Hypoglycemic Research Articles

The role of self-efficacy in managing type 2 diabetes and emotional well-being: a cross sectional study

BackgroundManaging chronic conditions like Type 2 diabetes presents significant challenges, with self-efficacy—one’s belief in their ability to manage their health—playing a crucial role. This study investigates the influence of self-efficacy on emotional distress and health outcomes among Type 2 diabetes patients.MethodsWe conducted a cross-sectional study in Damascus with 336 Type 2 diabetes patients from three healthcare facilities. Data were collected through face-to-face interviews using validated questionnaires: the Diabetes Management Self-Efficacy Scale (DMSES), Problem Areas in Diabetes (PAID-5), and the World Health Organization-Five Well-being Index (WHO-5).ResultsAnalysis revealed that female gender and older age are significant factors influencing diabetes distress, with higher levels of distress observed in females and older patients. A negative correlation was found between self-efficacy and age, indicating reduced confidence in diabetes management among older individuals. Treatment modalities, such as oral hypoglycemic agents, were positively associated with higher self-efficacy. Significant associations were found between diabetes duration, age, and diabetes distress (PAID-5 scores), while self-efficacy (DMSES scores) varied based on treatment types.ConclusionsDespite high levels of diabetes distress and low psychological well-being, patients demonstrated commendable self-efficacy in managing their diabetes. Targeted interventions should address the needs of elderly female patients and those undergoing specific treatments to improve care outcomes. This study highlights the importance of tailored support and a holistic approach to diabetes management.

Nanotechnology-Based Approaches for the Management of Diabetes Mellitus: An Innovative Solution to Long-Lasting Challenges in Antidiabetic Drug Delivery

Diabetes is a widespread metabolic illness. Mismanagement of diabetes can lead to severe complications that tremendously impact patients’ quality of life. The assimilation of nanotechnology in diabetes care holds the potential to revolutionize treatment paradigms, improve patient outcomes, and reduce the economic burden associated with this pervasive disease. This manuscript explores the multifaceted utilization of nanomaterials in diabetes care, emphasizing the unique features of nano-based medication delivery methods and smart drug delivery mechanisms. Additionally, this paper talks about research on nanocarrier-integrated oral, transdermal, and inhalable insulin delivery; dendrimer- and nanocarrier-coupled antisense oligonucleotide-driven gene therapy; the implementation of gold nanoparticles and quantum dots for glucose surveillance; and nucleic acid therapies. There are certain restrictions when using medication delivery methods that are commonly available to handle diabetes. In order to increase efficacy and safety, the rapidly developing science of nanotechnology is also being explored and employed in medical biology. Nanomaterials like liposomes, dendrimers, niosomes, polymeric and metallic nanocarriers, and solid lipid nanoparticles are among the nanocarriers that have been developed for better delivery of various oral hypoglycemic agents in comparison to conventional therapies. These nanocarriers provide great control over elevated blood glucose levels, making them one of the most intriguing and promising technologies available today. Furthermore, adding additional ligands to nanocarriers allows for more focused distribution while protecting the encapsulated hypoglycemic drugs.

Metformin: exploring its potential as an anticancer drug

Metformin is a commonly used hypoglycemic agent that has received much attention in recent years for its potential in cancer therapy. This paper reviews and concludes the anti-cancer mechanisms of metformin and its clinical applications in different cancer types. It was found that metformin indirectly inhibits cancer cell growth by activating AMPK and inhibiting the mTOR pathway and decreasing insulin and IGF-1 levels. In addition, metformin directly inhibits cancer cell proliferation by inducing apoptosis and autophagy. Clinical data suggest that metformin significantly improves survival and reduces cancer recurrence in patients with gastric, renal, endometrial and esophageal cancers. However, despite the preliminary evidence provided by existing studies, discrepancies remain between the results of different studies, and further large-scale randomized controlled trials are needed to validate its anticancer effects and optimize application strategies. Future studies should focus on clarifying the specific mechanism of action of metformin and its potential application prospect in individualized therapy.

