Control In Diabetic Patients Research Articles

Immune Evasion in Stem Cell-Based Diabetes Therapy—Current Strategies and Their Application in Clinical Trials

Background/Objectives: Human pancreatic islet transplantation shows promise for long-term glycemic control in diabetes patients. A shortage of healthy donors and the need for continuous immunosuppressive therapy complicates this. Enhancing our understanding of the immune tolerance mechanisms related to graft rejection is crucial to generate safer transplantation strategies. This review will examine advancements in immune protection strategies for stem cell-derived islet therapy and discuss key clinical trials involving stem cell-derived β-cells and their protective strategies against the host immune system. Methods: A comprehensive literature search was performed on peer-reviewed publications on Google Scholar, Pubmed, and Scopus up to September 2024 to extract relevant studies on the various strategies of immune evasion of stem cell-derived β-cells in humans. The literature search was extended to assimilate all relevant clinical studies wherein stem cell-derived β-cells are transplanted to treat diabetes. Results: Our analysis highlighted the importance of human pluripotent stem cells (hPSCs) as a potentially unlimited source of insulin-producing β-cells. These cells can be transplanted as an effective source of insulin in diabetes patients if they can be protected against the host immune system. Various strategies of immune protection, such as encapsulation and genetic manipulation, are currently being studied and clinically tested. Conclusions: Investigating immune tolerance in hPSC-derived islets may help achieve a cure for diabetes without relying on exogenous insulin. Although reports of clinical trials show promise in reducing insulin dependency in patients, their safety and efficacy needs to be further studied to promote their use as a long-term solution to cure diabetes.

International co-validation of glycated hemoglobin A1c certified reference materials.

Accurate quantification of glycated hemoglobin A1c (HbA1c) is essential for the diagnosis and glycemic control in diabetic patients. The validation of HbA1c certified reference material (CRM) enhances the accuracy and comparability of HbA1c measurements. An international co-validation of HbA1c CRMs was conducted among the National Institute of Metrology, P.R. China (NIM), the Korea Research Institute of Standards and Science (KRISS), and the National Metrology Institute of Japan (NMIJ). Candidate reference materials (RMs) of VHLTPE, glycated VHLTPE, and two levels of HbA1c were developed and supplied by NIM. NIM investigated the homogeneity and stability of these materials, finding no inhomogeneity and confirming stability throughout the co-validation period. Isotope dilution mass spectrometry was employed for the quantitation of both hexapeptides in solution and HbA1c in amatrix. All three national metrology institutes (NMIs) were involved in the quantification of hexapeptides in solution, whereas only NIM and KRISS were involved in the quantification of HbA1c in thematrix. En values for both hexapeptides and HbA1c in the matrix were calculated, all being less than 1, indicating good agreement with the certified values. The successful co-validation of these CRMs demonstrates the reliability of the certified values, thereby benefiting the accuracy and comparability of HbA1c measurements.

Key molecular scaffolds in the development of clinically viable α-amylase inhibitors.

The escalating cases of type II diabetes combined with adverse side effects of current antidiabetic drugs spurred the advancement of innovative approaches for the management of postprandial glucose levels. α-Amylase is an endoamylase responsible for the breakdown of internal α-1,4-glycosidic linkages in dietary starch, producing oligosaccharides. Subsequently, α-glucosidase degraded these oligosaccharides to monosaccharides, which are absorbed into the bloodstream and become available to the body. The inhibitors of α-amylase reduced the digestibility of carbohydrates accompanied by delayed glucose absorption, leading to decreased blood glucose levels after meals and thus, inhibition of the enzyme seems to be a crucial strategy for diabetes management and improving overall glycemic control in diabetic patients. The present review article emphasizes the therapeutic promise of recently discovered potential α-amylase inhibitors, highlighting their in vitro, in silico and in vivo profiles. Ultimately, we addressed the contemporary challenges and potential routes ahead in the search for safe and reliable α-amylase inhibitors for clinical use, summarizing the most recent research in the field.

Preoperative Risk Assessment for Lumbar Fusion in Patients With Diabetes: Data-Driven Stratification of HbA1c and Same Day Glucose Levels that Predict 90-Day Complication Rates.

