Treatment Of Diabetes Mellitus Research Articles

Anti-diabetic, anti-pancreatic lipase, and anti-protein glycation potential of Irvingia gabonensis stem bark extracts: in vitro and in silico studies.

Diabetes mellitus is a chronic metabolic disorder that affects glucose, lipid, and protein metabolism. Targeting these metabolic derangements can optimize the therapeutic strategies for this disease. Utilizing in vitro and in silico models, this study investigated the ability of aqueous and ethanol extracts of Irvingia gabonensis to inhibit α-amylase, α-glucosidase, pancreatic lipase, and protein glycation. High-performance liquid chromatography (HPLC) was used to identify the compounds found in the stem bark of I. gabonensis. In silico analysis determined the binding mode and mechanism of interactions between the enzymes and phytochemicals. With an IC50 value of 11.47µg/ml, the aqueous extract demonstrated higher inhibitory efficacy against α-amylase compared to the ethanol extract (IC50 19.88µg/ml). However, the ethanol extract had stronger inhibitory activities against α-glucosidase, pancreatic lipase, and protein glycation compared to the aqueous extract (IC50 values of 3.05, 32.85, 0.0014 versus 25.72, 332.42, 0.018µg/ml respectively). Quercetin ranked highest in binding energy with α-amylase (-6.6kcal/mol), α-glucosidase (-6.6kcal/mol), and pancreatic lipase (-5.6kcal/mol). This was followed by rhamnetin (6.5, 6.5, and 6.1kcal/mol respectively). Hydrogen bonding, hydrophobic interactions, and pi-pi stacking are forces responsible for the binding of quercetin and rhamnetin to these enzymes. Molecular dynamics simulation showed that the lead phytochemicals formed stable and energetically stabilized complexes with the target proteins. This study showed that the extracts of I. gabonensis stem bark had significant in vitro anti-diabetic, anti-pancreatic lipase, and anti-protein glycation activities. The strong binding affinities of some of the identified compounds could be responsible for the inhibitory potential of the extracts. I. gabonensis stem bark could be further explored as a natural remedy for the treatment of diabetes mellitus and its complications.

Cissus sicyoides phytotherapy as complementary to the treatment of type II diabetes mellitus

Diabetes Melitus (DM) has become a public health issue in recent years. The comorbidities that affect their sufferers lead to a reduction in daily activities, a worsening of quality of life and an increase in mortality as a result of illnesses and complications of the disease. Basic health units, together with their health promotion programs and prevention strategies, have been adapting protocols for comprehensive care for patients with diabetes mellitus, guiding them towards a healthier lifestyle. This work showed the benefits of the complementary use of phytotherapy, specifically Cissus sicyoides in patients with diabetes mellitus, demonstrating hypoglycemic effects in 50% of patients subjected to the use of the dry extract. Adjunct to the treatment of diabetes mellitus II there is a need to implement strategies that reinforce the use of herbal therapies and research needs to be carried out to this end.

NF-κB pathway as a molecular target for curcumin in diabetes mellitus treatment: Focusing on oxidative stress and inflammation.

Diabetes mellitus (DM) is a collection of metabolic disorder that is characterized by chronic hyperglycemia. Recent studies have demonstrated the crucial involvement of oxidative stress (OS) and inflammatory reactions in the development of DM. Curcumin (CUR), a natural compound derived from turmeric, exerts beneficial effects on diabetes mellitus through its interaction with the nuclear factor kappa B (NF-κB) pathway. Research indicates that CUR targets inflammatory mediators in diabetes, including tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6), by modulating the NF-κB signaling pathway. By reducing the expression of these inflammatory factors, CUR demonstrates protective effects in DM by improving pancreatic β-cells function, normalizing inflammatory cytokines, reducing OS and enhancing insulin sensitivity. The findings reveal that CUR administration effectively lowered blood glucose elevation, reinstated diminished serum insulin levels, and enhanced body weight in Streptozotocin -induced diabetic rats. CUR exerts its beneficial effects in management of diabetic complications through regulation of signaling pathways, such as calcium-calmodulin (CaM)-dependent protein kinase II (CaMKII), peroxisome proliferator-activated receptor gamma (PPAR-γ), NF-κB, and transforming growth factor β1 (TGFB1). Moreover, CUR reversed the heightened expression of inflammatory cytokines (TNF-α, Interleukin-1 beta (IL-1β), IL-6) and chemokines like MCP-1 in diabetic specimens, vindicating its anti-inflammatory potency in counteracting hyperglycemia-induced alterations. CUR diminishes OS, avert structural kidney damage linked to diabetic nephropathy, and suppress NF-κB activity. Furthermore, CUR exhibited a protective effect against diabetic cardiomyopathy, lung injury, and diabetic gastroparesis. Conclusively, the study posits that CUR could potentially offer therapeutic benefits in relieving diabetic complications through its influence on the NF-κB pathway.

Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment

IntroductionOver the past two decades, Tanzania’s burden of non-communicable diseases has grown disproportionately, but limited resources are still prioritized. A trained human resource for health is urgently needed to combat these diseases. However, continuous medical education for NCDs is scarce. This paper reports on the mid-level healthcare workers knowledge on NCDs. We assessed the knowledge to measure the effectiveness of the training conducted during the initiation of a Package for Essential Management of Severe NCDs (PEN Plus) in rural district hospitals in Tanzania.MethodsThe training was given to 48 healthcare employees from Dodoma Region’s Kondoa Town Council District Hospital. For a total of five (5) days, a fundamental course on NCDs featured in-depth interactive lectures and practical workshops. Physicians from Tanzania’s higher education institutions, tertiary university hospitals, research institutes, and medical organizations served as trainers. Before and after the training, a knowledge assessment comprising 28 questions was administered. Descriptive data analysis to describe the characteristics of the specific knowledge on physiology, diagnosis and therapy of diabetes mellitus, rheumatic fever, heart disease, and sickle cell disease was done using Stata version 17 (STATA Corp Inc., TX, USA).ResultsComplete assessment data for 42 out of the 48 participants was available. Six participants did not complete the training and the assessment. The mean age of participants was 36.9 years, and slightly above half (52%) were above 35 years. Two-thirds (61.9%) were female, and about half (45%) were nurses. The majority had the experience of working for more than 5 years, and the average was 9.4 years (+/- 8.4 years). Overall, the trainees’ average scores improved after the training (12.79 vs. 16.05, p < 0.0001) out of 28 possible scores. Specifically, trainees’ average scores were better in treatment than in diagnosis, except for sickle cell disease (1.26 vs. 1.83). Most were not able to diagnose rheumatic heart disease (47.6% able) compared to diabetes mellitus (54.8% able) or sickle cell disease (64.3% able) at baseline. The proportion of trainees with adequate knowledge of the treatment of sickle cell disease and diabetes mellitus was 35% and 38.1%, respectively, and there was a non-statistical difference after training. Those working for less than 5 years had a higher proportion of adequate knowledge (30.8%) compared to their more experienced colleagues (6.9%). After the training, participants’ knowledge of NCDs increased by three times (i.e., aPR 3, 95% CI = 1.1, 1.5, and 6.0).Conclusion and recommendationsPEN Plus training improved the knowledge of healthcare workers at Kondoa Town Council District Hospital. Training is especially needed among nurses and those with a longer duration of work. Continuing education for human resources for health on the management of NCDs is highly recommended in this setting.

Pathophysiology and Advances in the Therapy of Cardiomyopathy in Patients with Diabetes Mellitus.

Diabetes mellitus (DM) is known as the first non-communicable global epidemic. It is estimated that 537 million people have DM, but the condition has been properly diagnosed in less than half of these patients. Despite numerous preventive measures, the number of DM cases is steadily increasing. The state of chronic hyperglycaemia in the body leads to numerous complications, including diabetic cardiomyopathy (DCM). A number of pathophysiological mechanisms are behind the development and progression of cardiomyopathy, including increased oxidative stress, chronic inflammation, increased synthesis of advanced glycation products and overexpression of the biosynthetic pathway of certain compounds, such as hexosamine. There is extensive research on the treatment of DCM, and there are a number of therapies that can stop the development of this complication. Among the compounds used to treat DCM are antiglycaemic drugs, hypoglycaemic drugs and drugs used to treat myocardial failure. An important element in combating DCM that should be kept in mind is a healthy lifestyle-a well-balanced diet and physical activity. There is also a group of compounds-including coenzyme Q10, antioxidants and modulators of signalling pathways and inflammatory processes, among others-that are being researched continuously, and their introduction into routine therapies is likely to result in greater control and more effective treatment of DM in the future. This paper summarises the latest recommendations for lifestyle and pharmacological treatment of cardiomyopathy in patients with DM.

