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Issues Addressed Methods Results Conclusions So What? Addressing the disproportionate burden of type 2 diabetes prevalence in Aboriginal communities is critical. Current literature on diabetes care for Aboriginal people is primarily focused on remote demographics and overwhelmingly dominated by Western biomedical models and deficit paradigms. This qualitative research project adopted a strengths‐based approach to explore the barriers and enablers to diabetes care for Aboriginal people on Ngarrindjeri Country in rural South Australia.Knowledge Interface methodology guided the research as Aboriginal and Western research methods were drawn upon. Data collection occurred using three yarning sessions held on Ngarrindjeri Country. Yarns were transcribed and deidentified before a qualitative thematic analysis was conducted, guided by Dadirri and a constructivist approach to grounded theory.A total of 15 participants attended the yarns. Major barriers identified by participants were underscored by the ongoing impacts of colonisation. This was combated by a current of survival as participants identified enablers to diabetes care, namely a history of healthy community, working at the knowledge interface, motivators for action, and an abundance of community skills and leadership.Despite the raft of barriers detailed by participants throughout the diabetes care journey, Aboriginal people on Ngarrindjeri Country were found to be uniquely positioned to address diabetes prevalence and management.Health promotion efforts with Aboriginal people on Ngarrindjeri Country must acknowledge the sustained impacts of colonisation, while building on the abundance of community enablers, skills and strengths. Opportunities present to do so by adopting holistic, community‐led initiatives that shift away from the dominant biomedical approach to diabetes care. [ABSTRACT FROM AUTHOR]

This study aimed to assess the burden of type 2 diabetes mellitus (T2DM) in Latin America. An ecological study design was applied. The data on T2DM (i.e. incidence, mortality, disability-adjusted life years [DALYs], years lived with disability [YLDs] and years of life lost [YLLs]) were extracted from the Global Burden Disease 2019 study. To assess the trends, the average annual percentage change was computed using the joinpoint regression analysis. Approximately 2.3 million new cases of T2DM were diagnosed in Latin America in 2019, with about 214,000 deaths. The age-standardised rates of T2DM burden in 2019 were highest in Central Latin America. Incidence of T2DM has increased in both males and females in Latin America over the last three decades, while mortality has increased only in males. Of particular concern are the significant increasing trends in the incidence of T2DM among individuals in the young age and middle age groups (15–64 years) in both men and in women. Increasing trends in the burden of T2DM were observed in almost all countries of Andean Latin America, the Caribbean and Central Latin America (in particular, in Guatemala, where T2DM incidence increased by 2.4% per year, mortality by 3.7%, DALYs by 3.4%, YLDs by 2.7% and YLLs by 3.8%). T2DM is an important health issue in Latin America due to the high mortality and disability burdens and the impact on life expectancy and quality of life of the population. Unfavourable trends in T2DM burden highlight the need to introduce effective public health disease management strategies. [ABSTRACT FROM AUTHOR]

The American Diabetes Association (ADA) guidelines prioritize Sodicum-glucose transporter-2-inhibitors (SGLT2i) given cardio-renal and glycemic benefits. This study was conducted to observe clinical factors associated with initial SGLT2i prescription in type 2 diabetes patients eligible for SGLT2i by the ADA. Methods. A retrospective case-control study was performed in a safety-net clinic and consisted of the initial SGLT2i prescriptions group and the group without. The data from the electronic medical records between July 2021 and December 2022 were analyzed in the regressional models. Results. There was a significant association between A1c ≥8% (OR 3.7, p=.01), heart failure (OR 19.3, p<.0001), a history of hypotension (OR 11.9, p=.01), and sulfonylureas (OR 6.5, p=.003) with the SGLT2i prescription. Conclusion. Patients with high A1c levels, heart failure, a history of hypotension, and sulfonylureas were more likely than their counterparts to receive SGLT2i prescriptions. Future research should investigate adherence and provider prescribing behaviors related to SGLT2i to further assess optimal drug use. [ABSTRACT FROM AUTHOR]

Introduction: For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent. Areas covered: We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles. Expert opinion: There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care. [ABSTRACT FROM AUTHOR]

