Control Of Blood Glucose Levels Research Articles

Assessing the Catalytic Role of Native Glucagon Amyloid Fibrils.

Glucagon stands out as a pivotal peptide hormone, instrumental in controlling blood glucose levels and lipid metabolism. While the formation of glucagon amyloid fibrils has been documented, their biological functions remain enigmatic. Recently, we demonstrated experimentally that glucagon amyloid fibrils can act as catalysts in several biological reactions including esterolysis, lipid hydrolysis, and dephosphorylation. Herein, we present a multiscale quantum mechanics/molecular mechanics (QM/MM) simulation of the acylation step in the esterolysis of para-nitrophenyl acetate (p-NPA), catalyzed by native glucagon amyloid fibrils, serving as a model system to elucidate their catalytic function. This step entails a concerted mechanism, involving proton transfer from serine to histidine, followed by the nucleophilic attack of the serine oxy anion on the carbonyl carbon of p-NPA. We computed the binding energy and free-energy profiles of this reaction using the protein-dipole Langevin-dipole (PDLD) within the linear response approximation (LRA) framework (PDLD/S-LRA-2000) and the empirical valence bond (EVB) methods. This included simulations of the reaction in an aqueous environment and in the fibril, enabling us to estimate the catalytic effect of the fibril. Our EVB calculations obtained a barrier of 23.4 kcal mol-1 for the enzyme-catalyzed reaction compared to the experimental value of 21.9 kcal mol-1 (and a calculated catalytic effect of 3.2 kcal mol-1 compared to the observed effect of 4.7 kcal mol-1). This close agreement together with the barrier reduction when transitioning from the reference solution reaction to the amyloid fibril provides supporting evidence to the catalytic role of glucagon amyloid fibrils. Moreover, employing the PDLD/S-LRA-2000 approach further reinforced exclusively the enzyme's catalytic role. The results presented in this study contribute significantly to our understanding of the catalytic role of glucagon amyloid fibrils, marking, to the best of our knowledge, the first-principles mechanistic investigation of fibrils using QM/MM methods. Therefore, our findings offer fruitful insights for future research into the mechanisms of related amyloid catalysis.

Effect of dapagliflozin on blood glucose control, cardiac function, and myocardial injury markers in patients with type 2 diabetes and heart failure

Purpose: To investigate the impact of dapagliflozin treatment on blood glucose control, cardiac function, and myocardial injury markers in patients with type 2 diabetes and heart failure. 
 Methods: In a retrospective analysis of clinical data for 132 patients with type 2 diabetes and heart failure admitted to Beijing Tongren Hospital, China from January 2020 to June 2021, these patients were stratified into two groups (66 patients each). Control group received conventional pharmacotherapy and study group received additional treatment with dapagliflozin. Both treatment courses lasted for 6 months. The levels of blood glucose control, cardiac function, and myocardial injury markers before and after 6 months of treatment were compared between the two groups, as well as safety during treatment. 
 Results: After 6 months of treatment, both groups exhibited significant reductions in fasting plasma glucose (FPG), 2-h postprandial glucose (2 h PG), glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), creatine kinase-MB isoenzyme activity (CK-MB), aspartate aminotransferase (AST) levels, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, with study group showing a greater improvement (p < 0.05). 
 Conclusion: Dapagliflozin enhances blood glucose control and cardiac function, improving quality of life in patients with type 2 diabetes and heart failure. Furthermore, Dapagliflozin demonstrates a safe and well-tolerated profile. Future studies will require establishing the mechanism of dapagliflozin action in a larger and more diverse population.

