Type 2 Diabetes Mellitus Patients Research Articles

Untargeted and Targeted Lipidomics Unveil Dynamic Lipid Metabolism Alterations in Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder with a growing body of evidence suggesting the central role of lipid metabolism in its pathogenesis. However, the dynamic changes in lipid metabolism across different stages of T2DM remain understudied. This study aimed to elucidate the temporal alterations in lipid metabolism in T2DM using an integrated lipidomics approach. Serum samples from 155 subjects were analyzed using LC-MS-based lipidomics, including untargeted and targeted approaches. We identified significant alterations in 44 lipid metabolites in newly diagnosed T2DM patients and 29 in high-risk individuals, compared with healthy controls. Key metabolic pathways such as sphingomyelin, phosphatidylcholine, and sterol ester metabolism were disrupted, highlighting the involvement of insulin resistance and oxidative stress in T2DM progression. Moreover, 13 lipid metabolites exhibited diagnostic potential for T2DN, showing consistent trends of increase or decrease as the disease progressed. Our findings underscore the importance of lipid metabolism in T2D development and identify potential lipid biomarkers for early diagnosis and monitoring of disease progression, which contribute to paving the way for novel therapeutic strategies.

Assessing Dietary Habits of Saudi Patients With Type 2 Diabetes at Primary Healthcare Centers in Jeddah, Saudi Arabia.

Background Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by impaired glucose regulation. Managing T2DM requires healthy dietary habits to achieve glycemic control and reduce the risk of complications. However, T2DM patients often struggle to adhere to these patterns due to cultural practices, socioeconomic factors, and insufficient nutritional education. Saudi Arabia has the second-highest prevalence of diabetes in the Middle East and ranks seventh in the world. Aim The current study aimed to evaluate dietary habits and assess theassociated factors with them, such as sociodemographic and clinical characteristics. Methods This cross-sectional, observational, survey-based study was conducted between Januaryand July 2023. Adult patients with T2DM attending primary healthcare centers in Jeddah Second Health Cluster, Saudi Arabia, were included in the study. Pediatric patients who are not Saudi and have type I diabetes or gestational diabetes mellitus were excluded from the study. The data were collected using a validated self-administered questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ). Statistical analysis was performed using the computer program IBM SPSS (version 26.0, IBM Corp., Armonk, USA).The total score of questions from question 1 to question 24 (except questions 18, 20, 22, and 23) was calculated for everyone regarding the validated questionnaire. Comparisons between the demographic factors and UKDDQ scores (not normally distributed) were conducted using the Mann-Whitney test. A Spearman's test was done to explore the correlation between the numerical factors and the scores of the questions. The p-value less than 0.05 was considered statistically significant. Results The study included 428 Saudi patients with T2DM with a mean (standard deviation (SD)) age of 47.8 ± 11.7 years old. More than two-thirds were overweight 165 (38.6%) and obese 124 (29.0%). Two-thirds of the patients were married 278 (65%), and most were employed 322 (75.2%). The mean (SD) of the total UKDDQ score was 2.7 ± 0.4 out of 5. The results showed that males demonstrated better dietary habits than females, as reflected in their higher UKDDQ scores (P = 0.029). Additionally, patients with a university education or higher, as well as unemployed individuals, reported significantly better scores (P = 0.022 and P <0.001, respectively).Furthermore, participants without a family history of diabetes had higher UKDDQ scores compared to those with such a history (P = 0.009). There was also a very weak positive correlation between age and UKDDQ scores (r = 0.135, P = 0.005). Conversely, a very weak negative correlation was found between Body Mass Index (BMI) and the number of years living with diabetes (r = -0.096), as well as between BMI and UKDDQ scores (r = -0.156), both with significant p-values (P = 0.049 and P = 0.001, respectively). Conclusions The findings underscore the complexity of factors influencing T2DM patients' dietary habits. Notably, males and participants with lower BMI, higher education, unemployment, and those without a family history or complications exhibited more favorable dietary scores. Essential approaches include tailored interventions, health literacy initiatives, community programs, family involvement, long-term follow-up, multidisciplinary care, and addressing socioeconomic barriers are crucial to improve glycemic controland preventing diabetes-related complications.

Adiponectin may play a crucial role in the metabolic effects of GLP-1RAs treatment in patients with Type 2 Diabetes Mellitus: a preliminary longitudinal study.

