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Bala Durairajan M, Velavan Sundararajan V, Kannan G, Mathews Paul B, Muniyandi K, Thangaraj P. Elicitation of nutritional, antioxidant, and antidiabetic potential of barnyard millet (Echinochloa esculenta (A. Braun) H. Scholz) sprouts and microgreens through in vitro bio-accessibility assessment. Food Chem 2024; 441:138282. [PMID: 38199108 DOI: 10.1016/j.foodchem.2023.138282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/12/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
This study has redirected focus towards the untapped potential of millets, exploring their utilization as small-scale vegetables like sprouts and microgreens. This study assessed the metabolite profiles and therapeutic efficacy of barnyard millets as sprouts and microgreens for antioxidant, anti-diabetic, and bioaccessibility properties. Based on the study, sprouts contained 456.52 mg GE/g of starch and microgreens contained 470.04 mg GE/g of carbohydrates, whereas the gastric phase of microgreens showed 426.85 mg BSAE/g, 397.6 mg LE/g, 348.19 g RE/g, and 307.40 g AAE/g of proteins, amino acids, vitamin A and vitamin C respectively. Secondary metabolites were significantly concentrated in the microgreen stage which is responsible for their increased antioxidant and antidiabetic potential than sprouts. This study validated the therapeutic and nutritional value of millet sprouts and microgreens by demonstrating their significant nutritional composition.
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Affiliation(s)
- Madhu Bala Durairajan
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore 641 046, India
| | | | - Gowtham Kannan
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore 641 046, India
| | - Benedict Mathews Paul
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore 641 046, India
| | - Kasipandi Muniyandi
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore 641 046, India
| | - Parimelazhagan Thangaraj
- Bioprospecting Laboratory, Department of Botany, Bharathiar University, Coimbatore 641 046, India.
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Pan J, Shi Y, Zou J, Zhang X, Xin B, Zhai B, Guo D, Sun J, Luan F. Preparation technologies, structural features, and biological activities of polysaccharides from Mesona chinensis Benth.: A review. J Ethnopharmacol 2024; 326:117979. [PMID: 38412892 DOI: 10.1016/j.jep.2024.117979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 02/29/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mesona chinensis Benth. (or Platostoma palustre (Blume) A. J. Paton) is an important medicinal and edible plant also known as the Hsian-tsao in China and Southeast Asian countries. It is cold in nature and sweet in taste, with the effects of clearing heat, relieving heatstroke and diuretic, and traditionally used to treat heatstroke, erysipelas, hypertension, joint pain and other diseases in folk medicine. It is also a popular supplement with the function of detoxifying and heat-clearing use in Asia. It is used to be processed into the popular tea, Bean jelly, and so on. Published studies have demonstrated that polysaccharides from M. chinensis (MCPs) are one of the principal bioactive ingredients with a variety of health-promoting effects in the prevention and treatment of diseases, including antioxidant, immunomodulation, anti-inflammatory, hepatoprotective, anti-tumor, hypoglycemic, regulation of gut microbiota, and other pharmacological properties. AIM OF THE REVIEW This review aims to compile the extraction and purification methods, structural characteristics, pharmacological activities including the mechanism of action of MCPs, and to further understand the applications of M. chinensis in order to lay the foundation for the development of MCPs. MATERIALS AND METHODS By inputting the search term "Mesona chinensis polysaccharides", relevant research information was obtained from databases such as PubMed, Google Scholar, Web of Science, and China National Knowledge Infrastructure (CNKI). RESULTS More than 40 polysaccharides have been extracted from M. chinensis, different extraction and purification methods have been described, as well as the structural features and pharmacological activities of MCPs have been systematically reviewed. Polysaccharides, as important components of M. chinensis, were mainly extracted by methods such as hot water dipping method, hot alkali extraction method, enzyme-assisted extraction method and ultrasonic-assisted extraction method, subsequently obtained by decolorization, deproteinization, removal of other small molecules and separation on various chromatographic columns. The chemical composition and structure of MCPs show diversity and have a variety of pharmacological activities, including antioxidant, immunomodulation, anti-inflammatory, hepatoprotective, anti-tumor, hypoglycemic, regulation of gut microbiota, and so on. CONCLUSIONS This article systematically reviews the research progress of MCPs in terms of extraction and purification, structural characteristics, rheological gel properties, pharmacological properties, and safety assessment. The potentials and roles of M. chinensis in the field of medicine, functional food, and materials are further highlighted to provide references and bases for the high-value processing and utilization of MCPs.
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Affiliation(s)
- Jiaojiao Pan
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Yajun Shi
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Junbo Zou
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Xiaofei Zhang
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Bao Xin
- School of Public Health, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Bingtao Zhai
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Dongyan Guo
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Jing Sun
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China
| | - Fei Luan
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, 712046, Shaanxi, PR China.
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Chen X, Wu Y, Wu S, Gu Y, Luo J, Kong L. Paper-based ligand fishing method for rapid screening and real-time capturing of α-glucosidase inhibitors from the Chinese herbs. J Pharm Biomed Anal 2024; 242:116037. [PMID: 38387130 DOI: 10.1016/j.jpba.2024.116037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Identifying medicinally relevant compounds from natural resources generally involves the tedious work of screening plants for the desired activity before capturing the bioactive molecules from them. In this work, we created a paper-based ligand fishing platform to vastly simplify the discovery process. This paper-based method exploits the enzymatic cascade reaction between α-glucosidase (GAA), glucose oxidase (GOx), and horseradish peroxidase (HRP), to simultaneously screen the plants and capture the GAA inhibitors from them. The designed test strip could capture ligands in tandem with screening the plants, and it features a very simply operation based on direct visual assessment. Multiple acylated flavonol glycosides from the leaves of Quercus variabilis Blume were newly found to possess GAA inhibitory activities, and they may be potential leads for new antidiabetic medications. Our study demonstrates the prospect of the newly discovered GAA ligands as potential bioactive ingredients as well as the utility of the paper-based ligand fishing method.
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Affiliation(s)
- Xinlin Chen
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Bioactive Natural Product Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China
| | - Ying Wu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Bioactive Natural Product Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China
| | - Sifang Wu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Bioactive Natural Product Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China
| | - Yucheng Gu
- Syngenta, Jealott's Hill International Research Centre, Bracknell, Berkshire RG42 6EY, United Kingdom
| | - Jianguang Luo
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Bioactive Natural Product Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China.
| | - Lingyi Kong
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Bioactive Natural Product Research, School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, China.
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Yang L, Zi C, Li Y, Huang J, Gu Z, Wang C, Hu JM, Jiang Z, Zhang W. An in-depth investigation of molecular interaction in zeaxanthin/corn silk glycan complexes and its positive role in hypoglycemic activity. Food Chem 2024; 438:137986. [PMID: 38000158 DOI: 10.1016/j.foodchem.2023.137986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/08/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023]
Abstract
Glycans in corn silk could interact with co-existing small molecules during its absorption, digestion, and biological process. In order to understand the exact mechanism of action of zeaxanthin, it is critical to investigate the biomolecular interactions, which were necessary to form a glycan-small molecule complex and yet produce the bioactive effect. So far, the in-depth study of these natural interactions has not been fully elucidated. Here, we probed that the molecular interaction between zeaxanthin (ZEA) and glycans from corn silk (CSGs) was driven by enthalpy. More importantly, it was the first time found that CSGs can bind to lipid-soluble ZEA could be binded with CSGs. It was the first report on the thermostability of insulin structure and natural glycans. This study should facilitate our understanding of the interaction between lipid soluble molecules and glycans, and provide a more comprehensive understanding of the nutrient base in food.
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Affiliation(s)
- Liu Yang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau; State Key Laboratory of Phytochemistry and Plant Resources in West China, and Yunnan Key Laboratory of Natural Medicinal Chemistry, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
| | - Chengting Zi
- College of Science, Yunnan Agricultural University, Kunming, Yunnan 650201, China
| | - Yanlang Li
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and Yunnan Key Laboratory of Natural Medicinal Chemistry, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
| | - Jia Huang
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and Yunnan Key Laboratory of Natural Medicinal Chemistry, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
| | - Zhijia Gu
- Key Laboratory for Plant Biodiversity and Biogeography of East Asia, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, Yunnan 650201, China
| | - Caiyun Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau
| | - Jiang-Miao Hu
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and Yunnan Key Laboratory of Natural Medicinal Chemistry, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, Yunnan 650201, China.
| | - Zhihong Jiang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau.
| | - Wei Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa 999078, Macau.
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Sun Y, Meng X, Chen M, Li D, Liu R, Sun T. Isolation, structural properties and bioactivities of polysaccharides from Crataegus pinnatifida. J Ethnopharmacol 2024; 323:117688. [PMID: 38159827 DOI: 10.1016/j.jep.2023.117688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Abstract
ETHNOPHARMACOLOGIC RELEVANCE Crataegus pinnatifida, commonly known as hawthorn, is a plant species with a long history of medicinal use in traditional Chinese medicine. Hawthorn polysaccharides (HP) have gained worldwide attention due to their decent biological activities and potential health benefits. Their excellent antioxidant activity, antitumor activity, immunomodulatory activity, hypoglycemic effect and hypolipidemic effects, intestinal microbiota modulatory activity makes them valuable in the field of ethnopharmacological research. AIM OF THE STUDY The purpose of the current review is to provide a systematic and comprehensive summary of the latest literatures and put forward the future perspectives on hawthorn polysaccharides in the context of its extraction, purification, structural characteristics and bioactivities. Furthermore, the underlying structure-bioactivity relationship of hawthorn polysaccharides was also explored and discussed. The current review would provide the important research underpinnings and the update the information for future development and application of hawthorn polysaccharides in the pharmaceutical and functional food industries. MATERIALS AND METHODS We use Google Scholar, CNKI, PubMed, Springer, Elsevier, Wiley, Web of Science and other online databases to search and obtain the literature on extraction, isolation, structural analysis and the biological activity of hawthorn polysaccharides published before October 2023. The key words are "extraction", "isolation and purification", "bioactivities", and "Crataegus pinnatifida polysaccharides ". RESULTS Crataegus pinnatifida has been widely used for the treatment of cardiovascular diseases, digestive disorders, inflammatory and oxidative stress in traditional Chinese medicine. Polysaccharides are the key active components of Crataegus pinnatifida which have gained widespread attention. The structure and bioactivity of polysaccharides from Crataegus pinnatifida varies in terms of raw materials, extraction methods and purification techniques. Crataegus pinnatifida polysaccharides possess diverse bioactivities, including antitumor, immunomodulatory, hypoglycemic activity, cardioprotective and antioxidant activities, among others. These biological properties can not only lay firm foundation for the treatment of diverse diseases, but also provide a theoretical basis for the in-depth study of the structure-activity relationship. In addition, the underlying structure-activity relationship is also explored and discussed, and further research and development of hawthorn polysaccharides are also prospected. CONCLUSION As a natural compound, hawthorn polysaccharides has garnered significant attention and held immense research potential. Hawthorn polysaccharides can be obtained through different extraction methods, including hot water extraction method, ultrasonic extraction method and enzymatic extraction method etc. The structures of hawthorn polysaccharides have also been characterized and reported in numerous studies. Moreover, hawthorn polysaccharides exhibit a wide range of bioactivities, such as the antioxidant activity, the antitumor activity, the immunomodulatory activity, the hypoglycemic effect and the hypolipidemic effect, as well as the intestinal microbiota modulatory activity. These diverse bioactivities contribute to the growing interest in hawthorn polysaccharides and its potential applications. Hawthorn polysaccharides has promising application prospects in various industries, including functional food, pharmaceuticals and biomedical research. Therefore, it is imperative to fully explore and harness the potential of hawthorn polysaccharides in the food and medicine fields.
