Management Of Type 2 Diabetes Mellitus Research Articles

Real-World Observational Study on Vildagliptin With Insulin (VIL-INS) or Vildagliptin and Metformin With Insulin (VIL-MET-INS) Therapy in Indian Patients With Type 2 Diabetes Mellitus.

The therapeutic use of vildagliptin and insulin (VIL-INS) or vildagliptin and metformin in combination with insulin (VIL-MET-INS) in the Indian scenario has yet to be explored by generating real-world evidence. Therefore, the present study aimed to evaluate the demographic, clinical characteristics, and treatment patterns of patients with type 2 diabetes mellitus (T2DM) in Indian settings in the above context. This observational study conducted at 600 healthcare centers in India retrospectively analyzed data of adult patients with T2DM who had been treated with either vildagliptin with insulin or a combination of vildagliptin and metformin with insulin. Data were collected from medical records and analyzed by appropriate statistical tests. A total of 12,603 patients with T2DM were included with a mean age of 53.4 years of which 63.8% were males. The majority of patients (n=6511; 51.7%) received a combination of vildagliptin and metformin on top of insulin. A significantly high proportion of patients in the age group of 18-40 years received this treatment compared to patients who were initiated on insulin treatment after vildagliptin and metformin combination (11.6% vs. 9.7%; P<0.001). Of all the patients, 70.0% were able to achieve target glycemic control with either VIS-INS or VIL-MET-INS. After treatment with VIL-INS or VIL-MET-INS, the mean glycated hemoglobin (HbA1c) levels significantly decreased with a mean change of 1.46%. Out of all patients, 13.5% experienced weight changes during treatment, with 67.4% of them showing weight loss. A total of 68 patients reported hypoglycemic events and among them, 49 patients had mild hypoglycemic events. Physician global evaluation of efficacy and tolerability showed a majority of patients rated their experience as good to excellent (86.3% and 86.0%, respectively). Both treatment regimens wereeffective in terms of reduced HbA1c to achieve glycemic control. Furthermore, it is well tolerated without an increase in the risk of hypoglycemia or weight gain. Hence, this therapy has favorable outcomes for T2DM management in Indian clinical settings.

The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis.

Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs. Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis. Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence. The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.

What can go wrong with the medication adherence a patient suffers due to diabetes distress? A narrative review

Background: Type 2 Diabetes Mellitus (T2DM) is a major public health concern associated with distress. Distress is a rational emotional response to living with T2DM. Diabetes distress has been found to significantly affect the clinical outcome of T2DM. However, little is known regarding how distress may affect medication adherence. Objective: To investigate the relationship between distress and poor medication adherence in people with T2DM. Method: A literature search was conducted to identify relevant research articles published from 2014 to 2022 in three electronic databases (Scopus, PubMed, and SpringerLink) regarding “diabetes distress”, “T2DM management” and “medication adherence”. In addition, a search was also carried out using Google Scholar. Results: A total of seven articles were identified. Amongst these articles, three studies revolved around evaluating the effect of diabetes distress on blood glucose control. All articles mentioned the significant association between distress and poor medication adherence, leading to seemingly comprehensive findings regarding the impact of diabetes distress on T2DM patients. Conclusion: It is important for healthcare providers, particularly pharmacists, to understand the holistic feature of T2DM patients.

Probiotics and Their Role in the Management of Type 2 Diabetes Mellitus (Short-Term Versus Long-Term Effect): A Systematic Review and Meta-Analysis.

