Reduction In Fasting Blood Sugar Research Articles

Treatment with Metformin Can Improve Insulin Resistance and Lipid Profile in Non-Diabetic Iraqi Women with Polycystic Ovary Syndrome

Abstract Background: Women with polycystic ovary syndrome (PCOS) are usually at increased risk of metabolic syndrome and insulin resistance (IR), regardless of their body weight, and the development of type 2 diabetes in those women is not uncommon. Metformin is an oral hypoglycemic drug with a significant role in improving IR and lipid profile in diabetic persons without causing hypoglycemia. Objectives: To study the effectiveness of metformin in reducing body weight, IR, and lipid profile in non-diabetic PCOS women. Materials and Methods: Two hundred women with PCOS were included in the study. Serum was taken from them, and measurement of insulin level, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and lipid profile were performed as a baseline. Metformin tabs of 500 mg twice daily were given for 3 months, and measurement of the previous parameters was also performed following treatment. The results were compared between pre- and post-treatment. Results: The study showed that body mass index was not changed following 3 months of metformin intake, while there was a significant reduction in FBS, serum level of insulin, HbA1c, and Homa-IR following treatment. Together and with the exception of a non-significant mild improvement in serum high-density lipoprotein level, serum levels of cholesterol, triglyceride, and low-density lipoprotein were improved with a significant reduction following metformin treatment. Conclusion: Regardless its ability to reduce body weight, metformin can be effectively used for lowering FBS, lipid profile, and improving IR in non-diabetic PCOS women and can be used as an effective intervention to improve the quality of life in women with PCOS.

Redesigning telemedicine: preliminary findings from an innovative assisted telemedicine healthcare model

BackgroundTelemedicine holds immense potential to revolutionise healthcare delivery, particularly in resource-limited settings and for patients with chronic diseases. Despite proven benefits and policy reforms, the use of telemedicine remains low due to several patient, technology, and system-level barriers. Assisted telemedicine employs trained health professionals to connect patients with physicians, which can improve access and scope of telemedicine. The study aims to describe the design, service utilisation and chronic disease outcomes following the implementation of an assisted telemedicine initiative.MethodsThis is an observational implementation study. Barriers and potential solutions to the implementation of telemedicine were identified through interviews with key stakeholders. The assisted telemedicine solution using an interoperable platform integrating electronic health records, point-of-care diagnostics, and electronic clinical decision support systems was designed and piloted at three telemedicine clinics in Tamil Nadu, India. Nurses were trained in platform use and facilitation of tele-consultations. Health records of all patients from March 2021 to June 2023 were included in the analysis. Data were analysed to assess the utilisation of clinic services and improvements in health outcomes in patients with diabetes mellitus and hypertension.ResultsOver 2.4 years, 11,388 patients with a mean age of 45 (± 20) years and median age of 48 years, predominantly female (59.3%), accessed the clinics. The team completed 15,437 lab investigations and 26,998 consultations. Among 5542 (48.6%) patients that reported chronic conditions, diabetes mellitus (61%) and hypertension (45%) were the most frequent. In patients with diabetes mellitus and hypertension, 43% and 75.3% were newly diagnosed, respectively. Diabetes mellitus and hypertension patients had significant reductions in fasting blood sugar (-33.0 mg/dL (95% CI (-42.4, -23.7, P < 0.001)), and systolic (-9.6 mmHg (95% CI (-12.1, -7.0), P < 0.0001)) and diastolic blood pressure (-5.5 mmHg (95% CI (-7.0, -4.08), P < 0.0001)) at nine months from first visit, respectively.ConclusionsThe ‘Digisahayam’ model demonstrated feasibility in enhancing healthcare accessibility and quality by bridging healthcare gaps, diagnosing chronic conditions, and improving patient outcomes. The model presents a scalable and sustainable approach to revolutionising patient care and achieving digital health equity, with the potential for adaptation in similar settings worldwide.

