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Background/Objectives: Obesity and type 2 diabetes (T2D) are associated with significant alterations in various metabolic biomarkers. Isthmin-1 (Ism1) has recently emerged as a potential marker of metabolic health and was shown in animal studies to associate with metabolic-associated fatty liver disease (MAFLD). In this study, we aimed to investigate the circulatory levels of Ism1 in individuals with obesity compared to non-obese individuals and evaluate their association with insulin resistance, MAFLD, and T2D. The primary outcomes of this study are obesity, insulin resistance, MAFLD, and T2D, while the secondary outcome is hypertension; Methods: This is a cross-sectional study involving 450 participants, who were divided based on their obesity status into people with obesity (n = 182) and those without obesity (n = 265). Circulating Ism1 levels were measured by ELISA and were compared between the groups. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR), and fatty liver was evaluated using Fibroscan; Results: Our results showed a significant reduction in circulating Ism1 levels in individuals with obesity (p-value = 0.002). Ism1 levels were negatively associated with the odds of T2D, possibly suggesting a protective role. Additionally, individuals with higher CAP scores demonstrated significantly lower Ism1 levels, and the Spearman's rank correlation revealed a negative association between Ism1 and both CAP scores (r = −0.109, p-value = 0.025) and insulin resistance (r = −0.141, p-value = 0.004). Logistic regression analysis further supported Ism1 as an independent significant protective factor against obesity-related metabolic dysfunction. This significance persisted after adjusting for several confounders. Furthermore, our ROC results indicate that circulatory Ism1 levels possess significant diagnostic capability for identifying individuals with obesity-related metabolic imbalances with an area under the curve of 0.764 (95% CI = 0.718, 0.811). Finally, the adjusted multinomial analysis suggested that higher levels of Ism1 may play a protective role against pre-diabetes (AOR = 0.88, 95% CI = 0.838, 0.925) and T2D (AOR = 0.87, 95% CI = 0.814, 0.934); Conclusions: This study suggests that reduced Ism1 levels are linked to increased insulin resistance, MAFLD, and T2D in obese individuals. Our findings further corroborate the protective role of Ism1 and highlight its potential utility as a biomarker for monitoring obesity-related metabolic diseases. [ABSTRACT FROM AUTHOR]

Aim: To compare hepatic stiffness and fat fraction in patients with obesity and type 1 diabetes (T1D) with type 2 diabetes (T2D) with a similar body mass index (BMI). Methods: In this prospective cross‐sectional study, 90 participants with T1D (BMI 30.5 ± 4.5 kg/m2; diabetes duration 20.5 ± 9.8 years; HbA1c 8.2% ± 1.4%) and 69 with T2D (BMI: 30.8 ± 4.6 kg/m2; diabetes duration: 11.7 ± 7.8 years; HbA1c: 7.3% ± 1.4%) were included. Liver fat fraction and stiffness were examined by magnetic resonance imaging and elastography, respectively. Logistic regressions were used to evaluate associations with biomedical variables. Results: The mean liver stiffness score in patients with obesity and T1D was 2.2 ± 0.5 kPa, while in T2D it was 2.6 ± 0.8 kPa (P <.001). The liver fat fraction in patients with obesity and T1D was 3.7% ± 6.3%, and in T2D it was 10.6% ± 7.9% (P <.001). Metabolic dysfunction‐associated steatotic liver disease (MASLD) was present in 13.3% of patients with T1D and in 69.6% of patients with T2D, whereas fibrosis was suggested in 7.8% of patients with T1D and in 27.5% of patients with T2D. Liver stiffness was four times higher in patients with T2D compared with those with T1D (odds ratio = 5.4, 95% confidence interval: 2.1‐13.6, P <.001). Aspartate transaminase (AST), alanine transaminase, gamma‐glutamyl transferase (GGT), triglycerides and the android‐to‐gynoid ratio were associated with elevated fat fraction in both cohorts. AST and GGT were associated with elevated liver stiffness in both cohorts. Conclusions: Patients with obesity and T1D had lower liver fat and liver stiffness compared with those patients with T2D, despite similar levels of BMI, a longer duration of diabetes and worse glycaemic control. