Complications Of Type 2 Diabetes Mellitus Research Articles

Abstract 18170: Microvascular Complications of Type 2 Diabetes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction in the DELIVER Trial

Introduction: The role of microvascular complications of type 2 diabetes mellitus (T2DM) in heart failure (HF) with mildly reduced or preserved ejection fraction is poorly understood. Aim: To assess outcomes and the response to dapagliflozin in the DELIVER trial by the presence of microvascular complications of T2DM. Methods: DELIVER was a multicentre, double-blind randomised controlled trial in patients with an ejection fraction >40% that compared the efficacy of dapagliflozin to placebo. Data on past medical history of T2DM and microvascular complications (nephropathy, angiopathy, retinopathy, peripheral neuropathy, and autonomic neuropathy) were collected at the initial trial visit. Patients were classed as no T2DM, T2DM only and T2DM and microvascular complications. The primary composite outcome was worsening HF or cardiovascular death. Secondary outcomes were HF events, cardiovascular death, and all-cause mortality. Results: 6263 patients were analysed. 3457 (55.1%) patients did not have T2DM, 1840 (29.4%) had diabetes only and 966 (15.4%) had diabetes with a microvascular complication. The unadjusted and adjusted hazard ratio for the primary and secondary outcomes is shown in the Table for those with T2M and T2DM with MVC compared to no T2DM.The risk of outcomes was highest in those with T2DM and microvascular complications but was not significant after adjustment. There was no difference in the effect of dapagliflozin on each outcome by T2DM status (Table). Conclusions: In HF and an ejection fraction >40%, T2DM with MVC is associated with poorer outcomes. The efficacy of dapagliflozin did not differ by diabetes status or the presence of MVC.

Bone Marrow as a Therapeutic Target for Type 2 Diabetes Complications.

Type 2 diabetes mellitus (T2DM) is a world epidemic with a high prevalence and mortality. The origin of macro and microvascular complications associated with T2DM is complex and new mechanisms to explain their development are emerging. The changes induced by T2DM in the microenvironment of bone marrow (BM) alter the expansion and differentiation of stem cells and have been related to the development of micro and macrovascular diseases. Alterations in the differentiation and function of hematopoietic, endothelial, and mesenchymal stem cells in T2DM patients reduced the mobility of BM stem cells to the circulation and some immature, dysfunctional, or inflammatory cells pass to the blood (mobilopathy). Consequently, tissue repair is impaired, and the tissue damage caused by hyperglycemia, oxidative stress, and inflammation is increased. These alterations can contribute to diabetic complications, decreasing the quality of life, and increasing mortality. The modulation of the bone marrow microenvironment may be a therapeutic target for treating T2DM and its complications. This article analyses the changes induced in BM and their impact on the development of cardiovascular and kidney complications in T2DM. Also, different therapeutic strategies to restore the bone marrow microenvironment and function through the modulation of oxidative stress, inflammation, and adipogenicity are discussed, considering bone marrow as a novel potential therapeutic target to treat vascular complications of diabetes.

Unsupervised cluster analysis of clinical and metabolite characteristics in patients with chronic complications of T2DM: an observational study of real data.

