Management Of Type 2 Diabetes Mellitus Research Articles

Empowering Through Group Exercise: Beat It Trainers’ Views on Successful Implementation of a Diabetes Management Program Online and In-Person

Background: The Beat It program is a clinician-led, community-based group exercise intervention for adults with Type 2 Diabetes Mellitus (T2DM). While previous studies have demonstrated its effectiveness in improving physical and mental health outcomes, this study explores the perspectives of Beat It Trainers to identify key factors contributing to the program’s success and areas for improvement. Methods: Semi-structured interviews were conducted with 11 Accredited Exercise Physiologists who had delivered both in-person and online versions of the program. Interviews were thematically analyzed using inductive approaches. Results: Eight main themes emerged: customization to individual needs, capability building, outcome improvement, affordability, accessibility, sustainability, and a holistic approach delivered in a group setting. Challenges identified included managing group dynamics, maintaining participant commitment in a fully subsidized program, and providing nutrition advice within the trainers’ scope of practice. The program’s adaptability to both in-person and online delivery modes was highlighted as enhancing its accessibility and resilience. Conclusions: This study provides valuable insights into the factors contributing to the success of the Beat It program from the implementers’ perspective. The findings suggest that investing in comprehensive training for facilitators, particularly in group dynamics management, could benefit similar programs. While the program’s fully subsidized structure reduces financial barriers to entry, innovative strategies to enhance participant engagement and perceived value should be explored. The success of the online delivery mode indicates that hybrid models offering both in-person and virtual options could increase accessibility in future supervised, community-based exercise programs for T2DM management.

Hovenia dulcis (Guaizao) polysaccharide ameliorates hyperglycemia through multiple signaling pathways in rats with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) poses a significant threat to human health, with its incidence and mortality rates increasing annually. This study investigated the hypoglycemic effects and underlying mechanisms of pure Hovenia dulcis (Guaizao) polysaccharide (HDPs-2A) in rats subjected to a high-fat and high-sugar diet combined with streptozotocin-induced T2DM. Oral administration of HDPs-2A resulted in significant increases in body weight and liver glycogen levels compared to untreated controls. Moreover, a reduction in fasting blood glucose levels, alleviation of hyperinsulinemia, enhanced glucose tolerance, and improved insulin resistance were observed in the HDPs-2A-treated group. HDPs-2A also effectively reversed diabetes-induced dyslipidemia, as evidenced by decreased total cholesterol and triglyceride levels, alongside increased high-density lipoprotein cholesterol levels. Histopathological analyses confirmed that HDPs-2A partially repaired liver tissue damage by mitigating oxidative stress responses in the liver. Additionally, treatment with HDPs-2A significantly elevated short-chain fatty acid levels in T2DM rats. Real-time quantitative PCR and Western blot analyses indicated that HDPs-2A significantly enhanced the expression of InsR, IRS2, PI3K, Akt, and GLUT4, suggesting that HDPs-2A regulates insulin resistance and glycometabolism through the activation of the PI3K/Akt signaling pathway. Furthermore, HDPs-2A appeared to modulate the expression of GS, GSK-3β, and FoxO1 to improve glucose metabolism and reduce insulin resistance. It also improved glucose metabolism by activating the AMPK pathway and modulating G6Pase and PEPCK expression. This study provides novel insights into the antidiabetic effects of HDPs, positioning them as promising nutritional agents for the management of T2DM.

Effectiveness Of non-Pharmacological Strategies in The Management of Type 2 Diabetes In Primary Care: A Systematic Review And Network Meta-analysis