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Affiliation(s)
- Yuan Sun
- Center of Pharmaceutical Engineering and Technology, Harbin University of Commerce, Harbin, 150076, China.
| | - Xianwei Meng
- Center of Pharmaceutical Engineering and Technology, Harbin University of Commerce, Harbin, 150076, China
| | - Mengjie Chen
- Center of Pharmaceutical Engineering and Technology, Harbin University of Commerce, Harbin, 150076, China
| | - Dan Li
- Center of Pharmaceutical Engineering and Technology, Harbin University of Commerce, Harbin, 150076, China
| | - Rui Liu
- Center of Pharmaceutical Engineering and Technology, Harbin University of Commerce, Harbin, 150076, China.
| | - Tiedong Sun
- College of Chemistry, Chemical Engineering and Resource Utilization, Northeast Forestry University, Harbin, 150040, China.
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Ssemmondo E, Deshmukh H, Wilmot EG, Adeleke KA, Shah N, Walton C, Barnes D, Ryder REJ, Sathyapalan T. Effect of intermittently scanned continuous glucose monitoring in people with diabetes with a psychosocial indication for initiation. Diabetes Obes Metab 2024; 26:1340-1345. [PMID: 38228571 DOI: 10.1111/dom.15435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
AIM To understand the effect of intermittently scanned continuous glucose monitoring (isCGM) in people with diabetes with a 'psychosocial' indication for access. METHODS The study utilized baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the UK. Diabetes-related distress (DRD) was assessed using the two-item diabetes-related distress scale (DDS). Participants were categorized into two groups: high DRD (DDS score ≥ 3) and lower DRD (DDS score < 3). The t-test was used to assess the difference in the pre- and post-isCGM continuous variables. RESULTS The study consisted of 17 036 people with diabetes, with 1314 (7%) using isCGM for 'psychosocial' reasons. Follow-up data were available for 327 participants, 322 (99%) of whom had type 1 diabetes with a median diabetes duration of 15 years; 75% (n = 241) had high levels of DRD. With the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in DDS score; 4 at baseline versus 2.5 at follow-up (P < .001). The prevalence of high DRD reduced from 76% to 38% at follow-up (50% reduction in DRD, P < .001). There was also a significant reduction in HbA1c (78.5 mmol/mol [9.3%] at baseline vs. 66.5 mmol/mol [8.2%] at follow-up; P < .001). This group also experienced an 87% reduction in hospital admissions because of hyperglycaemia/diabetic ketoacidosis (P < .001). CONCLUSION People with diabetes who had isCGM initiated for a psychosocial indication had high levels of DRD and HbA1c, which improved with the use of isCGM.
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Affiliation(s)
- Emmanuel Ssemmondo
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Harshal Deshmukh
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kazeem A Adeleke
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Najeeb Shah
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Thozhukat Sathyapalan
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Li L, Xiang F, Wang F, Chen A, Liu Y. Preparation and sustained-release mechanism of hydroxybutyl chitosan/graphene oxide temperature-sensitive hypoglycaemic subcutaneous implants. Colloids Surf B Biointerfaces 2024; 236:113801. [PMID: 38401183 DOI: 10.1016/j.colsurfb.2024.113801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
The current situation of diabetes prevention and control is extremely severe. For instance, glimepiride (GLM), a third-generation sulfonylurea, demonstrates suboptimal clinical efficacy in oral dosage forms, which underscores the pressing need for the development of a new dosage form. Recently, in situ gel subcutaneous implants have garnered considerable attention. Hydroxybutyl chitosan (HBC) can spontaneously crosslink to form a thermosensitive hydrogel and has good biocompatibility. However, its application is hindered by its limited mechanical properties. Graphene oxide (GO), known for its stable dispersion in water, can load GLM through π-π stacking interactions. When combined with HBC, GO enhances the mechanical properties and stability of the hydrogel. Therefore, an HBC-GO@GLM hydrogel was prepared. Rheological analysis revealed that the incorporation of GO increased the critical gelation temperature of the 5 wt% HBC hydrogel from 19.1°C to 27.2°C, considerably enhancing the mechanical properties of the hydrogel. Using encapsulation efficiency as an evaluation index, the optimal encapsulation efficiency of GO@GLM was determined to be 73.53% ± 0.45% with a drug loading capacity of 27.39 ± 0.17% using the Box-Behnken design model. Computer simulation technology validated the interaction between the materials and the drug release mechanism. Pharmacokinetic results showed that compared to the HBC@GLM group, the half-life (t1/2), mean residence time and the area under the curve for the HBC-GO@GLM group were approximately 3 times those of the HBC@GLM group. Subcutaneous implantation of the HBC-GO@GLM hydrogel for drug delivery considerably extended the drug's action time in the body, thereby maintaining blood sugar levels within a normal and stable range for an extended period.
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Affiliation(s)
- Li Li
- School of Pharmaceutical Sciences, Liaoning University, Shenyang 110036, China
| | - Fengting Xiang
- School of Pharmaceutical Sciences, Liaoning University, Shenyang 110036, China
| | - Fan Wang
- School of Pharmaceutical Sciences, Liaoning University, Shenyang 110036, China
| | - Anqi Chen
- School of Pharmaceutical Sciences, Liaoning University, Shenyang 110036, China
| | - Yu Liu
- School of Pharmaceutical Sciences, Liaoning University, Shenyang 110036, China; LiaoNing University Judicial Authentication Centre, Shenyang 110036, China.
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Agarwal S, Qamar U, Fujiwara Y, Guha A, Naqash AR, Yang EH, Addison D, Barac A, Asad ZUA. The Effect of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Outcomes in Patients With Cancer: A Systematic Review and Meta-Analysis. Am J Cardiol 2024; 216:87-90. [PMID: 38373679 DOI: 10.1016/j.amjcard.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/28/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Usama Qamar
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Yu Fujiwara
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Abdul Rafeh Naqash
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Daniel Addison
- Cardio-Oncology Program, The Ohio State University, Columbus, Ohio
| | - Ana Barac
- Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, Virginia
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Lau D, Gamble JM. Suicidality among users of glucagon-like peptide-1 receptor agonists: An emerging signal? Diabetes Obes Metab 2024; 26:1150-1156. [PMID: 38229461 DOI: 10.1111/dom.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Darren Lau
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John-Michael Gamble
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Ontario, Canada
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de Lemos JA, Linetzky B, le Roux CW, Laffin LJ, Vongpatanasin W, Fan L, Hemmingway A, Ahmad NN, Bunck MC, Stefanski A. Tirzepatide Reduces 24-Hour Ambulatory Blood Pressure in Adults With Body Mass Index ≥27 kg/m 2: SURMOUNT-1 Ambulatory Blood Pressure Monitoring Substudy. Hypertension 2024; 81:e41-e43. [PMID: 38314555 PMCID: PMC10956672 DOI: 10.1161/hypertensionaha.123.22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Affiliation(s)
- James A. de Lemos
- Cardiovascular Division, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., W.V.)
| | - Bruno Linetzky
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland (C.W.l.R.)
| | - Luke J. Laffin
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, OH (L.J.L.)
| | - Wanpen Vongpatanasin
- Cardiovascular Division, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., W.V.)
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Andrea Hemmingway
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Nadia N. Ahmad
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Mathijs C. Bunck
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
| | - Adam Stefanski
- Eli Lilly and Company, Indianapolis, IN (B.L., L.F., A.H., N.N.A., M.C.B., A.S.)
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Harrod JC, Cheung YMM, Buckley L, Cromwell GE, Fowler KM, Hughes ME, Lin NU, Tolaney SM, Min L, McDonnell ME. Impact of personalized diabetes care on distress and treatment satisfaction in people with breast cancer. Diabet Med 2024; 41:e15292. [PMID: 38291604 DOI: 10.1111/dme.15292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
AIMS In patients with breast cancer (BCa) and diabetes (DM), diabetes distress (DD) and treatment satisfaction (DTS) can influence BCa management and outcomes. We assessed the impact of implementing a personalized diabetes care model in patients with BCa. METHODS Patients in active treatment or surveillance for BCa with an HbA1c > 53 mmol/mol (7%) or random blood glucose >11.1 mmol/L were included. Participants were offered continuous glucose monitoring (CGM), virtual care and a dedicated diabetes provider for 6 months. Primary outcomes included DD measured by the Diabetes Distress Survey (DDS) and DTS measured by the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Questionnaires were conducted at 0, 3 and 6 months. RESULTS Thirty-one women were enrolled (median age 61, IQR 49.0-69.0). Compared to baseline, the mean DDS score was lower at both 3 months (2.2 vs. 1.8 [n = 27], p = 0.004, SD = 0.70) and 6 months (2.3 vs. 1.8 [n = 23], p = 0.002, SD = 0.70). The mean DTSQ score was higher at 3 months (baseline: 20.5 vs. 3 months: 28.7 [n = 28], p < 0.001, SD = 9.2) and 6 months (baseline: 20.4 vs. 6 months: 30.0 [n = 26], p < 0.001, SD = 9.7). CONCLUSIONS Personalized diabetes care models that emphasize remote management and optimize access for those with BCa may lower DD and improve DTS.
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Affiliation(s)
- Julia C Harrod
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yee-Ming M Cheung
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Endocrinology, Diabetes and Metabolism, Northwell Health, Manhasset, New York, USA
| | - Lauren Buckley
- Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Grace E Cromwell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen M Fowler
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Melissa E Hughes
- Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy U Lin
- Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sara M Tolaney
- Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Le Min
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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Chen L, Hu Z, Rong Y, Lou B. Deep2Pep: A deep learning method in multi-label classification of bioactive peptide. Comput Biol Chem 2024; 109:108021. [PMID: 38308955 DOI: 10.1016/j.compbiolchem.2024.108021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
Functional peptides are easy to absorb and have low side effects, which has attracted increasing interest from pharmaceutical scientists. However, due to the limitations in the laboratory funding and human resources, it is difficult to screen the functional peptides from a large number of peptides with unknown functions. With the development of machine learning and Deep learning, the combination of computational methods and biological information provides an effective method for identifying peptide functions. To explore the value of multi-functional active peptides, a new deep learning method named Deep2Pep (Deep learning to Peptides) was constructed, which was based on sequence encoding, embedding, and language tokenizer. It can achieve predictions of peptides on antimicrobial, antihypertensive, antioxidant and antihyperglycemic by converting sequence information into digital vectors, combined BiLSTM, attention-residual algorithm, and BERT Encoder. The results showed that Deep2Pep had a Hamming Loss of 0.095, subset Accuracy of 0.737, and Macro F1-Score of 0.734. which outperformed other models. BiLSTM played a primary role in Deep2Pep, which BERT encoder was in an auxiliary position. Deep learning algorithms was used in this study to accurately predict the four active functions of peptides, and it was expected to provide effective references for predicting multi-functional peptides.
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Affiliation(s)
- Lihua Chen
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 201418, China
| | - Zhenkang Hu
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 201418, China
| | - Yuzhi Rong
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai 201418, China.
| | - Bao Lou
- Institute of Hydrobiology, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China.
