Management Of Diabetes Mellitus Research Articles

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

Pancreatic surgery units undertake several complex operations, albeit with considerable morbidity and mortality, as is the case for the management of complicated acute pancreatitis or chronic pancreatitis. The centralisation of pancreatic surgery services, with the development of designated large-volume centres, has contributed to significantly improved outcomes. In this editorial, we discuss the complex associations between diabetes mellitus (DM) and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis, highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services. Type 3c pancreatogenic DM, refers to DM developing in the setting of exocrine pancreatic disease, and its identification and management can be challenging, while the glycaemic control of such patients may affect their course of treatment and outcome. Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period. The incidence of new onset diabetes after pancreatic resection is widely variable in the literature, and depends on the type and extent of pancreatic resection, as is the case with pancreatic parenchymal loss in the context of severe pancreatitis. Early involvement of a specialist diabetes team is essential to ensure a holistic management. In the current era, large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery, with inclusion of provisions for optimisation of the perioperative glycaemic control, to improve outcomes. While various guidelines are available to aid perioperative management of DM, auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement. The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined, a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis. Therefore, pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams. With the ongoing accumulation of evidence, it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients.

Advances in fecal microbiota transplantation for the treatment of diabetes mellitus

Diabetes mellitus (DM) refers to a group of chronic diseases with global prevalence, characterized by persistent hyperglycemia resulting from various etiologies. DM can harm various organ systems and lead to acute or chronic complications, which severely endanger human well-being. Traditional treatment mainly involves controlling blood sugar levels through replacement therapy with drugs and insulin; however, some patients still find a satisfactory curative effect difficult to achieve. Extensive research has demonstrated a close correlation between enteric dysbacteriosis and the pathogenesis of various types of DM, paving the way for novel therapeutic approaches targeting the gut microbiota to manage DM. Fecal microbiota transplantation (FMT), a method for re-establishing the intestinal microbiome balance, offers new possibilities for treating diabetes. This article provides a comprehensive review of the correlation between DM and the gut microbiota, as well as the current advancements in FMT treatment for DM, using FMT as an illustrative example. This study aims to offer novel perspectives and establish a theoretical foundation for the clinical diagnosis and management of DM.

Physical Activity Detection for Diabetes Mellitus Patients Using Recurrent Neural Networks

Diabetes mellitus (DM) is a persistent metabolic disorder associated with the hormone insulin. The two main types of DM are type 1 (T1DM) and type 2 (T2DM). Physical activity plays a crucial role in the therapy of diabetes, benefiting both types of patients. The detection, recognition, and subsequent classification of physical activity based on type and intensity are integral components of DM treatment. The continuous glucose monitoring system (CGMS) signal provides the blood glucose (BG) level, and the combination of CGMS and heart rate (HR) signals are potential targets for detecting relevant physical activity from the BG variation point of view. The main objective of the present research is the developing of an artificial intelligence (AI) algorithm capable of detecting physical activity using these signals. Using multiple recurrent models, the best-achieved performance of the different classifiers is a 0.99 area under the receiver operating characteristic curve. The application of recurrent neural networks (RNNs) is shown to be a powerful and efficient solution for accurate detection and analysis of physical activity in patients with DM. This approach has great potential to improve our understanding of individual activity patterns, thus contributing to a more personalized and effective management of DM.

A CORRELATION STUDY OF BLOOD HBA1C WITH FASTING AND POSTPRANDIAL BLOOD GLUCOSE

Objectives: This study aimed to evaluate the correlation between raised blood sugar and glycated hemoglobin (HbA1c), a gold standard test for the assessment of glycemic control. Serial monitoring of HbA1C in diabetes mellitus helps in the prevention of microvascular and macrovascular complications. Methods: We retrospectively reviewed the laboratory reports of 397 patients who visited the hospital for various reasons. There were 195 males and 202 females in the study group. We evaluated the correlation between HbA1c and two indicators of glycemic control: fasting blood glucose (FBG) and postprandial blood glucose (PPBG). Results: Both FBG and PPBG showed a significant positive correlation with HbA1c. However, PPBG had a stronger correlation with HbA1c than FBG. The Spearman’s correlation coefficient (r) was 0.610 (p<0.05) for FBG and HbA1c and 0.683 (p<0.05) for PPBG and HbA1c. Conclusions: PPBG was a better predictor of HbA1c than FBG. PPBG may be an alternative marker of HbA1c for the management and monitoring of diabetes mellitus.

