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Kanagala A, J M H. Metabolic Dysregulation and Its Multifaceted Impact on Cardiovascular Autonomic Control in Type 2 Diabetes Mellitus: Insights From Comprehensive Assessment. Cureus 2024; 16:e59776. [PMID: 38846218 PMCID: PMC11154021 DOI: 10.7759/cureus.59776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with a spectrum of metabolic dysfunctions that significantly elevate the risk of cardiovascular disorders. Understanding the intricate relationship between metabolic control and cardiovascular autonomic function in individuals with T2DM is crucial for effective management and the prevention of associated complications. This insight is foundational in developing targeted strategies that can mitigate the heightened cardiovascular risks inherent to this condition, thereby enhancing patient outcomes and quality of life. AIM The primary aim of the study was to explore the interconnections between various aspects of metabolic control in individuals with T2DM. This includes examining how glycemic variability, lipid profiles, body mass index (BMI), duration of diabetes, inflammatory markers, and cardiovascular autonomic function are interrelated. METHODS A cross-sectional study was conducted involving 100 individuals with T2DM and 100 control participants. HbA1C levels, glycemic variability, lipid profile, BMI, duration of diabetes, and inflammatory markers were assessed. Cardiovascular autonomic function parameters, including resting heart rate and blood pressure responses, were evaluated using standardized tests. RESULTS People with T2DM had significantly higher levels of glycosylated hemoglobin (HbA1C) compared to controls (mean difference = 2.95%, p < 0.001). Elevated HbA1C levels were correlated with increased resting heart rate (mean difference = 10 bpm, p < 0.001) and aberrant blood pressure responses during autonomic function assessments (p < 0.01 for systolic blood pressure; p < 0.05 for diastolic blood pressure). Glycemic variability (correlation coefficient (𝑟) = 0.75, p < 0.001) and dyslipidemia (elevated triglycerides and LDL cholesterol, reduced HDL cholesterol) were associated with cardiovascular autonomic dysfunction. Higher BMI values in T2DM individuals were independently correlated with alterations in autonomic function (𝑟 = 0.60, p < 0.001). The prolonged duration of diabetes was linked to greater impairment in autonomic function (mean decrease = 0.5 points per year, p < 0.01). In the T2DM group, higher levels of inflammatory markers (C-reactive protein and interleukin-6) were seen, which may have led to problems with the autonomic nervous system. CONCLUSION Metabolic dysregulation, such as high HbA1C levels, glycemic variability, dyslipidemia, obesity, having diabetes for a long time, and inflammation, is linked to cardiovascular autonomic dysfunction in T2DM. Early intervention targeting these metabolic abnormalities may mitigate the risk of cardiovascular complications in individuals with T2DM.
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Affiliation(s)
- Amrutha Kanagala
- Physiology, Smt. B. K. Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, IND
| | - Harsoda J M
- Physiology, Smt. B. K. Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, IND
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Bovee LB, Hirsch IB. Should We Bury HbA1c? Diabetes Technol Ther 2024. [PMID: 38350127 DOI: 10.1089/dia.2024.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Laura B Bovee
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Irl B Hirsch
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
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Zhang F, Han Y, Zheng G, Li W. Gender Differences in the Incidence of Nephropathy and Changes in Renal Function in Patients with Type 2 Diabetes Mellitus: A Retrospective Cohort Study. Diabetes Metab Syndr Obes 2024; 17:943-957. [PMID: 38435634 PMCID: PMC10906732 DOI: 10.2147/dmso.s451628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose This research aims to examine and scrutinize gender variations in the incidence of diabetic nephropathy (DN) and the trajectory of renal function in type 2 diabetes mellitus (T2DM) patients. Patients and Methods We conducted a retrospective cohort study that enrolled 1549 patients diagnosed with T2DM from May 2015 to July 2023. We separately compared the clinical characteristics of male and female participants with and without DN. We utilized the Kaplan-Meier method to examine the cumulative incidence of DN among T2DM patients of varying genders. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using univariable and multivariable Cox proportional hazards regression analysis to evaluate the correlation between various factors and the risk of DN incidence. Multiple linear regression was utilized to investigate the relationship between ΔeGFR% and each factor. Logistic regression with cubic spline function and smooth curve fitting was employed to analyze the nonlinear link between ΔeGFR% and the risk of DN among participants of different genders. Results The prevalence of DN was higher in female participants (17.31%) than in male participants (12.62%), with a significant cumulative risk ratio (1.33 [1.02-1.73], P = 0.034). Multiple linear regression analysis revealed that creatinine, female gender, blood urea nitrogen, alkaline phosphatase, and total cholesterol had a significant impact on ΔeGFR% in T2DM patients, with standardized β coefficients of -0.325, -0.219, -0.164, -0.084, and 0.071, respectively. The restricted cubic spline analysis demonstrated a strong negative association between ΔeGFR% and the risk of developing DN (P < 0.001). Conclusion Both male and female patients with T2DM had a higher prevalence of DN over the 5-year follow-up period. However, women had a greater risk of developing DN and a faster decline in renal function compared to men.
