Diabetic Medicine Research Articles

Availability, price, and affordability of diabetes mellitus and thyroid dysfunction medicines in South Wollo zone, Northeast Ethiopia

BackgroundDiabetes mellitus and thyroid dysfunction are prevalent endocrine disorders that impose enormous burdens on patients and countries. However, access to essential medicines remains inadequate in many low-income countries. This study evaluated medications’ availability, price, and affordability for these conditions.MethodsA cross-sectional study was conducted at health facilities in the South Wollo zone in 2022. Following World Health Organization (WHO)/Health Action International (HAI) guidelines, 34 medicines were evaluated across 60 medicine outlets. Data were collected using a standardized tool adapted from WHO/HAI. Availability was measured by the percentage of facilities where the medicines were in stock. Prices were reported as median prices and median price ratios (MPR). Affordability was assessed based on the number of days’ wages required for the lowest-paid government workers to cover the full course of therapy.ResultsThe availability of lowest-priced generic (LPG) diabetes and thyroid dysfunction medicines in the public sector was 24.4% and 28.7%, respectively. In private pharmacies, availability was 26.3% for diabetes and 21% for thyroid dysfunction medicines. Median prices for LPG medicines were higher in private pharmacies than in public health facilities, with 81.81% showing a statistically significant difference (p < 0.05). In private pharmacies, the prices of LPG diabetes (5, 71.43%) and thyroid dysfunction medicines (5, 83.33%) exceeded the reference price. None of the LPG diabetes and thyroid dysfunction medicines were affordable in either setting.ConclusionsThe study revealed a very low availability of medicines and a financial burden on patients. Therefore, the government should improve the availability of these essential medicines and regulate their prices.

Understanding and improving the quality of primary care for people in prison: a mixed-methods study.

People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities. To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved. A mixed-methods study with six interlinked work packages. Predominantly the North of England. Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups. Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment. Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ. Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change. This study is registered at researchregistry.com (Ref: 5098). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.

8132 Prolonged Refractory Hypoglycemia For Seven Days After Discontinuation Of Neutral Protamine Hagedorn (NPH) Insulin And Injectable Semaglutide

Abstract Disclosure: A. Musleh: None. M.T. Rauf: None. E. Afroze: None. S. Al-Bacha: None. A 75-year-old male with Type 2 Diabetes was brought to the emergency department (ED) by emergency medical services (EMS) due to altered mentation. The patient’s wife found him unresponsive with seizure-like activity. EMS was called to the scene and obtained a capillary blood glucose reading of 31 mg/dL. Despite initial treatment with 50% dextrose the patient’s capillary blood glucose came down to 21 mg/dL in the ED and was confirmed by venous glucose. Workup including Computed Tomography (CT) imaging was inconsistent with a cerebrovascular accident. Given refractory hypoglycemia and delirium, the patient was started on a dextrose 10% infusion at 150 milliliters per hour. He was admitted to the intensive care unit for closer monitoring. His wife states that the patient had a few episodes of mild hypoglycemia overnight for the past several weeks, which improved after eating. His home medications included NPH insulin 46 units twice daily, empagliflozin 25 mg once daily, and injectable semaglutide 2 mg once weekly. The last dose of NPH insulin was the night before the presentation and the last dose of semaglutide was 5 days prior to admission. Serum creatinine levels were stable at 1.3-1.5 mg/dL throughout the hospitalization, which was below his baseline creatinine of 1.7 mg/dL. Laboratory results were as follows: hemoglobin A1c 5.9%, c-peptide level was 0.3 ng/mL (normal range 0.8-3.9 ng/mL) with a glucose of 68 mg/dL (normal range 70-100 mg/dL), insulin 203.8 mcIU/mL (normal range less than 24 mcIU/mL), proinsulin 3.2 pmol/L (normal range less than or equal to 8 pmol/L), beta-hydroxybutyrate 0.06 mmol/L (normal range 0.02-0.27), cortisol 66.6 mcg/dL (normal range 6.7-22.6 mcg/dL), insulin-like growth factor 1 123 ng/mL (normal range 53-222), and hypoglycemic agent panel was negative. On ICU Day 2, his mentation improved, he was allowed to eat but continued to require dextrose infusion to prevent hypoglycemia. Repeat fasting insulin levels even four days from prior showed an incremental decrease to 59.4 mcIU/mL with a glucose of 77 mg/dL. It took 7 days before the patient was able to maintain glucose above 70 mg/dL off of dextrose infusion. After which he had hyperglycemia requiring gradual reintroduction of his diabetes medicines other than insulin. It is rare to see such prolonged refractory hypoglycemia from an exogenous source of insulin as exhibited in this case. Notably, the patient was on semaglutide and had stable chronic kidney disease without acute kidney injury. Although multiple mechanisms explain the prolonged insulin duration of action in kidney disease, the effects of semaglutide on insulin action are unknown. Presentation: 6/3/2024

