Type 2 Diabetes Mellitus Outcomes Research Articles

Impact of Oral Hygiene Practices in Reducing Cardiometabolic Risk, Incidence, and Mortality: A Systematic Review

Cardiometabolic diseases share many modifiable risk factors. However, periodontitis, a chronic inflammatory condition of the gums, is a risk factor that is rarely publicized. This systematic review aims to evaluate the impact of oral hygiene practices on the risk, incidence, and/or mortality rate of cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Searches were conducted using MEDLINE, Embase, Scopus, and CINHAL. Randomized controlled trials (RCTs), quasi-RCTs, and observational studies were included. Eligible studies reported on associations of toothbrushing, interdental cleaning, mouthwash, or toothpaste use, either alone or in combination with CVD, CKD, and/or T2DM outcomes in adults ≥ 18 years. Fifty-five studies were included. Cochrane’s risk of bias tool and the Newcastle–Ottawa Scale were used for quality assessment. Data synthesis is narratively presented. Toothbrushing and interdental cleaning were associated with lower risk of developing T2DM or hypertension HR 0.54 [p < 0.001] and a lower mortality risk in those with CVD HR = 0.25 [p = 0.03]. Mouthwash use reportedly increased the risk of developing hypertension and diabetes by 85% and 55%, respectively. This review highlights how simple oral hygiene practices can reduce cardiometabolic risk. Non-dental clinicians could integrate the findings into chronic disease health promotion.

The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus-A living systematic review and meta-analysis.

While previously considered a transient condition, with no lasting adverse impact, gestational diabetes mellitus (GDM) is now a well-established risk factor for developing type 2 diabetes mellitus (T2DM). The risk of developing T2DM appears to be particularly high in the first few years after childbirth, providing a compelling case for early intervention. This review provides an up-to-date systematic review and meta-analysis to assess the effectiveness of interventions to reduce incidence of T2DM in women with a recent history of GDM. The search was conducted on October 20, 2023 with an annual surveillance planned for the next 5 years to maintain a living systematic review. The inclusion criteria were randomized controlled trials of any type in women within 5 years of GDM-complicated pregnancy that reported outcomes of T2DM diagnosis or measures of dysglycemia with a follow-up of at least 12 months. Seventeen studies met our inclusion criteria and have been included in this review. There were 3 pharmacological and 14 lifestyle interventions. Intervention was not associated with significant reduction in the primary outcome of T2DM (risk ratio, 0.78; 95% confidence interval [CI]: 0.43-1.41; p = 0.41; I2 = 79%) compared with the control group (placebo or usual care). However, meta-analysis of the four studies reporting hazard ratios suggested a reduction in diabetes incidence (hazard ratio, 0.68; 95% CI: 0.48-0.97; p = 0.03; I2 = 31%). This review provides equivocal evidence about the efficacy of interventions to reduce the risk of T2DM in women within 5 years of GDM-complicated pregnancy and highlights the need for further studies, including pharmacotherapy.

From diabetes to diverse domains: the multifaceted roles of GLP-1 receptor agonists.

Glucagon-like Peptide-1 (GLP-1) receptor agonists (GLP-1RAs) emerged as a primary treatment for type-2 diabetes mellitus (T2DM), however, their multifaceted effects on various target organs beyond glycemic control opened a new era of treatment. We conducted a comprehensive literature search using databases including Scopus, Google Scholar, PubMed, and the Cochrane Library to identify clinical, in-vivo, and in-vitro studies focusing on the diverse effects of GLP-1 receptor agonists. Eligible studies were selected based on their relevance to the varied roles of GLP-1RAs in T2DM management and their impact on other physiological functions. Numerous studies have reported the efficacy of GLP-1RAs in improving outcomes in T2DM, with demonstrated benefits including glucose-dependent insulinotropic actions, modulation of insulin signaling pathways, and reductions in glycemic excursions. Additionally, GLP-1 receptors are expressed in various tissues and organs, suggesting their widespread physiological functions beyond glycemic control potentially include neuroprotective, anti-inflammatory, cardioprotective, and metabolic benefits. However, further scientific studies are still underway to maximize the benefits of GLP-1RAs and to discover additional roles in improving health benefits. This article sought to review not only the actions of GLP1RAs in the treatment of T2DM but also explore its effects on potential targets in other disorders.

