Improved Glucose Levels Research Articles

Differential effect of nonpharmacological interventions according to prediabetes phenotype: Systematic review and meta-analysis of randomized clinical trials.

Impaired glucose intolerance (IGT) and impaired fasting glucose (IFG) are totally different. Lifestyle modification is effective in moving from prediabetes to normoglycaemia. There is a lack of information showing the effect of lifestyle modification according to each prediabetes and assessing its effect on the degree of reversibility to normoglycaemia and on cardiometabolic markers. We searched for randomized controlled trials (RCT) that enrolled individuals with IGT or IFG. Meta-analysis was performed to compare the proportion of subjects progressing to type 2 diabetes mellitus (T2DM); proportion reversing to normoglycaemia and mean differences in glucose level and cardiometabolic parameters. Thirty-six RCTs were included. The proportion of subjects progressing from impaired glycaemia to T2DM was higher among those with IGT (16.3% vs. 10.9%), whereas reversion to normoglycaemia was higher in subjects with IFG (27.2% vs. 24.8%). The effect of lifestyle modification on glucose level was significant on those with IFG (mean difference [MD] = -1.56 mg/dL, 95% CI: -2.71, -0.40), but not on those with IGT of (MD = 1.47 mg/dL, 95% CI: -1.33, 4.28). Diverse lifestyle modification interventions improved glucose levels in people with IFG, but not in those with IGT. Our findings imply that different non-pharmacological interventions are warranted for IGT and IFG.

Results From a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults With Type 2 Diabetes: The TIGHT Study.

To evaluate whether continuous glucose monitoring (CGM) could assist providers in intensifying glycemic management in hospitalized patients with type 2 diabetes. At six academic hospitals, adults with type 2 diabetes hospitalized in a non-intensive care setting were randomly assigned to either standard therapy with glucose target 140-180 mg/dL (standard group) or intensive therapy with glucose target 90-130 mg/dL guided by CGM (intensive group). The primary outcome was mean glucose measured with CGM (blinded in standard group), and the key secondary outcome was CGM glucose <54 mg/dL. For the 110 participants included in the primary analysis, mean ± SD age was 61 ± 12 years and mean HbA1c was 8.9 ± 2.3% (73.8 ± 1.6 mmol/mol). During the study, CGM-measured mean glucose was 170 mg/dL for the intensive group (n = 60) vs. 175 mg/dL for the standard group (n = 50; risk-adjusted difference -7 mg/dL, 95% CI -19 to 5; P = 0.25). Only 7% of the intensive group achieved the mean glucose target range of 90-130 mg/dL. CGM readings <54 mg/dL were infrequent (0.2% for intensive and 0.4% for standard; adjusted treatment group difference -0.1%, 95% CI -0.6 to 0.3). One severe hypoglycemia event occurred in the standard group. The study's glucose management approach using CGM did not improve glucose levels compared with standard glucose management in the non-intensive care unit hospital setting. A glucose target of 90-130 mg/dL may not be realistic in the current environment of insulin management in the hospital.

Hypolipidemic and Hepatoprotective Effect of Linum usitatissimum and Moringa oleifera Seeds in Diabetic Induced Damage in Rats

Background Diabetes mellitus is a chronic metabolic disorder and a fast-growing global problem. Studies have shown that Linum usitatissimum has anti-inflammatory and antioxidant properties that decrease blood sugar and cholesterol levels, and Moringa oleifera possesses hepatoprotective, anti-inflammatory and hypoglycaemic effects. Hence, this study investigated both extracts’ hypolipidemic and hepatoprotective effects on diabetes. Purpose To study the improvement in glucose level, lipid levels (total cholesterol, high-density lipoprotein, low-density lipoprotein) and hepatic parameters after giving L. usitatissimum and M. oleifera seed extract combination in diabetic rats. Methods A total of 36 healthy male Wistar rats were taken and divided into six groups (groups I–VI). Diabetes was induced by administering a single intraperitoneal injection of streptozotocin in overnight fasted rats. The mixture of aqueous extract of L. usitatissimum and M. oleifera seeds was prepared and given to rats of groups IV–VI daily for 4 weeks. After 28 days, the blood sample was collected from all the rats, and biochemical parameters were determined. Results All the values are expressed as mean ± standard deviation (SD). Significant decreases in lipid levels, urea, creatinine and liver function tests were seen at the end of 1 month in all the three groups receiving the extract. Conclusion From our study, it was found that the administration of L. usitatissimum and M. oleifera seeds extract possesses excellent hypolipidemic and hepatoprotective properties, making them effective in preventing long-term complications of diabetes.

