Control Of Blood Glucose Levels Research Articles

A Role of Sodium-Glucose Co-Transporter 2 in Cardiorenal Anemia Iron Deficiency Syndrome.

Heart failure, renal dysfunction, anemia, and iron deficiency affect each other and form a vicious cycle, a condition referred to as cardiorenal anemia iron deficiency syndrome. The presence of diabetes further accelerates this vicious cycle. Surprisingly, simply inhibiting sodium-glucose co-transporter 2 (SGLT2), which is expressed almost exclusively in the proximal tubular epithelial cells of the kidney, not only increases glucose excretion into the urine and effectively controls blood glucose levels in diabetes but can also correct the vicious cycle of cardiorenal anemia iron deficiency syndrome. This review describes how SGLT2 is involved in energy metabolism regulation, hemodynamics (i.e., circulating blood volume and sympathetic nervous system activity), erythropoiesis, iron bioavailability, and inflammatory set points in diabetes, heart failure, and renal dysfunction.

Exploring Edible Mushrooms for Diabetes: Unveiling Their Role in Prevention and Treatment.

Diabetes mellitus is a complex illness in which the body does not create enough insulin to control blood glucose levels. Worldwide, this disease is life-threatening and requires low-cost, side-effect-free medicine. Due to adverse effects, many synthetic hypoglycemic medications for diabetes fail. Mushrooms are known to contain natural bioactive components that may be anti-diabetic; thus, scientists are now targeting them. Mushroom extracts, which improve immune function and fight cancer, are becoming more popular. Mushroom-derived functional foods and dietary supplements can delay the onset of potentially fatal diseases and help treat pre-existing conditions, which leads to the successful prevention and treatment of type 2 diabetes, which is restricted to the breakdown of complex polysaccharides by pancreatic-amylase and the suppression of intestinal-glucosidase. Many mushroom species are particularly helpful in lowering blood glucose levels and alleviating diabetes symptoms. Hypoglycaemic effects have been observed in investigations on Agaricussu brufescens, Agaricus bisporus, Cordyceps sinensis, Inonotus obliqus, Coprinus comatus, Ganoderma lucidum, Phellinus linteus, Pleurotus spp., Poria cocos, and Sparassis crispa. For diabetics, edible mushrooms are high in protein, vitamins, and minerals and low in fat and cholesterol. The study found that bioactive metabolites isolated from mushrooms, such as polysaccharides, proteins, dietary fibers, and many pharmacologically active compounds, as well as solvent extracts of mushrooms with unknown metabolites, have anti-diabetic potential in vivo and in vitro, though few are in clinical trials.

Beneficial Synergistic Effect of Supplementation with Combined M. oleifera and L. speciosa Leaf Capsules in Patients with Type 2 Diabetes

Diabetes mellitus is a metabolic non-communicable chronic disease in which the body's ability to process glucose is impaired, resulting in higher blood glucose levels. If not controlled, this disease can lead to severe complications. Various plants with medicinal properties can treat chronic diseases, such as diabetes, due to therapeutically important phytochemicals and bioactive compounds. This study investigated the effect of antidiabetic medicinal plant leaves in controlling blood glucose levels among Wakhi diabetic patients in the Hunza district of Pakistan. The "Wakhis" are an ethnic group living in the remote region of Pakistan. The method used in this study was a placebo-controlled study. Leaf powders of Moringa oleifera and Lagerstroemia speciosa were filled in capsules of 1000 mg each. The antidiabetic potential of the medicinal plants was estimated by performing the biochemical blood profiles of diabetic patients before and after the trial. After the intervention, the level of glycated hemoglobin (HbA1c) reduced from 8.3±1.8 to 7.5±1.2% significantly (P = 0.0401). The fasting blood sugar (FBS) in the intervention group reduced significantly from 191±49 mg/dL to 169±41 mg/dL (P = 0.0041) after the trial. According to the findings of this study, the combined herbal capsules effectively controlled the blood sugar of type 2 diabetic patients. Conclusively, the combination of M. oleifera and L. speciosa have the potential to lower blood sugar levels supplementary to existing regimens. Further investigation is warranted to explore the mechanism resulting in the observed reduction in sugar levels in type 2 diabetic patients.