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Affiliation(s)
- Fan Zhang
- Department of Endocrinology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
- Department of Clinical Nutrition, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Yan Han
- Department of Endocrinology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
- Department of Clinical Nutrition, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Guojun Zheng
- Clinical Laboratory, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Wenjian Li
- Department of Urology, Changzhou Third People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
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Chegeni R, Pallesen S, Weldemariam H, Sagoe D. Systematic reviews and meta-analyses on androgen administration in humans: an umbrella review. Curr Opin Endocrinol Diabetes Obes 2023; 30:300-308. [PMID: 37603031 DOI: 10.1097/med.0000000000000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
PURPOSE OF REVIEW The present umbrella review systematically searches and synthesizes recent (2021-2023) systematic reviews and meta-analyses (SRMA) on androgen administration in humans. RECENT FINDINGS Results from 19 SRMA are synthesized. Four themes were identified: market for androgens, prevalence of androgen abuse, psychological effects of androgens, and clinical/therapeutic effects of androgens. One of three androgens on the illicit market are fake or substandard. Whereas one of three androgen users experiences dependence and various serious disorders, only one of three androgen users seeks physician support. Additionally, androgen administration increases self-reported aggression in healthy male individuals, and abuse positively correlates with interpersonal violence. Furthermore, androgen therapy is beneficial in treating persons suffering from various chronic diseases. SUMMARY In this umbrella review, we identified 19 SRMA on androgen use and abuse. Results show a high prevalence of fake androgens on the illicit market, a high prevalence of androgen abuse and dependence, and that a huge proportion of androgen users tend to avoid seeking support from clinicians. Also, androgen administration increases self-reported aggression among healthy male, and there is a positive correlation between androgen abuse and violent behavior. Finally, androgens have multiple therapeutic effects on various pathology.