The aim of this study was to cluster patients with chronic complications of type 2 diabetes mellitus (T2DM) by cluster analysis in Dalian, China, and examine the variance in risk of different chronic complications and metabolic levels among the various subclusters. 2267 hospitalized patients were included in the K-means cluster analysis based on 11 variables [Body Mass Index (BMI), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Glucose, Triglycerides (TG), Total Cholesterol (TC), Uric Acid (UA), microalbuminuria (mAlb), Insulin, Insulin Sensitivity Index (ISI) and Homa Insulin-Resistance (Homa-IR)]. The risk of various chronic complications of T2DM in different subclusters was analyzed by multivariate logistic regression, and the Kruskal-Wallis H test and the Nemenyi test examined the differences in metabolites among different subclusters. Four subclusters were identified by clustering analysis, and each subcluster had significant features and was labeled with a different level of risk. Cluster 1 contained 1112 inpatients (49.05%), labeled as "Low-Risk"; cluster 2 included 859 (37.89%) inpatients, the label characteristics as "Medium-Low-Risk"; cluster 3 included 134 (5.91%) inpatients, labeled "Medium-Risk"; cluster 4 included 162 (7.15%) inpatients, and the label feature was "High-Risk". Additionally, in different subclusters, the proportion of patients with multiple chronic complications was different, and the risk of the same chronic complication also had significant differences. Compared to the "Low-Risk" cluster, the other three clusters exhibit a higher risk of microangiopathy. After additional adjustment for 20 covariates, the odds ratios (ORs) and 95% confidence intervals (95%CI) of the "Medium-Low-Risk" cluster, the "Medium-Risk" cluster, and the"High-Risk" cluster are 1.369 (1.042, 1.799), 2.188 (1.496, 3.201), and 9.644 (5.851, 15.896) (all p<0.05). Representatively, the "High-Risk" cluster had the highest risk of DN [OR (95%CI): 11.510(7.139,18.557), (p<0.05)] and DR [OR (95%CI): 3.917(2.526,6.075), (p<0.05)] after 20 variables adjusted. Four metabolites with statistically significant distribution differences when compared with other subclusters [Threonine (Thr), Tyrosine (Tyr), Glutaryl carnitine (C5DC), and Butyryl carnitine (C4)]. Patients with chronic complications of T2DM had significant clustering characteristics, and the risk of target organ damage in different subclusters was significantly different, as were the levels of metabolites. Which may become a new idea for the prevention and treatment of chronic complications of T2DM.

Depression in Type 2 Diabetes Mellitus and its Relation with Complications of Diabetes Mellitus: A Cross-sectional Study in Central India

Background: The prevalence of Type 2 diabetes mellitus (T2DM) and depression has witnessed a steep rise. The relationship between these two conditions has been mostly studied in Western countries. The existing literature indicates that depression is more common in T2DM. However, data regarding its association with clinical profile of diabetes is conflicting. Despite the extensive occurrence of T2DM and depression in India, research on their association is limited. Aims and Objectives: To study the prevalence of depression and its association with complications of T2DM among inpatients of T2DM in a tertiary care center in Central India. Materials and Methods: Inpatients department of Medicine was taken as study site and 120 inpatients of T2DM aged 18 to 65 years were recruited after applying strict inclusion and exclusion criteria. They were assessed for depression using structured interview and ICD-10 criteria. The severity was assessed by HAMD-17 (Hamilton Rating Scale for Depression). The complications of diabetes were assessed. Results: The prevalence of depression in T2DM patients was 24.2% (29 cases) among which mild depression was present in 62.1% cases. There was a significant positive association (p&lt;0.05) between depression and socio-demographic variables of age, female gender, rural habitat and lower socio-economic status. There was a significant positive association between depression and duration of diabetes, BMI, serum triglyceride, serum creatinine and a significant negative association with serum HDL. Depression had a significant positive association with nephropathy and Coronary Artery Disease (CAD). Conclusion: The prevalence of depression is higher in T2DM as compared to normal population and is significantly associated with nephropathy and coronary artery disease. The findings highlight the need for timely screening of depression and integrated management approach.

Lanhuashen stimulates the positive cross-regulation mediated by the S1P axis to ameliorate the disorder of glucolipid metabolism induced by the high sucrose diet in Drosophila melanogaster

