Hypoglycemic Treatment Research Articles

Higher systolic blood pressure in left not right upper limb is associated with all-cause mortality risk in a community-based population

Abstract Background and Purpose Previous studies have shown that elevated inter-arm systolic blood pressure difference (SBPD) is a valuable indicator for assessing the risk of all-cause mortality. However, no research currently reports that the different impact of higher SBP in which upper limb on all-cause mortality risk. This study investigates which side of the upper limbs has a higher SBP that is more associated with all-cause mortality risk in a community population. Methods The subjects were from the a Atherosclerosis Cohort of the Department of Cardiology of our University First Hospital from 2012 to 2021, and those with missing data of brachial-ankle pulse wave velocity and a history of myocardial infarction or stroke in the baseline survey were excluded. The endpoint was defined as all-cause mortality. SBPD was defined as the difference between the systolic blood pressure of the right arm minus the systolic blood pressure of the left arm by the noninvasive arteriosclerosis detection device BP-203RPEIII (Omron, Japan). SBPD was categorized into four groups: 0-10 mmHg (right arm higher <10mmHg), ≥ 10 mmHg (right arm higher ≥ 10 mmHg ), -10 to < 0 mmHg (left arm higher ≤10 mmHg), and < -10 mmHg (left higher > 10mmHg). The relationship between SBPD and all-cause mortality risk was determined by multivariable Cox proportional hazards regression after adjusting for covariates (age, body mass index, gender, current smoking, current drinking, estimated glomerular filtration rate, diabetes, hypoglycemic treatment, total cholesterol, triglycerides, lipid-lowering treatment, and antihypertensive treatment). Results Totally, 8628 participants were included, with a mean age of 56.58 ± 8.97 years old, and 64.51% (5566) were female. Among them, 380 (4.40%) had an SBPD ≥ 10 mmHg, and 409 (4.74%) had an SBPD < -10 mmHg. During a median follow-up of 9.87 years, 442 cases of all-cause mortality (5.19%) occurred. The Kaplan-Meier curve suggested that the greater the difference in SBPD, the higher the cumulative risk of all-cause mortality. The Log-rank test showed a significant statistical difference (P= 0.0115). Compared to right arm higher <10mmHg group, the risk of all-cause mortality was not significantly elevated in right arm higher ≥ 10 mmHg (adjusted HR=1.17, 95% CI: 0.74-1.84, P=0.507) or left arm higher ≤10 mmHg group (adjusted HR=0.90, 95%CI: 0.74-1.11, P=0.329). However, the risk of all-cause mortality significantly increased by 59% in left higher > 10mmHg Group (adjusted HR=1.59, 95% CI: 1.10-2.30, P=0.013). The results remained significant after adjusting for peripheral right arm SBP (adjusted HR=1.56, 95% CI: 1.08-2.24, P=0.018). Conclusion This study found that a higher SBP in the left arm is associated with a higher risk of all-cause mortality in a Beijing community-based population, and they should be monitored and intervened more intensively.Hazard Ratios for all-cause mortalitySurvival curves for SBPD groups

8622 The Severity of Vasomotor Symptoms Is Associated With Metabolic Dysfunction Associated Liver Disease (Masld) in Peri- AndPostmenopausal Women

Abstract Disclosure: E. Armeni: None. A. Augoulea: None. I. Karagkouni: None. I. Avgousti: None. M. Charamanta: None. S. Stergiotis: None. I. Lambrinoudaki: None. Introduction: Reproductive aging and ovarian senescence are associated with accelerated accumulation of cardiometabolic risk factors, but also progressively increasing risk for cardiovascular disease (CVD). Metabolic-dysfunction-associated steatotic liver disease (MASLD) is linked with a higher risk for CVD. The prevalence of MASLD with regards to reproductive aging, and the possible link with vasomotor symptoms has not been evaluated yet Methods: For the purpose of this cross-sectional study, we evaluated 106 peri- and postmenopausal women, retrieved from the outpatient Menopause clinic of the Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece. The extent of steatotic liver disease (SLD) was estimated as values of the fatty liver index; using the known cut-off ≥ 60 for higher risk for SLD. MASLD was defined as the presence of ≥1 of the following risk factors in a woman with hepatic steatosis: 1) body mass index (BMI) ≥25 kg/m2 or waist circumference ≥85 cm; 2) fasting glucose ≥100 mg/dL or type 2 diabetes or hypoglycemic treatment; 3) blood pressure ≥130/85 mmHg or antihypertensive treatment; 4) triglycerides ≥150 mg/ dL or related treatment; and 5) high-density lipoprotein cholesterol ≤40 mg/dL or lipid-lowering treatment. The severity of vasomotor symptoms (VMS) was assessed using the Greene Climacteric Scale. Results: Moderate-to-severe VMS were evident in 42 women of our sample while 64 women had no-to-mild severity of VMS. Logistic regression analysis showed that moderate-to-severe VSM, as opposed to no-to-mild symptoms, were associated with MASLD (MASLD rates, moderate-to-severe VSM vs no-to-mild: 26.2% vs 12.5%, p-value=0.072; OR = 3.022, p-value =.041). This association became even stronger when we restricted the sample to early postmenopausal women (up to 5 years after the final menstrual period, N=57, VMS no-to-mild vs moderate-to-severe, 3.6% vs 24.1%, p-value = 0.025; OR=9.333, p-value=0.045). The models were adjusted for age, physical exercise, alcohol intake, current smoking, history of menstrual irregularity, and HRT use. Conclusion: The results of this study indicate that the severity of vasomotor symptoms is associated with the diagnosis of MASLD in midlife women, irrespective of the use of HRT. These observations underscore the importance of cardiovascular risk assessment in women with bothersome vasomotor symptoms. Presentation: 6/3/2024

