Prevention Of Type 2 Diabetes Mellitus Research Articles

Interactions between sex and the age at disease onset on cardiometabolic risk factors in a Ghanaian population with type 2 diabetes mellitus: A cross-sectional study.

The are sex differences in cardiometabolic risk factors in type 2 diabetes mellitus (T2DM) as well as the age at disease onset. However, the impact of these risk factors on the age at onset of T2DM is less known in the Ghanaian population. An understanding of the differential impact of cardiometabolic risk factors on the age at onset on T2DM may lead to sex-specific interventions in preventive and management strategies for T2DM. The study was cross-sectional from January to June 2019 at the Bolgatanga regional hospital. The study involved 163 T2DM patients (Female = 103, Male = 60), aged from 25 to 70 years. The body mass index (BMI) and the waist-to-hip ratio (WHR) were measured following standardized anthropometric techniques. Fasting venous blood samples were collected and analyzed for cardiometabolic risk factors including total cholesterol (TCHOL) and low-density lipoprotein (LDL) cholesterol. While TCHOL was higher in males than females (mean [SD]: F = .78 [1.37], M = 4.27 [1.39]) and LDL higher in females than males (mean [SD]: [F = 4.33 [1.22], M = 3.87 [1.26]), these did not, however, attain conventional statistical significance for TCHOL (t = 1.985, p = 0.05) and LDL (t = 2.001, p = 0.05). There were however, significant interactions between sex and the age at disease onset on TCHOL (t = -2.816, p = 0.006) and LDL (t = -2.874, p = 0.005), which were independent of the BMI, WHR and disease duration. The relationship between the age at disease onset and that of TCHOL and LDL were positive in females but negative in males. Fasting plasma TCHOL and LDL increases with increasing age at onset of T2DM in females but decreases in males. Strategies for the prevention and management of T2DM should be sex-specific. Females with T2DM should be given more attention regarding their fasting plasma cholesterol (total) and LDL cholesterol as they are more likely than men to have increased levels of these lipids with increasing age at disease onset.

Yoga Programme for Type2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India: A Multicenter Feasibility Randomized Controlled Trial.

Many Indians are at high risk of type2 diabetes mellitus (T2DM). The blood glucose level can be improved through a healthy lifestyle (such as physical activity and a healthy diet). Yoga can help in T2DM prevention, being a culturally appropriate approach to improving lifestyle. We developed the Yoga Programme for T2DM Prevention (YOGA-DP), a 24-week structured lifestyle education and exercise (Yoga) program that included 27 group Yoga sessions and self-practice of Yoga at home. In this study, the feasibility of undertaking a definitive randomized controlled trial (RCT) was explored that will evaluate the intervention's effectiveness among high-risk individuals in India. A multicenter, two-arm, parallel-group, feasibility RCT was conducted in India. The outcome assessors and data analysts were blinded. Adults with a fasting blood glucose level of 100-125mg/dL (i.e., at high risk of T2DM) were eligible. Participants were randomized centrally using a computer-generated randomization schedule. In the intervention group, participants received YOGA-DP. In the control group, participants received enhanced standard care. In this feasibility trial, the recruitment of participants took 4months (from May to September 2019). We screened 711 people and assessed 160 for eligibility. Sixty-five participants (33 in the intervention group and 32 in the control group) were randomized, and 57 (88%) participants were followed up for 6months (32 in the intervention group and 25 in the control group). In the intervention group, the group Yoga sessions were continuously attended by 32 (97%) participants (median (interquartile range, IQR) number of sessions attended = 27(3)). In the intervention group, Yoga was self-practiced at home by 30 (91%) participants (median (IQR) number of days per week and minutes per day self-practiced = 2(2) and 35(15), respectively). In the control group, one (3%) participant attended external Yoga sessions (on Pranayama) for 1week during the feasibility trial period. There was no serious adverse event. The participant recruitment and follow-up and adherence to the intervention were promising in this feasibility study. In the control group, the potential contamination was low. Therefore, it should be feasible to undertake a definitive RCT in the future that will evaluate YOGA-DP's effectiveness among high-risk people in India. Clinical Trials Registry-India (CTRI) CTRI/2019/05/018893; registered on May1, 2019.