Association between Gamma-Glutamyl Transferase Levels and Pancreatobiliary Cancer Risk in Patients with Diabetes: Evidence from the National Health Insurance Cooperation Health Checkup 2009 to 2012.

Elevated gamma-glutamyl transferase (GGT) levels indicate hepatic dysfunction and have been linked to an increased risk of pancreatobiliary cancers. However, this association, particularly in individuals with diabetes mellitus (DM), requires elucidation. We aimed to examine the association between elevated serum GGT levels and pancreatobiliary cancer risk in patients with diabetes. Our study included data from the National Health Insurance Service (NHIS) database for 2,459,966 adults aged >20 years diagnosed with DM between 2009 and 2012. We examined the association between serum GGT levels and pancreatobiliary cancer risk, considering DM-related factors. Serum GGT levels were categorized into quartiles, and Cox proportional hazards analysis was performed to evaluate the association between serum GGT levels and pancreatobiliary cancer risk. Over a median follow-up period of 7.2 years, 21,795 patients (0.89%) were newly diagnosed with pancreatobiliary cancer. The adjusted hazard ratio for pancreatobiliary cancer in quartiles 2-4 compared with that in quartile 1 was 1.091, 1.223, and 1.554, respectively, demonstrating a significant upward trend (p<0.001). This association remained consistent across all cancer types and was independent of the DM duration or treatment regimen. Elevated serum GGT levels were independently associated with an increased risk of pancreatobiliary cancer, regardless of the duration of DM or the use of oral hypoglycemic agents and insulin. While these findings suggest the potential utility of serum GGT as a biomarker for identifying individuals at higher risk of pancreatobiliary cancer within the diabetic population, further research is needed to validate its clinical applicability.

Spectrum of cutaneous manifestations in patients with type 2 diabetes mellitus

Background: Skin disorders, usually neglected and frequently under diagnosed among diabetic patients. These are common complications and encounter a broad spectrum of disorders in diabetes. Aims and Objectives: Present study, aimed to evaluate various cutaneous manifestations among type 2 diabetes mellitus (DM) patients. Materials and Methods: The present study was conducted at Dermatology, Diabetic Clinic of tertiary care centre hospital. After approval from the Institutional Ethics Committee and consent from study subjects, 240 subjects were included. All subjects underwent clinical examination-special emphasis on cutaneous manifestations. Blood samples were collected and used for the estimation of blood glucose, liver function tests and renal function tests, complete blood count, bacterial infections-Gram stain and culture, fungal infections-KOH (potassium hydroxide) mount, Gram stain (for Candida), and culture. Results: Out of 200, 140 (58.4%) were males and 100 (41.6%) were females. The majority of the patients were 5th, 6thand 7th decades. Acrochordons 22 (9.1%) and candidal balanoposthitis 21 (8.7%) were predominantly observed. Fungal, bacterial, and non-infective were 90 (37.5%), 54 (22.5%), and 112 (46.6%), respectively. On bacterial culture, Pyogenic ulcer was observed in 8, furunculosis in 6, etc. KOH mount positive in 22 patients and culture positive was seen in 16 patients. In non-infective dermatoses, Acrochordons were observed in 24 patients. The majority of the patients were on oral hypoglycemic agents. Conclusion: This study’s results showed demographic, social factors, and the prevalence of various dermatological manifestations in type 2 DM patients.

Current prevalence of rotator cuff tear in Type 2 diabetes mellitus patients and its association with type of diabetic drug regime (OHA’S vs. insulin therapy) – A prospective study