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Affiliation(s)
- Razieh Chegeni
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
| | - Ståle Pallesen
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Hailemariam Weldemariam
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Dominic Sagoe
- Human Enhancement and Body Image Lab (HEBI Lab), Addiction Research Group
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Olanrewaju OA, Sheeba F, Kumar A, Ahmad S, Blank N, Kumari R, Kumari K, Salame T, Khalid A, Yousef N, Varrassi G, Khatri M, Kumar S, Mohamad T. Novel Therapies in Diabetes: A Comprehensive Narrative Review of GLP-1 Receptor Agonists, SGLT2 Inhibitors, and Beyond. Cureus 2023; 15:e51151. [PMID: 38283440 PMCID: PMC10811430 DOI: 10.7759/cureus.51151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Diabetes mellitus, a widespread metabolic illness with increasing global occurrence, continues to have a significant impact on public health. Diabetes is a condition marked by long-term high blood sugar levels. It is caused by a combination of genetic, environmental, and lifestyle factors, which lead to problems with insulin production and insulin resistance. This dysfunctional state disturbs the delicate balance of glucose regulation, promoting the emergence of problems in both large and small blood vessels that have a substantial impact on illness and death rates. Traditional therapy methods have traditionally given more importance to managing blood sugar levels by using insulin sensitizers, secretagogues, and other medications that lower glucose levels. Advancements in our understanding of the underlying mechanisms of diabetes have led to a significant change in approach, focusing on comprehensive therapies that target not only high blood sugar levels but also the accompanying dangers to the heart and kidneys. This study examines the evolving field of diabetes therapies, explicitly highlighting the significance of GLP-1 receptor agonists and SGLT2 inhibitors. These two types of drugs have become essential components in modern diabetes management. GLP-1 receptor agonists replicate the effects of natural glucagon-like peptide-1, leading to insulin production that is reliant on glucose levels, reducing the release of glucagon, and providing cardiovascular advantages that go beyond controlling blood sugar levels. SGLT2 inhibitors, however, act on the process of renal glucose reabsorption, leading to increased excretion of glucose in the urine and showing significant benefits for cardiovascular and renal protection. This extensive investigation seeks to contribute to the ongoing discourse on diabetes therapies by synthesizing existing research. This review aims to provide clinicians, researchers, and policymakers with a comprehensive understanding of the disease background and the specific pharmacological details of GLP-1 receptor agonists, SGLT2 inhibitors, and other related treatments. The goal is to assist them in developing more effective and personalized strategies to tackle the complex challenges presented by diabetes.
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Affiliation(s)
- Olusegun A Olanrewaju
- Pure and Applied Biology, Ladoke Akintola University of Technology, Ogbomoso, NGA
- General Medicine, Stavropol State Medical University, Stavropol, RUS
| | - Fnu Sheeba
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Avinash Kumar
- Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Saad Ahmad
- Medicine, Shalamar Medical and Dental College, Lahore, PAK
| | - Narendar Blank
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Reema Kumari
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Komal Kumari
- Medicine, New Medical Centre Royal Family Medical Centre, Abu Dhabi, ARE
| | - Tamara Salame
- Biological Sciences, Wayne State University, Detroit, USA
| | - Ayesha Khalid
- Medicine, Fatima Memorial College of Medicine and Dentistry, Lahore, PAK
| | - Nazdar Yousef
- Medicine, University of Kalamoon, Deir Atiyah An-Nabek, SYR
| | | | - Mahima Khatri
- Internal Medicine/Cardiology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Satish Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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Iwasa T, Noguchi H, Tanano R, Yamanaka E, Takeda A, Tamura K, Aoki H, Sugimoto T, Sasada H, Maeda T, Minato S, Yamamoto S, Inui H, Kagawa T, Yoshida A, Mineda A, Nii M, Kinouchi R, Yoshida K, Yamamoto Y, Kaji T. Age-Dependent Changes in the Effects of Androgens on Female Metabolic and Body Weight Regulation Systems in Humans and Laboratory Animals. Int J Mol Sci 2023; 24:16567. [PMID: 38068890 PMCID: PMC10706411 DOI: 10.3390/ijms242316567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
In recent years, the effects of androgens on metabolic and body weight regulation systems and their underlying mechanisms have been gradually revealed in females. In women and experimental animals of reproductive age, androgen excess can adversely affect metabolic functioning, appetite, and body weight regulation. In addition, excess androgens can increase the risk of metabolic disorders, such as obesity, insulin resistance, and diabetes. These unfavorable effects of androgens are induced by alterations in the actions of hypothalamic appetite-regulatory factors, reductions in energy expenditure, insulin resistance in skeletal muscle, and β-cell dysfunction. Interestingly, these unfavorable effects of androgens on metabolic and body-weight regulation systems are neither observed nor evident in ovariectomized animals and post-menopausal women, indicating that the adverse effects of androgens might be dependent on the estrogen milieu. Recent findings may provide novel sex- and age-specific strategies for treating metabolic diseases.