Retrospective Database Analysis. Pre-operative glycemic control in diabetic patients undergoing lumbar fusion (LF) is essential for evaluating complication risk. However, current thresholds for preoperative HbA1c and same-day-glucose (SDG) are either non-specific or have low predictive power. This study uses HbA1c and SDG to provide data-driven risk stratification for 90-day major and wound complications in LF patients. Using a national database, patients undergoing LF from 2013-2022 with a recorded preoperative HbA1c and SDG level were included for analysis. Multiple HbA1c and SDG strata were identified using stratum specific likelihood ratio analysis (SSLR). Each stratum was then propensity-score matched to the lowest strata and compared using risk ratios. Significance level was set at a P-value <0.05. 12,026 patients met inclusion criteria. For 90-day major complications, SSLR identified 3 predictive HbA1c (4.5-5.4, 5.5-7.9, and 8.0+) and SDG strata (60-159, 160-239, and 240+). Following propensity-matching, the 90-day major complication risk sequentially increased for HbA1c: 5.5-7.9 (1.69; P = 0.001; 95% CI 1.24-2.30), 8.0+(2.31; P < 0.001; 95% CI 1.56-3.43). Following propensity-matching, the SDG strata similarly demonstrated sequentially increasing 90-day major complication risk: 160-239 (1.34; P < 0.001; 95% CI 1.18-1.54), 240+ (1.64; P < 0.001; 95% CI 1.31-2.05). Matched analysis demonstrated a higher relative-risk of 90-day wound complications for the 8.0+ HbA1c strata (2.23; P = 0.001; 95% CI 1.37-3.63) compared to the HbA1c 4.5-5.4 strata. No other strata were identified that predicted differences in 90-day wound complications. This study identified data-driven HbA1c and SDG strata that better risk-stratify 90-day major complications following LF. Instead of current single-value thresholds, these multiple strata may be utilized for better preoperative guidance.

The Effect of HbA1c level on Post-Operative Complications Following Rotator Cuff Tear Repair Surgery: A Meta-Analysis Study

Introduction: Rotator cuff repair is a widely performed orthopedic surgical procedure to ease pain and restore shoulder movement in individuals with tears in the rotator cuff. This meta-analysis examined the relationship between preoperative HbA1c levels and susceptibility to postoperative complications following rotator cuff tear repair surgery. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant studies published until July 2023 were identified across multiple databases. Results: The meta-analysis included 14 articles (3 prospective, 11 retrospective) with 113,286 diabetic and 342,895 non-diabetic patients. Diabetic patients were slightly older on average. There were more males and smokers in the non-diabetic group, while the diabetic group had more hypertensive patients. Diabetic patients had worse outcomes, including higher rates of rotator cuff retears (RR 1.62;95%1.27, 2.06; P&lt;0.001). Non-diabetic patients generally achieved better healing (OR;2.68;95%CI;1.45,4.95;P=0.002), pain, and range of motion improvements. Diabetes did not significantly impact infection risk or hospital utilization. Conclusions: The findings suggest that optimizing glycemic control in diabetic patients may be important for improving outcomes following rotator cuff repair. This opens new avenues for research to understand the mechanisms driving the differences in outcomes between diabetic and non-diabetic patients. Developing strategies to minimize the negative impact of diabetes on rotator cuff injuries and repair procedures could be beneficial.

Analysis of glycemic control in diabetic patients by monitoring HbA1c levels before, during and after Covid-19 confinement in Auvergne, France.

To describe glycemic control in diabetic patients monitored by glycated hemoglobin (HbA1c) before, during and after COVID-19 confinement. To identify factors, measured before confinement, associated with HbA1c testing during confinement and those associated with a 1 % increase in HbA1c after confinement. Retrospective, descriptive study of diabetic patients over 18 years old who underwent at least one HbA1c test before and after confinement. The data were collected from medical analysis laboratories in the Auvergne region (France) and included HbA1c measurements between March 17, 2019, and May 11, 2021, age, sex, residential area, and medical specialty of the prescribing physician. 70,286 patients were included (54.1 % men, mean age 71.7 ± 13.1 years). The average preconfinement HbA1c level (6.80 % ± 1.16) was similar to the average post-confinement HbA1c level (6.80 % ± 1.14). A larger median reduction of 0.90 % points in HbA1c level in the year following confinement was observed in patients whose preconfinement HbA1c level was ≥ 9 %. Only 24.5 % of the patients had an HbA1c test performed during confinement, the majority of whom were over 80 years of age and had an average HbA1c level between 7 and 9 % before confinement. For 5.1 % of the patients, the average HbA1c level increased by one percentage point or more after confinement. Patients ≤ 64, those with an insufficient number of blood tests before confinement and those with an imbalance in HbA1c before confinement were at risk of glycemic imbalance after confinement. Confinement had no impact on HbA1c levels in diabetic patients.