A Strategy for Prevention of Type 2 Diabetes Mellitus in Guyana: The Guyana Diabetes Risk Score

Background: Type 2 Diabetes Mellitus (T2DM) imposes an enormous and mounting burden on global public health systems, especially in developing countries such as Guyana. However, primary prevention of type 2 diabetes can be achieved through organized lifestyle intervention programs for weight loss, increased physical activity and dietary restrictions. Therefore, there is a need to develop local risk stratification tools tailored to the local population to identify high-risk individuals who may benefit from these interventions. Objectives: This study proposes implementing a program for the primary prevention of T2DM in high-risk adults (18 – 55 years) in Guyana. The main objective is to identify adults at high-risk for developing type 2 diabetes mellitus using a Diabetic Risk Score and to enroll the participants in a lifestyle intervention program. Methods: The health belief model is a theoretical framework that guides health promotion programs by predicting health behaviours. A health promotion campaign will target high-risk adults at local healthcare facilities and across Guyana through television, radio and social media adverts. The health promotion adverts will inform and educate the target population to complete the Guyana Diabetic Risk Score questionnaire. If the score on the Guyana Diabetic Risk Score questionnaire exceeds 50, the participants will be enrolled in a lifestyle intervention program, 'Healthy Me'. Results and Discussion: Minor changes in lifestyle, such as a healthy diet, increased physical activity, and healthy body weight, can reduce diabetes in high-risk adults by over 50%. Conclusions: The Guyana Diabetes Risk Score is a low-cost, non-invasive, practical tool to identify individuals at high risk for T2DM in Guyana. Keywords: Type 2 Diabetes Mellitus, T2DM, Guyana Diabetes Risk Score.

Benefits of Whey Proteins on Type 2 Diabetes Mellitus Parameters and Prevention of Cardiovascular Diseases.

Type 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality, and it is a major risk factor for the early onset of cardiovascular diseases (CVDs). More than genetics, food, physical activity, walkability, and air pollution are lifestyle factors, which have the greatest impact on T2DM. Certain diets have been shown to be associated with lower T2DM and cardiovascular risk. Diminishing added sugar and processed fats and increasing antioxidant-rich vegetable and fruit intake has often been highlighted, as in the Mediterranean diet. However, less is known about the interest of proteins in low-fat dairy and whey in particular, which have great potential to improve T2DM and could be used safely as a part of a multi-target strategy. This review discusses all the biochemical and clinical aspects of the benefits of high-quality whey, which is now considered a functional food, for prevention and improvement of T2DM and CVDs by insulin- and non-insulin-dependent mechanisms.

Adapting and Developing A Diabetes Prevention Intervention Programme for South Africa: Curriculum and Tools

The South African Diabetes Prevention Programme (SA-DPP) is a lifestyle intervention targeting individuals at high risk of developing type 2 diabetes mellitus (T2DM). In this paper we describe the mixed-method staged approach that was used to develop and refine the SA-DPP intervention curriculum and the appropriate tools for local resource-poor communities. During the preparation phase, existing evidence on similar DPP interventions was reviewed, focus group discussions with individuals from the target population were conducted as part of a needs assessment, and experts were consulted. The curriculum booklet, a participant workbook and facilitator workbook were developed, and the content was evaluated by experts in the field. The design and layout of the booklet and workbooks needed to be culturally and contextually appropriate. The printed material was evaluated for readability and acceptability by participants of the target population; based on their feedback, the design and layout were refined and the printed material was translated. The suitability of the intervention was tested in a pilot study; based on feedback from the participants and facilitator, the curriculum was revised where needed and finalised. Through this process a context specific intervention and printed materials were developed. A complete evaluation of this culturally relevant model for T2DM prevention in South Africa is pending.