Background: The weight-adjusted waist index (WWI) is a quantitative anthropometric index that can be applied to evaluate obesity. This study examined the relationship between adult United States (US) residents' risk of diabetes mellitus type 2 (T2DM) and WWI. Methods: The NHANES (National Health and Nutrition Examination Survey) 2001–2018 provided the data for this investigation. This study used multifactorial logistic regression analysis, smoothed curve fitting, subgroup analysis, and interaction tests to assess the association between WWI and T2DM. Additionally, threshold effects were calculated using a two-stage linear regression model. The receiver operating characteristic(ROC) curves evaluated the diagnostic ability of the WWI and commonly used obesity indicators. Results: 20,477 participants were enrolled in the analysis, and patients with greater levels of WWI had a higher prevalence of T2DM. WWI and T2DM have a non-linear relationship, with a positive association found on the left side of the breakpoint (WWI = 12.35) (OR = 1.82, 95%CI:1.64–2.02), whereas, on the right side, no such relationship was found (OR = 0.9, 95%CI:0.61–1.34). For every unit rise in WWI, the probability of having T2DM increased by 67% after controlling for all other variables (OR:1.67,95%CI:1.53–1.83). Based on subgroup analyses, individuals under 40 had a higher correlation between WWI and T2DM (P < 0.001).ROC analyses showed that WWI had the best discrimination and accuracy in predicting T2DM compared to other obesity indicators (WC, BMI, and Weight). Conclusion: Higher WWI values had a higher prevalence of T2DM in US individuals, especially in adults under 40. WWI has the strongest ability to predict T2DM. Therefore, the importance of WWI in the early identification of T2DM in US adults should be emphasized. [ABSTRACT FROM AUTHOR]

Background: Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC. Methods: This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes. Results: We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls. Conclusion: The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop a diabetic kidney disease (DKD) prediction model using long short term memory (LSTM) neural network and evaluate its performance using accuracy, precision, recall, and area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Methods: The study identified DKD risk factors through literature review and physician focus group, and collected 7 years of data from 6,040 type 2 diabetes mellitus patients based on the risk factors. Pytorch was used to build the LSTM neural network, with 70% of the data used for training and the other 30% for testing. Three models were established to examine the impact of glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), and pulse pressure (PP) variabilities on the model’s performance. Results: The developed model achieved an accuracy of 83% and an AUC of 0.83. When the risk factor of HbA1c variability, SBP variability, or PP variability was removed one by one, the accuracy of each model was significantly lower than that of the optimal model, with an accuracy of 78% (P<0.001), 79% (P<0.001), and 81% (P<0.001), respectively. The AUC of ROC was also significantly lower for each model, with values of 0.72 (P<0.001), 0.75 (P<0.001), and 0.77 (P<0.05). Conclusion: The developed DKD risk predictive model using LSTM neural networks demonstrated high accuracy and AUC value. When HbA1c, SBP, and PP variabilities were added to the model as featured characteristics, the model’s performance was greatly improved. [ABSTRACT FROM AUTHOR]

Background: Melatonin, mainly regulating the body's circadian rhythm, may have protective effects against type 2 diabetes mellitus (DM2)-induced depression due to its antioxidant and regulatory impact in the pathogenesis of both DM2 and depression. This study aimed to find the association of serum melatonin levels with depression in DM2 patients. Methods: A total of 50 DM2 patients were recruited in this retrospective cross-sectional study and divided into 25 patients with depression (DM2-DP) and 25 without depression symptoms (DM2-NDP). Depression was diagnosed using the Hospital Anxiety and Depression Scale (HADS) assessment. Fasting blood samples were collected and examined for the level of serum melatonin and other biomarkers. All statistical analysis was performed by SPSS software Version 22, and a p-value less than 0.05 was considered statistically significant for all tests. Results: The depression score was significantly lower in DM2-NDP than DM2-DP (p< 0.001). The mean weight was significantly lower in the DM2-DP group (P= 0.021). Total cholesterol, triglyceride, and anxiety scores were higher, and the melatonin level was lower in DM2-DP. The correlation of melatonin levels was positive with age, DBP, HbA1C, FBS, and TG. In contrast, it was negative with male gender, BMI, diabetes duration, SBP, TC, family history of DM, depression score, and anxiety score. However, no significant differences were seen. Conclusion: Lower melatonin may be associated with depression and anxiety in patients with DM2. The serum melatonin level might be a strong predictor of depression in DM2 patients. [ABSTRACT FROM AUTHOR]

