Blood HbA1c Levels Research Articles

Herbal supplementation improves clinical outcomes among diabetes mellitus patients

Hyperglycemic conditions are still common in diabetes melllitus (DM) patients with routine therapy. Rural communities in the Special Region of Yogyakarta habitually consume herbal medicines. Herbal nutritional supplements (MHM) were developed as additional therapy to increase the success of achieving therapeutic targets for DM patients. This study aimed to identify the clinical picture of DM patients who were given MHM at public health center (PHC) in the rural areas of Bantul Regency, Yogyakarta Special Region. This retrospective study was conducted on 94 DM patients with routine therapy. Patients who met the inclusion and exclusion criteria and had agreed to the informed consent were divided into two groups. Patients in the treatment group were asked to consume herbal supplement preparations (MHM) for 20 days. On day 21, each group measured clinical outcome parameters (blood pressure, blood glucose levels, triglycerides, cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), liver enzymes, urea, and creatinine). The mean difference test between the two groups (t-test) was carried out using a 95% confidence level. The results showed that the consumption of MHM herbal nutritional supplements for 20 days reduced blood sugar levels, Hb A1C levels, and urea levels (p<0.05). There were no differences in blood pressure, pulse, cholesterol, triglyceride, HDL, LDL, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and creatinine levels between the two groups (p>0.05). Administration of MHM for 20 days increased clinical outcomes in blood sugar, HbA1c, and urea levels in DM patients at PHC.

Preoperative Management of Diabetic Patients Undergoing Abdominal Surgery

Introduction: The management of diabetic patients undergoing abdominal surgery presents a multifaceted challenge that demands a comprehensive and tailored approach to ensure optimal perioperative outcomes Objectives: The basic aim of the study is to find the preoperative management of diabetic patients undergoing abdominal surgery Material and methods: A retrospective analysis was conducted, utilizing medical records from a cohort of 200 diabetic patients who had undergone various abdominal surgical procedures at Khyber Teaching Hospital Peshawar between August 2018 to March 2019. Ethical approval was obtained from the Institutional Review Board (IRB) prior to the commencement of data collection.Electronic medical records were meticulously reviewed to gather comprehensive patient information. Relevant demographic data, including age, gender, and body mass index (BMI), were documented. Preoperative glycemic status, measured through fasting blood glucose levels, HbA1c levels, and medication regimens, were recorded. Patient comorbidities, particularly cardiovascular conditions, were identified, and details of preoperative cardiovascular risk assessments were documented. Practical Implication: The prevalence of postoperative complications emphasizes the need for comprehensive management. These findings underscore the significance of holistic approaches to ensure safer surgeries and improved patient well-being. Conclusion: It is concluded that glycemic control, collaborative cardiovascular risk assessment, nutritional optimization, and patient education play pivotal roles in enhancing surgical outcomes. The prevalence of postoperative complications emphasizes the need for comprehensive management. Keywords: Diabetic, abdominal surgery, postoperative complications, nutritional optimization, cardiovascular risk, Nutritional Optimization

Socioeconomic disadvantage and high-effort coping in childhood: evidence of skin-deep resilience.

Low socioeconomic status (SES) is a risk factor for poor outcomes across development. Recent evidence suggests that, although psychosocial resilience among youth living in low-SES households is common, such expressions of resilience may not extend to physical health. Questions remain about when these diverging mental and physical health trajectories emerge. The current study hypothesized that skin-deep resilience - a pattern wherein socioeconomic disadvantage is linked to better mental health but worse physical health for individuals with John Henryism high-effort coping - is already present in childhood. Analyses focus on 165 Black and Latinx children (Mage = 11.5) who were free of chronic disease and able to complete study procedures. Guardians provided information about their SES. Children reported on their John Henryism high-effort coping behaviors. They also provided reports of their depressed and anxious mood, which were combined into a composite of internalizing symptoms. Children's cardiometabolic risk was captured as a composite reflecting high levels of systolic or diastolic blood pressure, waist circumference, HbA1c, triglycerides, and low high-density lipoprotein cholesterol. Among youth who reported using John Henryism high-effort coping, SES risk was unrelated to internalizing symptoms and was positively associated with cardiometabolic risk. In contrast, for youth who did not engage in high-effort coping, SES risk was positively associated with internalizing symptoms and was unrelated to cardiometabolic risk. For youth with high-effort coping tendencies, socioeconomic disadvantage is linked to cardiometabolic risk. Public health efforts to support at-risk youth must consider both mental and physical health consequences associated with striving in challenging contexts.

