Glycemic Parameters Research Articles

Probiotic for Pancreatic β-Cell Function in Type2 Diabetes: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial.

Many clinical studies have proved the effectiveness of probiotics in metabolic disorders associated with insulin resistance. However, the impact of probiotic therapy on pancreatic β-cell function is ambiguous. The influence of probiotic supplementation vs. placebo on β-cell function in people with type2 diabetes (T2D) was assessed in a double-blind, single-center, randomized, placebo-controlled trial (RCT). Sixty-eight patients with T2D were selected for participation in the RCT. Patients were randomly allocated to consumption of live multistrain probiotics or a placebo for 8weeks, administered as a sachet formulation in double-blind treatment. The primary main outcome was the assessment of β-cell function as change in C-peptide and HOMA-β (homeostasis model assessment-estimated β-cell function), which was calculated using the HOMA2 calculator (Diabetes Trials Unit, University of Oxford). Secondary outcomes were the changes in glycemic control-related parameters, anthropomorphic variables, and cytokines levels. Analysis of covariance was used to assess the difference between groups. Supplementation with live multiprobiotic was associated with slight significant improvement of β-cell function (HOMA-β increased from 32.48 ± 13.12 to 45.71 ± 25.18; p = 0.003) and reduction of fasting glucose level (13.03 ± 3.46 vs 10.66 ± 2.63mmol/L and 234.63 ± 62.36 vs 192.07 ± 47.46mg/dL; p < 0.001) and HbA1c (8.86 ± 1.28 vs 8.48 ± 1.22; p = 0.043) as compared to placebo. Probiotic therapy significantly affects chronic systemic inflammation in people with T2D by reducing pro-inflammatory cytokine levels. Probiotic therapies modestly improved β-cell function in patients with T2D. Modulating the gut microbiota represents a new diabetes treatment and should be tested in more extensive studies. NCT05765292.

Association between sleep variability and time in range of glucose levels in patients with type 1 diabetes: Cross-sectional study

ObjectiveSleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. MethodsSeventy-six non–shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters. ResultsMedian (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = −9.64, 95% confidence interval [−16.29, −2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = −0.18, 95% confidence interval [−0.32, −0.04]). ConclusionGreater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research. Data availability statementData are available upon a reasonable request to the corresponding author.

The Effect of Fenugreek in Type 2 Diabetes and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Fenugreek is a widely used herbal medicine as a complementary therapy for diabetes mellitus. Lots of clinical trials have proved its beneficial effect on glycemic control parameters and lipid profiles. Thus, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of fenugreek as a treatment for type 2 diabetes mellitus. We searched PubMed, Embase, Cochrane, China Knowledge Resource Integrated Database (CNKI), Korean studies Information Service System (KISS), Research Information Sharing Service (RISS), and ScienceON to select RCTs which used fenugreek targeting hyperglycemia with a control group. We used either a random effect model or a fixed model in a meta-analysis of Fasting blood glucose (FBG), 2 h plasma glucose during a 75 g oral glucose tolerance test (OGTT) (2-hPG), homeostatic model assessment for insulin resistance (HOMA-IR), glycosylated hemoglobin (HbA1c)/total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), body mass index (BMI). After screening, a total of 10 studies (706 participants) remained. Fenugreek significantly reduced FBG, 2-hPG, and HbA1c, but it did not significantly decrease HOMA-IR. Moreover, it significantly improved TC, TG, and HDL-C, while there were no significant differences in LDL-C and BMI. Hepatic or renal toxicity was not observed, and there were no severe adverse events associated with fenugreek despite mild gastrointestinal side effects in some studies. In conclusion, fenugreek improves overall glycemic control parameters and lipid profile safely.

