Type 2 Diabetes Mellitus Control Research Articles

Evaluation of biologic implant success parameters in type 2 diabetic glycemic control patients versus health patients: A meta-analysis.

The aim of the present systematic literature review was to evaluate bleeding on probing (BOP), pocket depth (PD), and marginal bone loss (MBL) in type 2 diabetes mellitus (T2DM) control patients. An electronic literature search was conducted through PubMed, Web of Science, Cochrane, Embase, and ScienceDirect. The search included prospective human clinical studies that analyzed the success of dental implants in T2DM control patients. For inclusion, studies should have had a minimum of 1-year follow up and should have assessed the following parameters: MBL, BOP and PD. Prior to meta-analysis, all of the studies were assessed for quality, bias, and heterogeneity. Risk of bias analysis indicated that all studies were of moderate quality. After a full-text evaluation, only seven studies met the inclusion criteria for this meta-analysis, with a combined total of 443 patients and 530 dental implants. The meta-analysis indicated a statistically significant difference between parameters of implants placed in the glycemic-controlled group and healthy group in MBL (P<.001), BOP (P<.04), and PD (P<.001). The results of the present study indicated that, despite being glycemic controlled, patients with T2DM were associated with a higher risk of peri-implant disease.

Glucagon-like peptide 1 receptor agonists in type 1 diabetes mellitus.

The role of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the treatment of type 1 diabetes mellitus (T1DM), including efficacy and safety evidence, is reviewed. Currently approved treatment options for glycemic control in T1DM include insulin, which combats insulin deficiency but does not effectively target disease progression or alpha cell dysfunction; and pramlintide, whose use requires multiple daily doses and involves a high likelihood of gastrointestinal side effects. GLP-1 RAs have a unique mechanism of action in T1DM, addressing alpha cell dysfunction and thereby suppressing inappropriate glucagon secretion. GLP-1 RA dosing varies from once weekly to twice daily, and the class is well tolerated in patients with type 2 diabetes. Among the GLP-1 RAs, exenatide and liraglutide have been studied in patients with T1DM, with published evidence consistently demonstrating weight loss, decreases in total daily insulin requirements, and modest improvements in glycemic control. GLP-1 RA therapy appears to be well tolerated in patients with T1DM and is associated with nonsignificant increases in hypoglycemia risk. GLP-1 RA therapy represents an important add-on therapy option for achieving decreased insulin doses, weight loss, and modest improvements in HbA1c levels without significantly increasing hypoglycemia risk in patients with T1DM. Patients who have detectable C-peptide and/or are overweight or cannot achieve glycemic goals without hypoglycemia have been found to benefit the most from GLP-1 RA therapy. Further studies are warranted to evaluate these agents' potential impact on clinical outcomes such as microvascular and macrovascular complications.

Thyroid Dysfunction and Type 2 Diabetes Mellitus: Screening Strategies and Implications for Management.

Diabetes mellitus (DM) and thyroid dysfunction (TD) often tend to coexist in patients. Both hypothyroidism and hyperthyroidism are more common in type 2 diabetes mellitus (T2DM) patients than in their nondiabetic counterparts. Current guidelines are neither clear nor specific about the frequency of thyroid function monitoring in T2DM patients. Circulating thyroid hormones affect several different organs and cells, have a major impact on glucose, lipid, and protein metabolism, and can worsen glycaemic control in T2DM. Hyperthyroidism and thyrotoxicosis can worsen subclinical DM and cause hyperglycaemia in T2DM patients, increasing the risk of diabetic complications. T2DM reduces thyroid-stimulating hormone levels and impairs the conversion of thyroxine (T4) to triiodothyronine (T3) in the peripheral tissues. Poorly managed T2DM can lead to insulin resistance and hyperinsulinaemia, which causes thyroid tissue proliferation and increases nodule formation and goitre size. In addition, while metformin can be beneficial in both T2DM and TD patients, other antidiabetics such as sulfonylureas, pioglitazone, and thiazolidinediones can negatively impact TD. Antithyroid drugs such as methimazole can impair glycaemic control in T2DM patients. Thyrovigilance in T2DM patients and diabetovigilance in TD patients may therefore be necessary to facilitate individualized care and management.Funding: Abbott India Ltd.

