Improvement In Glycemic Control Research Articles

Efficacy and safety of SGLT2 inhibitors in the treatment of maturity-onset diabetes of the young (MODY): a case report and literature review.

Sulfonylureas constitute the standard therapy for patients with HNF1A-MODY (maturity-onset diabetes of the young) but are characterized by an increased risk of hypoglycemia. While SGLT2 inhibitors (SGLT2i) may potentially represent a useful therapeutic option, data from the literature are scant. We report the case of a young woman affected by HNF1A-MODY who was successfully and safely treated with an SGLT2i in addition to sulfonylurea. After SGLT2i initiation, an improvement in the patient's glycemic control was observed and was maintained over time. No adverse effects were noted and, in particular, no increase in ketonemia or ketonuria occurred. The use of SGLT2i under controlled circumstances may represent a useful therapeutic option in patients with HNF1A-MODY.

Exercise Training and Cardiovascular Risk Factors in Males with Overweight or Obesity: A Systematic Review of Randomized Controlled Trials

Background and Objectives: Obesity is a significant risk factor for cardiovascular disease. Physical exercise has been established as an effective intervention for reducing cardiovascular mortality. This systematic review aimed to investigate the effects of various exercise modalities on cardiovascular risk factors in men with obesity. Materials and Methods: This review included randomized controlled trials (RCTs) published between 2005 and November 2023. Studies were eligible if they assessed the impact of exercise interventions on blood pressure (BP), lipid profiles, and glucose/insulin regulation in males aged 18 years or older with a body mass index (BMI) of 25 kg/m2 or greater. The quality of included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results: A total of 25 RCTs were included in the analysis, with PEDro scores ranging from 3 to 7. High-intensity interval training (HIIT) was associated with significant reductions in BP, with an average decrease of 12.5 mmHg. However, the magnitude of BP reduction varied across studies, likely due to differences in training protocols and study quality. Resistance training (RT) was associated with modest improvements in glycemic control, with some studies reporting a reduction in fasting blood glucose levels by 5–10%. Combined exercise (CT) programs, which included both aerobic and resistance training, as well as aerobic exercise alone, were shown to improve lipid profiles, with some studies showing reductions in total cholesterol levels ranging from 10–15%. However, the findings were inconsistent, highlighting the need for further research to better understand the potential benefits and optimal exercise regimens. Conclusions: This systematic review supports the potential of exercise training in reducing cardiovascular risk factors in men with obesity, though the effectiveness varies depends on the type of exercise. Combined exercise programs have shown promise for lipid profiles, but further research is needed to confirm these effects. HIIT has been linked to BP reductions in some studies, although the results are inconsistent and depend on protocols and study quality. The limitations in study quality may impact the reliability of these findings.

Efficacy and safety of combination of semaglutide and basal insulin in patients with of type 2 diabetes mellitus: A systematic review and meta-analysis.

Semaglutide has demonstrated efficacy in both glycemic control and weight loss. This systematic review and meta-analysis aimed to assess the efficacy and safety of the combined use of semaglutide and basal insulin in individuals diagnosed with type 2 diabetes mellitus (T2DM). PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (VIP) were searched to identify relevant publications. The primary outcome measure was the change in HbA1c levels. Secondary outcome measures encompassed change in body weight, fluctuations in FPG levels, occurrence of adverse events, serious adverse events, hypoglycemic episodes, and gastrointestinal reactions including nausea, vomiting, and diarrhea. Mean differences (MDs) and relative risk (RR) with confidence intervals (CI) of 95% were used to analyze the deference. 7 RCTs with 2354 patients were incorporated into the study. Compared to placebo or other active treatment, the addition of semaglutide to basal insulin demonstrated significant reductions in hemoglobin A1c (HbA1c) [mean differences (MD): -1.17%, P<0.00001], body weight [MD -5.99 kg, P<0.00001], and fasting blood glucose (FPG) [MD -1.08%, P<0.00001]. No evidence indicated a higher risk of adverse events [RR 1.46, P=0.13]. However, it did result in increased rates of gastrointestinal adverse events, including nausea, vomiting and diarrhea. The combination treatment of semaglutide and basal insulin demonstrates significant improvements in glycemic control and reduction in body weight, without an increased risk of hypoglycemia. Our findings provided support for the utilization of a combination therapy involving semaglutide and basal insulin in T2DM.

Can 12-Week Resistance Training Improve Muscle Strength, Dynamic Balance and the Metabolic Profile in Older Adults with Type 2 Diabetes Mellitus?