Ethnopharmacological relevanceHerba Wanlenbergiae, named ‘Lanhuashen’ (LHS) in Chinese, is derived from the dried herba of Wahlenbergia marginata (Thunb.) A.DC. It is an abundant resource that has been used in traditional Chinese medicine (TCM) for over 600 years. LHS has the effects of enriching consumptive disease and relieving deficient heat, consistent with the therapy for type 2 diabetes mellitus (T2DM) in TCM. As the basic remedy of Yulan Jiangtang capsules, a listed Chinese medicine specifically for treating T2DM, LHS is a potential candidate for an anti-T2DM drug. However, due to the lack of pharmacodynamic studies and chemical component analysis, the application and development of LHS as a treatment for T2DM have been hindered. Aim of the studyTo evaluate the regulation of the disorder of glucolipid metabolism using LHS extracts and its therapeutic potential in T2DM. Materials and methodsChemical components in LHS extracts were analysed using UPLC-Q Exactive-Orbitrap-MS. Subsequently, high sucrose diet (HSD)-induced Drosophila melanogaster were used as suitable models for T2DM in vivo. Behavioural and biochemical tests were performed to evaluate the regulation of the disorder of glucolipid metabolism using LHS in T2DM flies. Furthermore, integrative metabolomic and transcriptomic analysis was applied to reveal the specific effects of LHS extracts on metabolites and genes. Meanwhile, bioinformatic analysis was carried out to predict the targeted transcription factors (TFs) and potentially effective components of LHS extracts. ResultsWe redefined the chemical profile of LHS with 76 identified chemical components, including 65 chemical components for the first time. As indicated by decreased trehalose, glucose and triglyceride levels and increased total protein levels, LHS extracts were perceived to alleviate the disorder of glucolipid metabolism in HSD-induced T2DM fruit flies. Integrative metabolomic and transcriptomic analysis revealed that LHS extracts eliminated the accumulation of sphingolipids and subsequently stimulated the positive cross-regulation mediated by the sphingosine 1-phosphate (S1P) axis, resulting in the activation of the phosphatidylinositol-3-kinase (PI3K)-protein kinase B (Akt) signalling pathway and inhibition of lysosome-mediated apoptosis. Bioinformatic analysis revealed that the upstream TFs, transcriptional enhancer factor TEF-5 (TEAD3) and peroxisome proliferator-activated receptor alpha (PPARA), were the potential targets of atractylenolide III, dihydrokaempferol and syringaldehyde, the potentially effective components of LHS extracts. Therefore, this TF network was plausibly the basis for the efficacy. ConclusionsLHS extracts broadly modulated TF-dependent gene expression and subsequently stimulated the positive cross-regulation mediated by the S1P axis to ameliorate the disorder of glucolipid metabolism. Our study provides critical evidence considering LHS as a potential drug candidate for T2DM, inspiring the discovery and development of innovative therapeutic agents based on the cross-regulation mediated by the S1P axis for treating T2DM and related complications.

The Role of Nonspecific Inflammation in the Development of Diabetic Polyneuropathy

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus type 2 (DM2) and is associated with significant morbidity and mortality. The pathophysiological mechanisms leading to the development of DPN have not been fully studied and are still debatable. Currently, immune-mediated mechanisms of its development are being discussed. The aim of this study was to estimate the content of TNF-α in the blood serum of patients with DM2 complicated by DPN and to assess the significance of this factor in the development and progression of DPN. An open comparative study was conducted with the participation of 83 patients with DM2 of different duration. In patients with clinical manifestations of DPN and long-term course of DM2 (group 2), the level of TNF-α was significantly higher compared to patients with DM2 and duration of DPN less than 2 years, and both studied groups of patients with DM2 and DPN had a high level of TNF-α in comparison with the control group. The results obtained indicate a more aggressive immune-mediated process that develops with a longer duration of DM2 and makes a negative contribution to the functioning of the peripheral nerve fiber.

The Comparison of High-Intensity Interval Training and Moderate-intensity Continuous Training on Inflammatory and Metabolic Variables in Type 2 Diabetes: Study Protocol for A Pilot Randomized Controlled Trial

Abstract Background: The worldwide prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasing, and research has shown that low-grade inflammation leads to the development and progress of T2DM. Participating in physical activities, as part of the management program, is recommended to control inflammation and prevent the complications of T2DM. Although the most effective type and intensity of exercise training are not recognized yet, aerobic training has been reported to have beneficial effects. This manuscript describes the protocol of a study, in which we compared the effectiveness of 8 weeks of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on inflammatory, metabolic, and anthropometric variables in type 2 diabetes patients. Methods/Design: This study was designed as a pilot randomized controlled clinical trial with three parallel groups. Twenty-seven adults with type 2 diabetes were randomly assigned 1:1:1 to HIIT, MICT, and control groups. Participants in the HIIT and MICT groups were invited to undertake three sessions of supervised exercise each week for eight consecutive weeks. HIIT sessions consisted of seven 1-min intervals of running exercise on a treadmill at 90%–95% heart rate reserve (HRR) separated by 2 min of active recovery at 60%–70% HRR. MICT sessions involved 30 min of continuous running on the treadmill at 60%–70% HRR. Participants were assessed 24 h before the start and 24 and 72 h after the last training session. The control group, however, continued their everyday life during the project. The primary outcomes were the alterations of plasma calprotectin, myeloperoxidase (MPO), and interleukin-6. Conclusion: Evidence shows the link between inflammation and the development of type 2 diabetes complications. Therefore, finding ways to improve inflammatory state is of vital importance to these patients. This study is the first clinical trial comparing the impact of long-term HIIT and MICT on calprotectin and MPO for people with type 2 diabetes.