Impact of hyperglycaemia on molecular markers of oxidative stress and antioxidants in type 2 diabetes mellitus

Introduction. The pathogenesis of type 2 diabetes mel­litus (T2DM) is strongly linked to oxidative stress mainly caused by chronic hyperglycaemia. The present study investigates the association between hyperglycaemia with oxidative stress markers, antioxidants and lipid profile. Materials and methods. The case-control study in­volved two groups, T2DM patients (n = 83) and age and sex matched controls (n = 81). Serum levels of various molecular markers malondialdehyde (MDA), reactive oxygen species (ROS) and nitric oxide (NO), su­peroxide dismutase (SOD), catalase (CAT), glutathione (GSH), vitamin C, total antioxidant capacity (TAC) and lipid parameters total cholesterol, triglycerides, low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured using spectrophotometric as­says. Results were analysed to compare and correlate glycaemic levels with these molecular markers. Results. T2DM patients had a higher body mass index (BMI) and body fat percentage. 2 hour blood glucose, glycated haemoglobin A1c % (HbA1c), total cholesterol, triglycerides and LDL were higher in diabetics, HDL was found to be lower in diabetics than in controls. Mean levels of enzymatic and non-enzymatic antioxi­dants SOD, CAT, GSH, vitamin C and TAC were signifi­cantly lower while oxidative stress markers NO, ROS and MDA were higher in T2DM patients. NO showed a positive correlation (r = 0.3993, p < 0.0001) whereas TAC showed a negative correlation with glycaemia (r = –0.4796, p < 0.0001). Conclusions. Poor glycaemic control in T2DM causes elevated ROS and NO levels with increased lipid peroxi­dation and lowered antioxidant capacity. MDA and NO being the major risk factors could be used as a param­eter along with antioxidants to assess oxidative stress in T2DM patients.

Clinical improvement of diabetes mellitus type 1 by b-D-mannuronic acid (M2000) in a breast cancer patient — as a case report

A 56 years old female with breast cancer (BC) and poor controlled diabetes mellitus type 1 (DM1) which has registered in a clinical trial for assessment of thera­peutic efficacy of b-D-mannuronic acid (M2000) on pre-surgical BC patients is described in this case report. After receiving M2000, the patient was followed for 9 weeks. During this period, cancer mass details, fast­ing blood glucose (FBG) levels, 2-hour post-prandial blood glucose (2HPP), blood uric acid (BUA) level and urine analysis (UA) were continuously controlled. After 9 weeks of treatment with M2000, her FBG, BUA and UA decreased significantly. This finding was exactly in accordance with our published experimental data about the anti-diabetic effect of M2000 in an animal model. Therefore, it might be concluded that M2000 is probably able to improve DM1 by reducing FBG level, BUA level, glycosuria, ketonuria and proteinuria.

The Role of Zinc and Copper in Insulin Resistance and Diabetes Mellitus.

The prevalence of Type 2 Diabetes Mellitus (T2DM) is internationally ever-growing. Therefore, prevention, diagnostics, and control of insulin resistance and T2DM are of increasing importance. It has been suggested that mechanisms leading to insulin resistance and diabetes and its complications include high intake of refined and energy-rich food, which is presumed to be accompanied by suboptimal intake of trace elements, such as Zinc (Zn), Selenium (Se), Chromium (Cr), and Copper (Cu), which are essential and crucial for various biological processes. The purpose of this review is to highlight the role of Zn, Se, and Cu in T2DM. Diabetes seems prevalent when Zn, Se, and Cu are deficient, which may result from excessive intake of refined food. The literature search was conducted in PubMed and Scopus, supplemented with the reference lists of relevant articles and a Google Scholar search. We critically assessed all relevant citations, both review and research papers in English. The search terms that were used included Zn, Cu, diabetes, and diabetes mellitus. Research has shown that Zn, Se and Cu are involved in the pathogenesis of diabetes, but these trace elements can in excessive amounts be toxic. Zinc appears to activate key molecules that are involved in cell signaling, which maintain the homeostasis of glucose. Zinc also regulates insulin receptors, prolong the action of insulin, and promote healthy lipid profiles. Copper in excess can create oxidative stress, which is a factor in the onset and the progression of T2DM. Abnormal Zn and Cu metabolism appears to accompany and may also cause diabetes complications.