Impact of Dapagliflozin as add-on therapy on glycemic status and quality of life in type 2 diabetic patients

Evaluate the efficacy of dapagliflozin on glycaemic and non-glycaemic indices and assess quality of life in type 2 diabetes patients (T2DM) with inadequate glycaemic control on three oral antidiabetic agents (OADs). Patients with uncontrolled type 2 diabetes [Haemoglobin A1c 7.0%-12.0%] on sulfonylurea, metformin and gliptin were selected to receive dapagliflozin 5mg/day for 16 weeks (n=40). Fasting and postprandial plasma glucose, glycated haemoglobin A1c, body weight, and waist circumference were measured. Assessment of patients’ quality of life was performed using Quality of Life Scale for Iraqi Diabetic patients (QOLSID) at baseline and after administration of dapagliflozin. Dapagliflozin showed high significant reduction in fasting and postprandial plasma glucose, glycated haemoglobin A1c (HbA1c), body mass index (BMI) and index of central obesity (ICO) (p&lt;0.001). High significant changes in the QOLSID score after treatment (p&lt;0.001). High BMI is negative predictor for patients’ quality of life. Dapagliflozin improved both glycaemic and non-glycaemic parameters in T2DM patients who already on three OADs. This is promising results in short period makes the treatment a suitable alternative to insulin specially in patients not prefer to use injected medication. Dapagliflozin showed an improvement in the patients’ physical and psychological condition and consequently overall QOL.

Decreased plasma myonectin levels in female patients with type 2 diabetes mellitus and its correlation with lipid and glycemic parameters.

Myonectin is a novel myokine which has significant implications on diabetes. This study aimed to investigate plasma myonectin levels in patients with type 2 diabetes mellitus (T2DM), and their correlation with body composition, lipid and glycemic parameters. The study participants included 40 diabetic and 33 non-diabetic healthy adult Saudi females matched for their BMI and age. Body composition was assessed by bioelectrical impedance analysis. Fasting blood samples were used to investigate plasma myonectin levels by ELISA, along with lipid and glycemic parameters. We found that plasma myonectin levels were significantly decreased in diabetic patients (40.90±4.13 ng/ml, p<0.05) compared to non-diabetic participants (59.58±4.41). Diabetic patients with poor glycemic parameters had significantly decreased myonectin levels (35.18±4.03 ng/ml p<0.05) compared to non-diabetic healthy subjects. There was no significant difference in myonectin levels between diabetic patients with good glycemic control (55.76±8.09 ng/ml p>0.05) and non-diabetic healthy participants. Pearson correlation analysis indicated a significant negative correlation with fasting blood sugar (R=-0.366, p=0.001), HbA1c (R=-0.406, p<0.0001), triglycerides (R=-0.264, p=0.024), insulin (R=-0.278, p=0.017), and HOMA-IR (R=-0.409, p<0.0001). Our findings highlight an important aspect of myonectin in the pathophysiology of T2DM. They also show that myonectin has the potential to be a useful biomarker and therapeutic target in T2DM.

Association of TyG index with hypertension in Chinese adults: the China Health Examination Collaborative Study (CHEC Study).

We aimed to investigate the association of triglyceride-glucose (TyG) index with hypertension and compare the discriminative power of the TyG index, lipid, glycemic parameters for hypertension using the China Health Examination Collaborative study (CHEC Study). Data were collected at Ningbo Mingzhou Hospital and Beijing physical examination center from the CHEC Study during 2014 and 2021. Participants with ≥2 medical check-up times were included. The TyG index is the logarithmized product of fasting triglyceride and glucose. Generalised estimation equation (GEE) model was used to evaluate the association between the TyG index, lipid parameters, glycemic parameters and hypertension. Receiver operating characteristic (ROC) analysis was performed to explore the predictive ability of TyG index on hypertension at different years of medical check-up. 112,902 participants with an average age of 42.8 years were recruited in the study, 36,839 participants developed hypertension over the 8-year period. GEE model analysis showed that the ORs with 95% CI of hypertension were 3.35 (3.15-3.57), 1.86 (1.76-1.95), 1.67 (1.58-1.78), 1.45 (1.33-1.58), 1.24 (1.19-1.29), 0.92 (0.86-0.99), and 1.90 (1.83-1.97) in the highest versus lowest quintiles of TyG index, TG/HDL-C ratio, TG, TC, LDL-C, HDL-C and FPG in model 2. The area under the ROC curve of the overall years of medical check-up was signifi-cantly higher than a particular year in predicting hypertension (AUC: 0.883, p < 0.05). TyG index is associated with hypertension and shows the superior discriminative ability for hypertension compared with lipid and glycemic parameters.

