Central Diabetes Research Articles

Combination Therapy of SGLT 2 Inhibitors and GLP 1 Receptor Agonists for Glycaemic Management through Weight Reduction

A great deal of anti-diabetic drugs leads to weight gain, which could contribute to obesity and possibly both diabetes and obesity. Glucose-lowering medications that contain sodium-glucose co-transporter 2 (SGLT2) inhibitors work by preventing the kidneys from reabsorbing glucose and sodium, which causes glycosuria and lowers plasma glucose levels. Consequently, its effects include decreases in HbA1c, blood glucose levels, and blood pressure along with decline in body weight and adiposity. Consistently, people on medications that inhibit SGLT2 tend to lose weight, but this weight loss is only modest since opposing regulatory processes work to keep the body's weight constant. This has driven researchers to investigate the use of SGLT2 inhibitors in combination with other drugs that work by reducing appetite, such as glucagon-like peptide 1 receptor agonists (GLP1RAs). In a retrospective study at the Wolver Hampton Diabetes Centre, researchers evaluated the effectiveness of combination therapy using GLP-1 agonists and SGLT-2 inhibitors in the management of diabetes and obesity. Patients on the combined regimen showed statistically significant improvements in clinical measures like body weight reduction, glycated hemoglobin (HbA1c) reduction, lower BMI, and reduced insulin dose. Such combinations, which include SGLT2 inhibitors, are intriguing because of the bodyweight effects and the indications of protection of cardiovascular and renal problems. These results imply that combination therapy using GLP-1 agonists and SGLT-2 inhibitors offers individuals with diabetes and obesity a promising treatment choice Keywords: Diabetes Mellitus, obesity, SGLT 2 inhibitors, GLP 1 receptor agonist.

High-resolution whole-genome DNA methylation revealed unique signatures of painful diabetic neuropathy.

The aim of this work was to describe the DNA methylation signature and to identify genes associated with neuropathic pain in type 2 diabetes mellitus. We analyzed two independent diabetic neuropathy cohorts: PROPGER consisting of 72 painful and 67 painless patients recruited at the German Diabetes Center in Düsseldorf (DE), and PROPENG comprising 27 painful and 65 painless diabetic neuropathy patients recruited at the University of Manchester (UK). Genome-wide methylation data was generated using Illumina Infinium Methylation EPIC v1.0 BeadChip. We used four different selection criteria to identify promising pain-related genes. Our findings revealed significant differences in methylation patterns between painful and painless diabetic neuropathy and identified a set of individual CpG sites of unique candidate genes associated with the painful phenotype. Several of these genes, including GCH1, MYT1L and MED16, have been previously linked to pain-related phenotypes or diabetes. Through pathway enrichment analysis, we demonstrated that specific epigenetic signatures could contribute to the complex phenotype of diabetic neuropathy and cluster analyses highlighted significant epigenetic dissimilarities between painful and painless phenotypes. Our results uncovered epigenetic differences between painful and painless diabetic neuropathy patients and identified targeted genes linked to neuropathic pain through DNA methylation mechanisms. This approach holds promise for investigating other chronic pain conditions, such as secondary chronic pain from cancer treatment, thoracic surgery, and various transplant settings.

The management of patients with lipid disorders in Italian diabetes centers: results of a national survey

