Improvement In Glycemic Control Research Articles

Initiating or switching to insulin degludec/insulin aspart in a real-world population of adults with type 2 diabetes in Australia: results from a prospective, non-interventional study.

Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec and insulin aspart for the treatment of people with diabetes and suboptimal glycaemic control. Few real-world studies of IDegAsp treatment have been conducted. Here, we report results from the Australian cohort of the global ARISE study of real-world IDegAsp use. To investigate glycaemic control and other clinical outcomes in people with type 2 diabetes (T2D) treated with IDegAsp in a real-world setting in Australia. A total of 183 adults with T2D initiating or switching to IDegAsp in the Australian cohort of the open-label, non-interventional ARISE study were followed for 26-36 weeks from August 2019 to December 2020. IDegAsp was associated with significant reductions from baseline to end of study (EOS) in mean glycated haemoglobin (estimated change -0.8% (95% confidence interval (CI): -1.05 to -0.56; P < 0.0001)), fasting plasma glucose (-1.6 mmol/L (95% CI: -2.49 to -0.63; P = 0.0017)) and body weight (-2.6 kg (95% CI: -3.68 to -1.55; P < 0.0001)). In insulin-experienced patients, the mean total daily insulin dose did not change significantly (estimated change from baseline to EOS 3.8 (95% CI: -3.70 to 11.21; P = 0.3202)). The proportion of patients experiencing hypoglycaemia numerically decreased during the study (non-severe: 14.2-10.9%; nocturnal non-severe: 4.9-2.2%; and severe: 2.2-0%). Initiating or switching to IDegAsp in a real-world population of people with T2D in Australia was associated with significant improvements in glycaemic control and body weight, and numerically lower levels of hypoglycaemia compared with baseline.

Clinical Case Series on Assessment of Therapeutic Efficacy of Saroglitazar in MASLD Patients

Objective: This prospective case series aimed to evaluate the efficacy of saroglitazar 4 mg in improving clinical parameters in patients with type 2 diabetes mellitus (T2DM) with steatotic liver disease (SLD), focusing on glycemic control, lipid profile, liver enzymes, and transient elastography parameters (CAP and LSM scores). Materials and Methods: Eight T2DM patients having SLD; defined as Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) were enrolled from a single-center, Dr. Dang’s Clinic, Ghaziabad, Uttar Pradesh India. Saroglitazar 4 mg was administered daily, and various clinical parameters were monitored at baseline, 16 weeks, and 32 weeks. Statistical analysis was performed using paired t-tests to assess changes over time. Results: Saroglitazar treatment significantly reduced HbA1c, Triglycerides (TG), Alanine aminotransferase (ALT), transient elastography parameters (CAP and LSM) along with other lipid and glycemic parameters from baseline to weeks 32. These findings underscore potential role of saroglitazar in managing T2DM and associated SLD by improving metabolic parameters and liver health. Conclusion: Saroglitazar showed significant improvements in glycemic control, lipid profile, liver enzymes, liver fat and fibrosis in MASLD patients, indicating its potential as a therapeutic option for managing metabolic abnormalities and liver complications. Further research is needed to validate these findings.

Aerobic exercise as a non-pharmacological intervention for improving metabolic and hemodynamic profiles in type 2 diabetes.

Type 2 Diabetes Mellitus (T2DM) is a global health concern associated with numerous complications. Aerobic exercise is recognized as a crucial non-pharmacological intervention for T2DM management, but its specific effects on key health parameters warrant further investigation. This study aimed to evaluate the impact of a structured 8-week aerobic exercise program on fasting blood glucose (FBG), glycated haemoglobin (HbA1c), body mass index (BMI), blood pressure (BP), and resting heart rate (RHR) in individuals with T2DM. A prospective study was conducted with 100 participants diagnosed with T2DM. The intervention group (n = 50) underwent a supervised aerobic exercise program for eight weeks, while the control group (n = 50) received no structured exercise intervention. Pre- and post-intervention assessments were conducted to measure FBG, HbA1c, BMI, BP, RHR, and VO₂ max were taken. The aerobic group exhibited a significant reduction in FBG, declining from 141 to 132 mg/dl. Correspondingly, HbA1c decreased from 7.93 to 7.15%. Additionally, the aerobic group demonstrated a notable decrease in RHR from 72 to 66 bpm, indicating improved cardiovascular fitness. Concurrently, VO2 max increased from 22 to 26 mL/kg/min, further supporting the enhancement of cardiorespiratory capacity. Trends toward improvement were also observed in SBP and DBP. Correlation analysis revealed significant relationships between various health parameters, highlighting the interconnectedness of these variables in T2DM management. This study provides robust evidence supporting the benefits of aerobic exercise in individuals with T2DM. The improvements in glycemic control, blood pressure, and cardiorespiratory fitness underscore the importance of incorporating structured exercise programs into diabetes management protocols. The results emphasize the importance of incorporating regular physical activity into diabetes management strategies to optimize health outcomes and reduce the risk of complications.

