Management Of T2DM Research Articles

Safety of SGLT2 Inhibitors and Urinary Tract Infections in Clinical Practice—A Cross-Sectional Study

Background and Objectives: Type 2 diabetes (T2DM) affects millions across the globe, generating a veritable public health issue through quality-of-life-reducing chronic complications, among which urinary tract infections are the most common. A shift in the disease managing paradigm from a glucose-centered view to a concept of cardio-reno-metabolic health has uniquely placed SGLT2 inhibitors as viable medication for the complex management of T2DM and its comorbidities. Some concerns have been raised over the increased likelihood of urinary tract infections (UTIs) associated with SGLT2 inhibitor use. The current study aims to evaluate the risk of developing urinary tract infections if patients with type 2 diabetes take SGLT2 inhibitors and determine those factors which make these patients more prone to develop this undesired complication. Materials and Methods: A cross-sectional, noninterventional evaluation of 328 patients with type 2 diabetes consecutively admitted to the Diabetes Clinic of “Pius Brinzeu” County Emergency Hospital in Timisoara, between January and February of 2024, was performed by examining medical charts and running statistical analyses using MedCalc version 22.26.0.0. Results: There was no statistical difference between patients taking SGLT2 inhibitors and those taking other glucose lowering medications when examining the presence of UTIs. Those patients with a higher HbA1c or BMI showed an increased predisposition to contracting UTI. The female gender was also associated with an increased likelihood of UTI. A further evaluation of the sublot of patients taking SGLT2 inhibitors revealed that not only higher BMI or HbA1c could be a predictor for the likelihood of developing UTI, but also a longer duration of T2DM was a predisposing factor. Conclusions: The use of SGLT2 inhibitors did not increase the likelihood of developing a urinary tract infection in this patient population.

In Silico Molecular Dynamics and 3D‐QSAR Study on Thiazolidinedione Derivatives as Dual Inhibitors of DPP IV and PTP1B (DDPI's) for the Management of T2DM

AbstractSimultaneous inhibition of dipeptidyl peptidase IV and protein tyrosine phosphatase 1B as DDPI's emerged as a therapeutic intervention for the management of T2DM. In the present study, we have employed molecular dynamics simulation in conjugation with the field‐based 3D QSAR studies on a dataset having DDPI activities to identify the spatial fingerprints of target‐specific thiazolidinedione analogs. Separate contours were generated for both DPP IV and PTP1B showing respective pharmacophoric structural requirements for optimal inhibitory activity. These developed 3D QSAR models also showed good statistical measures (DPP IV: r2 = 0.9468; q2 = 0.7173, and PTP1B: r2 = 0.9718; q2 = 0.819) with the excellent predictive ability with PLS‐generated validation constraints. Comparative steric and electrostatic features were elucidated using respective contour maps for selective target‐specific favorable activity. Furthermore, molecular docking was used for elucidating the mode of binding as DDPI's to DPP IV and PTP1B, along with MD simulation (200 ns) analysis such as RMSD, RMSF, Rg, SASA, PCA, and FEL. These studies revealed that all the protein‐ligand docked complexes elicited an overall better stability as compared to reference ligand (vildagliptin or ertiprotafib) complexes. Molecular docking studies revealed that compound 24 (DPP IV: −150.667 kcal/mol; PTP1B: −142.792 kcal/mol) showed maximum affinity toward both the proteins DPP IV and PTP1B, as compared to their respective standard inhibitor, i.e., vildagliptin −99.9843 kcal/mol and ertiprotafib −125.399 kcal/mol, respectively. A comparative study of these developed multitargeted QSAR models along with molecular docking and dynamics study were employed for the optimization of drug candidates as DDPI's. Compound 24 showed most stable behavior in the binding pockets of both the enzymes, as compared to their respective standard inhibitors. This study will be helpful in designing novel DDPIs with appropriately substitute thiazolidinedione for the management of T2DM. The designed compound YSR‐14 exhibited the predicted IC50 values of 0.143 µM in DPP IV and 0.158 µM in PTP1B along with their excellent binding affinity against both targets.

