Journal of the Indian Institute of Science最新文献

Diabetes is an ancient disease and for centuries extreme diets and herbal remedies were used to treat diabetes symptoms. The discovery of insulin in 1921 transformed the landscape of diabetes treatment and was followed by the discovery of several new therapies which improved glycemia and increased patient life span. However, as patients with diabetes lived longer, they developed classic microvascular and macrovascular diabetes complications. In the 1990s, the DCCT and the UKPDS trials demonstrated that tight glucose control reduced the microvascular complications of diabetes, but had marginal effects on cardiovascular disease, the leading cause of death in patients with diabetes. In 2008, the FDA directed that all new diabetes medications demonstrate cardiovascular safety. From this recommendation emerged novel therapeutic classes, the GLP-1 receptor agonists and SGLT2-Inhibitors, which not only improve glycemia, but also provide robust cardio-renal protection. In parallel, developments in diabetes technology like continuous glucose monitoring systems, insulin pumps, telemedicine and precision medicine have advanced diabetes management. Remarkably, a century later, insulin remains a cornerstone of diabetes treatment. Also, diet and physical activity remain important components of any diabetes treatment. Today type 2 diabetes is preventable and long-term remission of diabetes is possible. Finally, progress continues in the field of islet transplantation, perhaps the ultimate frontier in diabetes management.

Quantum processors based on NMR architectures, which use nuclear spins as qubits and radio frequency pulses to implement unitary quantum gates, came into existence nearly two decades ago. Since their first proof-of-principle demonstrations as a testbed quantum processors, NMR quantum processors have contributed significantly to advances in various subareas of quantum information processing. Indian researchers have been working in this field since its inception and have continued to contribute to novel developments. This article begins by delineating the basic building blocks of an NMR quantum processor and evaluating the advantages and disadvantages of this quantum technology. Contributions of NMR quantum information processing techniques in the areas of the state initialization and quantum control, experimental implementation of quantum algorithms, entanglement detection and characterization, foundational tests of quantum mechanics, quantum state and process tomography, noise characterization and decoherence mitigation protocols, quantum simulation, and quantum thermodynamics are described. The article traces the historical development of this area, with an emphasis on Indian contributions and perspectives.

Deprescribing is the process by which medications are reduced without compromising safety to the patient (Jude et al. in 2022 Diabetes Ther 13: 619–634, 2022). The purpose of this narrative review is to discuss deprescribing as a topic, firstly discussing the benefits and pitfalls to such pharmacological interventions along with the current barriers and enablers to such a controversial topic, and then discussing deprescribing with respect to preventive medications, namely those that reduce the long term impacts of a condition or disease. Research that has previously focused on reducing polypharmacy has highlighted the benefits of such interventions, including reduction of adverse reactions or complications, improved patient satisfaction and quality of life, and improved cost effectiveness and drug compliance. Some potential harms that have been highlighted include an increased number of complications, increased symptoms of previously dampened conditions, and negligible changes in patient satisfaction that have stressed the importance of this intervention being patient centred and individualized to each patient. The implementation of deprescribing processes could drastically change the way people think about deprescribing and could be extremely beneficial to older patients living with type 2 diabetes worldwide. Developments in preventive medication deprescribing could pave the way for this intervention to become more common place improving the quality of life in patient’s final years.

Type 2 diabetes (T2D) is one of the major global public health concerns. The incidence of T2D is expected to increase dramatically in the coming years globally as well as in India. Development of T2D is a result of desensitization of peripheral tissue to stimulation of insulin. Skeletal muscle is responsible for the majority of postprandial glucose uptake and is of the utmost importance to maintain glucose homeostasis. T2D is manifested by structural, functional, and metabolic impairment of skeletal muscle and is characterized as the primary site of insulin resistance in T2D patients. T2D patients exhibit impaired insulin-stimulated muscle glucose uptake, fat metabolic abnormality, increased accumulated muscle fat, and a dysbalance in muscle protein synthesis and breakdown. Skeletal muscle mitochondrial dysfunction also plays an essential role in the pathogenesis of insulin resistance. Skeletal muscle fiber shift and diabetes-associated loss of muscle mass and strength further worsen insulin sensitivity. This review provides a comprehensive overview of skeletal muscle pathophysiological changes in diabetes and discusses the potential therapies targeting skeletal muscle pathophysiology to ameliorate diabetes.

The role of gut microbiota in type 2 diabetes (T2D) has been investigated through many recent studies conducted in different parts of the globe. However, intrinsic differences in the gut microbiota related to geography, ethnicity, dietary preferences, etc. tend to confound the disease-associated differences and make the search for any universal T2D-specific signature a challenging task. The present work makes an attempt to identify population or sub-population specific consensus gut microbiota signatures of T2D with a particular focus on Asian-Indians, who are reported to exhibit a distinct T2D phenotype. In this process, the article reviews and summarizes different microbial genera that have been reported to be associated with T2D in earlier studies conducted in different geographies. The results indicate that while the taxonomic signatures of T2D-associated gut microbiota (i.e. the presence and abundance of particular genera) may vary between populations, their functional roles in context of T2D pathophysiology have more coherence. Furthermore, it appears that while the gut microbiota of T2D subjects from different geographies are characterized by a combination of depletion of beneficial/ commensal taxa as well as an enrichment of harmful, pro-inflammatory and infectious taxonomic groups, the latter phenomenon may be more prevalent in Asian-Indian T2D subjects.

Diabetes is a chronic disease associated with a variety of metabolic abnormalities. Principal cause of disability and deaths in diabetes are coronary, peripheral, and cerebral vascular diseases mainly due to lipid abnormalities. Diabetic dyslipidemia is characterized by elevated small-dense low-density lipoprotein (LDL) cholesterol and triglycerides (TG) and low high-density lipoprotein (HDL) cholesterol. Elevated LDL cholesterol has been proven as causative for cardiovascular disease. Treatment thresholds for this variable have been advocated in multiple clinical practice recommendations and intensity of LDL lowering is dependent on associated risk factors. Statins are mainstay for treatment although combination therapies with ezetimibe and PCSK9 inhibitors are needed in very high-risk individuals. Recent research has confirmed role of raised TG as a cardiovascular risk factor. However, limited options are currently available as drug therapy. Low HDL cholesterol appears to be less of a contributor to cardiovascular risk than previously considered a risk marker. Primary cardiovascular disease prevention strategies in diabetes should focus on risk assessment, aggressive lifestyle interventions and treatment with statins, etc. In the present review we have focused on role of lipids in pathophysiology of diabetes associated cardiovascular disease and focus on evidence guided management.