Individualized assessment and optimization of post myocardial infarction care by introducing a hybrid clinic - A DGH experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Optimal secondary prevention remains key in improving cardiovascular outcomes post myocardial infarction. Barriers to achieving timely and individualized medical optimization include unavailability of close follow up’s, compliance to secondary prevention, and more recently, the impact of COVID pandemic on outpatient face to face clinic appointments. With the recent emphasis from the European Society of Cardiology on secondary prevention in addition to optimizing lipid therapy, a dedicated service for post MI patients to address individualized risks can provide a timely opportunity to improve holistic cardiovascular care. Purpose To assess established secondary prevention practices, we initially audited 52 patients who presented with ACS between Jan 2020 and July 2020. These patients were assessed for post MI care optimization at 6 weeks post discharge. Utilizing ESC guidelines as audit targets, in our 6-week post discharge audit, we identified that there was scope of ACE-inhibitor up titration in 55.8% of the patients, beta-blocker optimization in 9.6%, Lipid lowering agents in 15.4%, mineralocorticoid receptor antagonist addition in patients with impaired LV systolic function in 5.8% of the patients. 5% of patients with new diagnosis of diabetes required referral to specialist teams for diabetic medication initiation or optimization. These results provided an opportunity to introduce a structured post MI clinic that will allow individualized risk assessment on an outpatient basis. Method We proposed a one stop hybrid clinic where all patients discharged following a myocardial infarction received a consultation 6 – 8 weeks following a discharge. These patients were sent blood forms 2-3 weeks prior to their appointment for full blood count levels, renal functions, liver profile, HBa1c levels and lipid profile. Focus of this consultation was to assess and educate the patient on risk factors (smoking, diabetes, cardiac rehab program), assess and address compliance to secondary prevention medications and finally titrate medications to maximum tolerated doses whilst achieving ESC defined targets for secondary prevention (post MI target systolic BP<140mmHg in non diabetics and <130mmHg in diabetics, LDLc <1.4, smoking cessation, HBa1c <49). Where appropriately identified, referral to lipid specialist and diabetes specialist teams were made to provide holistic multi-disciplinary management. Results To understand the Impact made by the clinic we obtained patient list through local electronic records to filter those discharged with a primary diagnosis of myocardial infarction in 2022. An audit tool was created and data collection was performed including baseline characteristics as per table 1 and interventions made Table 2. Conclusion(s) By establishing the post MI clinic we were able to demonstrate efficient individualized assessment and optimization of secondary prevention risk factors and pharmacotherapy.

A Comparative Study of Plasma N-Terminal Pro- Brain Natriuretic Peptide to Assess Asymptomatic Cardiovascular Disease in Type 2 Diabetic Patients

Background: This study aimed to assess NT-pro BNP level in patients of T2DM without overt cardiovascular disease to determine presence of Asymptomatic Left Ventricular Dysfunction (ALVD) compared with matched control group. Methods: This study conducted at SMS Hospital, Jaipur by selecting 60 patients of type 2 diabetes mellitus and 60 control of non-diabetic population. Information regarding demographic data, clinical symptoms, past medical history, laboratory parameters, NT pro-BNP and 2D Echocardiography collected from selected sample population for comparative analysis among both groups. Results: Patients of T2DM have significantly higher value of NT pro-BNP, blood sugar and HbA1c with proportionally increased diastolic dysfunction as compared to matched non-diabetic population (P<0.05). Absolute value of NT pro-BNP in patients of T2DM is directly correlated with age, duration of diabetes, Blood pressure, blood sugar level, HbA1c level, creatinine, total cholesterol and urine protein (positive correlation coefficient with P-value<0.05). Left ventricular ejection fractions were found statistically similar among both groups. Conclusion: Heart failure in patients with T2DM is a most crucial diabetic complication for diagnosis as well as management. Level of NT-pro BNP in blood stream is an important tool for early diagnosis of heart failure especially HFpEF. This study suggests that the secretion of NT-pro BNP is increased in patients with T2DM compared with control subject without overt heart disease. Therefore, measurement of NT-pro BNP paired might be a simple screening tool to identify patients with diabetes at risk for ventricular dysfunction requiring further examination with echocardiography.