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13
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Wang C, Luo D, Zheng L, Zhao M. Anti-diabetic mechanism and potential bioactive peptides of casein hydrolysates in STZ/HFD-induced diabetic rats. J Sci Food Agric 2024; 104:2947-2958. [PMID: 38041433 DOI: 10.1002/jsfa.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Casein hydrolysates have attracted much interest as anti-diabetic food, but their hypoglycemic mechanism and biopeptides are not well understood. This study aimed to explore the anti-diabetic mechanism and potential biopeptides of casein hydrolysates in streptozotocin/high-fat-diet-induced diabetic rats and HepG2 cells. RESULTS Oral administration of casein hydrolysate prepared with papain-Flavourzyme combination (P-FCH) decreased fasting blood glucose, improved oral glucose tolerance, and reduced HbA1c values in diabetic rats. P-FCH was ineffective in alleviating insulin resistance (homeostasis model assessment and insulin sensitivity index) and enhancing hepatic insulin signaling transduction (phosphorylated Akt, hexokinase activity, and pyruvate kinase activity) in diabetic rats. However, P-FCH significantly upregulated adenosine monophosphate-activated protein kinase phosphorylation and glucose transporter-2 expression, inhibited phosphoenolpyruvate carboxylase kinase activity, and elevated glycogen content in liver tissue of diabetic rats. Furthermore, P-FCH increased glucose consumption independently in normal and insulin-resistant HepG2 cells without the presence of insulin. The peptide composition of P-FCH was characterized. The potential biopeptides in P-FCH showed the sequence characteristic of a Val at the N-terminal or a Pro at the P2 position, and the hypoglycemic activity of Val-Pro-Leu-Gly (the most potential biopeptide in P-FCH) was verified by oral glucose tolerance test in mice. CONCLUSION These results suggested that activation of the non-insulin-mediated AMPK pathway might be the determinant mechanism of P-FCH on the hypoglycemic effect. The novel peptide Val-Pro-Leu-Gly in P-FCH was effective in reducing blood glucose levels when orally administered to mice. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Chenyang Wang
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
- Guangdong Food Green Processing and Nutrition Regulation Technologies Research Center, Guangzhou, China
| | - Donghui Luo
- Chaozhou Branch of Chemistry and Chemical Engineering Guangdong Laboratory, Chaozhou, China
| | - Lin Zheng
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
- Guangdong Food Green Processing and Nutrition Regulation Technologies Research Center, Guangzhou, China
| | - Mouming Zhao
- School of Food Science and Engineering, South China University of Technology, Guangzhou, China
- Guangdong Food Green Processing and Nutrition Regulation Technologies Research Center, Guangzhou, China
- Chaozhou Branch of Chemistry and Chemical Engineering Guangdong Laboratory, Chaozhou, China
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14
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Mozaffarian D. GLP-1 Agonists for Obesity-A New Recipe for Success? JAMA 2024; 331:1007-1008. [PMID: 38421659 DOI: 10.1001/jama.2024.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
This Viewpoint discusses the drawbacks of using glucagon-like peptide 1 (GLP-1) agonists to treat obesity and presents an alternative approach of initial, staged GLP-1 agonist treatment supported by long-term lifestyle programming, including medically appropriate groceries or meals (“Food Is Medicine”), to address the cost, health, and equity burdens of obesity.
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Affiliation(s)
- Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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15
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Barry R, Murray G, Hellen R, Ní Raghallaigh S. Liraglutide, a GLP-1 agonist, as a new adjunct treatment in Hailey-Hailey disease: a case report. Clin Exp Dermatol 2024; 49:409-411. [PMID: 38039150 DOI: 10.1093/ced/llad429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
Hailey–Hailey disease (HHD) is a rare, heritable blistering disorder with a predilection for intertriginous areas, and is caused by mutations in the ATP2C1 gene. We present a case of a 60-year-old woman who has had poorly controlled HHD for 45 years, despite various treatments. Her HHD has become very well controlled since commencing liraglutide, for newly diagnosed type 2 diabetes, with loss of HHD disease control on discontinuation.
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Affiliation(s)
- Rory Barry
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Gregg Murray
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
| | - Rebecca Hellen
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
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16
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Sawamoto A, Okada M, Matsuoka N, Okuyama S, Nakajima M. Tipepidine activates AMPK and improves adipose tissue fibrosis and glucose intolerance in high-fat diet-induced obese mice. FASEB J 2024; 38:e23542. [PMID: 38466234 DOI: 10.1096/fj.202301861rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/13/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024]
Abstract
Tipepidine (3-[di-2-thienylmethylene]-1-methylpiperidine) (TP) is a non-narcotic antitussive used in Japan. Recently, the potential application of TP in the treatment of neuropsychiatric disorders, such as depression and attention deficit hyperactivity disorder, has been suggested; however, its functions in energy metabolism are unknown. Here, we demonstrate that TP exhibits a metabolism-improving action. The administration of TP reduced high-fat diet-induced body weight gain in mice and lipid accumulation in the liver and increased the weight of epididymal white adipose tissue (eWAT) in diet-induced obese (DIO) mice. Furthermore, TP inhibited obesity-induced fibrosis in the eWAT. We also found that TP induced AMP-activated protein kinase (AMPK) activation in the eWAT of DIO mice and 3T3-L1 cells. TP-induced AMPK activation was abrogated by the transfection of liver kinase B1 siRNA in 3T3-L1 cells. The metabolic effects of TP were almost equivalent to those of metformin, an AMPK activator that is used as a first-line antidiabetic drug. In summary, TP is a potent AMPK activator, suggesting its novel role as an antidiabetic drug owing to its antifibrotic effect on adipose tissues.
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Affiliation(s)
- Atsushi Sawamoto
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University, Matsuyama, Ehime, Japan
| | - Madoka Okada
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University, Matsuyama, Ehime, Japan
| | - Nanako Matsuoka
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University, Matsuyama, Ehime, Japan
| | - Satoshi Okuyama
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University, Matsuyama, Ehime, Japan
| | - Mitsunari Nakajima
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University, Matsuyama, Ehime, Japan
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17
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Haidar L, Crane HM, Nance RM, Webel A, Ruderman SA, Whitney BM, Willig AL, Napravnik S, Mixson LS, Leong C, Lavu A, Aboulatta L, Dai M, Hahn A, Saag MS, Bamford L, Cachay E, Kitahata MM, Mayer KH, Jacobson J, Moore RD, Delaney JAC, Drumright LN, Eltonsy S. Weight loss associated with semaglutide treatment among people with HIV. AIDS 2024; 38:531-535. [PMID: 37976053 PMCID: PMC10922142 DOI: 10.1097/qad.0000000000003791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE There is limited real-world evidence about the effectiveness of semaglutide for weight loss among people with HIV (PWH). We aimed to investigate weight change in a US cohort of PWH who initiated semaglutide treatment. DESIGN Observational study using the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. METHODS We identified adult PWH who initiated semaglutide between 2018 and 2022 and with at least two weight measurements. The primary outcome was within-person bodyweight change in kilograms at 1 year. The secondary outcome was within-person Hemoglobin A1c percentage (HbA1c) change. Both outcomes were estimated using multivariable linear mixed model. RESULTS In total, 222 new users of semaglutide met inclusion criteria. Mean follow-up was 1.1 years. Approximately 75% of new semaglutide users were men, and at baseline, mean age was 53 years [standard deviation (SD): 10], average weight was 108 kg (SD: 23), mean BMI was 35.5 kg/m 2 , mean HbA1c was 7.7% and 77% had clinically recognized diabetes. At baseline, 97% were on ART and 89% were virally suppressed (viral load < 50 copies/ml). In the adjusted mixed model analysis, treatment with semaglutide was associated with an average weight loss of 6.47 kg at 1 year (95% CI -7.67 to -5.18) and with a reduction in HbA1c of 1.07% at 1 year (95% CI -1.64 to -0.50) among the 157 PWH with a postindex HbA1c value. CONCLUSION Semaglutide was associated with significant weight loss and HbA1c reduction among PWH, comparable to results of previous studies from the general population.
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Affiliation(s)
- Lara Haidar
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | - Allison Webel
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Amanda L Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sonia Napravnik
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - L Sarah Mixson
- Department of Medicine, University of Washington, Seattle, WA
| | - Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alekhya Lavu
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laila Aboulatta
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mindy Dai
- Department of Medicine, University of Washington, Seattle, WA
| | - Andrew Hahn
- Department of Medicine, University of Washington, Seattle, WA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Laura Bamford
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Edward Cachay
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Kenneth H Mayer
- Department of Medicine, Harvard Medical School, Fenway Institute, Boston, MA
| | - Jeffrey Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph A C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Khadka A, Budha Magar A, Sharma KR. Chemical Profiling and Biological Activities on Nepalese Medicinal Plant Extracts and Isolation of Active Fraction of Nyctanthes arbor-tristis. ScientificWorldJournal 2024; 2024:5080176. [PMID: 38515931 PMCID: PMC10957254 DOI: 10.1155/2024/5080176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/21/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
The importance of medicinal plants for the treatment of different diseases is high from the aspects of the pharmaceutical industry and traditional healers. The present study involves nine different medicinal plants, namely, Neolamarckia cadamba, Nyctanthes arbor-tristis, Pogostemon benghalensis, Equisetum debile, Litsea monopetala, Spilanthes uliginosa, Desmostachya bipinnata, Mallotus philippensis, and Phoenix humilis, collected from Chitwan district of Nepal for biochemical analysis followed by the isolation of active plant fractions from the bioactive plant extract. The methanolic extracts of roots, barks, seeds, seed cover, and the other aerial parts of plants were used for the phytochemical analysis and biological activities. The DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging assay was adopted to evaluate the antioxidant activity. Antibacterial activity was evaluated using the agar well diffusion method. The antidiabetic activity was studied by the α-amylase enzyme inhibition assay. The highest antioxidant activity was observed in extracts of Nyctanthes arbor-tristis followed by Mallotus philippensis (seed cover), Pogostemon benghalensis, Litsea monopetala, Phoenix humilis, and Neolamarckia cadamba with IC50 values of 27.38 ± 1.35, 32.08 ± 2.81, 32.75 ± 2.13, 33.82 ± 1.07, 40.14 ± 0.93, and 50.44 ± 3.75 µg/mL, respectively. The highest antidiabetic activity was observed in extracts of Phoenix humilis followed by Desmostachya bipinnata and Pogostemon benghalensis with IC50 values of 95.69 ± 6.97, 99.24 ± 12.6, and 106.3 ± 12.89 µg/mL, respectively. The mild α-amylase enzyme inhibition was found in extracts of Nyctanthes arbor-tristis, Spilanthes uliginosa Swartz, Litsea monopetala, and Equisetum debile showing IC50 values of 110.4 ± 7.78, 115.98 ± 10.24, 149.83 ± 8.3, and 196.45 ± 6.04 µg/mL, whereas Mallotus Philippensis (seed cover), Mallotus philippensis (seed), and Desmostachya bipinnata showed weak α-amylase inhibition with IC50 values of 208.87 ± 1.76, 215.41 ± 2.09, and 238.89 ± 9.27 µg/mL, respectively. The extract of Nyctanthes arbor-tristis showed high zones of inhibition against S. aureus (ATCC 25923) and E. coli (ATCC 25922) of ZOI 26 and 22 mm, respectively. The chemical constituents isolated from the active plant Nyctanthes arbor-tristis were subjected to GCMS analysis where the major chemical compounds were 11,14,17-eicosatrienoic acid and methyl ester. These results support the partial scientific validation for the traditional uses of these medicinal plants in the treatment of diabetes and infectious diseases by the people living in different communities of Chitwan, Nepal.
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Affiliation(s)
- Anita Khadka
- Central Department of Chemistry, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Akash Budha Magar
- Central Department of Chemistry, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Khaga Raj Sharma
- Central Department of Chemistry, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Harris E. Tirzepatide Lowered Blood Pressure in People With Obesity. JAMA 2024; 331:821. [PMID: 38381469 DOI: 10.1001/jama.2024.0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
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20
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Goel V, Raizada A, Aggarwal A, Madhu SV, Kar R, Agrawal A, Mahla V, Goel A. Long-Term Persistence of COVID-Induced Hyperglycemia: A Cohort Study. Am J Trop Med Hyg 2024; 110:512-517. [PMID: 38350147 PMCID: PMC10919180 DOI: 10.4269/ajtmh.22-0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/16/2023] [Indexed: 02/15/2024] Open
Abstract
Although the short-term mortality of patients with COVID-19 infection and hyperglycemia has been well documented, there is little available data regarding longer-term prognosis. The presence of diabetes has not only influenced disease severity but has also impacted its transmission dynamics. In this study, we followed a historical cohort of patients without previous history of diabetes who presented with moderate to severe COVID-19 and were found to have hyperglycemia (random blood glucose > 140 mg/dL) at the time of admission. We evaluated the need for antidiabetic therapy in these patients at the end of 6 months and the risk factors associated with persistent hyperglycemia determined by monthly values of self-monitored blood glucose. Of the seventy participants who were followed telephonically, 54 (77%) continued to receive antidiabetic therapy or have persistent hyperglycemia (> 140 mg/dL) at the end of 6 months. Persistent hyperglycemia at the end of follow-up, was found to be associated with a higher blood glucose at presentation.