Burden of Portal Hypertension Complications Is Greater in Liver Transplant Wait-Listed Registrants with End-Stage Liver Disease and Type 2 Diabetes

Background and AimsImpact of type 2 diabetes mellitus (T2DM) in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT) remains poorly defined. The objective of the present study is to evaluate the relationship between T2DM and clinical outcomes among patients with LT waitlist registrants. We hypothesize that the presence of T2DM will be associated with worse clinical outcomes.Methods593 patients adult (age 18 years or older) who were registered for LT between 1/2010 and 1/2017 were included in this retrospective analysis. The impact of T2DM on liver-associated clinical events (LACE), survival, hospitalizations, need for renal replacement therapy, and likelihood of receiving LT were evaluated over a 12-month period. LACE was defined as variceal hemorrhage, hepatic encephalopathy, and ascites. Kaplan–Meier and Cox regression analysis were used to determine the association between T2DM and clinical outcomes.ResultsThe baseline prevalence of T2DM was 32% (n = 191) and patients with T2DM were more likely to have esophageal varices (61% vs. 47%, p = 0.002) and history of variceal hemorrhage (23% vs. 16%, p = 0.03). The presence of T2DM was associated with increased risk of incident ascites (HR 1.91, 95% CI 1.11, 3.28, p = 0.019). Patients with T2DM were more likely to require hospitalizations (56% vs. 49%, p = 0.06), hospitalized with portal hypertension-related complications (22% vs. 14%; p = 0.026), and require renal replacement therapy during their hospitalization. Patients with T2DM were less likely to receive a LT (37% vs. 45%; p = 0.03). Regarding MELD labs, patients with T2DM had significantly lower bilirubin at each follow-up; however, no differences in INR and creatinine were noted.ConclusionPatients with T2DM are at increased risk of clinical outcomes. This risk is not captured in MELD score, which may potentially negatively affect their likelihood of receiving LT.

Long-term cost-effectiveness analysis of rugby fans in training–New Zealand: a body weight reduction programme for males

ObjectivesWe sought to extrapolate the long-term costs and clinical impacts attributed to the rugby fans in training–New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand.DesignA modelled cost-effectiveness analysis using efficacy data...

Is Type 2 Diabetes Mellitus an Independent Risk Factor for Mortality in Hypertrophic Cardiomyopathy?

The mortality rate of hypertrophic cardiomyopathy (HCM) has decreased between 1999 and 2020. The risk factors for sudden cardiac death (SCD) in HCM were updated in the American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) 2020 guidelines by adding new risk factors, like the late gadolinium enhancement on cardiac magnetic resonance imaging (MRI). Type 2 diabetes mellitus (T2DM) is a major risk factor for most cardiac diseases; however, it is not included in these guidelines due to a lack of strong evidence of a correlation between T2DM and mortality in HCM. Therefore, we sought to investigate if T2DM increases the 5-year risk rate for adverse outcomes, such as heart failure and all-cause mortality in patients with HCM. We collected patient data from January 1, 2018, to March 1, 2023, using the TriNetX database. The sample included 80,502 individuals with HCM, then divided into two cohorts based on the absence (58,573; cohort 1) or presence (15,296; cohort 2) of T2DM. The two matched groups then underwent survival and risk analyses for all-cause mortality or the first incidence of heart failure diagnosis within 5 years from the point in time when the selection criteria were first met. We found a statistically significant increase in all-cause mortality and new-onset heart failure in HCM patients with diabetes compared to those without diabetes after adjusting for major risk factors. This is one of the largest retrospective cohort studies that examined the correlation between T2DM and adverse outcomes in patients with HCM. This underlines the need for future prospective studies investigating the effects of T2DM on HCM outcomes.