Background: A prospective study to assess the prevalence of rotator cuff (RC) tears in patients with Type 2 diabetes mellitus. Aims and Objectives: The purpose of this study is to assess the prevalence of RC tear in Type 2 diabetes mellitus patients presenting with shoulder pain to the outpatient clinic. Materials and Methods: A total of 100 diabetic patients with shoulder pain and restriction of movements formed the study group and were prospectively studied using magnetic resonance imaging and were evaluated with regard to the presence of RC tear. The factors that were analyzed included HBA1C levels, duration of diabetes, and type of diabetic medication. All these factors were evaluated with regard to their correlation with RC tear. Results: In our study, we found that the prevalence of RC tear was 37% and there seemed to be a significant correlation between HBA1C levels (P=0.007) as well as prolonged duration of diabetes (P=0.006) with RC tear. It has been established in our study that the occurrence of RC tear is lesser in oral hypoglycemic agents group as compared to insulin group in treating diabetic patients. Conclusion: One independent risk factor for RC tear is diabetes. The prevalence of RC tear is higher in the diabetic population with increased HBA1c levels and prolonged duration of diabetes mellitus. Metformin usage in diabetes mellitus has been associated with reduced incidence of RC tear due to diminished impregnation of advanced glycation end products with in the RC tendon.

Purification, structural identification, in vitro hypoglycemic activity and digestion characteristics of polysaccharides from the flesh and peel of wampee (Clausena lansium)

In this study, two polysaccharides were isolated from the flesh and peel of wampee, termed as PWP-F and PWP-P respectively, and their structural characteristics, in vitro antioxidant and hypoglycemic activities and digestion were investigated. Results indicated the molecular weight of PWP-F was higher than that of PWP-P and they were both mainly composed of galactose and arabinose. Both polysaccharides exhibited α-type and β-type glycosidic linkages based on FTIR analysis. NMR spectroscopy revealed that PWP-F mainly consisted of α-Araf-(1→, →3,5)-α-Araf-(1→, →2,5)-α-Araf-(1→, →4) → β-Galp-(1 → and α-GalpA-(1→, while PWP-P was composed of α-Araf-(1→, →3)-α-Araf-(1→, →5)-α-Araf-(1→, →3,6) → β-Galp-(1→ and α-GalpA-(1→. Scanning electron microscopy showed that PWP-P had more porous surface structure compared to PWP-F. Moreover, PWP-P exhibited superior antioxidant activity and significant inhibition of both α-glucosidase and α-amylase compared to PWP-F. Specifically, PWP-P demonstrated mixed inhibition against α-glucosidase and α-amylase. In vitro digestion results showed the molecular weight, polysaccharide and reducing sugar content of PWP-F and PWP-P decreased after simulative gastrointestinal digestion. Overall, PWP-P has great potential as a kind of new antioxidant and hypoglycemic agent.

Hypoglycemic Agents Increase Regulatory Factor X1 to Inhibit Cancer Cell Behaviour in Human Glioblastoma Cells.

Glioblastoma multiforme is a deadly brain tumour in humans. We have shown that regulatory factor X1 (RFX1), a transcription factor, inhibits the proliferation, migration and invasion of human glioblastoma cells. This study was designed to identify the existing medications that could increase RFX1 in human glioblastoma cells and to determine whether these medications could inhibit the cancer cell behaviours. A bioinformatics approach was used to identify the medications that increased RFX1. The effects of these medications on human glioblastoma cell proliferation, migration and invasion were assayed under cell culture and mouse brain xenograft conditions. Pioglitazone, rosiglitazone and WY-14643 increased RFX1 based on bioinformatics prediction and Western blotting data. These hypoglycemic agents reduced the proliferation, migration and invasion of human glioblastoma cell cultures. These agents reduced metalloproteinase 2 (MMP2) activity in the culture medium. Silencing RFX1 attenuated hypoglycemic agent-induced inhibition of cancer cell behaviours and MMP2 activity. Pioglitazone reduced the xenograft tumour volume and migration distance of U87 human glioblastoma cells in the mouse brain. RFX1-siRNA attenuated these effects. Our results provide additional evidence for RFX1 as a therapeutic target for human glioblastoma and suggest that pioglitazone, rosiglitazone and WY-14643 inhibit cancer cell behaviour of human glioblastoma cells via upregulating RFX1.