Unlocking the Insightful Antidiabetic Effects of Lemongrass (Cymbopogon citratus): A Comprehensive Review

Lemongrass (Cymbopogon citratus) has emerged as a noteworthy contender in traditional medicine for its aromatic and therapeutic attributes, yet its potential as an antidiabetic agent remains largely unexplored in the literature. To address this gap, this study endeavors to provide a comprehensive overview of lemongrass role in diabetes management and the underlying pathways involved. Rich in bioactive compounds such as citral, flavonoids, and essential oils, lemongrass boasts a diverse array of medicinal properties. Research indicates its capability to modulate blood glucose levels, improve insulin sensitivity, and fortify pancreatic β-cell function primarily through antioxidant and anti-inflammatory mechanisms. Animal studies have demonstrated substantial reductions in fasting blood glucose and enhanced glucose tolerance, ascribed to heightened insulin signaling and inhibition of carbohydrate metabolism enzymes. Additionally, lemongrass exhibits a positive impact on lipid profiles, thereby mitigating cardiovascular risks associated with diabetes. Limited human trials have corroborated these findings, showcasing improvements in glycemic control and lipid metabolism following lemongrass consumption. In conclusion, lemongrass emerges as a promising adjunctive therapy for diabetes management, owing to its natural composition and multifaceted mechanisms. Nonetheless, further investigation, particularly through rigorous clinical trials, is imperative to determine optimal dosages, long-term safety, and efficacy, thereby facilitating its seamless integration into conventional diabetes treatment protocols.

Effects of SGLT2 Inhibitors on Cardiac Mechanics in Hispanic and Black Diabetic Patients.

Background: Clinical trials demonstrating improved cardiovascular outcomes with SGLT2 inhibitors have often had limited representation from Black and Hispanic populations. While the mechanisms of action are not well known, ethnicity- or gender-based receptor physiology may render SGLT2 inhibitors a better agent in certain populations over others. Methods: A medical records query yielded diabetic patients initiated on SGLT2 inhibitors between 2013 and 2020. Patients with coronary artery disease, cardiac arrhythmias, and heart failure were excluded. Transthoracic echocardiographic studies (TTE) before and after starting SGLT2 inhibitors were analyzed, and post-processing left ventricular global longitudinal strain (LV GLS) analysis was also performed on each echocardiographic study. Univariate outliers and patients with missing data were excluded. Results: Among 94 patients with TTE (mean age 60.7 years; 68% Hispanics, 22.3% Blacks; median follow up of 7 months), there were significant improvements in the mean LV GLS (-15.3 vs. -16.5; p = 0.01), LV mass (LVM) (198.4 ± 59.6 g vs. 187.05 ± 50.6 g; p = 0.04), and LV mass index (LVMI) (100.6 ± 26.6 g/m2 vs. 94.3 ± 25.4 g/m2; p = 0.03) before and after initiating SGLT2 inhibitors but no significant change in the ratio (MV E/E') of peak early diastolic mitral flow velocity (E) and spectral pulsed-wave Doppler-derived early diastolic velocity from the septal mitral annulus (E') (12.5 ± 5.7 vs. 12.7 ± 4.8; p = 0.38). Changes in HbA1c (r2 = 0.82; p = 0.026), LVM (r2 = 0.20; p = 0.04), and LVMI (r2 = 0.20; p = 0.04) were found to be independently associated with changes in values of LV GLS on follow-up echocardiograms, when compared to the pre-medication LV GLS number. Conclusion: Non-White diabetic patients receiving SGLT2 inhibitors against a backdrop of other cardioprotective medications demonstrate significant improvements in LV remodeling and LV GLS, driven in part by an improvement in glycemic control. Large, prospective studies are needed to explore the differences in the therapeutic actions of SGLT2 inhibitors among different populations.