The present study aimed to evaluate the effects of 12-week resistance training (RT) on muscle strength, dynamic balance, glycemic control and the lipid profile. Methods: The Laboratory of Movement Studies in the University of São Paulo, Brazil, developed this longitudinal study between 2021 and 2023. It assessed 62 males with type 2 diabetes mellitus pre and post an RT protocol. The participants, who were 69.8 (±3.9) years old, took part in a 12-week twice-weekly RT program. Three sets of eight to twelve repetitions each were executed for eight exercises targeting the large muscle groups. The intensity was set between 7 and 8 out of 10 for perceived effort, according to the Omni Resistance Exercise Scale. All participants were evaluated pre and post in knee extensor and flexor strength by isokinetic dynamometry, handgrip strength by manual dynamometry and dynamic postural balance by a force platform, as well as blood tests to determine the lipid and glycemic profiles. For comparison, paired t or Wilcoxon tests were used at an alpha of 5%. Results: There was an improvement in muscular strength by handgrip restricted to the non-dominant side (p = 0.033) and for the bilateral knee flexors (p &lt; 0.001) and extensors (p &lt; 0.001), as determined by isokinetic dynamometry. There was no improvement in dynamic postural balance, glycemic control or lipid control. Conclusions: The 12-week RT promoted improved muscle strength in knee extension and flexion and non-dominant grip pressure but did not affect dynamic balance, glycemic control or the lipid profile.

Machine Learning-driven Identification of the Honeymoon Phase in Pediatric Type 1 Diabetes and Optimizing Insulin Management.

The honeymoon phase in Type 1 Diabetes (T1D) presents a temporary improvement in glycemic control, complicating insulin management. This study aims to develop and validate a machine learning-driven method for accurately detecting this phase to optimize insulin therapy and prevent adverse outcomes. Data from pediatric T1D patients aged 6-17 years, including continuous glucose monitoring (CGM) data, Glucose Management Indicator (GMI) reports, HbA1c values, and patient medical history, were used to train machine learning models. These models Long Short-Term Memory (LSTM) networks, Transformer models, Random Forest, and Gradient Boosting Machines were designed to analyze glucose trends and identify the honeymoon phase in T1D patients. The Transformer model achieved the highest accuracy at 91%, followed by Gradient Boosting Machines at 89%, LSTM at 88%, and Random Forest at 87%. Key features such as glucose variability, insulin adjustments, GMI values, and HbA1c levels were critical in model performance. Accurate identification of the honeymoon phase enabled optimized insulin adjustments, enhancing glucose control and reducing hypoglycemia risk. The machine learning-driven approach provides a robust method for detecting the honeymoon phase in T1D patients, demonstrating potential for improved personalized insulin management. The findings suggest significant benefits in patient outcomes, with future research focused on further validation and clinical integration.

The Impact of Sodium-Glucose Co-Transporter-2 Inhibition on Insulin Resistance and Inflammation in Patients with Type 2 Diabetes: A Retrospective Study

Background and Objectives: Insulin resistance (IR) is a key factor involved in the development of type 2 diabetes (T2D). Besides its role in the pathogenesis of T2D, insulin resistance is associated with impairment of glycemic control, reduced achievement of glycemic targets, and increases in cardiovascular risk and diabetes complications, being thus a negative prognosis factor. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are therapies for T2D which demonstrated, besides glycemic control, improvements of biomarkers traditionally associated with IR and inflammation. This study aimed to evaluate the impact of SGLT2i treatment on IR and inflammation biomarkers in patients with T2D. Materials and Methods: In a retrospective study, 246 patients with T2D treated with SGLT2i for a median of 5 years were evaluated regarding IR (estimated glucose disposal rate—eGDR, triglyceride/glucose index, triglyceride/HDLc index) and inflammation biomarkers (neutrophils to lymphocyte ratio, platelets to lymphocytes ratio and C-reactive protein) before and after intervention with SGLT2i. Results: After a median 5 years of SGLT2i treatment, patients with T2D had a higher eGDR (6.07 vs. 5.24 mg/kg/min; p &lt; 0.001), lower triglyceride/HDLc ratio (3.34 vs. 3.52, p &lt; 0.001) and lower triglyceride/glucose index (9.23 vs. 9.58; p &lt; 0.001). The inflammation biomarkers decreased after SGLT2i therapy: C-reactive protein (3.07 mg/L vs. 4.37 mg/L), NLR (0.68 vs. 0.72; p &lt; 0.001), and PLR (115 vs. 122; p &lt; 0.001). Intervention with SGLT2i also improved the biomarkers associated with diabetes complications and cardiovascular risk: HbA1c (7.1% vs. 8.4%; p &lt; 0.001), body mass index (30.0 vs. 31.5 kg/m2; p &lt; 0.001) and urinary albumin to creatinine ratio (4.75 vs. 11.00 mg/g; p &lt; 0.001). Conclusions: Treatment with SGLT2i in patients with T2D leads to decreases in IR and inflammation. These mechanisms may partially explain the additional cardiovascular and renal risk reductions associated with SGLT2i therapy, alongside the improvements in glycemic control, in patients with T2D.