Comparative study of autonomic function in diabetics and yoga practitioners using Ewing’s battery

ABSTRACT Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood sugar levels. It significantly increases the risk of cardiovascular diseases and autonomic neuropathy. Yoga has been shown to improve autonomic function and glycemic control in diabetic patients. Objective: To compare the autonomic nervous system (ANS) function between diabetic patients and regular yoga practitioners using Ewing’s battery tests. Methods: This cross-sectional study included 270 participants, divided into two groups: 135 diabetics (Group I) and 135 yoga practitioners (Group II). Participants’ height, weight, and BMI were measured. ANS function was assessed using Ewing’s battery tests, which included heart rate (HR) and blood pressure (BP) responses to various stimuli. Statistical analysis was performed using SPSS, with significance set at P ≤ 0.05. Results: Diabetic participants showed lower HR responses to standing from a supine posture, the Valsalva maneuver, and slow deep breathing, indicating impaired parasympathetic function. They also exhibited higher BP responses to the cold pressor test, sustained handgrip, and standing, reflecting sympathetic overactivity. In contrast, yoga practitioners demonstrated better autonomic function with higher HR responses and lower BP responses in these tests. The findings suggest that yoga promotes parasympathetic dominance and reduces sympathetic overactivity. Conclusion: Regular yoga practice significantly improves autonomic function in individuals, including those with diabetes. These results support the incorporation of yoga as a complementary therapy in diabetes management to enhance cardiovascular health and reduce autonomic dysfunction.

Identification of periodontal pathogens in type 2 diabetic patients with fixed orthodontic retainers

This study assessed the impact of orthodontic fixed retainers on periodontal health in 40 patients with type 2 diabetes, divided into two age groups: 18-30 years (n = 18) and over 30 years (n = 22). Bacterial loads were measured before and after a 10-14 day oral hygiene regimen using the micro-IDent test. In the younger group, the positive bacterial load decreased from 66.6% to 33.3% after treatment, while older patients showed less improvement. Pathogens like Treponema denticola and Prevotella intermedia were more resistant to treatment, especially in older patients. The study concluded that oral hygiene improves periodontal health and may benefit glycemic control in diabetic patients, but some pathogens require ongoing management for optimal outcomes.

Evaluation of the Effect of Routine Periodontal Treatment (SRP and Oral Hygiene Instruction) on Salivary Characteristics and Blood Sugar Control in Diabetic Patients: A Clinical Trial

Background: Diabetes mellitus is quite prevalent and causes many complications in different parts of the body. It also affects the quality of life by causing many complications in the oral cavity. This study examined a simple intervention to improve oral and periodontal tissue health and investigate its effect on the patient›s salivary characteristics and blood sugar control. Methods: This double-blind clinical trial was performed on 40 patients with type 2 diabetes. Fasting blood sugar (FBS), glycated hemoglobin (HbA1C), salivary glucose, amylase, total protein, viscosity, and pH were evaluated before and after scaling and oral hygiene instructions. The obtained data were entered into SPSS 17 statistical software and analyzed using the t-test, MannWhitney, and chi-square tests. Results: After the intervention, the FBS results in both groups (P value=0.015 in the case group and P value=0.017 in the control group) and HbA1C in the case group (P value=0.006) decreased significantly. Also, the difference in salivary viscosity, pH, and glucose between the case group and the control group was significant (P value=0.005, 0.008, and 0.021, respectively). Conclusion: Based on the results of the present study, scaling, and oral hygiene instructions reduce FBS and HbA1C, salivary glucose and amylase and oral conditions, leading to good blood sugar control.