Hypoglycemia-Induced Loss of Consciousness in an Immobilized Geriatric Patient: A Case Report

Introduction : Hypoglycemia in geriatric people is a less well recognized condition and have been correlated with acute outcomes such as seizure, coma, and cardiac arrhythmia. Symptoms of hypoglycemia tend to be less specific with ageing, where diagnosing these conditions in geriatric patient potentially becomes more difficult. Case Report : A 77-year-old man was brought to the ER due to unresponsive since 2 hours before admission. He was hypoglycemic with a plasma glucose level of 70 mg/dL, hypoalbuminemia (2,6 g/dL), and hyponatremia (121 mmol/L). After receiving intravenous dextrose, he regained consciousness and his plasma glucose level increased to 120 mg/dL. Electrolyte abnormalities were corrected, plasma glucose level monitored every 2 hours and titrated according to hypoglycemia standard procedure. He has been in total bed rest and immobilized for 5 years due to inferior paraparesis with decubitus ulcer, had a history of uncontrolled hypertension and diabetes mellitus. Physical examination showed reduced motor function in his lower extremities. The patient had significant recovery during the treatment course and was discharge 4 days after initial presentation. Discussion : Hypoglycemia is a low plasma glucose concentration state that could leads to defective glucose counter-regulation and hypoglycemia unawareness. The patient’s long immobilized state potentially leads to a catabolic state that results in muscle wasting. While his reduced intake leads to geriatric anorexia and become the potential cause of hypoglycemia. Mainstay of hypoglycemic treatment is the detection and treatment using interventions that rapidly increased blood sugar to a safe level, eliminating injury risks and quickly relived symptoms. Conclusion : Diabetes in geriatric has a higher risk for hypoglycemia and should be considered in treating an elderly patient presenting with unresponsiveness or loss of consciousness.

A Retrospective Herb-Drug Interaction Study of Oryeong-san (Wuling-san) Co-administration in Type 2 Diabetes Patients Receiving Hypoglycemic Treatment

Objectives: This study investigated the effects of Korean medicine Oryeong-san (五苓散) on blood glucose levels and evaluated its safety in patients with type 2 diabetes.Methods: A total of 87 patients aged 19 years and older, hospitalized for at least three days at the Kyung Hee University Korean Medical Hospital from January 1, 2021, to December 31, 2023 and continuously consumed Oryeong-san for a minimum of three days, were included. Their clinical characteristics and laboratory tests were reviewed retrospectively. The effects of Oryeong-san on fasting (FBS) and 2-hour postprandial (PP2) blood glucose were assessed by comparing the averages of measurements taken before and after the treatment. To evaluate the safety of the herbal extract, liver function test and kidney function test results were compared, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine (Cr), and estimated glomerular filtration rate (eGFR).Results: The average duration of Oryeong-san consumption was 17.71±26.82 days. Although the FBS decreased and the PP2 slightly increased, these changes were not statistically significant (p>0.05). Safety assessments showed that the average levels of AST decreased, while the level of ALT increased, without statistical significance. The BUN levels also significantly decreased, while Cr and eGFR levels remained stable.Conclusion: This study indicates that Oryeong-san is safe for use in type 2 diabetes patients without significant impact on blood glucose and that it has a positive safety profile.

Evaluation of a continuous glucose monitoring system in healthy dairy calves and adult goats.