Type 2 diabetes mellitus (T2DM) stands as the most prevalent metabolic disorder globally. T2DM entails numerous cardiovascular complications, which contribute significantly to morbidity, mortality, and increased public spending worldwide. The real challenge for new diabetes drugs lies not only in reducing blood glucose levels and glycated hemoglobin but also in preventing cardiovascular risk. Emerging receptor agonists for glucagon-like peptide-1 (GLP-1RAs) have demonstrated a pivotal role in diabetes management and mitigating cardiovascular risk. We conducted a 12-month longitudinal investigation evaluating the cardio-metabolic effects of GLP-1RAs on a cohort of 65 Caucasian patients diagnosed with T2DM who were scheduled for treatment with GLP-1RAs. Fifty-four T2DM patients successfully completed the 12-month study period, with 30 receiving dulaglutide and 24 receiving semaglutide. In our study population, GLP-1RAs resulted in several positive changes beyond the observed weight loss: a shift in fat distribution, indicated by a reduction in the percentage of visceral fat (1.21 vs. 1.17, p < 0.05); a significant decrease in LDL cholesterol levels (p < 0.05) and triglycerides (p < 0.01); and a significant increase in serum adiponectin levels (p < 0.05), potentially indicating a reduction in insulin resistance and inflammation. Additionally, we observed a significant decrease in microalbuminuria and media-intimal thickness at the carotid vessel level (p < 0.05). In patients with T2DM 1-year therapy with GLP-1RAs has a positive effect on the main determinants of cardiovascular risk including body weight, visceral fat, dyslipidemia, and atherosclerosis. Moreover, the increase in adiponectin may play a pivotal role in controlling the inflammatory state and the mechanisms of vascular damage.

Assessing the diagnostic utility of urinary albumin-to-creatinine ratio as a potential biomarker for diabetic peripheral neuropathy in type 2 diabetes mellitus patients

Background and aimsDiabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) both have microcirculation dysfunction. Urinary albumin-to-creatinine ratio (UACR) is a biomarker for DN. We aimed to explore the links between DPN and UACR in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 195 T2DM patients were defined as Control or DPN group. Clinical parameters were compared, and the association between HbA1c (or UACR) and DPN was analyzed. Risk factors for DPN were observed, and the diagnostic values of HbA1c and UACR were assessed.ResultsCompared with 104 participants without DPN, 91 individuals with DPN exhibited higher HbA1c and UACR levels. In all patients, increased HbA1c and UACR were identified as risk factors for DPN in individuals with T2DM. Moreover, increased HbA1c was a risk factor for DPN in volunteers without DN, whereas elevated UACR was determined as a risk factor for DPN in participants with DN. The cut-off point for HbA1c (7.65%) in patients without DN had a sensitivity of 86.0% and specificity of 44.6%, while the cut-off point for UACR (196.081 mg/g) in patients with DN had a sensitivity of 52.9% and specificity of 76.2%.ConclusionElevated HbA1c and UACR levels are risk factors for DPN and may serve as potential biomarkers for DPN in T2DM patients.

Survey of fear and compliance of Insulin Degludec and Insulin Aspart injection in type 2 diabetes mellitus patients and analysis of influencing factors.

This study aims to investigate the fear and compliance of Insulin Degludec and Insulin Aspart (IDegAsp) injection in type 2 diabetes mellitus (T2DM) patients and study the factors influencing patient compliance. A total of 120 patients with T2DM treated from February 2019 to March 2022 were investigated and analyzed for fear and compliance on the Diabetes Fear of Injecting and Self-testing Questionnaire of diabetic patients and were divided into compliance and noncompliance groups according to the results to analyze the factors affecting patient compliance. The study found a high level of fear of IDegAsp injection among the 120 T2DM patients, with an average Diabetes Fear of Injecting and Self-testing Questionnaire score of (39.19 ± 4.59) points. Scores for medication compliance, dietary compliance, blood sugar monitoring, and lifestyle changes were (10.48 ± 1.52) points, (12.18 ± 2.27) points, (0.84 ± 0.12) points, and (9.13 ± 2.21) points, respectively. There was no significant difference between the compliance and noncompliance groups in terms of gender, age, lifestyle, educational level, occupation, current treatment method, family monthly income per capita, and medical payment method (P > .05). However, there were significant differences influenced by disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status (P < .05). Multifactorial analysis showed that educational level, disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status all affected patient compliance (P < .05). Educational level, disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status are important factors affecting the fear and treatment compliance of IDegAsp injection in T2DM patients. These findings have implications for improving patient compliance and alleviating treatment fear.

Predictive Value of NT-proBNP, FGF21, Galectin-3 and Copeptin in Advanced Heart Failure in Patients with Preserved and Mildly Reduced Ejection Fraction and Type 2 Diabetes Mellitus.