Access to medicines among asylum seekers, refugees and undocumented migrants across the migratory cycle in Europe: a scoping review

IntroductionAccess to essential medicines is a critical element of health systems and an important measure of their performance. Migrants may face barriers in accessing healthcare, including essential medicines, throughout the...

Study of the Relationship between Insulin Resistance and Risk of Developing Depression and Anxiety Disorders

Abstract Background Studies have suggested that diabetes increases the risk of incident depression and anxiety. Also, it can contribute to a more severe course of depression and anxiety with different mechanisms. Moreover, Insulin resistance is an essential component in development of diabetes in diabetic patients. Yet, no sufficient studies revealed the relationship between insulin resistance and depression and anxiety. Hence, this is important to prevent, early detect, treat, and identify factors affecting their incidence, as this affects prognosis and insulin resistant individuals’ quality of life. Aim of the Work To study the relationship between insulin resistance and risk of developing depression and anxiety disorders. Patients and Methods This is a case control study conducted on patients from diabetes and Internal medicine clinics and department of Ain Shams University Hospitals. This present study aimed at analyzing the data of 60 participants divided into 3 groups. Group 1has 20 Insulin resistant diabetic patients. Group 2 has 20 Insulin resistant non diabetic patients. Group 3 has 20 Non insulin resistant non diabetic normal subjects, over two months period from December 2022 to March 2023. They were subjected to clinical examination and laboratory work up including (HbA1c, HOMA IR, lipid profile), then they were screened by PHQ and GAD. Results A total of 60 participants who are composed of 56.6% females, 70% non workers, 78% married, 30% smokers and 62% with BMI more than 25. As regards psychiatric assessment, PHQ assessment shows a total of 34 participants having depression representing (56.67%), while GAD assessment shows 28 subjects having anxiety disorder (46.67%). As regard the comparison between the 3 groups the HOMA IR values are higher in group 1 and 2, while, HbA1c values are more in group 1 which show a statistical significance with p value &amp;lt;0.001 each. As regards, psychiatric assessment of the participants, 75% of group 1, 60% of group 2 and only 35% of group 3 suffer from depression scored by PHQ. This shows a statistically significant correlation between DM, IR and depression (p value = 0.036) Furthermore, 65% of group 1, 55% of group 2 and only 20% of group 3 suffer from scored by GAD. This shows a statistically significant correlation between DM, IR and anxiety (p value = 0.011) Conclusion Depression shows significant correlation with HbA1c value and Anxiety shows significant correlation with HOMA IR value. Hence, psychiatric evaluation can’t be ignored in any case with insulin resistance or diabetes. Detecting factors which affect the prevalence of such complications will help in preventing them in the future. So, further research to establish management protocols to reduce these complications is needed.

Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors: Antidiabetics Medications for Treating Diabetes

Type 2 diabetes (T2D) is a progressive disease, and most patients need to treat with monotherapy and combinations of oral hypoglycaemic drugs. At present about 500 million people worldwide are suffering from T2D. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a novel antidiabetic drug class that mediates epithelial glucose transport at the renal proximal tubules, inhibiting glucose absorption that result in glycosuria, modest weight loss and improve glycaemic control with a low risk of hypoglycaemia. These are used by T2D patients together with diet and exercise, either alone or in combination with other diabetes medicines. The main side-effects of SGLT-2 inhibitors are urinary tract and genital infections, as well as euglycemic diabetic ketoacidosis. Some other probable adverse effects are lower limb amputations, risk of bone fractures, Fournier gangrene, male bladder cancer, female breast cancer, orthostatic hypotension, and acute kidney injury. This mini review explains aspects of SGLT-2 inhibitors with treatment procedures and side-effects.

Long-term Outcome of Coronavirus Disease-associated Mucormycosis: 1-year Follow-up Study from India.

Invasive fungal infections have recently become a public health problem, particularly in India following the second wave of coronavirus disease 2019 (COVID-19). India harbors the world's largest population of patients suffering from diabetes. What prompted the sudden spike of mucormycosis infections in the COVID pandemic needs investigation. To determine if COVID-19 infection prompted the spike in invasive fungal infections in diabetic population. To determine the long-term outcome of COVID-associated mucormycosis. To determine if COVID-19 infection causes diabetes mellitus transiently. The study was a prospective cohort study comprising patients suffering from mucormycosis. The study was planned from 20 May 2021, until 30 November 2022, to investigate the long-term follow-up (1 year) of mucormycosis patients. The study setting was a referral hospital. All the consecutive patients admitted to this hospital for treatment of mucormycosis were included in the study who consented to it. Intervention(s) (for clinical trials) or exposure(s) (for observational studies): All patients suffering with mucormycosis underwent treatment at this hospital with surgery and injectable systemic antifungal drugs alongside diabetes management. Primary outcome measurement was in the form of survival with cure of mucormycosis. Hypothesis being tested was formulated during data collection. The data of 98 participants was collected, but analysis was done after excluding the case of cutaneous mucormycosis (infant patient). Mean age for patients was 55.5 years, varying from 28 to 88 years. In our study, 63.3% of patients with mucormycosis were males and 37.8% were females, of which 55.7% (34) and 58.3% (21) were known diabetics, respectively. Previous history of diabetes mellitus was identified as an underlying comorbid condition in 56.7% of patients, while the rest were diagnosed with new-onset diabetes mellitus. Sugar levels ranged (on admission) from 112 to 494 mg/dL (median 212 mg/dL) for known diabetics and from 132 to 356 mg/dL (median 204 mg/dL) for newly diagnosed diabetics. Other comorbidities included hypertension (19.5%), ischemic heart disease (8.2%), chronic renal illness (3.09%), and one case (1.03%) of postoperative renal cell carcinoma (disease-free). The majority of cases (91.8%) were not vaccinated for COVID-19, while only two patients reported a history of vaccination with two doses, and six others had received only a single dose. At the 1-year follow-up, 57.7% of cases were disease-free, 30.9% had expired, and 11.3% were lost to follow-up. The mean glycated hemoglobin (HbA1c) at the time of admission was found to be statistically significant when compared between known diabetics and newly diagnosed ones [confidence interval (CI)-95%, p ≤ 0.01]. A total of seven patients from the newly diagnosed diabetic group no longer required medicines for diabetes at the end of 1 year (CI-95%, p ≤ 0.01). Diabetes mellitus, particularly with poor glycemic control, was the single most important factor associated with and predictor of outcome. Contrary to the popular hypothesis, industrial oxygen and oxygen masks were not the reasons for the mucormycosis pandemic. Additionally, immunization against COVID provided protection not only from severe COVID but also from COVID-associated mucormycosis. It is recommended that patients with mucormycosis be followed for longer periods as a few patients could be suffering from transient diabetes, particularly against the backdrop of a pandemic.