The Effects of Combined High-Intensity Interval and Resistance Training on Glycemic Control and Oxidative Stress in T2DM

Background: As part of type 2 diabetes mellitus (T2DM) lifestyle management, exercise programs must be demonstrably effective and safe. Objectives: A randomized controlled trial (RCT) was used to evaluate the results of glycemic control and oxidative stress of a new T2DM management exercise program in a training facility setting. Methods: The study participants were randomly allocated into either an experimental (EXP) group who participated in the new training program or a control (CTR) group who participated in continuous cardiorespiratory exercise. Each participant’s glycemic control (glycated hemoglobin A, HbA1c), fitness level (maximum oxygen uptake, VO2max), and oxidative stress (malondialdehyde, MDA and superoxide dismutase, SOD) were measured before and after the training program. The 12-week training program combined high-intensity interval training (HIIT) three times a week with resistance training (RT) twice a week while gradually increasing the intensity. The HIIT element was comprised of one minute of high-intensity exercise and four minutes of low-intensity exercise. The RT element was comprised of nine exercises for the core, upper extremities, and lower extremities. Results: The 42 T2DM patients who participated in this RCT were 35 - 64 years old. The HbA1c level of the EXP group decreased (Δ = -0.43 ± 1.01%), although not significantly. The VO2max was higher in the EXP group (38.13 ± 5.93 mL/kg/min) than in the CTR group (32.09 ± 5.24 mL/kg/min, P = 0.004). The overall oxidative stress decreased in the EXP group (MDA level Δ = -0.14 ± 0.39 nm/mL) when compared to the CTR group (MDA level Δ = 0.18 ± 0.26 nm/mL, P = 0.011), and the SOD level significantly increased more in the EXP group [median Δ = 0.47 U/mL (interquartile range = 0.08 - 0.74 U/mL)] when compared to the CTR group (Δ = 0.14 ± 0.35 U/mL, P = 0.036). The EXP group’s composite effects score was significantly higher (8.72 ± 1.27) than the CTR group’s score (7.20 ± 1.08, P = 0.001). Conclusions: The combined HIIT and RT exercise program was not significantly improving glycemic control, however it lowered oxidative stress.

Association between the UBE2Z rs46522 and TCF7L2 rs7903146 polymorphisms with type 2 diabetes in south western Iran.

Transcription factor 7-like 2 Protein (TCF7L2) has a strong role in the pathogenesis of type 2 diabetes mellitus (T2DM). Association between rs7903146 and T2D risk reported in some of populations. Also many loci such as UBE2Z rs46522 are affecting by TCF7L2 transcription factor have been found associated with T2D. The present study aimed to evaluate association of the SNPs with risk of T2D among our population. This case-control study was conducted on 150 T2D patients and 150 healthy people (as a control group) in south western Iran. Genotyping was performed by PCR-RFLP. The frequency of genotypes showed no remarkable difference between T2DM patients and control group. The odds ratios of rs7903146 (C/T) polymorphism for CC and TC genotypes were 1.9 (95% CI, 0.85 to 4.24; P=0.12) and 0.81 (95% CI, 0.47 to 1.38; P=0.43) compared with the TT genotype, respectively. The odds ratios of rs46522 (C/T) polymorphism for TT and TC genotypes were 1.75 (95% CI, 0.86 to 3.59; P=0.13) and 1.38 (95% CI, 0.81to 2.35; P=0.24) compared with the CC genotype, respectively. Our study indicates no association of T2D in south western Iran with the rs7903146 and rs46522 variants.

Study of type 2 diabetes management among patients in a Macau primary care setting

In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and...