The Therapeutic Role of Gastrodin in Combating Insulin Resistance, Inflammation, and Oxidative Stress Induced by Bisphenol-A

Objective Insulin resistance is a key feature of, type 2 diabetes mellitus (T2DM), and it has been linked to an environmental pollutant bisphenol-A (BPA). Gastrodin, a derivative of Chinese medicinal herb, has antioxidant and anti-inflammatory properties that can potentially ameliorate BPA-induced insulin resistance in albino rats. Method The study involved five groups of six rats each, including normal control, BPA-treated, metformin-treated, and gastrodin plus BPA-treated groups Insulin sensitivity index, homeostasis model assessment- index of insulin resistance (HOMA IR), and fasting insulin levels were assessed. Using ELISA, the study measured protein levels, including High-Sensitivity C-reactive Protein (hs-CRP,) Glucose Transporter 1 (GLUT1), Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), AMP-Activated Protein Kinase (AMPK), Inducible Nitric Oxide Synthase (iNOS), caspase-3, and Nuclear factor erythroid 2–related factor 2 (Nrf2), and analyzed factors like thiobarbituric acid reactive substances-malondialdehyde (TBARS-MDA), reduced glutathione, and catalase activity. Results BPA administration causes insulin resistance in albino rats, reducing insulin sensitivity. Gastrodin treatment attenuates resistance, improves glucose levels, and increased insulin sensitivity. Gastrodin also mitigates oxidative stress.by reducing reactive oxygen species (ROS) production and restoring antioxidant enzyme activities, while TBARS-MDA was reduced. Studied inflammatory indicators included; C-reactive protein, Tumor necrosis factor (TNF-α), and Interleukin 6. Notably, the administration of bisphenol-A caused a 2–3 fold increase in the serum levels of hs-CRP, TNF-α, and IL-6. All treatments by gastrodin (high and low doses) decreased these observed effects by bisphenol-A to values similar to the standard (metformin) and normal control rats. Gastrodin exerted its protective benefits via activating the AMPK/Nrf2 signaling pathway, increasing AMPK phosphorylation and Nrf2 nuclear translocation, resulting in improved cellular defense against oxidative stress. Indicators of possible inflammations on bisphenol-A treatment were also investigated. Conclusion This shows that gastrodin might be a promising therapeutic drug for the prevention and treatment of insulin resistance-related problems.

Experiences of adolescents and young adults with type 1 diabetes and chronically elevated glucose levels following the transition from multiple daily injections to advanced hybrid closed-loop: A qualitative study.

To understand experiences of using second-generation advanced hybrid closed-loop (AHCL) therapy in adolescents and young adults with chronically elevated glucose levels who were previously using multiple daily injections (MDI) therapy. Semi-structured interviews with participants aged 13-25 years, on AHCL therapy for 3 months as part of a single-arm prospective study. Key inclusions: HbA1c ≥69 mmol/mol (8.5%); diabetes duration ≥1 year; and using MDI therapy prior to the study. Qualitative content analysis was used to identify themes and subthemes. Interviews were conducted among 14 participants with mean age 19.4 ± 4.3 years and mean baseline HbA1c 90 ± 25 mmol/mol (10.4 ± 4.5%). Three themes were identified: (1) substantially improved glucose levels improved perceptions of overall health; (2) features of AHCL aid in adoption and ongoing self-management; and (3) burden of care was reduced through automation of insulin delivery. Overall, there were positive impacts on physical, mental and social well-being. Participants were willing to overlook minor frustrations with AHCL because of the vast benefits that they had experienced. Four participants reported transient pseudo-hypoglycaemia: symptoms of hypoglycaemia when objectively measured glucose was in the clinically recommended range (3.9-10 mmol/L, 70-180 mg/dL). Transition to AHCL therapy positively impacted diabetes management in adolescents and youth with chronically elevated glucose levels. It appears to create a window of opportunity in which youth may re-engage with diabetes management. Pseudo-hypoglycaemia can occur during the transition to AHCL. This could be a barrier to AHCL uptake and is likely to require individualised support.