Real-World Evaluation of Once-Weekly Subcutaneous Semaglutide in Patients with Type 2 Diabetes Mellitus in Spain (SEMA-RW Study).

Although, in randomized clinical trials, once-weekly subcutaneous semaglutide (OW s.c.) has demonstrated superior efficacy in comparison with placebo and active controls in terms of glycemic control and body weight reduction in patients with type 2 diabetes mellitus (T2DM), these results need to be confirmed in a real-world (RW) setting. An RW ambispective study (6 months retrospective and 6 months prospective) was conducted in 10 tertiary hospitals in Spain. We evaluated changes in HbA1c and body weight in patients with T2DM treated with semaglutide OW s.c. Additionally, we analyzed different subgroups of patients treated with semaglutide OW s.c. as an add-on to glucose-lowering therapy. A total of 752 patients with a mean age of 60.2 years, a mean HbA1c level of 8.5%, a mean body weight of 101.6 kg, and a mean T2DM duration of 10 years were included. At 12 months, compared with baseline, there was a mean difference of -2.1% in HbA1c levels (p < 0.001) and a mean difference of 9.2 kg in body weight (p < 0.001). Moreover, there were statistically significant differences (p < 0.001) between baseline and month 12 in both HbA1c and body weight in the four subgroups receiving semaglutide OW s.c. as an add-on to glucose-lowering therapy. Semaglutide OW s.c. was well tolerated, with gastrointestinal disorders being the most commonly reported side effects. In this RW study, 12 months of treatment with semaglutide OW s.c. in patients with T2DM was associated with significant and clinically relevant improvements in glycemic control and weight loss, regardless of the glucose-lowering therapy received, and the overall safety profile was positive.

Impact of concurrent training sequence on heart rate variability, glycemic control, body composition, lipid profile, and cardiorespiratory fitness in type 2 diabetes patients with cardiac autonomic neuropathy: A randomized controlled trial

BackgroundType 2 Diabetes Mellitus (T2DM) is a global health concern, with cardiac autonomic neuropathy (CAN) being a significant complication that exacerbates cardiovascular risks. Aerobic and resistance exercises are recognized for their benefits in managing T2DM, but the optimal integration of these modalities, especially for patients with T2DM, requires further exploration. ObjectiveTo investigate the effects of the sequence of aerobic and resistance training in a concurrent training regimen on heart rate variability (HRV), glycemic control, body composition, lipid profile, and cardiorespiratory fitness (CRF) in patients with T2DM. MethodsIn this randomized controlled trial, 45 T2DM patients with CAN were allocated to three groups: a control group, an aerobic then resistance training (ART) group, and a resistance then aerobic training (RAT) group. Measurements were taken at baseline and after a 13-week intervention, assessing HRV, glycemic control, body composition, lipid profile, and CRF. ResultsBoth ART and RAT groups showed significant improvements in HRV, glycemic control, body composition, lipid profile, and CRF compared to the control group. Notably, there were no significant differences between ART and RAT groups in these outcomes, suggesting that the sequence of aerobic and resistance exercises in concurrent training does not significantly affect the health benefits attained. ConclusionConcurrent aerobic and resistance training, irrespective of the sequence, effectively improves HRV, glycemic control, body composition, lipid profile, and CRF in T2DM patients with CAN. This study supports the inclusion of concurrent training in exercise prescriptions for managing T2DM and its complications.

Spanish Experience with Latero-Lateral Duodeno-Ileostomy + Sleeve Gastrectomy with Magnet Anastomosis System.