Diyabetik Gebelerde HbA1c ve Glukoz Düzeylerinin Doğum Ağırlığı Tahmininde Kullanılması

Aim: The aim of this study was to investigate the sensitivity of baby birth weight estimation in relation to HbA1c levels of pregnant women diagnosed with pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). 
 Material and Methods: 105 patients who met the criteria agreed to participate in our study, of whom 7 were type 1 DM and 32 were type 2 DM. The pregnancy history of the patients who agreed to participate was obtained with a lot of demographic information as well as weight gains during pregnancy, HbA1c and fasting blood glucose levels.
 Results: Fasting glucose values were measured at 28 and 32 weeks of gestation. The blood glucose values that we measured one hour after satiation and HbA1c were higher in the PDGM group than in the GDM group. There was no significant difference between weight gain and BMI values. We used ROC curve analysis to test the predictive power of fasting and postprandial blood glucose levels or weight gain during pregnancy in our patients with GDM for LGA babies(LGA) (AUC: 0.663, %95 CI [0.526, 0.800], AUC: 0.678, %95 CI [0.540, 0.816], AUC: 0.677, %95 CI [0.548, 0.805], respectively).In addition, ROC analysis was used in evaluating fasting blood glucose measurements, 1-hour postprandial blood glucose measurements, and HbA1c levels to predict LGA.(AUC: 0.889, %95 CI [0.782, 0.996], AUC: 0.893, %95 CI [0.737, 1.000], AUC:0.931, %95 CI [0.807, 1.000], respectively).
 Conclusion: In both healthy people and pregnant women, it is important to keep blood glucose levels within normal limits. In pregnant women diagnosed with PDGM or GDM, this is even more important as the welfare of the baby is considered. LGA deliveries can be avoided in pregnant women with PDGM by close monitoring of postprandial blood glucose and HbA1c levels. Close monitoring of GWG is also beneficial in the follow-up of pregnant women diagnosed with GDM.

In Vitro and In Vivo Antidiabetic Effects of Acidic Polysaccharides Extracted from Seaweeds.

We evaluated the α-glucosidase inhibitory activity of acidic polysaccharides (APs) extracted from seaweeds in vitro and their antidiabetic effects in KK-Ay mice. The α-glucosidase inhibitory activity of APs was differed among various seaweed species. Some APs showed higher inhibitory activity in the high-molecular-weight range, whereas others showed higher inhibitory activity in the low-molecular-weight range. Mice were fed low-molecular-weight APs from hijiki (LMWAPsH), which showed higher α-glucosidase inhibitory activity. Fasting blood glucose and HbA1c levels were significantly lower in the LMWAPsH group than in the control group (p<0.01). The calculated homeostasis model assessment-insulin resistance in the LMWAPsH group was significantly lower than that in the control group (p<0.05). These results suggest that α-glucosidase inhibitory activity differ among APs from different seaweed species, and each have an optimum molecular-weight range, and that LMWAPsH prevents the hyperglycemia in KK-Ay mice.

HbA1c, And Blood Glucose, Changes When Treating Periodontal Disease with the Perio Protect Method™

Periodontal disease is a chronic wound resulting in host elevated local and systemic inflammatory markers in response to the microorganisms of the periodontal biofilm. Separately from its importance as an oral ailment, chronic periodontitis has gained relevance since it can develop into a systemic condition characterized by hyper-inflammation, disruption of the innate and adaptive immune system, and other system-wide alterations. There is compelling evidence that inflammation and chronic infection play an essential role in the development of inflammatory markers and of type 2 diabetes. Studies in humans suggest that circulating inflammatory marker levels may predict type 2 diabetes years in advance of the onset of the disease. Local and systemic expression of inflammatory cytokines, such as TNF-alpha and IL-6, increase in individuals with periodontitis. TNF-alpha and IL-6 impair intracellular insulin signaling, which may lead to insulin resistance and are significantly associated with cardiovascular events and stroke. This case study demonstrates treating periodontal disease with a direct medication delivery method (Perio Protect Method™) manages the patient’s periodontal disease and lowers daily blood glucose and HbA1c levels.