Prescription patterns of oral antidiabetic agents in management of T2DM by doctors in Punjab

Prescription patterns of oral antidiabetic agents in management of T2DM by doctors in Punjab

Time to development of macrovascular complications and its predictors among type 2 diabetes mellitus patients at Jimma University Medical Center

BackgroundType 2 diabetes mellitus is a serious metabolic disease that is often associated with vascular complications. The increasing prevalence of type 2 diabetes mellitus poses significant public health challenges, particularly in Low and Middle-Income Countries where healthcare resources are often limited. In Africa, the burden of T2DM is rising rapidly, leading to a consequential increase in macrovascular complications such as cardiovascular disease and stroke. These complications not only affect the quality of life but also significantly contribute to morbidity and mortality among affected individuals. The main objective of this study was to assess the time to development of macrovascular complications and identify its predictors among type 2 diabetes mellitus patients in Jimma University medical center from 2018–2022.MethodsInstitutional-based retrospective follow-up study was conducted in Jimma University Medical Center among newly diagnosed type 2 diabetes mellitus patient from 2018, to 2022. A systematic sampling technique was used to recruit 452 records of type 2 diabetes mellitus patients. The Kaplan–Meier curve and the log-rank tests were used to determine the time to macro-vascular complications, and evaluate the significant difference in survival probability among predictors respectively. The overall goodness of the Cox proportional hazard model was checked by Cox-Snell residuals. Bivariable and multivariable cox-proportional hazard regression were used to identify the association between the variables and survival time.ResultsThe median survival time to development of macro vascular complications was 24 months. Urban residence [(Adjusted hazard ratio = 2.02; 95% CI: (1.33, 3.05)], having hypertension at start of diabetic treatment [(AHR = 1.52; 95% CI: (1.06, 2.13)], baseline age ≥ 60 years [(AHR = 4.42; 95% CI: (1.72, 11.29)], having dyslipidemia at baseline [(AHR = 1.82; 95% CI: (1.13, 2.93)], High density lipoprotein cholesterol levels < 40 mg/dl [(AHR = 2.11; (1.16, 3.81)], triglycerides > 150 mg/dl [(AHR = 1.48; 95% CI:( 1.02, 2.13)], Hemoglobin A1C level > 7% [(AHR = 1.49; 95% CI: (1.04, 2.14)], and Oral hypoglycemic agents + insulin [(AHR = 2.73; 95% CI: (1.81, 4.09)] were the significant predictors of the time to development of macro vascular complications.ConclusionFindings in this study indicated that the median time to development of macro vascular complications among type 2 diabetes mellitus patients was 24 months. Baseline age category in years, residence, presence of hypertension, presence of dyslipidemia, High density lipoprotein-cholesterol level < 40 mg/dl, triglyceride > 150 mg/dl, HgbA1C > 7% at baseline, and medication regimens were identified as independent significant predictors of the time to development of macro vascular complications among type 2 diabetes mellitus patients. The findings call attention to the role of treatment regimens, particularly the use of combination therapies involving oral hypoglycemic agents and insulin, which were associated with increased hazards for complications. High incidence of macrovascular complications within a short follow-up period underscores the need for proactive, individualized care strategies in T2DM management. By focusing on early identification of at-risk patients and tailoring treatment plans accordingly, healthcare providers can potentially improve outcomes and reduce the burden of macro vascular complications in this population.

Resistance Exercise Improves Glycolipid Metabolism and Mitochondrial Biogenesis in Skeletal Muscle of T2DM Mice via miR-30d-5p/SIRT1/PGC-1α Axis.

Exercise is a recognized non-pharmacological treatment for improving glucose homeostasis in type 2 diabetes (T2DM), with resistance exercise (RE) showing promising results. However, the mechanism of RE improving T2DM has not been clarified. This study aims to investigate the effects of RE on glucose and lipid metabolism, insulin signaling, and mitochondrial function in T2DM mice, with a focus on the regulatory role of miR-30d-5p. Our results confirmed that RE significantly improved fasting blood glucose, IPGTT, and ITT in T2DM mice. Enhanced expression of IRS-1, p-PI3K, and p-Akt indicated improved insulin signaling. RE improved glycolipid metabolism, as well as mitochondrial biogenesis and dynamics in skeletal muscle of T2DM mice. We also found that miR-30d-5p was upregulated in T2DM, and was downregulated after RE. Additionally, in vitro, over-expression of miR-30d-5p significantly increased lipid deposition, and reduced glucose uptake and mitochondrial biogenesis. These observations were reversed after transfection with the miR-30d-5p inhibitor. Mechanistically, miR-30d-5p regulates glycolipid metabolism in skeletal muscle by directly targeting SIRT1, which affects the expression of PGC-1α, thereby influencing mitochondrial function and glycolipid metabolism. Taken together, RE effectively improves glucose and lipid metabolism and mitochondrial function in T2DM mice, partly through regulating the miR-30d-5p/SIRT1/PGC-1α axis. miR-30d-5p could serve as a potential therapeutic target for T2DM management.