Designed multiple ligands for the treatment of type 2 diabetes mellitus and its complications: Discovery of (5-arylidene-4-oxo-2-thioxothiazolidin-3-yl)alkanoic acids active as novel dual-targeted PTP1B/AKR1B1 inhibitors

Type 2 diabetes mellitus (T2DM) is a serious chronic disease with an alarmingly growing worldwide prevalence. Current treatment of T2DM mainly relies on drug combinations in order to control blood glucose levels and consequently prevent the onset of hyperglycaemia-related complications. The development of multiple-targeted drugs recently emerged as an attractive alternative to drug combinations for the treatment of complex diseases with multifactorial pathogenesis, such as T2DM. Protein tyrosine phosphatase 1B (PTP1B) and aldose reductase (AKR1B1) are two enzymes crucially involved in the development of T2DM and its chronic complications and, therefore, dual inhibitors targeted to both these enzymes could provide novel agents for the treatment of this complex pathological condition. In continuing our search for dual-targeted PTP1B/AKR1B1 inhibitors, we designed new (5-arylidene-4-oxo-2-thioxothiazolidin-3-yl)alkanoic acids. Among them, 3-(4-phenylbutoxy)benzylidene derivatives 6f and 7f, endowed with interesting inhibitory activity against both targets, proved to control specific cellular pathways implicated in the development of T2DM and related complications.

Factors associated with poor glycemic control among adult patients with type 2 diabetes mellitus in Gamo and Gofa zone public hospitals, Southern Ethiopia: A case-control study.

Diabetes mellitus is a serious global public health problem that affects the whole life of people in terms of their biological, psychological, and social effects. Complications and death from diabetes occur from poorly controlled blood glucose levels. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess factors associated with poor glycemic control among type2 diabetes patients in public hospitals of Gamo and Gofa zone southern, Ethiopia, 2021. An institution-based unmatched case-control study was employed among 312 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identify factors associated with poor glycemic control using IBM SPSS version 25. The strength of association was assessed by using an Adjusted odds ratio (AOR) with a 95% confidence interval (CI). Factors associated with poor glycemic control based on multivariable analysis were, having comorbidity (AOR = 2.35, 95% CI (1.39-3.95)), adhering to dietary recommendations (AOR = 0.31, 95% CI (089-0.51)), poor social support (AOR = 3.31, 95% CI (1.59-6.85)), physical exercise (AOR = 1.86 95% CI (1.11-3.12)), and having poly-pharmacy (AOR = 2.83, 95% CI (1.39-5.74)). This study indicated a significant association of comorbidity, physical exercise, poly-pharmacy, low social support, and adherence to dietary recommendations with poor glycemic control. We suggest that the health care providers and concerned bodies encourage patients to have regular check-ups and work on providing necessary social support.

Tirzepatide: A Novel Glucose-Dependent Insulinotropic Polypeptide/Glucagon-Like Peptide 1 Receptor Agonist for the Treatment of Type 2 Diabetes: The First Twincretin.

Tirzepatide is a dual-action glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 (GLP-1) receptor agonist and the first drug in a new class known as twincretins. It is similar to GLP-1 receptor agonists but provides a synergistic enhancement of the incretin effect to control blood glucose levels and reduce weight. Across the SURPASS research program trials, tirzepatide lowered A1C by 1.7-2.4% from baseline. The proportion of patients using tirzepatide who achieved an A1C <7% ranged from 91 to 97%. Patients in the treatment groups averaged a weight loss of 5.44-11.34 kg (12-25 lb). Across all trials, patients on tirzepatide 15 mg lost 8.8-12.9 kg (19.4-28.44 lb) or 9.17-13.7% body weight. In the SURMOUNT-1 trial, maximum weight loss was 23.6 kg (52 lb) or 22.5% body weight. Tirzepatide is a potent new weapon in the arsenal against diabetes.

Evolution and Revolution-Our Changing Relationship With Insulin.