Enhancing glycaemic control and promoting cardiovascular health: the therapeutic potential of Trigonella foenumgraecum in diabetic patients – a systematic review and meta-analysis

Background: The antidiabetic potential of fenugreek has been highlighted in past literature, and various in-vitro and in-vivo studies have validated its glucose-lowering effects; however, very limited data are available on its effects on diabetic patients. Objective: An updated systematic review and meta-analysis of randomized control trials that assessed patients who were administered fenugreek. Methods: The PRISMA guidelines (Supplemental Digital Content 1, http://links.lww.com/MS9/A361) were followed when conducting this meta-analysis. PubMed, Scopus, Google Scholar and MEDLINE were searched from inception until June 2023, for randomized control trials that compared fenugreek with control in patients with type 2 diabetes mellitus (DM) and reported the following outcomes of interest: fasting blood glucose, glycated haemoglobin A1c (HbA1c) and postprandial glucose levels. The findings were presented as mean difference (MD) with 95% confidence intervals (CIs) and were pooled using a random effects model. Results: Fenugreek significantly (P&lt;0.001) reduced the fasting blood sugar (FBS), HbA1c levels and postprandial glucose levels in diabetic patients when compared to the control. Conclusion: Among patients with type 2 DM, our comparisons demonstrated a reduction in FBS, HbA1c levels and postprandial glucose levels with the administration of fenugreek seed at 2–5 mg dose in powder form.

A Study to Evaluate the Effect of Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors on Oxidative Stress Parameters in Type 2 Diabetes Mellitus Patients.

Introduction Diabetes mellitus (DM) is a global health issue with 50 million diabetics currently residing in India. Hyperglycemia causes tissue damage due to mitochondrial overproduction of reactive oxygen species. Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) have shown a decrease in oxidative stress by either amelioration of free-radical generation or potentiation of cellular antioxidative capacity in preclinical studies. However, there is a paucity of published clinical studies. Hence, this study was undertaken to evaluate the effect of co-administration of SGLT2i with other drugs on oxidative stress in type 2 DM (T2DM) patients. Methods A prospective, parallel, open-label study in T2DM patients attending endocrinology OPDwas conducted for a period of 12 months. At the clinician's discretion, patients were grouped as SGLT2i as an add-on to standard drugs vs standard drugs alone. Blood samples were collected at baseline and at the end of 12 weeks to estimate malondialdehyde (MDA), nitric oxide (NO), and glutathione (GSH) levels. Secondary parameters - glycemic indices and lipid profile - were estimated every four weeks. Results A total of 32 patients were enrolled in the study (16 per group). There was a significant decrease in MDA (p < 0.05) and NO (p < 0.01) and a highly significant increase in GSH (p < 0.001) at 12 weeks from baseline in the SGLT2i group. A reduction in fasting blood sugar (FBS) and post-prandial blood sugar (PPBS) and a 0.56% difference in HbA1c were also noted in the SGLT2i group.Significant lowering of low-density lipoprotein (LDL, p < 0.05) and elevation in HDL levels (p < 0.05) from baseline was seen in the SGLT2i group. Conclusion Co-administration of SGLT2i with antidiabetic drugs demonstrated a significant effect in improving oxidative stress biomarkers and glycemic and lipid profiles among T2DM patients.

ROSELLE CALYX (HIBISCUS SABDARIFFA. L) AS AN ANTI-DIABETIC: ETHYL ACETATE FRACTION REDUCE FASTING BLOOD GLUCOSE TOTAL CHOLESTEROL AND REPAIR PANCREAS FUNCTION ON DIABETIC MODEL

Objective: In general, people with diabetes mellitus will experience disturbances in fat metabolism that lead to hypercholesterolemia. This study aims to determine the effect of ethyl acetate fraction hibiscus calyx on blood sugar, blood cholesterol level, and pancreas histology in diabetic Wistar Kyoto rats induced by streptozotocin.&#x0D; Methods: Thirty-six Wistar Kyoto rats were induced with intra-peritoneal streptozotocin at 55 mg/kg BW and stabilized for five days to obtain diabetic conditions. Diabetic animals were divided into four groups; the diabetic group was given vehicle, the glibenclamide group was given 0.45 mg/kg BW of Glibenclamide, and two groups were administered the ethyl acetate fraction of hibiscus calyxes (EAFHC) at doses of 100 mg/kg BW and 200 mg/kg BW for five days. Fasting blood sugar and lipids (total cholesterol and triglycerides) were measured on days 0, 1, 3, and 5. Pancreats were collected on days 1, 3 and 5 for weighing and histology examination. All data were analyzed using two-way ANOVA followed by the Duncan Multiple Rank Test (DMRT).&#x0D; Results: EAFHC significantly reduced fasting blood sugar and total cholesterol (p&lt;0.05) but did not have a significant effect on triglycerides (p&gt;0.05). Histology examination showed that EAFHC repaired pancreatic damage, as seen from the decrease in pancreatic histology scores (p&lt;0.05), but the organ ratio did not show a significant improvement (p&gt;0.1). &#x0D; Conclusion: This study revealed that EAFHC could be an alternative medicine in managing blood sugar levels and total cholesterol and improving pancreas function in associated models of diabetes mellitus hypercholesterolemia complications.