Effect of complex micronutrient supplement and vitamin D as adjunct to insulin therapy in patients with gestational diabetes mellitus

Purpose: To determine the effect of complex micronutrient supplements and vitamin D as adjunct therapy on pancreatic function, oxidative stress, glucose metabolism and pregnancy outcomes in patients diagnosed with gestational diabetes mellitus (GDM). 
 Methods: 100 GDM patients admitted to Hangzhou Linping District Maternal and Child Health Care Hospital, China between March 2022 and February 2023, were randomly allocated to control and study groups (50 patients each). Control group received insulin injections, whereas study group received complex micronutrients with vitamin D as supplements to insulin. Differences in terms of pancreatic function (homeostatic model assessment-insulin resistance index (HOMA-IR), homeostatic model assessment-beta-cell function index (HOMA-β)), oxidative stress (total antioxidant capacity (TAC), malondialdehyde (MDA)), glucose metabolism indicators (fasting blood glucose (FBG), 2-hour postprandial glucose (2hPG), glycated hemoglobin (HbA1c)) and pregnancy outcomes was assessed. 
 Results: After treatment, both groups showed reductions in serum levels of FBG, 2hPG and HbA1c, but study group exhibited a considerably greater decrease (p < 0.05). In addition, study group had lower HOMA-IR and MDA levels as well as higher HOMA-β and TAC levels (p < 0.05). Negative delivery outcomes occurred less frequently in study group than in control group (p < 0.05). 
 Conclusion: Complex micronutrient supplements (rich in magnesium, calcium, and zinc) in combination with vitamin D as adjunct to insulin treatment effectively reduce pancreatic function and oxidative stress, significantly control blood glucose levels and lower the occurrence of adverse pregnancy outcomes in GDM patients. Further studies will be required in a larger more diverse population to determine the mechanism of enhancing pancreatic function.

The impact of diabetes on postoperative infections in colorectal cancer: A meta-analysis

Objective: This study aims to analyze and summarize the evidence concerning the relationship between diabetes and postoperative infections in colon cancer through a literature review. Methods: A comprehensive search was conducted on Chinese databases, including CNKI, VIP, Wanfang, and the biomedical literature database, as well as the English database PubMed. The search covered the period from February 1, 2003, to February 28, 2023. The Newcastle-Ottawa Scale was employed to score the included literature, and funnel plots along with Eggers regression test were used to analyze publication bias. Stata 12.0 was utilized for the analysis of the collected raw data. Results: Following inclusion and exclusion criteria, this study incorporated seven retrospective studies, with a total of 4607 cases in the infection group and 9102 cases in the non-infection group. The quality scores of the seven studies ranged between 7 and 8 points. Funnel plot and Eggers regression test analyses revealed no significant publication bias in the included literature. A correlation was identified between diabetes and postoperative infections in colon cancer, implicating diabetes as a risk factor for such infections. Subgroup analysis indicated that nationality, surgical methods, and infection types had no significant impact on the meta-analysis results. Conclusion: The analysis revealed a significant correlation between diabetes and postoperative infections in colon cancer. Diabetes emerged as a risk factor for postoperative infections, with odds ratios (OR) of 3.82 (P0.1) and 95% CI of 2.91-5.01. Controlling blood glucose levels was associated with a reduced risk of postoperative infections in colon cancer.

Pharmacodynamic Interaction of Areca catechu with Gliclazide in Wistar Rats

Background and Purpose In alloxan-induced diabetic rats, this study sought to evaluate the hypoglycemic potential of the hydroalcoholic seed extract of Areca catechu, also referred to as areca nut, both as a stand-alone treatment and in combination with the diabetic drug gliclazide. Materials and Methods The hot percolation method was used to produce the hydroalcoholic seed extract of A. catechu. Rats were given alloxan monohydrate and developed type II diabetes. The hydroalcoholic seed extract of A. catechu (1000 mg/kg p.o.) alone or in different combinations of gliclazide (25 mg/kg p.o.) and A. catechu extract (250, 500, and 1000 mg/kg p.o.) were administered to the six diabetic rats. Body weights and blood glucose levels were measured on days 7, 14, 21, and 28 of the treatment. On the 28th day, the kidney, liver, and pancreas underwent histological investigations in addition to an oral glucose tolerance test (OGTT). Results Blood glucose levels were significantly lowered upon administration of A. catechu’s hydroalcoholic seed extract, both alone and in conjunction with gliclazide. Comparing the diabetic control group to the A. catechu extract-treated group, histopathological examinations showed that high amounts of the extract, either by itself or in conjunction with gliclazide, caused the active proliferation of pancreatic beta cells, protecting against damage to the liver and kidneys. Conclusion The hydroalcoholic seed extract of A. catechu showed promise as a monotherapy for controlling blood glucose levels, and as a co-administer for gliclazide, it showed signs of hypoglycemia. These results indicate A. catechu’s possible therapeutic benefit as an adjuvant diabetic treatment. To investigate the underlying mechanisms of action and evaluate its safety and effectiveness in clinical settings, more study is necessary.