Modulation of Inflammatory Markers in Type 2 Diabetes Mellitus Through Gut Microbiome-Targeted Interventions: An umbrella review on meta-analyses

Background & AimsType 2 diabetes mellitus (T2DM) poses a significant global health challenge due to various lifestyle factors contributing to its prevalence and associated complications. Chronic low-grade inflammation, characterized by elevated levels of inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), plays a pivotal role in the pathogenesis of T2DM. Modulation of the gut microbiota through microbiome-targeted therapy (MTT), including probiotics, prebiotics, and synbiotics, has emerged as a potential strategy to mitigate inflammation and improve metabolic outcomes in T2DM. MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the impact of MTT on inflammatory markers in patients with T2DM. Searches were performed in PubMed, Scopus, and Web of Science databases up to June 2024, with inclusion criteria limited to English-language meta-analyses of randomized controlled trials (RCTs) assessing the effects of probiotics, prebiotics, or synbiotics on inflammatory markers in T2DM patients. ResultsTen meta-analyses met the inclusion criteria, comprising studies investigating the effects of various MTT interventions on CRP, IL-6, and TNF-α levels in T2DM patients. Meta-analysis results indicated significant reductions in CRP (SMD: -0.070; 95% CI: -0.119 to -0.020) and TNF-α (SMD: -0.370; 95% CI: -0.554 to -0.186) levels following MTT, while IL-6 reductions (SMD: -0.070; 95% CI: -0.269 to 0.129) did not reach statistical significance. However, heterogeneity in study quality, intervention protocols, and participant demographics posed challenges in interpretation. ConclusionsWhile improvements in inflammatory markers with MTT have been observed, significant limitations—such as heterogeneity in study quality and variation in intervention protocols—highlight the need for further research to confirm its efficacy and clarify underlying mechanisms. Future studies should aim to address these limitations by exploring variations in dosage, supplement formulations, and bacterial strains, which are crucial for improving the reliability and broader applicability of MTT in the management of T2DM.

The impact of GLP-1 receptor agonists on postoperative outcomes following total shoulder arthroplasty

BackgroundTotal Shoulder Arthroplasty (TSA) is a commonly performed orthopedic procedure for shoulder arthritis. Type II Diabetes Mellitus (T2DM) has been associated with negative postoperative outcomes following TSA. Glucagon-like peptide-1 receptor (GLP-1) agonists are increasingly popular drugs that have proven to be effective in the management of T2DM. To date, there is no study evaluating the complication profile following TSA of patients taking GLP-1 agonists. MethodsA retrospective cohort analysis was conducted on patients from the TriNetX Database who underwent TSA between January 2018 and December 2023. All patients had a diagnosis of T2DM at the time of index procedure. Patients were stratified into two groups according to their GLP-1 agonist prescription status. Medical complications that occurred within 90 days and surgical complications that occurred within 2 years of index procedure were collected. A univariate logistic regression analysis was conducted to examine the initial connection between the active use of GLP-1 agonists and postoperative outcomes. Subsequently, an inverse propensity score-weighted binary logistic regression was used to adjust for potential biases. ResultsA total of 8254 patients met our inclusion criteria. The “non-GLP-1” and “GLP-1” groups included 7749 and 505 patients, respectively. The use of GLP-1 agonists did not incur increased risk of any medical or surgical complications following TSA. Our unadjusted analysis demonstrated that the use of GLP-1 agonists was significantly associated with lower odds of mortality within 90 days of surgery (OR 0.17, 95% CI 0.0043-0.99, P = .0435). GLP-1 agonist use was associated with decreased risk of mortality within 90 days when subjected to inverse propensity score-weighted analysis (OR 0.077, 95% CI 0.011-0.554, P = .011). The use of GLP-1 agonists was not a predictor for any other medical or surgical complications in inverse-propensity score weighted-analysis, although decreased risk of wound dehiscence approached significance (OR 0.256, 95% CI 0.061-1.074, P = .063). ConclusionPreoperative GLP-1 agonist use is associated with reduced 90-day mortality in T2DM patients undergoing TSA, without increasing other postoperative complications. These findings support the continued use of GLP-1 agonists in perioperative management to optimize surgical outcomes in this patient population.