Antidiabetic and antioxidative effects of Lepisanthes fruticosa fruit seed extract in type 2 diabetic experimental rats

Lepisanthes fruticosa (Roxb) Leenh or locally known as ceri Terengganu is an underutilised fruit species from the Sapindaceae family. The species was previously identified as a potent antioxidant source, but scientific information is still lacking and limited to in vitro. Therefore, the present study aimed to investigate the in vivo antidiabetic and antioxidative effects of L. fruticosa fruit seed extract (LFSE) in a high-fat diet, streptozotocin (HFD/STZ)-induced Sprague Dawley rats. After 8 weeks of HFD feeding, a low-dose STZ (35 mg/kg body weight) was injected to induce type 2 diabetes mellitus (T2DM). Two dosages of LFSE (300 and 600 mg/kg body weight) were orally administered to diabetic rats for 4 weeks. High dosage LFSE (600 mg/kg body weight) showed a more pronounced effect in anti-hyperglycemic activities as indicated by both sub-chronic and acute studies. The glucose-lowering ability of LFSE was supported by its improved serum insulin level (40%) as compared to diabetic control. LFSE (600 mg/kg) also resulted in a significant (P<0.05) increase in superoxide dismutase (SOD) (20%) and catalase (CAT) (43%) activities, with a significant (P<0.05) decrease in lipid peroxidation (28%) as compared to diabetic control. With regard to lipid profile, low dosage LFSE (300 mg/kg) led to a significant (P<0.05) improvement in high-density lipoprotein cholesterol (HDL-c) (39%). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of LFSE showed the presence of various phytochemicals with antidiabetic and antioxidant properties, with α-kojibiose, genistein-7,4'-di-O-β-D-glucoside and soyacerebroside II being the predominant ones. The findings may suggest that L. fruticosa fruit seed extract is potential in reducing hyperglycaemia and enhancing antioxidant status in HFD/STZ-induced diabetic rats. Therefore, it can be concluded that L. fruticosa fruit species may be considered as a promising candidate for a new and safe alternative remedy for the prevention and treatment of T2DM.

Pattern of macronutrients intake among type-2 diabetes mellitus (T2DM) patients in Malaysia

BackgroundThe incidence of type 2 diabetes mellitus (T2DM) is rising rapidly in Malaysia. Modifying dietary intake is key to both the prevention and treatment of T2DM. This study aims to investigate the pattern of macronutrient intake among T2DM patients in Malaysia.MethodsThis study was carried out on adults aged between 35 and 70 years, residing in urban and rural Malaysian communities. A series of standardised questionnaires was used to assess the sociodemographic information, dietary intake and physical activity level of 15,353 respondents who provided informed consent to participate in this study. Blood sampling (finger prick test) and physical examination were performed to obtain blood glucose and anthropometric data, respectively. The Chi-square test was used to assess differences in the trends of macronutrient intake among T2DM patients.ResultsThe total number of participants diagnosed with T2DM in this study was 2254. Of these, 453 (20.1%) were newly diagnosed, 1156 (51.3%) were diagnosed for ≤5 years and 645 (28.6%) were diagnosed for > 5 years. Male patients show that there were significant differences among the three groups of T2DM according to the following variables: age, BMI, residency, participant comorbidity of hypertension, family history of T2DM and hypertension, and active smoker. Meanwhile, female patients show significant differences among the three groups of T2DM according to the following variables: age, BMI, marital status, education level, residency, participant comorbidity of hypertension and family history of T2DM. Most of the male patients consumed appropriate proportions of carbohydrate (458, 60.7%) and protein (618, 81.9%). However, female patients did not show any significant differences of the macronutrients intake among the three groups of T2DM patients.ConclusionsThe pattern of dietary intake among T2DM patients in this study showed consumption of carbohydrate and protein within the range of Malaysian RNI, coupled with high fat intake. Compliance with the Recommended Nutrient Intake (RNI) was satisfactory for both carbohydrate and protein but not for fat. The pattern indicated a preference for fat rather than protein when carbohydrate intake was restricted.

Associations between Conventional and Emerging Indicators of Dietary Carbohydrate Quality and New-Onset Type 2 Diabetes Mellitus in Chinese Adults.