Introdução Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but various of them have never been compared directly to determine the best strategies. Objective: This study evaluated the comparative effects of non-pharmacological strategies in the management of T2DM in primary care or community settings. Métodos We have performed a systematic review and network meta-analysis (NMA) following the Cochrane collaboration and reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) Statement. We included randomized controlled trials if non-pharmacological strategies in the management of type 2 diabetes were applied in adult patients with T2DM in primary care. The primary outcome was glycemic control (glycated hemoglobin [HbA1c] [%]). We developed search strategies for Embase, Medline, Latin American and Caribbean Health Sciences Literature, Cochrane Central Register of Controlled Trials, Trip database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL). Four reviewers assessed the studies for their eligibility and their risk of bias in pairs and independently. A NMA have been performed using Stata Statistical Software 18 (Stata Statistical Software: Release 18. College Station, TX, StataCorp LLC, USA). Resultados After removing duplicates, the search strategies yielded 4314 studies. After a thorough evaluation of the references, 129 studies encompassing a total of 35,975 individuals have been included in this review. Twenty and three strategies were founded. The most frequent strategy was diabetes self-management and support (DSMES), followed by diabetes self-management education, technology enabled DSMES, self-monitoring of blood glucose, multidisciplinary approach, health coach, benchmarking, low carb diet, low fat diet, plate diet, food substitution diet, yoga, leaflet, group outpatient visit model, patient-centered communication and shared decision making, and some combinations among two or more strategies. The most frequent comparator has been usual care (92%). The consistency assumption could be accepted at the overall level of each treatment ( test for inconsistency: chi2( 8) =11.01, p= 0.2011). Regarding relative rankings, DSMES associated with social support showed a 35% probability of being the best treatment in terms of HbA1c reduction, followed by plate diet (16.9%), low fat diet (11.8%) and food substitution diet (10%). Discussão e conclusões Although several systematic reviews have evaluated the effectiveness of these strategies in the management of T2DM,to the best of our knowledge to date, there are no systematic reviews and NMA considering the direct and indirect effects of non-pharmacological interventions targeting a greater control of T2DM. Conclusion: This review has founded 23 non-pharmacological strategies in the management of type 2 diabetes in primary care, being the most frequent DSMES, and DSMES associated with social support presented the highest probability to be the best in terms of HbA1c reduction. This research has been supported by the São Paulo Research Foundation (Grant number: 2021/07229-0)

Discovering the therapeutic potential of Naringenin in diabetes related to GLUT-4 and its regulatory factors: A computational approach

This study explores the therapeutic potential of Naringenin, a natural flavonoid, in managing Type 2 Diabetes Mellitus (T2DM) by focusing on Glucose Transporter 4 (GLUT4) and related regulatory proteins that play a role in glucose and lipid metabolism. Through bioinformatics analysis, key proteins such as Carnitine palmitoyltransferase I, mitochondrial carnitine/acylcarnitine carrier protein, and PPARγ were identified, highlighting their importance in insulin sensitivity. Molecular docking results indicated that Naringenin has a strong binding affinity for GLUT4 and PPARγ, with binding energies of -8.18 kcal/mol and -8.21 kcal/mol, respectively. This suggests that Naringenin may modulate these proteins to enhance insulin sensitivity. In contrast, its weaker binding with Enhancer-Binding Protein Alpha points to Naringenin's selective efficacy among various targets. Molecular dynamics (MD) simulations conducted over 100 ns confirmed the stability of the GLUT4-Naringenin complex, showing a reduced RMSD of 1.25 nm and a more compact structure with a Radius of Gyration (Rg) value of 2.14 nm. However, Rho-related GTP exhibited increased instability upon Naringenin binding, indicating a potential inhibitory effect. Additionally, an in silico ADMET profile revealed Naringenin's favorable pharmacokinetics, including low hepatotoxicity, no mutagenic effects, and a high maximum tolerated dose, which supports its safety for drug development. In conclusion, Naringenin shows promising potential in enhancing glucose metabolism and insulin sensitivity, positioning it as a viable candidate for future preclinical and clinical studies in T2DM management. Future research should aim to validate these computational findings through experimental methods and investigate possible synergistic effects with existing antidiabetic medications to improve treatment outcomes.

Managing Type 2 Diabetes Mellitus via the Regulation of Gut Microbiota: A Chinese Medicine Perspective.

Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder characterized by insulin resistance and inadequate insulin production. Given the increased frequency of T2DM and the health issues it can cause, there is an increasing need to develop alternative T2DM management strategies. One such approach is Chinese Medicine (CM), a complementary therapy widely used in T2DM treatment. Given the emphasis on gut microbiota in current research, studying CM in the treatment of T2DM via gut microbiota modulation could be beneficial. Scope and approach: The use of various CM methods for managing T2DM via gut microbiota modulation is highlighted in this review. Following an introduction of the gut microbiota and its role in T2DM pathogenesis, we will review the potential interactions between gut microbiota and T2DM. Thereafter, we will review various CM treatment modalities that modulate gut microbiota and provide perspectives for future research. Key findings and discussion: In T2DM, Akkermansia, Bifidobacterium, and Firmicutes are examples of gut microbiota commonly imbalanced. Studies have shown that CM therapies can modulate gut microbiota, leading to beneficial effects such as reduced inflammation, improved metabolism, and improved immunity. Among these treatment modalities, Chinese Herbal Medicine and acupuncture are the most well-studied, and several in vivo studies have demonstrated their potential in managing T2DM by modulating gut microbiota. However, the underlying biomolecular mechanisms of actions are not well elucidated, which is a key area for future research. Future studies could also investigate alternate CM therapies such as moxibustion and CM exercises and conduct large-scale clinical trials to validate their effectiveness in treatment.

Quality priorities related to the management of type 2 diabetes in primary care: results from the COMPAS + quality improvement collaborative

BackgroundThis study aims to describe the main type 2 diabetes mellitus (T2DM) quality improvement (QI) challenges identified by primary care teams in the province of Quebec who participated in the COMPAS + QI collaborative.MethodsA qualitative descriptive design was used to analyse the results of 8 COMPAS + workshops conducted in 4 regions of the province between 2016 and 2020. Deductive content analysis was performed to classify the reported QI priorities under the Consolidated Framework for Implementation Research domains; and proposed change strategies under the Behavior Change Wheel (BCW) intervention functions.ResultsA total of 177 participants attended the T2DM COMPAS + workshops. Three QI priorities were identified: (1) lack of coordination and integration of T2DM care and services; (2) lack of preventive services for pre-diabetes and T2DM; and (3) lack of integration of the patients-as-partners approach to support T2DM self-management. The proposed QI strategies to address those priorities were classified under the education, training, persuasion, habilitation and restructuring BCW intervention functions.ConclusionThis study provides insights on how QI collaboratives can support the identification of QI priorities and strategies to improve T2DM management in primary care.

Targeting gut microbiota as a therapeutic target in T2DM: A review of multi-target interactions of probiotics, prebiotics, postbiotics, and synbiotics with the intestinal barrier

The global epidemic of type 2 diabetes mellitus (T2DM) imposes a substantial burden on public health and healthcare expenditures, thereby driving the pursuit of cost-effective preventive and therapeutic strategies. Emerging evidence suggests a potential association between dysbiosis of gut microbiota and its metabolites with T2DM, indicating that targeted interventions aimed at modulating gut microbiota may represent a promising therapeutic approach for the management of T2DM. In this review, we concentrated on the multifaceted interactions between the gut microbiota and the intestinal barrier in the context of T2DM. We systematically summarized that the imbalance of beneficial gut microbiota and its metabolites may constitute a viable therapeutic approach for the management of T2DM. Meanwhile, the mechanisms by which gut microbiota interventions, such as probiotics, prebiotics, postbiotics, and synbiotics, synergistically improve insulin resistance in T2DM are summarized. These mechanisms include the restoration of gut microbiota structure, upregulation of intestinal epithelial cell proliferation and differentiation, enhancement of tight junction protein expression, promotion of mucin secretion by goblet cells, and the immunosuppressive functions of regulatory T cells (Treg) and M2 macrophages. Collectively, these actions contribute to the amelioration of the body's metabolic inflammatory status. Our objective is to furnish evidence that supports the clinical application of probiotics, prebiotics, and postbiotics in the management of T2DM.

The First Nations Community Experiences With the SOAR Research Program: Improving Type 2 Diabetes Prevention and Management

ObjectivesIndigenous peoples in Canada are considered the highest risk populations for type 2 diabetes mellitus (T2DM). Quality improvement (QI) strategies may be considered effective interventions for improving T2DM health outcomes. The purpose of this study was to understand experiences associated with implementation of the SOAR QI program to improve prevention and management of T2DM. MethodsA qualitative study was conducted, and in-depth, semistructured interviews were held with QI team members and key contacts, in person and through videoconference with 2 First Nations communities. Interviews were audio-recorded and transcribed for data analysis. ResultsTen interviews were conducted and emerging themes from the data analysis were organized into 2 categories: facilitators and barriers. Four subthemes were identified. Two subthemes emerged under the category of facilitators (cultural relevance and partnership building) and 2 subthemes emerged under the category of barriers (workload burden, role ambiguity). ConclusionsThis study highlights the necessity of implementing diabetes QI strategies that foster cultural sensitivity and provide opportunities for partnership building to strengthen community relationships. We also highlight the importance of diminishing role ambiguity, and increased workload burdens, which can hinder the successful implementation of QI programs long term. Our findings can be used to improve future adaptations of SOAR and other diabetes First Nations–focussed QI strategies, to benefit Indigenous people in acquiring optimal outcomes relative to T2DM care. Findings can also inform the design, practices, and policies of such QI interventions in support of the spread and sustainability of the intervention long term.