Abstract Background The weight-adjusted waist index (WWI) is a quantitative anthropometric index that can be applied to evaluate obesity. This study examined the relationship between adult United States (US) residents’ risk of diabetes mellitus type 2 (T2DM) and WWI. Methods The NHANES (National Health and Nutrition Examination Survey) 2001–2018 provided the data for this investigation. This study used multifactorial logistic regression analysis, smoothed curve fitting, subgroup analysis, and interaction tests to assess the association between WWI and T2DM. Additionally, threshold effects were calculated using a two-stage linear regression model. The receiver operating characteristic(ROC) curves evaluated the diagnostic ability of the WWI and commonly used obesity indicators. Results 20,477 participants were enrolled in the analysis, and patients with greater levels of WWI had a higher prevalence of T2DM. WWI and T2DM have a non-linear relationship, with a positive association found on the left side of the breakpoint (WWI = 12.35) (OR = 1.82, 95%CI:1.64–2.02), whereas, on the right side, no such relationship was found (OR = 0.9, 95%CI:0.61–1.34). For every unit rise in WWI, the probability of having T2DM increased by 67% after controlling for all other variables (OR:1.67,95%CI:1.53–1.83). Based on subgroup analyses, individuals under 40 had a higher correlation between WWI and T2DM (P

Abstract Background Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC. Methods This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes. Results We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls. Conclusion The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes.

Objective To explore the roles of serum tissue inhibitor of matrix metalloproteinase 3（TIMP3） and sex determining region Y box protein 2（SOX2） in an early diagnosis of renal injury in type 2 diabetes mellitus（T2DM）. Methods From April 2022 to April 2023， 102 T2DM patients visiting General Hospital of North China Petroleum Administration Bureau were recruited as research subjects. Based upon 24 h serum urinary protein excretion rate（UAER）， they were assigned into two groups of renal injury（n = 40） and renal non-injury（n = 62）. Another 50 patients undergoing health examinations at General Hospital of North China Petroleum Administration Bureau were regarded as control group. Enzyme-linked immunosorbent assay（ELISA） was utilized for measuring the serum levels of TIMP3 and SOX2. General profiles， serum levels of TIMP3， SOX2， glycosylated hemoglobin（HbA1c）， UAER， serum creatinine（Scr） and glomerular filtration rate（eGFR） of three groups were compared. Pearson’s correlation was utilized for examining the relationship between serum TIMP3/SOX2 and HbA1c， UAER， Scr and eGFR. Receiver operating characteristic curve（ROC） was applied for examining the diagnostic value of serum TIMP3/SOX2 for renal injury in T2DM patients. Results The serum levels of TIMP3 [（0.68 ± 0.17）μg/L vs （1.35 ± 0.35）μg/L] and eGFR [（105.99 ± 20.56）mL·min−1·（1.73 m2）−1 vs （133.15 ± 26.18）mL·min−1·（1.73 m2）−1] were obviously lower in T2DM patients than those in control group（P＜0.05）. Serum levels of TIMP3 [（0.47 ± 0.11）μg/L vs （0.82 ± 0.21）μg/L] and eGFR [（74.69 ± 10.22）mL·min−1·（1.73 m2）−1 vs （126.18 ± 27.23）mL·min−1·（1.73 m2）−1] were obviously lower in patients with renal injury than those without（P＜0.05）. Serum levels of SOX2 [（8.91 ± 1.82）kU/L vs （5.15 ± 1.31）kU/L]， HbA1c[（8.80 ± 1.55）% vs （5.52 ± 0.83）%]， UAER [（70.13 ± 18.06）mg/24 h vs （13.22 ± 3.61）mg/24 h] and Scr [（82.14 ± 15.23）µmol/L vs （53.19 ± 5.62）µmol/L] were obviously higher than those in control group（P＜0.05）. Serum levels of SOX2 [（10.81 ± 2.13）kU/L vs （5.15 ± 1.31）kU/L]， UAER [（156.83 ± 40.29）mg/24 h vs （13.22 ± 3.61）mg/24 h] and Scr [（113.77 ± 13.58）µmol/L vs （53.19 ± 5.62）µmol/L] were obviously higher in patients with renal injury than in patients without（P＜0.05）. Pearson’s correlation analysis revealed that TIMP3 was obviously correlated negatively with HbA1c， UAER and Scr（P＜0.05） and positively with eGFR（P＜0.05）. SOX2 was obviously correlated positively with HbA1c， UAER and Scr（P＜0.05） and negatively with eGFR（P＜0.05）. An obvious negative correlation existed between serum TIMP3 and SOX2（r = −0.590，P＜0.05）. The results of ROC indicated that the sensitivity and specificity of serum TIMP3 plus SOX2 in the diagnosis of renal injury in T2DM patients were 95.0% and 85.3% respectively. Both were obviously higher than those of TIMP3 and SOX2 alone. Conclusions Serum levels of TIMP3 and SOX2 decline markedly and the two are closely correlated with renal injury in T2DM patients. Both may be used for an early diagnosis of renal injury in T2DM patients.