Euonymus alatus Extract Reduces Insulin Resistance in db/db Mice by Regulating the PI3K–AKT Pathway

In accordance with the usage of Euonymus alatus (EA) as folk medicine in diabetes, the present study employed water and 70% ethanol twig extract to assess its antidiabetic effects in C57BL/KsJ-db/db mice. These effects were then compared with those observed in normal C57BL/6J Jms Slc mice. After 4 weeks of supplementation with 70% ethanolic EA extract or water EA extract by oral gavage at a dose of 500 mg/kg with distilled water (DW) per day, body weight was measured and compared with the diabetic group (Db). HPLC demonstrated that the maximum flavonoids were extracted in the Et.EA extract rather than in the water EA extract. The supplementation of the Et.EA extract significantly increased liver and muscle glycogen content with respect to the Db group. Additionally, the Et.EA extract modulated the expression of glycogen synthase (GS) in the liver and muscles of Db mice, indicating that it plays a promotive role in glycogen synthesis. Mechanistically, Et.EA extract activates insulin receptor substrate (IRS1/IRS2)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) in the liver and muscles of Db mice. In conclusion, Et.EA extract attenuates insulin resistance by regulating the expression of metabolic enzymes and signaling pathways.

Evaluation of serum electrolyte abnormalities in type II diabetic patients presenting in Gulab Devi hospital, Lahore

Background: The hallmark of diabetes mellitus (DM) is hyperglycemia brought on by an absolute or relative insulin shortage. Globally, the prevalence of DM is a major cause for worry. The International Diabetes Federation estimates that 26.7% of Pakistan's adult population would have diabetes in 2022, totalling over 33,000,000 cases 1. Patients with diabetes are more likely to experience electrolyte imbalances, which may be caused by an imbalance in the distribution of electrolytes. Electrolytes play a vital role in the maintenance of blood acid-base balance, composition of body fluids, blood clotting, muscle and nerve conduction. Impaired electrolytes balance in diabetics may lead to micro and macrovascular complications. Aims and objectives: The objective of this study is to investigate disturbances in serum electrolytes including Sodium (Na+), Potassium (K+) and Chloride (Cl) in Type II diabetics. Methodology: This has been a descriptive cross-sectional study where random sampling technique was used. 3cc clotted blood samples of 100 Type II diabetic patients were collected from diabetic OPD and medicine wards of Gulab Devi Chest Hospital Lahore and processed in the Pathology lab of Gulab Devi Educational Complex. Results: Out of 100 samples of type II diabetic patients, there were 65 patients in which serum sodium levels were decreased. Serum potassium and serum chloride were slightly increased in some patients. Conclusion: In this study, serum sodium levels were significantly decreased in type II diabetic patients, while no significant alteration was observed in serum potassium and chloride levels. Serum electrolytes should be routinely measured in diabetics to prevent complications.

Indonesian Perspective: Identification of Stevia Plant (Stevia Rebaudiana Bertoni M.) as Medicine Prospects

Stevia plant has the potential for development as a source of natural sweeteners, a plant from South America and indigenous of Paraguay, has shown several advantages including the level of sweetness that reaches 100-200 the sweetness of sugar cane and low calorie also constituting a source of many substances with a nutritional effect on the human beings. Folk medicine of Indonesian indigenous tribes recommends it particularly as a substance strengthening the heart, the circulatory system and regulating blood pressure. It exhibits antibacterial, antifungal and anticaries properties. This stevia study aimed to educate people about the efficacy and safety of the stevia plant as a sweetener to replace sugar and medicines by diabetic patients as a part of Indonesia perspective the aims also to enrich information about the stevia plant which has the potential for development as a source of natural sweeteners, and as a medicine for diabetes with a bright prospects in the future.

Fabrication and characterization of gold nanoparticles using alginate: In vitro and in vivo assessment of its administration effects with swimming exercise on diabetic rats.