Efficacy of single anastomosis sleeve-ileal bypass in weight control and resolution of type 2 diabetes mellitus – a retrospective cohort study

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder exacerbated by obesity. Single Anastomosis Sleeve-Ileal Bypass (SASI) has emerged as a promising metabolic bariatric procedure that combines sleeve gastrectomy and ileal bypass, facilitating substantial weight loss and T2DM remission through restrictive and malabsorptive mechanisms. This study aims to evaluate the effects of SASI on T2DM remission, weight loss, and safety in one year follow-up. A retrospective cohort study analyzed 31 patients with obesity and T2DM who underwent SASI. Data collected included demographic characteristics, preoperative and postoperative BMI, HbA1c levels, and bariatric outcomes, including %TWL and T2DM changes. The mean age was 45 years, with a mean preoperative BMI of 40.7 kg/m². One year postoperatively, the mean %EWL was 85.6% and %TWL was 31.7%. T2DM remission was achieved in 24 (77.4%) patients, improvement in 4 (12.9%), and no change in 3 (9.7%). Hypertension improved in 21 (87.5%) patients, with 12 (50%) achieving remission. Significant reductions in BMI and HbA1c levels were observed (p < 0.001). Responders (R) and non-responders (NR) groups showed significant differences in postoperative BMI and %EWL (p = 0.007, p = 0.023). One patient experienced a Clavien-Dindo Grade III complication; no deaths occurred. SASI is an effective and safe procedure for treating T2DM, resulting in significant weight loss and metabolic improvements over a one-year follow-up. SASI seems to be a favorable option for T2DM management in metabolic bariatric surgery.

Acceptability and Scalability of a Meditation App Among Adolescents With Type 1 Diabetes Mellitus.

Background Adolescents with type 1 diabetes mellitus (T1DM) experience stress from general life stressors and diabetes-specific stressors. This stress manifests in a range of ways, such as mood swings, heightened frustration, strained familial relationships, and difficulties in T1DM self-management, which then leads to worse health outcomes. There is small to moderate evidence that frequent use of mental health applications (MHapps) improves mental and physical health outcomes. Meditation apps may help reduce some of the stress associated with living with T1DM. This study explores the acceptability and scalability of a self-guided, smartphone-based meditation app, the Healthy Minds Program (HMP) app, among adolescents with T1DM using the Unified Theory of Acceptance and Use of Technology. Methods Eight adolescents ages 15-19 were recruited from a pediatric clinic in a Midwestern state and introduced to the HMP app. After using the HMP app for one week, they were invited to participate in three successive focus group meetings. During the meetings, they shared their perspectives on the content, navigation, and acceptability of the HMP app and strategies to introduce and scale app utilization among adolescents with T1DM. Researchers conducted conventional content analysis using a hybrid coding approach. Data was managed and analyzed using NVivo 10 (Lumivero, Denver, Colorado, USA). Findings Participants believed that the HMP app has the potential to enhance their stress management, mood, and coping abilities when dealing with the challenges of T1DM management. They found the app enjoyable and easy to use but expressed concerns about time constraints as a potential barrier. To address this, they shared recommendations for facilitating app uptake and usage. Conclusions This study's results provide an in-depth understanding of how positively this subset of adolescents with T1DM viewed the HMP app. The participants also offered valuable suggestions that can promote the adoption and sustained use of MHapps by adolescents living with T1DM.