Does Improvement of Glycemic Control Cause Acute Charcot Foot in Patients with Diabetes?

Recent studies have suggested that improved glycemic control in patients with diabetes may cause acute Charcot foot. To conduct a narrative review of studies investigating whether improved glycemic control in patients with diabetes causes acute Charcot foot.Publications found by searching PubMed, EMBASE, and Cochrane Library as well as reference lists of identified publications were reviewed.Very few publications were found, primarily consisting of case reports and case studies without control groups, documenting instances where cases of acute Charcot foot had been preceded by improved glycemic control. Recent large multicenter randomized placebo-controlled clinical trials of anti-hyperglycemic agents in patients with diabetes, where significant improvement of glycemic control occurred, have not reported incidences of acute Charcot foot.There is so far no solid evidence to suggest that improvement of glycemic control in patients with diabetes causes acute Charcot foot.

Gene Therapy and Diabetes: A Narrative Review of Recent Advances and the Role of Multidisciplinary Healthcare Teams.

Introduction: Gene therapy has emerged as a promising frontier in the management of diabetes, offering innovative approaches to address both type 1 and type 2 diabetes. This narrative review examines the advancements in gene therapy applications, focusing on both animal and human studies, and includes a total of 11 studies in adherence to PRISMA guidelines. These studies utilize various viral vectors, such as adeno-associated virus (AAV) and lentivirus, to deliver genes that regulate insulin production and enhance angiogenesis. This review aims to synthesize recent advancements in gene therapy for both type 1 and type 2 diabetes and its complications, and to explore the evolving role of pharmacists in this emerging field. Methods: A comprehensive search was conducted to identify relevant studies on gene therapy for diabetes. Databases such as PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Google Scholar were queried using keywords such as "Diabetes", "gene therapy", "Type 1 diabetes", and "Type 2 diabetes". Both animal and human studies were included to provide a broad perspective on the advancements in this field. Results: Animal model studies have shown promising results, including sustained insulin production, improved glucose homeostasis, and enhanced wound healing. Human studies, though fewer in number, have reported significant advancements. Patients with diabetic neuropathy treated with plasmid VEGF and recombinant adeno-associated virus (rAAV) showed improvements in neuropathic symptoms and glycemic control. Other studies involving intramuscular injections of VM202 and bicistronic VEGF165/HGF plasmid have reported pain reduction, improved healing of ischemic lesions, and increased angiogenesis. Conclusions: Despite these encouraging results, limitations such as small sample sizes, short follow-up periods, and the necessity for more extensive clinical trials persist. Diabetes is a metabolic syndrome that requires the collaboration of a multidisciplinary team to assist in several aspects of implementing successful gene therapy. Several healthcare providers and policy makers may play a crucial role in patient education, counseling, and the management of gene therapy treatments.

Is Weight Loss the Main Driver for A1C Improvement by Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists? A 2.5-Year Analysis in Real-World Clinical Practice.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are established treatment options for type 2 diabetes (T2D). In addition to their glycemic benefit, GLP-1 RAs also induce weight loss by suppressing appetite via hypothalamic pathways. However, it remains unclear whether weight reduction is the primary driver of glycemic improvement. We retrospectively evaluated 256 patients with T2D who were treated with exenatide (n = 84), dulaglutide (n = 99), or semaglutide (n = 73) for 2.5 years without interruption in real-world clinical practice. Body weight and A1C were measured every 6 months. Baseline characteristics included an average age of 61.8 ± 11.9 years, 51.5% female, diabetes duration of 12.9 ± 8.3 years, weight of 103.1 ± 20.7 kg, BMI of 35.7 ± 7.5 kg/m2, and A1C of 8.2% ± 1.5%. Patients were stratified into tertiles based on percentage weight change at 2.5 years within the overall cohort and for each GLP-1 RA group. The first tertile experienced an average weight loss of -12.2% ± 5.7% (p < 0.0001), the second tertile lost -3.5% ± 1.4% (p < 0.0001), and the third tertile gained +2.8% ± 3.4% (p < 0.0001). The average changes in A1C were - 0.98 ± 1.8% (p < 0.0001), -0.56% ± 1.4% (p < 0.001), and -0.19% ± 1.9% (p = 0.4), respectively. A1C strongly correlated with weight change (p < 0.001). The same observations were reproducible in each medication group. These findings suggest that the long-term improvement in glycemic control associated with GLP-1 RA therapy is primarily driven by weight loss rather than any other intrinsic effect of GLP-1 RA. This highlights the importance of weight reduction as a key therapeutic target for optimizing glycemic outcomes in patients with T2D receiving GLP-1 RAs.