Exploring the Synergistic Effects of Concurrent Exercise for Managing Type-II Diabetes Mellitus: A Meta-Analysis.

The effectiveness of concurrent exercise (CE) as an emerging approach for type-II diabetes mellitus (T2DM) patients was evaluated through a comprehensive search on Google Scholar, PubMed, Pedro, CINAHL, and Medline from 2015 to March 2023. Sixteen RCTs were selected which evaluated CE (aerobic + resistance in the same session) effects on a minimum of three days/week among T2DM patients, and the control group received usual care or no exercise. Studies that evaluated at least one glycaemic variable, i.e. HbA1C, fasting blood glucose level (FBGL), andHomeostatic Model Assessment for Insulin Resistance (HOMA-IR), were eligible. Intervention with a follow-up period of ≥8 weeks, patients of any age and gender, and literature in the English language were included. A rigorous review was performed using the Cochrane Collaboration risk of bias tool (RoB 2) to minimise biases, which include the randomisation process, deviation from intended intervention, missing outcome data, outcome measurement, and selection bias. CE significantly improved HbA1C (95% CI of -0.654 to 0.363, I2 = 84.92% moderate heterogeneity), FBGL (95% CI of -0.239 to 1.145, I2 = 93.74% - high level of heterogeneity), and insulin resistance (HOMA-IR) (95% CI of -0.593 to 0.544, I2 = 92.85% - high level of heterogeneity). Collectively, findings indicate the potential of CE as an intervention to impact glycaemic control in T2DM patients positively. However, the relatively high I² values suggest notable variability among studies, and further research to explore the factors contributing to this heterogeneity, exercise protocol along with progression, and duration of diabetes are needed, which is more challenging to determine a precise dose-response relationship. Therefore, more studies are required to provide thorough insights into these components for T2DM management. Key Words: Glycated haemoglobin, Glycaemic control, Insulin resistance, Physical exercise, Type-II diabetes mellitus.

Exploring the Synergistic Effects of Concurrent Exercise for Managing Type-II Diabetes Mellitus: A Meta-Analysis.

The effectiveness of concurrent exercise (CE) as an emerging approach for type-II diabetes mellitus (T2DM) patients was evaluated through a comprehensive search on Google Scholar, PubMed, Pedro, CINAHL, and Medline from 2015 to March 2023. Sixteen RCTs were selected which evaluated CE (aerobic + resistance in the same session) effects on a minimum of three days/week among T2DM patients, and the control group received usual care or no exercise. Studies that evaluated at least one glycaemic variable, i.e. HbA1C, fasting blood glucose level (FBGL), andHomeostatic Model Assessment for Insulin Resistance (HOMA-IR), were eligible. Intervention with a follow-up period of ≥8 weeks, patients of any age and gender, and literature in the English language were included. A rigorous review was performed using the Cochrane Collaboration risk of bias tool (RoB 2) to minimise biases, which include the randomisation process, deviation from intended intervention, missing outcome data, outcome measurement, and selection bias. CE significantly improved HbA1C (95% CI of -0.654 to 0.363, I2 = 84.92% moderate heterogeneity), FBGL (95% CI of -0.239 to 1.145, I2 = 93.74% - high level of heterogeneity), and insulin resistance (HOMA-IR) (95% CI of -0.593 to 0.544, I2 = 92.85% - high level of heterogeneity). Collectively, findings indicate the potential of CE as an intervention to impact glycaemic control in T2DM patients positively. However, the relatively high I² values suggest notable variability among studies, and further research to explore the factors contributing to this heterogeneity, exercise protocol along with progression, and duration of diabetes are needed, which is more challenging to determine a precise dose-response relationship. Therefore, more studies are required to provide thorough insights into these components for T2DM management. Key Words: Glycated haemoglobin, Glycaemic control, Insulin resistance, Physical exercise, Type-II diabetes mellitus.