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association of physical activity and sleep metrics, measured via wrist-worn accelerometers, with depression in people with type 1 diabetes. Patients and Methods: People with type 1 diabetes were recruited from the Dasman Diabetes Institute in Kuwait and were invited to wear a wrist-worn accelerometer device for 7 days. Mean physical activity (overall acceleration), inactivity, light activity, moderate activity, vigorous activity, the distribution of physical activity intensity (intensity gradient), sleep duration and sleep efficiency were quantified from the accelerometer data. The associations of these metrics with depression were investigated using multiple linear regression. Results: A total of 551 people with type 1 diabetes (age 33.1 (9.5) years) were included. Overall physical activity (B = − 0.09, CI = − 0.14 to – 0.04), moderate intensity activity (B = − 0.02, CI = − 0.02 to − 0.01), vigorous intensity activity (B = − 0.16, CI = − 0.27 to − 0.05), and the intensity gradient (B = − 2.11, CI = − 3.51 to − 0.72) were negatively associated with depression score (p < 0.01) and these associations remain significant even after adjustment for age, sex, diabetes duration, and BMI. However, sleep duration and efficiency were not associated with depression. After mutual adjustment overall physical activity (B = − 0.07, CI = − 0.12 to − 0.01), but not the intensity gradient (B = − 0.90, CI = − 2.47 to 0.68), remained associated with depression. Conclusion: Overall, moderate and vigorous physical activity, and the intensity gradient were associated with lower symptoms of depression. Overall physical activity, rather than the distribution of activity intensity, appears more important in depression. This information can help guide physical activity interventions to improve depression in people with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions. Methods: A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores =10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected. Results: The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the cooccurrence of diabetes distress and depressive symptoms (p< 0.05 for all). Conclusion: The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors. [ABSTRACT FROM AUTHOR]

Background: Trials investigating the role of carbohydrate restriction in the management of glycaemia in type 2 diabetes (T2D) have been confounded by multiple factors, including degree of calorie restriction and dietary protein content, as well as by no clear definition of a low‐carbohydrate diet. The present study aimed to provide insight into the relationship between carbohydrate restriction and glycaemia by testing the effect of varying doses of carbohydrate on continuous glucose concentrations within a range of intakes defined as low‐carbohydrate at the same time as controlling for confounding factors. Methods: This was a randomised crossover trial in participants with T2D (HbA1c: 6.6 ± 0.6%, 49 ± 0.9 mmol mol–1) testing five different 6‐day eucaloric dietary treatments with varying carbohydrate content (10%, 15%, 20%, 25%, and 30% kcal). Diets exchanged %kcal from carbohydrate with fat, keeping protein constant at 15% kcal. Daily self‐weighing was employed to ensure weight stability throughout each treatment arm. Between dietary treatments, participants underwent a washout period of at least 7 days and were advised to maintain their habitual diet. Glycaemic control was assessed using a continuous glucose monitoring device. Results: Twelve participants completed the study. There were no differences in 24‐h and post‐prandial sensor glucose concentrations between the 30 and 10%kcal doses (7.4 ± 1.1 mmol L–1 vs. 7.6 ± 1.3 mmol L–1 [p = 0.28] and 8.1 ± 1.5 mmol L–1 vs. 8.5 ± 1.4 mmol L–1 [p = 0.28], respectively). In our exploratory analyses, we did not find any dose–response relationship between carbohydrate intake and glycaemia. A small amount of weight loss occurred in each treatment arm (range: 0.4–1.1 kg over the 6 days) but adjusting for these differences