Background: Coronary Heart Disease (CHD) is a disease caused by the narrowing of the coronary artery wall as a result of the atherosclerosis process. Atherosclerosis plays an important role from the beginning of plaque formation until plaque rupture which causes blood clots. Diabetes mellitus and dyslipidemia are one of the major risk factors for CHD. In patients with type 2 Diabetes Mellitus, there was an altered lipid profile which led to endothelial damage that caused the formation of atherosclerosis. HDL cholesterol labeled as good cholesterol was decreased due to uncontrolled LDL cholesterol labeled as bad cholesterol. LDL cholesterol synthesis process was disrupted then causing plaque formation in the arteries which causes CHD. Aim: The aim of this study was to analysis correlation between HbA1c levels, triglyceride levels, HDL levels and the degree of stenosis in coronary heart disease sufferers with type 2 diabetes mellitus. Method: This study was an observational cross-sectional analytical study with total of 51 patients with CHD who underwent cardiac catheterization at Telogorejo Hospital. Semarang. The correlation test in this study using the Spearman test with p

Background and Objective: Lack of sleep and insomnia are associated with an increase in the risk of diabetes. Sleep disorders in diabetic people are significantly higher than in healthy people. Moreover, sleep duration is related to blood sugar control in diabetes. This study was conducted with the purpose of investigating the level of sleepiness and obstructive sleep apnea in type 2 diabetic patients and its relationship with glycemic levels. Materials and Methods: This cross-sectional study was conducted on 200 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Hamadan in­ 2023­. Diabetes control status was evaluated by hemoglobin A1c, and the frequency of sleepiness and obstructive sleep apnea was assessed by the Epworth Sleepiness Scale and STOP-BANG questionnaires. Data analysis was done using SPSS 26 statistical software. Results: The mean age of the participants was 56.16 ± 9.77 years. A significant difference was observed between the frequency of daily sleepiness score with gender (P

Abstract Background Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. Methods Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. Results A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. Conclusions This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.

In this review, information is presented within the triad: obstructive sleep apnea/hypopnea syndrome (OSA), glycemic variability, and cardiac arrhythmias in patients with type 2 diabetes mellitus (DM2). Epidemiological aspects, pathogenetic relationships, possible instrumental and laboratory diagnostic methods, as well as approaches to personalized therapy are analyzed. Research is being actively conducted in certain areas of the designated triad, however, no studies have been found that include simultaneous monitoring of indicators reflecting these disorders in patients with DM2. Many issues are still controversial. Sleep disturbances in patients with DM2 are actively studied, but more often questionnaires are used for diagnosis, rather than instrumental methods. There is insufficient data examining the effect of hypoxia on the progression of complications in patients with DM2. Rhythm disturbances are being actively studied in patients with DM2 in combination with various cardiological problems. Of greatest interest is the study of rhythm disturbances in patients with DM2 without concomitant comorbid conditions of the cardiovascular system, in order to identify early signs of diabetic cardiovascular autonomic neuropathy and cardiomyopathy, as well as additional early risk factors for the development and progression of cardiovascular diseases. Most of the studies are devoted to the study of the association of OSA and various arrhythmias in cardiac patients. However, there is no data on the combined effect of glycemic variability and OSA on the development of cardiac arrhythmias in patients with DM2. Additional studies are needed to identify the features of the effect of OSA on cardiac arrhythmias in patients with DM2.

Introduction: Insulin resistance is a common condition affecting thousands of people worldwide. This paper aims to examine the mechanisms underlying insulin resistance among people suffering from obesity. Methods and Design: This study entailed identifying articles related to insulin resistance and obesity. The publications were obtained using different electronic databases, including PubMed, EBSCO, and LILACS. The search terms included “insulin”, “resistance”, “obesity”, and “mechanisms”. Boolean operators were used to combine terms and phrases. Results: Insulin resistance is a physiological condition characterized by the impaired action of insulin in the body. The association between obesity and insulin resistance is linked to inflammatory, neural, and endocrine pathways that affect the sensitivity of organs to the level of insulin in the body. Discussion: Molecular studies have helped discover some of the fundamental mechanisms leading to the development of insulin resistance. Further investigations are needed to enhance our understanding of the connections among the inflammatory, neural, and cellular processes underlying the association between insulin resistance and obesity. Conclusion: This study revealed that a complex correlation exists between insulin resistance and obesity. This relationship involves a wide range of inflammatory, neural, and endocrine processes.