Frexalimab (SAR441344) as a potential multiautoimmune disorder tackling mAB targeting the CD40-CD40L pathway undergoing clinical trials: a review.

Autoimmune disorders exhibit intricate pathology. Their mechanisms are complex, which attenuates the need for novel therapeutic interventions. Frexalimab, a potent monoclonal antibody targeting the dysregulated CD40-CD40L pathway, stands out as a formidable weapon against the assault of inflammation and tissue devastation. Diverse electronic databases were searched using relevant keywords to extract data on the role of Frexalimab in combating various autoimmune diseases. This review highlights Frexalimab's efficacy in improving various disability indicators of relapsing multiple sclerosis (RMS), alleviating fatigue in primary Sjögren's syndrome (PSJS), and improving glycemic control in diabetic patients. Across multiple trials, its favorable safety profile has proven its superiority over first-generation drugs in minimizing side effects. Indeed, Frexalimab has become a harbinger of hope in the fight against autoimmune diseases and has pioneered a unique and unchallenging way for tackling complex autoimmune diseases in the clinical realm, however, further large-scale trials are needed to establish its therapeutic benefits across different autoimmune conditions.

Oral Health and Systemic Disease: A Systematic Review of the Impact of Dental Care on Overall Health

Oral health is increasingly recognized as a critical component of overall health, with research highlighting its potential impact on various systemic diseases. This systematic review examines the current evidence on the association between oral health, particularly dental care, and systemic conditions such as cardiovascular disease, diabetes, respiratory illnesses, and adverse pregnancy outcomes. A comprehensive literature search was conducted across multiple databases, focusing on studies published from 2016 onward. Studies indicate that periodontal disease and other oral health issues may contribute to systemic inflammation, a common factor in many chronic conditions. Specifically, findings suggest that managing oral health can have beneficial effects on cardiovascular health, glycemic control in diabetic patients, and respiratory function, as well as reduce risks for adverse pregnancy outcomes. However, while associations are evident, causality remains difficult to establish, and further longitudinal research is needed to clarify these relationships. This review underscores the importance of incorporating dental care into holistic health approaches, advocating for greater collaboration between dental and medical professionals. Public health initiatives promoting regular dental check-ups and preventive care may play a crucial role in improving overall health outcomes.

A review on the impact of the worldwide shortage of glucagon-like peptide-1 medications on control of diabetic patients

Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have shown promising benefits in improving outcomes for patients with type 2 diabetes, particularly those affected by obesity-related complications such as cardiovascular disease, cardiometabolic disorders, and heightened cancer risks, posing significant public health challenges. Notably, GLP-1 RA have been recognized for their potential to achieve up to a 15% weight reduction over a span of two years, making them a preferred choice in specific conditions for diabetic patients with a body mass index (BMI) above 27. However, widespread public interest, particularly amplified through social media, has intensified the demand for GLP-1 RA due to their weight loss properties, thereby straining global supplies and fostering a black market among non-diabetic individuals seeking these effects. This heightened attention has prompted various medical regulatory bodies worldwide to enact strategies and policies aimed at alleviating shortages. Measures include minimizing new prescriptions of GLP-1 RA, exploring alternative medications within the GLP-1 RA category, carefully transitioning patients to other anti-diabetic treatments and managing patient expectations. These efforts appear effective in managing overall outcomes amid ongoing supply challenges. This narrative review provides a focused evaluation of how these GLP-1 RA medication shortages have impacted type 2 diabetic patients around the world and their overall diabetic outcomes.

6521 Continuation of Continuous Glucose Monitors in Hospitalized Diabetic Patients Decreased the Incidence of Hypoglycemia