Exosomes as biomarkers and therapy in type 2 diabetes mellitus and associated complications.

Type 2 diabetes mellitus (T2DM) is one of the most prevalent metabolic disorders worldwide. However, T2DM still remains underdiagnosed and undertreated resulting in poor quality of life and increased morbidity and mortality. Given this ongoing burden, researchers have attempted to locate new therapeutic targets as well as methodologies to identify the disease and its associated complications at an earlier stage. Several studies over the last few decades have identified exosomes, small extracellular vesicles that are released by cells, as pivotal contributors to the pathogenesis of T2DM and its complications. These discoveries suggest the possibility of novel detection and treatment methods. This review provides a comprehensive presentation of exosomes that hold potential as novel biomarkers and therapeutic targets. Additional focus is given to characterizing the role of exosomes in T2DM complications, including diabetic angiopathy, diabetic cardiomyopathy, diabetic nephropathy, diabetic peripheral neuropathy, diabetic retinopathy, and diabetic wound healing. This study reveals that the utilization of exosomes as diagnostic markers and therapies is a realistic possibility for both T2DM and its complications. However, the majority of the current research is limited to animal models, warranting further investigation of exosomes in clinical trials. This review represents the most extensive and up-to-date exploration of exosomes in relation to T2DM and its complications.

The Prevalence of Peripheral Vascular Disease (PVD) and Its Correlation with Biochemical Parameters in Type 2 Diabetes Mellitus (T2DM) - A Tertiary Care Hospital Based Study in Eastern India

INTRODUCTION PVD, one of the major macrovascular complications of T2DM, usually begins at an earlier age and remains subclinical for a long duration. So early detection of PVD will help to assess its true prevalence and hence prevention of overt manifestation. OBJECTIVES To assess the true prevalence of PVD in T2 DM from Eastern India and its correlation with clinical and biochemical parameters METHODS It was a cross sectional study with consecutive diabetes patients attending OPD from 2015 January to 2016 July. Each was subjected to meticulous history, measurement of ABPI by handheld Doppler and various laboratory parameters. Patients having known vascular disease due to other causes were excluded. RESULTS Out of 103 patients, PVD was present in around 25% cases with positive association with age, male gender, and high body weight. Hypertension, hyperglycemic state (PPBS, HbA1C), total cholesterol, triglyceride and LDL independently increases the risk of PVD. Though low levels of HDL are a well-recognized risk factor for PVD, this was not reflected in study. CONCLUSION The true prevalence of PVD is higher in DM and ABPI can detect subclinical PVD much before its progression and overt manifestations

Pancreatic Stone Protein/ regenerating Protein (PSP/reg) as a Biochemical Marker for prediction of Microvascular Complications of Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) characterized by insulin resistance (IR) and progressive decline in functional beta (β) cell mass partially due to increased β cell apoptosis rate. Pancreatic stone protein /regenerating protein (PSP/reg) is produced mainly by the pancreas and elevated drastically during pancreatic disorder. Beta cells are experiencing apoptosis that stimulate the expression of PSP/reg gene in surviving neighboring cells, and that PSP/reg protein is subsequently secreted from these cells which could play a role in their regeneration. Objectives: To analyze serum levels of PSP/reg protein in T2DM patients and evaluate its correlation with the microvascular complications of the disease. Subjects and Methods: One hundred fifty participants (64 males, 86 females; aged 40–70 years) include T2DM patients with and without microvascular complications as well as healthy controls were enrolled in this study. Biochemical parameters like random blood glucose (RBG), glycated hemoglobin (HbA1c), lipid profile, urea and creatinine (Cr) were measured. Serum values of PSP/reg protein were measured by enzyme- linked immunosorbent assay (ELISA). Results: Serum levels of PSP/reg protein were found significantly elevated in T2DM patients with microvascular complications compared with those of controls (p&lt;0.001) and T2DM patients without microvascular complications (p&lt; 0.001).PSP/reg protein is correlated with type 2 DM duration (p&lt;0.001), RBG (p&lt;0.001), and HbA1c (p&lt;0.001). The area under the curve (AUC) for the presence of microvascular complications was 0.973. Conclusion: PSP/reg protein may be used as biochemical marker to predict microvascular complications of T2DM.