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Affiliation(s)
- Vrinda Goel
- Department of Medicine, University College of Medical Sciences, Delhi, India
| | - Alpana Raizada
- Department of Medicine, University College of Medical Sciences, Delhi, India
| | - Amitesh Aggarwal
- Department of Medicine, University College of Medical Sciences, Delhi, India
| | - SV Madhu
- Department of Endocrinology, University College of Medical Sciences, Delhi, India
| | - Rajarshi Kar
- Department of Biochemistry, University College of Medical Sciences, Delhi, India
| | - Ananya Agrawal
- Hamdard Institute of Medical Sciences and Research, Delhi, India
| | - Vikash Mahla
- Department of Medicine, University College of Medical Sciences, Delhi, India
| | - Ashish Goel
- Department of Medicine, Ambedkar State Institute of Medical Sciences, Sahibzada Ajit Singh Nagar, Punjab, India
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Smudja M, Milenković T, Minaković I, Zdravković V, Javorac J, Milutinović D. Self-care activities in pediatric patients with type 1 diabetes mellitus. PLoS One 2024; 19:e0300055. [PMID: 38442115 PMCID: PMC10914259 DOI: 10.1371/journal.pone.0300055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics. METHODS This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data. RESULTS A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes. CONCLUSIONS Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes.
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Affiliation(s)
- Mirjana Smudja
- Department of Higher Medical School, Academy for Applied Studies Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Milenković
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Ivana Minaković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Health Center Novi Sad, Novi Sad, Serbia
| | - Vera Zdravković
- University Children’s Hospital Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovan Javorac
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dragana Milutinović
- Department of Nursing, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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22
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Ohshiro Y. Rethinking eGFR Comparisons in SGLT2 Inhibitor Research. J Am Coll Cardiol 2024; 83:e87. [PMID: 38418012 DOI: 10.1016/j.jacc.2023.09.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 03/01/2024]
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23
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Chatur S, Vaduganathan M, Claggett B, Solomon SD. Reply: Rethinking eGFR Comparisons in SGLT2 Inhibitor Research. J Am Coll Cardiol 2024; 83:e89. [PMID: 38418013 DOI: 10.1016/j.jacc.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Safia Chatur
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Claggett
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Parvaiz N, Abro A, Azam SS. Three-state dynamics of zinc(II) complexes yielding significant antidiabetic targets. J Mol Graph Model 2024; 127:108665. [PMID: 38029632 DOI: 10.1016/j.jmgm.2023.108665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
Protein Tyrosine Phosphatase 1B (PTP1B), being negative regulator of insulin signaling pathways is considered as potential medicinal target. Selective and targeted inhibitors for PTP1B can impact the therapeutic options available to cure chronic illness such as diabetes. Significant research evidence including computational studies on the role of Zn2+ in binding and inhibiting the catalytic pocket have been reported along with experimental exploration of zinc(II) complexes as potent inhibitors of the enzyme. The current study has employed advanced computational methods to explore the binding and conformational orientation of zinc(II) complexes in the active site of apoenzyme, phosphoenzyme, and TSA 2 of PTP1B. Metal ion modeling was performed for zinc metal center (Zn-OOOO) utilizing a Python based Metal Center Parameter Builder (MCPB.py). The findings of the study suggest that zinc(II) complex binds to structurally and functionally important residues in open and closed conformation as well as in the phosphorylated state of the enzyme. It was observed that when the catalytic cysteine is phosphorylated in a closed conformation, the zinc(II) complex forms significant interactions with PHE182, VAL184, GLY183, and PRO180 while pushing away Q-loop GLN262 which is crucial for the hydrolysis of phosphoenzyme. Subsequently, the reported inhibitor has also demonstrated its potential to function as allosteric modulator of the enzyme occupying catalytic WPD loop residues. The study uncovers putative binding sites of zinc-containing drugs and gives insight into the size and design of such compounds which keeps them accessible and anchored in the vicinity of active site residues. Reported inhibitor offers enhanced selectivity and inhibition in all three states of the enzyme in contrast to zinc ions which can only impede enzyme in the phosphorylated state. In addition to this, investigation of ASP265→GLU265 mutation reveals the role of GLU265 in affecting the flexibility of WPD loop residues highlighting it as loss-of-function mutation. Our results hints towards a metallodrug approach that builds on the research evidence of inhibition effects of Zn2+ in the binding pocket of PTP1B. The findings presented are noteworthy, not just due to their significant relevance for clinical application, but also for the design and synthesis of novel zinc(II) complexes.
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Affiliation(s)
- Nousheen Parvaiz
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, 45320, Islamabad, Pakistan
| | - Asma Abro
- Balochistan University of Information Technology Engineering and Management Sciences, Quetta, Pakistan.
| | - Syed Sikander Azam
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, 45320, Islamabad, Pakistan.
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Pintaudi B, Gironi I, Mion E, Di Vieste G, Meneghini E, Disoteo O, Pani A, Bonomo M, Bertuzzi F. The Effectiveness of Superbolus on Postprandial Blood Glucose Management of Pregnant Women With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:402-406. [PMID: 35787016 DOI: 10.1177/19322968221109262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Pregnancies of women with pregestational diabetes are at risk of after-meal glucose peaks and late after-meal hypoglycemia, particularly at breakfast. We aimed to explore the effectiveness of a specific feature of insulin pump therapy called superbolus in preventing these glucose swings. METHODS In this retrospective observational study, we analyzed continuous glucose monitoring data of patients with type 1 diabetes in pregnancy who were advised to use superbolus to manage their breakfast. Some of the postprandial basal insulin delivery was partially reduced and delivered instead as additional insulin bolus on top of a normal bolus. Outcomes of interest were one hour after breakfast glucose levels, the time in glucose range for after breakfast period, the number of late hypoglycemic episodes. RESULTS Overall, 21 consecutive pregnant women with type 1 diabetes (mean age 34.3 ± 5.5 years, mean pregestational body mass index 23.7 ± 4.7 kg/m2, HbA1c levels during pregnancy 6.1 ± 0.6%) were studied. Superbolus reduced after breakfast glucose peaks (one hour after breakfast glucose levels 130 ± 17 mg/dL vs 123 ± 10 mg/dL before and after superbolus use, respectively, P = .01), improved the time in glucose range for after breakfast period (70.4% vs 50.8%, P = .001), and reduced the number of late hypoglycemic episodes (3 [1-5] vs 1 [0-2], P< .0001). CONCLUSION Superbolus was effective in avoiding after-meal glucose peaks, increased postprandial glucose time in target, without late hypoglycemia occurrence. It represents a valid option for the treatment of pregnant women with type 1 diabetes using insulin pump.
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Affiliation(s)
- Basilio Pintaudi
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
| | - Ilaria Gironi
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
| | - Elena Mion
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
| | | | - Elena Meneghini
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
| | - Olga Disoteo
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
| | - Arianna Pani
- Department of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Matteo Bonomo
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
| | - Federico Bertuzzi
- Diabetes Unit, Interdisciplinary Diabetes and Pregnancy Center, Niguarda CàGranda Hospital, Milan, Italy
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Sebastian-Valles F, Martínez-Alfonso J, Arranz Martin JA, Jiménez-Díaz J, Hernando Alday I, Navas-Moreno V, Armenta Joya T, Fandiño García MDM, Román Gómez GL, Lander Lobariñas LE, Martinez de Icaya P, Sampedro-Nuñez MA, Martínez-Vizacaíno V, Marazuela M. Scans per day as predictors of optimal glycemic control in people with type 1 diabetes mellitus using flash glucose monitoring: what number of scans per day should raise a red flag? Acta Diabetol 2024; 61:343-350. [PMID: 37930420 PMCID: PMC10948530 DOI: 10.1007/s00592-023-02204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
AIMS This study aimed to determine the minimum frequency of flash glucose monitoring (FGM) scans necessary for optimal glycemic control in patients with type 1 diabetes (T1D). METHODS Data were collected from 692 patients (47.5% female, with a median age of 47.4 years) who used FGM systems daily and recorded their clinical variables and device data. RESULTS Logistic regression models showed that performing more than 12 scans per day was associated with improved T1D control (OR = 4.22, p < 0.001) and a reduction in HbA1c (7.6 vs 7.0%, 60-53 mmol/mol p < 0.001). However, those performing less than 6 scans showed no improvement in HbA1c (7.9 vs 7.8%, 63-61 mmol/mol p = 0.514). Thirteen daily scans were determined as the optimal cutoff point for predicting optimal glycemic control using a maximally selected rank algorithm. Significant reductions were observed in mean glucose (< 0.001), coefficient of variation (< 0.001), HbA1c (< 0.001), and an increase in TIR (< 0.001) in patients who performed more than 12 daily scans. CONCLUSIONS The results suggest that a higher frequency of daily scans by T1D patients using FGM systems leads to improved chronic glycemic control. The minimum recommended frequency for optimal control is 13 scans per day, and more than 6 daily scans are needed to improve HbA1c.
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Affiliation(s)
- Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain.
| | - Julia Martínez-Alfonso
- Department of Family and Community Medicine, Hospital La Princesa/Centro de Salud Daroca, 28006, Madrid, Spain
| | - Jose Alfonso Arranz Martin
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Jessica Jiménez-Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28194, Leganés, Madrid, Spain
| | - Iñigo Hernando Alday
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, 48013, Bilbao, Spain
| | - Victor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Teresa Armenta Joya
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | | | - Gisela Liz Román Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, 28194, Leganés, Madrid, Spain
| | | | | | - Miguel Antonio Sampedro-Nuñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Vicente Martínez-Vizacaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
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Su YC, Hsieh PC, Lai ECC, Lin YC. Risk of rotator cuff tear and rotator cuff repair surgery comparison between sodium-glucose cotransporter 2 inhibitors and glucagon like peptide-1 receptor agonists: A real-world study. Diabetes Metab 2024; 50:101522. [PMID: 38341131 DOI: 10.1016/j.diabet.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
AIM Theoretically, sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce the risk of rotator cuff tear through an anti-inflammatory mechanism. To clarify this association, in this study, we compared SGLT2is users and glucagon-like peptide-1 receptor agonists (GLP-1RAs) users in terms of the risk of rotator cuff tear and the risk of receiving rotator cuff repair surgery. METHODS A retrospective cohort analysis was conducted using data from the TriNetX platform. A target trial design was adopted to identify patients with type 2 diabetes mellitus who started receiving SGLT2is or GLP-1RAs. Propensity score matching was used to form two homogeneous groups. The study outcomes were the risk of rotator cuff tear and the risk of receiving rotator cuff repair surgery. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated within the TriNetX platform. RESULTS Initially, 351,800 SGLT2is users and 387,616 GLP-1RAs users were identified. After propensity score matching, each group comprised 274,026 patients. The mean age was 59.5 years in both groups; the proportions of women in the SGLT2is and GLP-1RAs groups were 46.9 % and 46.7 %, respectively. Compared with the GLP-1RAs group, the SGLT2is group had significantly reduced risks of rotator cuff tear (HR 0.812 [0.761;0.867]) and rotator cuff repair surgery (HR 0.900 [0.815;0.994]). CONCLUSION SGLT2is appear to reduce the risk of rotator cuff tear and the risk of receiving rotator cuff repair surgery in patients with type 2 diabetes mellitus. Further prospective studies are needed to validate our findings.