The partial diversion of intestinal contents facilitates achieving and maintaining weight loss and improving glycemic control in patients with obesity and with or without T2DM. The purpose of this study is to report our experience and 1-year follow-up with novel modification of SADI-S. This study is a part of a multicentric trial of patients that underwent primary side-to-side duodeno-ileostomy and sleeve gastrectomy (SG) with GT metabolic solutions magnetic anastomosis system. Feasibility, safety, and initial efficacy were evaluated. The mean age of the patients included was 48 ± 8.75years and the preoperative BMI was 43.32 ± 2.82kg/m2. The complications were present in 30% of patients. The anastomosis patency was confirmed by the passage of radiological contrast under fluoroscopy at a mean of 17days (17-29days), and the mean expulsion time was 42days (32-62). The mean diameter of the anastomosis after the magnet expulsion was 13.8 × 11.4mm. The percentage of total weight lost at 1year was 38.68 ± 8.48% (p < 0.001). The percentage of excess weight loss 82.5 ± 18.44% (p < 0.001) and improvements in glucose profiles were observed. Mean baseline HbA1c 5.77 ± 0.31% was reduced to 5.31 ± 0.26% (p < 0.024). Latero-lateral duodeno-ileostomy + SG with magnetic duodenal bipartition is afeasible and reasonably safe technique and induces weight loss in patients with obesity and improvement of glycemic control. This modification could be considered as an option to standard SADI-S or as a first step in two stages procedure. However, larger studies are needed. Clinicaltrials.gov Identifier: #NCT05322122.

Impact of HCV eradication by directly acting antivirals on glycemic indices in chronic hepatitis C patients -a nationwide Taiwan HCV registry

Background/AimsHepatitis C virus (HCV) eradication using antiviral agents augments the metabolic profile. Changes in glycated hemoglobin (HbA1c) levels in chronic hepatitis C patients who receive glecaprevir/pibrentasvir (GLE/PIB) remain elusive. MethodsData from 2417 patients treated with GLE/PIB from the Taiwan HCV Registry were analyzed, and pretreatment HbA1c levels were compared with 3-months after the-end-of treatment levels. A sustained virological response (SVR) was defined as undetectable HCV RNA at 12 weeks after the end of treatment. A significant change in HbA1c level was defined as the 75th percentile of the change in the HbA1c level before and after treatment (decrement >0.2%). ResultsSerum HbA1c levels decreased significantly (6.0 vs 5.9%, P < 0.001). Post-treatment HbA1c levels decreased in all subgroups, except in non-SVR patients (5.7 vs 5.7%, P = 0.79). Compared to patients without significant HbA1c improvement (decrement >0.2%), those with HbA1c improvement were older (60.2 vs 58.6 years, P < 0.001), had higher serum creatinine levels (1.9 vs 1.6 mg/dL, P < 0.001), triglycerides (129.8 vs 106.2 mg/dL, P < 0.001), fasting glucose (135.8 vs 104.0 mg/dL, P < 0.001), and pretreatment HbA1c (7.1 vs 5.7%, P < 0.001) and had a higher proportion of male sex (57.9% vs 50.9%, P = 0.003), diabetes (84.3 vs 16.8%, P < 0.001), more advanced stages of chronic kidney disease (CKD) (15.7 vs 11.1 %, P < 0.001), anti-diabetic medication use (47.3 vs 16.4%, P < 0.001) and fatty liver (49.6 vs 38.3 %, P < 0.001). Multivariate analysis revealed that the factors associated with significant HbA1c improvement were age (odds ratio [OR]/95% confidence intervals [CI]: 1.01/1.00–1.02, P = 0.01), HbA1c level (OR/CI: 2.83/2.48–3.24, P < 0.001) and advanced CKD stages (OR/CI: 1.16/1.05–1.28, P = 0.004). If the HbA1c variable was not considered, the factors associated with significant HbA1c improvement included alanine aminotransferase level (OR/CI, 1.002/1.000–1.004, P = 0.01), fasting glucose level (OR/CI: 1.010/1.006–1.013, P < 0.001), and diabetes (OR/CI: 3.35/2.52–4.45, P < 0.001). ConclusionsThe HbA1c levels improved shortly after HCV eradication using GLE/PIB. The improvement in glycemic control can be generalized to all subpopulations, particularly in patients with a higher baseline HbA1c level or diabetes.

Digital Storytelling Intervention for Hemoglobin A1c Control Among Hispanic Adults With Type 2 Diabetes

Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking. To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D. This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023. The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials. The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires. There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high. In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults. ClinicalTrials.gov Identifier: NCT03766438.

Effects of concurrent training on glycemic and vascular parameters among patients with T2DM-associated Peripheral Artery Disease.