Effect of Moringa oleifera Leaf Extract on Glycemic Parameters in Patients with Type 2 Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-analysis

Background: Moringa oleifera leaf (MOL) extract has been used traditionally for treating several diseases, including diabetes mellitus (DM). This study aimed to holistically analyze and summarize the efficacy and safety of MOL extract on glycemic parameters in patients with type 2 DM (T2DM) and prediabetes. Materials and Methods: Electronic databases were searched for randomized controlled trials (RCTs) and nonrandomized trials involving patients with T2DM or prediabetes receiving MOL extract in the intervention arm and placebo (or no MOL extract) in the control arm. The primary outcome was the changes in glycemic parameters, for example, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-h postprandial plasma glucose (2-h PPG), from the baseline at the end of the trial. Results: From 86 initially screened articles, data from 5 studies (3 RCTs and 2 nonrandomized trials) involving 260 subjects were analyzed. Subjects in the MOL extract group had similar reductions in HbA1c (mean difference [MD] −0.11%, 95% confidence interval [CI] [ −0.37, 0.14], P = 0.39, I 2 = 24% [not important heterogeneity], very low certainty of evidence) and FPG (MD −0.63 mmol/L, 95% CI [−1.89, 0.64], P = 0.33, I 2 = 94% [high heterogeneity], very low certainty of evidence) than the control group although reductions in 2-h PPG were greater in the MOL extract group (MD −3.46 mmol/L, 95% CI [−4.96, −2.16], P &lt; 0.00001, I 2 = 0% [not important heterogeneity], very low certainty of evidence). Subjects in the MOL extract group achieved greater systolic and diastolic blood pressure reductions than the control group. No hypoglycemic events were reported in either group. Conclusion: Current preliminary data do not support MOL extract’s glucose-lowering efficacy in patients with T2DM and prediabetes.

Absence of the influence of the APOE gene on the incidence of type 2 diabetes mellitus in a cohort of workers: Effect of diet and shift work

BackgroundAPOE gene encoded a multifunctional protein in lipid metabolism, also associated with inflammatory markers. Type 2 diabetes (T2D) is a complex metabolic disease related to increased blood glucose, triglycerides and VLDL and associated with different dyslipidaemias. The aim of this study was to analyze whether the APOE genotype could determining the risk of developing T2D in a large cohort of workers. Material and methodsData from the Aragon Workers Health Study (AWHS) (n=4895) were used to investigate the relationship between glycemic levels and APOE genotype. All patients in the AWHS cohort had their blood drawn after an overnight fast and laboratory tests were performed on the same day as the blood drawn. Dietary and physical assessment was assessed by face-to-face interview. APOE genotype was determined by the Sanger sequencing method. ResultsThe relationship between APOE genotype and glycemic profile showed that glucose, Hb1Ac, insulin and HOMA levels did not seem to be associated with the APOE genotype (p=0.563, p=0.605, p=0.333 and p=0.276, respectively). In addition, the T2D prevalence did not show an association with the APOE genotype (p=0.354). Along the same lines, blood glucose levels and T2D prevalence did not show association with the APOE allele. Shift work had some effect on the glycaemic profile, showing that night shift workers have significantly lower levels of glucose, insulin and HOMA (p<0.001). However, the APOE genotype did not show difference in the concentration of glycaemic parameters adjusting by sex, age and BMI, work shift and dietary parameters. ConclusionGlycemic profile and T2D prevalence did not show any significant association with the APOE genotype. Besides, individuals, who worked in non-rotating night shift showed significantly lower glycemic levels, while workers in the morning-afternoon-night shift showed significantly higher values.

A retrospective comparison between intensive and nonintensive insulin regimens in type 2 diabetes mellitus.

This study compared the outcomes between intensive and nonintensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type-2-diabetes-mellitus (T2DM) patients requiring insulin therapy. A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and nonintensive insulin therapy (79 patients) were conducted. No significant differences were found when the intensive and nonintensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the nonintensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively. Both intensive and nonintensive insulin therapies improved the baseline glycemic parameters but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.

Denosumab Improves Glycaemic Parameters in Postmenopausal Osteoporosis Patients with Combined Type 2 Diabetes Mellitus.

