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Abstract: Background: Numerous studies have revealed the protective role of dietary antioxidants against hypertension and diabetes. In the current systematic review and meta-analysis, we evaluated the possible role of dietary total antioxidant capacity (TAC) against metabolic parameters in the adult population. Methods: A literature search of authentic electronic resources including PubMed, Scopus, Web of Sciences, and Cochrane had been performed to retrieve the qualified observational studies that reported the mean plus/minus the SD for the parameter in subjects of the highest versus lowest dietary TAC categories up to July 2020. Results: Totally, the number of included studies was 13 for fasting blood sugar (FBS), 12 for systolic blood pressure (SBP), and 12 for diastolic blood pressure (DBP), with the participants’ number of 26349. The results of the current study showed that being at highest category of TAC significantly reduces serum FBS (WMD: −2.381; CI: −3.445, −1.316; P2DM) (P=0.37) and hypertension (HTN) (P=0.09) was observed. Subgroup analysis revealed the geographical location, dietary assessment tool, sample size, and gender as possible sources of heterogeneity. Conclusion: Higher intake of dietary TAC was associated with reduced SBP, DBP, and FBS in the current observational studies of this meta-analysis. These findings further confirm the clinical importance of dietary antioxidants in the prevention of different metabolic disorders.

One of the chronic diseases is Diabetes, Diabetes is a metabolic disorder category caused by continued high levels of blood sugar. It is regarded as one of the most deadly diseases in the world. If accurate early prediction is possible, Diabetes severity and risk factor can be significantly lowered. Machine learning has become more popular in the medical community as a result of its ascent, and in the field of diseases in particular. In this paper, we propose a model that can predict where the patient has or hasn't have diabetes. Our model is based on the prediction precision of certain powerful machine learning (ML) algorithms based on different measures such as precision, recall, and F1-measure. The Pima Indian Diabetes (PIDD) dataset has been used, that can predict diabetic onset based on diagnostics manner. The results we obtained using Logistic Regression (LR), Naive Bayes (NB), and K-nearest Neighbor (KNN) algorithms were 94%, 79%, and 69% respectively. The results show that LR is more efficient at predicting diabetes Compared to other algorithms.

Diabetes mellitus is a fast-growing health problem worldwide, entailing an enormous financial burden on medical care and policy issues, particularly among middle-class families and developing countries. India has emerged as the capital of the diabetes epidemic. Indians show a significantly higher prevalence of diabetes when compared with other citizens. Therefore, prevention is better than cure, and in this view, we must think about our traditional food and medicinal systems. There are several effective antidiabetic plants that are reported to be of Indian origin, and now is the time to use them. Hence, the book Antidiabetic Plants Vol. I will be very helpful in the prevention of these fast-growing health problems. I hope the book will be a reference, literature for utilization as medicine, and further advanced research.

Patients with glycogen storage diseases pose unique management challenges to clinicians.These challenges are exacerbated wheneverthey undergo surgery as the basic anomaly in their glycogen storage pathways make them susceptible to organic acidosis, which may in turn complicate their preoperative, intraoperative, and postoperative course. Because of the rarity of these diseases, clinicians may not be aware of the specific management concerns. In the case reported here, a 37-year-old patient with glycogen storage disease type 1 underwentleft hepatectomy for hepatic adenomatosis, which was complicated by intraoperative severe lactic acidosis that was successfully treated. After successful hepatectomy, the patient underwent liver transplant without major lactic acidosis or hemodynamic instability. Early recognition and aggressive management of blood sugar and lactic acidosis in patients with glycogen storage diseases can allow for successful outcomes even when complex surgical procedures are required.

Coffee cherry pulp, a major waste product from coffee manufacturing, contains polyphenols with antioxidant activity. However, its clinical safety and health benefits are unclear. This randomized, double-blinded, placebo-controlled trial evaluated the safety and potential efficacy of coffee cherry pulp juice concentrate. A total of 61 participants were randomly divided into a study group (n = 30), receiving the juice, and a control group (n = 31), receiving a placebo drink of 14 g twice daily for 12 weeks. Adverse symptoms, changes in body weight, hematological and biochemical parameters, vital signs, and heart function were evaluated using subject diaries, interviews, blood and urine tests, and electrocardiograms. The results showed no intervention-related adverse events. Body weight, liver, renal function, complete blood counts, blood glucose, urinalysis, and electrocardiograms were not significantly altered throughout the study. Consuming the juice for at least 8 weeks significantly decreased cholesterol and LDL levels. The glucose levels were maintained significantly better than those of the placebo group. The findings suggest that continuously consuming 28 g/day of coffee pulp juice concentrate for 12 weeks is safe in healthy volunteers. Future studies could employ a dose of ≤28 g/day to investigate the efficacy of this novel food, especially for preventing dyslipidemia and diabetes.

Background and Aim: Subclinical hypothyroidism (SCH) is frequently seen in diabetic patients. Elevated levels of uric acid (UA) were also reported in diabetic patients. No study assessed the relation between SCH and UA levels in diabetic patients. We aimed to evaluate this relation and the association of both conditions with other clinical and laboratory parameters in diabetic patients. Subjects and Methods: This cross-sectional study included 100 T2DM patients in addition to 50 age and sex matched healthy controls. Diabetic patients comprised 50 patients with SCH and 50 euthyroid patients. All participants were subjected to careful history taking, thorough clinical examination and standard laboratory work up. The performed investigations included fasting and postprandial blood sugar, fasting insulin levels, HbA1c levels, thyroid hormones (FT3, FT4 and TSH), renal profile and serum UA. Results: Comparison between the studied groups regarding serum UA levels revealed significantly higher levels in the diabetic group (5.4 ± 1.9 versus 4.2 ± 1.0 mg/dl, p Conclusions: The present study suggests an association between SCH and increased UA levels in diabetic patients.