Fixed-dose Combination of Dapagliflozin and Linagliptin in Individuals with Type 2 Diabetes Mellitus Inadequately Controlled on Metformin: A Randomized Double-blind Multicenter Trial

Abstract Context: Combining dipeptidyl peptidase 4 inhibitors and sodium-glucose cotransporter-2 inhibitors in therapy could be beneficial for those with metformin intolerance or not achieving adequate control. Aims: To evaluate the efficacy, safety, and tolerability of a fixed-dose combination (FDC) of dapagliflozin plus linagliptin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin. Settings and Design: It is a phase III, prospective, randomized, double-blind, multicenter study. Materials and Methods: Patients with T2DM, with a stable dose of metformin ≥1000 mg/day as monotherapy for at least 3 months before screening, with inadequate glycemic control at screening were randomly assigned to either arm A (dapagliflozin 10 mg + linagliptin 5 mg) or arm B (linagliptin 5 mg) in a 1:1 ratio. Statistical Analysis Used: The primary and secondary efficacy endpoint analyses were done using repeated measures analysis of covariance or a two-sample t test. All safety parameters were analyzed using a two-sample t test and descriptive statistics. Results: A total of 232 patients were randomized in arm A (n = 112) and arm B (n = 110). At week 16, arm A showed a significant mean reduction in glycated hemoglobin (HbA1c) than arm B (−1.35% vs. −0.92%; P≤0.0001). Similarly, the mean reductions in fasting plasma glucose (−26.13 mg/dL vs. −22.59 mg/dL; P = 0.0492), 2-h postprandial plasma glucose (−52.29 mg/dL vs. −30.35 mg/dL; P≤0.0001), and body weight (−1.32 kg vs. −0.42 kg; P≤0.0001) were significantly higher in arm A than in arm B. Arm A had a higher proportion of patients achieving HbA1c &lt;7.0% (42.24% vs. 22.41%; P = 0.0012). Adverse events were comparable between study arms. Conclusions: The FDC of dapagliflozin and linagliptin was superior in terms of improvement in glycemic control and a higher proportion of patients achieving target HbA1c level, with both treatment arms being well-tolerated.

Glycemic Management of Patients with Hospital Hyperglycemia: A Retrospective Cohort Study on Adults Admitted in the Non-ICU Wards.

To identify the key populations for Hospital Hyperglycemia (HH) management and to assess recent trends in the management of HH. This retrospective study analyzed 1,136,092 point-of-care blood glucose (POC-BG) measurements from 40,758 patients with HH in non-intensive care unit (non-ICU) wards at Ningbo No.2hospital from January 2020 to December 2022. We compared glucose monitoring and management across varying years, age groups, and hospital departments. The overall incidence of HH was 16.87%. From 2020 to 2022, the number of patients with HH increased from 9,893 to 15,639, accompanied by a marginal improvement in average BG levels (slope difference, -8.137E-09 [CI, -8.742E-09 to -7.531E-09]; p <0.001). In the ≥80 years group, the median BG was 9.4mmol/L, significantly higher than in other age groups (p<0.001). Hypoglycemia in this group was most frequently detected during nighttime and bedtime, with an incidence of 2.67%, significantly higher than at other times of the day (p<0.001). The daily POC-BG testing rate was significantly higher in the medical ward group than it in the surgical ward group (57.9% vs 51.7%, p<0.05). Proportions of glycemic targets days were 35.66% and 39.90% in the medical wards on day 1 and day 7, respectively (Day 7 39.90% vs Day 1 35.66%, p>0.05), and 46.16% and 45.07% in the surgical wards (Day 7 45.07% vs Day 1 46.16%, p>0.05), showing no significant improvements in glycemic control. Endocrinology consultations occurred at rates of 14.2% in the medical wards and 14.9% in the surgical wards (p>0.05). Although the prevalence of HH is consistently high and the number of affected patients continues to rise, modest improvements in glycemic management have been observed. However, control among the elderly remains poor, with a notably high risk of hypoglycemia during nighttime and bedtime periods.