This study aimed to determine whether RANKL inhibitors in postmenopausal osteoporosis patients with combined type 2 diabetes mellitus (T2DM) could improve their glucose metabolism index. First of all, 84 patients affected with postmenopausal osteoporosis with combined T2DM attending the Department of Endocrinology at the Third Hospital of Hebei Medical University were selected and randomized into two groups of 42 patients each. One group was given Denosumab 60 mg once every six months (denosumab group, D.G.), and the other group was given 2 mg ibandronate once every three months (ibandronate group, I.G.). Blood glucose parameters were compared before and after treatment in both groups and serum active GLP-1 levels and DPP-4 levels were also assessed. After treatment, there was no significant difference in fasting glucose between the two groups, but there was a significant decrease in fasting glucose in the Denosumab Group (D.G.) compared to before treatment. There was a significant difference in 2-hour postprandial glucose (2hPG) between the two groups after treatment, with the D.G. being lower than the ibandronate group (I.G.). Glycosylated haemoglobin (HbA1c) was lower in the D.G. than in the I.G. after treatment, but the difference between them was insignificant. In the D.G., serum active GLP-1 levels increased after treatment, and serum DPP-4 levels decreased. Serum GLP-1 and DPP-4 levels in the I.G. did not change compared with those before treatment. In conclusion, In the clinical management of postmenopausal osteoporosis patients with combined T2DM, the choice of RANKL inhibitors as anti-osteoporosis therapy may benefit their glycaemic parameters by elevating serum active GLP-1 levels and decreasing serum DPP-4 levels.

Vitamin D as add on Therapy to Metformin and Teneligliptin in patients with type 2 Diabetes Mellitus

A low level of vitamin D is being attributed to the development of diabetes, which can cause insulin resistance, beta-cell death, and inflammation. Vitamin D supplementation can reduce inflammation and insulin resistance. we conducted this study for our population to evaluate the effect of vitamin D on blood glucose in type 2 diabetes mellitus. A prospective interventional, parallel, randomized study, was conducted on 112 type two diabetes and 25(OH) D deficient patients. The control group received Metformin (500mg BD) and Teneligliptin (20mg OD) only, while the intervention group was given Metformin plus Teneligliptin along with vitamin D (Cholecalciferol) (60,000 IU). At the end of 3rd of month follow-up, there was a significant difference in mean FPG and PPG (129.86±7.36mg/dl) vs. (136.12±11.31mg/dl) (p=0.002), (220.81±13.04mg/dl) vs. (228.06±19.40 mg/dl) (p=0.037). in the interventional and control group respectively. And subsequently, mean HbA1c improved significantly in the interventional group as compared to the control group 7.21±0.40% vs. 7.48.0.62% respectively (p = 0.015). also, the measures of glycemic control (FPG, PPG, HbA1c) showed a significant improvement at the end of the 6 months. Our study suggested, that add-on therapy of Vitamin D improved the glycemic parameters of type two diabetes mellitus with concurrent vitamin D deficiency over the course of the study.

Effects of Cornus mas L. on anthropometric and biochemical parameters among metabolic associated fatty liver disease patients: Randomized clinical trial

Ethnopharmacological relevanceCornus mas L. (Cornelian cherry, CM) fruits have been utilized for decades in numerous European and Asian countries as traditional cuisine and folk medicine. CM has antioxidant, anti-diabetic, anti-inflammatory, anti-obesity, and hypolipidemic activities due to its rich bioactive compounds, and CM fruits and other parts have been used for the prevention and treatment of a diverse variety of diseases in folk medicine. Obesity, insulin resistance, and inflammation are strongly associated with metabolic-associated fatty liver disease (MAFLD), therefore, CM may be hope for MAFLD patients. Aim of the studyThe study aimed to evaluate the effect of lyophilized CM fruit powder with/without diet therapy on biochemical parameters and anthropometric measurements in patients with MAFLD. Materials and methodsThis randomized clinical trial was conducted on 87 patients with MAFLD and 21 healthy individuals. Patients were randomly assigned into 4 groups: group-1 receiving 30 g/d lyophilized CM fruit powder plus diet therapy, group-2 receiving only diet therapy, group-3 receiving only 30 g/d lyophilized CM fruit powder, and group-4 had not undertaken any pharmacological treatment and diet therapy or lyophilized CM fruit powder for 8 weeks. Biochemical parameters, and anthropometric measurements at baseline and after the intervention were taken. ResultsAfter 8 weeks of intervention, a significant decrease in body weight, body mass index, body fat mass, waist and hip circumferences, fasting blood glucose, insulin, hbA1c, liver enzymes, total triglycerides, low-density lipoprotein, total cholesterol were found in group-1, 2 and 3. ConclusionLyophilized CM fruit powder in addition to diet therapy and only diet therapy had a positive and similar effect on anthropometric measurements and biochemical parameters in MAFLD patients. Furthermore, only lyophilized CM fruit powder improved glycemic parameters. Therefore, lyophilized CM fruit powder may be beneficial for adult patients with MAFLD.