MAFLD as part of systemic metabolic dysregulation.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. In recent years, a new terminology and definition of metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed. Compared to the NAFLD definition, MAFLD better emphasizes the pathogenic role of metabolic dysfunction in the development and progression of this highly prevalent condition. Metabolic disorders, including overweight/obesity, type 2 diabetes mellitus (T2DM), atherogenic dyslipidemia and hypertension, are often associated with systemic organ dysfunctions, thereby suggesting that multiple organ damage can occur in MAFLD. Substantial epidemiological evidence indicates that MAFLD is not only associated with an increased risk of liver-related complications, but also increases the risk of developing several extra-hepatic diseases, including new-onset T2DM, adverse cardiovascular and renal outcomes, and some common endocrine diseases. We have summarized the current literature on the adverse effect of MAFLD on the development of multiple extrahepatic (cardiometabolic and endocrine) complications and examined the role of different metabolic pathways and organ systems in the progression of MAFLD, thus providing new insights into the role of MAFLD as a multisystem metabolic disorder. Our narrative review aimed to provide insights into potential mechanisms underlying the known associations between MAFLD and extrahepatic diseases, as part of MAFLD as a multisystem disease, in order to help focus areas for future drug development targeting not only liver disease but also the risk of extrahepatic complications.

Individuals Diagnosed With Type 2 Diabetes Mellitus and the Status of Vitamin B12 Deficiency: A Review.

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder with a multifactorial etiology and a significant global burden. In recent years, emerging evidence has suggested a potential link between T2DM and vitamin B12 deficiency, raising concerns about its impact on disease progression, management, and associated complications. This comprehensive review critically examines the current understanding of the prevalence, risk factors, clinical implications, and management strategies related to vitamin B12 deficiency in individuals diagnosed with T2DM. The review begins by providing an overview of the epidemiology of T2DM and its associated complications, underscoring the need for comprehensive management approaches. Subsequently, it delves into the physiology of vitamin B12, including its sources, absorption mechanisms, and biological functions, laying the groundwork for understanding the potential implications of deficiency in T2DM. A thorough analysis of the literature is conducted to elucidate the prevalence and risk factors of vitamin B12 deficiency in individuals with T2DM, considering factors such as age, duration of diabetes, medication use (e.g., metformin), dietary patterns, and comorbidities. Special attention is given to the role of metformin, the first-line therapy for T2DM, in precipitating or exacerbating vitamin B12 deficiency through mechanisms involving alterations in the gut microbiota and intestinal absorption. The review further explores the clinical manifestations and diagnostic challenges associated with vitamin B12 deficiency in the context of T2DM, emphasizing the importance of recognizing subtle symptoms and implementing appropriate screening protocols. It discusses the potential implications of vitamin B12 deficiency on glycemic control, diabetic neuropathy, cognitive function, cardiovascular health, and overall quality of life in individuals with T2DM. In addressing the management of vitamin B12 deficiency in T2DM, the review examines various therapeutic strategies, including oral and parenteral supplementation, dietary modifications, and lifestyle interventions. It critically evaluates the evidence supporting routine screening for vitamin B12 deficiency in individuals with T2DM and discusses controversies surrounding optimal supplementation protocols, dosing regimens, and monitoring strategies. Furthermore, the review highlights gaps in current knowledge and identifies areas for future research, such as the long-term effects of vitamin B12 supplementation on clinical outcomes in T2DM, the impact of genetic factors on vitamin B12 metabolism, and the potential role of personalized interventions. Overall, this review consolidates existing evidence and provides insights into the complex relationship between T2DM and vitamin B12 deficiency, aiming to inform clinical practice, enhance patient care, and guide future research endeavors in this important area of metabolic medicine.