Impact of Diet and Exercise Interventions on Glycemic Control and Weight Management in Adults with Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials and Observational Studies

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition characterized by insulin resistance and impaired insulin production, leading to high blood glucose levels. It is the most common form of diabetes, accounting for 90%-95% of all cases globally. With an increasing prevalence of T2DM, effective management strategies are crucial to control glycemic levels and prevent associated complications. Diet and exercise are considered key interventions to improve glycemic control and manage weight in individuals with T2DM. Objective: This systematic review aims to evaluate the effects of diet and exercise interventions on glycemic control and weight management in adults with Type 2 diabetes. The review focuses on the impact of various diet plans, including low-carbohydrate and Mediterranean diets, as well as different exercise regimens. Methodology: A comprehensive search of randomized controlled trials (RCTs) and observational studies was conducted to identify research on the effects of diet and exercise interventions in managing T2DM. Studies assessing glycemic control (e.g., HbA1c levels) and weight loss outcomes were analyzed to determine the effectiveness of these interventions. Results: The review found that both diet and exercise interventions led to significant improvements in glycemic control and weight management. Low-carbohydrate diets and Mediterranean diets, in particular, demonstrated positive effects on blood glucose levels and insulin sensitivity. Regular physical activity, especially aerobic and resistance exercises, also contributed to improved glycemic control and weight reduction. Conclusion: Diet and exercise interventions are effective strategies for managing Type 2 diabetes, improving both glycemic control and weight management. Incorporating tailored diet plans and exercise regimens into clinical practice may significantly benefit individuals with T2DM. Further studies are needed to refine intervention protocols and address barriers to patient adherence.

Effect of Long-Term Taurine Supplementation on the Lipid and Glycaemic Profile in Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis.

Taurine has been demonstrated to regulate and improve metabolic health. However, physiological and pathological differences among individuals with overweight or obesity may result in varied responses to taurine supplementation. This study aims to estimate the effects of long-term taurine supplementation on blood lipids, glycemia, and insulin sensitivity in adults with overweight or obesity through a systematic review and meta-analysis. The literature search was based on six databases (Web of Science, PubMed, Scopus, EMBASE, Cochrane, and SPORTDiscus) up to October 2024. Subgroup analyses were performed based on daily taurine intake dosage (<3 g or 3 g), overweight (BMI 25-29.9 kg/m2), and obesity (BMI ≥30 kg/m2). The final number of studies that met the inclusion criteria was 9 RCTs. The overall analysis showed that taurine supplementation significantly decreased TG (WMD = -0.56 mg/dL, 95% CI: -0.92 to -0.2, p = 0.002, I2 = 63%), TC (WMD = -0.71 mg/dL, 95% CI: -1.17 to -0.25, p = 0.002, I2 = 73%), and fasting insulin (WMD = -2.15 µU/mL, 95% CI: -3.24 to -1.06, p = 0.0001, I2 = 9%). In the subgroup analysis, long-term taurine intake led to BMI improvement in overweight adults (WMD = -1.14 kg/m2, 95% CI: -1.81 to -0.47, p = 0.0008, I2 = 0%). Meanwhile, improvements in HbA1c (WMD = -0.33%, 95% CI: -0.53 to -0.12, p = 0.002, I2 = 16%) and HOMA-IR (WMD = -0.91, 95% CI: -1.74 to -0.08, p = 0.003, I2 = 54%) were observed only in obese participants following taurine supplementation. Additionally, the long-term intake of 3 g of taurine significantly improved HbA1c (WMD = -0.37%, 95% CI: -0.61 to -0.13, p = 0.003, I2 = 0%) and FPG levels (WMD = -7.14 mg/dL, 95% CI: -12.53 to -1.74, p = 0.003, I2 = 70%) in overweight/obesity. Long-term taurine supplementation is particularly effective in improving glycemic control and insulin sensitivity in obesity. Furthermore, higher doses of taurine (3 g per day) demonstrate even greater improvements in glycemic control.