Introduction Metabolic control in type 1 diabetes (T1D) depends on many factors such as eating habits, exercise and lifestyle. The objective of this study was to investigate how these factors were affected during the coronavirus disease 2019 (COVID-19) lockdown and impacted metabolic control in children with T1D. Materials and method One hundred children with T1D were enrolled in the study. Anthropometric measurements, snack and meal frequency, carbohydrate consumption, HbA1c levels, and exercise patterns were recorded and compared before and after the lockdown. Subjects were divided into two subgroups—patients with decreased and patients with increased HbA1c levels after the lockdown—and comparisons of the same parameters were also made between these two subgroups. Results In the overall group, the mean HbA1c level was significantly higher after the lockdown compared to before (p = 0.035). Meal schedules changed due to delayed sleep and waking times, and total daily carbohydrate consumption increased in the subgroup with increased HbA1c while it decreased in the subgroup with decreased HbA1c (p Conclusion Our study supports the notion that blood sugar management in children with T1D worsened during the COVID-19 pandemic. Although it is not possible to explain this with any one factor, some behavioral changes observed in our study, such as inactivity, irregular meal frequency and timing, and irregular sleep and waking patterns appeared to be associated with blood sugar management.

Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome. Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality. Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p 172 mg/dL (HR 21.257, 95% CI 2.832 – 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 – 0.995, p=0.031). Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

Multicollinearity is a relationship or correlation between predictor variables. Multicollinearity can also occur in longitudinal data, which is a combination of cross-section data and time-series data. The impact of multicollinearity causes the influence of the predictor variable on the response variable to be insignificant, the least-squares estimator, and the error to be sensitive to changes in the data. Therefore, the procedure to overcome multicollinearity uses the principal component analysis method. This study aims to model PCA longitudinal data regression with a fixed-effect model that is applied to blood sugar data of diabetic patients with a time span of January 2019 to July 2019 at Ibnu Sina Hospital Makassar City. The results of this study indicate that there are two main components formed from PCA longitudinal data regression modelling with a fixed-effect model. Obtained variable values are systolic blood pressure of -0.007, diastolic blood pressure of -0,016, the body temperature of -0.098, and platelets of 0.005 which affect blood sugar in patients with diabetes.

[SPA] Los pacientes con diabetes tipo 1 deben monitorear de cerca sus niveles de glucemia y administrar insulina para controlarlos. Se han propuesto métodos de control automatizado de la glucemia que eliminan la necesidad de intervención humana, y recientemente, el aprendizaje por refuerzo, un tipo de algoritmo de aprendizaje automático, se ha utilizado como un método efectivo de control en entornos simulados. Actualmente, los métodos utilizados para los pacientes con diabetes, como el régimen basal- bolus y los monitores continuos de glucemia, tienen limitaciones y todavía requieren intervención manual. Los controladores PID se utilizan ampliamente por su simplicidad y robustez, pero son sensibles a factores externos que afectan su efectividad. Las obras existentes en la literatura de investigación se han enfocado principalmente en mejorar la precisión de estos algoritmos de control. Sin embargo, todavía hay margen para mejorar la adaptabilidad a los pacientes individuales. La siguiente fase de investigación tiene como objetivo optimizar aún más los métodos actuales y adaptar los algoritmos para controlar mejor los niveles de glucemia. Una solución potencial es usar el aprendizaje por refuerzo (RL) para entrenar los algoritmos en base a datos individuales del paciente. En esta tesis, proponemos un control en lazo cerrado para los niveles de glucemia basado en el aprendizaje profundo por refuerzo. Describimos la evaluación inicial de varias alternativas llevadas a cabo en un simulador realista del sistema glucorregulador y proponemos una estrategia de implementación particular basada en reducir la frecuencia de las observaciones y recompensas pasadas al agente, y usar una función de recompensa simple. Entrenamos agentes con esa estrategia para tres grupos de clases de pacientes, los evaluamos y los comparamos con otras alternativas. Nuestros resultados muestran que nuestro método con Proximal Policy Optimization es capaz de superar a los métodos tradicionales, así como a propuestas similares recientes, al lograr períodos más prolongados de estado glicémico seguro y de bajo riesgo. Como extensión del aporte anterior, constatamos que la aplicación práctica de los algoritmos de control de glucemia requeriría interacciones de prueba y error con los pacientes, lo que es una limitación para entrenar el sistema de manera efectiva. Como alternativa, el aprendizaje reforzado sin conexión no requiere interacción con humanos y la investigación previa sugiere que se pueden lograr resultados prometedores con conjuntos de datos obtenidos sin interacción, similar a los algoritmos de aprendizaje automático clásicos. Sin embargo, aún no se ha evaluado la aplicación del aprendizaje reforzado sin conexión al control de la glucemia. Por lo tanto, en esta tesis, evaluamos exhaustivamente dos algoritmos de aprendizaje reforzado sin conexión para el control de glucemia y examinamos su potencial y limitaciones. Evaluamos el impacto del método utilizado para generar los conjuntos de datos de entrenamiento, el tipo de trayectorias (secuencias de estados, acciones y recompensas experimentadas por un agente en un entorno,) empleadas (método único o mixto), la calidad de las trayectorias y el tamaño de los conjuntos de datos en el entrenamiento y el rendimiento, y los comparamos con las alternativas como PID y Proximal Policy Optimization. Nuestros resultados demuestran que uno de los algoritmos de aprendizaje reforzado sin conexión evaluados, Trajectory Transformer, es capaz de rendir al mismo nivel que alternativas, pero sin necesidad de interacción con pacientes reales durante el entrenamiento. [ENG] Patients with Type 1 diabetes are required to closely monitor their blood glucose levels and administer insulin to manage them. Automated glucose control methods that eliminate the need for human intervention have been proposed, and recently, reinforcement learning, a type of machine learning algorithm, has been used as an effective control method in simulated environments. Currently, the methods used for diabetes patients, such as the basal-bolus regime and continuous glucose monitors, have limitations and still require manual intervention. The PID controllers are widely used for their simplicity and robustness, but they are sensitive to external factors affecting their effectiveness. The existing works in the research literature have mainly focused on improving the accuracy of these control algorithms. However, there is still room for improvement regarding adaptability to individual patients. The next phase of research aims to further optimize the current methods and adapt the algorithms to better control blood glucose levels. Machine learning proposals have paved the way partially, but they can generate generic models with limited adaptability. One potential solution is to use reinforcement learning (RL) to train the algorithms based on individual patient data. In this thesis, we propose a closed-loop control for blood glucose levels based on Deep reinforcement learning. We describe the initial evaluation of several alternatives conducted on a realistic simulator of the glucoregulatory system and propose a particular implementation strategy based on reducing the frequency of the observations and rewards passed to the agent, and using a simple reward function. We train agents with that strategy for three groups of patient classes, evaluate and compare it with alternative control baselines. Our results show that our method with Proximal Policy Optimization is able to outperform baselines as well as similar recent proposals, by achieving longer periods of safe glycemic state and low risk. As an extension of the previous contribution, we have noticed that, practical application of blood glucose control algorithms would necessitate trial-and-error interaction with patients, which could be a limitation for effectively training the system. As an alternative, offline reinforcement learning does not require interaction with subjects and preliminary research suggests that promising results can be achieved with datasets obtained offline, similar to classical machine learning algorithms. However, application of offline reinforcement learning to glucose control has to be evaluated yet. Thus, in this thesis, we comprehensively evaluate two offline reinforcement learning algorithms for blood glucose control and examine their potential and limitations. We assess the impact of the method used to generate training datasets, the type of trajectories employed (sequences of states, actions, and rewards experienced by an agent in an environment over time), the quality of the trajectories, and the size of the datasets on training and performance, and compare them to commonly used baselines such as PID and Proximal Policy Optimization. Our results demonstrate that one of the offline reinforcement learning algorithms evaluated, Trajectory Transformer, is able to perform at the same level as the baselines, but without the need for interaction with real patients during training. Escuela Internacional de Doctorado de la Universidad Politécnica de Cartagena Universidad Politécnica de Cartagena Programa Doctorado en Tecnologías de la Información y las Comunicaciones