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine.

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and is predicted to increase to 20.6% by 2020. This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. Anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs. A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal-Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A P value < 0.05 was considered statistically significant. More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per 1 year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These are results worth taking into consideration. This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

An Overview of the Therapeutic Efficacy of (-)-Epicatechin in the Management of Diabetes Mellitus

Background and Aims: Diabetes mellitus is a chronic metabolic disorder affecting global public health. Since ancient, natural-based compounds are widely used for multiple indications of diabetes. Methods: The natural-based (-)-Epicatechin has enormous biological functions including antioxidant and anti-inflammatory activities. This review mainly focuses on the importance of epicatechin in the control of pathogenesis involved in diabetic mellitus. Additionally, its possible mechanisms involved in beta cell regeneration, insulin secretion, and insulin sensitivity. Results: The present article explored the potential antioxidant, mitochondrial protection, and antiinflammatory properties using the preclinical and clinical model, and also established the role of (-)- Epicatechin in the mitigation of diabetic-associated complications. Lastly, the article mentioned the limitation of the use of epicatechin. Conclusion: This will provide new insight to budding scientists for the development of novel bioactivebased pharmaceuticals for the management of diabetic mellitus.

Comparing Equil patch versus traditional catheter insulin pump in type 2 diabetes using continuous glucose monitoring metrics and profiles.

It is not clear whether there are differences in glycemic control between the Equil patch and the MMT-712 insulin pump. Our objective was to compare two types of insulin pumps in the treatment of type 2 diabetes mellitus (T2DM), using continuous glucose monitoring (CGM) metrics and profiles. This was a randomized case-crossover clinical trial. Participants were hospitalized and randomly allocated to two groups and underwent two types of insulin pump treatments (group A: Equil patch-Medtronic MMT-712 insulin pump; group B: Medtronic MMT-712-Equil patch insulin pump) separated by a 1-day washout period. Glycemic control was achieved after 7-8 days of insulin pump therapy. Each patient received CGM for 5 consecutive days (from day 1 to day 5). On day 3 of CGM performance, the Equil patch insulin pump treatment was switched to Medtronic MMT-712 insulin pump treatment at the same basal and bolus insulin doses or vice versa. CGM metrics and profiles including glycemic variability (GV), time in range (TIR, 3.9-10.0 mmol/L), time below range (TBR, <3.9 mmol/L), time above range (TAR, >10.0 mmol/L), and postprandial glucose excursions, as well as incidence of hypoglycemia. Forty-six T2DM patients completed the study. There was no significant difference in parameters of daily GV and postprandial glucose excursions between the Equil patch insulin pump treatment and the Medtronic insulin pump treatment. Similarly, there was no between-treatment difference in TIR, TBR, and TAR, as well as the incidence of hypoglycemia. The Equil patch insulin pump was similar to the traditional MMT-712 insulin pump in terms of glycemic control. Equil patch insulin pump is a reliable tool for glycemic management of diabetes mellitus.

Beneficial effect of Barleria buxifolia leaves extract in the treatment of diabetes and associated complications

The global occurrence of diabetes has witnessed persistent escalation, starting from 151 million individuals in the year 2000, the time when the IDF Diabetes Atlas was initially introduced, to 285 million in 2009, and further reaching 382 million in 2013. Diabetes mellitus is characterized by elevated levels of glucose in the blood plasma. This condition emerges as a consequence of insufficient insulin secretion, insulin resistance or both, subsequently leading to metabolic abnormalities. The plant known as Barleria buxifolia (BB), belonging to the Acanthaceae family, is intended to possess the ability to treat various ailments in the traditional Indian system of medicine. Hence, this research aims to investigate the effects of methanolic and aqueous extracts of BB leaves on diabetic models of rats. STZ (60 mg/kg) was administered to induce diabetes in the rats. Both the extracts of BB were orally administered at doses of 200 and 400 mg/kg, respectively to the normal and diabetic rats, commencing from the 3rd day until the 28th day. Blood samples were examined to determine glucose levels. The diabetic rats exhibited a notable rise in blood glucose levels. The aqueous and methanolic extracts of BB reduced the elevated glucose levels significantly (P &gt; 0.01) and enhanced the body weight of rats. Thus, it can be inferred that BB possesses considerable potential for the management of diabetes mellitus.