Dietary glycemic index (GI), carbohydrate to fiber ratio (CF) and carbohydrate quality index (CQI) are conventional and emerging indicators for carbohydrate quality. We aimed to investigate the associations between these indicators and new-onset type 2 diabetes mellitus (T2DM) risk among Chinese adults. This prospective cohort study included 14,590 adults from the China Health and Nutrition Survey without cardiometabolic diseases at baseline. The associations between dietary GI, CF and CQI and T2DM risk were assessed using Cox proportional hazard regression analysis and dose-response relationships were explored using restricted cubic spline and threshold analysis. After a mean follow-up duration of 10 years, a total of 1053 new-onset T2DM cases occurred. There were U-shaped associations between dietary GI and CF and T2DM risk (both P-nonlinear < 0.0001), and T2DM risk was lowest when dietary GI was 72.85 (71.40, 74.05) and CF was 20.55 (17.92, 21.91), respectively (both P-log likelihood ratio < 0.0001). Inverse associations between CQI and T2DM risk specifically existed in participants < 60 y or attended middle school or above (both P-trend < 0.05). These findings indicated that moderate dietary GI and CF range and a higher dietary CQI score may be suggested for T2DM prevention in Chinese adults.

Interactions between structure and function of resistant glucans for alleviating type 2 diabetes mellitus (T2DM) and its complications in mice

Resistant glucan, a functional dietary fiber, has been shown to alleviate type 2 diabetes mellitus (T2DM) and its complications in clinical studies. However, the interactions between the special structure of resistant glucan and the metabolism-related pathways in T2DM have not yet been systematically studied. This study identified the structural differences between resistant glucans prepared by new and old methods. Oral gavage with two resistant glucans in T2DM mice, led to significant improvements in glucose and lipid metabolism as measured by related indicators (including gut microbiota, fecal metabolites, and physiological and biochemical indexes). According to these results, in addition to van der Waals forces, micelle formation, and hydrogen bonding, the branching structures of resistant glucans produced more hydroxyl, carbonyl, and keto groups that linked cholesterols, cholesterol esters, and low-density lipoprotein intermediates. Moreover, after lipid clearing, the metabolic environment was more conducive to the proliferation of specific gut microbiota (including Phascolarctobacterium, Prevotella, Butyricicoccus, Weissella, and Anaerostipes) with decreasing abundance ratios of Firmicutes and Bacteroides. This facilitated the synthesis of high-density lipoprotein, conversion of cholesterol into coprostanol, and production of short-chain fatty acids and bile acids. Our findings provide a foundation for comprehensive investigation of the structure of resistant glucan in the promotion and prevention of T2DM.

Dual Regulation of Sulfonated Lignin to Prevent and Treat Type 2 Diabetes Mellitus.

With the rapid increase of diabetes cases in the world, there is an increasing demand for slowing down and managing diabetes and its effects. It is considered that a viable prophylactic treatment for type 2 diabetes mellitus (T2DM) is to reduce carbohydrate digestibility by controlling the activities of α-amylase and α-glucosidase to control postprandial hyperglycemia and promote the growth of intestinal beneficial bacteria. In this work, the effects of sulfonated lignin with different sulfonation degrees (0.8 mmol/g, SL1; 2.9 mmol/g, SL2) on the inhibition of α-amylase and α-glucosidase and the proliferation of intestinal beneficial bacteria in vitro were investigated. The results showed that both SL1 and SL2 can inhibit the activity of α-amylase and α-glucosidase. The inhibition capacity (IC50, 32.35 μg/mL) of SL2 with a low concentration (0-0.5 mg/mL) to α-amylase was close to that of acarbose to α-amylase (IC50, 27.33 μg/mL). Compared with the control groups, the bacterial cell concentrations of Bifidobacteria adolescentis and Lactobacillus acidophilus cultured with SL1 and SL2 increased in varying degrees (8-36%), and the produced short-chain fatty acids were about 1.2 times higher. This work demonstrates the prospect of sulfonated lignin as a prebiotic for the prevention and treatment of T2DM, which provides new insights for opening up a brand new field of lignin.

Onchidium struma polysaccharides exhibit hypoglycemic activity and modulate the gut microbiota in mice with type 2 diabetes mellitus.