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Affiliation(s)
- Takeshi Iwasa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Hiroki Noguchi
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Risa Tanano
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Erika Yamanaka
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Asuka Takeda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Kou Tamura
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Hidenori Aoki
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Tatsuro Sugimoto
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Hikari Sasada
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Takaaki Maeda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Saki Minato
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Shota Yamamoto
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo 060-0808, Japan
| | - Hiroaki Inui
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Tomohiro Kagawa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Atsuko Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Ayuka Mineda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Mari Nii
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Riyo Kinouchi
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Kanako Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Yuri Yamamoto
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-Cho, Tokushima 770-8503, Japan; (H.N.); (R.T.); (E.Y.); (A.T.); (K.T.); (H.A.); (T.S.); (H.S.); (T.M.); (S.M.); (S.Y.); (H.I.); (T.K.); (A.Y.); (A.M.); (M.N.); (R.K.); (K.Y.); (Y.Y.); (T.K.)
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7
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Zakir M, Ahuja N, Surksha MA, Sachdev R, Kalariya Y, Nasir M, Kashif M, Shahzeen F, Tayyab A, Khan MSM, Junejo M, Manoj Kumar F, Varrassi G, Kumar S, Khatri M, Mohamad T. Cardiovascular Complications of Diabetes: From Microvascular to Macrovascular Pathways. Cureus 2023; 15:e45835. [PMID: 37881393 PMCID: PMC10594042 DOI: 10.7759/cureus.45835] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
Diabetes mellitus, with a growing risk of developing complications, has a significant negative impact on cardiovascular health, including microvascular and macrovascular issues. This thorough narrative study methodically examines the complex connection between cardiovascular problems and diabetes. We start by thoroughly introducing diabetes mellitus, classifying its various forms, and discussing its growing global impact. Then, we examine retinopathy, nephropathy, and neuropathy in detail, illuminating their biology, clinical presentations, and treatment options. Moving on to macrovascular consequences, we investigate the complex relationships between diabetes and coronary artery disease, stroke, and peripheral arterial disease, emphasizing risk factors, diagnostic standards, and treatment plans designed for people with diabetes. The review analyzes the pathophysiological pathways that link diabetes to cardiovascular problems, including endothelial dysfunction, chronic inflammation, immune system dysregulation, and oxidative stress brought on by hyperglycemia. Additionally, we review the critical function of risk monitoring, assessment, and predictive tools in early detection. While highlighting current research paths and the need for tailored medical approaches to address this complex health issue, the story also includes prevention and management strategies, ranging from lifestyle changes to developing medications. This narrative review concludes by providing a thorough summary of current information, highlighting research gaps, and advocating for interdisciplinary efforts to reduce the cardiovascular effects of diabetes.
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Affiliation(s)
- Mehreen Zakir
- Medicine, Sir Syed College of Medical Sciences, Karachi, PAK
| | - Neha Ahuja
- General Medicine, Chandka Medical College, Larkana, PAK
| | | | - Reya Sachdev
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Yash Kalariya
- Internal Medicine, Civil Hospital Rajkot, Rajkot, IND
| | - Muhammad Nasir
- Medicine, Rural Health Center (RHC) Dhonkal, Dhonkal, PAK
| | - Maham Kashif
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | - Fnu Shahzeen
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Arslan Tayyab
- Internal Medicine, Quaid e Azam Medical College, Bahawalpur, PAK
| | | | | | | | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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Kumar M, Dev S, Khalid MU, Siddenthi SM, Noman M, John C, Akubuiro C, Haider A, Rani R, Kashif M, Varrassi G, Khatri M, Kumar S, Mohamad T. The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management. Cureus 2023; 15:e45615. [PMID: 37868469 PMCID: PMC10588295 DOI: 10.7759/cureus.45615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