Application of Dietary Anthocyanins in Type 2 Diabetes Mellitus Treatment

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder characterized by impaired glucose control around the world that causes huge health challenges globally with increased morbidity and mortality. Inadequate insulin secretion and decreased insulin sensitivity are considered as main contributors to T2DM. Anthocyanin, a type of flavonoid compound, is one potentially feasible dietary intervention for T2DM treatment in addition to clinical drug interference. Dietary anthocyanins can be found in various berries, vegetables, and beverages, which provide vibrant colors. Anthocyanins are also increasingly used as colorants in the food industry. It is also seen as a supplement because of its antioxidation properties. Meanwhile, several evidence demonstrate the potential relationship between dietary anthocyanin intake and T2DM management. In this work, recent epidemiologic studies on the potential effects of anthocyanins in controlling T2DM have been reviewed, especially focusing on the typical indexes such as glycemic levels, insulin levels, etc. Many studies illustrate that appropriate intake of dietary anthocyanins could control glycemic levels, adjust insulin levels, and reduce insulin resistance. Because of these functions, dietary anthocyanins may trigger positive effects on T2DM treatment. Dietary anthocyanins could be seen as a good dietary intervention in T2DM control that meets the requirement of long-term management for the specific chronic disease.

Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador

Abstract Background The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context. Methods Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals. Results Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia. Conclusions The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations. Key messages • The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities. • Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.

Cross-national characteristics and differences in type 2 diabetes: Malta versus Luxembourg

Abstract Introduction Type 2 diabetes mellitus (T2DM) is a significant global health concern, requiring a thorough understanding of its population-level features and impact. This study aims to compare the characteristics of T2DM in Malta and Luxembourg, two European nations with distinctive healthcare systems and societal attributes. Methods Data from national health surveys conducted in Malta and Luxembourg, encompassing various factors such as socio-demographics, medical history, biochemical metrics, and anthropometric measurements, were analysed to investigate the features of T2DM. Comparative analyses were conducted utilizing chi-square tests, independent t-tests, and multivariable binary regression. Results Malta (8.23%) and Luxembourg (7.82%) shared similar T2DM prevalence, with a predominance of men having T2DM. Malta exhibited a higher prevalence of obesity among the individuals having T2DM. Multivariable analysis showed no significant association between living in Malta or Luxembourg and diabetes. However, being male (OR: 1.49, CI 95%: 1.07–2.08, p = 0.02), an occasional smoker (OR: 2.49, CI 95%: 1.54–4.03, p &amp;lt; 0.01), increasing age (OR: 1.05, CI 95%: 1.03–1.67), and larger waist circumference (OR: 1.02, CI 95%: 1.01–1.04, p = 0.01) were positively associated with diabetes. Conclusions Understanding similarities and differences in T2DM between Malta and Luxembourg is crucial for identifying common challenges to formulate effective prevention and management strategies. Despite similar T2DM prevalence rates, notable differences in obesity rates and socioeconomic factors may contribute to disparities in disease burden. The complex interplay of numerous population characteristics underscores the importance of tailored public health interventions. This study accentuates the need for interventions and evidence-based policies to address modifiable risk factors, and advocate for cross-national cooperation to reduce the T2DM epidemic, especially in the context of post-COVID public health planning and resource allocation. Key messages • Malta and Luxembourg share similar T2DM prevalence despite differences in other factors, hypothesised to be attributed to differences in risk factor profiles and health care infrastructure. • This study underscores the necessity for tailored interventions and cross-national cooperation to address common challenges in T2DM management in the two small countries.

Vitamin D Supplementation: Shedding Light on the Role of the Sunshine Vitamin in the Prevention and Management of Type 2 Diabetes and Its Complications.

As the incidence of type 2 diabetes mellitus (T2DM) continues to increase globally, researchers are keen to investigate various interventions to mitigate its impact. Among these, vitamin D supplementation has attracted significant attention due to its influence on insulin secretion from the pancreas and insulin receptors in body cells. A substantial body of evidence indicates that vitamin D supplementation can reduce low-grade inflammation, a critical factor in developing insulin resistance. In addition, vitamin D aids in sustaining low resting concentrations of reactive oxygen species and free radicals, normalizes Ca2+ signaling, diminishes the expression of cytokines that are pro-inflammatory, and enhances the production of cytokines that are anti-inflammatory. This review discusses the effects of vitamin D on the glycemic control of individuals with T2DM and evaluates the impact of vitamin D supplementation on glycemic markers in this population. The investigation employs a comprehensive analysis of the existing literature with a special focus on recent studies published in the past decade. Based on the findings in the literature, it can be concluded that vitamin D supplementation alongside anti-diabetic medications may enhance glycemic control and potentially reduce the risk of diabetic complications. The evidence supports the notion that vitamin D supplementation can be a valuable addition to pharmacological agents for the management of T2DM, potentially enhancing glycemic control and overall health outcomes in affected individuals.