Plant-Based Diets and Phytochemicals in the Management of Diabetes Mellitus and Prevention of Its Complications: A Review.

Diabetes mellitus (DM) is currently regarded as a global public health crisis for which lifelong treatment with conventional drugs presents limitations in terms of side effects, accessibility, and cost. Type 2 diabetes (T2DM), usually associated with obesity, is characterized by elevated blood glucose levels, hyperlipidemia, chronic inflammation, impaired β-cell function, and insulin resistance. If left untreated or when poorly controlled, DM increases the risk of vascular complications such as hypertension, nephropathy, neuropathy, and retinopathy, which can be severely debilitating or life-threatening. Plant-based foods represent a promising natural approach for the management of T2DM due to the vast array of phytochemicals they contain. Numerous epidemiological studies have highlighted the importance of a diet rich in plant-based foods (vegetables, fruits, spices, and condiments) in the prevention and management of DM. Unlike conventional medications, such natural products are widely accessible, affordable, and generally free from adverse effects. Integrating plant-derived foods into the daily diet not only helps control the hyperglycemia observed in DM but also supports weight management in obese individuals and has broad health benefits. In this review, we provide an overview of the pathogenesis and current therapeutic management of DM, with a particular focus on the promising potential of plant-based foods.

Design and Synthesis of Ester Linked 1,2,3‐Triazole Quinoline Derivatives with Pancreatic β Cells Protective Activity against Oxidative Stress and Endoplasmic Reticulum Stress for Better Management of Type II Diabetes Mellitus

AbstractUnresolved endoplasmic reticulum (ER) stress and oxidative stress lead to the pathogenesis of type II diabetes mellitus (DM). Connecting links between the ER stress and oxidative stress pathways might play an important role in treatment and pathogenesis of diabetes. Here, we used network pharmacology approach to find the target proteins linking the ER stress and oxidative stress pathways. CHOP emerged as a hub protein from our results and was targeted by 16 newly designed and synthesized ester linked 1,2,3‐triazole quinoline derivatives by molecular docking. Drug likeliness prediction studies revealed all compounds as good druggable candidates. Compounds 5b (R = H, R1 = F), 5j (R = CH3, R1 = F), 5m (R = OCH3, R1 = H), and 5n (R = OCH3, R1 = F) were found to have considerable binding energies and active site amino acid interactions with CHOP. We further showed that compounds 5b, 5m, and 5n exhibited low toxicity with more than 50% cell survival and low IC50 values. These were therefore subjected to evaluate their effects on ER stress and oxidative stress. Finally, compound 5n (R = OCH3, R1 = F) was found to alleviate ER stress and is also a good antioxidant. Identification of such targets and compounds effective in improving ER stress and oxidative stress may provide new insights in the development of therapies and management of T2DM.

Tests employed in the psychometric validation of the Insulin Treatment Appraisal Scale (ITAS) in T2DM patients; a systematic review of the literature