The complex and mutually influential connection between diabetes mellitus and chronic kidney disease (CKD) is a significant focal point in the current healthcare landscape. Diabetes, a medical condition characterized by elevated blood glucose levels resulting from impaired insulin action or secretion, has become a significant global epidemic. It poses considerable challenges to healthcare systems and affects millions of individuals worldwide. Concurrently, CKD, characterized by the gradual decline of kidney function, has become a persistent health challenge. This narrative review explores the complex relationship between these two conditions, shedding light on their significant implications for public health, clinical practice, and biomedical research. The correlation between diabetes and kidney disease is not merely coincidental. Diabetes is recognized as a significant risk factor for CKD, as individuals with diabetes are considerably more vulnerable to developing renal complications. Diabetic nephropathy, a distinct type of kidney disease closely associated with diabetes, is a significant factor in developing end-stage renal disease. It is imperative to implement efficient diabetes management strategies to regulate blood sugar levels and prevent potential kidney damage. On the other hand, kidney disease may contribute to the development of diabetes. The kidneys regulate glucose levels by filtering the blood and selectively reabsorbing glucose as necessary. In compromised kidney function, such as CKD, impaired glucose metabolism can give rise to insulin resistance and diabetes. As a result, the management of kidney disease plays a dual role in both preserving renal function and preventing diabetes in individuals who are at risk. The coexistence of diabetes and kidney disease in a patient presents complex clinical challenges. Achieving effective management requires a meticulous balance between glycemic control and preservation of renal function. Failing to maintain this delicate equilibrium can lead to cardiovascular complications and subsequent hospitalizations. This comprehensive narrative review aims to thoroughly examine the pathophysiological mechanisms that connect diabetes and kidney disease. It will provide insights into the clinical manifestations and diagnostic methods, explore various approaches to managing the condition, discuss the crucial role of nutrition, delve into pharmacological interventions, emphasize the importance of patient education and self-care, and shed light on emerging research areas. In addition to impacting individual health outcomes, this reciprocal relationship has significant implications for healthcare systems, socioeconomic landscapes, and public health policy. Comprehending this complex interaction is crucial for making well-informed clinical judgments, improving patient care, and developing a more efficient public health approach to address the interconnected issues of diabetes and kidney disease.
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Affiliation(s)
| | - Shah Dev
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | | | - Chris John
- Internal Medicine, University College Dublin, Dublin, IRL
| | | | - Anum Haider
- Internal Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Riya Rani
- Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Maham Kashif
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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Sugandh F, Chandio M, Raveena F, Kumar L, Karishma F, Khuwaja S, Memon UA, Bai K, Kashif M, Varrassi G, Khatri M, Kumar S. Advances in the Management of Diabetes Mellitus: A Focus on Personalized Medicine. Cureus 2023; 15:e43697. [PMID: 37724233 PMCID: PMC10505357 DOI: 10.7759/cureus.43697] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Diabetes mellitus poses a substantial global health challenge, necessitating innovative approaches to improve patient outcomes. Conventional one-size-fits-all treatment strategies have shown limitations in addressing the diverse nature of the disease. In recent years, personalized medicine has emerged as a transformative solution, tailoring treatment plans based on individual genetic makeup, lifestyle factors, and health characteristics. This review highlights the role of genetic screening in predicting diabetes susceptibility and response to treatment, as well as the potential of pharmacogenomics in optimizing medication choices. Moreover, it discusses the incorporation of lifestyle modifications and behavioral interventions to empower patients in their health journey. Telemedicine and remote patient monitoring are also examined for their role in enhancing accessibility and adherence. Ethical considerations and challenges in implementing personalized medicine are addressed. The review envisions a future where personalized medicine becomes a cornerstone in diabetes management, ensuring improved patient outcomes and fostering more effective and patient-centric care on a global scale.