7765 Exploring the Synergistic Effect of GHRH Receptor Agonist MR-409 and Incretin-based Therapies in Type 1 Diabetes Using a Low-dose Streptozotocin Model

Abstract Disclosure: M. Gonzalez Medina: None. R. Louzada: None. V. Pita-Grisanti: None. M. Blandino: None. T. Cui: None. W. Sha: Owner/Co-Owner; Self; WS. is co-inventor on GHRH agonists MR-409 patent, assigned to the University of Miami and the Veterans Affairs. R. Cai: Owner/Co-Owner; Self; R.C. is co-inventor on GHRH agonists MR-409 patent, assigned to the University of Miami and the Veterans Affairs. A.V. Schally: Owner/Co-Owner; Self; A.V.S. is co-inventor on GHRH agonists MR-409 patent, assigned to the University of Miami and the Veterans Affairs.. E. Bernal-Mizrachi: None. Patients with type 1 diabetes (T1D) have decreased functional β-cell mass due to inflammatory cell infiltration and cytokine-induced β-cell death. Clinical trials using a combination of immunomodulatory agents and β-cell protecting medications such as GLP1-R agonists (GLP1-Ra) are being considered. A potential limitation for the clinical efficacy of GLP1-R agonists is the loss of GLP-1-R at the cell surface in states of hyperglycemia. Hence, novel agents that enhance β-cell survival and proliferation through parallel pathways could improve responses to GLP1-R agonists and/or synergistically potentiate β-cell responses. Previous studies have demonstrated beneficial effects of growth hormone-releasing hormone receptor agonists (GHRH-Ra), such as MR-409 on islet preconditioning in transplantation models. Our previous studies showed that GHRH-Ra protects β-cells from autoimmune injury in vitro and improves glucose levels in a model of high-dose streptozotocin-induced diabetes via stimulation of the cAMP/PKA/CREB/IRS2 axis. However, the effects of combination of incretin-based therapy with GHRHRa on β-cell survival in T1D models have not yet been explored. Using the low-dose STZ model in C57/B6 mice, we investigated how MR-409 alone or in combination with GLP1-R agonists (Exendin-4 or Ex-4) promotes β-cell survival and prevents T1D. Low-dose STZ treated mice received daily MR-409 and Ex-4 injections, either alone or in combination for six weeks. We found that, STZ-treated mice that received either MR-409, Ex-4 or combination exhibited better glucose homeostasis while the combination failed to induce any additional effect. Interestingly, glucose tolerance and insulin levels were improved only in the MR-409-treated mice. β-cell mass was similarly increased in mice that received MR-409, Ex-4 and combination groups compared to the vehicle-treated. Further, treatment of human islets with MR-409 and/or Ex-4 induced insulin receptor substrate 2 (IRS2) expression, a master regulator of survival and growth in β-cells, while the combination of both therapies did not have any additional effect. Experiments in human islets exposed to proinflammatory cytokines treatment demonstrated that MR-409 and/or Ex-4 was associated with a decrease in β-cell death and improved insulin secretory function by activation of the cAMP/PKA/CREB/IRS2 axis. These studies demonstrate that although there was no evidence for a synergistic effect between MR-409 and Ex-4, MR-409 appears to have more potent effects on improving glucose tolerance and insulin levels when compared to the long-term effect of Ex-4 in a low-dose STZ model, suggesting that MR-409 could be an alternative therapeutic agent in the treatment of β-cell death in T1D. Presentation: 6/2/2024

Design, Synthesis, Computational Study, and Antidiabetic Evaluation of Benzoxazole Derivatives

AbstractAlpha‐amylase plays a crucial role in blood glucose levels, and thus, its inhibitor can be used to control diabetes. Thus, in vitro alpha‐amylase inhibitory activities were studied for synthesized benzoxazole compounds. The 2‐amino‐benzoxazoles were prepared by reacting 2‐aminophenol with cyanogen bromide, which was coupled with phenoxy acetic acid derivatives (6 a‐n). The compound 6 h was found to be significantly active with IC50 values of 348.43 μg/mL against alpha‐amylase compared to acarbose (IC50=682.54 μg/mL). The molecular docking and molecular dynamic simulation showed better affinity and stability of 6 h at the binding site of the alpha‐amylase protein. Further, a preliminary bioevalauation and antidiabetic study were done through in vivo using SD rats. The efficacy study showed a significant improvement in glucose levels, total cholesterol, triglyceride, LDL, and HDL levels in the compound 6 h and was found to be a lead antidiabetic agent.