Onchidium struma polysaccharides (OsPs) are natural biologically active compounds, and our previous work showed that they can inhibit the activity of α-glucosidase in vitro, showing potential hypoglycemic activity. However, the effects of OsPs on type 2 diabetes mellitus (T2DM) in vivo remain unknown. Thus, the anti-diabetic activity of OsPs was evaluated in the present study in diabetic mice. The results showed that OsPs can significantly ameliorate the features of T2DM in mice by improving the levels of fasting blood glucose (FBG), oral glucose tolerance test (OGTT), and pro-inflammatory factors, and ameliorating insulin resistance. Furthermore, OsPs can significantly improve biochemical indicators, decrease the contents of total cholesterol (TC) and triglyceride (TG), and reduce lipid accumulation in the liver. The possible mechanism of the prevention and treatment of T2DM by OsPs may involve the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT-1) signaling pathway. OsPs can regulate the dysbiosis of gut microbiota and reverse the abundance of Lactobacillus in mice with T2DM. Moreover, OsPs significantly increased the concentration of short-chain fatty acids (SCFAs) in mice with T2DM. Our results indicate that OsPs can be used as a novel food supplement for the prevention and treatment of T2DM.

Features of the metabolism of polyunsaturated fatty acids in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a widespread disease with a high risk of cardiovascular complications, disability and mortality. The progression of T2DM is closely related to lipid metabolism disorders, caused both by insufficient intake of polyunsaturated fatty acids (PUFAs), and by a violation of their endogenous metabolism. Desaturase enzymes, FADS1/2, are involved in the regulation of PUFA metabolism. Violation of the functioning of FADS1/2 and their genes leads to a change in the biosynthesis of PUFAs and the fatty acid composition of cell membranes. The purpose of this research was to summarize the data of modern literature on the metabolism of PUFAs and the effect of FADS genetic variants on the fatty acid composition of cell membranes in T2DM. Material and methods. The search and analysis of publications was carried out using the PubMed, MEDLINE, Web of Science databases, mainly for the last 10 years, using the search keywords: polyunsaturated fatty acids, fatty acid desaturases, desaturase genes, type 2 diabetes mellitus. Results. In the pathogenesis of T2DM and its complications, many factors play a role, including impaired PUFA metabolism. A large evidence base has been accumulated on the effect of PUFAs on cardiometabolic risk factors in T2DM. The effect of desaturase activity on the fatty acid composition of cells was identified as the most important link in the metabolism of PUFAs. Focusing on the modulation of desaturase activity and studying the polymorphism of fatty acid desaturase genes may be a useful therapeutic option in the treatment of patients with T2DM and its complications. Conclusion. A promising direction of scientific research in the treatment and prevention of T2DM and its complications is the study of genetic mechanisms associated with the metabolism of PUFAs and their metabolites.

Intervention for Prevention of Type 2 Diabetes Mellitus Among Prediabetes: A Review of the Literature.

In recent decades, the prevalence and incidence of type 2 diabetes mellitus (T2DM) have increased rapidly and represent a significant public health problem worldwide. Long-term T2DM is associated with microvascular complications such as retinopathy, nephropathy, and neuropathy. Prediabetes is a state of hyperglycemia with blood glucose levels higher than normal but lower than the diabetes threshold. Several studies have demonstrated the effectiveness of lifestyle interventions that resulted in a 40% to 70% reduction in diabetes mellitus in adults with prediabetes. These interventions focused on increased physical activity and dietary changes that were able to prevent or delay the onset of T2DM in prediabetes. However, most review studies focused on interventions to prevent T2DM in high-risk groups such as obesity. There was a limitation of reports related to prediabetes. Nevertheless, it remains a high-risk condition for the development of T2DM with a conversion rate of 5% to 10% per year. Therefore, the aim of this study was to review the current evidence on intervention studies aimed at reducing the incidence of type 2 diabetes in prediabetes. The researcher conducted a literature search of common online databases such as Medline, Google Scholar, and Cochrane Library between January 2011 and December 2021. The intervention for the prevention of T2DM in prediabetes consisted of a lifestyle intervention, a nutritional supplementation intervention, and a pharmacological intervention. Several studies suggest that T2DM in prediabetes can be prevented by lifestyle modification and pharmacological interventions, or a combined intervention. However, further interventions may be needed to confirm this.