Construction and characterization of Laminaria polysaccharide functionalized selenium nanoparticles based on an activity-oriented approach

Laminaria polysaccharides (LP) have been shown to effectively stabilize selenium nanoparticles (SeNPs), forming LP–SeNP complexes with enhanced bioactivity. However, the correlation between their bioactivity and physicochemical properties remains inadequately explored. This study used chemical reduction with LP as stabilizer to investigate how LP-to-selenium mass ratio (LPSMR), reaction time, and temperature influence particle size, selenium content, and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity of LP–SeNPs. The results showed that enhanced DPPH scavenging correlated with higher selenium content and smaller particle size, primarily modulated by LPSMR and temperature. Under optimal conditions (LPSMR of 1; temperature of 25°C), the resulting LP–SeNPs exhibited uniform morphology with a particle size of 81.41nm and selenium content of 653.91mg/g. This stability was achieved through non-covalent interactions between LP and SeNPs, providing superior light and acid resistance compared to unmodified SeNPs. Notably, LP–SeNPs showed synergistic antioxidant effects, with lower half-maximal inhibitory concentration (IC50) values for scavenging DPPH, hydroxyl, and superoxide anion radicals than LP or SeNPs alone, and enhanced hypoglycemic activity. Cytotoxicity assays confirmed LP–SeNPs had reduced toxicity compared to Na2SeO3 and selenopeptide. These findings provide insights into the structure-activity relationships of LP–SeNPs and support their potential application as antioxidant and hypoglycemic agents.

Oxygen influences in vitro assessment for phenolic compounds: Digestive stability, α-glucosidase inhibitory activity and bioavailability

Phenolic compounds are popular in screening novel hypoglycemic agents, but the impact of oxidative degradation on the determination of α-glucosidase inhibitory activity and bioavailability is unclear. Here we showed 12 phenolic compounds structure-dependently degraded during standard simulated digestion, while in physiological hypoxia their retention rates were all over 87.89 %. This enhancement of digestive stability resulted in the biggest drop of 31.72 % in IC50 against α-glucosidase and a significant increase in bioavailability. Enzyme kinetic and multi-spectroscopic analysis confirmed oxygen weakened the affinity of compounds to α-glucosidase, but the mechanisms were not changed. Moreover, a two-chamber culture system was designed to meet conflicting demands for oxygen between epithelium and cavity, and better α-glucosidase inhibitory activities (51.61 % maximum reduction in glucose production) and absorption rates (up to 1.10 % from undetectable) were obtained than those of uncontrolled oxygen. Hence, the oxygen level should be monitored to assess the activities of phenolic compounds in vitro.

Improved glycemic and weight control with Dulaglutide addition in SGLT2 inhibitor treated obese type 2 diabetic patients at high cardiovascular risk in a real-world setting. The AWARE -2 study

We evaluated the effects on glycemic control and body weight of GLP1-RA in obese type 2 diabetic patients treated with SGLT2-inhibitors and other hypoglycemic agents and/or insulin, in a real-world setting. A cohort of 583 type 2 diabetic outpatients treated with an SGLT2 inhibitor and/or other anti-diabetic medications were examined. Because patients had suboptimal glycemic control, the GLP1-R.A. Dulaglutide was added to ongoing medications. At 6 months, 334 patients had a follow-up visit. Patients were classified in terms of cardiovascular risk (CVR) employing the ESC-EASD 2019 criteria, with the Aware APP. The study's primary endpoints were changes in: 1) HbA1c level, 2) BMI, and 3) body weight after six months of treatment. Secondary endpoints were evaluation of Dulaglutide addition in type 2 diabetic patients: 1) with more or less than ten years of T2DM; 2) more or less than 75 years of age and in different subgroups of CVR. In the 334 patients which had a 6 months follow-up visit, age was 65,9+9,8; 33.5% (112) were females and 66.5% (222) were males. After six months of Dulaglutide treatment, we found a significant reduction in HbA1c levels (8.0+10.5mmol/mol; p<0.0001) and in body mass index (1.1+1.1kg/m2; p<0.0001). Efficacy of Dulaglutide was not affected by different CVD risk categories, age and T2DM duration. This real world study provide evidence for significant reductions in HbA1c level, body mass index, and body weight in obese type 2 diabetic patients who received add-on treatment with a weekly GLP-1RA, Dulaglutide.