Forecasting glucose values for patients with type 1 diabetes using heart rate data

Background:Type 1 Diabetes Mellitus (T1DM) is a chronic metabolic disease affecting millions of people worldwide. T1DM requires patients to continuously monitor their blood glucose levels. Due to pancreatic dysfunctions, patients use insulin injections to correct glucose values by synthetic insulin. Continuous Glucose Monitoring (CGM) is a system which includes an algorithm allowing to measure (and in some cases to predict) glucose levels at a frequent sampling time. This enable implementing advanced devices, including automated insulin pump delivery. Nevertheless, CGM still presents some limitations, including (i) the delay (time lag) in detecting change in glucose levels compared to the traditional blood glucose measurement, and (ii) the lack of a sufficient and acceptable time to accurately predict glucose values. Methods:We propose a framework based on a Gated Recurrent Unit (GRU) model to forecast both short- and long-term glucose values using heart rate (HR) and interstitial glucose (IG) values. The framework acquires HR and IG data and predicts glucose values with higher precision compared to state-of-the-art models. For training and testing the proposed framework, we used the OhioT1DM Dataset, which includes physiological data such as HR and IG values collected over an 8-week observation period. Additionally, we validated our framework using two other glucose datasets to ensure its generalizability across different HR and IG sampling frequencies. The proposed framework can be used to optimize the CGM system by incorporating patient HR measurements, thereby improving the prediction of short- and long-term glucose levels and reducing risks associated with conditions like hypoglycemia. Results:Experimental tests were conducted using HR and IG data from the OhioT1DM Dataset, as well as from two additional T1DM patient datasets. We analyzed 6 patients from Ohio dataset while we validated the algorithm on 23 patients coming from two different university hospitals (6 from the University of Catanzaro medical hospital and 17 gathered from a validated study at IRCCS San Matteo Hospital in Pavia) for a total number of 29 patients. Our framework demonstrates an improvement in forecasting IG values in terms of RMSE and MAE for different choice of prediction horizons (PH). In the case of a PH of 5, 10, 20, 30, and 60 min, we reach an RMSE of 5.0, 9.38, 15.27, 20.48, and 34.16 respectively. The framework is freely available as an open-source, with an example dataset on a GitHub repository (see https://github.com/rafgia/attention_to_glycemia). Conclusion:Our framework offers a promising solution for improving glucose level prediction and management in T1DM patients. By leveraging a GRU model and incorporating HR and IG values, we achieve more precise glucose level forecasting compared to state-of-the-art models. This approach not only enhances the accuracy of glucose predictions but also mitigates the risks associated with hypoglycemia.

Serum proteomic profiling of physical activity reveals CD300LG as a novel exerkine with a potential causal link to glucose homeostasis

Background:Physical activity has been associated with preventing the development of type 2 diabetes and atherosclerotic cardiovascular disease. However, our understanding of the precise molecular mechanisms underlying these effects remains incomplete and good biomarkers to objectively assess physical activity are lacking.Methods:We analyzed 3072 serum proteins in 26 men, normal weight or overweight, undergoing 12 weeks of a combined strength and endurance exercise intervention. We estimated insulin sensitivity with hyperinsulinemic euglycemic clamp, maximum oxygen uptake, muscle strength, and used MRI/MRS to evaluate body composition and organ fat depots. Muscle and subcutaneous adipose tissue biopsies were used for mRNA sequencing. Additional association analyses were performed in samples from up to 47,747 individuals in the UK Biobank, as well as using two-sample Mendelian randomization and mice models.Results:Following 12 weeks of exercise intervention, we observed significant changes in 283 serum proteins. Notably, 66 of these proteins were elevated in overweight men and positively associated with liver fat before the exercise regimen, but were normalized after exercise. Furthermore, for 19.7 and 12.1% of the exercise-responsive proteins, corresponding changes in mRNA expression levels in muscle and fat, respectively, were shown. The protein CD300LG displayed consistent alterations in blood, muscle, and fat. Serum CD300LG exhibited positive associations with insulin sensitivity, and to angiogenesis-related gene expression in both muscle and fat. Furthermore, serum CD300LG was positively associated with physical activity and negatively associated with glucose levels in the UK Biobank. In this sample, the association between serum CD300LG and physical activity was significantly stronger in men than in women. Mendelian randomization analysis suggested potential causal relationships between levels of serum CD300LG and fasting glucose, 2 hr glucose after an oral glucose tolerance test, and HbA1c. Additionally, Cd300lg responded to exercise in a mouse model, and we observed signs of impaired glucose tolerance in male, but not female, Cd300lg knockout mice.Conclusions:Our study identified several novel proteins in serum whose levels change in response to prolonged exercise and were significantly associated with body composition, liver fat, and glucose homeostasis. Serum CD300LG increased with physical activity and is a potential causal link to improved glucose levels. CD300LG may be a promising exercise biomarker and a therapeutic target in type 2 diabetes.Funding:South-Eastern Norway Regional Health Authority, Simon Fougners Fund, Diabetesforbundet, Johan Selmer Kvanes’ legat til forskning og bekjempelse av sukkersyke. The UK Biobank resource reference 53641. Australian National Health and Medical Research Council Investigator Grant (APP2017942). Australian Research Council Discovery Early Career Award (DE220101226). Research Council of Norway (Project grant: 325640 and Mobility grant: 287198). The Medical Student Research Program at the University of Oslo. Novo Nordisk Fonden Excellence Emerging Grant in Endocrinology and Metabolism 2023 (NNF23OC0082123).Clinical trial number:clinicaltrials.gov: NCT01803568.