Mucinous breast carcinoma is a rare subtype of mammary neoplasm encountered in medical practice. It represents approximately 1-6% of all breast cancers and is more common in postmenopausal women. There are two subtypes of mucinous breast carcinoma: pure and mixed. We report the case of a 73-year-old Caucasian woman diagnosed with mucinous pancreatic cystadenoma in 2007. She underwent a surgical procedure involving pancreatectomy of the body and tail, along with multiple known cardiovascular and metabolic comorbidities. In November 2019, during a clinical-biological evaluation for associated diseases, a mucinous carcinoma of the right breast was accidentally detected and later confirmed through further investigations. For treatment, a surgical procedure was performed involving lower right quadrantectomy with right axillary lymph node dissection. The postoperative clinical course was favorable. In conclusion, we present the case of a patient diagnosed with mixed mucinous breast carcinoma, without axillary lymph node invasion. Postmenopausal women with diabetes, overweight, and obesity have an increased susceptibility to breast cancer, with our patient having all these risk factors. To date, no study has demonstrated the genetic or radiation implication in the occurrence of mucinous carcinomas, nor the possible development of mucinous carcinomas in series in the same patient. Yet, current data are insufficient to provide recommendations for the screening of malignant mucinous tumors in subjects with significant cardiometabolic risk factors.

The prevalence of diabetes mellitus type 2 (DMT2) is increasing exponentially worldwide. DMT2 patients have been found to be at a higher risk for bone fractures than the healthy population. Hence, improving our understanding of the impact of antidiabetic drugs on bone metabolism is crucial.

Objective To explore the predictive value of serum levels of endothelial nitric oxide synthase (eNOS) and Omentin-1 for the occurrence of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients. Methods From May 2020 to February 2023, 124 hospitalized patients with type 2 DKD were selected as DKD group and 125 patients with simple type 2 diabetes as control group. Clinical parameters of all patients were collected. Serum levels of eNOS and Omentin-1 were detected by enzyme-linked immunosorbent assay (ELISA). Pearson’s method was utilized for examining the correlation between serum eNOS, Omentin-1 and clinical parameters. Multivariate Logistic regression model was employed for examining the risk factors of DKD occurrence in T2DM. The predictive value of serum levels of eNOS and Omentin-1 for the occurrence of DKD was examined by receiver operating characteristic (ROC) curve. Results As compared with control group, serum levels of total cholesterol [(4.75±0.91) mmol/L vs (4.48±0.96) mmol/L], glycosylated hemoglobin [(9.32±1.25)% vs (8.56±1.23)%], 24 h urinary protein quantity [(2.78±0.31) g vs (0.15±0.02) g], urinary microalbumin (mAlb) [(273.12±20.41) mg/L vs (23.08±3.35) mg/L] and serum creatinine (Scr) [(209.53±22.59) μmol/L vs (73.52±9.21) μmol/L] spiked markedly in DKD group. And the levels of estimated glomerular filtration rate (eGFR) [(72.52±13.51) mL·min−1·(1.73 m2)−1 vs (107.34±10.27) mL·min−1·(1.73 m2)−1], serum eNOS [(24.48±3.37) U/L vs (33.82±4.52) U/L] and Omentin-1 [ (28.75±4.42) μg/L vs (43.63±6.78) μg/L] rose sharply (P