Relationship between Abdominal Obesity and Insulin Resistance, Growth Hormone, and Insulin-like Growth Factor-1 in Individuals with Type 2 Diabetes.

This experiment was designed to investigate the correlation between abdominal obesity and insulin resistance (IR), growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in patients with type 2 diabetes mellitus (T2DM). To do this experiment, 200 patients with T2DM were enrolled in this cross-sectional study. They were divided into the control group (T2DM without abdominal obesity) and the observation group (T2DM combined with abdominal obesity) according to the diagnostic criteria of abdominal obesity. General data and biochemical indices were recorded from all patients. Results showed that 97 patients (48.50%, 97/200) with abdominal obesity were included in the observation group, and 103 patients (51.50%,103/200) without abdominal obesity were included in the control group. Meanwhile, the body weight, BMI, waist circumference and waist-to-hip ratio were higher in the observation group than in the control group (P<0.05). Meanwhile, the visceral fat in the observation group, TC, and TG were higher (P<0.05) compared with the control group (Visceral Fat, 92.55±3.07 vs 87.63±3.14. TC, 5.14±0.48 vs 4.97±0.51), and TG,1.89±0.13 vs 1.53±0.16). In addition, the levels of FBG, FINS and HOMA-IR were higher (P<0.05) in the observation group than those in the control group (FBG, 13.06± 2.17 vs 10.62±2.35. FINS, 16.25±2.14 vs 13.33±3.21. HOMA-IR, 9.43±1.90 vs 6.29±2.10). However, the levels of GH and IGF-1 were lower (P<0.05) in the observation group than those in the control group (GH, 1.16±0.08 vs 1.24±0.11. IGF-1, 125.14±11.46 vs 135.71±12.33). Spearman's correlation analysis showed that abdominal obesity was positively correlated with IR (R0.372, P=0.000) in patients with T2DM, while negatively correlated with GH (R=-0.271, P=0.000) and IGF-1(R-0.219, P=0.000) levels. In conclusion, abdominal obesity in patients with T2DM is positively associated with IR, and negatively correlated with GH and IGF-1 levels. Thus, improvement of IR as well as regulating the levels of growth hormone and IGF-1 might play crucial roles in the early prevention and efficient clinical treatment of T2DM with abdominal obesity patients.

Association of Serum Antioxidant Minerals and Type 2 Diabetes Mellitus in Chinese Urban Residents.

Antioxidant minerals including zinc, copper and selenium play critical roles in the maintenance of the redox balance in the body. However, their influences on type 2 diabetes mellitus (T2DM) are still inconclusive in Chinese populations. To elucidate the relationship between antioxidant minerals and T2DM, serum zinc, copper and selenium concentrations were measured in 1443 Chinese urban residents using a 1:2 matched case-control study. Conditional logistic regression models (CLR) were used to obtain the odds ratios (ORs) and 95% confidence intervals (CIs), and restricted cubic splines (RCS) were used to examine their dose-response associations. Serum zinc (OR = 0.52 [0.35, 0.77]) and copper concentrations (OR = 0.25 [0.17, 0.37]) were negatively associated with T2DM in a fully adjusted model. An L-shaped zinc-T2DM association (Poverall association = 0.003, and Pnonlinearity = 0.005) and a negative linear copper-T2DM association (Poverall association &lt; 0.0001, and Pnonlinearity = 0.395) were observed. No association was found between serum selenium and T2DM in fully adjusted CLR or RCS models. In addition, joint associations with T2DM were identified between serum zinc and copper and between serum selenium and copper. In conclusion, our study emphasizes the importance of an adequate intake of antioxidant minerals for T2DM prevention in the Chinese population.

