Treatment Modality For Diabetes Research Articles

Advancing diabetes treatment: the role of mesenchymal stem cells in islet transplantation.

Diabetes mellitus, a prevalent global health challenge, significantly impacts societal and economic well-being. Islet transplantation is increasingly recognized as a viable treatment for type 1 diabetes that aims to restore endogenous insulin production and mitigate complications associated with exogenous insulin dependence. We review the role of mesenchymal stem cells (MSCs) in enhancing the efficacy of islet transplantation. MSCs, characterized by their immunomodulatory properties and differentiation potential, are increasingly seen as valuable in enhancing islet graft survival, reducing immune-mediated rejection, and supporting angiogenesis and tissue repair. The utilization of MSC-derived extracellular vesicles further exemplifies innovative approaches to improve transplantation outcomes. However, challenges such as MSC heterogeneity and the optimization of therapeutic applications persist. Advanced methodologies, including artificial intelligence (AI) and single-cell RNA sequencing (scRNA-seq), are highlighted as potential technologies for addressing these challenges, potentially steering MSC therapy toward more effective, personalized treatment modalities for diabetes. This review revealed that MSCs are important for advancing diabetes treatment strategies, particularly through islet transplantation. This highlights the importance of MSCs in the field of regenerative medicine, acknowledging both their potential and the challenges that must be navigated to fully realize their therapeutic promise.

Baseline treatments and metabolic control of 288,913 type 2 diabetes patients in a 10-year retrospective cohort in Malaysia

Diabetes is one of the quickest-growing global health emergencies of the twenty-first century, and data-driven care can improve the quality of diabetes management. We aimed to describe the formation of a 10-year retrospective open cohort of type 2 diabetes patients in Malaysia. We also described the baseline treatment profiles and HbA1c, blood pressure, and lipid control to assess the quality of diabetes care. We used 10 years of cross-sectional audit datasets from the National Diabetes Registry and merged 288,913 patients with the same identifying information into a 10-year open cohort dataset. Treatment targets for HbA1c, blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were based on Malaysian clinical practice guidelines. IBM SPSS Statistics version 23.0 was used, and frequencies and percentages with 95% confidence intervals were reported. In total, 288,913 patients were included, with 62.3% women and 54.1% younger adults. The commonest diabetes treatment modality was oral hypoglycaemic agents (75.9%). Meanwhile, 19.3% of patients had ≥ 3 antihypertensive agents, and 71.2% were on lipid-lowering drugs. Metformin (86.1%), angiotensin-converting enzyme inhibitors (49.6%), and statins (69.2%) were the most prescribed antidiabetic, antihypertensive, and lipid-lowering medications, respectively. The mean HbA1c was 7.96 ± 2.11, and 31.2% had HbA1c > 8.5%. Only 35.8% and 35.2% attained blood pressure < 140/80 mmHg and LDL-cholesterol < 2.6 mmol/L, respectively. About 57.5% and 52.9% achieved their respective triglyceride and HDL-cholesterol goals. In conclusion, data integration is a feasible method in this diabetes registry. HbA1c, blood pressure, and lipids are not optimally controlled, and these findings can be capitalized as a guideline by clinicians, programme managers, and health policymakers to improve the quality of diabetes care and prevent long-term complications in Malaysia.

Water and Diabetes: Prevention and Cure.

Water is ubiquitous in nature, and that is why, perhaps, it is not viewed as a nutrient. In the context of diabetes, water intake may have implications in increasing insulin resistance, development of complications, relation to anti-diabetic agents and also in prevention of diabetes. In this brief article, we list various aspects of water nutrition, i.e., hydration that support its status as a mega- nutrient, as a preventative therapy against diabetes, and as a treatment modality for diabetes and its complications.

Improving Self-Management of Diabetes and Hearing Loss Program

Upon completion, participants will be able to identify innovative interdisciplinary treatment modalities for diabetes and hearing loss, 2 well-known factors for late onset dementia and cognitive decline.