La malattia cardiovascolare (CV) aterosclerotica rappresenta la prima causa di morbilità e mortalità nel mondo occidentale, in particolare per le persone con diabete. Il diabete e l’iperglicemia che lo caratterizza rappresentano infatti essi stessi un potente fattore di rischio CV, pertanto, è indispensabile nelle persone con diabete perseguire contemporaneamentenon solo l’ottimizzazione del controllo glicemico ma anche del colesterolo LDL con l’obbiettivo di abbattere il rischio di sviluppare eventi cardiovascolari maggiori. Nella pratica clinica tuttavia molto spesso i nostri pazienti presentano dei livelli di colesterolemia LDL lontani da quelli che dovrebbero essere gli obbiettivi che le linee-guida raccomandano. Questo fenomeno è in parte dovuto ad un sotto trattamento dei fattori di rischio cardiovascolare da parte dei clinici e in parte attribuibile ad una scarsa aderenza terapeutica dei nostri pazienti. Negli ultimi anni la ricerca scientifica ha messo a disposizione di medici e pazienti nuove molecole molto efficaci nel ridurre la colesterolemia LDL e potenzialmente capaci di favorire l’aderenza terapeutica dei pazienti in virtù della facilità di utilizzo, degli scarsi effetti collaterali e della possibilità di essere assunti dal paziente mensilmente o addirittura semestralmente a vantaggio della aderenza alla terapia. Ad oggi tuttavia non tutti i diabetologi italiani sono messi nelle condizioni di utilizzare al meglio questa nuova arma a disposizione per la cura dei propri pazienti, sia per problematiche di origine burocratica che di tipo organizzativo. Scopo di questa survey è quindi quella di valutare tra un gruppo rappresentativo di diabetologi italiani quale sia lo stato dell’arte nella gestione della dislipidemia nelle varie realtà dove essi operano. PAROLE CHIAVE dislipidemia, rischio cardiovascolare, survey, Annali AMD

Determination Superoxide Dismutase and Glutathione Levels in Serum of Patients with Diabetic Foot Infection in Karbala City

Background: Diabetic foot infections (DFIs) are identified as localized purulence or inflammation that appears at the site beneath the malleoli in a diabetic patient. The goal of this study was to measure the levels of glutathione (GSH) and superoxide dismutase (SOD) in healthy people in Karbala city as well as in patients with type 2 diabetes mellitus who had or did not have diabetic foot ulcers. Materials and Methods:This study involved 120 participants ranging in age from 35 to 75 years, and was conducted at the Imam Al-Hassan Center for Endocrinology and Diabetes in Karbala, Iraq. To seperate the serum, five milliliters of the participants' blood were collected, put within gel tubes, and spun at 4000 xg in a cooled centrifuge. The serum was stored at -20˚C in Eppendorf tubes prior to utilizing it in determination of SOD and GSH levels. Results: Superoxide dismutase (SOD) activity mean levels in DFI group where the result from patient were significantly lower (241.4±35.61) (U / L) (p≤0.001) than in diabetic patients and healthy individuals. Similarly, glutathione (GSH) mean levels in DFI group patients were lower than in diabetic patients and healthy individuals (26.586±2.77) µmole/ml (p≤0.001). Conclusion: These results imply that diabetic foot infections may be influenced by decreased antioxidant levels. This suggests that these antioxidants may be used as possible markers to diabetic those who are more vulnerable.

Oral Candidiasis in Diabetes Patients

Objective :1. Identification and isolation of candida spp in Patients with diabetes mellitus (DM). 2.To identify the relationship between some important parameters (age , gender , Glycosylated hemoglobin (HbA1c) ) Associated with diabetes and oral candidiasis . This study was performed in AL- Zahraa Teaching Hospital (Diabetic Center ) Wasit Governorate during the period from the first of December 2018 to the end of July 2019.The samples were collected from oral swabs ,then cultured on sabouraud dextrose agar (SDA) , examined under microscope to show hypha and pseudohypha of Candida spp and cultured on chrom agar for identifying the Candida spp. The molecular methods that used in this study were vitek 2 system and Polymerase chain reaction(PCR). The results showed that from 50 oral sample from Patients with diabetic mellitus showed 23 (46.6%) infected with candidiasis ,22 (95.6%) of them were C.albicans and 1(4.4 %) was other Candida spp (C.Dubliniensis) , while 27 (53.4%) were not infected. The Current study found a significant correlation between glycosylated hemoglobin and oral Candidiasis when the HbA1c was ranging from (6.5-8.5).