Study of Serum Apelin and Insulin Resistance in Type 2 Diabetes Mellitus Patients With or Without Obesity.

Type 2 diabetes mellitus (T2DM) is a chronic disorder characterized by persistent hyperglycemia. Chronic hyperglycemia in diabetes mellitus can cause microvascular and macrovascular complications. Obesity is a major risk factor contributing to disease progression and complications of T2DM. Apelin is an adipokine having a compensatory role in reducing insulin resistance (IR)in morbidly obese individuals. This study was undertaken to find a correlation between Apelin, IR, and obesity. This case-control study included 180 participants, cases (n=90) having T2DM, and healthy controls (n=90). Further, the case and control groups were divided into group I (non-obese) and group II (obese) according to their body mass index (BMI) as per the Asia Pacific classification of BMI. Following obtainingconsent, anthropometrical measurements and blood parameters likeserum total lipid profile, fasting and postprandial glucose level, Apelin, and insulin were done,and results were analyzed statistically usingStatistical Package for the Social Sciences (SPSS) version 21(IBM Corp., Armonk, NY). A significantly higher Apelin level was observed in diabetes patients with obesity (265.16±11.0 pg/mL) as compared to non-obese (206.44±83.0 pg/mL). A positive correlation between serum Apelin levels and BMI was found (r=0.367, p=0.003). Homeostasis Model Assessment of IR (HOMA-IR) is increased in obese patients in comparison to the control group. A significant positive correlation between BMI and HOMA-IR (r=0.429, p=0.001) and Apelin and IR (r=0.742, p=0.000) was found in this study. On the basis of the finding of this study, we may conclude that Apelin has a role in improving insulin sensitivity in T2DM. Larger and multicentric studies are further required to discover the therapeutic role of Apelin in T2DM.

The genetic polymorphisms and activity of glyoxalase 1 as a risk factor for acute coronary syndrome in South Indians with type 2 diabetes mellitus

ObjectiveThe individuals’ genetic traits predispose them to a higher or lower risk of Type 2 diabetes mellitus (T2DM) and its complications, for example, acute coronary syndrome (ACS). As carbonyl stress is responsible for the pathogenesis and complications of T2DM, and glyoxalase 1 (GLO1) is the most crucial determinant of carbonyl stress, the study aimed to explore the association between GLO1 gene polymorphism, GLO1 activity in red blood cell (RBC), plasma methylglyoxal (MG) levels, and ACS risk in South Indian T2DM patients. MethodsA total of 150 T2DM patients with ACS as cases and 150 T2DM patients without ACS as controls were recruited in a case-control study. The rs4746, rs1049346 and rs1130534 of the GLO1 gene were analysed using TaqMan allele discrimination assay. The RBC GLO1 activity and plasma MG levels were measured. ResultsSignificantly lower RBC GLO1 activity and higher plasma MG levels were found in cases compared to controls (p < 0.001 and p = 0.008, respectively). The genotype and allele frequencies of rs1049346 significantly differed between cases and controls (p < 0.001). For rs1130534 and rs1049346, no significant difference was found. For rs1049346, the TT and CC genotypes were associated with higher (p = 0.002) and lower (p = 0.001) ACS risk, respectively, in various genetic models. The TT genotype of rs1049346 was associated with lower RBC GLO1 activity (p = 0.004) and higher MG level (p = 0.010). In haplotype analysis, higher ACS susceptibility with the TAT haplotype (p < 0.001) and lower ACS susceptibility with the TAC haplotype (p < 0.001) were observed. Also, lower RBC GLO1 activity was associated with the TAT haplotype (p = 0.002). ConclusionsThe rs1049346 of the GLO1 gene may be associated with ACS risk in South Indian T2DM patients, and the T and C allele might be essential precipitating and protective factors, respectively.