Quercetin analogs as α-glucosidase inhibitors with antidiabetic activity

This study investigated the inhibitory effects of synthesized quercetin analogs (Q1–Q23) on α-glucosidase, particularly Q7. Q7, a synthetic analog of quercetin, exhibits superior α-glucosidase inhibitory properties compared with quercetin and the standard drug acarbose. This effect is attributed to the unique –CF3 group on the benzene ring of Q7, which enhances its inhibitory effect. As a non-competitive inhibitor, Q7 shows strong binding and stability within the α-glucosidase-Q7 complex. In vivo experiments showed that Q7 significantly reduced fasting blood sugar levels in diabetic mice, surpassing the effects of metformin. In addition, it affects the gut microbiota, particularly the microbes associated with anti-inflammatory responses and short-chain fatty acid production, which are crucial for the treatment of type 2 diabetes. However, the current Q7 dosage led to carbohydrate accumulation in the colon of mice, impairing the function of the intestinal microbiota. This study highlights the potential of Q7 for treating type 2 diabetes and emphasizes the need to determine the optimal dosages that balance therapeutic effects and gut health.

Effect of Cynara scolymus L. on Cardiometabolic Outcomes: An Updated Meta-analysis of Randomized Controlled Trials and Meta-regression

Background Artichoke ( Cynara scolymus L.) has the potential to treat diabetes, dyslipidemia, hypertension, and obesity. However, the evidence from previous studies is not consistent. Objectives This meta-analysis evaluated the efficacy of products derived from artichokes on blood glucose, lipid level, blood pressure, and anthropometric parameters. Methodology The literature was reviewed via international databases (PubMed, ScienceDirect, and Scopus). A total of 21 RCTs with high quality, assessed by the Cochrane risk-of-bias tool, were included. Results Artichoke was linked to a significant reduction in fasting blood sugar (FBS) (WMD: −3.76 mg/dL: 95%CI −7.31, −0.22), insulin level (WMD: −1.35 mIU/L: 95%CI −2.29, −0.41), and HOMA-IR (WMD: −1.00: 95%CI −1.95, −0.06). Similar results were observed for LDL-c (WMD: −12.94 mg/dL: 95%CI −18.02, −7.87), total cholesterol (TC) (WMD: −19.64 mg/dL: 95%CI −23.94, −15.35), and triglyceride (TG) (WMD: −13.36 mg/dL: 95%CI −19.06, −7.66). Moreover, participants who administered artichoke experienced a significant reduction in SBP (WMD: −1.59 mmHg: 95%CI −3.02, −0.16), body weight (BW) (WMD: −1.17 kg: 95%CI −1.75, −0.60), and BMI (WMD: −0.30 kg/m2: 95%CI −3.02, −0.16). Conclusion Artichoke may improve blood glucose, lipid profile, blood pressure, and anthropometric parameters. A large, well-designed RCT and head-to-head comparison using a standardized preparation of artichoke will provide definitive data on specific participants.

Long-term effects of warm water immersion on kidney tissue damage in diabetic rats.

This study aimed to investigate the effects of Warm Water Immersion (WWI) on inflammation, kidney function, and kidney tissue damage in rats with diabetes mellitus (DM). Forty male rats were divided into four groups: Healthy Control (HC), Diabetic Control (DC), Diabetic Rats treated with WWI (DW), and Healthy Rats treated with WWI (HW). Daily 15-minute WWI sessions at 43 °C were administered for eight weeks. Various parameters including lipids, fasting blood sugar (FBS), HbA1C, insulin, advanced glycation end products (AGEs), HSP70, glomerular filtration rate (GFR), urinary albumin excretion, creatinine, blood urea nitrogen (BUN), oxidative stress, anti-oxidant parameters, and gene expression of RAGE, VEGF, and TGFß1 were assessed. Histological examination of kidney tissue was also conducted. Significant reductions in FBS, AGEs, glutathione, superoxide dismutase (SOD), and nitric oxide (NO) levels were observed in the DW group compared to DC. Expression of RAGE, VEGF, and TGFß1 genes decreased in DW. Triglycerides, total cholesterol, and LDL cholesterol were lower in DW. Insulin, HDL cholesterol, catalase, total anti-oxidant capacity (TAC), and tissue HSP70 were higher in DW. Histological assessment revealed reduced kidney damage in DW compared to DC. WWI for eight weeks shows promise in mitigating diabetic nephropathy in rats, suggesting its potential as a non-invasive adjunctive therapy for managing diabetes complications.