Effect of Multisensory Exercise Training on Sensation and Balance in Patients with Diabetic Neuropathy – A Pilot Study

Background: Diabetic peripheral neuropathy, is a common manifestation of peripheral nervous system in diabetes due to elevated glucose level. Symptoms include painful lower limbs, altered sensation, reduce reflexes and weakness of lower limb resulting in impairment in balance and gait. As treatment various interventions are used such as balance training, strength training, aerobic exercise, sensory motor training. Aim of study: This study was to assess the effect of multisensory exercise training on sensation and balance in patients with diabetic neuropathy. Methodology: This study was conducted in various OPDs and diabetic center of Surat. 10 diabetic neuropathic patients were randomly assigned in to 2 groups; 5 patients were allocated in group A (conventional & multisensory training) and 5 patients were allocated in group B (conventional therapy). Patients in both groups were treated for 3 days per week for 4 weeks. Conventional physiotherapy was given for 3 days in a week at home for 4 weeks. Sensation and balance were assessed by using Semmes-Weinstein Monofilaments and berg balance scale respectively. Data were recorded at baseline and after 4 weeks of training. Result: The result showed there was no significant difference in effect of multisensory exercise on sensation and there was significant improvement in balance in patients with diabetic neuropathy. Conclusion: The result of study indicate that 4 weeks of multisensory exercise program was improving balance in patients with diabetic neuropathy as compare to conventional therapy. Key words: Multisensory exercise, Sensation, Balance, Diabetic neuropathy

The Cost of Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Type 1 Diabetes Pregnancies in the United States: A Cost-Consequences Analysis Using Real-World Evidence.

Data on the cost implications of continuous glucose monitoring (CGM) use in type 1 diabetes (T1D) pregnancies in the United States are sparse. Drawing on associations identified in real-world evidence from a retrospective chart review at the Barbara Davis Center for Diabetes, we conducted a cost-consequences analysis of CGM use versus self-monitoring of blood glucose (SMBG), inclusive of neonatal intensive care unit (NICU) spending. In the base-case analysis assuming per-label CGM use and per-guideline finger-stick frequency, the per-person cost was $16,254 for CGM versus $15,182 for SMBG. In a real-world scenario analysis, the per-person cost was $13,708 for CGM versus $14,524 for SMBG. In both analyses, there was a cost savings for NICU admissions of $2,903 with CGM use. In the probabilistic sensitivity analysis, CGM was cost saving in 25% of base-case model iterations and 46% of real-world model iterations. This study adds to the growing evidence base that the increased costs of CGM use versus SMBG to manage T1D pregnancies are likely offset by better neonatal health outcomes.

Implementation of hybrid closed loop therapy in the NHS: experiences from the adult diabetes centre in Derby and Burton

Implementation of hybrid closed loop therapy in the NHS: experiences from the adult diabetes centre in Derby and Burton

Association of Abnormal Serum Bilirubin and Liver enzymes in Iraqi Patients with Metabolic Syndrome (A cross-sectional study)