Background and Objectives: Heart failure (HF) is one of the most common initial presentations of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). There are different cardiac biomarkers related to the pathophysiological mechanisms of HF in T2DM. The current research aims to identify additional biomarkers that could improve the diagnosis and prognosis of HFpEF, which is currently assessed using NT pro-BNP levels. NT pro-BNP is a valuable tool for diagnosing heart failure but may not always correlate with clinical symptom severity or can present normal levels in certain cases, such as obesity. Biomarkers like FGF-21 and galectin-3 could provide greater insight into heart failure severity, especially in diabetic patients. The main objective of the current study is to assess the performance of NT-proBNP, FGF21, Galectin-3 and Copeptin to discriminate between advanced and mild HF. Materials and Methods: A total of 117 patients were enrolled in this study and divided into two groups: 67 patients in NYHA functional class I-II (mild HF) and 50 patients in NYHA III-IV (advanced HF). NT-pro BNP, FGF21, Galectin 3 and Copeptin serum levels were determined with the ELISA method. Receiver operating characteristic (ROC) analysis and binomial logistic regression analysis were used to measure the ability of the studied biomarkers to distinguish between advanced and mild HF patients. Results: In patients with T2DM with advanced HF, serum FGF21 level was significantly positively correlated with eGFR (ρ = 0.35, p = 0.0125) and triglycerides (ρ = 0.28, p = 0.0465) and significantly negatively correlated with serum levels of HDL cholesterol (ρ = -0.29, p = 0.0386) and with RV-RA gradient (ρ = -0.30, p = 0.0358). In patients with mild HF, serum FGF21 level was significantly negatively correlated with NT-proBNP levels (ρ = -0.37, p = 0.0022), E/e' ratio (ρ = -0.29, p = 0.0182), TR velocity (ρ = -0.24, p = 0.0470) and RV-RA gradient (ρ = -0.24, p = 0.0472). FGF21 (AUC = 0.70, 95% CI: 0.60-0.79) and NT-proBNP (AUC = 0.73, 95% CI: 0.63-0.82) demonstrated significant predictive value to discriminate T2DM patients with advanced HF from those with mild HF. Elevated values for FGF21 (≥377.50 ng/mL) or NTproBNP (≥2379 pg/mL) were significantly associated with increased odds of advanced HF after adjusting for demographic and clinical covariates. Conclusions: NTpro-BNP and FGF21 have a similar ability to discriminate T2DM patients with advanced HF from those with mild HF. Univariable and multivariable logistic models showed that, FGF21 and NTproBNP were independent predictors for advanced HF in patients with preserved and mildly reduced ejection fraction and T2DM.

Impact of allulose on blood glucose in type 2 diabetes: A meta-analysis of clinical trials

ObjectiveThis meta-analysis aims to evaluate the impact of allulose on blood glucose levels in patients with type 2 diabetes mellitus (T2DM). Primary outcomes include postprandial blood glucose, while secondary outcomes are time in range (TIR), time above range (TAR), fasting plasma glucose (FPG), and insulin area under the curve (AUC). MethodsA systematic search was conducted across PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library until May 20, 2024. Randomized controlled trials assessing the effect of allulose on glycemic parameters in T2DM patients were included. Data were synthesized using a random-effects meta-analysis model, and the quality of studies was assessed using the Cochrane Risk of Bias tool. ResultsSix studies involving 126 participants were included. Allulose significantly reduced glucose AUC (SMD: −0.6662, 95 % CI [-1.1360, −0.1964], p = 0.0054) with moderate heterogeneity (I2 = 58.3 %). Insulin AUC showed a non-significant reduction (SMD: −0.3648, 95 % CI [-0.7783, 0.0488], p = 0.0839). FPG demonstrated a non-significant reduction (MD: −5.8925, 95 % CI [-20.4892, 8.7043], p = 0.4288), while TAR significantly decreased (MD: −8.8204, 95 % CI [-14.4101, −3.2307], p = 0.0020). No significant changes were observed in TIR (MD: 7.1211, 95 % CI [-1.6028, 15.8450], p = 0.1096). ConclusionAllulose demonstrated a significant reduction in postprandial glucose levels and TAR, supporting its role as a dietary intervention for glycemic control in T2DM patients. The findings are robust, though further research is needed to confirm its long-term effects on insulin sensitivity and metabolic health.

Clinical, genomic, and proteomic perspectives in the analysis of comorbid conditions in type 2 diabetes mellitus: a retrospective study.