Gold nanoparticles (AuNPs) have unique features that might lead to the development of a new class of diabetic medicines. AuNPs were biosynthesized utilizing sodium-alginate. UV-Vis-spectroscopy, Fourier transforms infrared, field emission scanning electron microscopy (FESEM), and energy dispersive X-ray were used to examine the particles. The potential of AuNPs for improving the diabetes condition was examined along with swimming in rats. FESEM image revealed the spherical morphology with an average particle size of 106.6 ± 20.8 nm. In the diabetic group, serum glucose, blood urea nitrogen (BUN), creatinine, cholesterol, and triglyceride (TG) levels were significantly higher than the control group. Low-density lipoprotein (LDL) was significantly higher and high-density lipoprotein (HDL) was significantly lower in the diabetic group compared to the control group. Malondialdehyde (MDA) levels were also significantly higher in the D group. However, in the groups treated with swimming and gold, these parameters were significantly improved. Specifically, serum-glucose, BUN, creatinine, cholesterol, and TG levels were significantly reduced, while LDL was significantly decreased in the diabetic + swimming + AuNPs group and HDL was significantly increased in the diabetic + AuNPs group. MDA levels were significantly decreased in the treated groups, and other antioxidants were significantly improved in the diabetic + swimming + AuNPs group. Catalase levels were also significantly improved in the D + gold group. It can be concluded that both AuNPs and swimming can decrease diabetic complications.

How far has diabetes-related foot disease research progressed in Australia? A bibliometric review (1970-2023).

Diabetes-related foot disease (DFD) is a leading cause of the Australian and global disease burdens and requires proportionate volumes of research to address. Bibliometric analyses are rigorous methods for exploring total research publications in a field to help identify volume trends, gaps and emerging areas of need. This bibliometric review aimed to explore the volume, authors, institutions, journals, collaborating countries, research types and funding sources of Australian publications investigating DFD over 50years. A systematic search of the Scopus® database was conducted by two independent authors to identify all Australian DFD literature published between 1970 and 2023. Bibliometric meta-data were extracted from Scopus®, analyzed in Biblioshiny, an R Statistical Software interface, and publication volumes, authors, institutions, journals and collaborative countries were described. Publications were also categorised for research type and funding source. Overall, 332 eligible publications were included. Publication volume increased steadily over time, with largest volumes (78%) and a 7-fold increase over the last decade. Mean co-authors per publication was 5.6, mean journal impact factor was 2.9 and median citation was 9 (IQR2-24). Most frequent authors were Peter Lazzarini (14%), Vivienne Chuter (8%) and Jonathon Golledge (7%). Most frequent institutions affiliated were Queensland University Technology (33%), University Sydney (30%) and James Cook University (25%). Most frequent journals published in were Journal Foot and Ankle Research (17%), Diabetic Medicine (7%), Journal Diabetes and its Complications (4%) and International Wound Journal (4%). Most frequent collaborating countries were the United Kingdom (9%), the Netherlands (6%) and the United States (5%). Leading research types were etiology (38%), treatment evaluation (25%) and health services research (13%). Leading funding sources were no funding (60%), internal institution (16%) and industry/philanthropic/international (10%). Australian DFD research increased steadily until more dramatic increases were seen over the past decade. Most research received no funding and mainly investigated etiology, existing treatments or health services. Australian DFD researchers appear to be very productive, particularly in recent times, despite minimal funding indicating their resilience. However, if the field is to continue to rapidly grow and address the very large national DFD burden, much more research funding is needed in Australia, especially targeting prevention and clinical trials of new treatments in DFD.

Seaweeds as Nutraceutical Elements and Drugs for Diabetes Mellitus: Future Perspectives.