Cardiotrophin-1 as a prognostic biomarker of hypertension and a key regulator of cardiac glucose metabolism

Background. Hypertension, type 2 diabetes mellitus (T2DM), and obesity are among the most common diseases in the world, and their growth rates are of a pandemic nature. Since cardiovascular diseases still occupy a leading place in the structure of mortality, the study of biomarkers continues that can be key in the diagnosis of early signs of cardiovascular pathology. Such promising molecule is cardiotrophin-1 (CTF-1). CTF-1 is a protein with a molecular weight of 21.5 kDa, which belongs to the interleukin-6 (IL-6) family. The purpose of this study is to evaluate the circulating level of CTF-1 in comorbid patients with hypertension, and to conduct a comparative analysis of its serum concentration in the presence of various comorbidities. Materials and methods. One hundred and eleven patients with hypertension (men/women— 50/61) aged (54.37±1.18) years and 20 persons of the control group were examined. In the process of examination, they were divided into 4 groups depending on the presence of comorbid pathology: hypertension— group 1 (n=22); hypertension combined with obesity— group 2 (n=30); hypertension and T2DM— group 3 (n=31); hypertension, T2DM and obesity— group 4 (n=28). In all patients, body weight and height were measured, body mass index (BMI) was calculated, glycated hemoglobin (HbA1c) levels, lipid metabolism indicators were determined, systolic and diastolic blood pressure levels were measured. CTF-1 content in blood serum was determined by enzyme-linked immunosorbent assay. Results. A direct correlation of CTF-1 level with weight, BMI, HbA1c level, systolic and diastolic blood pressure was found (p &lt; 0.001). The data obtained prove that CTF-1 can be a trigger for the occurrence of cardiovascular complications, since its level progressively increases with increasing severity of comorbid pathology, and its highest serum concentration is found in patients with hypertension, concomitant T2DM and obesity. The detected changes demonstrate the role of CTF-1, the adipose tissue hormone, in the development of comorbid pathology and make it possible to assert that CTF-1 is a potential biomarker of cardiovascular complications. Conclusions. The level of CTF-1 was significantly higher in patients with hypertension, T2DM, obesity compared to those with hypertension, hypertension and obesity, as well as compared to this indicator in the control group. The concentration of CTF-1 in blood serum positively correlates with the levels of systolic and diastolic blood pressure, body weight, BMI, total cholesterol and HbA1c level. The study of the relationship between the serum level of CTF-1 and metabolic and hormonal indicators in comorbid patients is a promising direction for further research.

To Study and Compare the Efficacy of LM Potency and Centesimal Potency of Homoeopathic Medicine Acid Phosphoricum in Management of Type-2 Diabetes Mellitus

Background: Diabetes Mellitus has emerged as one of the prominent leading risk factors for cardio-vascular diseases. The prevalence rate of Diabetes Mellitus in India is said to be 25% in urban and 10% in the rural population. If we were to see the gender wise prevalence of Diabetes Mellitus in urban India, it is approximately 30-45% in males and 25-38% in females. However, only about 26% of the treated diabetic patients had their blood sugar level within normal limits. This study aims to study the efficacy of 50-Millesimal potency in management of Type-2 Diabetes Mellitus. Methods: It was a randomized parallel group study, wherein 50 patients satisfying the case definition, inclusion and exclusion criteria were selected for the study of which 25 patients were administered L M Potency of the homoeopathic medicine Acid Phosphoricum and remaining 25 patients were administered Centesimal potency of homoeopathic medicine Acid Phosphoricum. The subjects were clinically assessed every week. Investigations were done at baseline, blood sugar levels every month and HbA1C every 3 months of treatment till the end of the study period. All the data was measured and analysed at entry and every 3 months till the completion of the study period. Results: At the end of the study, significant decrease in the blood sugar and HbA1C levels was recorded in case of LM Potency as compared to Centesimal potencies. Conclusion: LM Potencies are more efficient in management of Type-2 Diabetes Mellitus as compared to Centesimal scale of potencies.