Type-2 Diabetes Mellitus (T2DM) affects millions globally, with escalating rates. It often leads to undiagnosed complications and commonly coexists with other health conditions. This study investigates two types of prevalent comorbidities related to T2DM-the circulatory system (DCM1) and digestive system diseases (DCM2)-using clinical, genomic and proteomic datasets. The aim is to identify new biomarkers by applying existing machine learning (ML) based techniques for early detection, prognosis and diagnosis of these comorbidities. Here, we report a cross-sectional retrospective analysis from a T2DM dataset of T2DM associated concordant comorbidities (diseases with shared pathophysiology and management) from the Diastrat cohort (a T2DM cohort) recruited at the Northern Ireland Centre for Stratified Medicine (NICSM), in Northern Ireland. In the clinical data analysis, we identified that lipidemia was shown to negatively correlate with depression in the DCM1 group while positively correlate with depression in the DCM2 group. In genomic analysis, we identified statistically significant variants rs9844730 in procollagen-lysine (PLOD2), rs73590361 in beta-1,4-N-acetyl- galactosaminyl-transferase (B4GALNT3) and rs964680 in A kinase (PRKA) anchor protein 14 (AKAP14) which appear to differentiate DCM1 and DCM2 groups. In proteomic analysis, we identified 4 statistically significant proteins: natriuretic peptides B (BNP), pro-adrenomedullin (ADM), natriuretic peptides B (NT-proBNP) and discoidin (DCBLD2) that can differentiate DCM1 and DCM2 groups and have built robust ML model using clinical, genomic, and proteomic markers (0.83 receiver operative characteristics curve area, 84% positive predictive value and 83% negative predictive value and a classification accuracy of 83%) for prediction of DCM1 and DCM2 groups. Our study successfully identifies novel clinical, genomic, and proteomic biomarkers that differentiate between circulatory and digestive system comorbidities in Type-2 Diabetes Mellitus patients. The machine learning model we developed demonstrates strong predictive capabilities, providing a promising tool for the early detection, prognosis, and diagnosis of these T2DM-associated comorbidities. These findings have the potential to enhance personalized management strategies for patients with T2DM, ultimately improving clinical outcomes. Further research is needed to validate these biomarkers and integrate them into clinical practice.

Exploring the interplay between DHCR7, vitamin D deficiency, and type 2 diabetes mellitus (T2DM): a systematic review.

Type 2 diabetes mellitus (T2DM) is a growing global health concern. The pathogenesis of T2DM is multifactorial and intricate, involving a complex interplay of genetic predisposition, environmental factors, and molecular interactions. Vitamin D (circulating 25-hydroxyvitamin D concentration) regulates factors crucial for T2DM, including insulin secretion, sensitivity, and inflammation. Thus, vitamin D deficiency has been linked to poor health outcomes in T2DM patients. The cholesterol-synthesizing enzyme 7-dehydrocholesterol reductase (DHCR7) represents a critical regulatory switch between cholesterol and vitamin D3 synthesis. Recent findings suggest that the enzyme DHCR7 may indicate T2DM glycolipid metabolic disorder and is associated with deficient circulating vitamin D (circulating 25-hydroxyvitamin D concentration) status. In this PRISMA-guided systematic review, articles were sourced from two databases, namely, PubMed and Cochrane Library, to evaluate the impact of vitamin D deficiency in patients with T2DM and to explore the emerging role of DHCR7 in T2DM pathogenesis. Our findings strongly indicate a positive correlation between deficient vitamin D status and poor health outcomes in T2DM patients. Finally, this systematic review presents a novel perspective on T2DM development, focusing on the interplay between T2DM-associated hyperglycemia, expression of DHCR7, and abrogation of vitamin D synthesis.

Vitamin D Deficiency in Patients with Type 2 Diabetes Mellitus with and without Pulmonary Tuberculosis