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Affiliation(s)
- Fnu Sugandh
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
- Medicine, Civil Hospital Karachi, Karachi, PAK
| | - Maria Chandio
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fnu Raveena
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Lakshya Kumar
- General Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Fnu Karishma
- Medical School, Jinnah Sindh Medical University, Karachi, PAK
| | - Sundal Khuwaja
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Unaib Ahmed Memon
- Neurology, Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Karoona Bai
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Maham Kashif
- Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
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Patel T, Nageeta F, Sohail R, Butt TS, Ganesan S, Madhurita F, Ahmed M, Zafar M, Zafar W, Zaman MU, Varrassi G, Khatri M, Kumar S. Comparative efficacy and safety profile of once-weekly Semaglutide versus once-daily Sitagliptin as an add-on to metformin in patients with type 2 diabetes: a systematic review and meta-analysis. Ann Med 2023; 55:2239830. [PMID: 37498865 PMCID: PMC10375936 DOI: 10.1080/07853890.2023.2239830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The emergence of genetically-modified human proteins and glucagon-like peptide-1 (GLP-1) receptor agonists have presented a promising strategy for effectively managing diabetes. Due to the scarcity of clinical trials focusing on the safety and efficacy of semaglutide as an adjunctive treatment for patients with type 2 diabetes who had inadequate glycemic control with metformin, we conducted a systematic review and meta-analysis. This was necessary to fill the gap and provide a comprehensive assessment of semaglutide compared to sitagliptin, a commonly prescribed DPP-4 inhibitor, in this patient population. METHODS A comprehensive and systematic search was carried out on reputable databases including PubMed, the Cochrane Library, and Elsevier's ScienceDirect to identify relevant studies that compared the efficacy of once-weekly Semaglutide with once-daily Sitagliptin in individuals diagnosed with type 2 diabetes mellitus. The analysis of the gathered data was performed utilizing the random-effects model, which considers both within-study and between-study variations. RESULTS The meta-analysis incorporated three randomized controlled trials (RCTs), encompassing 2401 participants, with a balanced distribution across the treatment groups. The primary focus of the study revolved around evaluating changes in HbA1C, blood pressure, pulse rate, body weight, waist circumference, and BMI. The findings revealed that once-weekly Semaglutide showed substantially improved HbA1C (WMD: -0.98; 95% CI: -1.28, -0.69, p-value: < 0.0001; I2: 100%), systolic (WMD: -3.73; 95% CI: -5.42, -2.04, p-value: <0.0001; I2: 100%) and diastolic blood pressures (WMD: -0.66; 95% CI: -1.02, -0.29, p-value: 0.0005; I2: 100%), and body weight (WMD: -3.17; 95% CI: -3.84, -2.49, p-value: <0.00001; I2: 100%) compared to once-daily Sitagliptin. However, there was an observed increase in pulse rate (WMD: 3.33; 95% CI: 1.61, 5.06, p-value: <0.00001; I2: 100%) associated with Semaglutide treatment. Regarding secondary outcomes, there was an elevated risk of total adverse events and premature treatment discontinuation with Semaglutide. The risk of serious, severe, moderate, and mild adverse events did not significantly differ between the two treatments. CONCLUSIONS In conclusion, the administration of once-weekly Semaglutide exhibited a substantial reduction in HbA1c, average systolic blood pressure (SBP), mean diastolic blood pressure (DBP), body weight, waist circumference, body mass index (BMI), and a rise in pulse rate, as opposed to the once-daily administration of Sitagliptin.
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Affiliation(s)
- Tirath Patel
- Medicine, American University of
Antigua, Antigua and Barbuda
| | - Fnu Nageeta
- Medicine, Ghulam Muhammad Mahar Medical
College, Sukkur, Pakistan
| | - Rohab Sohail
- Medicine, Quaid-e-Azam Medical College
Bahawalpur, Pakistan, Pakistan
| | | | | | | | - Muhammad Ahmed
- Medicine, American University of the
Carribean, United States of America
| | - Mahrukh Zafar
- Medicine, University of Medicine and health
sciences, St. Kitts, Carribean, United States of
America
| | - Wirda Zafar
- Medicine, University of Medicine and health
sciences, St. Kitts, Carribean, United States of
America
| | | | | | - Mahima Khatri
- Medicine, Dow University of Health Sciences,
Karachi, Pakistan
| | - Satesh Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto
Medical College, Karachi, Pakistan
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