The off-target NHE1 inhibitory effect of SGLT2 inhibitors in cardiac remodeling

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, approved for the treatment of diabetes mellitus, have gained attention for their cardioprotective effect. The exact mechanism by which SGLT-2 inhibitors exert their cardioprotective effect remains unclear. Recent studies have suggested that empagliflozin (EMPA), an SGLT inhibitor, exerts its car¬dioprotective effect by inhibiting the Na+/H+ exchanger (NHE); a group of membrane proteins that regulate intracel¬lular pH and cell volume. Increased activity and expression of NHE isoform 1 (NHE1), the predominant isoform ex¬pressed in the heart, leads to cardiac hypertrophy. Our research group investigates the indirect mechanisms by which SGLT inhibitors exert their cardioprotective effect and have demonstrated that angiotensin II (ANG)-induced hyper¬trophy of H9c2 cardiomyoblasts is accompanied with increased SGLT-1 and NHE1 protein expression; an effect which is reversed in the presence of EMPA. In addition, we demonstrated that dapagliflozin improved survival of transgenic mice expressing cardiac-specific NHE1.

A multicenter, open-label, single-arm trial of the long-term safety of empagliflozin treatment for refractory diabetes mellitus with insulin resistance (EMPIRE-02).

Insulin resistance syndrome and lipoatrophic diabetes are rare conditions characterized by the development of treatment-refractory diabetes with severe insulin resistance. We recently conducted a 24 week, multicenter, single-arm trial (EMPIRE-01) that demonstrated a certain level of effectiveness and safety of empagliflozin for these conditions. To evaluate treatment safety over a longer period, we have now performed an additional 28 week trial (EMPIRE-02) that followed on from EMPIRE-01. The primary and secondary outcomes were safety and efficacy evaluations, respectively. All eight subjects of the EMPIRE-01 trial participated in EMPIRE-02. Twenty adverse events (AEs) were recorded among five individuals during the combined 52 week treatment period of both trials. Whereas one case of chronic hepatitis B was moderate in severity, all other AEs were mild. There were thus no serious AEs or events necessitating discontinuation or suspension of treatment or a reduction in drug dose. Whereas ketoacidosis or marked increases in serum ketone body levels were not observed, the mean body mass of the subjects was decreased slightly after completion of EMPIRE-02. The improvement in mean values of glycemic parameters observed in EMPIRE-01 was not sustained in EMPIRE-02, mostly because of one individual whose parameters deteriorated markedly, likely as a result of nonadherence to diet therapy. The improvement in glycemic parameters was sustained during EMPIRE-02 after exclusion of this subject from analysis. Empagliflozin demonstrated a certain level of safety and efficacy for the treatment of insulin resistance syndrome and lipoatrophic diabetes over 52 weeks, confirming its potential as a therapeutic option.

Abstract PO1-05-11: Efficacy of metformin as adjunctive therapy in patients with de novo metastatic breast cancer: a retrospective cohort study