The impact of type 2 diabetes mellitus on the clinical profile, myocardial fibrosis, and prognosis in non-ischemic dilated cardiomyopathy: a prospective cohort study

BackgroundThe impact of the coexistence of type 2 diabetes mellitus (T2DM) in patients with non-ischemic dilated cardiomyopathy (DCM) on clinical profiles, myocardial fibrosis, and outcomes remain incompletely understood.MethodA total of 1152 patients diagnosed with non-ischemic DCM were prospectively enrolled from June 2012 to October 2021 and categorized into T2DM and non-T2DM groups. Clinical characteristics, cardiac function, and myocardial fibrosis evaluated by CMR were compared between the two groups. The primary endpoint included both all-cause mortality and heart transplantation. Cause of mortality was classified into heart failure death, sudden cardiac death, and non-cardiac death. Cox regression analysis and Kaplan-Meier analysis were performed to identify the association between T2DM and clinical outcomes. Propensity score matching (PSM) cohort including 438 patients was analyzed to reduce the bias from confounding covariates.ResultsAmong the 1152 included DCM patients, 155 (13%) patients had T2DM. Patients with T2DM were older (55 ± 12 vs. 47 ± 14 years, P < 0.001), had higher New York Heart Association (NYHA) functional class (P = 0.003), higher prevalence of hypertension (37% vs. 21%, P < 0.001), atrial fibrillation (31% vs. 16%, P < 0.001), lower left ventricular (LV) ejection fraction (EF) (23 ± 9% vs. 27 ± 12%, P < 0.001), higher late gadolinium enhancement (LGE) presence (55% vs. 45%, P = 0.02), and significantly elevated native T1 (1323 ± 81ms vs. 1305 ± 73ms, P = 0.01) and extracellular volume fraction (ECV) (32.7 ± 6.3% vs. 31.3 ± 5.9%, P = 0.01) values. After a median follow-up of 38 months (interquartile range: 20–57 months), 239 patients reached primary endpoint. Kaplan-Meier analysis showed that patients with T2DM had worse clinical outcomes compared with those without T2DM in the overall cohort (annual events rate: 10.2% vs. 5.7%, P < 0.001). T2DM was independently associated with an increased risk of primary endpoint in the overall (Hazard ratio [HR]: 1.61, 95% CI: 1.13–2.33, P = 0.01) and PSM (HR: 1.54, 95% CI: 1.05–2.24, P = 0.02) cohorts. Furthermore, T2DM was associated with a higher risk of heart failure death (P = 0.006) and non-cardiac death (P = 0.02), but not sudden cardiac death (P = 0.16).ConclusionsPatients with T2DM represented a more severe clinical profile and experienced more adverse outcomes compared to those without T2DM in a large DCM cohort.Trial registrationTrial registration number: ChiCTR1800017058; URL: https://www.clinicaltrials.gov.

Effects of intensive glycemic control on microvascular outcomes in type 2 diabetes mellitus are modified by long-term HbA1c variability: A post hoc analysis of the ACCORD trial

AimsTo assess the impact of long-term visit-to-visit variability in HbA1c on microvascular outcomes in type 2 diabetes mellitus (T2DM), and its influence on the effects of intensive glycemic control. MethodsIncluded were participants with T2DM enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) who had at least three measurements of HbA1c prior to new-onset microvascular outcomes, namely nephropathy, retinopathy and neuropathy. Variability in HbA1c was defined as the coefficient of variation (CV) across HbA1c measurements obtained from enrollment to the transition from intensive to standard glycemic therapy. ResultsDuring a median of 22,005, 23,121, and 13,080 person-years of follow-up, 2,905 nephropathy, 2,655 retinopathy, and 1,974 neuropathy cases were recorded, respectively. Median CV (IQR) was 7.91 % (5.66 %-10.76 %) in the standard treatment group and 9.79 % (7.32 %-13.35 %) in the intensive treatment group. In the standard treatment group, lower HbA1c-CV (the first versus the second quartile) was associated with a higher risk of all microvascular outcomes, while higher HbA1c-CV (the fourth quartile) was associated with a higher risk of nephropathy only. In the intensive treatment group, only higher HbA1c-CV was associated with a higher risk of developing the microvascular outcomes. Intensive therapy reduced all microvascular outcomes among individuals with lower HbA1c-CV, but increased the risk among those with the highest HbA1c-CV (all P values for interaction < 0.0001). For example, hazard ratios (95 % CI) of retinopathy comparing intensive with standard treatments were 0.65 (0.56–0.75), 0.84 (0.71–0.98), 0.97 (0.82–1.14) and 1.28 (1.08–1.53) across the lowest to the highest quartiles of HbA1c variability. ConclusionsThe effects of intensive glycemic control on microvascular outcomes in T2DM appear to be modified by the variability of HbA1c during the treatment process, suggesting the significance of dynamic monitoring of HbA1c levels and timely adjustments to the therapeutic strategy among individuals with a high HbA1c variability.