Diabesity phenotype in relation to the incidence and resolution of nonalcoholic fatty liver disease: A prospective cohort study.

Diabesity is a term used to emphasize the dual epidemic and the combined detrimental effects of diabetes and obesity. We aimed to investigate the associations of diabesity with the incidence and resolution of nonalcoholic fatty liver disease (NAFLD). This prospective cohort study included 5549 participants with a median follow-up of 4.3 years (2010-2015). Diabesity was defined as six categories by the combinations of glucose tolerance status (normal glucose tolerance [NGT], prediabetes, and diabetes) diagnosed by fasting and oral glucose tolerance test 2-h glucose and hemoglobin A1c and general or abdominal obesity status. We examined the odds ratios (ORs) for the incidence and resolution of NAFLD associated with diabesity categories, respectively. For NAFLD incidence, compared with the diabesity category of NGT with nonobesity, the categories of either glucose intolerance or general obesity were associated with higher risks of NAFLD, of which the categories with obesity, regardless of glucose intolerance status, exhibited greater risks (ORs ranged from 3.19 to 4.49) than the categories of nonobesity. For NAFLD resolution, the categories of prediabetes or diabetes with obesity were associated with decreased likelihoods of a resolution of NAFLD (ORs ranged from 0.40 to 0.58). These association patterns were consistent across various definitions of diabesity by glucose tolerance status diagnosed by different combinations of glycemic parameters and general or abdominal obesity. The diabesity association pattern with NAFLD incidence was mainly determined by obesity, while that with NAFLD resolution was driven by the combined phenotype of glucose intolerance and obesity.

Glycemic Control and Metabolic Parameters in Children and Adolescents With Type 1 Diabetes.

The association between glycemic control and metabolic status is poorly defined in children and adolescents with T1D, besides being biologically plausible. We aimed to evaluate the association between glycemic control and body mass index (BMI), blood pressure (BP), and lipid profile in children and adolescents with T1D. Observational cross-sectional study including children and adolescents (5-18 years old) followed in our outpatient clinic with the diagnosis of T1D for at least a year. We used linear regression models (unadjusted and adjusted to sex and age) to evaluate the association between glycated hemoglobin (A1c) and time in range (TIR), several prespecified metabolic parameters, and prespecified demographic and clinical characteristics. We considered a p-value of <0.05 to be statistically significant. A total of 144 patients were included, 51% of whom were female. The population had a mean age of 12.7±3.4 years old. We report a positive association between A1c and BMI, systolic and diastolic BP, total- and LDL-cholesterol and triglycerides. Females and patients diagnosed at a younger age presented with higher A1c values. There is a tendency for a negative association between TIR and the former parameters. Higher A1c levels and lower TIR were associated with higher glycemic variability and were treated with a higher basal insulin per Kg dose. Our results support an important association between worse glycemic control and an unhealthier metabolic profile in children and adolescents with T1D. We can hypothesize that a good glycemic profile is needed to achieve good metabolic control at a young age.

STAR (Survey for ManagemenT of DiAbetes with FibeR-rich Nutrition Drink): A Pan India Survey to Understand the Physician and Patient Perspective Regarding the Role of Dietary Fiber Supplement in the Management of Type 2 Diabetes