Glucometric parameter changes in patients with type 2 diabetes during ramadan fasting: A prospective comparative real-world study

BackgroundThis study assessed glucometric changes in Type 2 diabetes mellitus (T2DM) patients before, during, and after Ramadan fasting using an intermittently scanned continuous glucose monitoring system (isCGMS). MethodsThis prospective comparative study included T2DM patients aged 30–70 years who were receiving nonintensive insulin in Riyadh, Saudi Arabia. In addition to the baseline characteristics, glycated hemoglobin (HbA1c) and ambulatory glucose profile (AGP)-derived metric data were collected at three specific points: pre-, during-, and post-Ramadan. Self-care activities during Ramadan were evaluated using the Diabetes Self-Management Questionnaire (DSMQ). ResultsOverall, a total of 93 T2DM patients were enrolled in the study. Their mean age ±SD age was 47.9 ± 7.5 years, and 51.6 % of them were males. Compared with pre- and post-Ramadan, there was a significant decrease in HbA1c (p < 0.001 for both periods), average glucose level (p = 0.001 and p = 0.026, respectively), glucose variability (p = 0.043 and p = 0.005, respectively), and % time above the range of 181–250 mg/dL (p < 0.001 for both periods), as well as a significant increase in % time in target (70–180 mg/dL) during Ramadan (p < 0.001 for both periods). However, the % time below 54 mg/dL was slightly greater during Ramadan than both pre- and post-Ramadan (p < 0.001 and p = 0.002, respectively). Furthermore, 32.3 % reported inadequate self-care behaviors during Ramadan. ConclusionsRamadan fasting could improve glucose levels in T2DM patients who were not on intensive insulin, with a relatively low incidence of hypoglycemia.

Closed-loop Versus Sensor Pumps Therapy for Type 1 Diabetes: A Systematic Review and Meta-analysis

Abstract Background: The emergence of advanced technologies such as closed-loop systems (CLSs) and sensor-augmented pump (SAP) therapy has revolutionised type 1 diabetes (T1DM) management. To optimise patient care, a clear understanding of their relative effectiveness is crucial. Therefore, we conducted a systematic review and meta-analysis evaluating existing literature to compare the effectiveness of CLS versus SAP therapy. Methods: We performed a comprehensive search across major databases, including Cochrane CENTRAL, Scopus, Web of Science and PubMed following preferred reporting items for systematic reviews and meta-analyses guidelines, and identified relevant randomised controlled trials (RCTs). Studies comparing CLS therapy with SAP therapy in individuals with type 1 diabetes were included for analysis. We then extracted data from the selected studies, assessed their quality using the Cochrane risk of bias tool, and conducted a meta-analysis to quantitatively synthesize the findings. Results: A meta-analysis of 17 RCTs encompassing a total of 858 patients (CLS = 465, SAP = 393) showed that CLSs significantly improved glucose levels in T1DM compared to SAPs, with an average difference of − 0.37 (95% confidence interval [−0.51, −0.24], P &lt; 0.00001), highlighting the potential benefits of CLS therapy. Conclusion: This analysis of multiple studies suggests that CLSs are more effective than SAP therapy for managing type 1 diabetes, as CLS users showed better blood sugar control.