Abstract Background: Metformin, an oral biguanide used for the treatment of type-2 diabetes mellitus (DM), has been shown in a considerable number of studies to have an anti-tumorigenic impact against breast cancer cells through several mechanisms,thereby improving breast cancer outcomes. However, the impact of metformin treatment on survival outcomes in patients with non-diabetic breast cancer is still under debate, with very few data available regarding metformin administration in de novo metastatic breast cancer (dnMBC). This study was conducted to investigate and evaluate the impact on survival outcomes of patients with dnMBC treated with metformin as adjunctive therapy at our institutes. Methods: All dnMBC women who received chemotherapy-based systemic therapy or combined with metformin administered orally in our hospitals between March 2007 and November 2016 were enrolled in the study. Data were retrospectively extracted from the patients’case records. Data were analyzed according the clinicopathological features and treatment outcomes. All specimens were rechecked for the purpose of the research. Overall survival (OS), as the study endpoint, was defined as the time from pathologically confirmed diagnosis to all-cause death or end of the follow-up time.Kaplan-Meier estimate was used to calculate the survival rates.The difference between metformin and non-metformin groups was compared by the log-rank method.Cox regression analysis (uni-and multivariate analysis) was used to assess the effect of variables on survival outcomes.Analyses were performed by Stata 17 software for windows version. Results: A total of 252 women with dnMBC were included with an average age of 54.41±11.61 years. Among them, 97 patients (including 11 DM patients) received chemotherapy-based systemic therapy plus oral administration of metformin 850-1000mg twice daily (metformin group), and 155 patients received chemotherapy-based systemic therapy (non-metformin group). There was no significant difference in body mass index, age, N-stage, P53 index, ER/PR status, HER-2 expression and initial metastatic sites between metformin group and non-metformin group. But there were differences in T-stage and Ki67 index between the two groups (Table 1). The median follow-up was 70 months.The median OS was 24 months.The 3-year and 5-year OS rates for all patients were 29.8% (95% CI:24.2% to 35.4%) and 11.6% (95% CI:7.5% to 16.7%),respectively; Log-rank test showed that the metformin group had a significant advantage over the non-metformin group in OS rates(p=0.0002).The 3-year and 5-year OS rates in the metformin group were 42.3% (95% CI:32.4% to 51.8%) and 21.2% (95% CI:12.8% to 31.1%), respectively; the same rates for non-metformin group were 21.9% (95% CI: 15.8% to 28.7%) and 5.6% (95% CI: 2.4% to 11.1%), respectively. Results of proportional hazards model, after adjustment for T-stage and Ki67 index, depicted an independent prognostic value of metformin use with multivariate hazard ratio of 0.61 (95% CI: 0.45 to 0.81) for OS compared to non-metformin group (p=0.001).No survival advantage was found for DM patients (0.59;95% CI:0.29 to 1.22; p=0.159). Conclusions: Our data support a favorable outcome for survival associated with metformin use in dnMBC patients. However, the retrospective nature and small sample size of the current study are major limitations to reliable conclusions about metformin's potential to improve OS in patients. Therefore, prospective evidence from phase-3 randomized controlled trials on the feasibility of metformin use in dnMBC is required before its routine use can be recommended. Keywords: Metformin; De novo metastatic breast cancer; Adjunctive therapy; Survival outcomes Citation Format: Ren Chongxi, Sun Jianna, Kong Lingjun, Hongjun Yu. Efficacy of metformin as adjunctive therapy in patients with de novo metastatic breast cancer: a retrospective cohort study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-05-11.

Network Pharmacology Prediction and Metabolomics Validation of the Novel Targets of Morus alba L. against High-Fat Diet-Induced Diabetes Mellitus in C57/6J Mice

Diabetes mellitus (DM) is an endocrine-metabolic disorder that has limited approaches to treat effectively. Morus alba L., also known as mulberry, is a well-known medicinal plant, and its branch bark has shown hypoglycemic activity. It is rich in antioxidant and anti-inflammatory ingredients. In this study, we used metabolomics combined with network pharmacology to investigate the molecular mechanism and potential key targets of mulberry branch bark powder (MBBP) for treating DM. Serum metabolomics was performed to analyze the differences in metabolites and enrich metabolic pathways. Network pharmacology, based on systems biology tools, was applied to generate the pathway-target-compound network. Integrated analyses were then used to screen for key targets. To verify the obtained key targets, we used a molecular docking method and experimental validation. Our findings revealed that thirty-five endogenous metabolites contributed to the therapeutic impact of MBBP against DM. The analysis of 10 hub genes in the compound-target network partially supported the enrichment of metabolic pathways. Further analysis focused on two compounds (eugenol and mulberrofuran A) and three key targets (NOS2, MAOA, and CYP1A1). This study explores the active compounds of MBBP against DM and provides a novel perspective for improving DM treatment based on key targets.