Objectives: The aim of the STAR survey was to understand the physicians’ knowledge, attitude and perception regarding the role of nutritional dietary fiber supplements in the daily management of type 2 diabetes mellitus (T2DM). It also aimed to compare the changes in glycemic parameters as well as energy and satiety levels between patients taking a high-fiber supplement and those not taking a fiber supplement. Methods: Two cross-sectional pan-India surveys were conducted. The first was among 152 physicians who had &gt;5 years of experience in treating patients with T2DM and treated &gt;50 patients with T2DM per month. A self-administered paper-based questionnaire was used for the survey. The other survey was conducted among 3,042 patients with T2DM who were receiving treatment with antidiabetics. These patients were further categorized into the Horlicks Diabetes Plus (HDP) group, which consisted of 1,524 patients who had consumed the HDP fiber supplement for a minimum of 3 months and the non-HDP group, which included 1,518 patients who had never consumed HDP. Results: Almost all physicians prescribed fiber-rich nutritional supplements to their patients with T2DM and believed that dietary fiber has an important role in managing glycated hemoglobin (HbA1c) values, healthy weight and cholesterol levels. Among the main benefits of HDP seen by physicians were improvement in satiety levels and increase in physical activity, reduction in HbA1c, fasting and postprandial glucose, and reduction in dose and/or number of hypoglycemic medications. All physicians recommended that it was important to increase awareness among patients as well as doctors regarding the benefits of HDP in patients with T2DM. Patients in the HDP group reported a mean decrease of 0.72 in their HbA1c value which was statistically significant at 3 months (8.04 at baseline to 7.32 at 3 months). In contrast, the non-HDP group showed a non-statistically significant decrease of 0.61 in HbA1c from a baseline value of 8.15. Furthermore, patients reported a significant decrease in weight of 3 kg in 3 months from baseline value of 72.11 kg to 69.11 kg. This reduction in weight was observed in 82% patients in the HDP group, while the non-HDP group showed an insignificant weight reduction from a baseline value of 72.14 kg to 71.46 kg in 3 months. About 83% of patients reported feeling full for longer periods of time and 92.62% reported feeling more energetic after starting HDP. The compliance and satisfaction rates with HDP were 96% and 75%, respectively. Conclusion: A high-fiber supplement taken along with patients’ existing antidiabetic treatment plan has the potential to decrease glycemic parameters and weight while increase the satiety and energy levels among patients with T2DM. However, these results need to be evaluated further with long-term clinical studies conducted in the real world.

ОЦЕНКА ЭФФЕКТИВНОСТИ МОДЕЛИ МЕДИЦИНСКОЙ ПОМОЩИ ДЕТЯМ С САХАРНЫМ ДИАБЕТОМ 1 ТИПА, ПРОВОДИМОЙ С ПРИМЕНЕНИЕМ МОБИЛЬНОГО ПРИЛОЖЕНИЯ И ДИСТАНЦИОННЫХ КОНСУЛЬТАЦИЙ: АДРЕСНАЯ ПОМОЩЬ ДЕТЯМ-ИНВАЛИДАМ С САХАРНЫМ ДИАБЕТОМ И ИХ СЕМЬЯМ В РАМКАХ ПРОГРАММЫ «АЛЬФА-ЭНДО»

Telemedicine technologies in pediatric patients with type 1 diabetes mellitus (T1D) is an effective approach that have begun to be used recently. The purpose of this research was to evaluate the possibility and effectiveness of remote observation and training of children with newly diagnosed T1D in selected Russia regions. Materials and methods used: a multicenter prospective open uncontrolled experimental clinical study involved 92 children aged 1 to 18 y/o with T1D receiving intensified insulin therapy who were divided into two groups: G1 of 60 patients with T1D manifestation of less than 12 weeks prior to the inclusion in the study, and G2 of 32 children with T1D manifestation lasting over 12 weeks prior to the inclusion with poor disease control (glycated hemoglobin at 8% and above) from troubled families. The main indicator for evaluating the effectiveness was the glycated hemoglobin (HbA1c) level. Results: median age was 9.2 (6.2-11.2) y/o, 47 boys/45 girls. A total of 401 remote consultations had been carried out in various forms. The HbA1c level decreased statistically significantly by the end of the study by 3.5% and 0.6% (p&lt;0.001) in G1 and G2, respectively. Statistically significant (p&lt;0.001) increase in the number of patients with HbA1c at the level of less than 7% was reached, with most of them (52%) reaching the target glycemic control parameters. Telemedicine technologies therefore represent the effective (in terms of glycemic control) addition to the traditional dispensary observation, which in its turn increases the availability of medical care for children with endocrine diseases.

Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4).