Determinants of glycemic control among persons living with type 2 diabetes mellitus attending a district hospital in Ghana

Determinants of glycemic control among persons living with type 2 diabetes mellitus attending a district hospital in Ghana

Time to development of macrovascular complications and its predictors among type 2 diabetes mellitus patients at Jimma University Medical Center

BackgroundType 2 diabetes mellitus is a serious metabolic disease that is often associated with vascular complications. The increasing prevalence of type 2 diabetes mellitus poses significant public health challenges, particularly in Low and Middle-Income Countries where healthcare resources are often limited. In Africa, the burden of T2DM is rising rapidly, leading to a consequential increase in macrovascular complications such as cardiovascular disease and stroke. These complications not only affect the quality of life but also significantly contribute to morbidity and mortality among affected individuals. The main objective of this study was to assess the time to development of macrovascular complications and identify its predictors among type 2 diabetes mellitus patients in Jimma University medical center from 2018–2022.MethodsInstitutional-based retrospective follow-up study was conducted in Jimma University Medical Center among newly diagnosed type 2 diabetes mellitus patient from 2018, to 2022. A systematic sampling technique was used to recruit 452 records of type 2 diabetes mellitus patients. The Kaplan–Meier curve and the log-rank tests were used to determine the time to macro-vascular complications, and evaluate the significant difference in survival probability among predictors respectively. The overall goodness of the Cox proportional hazard model was checked by Cox-Snell residuals. Bivariable and multivariable cox-proportional hazard regression were used to identify the association between the variables and survival time.ResultsThe median survival time to development of macro vascular complications was 24 months. Urban residence [(Adjusted hazard ratio = 2.02; 95% CI: (1.33, 3.05)], having hypertension at start of diabetic treatment [(AHR = 1.52; 95% CI: (1.06, 2.13)], baseline age ≥ 60 years [(AHR = 4.42; 95% CI: (1.72, 11.29)], having dyslipidemia at baseline [(AHR = 1.82; 95% CI: (1.13, 2.93)], High density lipoprotein cholesterol levels < 40 mg/dl [(AHR = 2.11; (1.16, 3.81)], triglycerides > 150 mg/dl [(AHR = 1.48; 95% CI:( 1.02, 2.13)], Hemoglobin A1C level > 7% [(AHR = 1.49; 95% CI: (1.04, 2.14)], and Oral hypoglycemic agents + insulin [(AHR = 2.73; 95% CI: (1.81, 4.09)] were the significant predictors of the time to development of macro vascular complications.ConclusionFindings in this study indicated that the median time to development of macro vascular complications among type 2 diabetes mellitus patients was 24 months. Baseline age category in years, residence, presence of hypertension, presence of dyslipidemia, High density lipoprotein-cholesterol level < 40 mg/dl, triglyceride > 150 mg/dl, HgbA1C > 7% at baseline, and medication regimens were identified as independent significant predictors of the time to development of macro vascular complications among type 2 diabetes mellitus patients. The findings call attention to the role of treatment regimens, particularly the use of combination therapies involving oral hypoglycemic agents and insulin, which were associated with increased hazards for complications. High incidence of macrovascular complications within a short follow-up period underscores the need for proactive, individualized care strategies in T2DM management. By focusing on early identification of at-risk patients and tailoring treatment plans accordingly, healthcare providers can potentially improve outcomes and reduce the burden of macro vascular complications in this population.