To evaluate the effects of CT to improve HbA1C and ABI among the T2DM-associated PAD population. A randomized, single-blinded, two-arm trial was conducted at the Department of Rehabilitation Sciences of Dr. Ziauddin Hospital in Karachi between July to September 2023. A total of 80 T2DM-associated PAD patients were included and randomly divided into Experimental Group (n=40) and Control Group (n=40), using the sealed envelope method. Experimental group patients received Concurrent Training (CT), whereas Control Group patients underwent Aerobic Training (AT) for 12 weeks. Both groups received thirty-minute sessions three times a week that was progressed to 60 minutes over 12 weeks. HbA1C and ABI were measured at baseline and after 12 weeks. Analysis revealed an average age of 46.75±3.59 and the duration of T2DM for developing PAD is 14.82±2.23 on average. Findings revealed that both training groups were significantly effective (p<0.000) at 95% CI in improving glycemic and vascular parameters after 12 weeks. Subsequently, findings showed that the CT group showed more significant improvement than AT group in improving HbA1C for glycemic control (p=0.002, CT: pre: 9.53±1.406, post: 7.81±0.81, AT: pre: 8.74±0.908, post: 8.15±0.83) and ABI for systemic blood flow (p=0.0001, CT: pre: 0.84±0.03, post: 0.94±0.03, AT: pre: 0.82±0.02, post: 0.86±0.02). CT showed a two-fold improvement in glycemic control and arterial blood flow than AT group, which represents that CT is an effective therapeutic approach for T2DM-associated Fontain's stage IIa PAD rehabilitation.

Aggressive behaviour and diabetes: A clinical case of atypical metabolic improvement during clozapine treatment.

Aggressive and violent behaviour is a challenging psychiatric emergency to manage, especially among vulnerable categories such as patients with Intellectual Developmental Disorder. Although there is some evidence that clozapine may be useful as an anti-violence compound, its use is limited by common metabolic complications. An adult patient presented with obesity, type II diabetes mellitus, compulsive food intake, severe Intellectual Developmental Disorder, and a treatment-resistant aggressive behaviour. Clozapine was administered resulting in reduced aggressive behaviour. Unexpectedly, a reduction in the food craving as well as a sustained improvement in both anthropometric parameters and glycemic control were observed during the clozapine treatment. Our case report, describes these findings for the first time, highlighting the need for more clinical research to investigate both the efficacy of clozapine in the Intellectual Developmental Disorder populations and its long-term effects with special regard to the metabolic outcomes in this type of patients.

Treatment Outcomes of Dipeptidyl Peptidase-4 Inhibitors and Sodium-Glucose Co-Transporter-2 Inhibitors in Diabetes Mellitus with Poor Glycemic Control

Background: Diabetes, a progressive disease necessitating multifaceted pharmacological interventions for glycemic control, commonly employs Dipeptidyl Peptidase-4 inhibitors (DPP-4i) and Sodium-Glucose Co-Transporter-2 inhibitors (SGLT-2i). The ongoing challenge lies in determining the superior option for safety and efficacy. Objective: This study aims to describe the treatment outcomes of DPP-4 inhibitors (DPP-4i) and Sodium- Glucose Co-Transporter-2 inhibitors (SGLT-2i) in individuals with diabetes mellitus (DM) receiving metformin with poor glycemic control. Methods: This prospective study was conducted at the Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka, and included 90 individuals with diabetes mellitus who met the selection criteria. Divided into two groups, Group I (n=45) received DPP-4 inhibitors plus metformin, and Group II (n=45) received SGLT2 inhibitors plus metformin. Baseline data, including HbA1c, fasting blood glucose (FBG), blood glucose 2 hours after breakfast, weight, lipid profile, and serum creatinine, were recorded at the first visit and 12 weeks. Safety was assessed based on adverse drug effects. Results: After 12 weeks, both groups exhibited significant reductions in HbA1c, FBG, and postprandial blood glucose levels. However, the SGLT-2i group demonstrated significant improvements in HbA1c (P&lt;0.012), fasting plasma glucose (P&lt;0.003), and postprandial glucose levels (P&lt;0.001), along with a reduction in body weight (P&lt;0.042). Hypoglycemia rates were low and balanced between groups. Notably, SGLT-2i usage correlated with an increased incidence of urinary tract infections (13.33% vs. 6.66% in DPP-4i) and exclusive genital infections (11.11%, P&lt;0.022). Conclusion: Diabetic patients receiving SGLT-2 inhibitors had better glycemic control and body weight improvements in comparison to DPP-4 inhibitors. However, SGLT-2 inhibitors encountered more genital infections than DPP-4 inhibitors. J MEDICINE 2024; 25: 107-114