Background: Metabolic syndrome affects people worldwide. Hypertension, insulin resistance, central obesity, dyslipidemia, and pro-inflammatory state are cardiometabolic risk factors. Bilirubin is produced from the breakdown of haemoglobin. Recent studies show that small bilirubin elevations can protect tissue and control oxidative stress and inflammation. Alanine aminotransferase (ALT) is primarily located in the liver but also in the heart, kidneys, and muscles. Aspartate aminotransferase (AST) is present in the liver, kidneys, skeletal and cardiac muscles, and brain. Objectives: The study aims to assess the impact of bilirubin and liver enzymes on the components and severity of metabolic syndrome(Obesity, fasting blood glucose, Triglycerides, HDL, and blood pressure). Materials and methods: This cross-sectional study was conducted at the diabetes center in Al-Najaf City, Iraq, from October 2023 to February 2024. Age, gender, blood pressure, height, weight, fasting blood glucose, bilirubin, ALT&AST, triglycerides, and HDL were examined in 122 Mets patients. Results: The study results show a significant difference (P<0.05) in the levels of bilirubin(0.9280±0.03783), ALT(12.8934±0.40234), and AST (22.0410 ± 0.89667) among individuals with metabolic syndrome. Also, the study found a significant difference in ALT levels between overweight (19.8409±1.17134), obese (24.0192±.96722), and normal BMI persons (13.7692±.84909). A significant difference in AST levels was observed between those with normal BMI (16.0000±1.29970) and those with overweight (21.3182±1.72740) or obesity (22.4615±.93791). Between BMI groups, bilirubin levels were not substantially different. The study found a positive correlation between ALT and AST with fasting blood glucose and triglyceride. Conclusion: Metabolic syndrome patients have greater liver enzyme levels than others, which increases insulin resistance and oxidative stress, increasing MS risk. Furthermore, liver aminotransferases have the potential to induce diabetes. Furthermore, increased triglyceride levels led to the release of greater hepatic enzyme concentrations; however, total bilirubin and MS do not correlate.

Evaluation of Knowledge and Attitude toward Diabetes among Adolescents with Diabetes Mellitus attending Diabetes and Endocrine Center in Babylon Governorate/ Iraq

Background: Diabetes is a lifelong chronic condition that is becoming more common in both industrialized and developing countries. People who have diabetes are more likely than those who do not to experience a wide range of illnesses. Aim: to measure the knowledge and attitude among diabetic adolescents and find their relationship with socio-demographic features of patients, their families, clinical history, family history, and lifestyle features. Patient and methods: a Cross -sectional study carried out at a diabetic and endocrine center included 300 Adolescents aged 13–19 years who were diagnosed with diabetes mellitus by clinicians and attended the center from October first, 2023, to February first, 2024. The questionnaire included: - Socio-demographic features of the participants and their families, Knowledge about Diseases, attitude of the patient toward disease, SPSS version 26 was used to analyze data and a P value≤ 0.05 considered statistically significant. Results: patients' mean knowledge and attitude scores were significantly higher for older age group patients, urban residence, higher level of education, older parents, family history of the disease, longer duration of disease and current smoking. (P< 0.05), high mean score of knowledge was found among those with retired fathers and older mothers. higher mean attitude score was found among engaged patients. Conclusion: The result of the present study showed about two-third of the participants had good knowledge scores while only half had good attitude score. older age, higher education, living in urban areas, lived with disease for more than 5 years, had a family history of disease and smoking are significant determinants of knowledge and attitude.

Generalizability of kidney and cardiovascular protection by finerenone to the real world in Italy: insights from Fidelio and Figaro studies.

We evaluated the proportion of Type 2 diabetes (T2D) patients with chronic kidney disease (CKD) participating in the AMD (Association of Medical Diabetologists) Annals initiative who met the eligibility criteria for phase III-studies on finerenone, showing its renal and cardiovascular benefits. This analysis involved all T2D patients seen in 2019 in 282 diabetes centers in Italy, for whom data on kidney function (estimated glomerular filtration rate and albuminuria) were available. Data are presented separately for different scenarios, covering the population with main eligibility criteria for inclusion in the FIDELIO-DKD and FIGARO-DKD trials. Among 343,037 T2D patients involved in the analysis, 5.4% met the eligibility criteria of the FIDELIO-DKD study (13.3% if we consider the population with fundus data) and 22.3% met those of the FIGARO-DKD trial. Overall, 110,000 (33%) patients were eligible for treatment with finerenone, with a male prevalence, an average age of 71years, and good control of the main risk factors (HbA1c 7.3%; BP 138/76mmHg; LDL-c 87mg/dl), albeit with large percentages of not well controlled patients (50% with SBP > 140mmHg; > 30% with LDL-c > 100mg/dl). Over 12% were on sodium/glucose cotransporter 2 inhibitors or glucagon-like peptide 1 receptor agonists. Based on the event rate from the FIDELITY pooled analysis, the number of potentially avoidable events was 21.7 per 1000 eligible patients for the cardiovascular composite outcome and 16.7 for the renal outcome. This analysis showed that approximately 33% of patients with T2D present the main eligibility criteria for treatment with finerenone and could therefore benefit from it in the near future.