Evaluation of Female Sexual Function in Persons With Type 2 Diabetes Mellitus Seen in a Tertiary Hospital in Southeast Nigeria With Emphasis on its Frequency and Predictors

Women with diabetes are at increased risk of sexual problems. However, this problem is underreported; hence, the need for this study. This was a cross sectional case-controlled study. Seventy-five consenting females with type 2 diabetes mellitus (T2DM) were enrolled from the Diabetes Clinic of the Federal Medical Center, Umuahia, while 75 persons, which included hospital workers and female companions of subjects, were recruited as a control group. Sexual dysfunction in both groups was diagnosed and characterized using the female sexual function index (FSFI). Data obtained from this study was presented as Mean ± SD and analyzed using SPSS 17 software. The mean age of the T2DM group and control were 44.5 years and 38.9 years, respectively. The mean total female sexual score was 22.10 ± 6.66 in the T2DM subjects, while in the control subjects it was 22.43 ± 5.29. This was not statistically significant. The FSFI scores in the desire, lubrication, and orgasm domains were all lower in the diabetic women and this was statistically significant (p < 0.05). The domains of pain and arousal were also lower in the diabetic women, although this was not statistically significant (p > 0.05). The proportion of diabetic females who reported problems in the arousal, lubrication, orgasm, and pain domains was higher (40.0, 36.4, 32.7, 29.1) than the controls (27.9, 16.2, 14.7, 19.1; p < 0.05). The prevalence of female sexual dysfunction in our study was high. Similarly, the FSFI score was low in women with diabetes when compared with controls. The domains of arousal, pain, orgasm, and satisfaction were the most affected in subjects with DM. Age, marital status, body mass index, fasting blood sugar, and hypertension were predictive of sexual dysfunction in the diabetic women.

Improvement in fasting blood sugar, anthropometric measurement and hs-CRP after consumption of epigallocatechin-3-gallate (EGCG) in patients with type 2 diabetes mellitus

Purpose The epigallocatechin gallate (EGCG) effect in diabetes has been investigated in animal studies, but results of clinical trials are inconsistent. Thus, this study aims to evaluate the effects of EGCG supplementation in patients with type 2 diabetes mellitus (T2DM). Design/methodology/approach A total of 50 patients with T2DM were recruited in a double-blind, randomized, placebo-controlled trial. The eligible participants were randomly allocated to EGCG (n = 25) and placebo (n = 25) groups. The EGCG group received two capsules of EGCG (each capsule contained 150 mg; Shari Made®, Iran) and placebo group was administered two capsules of placebo (starch) for eight weeks. A three-day 24-h dietary recall and anthropometric and laboratory measurements were carried out at the beginning and the end of the study. Findings At the end of the trial, weight and body mass index (BMI) were decreased significantly in both groups, but the reduction was not statistically significant between the two groups. Fasting blood sugar decreased significantly in EGCG group. No significant between-group and within-group differences were found in insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index values. The high-sensitive C-reactive protein (hs-CRP) was significantly reduced in the EGCG group (4.13 ± 0.48-3.93 ± 0.50, p = 0.003) compared to baseline. Originality/value This study showed that consuming 300 mg/day of EGCG for eight weeks in patients with T2DM caused a significant decrease in fasting blood glucose, body weight, BMI and hs-CRP compared to baseline. Therefore, the EGCG supplementation may improve glycemic control, anthropometric and inflammation status in T2DM.

Type 2 diabetes causes skeletal muscle atrophy but does not impair resistance training-mediated myonuclear accretion and muscle mass gain in rats.

New Findings What is the central question of this study? Type 2 diabetes mellitus (T2DM) causes skeletal muscle atrophy; does it affect resistance training (RT)‐mediated molecular adaptations and subsequent muscle hypertrophy? What is the main finding and its importance? Although skeletal muscle mass and regulation were not preserved under conditions of T2DM, the response of RT‐induced skeletal muscle hypertrophy was not impaired in T2DM rat skeletal muscle. These findings suggest that the capacity of RT‐mediated muscle mass gain is not diminished in the T2DM condition. Type 2 diabetes mellitus (T2DM) is known to cause skeletal muscle atrophy. However, it is not known whether T2DM affects resistance training (RT)‐mediated molecular adaptations and subsequent muscle hypertrophy. Therefore, we investigated the effect of T2DM on response of skeletal muscle hypertrophy to chronic RT using a rat resistance exercise mimetic model. T2DM and healthy control rats were subjected to 18 bouts (3 times per week) of chronic RT on unilateral lower legs. RT significantly increased gastrocnemius muscle mass and myonuclei in both T2DM and healthy control rats to the same extent, even though T2DM caused muscle atrophy in the resting condition. Further, T2DM significantly reduced mechanistic target of rapamycin complex 1 (mTORC1) activity (phosphorylation of p70S6KThr389 and 4E‐BP1Thr37/46) to insulin stimulation and the number of myonuclei in the untrained basal condition, but RT‐mediated adaptations were not affected by T2DM. These findings suggested that although the skeletal muscle mass and regulation were not preserved under basal conditions of T2DM, the response of RT‐induced skeletal muscle hypertrophy was not impaired in T2DM rat skeletal muscle.