A randomized controlled trial to assess if changing sleep timing can improve glucose metabolism in people with prediabetes and type 2 diabetes

BackgroundSocial jetlag is a chronic disruption of sleep timing that is characterized by different sleep timing during workdays and free days. Social jetlag has been associated with disturbed glucose metabolism, insulin resistance, and increased risk of metabolic syndrome and type 2 diabetes. In this study, we aim to investigate whether a combination of bright light therapy in the morning, bright light reduction in the evening and sleep advance instructions for 3 weeks reduces social jetlag and if this results in improvement of glycemic and metabolic control, sleep, mood and quality of life after 3 and 12 weeks in people with prediabetes and type 2 diabetes and to assess possible mediators, compared to regular sleep habits.MethodsIn this randomized controlled trial, 60 people with prediabetes or type 2 diabetes with > 1 h social jetlag will be recruited. The intervention consists of bright light therapy (5000 lx) emitted by Vitamine-L (Lumie, UK) for 30 min each morning, combined with the advice to follow sleep advance instructions and to wear bright light-dimming goggles every evening for a period of 3 weeks. The control group adheres to their regular sleep habits and conditions. The primary outcome is glycated hemoglobin (HbA1c) after 12 weeks comparing the intervention and control in an intention-to-treat analysis. Secondary outcomes at 3 and 12 weeks are (1) social jetlag; (2) insulin sensitivity, fasting blood glucose, glucose-lowering medication use, and frequency of perceived hypoglycemia; (3) metabolic outcomes, including body mass index (BMI), waist circumference, body fat percentage, and blood pressure; (4) mood, including depression, fatigue and anxiety (measured with questionnaires); and (5) quality of life measured using EQ5D questionnaire. To assess other factors that might play a role as possible mediators, we will measure (para)sympathetic nervous system activity assessed with ECGs and electrochemical skin conductance tests, sleep quality and sleep phase distribution assessed with a sleep measuring headband (ZMax), the Dim Light Melatonin Onset in saliva samples (in a subgroup) at 3 and 12 weeks, the feeling of satiety and satiation with a 10-cm visual analog scale (VAS), diet using a food frequency questionnaire, and physical activity using an accelerometer (ActiGraph).DiscussionSocial jetlag can contribute to poorer glycemic control and metabolic control in those with type 2 diabetes. With this intervention, we aim to reduce social jetlag and thereby improve glycemic and metabolic control. This could offer a way to improve overall population health and to reduce the disease burden of type 2 diabetes.Trial registrationISRCTN registry ISRCTN11967109. Registered on 9 May 2024.

SGLT2 inhibitor use in the management of feline diabetes mellitus.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are routinely used in the management of human type 2 diabetes and have been shown to effectively mitigate hyperglycemia and reduce the risks of cardiovascular and renal compromise. Two SGLT2 inhibitors, namely bexagliflozin and velagliflozin, were recently FDA approved for the treatment of uncomplicated feline diabetes mellitus. These oral hypoglycemic agents are a suitable option for many newly diagnosed cats, with rapid improvements in glycemic control and clinical signs. Suitable candidates must have some residual β-cell function, as some endogenous insulin production is required to prevent ketosis. Appropriate patient selection and monitoring are necessary, and practitioners should be aware of serious complications such as euglycemic diabetic ketoacidosis.

Dual effects of dulaglutide on glycemic control and knee osteoarthritis pain in elderly patients with Type 2 diabetes.

Aim: This study aims to evaluate the dual benefits of dulaglutide in improving glycemic control and reducing knee OA pain.Patients & methods: Elderly T2DM patients diagnosed with bilateral knee OA on conventional OA treatment for at least 3 months were studied for their glycemic metrics, OA pain scores and NSAID consumption at baseline, 3 months and 6 months.Results: Significant improvements in glycemic control were observed, HbA1c decreased from 8.7% to 6.5% over 6 months. Pain scores, NSAID, body weight and BMI showed substantial reductions over time. Positive correlation (r=0.73, p<0.001) was found between glycemic control and pain reduction.Conclusion: Dulaglutide improves glycemic control, knee joint OA pain and weight management in elderly patients with T2DM.