BackgroundPsychological Insulin Resistance (PIR) and negative perceptions regarding insulin treatment are noteworthy challenges in T2DM management, which hinder the timely initiation of insulin treatment. To get past these obstacles a reliable tool is required to evaluate patients’ perspectives on insulin administration. Our study aims to conduct a comprehensive systematic review to evaluate the validity and reliability of different validation tests used in the psychometric validation of the ITAS in T2DM patients.MethodsA literature search was carried out, using PubMed, Google Scholar, EMBASE, Cochrane Library and Science Direct. Only those studies assessing content validity, construct validity, concurrent validity, discriminant validity, internal consistency reliability (Cronbach’ α), and items-total correlation were retrieved.ResultsA total of 14 studies illustrated the validity and reliability of ITAS in T2DM patients. Content validity results of S-CVI was 0.97, and I-CVI was 0.8–1.00. Construct validity with factor loading was greater than the threshold value of 0.3. The concurrent validity of ITAS vs. PAID, WHO-5, and SPI was 0.35 (P < 0.05), −0.14 (P < 0.05), and 0.80 (P < 0.001) respectively. The mean difference between insulin and non-insulin group was significant (P < 0.001) showing reliable discriminant validity. Reported results of Cronbach’s α for the main scale (0.79–0.89), subscale-1 (0.72–0.9), and subscale-2 (0.61–0.89) showed “good to excellent” internal consistency reliability of ITAS. Item-total correlation results for the main scale, subscale-1, and subscale-2 were (0.40–0.82), (0.31–0.74) and (0.34–0.58) respectively. Test-retest reliability of ITAS was 0.571–0.87.ConclusionsStudy findings confirm the robustness of various validation tests utilized in the psychometric validation of ITAS in T2DM patients. ITAS is a well-validated and reliable tool for determining the perspectives, PIR, and changes in patients’ perception over time and it can be used to overcome hurdles in the timely initiation of insulin treatment in T2DM patients.

A critical review on diabetes mellitus type 1 and type 2 management approaches: from lifestyle modification to current and novel targets and therapeutic agents.

Diabetes mellitus (DM) has emerged as an international health epidemic due to its rapid rise in prevalence. Consequently, scientists and or researchers will continue to find novel, safe, effective, and affordable anti-diabetic medications. The goal of this review is to provide a thorough overview of the role that lifestyle changes play in managing diabetes, as well as the standard medications that are currently being used to treat the condition and the most recent advancements in the development of novel medical treatments that may be used as future interventions for the disease. A literature search was conducted using research databases such as PubMed, Web of Science, Scopus, ScienceDirect, Wiley Online Library, Google Scholar, etc. Data were then abstracted from these publications using words or Phrases like "pathophysiology of diabetes", "Signe and symptoms of diabetes", "types of diabetes", "major risk factors and complication of diabetes", "diagnosis of diabetes", "lifestyle modification for diabetes", "current antidiabetic agents", and "novel drugs and targets for diabetes management" that were published in English and had a strong scientific foundation. Special emphasis was given to the importance of lifestyle modification, as well as current, novel, and emerging/promising drugs and targets helpful for the management of both T1DM and T2DM.

Type 1 Diabetes and Pregnancy: Challenges in Glycemic Control and Maternal-Fetal Outcomes.

Managing type 1 diabetes during pregnancy presents significant challenges due to physiological and hormonal changes. These factors contribute to major changes in insulin sensitivity, complicating efforts to achieve and sustain optimal blood glucose levels. Poorly controlled glucose levels during pregnancy can result in diabetic embryopathy and elevate the risks of maternal complications such as hypertensive disorders and diabetic ketoacidosis. Fetal complications may include preterm birth, fetal demise, and admission to neonatal intensive care units. It is essential to recognize that there is no universal approach to managing glycemic control in pregnant women with T1DM and care should be individualized. Effective management requires a multidisciplinary approach involving regular monitoring, adjustments in insulin therapy, dietary modifications, and consistent prenatal care. Continuous glucose monitoring has emerged as a valuable tool for real-time glucose monitoring, facilitating tighter glycemic control. Education and support for self-management are important in addressing these challenges. Future developments in technology and personalized approaches to care show promising potential for advancing diabetes management during pregnancy. This provides a comprehensive overview of current literature on the challenges with the management of T1DM during pregnancy, focusing on its impact on maternal and neonatal outcomes and highlighting effective strategies for achieving optimal glycemic control.

Barriers and facilitators to primary care for people living with HIV and diabetes in Harare.