Effect of Teneligliptin in comparison with Voglibose as an add on therapy in reducing microvascular complications in type II Diabetes Mellitus patients – A Prospective randomized control trial

Background: The strict glycaemic control postpones all the microvascular and macrovascular complications. In type 2 diabetes the initiation of metformin is the cornerstone in reducing blood sugar. The next option is either insulin or oral hypoglycaemic agents. The DPP-4 inhibitors like gliptins have the advantages of less incidence of hypoglycaemia, good safety profile and can be combined to any oral hypoglycaemics. The meta-analysis showed that teneligliptin has less adverse profile in number of Japanese and Korean studies. It was proved that the fasting glucose and postprandial glucose substantially reduced with a potential benefit of reducing cholesterol, thereby reducing the risk of cardiovascular diseases. The advantage of using this drug as is does not worsen the hepatic and renal status. Voglibose an α-glycosidase inhibitors delay the glucose absorption from GIT hence effective in reducing postprandial hyperglycaemia. Methods: This prospective randomized controlled study was designed to compare the efficacy of teneligliptin and voglibose as an add on therapy on patients with uncontrolled blood sugar in addition to metformin 500mg BD and glimepiride 2 mg OD. Totally 80 patients were included between the age groups of 40 to 70 years. Patients were divided into two groups 40 patients each, group A were given teneligliptin and group B patients were given voglibose for a period of 6 months. At the end of 3rd month and 6th month investigations were done for FBS, PPBS and HbA1c.Statisticalmethods: Data were tabulated and results were analysed by using Analysis of Variance. AP value of &lt;0.05 was considered as statistically significant. Results: At the end ofsix months group II showed significant reduction in fasting blood sugar and post-prandial blood sugar level. A significant reduction in FBS, PPBS, HbA1c is seen in both the groups, where teneligliptin has a favourable glucose reduction along with voglibose. Conclusions: Our study concludes that teneligliptin is better than voglibose as the 2nd line add on therapy to sulphonylureas, metformin or insulin.

The effect of alpha-lipoic acid supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in individuals with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials.

This systematic review and meta-analysis aimed to examine the effect of the antioxidant alpha-lipoic acid (ALA) on various cardiometabolic risk factors and hormonal parameters in patients with polycystic ovary syndrome (PCOS). We searched PubMed, EMBASE, SCOPUS, Cochrane Library, and Web of Science databases without language restrictions until May 2023 to find randomized controlled trials (RCTs) that assessed the impact of ALA supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in women with PCOS. Outcomes were summarized using the standardized mean difference (SMD) and 95% confidence interval (CI) in a random-effects model. An I2 statistic of >60% established significant between-study heterogeneity. The overall certainty of the evidence for each outcome was determined using the grading of recommendations, assessment, development, and evaluations system. Seven RCTs met the inclusion criteria. The ALA group had significant reductions in fasting blood sugar (fasting blood sugar (FBS), n=7 RCTs, SMD, -0.60; 95% CI, -1.10 to -0.10; I2=63.54%, moderate certainty of evidence) and homeostatic model assessment for insulin resistance (homeostatic model assessment of insulin resistance (HOMA-IR), n=4 RCTs, SMD, -2.03; 95% CI, -3.85 to -0.20; I2=96.32%, low certainty of evidence) compared with the control group. However, significant differences were observed between the groups in body mass index, insulin, estrogen, follicle-stimulating hormone, luteinizing hormone, testosterone, low-density lipoprotein, highdensity lipoprotein, triglyceride, total cholesterol, malondialdehyde, or total antioxidant capacity profiles. ALA supplementation improves FBS and HOMA-IR levels in women with PCOS. ALA consumption is an effective complementary therapy for the management of women with PCOS.

Effectiveness of telehealth on the glycemic control of patients with type 2 diabetes mellitus during the COVID-19 pandemic: A systematic review and meta-analysis of randomised controlled trials

