Frontiers in clinical diabetes and healthcare最新文献

Introduction: Chronic kidney disease (CKD) may improve with appropriate management and close monitoring to prevent the risk of progression to end-stage kidney disease (ESKD). The present study aimed to determine oxidative damage and DNA repair in early kidney disease in patients with and without type 2 diabetes (T2D).

Methods: Using ELISA, serum levels of the oxidative DNA damage marker (8OHdG) and the DNA repair marker (hOGG1) were determined in 100 patients with T2D and 88 without T2D in stages 1, 2, and 3 of CKD.

Results: The mean number of years of T2D in patients in stages 1, 2, and 3 was 13.93 ± 2.09 years. Significantly increased levels of the 8-OHdG marker were found in stage 3 CKD patients with T2D, 4.96(4.17-5.08) ng/mL vs. 4.13(3.49-4.60) ng/mL without T2D (p=0.006). hOGG1 enzyme levels were significantly decreased in patients with T2D from stage 2, 0.08(0.063-0.082) ng/mL vs. 0.37(0.18-0.36) ng/mL, (p=0.006) and in stage 3 with T2D 0.09(0.08-0.11) ng/mL vs. 0.53(0.07-0.96) ng/mL without T2D (p=0.007). A positive correlation was found between CKD stage and hOGG1 levels in patients with T2D (rho=0.473, p<0.001). 8-OHdG concentration showed an inverse correlation with CKD stage in patients without T2D (rho=-0-274, p=0.030). In conclusion, we found an imbalance of DNA repair enzymes in stages 2 and 3 of CKD in T2D patients and an increase of oxidative DNA damage markers in stage 3 of CKD in T2D patients. Determination of DNA damage and repair markers in the early stages of CKD may facilitate timely diagnosis and treatment of CKD.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used to improve glycemic control and induce weight loss in individuals with type 2 diabetes (T2D), yet treatment responses vary significantly among individuals. Eating behavior has been hypothesized to influence therapeutic efficacy, but supporting evidence remains limited.

Methods: In this multicenter, prospective observational study, we enrolled 92 individuals with T2D initiating GLP-1RA therapy (liraglutide, dulaglutide, oral semaglutide, or injectable semaglutide) at four institutions in Gifu Prefecture, Japan. Participants were assessed at baseline, 3 months, and 12 months for clinical parameters, dietary intake, and eating behaviors using validated tools (Food Frequency Questionnaire and the Japanese version of the Dutch Eating Behavior Questionnaire [DEBQ-J]). Primary and secondary outcomes included changes in HbA1c, body weight, and eating behavior patterns over 12 months.

Results: GLP-1RA therapy significantly reduced HbA1c, body weight, and body fat percentage at 12 months. Notably, external eating scores showed a sustained decrease, while emotional and restrained eating scores exhibited transient changes. Higher baseline external eating scores were independently associated with greater weight reduction and showed a trend toward enhanced glycemic improvement. No significant associations were observed between emotional or restrained eating scores and clinical outcomes.

Conclusion: This study demonstrates that GLP-1RAs improve both metabolic parameters and external eating behavior in T2D individuals. External eating emerged as a potential behavioral marker predictive of treatment response. These findings suggest that integrating eating behavior assessments may help personalize GLP-1RA therapy and optimize outcomes in clinical practice.

Clinical trial registration: UMIN Clinical Trials identifier, UMIN000045362.

Introduction: Food insecurity is a multidimensional issue that has been related with poor overall health, obesity and chronic diseases and not only related with increased prevalence of diabetes but also with increasing health care expenses. There is paucity of researches conducted to assess food insecurity and its associated factors among adult diabetic clients in Ethiopia. Hence this study was aimed to assess food insecurity and its associated factors among adult diabetic patients in Gambella town public hospitals.

Methods: A facility based cross sectional study was conducted among adult diabetic clients in Gambella town public hospital from May 1 to June 30, 2023. A systematic sampling technique was used to select a sample of 412 patients. Data were collected by trained data collectors using structured questionnaires. Data were checked for its completeness and consistence then entered into Epidata 4.6 and transported to SPSS version 26 for analysis. Bivariate analysis was done to make variables candidate for multivariate analysis at p-value <0.25. In multivariate analysis AOR with 95% CI were used to declare factors associated with food insecurity at p-value <0.05.

Results: The prevalence of food insecurity was found to be 59.5% (95% CI: 54.6%-64.3%). In multivariate analysis the variables age 18 to 24 years (AOR=0.093,95% CI:0.02-0.30), able to read and write (AOR=4.31, CI:1.246-11.250), employed (AOR=0.20; 95% CI: 0.063-0.63), low wealth status (AOR=3.02, CI:1.265-4.788) OR=2.46, CI:1.265-4.788), medium wealth status (AOR=1.88, CI:1.002-3.815). Family size (AOR=0.48; 95% CI: 0.27-0.87), and family history of diabetes (AOR=2.86, CI: 1.43- 5.72) were significantly associated with food insecurity. income and (AOR=1.88, CI:1.002-3.815).