Introduction A cell surface bile acid receptor TGR5 can be considered a promising target for the treatment of various metabolic diseases. The TGR5 receptor is expressed in various tissues, including the liver, kidney, intestine, and adrenal glands, causing its effect in each tissue to differ. A major role for TGR5 is to maintain blood sugar levels. Also, TGR5 is postulated to contribute to an increase in energy expenditure. These benefits make it a potential candidate for the treatment of type 2 diabetes, obesity, and other metabolic diseases. Area covered This paper highlights recent advances in the development of potent steroidal and non-steroidal TGR5 agonists and the peer-reviewed scientific articles that have led to understanding the structure-activity relationship for TGR5 agonists (2012-2020). The review also discusses the clinical progress made by some TGR5 agonists over the past eight years. Expert opinion Preclinical studies have suggested a key role for the TGR5 receptor in GLP-1 secretion and have shown promising outcomes such as weight loss, anti-inflammatory, anti-diabetic effects. Along with the evaluation of semisynthetic derivatives, synthetic compounds can also be considered as a possible avenue for the discovery of novel TGR5 agonists. Currently, few TGR5 agonists have reached the clinical trial stage, and, likely, we will soon discover a novel TGR5 modulator with fewer adverse effects. In silico studies can be performed with these scaffolds ranging from steroidal to heterocyclic rings to discover selective and safe TGR5 agonists.

Background. The chronic complications of diabetes mellitus (DM) result from a wide variety of effects of disease. The correlation between blood sugar level and chronic complications has been demonstrated in various studies. Patient education, risk factor management, and other preventative measures are critical elements in reducing the incidence of diabetes complications such as Diabetic Foot Syndrome (DFS). We purposed to evaluate knowledge and attitudes towards foot care amongst patients with diabetes mellitus; in addition, we investigated the correlation between glycemic control and DFS. Materials and methods. This was a descriptive cross-sectional evaluation of patients who were diagnosed with diabetes mellitus seeking outpatient medical care with data being collected through patient surveys, clinical evaluation, specialty consultation, and biochemical analysis of glycated haemoglobin (HbA1c) serum levels. The population of the study was composed of 90 patients diagnosed with DM. Results. A total of 90 patients, 42 (46.7 %) females and 48 (53.3 %) males were included in the study. The rate of participants who reported completing daily self-evaluations for wounds, cracks, and discoloration on the feet was significantly higher (68.9 %) than those who reported not evaluating on a daily basis (31.1 %). Almost half of the participants were diagnosed with DFS (n = 43; 47.7 %) with the HbA1c levels of patients with DFS being significantly higher compared to the HbA1c levels of patients without DFS (p < 0.05). Conclusions. As a high incidence of DFS was found with a positive and statistically significant correlation between the HbA1c level and DFS presence, our study highlights the importance of close monitoring, education, and treatment given the risk of serious complications of DM such as DFS in setting of poorly controlled DM., Актуальність. Хронічні ускладнення цукрового діабету (ЦД) є наслідком широкого спектра патогенезу захворювання. Кореляція між рівнем цукру в крові та хронічними ускладненнями була продемонстрована в різних дослідженнях. Навчання пацієнтів, управління факторами ризику та інші профілактичні заходи є найважливішими елементами зменшення частоти ускладнень ЦД, зокрема синдрому діабетичної стопи (СДС). Мета дослідження — оцінити рівень знань та ставлення до догляду за ногами серед хворих на цукровий діабет, а також встановити кореляцію між глікемічним контролем та розвитком СДС. Матеріали та методи. Проведене описове перехресне дослідження хворих на цукровий діабет, які зверталися за амбулаторною медичною допомогою. Проведений аналіз даних, зібраних за допомогою опитувань пацієнтів, клінічної оцінки, консультацій суміжних спеціалістів та визначення рівня глікованого гемоглобіну (HbA1c) у сироватці крові. У дослідження включені 90 пацієнтів із діагнозом ЦД. Результати. Із 90 хворих на ЦД, включених у дослідження, під спостереженням перебували 42 (46,7 %) жінки та 48 (53,3 %) чоловіків. Серед учасників дослідження число осіб, які повідомили про щоденне самооцінювання стану ніг (наявність ран, тріщин та зміни кольору шкіри), було вірогідно вищим (68,9 %), ніж тих, хто повідомив, що не проводив оцінку щодня (31,1 %). Майже в половини учасників діагностований СДС (n = 43; 47,7 %), при цьому рівні HbA1c у пацієнтів із СДС були вірогідно вищими порівняно з показниками HbA1c у пацієнтів без СДС (p < 0,05). Висновки. У дослідженні був виявлений високий рівень захворюваності на СДС із позитивною та статистично значущою кореляцією між рівнем HbA1c та наявністю СДС. Проведене дослідження підкреслює важливість ретельного моніторингу, навчання та дотримання рекомендацій лікарів з огляду на ризик серйозних ускладнень ЦД, зокрема СДС, при незадовільно конт­рольованому ЦД.