Evaluating the patient's serum for thyroid stimulating immunoglobulin and Cytotoxic -T-lymphocyte associated protein 4 in Graves hyperthyroidism

Graves' disease (GD) is a common autoimmune disorder that causes an excess of thyroid hormone production. It is mainly due to the production of IgG antibodies that activate the thyrotropin receptor. The aim of this study is to measure the levels of Cytotoxic -T-lymphocyte associated protein 4 and thyroid stimulating immunoglobulin in individuals with GD. It also seeks to establish the connection between thyroid stimulating immunoglobulin and thyroid stimulating hormone (TSH), as well as to assess the predictive value of CTLA4 for Graves' disease. The study was a case-control investigation conducted at the Alrusafa Center for Diabetes and Endocrinology. It involved a total of 45 people diagnosed with Graves' illness. The healthy group consisted of 45 individuals who had no previous medical history or clinical indications of hyperthyroidism or any other chronic condition. Blood samples from 90 individuals diagnosed with Graves' illness and a control group were analyzed to measure the levels of CTLA4, TSI by ELISA. The findings indicated a robust and statistically significant association (P.value<0.01) serum levels of CTLA4 in the patients for Graves' disease comparing to the control group. The patient samples included 13 men (28.89%) and 32 women (71.11%). There was no significant relationship found between TSI and TSH.

The distribution of the ABO and rhesus blood groups among diabetes mellitus patients in Zintan City, Libya

Numerous studies have explored the potential connection between ABO blood groups and the risk of developing specific illnesses in the literature. This study aimed to examine the distribution of ABO blood and rhesus (Rh) groups among patients with diabetes mellitus (DM) at the Endocrinology and Diabetes Center in Al-Zintan City, Libya. This cross-sectional study took place from October to December 2022, involving 144 blood samples (99 from diabetic patients and 45 from non-diabetic individuals aged 15 to 85 years). Ethical approval and informed consent were obtained from the Endocrinology and Diabetes Center in Al-Zintan, where all laboratory work and statistical analysis using SPSS were conducted. Of the diabetic patients, 46% were male and 53% were female. The test results showed no association between ABO and Rh blood groups in individuals with diabetes mellitus. Among diabetics, the O blood group was most prevalent at 49%, followed by A (34%), B (11%), and AB (5%). Rh+ was more common (n=88) than Rh- (n=11), with no significant difference (p=0.733). Gender distribution also showed no significant difference (p>0.05). The O blood group was more common in females (55.10%) than males (44.90%), and the B blood group was found more often in females (72.73%) than in males (27.27%). This research shows no significant relationship between ABO and Rh blood types and diabetes mellitus occurrence among patients at the endocrinology and diabetes center in Al-Zintan City. Blood group variations do not influence diabetes prevalence or characteristics in this population.

A comprehensive review of biomarker research in diabetic nephropathy from a global bibliometric and visualization perspective.