Tracing mitochondrial dysfunction pathways in type 2 diabetes: The promise of mitochondria-targeted therapeutics

The alarmingly high global prevalence of Type 2 Diabetes Mellitus (T2DM) has made novel treatment strategies imperative. One major contributing factor to the onset of T2DM is mitochondrial dysfunction, which deteriorates cellular health, interferes with energy metabolism, and reduces insulin sensitivity. Targeting mitochondrial pathways can enhance outcomes in T2DM. Promising therapeutic benefits can be derived from strategies that target and improve mitochondrial function, biogenesis, efficient turnover, and oxidative stress reduction. Through increased mitochondrial efficiency and improved insulin action, these treatments seek to address the complex problems associated with T2DM. The complexities of mitochondrial dynamics, such as their role in energy production, appropriate regulation of cell death, and creation of reactive oxygen species (ROS), highlight the necessity of comprehensive approaches in the development of medicines that target the mitochondria. This strategy represents a step forward in the management of T2DM and highlights a promising area of cutting edge research in the hunt for potent treatments that might stop or reverse the disease's development, improving patient outcomes and care.

DRIVE for Health Equity: Tailoring Quality Improvement, Clinical Education, and Community Engagement to Improve Type 2 Diabetes (T2DM) Outcomes for Minoritized Communities in Oakland, California

Background: Type 2 Diabetes Mellitus (T2DM) is influenced by various factors, with racial and ethnic minorities experiencing higher prevalence. Existing diabetes management programs focus on primary prevention, often neglecting optimal hemoglobin A1C (HbA1c) management for individuals with prediabetes. Consistent HbA1c monitoring is crucial for comprehensive care. This study highlighted the need for secondary prevention and community collaboration to enhance health equity for individuals with T2DM. The DRIVE program, conducted by the National Minority Quality Forum's (NMQF) Center for Sustainable Health Care Quality and Equity (SHC), aimed to improve health outcomes for individuals with Type 2 Diabetes Mellitus (T2DM) in Oakland, CA. Building on prior successes in New Orleans, Los Angeles, and Queens, NY, DRIVE employs a flexible and sustainable approach that integrates quality improvement strategies at clinic sites, focusing on patient and community engagement. The study addressed barriers to medication adherence, provided Diabetes Self-Management Education and Support (DSMES), fostered community partnerships, and utilized culturally appropriate resources. The program's impact was evaluated through changes in HbA1c levels and community participation. Methods: A pre-and post-test design was used, targeting patients of Baywell Health, Oakland, CA, aged 18 and older with initial HbA1c levels greater than 9%. The intervention, developed using SHC’s DRIVE program, included components such as food distribution events, workflow enhancements, identification and mitigation of medication adherence barriers, rapid cycle improvement processes, community educational sessions, and the creation of patient resources. This two-year study implemented four Plan-Do-Study-Act (PDSA) cycles, each lasting 2-4 months, following a three-month planning phase. HbA1c levels were measured at baseline, six months after implementation, and again at 18-month follow-up. Statistical Analysis Univariate analyses described demographic data, while paired sample t-tests assessed changes in HbA1c levels. Independent sample t-tests and ANOVA with pairwise comparisons were used to determine group differences. Results: Among the 255 participants, 58% identified as female and 42% as male. The majority were Black/African American (64%) and 73% were Non-Hispanic/Latino/a, with a mean age of 55.4 years. HbA1c levels were significantly reduced from an average of 10.3±1.4 to 9.4±2.1 at follow-up. Participants who enrolled the longest showed greater reductions. Community initiatives reached over 600 individuals, demonstrating the program's effectiveness in building partnerships and sustainability. Conclusion: SHC’s DRIVE program improved T2DM outcomes through community involvement, quality improvement, and culturally tailored education. This initiative highlighted the importance of addressing health inequities and barriers in diabetes care through culturally sensitive techniques and sustained interventions. DRIVE effectively reduced disparities and promoted sustainable health outcomes among minority groups. Collaborative efforts enhanced trust and demonstrated the advancement of health equity through tailored interventions, with DRIVE providing a flexible and sustainable framework for tailoring interventions to community needs. These findings underscored the need for individualized, culturally competent diabetes care, continuous education, community engagement, and equitable resource access to support communities of color and ethnic minorities in managing T2DM effectively.