Digital continuous glucose monitoring systems for patients with HIV-diabetes comorbidity in Ethiopia: a situational analysis

In patients with HIV-diabetes mellitus (DM) comorbidity, invasive blood glucose testing can increase the risk of HIV-related blood contamination and discourage regular glucose monitoring. Digital continuous glucose monitoring (CGM) systems may allow real-time glucose monitoring without the need for blood specimens. However, in high-burden HIV-DM countries, current glucose monitoring practices and their challenges are insufficiently explored to guide digital CGM research and developments. This study sought to explore the lived experiences of patients with HIV-DM comorbidity and their healthcare providers regarding glucose monitoring practices, and their openness to CGM and other digital technologies, to provide formative insights for a planned implementation trial of digital CGM in Ethiopia. A phenomenological qualitative study was conducted among patients with HIV-DM and their providers at the two largest public hospitals in Ethiopia. Both groups were interviewed face-to-face about DM clinic workflows, blood glucose monitoring and self-testing practices, and potential benefits and limitations of digital CGM systems. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. A total of 37 participants were interviewed, consisting of 18 patients with HIV-DM comorbidity and 19 healthcare providers. Patients had an average (min-max) duration of living with HIV and DM of 14 (8–31) and 6.6 (1–16) years, respectively, with 61% taking insulin—33% alone and 28% alongside oral hypoglycemic agents—and 79% having comorbid hypertension. The thematic analysis identified five main themes: “Diabetes routine clinical care and follow-up”, “Blood glucose monitoring practices”, “Perceptions about digital CGMs”, “Technology adoption”, and “Financial coverage”. Home self-testing was deemed beneficial, but the need for regular follow-ups, result cross-referencing, and glucometer reliability were emphasized. Patients performed fingerstick themselves or with family members, expressing concerns about waste disposal and the risk of HIV transmission. They rely mainly on health insurance for DM care. Patients and providers are happy with the quality of DM services but note a lack of integrated HIV-DM care. Very few providers and patients possessed background information about digital CGMs, and all have not yet utilized them in practice, but expressed keen interest in trying them, representing an important step for upcoming CGM clinical trials in these settings. Given the crucial role of regular glucose testing in managing HIV-DM comorbidity, it is essential to explore testing options that align with patient preferences and minimize the risk of HIV transmission.

Cardiovascular Diseases and Metabolic Medications in the Lebanese Population: A Post Hoc Analysis from a Nationwide Cross-Sectional Study.

This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients' subgroups. A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status. The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia. This study's findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries.

Morfo-Anatomic-Chemical Study of Medicinal Plants: Cissus Sicyoides and Momordica Charantia, Amazon Plants with Hipoglicemic Effect

Objectives: This study analyzes the morphological, anatomical and chemical characteristics of the plant species Cissus sicyoides and Momordica charantia. Theoretical Framework: These plants are empirically used by folk medicine to treat diabetes, a disease with high prevalence in Brazil. WHO data indicate a 7.6% prevalence of diabetes in Brazil, compared to 3 to 10% in the United States and Europe. In the Amazon, the prevalence is 3.3%. Diabetes mellitus is a metabolic disease characterized by hyperglycemia, and is either type 1 or 2. The therapy proposed by traditional medicine for type 1 is insulin, and for type 2, oral hypoglycemic agents, such as sulfonylureas and biguanides. However, in folk medicine, many plants are used to control hyperglycemia, with the same species being used in different countries, which indicates a high probability of drug efficacy. Method: Macroscopic and microscopic evaluation of plant structures. Using the analytical method of atomic absorption and emission, the leaves presented higher concentrations of inorganic compounds (chemical micro and macro elements). Results and Discussion: Based on these data, this research investigated the use of these plant species from the Amazonian biodiversity. It was observed, macroscopically, that both are climbing plants and have tendrils. Microscopically, Momordica charantia presents tector hairs and a centralized vascular bundle, while in Cissus sicyoides, its upper epidermis is composed of polyhedral cells with straight walls and six vascular bundles dispersed throughout the fundamental parenchyma. In contrast, the stomata in both are of the anomocytic type. Using the analytical method of atomic absorption and emission, the leaves presented higher concentrations of inorganic compounds (chemical micro and macro elements), in the order of 75% compared to the other plant structures, highlighting that, chemically, Cissus sicyoides has greater hypoglycemic relevance when compared to Momordica charantia. Research Implications: The implications of this investigation cover several areas, such as: pharmacy, biology, botany, biotechnology and medicine. Plants that can improve diabetes and they can be used as compounds for new medicines, highlighting the need to integrate approaches to preserving the Amazon rainforest with the production of new biotechnological products that will generate financial resources to keep the forest standing, bringing a new possibility of preserving this very important ecosystem for the entire planet. Originality/Value: This study contributes to the literature by analyzing innovative approaches for the integration of biotechnology, preservation of the Amazon rainforest and medicine. Its value lies in the need to develop projects that break the monotony of medicine using only synthetic compounds, promoting the possibility of new medicines from medicinal plants that can truly bring improvements in the socioeconomic conditions of the Amazonians who live and live in the forest. Experiences that enable them to preserve and work with it and not just deforest.