Diabetes is one of the most disturbing chronic diseases in the world. The improvement of treatment efficiency brought by self-monitoring of blood glucose can relieve symptoms and reduce complications, which is considered as the gold standard of diabetes diagnosis and nursing. Compared to the traditional finger pricking measurement with painful and discontinuous processes, continuous blood glucose monitoring (CGM) presents superior advantages in wearable and continuous assessment of blood glucose levels. However, widely used implantable CGM systems at present require implantation operation and are highly invasive, so it is hard to be accepted by users. Except for the blood, available fluids in humans, such as interstitial fluid (ISF), sweat, tears and saliva, also contain glucose associated with blood sugar and can be extracted more easily. Therefore, these more accessible fluids are expected to realize minimized traumatic blood glucose monitoring. This review introduces the latest development of wearable minimally-/non-invasive CGM device, focusing on the types of blood substitute biological fluid and suitable monitoring approaches. We also analysis the merits and drawbacks of each method, and discuss the properties such as sensitivity, stability and convenience of each meter. Beyond highlighting recent key work in this field, we discuss the future development trend of wearable minimally-/non-invasive glucose meters.

Background: Two distinct subtypes of treatment-resistant schizophrenia (TRS) have been recently reported, including early-treatment resistance (E-TR) as the dominant subtype and late-treatment resistance (L-TR). However, the response rate to clozapine, incidence of clozapine-induced prediabetes/diabetes, and effects of metformin at preventing clozapine-induced prediabetes/diabetes in patients with schizophrenia E-TR subtype need investigating. To assess clozapine-induced metformin-resistant prediabetes/diabetes and its correlation with clinical efficacy in schizophrenia E-TR subtype. Methods: This prospective cohort study enrolled 230 patients with schizophrenia E-TR subtype from Tianjin Kangtai Hospital between January 2015 and December 2020.The patients were treated with adequate doses of clozapine for 16 weeks, during which patients with prediabetes/diabetes were assigned to receive add-on metformin. Incidence of clozapine-induced prediabetes/diabetes and metformin-resistant prediabetes/diabetes and the efficacy of clozapine as assessed by the Positive and Negative Syndrome Scale (PANSS) score. Findings: Clozapine-induced prediabetes/diabetes occurred in 176 patients (170 prediabetes and 6 diabetes), with 76.52% incidence. The blood sugar of 43 (24.43%) patients was controlled with metformin. Despite add-on metformin, 47.06% (74/170) of patients with clozapine-induced prediabetes progressed to diabetes. In total, the incidence of clozapine-induced metformin-resistant prediabetes/diabetes was 75.57% (133/176). On completion of 16-week clozapine treatment, 16.52% (38/230) patients showed clinical improvement with PANSS scores of ≥50% declining. Furthermore, clozapine-induced prediabetes/diabetes was significantly correlated with the poor clinical efficacy of clozapine for schizophrenia E-TR subtype. In comparison with patients that did not have clozapine-induced prediabetes/diabetes, clinical efficacy was significantly lower in patients with clozapine-induced prediabetes/diabetes. Of note, the lowest clinical efficacy detected in patients with clozapine-induced diabetes [odds ratio (OR) of 0.18; 95% confidence interval (CI), 0.07–0.44]. Interpretation: The incidence of clozapine-induced metformin-resistant prediabetes/diabetes was considerably high in the schizophrenia E-TR subtype. Clozapine-induced metformin-resistant prediabetes/diabetes represents an independent risk factor that adversely affects the clinical efficacy of clozapine for the schizophrenia E-TR subtype. This study provided new evidence for re-evaluating the use of clozapine for TRS, especially E-TR subtype, and the use of metformin for the glycemic control of clozapine-induced prediabetes/diabetes. Funding: This study was supported by the National Natural Science Foundation of China (81871052 and 81571319). Declaration of Interests: All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and there is no conflict of interest to disclose. Ethics Approval Statement: The study protocol was reviewed and approved by the Ethic Committee of Tianjin Kangtai Hospital (Tianjin, China).

Background: Coronavirus disease-19 (COVID-19) is the disease caused by 2019-nCoV/SARS-CoV-2, a novel β corona- virus of group 2B . COVID-19 has been reported to be associated with severe condition with type 2 diabetes mellitus (T2DM). D-dimer is a by product of fibrin degradation. It is widely recognized as a biomarker for thromboembolism and as a prognostic marker for critical patients. Methods: This study uses secondary data, which is obtained by looking at the contents of patient medical records at H. Adam Malik Medan Hospital between 2020-2021. The population of this study was all inpatients confirmed COVID-19 through an RT-PCR SARS-CoV-2 swab examination. The study sample was obtained by the total sampling method, where all populations that meet the criteria of inclusion and exclusion are used as research samples. Patients were triaged as per severity on basis of national guidelines: asymptomatic, Mild (respiratory rate < 24/min, SpO2 >94% at room air), moderate (respiratory rate: 24-30/min, SpO2 90-94% at room air) and severe (respiratory rate >30/min SpO2 < 90%), ARDS and septic shock [6]. HbA1c implementation using HPLC methods and D-dimer is measured by ELISA method. Result: There were 163 patients consisting of 92 men and 71 women, the average age was 56.9±10.3 years, and HbA1c, FPG and PPG remained uncontrolled. There were no differences in age parameters of blood sugar profiles and D-dimers between men and women. D-dimers are significantly negatively correlated with PPG. Conclusion: Age, blood sugar profile and D-dimer did not differ significantly between men and women, and D-dimer had a correlation significantly with PPG on T2DM with COVID-19 patients. Keywords : D-dimer, T2DM, COVID-19

Alcohol, Blood Sugar, and Grip muscle strengths (GMS) may play key role in injury prevention and rehabilitation. In many cases, strengthening of the grip has been a prescription for rehabilitation from injuries such as golf and tennis elbow. In this study, the effects of alcohol and glucose consumption on grip muscle strength in early adult male subject was investigated. A total of thirty (200) human subjects of about18+ years old were recruited for the study. The subjects were administered varying doses of alcohol and glucose D, then allowed to rest for a period of 5 and 10 minutes before assessing their grip muscle strength, fasting blood sugar (FBS) and body weights. Obtained records were then compared with those of control (normal) subject who neither received alcohol nor glucose D. Differences in mean was obtained between groups using the student t-test. From the result, study found a statistically significant decrease (p < 0.05) in GMS for different times (5 min and 10 min) of alcohol administration as compared with control subjects. A notable significant decrease (p > 0.05) was also observed for FBS with increasing administration times as compared with control. This decrease was however insignificant for 10 min duration compared with 5 minutes. This decrease was however significant (p < 0.05) for alcohol 5 min intake as compared with control group. All test group (experimental) showed a statistically significant decrease in GMS after alcohol administration as compared with control. Lastly, a statistically significant decrease (p < 0.05) was observed in GMS for 10 min of Glucose D intake. Whereas, subject who took glucose D in 5 min showed an insignificant decrease as compared with control. It is recommended that more studies be conducted to corroborate the result of this study.