Gait Analysis, Metabolic Parameters and Adherence to the Mediterranean Diet in Patients with Type 2 Diabetes Mellitus Compared with Healthy Controls: A Pilot Study.

Patients with type 2 diabetes mellitus (T2DM) are prone to developing diabetic peripheral neuropathy (DPN) with an increased risk of injuries while walking, potentially leading to plantar ulcers. We aimed to assess the early gait changes in T2DM patients without clinical signs of DPN in comparison to age-matched healthy controls (HC). One hundred T2DM patients (78 women, mean age: 66.4 ± 11.5 years) and 50 age-matched HC (34 women, mean age 62.1 ± 7.9 years) were evaluated with the PODOSmart® gait analysis device. Anthropometric and biochemical data, as well as dietary habits were collected for all participants. T2DM patients also completed the Diabetes Distress (DS) self-report validated questionnaire. One patient was excluded from the study due to lack of recent biochemical data. Among the T2DM patients, 88.9% reported little or no DS and 11.1% moderate DS. The T2DM group had higher body mass index, waist circumference, systolic blood pressure, glycated hemoglobin A1c, sodium, white blood cell count, triglycerides and low-density lipoprotein cholesterol, but lower high-density lipoprotein cholesterol than HC (p < 0.05 for all comparisons). The MedDiet score was satisfactory in both groups (p > 0.05). Significant differences were found between the two study groups in gaitline heel off, propulsion speed, foot progression angle, time taligrade phase, stride length, walking speed, angle attack, oscillation speed, pronation-supination toe off and clearance. The T2DM patients without self-reported DS or clinical signs of DPN may exhibit significant differences in several gait parameters analyzed with PODOSmart®. Whether gait analysis can be used as an early diagnostic tool of T2DM complications should be further explored.

Machine Learning-based Prognosis for Early Detection of Heart Disease – A Comparative Study

Medical analysis is occasionally cited as a valuable source of insightful data. Coronary heart disease (CHD), a common and serious complication of diabetes mellitus type 2 (T2DM), is one of the most common chronic conditions characterized by an imbalance in insulin secretion. T2DM commonly has poor outcomes and even fatalities as a result of these complications. Identification of those who have an a higher risk of CHD problems is becoming more and more important due to the enormous number of people with T2DM, but a predictive method is still lacking. Early detection of CHD can help reduce mortality rates because it is one of the main causes of death in the globe. The challenge arises from the complexity of the data and relationship prediction using conventional methods. The purpose of this project is to use machine learning (ML) technologies and historical medical data to predict CHD. This study's primary objective is to identify correlations in CHD data using supervised learning methods such as Support Vector Machines (SVM), Decision Trees and Ensemble Classifiers. The researched ML techniques produce intelligent models. Empirical results demonstrate that probabilistic approaches are promising in diagnosing CHD using a variety of performance assessment parameters. Key Words: heart, health, machine learning, ensemble

Profiling of patients with type 2 diabetes based on medication adherence data.

Type 2 diabetes mellitus (T2DM) is a complex, chronic disease affecting multiple organs with varying symptoms and comorbidities. Profiling patients helps identify those with unfavorable disease progression, allowing for tailored therapy and addressing special needs. This study aims to uncover different T2DM profiles based on medication intake records and laboratory measurements, with a focus on how individuals with diabetes move through disease phases. We use medical records from databases of the last 20 years from the Department of Endocrinology and Diabetology of the University Medical Center in Maribor. Using the standard ATC medication classification system, we created a patient-specific drug profile, created using advanced natural language processing methods combined with data mining and hierarchical clustering. Our results show a well-structured profile distribution characterizing different age groups of individuals with diabetes. Interestingly, only two main profiles characterize the early 40-50 age group, and the same is true for the last 80+ age group. One of these profiles includes individuals with diabetes with very low use of various medications, while the other profile includes individuals with diabetes with much higher use. The number in both groups is reciprocal. Conversely, the middle-aged groups are characterized by several distinct profiles with a wide range of medications that are associated with the distinct concomitant complications of T2DM. It is intuitive that the number of profiles increases in the later age groups, but it is not obvious why it is reduced later in the 80+ age group. In this context, further studies are needed to evaluate the contributions of a range of factors, such as drug development, drug adoption, and the impact of mortality associated with all T2DM-related diseases, which characterize these middle-aged groups, particularly those aged 55-75. Our approach aligns with existing studies and can be widely implemented without complex or expensive analyses. Treatment and drug use data are readily available in healthcare facilities worldwide, allowing for profiling insights into individuals with diabetes. Integrating data from other departments, such as cardiology and renal disease, may provide a more sophisticated understanding of T2DM patient profiles.