India is witnessing an epidemic of type 2 diabetes. Overweight/obesity, overnutrition, physical inactivity, and family history are well-known risk factors for diabetes. We investigated the role of undernutrition in the development of diabetes among rural adolescent girls. DERVAN cohort study was set up in the KONKAN region of the western Indian state of Maharashtra. It enrolled 1,520 adolescent girls (16-18 years old at the time of enrollment). We measured glycemic parameters (glucose, insulin, and HbA1C) and body size using anthropometry and body composition using bioimpedance. Prediabetes was diagnosed using the American Diabetic Association (ADA) criteria. We also calculated various HOMA indices for insulin resistance (HOMA-IR), β-cell function (HOMA-β), insulin sensitivity (HOMA-S), and compensatory β-cell response using a homeostasis model. BMI, body fat%, and waist circumferences were treated as exposures and all the glycemic parameters and indices as outcomes. The median age of the subjects was 16.6 years. The median weight, height, and BMI were 40.7 kg, 151.7 cm, and 17.5 kg/m2, respectively. Prevalence of underweight was 28.8%, and stunting was observed in 30.4%. Thinness and obesity using BMI were observed in 58.4% and 4.2%, respectively. The median body fat% was 22.5, and excess body fat (>35%) was observed in 5.7%. The prevalence of prediabetes was 39.4%. Fasting insulin concentrations, HOMA-IR, and HOMA-β showed a positive trend across body composition quartiles (p < 0.001). HOMA-S and compensatory β-cell response showed an inverse trend (p < 0.001). Compared with prediabetic girls in the overweight/obese group, girls most undernourished group had lower median insulin concentrations (8.1 μIU/ml vs. 17.1 μIU/ml), lower HOMA-IR (1.1 vs. 2.3), and lower HOMA-β (75.6 vs. 129.2) but higher sensitivity (87.4 vs. 43.7) (p < 0.001) for all. We have reported a high prevalence of prediabetes among rural adolescent girls with a very low prevalence of obesity. Prediabetes in obesity is driven by hyperinsulinemia and overworking of the pancreas while poor β-cell function and poor insulin secretion are major drivers in the undernourished group. The high-risk diabetes screening programs are much needed for the undernourished populations. Caution should be exercised for planning the interventions as overfeeding (or overnutrition) is likely to put the populations at risk of development of obesity and insulin resistance.

Gallic acid as a Sestrin (SESN2) activator and potential obesity therapeutic agent: A molecular docking study

Sestrins (SESNs) are a family of evolutionarily conserved proteins among mammals. They have several body homeostatic functions such as antioxidant, metabolic, and anti-aging, and are required to regenerate hyperoxidized forms of peroxiredoxins and reactive oxygen species. Sestrin 2 has been studied as a therapeutic agent in obesity treatment. Gallic acid (GA) is a triphenolic compound with beneficial biological activities including anti-inflammatory, antidiabetic, antihypertensive, and antioxidant effects. Recent studies demonstrated the GA’s ability to reduce body weight gain and improve glycemic parameters. In this sense, the present study aims to investigate the GA activating potential of Sestrin using the molecular docking method. The 3D structure of gallic acid was retrieved from the NCBI PubChem database and the chemical structure of the Sestrin2 protein from the RCSB Protein Data Bank (5DJ4). The docking calculus was performed via UCSF Chimera and AutoDock Vinaprograms. The results showed that amino acids Arg390, Glu451, Trp444, Thr386, Arg448, Thr374, Tyr375, Asn376, Thr377, Leu389, His454, Ser450, His86, and Val455 are very important for GA stabilization, resembling the interactions that permit Leucine to activate SESN2. In this context, the obesity therapeutic property of GA can be understood from a Sestrin activating process through amino acid metabolism.

Protein supplementation changes gut microbial diversity and derived metabolites in subjects with type 2 diabetes

High-protein diets are promoted for individuals with type 2 diabetes (T2D). However, effects of dietary protein interventions on (gut-derived) metabolites in T2D remains understudied. We therefore performed a multi-center, randomized-controlled, isocaloric protein intervention with 151 participants following either 12-week high-protein (HP; 30Energy %, N= 78) vs. low-protein (LP; 10 Energy%, N= 73) diet. Primary objectives were dietary effects on glycemic control which were determined via glycemic excursions, continuous glucose monitors and HbA1c. Secondary objectives were impact of diet on gut microbiota composition and -derived metabolites which were determined by shotgun-metagenomics and mass spectrometry. Analyses were performed using delta changes adjusting for center, baseline, and kidney function when appropriate. This study found that a short-term 12-week isocaloric protein modulation does not affect glycemic parameters or weight in metformin-treated T2D. However, the HP diet slightly worsened kidney function, increased alpha-diversity, and production of potentially harmful microbiota-dependent metabolites, which may affect host metabolism upon prolonged exposure.