Effects of diabetes mellitus on osseointegration: a review of the available strategies for better outcomes

Diabetes mellitus, a metabolic disorder, is widely known to negatively affect bone healing, especially by interfering with dental implant osseointegration. This review aimed to explore the mechanisms of metabolic bone changes around dental implants in patients with diabetes and the available therapies to improve osseointegration. A literature search was conducted in the PubMed, Cochrane Library, and Embase electronic databases to identify relevant studies. A substantial body of evidence has demonstrated the negative impact of diabetes mellitus on bone health and osseointegration. This can be attributed to several factors, including the over-expression of reactive oxygen species, accumulation of advanced glycation end products, impaired angiogenesis, and altered expression of proteoglycans and bone-related biomarkers. Various therapeutic approaches have been proposed to enhance osseointegration of dental implants in patients with diabetes. These include insulin therapy, hypoglycemic agents, hyperbaric oxygen treatment, parathyroid hormone therapy, implant surface modification, natural substances, mesenchymal stem cell management, gene expression, and growth factor modulation. Despite the potential of numerous therapies, either for glycemic control or osseointegration improvement, additional preclinical and clinical investigations are necessary to validate their effectiveness and safety.

Assessment of risk factors, comorbidities, and treatment pattern in newly diagnosed patients of diabetes in India

Background: Early identification of risk factors and comorbidities is essential for optimizing treatment strategies in diabetes. The diabetes in India (DIAB India) study aims to evaluate risk factors, glycemic status, comorbidities, and initial management choices in newly diagnosed T2DM Methods: A retrospective, observational, multicenter study was conducted with a large cohort of 19,230 patients pan India. Data was collected from patient health records and meticulously stored into a standard format. Demographic data (age, gender, weight, height, risk factors, and blood pressure), clinical presentation (family history, complications, glycemic indices, and comorbidities), and choice of management were recorded and used for analysis. Results: Obesity and family history were most common risk factors for T2DM and were significantly correlated with its severity (p&lt;0.001). The most common comorbidity was neuropathy (59.8%) followed by nephropathy (27%) and CV events (25%). Obese patients have higher mean hemoglobin A1c (HbA1c) of 8.4%, fasting blood glucose (FBG) (160 mg/dL), and postprandial blood glucose (PPBG) (233.6 mg/dL) compared to non-obese. Both single and combination therapies led to significant improvements in HbA1c (Single: pre- 7.47, post-6.87; Combination: pre-8.26, post-7.13), FBG (Single: pre-138.94, post-118.89; Combination: pre-161.21, post-128.2), and PPBG (Single: pre-200.88, post-163.83; Combination: pre-235.10, post-177.87) levels after treatment, with combination therapy showing greater reductions across all markers (p&lt;0.001). The improvement in glycemic control was greater in patients who followed dietary advice (p&lt;0.001). Conclusions: Obesity and family history were the most common risk factors contributing to diabetes in the newly diagnosed Indian patients. The comorbidities usually associated with diabetes are identified as neuropathy and cardiovascular conditions. While dietary measures are not widely used, significant improvement in glycemic status is reported using pharmacotherapy (monotherapy or combination). Choice of pharmacological and non-pharmacological treatments should be tailored to patient preferences, demographics, comorbidities, age, and other factors.

An acute bout of 4 × 4-min or 10 × 1-min HIIT improves β cell glucose sensitivity in postmenopausal females with type 2 diabetes: a secondary analysis.

Improvements in glycemic control following acute exercise are typically attributed to improved postexercise insulin sensitivity (IS) with comparatively little known about how acute exercise impacts β cell function, especially in postmenopausal females. We determined how two high-intensity interval training (HIIT) protocols, matched for total estimated energy expenditure, impact β cell function in postmenopausal females with type 2 diabetes. Thirteen postmenopausal females (70 ± 5 yr; 12 ± 7 yr since diagnosis, 80.9 ± 13.8 kg, 32.4 ± 5.6 kg·m2; HbA1c-49.8 ± 10.3 mmol/mol [6.7 ± 1.0]) living with type 2 diabetes were included in this semirandomized crossover trial. The trial involved an initial resting control condition followed by two HIIT conditions [4 × 4-min HIIT (HIIT4) and 10 × 1-min HIIT (HIIT10)] completed in a randomized order 2-4 days apart. β cell function (glucose sensitivity) and insulin sensitivity were determined from a 2-h mixed-meal tolerance test performed 2 h after rest or HIIT. Both HIIT4 and HIIT10 significantly improved β cell glucose sensitivity compared with control (15 pmol/min/m2/[mmol/L], [95% confidence interval (CI) 6, 23]; P = 0.002 and 16 pmol/min/m2/[mmol/L], [95% CI 7, 25]; P = 0.002, respectively), with no difference between HIIT protocols (1 [-8, 10], P = 0.79). There were no significant differences in IS metrics (Matsuda index, OGIS, Stumvoli, and QUICKI) between the conditions. An acute bout of 4 × 4-min or 10 × 1-min HIIT improves β cell glucose sensitivity in postmenopausal females living with type 2 diabetes. ClinicalTrials.gov: NCT04986345.NEW & NOTEWORTHY This is the first study to explore the effects of acute high-intensity interval training (HIIT) on β cell function in postmenopausal women with type 2 diabetes. Our crossover trial compares two HIIT protocols, matched for total estimated energy expenditure, examining their impacts on β cell function and insulin sensitivity. Despite the absence of an insulin-sensitizing effect, we show robust effects of HIIT on β-cell function, including an improvement in β-cell glucose sensitivity.