Type 2 diabetes is a progressive condition with a complex pathophysiology. Over time, additional therapies are needed to maintain glycemic control. It is well known that, by the time of diagnosis, beta cell function has already declined by 50% to 80%. When the body is no longer able to make enough insulin to control blood glucose levels, insulin replacement therapy is needed. However, barriers to initiation of insulin therapy are multifactorial and contribute to delays in treatment and consequent uncontrolled glycemia; this leads to an increased risk of disease complications. In this roundtable discussion, the authors review how people living with type 2 diabetes and their healthcare providers view the initiation of insulin. Other topics include the benefits of longer-acting basal insulin analogs compared with long-acting analogs. The authors emphasize the importance of early and positive conversations about insulin therapy, as well as the benefits of shared decision-making and the use of the wider medical team for the timely initiation of basal insulin therapy.

A Diversifiable Synthetic Platform for the Discovery of New Carbasugar SGLT2 Inhibitors Using Azide-Alkyne Click Chemistry.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are clinically available to control blood glucose levels in diabetic patients via an insulin-independent mechanism. It was found that some carbasugar analogs of known SGLT2 inhibitors exert a high inhibiting ability toward SGLT2 and have a prolonged blood glucose lowering effect. In this study, we designed new candidates of carbasugar SGLT2 inhibitor that can be synthesized using copper-catalyzed azide-alkyne cycloaddition (CuAAC) into an aromatic ring, which is a part of the pharmacophore at the final stage in the synthetic protocol for the easier discovery of superior SGLT2 inhibitors. Based on the results of molecular docking studies, some selected compounds have been synthesized. Evaluation of these compounds using a cell-based assay revealed that the majority of these compounds had SGLT2 inhibitory activity in a dose-dependent manner. The SGLT2 inhibitory activity of 7b and 7c was almost equal to that of SGLT2 inhibitors in current use. Furthermore, molecular dynamics simulations also revealed that 7c is a promising novel SGLT2 inhibitor.

Abstract P249: Moderate-to-Severe Depression Symptoms Are Associated With Poorly Controlled Glucose Levels in Persons With Type 2 Diabetes Mellitus

Objective: To investigate whether the severity of depression symptoms is associated with poor long-term control of plasma glucose levels in individuals with type 2 diabetes. Methods: Electronic health record [EHR] data of 2842 individuals with mental illness enrolled in the Penn State Clinical Assessment and Rating Evaluation System [PCARES] registry were used. Demographics, body mass index [BMI], baseline type 2 diabetes mellitus [T2DM] status and all available glucose labs were extracted from the EHR. The nine-item patient health questionnaire [PHQ-9] was used to determine baseline depression symptoms. PHQ-9 scores greater than/equal to 10 indicated moderate-to-severe depression symptoms, whereas scores less than 10 indicated none-to-mild depression symptoms. While the baseline glucose measurement had to be within ± 90 days of the baseline PHQ-9 date, longitudinal glucose measurements had to be on or after this date and within one year of the second follow-up glucose lab test date. Each glucose lab test had to be within one year of the preceding lab test. There were 917 individuals that met the criteria for baseline and follow-up glucose measurements and contributed to the effective study sample. Linear mixed-effects models were used to assess the association between baseline depression and changes in glucose levels, with a focus on persons with baseline diabetes. Results are reported as beta-coefficients (standard errors [SE]) and P -values. Results: The study sample included 917 individuals, with 65% females (596 of 917) and 85% (780 of 917) Non-Hispanic Caucasians. The mean (SD) age, PHQ-9 score, BMI, and glucose were 47.7 (16.9) years, 12.0 (7.1), 31.6 (8.6) Kg/m 2, and 115.9 (48.8) mg/dl, respectively. At baseline, 62.0% had moderate-to-severe depression (569 of 917), and 37.1% of persons had T2DM (341 of 917). Among individuals without T2DM, there was no association between the severity of depression symptoms and follow-up glucose levels with a beta (SE) of 1.1 (1.1) and P =0.32. Among persons with T2DM (N=341), there was an average increase in glucose levels by 2.8 (2.1) mg/dl, P =0.17, per year of follow-up. When stratified by the severity of depression symptoms, individuals with moderate-to-severe depression symptoms had a significant increase in glucose levels at 6.2 (2.7) mg/dl, P =0.02, per year of follow-up, indicative of poor control of blood glucose levels. Whereas, among persons with none-to-mild depression symptoms, blood glucose levels showed a non-significant decline at 2.6 (3.4) mg/dl, P =0.45, per year of follow-up. Conclusions: In this clinic-based sample of persons with mental illness, moderate-to-severe depression symptoms were associated with significantly increasing blood glucose levels among persons with co-morbid T2DM. Our findings underscore integrated physical and mental healthcare services and routine depression screening among persons with diabetes.