From control to remission: Empowering change in type 2 diabetes care

Madam, Pakistan currently ranks third globally in terms of its diabetic population, with approximately 33 million diagnosed cases of Type 2 Diabetes Mellitus (T2DM). Additionally, there are 11 million individuals living with impaired glucose tolerance and 8.9 million people in Pakistan are unaware that they have diabetes1. Poor dietary habits and sedentary lifestyles are the major factors contributing to Pakistan's high prevalence of diabetes2. Metformin is commonly prescribed as the leading therapeutic choice for type 2 diabetes, either as a standalone treatment or combined with insulin or other glucose-lowering therapies3. However, despite adherence to guidelines-based practices, a significant number of individuals fail to achieve remission in T2DM which has led to the exploration of alternative approaches. The DiRECT trial, which primarily involved ethnically white participants, aimed to reverse the diagnosis of T2DM and restore normal metabolic features through a weight-loss protocol. Within 12 months, nearly 50% of the participants achieved remission to a non-diabetic state and discontinued antidiabetic medications. The trial also highlighted the significant role of visceral fat in the development and remission of T2DM 4. However, the trial's lack of South Asian participants and the well-documented variations in disease severity and average body fat levels between South Asians and other populations raised concerns about its relevance to this particular group. To address this, the STANDby trial was conducted which showed that the remission rates observed in UK-based South Asians were similar to those in white cohorts5. These trials have demonstrated the possibility of achieving T2DM remission, particularly within the first six years following diagnosis. Given these findings, we propose that implementing this weight management program in Pakistan could be a suitable alternative to the current guidelines. This program effectively targets the key factors contributing to the high prevalence of diabetes in the country and emphasizes the importance of facilitating the remission of T2DM rather than just disease control. By addressing dietary habits, promoting physical activity, and targeting visceral fat reduction, this protocol can potentially bring about significant improvements in T2DM outcomes in Pakistan.

Serum 25-hydroxyvitamin D, type 2 diabetes, and liver-related outcomes: Secondary data analysis of a prospective recruited cohort.

The association of vitamin D deficiency, which is prevalent in type 2 diabetes mellitus (T2DM), with liver disease and related mortality has not been quantified. Our study aimed to (1) investigate whether there is a synergistic association of vitamin D deficiency and T2DM with liver-related outcomes and (2) explore whether high 25-hydroxyvitamin D [25(OH)D] concentrations are associated with a lower risk of liver-related outcomes in T2DM. Leveraging the data from UK Biobank, we conducted 2 studies: study I assessed the joint associations of vitamin D deficiency [25(OH)D <50nmol/L] and T2DM with liver-related outcomes among 439,276 participants, and study II explored the associations of vitamin D status with liver-related outcomes among 21,519 individuals with T2DM. Baseline T2DM was identified through medication, laboratory test, and electronic health-related records. Serum 25(OH)D was measured by direct competitive chemiluminescent immunoassay. Liver-related outcomes included 6 liver disease end points and mortality by overall liver disease, chronic liver disease, and severe liver disease. During an average follow-up duration of 11.6 years, we observed a significant positive additive interaction effect (all synergy index>1.0) of T2DM and vitamin D deficiency on the risk of liver-related outcomes. Compared with participants without either T2DM or vitamin D deficiency, the multivariable-adjusted HRs of overall liver diseases were 1.29 for participants without T2DM but with vitamin D deficiency, 1.73 for participants with T2DM but without vitamin D deficiency, and 2.19 for participants with both T2DM and vitamin D deficiency. In individuals with T2DM, we observed that participants without vitamin D deficiency were inversely associated with incident liver disease and related mortality (multivariable-adjusted HRs 0.41-0.81) when compared with individuals with vitamin D deficiency. There are positive synergistic associations of vitamin D deficiency and T2DM with liver-related outcomes. Inverse associations between serum 25(OH)D concentrations and liver-related outcomes were observed in individuals with T2DM.