Effects of Physalis peruviana L. (leaf crude extracts) on blood glucose and functional biomarkers in streptozotocin-nicotinamide-induced diabetic rats.

Promoting antidiabetic phytomedicines necessitates evidence-based preclinical investigations, particularly in animal models. The present study investigated the validity of using the streptozotocin-nicotinamide-induced type 2 diabetic (STZ/NA-induced T2DM) model to evaluate the effects of Physalis peruviana leaf crude extracts on controlling blood glucose levels and regulating physiological biomarkers in rats. Aqueous and methanol extracts dissolved in carboxymethylcellulose 1% (100, 200, mg/kg/day) were administered orally to STZ/NA-induced T2DM rats alongside glibenclamide (5 mg/kg) as the standard drug for four weeks. Blood samples were collected in fasting rats on days 1, 7, 14, 21, and 28 to measure glucose concentration, lipoprotein-cholesterol, and common serum biomarkers. Nutrition characteristics were also monitored, as well as the pancreas histology. Administration of STZ/NA in Wistar rats induced the T2DM significantly lower than did STZ alone (glycaemia 200 vs 400 mg/dL). The significant effects observed with plant extracts compared to untreated diabetic rats were blood glucose reduction (28-52 %), HDL-C increase, LDL-C decrease, ALAT increase, WBC increase, body weight gain (24%), and pancreas protection. The findings confirm the antidiabetic effect of P. peruviana in T2DM animal model.

Glu and GSH double-unlocked immunomodulatory tri-cascade nanoreactor for biofilm-infected diabetic wounds healing

The treatment of diabetic wounds remains a challenge due to the interaction between hyperglycemia, immune imbalance and bacterial infection. Herein, we developed a Glu and GSH double-unlocked immunomodulatory nanocascade reactor to accelerate diabetic wounds healing which dynamically manages the wound microenvironment by controlling blood glucose levels, restoring immune regulation and eliminating bacteria. On the one hand, ultra-small gold nanoparticles with GOx activity can catalyse glucose at the diabetic wound site, which can be further enhanced by photothermal effects, thus destroying bacterial biofilm structures, reversing wounds pH, and reducing bacterial reproduction. On the other hand, the sustained controlled release of NO at specific sites was achieved by depleting over-expressed GSH in the wounds to restore normal immune regulation, which not only promotes M2 macrophage polarisation and expressions of anti-inflammatory factors such as IL-10 and TGF-β1, but also produces VEGF and CD31 via the PI3K/AKT signalling pathway. Especially, the chemical resonance energy transfer (CRET) strategy was first applied to diabetic wounds treatment, achieving chemical photodynamic therapy (PDT) while reducing the secondary tissue damage caused by catalytically-generated H2O2. In summary, the nanocascade reactor provides a new reference for bacterialy-infected diabetic wounds treatment mode by reducing blood glucose and restoring immune regulation in parallel.

Case of a patient with type 1 diabetes mellitus and anorexia nervosa with changes to the central nervous system

Co-occurrence of anorexia nervosa (AN) and diabetes mellitus type 1 (T1DM) is an uncommon disease combination in clinical practice. Treatment of T1DM may affect outcomes in AN patients due to self-modification of insulin dosage. In the presented case 14-year-old patient diagnosed with both T1DM and AN has been modifying her insulin-dependent treatment to prevent gaining weight. Undercontrolled glucose levels resulted in early-stage diabetic vascular complications in the central nervous system found in MRI. Due to higher T1DM morbidity of eating disorders patients, adjustments and special control of insulin treatment and blood glucose levels as well as HbA1c should be maintained in the prevention of diabetic complications, especially in individuals with lower treatment compliance. As AN may lead to structural changes and a decrease in cognitive functions, increased supervision of AN patients with T1DM can lower the risk of cumulative negative effects on the brain.