Hypertension and diabetes control: faith-based centres offer a promise for expanding screening services and linkage to care in Ghana

BackgroundHypertension and type 2 diabetes mellitus (T2DM) are important contributors to noncommunicable disease related morbidity and mortality. Health systems could benefit from exploring the use of Faith-Based Centres (FBC) to screen and link suspected cases for further care in order to help achieve Sustainable Development Goal (SDG) 3. The study investigated the role of faith-based screening for T2DM and hypertension and the linkage of cases to the healthcare system and examined the care cascade in the Kassena Nankana Districts of Northern Ghana.MethodsWe screened individuals from 6 FBCs for elevated blood pressure and hyperglycaemia. Suspected hypertension and T2DM cases were referred to health facilities for confirmation and subsequently followed them up for 3 months. We assessed the prevalence of behavioural and metabolic risk factors, including hypertension and T2DM, and the retention of referred cases in the healthcare system over follow up period. We further assessed levels of awareness, treatment and adequate control of hypertension and T2DM.ResultsA total of 631 participants were screened, (mean age 49 ± 16years, 73% female) from 6 Faith based Centres. More males than females reported smoking tobacco (14.5% vs. 0.7%) and been physically active (64.5% vs. 52.7%) while more females were obese (29.6 kg/m2 vs. 14.5 kg/m2) and had a higher mean waist circumference (89.0 cm IQR 75-116 cm vs. 84.2 cm IQR 72–107 cm), hip circumference (101.5 ± 10.6 cm vs. 96.4 ± 8.6 cm) and waist-to-hip ratio (0.86 ± 0.1 cm vs. 0.87 ± 0.1 cm) than males. The prevalence of confirmed hypertension and T2DM was 27.9% and 3.5% respectively with no observed sex differences. We observed deficits in the hypertension and T2DM care cascade with reported low awareness, treatment and uncontrolled levels. A 3-month follow up showed a retention in care of 100% in month one and 94.9% in the third month. There was an increase in treatment (39.4% in month-1 and 82.8% in month-3) and control (26.3% in month-1 and 76.3% in month-3) of hypertension and T2DM combined.ConclusionFaith-based centres have the potential to enhance the screening, linkage to the healthcare system, and management of hypertension and T2DM. This improvement over the routine system could lead to earlier diagnoses, a reduction in complications, and decreased premature mortality from cardiovascular diseases. Consequently, these efforts would contribute significantly to achieving SDG 3.

Development and Validation of Selective and Sensitive Liquid Chromatography - Tandem Mass Spectroscopy (UHPLC-MS/MS) Method for Bioanalysis of Remogliflozin in Rat Plasma

Remogliflozin is an inhibitor of sodium-glucose cotransporter 2 inhibitors (SGLT-2) protein and plays an important role in the treatment and management of type-2 diabetes mellitus. In this study, a selective isocratic method was developed and validated using liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) for the determination of remogliflozin in rat plasma. Acetonitrile with formic acid was used as a precipitating agent. Chromatographic separation was achieved by using X select CSH Fluorophenyl (150 mm x 4.6 mm, 3.5 µm) column and 0.1% formic acid in milli-Q water (20%) and acetonitrile (80%), v/v as a mobile phase for isocratic elution method. Flow rate and injection volume were maintained at 0.7 mL/min and 10 µL, respectively. The validated method was linear in the range of 15– 2009 ng/mL with the lower limit of quantification (LLOQ) of 18 ng/mL. Also, the method was precise with a % CV less than 5.75 and accuracy within ±10% of nominal concentration. The method is accurate, simple, precise, and suitable for its application in further bioequivalence and pharmacokinetic studies.

Best Evidence Summary for Management of Older People With Type 2 Diabetes Mellitus Using 'Internet Plus Nursing Services'.