MAXIMAL FAT OXIDATION DURING AEROBIC EXERCISE IN ADOLESCENTS WITH TYPE 1 DIABETES

ABSTRACT Objective: To compare maximal fat oxidation rates (FATMAX) and analyze their association with cardiorespiratory fitness in adolescents with type 1 diabetes mellitus (T1DM). Methods: Twenty-two male and female adolescents aged between 11 to 17 years, following clinical and anthropometric evaluations, were assigned to the diabetic group (DG; n = 10) or control group (CG; n = 12). Cardiorespiratory fitness was determined by maximal oxygen uptake (VO2max) during a maximal aerobic test on a cycle ergometer using the Balke protocol. Maximal fat oxidation (FATMAX) was determined by the respiratory exchange ratio proposed in the Lusk table. Results: Adolescents in the DG had lower mean FATMAX (p&lt;0.01) and %VO2FATMAX (p=0.001) values when compared with those in the CG. FATMAX values were inversely correlated with serum glycosylated hemoglobin (HbA1c) levels (r= −0.77) and directly correlated with BMI z-scores (r=0.76), while %VO2FATMAX results were correlated with age (r=0.81), BMI z-scores (r=0.65), and VO2max values (r=0.81). On multiple linear regression, HbA1c values explained 54% (adjusted r²=0.54, p=0.009) and BMI z-scores explained 3.1% (adjusted r²=-0.031, p=0.009) of the variation in FATMAX in the DG. Adolescents with T1DM had similar cardiorespiratory fitness and lower FATMAX rates (35±11 VO2max) when compared with controls (60±12 VO2max). Conclusion: These results suggest lower fat oxidation rates and greater use of glucose as an energy substrate during exercise and worse control in T1DM. Therefore, results may contribute to appropriate exercise prescription in T1DM, after verifying exercise intensity to reduce hypoglycemia risk. Level of evidence III; Case-control study.

Postoperative Healing after Endodontic Treatment of Teeth with Apical Periodontitis in Controlled diabetic Patients: A Cohort Prospective Study

Aim: The purpose of the study was to assess whether postoperative periapical healing of apical periodontitis & postoperative pain differ in patients with controlled diabetes type 2 compared to diabetes-free patients after receiving one-visit root canal treatment. Subjects and Methods: in a cohort prospective study, Forty six necrotic mature teeth with apical periodontitis of patients 18-60 years old were divided into 2 groups. A) Control group diabetic free patients B) Diabetic group who suffered from controlled diabetes mellitus type 2. Protaper files were used for mechanical preparation together with sodium hypochlorite irrigation and EDTA as a final flush. All procedures were done in single visit; follow-up was done up to 12 months using standardized digital radiographs. Results: preoperative swelling was significantly greater in diabetic group (P=0.047). Also, duration of session was significantly greater in diabetic group (p=0.016). In addition, there was a significantly greater postoperative pain incidence after 12 hours in diabetic group (P=0.027). While, no difference was found regarding postoperative healing at different follow up intervals in both groups. Conclusion: Generally necrotic teeth with periapical periodontitis were successfully treated regarding the healing of the periapical lesions. Single visit endodontic treatment of necrotic teeth with apical peridontitis, could be successfully done in controlled diabetic patients.

Influence of Supervised Disease Understanding and Diabetes Self-Management on Adherence to Oral Glucose-Lowering Treatment in Patients with Type 2 Diabetes.