The effect of mindful eating on dietary behaviour and fasting blood glucose in type 2 diabetes mellitus patients

Diet plays a pivotal role in the comprehensive therapy for individuals with type 2 diabetes mellitus, contributing significantly to maintaining stable glycemic control. Mindful Eating, as an intervention, focuses on enhancing dietary behavior by directing attention, thoughts, and feelings towards eating activities. This study aimed to investigate the impact of mindful eating on dietary behavior and fasting blood glucose levels in individuals with type 2 diabetes mellitus. Employing a quasi-experimental method with a pretest-posttest control group design, the study included a sample of 63 participants (selected through convenience sampling). Data collection utilized the Personal Diabetes Questionnaire (PDQ) and a glucometer. Statistical analysis involved Wilcoxon, Mann-Whitney, and Independent T-tests. The findings revealed that mindful eating exercises had a significant influence on dietary behavior (p = 0.025) and fasting blood glucose levels (p = 0.033). The practice of mindful eating led to notable improvements in dietary behavior and ensured controlled fasting blood glucose levels by the study's conclusion. Incorporating mindful eating exercises into eating patterns is recommended as a crucial aspect of diabetes management, aiming to enhance dietary behavior and sustain stable glycemic control.

THE ANTI-DIABETIC POTENTIAL OF MUSHROOMS: A REVIEW

It is crucial to discover new nutraceuticals or medications to cure or prevent diabetes because it is becoming a pandemic. Some mushrooms seem to have benefits in controlling blood glucose levels and correcting diabetes problems without any negative side effects. Only a few regions employ mushrooms as appetizing food, health-improving dietary supplements, or medicine because they contain immune-modulating polysaccharides. However, scientific or clinical research on mushrooms has not been sufficient to allow them to be used as recognized medicines or nutraceuticals worldwide. These functional fungi may have a greater impact on the prevention and diabetes treatment. This review focuses on prospective mushrooms that have demonstrated anti-diabetic effects in clinical or experimental studies and prevent or slow the progression of diabetes mellitus.

Antidiabetic Effectiveness Test of Ethanol Extract of Brown Leaves (Theobroma Cacao L.) Against Mice (Mus Musculus)

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia that occurs due to abnormalities in insulin secretion, insulin action or both. DM sufferers are increasing from year to year, accompanied by increasing costs of therapy, therefore, as an alternative to controlling blood glucose levels, use natural ingredients such as cocoa leaves. The aim of this research was to determine the effectiveness of ethanol extract of cocoa leaves (Theobroma cacao L.) in reducing blood glucose levels in mice that had been induced by Aloxan. The research method used was experimental research. The research stages were sample collection, sample identification, making simpilicia, examining the characteristics of simpilicia, making extracts using maceration using 96% ethanol solvent, and testing the antidiabetic effect of EEDC in mice induced by alloxan at a dose of 175 mg/kg. bb intraperitoneally. Diabetic mice were divided into 5 groups, each group consisting of 5 mice that were given the test material 50 mg/KgBB of ethanol extract of brown leaves; 100 mg/KgBB; and 200 mg/KgBB, Metformin 65 mg/KgBB, and CMC 0.5%. Next, blood glucose levels were measured on days 3, 6, 9, 12, and 15, the percentage reduction in blood glucose levels was calculated, then the data was analyzed using the One-Way ANOVA method and Duncan's test, to see real differences between treatments. The research results showed that simplicia, the ethanol extract of brown leaves contains flavonoids, alkaloids, tannins, steroids/triterpenoids, saponins and glycosides. Cocoa leaf ethanol extract has effectiveness in lowering glucose levels, at the 5th and 6th hours it shows good effectiveness at a dose of 200 mg/KgBW of (72.16 ± 0.1.51)% and (82.80 ± 0.73 )%, not significantly different from metfromin 65 mg/KgBB of (74.45 ± 1.51)% and (83.29 ± 1.01).