Meriem Chayah,1– 3 Angélica Luque-González,1 Verónica Gómez-Pérez,1 Diego Salagre,4,5 Amjad Al-Shdaifat,6 Joaquín María Campos,1,2 Ana Conejo-García,1,2 Ahmad Agil2,4,5 1Department of Medicinal and Organic Chemistry and Excellence Research Unit of Chemistry Applied to Biomedicine and the Environment, Faculty of Pharmacy, University of Granada, Granada, Spain; 2Biosanitary Institute of Granada (Ibs.granada), SAS-University of Granada, Granada, Spain; 3Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government (GENYO), Granada, Spain; 4Department of Pharmacology, Faculty of Medicine, University of Granada, Granada, Spain; 5Federico Oloriz Neuroscience Institute, University of Granada, Granada, Spain; 6Department of Medicine and Family Medicine, Faculty of Medicine, Hashemite University, Zarqa, JordaniaCorrespondence: Ahmad Agil; Ana Conejo-García, Email aagil@ugr.es; aconejo@ugr.esAbstract: Type 2 diabetes mellitus (T2DM) is one of the world’s principal metabolic diseases characterized by chronic hyperglycemia. The gut incretin hormones, glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP), which has been proposed as a new treatment for T2DM, are extensively metabolized by Dipeptidyl peptidase 4 (DPP-4). Inhibitors of DPP-4 block the degradation of GLP-1 and GIP and may increase their natural circulating levels, favoring glycemic control in T2DM. A novel and potent selective inhibitor of DPP-4 with an 8-purine derived structure ( 1) has been developed and tested in vitro and in vivo in Zücker obese diabetic fatty (ZDF) rats, an experimental model of the metabolic syndrome and T2DM to assess the inhibitory activity using vildagliptin as reference standard. ZDF rats were subdivided into three groups (n = 7/group), control (C-ZDF), and those treated with compound 1 (Compound 1-ZDF) and with vildagliptin (V-ZDF), both at 10 mg/kg/d rat body weight, in their drinking water for 12 weeks, and a group of lean littermates (ZL) was used. ZDF rats developed DM (fasting hyperglycemia, 425 ± 14.8 mg/dL; chronic hyperglycemia, HbA1c 8.5 ± 0.4%), compared to ZL rats. Compound 1 and vildagliptin reduced sustained HbAl1c (14% and 10.6%, P < 0.05, respectively) and fasting hyperglycemia values (24% and 19%, P < 0.05, respectively) compared to C-ZDF group (P < 0.001). Compound 1 and vildagliptin have shown a potent activity with an IC50 value of 4.92 and 3.21 μM, respectively. These data demonstrate that oral compound 1 administration improves diabetes in ZDF rats by the inhibitory effect on DPP-4, and the potential to be a novel, efficient and tolerable approach for treating diabetes of obesity-related T2DM, in ZDF rats.Keywords: diabetes mellitus type 2, DPP-4 inhibitors, purine derivatives, ZDF rats

Background: Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. Methods: Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. Results: A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. Conclusions: This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 (GLP-1) is an incretin hormone secreted by food intake from L cells of the ileum. GLP-1 contributes to blood glucose control through three main mechanisms: promoting glucose-dependent insulin secretion from pancreatic beta cells, suppressing glucagon hypersecretion from pancreatic alpha cells, and delaying gastric emptying time. GLP-1 receptor agonists (RAs) have been developed for administration twice daily, once daily, and once weekly as subcutaneous injection formulation and as a daily oral formulation. GLP-1 RAs have benefits in reducing glycated hemoglobin, weight, and blood pressure, as well as in managing lipid profiles. Additionally, some GLP-1 RAs have demonstrated cardiovascular benefits. Therefore, the guidelines recommend GLP-1 RA treatment of type 2 diabetes patients with preexisting atherosclerotic vascular disease. GLP-1 RA may also improve renal outcomes. The most frequently reported side effects of GLP-1 RA are gastrointestinal symptoms, which can be minimized by gradually starting treatment at a low concentration and then increasing to the final dosage. Considering the efficacy, administration frequency, and cost of each GLP-1 RA treatment, it can be selected as monotherapy or in combination with oral hypoglycemic agents and basal insulin in free or fixed dose formulation. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first noninsulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. Methods: A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society Beers criteria 2015 was used for older (≥65 years) patients and the Prescribing Optimally in Middle‐age People's Treatments criteria was used for middle‐aged (45‐64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymized electronic health records in the UK. Results: Among 28 604 patients initiating NIADs, 18 494 (64.7%) received polypharmacy. In older and middle‐aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIP. At the individual PIP level, long‐term proton pump inhibitors (PPI) use was the most frequent PIP among older adults, and strong opioid without laxatives was the most frequent PIP in middle‐aged patients with polypharmacy (11.1% and 4.1%, respectively). Conclusions: This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimization. [ABSTRACT FROM AUTHOR]