People living with human immunodeficiency virus (HIV) and comorbid diabetes mellitus (DM) face significant challenges owing to the complex interplay between these chronic conditions and the need for comprehensive and integrated care. Service availability and readiness for primary care are essential for the health of individuals and populations. This study aimed to explore barriers and facilitators to the provision of care to the patients with HIV and T2DM comorbidity. The study was conducted at Primary health centres in Harare, Zimbabwe. A mixed-methods design was applied. An audit of primary care facilities identified that there was adequate infrastructure and equipment for HIV and T2DM diagnosis and treatment. However, there are gaps in the availability of essential medicines and supplies, such as test strips for blood glucose monitoring. The assessment also showed that the centres had a chronic shortage of healthcare providers, including doctors, nurses and counsellors, and there was a need for additional training and support for healthcare providers in the management of HIV and T2DM. The study concludes that the delivery of health services to patients with HIV and T2DM at primary care centres in Harare, Zimbabwe, faces significant challenges. Suggestions included improved resource allocation and multisectoral collaboration to improve the delivery of healthcare services.Contribution:The research contributes insight into disparities between urban and rural primary care facilities in providing services, emphasizing the need for targeted interventions to bridge gaps and enhance care quality.

A comparison of the Anti-diabetic Potential of Magnetized Water, Metformin, and Their Combination in A Rat Model of Type II Diabetes

DM is a collection of metabolic disorders brought on by abnormalities in secretion, action, or combination of both of insulin. Nowadays, many efforts are made to change lifestyles to get a moderate outcome with the fewest possible side effects and reduce complications. Although magnetized water (MW) has been promoted since 1930s, it has not received wide approbation since its effectiveness is still in question; however, the therapeutic potential of MW on the body has been reported. This study investigated the impact of MW supplementation on glucose, insulin, antioxidant status, inflammatory condition, DNA fragmentation and gene expression associated with the metabolism of glucose in STZ-induced diabetes in rats. Adult female Wistar rats (6 groups) were used in this study: G1: Control group+ tap water (TW); G2: Control group+ MW; G3: Diabetic group+ TW; G4: Diabetic group+ MW; G5: Diabetic group+ metformin (Met)+ TW; G6: Diabetic group+ Met+ MW. Additionally, lowering serum glucose and raising insulin level, MW consumption repaired DNA damage, enhanced antioxidant status, reduced inflammatory response, and upregulated genes linked to glucose metabolism. Furthermore, as shown by the histological analysis of pancreatic tissue sections, supplementation with MW could reverse the detrimental effects of STZ on the pancreas. This study offers novel insights into how MW consumption can help reduce T2DM by reducing hyperglycemia, restoring the equilibrium between antioxidants and oxidants, reducing inflammatory responses, and altering genes involved in glucose metabolism. Therefore, MW may be used as an adjuvant in T2DM management.

Prevalence of Thyroid Dysfunction among Patients with Type II diabetes Mellitus in Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Diabetes mellitus (DM) and thyroid dysfunction (TD) are two of the most prevalent endocrine disorders globally. Both conditions have significant effects on metabolism and are known to influence each other. Thyroid hormones play a crucial role in glucose homeostasis by affecting insulin secretion, sensitivity, and glucose metabolism.Conversely, altered glucose metabolism in diabetes can impact thyroid function, leading to a higher prevalence of thyroid disorders in diabetic patients. Understanding this relationship is important for improving the clinical management of patients with Type II DM. However, there is limited data on the prevalence of thyroid dysfunction in diabetic populations within specific regions. Methods: A cross-sectional descriptive study was conducted from February to September 2023 among 209 patients diagnosed with Type II DM at a tertiary care center after obtaining ethical approval from Institutional Review Committee(Reference No: 367 (6-11) E2). Thyroid function was assessed using thyroid-stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4) levels. Thyroid dysfunction was classified into hypothyroidism and hyperthyroidism based on standard clinical and laboratory criteria. Data management involved entry into Microsoft Excel, verification for accuracy, and subsequent analysis using SPSS version 29.Results: The study included 209 patients (61% female, 39% male), with a mean age of 65.87 ± 13.7 years. The prevalence of thyroid disorders was 77(36.8%): 53(25.3%) hypothyroidism,24 (11.4%) hyperthyroidism among patient with type II diabetes mellitus.Conclusions: Our study shows a high prevalence of thyroid disorders, especially subclinical hypothyroidism, in individuals with type 2 diabetes. Poorly controlled blood glucose (HbA1c ≥ 7.5) significantly increases the risk, underscoring the need for routine thyroid screening in T2DM management

The role of flozins in managing cardiovascular risk in patients with type 2 diabetes - narrative review