Evaluation of compliance and adherence to medications in diabetic and/or hypertensive patients during the lockdown period and the effect of COVID-19 lockdown on blood glucose levels and blood pressure levels

Background: To contain the COVID-19 pandemic, a nationwide lockdown was imposed, which affected the lives of people with diabetes and hypertension as the patients were not able to regularly follow up with the doctor. Aims and Objectives: This prospective observational study was conducted to find out the compliance and adherence to oral hypoglycemic agents and antihypertensives during lockdown, to consult with doctors during lockdown, and also to analyze the effect of lockdown on blood glucose levels and blood pressure control by comparing the pre- and post-lockdown blood pressure and blood glucose levels. Materials and Methods: A prospective observational study was conducted on 100 participants aged between 35 and 85 years. They were studied by a questionnaire for a period of 3 months. The majority belonged to the 55–65 years of age group, and a male predominance was seen across all age groups. The changes in lifestyle habits of the participants during lockdown and complications due to diabetes and hypertension were also studied. Results: There was a statistically significant decrease in the adherence to prescribed medications during lockdown due to various reasons, the most important of which was the lack of access to personal consultation with the doctor during lockdown. Patients also could not follow their diet and physical exercises due to lockdown. All these factors led to poor control of blood pressure and blood glucose levels, as evidenced by comparing the pre- and post-lockdown blood glucose levels and blood pressure. Conclusion: This study concludes that there was a significant decrease in adherence to medications during the COVID-19 lockdown and there was poor control of blood pressure and blood glucose levels due to the lockdown period.

In Vitro and in Silico Analysis of α -Amylase Inhibitory Activity of Ethanolic Extract of Adhatoda vasica Leaves.

Diabetic individuals have a higher probability of suffering from illness and death due to small blood vessel-related problems such as retinopathy, neuropathy, nephropathy, and stroke than other complications. There are many synthetic anti-diabetic agents available, but these can be expensive and have undesirable pathological effects. The enzyme α-amylase (hydrolase), catalyzes the hydrolysis of starch to maltose and glucose via the cleavage of α-1,4-glucosidic linkages. Diabetes mellitus patients may benefit from a therapeutic strategy that involves slowing the hydrolysis of starch by inhibiting the activity of α-amylase. Thus, looking for cost-effective, natural, and safe antidiabetic agents is essential. This study aims to screen phytoconstituents and evaluate the in-vitro and in-silico α-amylase inhibitory activity of the ethanolic extract of Adhatoda vasica leaves. The extraction of Adhatoda vasica leaves was performed using ethanol via the Soxhlet extraction process. Different concentrations (100μg/mL to 1000μg/mL) of ethanolic extract, Acarbose, and Sitagliptin, were prepared and evaluated for α-amylase inhibitory activity using the spectrophotometric method. Molecular docking (AutodockVina 1.2.0) and toxicity profiling (SToPToX web server) studies were performed. The ethanolic extract of Adhatoda vasica leaves showed the highest percentage inhibition against α-amylase (56.763 ± 0.0035) at a concentration of 1000μg/mL. The in-silico study supported this inhibitory activity. Vasicoline (C5) and Quercetin (C9), the active constitute of Adhatoda vasica, showed the best binding energies of -8.3 and -8.0Kcal/mol, respectively against α-amylase enzyme (PDBID: 4W93). A toxicity study revealed the safety profile of the plant extract. It was concluded that Adhatoda vasica leaves possess some bioactive compounds that are responsible for controlling blood glucose levels, and their identification, purification, and isolation may lead to the development of new therapeutic agents with fewer side effects than the available drugs.