Introduction: Insulin resistance is a common condition affecting thousands of people worldwide. This paper aims to examine the mechanisms underlying insulin resistance among people suffering from obesity. Methods and Design: This study entailed identifying articles related to insulin resistance and obesity. The publications were obtained using different electronic databases, including PubMed, EBSCO, and LILACS. The search terms included "insulin", "resistance", "obesity", and "mechanisms". Boolean operators were used to combine terms and phrases. Results: Insulin resistance is a physiological condition characterized by the impaired action of insulin in the body. The association between obesity and insulin resistance is linked to inflammatory, neural, and endocrine pathways that affect the sensitivity of organs to the level of insulin in the body. Discussion: Molecular studies have helped discover some of the fundamental mechanisms leading to the development of insulin resistance. Further investigations are needed to enhance our understanding of the connections among the inflammatory, neural, and cellular processes underlying the association between insulin resistance and obesity. Conclusion: This study revealed that a complex correlation exists between insulin resistance and obesity. This relationship involves a wide range of inflammatory, neural, and endocrine processes. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus has become increasingly common worldwide, with many serious complications. Diabetic nephropathy is one such complication that affects the kidney and leads to end-stage renal failure worldwide. Microalbuminuria represents an abnormal elevation in urine albumin levels, which is an early marker of diabetic nephropathy. It is likely to be found in one-third or more of diabetic patients. Early recognition of microalbuminuria in diabetic nephropathy permits successful therapeutic intervention and significant postponement of terminal renal failure. Objective: To investigate the prevalence of microalbuminuria in type 2 diabetes patients attending AL-Thawra Hospital and Saref Medical Centre in Sana'a City. Materials and Methods: This study was carried out in AL-Thawra Hospital and Saref Medical Center in Sana'a City, during the period (from 1 February to 30 April 2021). 125 Type 2 diabetic patients (diagnosed according to American Diabetes Association (ADA) criteria for diagnosis of diabetes) were selected). Medical records were used to collect data on duration of diabetes, gender, age and body mass index (BMI). Microalbuminuria was assessed using mispa-i3 kits in spot of the morning urine samples. Results: The prevalence of microalbuminuria and macroalbuminuria among type 2 diabetic patients was 44.8% and 12 %, respectively. Microalbuminuria had a statistically significant association with longer duration (P = 0.031), and no statistically significant association was found between microalbuminuria and gender (P = 0.419), age (P = 0.299) and body mass index (P = 0.390). Conclusion: The prevalence of microalbuminuria in this study was considerably high (44.8%) in type 2 diabetes. 44.8% (nearly half) of type 2 diabetic patients in this study are at risk of developing kidney disease due to their high microalbuminuria level. This calls for regular and early screening for microalbuminuria is recommended for all diabetic patients, as early treatment is critical for reducing the progression to the late stage of diabetic nephropathy (overt proteinuria and end-stage renal disease). [ABSTRACT FROM AUTHOR]

To assess the willingness of people with type 2 diabetes (T2D) to engage in healthy eating, physical activity and medication taking, and explore associated patient factors. Online survey among recently diagnosed T2D patients recruited in the Netherlands and the United Kingdom (UK). Patient factors included general factors and behaviour-specific beliefs. Logistic regression analyses and explorative comparisons were conducted. Overall, 48% of 67 patients were willing to engage in all three management options, whereas 6% were not willing to follow any of them. 73% were willing to manage T2D with healthy eating, 73% with physical activity, and 72% with medication. Country of recruitment was significantly associated with willingness for healthy eating, with higher willingness among Dutch participants. Beliefs surrounding capability, opportunity, and motivation were significantly associated with willingness to engage in physical activity and medication taking. Many beliefs were similar regardless of willingness but those willing to engage in physical activity perceived less barriers and those willing to take medication had more positive and less negative outcome beliefs than those not willing. Willingness to engage in all management options was limited among recently diagnosed patients, and partly associated with behaviour-specific patient beliefs. • Willingness for diabetes management with all options is limited in recently diagnosed people. • People willing or not willing to engage in a management option shared similar beliefs. • Capability-opportunity-motivation beliefs were relevant for some of the options. • Willingness to follow a recommended diet differed between countries of recruitment. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes mellitus type 2 (DM2) is a hypercoagulable state with enhanced platelet (PLT) activation and increased clotting factor production. Simultaneously, the fibrinolytic cell system is inhibited due to the formation of clots with high fibrinolysis resistance. The stages of PLT "activation" have been well characterized microscopically, morphometrically, and nanomechanically using a light microscope, transmission electron microscope (TEM), scanning electron microscope (SEM), and atomic force microscope (AFM). Thrombocytes in an "activated" (procoagulant) state play a central role in two main biological processes: hemostasis and vascular vessel repair. Enhanced PLT reactivity in diabetic patients is considered a "pro-thrombotic" state. PLT hematometric indices are higher in retrospective and prospective studies, such as PLTs (count), MPV (mean platelet volume), PDW (platelet distribution width), PCR (platelet crit), and the PLTs/Ly ratio. The platelet indices MPV and PDW are higher in people with diabetes who have chronic vascular complications, and are statistically significant. PLT parameters/indices are useful biomarkers in the early diagnosis and prognosis of DM2. Precise studies of PLT activation state during DM2 may be useful for new diabetes (DM2) treatment strategies and effective therapeutic agents. Researchers have observed an association between MPV and medications such as insulin, metformin, and sulfonylureas using the blood glucose concentration attached to hemoglobin (HbA1c values) as markers of glycemic control in patients with diabetes. Computational modeling of PLT activation in DM2 is also a controlling factor for thrombocyte distribution and margination in blood vessels, both of which are associated with micro- and macrovascular disease in DM2. PLT-derived microRNAs (miRNAs) are novel molecular biomarkers for the diagnosis and prognosis of DM2, insulin resistance, and diabetes complications. Anti-platelet agents and natural plant products may also be effective in the prevention and secondary treatment of micro- and macrovascular complications in type 2 diabetes mellitus. To determine new ways of diagnosing, treating, predicting, and managing DM2 and its related vascular complications, we propose monitoring a combination of hematological, hemorheological, and hemostatic parameters (indices), which merit future studies. [ABSTRACT FROM AUTHOR]