Management of Gestational Diabetes Mellitus in Middle East and North Africa: Systematic review

Management of Gestational Diabetes Mellitus in Middle East and North Africa: Systematic review

Application of Genetic Algorithms for Medical Diagnosis of Diabetes Mellitus

The system of glucose-insulin control and associated problems in diabetes mellitus were studied by mathematical modeling. It is a helpful theoretical tool for understanding the basic concepts of numerous distinct medical and biological functions. It delves into the various risk factors contributing to the onset of diabetes, such as sedentary lifestyle, obesity, family history, viruses, and increasing age. The study emphasizes the importance of mathematical models in understanding the dynamic characteristics of biological systems. The study emphasizes the increasing prevalence of diabetes, especially in India, where urbanization and lifestyle changes contribute to the rising incidence. The present investigation describes the use of John Holland's evolutionary computing approach and the Genetic Algorithm (GA) in diabetes mellitus. The Genetic Algorithm is applied to address issues related to diabetes, offering a generic solution and utilizing MATLAB's Genetic Algorithm tool. The Mathematical Model provides differential equations representing glucose and insulin concentrations in the blood. The results represent testing outcomes for normal, prediabetic, and diabetic individuals, optimized with Genetic Algorithm showcased through fitness value plots. The conclusion highlights the effectiveness of Genetic Algorithm as an optimization tool in predicting optimal samples for diabetes diagnosis. The paper encourages the use of heuristic algorithms, such as Genetic Algorithms, to address complex challenges in the field of diabetes research. Future scope includes further exploration of biomathematics and Genetic Algorithm applications for enhanced understanding and management of diabetes mellitus. It is critical for people with diabetes to consistently check their blood glucose levels and follow their treatment plan.

A Systematic Review on the Hypoglycemic Potentials of Mahogany (Swietenia spp.) Seeds as Antioxidants in the Management of Gestational Diabetes Mellitus

A Systematic Review on the Hypoglycemic Potentials of Mahogany (Swietenia spp.) Seeds as Antioxidants in the Management of Gestational Diabetes Mellitus

Melatonin increases AKT and SOD gene and protein expressions in diabetic rats

Diabetes mellitus (DM) is a chronic metabolic disease marked by hyperglycemia due to insulin deficiency or insulin resistance leading to many chronic complications. It is thus important to manage diabetes effectively in order to prevent and or delay these complications. Melatonin is produced by the pineal gland and regulates the wake-sleep circadian rhythm. Existing evidence suggests that melatonin may be effective in the management of DM. However, the evidence on the mechanism of the beneficial effect melatonin as a treatment for DM is limited. In this study, we investigated the effect of melatonin treatment on blood glucose, insulin (INS), AKT and superoxide dismutase (SOD) gene levels in diabetic rats. Non-diabetic and diabetic rats were treated orally for 4 weeks with either 25 mg or 50 mg/kg body weight of melatonin. At the end of the study, pancreatic and liver tissues morphology, glucose homeostasis, serum insulin and SOD levels, hepatic gene and protein expression of SOD as protecting antioxidant enzyme and AKT as central element involved in PI3K/AKT insulin signaling pathway were estimated. Melatonin treated diabetic rats showed reduced hyperglycemia, and increased serum insulin and SOD levels. In addition, melatonin induced an increased gene and protein expression of SOD and AKT. In conclusion, melatonin may play a role in treating diabetic rats via stimulation of insulin secretion, insulin signaling and reduction in oxidative stress.

Review on the Therapeutic Role of Asclepias tuberosa Seeds in Diabetes Management

Diabetes mellitus (DM) presents a significant global health challenge characterized by elevated blood glucose levels, leading to debilitating complications. Despite various therapeutic approaches, effective glucose regulation remains elusive, often accompanied by adverse effects from current medications. Medicinal plants, including Asclepias tuberosa, have shown promise in managing blood glucose levels with fewer side effects. This review highlights the potential of Asclepias tuberosa as herbal antidiabetic agents based on recent literature, suggesting avenues for further research and therapeutic development in DM management. Considering the urgent need for safer and more effective antidiabetic treatments, exploring the therapeutic potential of Asclepias tuberosa presents a promising avenue for addressing this growing public health concern. Future studies should focus on elucidating the mechanisms of action, conducting clinical trials to validate the efficacy and safety of Centaurea-based interventions in DM management, and exploring synergistic effects with existing therapies.&#x0D; Furthermore, within the context of utilizing plant materials for the treatment of Diabetes mellitus, particular attention is directed towards the utilization of Asclepias tuberosa seeds. Asclepias tuberosa, commonly known as butterfly weed or pleurisy root, is a medicinal plant native to North America. Traditionally, various parts of this plant, including the roots, leaves, and seeds, have been used in folk medicine for their purported therapeutic effects&#x0D; Keywords: Diabetes mellitus, Asclepias tuberosa, antidiabetic agents, herbal remedies, blood glucose regulation.