Abstract Disclosure: C.E. DeClue: None. S. Bao: None. Objective: Glycemic control improves patient outcomes in hospitalized patients, and this is generally achieved by monitoring point-of-care (POC) capillary glucose levels. In the outpatient setting, continuous glucose monitoring (CGM) devices have shown improved glycemic control in diabetic patients, but their evidence in hospitalized patients is lacking. Methods: To evaluate CGM accuracy and safety of use in the inpatient setting, 567 consults were analyzed in a single-center inpatient diabetes service between November 2022 and January 2023. Patients were included if managed with multiple daily injections or insulin pump therapy and separated into four groups based on CGM continuation and type of diabetes. POC glucose and incidence of hypoglycemia were recorded over 72 hours from the time of consultation. Results: Forty-six Type-1 (T1DM) and 72 Type-2 (T2DM) diabetic patients were included in this study, with average hemoglobin A1c of 8.6% and 9.0%, respectively. Both diabetic groups showed an average POC glucose that was not statistically different based on CGM continuation (185 mg/dL for T1DM and 187 mg/dL for T2DM continued on CGM versus 183 mg/dL for T1DM and 188 mg/dL for T2DM not using CGM). However, only 2 of the 18 T1DM patients continued on CGM experienced hypoglycemia, whereas 17 of the 28 T1DM patients not using CGM experienced at least 1 hypoglycemic event. Similarly, only 2 of the 20 T2DM patients continued on CGM experienced hypoglycemia, whereas 13 of the 52 patients not using CGM experienced at least 1 hypoglycemic event. Additionally, less glucose variability was observed in both T1DM and T2DM patients continued on CGM (average standard deviation of 64 mg/dL and 55 mg/dL, respectively) compared to those not using CGM (average standard deviation of 84 mg/dL and 62 mg/dL, respectively). Conclusion: CGM has great potential to improve patient care and nursing workload in the hospital, but the safety and accuracy are not yet well-established. In this study, there seemed to be a statistically insignificant trend to less glycemic variability for CGM users despite no glycemic difference on average POC testing. Importantly, significantly fewer hypoglycemic events were observed in patients continued on CGM devices regardless of type of diabetes or baseline glycemic control. This study adds further evidence to the growing body of work supporting improved safety of CGM utilization in hospitalized diabetic patients. Presentation: 6/1/2024

A-045 Analytical and Clinical Evaluation of A1c Test by HPLC - Lifotronic™ H100Plus Analyzer - in a Brazilian Clinical Laboratory

Abstract Background Over the years, the measurement of Glycated Hemoglobin (A1c) has solidified as an important risk marker for pre-diabetic patients and for the diagnosis and control of diabetic patients. The High-Performance Liquid Chromatography (CLAE) method has been adopted in prospective studies such as the DDCT, and international certification by the NGSP is available. In this study, analytical performance metrics including imprecision, correlation, linearity, carryover, and detection of hemoglobin variants were evaluated for the Lifotronic® H100 Plus analyzer from China. Methods The results were evaluated following CLSI guidelines on samples within stability, collected according to standardized procedures. For the comparative method, 40 patient samples ranging from 4 to 15.4% were analyzed, and two concentrations of internal quality control material were used for intra-assay (5 repetitions per day) and inter-assay (over five days) imprecision testing. Linearity was assessed using samples at two concentrations, one low (4.5%) and another high (17.2%). For carryover evaluation, low (4.98%), intermediate (9.97%), and high (14.96%) concentrations were assayed in an interleaved manner. Hemoglobin variants found in the studied population were determined using the same method employed in correlation tests (HbS, HbF, HbC, HbE, and HbD). Results The method comparison study revealed a Total Error for decision levels of 5.6%: 2.23% and 6.5%: 1.70%, which were lower than the maximum allowable Total Error of 3.3% (EFLM - EuBIVAS). The difference plot showed that 95% of the results fell within acceptable limits. Positive bias was observed in 7 out of 40 tested samples, predominantly in samples with concentrations above 6,5%, although the medical team assessed it as having no clinical impact. For intra-assay imprecision, the obtained result was 0.86%, and for inter-assay imprecision, it was 0.87%, both deemed acceptable according to the 3.0 % specification proposed by the supplier for the two tested levels.Linearity tests were approved for concentrations proposed by the manufacturer between 3 and 18%, and no carryover was found between samples. All hemoglobin variants previously detected in the comparative method were also identified in the test method without exception, although the specific type of Hb variant was not identified. Conclusions The Lifotronic™ H100Plus analyzer demonstrated approved analytical performance with some notable observations: positive bias was observed in samples with concentrations above 6,5%, though it was not considered clinically relevant, the throughput of 58 tests per hour could be a limitation for laboratories with high testing volumes and the analyzer detected the presence of Hb variants, although it did not identify their specific types.