Diabetic nephropathy (DN) is a common complication of diabetes, which is prone to develop into end-stage renal disease, and early diagnosis and treatment is the key to effective management of DN. Biomarkers have important clinical significance in the diagnosis and treatment of DN and have attracted extensive attention from researchers in recent years. The aim of this study was to visualize the field of biomarker research in DN through bibliometric analysis, to summarize the current status and predict future trends of this field, with a view to providing valuable insights for scholars and policy makers. Literature search and data collection from Web of Science Core Collection. Calculations and visualizations were performed using Microsoft Excel, VOSviewer, Bibliometrix R-package, and CiteSpace. We identified 1274 publications about biomarker research in DN from 1995 to November 01, 2023, with a steady increase in annual publications. China, Steno Diabetes Center in Denmark, and Frontiers in Endocrinology were the most productive country, institution, and journal, respectively; Mischak, Harald was both the most productive and highly cited author, and Kidney International was the most cited journal. The high frequency keywords were "albuminuria," "chronic kidney disease" and "expression." In addition, "macrophage," "fibrosis" and "omics" are potentially promising topics. Our study comprehensively and visually summarized the important findings of global biomarker research in DN and revealed the structure, hotspots, and evolutionary trends in this field. It would inspire subsequent studies from a macroscopic perspective and provide a basis for rational allocation of resources and identification of collaborations among researchers.

Retrospective Study of Fine Needle Aspiration Cytology of Patients with Thyroid Nodule in Benghazi in the Period of (2021-2023)

Background: Thyroid nodules constitute a common endocrine disorder, these nodules could be solitary, multiple, cystic, or solid. Increasing age, female gender, iodine deficiency, and history of thyroid radiation all are high risk for thyroid nodules. FNAC representing the most cost-effective diagnostic tool used in the assessment of nodules of the thyroid. Objective of the study: The aim of this study is to evaluate the result of fine needle aspiration cytology (FNAC) and assess thyroid status using of thyroid hormone obtained from patients with thyroid nodules. Materials and methods: this is a retrospective study, includes collection of data from available cases of thyroid nodules underwent fine needle aspiration between 2021 to 2023, data regarding age, sex, TFT, USS, FNAC was collected from the archive of endocrine out patients clinic of Benghazi Medical Center and from endocrine clinic of Benghazi diabetic center. The analysis was done using the SPSS program. Result: A total of 60 cases were studied, Data was collected from 60 patient’s files for years between 2021 and 2023. The mean age of the patients with FNAC selected for this study was 49.65, and ranged from 21-80 years. The gender distribution shows female predominance in which female cases were 53 (98.33%) while only one case (1.67%) was reported among men. The size of nodules in our cases range from 1cm to 4.5 cm. The mean size of nodules is 1.89cm. In this study the largest group of nodules located in right lobe (21) cases then left lobe (20) cases then both (17) cases and in isthmus only 2 cases. Most of the cases thyroid function test result shows an euthyroid status (38) cases. FNAC of thyroid nodule showed that most of patient’s result diagnosed as benign nodules (47) cases. Conclusion: FNAC is a key tool in diagnosis of thyroid nodule as it has safe, minimally invasive and cost effective diagnostic role.

The impact of insulin resistance and glycaemic control on insulin-like growth factor-1 in patients with type 2 diabetes: a cross-sectional study

BackgroundType 2 diabetes mellitus (T2DM) is a multifaceted metabolic disorder. Over the past decade, the potential role of Growth Hormone (GH) and Insulin-like Growth Factor-1 (IGF-1) in the pathogenesis and progression of T2DM has garnered scientific interest. These hormones, while interrelated, exert differential effects on glucose homeostasis; GH elevates blood glucose levels, whereas IGF-1 sustains insulin secretion and augments insulin sensitivity.ObjectiveThe study aimed to investigate the impact of insulin resistance and glycaemic control on IGF-1 levels and to assess other risk factors influencing IGF-1 in T2DM.MethodsA cross-sectional study was conducted at the National Diabetes Centre, Baghdad, Iraq, from May 2020 to May 2021. Sixty patients with T2DM were evaluated for fasting plasma glucose (FPG), GH, IGF-1, HbA1c, HOMA-IR, HOMA-B, and anthropometric measures following a comprehensive history and physical examination, focusing on any variables that could influence their metabolic profile. Patients with Type 1 diabetes mellitus, thyroid disease, pituitary disease, chronic kidney disease, hepatic disease, and pregnancy were excluded from the study.ResultsPatients with poorly controlled diabetes (HbA1c > 8) exhibited significantly elevated IGF-1 levels compared to those with HbA1c < 8 (166 vs. 134, P = 0.016). The mean IGF-1 was significantly lower in patients with insulin resistance (IR) compared to those without IR (143 vs. 192, P = 0.001), with a significant negative correlation with Body Mass Index (BMI) and a significant positive correlation with HbA1c and Quantitative Insulin Sensitivity Index (QUICKI). Elevated IGF-1 levels were observed with increasing age, duration of T2DM, higher HbA1c, higher QUICKI, and lower BMI. No significant difference was found in IGF-1 values with regards to HOMA-B, fasting insulin, and waist-hip ratio.ConclusionPatients with poorly controlled T2DM exhibit higher IGF-1 levels, while those with obesity and high insulin resistance demonstrate lower IGF-1 levels. Further prospective studies are warranted to evaluate the potential of using IGF-1 to reduce insulin resistance and improve metabolic and glycaemic measures in individuals with T2DM and obesity or insulin resistance.