Development and validation of prediction models for gestational diabetes treatment modality using supervised machine learning: a population-based cohort study

BackgroundGestational diabetes (GDM) is prevalent and benefits from timely and effective treatment, given the short window to impact glycemic control. Clinicians face major barriers to choosing effectively among treatment modalities [medical nutrition therapy (MNT) with or without pharmacologic treatment (antidiabetic oral agents and/or insulin)]. We investigated whether clinical data at varied stages of pregnancy can predict GDM treatment modality.MethodsAmong a population-based cohort of 30,474 pregnancies with GDM delivered at Kaiser Permanente Northern California in 2007–2017, we selected those in 2007–2016 as the discovery set and 2017 as the temporal/future validation set. Potential predictors were extracted from electronic health records at different timepoints (levels 1–4): (1) 1-year preconception to the last menstrual period, (2) the last menstrual period to GDM diagnosis, (3) at GDM diagnosis, and (4) 1 week after GDM diagnosis. We compared transparent and ensemble machine learning prediction methods, including least absolute shrinkage and selection operator (LASSO) regression and super learner, containing classification and regression tree, LASSO regression, random forest, and extreme gradient boosting algorithms, to predict risks for pharmacologic treatment beyond MNT.ResultsThe super learner using levels 1–4 predictors had higher predictability [tenfold cross-validated C-statistic in discovery/validation set: 0.934 (95% CI: 0.931–0.936)/0.815 (0.800–0.829)], compared to levels 1, 1–2, and 1–3 (discovery/validation set C-statistic: 0.683–0.869/0.634–0.754). A simpler, more interpretable model, including timing of GDM diagnosis, diagnostic fasting glucose value, and the status and frequency of glycemic control at fasting during one-week post diagnosis, was developed using tenfold cross-validated logistic regression based on super learner-selected predictors. This model compared to the super learner had only a modest reduction in predictability [discovery/validation set C-statistic: 0.825 (0.820–0.830)/0.798 (95% CI: 0.783–0.813)].ConclusionsClinical data demonstrated reasonably high predictability for GDM treatment modality at the time of GDM diagnosis and high predictability at 1-week post GDM diagnosis. These population-based, clinically oriented models may support algorithm-based risk-stratification for treatment modality, inform timely treatment, and catalyze more effective management of GDM.

Prevalence and risk factors of chronic kidney disease in Palestinian patients with diabetes: a cross-sectional study

BackgroundChronic kidney disease (CKD) is a worldwide public health problem because of high morbidity and mortality and high costs of treatment. Diabetes is a major risk factor for development and progression of CKD. In this study, we aimed to assess the prevalence of CKD among patients with type 2 diabetes treated in primary health care (PHC) centres in the north area of West Bank, occupied Palestinian territory. MethodsA cross-sectional study design was used. A sample size of 385 patients was calculated based on following sample size formula n=Z2 × P × (1 – P)/d2, where p is the expected CKD prevalence and d is the margin of error. All patients with diabetes are referred to their district's PHC clinics for follow-up and management, with 25·35 patients being seen per day. Patients eligible for this study had type 2 diabetes, were 18 years or older. Those with type 1 diabetes or gestational diabetes, women who were pregnant, and those who did not have at least two creatinine measurements at least 3 months apart were excluded from the study. Patients were recruited at random. Between September and December, 2018, every third patient on a given day's client list was chosen. Data were obtained from personal interviews with patients and from their electronic health records Collected data included patients’ characteristics, creatinine levels, blood pressure, glycated haemoglobin A1c (HbA1c), and duration of hypertension and diabetes. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was staged according to the Kidney Disease Improving Global Outcomes System 2012 guidelines. We did univariate and multivariate analyses in SPSS version 20. The threshold for significance was p<0·05. The study was approved by Al-Najah National University Institutional Review Board and the Palestinian Ministry of Health. Patients provided written informed consent. FindingsWe recruited 386 patients with diabetes (192 [50%] men, 194 [50%] women) with a mean age of 60·6 (10·4) years. The mean duration of diabetes was 12·4 years (range 3·9–20·9) and HbA1c concentrations ranged from 6·39% to 10·47% (mean 8·4% SD 2·0). The prevalence of CKD was 24% (95% CI 19–28). Among these, 76 (20%) had stage 3, ten (3%) had stage 4, and five (1%) had stage 5 CKD. In multivariate logistic regression, CKD was significantly associated with hypertension (adjusted odds ratio 5·7, 95% CI 2·2–15·2·2, p=0·0052), smoking (2·3, 1·3–4·2, p=0·0134), and age 60 years or older (3·2, 1·8–5·9, p<0·0001). InterpretationCKD was common among adults with diabetes attending PHC centres in this study. Screening of patients with diabetes to detect CKD at earlier stages and implementation of more aggressive treatment modalities for diabetes as well as other important risk factors, especially hypertension and smoking are recommended. FundingNone.