Introduction. Cardiovascular disease is a leading cause of morbidity and mortality among patients with type 2 diabetes mellitus. The emergence of flozins, a class of sodium-glucose co-transporter-2 inhibitors, has introduced a novel therapeutic avenue with potential cardiovascular benefits beyond glycemic control. Objective. This review aims to synthesize current evidence on the role of flozins in managing cardiovascular risk among patients with T2DM, examining their efficacy, safety profile, and mechanisms of action. Review methods. A comprehensive literature search was conducted using databases, covering studies published between 2015 and 2024. Clinical trials, meta-analyses, and observational studies evaluating the cardiovascular outcomes associated with flozins in T2DM patients were included. Brief description of the state of knowledge. Research shows that flozins improve glycemic control and provide significant cardiovascular protection, reducing major adverse cardiovascular events, heart failure hospitalizations, and cardiovascular mortality in T2DM patients. These benefits are likely due to hemodynamic changes, enhanced cardiac function, and reduced inflammation and oxidative stress. Summary. Flozins represent a promising therapeutic option for reducing cardiovascular risk in T2DM patients. Their dual benefits on both metabolic and cardiovascular health position them as a cornerstone in the management of T2DM. Further research is needed to fully elucidate their long-term benefits and safety in diverse patient populations.

An Evidence-Based Measure to Assess Self-Efficacy Among Adolescents With Type 1 Diabetes Mellitus in Jordan.

The purpose of the study was to assess self-efficacy among adolescents with type 1 diabetes mellitus and to identify its contributing factors using a new measure based on the International Society for Pediatric and Adolescent Diabetes Guidelines: the Type 1 Diabetes Mellitus Self-Efficacy Scale (T1DM-SES). A descriptive, cross-sectional design was used to collect data from 161 adolescents ages between 12 and 18 via an online questionnaire survey, including demographic and management-related variables and the 21 items of T1DM-SES. Results demonstrated that adolescents had high self-efficacy levels regarding the basic needs to manage their diabetes and relatively moderate and low levels regarding more sophisticated needs, such as adjusting insulin dose to correct fluctuated glucose levels, covering carbohydrates, and managing ketoacidosis at home. Adolescent females and adolescents who have working mothers or caregivers demonstrated higher levels of self-efficacy, whereas adolescents who have another family member with T1DM reported lower levels. Assessing adolescents' self-efficacy using evidence-based measures is crucial for informing health education plans. There should be a greater focus on acquiring the advanced knowledge and skills necessary for adolescents to manage the constantly evolving challenges of diabetes management. Access to health care and sufficient health insurance coverage that encompasses modern technology are fundamental for the effective management of T1DM.

A mixed methods study on non-adherence to oral antidiabetic agents in type 2 diabetes mellitus patients: Unveiling the post-intervention outcomes

Abstract Background: Type 2 diabetes mellitus (DM) is a chronic metabolic disease. Despite available treatments, non-adherence to prescribed regimens remains a significant challenge, influenced by various factors. Objective: This study aims to investigate the effectiveness of interventions targeting adherence to oral hypoglycemic agents (OHAs) in T2DM management while understanding the factors contributing to treatment failure and exploring strategies to improve medication adherence and overall disease management. Materials and Methods: A mixed research design, integrating qualitative and quantitative methods, was applied in this study. In-depth interviews and focus group discussions were conducted among 327 patients with T2DM attending the medicine department of a tertiary medical college in Bihar for 3 years. Participants were individuals (&gt;18 years) taking OHAs but experiencing symptoms despite treatment. Various intervention techniques were applied. Data analysis involved qualitative coding and categorization of interview transcripts. Results: The study revealed significant insights into the demographic profile of patients with T2DM, with notable patterns in age, gender, educational status, and employment. Forgetfulness, economic concerns, fear of adverse effects, complexity of treatment plans, non-availability of medication, and preference for alternative treatments emerged as primary barriers to adherence. Interventions led to improved adherence and diabetes management for the majority of patients, with 203 (62%) showing signs of improvement post-intervention. Conclusion: This study highlights the significance of understanding and addressing barriers to adherence in T2DM management. Despite limitations, the insights gained offer valuable directions for future research and interventions aimed at enhancing adherence and patient outcomes in T2DM treatment.