Insulin-induced Lipohypertrophy in a Patient with Type 2 Diabetes

Abstract Lipohypertrophy (LH) is a common side effect of insulin treatment in patients with diabetes, characterized by soft, benign nodules in the subcutaneous tissue. This case report describes the management of insulin-induced LH in a 66-year-old male with type 2 diabetes. The patient had been on a combination of oral antidiabetic agents (ODAs) and biphasic human insulin for 5 years, experiencing the symptoms of numbness, leg swelling, fatigue, and frequent hypoglycemic episodes. Upon examination, LH with skin pigmentation was observed at the insulin injection sites on both calves. The patient’s laboratory investigations revealed poor glycemic control with high glycated hemoglobin percentage. To address the condition, the patient was advised to change the injection site, use proper site rotation, and change the insulin needle daily. The insulin therapy was modified by switching to biphasic premixed analog insulin injected 5 min before meals using the insulin pen. In addition, ODAs were adjusted for better glycemic control. Following these interventions, the patient reported improved glucose levels and stable kidney function. This case report emphasizes the importance of early detection and appropriate management of insulin-induced LH through patient education and insulin therapy adjustments. Health-care providers should remain vigilant for LH and educate patients on proper injection practices to optimize diabetes management and prevent complications.

Understanding the Association Between Type 2 Diabetes Mellitus and Cognitive Impairment: A Single-centre Experience.

The global prevalence of diabetes mellitus has been increasing, leading to a rise in morbidity associated with the disease. While diabetic nephropathy, retinopathy and neuropathy are routinely screened in diabetic patients, the cognitive decline associated with diabetes is often overlooked. The purpose of this study is to investigate the prevalence of cognitive impairment and its associated risk factors among patients with type 2 diabetes mellitus (T2DM). An observational cross-sectional study was conducted for two months. The Montreal Cognitive Assessment (MoCA) test, which consists of 30 questions, was used to assess cognitive function. In-depth clinical history along with glycaemic parameters were collected. The chi-square test was used to find out the association between categorical variables and cognitive impairment. Pearson's correlation test was performed to determine the correlation between glycaemic parameters and cognitive impairment. A total of 96 patients participated in the study. The mean HbA1c (%) was 9.08 ± 1.73, and the mean MoCA score was 25.14 ± 1.63. Mild cognitive impairment (MCI) was noted in 56% patients. Attention was the most common cognitive domain defect found in all MCI patients-100%. Delayed recall and memory were the second most common cognitive domain defect found-92.5%. Higher HbA1c, high FBS and higher PPBS were found to be statistically associated with MCI. A negative correlation was found between glycaemic parameters (HbA1c, FBS and PPBS levels) and MoCA scores. More than half of our study participants reported mild cognitive impairment. It highlights the need for the implementation of routine cognitive testing for diabetes patients. There is a strong negative correlation between MoCA scores and parameters of glycaemic control; higher levels of HbA1c, FBS, and PPBS are seen in people with a lower MoCA score, indicating mild cognitive impairment. Further studies are needed to evaluate whether improving glucose levels helps in improving cognition or not.

Impact of lifestyle moderate-to-vigorous physical activity timing on glycemic control in sedentary adults with overweight/obesity and metabolic impairments.

Moderate-to-vigorous physical activity (MVPA) improves glucose levels; however, whether its timing affects daily glycemic control remains unclear. This study aims to investigate the impact of lifestyle MVPA timing on daily glycemic control in sedentary adults with overweight/obesity and metabolic impairments. A total of 186 adults (50% women; age, 46.8 [SD 6.2] years) with overweight/obesity (BMI, 32.9 [SD 3.5] kg/m2) and at least one metabolic impairment participated in this cross-sectional study. MVPA and glucose patterns were simultaneously monitored over a 14-day period using a triaxial accelerometer worn on the nondominant wrist and a continuous glucose-monitoring device, respectively. Each day was classified as "inactive" if no MVPA was accumulated; as "morning," "afternoon," or "evening" if >50% of the MVPA minutes for that day were accumulated between 0600 and 1200, 1200 and 1800, or 1800 and 0000 hours, respectively; or as "mixed" if none of the defined time windows accounted for >50% of the MVPA for that day. Accumulating >50% of total MVPA during the evening was associated with lower 24-h(mean difference [95% CI], -1.26 mg/dL [95% CI: -2.2 to -0.4]), diurnal (-1.10 mg/dL [95% CI: -2.0 to -0.2]), and nocturnal mean glucose levels (-2.16 mg/dL [95% CI: -3.5 to -0.8]) compared with being inactive. This association was stronger in those participants with impaired glucose regulation. The pattern of these associations was similar in both men and women. These findings suggest that timing of lifestyle MVPA is significant. Specifically, accumulating more MVPA during the evening appears to have a beneficial effect on glucose homeostasis in sedentary adults with overweight/obesity and metabolic impairments.