To determine the accuracy of a continuous glucose monitoring system (CGMS) device by comparing glucose concentrations measured over time as determined by the CGMS to those of the chemistry analyzer (reference method). 7 healthy goats and 7 dairy calves. A randomized, crossover design with 3 treatments: control, hypoglycemia, and hyperglycemia. The CGMS device was applied to the neck. Hypoglycemia and hyperglycemia were induced by insulin and xylazine, respectively. Glucose concentrations were measured by the chemistry analyzer CGMS, point-of-care glucometer, and intensive care unit machine at 0 (before treatment), 2, 4, 6, 8, 10, and 12 hours. Agreement between the CGMS and the chemistry analyzer was determined by Bland-Altman plots. The analytical and clinical accuracy of the CGMS was determined using the International Organization for Standardization (ISO) 15197:2013 criteria and the Parkes error grid analysis. In goats, the CGMS overestimated glucose concentrations during the hypoglycemic, normoglycemia, and hyperglycemia treatments. In calves, the CGMS underestimated glucose concentrations during the hypoglycemic treatment but overestimated glucose concentrations in normoglycemia and hyperglycemic treatments. The CGMS met the ISO clinical accuracy criteria for goats and calves, with > 99% of the glucose measurements in zones A and B of the Parkes grid. However, the CGMS did not meet the ISO 15197:2013 criteria for analytical accuracy. The CGMS evaluated in our study only met the ISO 15197:2013 clinical accuracy criteria, not the analytical accuracy. Therefore, the device might be considered for clinical use.

Effect of Infection on the Incidence of Hyperglycemic Hemichorea: A Case-Series.

To explore the effect of infection on hyperglycemic hemichorea. The clinical data of 11 patients with hyperglycemic hemichorea admitted to the Affiliated People' s Hospital of Xinxiang Medical College and the Second People's Hospital of Xinxiang were retrospectively analyzed, including gender, age, clinical symptoms, imaging features, blood glucose, glycated hemoglobin, infection indicators, and treatment conditions. Eleven patients had acute or sub-acute onset, including 9 females and 2 males, with an average age of 74.55 years. Nine patients presented with unilateral limb involuntary movement and 2 patients presented with bilateral limb involuntary movement. Imaging findings of 9 patients showed abnormalities in the basal ganglia region. Random blood glucose levels were all elevated at admission, with an average blood glucose value of 26.20 mmol/l. Urine ketone bodies were positive in 2 patients, inflammatory indexes were elevated in 7 patients, symptoms of hypoglycemic treatment and anti-infection treatment in 10 patients disappeared, and symptoms of 1 patient disappeared after improved microcirculation treatment. The disease tends to occur in middle-aged and elderly women, and the blood glucose may fluctuate significantly during the onset. Infection may lead to the occurrence and development of the disease. Active control of blood sugar, inflammation and improvement of brain metabolism can effectively control symptoms and prevent recurrence.

First Report of Root Rot on Rhizome of Polygonatum kingianum Caused by Aspergillus awamori