did not influence the primary or secondary outcomes. Conclusions: Modest changes in dietary carbohydrate content in the absence of weight loss at the same time as keeping dietary protein intake constant do not appear to influence glucose concentrations in people with well‐controlled T2D. Summary: This study randomised people with T2D to receive five different doses of carbohydrate from 10% to 30% of calories in random order to see what effect it had on their blood glucose. Key points: Decreasing the carbohydrate content of the diet from 30 to 10%kcal had no detectable effect on blood glucose concentration. There was no observed relationship between the dose of carbohydrate as a %kcal and glucose concentration. It is possible that a low carbohydrate diet needs to be combined with high protein to lower glucose in type 2 diabetes. This study was specifically designed to prevent weight loss and therefore our results do not mean that a low carbohydrate which causes weight loss would not be beneficial for type 2 diabetes. [ABSTRACT FROM AUTHOR]

Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum., Competing Interests: All authors have provided consultancy services to Merck Serono Middle East FZ-Ltd, as per the “Funding” section, below. Additionally: Tarik Elhadd provided consultancy services to NovoNordisk, Eli Lilly, MSD, and Amgen. Thamer Alessa has also provided consultancy services and /or Speaker honorarium to NovoNordisk, Sanofi, Eli Lilly, MSD, Servier, Merck, Astra Zeneca and Amgen. Fatheya Al Awadi received speaker honoraria, and was part of advisory boards of the following pharmaceutical companies: Eli Lilly, Novo Nordisk, Servier, Pfizer, MSD, Merck and Sanofi-Aventis. Dalal Alromaihi received speaker honoraria and was part of advisory boards of the following pharmaceutical companies: Novo Nordisk, Servier, Astra Zeneca and Sanofi-Aventis. Raya Kalimat is a full-time employee of Merck Serono Middle East FZ-Ltd, Dubai, UAE, an affiliate of Merck KGaA, Darmstadt, Germany. Kerstin Brand is a full-time employee of Merck Healthcare KGaA, Darmstadt, Germany. Abdallah A Gunaid, Amin Jayyousi, Ali Al Mamari, Juma Al Kaabi, Ebaa Al Ozairi, and Mohammed Hassanein declared no duality of interest., (© 2024 Alessa et al.)

Purpose: The aim of this cross-sectional study was to compare the Arabic version of International Physical Activity Questionnaire (IPAQ) measured moderate-to-vigorous physical activity (MVPA) with accelerometer-measured MVPA in people with diabetes., Methods: From 2020 to 2022 physical activity was measured people ≥18 years with type 1 or type 2 diabetes in Kuwait. Self-reported MVPA was measured over 7 days with the Arabic version of the IPAQ. During the same 7-day period wrist worn accelerometers were used to objectively measure MVPA. IPAQ MVPA was calculated both including and excluding walking physical activity. MVPA measures were compared by limits of agreement approach, Pearson correlations and concordance correlations., Results: We recruited 240 participants with type 1 diabetes and 343 participants with type 2 diabetes for the study. In people with type 1 diabetes, there were no concordance correlations between IPAQ MVPA, both including (rho = -0.011 (-0.038, 0.017), p = 0.444) and excluding (rho = -0.001 (-0.067, 0.065), p = 0.978) walking physical activity. MVPA measured by IPAQ was 43.3(-85.6, 172.2) min/day higher than accelerometer-measured MVPA, when including walking, and 8.88(-60.4, 78.2) min/day higher, when excluding walking. In people with type 2 diabetes, there were significant positive concordance correlations between IPAQ MVPA, both including (rho = 0.038 (0.02, 0.06), p < 0.001) and excluding (rho = 0.34 (0.27, 0.41), p < 0.001) walking physical activity. MVPA measured by IPAQ was 62.3 (95% CI -61.5 to 186.0) min/day higher than accelerometer-measured MVPA, when including walking, and 4.0 (95% CI -34.1 to 42.0) min/day higher, when excluding walking., Conclusion: In people with type 1 or type 2 diabetes, caution should be exercised when using the Arabic version of the IPAQ to measure MVPA., Competing Interests: The authors report no completion interests in this work., (© 2024 Al Ozairi et al.)