Why is it necessary to screen for periodontal disease in diabetic patients?

Periodontal diseases include gingivitis (inflammation of gingiva caused by the bacterial biofilm) and periodontitis involving loss of the supporting structures around the teeth, respectively cementum, periodontal ligament and alveolar bone. Diabetes increases the risk of periodontal diseases; the plausible mechanisms are: alterations in the immunoinflammatory response of bacteria, increased bone loss, the decrease in matrix-producing cells to maintain the periodontium, microvascular changes and alteration in collagen synthesis and metabolism. Treatment of periodontitis influence glycemic control in diabetic patients and intervention trial suggests that this can generate a reduction of circulating inflammatory markers and improves metabolic control in diabetic patients. International forums recommend oral examination as a component of medical care for diabetic patients. Our review summarizes current information on the association of diabetes with periodontal disease.

Correlation of Serum Electrolyte Imbalances With Diabetic Duration and Medication Use: A Cross-Sectional Comparative Study.

Certain anti-diabetic medications may exacerbate electrolyte imbalances, potentially complicating glycemic control in diabetic patients. The present study aimed to correlate the serum electrolyte imbalances such as Na+, K+, Ca+2, Cl-, and Mg+2 with the duration of disease, glycemic control, and medication regimens. In this cross-sectional study, 31 patients with type 2 diabetes mellitus (T2DM) and 30 healthy controls, with mean ages of 52.06 and 48.5 years, respectively, were recruited based on eligibility criteria. Data on demographic information, medication history, and duration of diabetes were collected. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1C), and serum electrolytes were measured. The data were statistically analyzed. The mean differences in serum electrolytes between T2DM patients and non-diabetic participants were compared using the Mann-Whitney U test, and correlation analysis was performed. A p-value of <0.05 was considered statistically significant. Around 9.6% of participants had diabetes duration of less than one year, while the majority (45%) fell within the 1-5-year duration range. Most diabetic patients (61.2%) exhibited poor glycemic control. Statistically significant differences were observed between the mean FBS, PPBS, and HbA1C levels of T2DM (150, 249, and 8.82, respectively) and control group (95, 114, and 5.52, respectively). Analysis of serum electrolytes showedstatistically significant differences with regard toNa+, K+, andCl-between the diabetic and control groups. Mean sodium and chloride levels were lower and potassium levels were higher in diabetic patients compared to the control group. Negative correlations were observed between sodium and chloride levels and duration of diabetes and HbA1C levels. The study reveals significant electrolyte imbalances in patients with T2DM, characterized by reduced sodium and chloride levels and elevated potassium levels compared to healthy controls. These alterations are closely associated with poor glycemic control and longer disease duration, emphasizing the importance of regular electrolyte monitoring in T2DM management to mitigate potential complications.

Comparative Analysis of Bariatric Surgery and Non-surgical Therapies: Impact on Obesity-Related Comorbidities.

Obesity is associated with a broad spectrum of comorbidities, including metabolic dysregulation, cardiovascular complications, and socioeconomic impacts. Traditional lifestyle interventions often yield transient results in weight management, while bariatric surgery offers a promising alternative. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and focused on randomized controlled trials comparing bariatric surgery (e.g., Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG)) with non-surgical therapies (drug therapy and lifestyle modifications) in the management of obesity-related comorbidities, particularly hypertension and type 2 diabetes mellitus (T2DM). We comprehensively searched databases like PubMed, PMC, and EBSCO using Medical Subject Headings (MeSH) terms related to obesity, bariatric surgery, and non-surgical treatments. We included seven studies involving participants aged 18-64 published within the last six years. We rigorously assessed these studies for quality and extracted data to evaluate outcomes such as weight loss, diabetes remission rates, hypertension management, and renal function. The review found that bariatric surgery consistently resulted in substantial and sustained weight loss compared to non-surgical therapies. Surgical interventions significantly improved hypertension control, reduced cardiovascular risks, and enhanced glycemic control in diabetic patients. The effectiveness of bariatric surgery in promoting diabetes remission was attributed not only to weight loss but also to physiological changes in gastrointestinal anatomy, gut hormones, and energy balance regulation. Limitations identified in the literature included variations in study methodologies, follow-up durations, and patient characteristics, which limited direct comparisons and generalizations. Future research should incorporate more extended follow-up periods and standardized methods to further validate these findings' durability and broad applicability across diverse patient populations. In conclusion, bariatric surgery emerges as an effective treatment option for managing obesity-related comorbidities, particularly hypertension and T2DM. While acknowledging the inherent risks and complexities associated with surgical interventions, ongoing research and clinical innovations are crucial to optimizing patient outcomes and reducing the global burden of obesity-related diseases.