Hierarchical management is an essential component of nurse post management and an unavoidable tendency in nursing education. According to their existing condition, various hospitals around the country have actively tested the hierarchical usage and management model of clinical nurses, with some success. The application impact of hierarchical nursing care in patients with hypertension complicated by cardiovascular and cerebrovascular risk factors is the focus of this research. In a hospital, 300 patients with hypertension complicated by cardiovascular and cerebrovascular risk factors were chosen. All patients were split into two groups using the coin-throwing random method: the observation group received hierarchical nurse management and the control group received regular nursing management, with 150 cases in each group. The two groups’ blood pressure, blood lipids, blood glucose, poor habits, rehospitalization rate, and cardiovascular and cerebrovascular problems were also examined. At the same time, the patients’ poor mood and quality of life were assessed before and after the intervention. In the control group followed up for 1 year, the blood pressure compliance rate was 44.88%, the blood lipid compliance rate was 28.65%, the blood glucose compliance rate was 45.00%, the smokers with bad lifestyle habits were 26.57%, the overweight and obese were 23.5%, the high sodium was 31.67%, the rehospitalization rate was 15.48%, and the incidence of cardiovascular and cerebrovascular complications was 43.00%. The observation group’s blood pressure, blood lipids, and blood sugar compliance rates rose substantially ( P = 0.05 ) as compared to the control group. The occurrence of poor luck living habits, the rate of rehospitalization, and the incidence of cardiovascular and cerebrovascular complications were significantly reduced ( P < 0.05 ). Before nursing intervention, there was no significant difference in the bad mood scores SAS, SDS, and quality of life between the two groups of patients ( P > 0.05 ); after nursing intervention, compared with the control group, the observation group’s bad mood scores were significantly reduced, physical factors, psychological factors, and total scores all increased significantly, and the difference was statistically significant ( P < 0.05 ).

Acute respiratory distress syndrome (ARDS) is a life-threatening condition in which the lungs become severely inflamed, causing the alveoli to constrict or fill with fluid, which prevents the lungs from functioning properly. This disease becomes more dangerous when it occurs in patients with diabetes. Because of the clinical condition of these patients, it is not possible to treat them with usual medicines. One of the best options for treating these people is to use herbs. Borage (Borago officinalis) is a medicinal herb that, in addition to its anti-inflammatory properties, is also able to control blood sugar. Therefore, in the current study, the effect of borage oil was considered on the signaling pathway of the NLRP3 inflammasome complex, TLR4, and serum levels of inflammatory cytokines (IL-1? and IL-18) in type II diabetic patients with ARDS. For this purpose, 25 diabetic type II patients with ARDS were divided into three groups by ARDS Berlin Definition. Then, after providing the demographic and clinical characteristics of the patients, they were treated with 30 mg/day borage oil for seven days. The expression of NLRP3 and TLR4 genes (by Real-time PCR technique) and serum levels of IL-1? and IL-18 (by ELISA test) were evaluated before and after treatment with borage oil through blood samples taken from patients. The results showed that serum levels of inflammatory cytokines (IL-1? and IL-18), NLRP3 gene, and TLR4 gene were significantly decreased in diabetic type II patients with mild ARDS by treating with borage oil. IL-1? serum level and TLR4 were significantly decreased in diabetic type II patients with moderate ARDS. But there was not any significant decrease or increase in IL-1?, IL-18, NLRP3 gene, and TLR4 gene in diabetic type II patients with severe ARDS after 7 days of treatment with borage oil. According to the obtained results, borage oil can act as a double-edged blade. Thus, in the early and middle stages of ARDS, borage oil can be effective in reducing the inflammasome pathway of inflammation and also reduce blood sugar levels in these diabetic patients. But in the severe stage of ARDS, it not only does not help to treat the ARDS; it also increases systolic and diastolic blood pressure in diabetic patients.

Objectives: The primary and secondary objectives were to compare the glycaemic control and frequency of hypoglycaemia between continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG). Methods: A single centre, randomised, parallel-group controlled trial was conducted involving twenty-two type one Diabetes Mellitus (T1DM) patients with the mean age of 13.8 years assigned to either intervention or control group. All respondents wore the CGMS device at the beginning of the study. Intervention group (n=11) had their insulin adjusted based on the CGMS data, while the control group (n=11) was based on SMBG. Monthly average blood sugar level (BSL) and monthly mean hypoglycemic events per week (HE/wk) were measured at baseline, first month, second month, and third month. HbA1c levels were measured at baseline and in the third month. Results: The baseline characteristics were similar. The data were analysed using repeated measure analysis of variance (ANOVA). The mean difference of HbA1c within the group was not statistically significant with p=0.322. There were significant differences in the monthly mean HE/wk within and between groups, p=0.004, and p=0.037. Conclusion: In conclusion, CGMS is equivalent to SMBG in optimising glycaemic control but is more effective in detecting hypoglycaemia in children.