Improvement of osteogenic differentiation potential of placenta-derived mesenchymal stem cells by metformin via AMPK pathway activation

BackgroundPlacenta-derived human mesenchymal stem cells (PL-MSCs) have gained a lot of attention in the field of regenerative medicine due to their availability and bone-forming capacity. However, the osteogenic differentiation capacity of these cells remains inconsistent and could be improved to achieve greater efficiency. Although metformin, a widely used oral hypoglycemic agent, has been shown to increase bone formation in various cell types, its effect on osteogenic differentiation of PL-MSCs has not yet been investigated. Therefore, the objective of this study was to examine the effect of metformin on the osteogenic differentiation capacity of PL-MSCs and the underlying mechanisms.MethodsThe PL-MSCs were treated with 0.5 to 640 µM metformin and their osteogenic differentiation capacity was examined by an alkaline phosphatase (ALP) activity assay, Alizarin red S staining and expression levels of osteogenic genes. The role of adenosine 5′-monophosphate-activated protein kinase (AMPK) signaling in mediating the effect of metformin on the osteogenic differentiation capacity of PL-MSCs was also investigated by determining levels of phosphorylated AMPK (pAMPK)/AMPK ratio and by using compound C, an AMPK inhibitor.ResultsThe results showed that 10–160 µM metformin significantly increased the viability of PL-MSCs in a dose- and time-dependent manner. Furthermore, 80–320 µM metformin also increased ALP activity, matrix mineralization, and expression levels of osteogenic genes, runt-related transcription factor 2 (RUNX2), osterix (OSX), osteocalcin (OCN) and collagen I (COL1), in PL-MSCs. Metformin increases osteogenic differentiation of PL-MSCs, at least in part, through the AMPK signaling pathway, since the administration of compound C inhibited its enhancing effects on ALP activity, matrix mineralization, and osteogenic gene expression of PL-MSCs.ConclusionsThis study demonstrated that metformin at concentrations of 80–320 μM significantly enhanced osteogenic differentiation of PL-MSCs in a dose- and time-dependent manner, primarily through activation of the AMPK signaling pathway. This finding suggests that metformin could be used with other conventional drugs to induce bone regeneration in various bone diseases. Additionally, this study provides valuable insights for future osteoporosis treatment by highlighting the potential of modulating the AMPK pathway to improve bone regeneration.

Practice guideline: Statement regarding treatment for suspected slowly progressive type 1 diabetes (SPIDDM; probable) cases (English version).

Insulin treatment should be introduced in patients with slowly progressive type 1 diabetes (SPIDDM; definite), according to the revised diagnostic criteria of SPIDDM (2023). In contrast, SPIDDM (probable) patients are in a non-insulin-dependent state; therefore, a more flexible treatment can be considered, although sulfonylurea agents should be avoided. Insulin treatment has been shown to maintain endogenous insulin secretion capacity in SPIDDM (probable); however, this does not mean that all SPIDDM (probable) patients should use insulin from the early phase. Dipeptidyl peptidase-4 inhibitors and biguanides might be the treatment of choice for SPIDDM (probable), but no evidence exists for other hypoglycemic agents. In any case, careful monitoring of the endogenous insulin secretion capacity should be carried out, and if a decrease in insulin secretion capacity is suspected, a change in treatment should be considered to prevent progression to an insulin-dependent state.

