct association between CD, DM-2, and AF with SCORE2, cognitive parameters, ADL, and depression. In patients with DM-2 and/or AF, it is important to identify subclinical CD to prevent the evolution to dementia.

Relationships Between APOE, Type 2 Diabetes, and Cardiovascular Disease in Postmenopausal Women

BACKGROUND

The apolipoprotein E (APOE) ε4 allele, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) are well-established risk factors for dementia. Relationships between APOE and incidence of T2DM and CVD are not fully understood but may shed light on the mechanisms underlying dementia pathogenesis.

METHODS

Postmenopausal women (N = 6 795) from the Women's Health Initiative hormone therapy clinical trial with APOE genotyping and no prior diagnosis of T2DM or CVD were included. We examined associations of APOE status (APOE2+ [ε2/ε2, ε2/ε3], APOE3 [ε3/ε3], and APOE4+ [ε4/ε4, ε3/ε4] carriers) with incidence of T2DM, coronary heart disease, stroke, and total CVD events using Cox regression. CVD outcomes were examined in baseline non-statin users and adjusted for statin initiation over follow-up to account for possible confounding by statins.

RESULTS

Among all participants (mean age 66.7 ± 6.5 years, 100% non-Hispanic White), 451 (6.6%) were using statins at baseline. Over the follow-up (mean 14.9 and 16.0 years for T2DM and CVD, respectively), 1 564 participants developed T2DM and 1 578 developed CVD. T2DM incidence did not differ significantly by APOE status (ps ≥ .09). Among non-statin users, APOE4+ had higher incidence of total CVD (hazard ratio [95% confidence interval] = 1.18 [1.02-1.38], p = .03) compared with APOE3 carriers, but risks for coronary heart disease (1.09 [0.87-1.36], p = .47) and stroke (1.14 [0.91-1.44], p = .27) were not significantly elevated when examined individually. CVD outcomes did not differ between APOE2+ and APOE3 carriers (ps ≥ 0.11).

CONCLUSIONS

T2DM risk did not differ by APOE status among postmenopausal women, but APOE4+ carriers not using statins had an increased risk of total CVD events.

Baseline and cumulative Chinese visceral adiposity index and diabetic kidney disease: A prospective cohort study

BACKGROUND

Diabetic kidney disease (DKD) makes up nearly half of all chronic kidney disease cases and is a major cause of mortality for people with diabetes. However, the study of the association of longitudinal Chinese visceral adiposity index (CVAI) with DKD is still missing.

METHODS

This prospective cohort study included 7874 diabetes patients from the Kailuan study. These participants had complete repeated waist circumference, body mass index, triglycerides and high-density lipoprotein cholesterol measurements that formed the continuous CVAI records. DKD was defined by increased proteinuria or decreased estimated glomerular filtration rate (eGFR), preceded by diabetes. Cox proportional hazard regression models were used to examine the associations between baseline and cumulative CVAI and the risk of DKD.

RESULTS

There is a positive association between the CVAI level, whether baseline or cumulative, and the incidence of DKD among diabetic patients (p for log-rank tests <0.001). Compared to low CVAI level, the high baseline CVAI level was positively associated with the risk of DKD (HR: 1.24, 95% CI: 1.09-1.42), as well as the high cumulative CVAI level (HR: 1.62, 95% CI: 1.29-2.04). In addition, the assumption of linearity for the positive associations between both baseline (P-nonlinear = 0.264, p for overall <0.001) and cumulative (P-nonlinear = 0.765, p for overall <0.001) CVAI with incident DKD was satisfied.

CONCLUSIONS

Higher baseline and cumulative CVAI are associated with a higher risk of DKD. This finding suggests the health benefits of low levels of CVAI and the importance of its regular surveillance among individuals with diabetes.

Development and Validation of a Risk Prediction Model for Cognitive Frailty in Elderly Patients With Type 2 Diabetes Mellitus

AIMS

This study aimed to develop and validate a risk prediction model for cognitive frailty in elderly patients with Type 2 diabetes mellitus (T2DM).

DESIGN

A cross-sectional design.

METHODS

From February to November 2023, a convenience sample of 430 older adults with T2DM was enrolled at a tertiary hospital in Jinzhou. The study analysed 22 indicators, including sociodemographic characteristics, behavioural factors, information related to T2DM, nutritional status, instrumental activities of daily living (IADL) and depression. Independent risk factors related to cognitive frailty were identified using LASSO and multivariate logistic regression analysis. A prediction model was created using a nomogram. The calibration curve, decision curve analysis (DCA) and receiver operating characteristic (ROC) curve were used to evaluate model performance. This study was reported using the STARD checklist (Data S1).

RESULTS

The study found that cognitive frailty was prevalent in 30.7% of elderly patients with T2DM. Age, physical activity, glycosylated haemoglobin (HBA1c), duration of diabetes, nutritional status, IADL and depression were predictors of cognitive frailty. The ROC curve shows that the nomogram has good discriminative power. The calibration plots demonstrated a good fit between the observed and ideal curves. Additionally, DCA highlighted the clinical application of the nomogram.

CONCLUSIONS

This study provided an effective and convenient approach to evaluating the risk of cognitive frailty among elderly T2DM patients, which can help in the clinical screening of high-risk individuals.

IMPACT

Nurses should emphasise the care of comorbid cognitive frailty in elderly patients with T2DM. The intuitive and noninvasive nomogram can help clinical nurses assess the risk probability of cognitive frailty in this population. Tailored prevention strategies for high-risk populations can be rapidly developed with this tool, significantly improving patients' quality of life.

PATIENT OR PUBLIC CONTRIBUTION

Some patients were involved in data interpretation. No public contribution.

Understanding Patterns of the Gut Microbiome May Contribute to the Early Detection and Prevention of Type 2 Diabetes Mellitus: A Systematic Review

The rising burden of type 2 diabetes mellitus (T2DM) is a growing global public health problem, particularly prominent in developing countries. The early detection of T2DM and prediabetes is vital for reversing the outcome of disease, allowing early intervention. In the past decade, various microbiome-metabolome studies have attempted to address the question of whether there are any common microbial patterns that indicate either prediabetic or diabetic gut microbial signatures. Because current studies have a high methodological heterogeneity and risk of bias, we have selected studies that adhered to similar design and methodology. We performed a systematic review to assess if there were any common changes in microbiome belonging to diabetic, prediabetic and healthy individuals. The cross-sectional studies presented here collectively covered a population of 65,754 people, with 1800 in the 2TD group, 2770 in the prediabetic group and 61,184 in the control group. The overall microbial diversity scores were lower in the T2D and prediabetes cohorts in 86% of the analyzed studies. Re-programming of the microbiome is potentially one of the safest and long-lasting ways to eliminate diabetes in its early stages. The differences in the abundance of certain microbial species could serve as an early warning for a dysbiotic gut environment and could be easily modified before the onset of disease by changes in lifestyle, taking probiotics, introducing diet modifications or stimulating the vagal nerve. This review shows how metagenomic studies have and will continue to identify novel therapeutic targets (probiotics, prebiotics or targets for elimination from flora). This work clearly shows that gut microbiome intervention studies, if performed according to standard operating protocols using a predefined analytic framework (e.g., STORMS), could be combined with other similar studies, allowing broader conclusions from collating all global cohort studies efforts and eliminating the effect-size statistical insufficiency of a single study.