Background: Vitamin D has a role in the body's calcium balance and immunodeficiency effects, and stimulates dendric cells, monocytes, T cells, macrophages in pathogenic microbes’ elimination. The variation occurrence as polymorphism on VDR might cause problem in production, transportation, and activity of vitamin D. The gap between the occurrence findings in previous studies shows that there are indication factors of VDR levels that probably associate with the T2DM range in comorbid with pulmonary tuberculosis. To determine vitamin D levels and factors associated with vitamin D deficiency in Type 2 Diabetes Mellitus (T2DM) patients with and without pulmonary Tuberculosis (TB). Method: The design of this study was cross-sectional. T2DM subjects with pulmonary TB were 45 people, and 43 people without pulmonary TB were 43 people. Sampling was done by consecutive sampling from October to December 2017. We collected data through interviews and examination of plasma vitamin D (25-OH) levels by ELISA. Data analysis using the Mann-Whitney test, and chi-square test with a confidence level of 95%. Result: There were 88 T2DM patients who met the inclusion criteria, consisting of 43 T2DM patients without pulmonary TB and 45 T2DM patients with pulmonary TB as the study subjects. There were differences in the distribution of T2DM subjects based on sex and BMI measurements. The mean plasma vitamin D levels in T2DM with pulmonary TB and T2DM without pulmonary TB were 20.08 ng/ml (SD ± 0.83 ng/ml) and 20.29 ng/ml (SD ± 0.81 ng/ml), respectively, we found no significant result in statistic (p = 0.287). Vitamin D deficiency was not associated with the incidence of pulmonary TB in T2DM, whereas female sex, age&gt; 50 years, BMI ? 25.0 kg /m2, and duration of T2DM&gt; 5 years were associated with vitamin D deficiency (p &lt;0.05). This research has contributed in novel findings of the correlation between sex and BMI associated in duration of T2DM impacted the Vitamin D insufficiently. Conclusion: Sex, age, BMI, and duration of T2DM had a significant correlation with vitamin D deficiency in T2DM patients with and without pulmonary TB.

Association between blood heavy metals and diabetic kidney disease among type 2 diabetic patients: a cross-sectional study.

Studies on the correlation of exposure to metals with diabetic kidney disease (DKD) is scarce, especially concerning the impact of mixed metals on DKD. This study aimed to explore the association of blood heavy metals with DKD risk among type 2 diabetes mellitus (T2DM) patients. This cross-sectional study enrolled patients with T2DM in NHANES 2011-2020. ICP‒MS was applied to detect five metals, namely, Pb, Cd, Hg, Se and Mn, in blood. At the same time, the impacts of exposure to single and mixed metals on DKD were assessed using multivariable logistic regression, WQS, and BKMR models. The relationship was examined based on age, sex, BMI, hypertension, smoking status and PIR. Totally 2362 participants were enrolled for final analysis. Among them, 634 (26.84%) patients undergoing T2DM had DKD. Logistic regression indicated that, Pb (Q4: OR [95% CI]: 1.557 [1.175, 2.064]) was related to DKD when all covariates were adjusted. The WQS analysis, which was set in a positive directional mode, suggested that Pb was correlated positively with a higher incidence of DKD. In BKMR analysis, linear dose‒response curves were generated for Pb when fixing the other metals in the 50th percentile. In addition, exposure to mixed metals was significantly positively related to DKD. Subgroup analysis during logistic regression demonstrated that Pb was significantly and positively related to DKD in females, over 50 years, those with over 25kg/m2, no hypertension, no smoking status and under PIR. Serum albumin (ALB) did not regulate the indirect impact of blood Pb on DKD risk. The results showed that the increased mixed metal concentration may lead to an increased DKD risk among patients with T2DM. Blood Pb is positively related to the DKD risk in diabetic patients, especially, in females, over 50 years, those with over 25kg/m2, no hypertension, no smoking status and under PIR in T2DM patients. According to our observations, Pb absorption at least slightly influences DKD occurrence and progression. More studies are needed to validate the results in this work and illustrate the relevant biological mechanism.

Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.

Comparison of clinical characteristics, microvascular complications and inflammatory markers in type 2 diabetic patients under insulin versus metformin treatment: A cross-sectional study at Karbala Diabetic Center, Iraq.