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Affiliation(s)
- Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Wang K, Bai F, Chen X, Miller JD, Chen X, Yun C, Sun Z, Yuan X, Lou Q. Perioperative Insulin Pump Therapy Decreases Readmission Risk and Improves Outcomes in Patients with Diabetes. Exp Clin Endocrinol Diabetes 2024; 132:142-151. [PMID: 38365207 DOI: 10.1055/a-2218-4574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To evaluate the impact of temporary insulin pump use during hospitalization on glycemia, postoperative complications, and cost/utilization in perioperative patients with diabetes. METHODS Patients (n=159) with type 2 diabetes and hospitalized for elective surgery were recruited from three hospitals. Subjects were categorized into the insulin pump group and the multiple daily subcutaneous insulin injection group according to their treatment therapy. Data were collected at admission, discharge, and 3 months post-discharge. RESULTS Subjects in the CSII group who were still on insulin therapy transitioned from CSII to MDII; however, their daily insulin dosages were lower than those in the MDII group (15.31±10.98 U/d vs. 23.48±17.02 U/d, P=0.015) after discharge. In terms of medical costs, the CSII group had significantly higher hospitalization costs than the MDII group (112.36±103.43 thousand RMB vs. 82.65±77.98 thousand RMB, P=0.043). After 3 months, the CSII group had significantly lower outpatient costs than the MDII group (3.17±0.94 thousand RMB vs. 3.98±1.76 thousand RMB, P ˂ 0.001). In the MDII group, 10 patients reported severe postoperative complications requiring re-hospitalization; there were no similar reports in the CSII group. CONCLUSION Temporary use of insulin pump therapy for perioperative patients with diabetes results in a reduction in blood glucose and blood glucose fluctuation during hospitalization, HbA1c, and the risk of postoperative complication and readmission, thus significantly decreasing costs in this complex patient cohort. Further work is needed to better understand indications for utilizing pump therapy based on diabetes phenotype and the complexity of planned surgical intervention.
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Affiliation(s)
- Kun Wang
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Fang Bai
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
| | - Xiaopan Chen
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
| | - Joshua D Miller
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Xue Chen
- Jiangsu College of Nursing, Huaian, Jiangsu, China
| | - Chuan Yun
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
| | - Zhenzhen Sun
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Xiaodan Yuan
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Qingqing Lou
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan, China
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Bottanelli M, Galli L, Guffanti M, Castagna A, Muccini C. Are glucagon-like peptide 1 receptor agonists effective in decreasing body weight and body mass index in people living with diabetes and HIV? HIV Med 2024; 25:404-406. [PMID: 37990373 DOI: 10.1111/hiv.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Martina Bottanelli
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Guffanti
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Muccini
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Russo M, Wang SV. An open-source implementation of tree-based scan statistics. Pharmacoepidemiol Drug Saf 2024; 33:e5765. [PMID: 38453354 DOI: 10.1002/pds.5765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE We develop an open-source R package to implement tree-based scan statistics (TBSS) analyses. METHODS TBSS are data mining methods used by the United States Food and Drug Administration and the Centers for Disease Control. They simultaneously screen thousands of hierarchically aggregated outcomes to identify unsuspected adverse effects of drugs or vaccines, accounting for multiple comparisons. The general structure of TBSS is highly adaptable, with four essential components: (1) a hierarchical outcome structure, (2) a test statistic to be computed for each element of the hierarchy, (3) an algorithm to generate data replicates under a null distribution, and (4) observed outcomes at the lower level of the hierarchy. We encode the general TBSS framework in a convenient R package that offers user-friendly functions for the most used TBSS methods. To illustrate the performance of our software, we evaluated two examples of archetypical TBSS analyses previously analyzed using proprietary, closed-source TreeScan™ software. The first considers the risk of congenital malformations associated with first-trimester exposure to valproate, and the second compares exposure to newly prescribed canagliflozin with a dipeptidyl peptidase 4 inhibitor in adults affected by type 2 diabetes. RESULTS The results of the original studies are replicated. CONCLUSIONS The diffusion of an open-source implementation of TBSS can enhance innovation of TBSS methods and foster collaborations. We offer an intuitive R package implementing standard TBSS methods with accompanying tutorials. Our unified object-oriented implementation allows expert users to extend the framework, introduce new features, or enhance existing ones.
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Affiliation(s)
- Massimiliano Russo
- Department of Statistics, The Ohio State University, Columbus, Ohio, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Turbitt J, Moffett RC, Brennan L, Johnson PRV, Flatt PR, McClenaghan NH, Tarasov AI. Molecular determinants and intracellular targets of taurine signalling in pancreatic islet β-cells. Acta Physiol (Oxf) 2024; 240:e14101. [PMID: 38243723 DOI: 10.1111/apha.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
AIM Despite its abundance in pancreatic islets of Langerhans and proven antihyperglycemic effects, the impact of the essential amino acid, taurine, on islet β-cell biology has not yet received due consideration, which prompted the current studies exploring the molecular selectivity of taurine import into β-cells and its acute and chronic intracellular interactions. METHODS The molecular aspects of taurine transport were probed by exposing the clonal pancreatic BRIN BD11 β-cells and primary mouse and human islets to a range of the homologs of the amino acid (assayed at 2-20 mM), using the hormone release and imaging of intracellular signals as surrogate read-outs. Known secretagogues were employed to profile the interaction of taurine with acute and chronic intracellular signals. RESULTS Taurine transporter TauT was expressed in the islet β-cells, with the transport of taurine and homologs having a weak sulfonate specificity but significant sensitivity to the molecular weight of the transporter. Taurine, hypotaurine, homotaurine, and β-alanine enhanced insulin secretion in a glucose-dependent manner, an action potentiated by cytosolic Ca2+ and cAMP. Acute and chronic β-cell insulinotropic effects of taurine were highly sensitive to co-agonism with GLP-1, forskolin, tolbutamide, and membrane depolarization, with an unanticipated indifference to the activation of PKC and CCK8 receptors. Pre-culturing with GLP-1 or KATP channel inhibitors sensitized or, respectively, desensitized β-cells to the acute taurine stimulus. CONCLUSION Together, these data demonstrate the pathways whereby taurine exhibits a range of beneficial effects on insulin secretion and β-cell function, consistent with the antidiabetic potential of its dietary low-dose supplementation.
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Affiliation(s)
- Julie Turbitt
- School of Biomedical Sciences, Ulster University, Coleraine, UK
| | | | - Lorraine Brennan
- UCD Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin 4, Republic of Ireland
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Republic of Ireland
| | - Paul R V Johnson
- Nuffield Department of Surgical Sciences, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK
- Oxford Biomedical Research Centre (OxBRC), Oxford, UK
| | - Peter R Flatt
- School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Neville H McClenaghan
- School of Biomedical Sciences, Ulster University, Coleraine, UK
- Department of Life Sciences, Atlantic Technological University, Sligo, Republic of Ireland
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Persell SD, Petito LC, Lee JY, Meeker D, Doctor JN, Goldstein NJ, Fox CR, Rowe TA, Linder JA, Chmiel R, Peprah YA, Brown T. Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled Trial. Ann Intern Med 2024; 177:324-334. [PMID: 38315997 DOI: 10.7326/m23-2183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Effective strategies are needed to curtail overuse that may lead to harm. OBJECTIVE To evaluate the effects of clinician decision support redirecting attention to harms and engaging social and reputational concerns on overuse in older primary care patients. DESIGN 18-month, single-blind, pragmatic, cluster randomized trial, constrained randomization. (ClinicalTrials.gov: NCT04289753). SETTING 60 primary care internal medicine, family medicine and geriatrics practices within a health system from 1 September 2020 to 28 February 2022. PARTICIPANTS 371 primary care clinicians and their older adult patients from participating practices. INTERVENTION Behavioral science-informed, point-of-care, clinical decision support tools plus brief case-based education addressing the 3 primary clinical outcomes (187 clinicians from 30 clinics) were compared with brief case-based education alone (187 clinicians from 30 clinics). Decision support was designed to increase salience of potential harms, convey social norms, and promote accountability. MEASUREMENTS Prostate-specific antigen (PSA) testing in men aged 76 years and older without previous prostate cancer, urine testing for nonspecific reasons in women aged 65 years and older, and overtreatment of diabetes with hypoglycemic agents in patients aged 75 years and older and hemoglobin A1c (HbA1c) less than 7%. RESULTS At randomization, mean clinic annual PSA testing, unspecified urine testing, and diabetes overtreatment rates were 24.9, 23.9, and 16.8 per 100 patients, respectively. After 18 months of intervention, the intervention group had lower adjusted difference-in-differences in annual rates of PSA testing (-8.7 [95% CI, -10.2 to -7.1]), unspecified urine testing (-5.5 [CI, -7.0 to -3.6]), and diabetes overtreatment (-1.4 [CI, -2.9 to -0.03]) compared with education only. Safety measures did not show increased emergency care related to urinary tract infections or hyperglycemia. An HbA1c greater than 9.0% was more common with the intervention among previously overtreated diabetes patients (adjusted difference-in-differences, 0.47 per 100 patients [95% CI, 0.04 to 1.20]). LIMITATION A single health system limits generalizability; electronic health data limit ability to differentiate between overtesting and underdocumentation. CONCLUSION Decision support designed to increase clinicians' attention to possible harms, social norms, and reputational concerns reduced unspecified testing compared with offering traditional case-based education alone. Small decreases in diabetes overtreatment may also result in higher rates of uncontrolled diabetes. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Stephen D Persell
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago; and Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.D.P., J.A.L.)
| | - Lucia C Petito
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (L.C.P.)
| | - Ji Young Lee
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.Y.L., T.A.R., Y.A.P., T.B.)
| | | | - Jason N Doctor
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California (J.N.D.)
| | - Noah J Goldstein
- UCLA Anderson School of Management, UCLA Geffen School of Medicine, Los Angeles, California (N.J.G., C.R.F.)
| | - Craig R Fox
- UCLA Anderson School of Management, UCLA Geffen School of Medicine, Los Angeles, California (N.J.G., C.R.F.)
| | - Theresa A Rowe
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.Y.L., T.A.R., Y.A.P., T.B.)
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago; and Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.D.P., J.A.L.)
| | - Ryan Chmiel
- Information Services, Northwestern Memorial HealthCare, Chicago, Illinois (R.C.)
| | - Yaw Amofa Peprah
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.Y.L., T.A.R., Y.A.P., T.B.)
| | - Tiffany Brown
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.Y.L., T.A.R., Y.A.P., T.B.)
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Elliott RA, Rogers G, Evans ML, Neupane S, Rayman G, Lumley S, Cranston I, Narendran P, Sutton CJ, Taxiarchi VP, Burns M, Thabit H, Wilmot EG, Leelarathna L. Estimating the cost-effectiveness of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in England. Diabet Med 2024; 41:e15232. [PMID: 37750427 DOI: 10.1111/dme.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self-monitoring of blood glucose with finger pricking (SMBG) in adults with type 1 diabetes and high HbA1c levels (58-97 mmol/mol [7.5%-11%]). We aim to assess the economic impact of isCGM compared with SMBG. METHODS Participant-level baseline and follow-up health status (EQ-5D-5L) and within-trial healthcare resource-use data were collected. Quality-adjusted life-years (QALYs) were derived at 24 weeks, adjusting for baseline EQ-5D-5L. Participant-level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%. RESULTS Within-trial EQ-5D-5L showed non-significant adjusted incremental QALY gain of 0.006 (95% CI: -0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381-714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (-5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195-0.652) resulting in an incremental cost-per-QALY of £4477. In all subgroups, isCGM had an incremental cost-per-QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost-saving. Sensitivity analysis suggested that isCGM remains cost-effective if its effectiveness lasts for at least 7 years. CONCLUSION While isCGM is associated with increased short-term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long-term health-gains and cost-savings to justify costs, so long as the effect lasts into the medium term.