A CORRELATION BIOMARKER BETWEEN BMI AND LIPID PEROXIDATION IN TYPE 2 DIABETES MELLITUS WITH AND WITHOUT OTHER COMPLICATIONS

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with several complications, such as cardiovascular disease and retinopathy. Objective: The main objective is to find the correlation between body mass index (BMI) and lipid peroxidation biomarkers in T2DM patients with and without complications. This cross-sectional study involves 50 T2DM patients, with 25 patients having complications and 25 without complications. The study was conducted at Nishtar Medical University and Hospital from August 2022 to February 2023. BMI and lipid peroxidation biomarkers were measured, including malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE). T2DM patients with complications had a significantly higher BMI and higher levels of MDA and 4-HNE compared to those without complications. A positive correlation was observed between BMI and lipid peroxidation biomarkers in both groups of T2DM patients.&#x0D; Furthermore, T2DM patients with complications had significantly higher levels of fasting blood glucose, HbA1c, total cholesterol, LDL cholesterol, triglycerides, and serum creatinine, and lower levels of HDL cholesterol compared to those without complications. Our study highlights the importance of managing BMI and oxidative stress in preventing and managing T2DM complications. More studies are required to find the mechanisms underlying the association between BMI and lipid peroxidation in T2DM patients and to investigate the potential therapeutic implications of managing BMI and oxidative stress in T2DM patients.

Investigation of body awareness and body image perception in patients with type 2 diabetes mellitus

ObjectivesThe purpose of the study is to investigate body awareness and body image perception of patients with type 2 diabetes mellitus (T2DM) and to explore the association between clinical parameters and body awareness. MethodsA total of 92 participants with T2DM (38 women and 54 men) aged 36–76 years were recruited. Biochemical measurements, including fasting blood glucose, postprandial blood glucose and hemoglobin A1c (HbA1c), were obtained from the patients’ blood sample records. The Body Awareness Questionnaire (BAQ), Body Cathexis Scale (BCS) and Awareness Body Chart (ABC) were filled in by all subjects. ResultsMost participants had an above-average BAQ (81.5%) and BCS (87%) score. There was a significant correlation between body mass index and ABC pain subscale. HbA1c was significantly associated with the duration of diabetes and sleep-wake cycle, process domains and total BAQ score. The body awareness score for the lower leg and foot regions (ABC parts) was negatively correlated with fasting blood glucose and HbA1c levels, while body awareness in the foot region was negatively correlated with the duration of diabetes. There was no association between BCS and any clinical parameters. ConclusionThis study showed that body awareness is associated with diabetes-related clinical parameters, such as fasting blood glucose and HbA1c levels, and duration of diabetes in patients with T2DM. Following diabetes progression and an increase in blood glucose levels, body awareness tended to decrease, particularly in the lower leg and foot regions. These findings highlighted the importance of evaluating body awareness in patients with T2DM.

Role of yoga in type 2 diabetes mellitus

Type 2 Diabetes Mellitus (T2DM) has become most common problem worldwide. Yoga provides best means of self-improvement and gaining full potential of one’s body, mind &amp; soul. It has been proved that pranayama and certain Asana’s help in lowering blood glucose, balancing blood pressure and calms nervous system. The asanas improve the sensitivity of β-cells to glucose, improves insulin secretion, and improves glucose uptake. Hence, Yogic asanas are important for preventing and curing many ailments. The effect of yogic practices in diabetics has to be investigated well. To assess the effect of yoga on blood glucose levels and anthropometric parameters before and after doing yoga in T2DMpatients. A total of 100 T2DM diabetic patients in age group 30-60 years were taken. Effect of Yoga on fasting Blood glucose (FBG), Post prandial blood glucose (PPBG), HbA1c levels and serum insulin were assessed. Anthropometric parameters like BMI and waist hip ratio were also assessed. There was significant decrease in FBG, PPBG and HbA1c levels with p value&amp;#60;0.001 after doing yoga. There was also significant improvement in serum insulin levels and decrease in BMI &amp; waist hip ratio. A significant improvement in the blood glucose levels occurred in subjects who practiced Yoga. There was also lowering of the drug requirement.

GCK exonic mutations induce abnormal biochemical activities and result in GCK-MODY.