Changes in body weight and composition, metabolic parameters, and quality of life in patients with type 2 diabetes treated with subcutaneous semaglutide in real-world clinical practice.

Subcutaneous once-weekly (ow) semaglutide is a recent treatment option for type 2 diabetes (T2D) and obesity, but real-world data on weight loss and associated changes in body composition, nutrients intake, and quality of life are still scarce. This observational, prospective clinical study involved all T2D patients starting ow semaglutide according to routine care between December 2021 and February 2022. Clinical information was collected after 6 months (T6) and 12 months (T12) from semaglutide initiation (T0). Bioelectrical Impedance Analysis (BIA) was performed to measure changes in body composition. Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the 36 - items Short Form Health Survey (SF-36) were administered as patient-reported outcomes (PROs). Changes in continuous endpoints (weight, body composition, nutrients intake, other clinical parameters, and PROs) were assessed using mixed models for repeated measurements. Overall, 90 patients (age 63.0 ± 10.0 years; diabetes duration 7.6 ± 5.9 years; 58.9% men; HbA1c 7.7 ± 1.1%; weight 95.4 ± 19.4 Kg, BMI 34.6 ± 6.4 Kg/m2; 36.7% naïve to diabetes treatment, 43.3% on metformin, 10.0% on dual oral therapy, and 10.0% treated with schemes including insulin) were included in the study. After 6 months from semaglutide initiation, body weight significantly decrease by -4.69 Kg (95%CI -6.19;-3.19) (primary endpoint). After 12 months, body weight was further reduced (-5.38 Kg; 95%CI -7.79;-2.97). At BIA, fat mass was significantly reduced by 2.1 Kg after 6 months but only slightly reduced after 12 months vs. baseline; lean mass was also significantly reduced by over 3 Kg both at 6 and 12 months. Intake of all nutrients declined in the first 6 months of therapy, although only lipids reduction reached the statistical significance (-6.73g; p=0.02). Statistically significant improvements in BMI, waist circumference, glycemic control, blood pressure and lipid profile were documented. Satisfaction with treatment (DTSQ questionnaire) and mental health (MCS score of SF-36 questionnaire) significantly increased during the follow-up. The study documented real-world benefits of semaglutide for treating obesity in T2D subjects, with important changes on clinical and patient-reported outcomes. Loss of lean mass associated with weight loss warrants attention; parallel strategies to preserve skeletal muscle and improve physical function, i.e. nutritional education and structured exercise, are of great importance.

Effect of Vitamin C on Blood Glucose Levels, Glycosylated Hemoglobin, and Serum Lipid Profile in Patients with Type 2 Diabetes Mellitus: A Prospective Study

Abstract Background: Vitamin C reduces oxidative stress as well as prevents nonenzymatic glycosylation of proteins because of its structural similarity to glucose. This prospective study was conducted to investigate the impact of vitamin C supplementation on glycemic control and serum lipid profile in newly diagnosed patients with type 2 diabetes mellitus (T2DM). Materials and Methods: Adult patients attending the outpatient department of a tertiary care hospital, diagnosed with T2DM within the last 3 months, with fasting blood glucose (FBG) levels exceeding 126 mg/dL, were randomly assigned to either control group (n = 98) or study group (n = 102). The study group received oral vitamin C (1 g/day) in addition to metformin 500 mg twice daily, while the control group received metformin 500 mg twice daily alone. Baseline characteristics, including age, gender, and comorbidities, were recorded. The parameters FBG, postprandial blood glucose (PPBG), glycosylated hemoglobin (HbA1c), and serum lipid profile were measured at baseline and at the 12th week. Results: Both the control and study groups experienced significant reductions in FBG, PPBG, and HbA1c levels after 12 weeks. However, the study group exhibited greater improvements, with FBG decreasing by 22.42 ± 2.7 mg/dL (P &lt; 0.05), PPBG decreasing by 33.25 ± 4.9 mg/dL (P &lt; 0.05), and HbA1c decreasing by 1.33 ± 0.3 g% (P &lt; 0.05). Additionally, both groups demonstrated significant improvements in serum lipid profile parameters, with the study group showing more significant improvements in high-density lipoprotein, low-density lipoprotein, triglycerides, and total cholesterol levels compared to the control group. Conclusion: Vitamin C supplementation as an adjuvant therapy with metformin for 12 weeks produces beneficial effects in T2DM patients, including improved glycemic control and significant improvement in the lipid profile.