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Affiliation(s)
- Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Mark L Evans
- Wellcome-MRC Institute of Metabolic Science, NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge, UK
| | - Sankalpa Neupane
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Gerry Rayman
- The Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | - Iain Cranston
- Academic Department of Diabetes & Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher J Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew Burns
- Manchester Clinical Trials Unit, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK
| | - Hood Thabit
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Lalantha Leelarathna
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Choudhary P, Arrieta A, van den Heuvel T, Castañeda J, Smaniotto V, Cohen O. Celebrating the Data from 100,000 Real-World Users of the MiniMed™ 780G System in Europe, Middle East, and Africa Collected Over 3 Years: From Data to Clinical Evidence. Diabetes Technol Ther 2024; 26:32-37. [PMID: 38377326 PMCID: PMC10890936 DOI: 10.1089/dia.2023.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Introduction: The present report celebrates the benchmarking of 100,000 MiniMed™ 780G system users in Europe, Middle East, and Africa (EMEA) and summarizes the major insights into the usability and outcomes of this system. Methods: Carelink Personal data (August 2020-August 2023) of users living in EMEA were analyzed. Continuous glucose monitoring-based endpoints were aggregated for (1) the full cohort and (2) a 12-month longitudinal cohort. Subanalyses were done for users on optimal settings (those spending ≥95% of time with glucose target of 100 mg/dL, and ≥95% of time with active insulin time of 2 h), for self-reported age groups (≤15 and ≥56 years) and for various countries/regions. Results: Data from 101,629 users (34 countries) were analyzed. Mean time in range (TIR) was 72.3%, glucose management indicator (GMI) was 7%, time below 70 mg/dL (TBR70) was 2.0% and time below 54 mg/dL (TBR54) was 0.4%. In terms of international targets, 59.6% of users achieved a GMI <7%, 62.5% a TIR >70%, 88.4% a TBR70 < 4%, and 90.0% a TBR54 < 1%. Data improved impressively in optimal setting users (TIR = 78.8%, and users reaching TIR >70% = 86.3%) while safety remained (TBR70 = 2.2% and TBR54 = 0.4%). Data showed consistency across self-reported age groups and geographies. In the longitudinal cohort, TIR reached 75.5% in the first month and remained 73.3% or higher over the 12-month period. Conclusion: Over 100,000 users of the MiniMed™ 780G system have demonstrated consistency in achieving target control of glycemia.
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Affiliation(s)
- Pratik Choudhary
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
- Leicester Diabetes Center, University of Leicester, Leicester, United Kingdom
| | - Arcelia Arrieta
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Tim van den Heuvel
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Javier Castañeda
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Vittorino Smaniotto
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Ohad Cohen
- Medtronic Diabetes, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Mathieu C, Ahmed W, Gillard P, Cohen O, Vigersky R, de Portu S, Ozdemir Saltik AZ. The Health Economics of Automated Insulin Delivery Systems and the Potential Use of Time in Range in Diabetes Modeling: A Narrative Review. Diabetes Technol Ther 2024; 26:66-75. [PMID: 38377319 DOI: 10.1089/dia.2023.0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Intensive therapy with exogenous insulin is the treatment of choice for individuals living with type 1 diabetes (T1D) and some with type 2 diabetes, alongside regular glucose monitoring. The development of systems allowing (semi-)automated insulin delivery (AID), by connecting glucose sensors with insulin pumps and algorithms, has revolutionized insulin therapy. Indeed, AID systems have demonstrated a proven impact on overall glucose control, as indicated by effects on glycated hemoglobin (HbA1c), risk of severe hypoglycemia, and quality of life measures. An alternative endpoint for glucose control that has arisen from the use of sensor-based continuous glucose monitoring is the time in range (TIR) measure, which offers an indication of overall glucose control, while adding information on the quality of control with regard to blood glucose level stability. A review of literature on the health-economic value of AID systems was conducted, with a focus placed on the growing place of TIR as an endpoint in studies involving AID systems. Results showed that the majority of economic evaluations of AID systems focused on individuals with T1D and found AID systems to be cost-effective. Most studies incorporated HbA1c, rather than TIR, as a clinical endpoint to determine treatment effects on glucose control and subsequent quality-adjusted life year (QALY) gains. Likely reasons for the choice of HbA1c as the chosen endpoint is the use of this metric in most validated and established economic models, as well as the limited publicly available evidence on appropriate methodologies for TIR data incorporation within conventional economic evaluations. Future studies could include the novel TIR metric in health-economic evaluations as an additional measure of treatment effects and subsequent QALY gains, to facilitate a holistic representation of the impact of AID systems on glycemic control. This would provide decision makers with robust evidence to inform future recommendations for health care interventions.
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Affiliation(s)
- Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium
| | - Waqas Ahmed
- Covalence Research Ltd, Harpenden, United Kingdom
| | - Pieter Gillard
- Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium
| | - Ohad Cohen
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Simona de Portu
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
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Cheng R, Taleb N, Wu Z, Bouchard D, Parent V, Lalanne-Mistrih ML, Boudreau V, Messier V, Lacombe MJ, Grou C, Brazeau AS, Rabasa-Lhoret R. Managing Impending Nonsevere Hypoglycemia With Oral Carbohydrates in Type 1 Diabetes: The REVERSIBLE Trial. Diabetes Care 2024; 47:476-482. [PMID: 38194601 DOI: 10.2337/dc23-1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Current guidelines recommend initiating treatment for nonsevere (NS) hypoglycemia with 15 g carbohydrates (CHO) at 15-min intervals when blood glucose (BG) reaches <70 mg/dL (3.9 mmol/L). Despite this recommendation, NS hypoglycemia management remains challenging for individuals living with type 1 diabetes (T1D). We aimed to assess the efficacy of 15 g CHO at higher BG levels. RESEARCH DESIGN AND METHODS A total of 29 individuals with T1D participated in an open-label crossover study. After an inpatient subcutaneous insulin-induced decrease in BG in the fasting state, 16 g CHO was administered orally at a plasma glucose (PG) of <70 (3.9), ≤80 (4.5), or ≤90 mg/dL (5.0 mmol/L). The primary outcome was time spent in hypoglycemia (<70 mg/dL) after initial CHO intake. RESULTS When comparing the <70 (control) with the ≤80 and ≤90 mg/dL treatment groups, 100 vs. 86 (P = 0.1201) vs. 34% (P < 0.0001) of participants reached hypoglycemia, respectively. These hypoglycemic events lasted 26.0 ± 12.6 vs. 17.9 ± 14.7 (P = 0.026) vs. 7.1 ± 11.8 min (P = 0.002), with a PG nadir of 56.57 ± 9.91 vs. 63.60 ± 7.93 (P = 0.008) vs. 73.51 ± 9.37 mg/dL (P = 0.002), respectively. In the control group, 69% of participants required more than one treatment to reach or maintain normoglycemia (≥70 mg/dL), compared with 52% in the ≤80 mg/dL group and 31% in the ≤90 mg/dL group, with no significant rebound hyperglycemia (>180 mg/dL) within the first hour. CONCLUSIONS For some impending NS hypoglycemia episodes, individuals with TID could benefit from CHO intake at a higher BG level.
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Affiliation(s)
- Ran Cheng
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Endocrinology Division, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Endocrinology Division, Hôpital Santa-Cabrini, Montréal, Québec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Endocrinology Division, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Zekai Wu
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Experimental Medicine Division, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Delphine Bouchard
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Valérie Parent
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | | | - Valérie Boudreau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Virginie Messier
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | | | - Caroline Grou
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Anne-Sophie Brazeau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- School of Human Nutrition, McGill University, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Endocrinology Division, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Montreal Diabetes Research Center, Montréal, Québec, Canada
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Mittman BG, Le P, Payne JY, Ayers G, Rothberg MB. Sociodemographic disparities in GLP-1RA and SGLT2i use among US adults with type 2 diabetes: NHANES 2005-March 2020. Curr Med Res Opin 2024; 40:377-383. [PMID: 38193509 PMCID: PMC10947468 DOI: 10.1080/03007995.2024.2303413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/05/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Type 2 Diabetes (T2D) is a major cause of morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) are highly effective but underutilized. Our objective was to assess racial/ethnic and other sociodemographic disparities in GLP-1RA/SGLT2i use among US adults with T2D. METHODS We conducted a retrospective analysis using the National Health and Nutrition Examination Survey from 2005-March 2020. Participants were adults with T2D taking ≥1 anti-diabetic medication, excluding pregnant women and adults with probable T1D. We performed univariate analyses to examine the characteristics of patients using GLP-1RA/SGLT2i and multivariable logistic regression to assess disparities in GLP-1RA/SGLT2i use after adjusting for other patient factors. RESULTS Among 4777 people with T2D (representing >18 million US adults) taking ≥1 medication, GLP-1RA/SGLT2i usage increased from 1.4% in 2005-2006 to 13.3% in 2017-2020. In univariate analyses, patients using GLP-1RA/SGLT2i vs. other T2D drugs were more likely to be White than nonwhite (72% vs. 60%, p = .001), but in multivariable analysis there was no significant difference in GLP-1RA/SGLT2i use for nonwhite vs. White patients (aOR = 0.84, 95% CI [0.61, 1.16]). GLP-1RA/SGLT2i use was higher for patients who completed some college (aOR = 1.83, 95% CI [1.06, 3.15]) or above (aOR = 2.06, 95% CI [1.28, 3.32]) vs. high school or less, and for those with an income-poverty ratio ≥4 vs. <2 (aOR = 2.11, 95% CI [1.30, 3.42]). CONCLUSIONS The use of GLP-1RA/SGLT2i drugs increased over time but remained low in March 2020. Higher education and income, but not race/ethnicity, were associated with GLP-1RA/SGLT2i use.