Kiwifruit (Actinidia deliciosa) aqueous extract improves hyperglycemia, testicular inflammation, apoptosis, and tissue structure induced by Streptozotocin via oxidative stress inhibition

Diabetes mellitus (DM) is a well-known hyperglycemic metabolic condition identified by oxidative stress and biological function disruption. Kiwifruit is a valuable source of polyphenols and vitamin C with great antioxidant, nutritional, and health-promoting effects. Therefore, this study was initiated to explore the antioxidant and anti-hyperglycemic effects of kiwifruit aqueous extract (KFE) against oxidative injury and testis dysfunction in rats with diabetes. Twenty-four male Wistar Albino rats (160–170 g) were divided into four groups: Group 1 served as the control, Group 2 supplemented orally with kiwifruit extract (KFE; 1 g/kg/day) for one month, Group 3 was treated with a single streptozotocin dose (STZ; 50 mg/kg ip), and Group 4 where the diabetic rats were administered with KFE, respectively. According to the results, the GC-MS analysis of KFE revealed several main components with strong antioxidant properties. In diabetic rats, lipid peroxidation and hyperglycemia were accompanied by perturbations in hormone levels and sperm characteristics. Antioxidant enzymes, glutathione content, aminotransferase, phosphatase activities, and protein content were decreased. Furthermore, histology, immunohistochemical PCNA expression, and histochemical analysis of collagen, DNA, RNA, and total protein. were altered in rat testis sections, supporting the changes in biochemistry. Furthermore, diabetic rats supplemented with KFE manifested considerable amendment in all the tested parameters besides improved tissue structure and gene expressions (NF-kB, p53, IL-1β, Bax, IL-10, and Bcl2) relative to the diabetic group. In conclusion, KFE has beneficial effects as it can improve glucose levels and testis function, so it might be used as a complementary therapy in DM.

The impact of early-life exercise on CREB-signaling pathway and hippocampus neuroplasticity in diabetic adult male rats; the study of developmental model

ABSTRACT Background Childhood exercise enhances brain structure, while diabetes detrimentally affects it. This study examines early-life exercise’s influence on adult diabetic rats’ memory and neuroplasticity. Methods Male Wistar pups were divided into Control, Diabetes, Exercise Training, and Diabetes exercise groups. Diabetes was induced on day 23 with Alloxan (200 mg/kg). A 3-week regimen included aerobic and resistance training thrice weekly. The aerobic intensity was 70%, and resistance varied from 50% to 100% of the maximal carrying capacity (MCC). Following the last training sessions, spatial memory and retrieval tests were performed in infancy, childhood, and emerging adulthood using the Morris Water Maze test (MWM). The hippocampus was excised to measure protein and gene expression of brain-derived neurotrophic factor (BDNF), calmodulin-dependent protein kinase (CAMKII), N-methyl-D-aspartate receptors (NMDAR), and cAMP-response element-binding protein (CREB) by western blotting and reverse transcription–polymerase-chain reaction (RT-PCR) methods. Blood samples were collected during each developmental stage to measure glucose levels, at the study’s conclusion, to assess Interleukin-1β levels using the ELISA method. The Nissel staining assessed dead hippocampal cells in CA1. Results Post-natal exercise improved spatial memory (p < 0.05) and glucose levels (p < 0.05) in diabetic rats during adolescence and emerging adulthood. Despite reduced mRNA expression (NMDAR 40%, BDNF 62%, CREB 43%, CAMKII 66%), diabetic rats, by study end, showed increased BDNF, NMDARR, CAMKII, CREB protein/gene expression (p < 0.05) in emerging adulthood for both training groups. Conclusion Early-life exercise influenced hippocampal BDNF/NMDAR-CAMKII/CREB pathways in a diabetic rat model, highlighting post-natal exercise’s role in neuroplasticity memory enhancement and improved glucose level.

Automated Insulin Delivery in Women With Pregnancy Complicated by Type 1 Diabetes

(N Engl J Med. 2023;389:1566–1578) Type 1 diabetes often causes significant complications both during pregnancy and immediately after delivery for both mother and infant. This makes glycemic control during pregnancy for these women of utmost importance for their health and that of their baby. Several therapies have been introduced for pregnancies complicated by type 1 diabetes, and one that is relatively new is hybrid closed loop therapy; because of its recent development, the efficacy of this treatment is still unclear. This study was designed to test if the initiation of hybrid closed loop therapy before 16 weeks of gestation would improve glucose levels during pregnancy. The primary outcome for this study was the percentage of time that glucose levels were within the pregnancy-specific target range of 63 to 140 mg per deciliter.