THERAPEUTIC EFFECT OF MORINGA LEAF DECOCTION TO DECREASE BLOOD SUGAR LEVELS AND HBA1C VALUES OF DIABETICS TYPE II DIABETES MELLITUS AT KARANG PANJANG AMBON HEALTH CENTER

Abstract Type 2 Diabetes (T2DM) is the most common type of diabetes and is still become one of the causes of death. One way of managing T2DM is mostly by controlling blood sugar, HbA1c levels, developing a healthy diet and herbal alternative therapies. One intervention that does not require expensive costs can be done to improve treatment outcomes in patients with T2DM by controlling blood glucose levels and HbA1c is through moringa leaf decoction therapy. Moringa oleifera (Moringa oleifera) contains and benefits from moringa leaves which have high nutritional value, are rich in minerals, vitamins, and other important phytochemicals. Extracts from the leaves are used to treat malnutrition, as a potential antioxidant, anticancer, anti-inflammatory, antidiabetic and antimicrobial agents. This study aims to analyze the therapeutic effect of moringa leaf decoction to decrease blood sugar and HbA1C levels of Type II diabetes mellitus patients in Karang Panjang Ambon Health Center. Sampling technique using consecutive sampling in one intervention group. The study was conducted for seven days with the number of subjects involved in this study as many as 27 people who were measured blood sugar levels and HbA1C before and after treatment. This study is a type of quantitative research using pre-experimental approach one group pre-post design. The results of the study obtained the value of SIG 0.000 < 0.050 this states that there is a significant effect of moringa leaf decoction therapy to reduce blood sugar levels and HbA1c values in patients DM Type II Keywords: moringa leaves, diabetes mellitus Type II, blood sugar, HbA1c

Pengaruh Senam Apiyu Terhadap Kadar Glukosa Darah Pasien Diabetes Mellitus (DM) Tipe II Di Puskesmas Rejosari Kota Pekanbaru

Diabetes Mellitus (DM) is a disease caused by the body not being able to adequately release or use insulin so that blood glucose levels in the blood are high. The purpose of this study was to determine the effect of APIYU exercise on blood glucose levels of Diabetes Mellitus (DM) Type II patients. Method: Quantitative Research Design Quasy Experiment. The study sample was 34 respondents, Purposive sampling technique which was divided into 2 groups, namely 17 experimental respondents given APIYU exercise intervention and 17 control group respondents were not given APIYU exercise intervention. Both groups continued to take the drugs Glibenclamide and Metformin. The measuring instruments used are observation sheets and glucometers with pre-test and post test for 3 consecutive days after doing APIYU exercise. The statistical tests used are the Paired Samples T Test and the Mann Whitney test. Result:. There was a significant difference in the mean blood glucose levels of the pre-test and post-test in the experimental group with a p value of 0.000. APIYU exercise affects blood glucose levels in Type II Diabetes Mellitus (DM) patients with a ? value of 0.000 (<0.05) Conclusion: APIYU exercise affects the blood glucose level of people with Type II Diabetes Mellitus (DM). These results are expected to be an alternative treatment in controlling blood glucose levels of people with Type II Diabetes Mellitus (DM). Keywords: , ,