Diabetes is a major economic burden and an illness with a rising incidence worldwide. Type 2 diabetes mellitus (T2DM), the most prevalent kind of diabetes, is characterized by insulin resistance and insufficient insulin production. Recent research has implicated gut microbiota dysbiosis as a contributing factor to T2DM pathogenesis. The present study employed a methodology based on randomized controlled trials (RCTs) to assess the therapeutic efficacy of probiotics in the treatment of T2DM. A thorough search was done in PubMed and Medline for articles written in English and published between 2017 and 2023. Studies were chosen based on predetermined inclusion criteria, and the search technique adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) principles. This study also employed a robust assessment instrument, widely recognized in the medical and health sciences, to evaluate the potential presence of bias within the selected research studies. Out of 96 identified articles, 22 RCTs met the eligibility criteria. Both short-term (8 weeks or less) and long-term (12 weeks or more) probiotic administrations were made. The results of the meta-analysis demonstrated a significant improvement in the homeostatic model assessment of insulin resistance (HOMA-IR) following the probiotic intervention (P=0.02) and considerably decreased glycated hemoglobin HbA1c levels (P=0.004) and fasting blood glucose (FBG) levels (P<0.0001) in T2DM patients compared to placebo. This research offers proof that probiotics are clinically effective in the treatment of T2DM. Probiotic supplementation demonstrated favorable effects on glycemic control markers. However, the findings from RCTs were heterogeneous, and some studies showed inconsistent results. To clarify the processes underlying the probiotics' therapeutic benefits and to determine the best probiotic strains, doses, and therapy durations, more research is required. Nevertheless, probiotics offer a promising therapeutic approach for T2DM management and warrant consideration as a potential adjunct therapy in clinical practice.

FRI650 Effectiveness Of Non-pharmacological Strategies In The Management Of Type 2 Diabetes In Primary Care: A Systematic Review And Network Meta-analysis

Abstract Disclosure: R.G. Occhiuto: None. L. Banzato: None. A.L. Mendes: None. F. Bolfi: None. V.D. Nunes-Nogueira: None. Introduction: Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but various of them have never been compared directly to determine the best strategies. Objective: This study has evaluated the comparative effects of non-pharmacological strategies in the management of T2DM in primary care or community settings. Methods and Analysis: We have performed a systematic review and network meta-analysis (NMA) and have include randomized controlled trials if non-pharmacological strategies in the management of type 2 diabetes were applied in adult patients with T2DM in primary care. The primary outcome was glycemic control (glycated hemoglobin [HbA1c] [%]). We have developed search strategies for Embase, Medline, Latin American and Caribbean Health Sciences Literature, Cochrane Central Register of Controlled Trials, Trip database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Australasian Medical Index, and Chinese Biomedical Literature Database. Four reviewers have assessed the studies for their eligibility and their risk of bias in pairs and independently. A NMA have been performed using Stata Statistical Software 17 (Stata Statistical Software: Release 17. College Station, TX, StataCorp LLC, USA). Results: After removing duplicates, the search strategies yielded 4314 studies. After a thorough evaluation of the references, 129 studies encompassing a total of 35975 individuals have been included in this review. Twenty and three strategies were founded. The most frequent strategy was diabetes self-management and support (DSMES) (60%), followed by diabetes self-management education (22%), self-monitoring of blood glucose (7%) and health coach (5). The most frequent comparator has been usual care (92%). Regarding relative rankings of treatments, the NMA has showed that nutritional therapy plate method has a 37.6% probability of being the best treatment in terms of HbA1c reduction, followed by DSMES associated with social support (24%) and low-fat diet (19.6%). Conclusion: This review has founded 23 non-pharmacological strategies in the management of type 2 diabetes in primary care, being the most frequent DSMES. Grant FAPESP:2021/07229-0 Presentation: Friday, June 16, 2023

SAT124 GRADE-adolopment Of Adult Diabetes Mellitus Management Guidelines For A Pakistani Context