Petroleum ether extract of Schisandra sphenanthera prevents hyperglycemia and insulin resistance in association with modulation of sweet taste receptors and gut microbiota in T2DM rats

Ethnopharmacological relevanceSchisandra sphenanthera (Schisandra sphenanthera Rehd. et Wils.) is the dried mature fruit of Schisandra sphenanthera, a plant in the Magnoliaceae family. It was used in the treatment of diabetes mellitus in the Jade Fluid Decoction and the Xiaoke pills, which were recorded in ancient books. However, its mechanism of action in the treatment of type 2 diabetes mellitus (T2DM) was unclear and needs further study. Aim of the studyThis research aimed to investigate the chemical composition and lignan content of Schisandra sphenanthera petroleum ether parts (SPEP) and to evaluate the effects of SPEP on sweet taste receptors (STRs) and intestinal flora in rats on a high-fat diet (HFD). Additionally, the relationships between SPEP and hyperglycemia and insulin resistance were examined. Materials and methodsGC-MS was used to determine the chemical composition of SPEP, and HPLC was used to determine the lignin content. A combination of the HFD and the administration of streptozotocin (STZ) was employed to generate a rat model of T2DM. Petroleum ether extracts from Schisandra sphenanthera were used as the focus of the research to evaluate the effects of these extracts on the glucolipid metabolism of T2DM rats, as well as the underlying mechanisms. ResultsAnalysis of the GC-MS spectrum of SESP revealed a total of 58 compounds. HPLC analysis revealed that SPEP had the highest concentration of Schisandrin A and the lowest concentration of Schisandrol A. The drug administration intervention resulted in a significant decrease in body weight and pancreatic weight of diabetic rats compared to the Normal group. When compared to the Model group, the body weight of rats in the drug administration group and the Metformin group had a more moderate decrease, while the pancreatic weight and pancreatic-to-body ratio increased. The Model group shown significant increases in FBG, OGTT, GHb, TC, TG, LDL-C, ALT, AST, MDA, FINS, and NEFA, as well as significant decreases in HDL-C and SOD, when compared to the Normal group (P<0.05). The administration of each group was found to be significantly effective in decreasing FBG, OGTT, GHb, TC, TG, LDL-C, ALT, AST, MDA, FINS, NEFA, while increasing HDL-C and SOD when compared to the Model group. The application of SPEP had a positive impact on hepatocyte swelling, hepatocyte degeneration, and necrosis, as well as the morphological structure of pancreatic islet cells. Furthermore, the protein expression levels of T1R2, TRPM5 and GLP-1 in the small intestine of the Model group were reduced. After a period of six weeks, the protein expression levels began to align more closely with those of the Normal group of rats. Analysis of 16S rRNA sequencing revealed that the intestinal microbiota of diabetic rats was significantly disrupted, with a decrease in the abundance of the Firmicutes phylum and an increase in the abundance of the Bacteroidetes phylum. Furthermore, the composition of the dominant genus was distinct from that of the control group. After the drug intervention, the microbiota of diabetic rats was significantly altered, exhibiting a higher abundance and diversity, as well as a significant enrichment of the community. The SPEP treatment resulted in a significant increase in acetic acid, propionic acid, and butyric acid. ConclusionsThe findings of this research indicated that SPEP could be effective in treating T2DM through the regulation of STRs, the adjustment of disturbed metabolite levels, and the alteration of intestinal flora.

Kinetics and molecular modeling studies on the inhibition mechanism of GH13 α-glycosidases by small molecule ligands

Alpha-glucosidase inhibitors play an important role in Diabetes Mellitus (DM) treatment since they prevent postprandial hyperglycemia. The Glycoside Hydrolase family 13 (GH13) is the major family of enzymes acting on substrates containing α-glucoside linkages, such as maltose and amylose/amylopectin chains in starch. Previously, our group identified glycoconjugate 1H-1,2,3-triazoles (GCTs) inhibiting two GH13 α-glycosidases: yeast maltase (MAL12) and porcine pancreatic amylase (PPA). Here, we combined kinetic studies and computational methods on nine GCTs to characterize their inhibitory mechanism. They all behaved as reversible inhibitors, and kinetic models encompassed noncompetitive and various mechanisms of mixed-type inhibition for both enzymes. Most potent inhibitors displayed Ki values of 30 μM for MAL12 (GPESB16) and 37 μM for PPA (GPESB15). Molecular dynamics and docking simulations indicated that on MAL12, GPESB15 and GPESB16 bind in a cavity adjacent to the active site, while on the PPA, GPESB15 was predicted to bind at the entrance of the catalytic site. Notably, despite its putative location within the active site, the binding of GPESB15 does not obstruct the substrate's access to the cleavage site. Our study contributes to paving the way for developing novel therapeutic strategies for managing DM-2 through GH13 α-glycosidases inhibition.