BackgroundDuring the COVID-19 pandemic, telehealth was employed to enhance clinical outcomes for patients with type 2 diabetes mellitus. However, the effectiveness of telehealth remains inconclusive. ObjectiveThis study aimed to examine the impact of telehealth on the glycemic control of individuals with type 2 diabetes mellitus during the pandemic. DesignA systematic review and meta-analysis of randomized controlled trials. SettingN/A ParticipantsA total of 669 studies was sourced from electronic databases, including EMBASE, PubMed, and Scopus. Among these, twelve randomized controlled trials, comprising 1498 participants, were included. MethodsA comprehensive search was performed in electronic databases. The quality of the included studies was assessed using the Cochrane Risk of Bias tool, and statistical heterogeneity was assessed using I² and Cochran's Q tests. A random-effects model was utilized to combine the outcomes. Grading of Recommendations, Assessment, Development, and Evaluations was used to evaluate the certainty of the evidence. ResultsThe meta-analysis showed that participants receiving a telehealth intervention achieved a greater reduction in the glycated haemoglobin (HbA1C) compared to those receiving usual care, with a weighted-mean difference of -0.59 (95 % CI -0.84 to -0.35, p < .001, I² = 74.1 %, high certainty of evidence). Additionally, participants receiving telehealth interventions experienced better secondary outcomes, including a reduction in fasting blood sugar (16.06 %, 95 %CI -29.64 to -2.48, p = .02, high certainty of evidence), a decrease in body mass index (1.5 %, 95 %CI -1.98 to -1.02, p < .001, high certainty of evidence), and a decrease in low-density lipoprotein (7.8 %, 95 %CI -14.69 to -0.88, p = .027, low certainty of evidence). ConclusionsIn our review, we showed telehealth's positive impact on glycaemic control in type 2 diabetes mellitus patients. Healthcare professionals can use telehealth in diabetes care. Caution is needed due to heterogeneity of the results. Further research should explore the long-term impacts of telehealth interventions. RegistrationThe study was registered with PROSPERO, CRD42022381879.

Menthol Attenuates Cholinergic Dysfunction and Neurotransmitter Imbalance in Experimental Diabetes

One of the most predominant enduring consequences of Diabetes Mellitus (DM) is Diabetic Encephalopathy (DE), which has neither a reliable treatment nor an effective preventive strategy. Cognitive dysfunction is the primary problem allied with DE. The current inquiry aims to determine the potency of menthol in reducing the risk of brain complications induced by Streptozotocin (STZ) in diabetic rats. A single STZ intraperitoneal injection (40 mg/kg body weight) was employed to induce DM in Sprague-Dawley male rats and animals were held without treatment for 30 days to develop DE. The Morris water maze test, followed by the supplementation of menthol and metformin for 60 days at 50 and 100 mg/kg body weight dosages, verified the cognitive deficit in diabetic rats. After 60 days of therapy, rats were sacrificed to obtain blood and brain tissues for biochemical investigation. Oral delivery of menthol enhanced cognitive function in DE rats. Furthermore, menthol markedly reduced fasting blood sugar, glycosylated Hemoglobin (HbA1c), and elevated plasma insulin levels. In the brain, menthol increases neurotransmitter levels and choline acetyltransferase activity while decreasing AChE activity. Menthol also downregulated the expressions of monoamine oxidase A and B. Thus, the study indicates that menthol was effective in attenuating the neurodegenerative alterations in DE rats. It had a therapeutic potential and could be effectively utilized as a dietary supplement for regulating complications associated with encephalopathy.

Effect of concurrent resistance-aerobic training on inflammatory factors and growth hormones in children with type 1 diabetes: a randomized controlled clinical trial

BackgroundExercise training is a major factor in controlling type 1 diabetes mellitus (T1DM) in children. The present study aimed to assess the effect of concurrent resistance-aerobic training on selected inflammatory factors and hormones related to blood glucose homeostasis in children with T1DM.MethodsIn this randomized controlled clinical trial, 40 children (with the mean age of 11.11 ± 2.29 years) were randomly assigned to an experimental (N = 20) or control group (N = 20). They underwent a 16-week training program, composed of concurrent resistance-aerobic training performed intermittently for 60 min three times a week. Before and after training, blood samples were analyzed for glucose homeostasis, selected inflammatory factors, and growth factors. Data were analyzed by paired t-test and analysis of covariance (ANCOVA) in IBM SPSS version 22.ResultsThe exercise training intervention reduced fasting blood sugar index (P = 0.002) and glycosylated hemoglobin significantly (P = 0.003). The growth hormone levels were increased significantly only in the experimental group (P = 0.037), whereas no significant difference was noted in the insulin-like growth factor-1 (P = 0.712). It was also found that interleukin-1β and high-sensitivity C-reactive protein did not change in the experimental or control group as compared to the pretest (P > 0.05).ConclusionAs it was shown, it seems that concurrent resistance-aerobic training may improve blood glucose homeostasis and growth hormone. Therefore, these findings may suggest the benefit from exercise training of moderate intensity in children with T1DM. Besides, we recommend undertaking further clinical trials to determine if the exercise training was effective.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials under the code IRCT20150531022498N30: https://en.irct.ir/trial/41031. Registered on July 26, 2019. All experiments on the participants were following the Declaration of Helsinki.