Type 2 diabetes mellitus (T2DM) is a major global health issue associated with chronic inflammation, which contributes to both disease progression and its complications, including cardiovascular and microvascular disorders. Key inflammatory markers such as tumor necrosis factor-alpha, interleukin-6 (IL-6), E-selectin, and P-selectin are elevated in T2DM patients and are implicated in the development of these complications. Understanding how treatments such as insulin and metformin affect these markers is crucial for improving therapeutic strategies in T2DM. This study investigated the effects of insulin and metformin on these inflammatory markers in T2DM patients. This was a cross-sectional study involving patients with diabetes on insulin (group A), metformin only (group B), and healthy controls (group C). Participants were enrolled from the Diabetic Center in Karbala, Iraq and underwent clinical assessments including ophthalmologic examinations. Fasting blood glucose, HbA1c and lipids levels were assessed. The levels of inflammatory markers (IL-6 and TNF-α), and adhesion molecules (sE-selectin and sP-selectin) were measured using Enzyme-Linked Immunosorbent Assay (ELISA). The study included 522 patients with diabetes: 356 receiving insulin (group A), 70 receiving metformin (group B) and 96 healthy controls (group C). T2DM patients treated with insulin exhibited significantly more microvascular complications than those treated with metformin. Higher rates of retinopathy (64.3% vs 11.4%) and neuropathy (69.9% vs 11.4%) were observed in the insulin group, whereas the incidence of nephropathy did not differ significantly (14.6% vs 11.4%). Inflammatory markers were lower in the insulin group: TNF-α levels were 3-fold lower and IL-6 levels were 8-fold lower. Conversely, sE-selectin levels were 1.5-fold higher in the insulin group, and sP-selectin levels were 1.4-fold higher in the metformin group. This study highlights distinct differences in inflammatory markers and systemic complications between T2DM patients treated with insulin and those treated with metformin alone. Further research is needed to explore the mechanisms underlying these observations and optimize treatment strategies for T2DM patients.

Effectiveness of health education on insulin injection technique in patients with type 2 diabetes mellitus: A quasi-experimental Pre-test post-test research

ABSTRACT Introduction: Type 2 Diabetes Mellitus (T2DM) patients often exhibit gaps in knowledge and improper practices regarding insulin injection techniques. This quasi-experimental study aimed to assess the effectiveness of tailored health education in bridging these gaps and improving insulin injection practices among T2DM patients. Objectives: The study aimed to evaluate baseline knowledge and practices related to insulin injection techniques among T2DM patients, implement a tailored health education intervention, and assess the impact of this intervention on knowledge and practices. Methodology: Participants included T2DM patients attending rural health centers. A structured questionnaire was utilized to assess baseline knowledge and practices. Tailored health education sessions were then conducted, incorporating video-based teaching, mock demonstrations, and handouts in the local language. Post-intervention assessments were performed using the same questionnaire. Data were analyzed using appropriate statistical methods. Results: At baseline, a significant knowledge gap and improper insulin injection practices were identified among participants. Following the tailored health education intervention, a substantial improvement in participants’ knowledge of insulin storage, handling, and administration was observed. The intervention also positively impacted insulin injection practices, emphasizing key areas such as handwashing, site cleansing, and needle disposal. Conclusion: This quasi-experimental study highlights the effectiveness of tailored health education in enhancing insulin injection practices among T2DM patients. The findings emphasize the potential for structured health education programs to address knowledge gaps, improve healthcare standards, and enhance the overall quality of life for individuals with T2DM. The study underscores the importance of individualized educational approaches to meet patient needs better.

The Dominant Personality Trait in Type 2 Diabetes Mellitus Patients at Dr. Soetomo General Hospital Surabaya

Introduction: Diabetes mellitus (DM) is a chronic disease characterized by elevated blood sugar levels above the normal range. The global prevalence of DM increased, with over 90% of cases being Type 2 Diabetes Mellitus (T2DM). People attempted various physical therapies, including adopting a healthy lifestyle through dietary adjustments, physical activity, and pharmacological interventions. However, we have not extensively explored non-physical therapies related to personality traits, and the incidence of DM remains high. The Big Five Personality Theory encompasses openness, conscientiousness, extraversion, agreeableness, and neuroticism. Each personality trait is believed to have specific tendencies toward diseases, emphasizing the importance of identifying the dominant personality traits in T2DM patients. This study aims to identify the dominant personality type in T2DM patients based on the Big Five Personality Theory at Dr. Soetomo General Hospital Surabaya. Methods: We employed a cross-sectional approach for data collection, using Big Five personality questionnaires as the primary data sources. Results: Among the 68 T2DM patients who participated in this study at Dr. Soetomo General Hospital Surabaya, from October 2022 to May 2023, the mean age of patients was 51-60 years, with a majority of female participants (63.2%) and male participants (37.8%). The questionnaire results indicated that the dominant personality trait was agreeableness (85.3%). Conclusion: The dominant personality type in T2DM patients, according to the Big Five Personality Theory at Dr. Soetomo General Academic Hospital Surabaya, was agreeableness (85.3%).

Correlation of Circulating Complement Levels with Clinical Characteristics of Patients with Diabetic Retinopathy.