In Indonesia the incidence of diabetes mellitus continues to increase. Complications of diabetes occur in all organs of the body with a 50% cause of death due to coronary heart disease and 30% due to kidney failure. Besides death, diabetes also causes disability. As many as 30% of diabetics overcome the complications of retinopathy and 10% overcome foot amputations due to diabetic ulcers. Diabetes mellitus is a disease characterized by evolution caused by differences in insulin production or impaired insulin performance or because of both. Management of diabetes mellitus through the five main pillars, one of which is diabetic exercise. Diabetic gymnastics is a form of aerobic physical exercise for diabetics with movements that have been deliberately chosen to follow the rhythm of the chosen music that requires the provision of rhythmic, continuity and a certain duration to achieve the expected goals. This gymnastics suggests 3-5 times / week. The aim is to determine the sensitivity of the feet of people with diabetes mellitus, the difference in blood sugar levels before and after formulation in patients with Type II DM. This search article is based on data such as Google Scholar. The key words are "diabetes exercise", "foot sensitivity", "blood glucose levels", "type II diabetes patients" and the authors found 5 relevant articles from 2014-2020. This article is expected to be an additional information to keep scheduling diabetic gymnastics regularly and continuously

Diabetes mellitus (DM) is a metabolic disorder characterized by high levels of glucose in the blood. Micromineral levels are related to the mechanism of glucose homeostasis. The abnormal zinc levels can be risk factors for DM. Improvement of micro-mineral levels can improve blood sugar levels. This study aimed to review the effects of zinc supplementation on blood glucose levels and insulin resistance. This study showed that DM was associated with low zinc levels in body serum. Zinc supplementation reduced fasting blood glucose, hemoglobin A1c levels, and insulin resistance in rat model DM and human researchs. It occurs in many types of Zn supplements. Differences in results may be due to differences in the characteristics of the subjects, doses, and periods of administration. Zn can be used for nutritional therapy in DM by considering the dose and period of supplementation, and patient characteristics to get optimal results

Penyakit Tidak Menular (PTM) merupakan penyakit yang tidak ditransmisikan dan tidak dapat ditularkan kepada orang lain dengan bentuk kontak apapun yang dapat menyebabkan kematian dan membunuh 60% dari seluruh kematian secara global dan data prevalensi di negara berkembang mencapai 80%. Penyakit Tidak Menular, khususnya penyakit kardiovaskuler, kanker, penyakit pernapasan kronis, dan diabetes melitus merupakan ancaman utama bagi kesehatan dan perkembangan manusia saat ini. Pengabdian masyarakat ini bertujuan untuk mendeteksi penyakit tidak menular yaitu skrining tekanan darah, kadar gula darah sewaktu (GDS), kolesterol, dan asam urat, pada masyarakat Padukuhan Pikgondang Desa Condongcatur Depok Sleman Yogyakarta. Jenis kegiatan yang dilakukan berupa penyuluhan kesehatan, pemeriksaan tekanan darah, kadar kolesterol, gula darah sewaktu dan asam urat. Tekanan darah diukur menggunakan spignomanometer dan stetoskop sedangkan analisis kolesterol, gula darah dan asam urat menggunakan alat pengecekan digital. Pengabdian masyarakat ini, telah dilakukan skrining dan deteksi dini factor risiko penyakit tidak menular terhadap 46 orang responden, meliputi 28 laki-laki dan 18 perempuan. Adapun hasil pemeriksaan tersebut menunjukkan bahwa tekanan darah sistole rata-rata pada laki-laki 135 mmHg, sedangkan perempuan 140 mmHg. Rata-rata tekanan darah diastole pada laki-laki 80 mmHg dan perempuan 80 mmHg dan dapat diketahui bahwa sebagian besar warga memiliki tekanan darah tinggi sebesar 86,96% dan sebesar 58,70 % warga memiliki kadar kolesterol normal (

Obesity or excess body weight is a predisposing factor for various diseases, one of which is because the accumulation of fatty tissue causes insulin resistance and causes an increase in sugar levels. This study aims to determine the description of glucose levels in obese patients. This research method is carried out through literature review that comes from various related studies, the stages starting from data collection, deepening the problem to be studied, then processing and analyzing the data obtained. From the literature results obtained several descriptions of glucose levels with various criteria for different respondents. Based on the description of various research results, it is found that there are differences in the value of blood sugar levels in obese and non-obese people and there is no relationship between physical activity and fasting blood glucose levels in DM patients

Stroke is a disease caused by disturbance of brain blood circulation influenced by many risk factors such as age, blood pressure, blood sugar, and blood lipid level. This study aimed to determine the prevalence of risk factors that contribute to stroke incidence in stroke patients hospitalized at UKI General Hospital in 2015. The design of this study is retrospective with research methodology descriptive observational. The sample in this study is all cases of a stroke at UKI General Hospital in 2015. The result showed that the highest type of stroke is ischemic stroke (77%) with the largest age group of 40-60 years (51.3%), male sex (60 people). Prevalence risk factors are hypertension stage 2 (52,2%), blood glucose level

There is some emerging evidence that suggests certain supplements help lower blood sugar levels. One of these is cinnamon, which exhibits characteristics that mimic insulin, such as the activity of biologically active substances to activate insulin receptor kinase, increasing glucose uptake, autophosphorylation of the insulin receptor, and glycogen synthase activity. To assess the effect of the cinnamon substance on lowering fasting blood sugar, modifying body weight, body mass index (B.M.I.), and waist circumference in type two diabetics. A randomized controlled intervention clinical trial. The study was conducted on 60 patients with type II diabetes mellitus; the study followed both gender patients for four weeks. The contributors were allocated randomly into a group that receives 2 g/d cinnamon substance (intervention group), and a group without cinnamon substance is given (control group). Fasting plasma glucose (F.P.G.) and anthropometrics measurement at the beginning (beforehand cinnamon supplementation and 4week at the end of the study duration). After 4 weeks of cinnamon taken, serum F.P.G. levels significantly improved (P≤0.0001). Anthropometric measurements (weight, height, B.M.I.) were reduced significantly (change mean ≤ P=0.001) for all. The Present study disclosed that supplementation of 2 gm cinnamon improves F.P.G. and has a good role in anthropometric indices (weight, waist circumference, B.M.I.).

Gastric cancer is a malignant tumor that originates from the epithelium of the gastric mucosa. It is the result of a combination of multiple factors, but the current research has not yet clarified its pathogenesis, so further research and exploration are needed. This article is mainly based on the meta-analysis of the improvement of gastrointestinal tumor-related symptoms and prognosis based on medical care and exercise intervention. The control group followed routine care after enrollment. In addition to routine care, patients in the intervention group exercised through assessment, formulation of exercise prescriptions, implementation of supervision, and adjustment. By viewing the subjects' physical examination reports, determine their blood routine, urine routine, blood lipids, blood sugar, liver and kidney function, and electrocardiogram examination. In this experiment, dual-contrast ultrasound in each T staging was greater than 0.8, indicating that the diagnostic method is very accurate in the preoperative diagnosis of gastric cancer T staging. The results show that exercise intervention can improve the pain of patients with gastrointestinal tumors after chemotherapy, relieve cancer-induced fatigue, and improve the quality of life.