Combined Antidiabetic and Antidyslipidemic Activity of Ageratum conyzoides and Gynura procumbens in Alloxan-induced Diabetic Rats

Unhealthy lifestyle habits greatly increase the risks of various degenerative illnesses, for example, diabetes mellitus as well as dyslipidemia. Recent studies have shown that the pharmaceutical drugs used for the treatment of these conditions have undesirable side effects. This indicates that it is necessary to find more effective and safe alternative treatment options, particularly in medicinal plants, such as Ageratum conyzoides and Gynura procumbens. Therefore, this research examined the combined antidiabetic and antidyslipidemic activity of Ageratum conyzoides and Gynura procumbens extracts in alloxan-induced diabetic rats. The insulin sensitivity of the test animals was assessed at the beginning of the experiment using the oral glucose tolerance test (OGTT) through the administration of 3 g/kgBW glucose. Pancreatic destruction was induced with the intraperitoneal injection of a single dose of 150 mg/kgBW alloxan, and the rats were treated with ethanol extract for 14 days. High-density lipoprotein cholesterol (HDL-C), Triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were measured using the enzymatic method. The results showed that the single extracts and their combination exhibited high antidiabetic and antidyslipidemic activity. This was indicated by a substantial reduction in fasting blood sugar, TG, TC, and LDL-C (p&lt;0.05), and an insignificant increase in HDL-C. The activity of the combined extract was similar to the single extracts, but it was not better in decreasing TG levels. Based on these findings, 95% ethanol extract of Ageratum conyzoides, Gynura procumbens, and their combination exhibited high antidiabetic and antidyslipidemic activity in alloxan-induced rats.

EFFECTIVENESS OF ZINC SUPPLEMENTATION FOR TYPE II DIABETES PREVENTION: A SYSTEMATIC REVIEW

Background: The incidence of prediabetes is predicted to continue to increase. Approximately 25% of prediabetes patients develop type 2 diabetes mellitus (T2DM) within 3–5 years. Zinc is known to have a role in the synthesis, storage, secretion, and action of the insulin hormone.&#x0D; Purpose: The aim of the study is to know about the impact of zinc supplementation in type 2 diabetes mellitus (DM) prevention.&#x0D; Methods: A systematic literature search was performed using the PubMed, Cochrane, and EBSCOHost search engines. The inclusion study includes systematic review and metaanalysis of randomized clinical trials study and randomized clinical study, and we only include the research of the last 10 years.&#x0D; Results: Three RCTs were selected from 175 articles to undergo a critical review with a total of 353 patients with a duration of 6-12 months (level of evidence II-III). The incidence of T2DM in the intervention group decreased significantly (OR: 0.37 [95% CI 0.7-0.8]; RR: 0.44; ARR: 14% [95% CI 3.5-24.5%]; NNT: 7.14 [4-29]) in one study. Zinc supplementation significantly reduced Fasting Blood Sugar (FBS) in two studies (mean difference -17.3 and -5.76) and oral glucose tolerance test (OGTT) in one study (MD -22.6).&#x0D; Conclusion: Administration of zinc in prediabetes patients to prevent the development of T2DM still requires further study with a larger sample, longer duration, and control variables by design and statistics.

Effects of Vincamine on Testicular Dysfunction in Alloxan-induced Diabetic Male Rats.

Diabetes mellitus (DM) is frequently linked with problems of several organ systems, including retinopathy, neuropathy, and nephropathy. Additionally, patients have changes in sexual functioning, such as decreased libido and fertility. Vincamine, a monoterpenoid indole alkaloid, has hypoglycemic and antioxidant effects. This research assessed the impact of vincamine on testicular dysfunction in alloxan-induced male rats by measuring fasting blood glucose, oxidative stress, seminal analysis, and histological examination of the testis. Wister-albino male rats were randomized into the following groups at random: Untreated-healthy, untreated-DM, vincamine-treated (20 mg/kg) DM, vincamine-treated (40 mg/kg) DM, and clomiphene-treated DM (5 mg/kg). On day 14, rats were sacrificed, and semen/blood samples were collected. Sperm count, motility, and morphological abnormalities were noted by microscopic examination. The testis was examined histopathologically and assessed using Johnsen's score. Compared with the untreated diabetic group, a dosage of 40 mg/kg vincamine generate a significant reduction in fasting blood sugar (FBG). Compared with the untreated diabetic group, the vincamine-treated rats produced greater plasma testosterone levels and Johnsen scores. In the vincamine 20 mg/kg group, sperm concentration was higher than in the vincamine 40 mg/kg group. It is possible that vincamine has a potential preventive effect against diabetes-related reproductive problems attributable to its antioxidant activity and capacity to restore testicular steroidogenesis.