Type 2 diabetes mellitus (T2DM) is associated with diabetic retinopathy (DR). The complement system maintains the normal physiologic microenvironment of the retina. The relationship between serum complement levels and clinical features of DR remains unclear. Clinical characteristics of 252 patients with T2DM including 101 with non-DR (NDR), 79 with nonproliferative DR (NPDR), and 72 with proliferative DR (PDR) were prospectively analyzed. Serum complement levels were compared between NDR and DR patients. The correlation between clinical characteristics and complement levels in DR patients was analyzed. A multifactorial logistic analysis was constructed to predict the risk of developing DR in T2DM. Serum C4, CFB, CFI, C3 and C5 levels were higher in DR patients than in NDR patients (all P < 0.05). In T2DM patients, C3 and C4 levels were higher in PDR patients than in DR patients (all P < 0.05), and MBL levels were not statistically different between the two cohorts (P > 0.05). These complement components or fragments were positively correlated with the duration of diabetes, glycosylated hemoglobin (HbA1c), and triglycerides (TG) (all P < 0.05). C3, C5, the duration of diabetes, HbA1c, and TG were the independent risk factors for DR in T2DM patients. The ROC model showed good value for predicting the risk of developing DR in T2DM with an area under the curve of 0.887. Serum complements C3 and C5 are predictive factors for DR in patients with T2DM. The prediction model constructed by the clinical characteristics of patients with T2DM and complement can better distinguish between NDR and DR, and can be used as a potential biomarker for assessing the risk of developing DR.

Bone fragility in Type 2 Diabetes Mellitus. Influence of sex and cardiovascular disease in a pilot study using metabolomics

Type 2 diabetes mellitus (T2DM) is one of the most common worldwide metabolic disorders, characterized by insulin resistance (IR) and defective insulin secretion by pancreatic β-cells which leads to multiple complications such as bone fragility. This complication might be influenced by other factors such as gender and cardiovascular disease (CVD). However, it is unclear why a certain T2DM group develops bone fragility, and what the molecular mechanism is. Metabolomics is a powerful approach to the study of human metabolism, especially in complex diseases such as T2DM. Thus, this study aimed to identify significant metabolites associated with bone fragility in T2DM patients. To achieve this, 81 individuals were enrolled and classified as T2DM patients (D, n=28), T2DM with bone fragility (D-Frag, n=25), or age-matched non-diabetic subjects (ND, n=28) as the control group. Serum samples were collected and analyzed using liquid chromatography and gas chromatography, both coupled to mass spectrometry (LC-MS and GC-MS, respectively). Samples were compared within four different scenarios: 1) the classical comparison of D vs ND to corroborate previous studies; 2) D-Frag vs D to explore the metabolites mainly associated with bone fragility; 3) the same comparison using male data (MD-Frag vs MD) to study as a more homogeneous model of bone fragility as in women, bone fragility could be mainly associated with hormonal stage and pregnancy; and 4) MD-Frag-CVD vs MD-CVD to explore the influence of bone fragility in the male-based model with CVD considering that most of the T2DM patients suffer from CVD. After analysis of these scenarios, our results suggest that acylcarnitines and glycerophospholipids, among other metabolites, are involved in the development of bone fragility in T2DM.

Correlations between the long noncoding RNA MEG3 and clinical characteristics for diabetic kidney disease in type 2 diabetes mellitus

Background and aimsDiabetic kidney disease (DKD) is a common complication of type 2 diabetes mellitus (T2DM) that leads to systemic inflammation. Maternally expressed gene 3 (MEG3) is a tumor suppressor that is involved in inflammation regulation. The current study investigated the association between DKD and the prevalence of the single-nucleotide polymorphisms (SNPs) of MEG3.MethodsA total of 706 and 735 patients were included in the DKD and non-DKD groups, respectively. The five SNPs of MEG3, namely rs4081134 (G/A), rs10144253 (T/C), rs7158663 (G/A), rs3087918 (T/G), and rs11160608 (A/C), were genotyped using TaqMan allelic discrimination.ResultsOur results revealed that, in the DKD group, the distribution of the GG genotype of the MEG3 SNP rs3087918 was significantly lower than that of the wild-type genotype (AOR: 0.703, 95% CI: 0.506–0.975, P = 0.035). In addition, in the pre-ESRD DKD subgroup, the distribution of the TG + GG genotype of the MEG3 SNP rs3087918 was significantly lower than that of the wild-type genotype (AOR: 0.637, 95% CI: 0.421–0.962, P = 0.032). In addition, among men in the DKD subgroup, the distribution of the GG genotype of the MEG3 SNP rs3087918 was significantly lower than that of the wild-type genotype (AOR: 0.630, 95% CI: 0.401–0.990, P = 0.045). Glycated hemoglobin (HbA1c) level was significantly higher in all T2DM patients with the wild-type genotype of the MEG3 SNP rs3087918 (P = 0.020). In addition, HbA1c levels were significantly higher in male patients and male DKD patients with the wild-type genotype of the MEG3 SNP rs3087918 (P = 0.032 and 0.031, respectively).ConclusionMEG3 SNP rs3087918 is significantly less prevalent in patients with DKD, and the SNP rs3087918 of MEG3 is associated with lower HbA1c levels.