Diabetes mellitus is a severe condition in which the pancreas produces inadequate insulin or the insulin generated is ineffective for utilisation by the body; as a result, insulin therapy is required for control blood sugar levels in patients having type 1 diabetes and is widely recommended in advanced type 2 diabetes patients with uncontrolled diabetes despite dual oral therapy, while subcutaneous insulin administration using hypodermic injection or pump-mediated infusion is the traditional route of insulin delivery and causes discomfort, needle phobia, reduced adherence, and risk of infection. Therefore, transdermal insulin delivery has been extensively explored as an appealing alternative to subcutaneous approaches for diabetes management which not only is non-invasive and easy, but also avoids first-pass metabolism and prevents gastrointestinal degradation. Microneedles have been commonly investigated in human subjects for transdermal insulin administration because they are minimally invasive and painless. The different types of microneedles developed for the transdermal delivery of anti-diabetic drugs are discussed in this review, including solid, dissolving, hydrogel, coated, and hollow microneedles. Numerous microneedle products have entered the market in recent years. But, before the microneedles can be effectively launched into the market, a significant amount of investigation is required to address the numerous challenges. In conclusion, the use of microneedles in the transdermal system is an area worth investigating because of its significant benefits over the oral route in the delivery of anti-diabetic medications and biosensing of blood sugar levels to assure improved clinical outcomes in diabetes management.

Aim: To evaluate the frequency of acute ischemic stroke in patients with type-II diabetes mellitus. Study Design: Descriptive Cross sectional Study Place & Duration of Study: The study was carried out at Department of Medicine, DHQ Teaching Hospital, Dera Ismail Khan for the period of 06 months from 06 Feb, 2018 to 06 Aug, 2018. Methodology: All patients admitted through OPD presented with type-II diabetes mellitus and having acute ischemic stroke after radiological confirmation using non-contrast enhanced CT scan brain with type-II diabetes (as per operational definitions above) were enrolled in study. Informed written consent was taken by the researcher with detailed history followed by detailed clinical examination and all patients who was give their consent to participate in the study was questioned about their medical history and was examined in detail for their neurological deficits. All the laboratory investigation was done from single hospital laboratory and all the radiological investigations were done from hospital radiology department. Results: As per frequencies and percentages for acute ischemic stroke, 215 (74.65%) patients were found having acute ischemic stroke. Conclusion: In this study, we concluded that there is a significant age difference between the diabetes-stroke co-morbid patient and non-diabetic stroke patient. Therefore, health education on preventive measures for type 2 DM, adequate regulation of blood pressure and blood sugar level through compliance to medical advice and medication, regular clinic attendance and periodic measurement of blood pressure and blood sugar level.

The medicinal recipe composed of Parquetina nigrescens (Periplocaceae) and Erythrina senegalensis (Fabaceae) is a remedy used in traditional medicine in Cote d'Ivoire to treat diabetes. this study aims to assess the potential anti-diabetic effect of the drug recipe (RPNES) and its effect on the lipid profile and hemoglobin glycation in diabetic rats. Diabetes mellitus is induced by an intraperitoneal injection of streptozotocin, dissolved in a citrate buffer solution, at a dose of 65 mg/kg BW and a nicotinamide solution at a dose of 230 mg/kg BW to Wistar rats. Healthy rats and diabetic rats are treated orally with RPNES daily for 28 days and blood samples from control and treated rats are taken for assay of biochemical parameters. This study shows that RPNES, administered at doses greater than or equal to 600 mg/kg BW, causes a significant decrease in blood sugar in diabetic rats. in addition, a significant decrease in serum total cholesterol and triglyceride levels, associated with an increase in serum HDL cholesterol level, was observed in diabetic rats which received RPNES at 800 mg/kg BW, after 28 days treatment. In addition, after 90 days of treatment, RPNES (800 mg/kg BW) induces a significant decrease in the percentage of glycated hemoglobin in diabetic rats. This study also revealed that, in diabetic rats, RPNES had antihyperglycemic and antidiabetic effects similar to those of glibenclamide. RPNES is also a hypolipemic substance which corrects lipid disorders associated with diabetes, normalizes HDL cholesterol and lowers HbA1c levels in diabetic rats. These results justify the use in traditional medicine of this medicinal recipe composed of Parquetina nigrescens and Erythrina senegalensis to treat diabetes.

Osteoarthritis (OA) is significantly associated with diabetes, but how hyperglycemia induces or aggravates OA has not been shown. The synovium plays a critical role in cartilage metabolism and substance exchange. Herein, we intended to investigate whether and how hyperglycemia affects the occurrence and progression of OA by influencing the synovium. In patients with knee OA and diabetes (DM OA), we found a more severe inflammatory response, higher endoplasmic reticulum stress (ERS) levels, and more advanced glycosylation end products (AGEs) accumulation in the synovium than in patients without diabetes. Subsequently, we found similar results in the DM OA group in a rat model. In the in vitro cocultivation system, high glucose-stimulated AGEs accumulation, ERS, and inflammation in rat fibroblast-like synoviocytes (FLSs), which resulted in chondrocyte degeneration due to inflammatory factors from FLSs. Furthermore, in the synovium of the DM OA group and FLSs treated with high glucose, the expression of glucose transporter 1 (GLUT1) and its regulatory factor hypoxia-inducible factor (HIF)-1α was increased significantly. Inhibitors of HIF-1α, GLUT1 or AGEs receptors attenuated the effect of high glucose on chondrocyte degradation in the FLS-chondrocyte coculture system. In summary, we demonstrated that hyperglycemia caused AGEs accumulation in FLSs via the HIF-1α-GLUT1 pathway, which increases the release of inflammatory factors from FLSs, subsequently inducing chondrocyte degradation and promoting OA progression., Osteoarthritis: clarifying the links to diabetes High blood sugar caused by diabetes can promote the progression of osteoarthritis (OA) by triggering joint-damaging inflammation. Although OA is known to be linked to diabetes, the mechanism was unclear. Liaobin Chen and Hui Wang at Wuhan University in China and coworkers investigated how high blood sugar affects OA progression in the synovium, the membrane surrounding the fluid-filled capsule inside the knee and other joints. The researchers found that the synovium was more inflamed in patients with diabetes and OA than in patients with OA alone. Investigation in a rat model showed that high blood sugar levels caused accumulation of sugar–protein complexes (AGEs) that trigger inflammation, and of a protein that transports sugar (GLUT1). Blocking GLUT1 in cultured cells decreased AGEs accumulation, flagging it as a potential target for developing treatments for knee OA.