Abstract Disclosure: A. Pervez: None. R. Martins: None. M. Masood: None. O. Mahmud: None. N. Rizvi: None. A. Sheikh: None. N. Islam: None. A. Khowaja: None. N. Ram: None. S. Furqan: None. M. Mustafa: None. S. Aamdani: None. A. Haider: None. S. Nadeem: None. Background: Pakistan has the highest national prevalence (1 in 4 adults) of type 2 diabetes mellitus (T2DM) in the world. Most T2DM clinical practice guidelines (CPGs) originate from high-income countries and are evidence based. Due to the lack of research infrastructure and financial resources, lower-middle income countries face challenges in the de novo creation of CPGs. Thus, we aimed to develop a comprehensive, high-quality CPG with a local context for adult outpatient T2DM management in Pakistan based on the GRADE-ADOLOPMENT process. Methods: In collaboration with the GRADE working group, an adaptation of the GRADE-ADOLOPMENT approach was followed. Adolopment is a combination of adoption, adaptation, and de novo development. The American Diabetes Association (ADA) Standards of Medical Care in Diabetes - 2021 was utilized as the source CPG by local endocrinology experts in Pakistan. Recommendations from the source CPG were either adopted as is, excluded, or adapted. Adaptation was done using the evidence-to-decision framework with a panel of experts. Results: The source CPG contained 243 recommendations, 219 of which were adopted without change. 5 recommendations were adopted with minor changes related to cost effectiveness to minimize cost-related nonadherence. 18 recommendations were excluded due to reasons including but not limited to the scope being beyond the initial aim of our guideline centers’ objective (such as recommendations related to pediatric or inpatient care), unavailability of medication, or inapplicability to the existing health-care system of Pakistan. One recommendation was adapted pertaining to the screening age for the diagnosis of T2DM. This was recommended to be lowered from the age of 45 years to 30 years due to the higher prevalence of T2DM in younger Pakistanis. This will enable the early detection and management of T2DM. Earlier screening highlights the opportunity to intervene early on and reduce complications. This, coincidentally, was also addressed by the ADA in their 2022 guideline, where the screening age was revised from 45 years to 35 years. Conclusion: Our GRADE-ADOLOPED CPG for T2DM management comprises of 225 recommendations. We recommend earlier screening for T2DM in Pakistan. We additionally suggest careful consideration of cost to promote adherence while also recommending CGM use in the management plan of people with T2DM who can afford it. Our modified methodology provides an excellent resource efficient method to create locally contextualized evidence-based CPGs. Our goal is to publish and disseminate this CPG to improve the quality of T2DM care in Pakistan. Rigorous expanded research exploring the effectiveness of earlier screening for T2DM in Pakistan should be conducted in the future. Presentation: Saturday, June 17, 2023

PROFILING OF CLINICAL DYNAMICS OF TYPE 2 DIABETES MELLITUS IN PATIENTS: A PERSPECTIVE REVIEW

Type 2 diabetes mellitus (T2DM), also known as Non-Insulin Dependent Diabetes Mellitus (NIDDM) is one of the common metabolic disorders in the world. T2DM accounts for around 90% of all cases of diabetes mellitus, afflicting millions worldwide. It is a significant global health burden with a steadily increasing prevalence. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. Risk factors for T2DM are diverse. Some are modifiable, and others are not. Modifiable risk factors include overweight/obesity, lack of exercise or physical inactivity, poor nutrition, etc. Non-modifiable risk factors include age, ethnicity/race, family history, history of gestational diabetes mellitus, etc. The starting points and mainstays of treatment for T2DM are diet and lifestyle modifications such as increased physical activity and stoppage of smoking. In addition to the diet and lifestyle modifications, drugs are also used in the management of T2DM. This study aimed to profile the clinical dynamics of type 2 diabetes mellitus in patients. Current literatures from different databases including MEDLINE, PubMed, EMBASE, CINAHL, Google Scholar, etc. on the topic were searched online and reviewed.