Hypoglycemia awareness and its associated risk factors, in non-insulin-dependent diabetes in Hail region, Saudi Arabia.

Hypoglycemia is one of the avoidable complications of diabetes mellitus type 1 or 2, which occurs in between 24% to 60% of diabetic patients. It is a state of low plasma glucose concentration, either with or without symptoms, that can expose the patient to risks. Hypoglycemia is associated with impaired brain function, cardiovascular and visual effects, and increased mortality. This study was conducted to assess the knowledge of hypoglycemia as a complication of diabetes mellitus type 2 and the awareness of risk factors among the Hail City population, Kingdom of Saudi Arabia. We conducted a cross-sectional study targeting diabetic patients with type 2 in Hail province from April to August 2022. We used an online questionnaire distributed through popular social media, which included questions on age group, gender, BMI, social status, occupation, education, and income. Approximately 48.2% of patients had episodes of hypoglycemia in the previous three months, while 43% did not have hypoglycemic episodes. Among patients, 424 (73.7%) had less than three hypoglycemic episodes during the previous three months, and 121 (21%) had 3-6 episodes. Hypoglycemic episodes among diabetic patients have critical effects on the patient and may lead them to avoid diabetic drugs, causing hyperglycemia.

Investigating the prevalence of diabetic peripheral neuropathy in patients diagnosed with type 2 diabetes mellitus

Abstract Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder affecting millions of individuals reaching epidemic proportions globally. diabetic peripheral neuropathy (DPN) is one of the most prevalent and debilitating complications of T2DM, affecting the lower limbs and increasing the risk of foot ulcers, infections, and lower limb amputations. The current study aims to assess the prevalence and severity of DPN using monofilament and MNSI tests in patients diagnosed with T2DM and examine factors associated with the onset and progression of DPN. Objective: To study the prevalence of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus. Materials and Methods: A cross-sectional study was conducted at the Department of Medicine &amp; Diabetology, Marwari Hospital Assam. A total of 226 patients with type 2 diabetes were assessed for DPN using the Michigan Neuropathy Screening Instrument (MNSI). Results: The study assessed the prevalence of DPN among patients with diabetes mellitus. among the 226 participants, 32% had moderate neuropathy and 11% had severe neuropathy. Symptoms such as numbness, burning pain, and muscle cramps were reported by a significant proportion of participants. Examination findings showed foot-related complications and reduced nerve function in a considerable number of participants. The prevalence of neuropathy varied among different duration groups of patients with diabetes. The severity of neuropathy was higher among patients with longstanding diabetes. These findings emphasize the significant burden of DPN and the importance of diabetes management in managing and preventing diabetic neuropathy. Conclusion: This study revealed a considerable prevalence of DPN among patients with diabetes mellitus. The prevalence of neuropathy varied with the duration of diabetes, suggesting an increased risk with a longer disease duration. Timely intervention and appropriate diabetes management strategies are crucial in reducing the burden of DPN and improving patient outcomes.

Diagnosis and Non-Invasive Treatment of Obesity in Adults with Type 2 Diabetes Mellitus: A Review of Guidelines.

Obesity, a chronic disease with multifactorial etiopathogenesis, is characterized by excessive accumulation of adipose tissue. Obesity prevalence is growing globally at an alarming rate. The overwhelming majority of obesity cases are caused by inappropriate lifestyles, such as overconsumption of food and inadequate physical activity. Metabolic and biochemical changes due to increased adiposity resulted in numerous comorbidities, increased all-cause mortality, and reduced quality of life. T2DM (type 2 diabetes mellitus) and obesity have many common pathogenetic points and drive each other in a vicious cycle. The aim of this article is to review obesity management guidelines and highlight the most important points. Management of both obesity-related and T2DM complications incur enormous expenses on healthcare systems. It is, therefore, paramount to provide streamlined yet custom-tailored weight management in order to avoid the negative ramifications of both diseases. Efficient obesity treatment leads to better diabetes control since some antidiabetic medications support weight reduction. Obesity treatment should be overseen by a multi-disciplinary team providing indispensable information and individually tailored regimens to patients. Weight management should be multimodal and consist chiefly of MNT (medical nutrition therapy), physical activity, and lifestyle changes. A comprehensive approach to obesity treatment may give tangible results to quality of life and comorbidities.