Diabetes mellitus is a chronic metabolic condition marked by high blood glucose levels caused by inadequate insulin synthesis or poor insulin use. This condition affects millions of individuals worldwide and is linked to a variety of consequences, including cardiovascular disease, neuropathy, nephropathy, and retinopathy. Diabetes therapy now focuses on controlling blood glucose levels through lifestyle changes, oral medicines, and insulin injections. However, these therapies have limits and may not successfully prevent or treat diabetic problems. Several marine-derived chemicals have previously demonstrated promising findings as possible antidiabetic medicines in preclinical investigations. Peptides, polyphenols, and polysaccharides extracted from seaweeds, sponges, and other marine species are among them. As a result, marine natural products have the potential to be a rich source of innovative multitargeted medications for diabetes prevention and treatment, as well as associated complications. Future research should focus on the chemical variety of marine creatures as well as the mechanisms of action of marine-derived chemicals in order to find new antidiabetic medicines and maximize their therapeutic potential. Based on preclinical investigations, this review focuses on the next step for seaweed applications as potential multitargeted medicines for diabetes, highlighting the bioactivities of seaweeds in the prevention and treatment of this illness.

Psychosocial Factors and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes

Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions. To identify psychosocial factors associated with glycated hemoglobin (HbA1c) levels in young adults with youth-onset type 2 diabetes. For the iCount cohort study, HbA1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023. Glycemic control was examined categorically (high [≥8.0%] vs low [<8.0%] HbA1c), continuously (HbA1c level), and over time (change in HbA1c: decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA1c of 8.0% or greater, T2 HbA1c level, and change in HbA1c. Of the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA1c at T2. Diabetes distress was associated with higher HbA1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA1c decrease of at least 0.5% over 1 year. In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.

Impact of Mushroom Consumption on Diabetic Type 2 Patients

The complicated disease known as diabetes mellitus is caused by the body producing insufficient amounts of insulin to regulate blood glucose levels. This illness poses a global health risk and calls for inexpensive, non-adverse medication. Many synthetic hypoglycemia diabetes medicines are ineffective due to side effects. This has caused studies to focus more on medicinal plants and herbs, which are thought to be relatively harmless. There is a kind of phytotherapy that includes edible mushrooms that may be used to treat diabetes. They are abundant in naturally occurring substances such fibers, polysaccharides, phenolics, and alkaloids and have long been recognized for their ability to have antihyperlipidemic, antioxidant, and antidiabetic properties. Dietary supplements and functional foods derived from mushrooms can help treat pre-existing problems and postpone the start of potentially fatal diseases. This is confined to the suppression of intestinal glucosidase and the breakdown of composite polysaccharides by pancreatic amylase, which helps prevent and effectively cure type 2 diabetes. Additionally, the carbohydrates included in mushrooms function as prebiotics and alter the makeup of gut bacteria, which can lower insulin resistance. This paper explores the phathophysiology and complication of diabetes and provides details on the potential antidiabetic properties of several mushroom species. Nevertheless, more investigation is required to completely comprehend the therapeutic applications of mushrooms. Pre-clinical and clinical research, tests for enzyme inhibition, human trials, pilot studies, prospective and retrospective studies, and human trials should all be included in this research.