SAT364 A Rare Cause of Hyperandrogenism in a Premenopausal Woman

Abstract Disclosure: L. El Musa Penna: None. W. Medina-Torres: None. L.R. Sepulveda-Garcia: None. L.N. Madera Marin: None. A. Rosado-Burgos: None. M.A. Ortiz-Rivera: None. B. Torres Rivera: None. M. Alvarado: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. M. Marcos Martínez: None. M. Correa Rivas: None. N. Bracero, MD: None. Hyperandrogenism in premenopausal women is most commonly associated to polycystic ovarian syndrome (PCOS). Approximately 10% of females in reproductive age present with clinical and/or biochemical findings of androgen excess, such as hirsutism, acne, alopecia, oligo-amenorrhea or if hyperandrogenism is severe it can lead to extreme virilization. Androgen excess can also contribute to insulin resistance. In this case we discuss a patient with severe hyperandrogenism, extreme insulin resistance and a rare cause of androgen excess in a woman of childbearing age. 34-year-old female patient G0P0 with type 2 diabetes mellitus (T2DM) on continuous insulin infusion system (CIIS), familial partial lipodystrophy, PCOS and severe hyperandrogenism, who was referred to our clinics for management of uncontrolled T2DM. Patient was on CIIS with regular insulin U-500 using a total daily dose of 95 units. She referred amenorrhea for the past 12 years and significant progression of hirsutism, alopecia and acanthosis nigricans in the past two years. Patient had clinical findings of hyperandrogenism such as hirsutism evaluated with modified Ferriman-Gallwey scale with a score of 32, alopecia Ludwig class 3 and marked acanthosis nigricans in neck and abdomen.Pre-operative laboratories: hemoglobin (Hgb) level 15.13 g/dL, hematocrit (Ht) 44.59 %, total testosterone level 525 ng/dL (13-53 ng/dL) and DHEAS 113 ug/dL (95.8-511.7 ug/dL), suggesting an ovarian source of androgen excess. Transvaginal ovarian ultrasound showed at the posteromedial edge of right ovary a hyperechoic structure measuring 1.5 cm long x 1.0 cm AP representing a lesion of unknown etiology. After discussion with patient a decision for oophorectomy was made. Pathology report described the ovary negative for neoplasia with findings consistent with hyperthecosis. Laboratories two weeks post-operative showed significant decrease in total testosterone to 81 ng/dL and in Hgb/ Ht (12.50 g/dL and 37.8% respectively). Insulin requirement decreased and she was able to be transitioned to U-100 insulin lispro with a total daily dose of 100. Four weeks after surgery patient had her menstrual period. Ovarian hyperthecosis is a disorder where there is an increased tissue with luteinized theca cells in the ovarian stroma; these cells are ovarian interstitial cells that differentiate into steroidogenically active cells. It is most commonly observed in post-menopausal women, but it has been described in women of childbearing age presenting with worsening hirsutism, virilization and insulin resistance. Monitoring patterns and progression of androgen excess is important in premenopausal women with a diagnosis of PCOS. Severe biochemical or clinical presentation, as well as progression of hyperandrogenism should increase suspicion of additional pathological entities as it will improve patient’s quality of life with the appropriate management. Presentation Date: Saturday, June 17, 2023

Role of canagliflozin in ameliorating isoprenaline induced cardiomyocyte oxidative stress via the heme oxygenase-1 mediated pathway

ABSTRACT Canagliflozin (CZ) is commonly prescribed for management of type-2 diabetes mellitus (T2DM); it also can reduce the risk of myocardial infarction. We used 80 albino Wistar rats to investigate the cardioprotective potential of CZ against oxidative stress caused by administration of isoprenaline (ISO). We found that ISO stimulates production of reactive oxygen species and that CZ administration caused up-regulation of antioxidants and down-regulation of oxidants due to nuclear factor erythroid-2 related factor-2, as well as by enhancement of the heme oxygenase-1 mediated cascade. CZ monotherapy may play a cardioprotective role in diabetic patients. CZ possesses strong antioxidant potential that ameliorates cardiac damage induced by ISO administration.

Add-on effect of proprietary Ayurvedic medicine Diabrishta-21 in managing glucose variability measured through continuous glucose monitoring device: A case report

Abstract: In the scenario of modern health issues, Type 2 Diabetes Mellitus (T2DM) has gained much importance as “adult-onset diabetes” which represents a combination of genetic, environmental, and lifestyle choices. It predominantly shows hyperglycemia or increased blood glucose levels, insulin deficiency, and insulin resistance, which typically characterizes this metabolic disorder whilst manifesting life-threatening complications. This report presents the case of a 55-year-old male with T2DM whose glucose levels were monitored during a period when he was on his prescribed antidiabetic medicines, followed by the addition of an Ayurvedic preparation Diabrishta-21. His glucose summary, obtained by the Continuous Glucose Monitoring (CGM) approach depicts a change in the average value of blood sugar levels and glycated hemoglobin levels, decreasing from 167 to 108 mg/dL, and from 7.4% to 5.4%, respectively. Moreover, the percentage of time the blood glucose levels were in the desired target range increased from 29% to 79%. Thus, Diabrishta-21 in this case report appears to be beneficial in the management of T2DM by aiding in controlling the glucose variability and lowering the blood glucose levels.