A prospective, multicentre study evaluating safety and efficacy of a fixed dose combination of Remogliflozin etabonate, Vildagliptin, and Metformin in Indian patients with type 2 diabetes mellitus (Triad-RMV)

AimsThe ICMR INDIAB-17 study revealed a diabetes prevalence of 11.4% in India, emphasizing the need for effective treatment for glycemic control. A Phase IV study was conducted to evaluate the safety and efficacy of a Fixed Dose Combination (FDC) of Remogliflozin, Metformin and Vildagliptin (RMV) in Type 2 Diabetes Mellitus (T2DM) patients uncontrolled on Metformin plus SGLT2 inhibitor or Metformin plus DPP4 inhibitor dual therapy.MethodsA total of 215 patients (mean age: 46.4 years; 64% male, 36% female) were enrolled across multiple centers in India. The study population included patients with a baseline HbA1c ≥ 8% at the time of screening. The primary objective was to assess safety based on treatment-emergent adverse events (TEAEs), while the secondary. aim was to evaluate effectiveness in terms of glycemic (HbA1c, fasting plasma glucose, postprandial glucose) and extra-glycemic measures (renal and lipid parameters). Statistical analysis was conducted using paired t-tests and the Wilcoxon signed-rank test for within-group comparisons, and the Bonferroni correction was applied to adjust for multiple comparisons. Effectiveness was evaluated at baseline, week 12, and week 24.ResultsThe study demonstrated statistically significant reductions in mean HbA1c levels from baseline to both week 12 and week 24 (p < 0.00001). At 24, weeks, 45.1% of patients achieved target HbA1c levels of ≤ 7%. Significant reduction was also observed in fasting plasma glucose (FPG) and postprandial glucose (PPG) levels. Renal parameters remained stable or improved, and lipid profile parameters, including LDL-C and triglycerides, showed favorable changes. Adverse events of special interest, including hypoglycemia and urinary tract infections, were reported in 4.7% of patients, with no serious adverse event recorded.ConclusionsThe twice daily triple FDC of RMV was well tolerated, safe and effective in patients with Type 2 Diabetes Mellitus uncontrolled on dual drug therapy of Metformin plus SGLT2i or Metformin plus DPP4i. The treatment led to significant improvements in glycemic control and other metabolic parameters over 24 weeks, without compromising renal function or causing serious adverse events.Trial registrationCTRI, CTRI/2022/05/042581. Registered 17 May 2022, https//ctri.nic.in/Clinicaltrials/rmaindet.php? trialid=68,757&EncHid=36127.16500&modid=1&compid=19.

Jamun (Syzygium cumini Linn.) Seed Extract as a Potential Antidiabetic Agent: Effects on Blood Glucose Levels, Haematological Parameters and Biochemical Profiles in Alloxan-Induced Diabetic Albino Rats

Diabetes mellitus is rapidly increasing in India, making it essential to find alternative therapies that minimize side effects and improve patient outcomes. Safer treatment options are needed to manage the growing burden of this chronic condition effectively. This study evaluates the antidiabetic potential of Syzygium cumini seed extract (SCSEt) in alloxan-induced diabetic rats. Diabetes was induced by administering alloxan (120 mg/kg) in albino rats, and diabetes was confirmed with blood glucose levels ≥290 mg/dL. Rats were treated with SCSEt at doses of 2, 4, and 6 g/kg orally, with insulin (1.0 IU/kg/day) serving as a reference treatment. Over four weeks, SCSEt demonstrated a significant reduction in blood glucose levels compared to untreated diabetic controls, though less effective than insulin. Blood glucose levels in SCSEt-treated groups decreased from 286 ± 1.10 mg/dL (low-dose) to 110 ± 3.21 mg/dL (high-dose), compared to insulin-treated rats with levels of 112 ± 1.96 mg/dL. Haematological parameters improved with SCSEt, particularly at higher doses, where packed cell volume (PCV) reached 42.91 ± 0.98% and haemoglobin levels were 17.08 ± 2.06 g/dL. Biochemical analyses revealed reduced serum cholesterol and improved protein levels in high-dose SCSEt rats, with cholesterol dropping to 112 ± 1.92 mg/dL and protein rising to 6.39 ± 0.09 mg/dL. SCSEt also enhanced glucose tolerance, with high-dose SCSEt rats achieving the lowest glucose level of 104 ± 1.62 mg/dL at 100 minutes during the oral glucose tolerance test (OGTT). Although SCSEt was less effective than insulin in glucose management, its potential as a complementary therapy is supported by its significant improvements in glycemic control and lipid profile.