Reduced Aqueous Retinol-Binding Protein 3 Concentration Is Associated With Diabetic Macular Edema and Progression of Diabetic Retinopathy.

To evaluate the association of aqueous retinol-binding protein 3 (RBP3) with history of diabetic macular edema (DME) and diabetic retinopathy (DR) progression. RBP3 concentration was measured by ELISA in aqueous from patients undergoing cataract surgery at Joslin Diabetes Center. DR progression was defined as two-step or more worsening on the Early Treatment Diabetic Retinopathy Study severity scale, and DME history was determined by clinical diagnosis. In 153 eyes (31 with type 1 and 122 with type 2 diabetes; n = 149 patients), 37% had no signs of DR, 40% had mild nonproliferative DR (NPDR), and 23% had moderate NPDR. Aqueous RBP3 decreased from a median of 2.1 nmol/L (interquartile range 0.8-3.4) in eyes with no DR to 1.5 nmol/L (0.8-3.8) in eyes with mild-to-moderate NPDR (P = 0.047). The difference between aqueous RBP3 levels in those with type 1 or type 2 diabetes was not significant. Elevated RBP3 (β = -0.701, 95% CI -1.151 to 0.250, P = 0.002) was associated with no DME history. With a mean follow-up of 5.5 ± 3.6 years, elevated RBP3 at baseline was associated with less subsequent DR progression (odds ratio 0.51, 95% CI 0.28-0.93, P = 0.03). In multivariable analyses, RBP3 remained significantly associated with a DR progression and history of DME. A 5% improvement was seen in the area under the curve when RBP3 was added to clinical models for predicting DR progression (P < 0.05). This study suggests that aqueous RBP3 may be an important protective factor, the first neuroretinal-specific biomarker of DME or DR progression, and a possible therapeutic target.

Adherence to Treatment Guidelines Among Patients With Type 2 Diabetes Attending a Tertiary Hospital in Jeddah, Saudi Arabia.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that is associated with many complications if untreated.Guidelines, including those from the American Diabetes Association (ADA), are published regularly to enhance the management of diabetes in all aspects of care including regular screening of diabetic complications and encouraging the use of newer medications such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1a). This study aims to assess the adherence to ADA guidelines at a tertiary care center in Saudi Arabia. The study employed an observational, retrospective chart review design, utilizing medical records and patient charts from the Diabetic Center at the National Guard Health Affairs (NGHA) Hospital in the western region. The study included a sample of 384 patients from a total population of 3,985 individuals. Participants were adults over 18 years of age with T2DM who were being treated at the diabetic center. The study included 384 patients, with 56% being female (215 patients), and the mean age was 62.8(±11) years.The mean duration of DM was 17.6(±9.6) years and the mean body mass index (BMI) was 31 kg/m2(±6.3). SGLT2i and GLP-1a were prescribed in 226 (59%) and 196 (51%) of cases, respectively. Two hundred and ninety-six (76.6%) patients measured theirglycated hemoglobin (HbA1c) twice annually which meets with ADA recommendations, and the mean HbA1c was 7.8(±1.6) which is lower than two local and two regional studies. Blood pressure (BP) was controlled (<130/80) in 40% of patients, which is in between according to three local studies. Lipid profile was checked annually in 95% of patients, but only 27% met the ADA primary or secondary prevention goals. Regarding urine albumin-to-creatinine ratio (ACR), it was done annually in 75% of patients, and 89% of patients have seen an ophthalmologist which indicates better adherence than other studies. The results conclude that the diabetic center at the NGHA Hospital in Jeddah generally provides good quality of care with high adherence to ADA guidelines; however, some aspects of care need to be improved including hypertension and dyslipidemia management. Moreover, further research should aim to be more specific when addressing the use of newer medications including SGLT2i and GLP-1a and its outcome in diabetes complications and patients' satisfaction.