Molecular Changes in Cells of Patients with Type 2 Diabetes Mellitus Depending on Changes in Glycemia Level in the Context of Lifestyle-An Overview of the Latest Scientific Discoveries.

Diabetes mellitus is a significant health problem for medicine and economics. In 80-90% of cases, it is type 2 diabetes (T2DM). An essential aspect for people with T2DM is to control blood glucose levels and avoid significant deviations. Modifiable and non-modifiable factors influence the incidence of hyperglycemia and, sometimes, hypoglycemia. The lifestyle modifiable factors are body mass, smoking, physical activity, and diet. These affect the level of glycemia and impact molecular changes. Molecular changes affect the cell's primary function, and understanding them will improve our understanding of T2DM. These changes may become a therapeutic target for future therapy of type 2 diabetes, contributing to increasing the effectiveness of treatment. In addition, the influence of external factors (e.g., activity, diet) on each domain of molecular characterization has gained importance towards a better understanding of their role in prevention. In the current review, we aimed to collect scientific reports on the latest research about modifiable factors connected with the style of life which affect the glycemic level in the context of molecular discoveries.

Detailed study on Costus igneus plant for its medicinal importance - A Review

A medicinal shrub called Costus Igneus may have a miraculous treatment for diabetes. The leaf of this medicinal plant, which is a member of the Costaceae family, strengthens the beta cells in the pancreas, which helps the body produce more insulin. This is why it is known as the "Insulin Plant" in India. There is a strong belief that eating the leaves of this plant can control blood glucose levels and diabetics, according to earlier research. For antidiabetic activities, the experts have used various extracts from plant parts or specific phytochemicals. This review provides the scholar with information on numerous activities on various diseases in addition to just antidiabetic activities

Socioeconomic inequality in awareness, treatment and control of diabetes among adults in India: Evidence from National Family Health Survey of India (NFHS), 2019–2021

Diabetes is a growing epidemic and a major threat to most of the households in India. Yet, there is little evidence on the extent of awareness, treatment, and control (ATC) among adults in the country. In this study, we estimate the prevalence and ATC of diabetes among adults across various sociodemographic groups and states of India. We used data on 2,078,315 individuals aged 15 years and over from the recent fifth round, the most recent one, of the National Family Health Survey (NFHS-5), 2019–2021, that was carried out across all the states of India. Diabetic individuals were identified as those who had random blood glucose above 140 mg/dL or were taking diabetes medication or has doctor-diagnosed diabetes. Diabetic individuals who reported diagnosis were labelled as aware, those who reported taking medication for controlling blood glucose levels were labelled as treated and those whose blood glucose levels were < 140 mg/dL were labelled as controlled. The estimates of prevalence of diabetes, and ATC were age-sex adjusted and disaggregated by household wealth quintile, education, age, sex, urban–rural residence, caste, religion, marital status, household size, and state. Concentration index was used to quantify socioeconomic inequalities and multivariable logistic regression was used to estimate the adjusted differences in those outcomes. We estimated diabetes prevalence to be 16.1% (15.9–16.1%). Among those with diabetes, 27.5% (27.1–27.9%) were aware, 21.5% (21.1–21.7%) were taking treatment and 7% (6.8–7.1%) had their diabetes under control. Across the states of India, the adjusted rates of awareness varied from 14.4% (12.1–16.8%) to 54.4% (40.3–68.4%), of treatment from 9.3% (7.5–11.1%) to 41.2% (39.9–42.6%), and of control from 2.7% (1.6–3.7%) to 11.9% (9.7–14.0%). The age-sex adjusted rates were lower (p < 0.001) among the poorer and less educated individuals as well as among males, residents of rural areas, and those from the socially backward groups Among individuals with diabetes, the richest fifth were respectively 12.4 percentage points (pp) (11.3–13.4; p < 0.001), 10.5 pp (9.7–11.4; p < 0.001), and 2.3 pp (1.6–3.0; p < 0.001) more likely to be aware, getting treated, and having diabetes under control, than the poorest fifth. The concentration indices of ATC were 0.089 (0.085–0.092), 0.083 (0.079–0.085) and 0.017 (0.015–0.018) respectively. Overall, the ATC of diabetes is low in India. It is especially low the poorer and the less educated individuals. Targeted interventions and management can reduce the diabetes burden in India.

Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study

BackgroundThe optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG.MethodA total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not.ResultsA total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18–4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01–3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12–2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17–2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02).ConclusionsAfter On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.

Enhanced Endosomal Signaling and Desensitization of GLP-1R vs GIPR in Pancreatic Beta Cells.

The incretin receptors, glucagon-like peptide-1 receptor (GLP-1R) and glucose-dependent insulinotropic polypeptide receptor (GIPR), are prime therapeutic targets for the treatment of type 2 diabetes (T2D) and obesity. They are expressed in pancreatic beta cells where they potentiate insulin release in response to food intake. Despite GIP being the main incretin in healthy individuals, GLP-1R has been favored as a therapeutic target due to blunted GIPR responses in T2D patients and conflicting effects of GIPR agonists and antagonists in improving glucose tolerance and preventing weight gain. There is, however, a recently renewed interest in GIPR biology, following the realization that GIPR responses can be restored after an initial period of blood glucose normalization and the recent development of dual GLP-1R/GIPR agonists with superior capacity for controlling blood glucose levels and weight. The importance of GLP-1R trafficking and subcellular signaling in the control of receptor outputs is well established, but little is known about the pattern of spatiotemporal signaling from the GIPR in beta cells. Here, we have directly compared surface expression, trafficking, and signaling characteristics of both incretin receptors in pancreatic beta cells to identify potential differences that might underlie distinct pharmacological responses associated with each receptor. Our results indicate increased cell surface levels, internalization, degradation, and endosomal vs plasma membrane activity for the GLP-1R, while the GIPR is instead associated with increased plasma membrane recycling, reduced desensitization, and enhanced downstream signal amplification. These differences might have potential implications for the capacity of each incretin receptor to control beta cell function.

Prevalence of anemia and its predictors among patients with chronic kidney disease admitted to a teaching hospital in Ethiopia: A hospital-based cross-sectional study.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with adverse patient outcomes. However, data on the prevalence of anemia in CKD patients is sparse, particularly in resource-limited settings. Therefore, this study aimed to assess the prevalence of anemia and its predictors among patients with CKD admitted to the Jimma medical center, southwest Ethiopia. A hospital-based prospective cross-sectional study was conducted from September 1 to November 30, 2020. All adult patients with CKD aged ≥18 years who fulfilled the inclusion criteria were consecutively recruited into the study. Data were entered into the Epi data manager version 4.4.1 and then exported to SPSS version 22 (IBM Corp., Armonk, NY) for analysis. The predictors of anemia were determined using multivariable logistic regression analysis. Statistical significance was set at P < .05. A total of 150 patients were included in this study. Of these, 64.67% were male, 56.67% had stage 5 CKD, 78% had a CKD duration of less than 1 year, and 74% had proteinuria. Hypertension (40.7%) and diabetes (14.7%) were the common causes of CKD. The prevalence of anemia was 85.33%. Of the patients, 28.67%, 40.67%, and 16% had mild, moderate, and severe anemia, respectively. On multivariate logistic regression, stage 4 CKD (adjusted odds ratio [AOR] 3.2, confidence interval [CI]: 1.78-12.91, P = .025), stage 5 CKD (AOR 4.03, CI: 1.17-13.73, P = .016), and CKD duration of less than 1 year (AOR 3, CI: 1.19-9.11, P = .007) were significantly associated with anemia. The prevalence of anemia among stage 3 to 5 CKD patients was very high. Anemia was significantly associated with the severity and duration of CKD. Therefore, serial follow-up of patients with a long duration and advanced stages of CKD may help prevent anemia and its adverse consequences.