Estimated Sustainable Cost-Based Prices for Diabetes Medicines

The burden of diabetes is growing worldwide. The costs associated with diabetes put substantial pressure on patients and health budgets, especially in low- and middle-income countries. The prices of diabetes medicines are a key determinant for access, yet little is known about the association between manufacturing costs and current market prices. To estimate the cost of manufacturing insulins, sodium-glucose cotransporter 2 inhibitors (SGLT2Is), and glucagonlike peptide 1 agonists (GLP1As), derive sustainable cost-based prices (CBPs), and compare these with current market prices. In this economic evaluation, the cost of manufacturing insulins, SGLT2Is, and GLP1As was modeled. Active pharmaceutical ingredient cost per unit (weighted least-squares regression model using data from a commercial database of trade shipments, data from January 1, 2016, to March 31, 2023) was combined with costs of formulation and other operating expenses, plus a profit margin with an allowance for tax, to estimate CBPs. Cost-based prices were compared with current prices in 13 countries, collected in January 2023 from public databases. Countries were selected to provide representation of different income levels and geographic regions based on the availability of public databases. Estimated CBPs; lowest current market prices (2023 US dollars). In this economic evaluation of manufacturing costs, estimated CBPs for treatment with insulin in a reusable pen device could be as low as $96 (human insulin) or $111 (insulin analogues) per year for a basal-bolus regimen, $61 per year using twice-daily injections of mixed human insulin, and $50 (human insulin) or $72 (insulin analogues) per year for a once-daily basal insulin injection (for type 2 diabetes), including the cost of injection devices and needles. Cost-based prices ranged from $1.30 to $3.45 per month for SGLT2Is (except canagliflozin: $25.00-$46.79) and from $0.75 to $72.49 per month for GLP1As. These CBPs were substantially lower than current prices in the 13 countries surveyed. High prices limit access to newer diabetes medicines in many countries. The findings of this study suggest that robust generic and biosimilar competition could reduce prices to more affordable levels and enable expansion of diabetes treatment globally.

Advances in the clinical measurement of glucagon: from diagnosis to therapy.

Glucagon has many functions: it promotes glucose production, fatty acid oxidation, thermogenesis, energy consumption, lipolysis, and myocardial contraction, and suppresses lipogenesis, appetite, and gastrointestinal motility. Which of these functions are physiological and which are pharmacological is not fully understood. Although the Mercodia sandwich ELISA provides significantly higher specificity of glucagon measurement than does conventional competitive RIA, it cannot provide accurate plasma glucagon values in the presence of elevated cross-reacting plasma glicentin. This occurs in patients post-pancreatectomy or bariatric surgery and in around 30% of outpatients suspected for glucose intolerance who have not had surgery. Thus, our newly developed sandwich ELISA with higher specificity and higher sensitivity than the Mercodia sandwich ELISA is needed for accurate measurements of plasma glucagon in diabetic patients. It is expected that the new sandwich ELISA will contribute to personalized medicine for diabetes by its use in clinical tests to accurately diagnose the conditions of diabetic patients in order to design better individual treatment strategies. Meanwhile, clinical trials are being conducted worldwide to apply glucagon/GLP-1 receptor dual agonists and glucagon/GLP-1/GIP receptor triagonists to the treatment of obesity, fatty liver, and diabetes. Most clinical trials have shown that both types of drugs have stronger effects on weight reduction, improving fatty liver, and glucose tolerance than do the single GLP-1 receptor agonists. Glucagon is expected to be used as a new diagnostic marker and in a new therapeutic strategy based on a true understanding of its physiological and pharmacological functions.

Abstract P418: Pre-Stroke Use of Loop Diuretics in Elderly Patients Aggravates Renal Function at the Onset of Acute Stroke: A Propensity Score-Matched, Retrospective Cohort Study

Introduction: Renal function is often impaired in elderly patients experiencing acute stroke (AS) due to pre-existing chronic kidney disease (CKD), which can progress to severe renal dysfunction (SRD). SRD can limit pharmacological treatments, such as anticoagulants, antiplatelets, diabetes medicines, or antihypertensives during the AS phase. Therefore, preventing CKD progression to SRD and minimizing the use of renal-impairing agents before SRD development is crucial. Loop diuretics, commonly prescribed for heart failure, have been reported to exacerbate renal function. Sex-based differences in renal function due to gonadal hormones exist. However, the impact of loop diuretics on the risk of SRD before AS in both sexes remains unclear. Hypothesis: The pre-stroke use of loop diuretics in elderly patients aggravates renal function at the onset of AS in both sexes. Methods: We conducted a propensity score-matched, retrospective cohort study involving patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined SRD as a calculated creatinine clearance (Ccr) of &lt;30 ml/min. We analyzed logistic regression using variables for pre-stroke loop diuretics initiation, calculated propensity scores for pre-stroke loop diuretics usage, and implemented a one-to-one propensity score matching (PSM) by sex. We compared the incidence of SRD between loop diuretics users and non-users within each sex group. Results: Among 4294 patients with AS, 3472 met the inclusion criteria. Among these, 129 male and 143 female loop diuretic users were matched with non-users using the one-to-one PSM. After the PSM, median ages were 80 years in males and 86 years in females, respectively. The SRD incidence was 38.0% (49/129) versus 16.8% (21/129) in males (p&lt;0.0001) and 50.4% (78/143) versus 23.1% (48/143) in females (p&lt;0.0001), comparing users to non-users. Conclusions: The pre-stroke use of loop diuretics in elderly patients may increase the risk of SRD at the onset of AS in both sexes. Therefore, cautious utilization of loop diuretics in elderly patients is recommended to prevent SRD before AS. A possible option is to switch loop diuretics to other medications, which have been shown to have better renal protective effects. Further prospective studies are needed to validate our findings and establish the appropriate usage of loop diuretics in elderly patients before AS.