Objective: Glucokinase-maturity-onset diabetes of the young (GCK-MODY; MODY2) is a rare genetic disorder caused by mutations in the glucokinase (GCK) gene. It is often under- or misdiagnosed in clinical practice, but correct diagnosis can be facilitated by genetic testing. In this study, we examined the genes of three patients diagnosed with GCK-MODY and tested their biochemical properties, such as protein stability and half-life, to explore the function of the mutant proteins and identify the pathogenic mechanism of GCK-MODY. Methods: Three patients with increased blood glucose levels were diagnosed with MODY2 according to the diagnostic guidelines of GCK-MODY proposed by the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2018. Next-generation sequencing (whole exome detection) was performed to detect gene mutations. The GCK gene and its mutations were introduced into the pCDNA3.0 and pGEX-4T-1 vectors. Following protein purification, enzyme activity assay, and protein immunoblotting, the enzyme activity of GCK was determined, along with the ubiquitination level of the mutant GCK protein. Results: Genetic testing revealed three mutations in the GCK gene of the three patients, including c.574C>T (p.R192W), c.758G>A (p.C253Y), and c.794G>A (p.G265D). The biochemical characteristics of the protein encoded by wild-type GCK and mutant GCK were different, compared to wild-type GCK, the enzyme activity encoded by the mutant GCK was reduced, suggesting thermal instability of the mutant GST-GCK. The protein stability and expression levels of the mutant GCK were reduced, and the enzyme activity of GCK was negatively correlated with the levels of fasting blood glucose and HbA1c. In addition, ubiquitination of the mutant GCK protein was higher than that of the wild-type, suggesting a higher degradation rate of mutant GCK than WT-GCK. Conclusion: GCK mutations lead to changes in the biochemical characteristics of its encoded proteins. The enzyme activities, protein expression, and protein stability of GCK may be reduced in patients with GCK gene mutations, which further causes glucose metabolism disorders and induces MODY2.

Evogliptin, a DPP-4 inhibitor, prevents diabetic cardiomyopathy by alleviating cardiac lipotoxicity in db/db mice

Dipeptidyl peptidase-4 (DPP-4) inhibitors are glucose-lowering drugs for type 2 diabetes mellitus (T2DM). We investigated whether evogliptin® (EVO), a DPP-4 inhibitor, could protect against diabetic cardiomyopathy (DCM) and the underlying mechanisms. Eight-week-old diabetic and obese db/db mice were administered EVO (100 mg/kg/day) daily by oral gavage for 12 weeks. db/db control mice and C57BLKS/J as wild-type (WT) mice received equal amounts of the vehicle. In addition to the hypoglycemic effect, we examined the improvement in cardiac contraction/relaxation ability, cardiac fibrosis, and myocardial hypertrophy by EVO treatment. To identify the mechanisms underlying the improvement in diabetic cardiomyopathy by EVO treatment, its effect on lipotoxicity and the mitochondrial damage caused by lipid droplet accumulation in the myocardium were analyzed. EVO lowered the blood glucose and HbA1c levels and improved insulin sensitivity but did not affect the body weight or blood lipid profile. Cardiac systolic/diastolic function, hypertrophy, and fibrosis were improved in the EVO-treated group. EVO prevented cardiac lipotoxicity by reducing the accumulation of lipid droplets in the myocardium through suppression of CD36, ACSL1, FABP3, PPARgamma, and DGAT1 and enhancement of the phosphorylation of FOXO1, indicating its inhibition. The EVO-mediated improvement in mitochondrial function and reduction in damage were achieved through activation of PGC1a/NRF1/TFAM, which activates mitochondrial biogenesis. RNA-seq results for the whole heart confirmed that EVO treatment mainly affected the differentially expressed genes (DEGs) related to lipid metabolism. Collectively, these findings demonstrate that EVO improves cardiac function by reducing lipotoxicity and mitochondrial injury and provides a potential therapeutic option for DCM.

Evaluation of Sida cordifolia and Sida rhombifolia extracts in a rat model of streptozotocin-induced diabetic nephropathy.

Sida cordifolia and Sida rhombifolia are regarded as useful herbs as they have been shown to be effective, inexpensive and harmless in the prevention of diabetes, and are recognized as valuable therapeutic substances. The purpose of this study was to assess the effect of S. cordifolia and S. rhombifolia in the treatment of diabetic nephropathy using a rat model. Extracts of S. cordifolia and S. rhombifolia were obtained using the Soxhlet method. The hydroalcoholic extract solvent was used in the following proportions: 70:30, 50:50 and 80:20. The 80:20 hydroalcoholic extract was observed to be the most potent. The inhibitory effects of the extract were determined using the α-amylase assay. The most potent extract also underwent total flavonoid, phenolic and free radical scavenging tests, and was incorporated into an animal study. Diabetes was induced in rats by administering nicotinamide (NAD; 230 mg/kg) and streptozotocin (STZ; 65 mg/kg) intraperitoneally. In addition to a standard control of pioglitazone, the rats received extract dosages of 100 mg/kg/day or 200 mg/kg/day. Body weight, blood glucose, glycated hemoglobin (HbA1c), blood urea nitrogen (BUN), serum albumin, serum creatinine, homeostatic model assessment of insulin resistance (HOMA-IR), and oral glucose tolerance were assessed at various time points. The animals also underwent histopathological examination to observe alterations induced by the treatment. Sida cordifolia was the most successful in lowering blood glucose and HbA1c levels. Renal function indices and antioxidant enzyme levels were regained in a dose-dependent manner. Furthermore, S. cordifolia (200 mg/kg/day) extract, similar to pioglitazone, inhibited the production of advanced glycation byproducts by the kidney. The effects of various S. cordifolia and S. rhombifolia extracts on rats with diabetic nephropathy were observed. Sida cordifolia may be further explored for the treatment of diabetic nephropathy and, due to its diverse nature, may be utilized for the treatment of a wide range of diseases, as it provided more significant findings.