Screening bifunctional flavonoids of anti-cholinesterase and anti-glucosidase by in vitro and in silico studies: Quercetin, kaempferol and myricetin

Type 2 diabetes mellitus (T2DM) and Alzheimer disease (AD) are two independent non-infectious diseases, however, evidences demonstrate that insulin resistance (IR) directly affects the glucose metabolism of the central nervous system (CNS), ultimately leading to neurodegenerative disorders, such as AD. Therefore, developing anti-AD/-diabetes inhibitors with fewer side effects have become a focus of the public and pharmacologist. In this study, the inhibitory activities of 16 flavonoids and 3 standards (galantamine, donepezil hydrochloride and acarbose) on acetylcholinesterase (AChE), butyrylcholinesterase (BChE), α-glucosidase (αG) and α-amylase (αA) and their corresponding structure-activity relationships were studied by multiple methods. The results showed that, unlike the positive effect of hydroxyl group, methoxy group of flavonoids had a negative effect on the inhibitory activity of enzyme. Besides, the glycosylation of C3 and C7 significantly reduced the inhibitory effect of flavonoids, and the hydrogenation of C2 = C3 double bond also had a similar inhibitory effect. Hence, flavonols, especially quercetin, kaempferol and myricetin showed high anti-AChE/-BChE/-αG/-αA activities, and their activities had a highest correlation with their antioxidant activities, while catechin, epicatechin, and artemetin had low inhibitory activities. Furthermore, molecular docking further confirmed the C4′-OH, C5′-OH and C3–OH of flavonoids skeleton played an important role in the binding and interaction between flavonoids and enzymes. In conclusion, flavonoids with specific structures may be used as inhibitors of cholinesterase, αG and αA in the treatment and prevention of AD and T2DM.

The Correlation of Nrf2 rs6721961 Variants with the Risk of Type 2 Diabetes Mellitus and Obesity in Kurdistan of Iraq

Background: Type 2 diabetes mellitus (T2DM) is an endocrine and metabolic disease that the interaction of genetic background with environmental factors could enhance its risk. The nuclear erythroid-2-related factor 2 (Nrf2) protects cells against oxidative damage and toxicity. Objectives: This study aimed to determine the possible correlation between the Nrf2 gene variants with the risk of T2DM and obesity in the Kurdistan of Iraq. Methods: This study was conducted on 250 individuals categorized into 4 groups: 67 obese T2DM patients (body mass index (BMI) ≥ 30 kg/m2), 65 normal BMI diabetic patients (BMI &lt; 25 kg/m2), 62 obese non-diabetics, and 56 normal BMI non-diabetic individuals. The Nrf2 rs6721961 variants were identified by polymerase chain reaction (PCR) technique followed by digestion with the restriction enzyme of NgoMIV. Results: In the obese T2DM group, the levels of waist, and wrist circumference were significantly more than those of obese non-diabetic controls. Total antioxidant capacity level was not significantly different comparing patients with their controls. The Nrf2 T allele significantly decreased the risk of T2DM in normal BMI patients. In addition, carrying the T allele significantly reduced the risk of obesity. Conclusions: According to the results, significantly higher levels of anthropometric parameters was detected in obese T2DM compared with obese non-diabetic controls. The T allele of Nrf2 decreased T2DM risk among patients with normal BMI and obesity risk among Kurdish residents of Iraq. The findings of our research can be used in the prevention and management of T2DM by improving lifestyle habits.

Circulating Bone Morphogenetic Protein-9 is Decreased in Patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease.

We aimed to examine the association between bone morphogenetic protein-9 (BMP-9) and type 2 diabetes mellitus (T2DM) in conjunction with non-alcoholic fatty liver disease (NAFLD) and insulin resistance (IR) and to identify evidence supporting the potential role of BMP-9 in the clinical prevention and treatment of T2DM in conjunction with NAFLD. One hundred and twenty subjects were included in this study. We sorted all of the subjects into four groups of equal size (n=30 each). A trained expert assessed the height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) of the subjects and computed the body mass index (BMI). All subjects had their fasting blood glucose (FBG), fasting insulin (FINS), serum BMP-9, and biochemical indices assessed. Significant variations were observed in BMI, SBP, DBP, ALT, TC, TG, HDL-C, LDL-C, ApoB, FBG, FINS, HOMA-IR, and serum BMP-9 among the four groups (P<0.05). The level of serum BMP-9 was positively correlated with HDL-C, while the level of serum BMP-9 was negatively correlated with BMI, SBP, DBP, ALT, TC, TG, LDL-C, FBG, FINS, and HOMA-IR. Multiple stepwise regression analyses revealed that FINS, LDL-C, HDL-C, and BMI were independent factors impacting serum BMP-9 levels (P<0.05). Logistic regression analyses revealed that BMP-9 was a protective factor for T2DM paired with NAFLD, while HOMA-IR was a risk factor. Serum BMP-9 levels are significantly lower in the T2DM+NAFLD group when compared to other groups, and BMP-9 is an independent risk factor for T2DM paired with NAFLD.