Effects of pharmacist-led interventions on glycaemic control, adherence, disease management and health-related quality of life in patients with type 2 diabetes: a protocol for a network meta-analysis

IntroductionThe increase in the number of patients with uncontrolled type 2 diabetes mellitus (T2DM) is in need of effective management interventions. However, research to date has been limited to the...

Unveiling the Evidence for the Use of Pulses in Managing Type 2 Diabetes Mellitus: A Scoping Review.

Management of type 2 diabetes mellitus (T2DM) is a pressing global healthcare challenge. Innovative strategies that integrate superior medical and nutritional practices are essential for holistic care. As such, pulse consumption is encouraged for its potential benefit in reducing hypercholesterolaemia, dyslipidaemia, and triglyceride levels, as well as enhancing glycaemic control. This scoping review aims to assess the depth of evidence supporting the recommendation for pulse consumption in T2DM management and to identify gaps in the existing literature. We conducted a comprehensive search across the databases MEDLINE, Global Health, EMBASE, CINAHL, Web of Science, and the Cochrane Library (up to July 2023). We included population-based studies of any design, and excluded review-style articles. Articles published in languages other than English were also excluded. From the 2449 studies initially identified, 28 met our inclusion criteria. Acute postprandial trials demonstrated improved glucose responses and enhanced insulin responses to pulse-based intervention. Meanwhile, long-term trials reported meaningful improvements in T2DM indicators such as haemoglobin A1C (HbA1c), fasting glucose, fasting insulin, C-peptide, and markers of insulin resistance like homeostatic model assessment (HOMA). Integrating more pulses into the diets of diabetic individuals might offer an efficient and cost-effective strategy in the global initiative to combat T2DM.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives.

Type 1 diabetes mellitus (T1DM) is one of the important causes of chronic kidney disease (CKD) and end-stage renal failure (ESRF). Even with the best available treatment options, management of T1DM poses significant challenges for cli nicians across the world, especially when associated with CKD and ESRF. Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM. Simultaneous pancreas-kidney transplant (SPK) is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications. However, limited availability of the organs for transplantation, the need for long-term immunosuppression to prevent rejection, peri- and post-operative complications of SPK, lack of resources and the expertise for the procedure in many centers, and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe. This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

'I accept his manhood is on life-support': A qualitative understanding of the impact of diabetes on sexual relationships among men and women living with type 2 diabetes and their partners in South Africa.

To explore the impact of diabetes on sexual relationships among men and women living with type 2 diabetes People living with type 2 diabetes (PLWD) and their partners in Cape Town, South Africa. As part of a larger study developing an intervention to improve type 2 diabetes mellitus (T2DM) self management, we conducted in-depth individual interviews with 10 PLWD and their partners without diabetes about experiences living with T2DM, between July 2020 and January 2021. We used inductive thematic analysis. Both PLWD and partners felt that their sexual relationships and desires changed post-diagnosis, in ways beyond biomedical issues. Although couples' reports on the quality of their sexual relationships were concordant, most participants had not communicated their sexual desires and concerns with each other, causing unhappiness and fears of disappointing or losing their partner. Participants felt uninformed about sexual dysfunction but had not discussed this with their healthcare provider, leading to increased anxiety. PLWD and their partners need more informational support to increase their understanding of diabetes-associated sexual dysfunction and to decrease fears and anxiety. Strengthening communication within couples on sexual issues may empower them to find solutions to problems experienced. This may improve couples' relationships and quality of life, and indirectly result in better self management of T2DM.