An insight into the mechanistic role of (-)-Ampelopsin F from Vatica chinensis L. in inducing insulin secretion in pancreatic beta cells

Resveratrol oligomers, ranging from dimers to octamers, are formed through regioselective synthesis involving the phenoxy radical coupling of resveratrol building blocks, exhibiting remarkable therapeutic potential, including antidiabetic properties. In this study, we elucidate the mechanistic insights into the insulin secretion potential of a resveratrol dimer, (-)-Ampelopsin F (AmF), isolated from the acetone extract of Vatica chinensis L. stem bark in Pancreatic Beta-TC-6 cell lines. The AmF (50 µM) treated cells exhibited a 3.5-fold increase in insulin secretion potential as compared to unstimulated cells, which was achieved through the enhancement of mitochondrial membrane hyperpolarization, elevation of intracellular calcium concentration, and upregulation of GLUT2 and glucokinase expression in pancreatic Beta-TC-6 cell lines. Furthermore, AmF effectively inhibited the activity of DPP4, showcasing a 2.5-fold decrease compared to the control and a significant 6.5-fold reduction compared to the positive control. These findings emphasize AmF as a potential lead for the management of diabetes mellitus and point to its possible application in the next therapeutic initiatives.

Quality assessment of glucose measurement with regard to epidemiology and clinical management of diabetes mellitus in Germany.

During the last decade, Germany has seen an increased prevalence and a redistribution from undetected to diagnosed diabetes mellitus. Due to this substantial epidemiological development, the number of people with documented type 2 diabetes was 8.7 million in 2022. An estimated two million undiagnosed subjects are to be added. Beyond that, the life expectancy of diabetic subjects is increasing due to more responsive health systems in terms of care. Possible reasons include improved screening of at-risk individuals, the introduction of HbA1c for diagnosis in 2010, and the higher use of risk scores. Additionally, quality aspects of the laboratory methodology should be taken into consideration. Epidemiology and clinical management of diabetes in Germany are presented in the light of publications retrieved by a selective search of the PubMed database. Additionally, the data from German external quality assessment (EQA) surveys for the measurands glucose in plasma and HbA1c in whole blood, reviewed from 2010 until 2022, were evaluated. Above this, data concerning the analytical performance of near-patient glucometer devices, according to the ISO norm 15197:2013, were analyzed. Two laboratory aspects are in good accordance with the observation of an increase in the diabetes mellitus prevalence when retrospectively reviewing the period 2010 to 2022: First, the analytical performance according to the ISO norm 15197:2013 of the glucometer devices widely used by patients with diabetes for the glucose self-testing, has improved during this period. Secondly, concerning the EQA program of INSTAND, the number of participating laboratories raised significantly in Germany. The spreads of variations of the specified results for plasma glucose remained unchanged between 2010 and 2022, whereas for HbA1c a significant decrease of the result scattering could be observed. These retrospectively established findings testify to an excellent analytical quality of laboratory diagnostics for glucose and HbA1c throughout Germany which may be involved in a better diagnosis and therapy of previously undetected diabetes mellitus.

Herbal Nanoformulations for Diabetes: Mechanisms, Formulations, and Clinical Impact.

Diabetes mellitus remains a global health challenge, demanding innovative therapeutic strategies. Herbal remedies have garnered attention for their potential in diabetes management, and recent advancements in nanotechnology have enabled the development of herbal nanoformulations with enhanced efficacy and bioavailability. This review aimed to comprehensively analyze the mechanisms, formulations, and clinical impact of herbal nanoformulations in managing diabetes mellitus. A systematic literature search was conducted to identify relevant studies exploring the mechanisms of action, various formulations, and clinical outcomes of herbal nanoformulations in diabetes management. Herbal nanoformulations exert their anti-diabetic effects through multiple mechanisms, including enhanced bioavailability, improved tissue targeting, and potentiation of insulin signaling pathways. Various herbal ingredients, such as bitter melon, fenugreek, and Gymnema sylvestre, have been encapsulated into nanocarriers, like liposomes, polymeric nanoparticles, and solid lipid nanoparticles, to enhance their therapeutic potential. Clinical studies have demonstrated promising results, showing improvements in glycemic control, lipid profile, and antioxidant status with minimal adverse effects. Herbal nanoformulations represent a promising avenue for the management of diabetes mellitus, offering improved therapeutic outcomes compared to conventional herbal preparations. Further research is warranted to optimize formulation strategies, elucidate long-term safety profiles, and explore the potential synergistic effects of herbal nanoformulations in combination therapies for diabetes management.