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Affiliation(s)
- Benjamin G. Mittman
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Phuc Le
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Julia Y. Payne
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gina Ayers
- Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, OH, USA
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Sönmez Sari E, Semerci Çakmak V, Çetinkaya Özdemir S, Eşsiz Sefer B. Hypoglycaemic confidence levels and experiences related to the hypoglycaemia of patients with diabetes: A mixed methods study. J Clin Nurs 2024; 33:1022-1035. [PMID: 38284517 DOI: 10.1111/jocn.17038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIMS This study had three aims: to determine the hypoglycaemic confidence levels of participants, to identify factors affecting hypoglycaemic confidence levels of participants and to assess experiences related to hypoglycaemia of participants. DESIGN The explanatory-sequential-mixed method was used in this study. METHODS The quantitative stage included a sample of 177 people, and the qualitative stage included a sample of 18 people. Data of the study were collected between April and June 2023 with the Hypoglycemic Confidence Level Scale, Personal Information Form and Semi-Structured Interview Form. Descriptive statistics, independent samples t-test, one-way ANOVA and multiple linear regression analysis were used for quantitative data analysis. For the qualitative data analysis, content analysis was performed in the MaxQda program. RESULTS The scale items are scored between 1 and 4, and an increase in the score obtained from the scale indicates an increase in confidence levels. The mean hypoglycaemic confidence level score of the participants was 3. The data obtained in the qualitative stage were grouped under three main themes: Experiences Related to Hypoglycaemia, Reasons for Experiencing Hypoglycaemia and Managing Hypoglycaemia. CONCLUSION Identifying hypoglycaemic confidence levels and hypoglycaemia experiences of patients with diabetes can guide health professionals, especially nurses, in promoting person-centred care interventions. IMPACT The study discussed the hypoglycaemic confidence levels of diabetic patients and their experiences related to hypoglycaemia. The factors affecting the hypoglycaemic confidence level of the participants were educational status, income status, fear of experiencing hypoglycaemia, ability to self-administer insulin, receiving hypoglycaemia training and frequency of experiencing hypoglycaemia. The results of this study may provide guidance for the development of appropriate prevention and coping strategies for hypoglycaemia. Identifying the experiences of patients with diabetes with hypoglycaemia can guide health professionals, especially nurses, in promoting person-centred care interventions. REPORTING METHOD The Good Reporting of a Mixed Methods Study (GRAMMS) checklist was used for reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ebru Sönmez Sari
- Department of Nursing, Faculty of Health Sciences, Bayburt University, Bayburt, Turkey
| | - Vahide Semerci Çakmak
- Department of Nursing, Faculty of Health Sciences, Bayburt University, Bayburt, Turkey
| | - Serap Çetinkaya Özdemir
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Betül Eşsiz Sefer
- Department of Diabetes Polyclinic, Kartal Kosuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
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Hammad RW, Sanad RAB, Abdelmalak NS, Latif R. Cubosomal functionalized block copolymer platform for dual delivery of linagliptin and empagliflozin: Recent advances in synergistic strategies for maximizing control of high-risk type II diabetes. Drug Deliv Transl Res 2024; 14:678-695. [PMID: 37805954 PMCID: PMC10810935 DOI: 10.1007/s13346-023-01423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
A well-made chitosan-PVP block copolymer platform was equipped with highly ordered and uniform nano-channels. This highly adhesive block copolymer platform was designed to ensure the efficient co-delivery of two synergistic-acting hypoglycemic drugs. Linagliptin oral bioavailability is 30% due to poor permeability and intestinal degradation. Its pharmacokinetics shows a non-linear profile. Empagliflozin exhibited decreased permeability and decreased solubility in aqueous media between pH 1 and 7.5. Cubosomes were functionalized as a good microdomain to guest and improve the physicochemical characteristics of drug molecules with decreased permeability and solubility. Cubosomes loaded with linagliptin (linagliptin cubosomes (LCs)) and empagliflozin (empagliflozin cubosomes ECs) were separately prepared using the top-down method and optimized by applying 23 factorial design. Optimized cubosomal systems LCs (F3) and ECs (F4) were incorporated into a chitosan-PVP gel to obtain dual cubosome-loaded platforms (LECF) optimized through 22 factorial design. The permeation study from the optimized LECF (C1) ensured enhanced empagliflozin permeation alongside continued efflux for linagliptin, resolving potential risks due to its non-linear plasma profile. The in-vivo study revealed that AUC(0-∞) of linagliptin and empagliflozin was enhanced by 2- and threefold, respectively. Therefore, the chitosan-PVP block copolymer platform buccal application for the co-delivery of linagliptin and empagliflozin could contribute to enhanced clinical effectiveness in treating diabetes.
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Affiliation(s)
- Reham Waheed Hammad
- Department of Pharmaceutics, Egyptian Drug Authority (formerly National Organization of Drug Control and Research (NODCAR)), Giza, Egypt
| | - Rania Abdel-Basset Sanad
- Department of Pharmaceutics, Egyptian Drug Authority (formerly National Organization of Drug Control and Research (NODCAR)), Giza, Egypt
| | - Nevine Shawky Abdelmalak
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El Eini Street, Cairo, Egypt
- Department of Pharmaceutics and Industrial Pharmacy, School of Pharmacy, New Giza University, Giza, Egypt
| | - Randa Latif
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El Eini Street, Cairo, Egypt.
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Ramakrishnan RK, Srivastava A, Rajan R, Abusnana S, Mussa BM. Investigating the role of an immediate early gene FOS as a potential regulator of autophagic response to hypoglycemia in embryonic hypothalamic neurons. Clin Transl Sci 2024; 17:e13749. [PMID: 38488430 PMCID: PMC10941580 DOI: 10.1111/cts.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024] Open
Abstract
Hypoglycemia-associated autonomic failure (HAAF) is a well-established complication of diabetes. Although HAAF has serious outcomes such as recurrent morbidity, coma, and death, the mechanisms of HAAF and its pathological components are largely unknown. Our previous studies have revealed that hypoglycemia is associated with the upregulation of an immediate early gene - FOS. In addition, it is documented that glucose deprivation activates neuronal autophagic activities. Therefore, the present study aimed to identify the role of FOS and one of the core components of the autophagy pathway, Beclin-1 (encoded by the BECN1 gene), in the regulation of autophagic mechanisms in embryonic hypothalamic neurons in response to hypoglycemic conditions. Embryonic Mouse Hypothalamic Cell Line N39 (mHypoE-N39 or N39) was cultured in reduced concentrations of glucose (2000, 900, 500, and 200 mg/L). Gene and protein expression, as well as immunofluorescence studies on autophagy were conducted under different reduced glucose concentrations in N39 hypothalamic neurons with and without FOS and BECN1 gene knockdowns (KD). The outcomes of the present study have demonstrated a significant increase in autophagosome formation and subsequent lysosomal degradation in the hypothalamic neurons in response to reduced glucose concentrations. This hypoglycemic response appears to be lowered to a similar extent in the FOS KD and BECN1 KD cells, albeit insignificantly from the negative control, is indicative of the involvement of FOS in the autophagic response of hypothalamic neurons to hypoglycemia. Moreover, the KD cells exhibited a change in morphology and reduced cell viability compared with the control cells. Our findings suggest that reduced FOS expression could potentially be associated with impaired autophagic activities that are dependent on BECN1, which could lead to decreased or blunted hypothalamic activation in response to hypoglycemia, and this, in turn, may contribute to the development of HAAF.
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Affiliation(s)
- Rakhee K. Ramakrishnan
- Research Institute for Medical and Health Sciences, College of Medicine, University of SharjahSharjahUnited Arab Emirates
| | - Ankita Srivastava
- Research Institute for Medical and Health Sciences, College of Medicine, University of SharjahSharjahUnited Arab Emirates
| | - Reeja Rajan
- Research Institute for Medical and Health Sciences, College of Medicine, University of SharjahSharjahUnited Arab Emirates
| | - Salah Abusnana
- Diabetes and Endocrinology DepartmentUniversity Hospital SharjahSharjahUnited Arab Emirates
- Clinical Science DepartmentCollege of Medicine, University of SharjahSharjahUnited Arab Emirates
| | - Bashair M. Mussa
- Basic Medical Science DepartmentCollege of Medicine, University of SharjahSharjahUnited Arab Emirates
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Bazsefidpar N, Ghandehari Yazdi AP, Karimi A, Yahyavi M, Amini M, Ahmadi Gavlighi H, Simal-Gandara J. Brewers spent grain protein hydrolysate as a functional ingredient for muffins: Antioxidant, antidiabetic, and sensory evaluation. Food Chem 2024; 435:137565. [PMID: 37801764 DOI: 10.1016/j.foodchem.2023.137565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
This study assessed the fortification of muffins with 2, 4, and 6 % of brewer's spent grain protein hydrolysates to enhance their in vitro antioxidant, α-glucosidase, and α-amylase inhibitory activities. In addition, oxidative stability, hardness, color and sensory properties of fortified muffins were investigated. The fortification of muffin formulations with 6 % hydrolysates increased antioxidant activity six times higher than that of the control sample. As the hydrolysate increased to 6 %, the α-amylase and α-glucosidase inhibition also increased to 88 and 40 %, respectively. The 6 % fortified muffins exhibited lower peroxide and thiobarbituric acid values during a 14 day storage than the control muffins, while higher hydrolysate levels darkened the color and softened the texture. Sensory evaluation indicated that muffins with 2% hydrolysates achieved similar overall acceptance as the control. It can be concluded that brewer's spent grain hydrolysate is suitable for functional bakery products.
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Affiliation(s)
- Nooshin Bazsefidpar
- Department of Food Research and Development, Zar Research and Industrial Development Group, Alborz, Iran
| | | | - Amin Karimi
- Department of Food Science and Technology, Tarbiat Modares University, Tehran, Iran
| | - Matin Yahyavi
- Department of Food Research and Development, Zar Research and Industrial Development Group, Alborz, Iran
| | - Mahdi Amini
- Department of Food Research and Development, Zar Research and Industrial Development Group, Alborz, Iran
| | - Hassan Ahmadi Gavlighi
- Department of Food Science and Technology, Tarbiat Modares University, Tehran, Iran; Institute for Natural Products and Medicinal Plants, Tarbiat Modares University, Tehran, Iran.
| | - Jesus Simal-Gandara
- Universidade de Vigo, Nutrition and Bromatology Group, Analytical Chemistry and Food Science Department, Faculty of Science, E32004 Ourense, Spain.
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Shah CV. Sodium-glucose cotransporter 2 inhibition, epidermal growth factor, and magnesium homeostasis: is there a link? Kidney Int 2024; 105:638-639. [PMID: 38388148 DOI: 10.1016/j.kint.2023.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/20/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Chintan V Shah
- Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA.
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Abdelgani S, Khattab A, Adams J, Baskoy G, Triplitt C, DeFronzo RA, Abdul-Ghani M. The impact of increased hepatic glucose production caused by empagliflozin on plasma glucose concentration in individuals with type 2 diabetes and nondiabetic individuals. Diabetes Obes Metab 2024; 26:1033-1039. [PMID: 38131252 DOI: 10.1111/dom.15404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/25/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
AIM To examine the impact of increased hepatic glucose production (HGP) on the decrease in plasma glucose concentration caused by empagliflozin in individuals living with diabetes and in nondiabetic individuals. METHODS A total of 36 individuals living with diabetes and 34 nondiabetic individuals were randomized to receive, in double-blind fashion, empagliflozin or matching placebo in a 2:1 treatment ratio. Following an overnight fast, HGP was measured with 3-3 H-glucose infusion before, at the start of, and 3 months after therapy with empagliflozin. RESULTS On Day 1 of empagliflozin administration, the increase in urinary glucose excretion (UGE) in individuals with normal glucose tolerance was smaller than in those with impaired glucose tolerance and those living with diabetes, and was accompanied by an increase in HGP in all three groups. The amount of glucose returned to the systemic circulation as a result of the increase in HGP was smaller than that excreted by the kidney during the first 3 h after empagliflozin administration, resulting in a decrease in fasting plasma glucose (FPG) concentration. After 3 h, the increase in HGP was in excess of UGE, leading to a small increase in plasma glucose concentration, which reached a new steady state. After 12 weeks, the amount of glucose returned to the circulation due to the empagliflozin-induced increase in HGP was comparable with that excreted by the kidney in all three groups. CONCLUSION The balance between UGE and increase in HGP immediately after sodium-glucose cotransporter-2 (SGLT2) inhibition determined the magnitude of decrease in FPG and the new steady state which was achieved. After 12 weeks, the increase in HGP caused by empagliflozin closely matched the amount of glucose excreted by the kidneys; thus, FPG level remained stable despite the continuous urinary excretion of glucose caused by SGLT2 inhibition.
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Affiliation(s)
- Siham Abdelgani
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Ahmed Khattab
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - John Adams
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Gozde Baskoy
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Curtis Triplitt
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center, and Texas Diabetes Institute, San Antonio, Texas, USA
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Fichadiya A, Quinn A, Au F, Campbell D, Lau D, Ronksley P, Beall R, Campbell DJT, Wilton SB, Chew DS. Association between sodium-glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation. Europace 2024; 26:euae054. [PMID: 38484180 PMCID: PMC10939462 DOI: 10.1093/europace/euae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
AIMS Prior studies suggest that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes among patients with DM and pre-existing AF. METHODS AND RESULTS We conducted a population-based cohort study of adults with DM and AF between 2014 and 2019. Using a prevalent new-user design, individuals prescribed SGLT2i were matched 1:1 to those prescribed dipeptidyl peptidase-4 inhibitors (DPP4is) based on time-conditional propensity scores. The primary endpoint was a composite of AF-related healthcare utilization (i.e. hospitalization, emergency department visits, electrical cardioversion, or catheter ablation). Secondary outcome measures included all-cause mortality, heart failure (HF) hospitalization, and ischaemic stroke or transient ischaemic attack (TIA). Cox proportional hazard models were used to examine the association of SGLT2i with the study endpoint. Among 2242 patients with DM and AF followed for an average of 3.0 years, the primary endpoint occurred in 8.7% (n = 97) of patients in the SGLT2i group vs. 10.0% (n = 112) of patients in the DPP4i group [adjusted hazard ratio 0.73 (95% confidence interval 0.55-0.96; P = 0.03)]. Sodium-glucose cotransporter-2 inhibitors were associated with significant reductions in all-cause mortality and HF hospitalization, but there was no difference in the risk of ischaemic stroke/TIA. CONCLUSION Among patients with DM and pre-existing AF, SGLT2is are associated with decreased AF-related health resource utilization and improved arrhythmic outcomes compared with DPP4is.