P-26 Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: A case report

Abstract Introduction Factitious disorder (FD) is diagnosed by pretending to be sick with no abnormal examination or paraclinical study in the presence of psychiatric symptoms which also is named Munchausen's syndrome. The prevalence of the disease among hospitalized patients is approximately 9%. Clinical Case A 17-year-old girl with type 1 diabetes mellitus was referred to endocrinology clinic with uncontrolled diabetes, dizziness, abdominal pain, nausea and vomiting. She was treated with multiple daily insulin during 4 years but in last 8 months her self-monitoring of blood glucose ranges was out of control and have BG (blood glucose) different ranges of 40-560mg/dl. She was admitted to control her brittle diabetes with insulin infusion but even with high dose insulin infusion up to 20 IU/hr mostly her BS were above 400mg/dl. The notable point was that BG level was measured by laboratory was lower than glucometer. She also complained of severe abdominal pain and nausea during admission that mimics diabetic ketoacidosis in the presence of hyperglycemia despite the lack of ketonuria and metabolic acidosis. She admitted to hospital several times over the last year to control high level of BG. In psychiatric examination, she has good cooperation in response to questions. Mental Status Examination was not normal. Her mood was depressive and behavior was aggressive. Mild depressive symptoms and borderline features were seen in her Rorschach test. Finally because of high suspicion to associated psychiatric problems, to find the cause of high BG despite high insulin dose prescription, patient behaviors were monitored insensible. We found that she impregnated her finger to the date palm a few minutes before blood glucose check with glucometer devices at times when she is alone in the room. The patient had different deceptive behaviors depending on the method of treatment. But the answer to the question of why the patient was not suffering from hypoglycemia despite high doses of insulin injection is, when insulin infusion by pump was started to control high BG, intravenous cannula secretly separated from insulin infusion set and insulin thrown away. Also she secretly eats fruit juice and jam to prevent hypoglycemic attack for high-dose insulin injection. She took the water into the insulin pen instead of insulin and injected so that the nurses did not notice. Frauds were changed by switching the treatment methods. HbA1c was requested last week of hospitalization which shows 8%. Although all BGwas above 300 mg/dl during this prolonged hospitalization, it did not match with chronic hyperglycemia. Conclusion The main purpose of this article was in relation to a diabetic patient with brittle diabetes, difficulty in control BG level, discrepancies between patient symptoms and sings, factitious disorder or Munchausen syndrome should always be in our mind.

Experiences and self-care of pregnant nurses with gestational diabetes mellitus: a qualitative study

BackgroundPregnant nurses are at high risk of developing gestational diabetes mellitus (GDM), and nurses diagnosed with GDM face challenges in balancing disease management and work, which affects maternal and child health and the quality of care. GDM requires significant changes to lifestyle and physical activity to control blood glucose levels, which is key to reducing adverse pregnancy outcomes. However, few studies have focused on the experiences of pregnant nurses with GDM. This study aimed to gain insight into the experiences of pregnant nurses with GDM in China in terms of their illness, work burdens, and self-care.MethodsThis qualitative study used an interpretative phenomenological analysis. Face-to-face semi-structured in-depth interviews were conducted with pregnant nurses with GDM to investigate their experiences and self-care. The study was performed at Chongqing’s maternal and child health hospital in China. A purposive sampling was used. Nine pregnant nurses diagnosed with GDM were recruited and interviewed.ResultsThe interview data generated four themes and 11 sub-themes. The four themes were ‘the perceptions and feelings of GDM’, ‘experiences of lifestyle changes’, ‘social support needs’, and ‘health expectations and risk perception.’ConclusionMany factors such as the unique occupational environment, overwork, occupational pressure, shift work, family status, and education level may lead to difficulties in managing blood glucose in nurses with GDM. These findings suggest that managers should pay more attention to nurses with GDM and develop personalized medical care and work arrangements. These measures can improve the self-care and well-being of nurses with GDM and promote the health of nurses and their offspring.

Determinants of disparities of diabetes-related hospitalization rates in Florida: a retrospective ecological study using a multiscale geographically weighted regression approach