Existing and emerging GLP-1 receptor agonist therapy: Ramifications for diabetic retinopathy screening.

GLP-1 receptor agonist treatment revolutionised the management of type 2 diabetes mellitus with significant enhancement of cardiovascular risk reduction. They have been instrumental in effectively managing the glycaemic control of this at-risk patient group. This class of drugs are associated with rapid improvement in glucose levels and consequently, transient early worsening of pre-existing diabetic retinopathy (DR) which is well-recognised, but this paradox is less commonly perceived in routine clinical practice. The recent shortage of supply has resulted in an enforced hiatus to prescribing all existing GLP-1 receptor agonists, which is expected to last all through 2024. This becomes even more pertinent as their DR could have progressed due to worsening HbA1c as a result of the unforeseen interruption to GLP-1 receptor agonist treatment. Therefore, when these medications are recommenced in a few months' time, all prescribers need to be aware of these patients' most up-to-date DR status and liaise with their affiliated screening service.

Vitamin D therapy's preventive effect in type 2 diabetes mellitus

Diabetes type II (DM II) is becoming more common, and it is highly harmful to several bodily systems. It's critical to keep DM II under control in order to avoid consequences like diabetic nephropathy, peripheral neuropathy, and damage to the retina. The fact that vitamin D lowers hemoglobin A1c (HbA1c) levels is just one of its many benefits. It boosts insulin's sensitivity and secretion. To find pertinent data, we thoroughly searched PubMed, a Medline, PMC, and Google Scholar. Following the application process of the inclusion and exclusion criteria, the studies' quality was assessed using the Cochrane bias analysis, the SANRA (Scale for the Testing of Narrative Review Articles) checklist, the AMSTAR (A Measuring Tool to Assess A Systematic Reviews) criteria, and the AMSTAR criteria. Data has been collected from 14 studies, of which 5 case reports, 3 general articles about DM II and vitamin D, 1 review of the literature, and 8 systematic reviews or meta-analyses.&#x0D; Three were narrative reviews and three were randomized controlled studies. The clinical significance of vitamin D treatment in type 2 diabetes is also evaluated in this study from the perspectives of glucose metabolism and adverse effects such retinopathy, neurotoxicity, and proteinuria. In terms of hemoglobin A1c (HbA1c) reduction, the relief of diabetic neuropathy and nephropathy symptoms, and the reduction of oxidative stress brought on by hypoglycemia in the retinal cells, vitamin D improved glucose levels clinically.&#x0D; One of the essential vitamins for diabetics is vitamin D..

Comparison of Metabolic Risk Factors Based on the Type of Physical Activity in Korean Adolescents: Results from a Nationwide Population-Based Survey.

Physical activity (PA) is associated with a favorable metabolic risk profile in adults. However, its role in adolescents remains unclear. In this study, using data (2019-2021) from the 8th Korea National Health and Nutrition Examination Survey, we investigated the optimal exercise type for preventing metabolic complications in adolescents. A total of 1,222 eligible adolescent participants (12-18-year-old) were divided into four groups as follows: aerobic exercise (AE), resistance exercise (RE), combined aerobic and resistance exercise (CE), and no exercise (NE). Daily PA was assessed using the international PA questionnaire. Blood samples were collected to measure lipid, glucose, and insulin levels. Additionally, the homeostasis model assessment for insulin resistance (HOMA-IR) and triglyceride-glucose (TyG) indices were measured. Multivariate regression analysis was used to compare the metabolic risk factors across the PA groups before and after propensity score matching (PSM) adjustment for confounding variables. The CE group exhibited improved fasting glucose levels, lower TyG index, reduced white blood cell count, and higher high-density lipoprotein (HDL) cholesterol levels than the NE group. The RE group exhibited lower mean blood pressure, triglyceride, fasting insulin, HOMA-IR, TyG index and a reduced risk of metabolic syndrome than the NE group. The AE group had higher total and HDL cholesterol levels. In detailed comparison of the AE and RE groups, the RE group consistently exhibited favorable metabolic parameters, including lower blood pressure and total and low-density cholesterol levels, which persisted after PSM. These findings highlight the positive effects of PA on cardiovascular risk factors in adolescents. Thus, RE may have a more favorable metabolic effect than AE. Further studies are needed to validate the benefits of exercise according to the exercise type.