Drug repurposing for diabetes mellitus: In silico and in vitro investigation of DrugBank database for α-glucosidase inhibitors

The process of developing novel compounds/drugs is arduous, time-intensive, and financially burdensome, characterized by a notably low success rate and relatively high attrition rates. To alleviate these challenges, compound/drug repositioning strategies are employed to predict potential therapeutic effects for DrugBank-approved compounds across various diseases. In this study, we devised a computational and enzyme inhibitory mechanistic approach to identify promising compounds from the pool of DrugBank-approved substances targeting Diabetes Mellitus (DM). Molecular docking analyses were employed to validate the binding interaction patterns and conformations of the screened compounds within the active site of α-glucosidase. Notably, Asp352 and Glu277 participated in interactions within the α-glucosidase-ligand complexes, mediated by conventional hydrogen bonding and van der Waals forces, respectively. The stability of the docked complexes (α-glucosidase-compounds) was scrutinized through Molecular Dynamics (MD) simulations. Subsequent in vitro analyses assessed the therapeutic potential of the repositioned compounds against α-glucosidase. Kinetic studies revealed that “Forodesine” exhibited a lower IC50 (0.24 ± 0.04 mM) compared to the control, and its inhibitory pattern corresponds to that of competitive inhibitors. In-depth in silico secondary structure content analysis detailed the interactions between Forodesine and α-glucosidase, unveiling significant alterations in enzyme conformation upon binding, impacting its catalytic activity. Overall, our findings underscore the potential of Forodesine as a promising candidate for DM treatment through α-glucosidase inhibition. Further validation through in vitro and in vivo studies is imperative to confirm the therapeutic benefits of Forodesine in conformational diseases such as DM.

Modulation of Glycolipid Metabolism in T2DM Rats by Rubus Irritans Focke Extract: Insights from Metabolic Profiling and ERK/IRS-1 signaling pathway

Ethnopharmacological RelevanceThe extracellular regulated protein kinase (ERK) plays a crucial role in the mitogen-activated protein kinase (MAPK) family, influencing apoptosis, proliferation, and differentiation. It connection to the insulin (INS) signaling cascade and the development of type 2 diabetes mellitus (T2DM) has been established. Rubus irritans Focke, an indispensable herb in Chinese Tibetan medicine for diabetes mellitus treatment, lacks a comprehensive understanding of its effects and pharmacological mechanisms in T2DM. Aim of the studyThis study aimed to elucidate the effects of Rubus irritans Focke extract (Rife) on a T2DM rat model, exploring its impact on glycemic and lipid metabolism, histopathological changes, and its potential targeting of the extracellular regulated protein kinase/insulin receptor substrate-1 (ERK/IRS-1) signaling pathway. Materials and MethodsA T2DM rat model was induced by streptozotocin (STZ) injection (40 mg/kg) in high-fat diet-fed (HFD) male Wistar rats. Rife and metformin (Met) were administered for 4 weeks, and glycemic, lipid metabolism indices, and histopathological changes were assessed. Protein expression of ERK, IRS-1 in rat liver tissues was examined to evaluate the impact on the ERK/IRS-1 pathway. ResultsRife reducing hepatic ERK and IRS-1 protein expression in T2DM rats. Untargeted metabolomics identified 13 potential biomarkers and 4 differential metabolic pathways related to glycolipid metabolism disorders. ConclusionsRife demonstrated improved glycolipid metabolism in T2DM rats by inhibiting the ERK/IRS-1 related signaling pathway and influencing multiple metabolic pathways. This study provides valuable insights into the potential therapeutic mechanisms of Rife in the context of T2DM.