BackgroundEarly diagnosis, control of blood glucose levels and cardiovascular risk factors, and regular screening are essential to prevent or delay complications of diabetes. However, most adults with diabetes do not meet recommended targets, and some populations have disproportionately high rates of potentially preventable diabetes-related hospitalizations. Understanding the factors that contribute to geographic disparities can guide resource allocation and help ensure that future interventions are designed to meet the specific needs of these communities. Therefore, the objectives of this study were (1) to identify determinants of diabetes-related hospitalization rates at the ZIP code tabulation area (ZCTA) level in Florida, and (2) assess if the strengths of these relationships vary by geographic location and at different spatial scales.MethodsDiabetes-related hospitalization (DRH) rates were computed at the ZCTA level using data from 2016 to 2019. A global ordinary least squares regression model was fit to identify socioeconomic, demographic, healthcare-related, and built environment characteristics associated with log-transformed DRH rates. A multiscale geographically weighted regression (MGWR) model was then fit to investigate and describe spatial heterogeneity of regression coefficients.ResultsPopulations of ZCTAs with high rates of diabetes-related hospitalizations tended to have higher proportions of older adults (p < 0.0001) and non-Hispanic Black residents (p = 0.003). In addition, DRH rates were associated with higher levels of unemployment (p = 0.001), uninsurance (p < 0.0001), and lack of access to a vehicle (p = 0.002). Population density and median household income had significant (p < 0.0001) negative associations with DRH rates. Non-stationary variables exhibited spatial heterogeneity at local (percent non-Hispanic Black, educational attainment), regional (age composition, unemployment, health insurance coverage), and statewide scales (population density, income, vehicle access).ConclusionsThe findings of this study underscore the importance of socioeconomic resources and rurality in shaping population health. Understanding the spatial context of the observed relationships provides valuable insights to guide needs-based, locally-focused health planning to reduce disparities in the burden of potentially avoidable hospitalizations.

Ethanolamine as a biomarker and biomarker-based therapy for diabetic retinopathy in glucose-well-controlled diabetic patients

Diabetic retinopathy (DR) is the leading cause of blindness among the working-age population. Although controlling blood glucose levels effectively reduces the incidence and development of DR to less than 50%, there are currently no diagnostic biomarkers or effective treatments for DR development in glucose-well-controlled diabetic patients (GW-DR). In this study, we established a prospective GW-DR cohort by strictly adhering to glycemic control guidelines and maintaining regular retinal examinations over a median 2-year follow-up period. The discovery cohort encompassed 71 individuals selected from a pool of 292 recruited diabetic patients at baseline, all of whom consistently maintained hemoglobin A1c (HbA1c) levels below 7% without experiencing hypoglycemia. Within this cohort of 71 individuals, 21 subsequently experienced new-onset GW-DR, resulting in an incidence rate of 29.6%. In the validation cohort, we also observed a significant GW-DR incidence rate of 17.9%. Employing targeted metabolomics, we investigated the metabolic characteristics of serum in GW-DR, revealing a significant association between lower levels of ethanolamine and GW-DR risk. This association was corroborated in the validation cohort, exhibiting superior diagnostic performance in distinguishing GW-DR from diabetes compared to the conventional risk factor HbA1c, with AUCs of 0.954 versus 0.506 and 0.906 versus 0.521 in the discovery and validation cohorts, respectively. Furthermore, in a streptozotocin (STZ)-induced diabetic rat model, ethanolamine attenuated diabetic retinal inflammation, accompanied by suppression of microglial diacylglycerol (DAG)-dependent protein kinase C (PKC) pathway activation. In conclusion, we propose that ethanolamine is a potential biomarker and represents a viable biomarker-based therapeutic option for GW-DR.

Intensive start of therapy in modern strategies for managing type 2 diabetes mellitus

Type 2 diabetes mellitus continues to be one of the global medical and social problems. Early administration of combination therapy with hypoglycemic drugs acting on various pathophysiological mechanisms of diabetes development allows prolonging the duration of the therapeutic effect and achieving more stable control of blood glucose levels. Currently, a combination of metformin with dipeptidyl peptidase-4 (DPP-4) inhibitors is recommended as an initial therapy that meets these requirements. This combination has a synergistic effect on various links in the pathogenesis of the disease. The addition of gliptins to metformin enhances insulin secretion by beta cells of the pancreas and increases insulin sensitivity, which ultimately contributes to a longer preservation of the therapeutic effect. The only representative of the DPP-4 inhibitors class recommended as part of the initial combination therapy with metformin, taking into account the results of the VERIFY study, is vildagliptin. The use of a fixed combination of metformin and vildagliptin in one tablet increases patients' compliance with the treatment regimen, which, in turn, reduces the risk of complications and mortality.