HISTOGENESISAND DISTRIBUTION OF ISLETS IN HUMAN FETAL PANCREAS

The pancreas is a mixed exocrine and endocrine gland. Diabetes currently afflicts about 200 million people all over the world, and it is well known that the endocrine component of the pancreas has a direct correlation with the severity, morbidity, and treatment of the disease. Studies conducted in human fetal pancreas are very limited owing to ethical and technical issues. In cases of type I Diabetes mellitus, the knowledge of stepwise histogenesis of the endocrine component would be largely helpful to the surgeons for pancreatic transplant, and planning treatment protocols for pancreatic cancer.Study was performed on 30 aborted fetuses from 12 to 40 weeks, collected from Department of Obstetrics and Gynecology of the Institute, after due permission from institutional research and ethical committee. Pancreatic tissue was processed and stained with Hematoxylin and Eosin stains and examined for different components of pancreas correlating with development and distribution of islets.The parenchyma, exocrine and endocrine component of pancreases were observed. There was correlation between histogenesis of pancreas with regard to gestational age, gender, diabetic history of mother, congenital anomalies in fetus and distribution of islets throughout pancreas. Study would be helpful to know about the changes in histological development of fetal pancreas in relation to different gestational age and for planning treatment modalities for Diabetes and pancreatic diseases.

Poorer Attainment of Hemoglobin A1C, Blood Pressure and LDL-Cholesterol Goals among Younger Adults with Type 2 Diabetes

Concurrent attainment of glycated haemoglobin A1C, blood pressure, and LDL-cholesterol goals, or collectively known as the ‘ABC’ goals, help prevent cardiovascular complications in patients with type 2 diabetes (T2D). We aimed to determine the proportion of T2D patients who achieved all three ABC goals in Malaysia’s public health clinics. We also determined the association between age groups with the attainment of all the ABC goals. A cross-sectional analysis of the baseline findings from a retrospective open cohort study between 2013 and 2017 in Negeri Sembilan, Malaysia was conducted. The data was extracted from the National Diabetes Registry. The primary outcome was the proportion of patients who attained all three ABC goals. The exposure of interest was patients’ age groups, namely 18-44, 45-59 and ≥ 60 years. Multivariate logistic regression analysis was used to adjust demographics factors, comorbidities, complications and treatment profiles. Among 17,592 patients, the mean age was 59.1 years, with 56.3% females and 64.9% Malays. Overall, 4.5% (95% CI: 4.2-4.8) of the patients attained all the ABC goals. Compared to older adults aged ≥ 60 years, patients aged 18-44 and 45-59 years had adjusted odds ratios of 0.50 and 0.72, respectively, to achieve all the ABC goals. Ethnicity, body mass index, diabetes treatment modality, lipid-lowering agent and polypharmacy were independent factors associated with the outcome. In summary, achieving all the ABC goals in T2D patients is challenging, especially among younger adults. Our findings suggest that more targeted interventions should be directed towards this high-risk subpopulation.

Continuous Subcutaneous Insulin Infusions vs. Multiple Daily Injections of Insulin in Hospitalized Patients: Glycemic Trends in the First 24 Hours of Admission.

Continuous subcutaneous insulin infusion (CSII) is a common diabetes treatment modality. Glycemic outcomes of patients using CSII in the first 24 hours of hospitalization have not been well studied. This timeframe is of particular importance because insulin pump settings are programmed to achieve tight outpatient glycemic targets which could result in hypoglycemia when patients are hospitalized. This retrospective cohort study evaluated 216 hospitalized adult patients using CSII and 216 age-matched controls treated with multiple daily injections (MDI) of insulin. Patients using CSII did not make changes to pump settings in the first 24 hours of admission. Blood glucose (BG) values within the first 24 hours of admission were collected. The primary outcome was frequency of hypoglycemia (BG < 70 mg/dL). Secondary outcomes were frequency of severe hypoglycemia (BG < 40 mg/dL) and hyperglycemia (BG ≥ 180 mg/dL). There were significantly fewer events of hypoglycemia [incident rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.42-0.88, p = 0.007] and hyperglycemia (IRR 0.79, 95% CI 0.65-0.96, p = 0.02) in the CSII group compared to the MDI group. There was a trend toward fewer events of severe hypoglycemia in the CSII group (IRR 0.15, 95% CI 0.02-0.93, p = 0.06). Patients using CSII experienced fewer events of both hypoglycemia and hyperglycemia in the first 24 hours of hospital admission than those treated with MDI. Our study demonstrates that CSII use is safe and effective for the treatment of diabetes within the first 24 hours of hospital admission.