Polygonatum kingianum Coll. et Hemsl (Huangjing), which belongs to the family Asparagaceae, is a perennial traditional Chinese herb with homologous medicinal and edible value (Liu et al., 2021). Huangjing is known to promote blood circulation; it has anti-inflammatory properties, increases immunity, and provides hypoglycemic treatments (Ma et al., 2019). Root rot-infected P. kingianum exhibited withering yellow leaves and stems, rhizome rot, slowed growth, and plant death. In recent years, with an average incidence of up to 45%, the spread of HJ root rot (rhizome and stem bases) has resulted in a significant reduction in the quality and up to 63% reduction in the yields of Sichuan Junlian (104.5°E, 28.2°N) and Guizhou Zhunyi (107.0°E, 27.7°N). After collecting the diseased samples, we used the tissue isolation method to isolate the pathogenic fungi (Wu et al., 2020). Four fungal isolates associated with root rot were obtained: HJ-G2 (two strains), HJ-G3 (one strain), HJ-G4 (one strain), and HJ-G6 (two strains), of which HJ-G2 and HJ-G6 were the dominant species. To determine pathogenicity of each strain, tests were conducted by wounding rhizomes wth an inoculation needle and the pathogen strain was inoculated onto the wound and symptoms observed. The results reveal that HJ-G6 exhibited the strongest pathogenicity against P. kingianum (Figure 1). The HJ-G6 colonies were black, grew rapidly, and produced a large number of spores (Figure 1). A spherical apical sac (conidial head) is formed at the top with two palisades of cells, metulae and phialides, which are shaped radially and produce a large number of spores with 2-5 um in diameter (Figure 2). Morphological observations revealed that the isolate was consistent with Aspergillus awamori (Naher et al., 2021). To further confirm the fungal species, the ribosomal internal transcribed spacer (ITS), β-tubulin (TUB), and elongation factor 1-alpha (EF-1a) gene regions were amplified with ITS1/ITS4, Bt2a/ Bt2b, and EF1/EF2. Primer and PCR amplification were performed as previously described (Paul et al., 2017). The sequences were compared with those obtained from GenBank. The ITS sequences (GenBank accession number OR682143) of the isolates (HJ-G6) were 100% identical to those of the strain PANCOM10 (GenBank accession number MT007535.1) of Aspergillus awamori. The EF-1a sequences (GenBank accession OR752352) of the isolates (HJ-G6) were 98% identical with strain ITEM 4777 (GenBank accession FN665402.1) of Aspergillus awamori. The TUB sequences (GenBank accession number OR752351) of the isolate (HJ-G6) were 100% identical with strain AF158 (GenBank accession MH781275.1) of Aspergillus awamori. Three maximum likelihood trees were constructed using MEGA v5.0 (Kumar et al., 2018) based on the sequences (ITS, TUB, and EF-1a) of the HJ-G6 strain and that of Aspergillus spp. previously deposited in GenBank (Paul et al., 2017). Phylogenetic analysis showed that HJ-G6 belonged to the Aspergillus awamori clade (Figure 3). Combined with morphological analysis and DNA sequencing, HJ-G6 was identified as Aspergillus awamori. To verify pathogenicity, P. kingianum roots were inoculated with the colonized agar discs of the isolates. P. kingianum plants inoculated with uncolonized agar discs were used as controls. After inoculation, P. kingianum roots were moved to the inoculation chamber under high humidity at 28 °C for 1 d and then transferred to a greenhouse. Previous studies have reported that Fusarium sp. are root rot pathogens in the rhizomes of medicinal plants (Pang et al., 2022; Song et al., 2023). In this study, HJ-G2, HJ-G3, and HJ-G4 were used as the positive controls. Typical symptoms of root rot appeared 3 days after inoculation and were similar to those observed in the field, whereas the control plants remained symptomless. According to the results of the inoculation experiment, the pathogenicity of Aspergillus awamori to P. kingianum root rot was significantly stronger than that of Fusarium (Figure 1). The pathogen was isolated from the rotting root of P. kingianum and the ITS region was sequenced again. Alignment analysis of the ITS sequences revealed that the causal agents were consistent with those of the original isolates. These studies fulfill Koch’s postulates. As far as we know, this is the first report of Aspergillus awamori causing root rot in P. kingianum.

Chinese carrier of the HNF1A p.Gln444fs variant exhibits enhanced response to sulfonylureas

BackgroundWe assessed the response to sulfonylureas and the functional characteristics of HNF1A mutations in patients with maturity-onset diabetes of the young type 3 (MODY3). MethodsWe recruited a family with suspected MODY in this study, and gene sequencing (whole-exome sequencing) was used to screen germline mutations. Luciferase reporter assays were used to evaluate the activity of the mutated genes. ResultsHeterozygous HNF1A variant (NM_000545.8:c.1330_1331del, p.Gln444fs) was identified in the proband and was not found in his father, grandmother, and nonrelated healthy controls. The mutant protein had 552 amino acids, 110 fewer than the wild type protein. Furthermore, the amino acid sequence was completely different between the mutant protein and the wild type protein starting from the 444th amino acid. Luciferase reporter assays revealed that the variant had impaired HNF4A promoter–regulation activity. The patient did not achieve good hypoglycemic effects during long-term treatment with insulin and metformin. The effect of hypoglycemic treatment was highly significant after the addition of sulfonylurea drugs. ConclusionsThe HNF1A p.Gln444fs variant associated with MODY3, and most likely a truncated protein, impaired HNF1A transcriptional activity. The variant carrier experienced an enhanced response to sulfonylureas.