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.

Sex-Related Disparities in Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Type 2 Diabetes and Heart Failure.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and heart failure (HF). In consideration of emerging evidence that there are clinically relevant sex-related differences in the course of T2DM and subsequent cardiovascular outcomes, it is unknown if SGLT2i therapy is sex-independently utilized in daily clinical practice. Methods: Patients with T2DM and HF admitted to a tertiary academic center between January 2014 and April 2020 were identified through a search of electronic health records. Data on antidiabetic therapy were acquired at discharge and were screened for SGLT2i prescription. Results: Overall, 812 patients (median age 70 years, 29.7% female) were included in the present analysis. Only 17.3% of the study population received an SGLT2i. In comparison between sexes, females show lower rates of SGLT2i prescription (11.2% vs. 19.8%, p = 0.003), despite comparable patient characteristics. Furthermore, male HF patients showed a significantly higher probability of SGLT2i prescription with an adjusted odds ratio of 2.59 (95% confidence interval 1.29-5.19; p = 0.008). Females who did not receive an SGLT2i showed higher rates of chronic kidney disease (25.2% vs. 7.4%, p = 0.039) and greater levels of N-terminal pro b-type natriuretic peptide (NT-proBNP; 2092 vs. 825 pg/mL, p = 0.011) as compared to female SGLT2i recipients, which did not explain the observed sex-related disparities. Conclusion: SGLT2i are potentially underutilized in female patients with HF and T2DM, despite an overall increasing prescription trend during the observation period. Reasons for withholding therapy could not be objectified. The present data indicate a major need to increase awareness of guideline-directed therapy, especially in female HF patients.

Moderate elevation of serum uric acid levels improves short-term functional outcomes of ischemic stroke in patients with type 2 diabetes mellitus

BackgroundSerum uric acid (SUA), an end-product of purine catabolism diffused in the blood, is positively associated with the risk of type 2 diabetes mellitus (T2DM). However, in the T2DM population, the association of SUA fluctuation (DeltaSUA) with the functional outcome of ischemic stroke (IS) is still unclear. Accordingly, this study aimed to assess the correlation between DeltaSUA and short-term IS functional outcomes in T2DM patients.MethodsAll T2DM patients diagnosed with IS in the China National Stroke Registry III were included. DeltaSUA, which was defined as the difference between the SUA levels at baseline and 3 months after symptom onset, was classified into two groups, i.e., elevated DeltaSUA (DeltaSUA > 0) and reduced DeltaSUA (DeltaSUA le 0). The outcomes measured using the Modified Rankin Scale (mRS) were scored from 0 to 6, and poor functional outcome was defined as an mRS score of 3–6 at 3 months after IS.ResultsAmong the 1255 participants (mean age: 61.6 ± 9.8 years), 64.9% were men. Patients with elevated DeltaSUA had a lower incidence of poor functional outcomes at 3 months. Compared with reduced DeltaSUA, elevated DeltaSUA at 0–50 μmol/L (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.28–0.78, p = 0.004) and 50–100 μmol/L (OR = 0.40, 95% CI = 0.21–0.77, p = 0.006) was significantly correlated with a reduced risk of poor functional outcomes at 3 months.ConclusionThis study showed that a moderate increase in DeltaSUA in the range of 0–100 μmol/L at 3 months after IS might be beneficial in T2DM adults and more studies are warranted to confirm this.