Plasma Carnitine, Choline, -Butyrobetaine, and Trimethylamine N-oxide, but not Zonulin, are reduced in overweight/obese Patients with Pre/diabetes or Impaired Glycemia

Background and Aims: Zonulin, carnitine, choline, g-butyrobetaine (g-BB), and trimethylamine N-oxide (TMAO) are intricately involved in metabolic anomalies and type 2 diabetes mellitus (T2D). This study aimed to compare and correlate the plasma levels of zonulin, carnitine, choline, g-butyrobetaine, and TMAO, along with the adiposity, atherogenicity, surrogate insulin resistance (sIR), and proinflammatory hematological indices of newly diagnosed drug-naive pre-diabetic and diabetic patients vs. apparently healthy normoglycemic controls.&#x0D; Methods: In a cross-sectional study, 30 normoglycemic subjects (controls) and 16 pre-diabetic (PreDM) and 14 type 2 diabetes (T2D) cases, that were gender and age-matched, were enrolled. Zonulin, carnitine, choline, g-BB, and TMAO plasma levels were appraised using colorimetric assays. A comparison between the study groups was conducted by ANOVA while Spearman rank correlations between the metabolic risk biomarkers and between the risk markers and adiposity, sIR, atherogenicity, and proinflammatory hematological indices were also examined.&#x0D; Results: Significant intergroup discrepancies in plasma carnitine, choline, g-BB, and TMAO (but not zonulin) could be recognized in the cases vs. controls. Fasting blood glucose (FPG), glycated hemoglobin (A1C), triglycerides (TG), body mass index (BMI), lipid accumulation product (LAP), visceral adiposity index (VAI), atherogenic index of plasma (AIP), and all sIR were outstandingly higher in the cases vs. controls. Blood indices lacked a scoring value to discriminate cases from controls. Inadvertently, no relation was found between plasma carnitine, choline, g-BB, TMAO, or zonulin in cases. Among the rest of the markers and sIR indices; The triglyceride-glucose-body mass index (TyG*BMI) related reciprocally to zonulin. Noticeably, among adiposity indices, TyG*BMI, triglyceride glucose-waist circumference (TyG*WC), and metabolic score for insulin resistance (MetS-IR) positively associated with waist circumference (WC), hip circumference (HC), BMI, body adiposity index (BAI), and waist-to-height ratio (WHtR). Exceptionally LAP proportionally correlated with all sIR. TyG*WC and MetS-IR correlated directly with the conicity index (CI). WHR directly associated with triglyceride-glucose (TyG) index and TyG*WC. Remarkably, the TyG index (but not TyG*BMI, TyG*WC, or MetS-IR) positively associated with all atherogenicity indices and RDW (but none of other blood indices). TMAO correlated inversely (P &lt; 0.05) and moderately with choline. Distinctively, carnitine associated negatively with TC (P &lt; 0.05). Both choline and carnitine related similarly and directly with PLR but inversely with lymphocytes (p &lt;0.05). Effectively, gButyrobetaine associated with both WC and the TyG-WC index equally negatively (P &lt; 0.05). Substantially, gButyrobetaine correlated inversely with both atherogenic LDL-C/HDL-C ratio and MPV (P &lt; 0.05). No pronounced relations were detected between the five microbiome signature determinants and glycemic control parameters (FBG and A1C %), sIR (TyG, TyG-BMI or MetS-IR), adiposity (WHR, WHtR, CI, BAI, LAP, or VAI), atherogenicity indices (TC/HDL-C ratio, non‑HDL‑C/HDL-C ratio, or AIP), or blood indices (NLR or MLR).Conclusion: Given the intergroup discrepancies in sIR, plasma zonulin, carnitine, choline, g-BB, and TMAO along with their elective correlations with indices and clinical parameters of metabolic dysregulations, our study cannot rule out any possible molecular crosstalk and interplay of the biomarkers studied with the pathophysiology of prediabetes/diabetes. All in all, plasma zonulin, carnitine, choline, g-BB, and TMAO with sIR can be putative surrogates for molecular cardiometabolic risk biomarkers to use as prognostic/predictive tools for the diagnosis/prevention and potential targets for prediabetes/diabetes management modalities.