Molecular bioprospection of Helianthus annuus L. (sunflower) cypselae for antidiabetic therapeutics through network pharmacology, density functional theory and molecular dynamics simulation

Helianthus annuus cypsela (sunflower) is a staple oilseed crop with significant therapeutic applications against diverse diseases including type 2 diabetes mellitus (T2DM). Despite its reported antidiabetic potential, the implicated molecular mechanism of action is yet to be unravelled to date. This study evaluated the molecular mechanism of the antidiabetic activity of sunflower cypsela using network pharmacology (NP), density functional theory, and molecular dynamics (MD) simulation approaches. The six cultivars of sunflower cypsela used were profiled for their secondary metabolites using LC-MS and GC–MS techniques. Subsequently, the genes associated with the identified metabolites were screened against T2DM-associated genes using NP. Based on the KEGG enrichment analysis of the identified common genes, signaling pathways were subsequently identified. The results obtained revealed 87 intersecting genes between the metabolites of sunflower cypsela and T2DM, while the KEGG analysis identified 35 signaling pathways with the PPAR route and its associated genes as the most implicated in T2DM progression with respect to sunflower cypsela. Both MMP1 and PPARA in the PPAR pathways interacted most with the identified metabolites, with CGA (−43.74 kcal/mol), GPA (−41.62 kcal/mol), and CFG (−45.36 kcal/mol) having higher binding free energy than both ROS and MET (reference standards) against MMP1 after 100,000 ps MD simulation. In contrast, ROS (−46.98 kcal/mol) had better affinity against PPARA compared to the top hits of sunflower cypsela. However, against both gene targets, the top hits had significant thermodynamic stability, flexibility, and compactness, which are attributable to their bond interactions and molecular orbital properties. These findings are suggestive of the essential role of the top-hits in the antidiabetic potential of sunflower cypsela through activation of the PPAR signalling pathway and most especially MMP1. In this regard, the modulation of MMP1 and PPARA genes by the identified metabolites of sunflower cypsela may enhance insulin sensitivity and glucose homoeostasis in the management of T2DM.

Binding interactions of Vildagliptin with pepsin: A multi-spectroscopic and in-silico approach and a comparative account with metformin

Vildagliptin (VDG) and Metformin (Met) belong to a class of dipeptidylpeptidase-4 (DPP-4) inhibitor and biguanide, respectively and used for the management of diabetes mellitus type II (DMTII). Both the drugs are orally available which leads to various side effects due to its oral ingestion. Occurrence of these side effects might be due to some interactions with pepsin at a molecular level. Therefore, in order to investigate these interactions, multi-spectroscopic and in-silico techniques have been extensively studied to identify the binding characteristics of VDG with pepsin. Fluorescence data suggested that the quenching is due to dynamic and static mechanism and static was dominant one. However, fluorescence and UV–Vis spectroscopic measurement analysis suggested that VDG tends to associate with pepsin, via ground-state complex formation. Fluorescence study revealed the binding-constant value which was found to be 0.559 × 103 M−1 at 298.15 K that is non-covalent in nature. VDG-pepsin complex shows exothermic and spontaneous binding as confirmed by the calculated values of ΔH, ΔS, and ΔG, are majorly caused by van der Waals forces and H-bonding interactions. CD spectra of pepsin in presence of VDG confirmed post binding conformational change. Enzyme-activity assay showed that activity of pepsin was decreased by upto 28 %. FRET analysis suggested that energy transfer efficiency is negligible for VDG-pepsin interaction. In-silico analysis reveals that H-bonding and electrostatic negative forces are the significant driving forces involved in the interaction of VDG and pepsin.

Understanding Physical Activity Behavior in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study.

Despite a relatively low prevalence rate, sub-Saharan Africa bears a substantial diabetes burden. Physical activity (PA) plays a crucial role in managing type 2 diabetes mellitus (T2DM). However, PA levels among this population remain suboptimal. This study aimed to explore patients' perspectives on the barriers and facilitators to PA participation among Ghanaian adults with T2DM. Thirteen adults with T2DM were recruited from Korle-Bu Teaching Hospital, Ghana, for this qualitative descriptive study. Semi-structured interviews were conducted, and the data were analyzed using thematic analysis. Two overarching themes (personal factors and socio-structural factors) and 10 sub-themes relating to PA barriers and facilitators were identified. Participants had limited awareness of the recommended PA guidelines for T2DM management. Chronic illness-related factors hindered exercise participation. Difficulty differentiating between PA and exercise impeded the achievement of PA targets. Socio-structural barriers include concerns about social ridicule or embarrassment, safety during outdoor activities, a lack of culturally appropriate exercise facilities, and high social and work demands. Despite these barriers, participants were motivated by their understanding of the health benefits of PA. They emphasized integrating PA into daily routines through walking, work-related tasks, and household chores. Motivation and PA education from healthcare professionals are valued supports in achieving PA targets. Our findings showed that PA behaviour in Ghanaian adults with T2DM is influenced by both personal and external factors. Tailored PA interventions for this population should address identified barriers while leveraging facilitators to implement successful PA programs.