Factors Contributing to Noncompliance With Diabetic Medications and Lifestyle Modifications in Patients With Type 2 Diabetes Mellitus in the Eastern Province of Saudi Arabia: A Cross-Sectional Study.

Type 2 diabetes mellitus (T2DM) is defined as a chronic medical condition in which the blood glucose level remains high. The risk factors of T2DM are high body mass index due to obesity or being overweight, genetics, and certain medical conditions. Lifestyle modification plays a crucial role in T2DM regulation and prevention, and if it is not controlled well by eitherlifestyle modification or DM regulatory medications, it may lead to medical complications ranging from mild to life-threatening complications. The purpose of this study is to find the contributory factors of noncompliance with oral antidiabetic drugs and lifestyle modifications in patients with T2DM in the eastern province of Saudi Arabia. This will help control one of the most widespread comorbidities that might otherwise be a significant burden on patients' health and financial status as well as on the government. A cross-sectional questionnaire studywasconducted on T2DM patients in the eastern province of Saudi Arabia through a link distributed on social media, and the contributory factors of noncompliance to diabetes medication and lifestyle modification were evaluated. A total of 426 participants were included in the study. Regarding compliance with DM medications, 199 (46.7%) participants were adherent to their medications, 148 (34.7%) were not adherent to their medication, 42 (9.9%) were sometimes adherent, and 37 (8.7%) were mostly adherent to their medication. Regarding lifestyle modification, the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. According to the participants, the most reported factors contributing to noncompliance with DM medications and lifestyle modifications were forgetfulness, lack of knowledge about diabetes and the importance of controlling it, side effects of the medications, and difficulty in following a healthy diet. Regarding the influence of sociodemographic variables on the level of adherence in T2DM patients, factors such as age, marital status, occupation, comorbidities, diagnosis period, and previous complaints of DM complications showed significant associations with compliance with DM medication. The findings of this study revealed that the level of adherence to DM medications among T2DM patients in the eastern province was suboptimal. Although free medicines were available with a high level of healthcare access through government primary healthcare centers (PHCCs), poor adherence was observed. This study highlighted that medication adherence might be affected by age, marital status, occupation, chronic diseases, diagnosis period, and previous complaints of DM complications. Regarding lifestyle modification, this study showed that the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. Our recommendation is to measure the presence of dietician clinics, patient relationships with their healthcare providers, and their effect on patient compliance with DM medications. Further research is needed to include other factors that could influence adherence, such as patient-healthcare provider communication. Moreover, it is suggested that PHCCs discuss with noncompliant patients the reasons that prevent them from adhering to their medication and lifestyle modificationsas part of their care plan.

Diabetes in HIV: the Link to Weight Gain.

The burden of metabolic diseases, including type 2 diabetes mellitus (T2DM), is rising among persons with HIV (PWH) on antiretroviral therapy (ART). This increase coincides with an aging population and a greater proportion who are overweight/obese. This review summarizes the changing epidemic of T2DM on contemporary ART, the role of weight gain, and therapeutic options. Recent studies confirm that PWH face an epidemic of obesity and T2DM, similar to the general population. Contemporary ART is associated with greater weight gain and may contribute to the risk of T2DM. Recent advances in medical weight loss therapy offer a way forward in the prevention and treatment of weight-associated T2DM. Weight gain is one of the biggest contributors to T2DM in PWH. Future studies on the role of adipose tissue distribution, adipose tissue function and clinical use of effective weight loss medications may change the paradigm of care for PWH.