Conclusion and recommendations: The prevalence of food insecurity among adult diabetic patients was high. Therefore, health professionals should give emphasis to encourage self-management for those who have family history of diabetes in order to screen the clients at early before the occurrence of DM complication and health care expenditure.

Background: Diabetes mellitus (DM) is a major cause of morbidity and mortality globally as it is associated with long-term health complications which affect the quality of life. Several plants are used in traditional medicine to manage diabetes, with claims of efficacy from traditional healers. One such plant is Balanites aegyptiaca (L.) Delile commonly called Desert Date. This systematic review examines the therapeutic effect of B.aegyptiaca on diabetes mellitus.

Methods: The protocol for the systematic review was registered with PROSPERO (CRD42024587444). Four databases were searched for articles from 1986 to 1^st August 2024. Keywords related to "therapeutic effect", "Balanites aegyptiaca" and "diabetes mellitus" were used. Studies included were all animal models. Each article was critically appraised by two independent reviewers for their methodological quality using the Joanna Briggs Institute Case Control Checklist. The Cochrane SYRICLE Risk of bias tool was used for risk of bias assessment in these animal intervention studies. The animal experiments were conducted mainly in Alloxan- and streptozotocin-induced rat/mice diabetes and a control of non-diabetes induced rats.

Result: A total of 32 articles were included. All the studies were appraised for blood glucose levels, and a reduction in blood glucose was reported in all in vivo studies, regardless of the plant part used. Significant decrease in blood glucose level was recorded in Alloxan- and streptozotocin-induced rat/mice diabetes. All the studies reported reduced blood glucose, reduced levels of lipids, reduced weight and increased insulin production. B. aegyptiaca mitigated hyperglycaemia irrespective of the presentation form, which includes extract and meal supplementation in rodents, oral capsule intake, and tea or fruit consumption in humans. Various mechanisms, including modulation of glucose metabolizing enzymes, were reported to underlie the B. aegyptiaca antidiabetic effect.

Conclusions: Repeated administration of different parts of B. aegyptiaca in different presentation forms controlled hyperglycaemia in animal-models. A full-phase clinical trial is needed to determine the therapeutic effects of B. aegyptiaca in humans.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024587444.

Introduction: Diabetes mellitus (DM) is a global health challenge characterized by progressive beta cell dysfunction. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as promising therapies, enhancing insulin secretion while potentially preserving beta cell mass by inhibiting apoptosis. However, concerns persist regarding long-term beta cell adaptation and functional exhaustion. This meta-analysis synthesizes preclinical evidence to evaluate the effects of GLP-1RAs on beta cell apoptosis in DM.

Methods: Following PRISMA guidelines, we systematically searched Scopus, PubMed, Embase, and Google Scholar for preclinical studies assessing GLP-1RAs effects on human beta cell apoptosis. Five studies met inclusion criteria for meta-analysis. Data were extracted on apoptotic rates, and risk of bias was assessed using the OHAT tool. A random-effects model calculated pooled mean differences (MDs) in apoptosis, with sensitivity analyses and funnel plots evaluating robustness and publication bias.

Results: GLP-1RAs significantly reduced beta cell apoptosis (pooled MD: -0.10; 95% CI: -0.15 to -0.05, p = 0.0003), with high heterogeneity (I² = 100%). Sensitivity analyses confirmed consistency, with effect estimates ranging from -0.077 to -0.118 upon sequential study exclusion. Funnel plot and Egger's test (p = 0.80) indicated no significant publication bias, though limited study numbers constrain power.

Conclusions: GLP-1RAs demonstrate a robust anti-apoptotic effect on pancreatic beta cells in preclinical models, supporting their role in preserving beta cell mass. However, extreme heterogeneity and unresolved questions about long-term functional exhaustion warrant cautious interpretation. Future research should prioritize longitudinal human studies to assess clinical relevance and optimize therapeutic strategies. Introduction.

System review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024516313, identifier CRD42024516313.

Aims: To analyze the impact of the COVID-19 pandemic on the activity and outcomes of the Andalusian Program for Early Detection of Diabetic Retinopathy (APDR).

Methods: A retrospective observational study was conducted during 2018-2023. The following variables were analyzed annually: newly included patients, retinal photographs performed, and pathological findings categorized by severity. Moderate-to-severe non-proliferative and proliferative retinopathy were classified as vision-threatening diabetic retinopathy (VTDR).

Results: In 2020 and 2021, the number of newly included patients (11,897 and 18,343, respectively) and retinal photographs performed (39,667 and 64,092, respectively) decreased compared to previous years (2018 and 2019: 25,940 and 30,807 new patients, respectively; 85,171 and 100,849 retinal photographs, respectively). In 2022, activity levels increased 160% compared to 2019. The proportion of VTDR cases remained stable at 0.163%, 0.14%, and 0.075% during 2021, 2022, and 2023, respectively, compared to the prepandemic period (0.168% and 0.117% in 2018 and 2019, respectively).