Dapagliflozin alleviates high-fat-induced obesity cardiomyopathy by inhibiting ferroptosis.

Dapagliflozin (Dapa) is a novel hypoglycaemic agent with multiple cardiovascular protective effects, and it is widely used in treatment of heart failure patients, but whether it can improve obese phenotype of heart failure and its mechanism is still unclear. Ferroptosis is an iron dependent form of cell death and has been proved to be an important role in heart failure. The aim of this study is to determine whether Dapa improves obesity-related heart failure by regulating ferroptosis in high-fat diet rats. Male SD rats were fed a high-fat diet for 12 weeks and confirmed of obese heart failure by metabolic parameters and cardiac ultrasound. Being overweight by 20% compared with the normal group, with elevated systolic blood pressure and abnormal levels of insulin and blood lipid (TG and LDL-c), is recognized as obesity. The obese rats with reduced EF, FS, and E/A shown on ultrasound are defined as the obese heart failure (OHF) group. Histological tests confirmed the more pronounced cardiac fibrosis, mitochondrial volume and collagen deposition in OHF group. Dapa treatment effectively reduced body weight, INS, ISI/IRI index, TG and HDL-C levels (P < 0.05). Also, Dapa administration can slightly decrease the SBP and DBP levels; however, there was no statistical difference among those four groups. Furthermore, Dapa treatment can significantly improve high-fat induced systolic and diastolic dysfunction via regulating cardiac histological abnormalities, including less obvious mitochondrial swelling, muscle fibre dissolution and collagen deposition. Additionally, genes from the OHF group were used by GO enrichment analysis, and it shows that ferroptosis metabolic pathway participated in the development of obese phenotype of heart failure. More importantly, Dapa significantly inhibited Fe2+ and MDA levels (P < 0.05), but augmented GSH content (P < 0.05). In addition, the mRNAs and protein expression of some important regulators of ferroptosis, like GPX4, SLC7A11, FTH1 and FPN1, were all decreased after Dapa intervention. Dapa improved high-fat induced obese cardiac dysfunction via regulating ferroptosis pathway.

Diabetic Ketoacidosis as a Debut and Immune-Mediated Complication Caused by Pembrolizumab: Case Report

Background/Objectives: Diabetic ketoacidosis (DKA) is an acute and potentially life-threatening complication characterized by the accumulation of ketone bodies in the blood, primarily occurring in patients with type 1 diabetes and occasionally in those with type 2 diabetes under certain conditions. DKA presents with symptoms such as polyuria, polydipsia, polyphagia, and, in severe cases, mental status changes. Identifying the triggering factor is crucial to prevent complications and effectively manage this medical emergency. Methods: This report describes the case of a 58-year-old male patient with stage IIIb nodular melanoma, diagnosed in November 2022. Results: After receiving five cycles of pembrolizumab, the patient developed de novo DKA, presenting with blurred vision, asthenia, adynamia, polyuria, and polydipsia. He was admitted to the emergency department with a blood glucose level of 764 mg/dL, confirming hyperglycemia and metabolic acidosis. He was transferred to the intensive care unit for fluid resuscitation and insulin infusion. After adequate clinical evolution and meeting the criteria for DKA resolution, possible autoimmune endocrinopathies secondary to immunotherapy were considered. Due to this complication, the oncological treatment was changed. Finally, the patient was discharged with the need to continue insulin therapy and oral hypoglycemic agents, along with thyroid hormone supplementation. Conclusions: The novelty of this case lies in the presentation of DKA as an immune-mediated complication induced by pembrolizumab, highlighting the importance of closely monitoring patients receiving immune checkpoint inhibitors to detect and manage emerging autoimmune endocrinopathies. It is essential to adjust oncological treatment according to the patient’s response and promptly manage autoimmune endocrinopathies to improve clinical outcomes and the patient’s quality of life.