IntroductionSystematic patient education has been reported to improve adherence to treatment, leading to better clinical outcomes. This cluster randomized real-world study investigated the effect of a systematic education program and telephone support on self-reported adherence to oral glucose-lowering treatment in patients with type 2 diabetes mellitus (T2DM).MethodsCenters were randomized (1:1) to provide either standard-of-care (control group) or standard-of-care along with the education program and telephone support (empowerment group). Adherence to treatment and satisfaction with treatment were assessed using the four-item Morisky Medication Adherence Scale (MMAS-4) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The study population included 457 patients (258/199 male/female) with T2DM and non-optimal glycemic control, on oral antidiabetic treatment (age 62.7 [11.4]; disease duration 8.5 [6.5] years).ResultsMMAS-4 high adherence rates for the control and empowerment groups were increased by 3.8% and 16.8% at 4 months (Breslow-Day test p = 0.04) and by 8.5% and 18.8% at 8 months of follow-up, respectively (Breslow-Day test p = 0.09), compared to baseline. Intense physical activity was increased in both control and empowerment groups by 2.3% and 13.9% at 4 months (Breslow-Day test p = 0.082) and by 4.0% and 22.5% at 8 months of follow-up (Breslow-Day test p < 0.001). Baseline mean (SD) HbA1c was significantly lower in the control group compared with the empowerment group [7.7% versus 8.0%, p = 0.001] and decreased in both groups at 4 months by 0.7% and 0.9%, respectively. The change from baseline in the mean DTSQ status score at 4 months was greater in the empowerment group, and the effect was sustained at 8 months (control group: 29.1, 30.5, and 30.9; empowerment group: 25.0, 28.7, and 29.4 at baseline, 4 and 8 months, respectively, p < 0.001).ConclusionSystematic education combined with telephone support delivered by physicians might be associated with improvement in treatment adherence and treatment satisfaction in patients with T2DM.FundingMSD, Greece.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-0648-9) contains supplementary material, which is available to authorized users.

Lower Vitamin D Levels, but Not VDR Polymorphisms, Influence Type 2 Diabetes Mellitus in Brazilian Population Independently of Obesity.

Background and Objectives: Vitamin D levels have been associated with a diversity of diseases, including obesity. Vitamin D presents a pleiotropic action, and can regulate insulin secretion and inflammatory responses. Vitamin D receptor (VDR) gene polymorphisms are involved in the gene expression regulation and have been associated with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association between the polymorphisms ApaI (rs7975232), BsmI (rs1544410), FokI (rs10735810), and TaqI (rs731236) in the VDR gene in people diagnosed with T2DM, and plasma 25-hydroxivitamin D levels [25(OH)D]. Materials and Methods: A total of 101 T2DM patients and 62 gender, age, and body mass index (BMI) matched non-diabetic controls were included in this study. Molecular analyzes were performed by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). The plasma 25(OH)D levels were measured by high performance liquid chromatography. Results: The plasma 25(OH)D levels were lower in T2DM patients (17.2 (16.6) ng/mL) when compared with the control subjects (30.8 (16.2) ng/mL, p < 0.0001), independently of obesity status. We found no difference between genotypic and allelic frequencies of the VDR polymorphisms when comparing the T2DM group and control group (p > 0.05 for all), and did not show any association with plasma 25(OH)D levels. Conclusions: These results suggest that T2DM is associated with lower plasma 25(OH)D levels, which are not related to BMI and VDR gene polymorphisms.

Pharmacological Management of Cardiac Disease in Patients with Type 2 Diabetes: Insights into Clinical Practice.

Type 2 Diabetes Mellitus (T2DM) has emerged as a growing pandemic. Cardiovascular disease (CVD) constitutes another major health problem, with coronary heart disease being the leading cause of cardiovascular death. Patients with T2DM require a multilevel therapeutic approach, both for primary and secondary prevention of CVD. To present and summarize the most recent, highest level evidence retrieved from literature, relevant to the pharmaceutical management of CVD in T2DM. We conducted a comprehensive search of the literature on MEDLINE from its inception till today, primarily for relevant systematic reviews, meta-analyses and randomized controlled trials. There is a trend towards more intensified therapeutic interventions in T2DM, concerning glycemic, lipid and blood pressure control. New drugs, such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors might evolve as key players in the management of diabetes and its complications within the next years. Classic drugs, such as those targeting the renin-angiotensinaldosterone system, statins and aspirin remain first-line treatment options, both for primary and secondary prevention of CVD. Lifestyle interventions should always be integrated into a complete therapeutic strategy in diabetic patients. Novel drugs, such as finerenone and LCZ696 have provided significant results in cardiovascular outcome studies; however, their role in T2DM has to be further elucidated. Pharmaceutical approach of CVD in T2DM is multilevel and complex. Drug classes featuring pleiotropic effects may boost our armamentarium in the fight against CVD.