Hepatic insulin resistance affects the efficacy of metformin in patients with newly diagnosed type 2 diabetes: A Sub-Analysis of the MARCH trial

AimOur study aimed to analyze how hepatic insulin resistance (IR) influences the efficacy of 48 weeks of metformin treatment in newly diagnosed type 2 diabetes patients. MethodsWe chose 291 participants who were allocated to a 48-week metformin treatment in the “Metformin and Acarbose in Chinese as initial Hypoglycemic treatment” (MARCH) trial and calculated their hepatic insulin resistance indexes (HIRI). We equally grouped the subjects into tertiles: low, medium, and high HIRI groups based on baseline HIRI; Low, medium, and high ΔHIRI groups based on the decreasing extent of HIRI after a 48-week metformin treatment. ResultsMultiple linear regression showed that baseline HIRI was positively associated with the rising degree of Matsuda index and the falling range of fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and HIRI. Furthermore, baseline fasting insulin, homeostatic model assessment of β cell function (HOMA-β), HOMA-IR, and HIRI were positively associated with the decreasing extent of HIRI, while baseline Matsuda index had a negative association with the falling extent of HIRI. ConclusionsPatients with higher levels of hepatic IR obtained better curative effects from metformin in terms of glycemic control, insulin saving, insulin sensitivity enhancement, and IR improvement. Higher fasting blood glucose, fasting insulin, HOMA-β, IR, and lower Matsuda index were indicators of better hepatic IR improvement.

Association between glucose-lowering drugs and circulating insulin antibodies induced by insulin therapy in patients with type 2 diabetes.

Insulin antibodies (IAs) affect blood glucose control in patients receiving insulin therapy. To investigate the relationship between different hypoglycemic treatments and IAs in patients with type 2 diabetes mellitus (T2DM). This cross-sectional, retrospective study included 1863 patients with T2DM who were receiving exogenous insulin therapy. All patients received stable antidiabetic therapy in the last 3 months and IA levels were measured using an iodine-125 array. A total of 1863 patients were enrolled. There were 902 (48.4%) patients who had positive IAs (IA level > 5%), with a mean IA level of 11.06% (10.39%-11.72%). IA levels were positively correlated with high fasting blood glucose (odds ratio = 1.069, P < 0.001). The proportion of positive IAs was lowest in patients using glargine only (31.9%) and highest in patients using human insulin only (70.3%), P < 0.001. The IA levels in patients using sulfonylureas/glinides (8.3%), metformin (9.6%), and dipeptidyl peptidase-4 inhibitors (8.2%) were all lower than in patients without these drugs (all P < 0.05). Nearly half of patients on insulin therapy have positive IA antibodies, and IA antibody levels are associated with blood glucose control. Insulin glargine and a combination of oral glucose-lowering drugs were correlated with lower IA levels.

DEMIGOD: A Low-Cost Microcontroller-Based Closed-Loop System Integrating Nanoengineered Sweat-Based Glucose Monitoring and Controlled Transdermal Nanoemulsion Release of Hypoglycemic Treatment with a Software Application for Noninvasive Personalized Diabetes Care.

This study endeavored to design and develop an innovative closed-loop diagnostic and therapeutic system with the following objectives: (a) the noninvasive detection of glucose concentration in sweat utilizing nanonengineered screen-printed biosensors; (b) the management of measured data through a specialized computer system comprising both hardware and software components, thereby enabling the precise control of therapeutic responses via a patch-based nanomedicine delivery system. This initiative addresses the significant challenges inherent in the management of diabetes mellitus, including the imperative need for glucose-level monitoring to optimize glycemic control. Leveraging chronoamperometric results as a foundational dataset and the in vivo hypoglycemic activity of nanoemulsion formulations, this research underscores the efficacy and accuracy of glucose concentration estimation, decision-making mechanism responses, and transdermal hypoglycemic treatment effects, within the proposed system.

Hypoglycemic Response to Dorzagliatin in a Patient With GCK-MODY.

Metformin, insulin, and insulin secretagogues do not alter HbA1c levels in glucokinase maturity-onset diabetes of the young (GCK-MODY). However, the efficacy of the new hypoglycemic drugs on GCK-MODY remains unclear. We describe a case of GCK-MODY with unchanged blood glucose under different therapies during an 8 years' follow-up. His HbA1c and biochemical indices under different hypoglycemic treatments were recorded. Oral glucose-lowering drugs, including thiazolidinediones, dipeptidyl peptidase 4 inhibitor, α-glucosidase inhibitor, and sodium-glucose cotransporter 2 inhibitor that had not been evaluated previously, did not improve the HbA1c level in this patient. However, the glucokinase activator dorzagliatin effectively and safely lowered his HbA1c level. Dorzagliatin was effective and safe in this patient with GCK-MODY, providing potential application prospects for precise treatment of GCK-MODY with dorzagliatin.