Rationality of Prescribing Diabetes Mellitus Drugs Using Beers Criteria for Geriatric Patients in Outpatient Installations dr. Iskak Hospital

Diabetes mellitus (DM) is se group of metabolic disorders with symptom hyperglycemia Which happen caused because abnormality secretion insulin and insulin action or both . Diabetes mellitus (DM) is a global problem in which 20% of sufferers are geriatrics. Treatment of DM in geriatrics has the potential to occur irrationally due to the complexity of health problems in geriatrics. Irrational prescribing has a negative impact on health care facilities, patients, and society. One method of assessing rational prescribing is the Beers criteria, developed by the American Geriatrics Society Beers Criteria 2 019. The purpose of this study was to determine the rationality of prescribing DM drugs using the Beers criteria for geriatric patients at the outpatient installation at RSUD dr. Iskak Tulungagung. This research is a descriptive observational study with a cross sectional design. Retrospective data collection on 275 medical record documents of geriatric patients with a diagnosis of DM at the outpatient installation of RSUD dr. Iskak – Tulungagung in the 2021 period. Samples were analyzed using the American Geriatrics Society Beers Criteria 2019 guidelines . The results of the study DM drugs in the Sulfonylurea class were most widely used (13.1%) and 41,3 % identified potentially inappropriate medications (PIMs). The use of potentially inappropriate drugs is 7,32 %, the use of drugs that interact with disease is 3,8%, the drugs that must be used with caution, 6,4%, the drugs that have the potential to interact clinically 0,3%, and the use of drugs that must be avoided or reduced dose related to renal function 0,3%.

Screening for risk factors for type 2 diabetes mellitus using the Canadian Diabetes Risk Questionnaire (CANRISK) in the East Java Provincial Health Service, Indonesia

Diabetes Mellitus remains a serious and growing global challenge for public health. Early identification of cases prevents delays in treating diabetes mellitus, which often causes various complications in the body. Diabetes Mellitus screening includes anamnesis for family and personal history of the disease, measurement of height, weight, abdominal circumference, blood pressure examination, and examination of sugar levels. One instrument that can be used to assess the risk of developing type 2 diabetes mellitus is the Canadian Diabetes Risk Questionnaire (CANRISK). The aim of this research is to find out the characteristics of respondents and the risk categories of respondents suffering from type 2 diabetes mellitus in the next 10 years using CANRISK. This research uses quantitative methods. Based on the type of research, this research uses descriptive observational research. The research design used was cross sectional. The results showed that 78% of respondents had a low-moderate risk of developing type 2 DM, 6% had a high risk of developing type 2 DM, and 16% had a very high risk of developing type 2 DM. The conclusion of this study was that the risk factors for developing Type 2 DM 2 are age, BMI, waist circumference, physical activity habits, vegetable and fruit consumption habits, history of high blood pressure and high blood sugar, history of giving birth to a baby more than 4.1 kg, family history of diabetes, parents' ethnic group, and level of education.

Metabolite profile of tree marigold (Tithonia diversifolia (Hamsley) A. Grey) leaves

Tree marigold or Tithonia diversifolia (Hemsley) A. Grey) also known as Insulin leaves has traditionally been used as an herb for the treatment of diabetes mellitus (DM). Tree marigolds contain various metabolite compounds, which have various bioactivities, so research was carried out to study metabolite profiles using a non-target metabolism approach using a GC-MS (Gas Chromatography-Mass Spectrometry) instrument. The results of GC-MS analysis of Tree marigold ethanol extract showed 30 peaks in the chromatogram, of which 7 were dominant metabolite compounds including 1-butanol, 3-methyl acetate (28.11%), Thunbergol (14.28%), Geranyl acetate (12.13%). ), D-Limonene (6.64%), 4H-Pyran-4-one, 2,3-Dihydro-3,5-dihydroxy-6 -methyl (5.05%), acetic acid (4.10%), 7.8-epoxy-α-ionone (2.91%). The various categories of metabolites consist of the monoterpene class followed by fatty acids, terpenes, and sesquiterpenoids, as well as other compounds in the terpenoid esters class, alkanoic acids, fatty acids, proteins, amino acids, furanoids, ketones, and others. These metabolite compounds have antidiabetic, antioxidant, anti-inflammatory, antimicrobial, antibacterial, anticancer, and antitumor effects so they have potential as antidiabetic therapy.