The Effect of L-Citrulline Supplementation on Outcomes of Critically Ill Patients under Mechanical Ventilation; a Double-Blind Randomized Controlled Trial.

Effective parenteral and enteral amino acid replacement is crucial for critically ill patients with altered amino acid metabolism. This study aimed to assess the effects of l-citrulline supplementation on the clinical and laboratory outcomes in critically patients. This was a double-blind placebo-controlled randomized clinical trial. 82 critically ill patients who were expected to receive mechanical ventilation for more than 72 hours were selected. The patients were assigned to either a placebo or an intervention group. The patients in the placebo group received 10 gr of microcrystalline cellulose and the ones in the intervention group were given l-citrulline daily for 7 days. Serum levels of fasting blood sugar (FBS), lipid profile, hepatic enzymes, serum electrolytes, urea nitrogen, creatinine, and C-reactive protein (CRP) were evaluated before and after the intervention. Duration of invasive ventilation, intensive care unit (ICU) length of stay, ventilator-free days, and 28-day mortality rate were recorded and compared between groups. Eighty-two patients completed the trial. No statistically significant differences were observed between the two groups in terms of age (p = 0.46), sex (p = 0.49), body mass index (BMI) (p = 0.41), Sequential Organ Failure Assessment (SOFA) Score (p = 0.08), Clinical Pulmonary Infection Score (CPIS) score (p = 0.76), Acute Physiology and Chronic Health Evaluation (APACHE II) score (p = 0.58), risk factors (p = 0.13), ICU stay before randomization (p = 0.32), and reason of admission (p = 0.50) before the intervention. Citrulline group had a notable reduction in FBS (p = 0.04), total cholesterol (TC) (p = 0.02), low density lipoprotein (LDL-C) (p <0.001) and high-sensitivity CRP (hs-CRP) (p <0.001). Also, a significant increase in lactate dehydrogenase (LDH) concentration (p <0.001) was observed in the intervention group at the end of the trial. Total duration of invasive ventilation and the mean SOFA score on 7th day were significantly lower in the citrulline group compared to the control group. Moreover, a significant increase in days alive and ventilator-free days within 28 days after admission was found in the citrulline group at the end of the trial. Also, there were no significant differences between the groups in terms of mortality rate during intervention, serious adverse events, endotracheal intubation, the use of tracheotomy or non-invasive ventilation after extubation, length of ICU stay, ICU-free days at 28 days, and CPIS and APACHE II scores. For mortality, in the citrulline group, there was two deaths compared to eight deaths in the control group. This resulted in an absolute risk reduction (ARR) of 14.05% (95% CI: 0.39-27.71%) and a number needed to treat (NNT) of 7.1 (95% CI: 3.6-29.5), regarding mortality. The results of the present study demonstrated the probable positive effects of citrulline supplementation on lipid profile, hs-CRP levels, duration of invasive ventilation, and SOFA score. Also, l-citrulline consumption may increase the probability of survival without mechanical ventilation.

A novel method to derive personalized minimum viable recommendations for type 2 diabetes prevention based on counterfactual explanations.

Despite the growing availability of artificial intelligence models for predicting type 2 diabetes, there is still a lack of personalized approaches to quantify minimum viable changes in biomarkers that may help reduce the individual risk of developing disease. The aim of this article is to develop a new method, based on counterfactual explanations, to generate personalized recommendations to reduce the one-year risk of type 2 diabetes. Ten routinely collected biomarkers extracted from Electronic Medical Records of 2791 patients at low risk and 2791 patients at high risk of type 2 diabetes were analyzed. Two regions characterizing the two classes of patients were estimated using a Support Vector Data Description classifier. Counterfactual explanations (i.e., minimal changes in input features able to change the risk class) were generated for patients at high risk and evaluated using performance metrics (availability, validity, actionability, similarity, and discriminative power) and a qualitative survey administered to seven expert clinicians. Results showed that, on average, the requested minimum viable changes implied a significant reduction of fasting blood sugar, systolic blood pressure, and triglycerides and a significant increase of high-density lipoprotein in patients at risk of diabetes. A significant reduction in body mass index was also recommended in most of the patients at risk, except in females without hypertension. In general, greater changes were recommended in hypertensive patients compared to non-hypertensive ones. The experts were overall satisfied with the proposed approach although in some cases the proposed recommendations were deemed insufficient to reduce the risk in a clinically meaningful way. Future research will focus on a larger set of biomarkers and different comorbidities, also incorporating clinical guidelines whenever possible. Development of additional mathematical and clinical validation approaches will also be of paramount importance.