Secondary diabetes due to different etiologies: Four case reports

BACKGROUND As research on diabetes continues to advance, more complex classifications of this disease have emerged, revealing the existence of special types of diabetes, and many of these patients are prone to misdiagnosis and underdiagnosis, leading to treatment delays and increased health care costs. The purpose of this study was to identify four causes of secondary diabetes. CASE SUMMARY Secondary diabetes can be caused by various factors, some of which are often overlooked. These factors include genetic defects, autoimmune disorders, and diabetes induced by tumours. This paper describes four types of secondary diabetes caused by Williams–Beuren syndrome, Prader–Willi syndrome, pituitary adenoma, and IgG4-related diseases. These cases deviate significantly from the typical progression of the disease due to their low incidence and rarity, often leading to their neglect in clinical practice. In comparison to regular diabetes patients, the four individuals described here exhibited distinct characteristics. Standard hypoglycaemic treatments failed to effectively control the disease. Subsequently, a series of examinations and follow-up history confirmed the diagnosis and underlying cause of diabetes. Upon addressing the primary condition, such as excising a pituitary adenoma, providing glucocorticoid supplementation, and implementing symptomatic treatments, all patients experienced a considerable decrease in blood glucose levels, which were subsequently maintained within a stable range. Furthermore, other accompanying symptoms improved. CONCLUSION Rare diseases causing secondary diabetes are often not considered in the diagnosis of diabetes. Therefore, it is crucial to conduct genetic tests, antibody detection and other appropriate diagnostic measures when necessary to facilitate early diagnosis and intervention through proactive and efficient management of the underlying condition, ultimately improving patient outcomes.

Antioxidative and Anti-inflammatory Effects of Plant-derived Hypoglycemic Medicines: An In vivo/In vitro Systematic Review.

The activation of oxidative stress and inflammatory conditions has been associated with acceleration in diabetes (DM) onset and complications. Despite various anti-DM medications, there is a growing trend to discover inexpensive and effective treatments with low adverse effects from plants as one of the promising sources for drug development. This study aimed to systematically investigate the simultaneous anti-inflammatory and antioxidant effects of plant-derived hypoglycemic medicines in diabetic experimental models. The search terms consisted of "diabetes", "herbal medicine", "antioxidant", "Inflammatory biomarker", and their equivalents among PubMed, Scopus, Web of Science, and Cochrane Library databases up to 17 August 2021. Throughout the search of databases, 201 eligible experimental studies were recorded. The results showed that the most commonly assessed inflammatory and oxidative stress biomarkers were tumor necrosis factor (TNF)-α, interleukin (IL) 6, IL-1β, IL-10, malondialdehyde (MDA), and nitric oxide (NO). The activity of antioxidant enzymes, including superoxide dismutase (SOD), glutathione (GSH), and catalase (CAT) were assessed in the present review. Among herbal treatments, Trigonella foenum-graecum L., Centella asiatica (L.) Urb., Vitis vinifera L., and Moringa oleifera Lam. were most commonly used for diabetic complications. Due to the dispersion of the treatments, meta-analysis was not applicable. Our findings showed that the application of different plant-derived hypoglycemic treatments in animal models improved diabetes and its complications, as well as modulated concomitant inflammatory and oxidative stress biomarkers. These findings suggest that plant-based antidiabetic medicines and food supplements have the potential to manage diabetes and its complications.

Glucose-Induced Cellular Morphological Changes Across Mammalian Species

All organisms encounter environmental fluctuations and must contend with these changes to maintain homeostasis. Some mammals tolerate a wide range of intracellular conditions while others do not. Altered glucose levels are an example of a physiological challenge that can be encountered by cells. We studied responses of dermal fibroblasts obtained from skin biopsies to altered glucose treatments in culture using a comparative approach. Specifically, we investigated responses of mammals known to tolerate a range of blood glucose levels (fruit-eating geladas and Egyptian rousettes) as well as a hibernator (ground squirrel), which exhibits a marked winter decrease in glucose metabolism. As a comparison, we investigated species that maintain fairly stable blood glucose (human and rat). Fibroblasts were cultured at baseline (8mM glucose), then subjected to hypoglycemic (2.5mM) and hyperglycemic (30mM) treatment over 24h. We assayed glycolytic rate in human and rat fibroblasts using a Seahorse XFp analyzer, and found no significance between oxygen consumption or glycolysis across glucose treatments (all p&gt;0.05). To investigate underlying cell phenotypes, we used Cell Painting, employing fluorescent stains to mark organelles. Hoechst 34580 stained DNA, to quantify number and size of nuclei, offering insights into proliferation. MitoTracker Deep Red visualized mitochondria, providing information about energy generation. Alexa Fluor 488 Concanavalin A conjugate marked endoplasmic reticulum. F-actin was stained with Alexa Fluor 555 Phalloidin conjugate, detecting cytoskeletal organization and overall cell structure. Images were analyzed with CellProfiler software, which extracts ~1400 morphological cell features, including area, compactness, fluorescence intensity, and cell connectivity to quantify subtle changes in phenotype. Each extracted feature will be compared across treatments and within a comparative context. We predict that fibroblasts exposed to hyperglycemia exhibit mitochondrial fragmentation and redistribution (MitoTracker) and increased production of reactive oxygen species (assessed with MitoSOX), which is linked to the opening of mitochondrial permeability transition pores. Cell Profiler analysis will identify structural changes that could indicate negative outcomes, such as mitophagy. Hyperglycemia may also induce endoplasmic stress, increasing lipid droplets and altering shape and size of the endoplasmic reticulum. In contrast, hypoglycemia will cause mitochondrial degradation. In both hyper- and hypoglycemia, proliferation rates are predicted to decrease, resulting in fewer nuclei and reduced cell connectivity. Phenotypic differences across species, evaluated in the context of their organismal phenotype, will help explain the mechanisms of cell function in mammals under environmental stress. Funding by NSF #2022046. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A strategy based on integer programming for optimal dosing and timing of preventive hypoglycemic treatments in type 1 diabetes management