The Use of Semaglutide in Patients With Renal Failure-A Retrospective Cohort Study

ObjectiveSemaglutide, a glucagon-like peptide-1 receptor agonist is approved for weight loss and diabetes treatment, but limited literature exists regarding semaglutide use in patients with advanced chronic kidney disease (CKD). Therefore, this project assessed the safety and efficacy of semaglutide among patients with estimated glomerular filtration rate (eGFR) 15-29 mL/min/1.73 m2 (CKD stage 4), eGFR<15 mL/min/1.73 m2 (CKD stage 5) or on dialysis. MethodsThis is a retrospective electronic medical record based analysis of consecutive patients with advanced CKD (defined as CKD 4 or greater) who were started on semaglutide (injectable or oral). Data was collected between January 2018 and January 2023. Investigators verified CKD diagnosis and manually extracted data. Data were analyzed using Fisher’s exact test, paired t test, linear mixed effects models and Wilcoxon signed rank test. ResultsSeventy-six patients with CKD 4 or greater who initiated semaglutide were included. Most patients had a history of type 2 diabetes mellitus (96.0%), and most were males (53.9%). The mean age was 66.8 y (SD 11.5) with the mean body mass index was 36.2 (SD 7.5). The initial doses were 3 mg orally and 0.25 mg by injection. Maximum prescribed dose was 1 mg (injectable) in 28 (45.2%) patients and 14 mg (orally) in 2 (14.2%) patients. Patients received semaglutide for a median duration of 17.4 (IQR 0.43, 48.8) months. Forty-eight (63.1%) patients reported no adverse effects associated with the therapy. Mean weight decreased from 106.2 (SD 24.2) to 101.3 (SD 27.3) kg (P < .001). Eight patients (16%) with type 2 diabetes mellitus T2DM discontinued insulin after starting semaglutide. Mean hemoglobin A1c (HbA1c) decreased from 8.0% (SD 1.7) to 7.1% (SD 1.3) (P < .001). Adverse effects were the primary reason for semaglutide discontinuation (37.0%), with nausea, vomiting, and abdominal pain being the most common complaints. ConclusionsBased on this retrospective study semaglutide appears to be tolerated by most individuals with CKD 4 or greater despite associated gastrointestinal side effects similar to those observed in patients with better kidney function and leads to an improvement of glycemic control and insulin discontinuation in patients with T2DM. Modest weight loss (approximately 4.6% of the total body weight) was observed on the prescribed doses. Larger prospective randomized studies are needed to comprehensively assess the risks and benefits of semaglutide in patients with CKD 4 or greater and obesity.

TIRZEPATIDE: Trending ‘Weight loss’ Drug– Potential Influence in Tackling Obesity Epidemic

Obesity is a chronic disease that is associated with severe complications. A lifestyle involving an increased appetite and reduced energy expenditure promotes weight gain. A better understanding of the endocrine regulation of appetite has led to the development of newer medications for the treatment of obesity. Among these medications is an incretin-based drug named tirzepatide. Many studies have been conducted in obese, insulin-resistant, and lipid-diet-fed mice to evaluate the effect of tirzepatide and its combination of GIP and GLP-1 agonism demonstrated higher anorectic activity by increasing satiety and satiation, decreasing liking for high-fat diets and decreasing sweet taste reference as compared to the effects of semaglutide. Adverse effects of mild gastrointestinal events and decreased appetite were reported with tirzepatide (which reduced after some time) than with placebo. In phase 3 SURPASS clinical trial optimized dose escalation scheme was adopted to improve gastrointestinal tolerability with an initial low dose of tirzepatide. The results of the SURPASS-1 trial showed significant improvement in glycemic control and durable bodyweight reductions with all the doses (3 doses) of tirzepatide compared to placebo in type 2 diabetic patients along with diet and exercise. Weight loss occurred regardless of whether participants reported any gastrointestinal adverse events and did not elevate over the period.