Aromatase Enzyme Activity and Liver Receptor Homolog-1 Levels in Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM) is one of the prediabetes conditions in which high blood sugar levels and body weight increase during pregnancy. The underlying molecular and biochemical mechanisms of GDM are poorly defined. Introduction: Aromatase enzyme activity is responsible for the conversion of androgens to estrogens and has a share in the regulation of body fat distribution and liver receptor homolog-1 (LRH-1), which plays a critical role in cholesterol transport, acid homeostasis, and steroidogenesis in GDM patients. This study aims to determine the levels of aromatase enzyme and LRH-1 in GDM patients and to investigate the relationship between the levels of aromatase enzyme and LRH-1 and the levels of insulin, HbA 1c and total cholesterol. Method: This prospective cross-sectional study was conducted over eleven months (September 2020 to July 2021). The study population was selected at Harran University Teaching and Research Hospital. The study included 32 GDM patients and 32 healthy pregnants. The automated assay measured serum fasting blood glucose, HbA1c, and insulin levels (AVIDA 1800 Chemistry System; Siemens). Aromatase enzyme activity and LRH-1 levels were determined by using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Result: Aromatase activity decreased in GDM patients while LRH1 increased. Significant differences in means levels of fasting blood glucose (p=0.11), insulin (p= 0.001) and HbA1c (p= 0.001) between the patients and control groups. There was a significant negative correlation between the levels of aromatase and insulin (r=-370, p =0.037). In addition, a positive significant correlation coefficient (r=0.645, p=0.001) was found between HbA1c and total cholesterol among the patients' group. Conclusion: Our findings indicate that there is a negative relationship between aromatase activity and insulin levels. Aromatase and LRH 1 may play a role in the pathogenesis of GDM, and the use of LRH-1 agonists in treating the disease may be considered an alternative treatment in the future. However, additional studies are required to reveal the possible functions of these two proteins in GDM with their mechanisms.

High dose piracetam on alcoholic cerebellar degeneration: A case report

IntroductionChronic alcohol use is related to alcoholic cerebellar degeneration that is caused by B1 (thiamine) deficiency and associated with the degeneration of Purkinje cells in the cerebellar cortex.ObjectivesThis report aims to present a case with cerebellar ataxia and tremor due to alcoholic cerebellar degeneration that is unexpectedly regressed after starting piracetam infusion treatment in the inpatient Alcohol and Drug Addiction Research, Treatment and Education Center (AMATEM).MethodsWe investigated the case prospectively. The patient was informed and consent was obtained.A 57-year-old, divorced, retired, male with alcohol use disorder for 48 years (mostly high alcohol, cologne for 2 years) presented to our hospital with upper and lower limb tremors and balance problems for 2 years. Neurological examination revealed dysmetria, cerebellar tremor, hypoesthesia of lower extremities, ataxia so he was unable to tandem-walk. CIWA-Ar score:13. The blood test, including hemogram, biochemical, HbA1C, TFT, serum copper and ceruloplasmin levels, results were all normal. Diazepam 50 mg was started and titrated down by 5 mg per day and discontinued, 600 mg parenteral and 250 mg p.o thiamine initiated for 3 days and continued orally, propranolol 20 mg/day and ecopirin 100 mg/day were continued. Cranial CT, cranial MRI, and EMG were ordered.The patient was consulted to the neurologist for movement disorder.ResultsMRI appearance of the cortical sulcus, fissure, cisterna, and cerebellar folia were obvious. The ventricular system was assessed as ecstatic secondary to atrophy. Therefore the alcoholic cerebellar degeneration was diagnosed and increased propranolol to 30 mg/day dose. Furthermore iv infussion piracetam was empirically started at secuencely dose of 60 g/day for 3 days, 45 g/day for 3 days, 30 g/day for 3 days. Upper and lower limb tremor disappeared and ataxa regressed after the treatment was arranged.Image:Image 2:Image 3:ConclusionsSeveral authors proposed that serotonergic system among other neurotransmitters in the cerebellum might be affected in ACD. Recent studies investigating the use of buspirone in the treatment of ataxia has showed positive results (1-3).The mechanism of action of the piracetam is unclear. Supposed that piracetam binds to the polar head groups of membrane bilayers and induces distinct changes in membrane structure. Its actions in the nervous tissue include indirect modulation of several neurotransmitter systems, neuroprotective and anticonvulsant effects and positive influence on neuronal plasticity.In conclusion, we suggest that high dose piracetam has a potential antiataxic effect in ACD.Cessation of drinking and nutritional supplementation are the only treatments available for ACD. However, gait does not improve in most patients. Pysical therapy, canes, walkers, and wheelchairs are helpful in maintaining mobility (4). Similarly, we observed that the patient’s need for care has been continuing.Disclosure of InterestNone Declared