Influence of Nitrosyl Iron Complex with Thiosulfate Ligands on Therapeutically Important Targets Related to Type 2 Diabetes Mellitus.

The high prevalence of type 2 diabetes mellitus (T2DM), and the lack of effective therapy, determine the need for new treatment options. The present study is focused on the NO-donors drug class as effective antidiabetic agents. Since numerous biological systems are involved in the pathogenesis and progression of T2DM, the most promising approach to the development of effective drugs for the treatment of T2DM is the search for pharmacologically active compounds that are selective for a number of therapeutic targets for T2DM and its complications: oxidative stress, non-enzymatic protein glycation, polyol pathway. The nitrosyl iron complex with thiosulfate ligands was studied in this work. Binuclear iron nitrosyl complexes are synthetic analogues of [2Fe-2S] centers in the regulatory protein natural reservoirs of NO. Due to their ability to release NO without additional activation under physiological conditions, these compounds are of considerable interest for the development of potential drugs. The present study explores the effects of tetranitrosyl iron complex with thiosulfate ligands (TNIC-ThS) on T2DM and its complications regarding therapeutic targets in vitro, as well as its ability to bind liposomal membrane, inhibit lipid peroxidation (LPO), and non-enzymatic glycation of bovine serum albumin (BSA), as well as aldose reductase, the enzyme that catalyzes the reduction in glucose to sorbitol in the polyol pathway. Using the fluorescent probe method, it has been shown that TNIC-ThS molecules interact with both hydrophilic and hydrophobic regions of model membranes. TNIC-ThS inhibits lipid peroxidation, exhibiting antiradical activity due to releasing NO (IC50 = 21.5 ± 3.7 µM). TNIC-ThS was found to show non-competitive inhibition of aldose reductase with Ki value of 5.25 × 10-4 M. In addition, TNIC-ThS was shown to be an effective inhibitor of the process of non-enzymatic protein glycation in vitro (IC50 = 47.4 ± 7.6 µM). Thus, TNIC-ThS may be considered to contribute significantly to the treatment of T2DM and diabetic complications.

γ‐glutamylcysteine alleviates insulin resistance and hepatic steatosis by regulating adenylate cyclase and IGF‐1R/IRS1/PI3K/Akt signaling pathways

Type 2 diabetes mellitus (T2DM), a complex metabolism disease, which was characterized by metabolic disorders including hyperglycemia, has become a major health problem due to the increasing prevalence worldwide. γ-glutamylcysteine (γ-GC) as an immediate precursor of glutathione (GSH) was originally used for the treatment of sepsis, inflammation bowel disease, and senescence. Here, we evaluated the capacity of γ-GC on diabetes-related metabolic parameters in db/db mice and insulin resistance (IR) amelioration in cells induced by palmitic acid (PA). Our data suggested that γ-GC treatment decreased body weight, reduced adipose tissue size, ameliorated ectopic fat deposition in liver, increased the GSH content in liver, improved glucose control and other diabetes-related metabolic parameters in vivo. Moreover, in vitro experiments showed that γ-GC could maintain the balance of free fatty acids (FFAs) and glucose uptake through regulating the translocation of CD36 and GLUT4 from cytoplasm to plasma membrane. Furthermore, our finding also provided evidence that γ-GC could activate Akt not only via adenylate cyclase (AC)/cAMP/PI3K signaling pathway, but also via IGF-1R/IRS1/PI3K signaling pathway to improve IR and hepatic steatosis. Blocking either of two signaling pathways could not activate Akt activation induced by γ-GC. This unique characteristic ensures the important role of γ-GC in glucose metabolism. Collectively, these results suggested that γ-GC could serve as a candidate dipeptide for the treatment of T2DM and related chronic diabetic complications via activating AC and IGF-1R/IRS1/PI3K/Akt signaling pathways to regulate CD36 and GLUT4 trafficking.