Acanthopanax trifoliatus (L.) Merr polysaccharides ameliorates hyperglycemia by regulating hepatic glycogen metabolism in type 2 diabetic mice.

Drug monotherapy was inadequate in controlling blood glucose levels and other comorbidities. An agent that selectively tunes multiple targets was regarded as a new therapeutic strategy for type 2 diabetes. Acanthopanax trifoliatus (L.) Merr polysaccharide (ATMP) is a bio-macromolecule isolated from Acanthopanax trifoliatus (L.) Merr and has therapeutic potential for diabetes management due to its anti-hyperglycemia activity. Type 2 diabetes mellitus was induced in mice using streptozotocin, and 40 and 80 mg/kg ATMP was administered daily via the intragastric route for 8 weeks. Food intake, water intake, and body weight were recorded. The fasting blood glucose (FBG), fasting insulin (FINS) and an oral glucose tolerance test (OGTT) were performed. Histological changes in the liver and pancreas were analyzed by H&E staining. The mRNA and the protein levels of key factors involved in glycogen synthesis, glycogenolysis, and gluconeogenesis were measured by quantitative real time PCR and Western blotting. In this study, we found that ATMP could effectively improve glucose tolerance and alleviate insulin resistance by promoting insulin secretion and inhibiting glucagon secretion. In addition, ATMP decreases glycogen synthesis by inhibiting PI3K/Akt/GSK3β signaling, reduces glycogenolysis via suppressing cAMP/PKA signaling, and suppresses liver gluconeogenesis by activating AMPK signaling. Together, ATMP has the potential to be developed as a new multitargets therapeutics for type 2 diabetes.

Insulin modulates the free energy landscape of insulin degrading enzyme as it transitions between closed and open states.

Insulin Degrading Enzyme (IDE) is an enzyme that has been linked to type-2 diabetes mellitus as it degrades molecules responsible for controlling blood glucose level including insulin, amylin, and glucagon. It is also responsible for degrading amyloid beta, the main component of the amyloid plaques found in the brains of people with Alzheimer's disease. IDE transitions between open and closed conformations in the process of degrading insulin, however the exact mechanism of these conformational changes is not fully understood. We ran two sets of molecular dynamics simulations following the string method with swarms of trajectories and bias exchange umbrella sampling protocols in order to produce a physical pathway for IDE transitioning between closed and open states and to investigate the effect of insulin on this conformational change. We observed a free energy barrier between the closed and open conformations of the insulin-free system that could be attributed to the breakage of the ASP426-LYS571, ASP82-LYS243 and GLU428-LYS899 salt bridges that connect the D2 and D3 domains of IDE. The insulin-bound system had a considerable change in the shape of the free energy landscape where the transition energy barrier was lowered. Additionally, insulin stabilized the open state conformation of IDE by lowering its free energy. We observed the formation of three salt bridges in the insulin-bound system that were not present in the insulin-free system. Dynamical Network and Principal Component Analyses of our trajectories provided intuition as to how the different clusters of atoms within IDE interact with each other and with insulin, and how these interactions contribute to the overall conformational change. In particular, the first domain of IDE (shown experimentally to be important in insulin degradation) was divided into two dynamical subdomains.