In vitro validation of anti-diabetic and free radical scavenging property of Naaval Kottai Mathirai, a promising Siddha drug for the management of Diabetes mellitus

In vitro validation of anti-diabetic and free radical scavenging property of Naaval Kottai Mathirai, a promising Siddha drug for the management of Diabetes mellitus

Effectiveness of a Disease Management Program (DMP) in controlling the progression of Chronic Kidney Diseaseamong hypertensives and diabetics.

The occurrence rate of stage 5 chronic kidney disease (CKD) will be 151 per million population in India in the coming years. Comorbidities like diabetes mellitus and hypertension are the usual triggers of CKD. Hence this study aimed to control the progression of CKD and to note the effectiveness of a structured education program that would help in the prevention of complications related to diabetes and hypertension. This quasi-experimental study was conducted among 88 participants who had hypertension, diabetes mellitus, or both for five or more years. The study objective was to find the effect of a Disease Management Program on delaying progression of CKD in patients with hypertension or diabetes mellitus.The baseline data were obtained from demographic proforma, and the clinical data collected were the blood pressure, serum creatinine, and random blood sugar (RBS) of the participants. The management of hypertension and diabetes mellitus was taught to them. In the fourth and the eighth month, blood pressure and blood sugar were reassessed. At one-year blood pressure, blood sugar, and serum creatinine were tested. Baseline and one-year follow-up blood pressure, blood sugar, and estimated Glomerular Filtration Rate were compared. Descriptive statistics and "Wilcoxon signed-rank test" were used to analyze the data. In one year, the mean systolic blood pressure reduced by six mm of Hg and mean blood sugar by 24 mg/dl. The prevalence of CKD stage three and above (< 60 ml/min/m2) was nine (10.22%). The median decline in eGFR was 5 ml/min/m2 (Z= 5.925, P< 0.001). The Disease Management Program led to improvements in blood pressure and diabetes control and median progression of CKD was estimated at five ml/min/m2/year.

Education and Screening on Non-Communicable Diseases in Simokerto District, Surabaya, Indonesia

Non-communicable diseases (NCDs) are one of the leading causes of death in the world. Indonesia is one of the countries facing the problem of both communicable diseases and non-communicable diseases (NCDs). Non-communicable diseases are usually asymptomatic and do not show certain clinical signs, so most people are not aware of the dangers of non-communicable diseases. Non-communicable diseases (NCDs) are one of the health problems in society that has increased every year, and is the largest contributor to the incidence of death in Indonesia. Non-communicable diseases can be triggered by a lack of physical activity, smoking, ineffective diet, stress, which can lead to increased pressure, increased blood sugar, and increased blood fat. The purpose of this community service is to increase community knowledge and carry out health screening on non-communicable diseases in residents in RT 01 and RT 02 RW 04 Tambakrejo Village, Simokerto District, Surabaya City. The method of the community service are lectures on hypertension and diabetes mellitus followed by discussion and questions and answers. Furthermore, a demonstration on health screening in non-communicable diseases was conducted. To determine the benefits of this activity, the participants' knowledge was tested using questions in the pre-test and post-test sessions. Assessment of the participants' knowledge by counting the correct answers to the questions on the test sheet.There is an 80% increase in knowledge of residents about the management of hypertension and diabetes mellitus. The results of the screening identification obtained data that the body mass index of the community is as follows 45.2% of people with obese conditions; 41% of residents have grade 1 hypertension with blood pressure between 140- 159/90-99 mmHg; the results of random blood sugar checks are normal (79%); uric acid checks on residents have normal results (82%); and cholesterol levels in the body range normal, namely 52 people (71%). It is important to support residents' activities in improving healthy living behaviour through joint exercises.. It is expected that the cadres will maintain the performance that has been achieved, and form working groups in their respective neighbourhoods to share the health information in improving the level of health..

IDF23-0538 Bulgarian community pharmacists' knowledge towards diabetes mellitus management: results of a pilot survey

IDF23-0538 Bulgarian community pharmacists' knowledge towards diabetes mellitus management: results of a pilot survey