Sleeve Gastrectomy and Its Impact on Insulin Resistance and Metabolic Health: A Cohort Study.

Obesity is a prevalent metabolic disorder that significantly contributes to insulin resistance (IR), type 2 diabetes (T2DM), and metabolic syndrome. Sleeve gastrectomy has emerged as an effective surgical intervention for obesity, with potential benefits on metabolic health. This study investigates the impact of sleeve gastrectomy on serum insulin levels, IR (HOMA-IR), inflammatory markers, C-peptide, kidney function, and various biochemical parameters in diabetic and non-diabetic patients. A prospective cohort study was conducted, involving 199 patients over 18years old who were candidates for sleeve gastrectomy at Luqman Hakim Hospital from 2021 to 2022. Data were collected using standardized questionnaires and anthropometric measurements, and biochemical assessments were performed before surgery and 6months postoperatively. Statistical analyses included descriptive statistics, t-tests, Mann-Whitney tests, and repeated measures analysis of variances (ANOVA). The study included 199 patients (84.4% female) with a mean (± standard deviation (SD)) age of 39.79 ± 11.30years. Significant reductions were observed in weight, BMI, and abdominal circumference across all patient groups. Diabetic patients showed marked improvements in fasting blood sugar, 2-h postprandial blood sugar, and glycosylated hemoglobin levels. Insulin resistance decreased significantly, as did serum insulin and C-peptide levels. Improvements in lipid profiles and inflammatory markers were also noted. Insulin use post-surgery showed a significant inverse relationship with glycemic control improvement. Sleeve gastrectomy is a safe and effective procedure for obese patients, significantly improving insulin resistance and various obesity-associated diseases within 6months post-surgery.

Patient Experience in Older Adults with Diabetes: A Narrative Review on Interventions to Improve Patient Experience and Research Gaps.

Patient experience is a critical healthcare quality indicator, evolving from Patient Satisfaction (PS) and encompassing patients' concrete healthcare experiences. It is increasingly vital in aging societies where collaborative efforts among patients, families, and healthcare professionals are essential. Studies suggest that enhanced patient experience leads to better adherence, outcomes, and patient safety. This paper reviews patient experience evaluations in older adults with diabetes through randomized controlled trial (RCT)-based findings. The author searched PubMed/MEDLINE, Embase, AMED, and CINAHL. The review focused on RCTs examining interventions affecting patient experience and PS in T2D/T1D patients aged ≥65. A total of 13 RCTs were eligible for this review. This review highlights studies on diabetes management in older adults, assessing the impact of health education, diabetes management programs, treatments, mHealth, and advanced insulin delivery systems. Early studies showed that education improved self-care but had a limited impact on glycemic control. Key findings include the effectiveness of experience-based education in improving HbA1c, the benefits of insulin therapy for elderly patients, and the value of structured peer-to-peer diabetes management programs in enhancing satisfaction. Patient adherence, satisfaction, and personalized support emerged as critical factors influencing diabetes management across various interventions. More recent trials involving mHealth demonstrated improvements in glycemic control and PS through automated data sharing and app-based support. Closed-loop insulin delivery studies reported reduced mental strain, improved glycemic control, and better quality of life, despite barriers such as device cost and occasional system limitations. These interventions highlight the potential of advanced technologies to enhance diabetes care, particularly for aging populations. Previous RCTs show that education, structured management programs, effective insulin therapies, and advanced digital treatments improve patient experience, though well-designed studies focusing on patient experience as a primary outcome are lacking. Developing patient experience assessment scales for aging diabetes patients and adapting healthcare systems to maximize patient experience amid digitalization trends are essential, warranting further research.