To evaluate and summarise the evidence for the management of older people with Type 2 diabetes mellitus (T2DM) using 'Internet Plus nursing services (IPNS)'. This study was conducted as an evidence summary, adhering strictly to the evidence summary reporting standards established by Fudan University Center for Evidence-based Nursing. We systematically searched for the best available evidence pertaining to the management of older people with T2DM using the IPNS. The literature types encompassed clinical guidelines, expert consensuses, systematic reviews, evidence summaries and original research studies. In order to gather pertinent information, we conducted a comprehensive search across various databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, PubMed, Web of Science, Yi Maitong Guidelines Network, SinoMed, CNKI, WanFang database, Chinese Biomedical Literature Database and China Science and Technology Journal Database. The search spanned from the inception of each database up to July 2023, ensuring an extensive coverage of relevant resources. After rigorous screening and evaluation, our study ultimately identified 19 articles with high-quality research outcomes. These articles consisted of three guidelines, two expert consensus documents, three systematic reviews and eleven original research studies. Through collaborative and in-depth discussions, we extracted and synthesised 27 pieces of evidence related to the application of the IPNS to enhance the T2DM management for older people. We categorised the evidence into five primary themes: mobile terminal design, team building, health education design, interaction and social support, and information feedback. In designing the IPNS for older people with T2DM, utmost attention should be paid to the intricacies of Internet module development preceded by comprehensive guidance. It is imperative to establish multidisciplinary teams to oversee the curation of patient educational content, ensuring its relevance and effectiveness. Leveraging Internet-based information feedback mechanisms is crucial for fostering peer support, assisting in blood glucose control, enhancing self-management capabilities and ultimately improving overall quality of life. Healthcare professionals are supposed to customise the IPNS for this vulnerable population, taking into account institutional resources and local contextual realities. It is highly recommended that clinical medical personnel worldwide adhere to the evidence-based recommendations for better care of older people with T2DM using the IPNS. No patient or public contribution was incorporated in this study. Our study provides structured ideas for the application of IPNS in T2DM management, provides practicable new ways for IPNS to improve self-management of older people with T2DM, and encourages the provision of Internet-based nursing services based on the needs and characteristics of older people, and jointly solves the challenges of T2DM management in order to enhance the effectiveness of nursing services.

Patient-centered care model based on self-efficacy to improve self-care and quality of life of people with type 2 diabetes mellitus: A PLS-SEM approach.

The current model for managing type 2 diabetes mellitus (T2DM) is healthcare provider-centered rather than patient-centered. This approach may overlook individual patients' unique needs, potentially impacting the effectiveness of T2DM management goals. This study aimed to develop a patient-centered care model based on self-efficacy to enhance self-care and improve the quality of life for individuals with T2DM. The study employed a cross-sectional design with a sample size of 250 respondents recruited through multistage random sampling, Jember regency, East Java, Indonesia. The study variables included exogenous factors (people with T2DM, situational treatment, family, and healthcare services) and endogenous factors (self-efficacy, self-care, and quality of life). Data were collected from August to December 2022 using a questionnaire and analyzed descriptively and inferentially using SEM-PLS. The developed model was a good fit with strong predictive relevance (SRMR = 0.065; Q2 = 0.049). All exogenous factors-people with T2DM, situational treatment, family, and healthcare services-significantly affected self-efficacy (42.2%, 37%, 8.1%, and 17.3%; p <0.001). Self-efficacy had a 61.6% effect on self-care, and self-care had a 27.1% effect on quality of life (p <0.001). Only situational treatment factors had a direct effect on self-care (21.7%; p <0.001). All exogenous factors also influenced the quality of life through self-efficacy and self-care (7%, 6.2%, 1.3%, and 2.9%; p <0.05). A patient-centered care model based on self-efficacy for managing T2DM can improve self-care behaviors and quality of life for individuals with T2DM. This model can be utilized by nurses in healthcare services to enhance the management of T2DM.

Serum biochemical evaluation following administration of imidazolyl thiazolidinedione in streptozotocin-induced diabetic rats.