Comparison on cognitive outcomes of antidiabetic agents fortype 2 diabetes: A systematic review and network meta-analysis.

We aimed to summarise current evidence on different antidiabetic drugs to delay cognitive impairment, including mild cognitive impairment, dementia, Alzheimer's disease (AD) and vascular dementia, among subjects with type 2 diabetes mellitus (T2DM). Medline, Cochrane and Embase databases were searched from inception to 31 July 2022. Two investigators independently reviewed and screened trials comparing antidiabetic drugs with no antidiabetic drugs, placebo, or other active antidiabetic drugs on cognitive outcomes in T2DM. Data were analysed using meta-analysis and network meta-analysis. Twenty-seven studies met the inclusion criteria, including 3 randomised controlled trials, 19 cohort studies and 5 case-control studies. Compared with non-user, SGLT-2i (OR 0.41 [95% CI 0.22-0.76]), GLP-1RA (OR 0.34 [95% CI 0.14-0.85]), thiazolidinedione (OR 0.60 [95% CI 0.51-0.69]), and DPP-4i (OR 0.78 [95% CI 0.61-0.99]) users had a decreased risk of dementia, whereas sulfonylurea (OR 1.43 [95% CI 1.11-1.82]) increased dementia risk. Network meta-analysis showed that SGLT-2i was most likely to rank best (SUCRA=94.4%), GLP-1 RA second best (SUCRA=92.7%), thiazolidinedione third best (SUCRA=74.7%) and DPP-4i fourth best (SUCRA=54.9%), while sulfonylurea second worst (SUCRA=20.0%) for decreasing dementia outcomes, by synthesising evidence from direct and indirect comparisons of multiple intervention. Evidence suggests the effects of SGLT-2i≈GLP-1 RAs>thiazolidinedione>DPP-4i for delaying cognitive impairment, dementia and AD outcomes, whereas sulfonylurea was associated with the highest risk. These findings provide evidence for evaluating the optional treatment for clinical practice. PROSPERO REGISTRATION: Registration no. CRD42022347280.

Estimated Glucose Disposal Rate Predicts Renal Progression in Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

Insulin resistance is a feature of type 2 diabetes mellitus (T2DM). The estimated glucose disposal rate (eGDR), a validated marker for insulin resistance, is associated with complications of diabetes, but few studies have explored the relationship between eGDR and renal outcomes in T2DM. This study investigated the value of eGDR in predicting renal progression in T2DM. A total of 956 T2DM patients with a baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 and 5 years of follow-up were enrolled. Primary outcomes were rapid eGFR decline, eGFR <60 mL/min/1.73 m2, and composite renal endpoint consisting of 50% eGFR decline, doubling of serum creatinine, or end-stage renal disease. A continuous scale with restricted cubic spline curves and a generalized linear model were applied to evaluate the associations between eGDR and primary outcomes. Rapid eGFR decline was experienced by 23.95% of patients, 21.97% with eGFR <60 mL/min/1.73 m2, and 12.13% with the composite renal endpoint. The eGDR showed a relationship with follow-up eGFR and percentage change in eGFR (P < .001). An eGDR <6.34 mg/kg/min was an independent risk factor for rapid eGFR decline, eGFR < 60 mL/min/1.73 m2, or the composite renal endpoint(P < .05). Compared with eGDR of 5.65∼6.91 mg/kg/min, eGDR levels >8.33 mg/kg/min decreased the risk of rapid eGFR decline by 75%, eGFR < 60 mL/min/1.73 m2 by 60%, and the composite renal endpoint by 61%. Subgroup analysis was performed by sex, age, and diabetes duration, which showed that eGDR was associated with primary outcomes. Lower eGDR is a predictive factor for renal deterioration in T2DM patients.

Dietary interference for the prevention of type 2 diabetes

Medical nutrition therapy (MNT) provided by a registered dietician into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DMbased on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60–70%), proteins 20% and fats 10% that will be acceptable and beneficial in T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care.