Herbal Drugs Used in Diabetes Mellitus

Diabetes mellitus (DM) is the most common of the endocrine disorders. It is an important human ailment, afflicting many, from various walks of life in different countries. The prevalence of diabetes mellitus is expected to reach up to 4.4% in the world by 2030. Among all type of diabetes, type 2 diabetes is main complication. Currently available treatment option in modern medicine have several adverse effects. Therefore, there is a need to develop safe and effective treatment modalities for diabetes. Medicinal plants play an important role in the management of diabetes mellitus especially in developing countries where resources are meager. This article presents a review on some reported anti-diabetic medicinal plants

GPCRs and Insulin Receptor Signaling in Conversation: Novel Avenues for Drug Discovery.

Type 2 diabetes is a major health issue worldwide with complex metabolic and endocrine abnormalities. Hyperglycemia, defects in insulin secretion and insulin resistance are classic features of type 2 diabetes. Insulin signaling regulates metabolic homeostasis by regulating glucose and lipid turnover in the liver, skeletal muscle and adipose tissue. Major treatment modalities for diabetes include the drugs from the class of sulfonyl urea, Insulin, GLP-1 agonists, SGLT2 inhibitors, DPP-IV inhibitors and Thiazolidinediones. Emerging antidiabetic therapeutics also include classes of drugs targeting GPCRs in the liver, adipose tissue and skeletal muscle. Interestingly, recent research highlights several shared intermediates between insulin and GPCR signaling cascades opening potential novel avenues for diabetic drug discovery.

Determining minimum set of features for diabetes mobile apps.

Interest in mobile health applications (apps) for diabetes self-care is growing. Mobile health is a promising new treatment modality for diabetes, though few smartphone apps have been designed based on a proper study and prioritization. The aim of this study was to determine a minimum set of features for diabetes mobile apps. This study was conducted in three steps: 1.A review of the literature to collect all available features, 2. Assessing the validity of suggested features by Content Validity Index (CVI) and Content Validity Ratio (CVR), 3. Examining the importance of features by Friedman test. We retrieved all features of available mobile apps for type 2 diabetes, which are suggested and discussed in literature and compiled as a single list comprising of 33 features. Then, a survey of expert's opinion produced a set of 23 final minimum features which includes all types of tracking, mealtime tagging, food database, diet management, educational materials, healthy coping, reducing risks, problem solving, Email, color coding, alerts, reminder, target range setting, trend chart view, logbook view, numerical indicators view, customizable theme, preset notes, and custom notes. According to the mean rank which indicates the priority of each feature, the most important one was blood glucose tracking (with 16.71 mean rank) and the least important feature was the numerical indicators like such as standard deviation or average (with 6.50 mean rank). The present study is the first step towards the development of our mobile apps for people with type II diabetes, and highest the essential features that are required for an optimal self-care comprehensively.

Evaluation of Quality of Life in Type 2 Diabetes Mellitus Patients Using Quality of Life Instrument for Indian Diabetic Patients: A Cross-Sectional Study.

Background:Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with major impact on the quality of life (QoL) in terms of various domains such as social, physical, and mental well-being.Aim:This study aimed to study the factors determining the QoL in T2DM patients.Materials and Methods:A prospective, observational study was conducted in a tertiary care hospital for 6 months. Patients of age ≥18 years and diagnosed with T2DM for ≥6 months (with and without comorbidities) were enrolled for the study. The sociodemographic and clinical characteristics were noted in the self-designed pro forma. The QoL was assessed by the Marathi-translated version of QoL Instrument for Indian Diabetes Patients questionnaire of 34 items and 8 domains. The reliability was validated by Cronbach's alpha. The differences were analyzed by Mann–Whitney U-test and Kruskal–Walis test.Results:Out of 153 T2DM patients, majority were elderly males with mean age of 61.23 ± 11.4 years, married (83%), lower-middle income (57%), urban (51.6%), primary education (46.4%), had diabetes for 5 years or less (42.5%), had positive family history of diabetes (32.6%), and were treated by intensive therapy mainly insulin (41.2%). Statistically significant (P < 0.05) association was found between different domains of QoL and family history, hypertension, body mass index, educational status, marital status, income status, treatment, and complications. The domains of diet satisfaction and general health with the least mean estimates of 7.70 ± 2.62 and 8.25 ± 3.08, respectively, were predominantly affected.Conclusion:QoL is an important parameter in diabetes treatment modality. Different factors affected QoL in diabetics in our study. Further studies are definitely needed for better data generation at national level.