Background and objectivesOne of the major problems related to type 1 diabetes (T1D) management is hypoglycemia, a condition characterized by low blood glucose levels and responsible for reduced quality of life and increased mortality. Fast-acting carbohydrates, also known as hypoglycemic treatments (HT), can counteract this event. In the literature, dosage and timing of HT are usually based on heuristic rules. In the present work, we propose an algorithm for mitigating hypoglycemia by suggesting preventive HT consumption, with dosages and timing determined by solving an optimization problem. MethodsBy leveraging integer programming and linear inequality constraints, the algorithm can bind the amount of suggested carbohydrates to standardized quantities (i.e., those available in “off-the-shelf” HT) and the minimal distance between consecutive suggestions (to reduce the nuisance for patients). ResultsThe proposed method was tested in silico and compared with competitor algorithms using the UVa/Padova T1D simulator. At the cost of a slight increase of HT consumed per day, the proposed algorithm produces the lowest median and interquartile range of the time spent in hypoglycemia, with a statistically significant improvement over most competitor algorithms. Also, the average number of hypoglycemic events per day is reduced to 0 in median. ConclusionsThanks to its positive performances and reduced computational burden, the proposed algorithm could be a candidate tool for integration in a DSS aimed at improving T1D management.

Cost consequence analysis of adding semaglutide to treatment regimen for patients with Type II diabetes in Saudi Arabia

IntroductionSemaglutide, a Glucagon-like Peptide-1 Receptor Agonist (GLP-1 RA), is often prescribed for managing type 2 diabetes, particularly in cases unresponsive to other hypoglycemic agents. Despite its popularity, the real-world efficacy and cost-effectiveness of Semaglutide relative to other treatments remain understudied. ObjectiveThis study aimed to examine the direct medical cost and consequences of adding Semaglutide to the treatment regimen for patients with type 2 diabetes in Saudi Arabia. MethodsWe conducted a single-center, retrospective review of Electronic Medical Records (EMRs) for adults with type 2 diabetes. Patients who had been on Semaglutide for at least three months were matched with those receiving alternative hypoglycemic therapies. Exclusions were made for patients with cancer, incomplete EMRs, or lacking prescription data. Investigated outcomes included changes in HbA1C levels and weight, and the direct costs comprised medications, clinic visits, and emergency care. Baseline adjustments were made through inverse probability treatment weighting, and uncertainty was assessed via bootstrapping with 10,000 replications. ResultsOut of 350 patients meeting the criteria, 116 were on Semaglutide. Predominantly females (62%), the cohort had an average age of 60 and a disease duration of 22 years. The difference in HbA1C (%) reductions between Semaglutide and non-Semaglutide users over 3,6, and 12 months were 0.154 (95% CI: –0.452-0.483), –0.031(95% CI: –0.754-0.239), –0.16(95% CI: –1.425-0.840), respectively. Semaglutide users did experience modest weight reductions ranging from 0.42 kg to 1.16 kg. The annual additional direct medical cost for Semaglutide was USD 4,086.82 (95% CI: $3,710.85 - $4,294.99). ConclusionAlthough Semaglutide induced modest weight reductions, it did not offer significant advantages in lowering HbA1C levels compared to other hypoglycemic treatments. These findings suggest the need for further research involving larger and more diverse cohorts to corroborate these findings.