Implementing genetic testing in diabetes: Knowledge, perceptions of healthcare professionals, and barriers in a developing country.

Maturity-Onset Diabetes of the Young (MODY) is an unusual type of diabetes often missed in clinical practice, especially in Africa. Treatment decisions for MODY depend on a precise diagnosis, only made by genetic testing. We aimed to determine MODY knowledge among Nigerian healthcare professionals (HCPs), their perceptions, and barriers to the implementation of genetic testing in diabetes patients. A cross-sectional survey was conducted among doctors and nurses in three levels of public and private healthcare institutions in Ibadan, Nigeria, from December 2018 to June 2019. In all, 70% and 30% of a total 415 participants were recruited from public and private centers, respectively. HCPs were recruited in a 60:40% ratio, respectively. A 51-item instrument was used to assess MODY knowledge, perceptions of HCPs, and barriers to the implementation of genetic testing in diabetes patients. In the survey, 43.4% self-rated their current MODY knowledge to be at least moderate. About 68%, 73% and 86%, respectively, correctly answered 3 of 5 questions on basic genetics' knowledge. However, only 1 of 7 MODY-specific questions was answered correctly by 72.7% of the respondents. The mean basic genetics and MODY-specific knowledge scores were 2.6/5 (SD=1.0) and 1.8/9 (SD=1.3), respectively. Multiple linear regression showed higher mean scores among those aged 30-49 years, those with degrees and fellowships (except PhD), and general practitioners; 360 (80.0%) perceived that genetic testing plays a central role in diabetes care. Barriers to genetic testing were lack of access to testing facilities, guidance on the use of and updates/educational materials on genetic testing (82.7%, 62.1% and 50.3%, respectively). The level of MODY awareness and knowledge among Nigerian HCPs is unacceptably low with a lack of access to genetic testing facilities. These can hinder the implementation of precision diabetes medicine. Increased awareness, provision of decision support aids, and genetic testing facilities are urgently needed.

Anticoagulant Activity of Ethanol Extract Arcangelisia Flava ( L. ) Merr

Many types of plants can be used as medicinal plants, one of which is the Arcangelisia flava plant (L.) Merr (A. flava). According to the people of Maribu-Sentani-Papua, A. flava is used as medicine for antimalarial, jaundice, and diabetes. This study aims to determine the anticoagulant activity of A. flava ethanol extract using the Lee-White method. This research uses human blood with blood groups A, B, O, and AB who do not have blood coagulation disorders. Tests were carried out each with 5 treatments with two replications. The first treatment was carried out on blood as a control, the second treatment was on blood treated with ethanol, the third treatment was on blood treated with EDTA, the fourth treatment on blood given EDTA and A. flava extract, and the fifth treatment on blood given A. flava test extract. The results of the study showed that A. flava extract using a concentration of 150 ppm did not have an anticoagulant effect on human blood groups A, B, O, and AB.