Adverse Events Among Patients With Diabetes and Ambulatory Practice Characteristics: Evidence From a Nationally Representative Survey

Medications are the most common treatment modality for diabetes; however, medications may lead to inadvertent injury. Reducing adverse events in patients with diabetes is an important health care g...

Biochemical and cellular properties of insulin receptor signalling.

The mechanism of insulin action is a central theme in biology and medicine. In addition to the rather rare condition of insulin deficiency caused by autoimmune destruction of pancreatic β-cells, genetic and acquired abnormalities of insulin action underlie the far more common conditions of type 2 diabetes, obesity and insulin resistance. The latter predisposes to diseases ranging from hypertension to Alzheimer disease and cancer. Hence, understanding the biochemical and cellular properties of insulin receptor signalling is arguably a priority in biomedical research. In the past decade, major progress has led to the delineation of mechanisms of glucose transport, lipid synthesis, storage and mobilization. In addition to direct effects of insulin on signalling kinases and metabolic enzymes, the discovery of mechanisms of insulin-regulated gene transcription has led to a reassessment of the general principles of insulin action. These advances will accelerate the discovery of new treatment modalities for diabetes.

Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review.

BackgroundDiabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs. mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos.ObjectiveThe objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US.MethodsOur study consisted of two parts. First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities. Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents’ use of diabetes apps.ResultsApproximately one-third of apps reviewed were available in Spanish. The most common features were blood glucose recording/annotation and activity logs. The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account. Twenty percent of apps reviewed could connect directly with a glucometer, and 30% had reminder functionalities prompting patients to take medications or check blood glucose levels. Over 1600 online surveys were completed during the second half of April 2014. More than 90% of respondents were from the United States, including Puerto Rico. The majority of respondents used a device running on an Android platform while only a quarter used an iPhone. Use of diabetes apps was approximately 3% among diabetic respondents and 3.6% among diabetic respondents who also had a smartphone. Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used. A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor.ConclusionsLatino diabetics have unique needs and this should be reflected in diabetes apps designed for this population. Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps. We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish.

Mesenchymal Stem Cells: Rising Concerns over Their Application in Treatment of Type One Diabetes Mellitus.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that leads to beta cell destruction and lowered insulin production. In recent years, stem cell therapies have opened up new horizons to treatment of diabetes mellitus. Among all kinds of stem cells, mesenchymal stem cells (MSCs) have been shown to be an interesting therapeutic option based on their immunomodulatory properties and differentiation potentials confirmed in various experimental and clinical trial studies. In this review, we discuss MSCs differential potentials in differentiation into insulin-producing cells (IPCs) from various sources and also have an overview on currently understood mechanisms through which MSCs exhibit their immunomodulatory effects. Other important issues that are provided in this review, due to their importance in the field of cell therapy, are genetic manipulations (as a new biotechnological method), routes of transplantation, combination of MSCs with other cell types, frequency of transplantation, and special considerations regarding diabetic patients' autologous MSCs transplantation. At the end, utilization of biomaterials either as encapsulation tools or as scaffolds to prevent immune rejection, preparation of tridimensional vascularized microenvironment, and completed or ongoing clinical trials using MSCs are discussed. Despite all unresolved concerns about clinical applications of MSCs, this group of stem cells still remains a promising therapeutic modality for treatment of diabetes.

Components of Sustainable Health Systems: What Is Known About The Cost-Effectiveness of Clinical Care?

Evidence to ensure cost-effective purchasing of services are an important pre-requisite for ensuring financial sustainability of health systems. The Research Agenda for Health Economic Evaluation project aims to map out the economic evidence available for the treatment of the 10 highest burden conditions in the European Union and identify evidence gaps. The 10 highest burden diseases are selected by Disability Adjusted Life Years (DALYs) based on the Global Burden of Disease study for Europe (Ischemic Heart Disease, Low Back Pain, Stroke, Major Depressive Disorder, Lung Cancer, Falls, COPD, Diabetes, Other musculoskeletal, Neck pain). Clinical pathways are generated for these conditions by merging published clinical guidelines from public and professional bodies. Economic (cost-benefit and cost-effectiveness) evidence indexed by MEDLINE is stratified by treatment pathways to identify evidence gaps. Existing reviews are analysed to assess coverage of primary evidence. Results are presented for diabetes: 1,208 articles were retrieved from MEDLINE, of which 315 mapped to the treatment pathway. Most evidence was published after 2000.74 reviews were identified, of which 24 were published between 2009-13. Volume of economic studies for each treatment ranged from 0 to 39 studies. The most intensively studied were diabetic retinopathy (n=39), foot ulcers (n=34) and renal disease (n=31). Areas with no economic evidence included non-pharmacological blood pressure and dyslipidemia control. In some cases economic evidence was available, but no recent reviews of the evidence were identified (eg. islet or pancreas transplantation, diabetic neuropathy, interventions for weight loss). Economic evidence was available for the majority of treatment modalities for diabetes, however for several treatments no studies were identified. Importantly, reviews were not identified for several treatments where economic evidence was available. Lack of economic evidence prevents cost-effective commissioning, and lack of reviews of evidence may be a further barrier to translation.

