Diabetes/Metabolism Research and Reviews最新文献

Type 2 diabetes mellitus (T2DM) is present in 25% of patients with atrial fibrillation (AF), the most prevalent arrhythmia in the world. This concomitant disorder enhances thromboembolic events, length of hospital stay after AF ablation, renal impairment after anticoagulation, heart rate variability after glucose-lowering treatment, and cardiac mortality. These patients accumulate inflamed epicardial fat (EAT) with paracrine consequences on β-oxidation of mitochondria, cytosolic Ca²⁺ fluxes, and sarcomere shortening. Knowing these specific targets will improve the efficacy of personalised preventive and curative therapies since AF leads to AF and EAT accumulation. This review tries to clarify the interplay among epicardial fat accumulation and macrophages with concomitant T2DM and AF to provide a summary of current known mechanisms and therapeutic strategies.

Diabetic bone disease, a form of secondary osteoporosis, is characterised by reduced bone strength and increased fracture risk, particularly in patients with type 2 diabetes (T2D). Over 35% of T2D patients experience bone loss, with approximately 20% meeting diagnostic criteria for osteoporosis. This review highlights the complex mechanisms underlying diabetic bone disease, emphasising the need to reduce fracture risk and improve clinical outcomes. Key factors such as hyperglycemia, insulin resistance, insulin-like growth factors (IGFs), advanced glycation end products (AGEs), and proinflammatory cytokines disrupt bone turnover by impairing osteoblast and osteoclast function, leading to imbalanced bone formation and resorption. We explore the role of bone turnover and mineralisation in both cortical and trabecular bone, and the impact of microvascular complications on bone microarchitecture. Gut hormones, including Glucagon-like peptide-1 (GLP-1), Glucose-dependent insulinotropic polypeptide (GIP), and Parathyroid hormone (PTH), and the gut microbiota also play crucial roles in the pathogenesis of diabetic bone disease. Specific bacterial species, such as Akkermansia muciniphila and Bacteroides fragilis, are implicated in modulating the gut-bone axis through short-chain fatty acids (SCFAs) and other signalling pathways. These changes, along with altered gut hormone responses, affect bone density, microstructure, and material properties. Despite normal or increased bone mineral density (BMD) in some T2D patients, the material quality of bone is compromised, leading to greater fragility. This review integrates current knowledge of molecular, hormonal, and microbial interactions that contribute to diabetic bone disease, offering insights into potential therapeutic strategies and improving patient care.

N-lactoyl amino acids (Lac-AA) form an emerging class of metabolites that have gained significant attention in recent years due to their ubiquitous presence in different biological systems and potential roles in various biochemical processes. This narrative review aims to provide a comprehensive overview of the current understanding of Lac-AA, emphasising their biosynthesis, physiological roles, and potential implications in various diseases. We discuss the discovery of Lac-AA as signalling molecules, and their involvement in exercise-induced appetite suppression, energy metabolism, and other pathways. This review explores the complex relationship between Lac-AA and various pathological conditions, including mitochondrial disorders, type 2 diabetes, phenylketonuria, cancer, and rosacea. We also examine the interplay between Lac-AA and the gut microbiota, as well as their association with metformin treatment. Furthermore, we address the ongoing debate regarding whether Lac-AA are merely reflections of lactate and amino acid levels or independent signalling molecules. This review synthesises the latest research findings, highlights the significance of Lac-AA in metabolic research, and identifies promising avenues for future investigation in this rapidly evolving field.

Ramadan fasting is a sacred ritual observed by approximately 1.8 billion Muslims each year, most of whom adhere to fasting due to its significance as a core pillar of Islam. Able-bodied Muslims who are capable of fasting are religiously required to do so. Ramadan is profoundly spiritual and of great importance in the Muslim community that occurs for roughly 30 days, in alignment with the lunar calendar. During Ramadan, Muslims abstain from food and drink for 11–16 h a day on average; however, this could be significantly shorter or longer depending on the season and the geographic location, ultimately breaking their fast during the sunset meal ‘Iftaar’. Before the great strides were taken in the management of diabetes, these patients were initially considered not able to observe this holy month, creating significant frustration and disconnect with their families and loved ones. As patient outcomes improved through the emergence of better pharmacotherapy and increasing use of technology, these restrictions have been reconsidered. This prompted us to create the 2005 first global statement regarding best practices in the management of diabetes during Ramadan as an official American Diabetes Association (ADA) report. Since then, we have received numerous requests and comments asking for updated versions that include the latest data, medications, and technology. We decided to issue an update every 5 years, including 2010, 2015 and 2020. Our updated recommendations collate some of the more directly implicative findings on patient care for Ramadan fasting and align closely with the ADA's consensus for diabetes management. We recommend the prioritisation of pharmacologic therapies with a low risk profile for hypoglycaemia. Technological advancements, including integrated pump-sensor systems, hybrid closed-loop systems, and artificial intelligence (AI)-equipped continuous glucose monitoring (CGM) devices, show great promise in the monitoring of blood glucose levels and can provide tangible reductions in hypoglycaemia episodes, suggesting possible utility in the facilitation of fasting in patients with type 1 diabetes mellitus (T1D). Our recommendations align with the ADA consensus for the use of CGM devices, in concordance with appropriate time in range (TIR) targets to reduce hypoglycaemia and glycaemic variability. The implications of Ramadan fasting on atherosclerotic cardiovascular disease (ASCVD) risk remain uncertain due to the sparsity of evidence, but the literature suggests an increased risk. Until more conclusive evidence is reported, we advise patients with a high ASCVD risk to avoid Ramadan fasting. We emphasise the pivotal role primary care providers (PCPs) have in counselling, managing, and following patients who intend to fast and advise counselling to begin ideally 6–8 weeks prior to Ramadan start, with particular recommendations to be given to patients post-bariatric surgery.

Type 2 diabetes (T2D) is a pandemic and strongly impact patients' prognosis. Several barriers may hamper the achievement of good glycaemic control, which is the aim of diabetes care. These include but are not limited to poor treatment adherence, poor self-management, and heterogeneity of the disease context. Diabetes self-management is critical, particularly in insulin-treated patients and it is largely based on glucose monitoring, which allows recording glucose levels to make informed decisions with respect to meals, exercise, and other daily-life activities. For decades, glucose monitoring has been based on self-measurement of capillary blood glucose, which has some obvious important limitations. With the start of the new century, systems for continuous glucose monitoring (CGM) have become available. These systems measure subcutaneous interstitial glucose levels in a continuous or intermittent manner. They allow a better description of daily glucose pattern and glycaemic trend, a more accurate identification of glucose peaks and identification of otherwise unrecognised hypoglycaemic episodes, and a more reliable assessment of the stability of glycaemic control. CGM has been repeatedly shown to improve glycaemic control and reduce the risk of hypoglycaemia in type 1 diabetes (T1D). Over the years however, evidence has been gathered on the CGM use in T2D on different treatment regimens and wider applications are clearly desired. The aim of this expert opinion paper is to summarise the currently available evidence on CGM use across the whole spectrum of T2D and suggest practical indications beyond current guidelines.