Glycemic control among patients with Type 2 diabetes mellitus: in relation to medication adherence and life style

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world. Lifestyle management is a fundamental aspect of diabetes care and it includes nutrition, physical activity, smoking cessation, and psychosocial care. Good glycaemic control among type 2 diabetes mellitus patients involves interplay of self-management measures including physical activity and diet, in addition to medication adherence. One of the major contributing factors is poor medication adherence in type 2 diabetes mellitus which is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Observational cross sectional study, conducted at different major health care facilities in northern Jordan, recruited more than 300 adult patients who had been on the same antidiabetic treatment regimen for a minimum of 3 months. Patients’ data, physical measurements, medications and disease history, dietary carbohydrates and lipids intake data were obtained using pre-validated questionnaires. Fasting blood samples were collected and assessed for HbA1c. A total of 300 type2 diabetes mellitus patients were enrolled in this study, 63.7% of them were females and 36.3 % were males. The average age of patients was 60.1 years. About 52 (17.3%) of them were smokers, most of them were males (30%). Medication adherence showed that more than two-thirds (69.4%) of the study samples were highly adherent to their medication. Medication adherence was associated significantly with HbA1c level. Only 41.4% of the patients had diet counseling and 58.6% followed a diet plan, both of them were none significantly associated with HbA1c level. Glycemic control in type2 diabetes mellitus is not just a matter of proper medications use and dosages, but other factors may contribute to poor glycemic control.

Quantification of Pancreatic Fat Accumulation by Proton Magnetic Resonance Spectroscopy in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

Objectives: To quantify pancreatic fat content (PFC) in patients with newly diagnosed type 2 diabetes mellitus (T2DM) using proton magnetic resonance spectroscopy. Patients and Methods: Spectra of the pancreatic head, body, and tail were acquired by single-voxel point-resolved spectroscopy sequences on a 3.0-T magnetic resonance scanner in 59 newly diagnosed T2DM patients and 32 non-diabetics (controls). PFC values were calculated and compared between the patients and controls as well as among the head, body, and tail. Correlations were determined between PFC and age, body mass index (BMI), and serum triglyceride (TG) levels. Results: Mean fat fractions did not differ significantly (all Ps > 0.05) across the pancreatic head, body, and tail in either the T2DM group (15.14 ± 7.49%, 17.51 ± 7.74%, and 18.35 ± 7.58%, respectively) or the control group (12.27 ± 7.85%, 15.35 ± 8.53%, and 16.20 ± 10.02%, respectively). Overall, mean PFC values did not differ significantly (P > 0.05) between the T2DM group (16.82 ± 6.16%) and control group (14.56 ± 7.97%). Among T2DM patients, PFC did not correlate with age, TG levels, or BMI (r 0.05). Among non-diabetic controls, PFC correlated with BMI (r = 0.362, P = 0.042) and TG levels (r = 0.467, P = 0.007), but not with age (r 0.05). Conclusion: PFC in the head, body, and tail are similar for newly diagnosed T2DM patients and non-diabetic persons. PFC does not correlate with age, TG, or BMI in newly diagnosed T2DM patients.

Potential of trace elements as supplements for the metabolic control of Type 2 Diabetes Mellitus: A systematic review

Abstract The objective of this review was to understand the role of trace elements in the form of supplements in metabolic control of Type 2 Diabetes Mellitus (T2DM). A systematic research was performed following PRISMA recommendations. Although 3236 studies were identified, only 18 studies composed of nine animal studies and nine clinical studies were included in this review. The included trace elements were Chromium (Cr), Selenium (Se), Zinc (Zn) and Vanadium (V). The time, dose and type of supplement varied among the studies. Se, Cr, Zn and V improved glycemic profile and antioxidant status while Se, Cr and Zn affected lipid profile. Se and Zn supplementation improved endothelial function. Also, Se modified inflammatory profile. In general, cautious supplementation of trace elements promotes the metabolic control of T2DM.