ANGPTL3 as a target for treating lipid disorders in type 2 diabetes patients

Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disorder, and cardiovascular disease (CVD) is a significant cause of mortality and morbidity in diabetic individuals. In addition to hyperglycemia, lipid abnormalities associated with T2DM play a crucial role in the development of CVD complications. Diabetic dyslipidemia is characterized by elevated levels of triglyceride (TG)-rich lipoproteins and small dense low-density lipoprotein (LDL) particles, reduced high-density lipoprotein (HDL) cholesterol, and impaired HDL function. Angiopoietin protein-like 3 (ANGPTL3) is a liver-derived protein that plays a crucial role in regulating plasma lipoprotein metabolism by inhibiting lipoprotein lipase and influencing lipid levels. Inhibiting ANGPTL3 has shown promising effects in promoting HDL-mediated cholesterol reverse transport and reducing the levels of TG-rich lipoproteins and LDL cholesterol. Here, we explore the potential of ANGPTL3 as a therapeutic target for lipid management in T2DM patients.

Danggui Liuhuang Decoction Ameliorates Endothelial Dysfunction by Inhibiting the JAK2/STAT3 Mediated Inflammation

Ethnopharmacological relevanceVascular endothelial dysfunction (VED) is recognized as a key triggering diabetic vascular complications. Danggui Liuhuang Decoction (DGLHD) has shown potential in mitigating these complications. However, the clinical efficacy of DGLHD in enhancing endothelial function, as well as the molecular mechanisms underlying its alleviation of Type 2 Diabetes-Related Vascular Endothelial Dysfunction (T2DM-VED), remains insufficiently understood. Aim of the studyThis study aims to validate the therapeutic efficacy of DGLHD in ameliorating T2DM-VED through clinical research. Furthermore it seeks to analyze the pharmacodynamic basis and molecular mechanisms of DGLHD, elucidating the biological processes through which DGLHD alleviates VED in type 2 diabetes mellitus (T2DM). Materials and methodsPatients diagnosed with "Yin deficiency with hyperactive fire syndrome", who are at a high risk for atherosclerotic cardiovascular disease (ASCVD) associated with T2DM, were recruited for this study. The effect of DGLHD on vascular endothelial function in T2DM was assessed by measuring the levels of pro-inflammatory factors through enzyme-linked immunosorbent assay (ELISA) and flow-mediated dilation (FMD). The primary components of DGLHD were analyzed using the UHPLC-Q-Exactive Orbitrap system. Potential therapeutic targets of DGLHD were predicted using network pharmacology and molecular docking analysis. To validate the mechanism of DGLHD on T2DM-VED, endothelial injury and inflammation cell models were established using human umbilical vein endothelial cells (HUVECs). A mouse model of diabetic endothelial injury was also developed to observe the effects of DGLHD on pro-inflammatory factors and vascular endothelial factors were observed through immunohistochemistry. Additionally, the effects on the JAK2/STAT3 signaling pathway were observed through Western blot experiments. ResultsDGLHD was found to contain 201 active components. Network pharmacology analysis indicated that the treatment of T2DM-VED with DGLHD is associated with modulation of the JAK2/STAT3 signaling pathway. Molecular docking analysis demonstrated that small molecules in DGLHD interact with JAK2 and STAT3. Our clinical study demonstrated that DGLHD significantly reduces the levels of pro-inflammatory factors and improves FMD readings in diabetic patients, thereby alleviating T2DM-VED. DGLHD was shown to inhibit the phosphorylation of JAK2 and STAT3, which blocks the JAK2/STAT3 signaling pathway transmission, reducing the release of pro-inflammatory and vascular endothelial growth factors, and preventing the inflammatory response in vivo and in vitro. ConclusionThis study demonstrates the potential efficacy of DGLHD in improving endothelial function in T2DM patients at high risk for ASCVD. By inhibiting the JAK2/STAT3 signaling pathway, DGLHD effectively reduces the release of pro-inflammatory factors and vascular endothelial growth factors, alleviating VED.