Recent advances in immune checkpoint inhibitor-induced type 1 diabetes mellitus.

As a new group of anticancer drugs, immune checkpoint inhibitors (ICIs) have exhibited favorable antitumor efficacy in numerous malignant tumors. Anti-cytotoxic T lymphocyte associated antigen-4 (CTLA-4), anti-programmed cell death-1 (PD-1) and anti-programmed cell death ligand-1 (PD-L1) are three kinds of ICIs widely used in clinical practice. However, ICI therapy (monotherapy or combination therapy) is always accompanied by a unique toxicity profile known as immune-related adverse events (irAEs) affecting multiple organs. The endocrine glands are common targets of irAEs induced by ICIs, which cause type 1 diabetes mellitus (T1DM) when the pancreas is affected. Although the incidence rate of ICI-induced T1DM is rare, it will always lead to an irreversible impairment of β-cells and be potentially life-threatening. Hence, it is vital for endocrinologists and oncologists to obtain a comprehensive understanding of ICI-induced T1DM and its management. In our present manuscript, we have reviewed the epidemiology, pathology and mechanism, diagnosis, management, and treatments of ICI-induced T1DM.

Management of diabetes type 1 with hybrid closed-loop

Introduction: Type 1 diabetes mellitus (T1DM), in which the pancreas is no longer able to produce insulin to naturally control blood sugar, can be a major problem for the patient in terms of disease management. Closed-loop hybrid systems are designed to automate insulin delivery to improve T1DM outcomes and reduce the burden and distress for the user. The hybrid closed-loop makes an important contribution to reducing the difficulties of disease, also its control and management.Research goal: The goal is to examine how the closed hybrid loop system has contributed to the management of T1DM and improved the quality of life of patients.Participants and Methods: The survey was based on a non-experimental quantitative method with a questionnaire developed for the study. The surveys were distributed on Facebook in groups dedicated to patients with T1DM. The survey covered hybrid closed-loop users in Slovenia. Descriptive and inferential statistics were used for the statistical processing of the obtained data. IBM SPSS Statistics (version 20) was used.Results: The hybrid closed-loop system provides respondents with better management of T1DM and a better quality of life. 82.9% of respondents have fewer hypoglycaemic episodes than before using the hybrid system, 65.7% of respondents detect signs of hypoglycaemia earlier and fear of hypoglycaemia is reduced. 70.3% of respondents say they have less worries about diabetes.Conclusion: The study confirmed the prediction that respondents with T1DM are satisfied with the hybrid closed-loop system and notice fewer fluctuations in their blood sugar. The latest treatment method also helps to improve the quality of life. Because of its benefits, respondents recommend using a hybrid closed-loop system.

The role of weight control in the management of type 2 diabetes mellitus: Perspectives on semaglutide

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used to address multiple aspects of type 2 diabetes mellitus (T2DM) management, including glycaemic control, weight loss, and cardiovascular risk reduction. Semaglutide, a well-established GLP-1 RA approved for T2DM treatment and weight management, demonstrates marked efficacy in achieving these clinically important goals. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus report emphasizes the importance of a holistic approach to T2DM treatment, with weight control as a key component for improving patient outcomes. Notably, semaglutide is mentioned in the consensus report as having 'very high' efficacy for both glucose lowering and weight loss in T2DM treatment. Nevertheless, as has been observed with other weight-lowering drugs, weight loss observed with semaglutide appears less profound in individuals with T2DM than in those with obesity without T2DM, a phenomenon requiring further investigation. The semaglutide safety and tolerability profiles are well established, and it is approved in some countries to reduce cardiovascular risk in certain populations with T2DM. Thus, semaglutide offers a well-established therapeutic option that aligns well with guideline recommendations for T2DM management, emphasizing the high importance of weight control and amelioration of other cardiometabolic risk factors.