Diabetes mellitus represents a prominent global health concern, characterized by a rising prevalence rate. Type 2 Diabetes Mellitus (T2DM) is purported to be associated with an intricate interplay of genetic, environmental, and lifestyle factors. While some progress have been made in T2DM management, controlling associated complications remains a great challenge in medicine. This study investigated a synthesized Imidazolyl Thiazolidinedione antidiabetic agent (PA9), focusing on serum parameters. Streptozotocin-induced diabetic rats (n = 6) were subjected to orally treatment with PA9 (synthesized by Shakour et al. in an equal dose of a standard drug, 0.011mmol/kg). The study conducted to measure some specific serum factors, including lipid profiles, liver and kidney enzymes, cardiac enzymes, and oxidative stress markers, both before and after treatment. The study findings indicated that PA9 effectively ameliorates hyperlipidemia by significantly reducing total cholesterol and triglyceride levels in serum. Additionally, PA9 demonstrated hepatoprotective effects against TZD-induced injuries, as evidenced by decreased levels of alanine transaminase and, alkaline phosphatase. In addition, PA9 also exhibited a modulatory effect on a cardiac injury marker, creatine kinase MB. Moreover, PA9 demonstrated antioxidant properties by reducing oxidative stress markers and enhancing the activities of catalase, thiol, and superoxide dismutase. The synthesized TZD compound (PA9) stands out as a highly promising agent for the management of diabetes. Its significant antihyperlipidemic effects, preventive influences on organ injuries, and demonstrated efficacy in reducing oxidative stress marker (SOD) make it therapeutic agent in diabetes management. This study lays the groundwork for innovative strategies in diabetes management.

6741 Serum Urate-Lowering Effects Of Sodium-Glucose Transport Protein 2 Inhibitors Compared To Dipeptidyl Peptidase-4 Inhibitors In Gout Patients With Type 2 Diabetes Mellitus: A Population-Based Cohort Study

Abstract Disclosure: R.K. Shariff: None. C. Chung: None. P. Huang: None. S. Mon: None. K. Ma: None. Background/Purpose: Effective management of gout in patients requiring long-term urate-lowering therapy involves maintaining serum rate levels within specific ranges. Hyperuricemia and gout have been associated with an increased risk of Type 2 Diabetes Mellitus (T2DM), with a reported prevalence of 16% in gout patients. Pharmacological approaches to glycemic control, including Sodium-glucose Transport Protein 2 Inhibitors inhibitor (SGLT2i) and Dipeptidyl Peptidase-4 Inhibitors (DPP-4i), have showed potential serum urate lowering effects. However, a direct comparison of these effects in patients with gout and concomitant T2DM is lacking. This study aims to evaluate the serum urate-lowering effects of SGLT2i compared to DPP-4i in this patient population. Methods: This was a population-based cohort study of patients with gout diagnosed following the 2015 Gout classification criteria in the American College of Rheumatology/European League Against Rheumatism collaborative initiative and T2DM diagnosed following the American Diabetes Association criteria, respectively. Subjects treated between 2008 and 2023 at 92 United States hospitals were screened. Propensity score matching was used to balance the baseline differences in age of gout onset, sex, comorbidities, and past medical history between the two groups. The primary predictor variable was the use of therapies of SGLT2i and DPP-4i. The primary outcome of interest was the serum urate more than 6 mg/dL during the follow-up period. Kaplan-Meier analysis and log-rank tests were utilized to compare if the numbers of serum urate were higher than 6 mg/dL in both arms. A Cox proportional hazards model was utilized to estimate the association between the use of SGLT2i versus DPP-4i and the numbers of serum urate higher than 6 mg/dL. Inclusion criteria include patients with gout and concomitant T2DM, age over 18, and must have serum uric acid level data available. Results: Of the 11,495 gout patients, including 3,593 users of SGLT2i users, were propensity score-matched to 3593 DPP-4i users. Among gout patients with T2DM on SGLT2i, 598 experienced serum urate levels exceeding than 6 mg/dL, while in the DPP-4i group, 920 patients had serum urate higher than 6 mg/dL. The use of SGLT2i was associated with significantly lower odds of serum uric acid exceeding 6 mg/dl compared to DPP-4i. (OR: 0.580 [0.517-0.651]). Conclusion: Our study suggests that SGLT2i may offer a more effective means of managing serum uric acid levels in gout patients with concomitant T2DM compared to DPP-4i. Clinical trials are required to validate the findings. For clinical practice, the dosage for SGLT2i to cause the urate-lowering effect needs to be investigated. With further studies and clinical trials, the rationale of choosing SGLT2i over DPP-4i may be incorporated into the management of T2DM in gout patients with T2DM. Presentation: 6/1/2024