Metabolic syndrome among patients with type 2 diabetes in Jordan: A cross-sectional study.

Metabolic syndrome is a major public health problem worldwide and an independent predictor of cardiovascular disease in patients with type 2 diabetes (T2DM). This study aimed to determine the prevalence of metabolic syndrome and its individual components among Jordanian patients with T2DM. A cross-sectional design was conducted among T2DM patients at the National Center for Diabetes, Endocrinology and Genetics in Jordan. Data were collected using a structured questionnaire and clinical data extracted from medical records. The National Cholesterol Education Program-Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) diagnostic criteria were used to define metabolic syndrome. Among 1017 participants aged between 22 and 90 years, the overall prevalence of IDF defined metabolic syndrome was 84.2% (72.5% and 96.2% among males and females, respectively). Using ATP III criteria, overall prevalence was 79.1% (77.4% and 80.8% among males and females, respectively). Advancing age, female gender, nonadherence to a diet regimen, sedentary lifestyle or insufficient physical activity, and duration of diabetes ≥10 years were significantly associated with increased odds of metabolic syndrome, regardless of the definition used. Current smoking status and family history of cardiovascular diseases were significantly associated with increased likelihood of ATP III defined metabolic syndrome. The prevalence of metabolic syndrome among Jordanian patients with T2DM is extremely high. The main modifiable risk factors of metabolic syndrome among these patients include nonadherence to a diet regimen, insufficient physical activity, being overweight/obese and smoking. It is recommended that healthcare providers counsel patients on the importance of maintaining physical activity, smoking cessation, and adherence to a diet regimen.

Real world effectiveness of oral semaglutide: Focus on patients with type 2 diabetes older than 75 years

AimData on the efficacy of oral semaglutide (OS) in elderly patients with type 2 diabetes are still lacking. This study evaluates the effectiveness of OS in a real world setting with a large ≥75 year old population. MethodsThis study includes all type 2 diabetic patients who started OS between October 2021 and December 2023 in seven diabetes centers. Data were collected at baseline, 6 (T6) and 12 (T12) months. Effectiveness measures were assessed on the total sample and by patient age (<65, 65–75, >75 years). ResultsOverall 1824 patients started OS, of those 18.7 % were over 75 years (>75 yr). OS resulted in a significant reduction in rate of patients using sulphonylureas, rapid and basal insulin therapy, HbA1c reduced by 0.87 % at T6 and at T12 (both p < 0.0001), body weight by 2.78 Kg (p < 0.0001) at T6 and 3.89 Kg (p < 0.0001) at T12. Similarly, >75 yr showed HbA1c reduction at T6 (p < 0.0001) and T12 (p = 0.0003), body weight significantly reduced (p for interaction 0.005) both at T6 (−1.57 Kg; p = 0.0003) and T12 (−2.74 Kg; p < 0.0001). ConclusionIn our study, OS results efficacy in non-elderly and elderly patients, making it an effective treatment option also for very elderly type 2 diabetic patients.