Conclusions: Despite the slowdown in activity during the COVID-19 pandemic, the post-pandemic proportion of VTDR cases diagnosed through the APDR remained stable, suggesting resilience against severe outcomes despite healthcare disruption. The program has demonstrated an effective recovery. Ongoing long-term monitoring is essential to fully assess the pandemic's potential impact on late-stage complications.

Background: This study aims to assess the global burden of type 2 diabetes mellitus (T2DM) attributable to low physical activity from 1990 to 2021 and forecast of its global burden by 2050 using GBD 2021 data.

Method: This study uses data from the GBD 2021 to examine the global burden of T2DM attributable to low physical activity, focusing on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and Years of Life Lost (YLLs). Descriptive analysis was performed across gender, age, region, and country for 1990 and 2021, using age-standardized rates. Trend analysis assessed the average changes in these rates from 1990 to 2021 by calculating the estimated annual percentage change (EAPC). Projections for future burden were made using the exponential smoothing (ES) model and the autoregressive integrated moving average (ARIMA) model.

Result: In 2021, T2DM attributed to low physical activity caused 149,214 deaths and 5,523,050 DALYs, with significant increases since 1990. Both age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate (ASDR) rose, especially among females. The highest burden occurred in the 95+ and 70-74 age groups. High-SDI regions had the highest rates, with rapid increases in the high-middle SDI regions. Countries like the UAE, Montenegro, and Hungary showed the highest rates. Projections from 2022 to 2050 indicate a steady rise in deaths and DALYs, with a peak in 2050, though the rate of increase is slower according to the exponential smoothing model.

Conclusion: The burden of T2DM attributable to low physical activity has steadily increased, with concerning future trends.

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder typically managed with medication; however, fasting has recently attracted attention for its potential benefits in glycemic control, weight management, and even potential remission. This case report examines the effects of repeated long-term fasting on weight reduction, glycemic control, and medication requirements in a 57-year-old man with T2DM. The patient, who had a history of inadequate glycemic control despite conventional treatment, opted for repeated long-term fasting under medical supervision. He completed several fasts ranging from 11 to 20 days each, with each fasting period followed by a gradual reintroduction of food via a hypocaloric lactovegetarian diet (800-1,800 kcal) over 4 to 16 days. The intervention resulted in sustained weight loss and improved blood sugar control. Notably, clinically meaningful improvements occurred in fasting blood glucose levels, which necessitated adjustments in his antidiabetic medications. Enhanced insulin sensitivity was evidenced by decreased HbA1c levels and a reduced dependence on hypoglycemic agents. Additionally, post-fasting evaluations indicated improvements in inflammatory markers and a reduction in fatty liver disease. In summary, repeated long-term fasting in this patient was associated with sustained weight loss, improved glycemic control, and reduced medication requirements, thereby enhancing the overall management of T2DM. Further research, including randomized controlled trials, is needed to better understand the long-term safety and effectiveness of this intervention.

Introduction: Increasing evidence shows that hyperglycemia-induced glucotoxicity and lipotoxicity that usually accompany diabetes development damage the endoplasmic reticulum and mitochondria of the hepatocytes in diabetic patients. Clinical studies highlighted the association between type 2 diabetes mellitus, comorbidities, and medications with liver function. The objective of this study is to explore the association between liver function tests' abnormalities and comorbidities, medications, and other risk factors in type 2 diabetes patients registered in the Best-Care system of the Saudi Ministry of National Guard-Health Affairs.

Methods: This is a cross-sectional study employing a chart of patients diagnosed with type 2 diabetes mellitus. We drew a simple random sample of 523 T2DM patients who had a liver function test from the Best-Care database of the Ministry. We applied various statistical analyses, including Student's independent t-test, Pearson's chi-squared test, Fisher's exact test, and odd ratios, to measure associations between different variables and liver function tests' abnormalities.

Results: About 35% of patients included in this study showed an abnormal level of gamma-glutamyl transferase and prothrombin time. Abnormalities of serum albumin, prothrombin time, and total serum protein tests were significantly associated with age (P < 0.05). Gamma-glutamyl transferase test abnormalities were significantly associated with gender (P < 0.05). The study found associations between several comorbidities and the abnormalities of liver function tests. These tests include the total bilirubin, albumin, total serum protein, gamma-glutamyl trans, international normalized ratio, and alanine aminotransferase. The associations were at significant levels (P < 0.05). Liraglutide was significantly associated with aspartate aminotransferase (OR = 14.40, 95% CI = 2.8, 73.2), while allopurinol was significantly associated with international normalized ratios (OR = 24.67, 95% CI = 2.95, 206.58) and total serum protein (OR = 5.44, 95% CI = 1.43, 20.83).

Discussion: This study is the first to examine the association between type 2 diabetes mellitus and liver function tests' abnormalities in Saudi Arabia. Although the results have a limited generalizability due to inherent biases, the findings align with similar studies in other populations. The study stresses the need to monitor liver functions, especially of T2DM patients who suffer from other conditions.