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ABSTRACT: Type-2 diabetes mellitus (T2DM) is characterized by defects in insulin secretion and combined peripheral resistance to the hormone. Several non-human primates (NHP) species develop T2DM, mainly captive animals with reduced physical activity and incorrect feeding. This case report describes the T2DM treatment of a black-eared marmoset (Callithrix penicillata) by diet reformulation and metformin oral administration. An adult female was diagnosed with T2DM after hyperglycemia and high serum fructosamine associated with glycosuria and obesity. Metformin hydrochloride (125mg/animal, orally, q24h) associated with feeding intervention was started. After 26 days, a significant reduction in weight, glycemia, and serum fructosamine could be observed, showing satisfactory results for the adopted therapy. Metformin is considered a safe drug for T2DM treatment due to its low hypoglycemia risk. The new diet consisted of sweet potato, squash, and varied fruits offered twice daily. In addition, thawed-mice newborns, egg whites, and small portions of pelleted primate food. In the present report, metformin use, associated with a low glycemic index diet, was effective in treating this particular marmoset and may present a potential for T2DM treatment in other NHPs.

Background: Fasting during the holy month of Ramadan is one of the five pillars of Islam. Fasting is not meant to create excessive hardship on the Muslim individual according to religious tenets. It is important that health professionals are aware of potential risks associated with fasting during the month of Ramadan (mainly hypoglycemia and hyperglycemia). Aims: To explore the impact of applying the principles of our 2020 recommendations for the management of type 2 diabetes (T2D) during the month of Ramadan. Methods: A multinational randomized controlled trial (RCT) was conducted in five Muslim majority countries. Six hundred and sixty participants were deemed eligible for the study; however, 23% declined to participate later for various reasons. In total, 506 participants were enroled and were equally randomized to the intervention or the control group. At the end of the study, data from 231 participants in the intervention group and 221 participants from the control group were collected after 12.6% and 8.7% were, respectively, lost to follow‐up. Participants were randomized to receive a Ramadan‐focussed education with treatment for diabetes adjusted as per our 2020 recommendation update compared with the local usual care (control group). Results are presented using mean, standard deviation, odds ratio (OR), and percentages. Results: At the end of the study, the number of hypoglycemic episodes in the intervention group was less than in participants who received usual care. The intervention group had significantly lower severe hypoglycemia compared to the control group with an OR of 0.2 [0.1–0.8]. Compared to baseline, both groups had a significant reduction in glycated haemoglobin (HbA1c), but the improvements were significantly greater in the intervention group. Whilst body weight reduced and high‐density lipoprotein cholesterol increased with the intervention, these changes were not significantly different from usual care. Conclusions: A pre‐Ramadan assessment of people with T2D coupled with pre‐Ramadan education and an adjustment of glucose‐lowering treatment as per our updated 2020 recommendations can prevent acute complications and allow a safer fast for people with T2D. We have shown that such an approach reduces the risk of developing severe hypoglycemia and improves the metabolic outcomes in people with T2D. [ABSTRACT FROM AUTHOR]

Background and Objectives: Insulin and oral hypoglycemic agents are drugs widely used in the world population due to their therapeutic effects on diabetes mellitus. Despite these benefits, they can also cause accidental or voluntary drug overdose. This review aims to evaluate post-mortem investigations in cases of suspected hypoglycemic drug overdose. Materials and Methods: We performed a comprehensive search using the Preferred Reporting Items for Systematic Review (PRISMA) standards; we systematically searched the PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EM-BASE) databases from the point of database inception until August 2022. The following inclusion criteria were used: (1) original research articles, (2) reviews and mini-reviews, (3) case reports/series, (4) and only papers written in English. Results: Thirty-three scientific papers, including original research articles, case reports, and case series, fulfilled the inclusion criteria. A total of 109 cases of insulin or hypoglycemic drug overdose were found. There were 71 cases of suicide (65%), 25 cases of accidental poisoning (23%), and 13 cases of homicide (12%). The most commonly used drug was insulin (95.4%). Autopsy and post-mortem examinations were performed in 84 cases, while toxicological investigations were performed in 79 cases. The most common gross findings in the autopsy were pulmonary edema (55.7%) and congestion (41.8%), while the most common histological finding was neuronal depletion or necrosis (29.1%). Conclusions: In the suspicion of death from insulin or overdose from oral hypoglycemic agents, autopsy findings may be nonspecific, and the search for injection marks can be positive at the external examination. Significant post-mortal alterations can interest biological samples and an early autopsy investigation is recommended.

To describe the attitude of type 2 diabetes patients toward Ramadan fasting. A Secondary purpose was to describe rates of hypoglycemia during Ramadan according to type of treatment. A prospective, non-randomized study for 2 years. Participants with type 2 diabetes attending Dammam Diabetes Center, Saudi Arabia were stratified for fasting according to ADA recommendations. Results are presented using mean, standard deviation and percentages. Total of 360 participants with type 2 diabetes. Mean ± SD glycosylated hemoglobin was 8.9 ± 2.1. More than 80% of individuals were in the ADA higher risk group however, they all fasted Ramadan. The mean non-fasting days was 2.6 days and overall rate of hypoglycaemia was 24.7%. Both parameters were directly proportionate to the risk stratification level (P-value <0.05). Despite hypoglycaemia, 29.3% continued fasting. Hypoglycemia was highest in patients treated with insulin (P-value <0.05) followed by those treated with oral agents including sulphonylurea as compared to oral agents excluding sulfonylurea (P-value = 0.002). Those who experienced hypoglycemia prior to Ramadan had the highest rate of hypoglycemia during Ramadan (53.3%) (P-value = 0.0065). Despite medical advice, the vast majority of type 2 diabetes participants categorized as high risk, fasted Ramadan. Approximately one quarter of people with type 2 diabetes in our cohort experience hypoglycaemia and this was directly related to their fasting risk level. A sizeable proportion continued the fast despite hypoglycemic. Insulin therapy with or without oral agents and previous episodes of hypoglycemia before Ramadan predicted hypoglycemia risk during Ramadan. HbA1c and weight showed some clinical improvements post Ramadan fasting. This is a single center study of mostly high risk fasting patients and hence, these results should not be generalized. [ABSTRACT FROM AUTHOR]