Evaluation of the relationship between serum apelin levels and vitamin D and mean platelet volume in diabetic patients

ObjectivesIt was reported that Vitamin D deficiency was associated with a greater risk of cardiometabolic diseases, obesity, impaired glucose tolerance and diabetes mellitus type 2, arterial hypertension, and dyslipidemia. Apelin is an adipocytokine suspected to have a role in skeletal muscle glucose utilization and glycemic regulation which may be a promising treatment modality for diabetes. It was recently reported that increased mean platelet volume (MPV) was emerging as an independent risk factor for thromboembolism, stroke, and myocardial infarction. In patients with diabetes, MPV was higher compared with the normal glycemic controls; in addition, it has been proposed that an increase in MPV may play a role in the micro- and macro-vascular complications related to diabetes. We postulated that deficiency in Vitamin D levels might be associated with higher MPV and lower serum apelin levels leading a further increase in insulin resistance in diabetic patients. So, we aimed to investigate Vitamin D levels, MPV and serum apelin levels in diabetic patients and their correlations between each other. Materials and methodThis is a cross-sectional study design. Seventy-eight patients with Diabetes Mellitus type 2, admitted to our outpatient clinic of internal medicine department at Bezmialem Vakif University, were included in our study. Forty-one patients were female; 37 patients were male. Serum apelin levels, fasting glucose levels, urea, creatinine, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting serum insulin level, HbA1c, free T3, free T4, TSH, vitamin D (25-OH Vitamin D) and complete blood counts were analyzed in all subjects. ResultsEach sex was analyzed separately. We found that a positive correlation existed between serum apelin levels and BMI in female patients. (r: 0.380, P: 0.014) There was also a significant positive correlation between MPV and HbA1c and fasting glucose levels and a negative correlation between MPV and PLT. (r: 0.377, P: 0.021; r: 0.395, P: 0.014; r: −0.401, P: 0.011; respectively) We failed to show a significant relationship between serum vitamin D levels, serum apelin levels and MPV in patients with diabetes mellitus type 2. ConclusionWe failed to show an association between vitamin D, apelin and MPV higher volumes of which may have a role in cardiovascular complications related to diabetes by increasing platelet activation.

Ileal Glucose Infusion Leads to Increased Insulin Sensitivity and Decreased Blood Glucose Levels in Wistar Rats

ABSTRACTPurpose of the study: Rerouting of nutrients and/or increasing nutrient delivery to the small intestine after Roux-en-Y gastric bypass may have important potential as a diabetes treatment modality. However, it is still important question which part of the gastrointestinal tract is the most important for control of glycemia. The aim of this study was to investigate the role of different segments of the gastrointestinal tract on glucose metabolism in the physiological state. Materials and Methods: Forty 12-week-old male Wistar rats were divided into the following four groups of 10 animals each: the gastrostomy group, the duodenostomy group, the jejunostomy group, and the ileostomy group. All rats were subjected to a glucose tolerance test by infusion of glucose via the surgically inserted tubes in the stomach (gastrostomy), in the duodenum (duodenostomy), in the jejunum (jejunostomy), or in the ileum (ileostomy). Plasma glucagon-like peptide-17–36 (GLP-17–36) and insulin levels during the glucose tolerance test were assayed and Matsuda index was calculated. Results: Ileostomy rats exhibited significantly lower glycemic excursions compared with gastrostomy, duodenostomy, and jejunostomy rats. Insulin and GLP-1 levels during the glucose tolerance test were significantly higher in duodenostomy and jejunostomy rats than in gastrostomy and ileostomy rats. Matsuda index was significantly higher in ileostomy rats than in duodenostomy and jejunostomy rats. Conclusion: Ileal glucose infusion leads to increased insulin sensitivity, further decreasing blood glucose levels.