IL-33 is one of the novel IL-1 family members which are secreted in many tissues. Osteopontin (OPN) is a highly phosphorylated and glycosylated sialoprotein synthesized primarily in bone tissue, which the major role is to participate in biomineralization. Both IL-33 and OPN are mentioned associated with inflammatory disorders. Diabetes Mellitus Type 2 (T2DM) is a metabolic disorder in glucose homeostasis, which its pathophysiology involves a low-grade chronic inflammation. The aim of this study is to evaluate the IL-33 and OPN levels in well and poorly regulated T2DM patients. Three group were determined as; T2DM with HbA1c level below 8% as Group HbA1c <8, T2DM with HbA1c level of 8% and above as Group HbA1c ≥8, and control group consisting of healthy individuals respectively. Each group included 50 participant (n=50). Age, fasting plasma glucose, HbA1c and lipid parameters (total cholesterol, triglyceride, LDL, HDL), IL-33 and OPN values were examined. There was a significant statistical difference between the fasting plasma glucose, HbA1c, triglyceride, and HDL levels of the groups (p<0.001). OPN levels of the groups were not found statistically different but IL-33 levels were found to be significantly higher in the HbA1c <8 group compared to the control group (p=0.0108). IL-33 and OPN levels do not differ in terms of well or poorly regulation in T2DM patients and HbA1c level alone, is insufficient to be a predictor of OPN and IL-33 activity [ABSTRACT FROM AUTHOR]

Background. Myostatin (Mstn) plays an important role in adipocyte growth, differentiation and metabolism, leading to the development of obesity. Objectives. We aimed to explore the effect of Mstn on white fat browning in a mouse model of type 2 diabetes mellitus (T2DM). Materials and methods: Twelve wild-type (WT), 12 heterozygous (Mstn(+/-)) and 12 homozygous (Mstn(-/-)) male mice were randomly divided into 6 groups: WT, Mstn(+/-), Mstn(-/-), WT+DM, Mstn(+/-)+DM, and Mstn(-/-)+DM. The first 3 groups were fed normal chow, while the last 3 were fed high-fat diet and administered streptozotocin to generate T2DM. Subsequently, body mass, length, and white and brown fat masses were measured, after which Lee's index, white-brown ratio and fat index were calculated. The serum free fatty acid (FFA) levels were detected using enzyme-linked immunosorbent assay (ELISA). Hematoxylin and eosin (H&E) staining was used to analyze white and brown fat cell morphology. The relative expression levels of peroxisome proliferator-activated receptor-gamma (PPARγ), peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1a), uncoupling protein 1 (UCP1), and cluster of differentiation 137 (CD137) protein were determined with western blotting. Results: The Mstn(-/-) group displayed higher levels of PPARγ, PGC-1a and CD137 proteins in white and brown fat compared to the WT and Mstn(+/-) groups, while the expression level of UCP1 protein in the Mstn(-/-) group was higher than in the WT group. The expression levels of PPARγ, PGC-1a, UCP1, and CD137 proteins in the WT+DM group were lower than in the WT group. Moreover, PPARγ, PGC-1a, UCP1, and CD137 proteins were more highly expressed in the Mstn(-/-)+DM group compared to the WT+DM and Mstn(+/-)+DM groups. Conclusions. The Mstn gene inhibition antagonizes obesity phenotypes, such as white fat accumulation and lipid metabolism derangement caused by T2DM, thus promoting white fat browning. [ABSTRACT FROM AUTHOR]