ASSESSMENT OF STATUS OF DIABETES MELLITUS IN FIRST DEGREE RELATIVES OF DIABETES MELLITUS TYPE II PATIENTS

Type 2 diabetes mellitus is an important public health problem worldwide, and its prevalence is increasing in both developed and developing nations. Diabetes mellitus presents multiple challenges to public health, this disease contributes to signicant morbidity, including cardiovascular, cerebrovascular, and renal disease, premature mortality, may progress undetected for years and is often not diagnosed until onset of clinical symptoms or complications. This hospital based cross sectional study was conducted on a consecutive sample of 255 individuals who were rst degree relatives (FDR) of patients with type 2 diabetes mellitus attending the Medicine department out patients (OPD) &amp; Inpatient (IPD) of R.D.B.P Jaipuria Hospital, Jaipur attached with RUHS CMS Jaipur. The participants were divided in three groups as non-diabetic, pre-diabetic and diabetic on the basis of, fasting, post prandial blood glucose and HBA1C levels performed at the time of enrollment. First degree relatives who were already diagnosed with type-2 diabetes mellitus prior to the time of enrolment were not included. Out of total 255 participants, Non-Diabetics were 141(55.29%), Pre-Diabetics were 94(36.86%) and Diabetics were 20 (7.84%). Family history is an important information that should always be included in screening procedure. By identifying patients with pre-diabetes and diabetes and initiating early interventions in lifestyle and/or pharmacological treatments, the progression can be delayed, or in some cases even prevented. Earlier the diagnosis, easier it is to reverse the condition and curb the development of grave complications

DF-5 COMPOUND DELAYS DEVELOPMENT OF DIABETIC NEPHROPATHY IN RATS

Advanced glycation end-products play an important role in the development of diabetic complications, so slowing down of glycated proteins’ cross-links formation have been suggested as a potential therapeutic option for the treatment of vascular diabetic complications and preventing their progression.The aim of the work was to assess the influence of novel anticrosslinking agent DF-5 on the renal advanced glycation end-products and collagen contents, body weight, blood glucose and glycated hemoglobin levels and the development of early renal disease in streptozotocin-induced diabetic rats.Materials and methods. 40 male Sprague-Dawley rats were used in the study. Two months after inducing diabetes, the study substance was administered intragastrically once a day for 28 days (12.5 mg/kg). Measurements included the assessment of blood glucose and HbA1c levels, the evaluation of the renal function, and the results of histology and immunohistochemical staining of kidneys.Results. A repeated intragastric administration of DF-5 for 30 days significantly reduced the level of HbA1c in the blood, but did not affect the level of fasting blood glucose. DF-5 compound significantly reduced proteinuria and prevented kidney damage in experimental animals by limiting damage of the glomeruli and tubules. It was found that DF-5 inhibits the progression of an early renal dysfunction in rats with streptozotocin-induced diabetic nephropathy. This was associated with a decreased accumulation of advanced glycation end-products in the kidney, accompanied by the improvement of both renal morphology and function.Conclusion. The results obtained provide investigators with additional therapeutic options for the treatment of diabetic nephropathy and possibly other complications of diabetes.