Implementasi Terapi Relaksasi Otot Progresif Untuk Mengatasi Ketidakstabilan Kadar Glukosa Darah

Background of StudyDiabetes mellitus (DM) is a collection of symptoms in a person caused by an increase in blood glucose levels due to a progressive decrease in insulin secretion by insulin resistance. Non-pharmacological therapy that can be used for patients with diabetes mellitus in controlling blood glucose levels is one of them with progressive muscle relaxation therapyMethods : The writing of this scientific paper uses a descriptive method in the form of a study. Sampling was carried out using a purposive sampling technique with a sample of 1 personResults : A case study conducted on Bp. S with a diagnosis of diabetes mellitus and the main symptoms that appear are body weakness, headache and GDS 784mg/dL. The results showed that progressive muscle relaxation therapy was carried out for two days twice a day, on the first day before the intervention, blood glucose levels were 278mg/dL and after blood glucose levels were 277mg/dL, on the second day before the intervention, blood glucose levels were 299mg. /dL after intervention blood glucose levels 290mg/dL.Conclusion : This case study shows that progressive muscle relaxation in patients with diabetes mellitus can reduce blood glucose levels.Keywords : Progressive Muscle Relaxation, Diabetes Mellitus, Blood Glucose Level

Effectiveness of multidisciplinary intervention for gestational diabetes mellitus.

To explore the effectiveness of multidisciplinary intervention for patients with gestational diabetes mellitus (GDM). A total of 126 patients diagnosed with GDM from January 2020 to December 2021 in our hospital were enrolled in this retrospective study. Patients were divided into the control group (conventional treatment) and the study group (adding multidisciplinary intervention). Glucose index, self-management ability, psychological status, and delivery outcomes were evaluated. Fasting plasma glucose (4.32 ± 0.81 mmol/L), glycosylated hemoglobin (5.47 ± 1.09%), and postprandial blood glucose (6.02 ± 1.47 mmol/L) after intervention in study group were significantly lower than those in control group (p < 0.05), as well as those before intervention (p < 0.05). The score of GDM knowledge (38.03 ± 2.76), self-management (38.93 ± 2.32), social support (17.84 ± 1.23), and belief (17.93 ± 1.09) were all significantly higher than those of control group (p < 0.05), as well as those before intervention (p < 0.05). Besides, anxiety (7.83 ± 1.59) and depression (10.29 ± 1.82) evaluation scores showed that emotional relief were significantly achieved after intervention in study group compared with control group (p < 0.05). Moreover, the incidence of postpartum hemorrhage, cesarean delivery, premature delivery, macrosomia, and neonatal hypoglycemia was also significantly improved after intervention in study group compared with control group (p < 0.05). Multidisciplinary intervention can effectively control blood glucose levels, adjust self-management behavior, relieve psychological disorder, reduce complications, and improve delivery outcomes of GDM patients.

Blood Glucose Level and Pancreas Histological Section of Male Rabbits after Being Fed Commercial Feed Supplemented with Cod Liver Oil

Fish oil contains eicosapentaenoic acid (E.P.A.) and docosahexaenoic acid (D.H.A.) which are beneficial for heart health, controlling blood glucose, reducing atherosclerosis, and lowering the risk of cancer. This study aims to determine the effect of commercial feed supplemented with cod liver oil on blood glucose levels and pancreatic histology of male rabbits. Twenty rabbits were divided into four groups, namely commercial feed supplemented with cod liver oil 3% (P1), 4.5% (P2), 6% (P3), and commercial feed without cod liver oil supplementation (control). Each group consisted of five rabbits, and the treatment was given for four weeks. The parameters observed were blood glucose levels in the 1st, 2nd, 3rd, 4th, and 5th weeks and the histology of the male rabbits’ pancreas. Data were analyzed by Anova. The results showed that in the 1st, 2nd, and 3rd weeks there was no significant difference (P&gt;0.05). In contrast, in the 4th and 5th weeks, there was a significant difference (P&lt;0.05) between the control and treatment of cod liver oil supplementation on blood glucose levels in male rabbits, and the observational results on the histology of rabbits showed normal pancreatic histology. In conclusion, cod liver oil supplementation on commercial feed controlled blood glucose levels, and there was no disturbance in the histological structure of the pancreas of male rabbits.Keywords: fatty acid, glucose, cod liver oil, pancreas, rabbit