The benefits of hypoglycemic therapy for patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is often associated with glycemic abnormalities. This study is conducted to investigate the effects of hypoglycemic therapy on OSA-related indicators. We systematically searched Web of Science, PubMed, Embase, and the Cochrane Library for articles on OSA patients receiving any hypoglycemic drugs, published until December 25, 2022. Seven original studies were finally included. The proposal was registered with PROSPERO (CRD42022351206). In summary, in addition to reduced glycosylated hemoglobin A1c (HbA1c), we found that hypoglycemic treatment can lower the apnea-hypopnea index (AHI) by 7.07/h (p = 0.0001). Although long-term treatment (> 12 weeks) achieved a more significant reduction in HbA1c (- 1.57% vs. - 0.30%) compared to short-term treatment (≤ 12 weeks), there was no significant difference between the two in terms of AHI (intergroup p-value = 0.27). We also found that patients using sodium glucose cotransporter 2 inhibitors (SGLT2i) experienced a greater reduction in AHI (- 11.00/h, p < 0.00001). Additionally, hypoglycemic treatment also showed certain improvements in related indicators like Epworth Sleepiness Scale, body mass index, and blood pressure. Our results affirm the benefits of hypoglycemic treatment for OSA patients and highlight the notable effect of SGLT2i. Further researches are needed to help doctors gain a comprehensive understanding of the interaction between OSA and glycemic abnormalities.

Analysis of the Effect of Outpatient Nursing Intervention on Hypoglycemic Treatment Effect and Psychological Emotions of Diabetic Patients

Objective: To explore the effect of outpatient nursing interventions on the hypoglycemic treatment and psychological emotions of diabetic patients. Methods: 148 patients who came to our hospital for outpatient treatment from February 2022 to October 2023 were selected and divided into a control group and an observation group, with 74 cases per group, according to the random number table method. The control group received routine nursing intervention, and the observation group received outpatient nursing intervention based on the control group. The two groups were observed for their effects of hypoglycemic treatment and psychological and emotional improvement before and after outpatient nursing intervention. Results: The health behavior scores of the control group were lower than that of the observation group; the post-intervention fasting blood glucose, 2h postprandial blood glucose, anxiety self-rating scale (SAS), and the depression self-rating scale (SDS) of the control group were significantly higher than that of the observation group, and the difference was statistically significant (P &lt; 0.01). Conclusion: Outpatient nursing intervention encouraged patients to comply with healthy behaviors and helped control blood sugar levels. Patients’ anxiety, depression, and other adverse psychological states were also improved hence the outpatient nursing intervention is worthy of further promotion.

Vitamin D, selenium, and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis.

Diabetes and thyroiditis are closely related. They occur in combination and cause significant damage to the body. There is no clear treatment for type-2 diabetes mellitus (T2DM) with Hashimoto's thyroiditis (HT). While single symptomatic drug treatment of the two diseases is less effective, combined drug treatment may improve efficacy. To investigate the effect of a combination of vitamin D, selenium, and hypo-glycemic agents in T2DM with HT. This retrospective study included 150 patients with T2DM and HT treated at The Central Hospital of Shaoyang from March 2020 to February 2023. Fifty patients were assigned to the control group, test group A, and test group B according to different treatment methods. The control group received low-iodine diet guidance and hypoglycemic drug treatment. Test group A received the control treatment plus vitamin D treatment. Test group B received the group A treatment plus selenium. Blood levels of markers of thyroid function [free T3 (FT3), thyroid stimulating hormone (TSH), free T4 (FT4)], autoantibodies [thyroid peroxidase antibody (TPOAB) and thyroid globulin antibody (TGAB)], blood lipid index [low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triacylglycerol (TG)], blood glucose index [fasting blood glucose (FBG), and hemoglobin A1c (HbA1c)] were measured pre-treatment and 3 and 6 months after treatment. The relationships between serum 25-hydroxyvitamin D3 [25 (OH) D3] level and each of these indices were analyzed. The levels of 25 (OH) D3, FT3, FT4, and LDL-C increased in the order of the control group, test group A, and test group B (all P < 0.05). The TPOAB, TGAB, TC, TG, FBG, HbA1c, and TSH levels increased in the order of test groups B, A, and the control group (all P < 0.05). All the above indices were compared after 3 and 6 months of treatment. Pre-treatment, there was no divergence in serum 25 (OH) D3 level, thyroid function-related indexes, autoantibodies level, blood glucose, and blood lipid index between the control group, test groups A and B (all P > 0.05). The 25 (OH) D3 levels in test groups A and B were negatively correlated with FT4 and TGAB (all P < 0.05). The combination drug treatment for T2DM with HT significantly improved thyroid function, autoantibody, and blood glucose and lipid levels.