Synergistic effect of ethanol extracts of Vernonia amygdalina and Croton zambesicus in alloxan-induced diabetic rats

Introduction: Therapeutic application of medicinal plants is Therapeutic application of medicinal plants is largely based on their chemical contents which synergistically work together in the same or different plants. Aims: This research assessed the synergistic antidiabetic and hypolipidemic potential of ethanol leaf extract of Vernonia amygdalina (VAMG) and Croton zambesicus (CZMG) in alloxan-induced diabetic male Wistar rats in other to justify the traditional medicinal application of the extracts as antidiabetic agents. Materials and Methods: The plants were collected, air-dried, and extracted separately in ethanol to produce the respective extracts (VAMG and CZMG). Secondary metabolites in each extract were screened using standard methods. The acute toxicity tests were carried out to determine the median lethal dose (LD50) of the respective extracts. The animals were induced with diabetics using alloxan monohydrate and the ones showing fasting blood glucose of 250 mg/ dL were used for the study. The blood sugar levels and body weights of the diabetic rats were observed after the administration of the different extracts and the combined extracts for 28 days. The effects of the different extracts on lipid profile and hepatic enzymes of the diabetic rats were also studied. Results: The blood sugar levels and body weights of the diabetic rats were observed after the administration of the different extracts and the combined extracts for 28 days. The effects of the different extracts on lipid profile and hepatic enzymes of the diabetic rats were also studied. The extracts contained tannins, flavonoids, saponins, phenolics and glycosides. Moreover, the exposure of the alloxan-induced diabetic rats to the combined plant extract (VACZ) caused a significantly (P &lt; .05) reduced fasting blood sugar concentration, serum ALT, ALP, AST, total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol, and an increased body weight, total protein and HDL cholesterol. The activity was comparable with the glibenclamide. Conclusion: Thus, the tested leaf extracts contained bioactive components whose synergistic activity could trigger a significant reduction of the blood sugar concentration and regulates the activity of hepatic indices in alloxan-induced diabetic rats than during a single administration. The extracts’ biological activity was comparable to the glibenclamide, and could be used in the development of antidiabetic candidate. The results confirmed the scientific basis of the traditional application of these medicinal plants.

The effect of neuromuscular electrical stimulation on serum glucose levels in children and adolescents with type-1 diabetes mellitus: a single group clinical trial

BackgroundThis study aimed to evaluate the effect of Neuromuscular Electrical Stimulation (NMES) on serum glucose level in children and adolescents with type-1 diabetes.MethodsThis before-after, single-group, clinical trial was conducted on 29 patients with type-1 diabetes mellitus with the age range of 7–18 years. The patients underwent NMES in two 20-minute phases on the quadriceps and hamstrings muscles, three sessions per week for a period of 8 weeks. Fasting Blood Sugar (FBS), measured in two ways, by glucometer and laboratory testing, was considered as the primary outcome and the glycated hemoglobin (HbA1c) and the total daily dose (TDD) of insulin were measured as the secondary outcomes. The laboratory FBS and HbA1c were measured 1 day before the intervention (as a baseline value) and then 2 and 6 weeks after the last session of intervention. FBS by glucometer and total daily dose of insulin were recorded daily from 2 weeks before the intervention to the last day of the intervention and consequently, the weekly average of these variables was calculated and used for statistical analysis.ResultsThe serum level of FBS (measured by glucometer) and the total daily dose of insulin reduced significantly 2 weeks after beginning of intervention. The laboratory serum level of FBS decreased significantly in the second week after the end of intervention compared to the baseline values. Although the HbA1c level decreased at follow-up period (2 and 6 weeks after the intervention), it was not significant.ConclusionIt seems that 8 weeks of NMES has beneficial effects on the reduction of FBS and TDD of insulin therefore, it could be suggested as the contributory treatment in management of children and adolescents with type-1 diabetes.Trial registrationThe study was registered at https://fa.irct.ir/user/trial/51739/view (IRCT20100523003998N1) in date of 25/10/2020.