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Affiliation(s)
- Akash Fichadiya
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
| | - Amity Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - Flora Au
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - Dennis Campbell
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350 - 83 Avenue NW, T6G 2G3 Edmonton, AB, Canada
| | - Darren Lau
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350 - 83 Avenue NW, T6G 2G3 Edmonton, AB, Canada
| | - Paul Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
| | - David J T Campbell
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1 Calgary, AB, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1 Calgary, AB, Canada
| | - Derek S Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6 Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1 Calgary, AB, Canada
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Plachy L, Neuman V, Velichova K, Slavenko MG, Santova A, Anne Amaratunga S, Obermannova B, Kolouskova S, Pruhova S, Sumnik Z, Petruzelkova L. Telemedicine maintains good glucose control in children with type 1 diabetes but is not time saving for healthcare professionals: KITES randomized study. Diabetes Res Clin Pract 2024; 209:111602. [PMID: 38437986 DOI: 10.1016/j.diabres.2024.111602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
AIMS To evaluate glucose control non-inferiority and time benefits of telemedicine follow-up in children with type 1 diabetes (CwD). METHODS In a single-center 9-month-long randomized controlled study (clinicaltrials.gov NCT05484427), 50 children were randomized to either telemedicine group (TG) followed-up distantly by e-mail, or to face-to-face group (FFG) attending standard personal visits. The primary endpoint was non-inferiority of HbA1c at final visit (level of non-inferiority was set at 5 mmol/mol). The secondary endpoints were subcutaneous glucose monitoring parameters and time consumption from both study subjects' and the physicians' point of view. RESULTS Non-inferiority of HbA1c in the TG was proven (mean HbA1C 45.8 ± 7.3 [TG] vs. 50.0 ± 12.6 [FFG] mmol/mol, 6.3 vs. 6.7 % DCCT, p = 0.17; between groups HbA1C difference 95 % CI -10.2 to 1.9 mmol/mol). Telemedicine saved time for participants (mean visit duration [MVD] 50 [TG] vs. 247 min [FFG], p < 0.001). There were no other differences between groups neither in CGM parameters nor physician's time consumption (MVD 19 [TG] vs. 20 min [FFG], p = 0.58). CONCLUSIONS Nine-month telemedicine follow-up of the children with well-controlled T1D is not inferior to standard face-to-face visits. Telemedicine visits saved time for the participants but not for their diabetologists.
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Affiliation(s)
- Lukas Plachy
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Vit Neuman
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Katerina Velichova
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Matvei G Slavenko
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Alzbeta Santova
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Shenali Anne Amaratunga
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Barbora Obermannova
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Stanislava Kolouskova
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Stepanka Pruhova
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Zdenek Sumnik
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic.
| | - Lenka Petruzelkova
- Department of Pediatrics of Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague, 15000, Czech Republic
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Khoo B, Tan TMM. GLP-1 analogue therapy for obesity in people from Asia. Lancet Diabetes Endocrinol 2024; 12:153-154. [PMID: 38330985 DOI: 10.1016/s2213-8587(24)00031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Bernard Khoo
- Endocrinology, Division of Medicine, University College London, Royal Free Campus, London NW3 2PF, UK
| | - Tricia M-M Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0HS, UK.
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Polanco PM, Karalis JD, Abreu AA, Weis J, Zeh HJ. Robotic Enucleation of Pancreatic Head Insulinomas in Close Proximity to the Pancreatic Duct. Ann Surg Oncol 2024; 31:1834. [PMID: 38017126 DOI: 10.1245/s10434-023-14627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Insulinomas are rare pancreatic neuroendocrine tumors for which the main curative treatment is surgical resection. Enucleation is preferred over pancreatoduodenectomy to minimize morbidity and function loss.1 Robotic-assisted surgery offers improved versatility and less blood loss than laparoscopic surgery for pancreatic enucleation.2-4 Our video describes the technique for robotic enucleation of pancreatic head insulinomas in close proximity to the pancreatic duct. PATIENTS AND METHODS The video describes the presentation, diagnostic imaging, and technical aspects of the surgical approach in two patients with pancreatic head insulinomas that underwent robotic enucleation. RESULTS Case one was a 76-year-old woman who experienced syncope for 2 months. Case two was a 61-year-old man, previously treated for renal cancer, who had documented hypoglycemic symptoms. Computed tomography (CT) scan and magnetic resonance imaging (MRI) identified a 1.5 cm and 1.2 cm pancreatic head mass, respectively. Both patients presented with low glucose levels, and elevated C-peptide and proinsulin. In both cases, endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct stent placement were performed the same day of surgery for intraoperative identification and preservation of the duct. Robotic enucleation of the masses was performed, and an ultrasound was used to identify the masses and relation with main pancreatic duct. Pathology revealed a well-differentiated neuroendocrine tumor in both cases. The patient's postoperative course was uneventful, and they were discharged on day 5. Successful resolution of hypoglycemic events occurred in both patients. CONCLUSION Robotic enucleation is a safe and feasible option for treating pancreatic head tumors in challenging locations. Intraoperative ultrasound is an essential tool for the successful robotic enucleation of pancreatic head tumors.
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Affiliation(s)
- Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - John D Karalis
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andres A Abreu
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joshua Weis
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Herbert J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Paik JM, Tesfaye H, Curhan GC, Zakoul H, Wexler DJ, Patorno E. Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes. JAMA Intern Med 2024; 184:265-274. [PMID: 38285598 PMCID: PMC10825784 DOI: 10.1001/jamainternmed.2023.7660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/21/2023] [Indexed: 01/31/2024]
Abstract
Importance Type 2 diabetes (T2D) is associated with an increased risk of kidney stones. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) might lower the risk of nephrolithiasis by altering urine composition. However, no studies have investigated the association between SGLT2i use and nephrolithiasis risk in patients receiving routine care in the US. Objective To investigate the association between SGLT2i use and nephrolithiasis risk in clinical practice. Design, Setting, and Participants This new-user, active comparator cohort study used data from commercially insured adults (aged ≥18 years) with T2D who initiated treatment with SGLT2is, glucagon-like peptide 1 receptor agonists (GLP-1RAs), or dipeptidyl peptidase 4 inhibitors (DPP4is) between April 1, 2013, and December 31, 2020. The data were analyzed from July 2021 through June 2023. Exposure New initiation of an SGLT2i, GLP-1RA, or DPP4i. Main Outcomes and Measures The primary outcome was nephrolithiasis diagnosed by International Classification of Diseases codes in the inpatient or outpatient setting. New SGLT2i users were 1:1 propensity score matched to new users of a GLP-1RA or DPP4i in pairwise comparisons. Incidence rates, rate differences (RDs), and estimated hazard ratios (HRs) with 95% CIs were calculated. Results After 1:1 propensity score matching, a total of 716 406 adults with T2D (358 203 pairs) initiating an SGLT2i or a GLP-1RA (mean [SD] age, 61.4 [9.7] years for both groups; 51.4% vs 51.2% female; 48.6% vs 48.5% male) and 662 056 adults (331 028 pairs) initiating an SGLT2i or a DPP4i (mean [SD] age, 61.8 [9.3] vs 61.7 [10.1] years; 47.4% vs 47.3% female; 52.6% vs 52.7% male) were included. Over a median follow-up of 192 (IQR, 88-409) days, the risk of nephrolithiasis was lower in patients initiating an SGLT2i than among those initiating a GLP-1RA (14.9 vs 21.3 events per 1000 person-years; HR, 0.69 [95% CI, 0.67-0.72]; RD, -6.4 [95% CI, -7.1 to -5.7]) or a DPP4i (14.6 vs 19.9 events per 1000 person-years; HR, 0.74 [95% CI, 0.71-0.77]; RD, -5.3 [95% CI, -6.0 to -4.6]). The association between SGLT2i use and nephrolithiasis risk was similar by sex, race and ethnicity, history of chronic kidney disease, and obesity. The magnitude of the risk reduction with SGLT2i use was larger among adults aged younger than 70 years vs aged 70 years or older (HR, 0.85 [95% CI, 0.79-0.91]; RD, -3.46 [95% CI, -4.87 to -2.05] per 1000 person-years; P for interaction <.001). Conclusions and Relevance These findings suggest that in adults with T2D, SGLT2i use may lower the risk of nephrolithiasis compared with GLP-1RAs or DPP4is and could help to inform decision-making when prescribing glucose-lowering agents for patients who may be at risk for developing nephrolithiasis.
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Affiliation(s)
- Julie M. Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gary C. Curhan
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Heidi Zakoul
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Deborah J. Wexler
- Harvard Medical School, Boston, Massachusetts
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Du W, Wang H, Liu Y, Hong T. Recurrent hypoglycemia induced by clopidogrel: A case report and mini review. J Diabetes Investig 2024; 15:275-281. [PMID: 38063248 PMCID: PMC10906020 DOI: 10.1111/jdi.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 03/02/2024] Open
Abstract
This report describes a patient who developed recurrent hypoglycemia episodes after 23 days of antiplatelet therapy with clopidogrel for left subclavian artery stent implantation. The patient suffered from palpitation, profuse sweating and weakness on the 23rd day of clopidogrel treatment. The minimum plasma glucose was 2.2 mmol/L, and the hypoglycemia was associated with significantly elevated levels of insulin. A diagnosis of insulin autoimmune syndrome (IAS) was made with the presence of insulin autoantibody and a comprehensive differential diagnosis of other conditions related with hypoglycemia. Clopidogrel was stopped, and the patient was treated with acarbose and had frequent low-carbohydrate meals; his hypoglycemia did not occur within 10 days. To date, seven cases of IAS induced by clopidogrel have been reported. Most reported cases were male aged in their 70s, and the hypoglycemic attack appeared 1-4 weeks after exposure to clopidogrel, characterized by severe hyperinsulinemia hypoglycemia with high titers of insulin autoantibodies. Most IAS cases can resolve spontaneously when they stop using the trigger medicine. Severe cases had been treated with drugs that reduce pancreatic insulin secretion (such as somatostatin and diazoxide), immunosuppressants (glucocorticoids, azathioprine and rituximab) and even immunoadsorption to remove the insulin autoantibody from the body. Considering the hypoglycemic attack might increase the risk of cardiovascular events among patients taking clopidogrel, we recommend that doctors should be aware of IAS as a rare severe adverse effect of clopidogrel, and be vigilant for the symptoms related with hypoglycemia in clopidogrel users.
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Affiliation(s)
- Weiguan Du
- Department of Endocrinology and metabolismPeking University Third HospitalBeijingChina
| | - Haining Wang
- Department of Endocrinology and metabolismPeking University Third HospitalBeijingChina
| | - Ye Liu
- Department of Endocrinology and metabolismPeking University Third HospitalBeijingChina
| | - Tianpei Hong
- Department of Endocrinology and metabolismPeking University Third HospitalBeijingChina
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50
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DeFronzo RA. SGLT2 inhibitors: cardiorenal metabolic drugs for the ages. J Clin Invest 2024; 134:e177625. [PMID: 38426504 PMCID: PMC10904041 DOI: 10.1172/jci177625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
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