Clinical Efficacy and Body Composition Changes with Sodium Glucose Cotransporter 2 Inhibitor/Glucagon-like Peptide-1 Antagonist Combination Therapy in Patients with Type 2 Diabetes Mellitus-associated Nonalcoholic Fatty Liver Disease

Objective Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) treatment guidelines recommend sodium glucose cotransporter 2 inhibitor (SGLT2I) and glucagon-like peptide-1 agonist (GLP-1A) therapy in patients with type 2 diabetes mellitus (T2DM). SGLT2I improves the pathological condition of NAFLD/NASH in T2DM patients. However, cases of rebound during long-term SGLT2I treatment have been reported. This study investigated the efficacy of SGLT2I and GLP-1A combination therapy in diabetic patients with NAFLD by examining changes in computed tomography (CT)-based body composition and clinical outcomes. Methods Fifteen patients (5 men/10 women) with T2DM-associated NAFLD who had not responded to SGLT2I treatment and were being treated with GLP-1A combination therapy were included. Changes in the liver function, visceral adipose tissue index (VATI), and subcutaneous adipose tissue index (SATI) were compared using CT to evaluate the body composition. Results SGLT2I significantly improved alanine aminotransferase (28.0 to 13.0 IU/L), alkaline phosphatase (250.0 to 77.0 IU/L), and gamma glutamyl transpeptidase (23.0 to 12.0 IU/L) levels. The body mass index (BMI) decreased from 25.7 to 25.2 kg/m2. A CT-based analysis showed a significant improvement in SATI (80.9 to 66.1, p=0.002), with no significant change in VATI (53.2 to 51.5). GLP-1A addition improved the BMI (25.2 to 23.5 kg/m2) and hemoglobin A1c (6.5% to 6.2%, p=0.001). A further analysis revealed additional improvement in SATI (66.1 to 56.6, p=0.007) and a significant decrease in VATI (51.5 to 48.3, p=0.001). Conclusion SGLT2I and GLP-1A combination therapy improved the liver function, body composition, and glycemic control in diabetic patients with NAFLD/NASH, as well as SATI and VATI. The optimal timing of combination therapy remains to be determined.

Synthesis, in vitro and in silico study of novel 1,3-diphenylurea derived Schiff bases as competitive α-glucosidase inhibitors.

Diabetes mellitus has become a major global health burden because of several related consequences, including heart disease, retinopathy, cataracts, metabolic syndrome, collapsed renal function, and blindness. In the recent study, thirty Schiff base derivatives of 1,3-diphenylurea were synthesized and their anti-diabetic activity was evaluated by targeting α-glucosidase. The compounds exhibited an overwhelming inhibitory potential for α-glucosidase with higher potency ranging from 2.49-37.16 μM. The most effective compound, 5h, showed competitive inhibition of α-glucosidase (K i = 3.96 ± 0.0048 μM) in the kinetic analysis and strong binding interactions with key residues α-glucosidase in docking analysis, indicating its potential for better glycemic control in diabetes patients.

Pathogenic Mechanisms That May Link Periodontal Disease and Type 2 Diabetes Mellitus-The Role of Oxidative Stress.

Given the posited role of oxidative stress in the pathogenesis of both periodontitis and type 2 diabetes mellitus (T2DM), it may also serve as a link between these highly prevalent chronic inflammatory diseases. This view is supported by an ample body of evidence indicating that the severity and progression of periodontitis is in part driven by diabetes, while periodontal infection may hinder the attainment of adequate glycemic control in diabetic patients. Thus, this review focuses on the potential synergistic interactions along the oxidative stress-inflammation pathway characterizing both conditions. Because periodontitis and T2DM share the same risk factors and compromise patients' quality of life, to develop effective strategies for combatting both conditions, their mutual influence needs to be explored.