Alpha-Glucosidase Inhibition, Antioxidant Activities, and Molecular Docking Study of Krom Luang Chumphon Khet Udomsak, a Thai Traditional Remedy.

Krom Luang Chumphon Khet Udomsak remedy (KKR) has traditionally been used as an alternative treatment, particularly for hyperglycemia; however, its therapeutic efficacy has not been scientifically validated. Thus, this study aims to investigate the potential inhibitory and antioxidant effects of α-glucosidase enzyme and characterize the chemical profile of KKR extracts using gas chromatography-mass spectrometry (GC-MS). The investigation highlights both KKR extracts as potent inhibitors of α-glucosidase, with the ethanolic extract of KKR (KKRE) displaying an IC50 value of 46.80 µg/mL and a noncompetitive mode of action. The combination of ethanolic and aqueous extracts of KKR (KKRE and KKRA, respectively) with acarbose exhibited a synergistic effect against the α-glucosidase. The KKRE extract displayed strong scavenging effects in the DPPH assay (IC50 156.3 µg/mL) and contained significant total phenolic (172.82 mg GAE/g extract) and flavonoid (77.41 mg QE/g extract) contents. The major component of KKRE is palmitic acid (15.67%). Molecular docking revealed that the major compounds interacted with key amino acid residues (ASP215, GLU277, HIS351, ASP352, and ARG442), which are crucial for inhibiting α-glucosidase. Notably, campesterin had a more significant influence on α-glucosidase than acarbose, with low binding energy. These findings underscore the significance of KKR in traditional medicine and suggest that it is promising treatment for diabetes mellitus. Further studies using animal model will provide valuable insights for advancing this research.

In Vitro α-Glucosidase, α-Amylase Inhibitory and Antioxidant Activities of Root Crude Extract and Solvent Fractions of Arbutus unedo L. (Ericaceae)

Roots of Arbutus unedo (Ericaceae) have been used traditionally to treat diabetes in some countries. Conducting more experiments is needed to support this plant's potential antidiabetic properties, though. Ethanolic extract yielded by cold maceration was subjected into fractionation to get hexane, chloroform, ethyl acetate, butanol, and aqueous fractions. Total phenolic contents and antioxidant capacity have been estimated utilizing 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) and ferric ion reducing antioxidant potential (FRAP) assay models, respectively. Antidiabetic activity of A. unedo extracts were evaluated using in vitro α-glucosidase, α-amylase inhibition activity. The ethanol extract had the highest antioxidant activity among used extracts. While the results of both α-glucosidase, α-amylase enzyme inhibition activity was detected to be dose-dependent, the strongest inhibition activity for α-glucosidase and α-amylase was shown by ethanol extract (526.65 and 522.66 µg mL-1 respectively) compared to the standard acarbose. Results demonstrated the beneficial effects of A. unedo extracts by showing antioxidant and antidiabetic activities.

CiteSpace-based Visualization of Hotspots and Trends in Astragalus for Diabetes Mellitus Treatment

CiteSpace-based Visualization of Hotspots and Trends in Astragalus for Diabetes Mellitus Treatment

Molecular mechanisms of semaglutide and liraglutide as a therapeutic option for obesity.

Obesity, a chronic global health problem, is associated with an increase in various comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, hypertension, and certain types of cancer. The increasing global prevalence of obesity requires research into new therapeutic strategies. Glucagon-like peptide-1 receptor agonists, specifically semaglutide and liraglutide, designed for type 2 diabetes mellitus treatment, have been explored as drugs for the treatment of obesity. This minireview describes the molecular mechanisms of semaglutide and liraglutide in different metabolic pathways, and its mechanism of action in processes such as appetite regulation, insulin secretion, glucose homeostasis, energy expenditure, and lipid metabolism. Finally, several clinical trial outcomes are described to show the safety and efficacy of these drugs in obesity management.