The diagnosis of diseases in their early stages can assist us in preventing life-threatening infections and caring for them better than in the last phase because prevention is better than cure. The death rate can be very high due to the unapproachability of diagnosed patients at an early point. Expert systems help us to defeat the problem mentioned above and enable us to automatically diagnose diseases in their early phases. Expert systems use a fuzzy, rule-based inference engine to provide forward-chain methods for diagnosing the patient. In this research, data have been gathered from different sources, such as a hospital, by performing the test on the patients’ age, gender, blood sugar, heart rate, and ECG to calculate the values. The proposed expert system for medical diagnosis can be used to find minimum disease levels and demonstrate the predominant method for curing different medical diseases, such as heart diseases. In the next step, the diagnostic test at the hospital with the novel expert system, the crisp, fuzzy value is generated for input into the expert system. After taking the crisp input, the expert system starts working on fuzzification and compares it with the knowledge base processed by the inference engine. After the fuzzification, the next step starts with the expert system in the defuzzification process converting the fuzzy sets’ value into a crisp value that is efficient for human readability. Later, the expert physician system’s diagnosis calculates the value by using fuzzy sets, and gives an output to determine the patient’s heart disease. In one case, the diagnosis step was accomplished, and the expert system provided the yield with the heart disease risk level as “low”, “high”, or “risky”. After the expert system’s responsibilities have been completed, the physician decides on the treatment and recommends a proper dose of medicine according to the level the expert system provided after the diagnosis step. The findings indicate that this research achieves better performance in finding appropriate heart disease risk levels, while also fulfilling heart disease patient treatment due to the physicians shortfalls.

Background: Diabetes type 2 (DM-2) is one of the most prevalent forms of the disease, afflicting nearly 90% of the diabetic population in the USA, that is growing gradually without certain and perceptible symptoms. The current study mainly attempts to estimate some blood minerals in people eating too much sugar and in diabetic groups when compared with control groups (healthy people). Methods: The present study was conducted over the course of 19th November to 19th December 2019 in teaching Azadi Hospital and Technical College / Kirkuk. Sixty blood samples were taken from individuals between ages of 20-to 50 years, which were collected from groups that eat too much sugar, the diabetic group, and the control group based on the history, clinical examination, and questionnaire form. 3 mL of fasting venous blood samples without a tourniquet were drawn from each person eating too much sugar group, the diabetic group, and the control group. Serum glucose, calcium, and magnesium were determined by the enzymatic method by using a spectrophotometer. Results: The results of the study demonstrated an increase in fasting blood sugar concentration (104.14mg/dl) in the eating too much sugars group and (197mg/dL) in the diabetic group compared to the control group (p 0.05) Conclusion: The study indicates that there is a substantially low level of serum magnesium and calcium in people consuming too much sugars group and diabetic group which may be an essential factor in the early initiation of the disease in prone and vulnerable people.

The World Health Organization (WHO) predicts that diabetes Mellitus in Indonesia by 2030 will increase to 21.3 million people. There was a growing need for natural foods that can be used as a substitute for antihyperglycemic drugs and may lower the blood sugar levels of diabetes Mellitus patients without burdening the kidneys and causing other side effects. Citrulline, one of the amino acids that are useful for the immune system and improving blood flow circulation, is found in the white peel of watermelon in greater levels compared to the citrulline content of other fruits. Previous research has shown that citrulline supplementation significantly lowered fasting blood sugar and HbA1c as well as inflammatory biomarkers, including in obese subjects. Methods conducted in this study include watermelon peel extract making, jackfruit seed drink making, proximate analysis, total phenol testing, organoleptic testing, and data analysis. The results of proximate testing on jackfruit seed drink with additional citrulline (F1) were F1 samples consisting of 92.31% water, 0.47% protein, 0.99% fat, 0.00% ash, and 6.23% total carbohydrates. Sensory analysis revealed that the flavor of the drink was disliked, while the aroma of the drink was somewhat liked. The addition of watermelon peel extract in jackfruit seed drinks may increase nutrition value, antioxidant content, and has the potential to be a functional drink with antioxidant content and blood sugar reduction effects as antidiabetics.

Overcoming diabetes is a major health challenge of the 21st century. WHO predicts that by 2030 it will be the seventh leading cause of death in the world and calls for global action to stop its rise and improve care. Actually, Herbal and nutritional supplementation is required in the management of diabetic patients, a finding shared unanimously by scientists. Recently diabetologists have come to the evidence that a therapeutic supplement consisting of nutrients and herbal is necessary to optimize the treatment of diabetes. The treatment of Type 2 diabetes mellitus, which is very often associated with overweight, is based on hygiene and dietetic measures and, where appropriate, on taking oral antidiabetics .This review describes the therapeutic arsenal of conventional oral antidiabetic drugs and emphasizes on innovative therapeutic option introducing herbal medicine and nutrition to the management of diabetic patients. Recent studies showed interesting potential in the reduction of blood sugar for many herbal for example Cinnamon, also berberine has been linked to the reduction of blood glucose levels, insulin levels and showed to be as effective as metformin, the most commonly prescribed drug for diabetics, at controlling blood sugar levels in diabetics. Moreover, a medicinal plant or herbal mixture can provide multi-targeted therapeutic action due to its complex chemical composition with hundreds of active ingredients such as oligosaccharides, alkaloids, polyphenols, flavonoids, tannins and at the same time ensure safety for the patients. We conclude by the fact that herbal and nutritional supplementation can bring major and promising progress in order to improve the patient care, by slowing the progression of type 2 diabetes and limiting its complications.

Diabetes mellitus (DM) with uncontrolled blood sugar causes a variety of problems, including coronary artery disease, stroke, heart failure, hypertension, nephropathy, neuropathy, and retinopathy. These consequences harm the diabetic patients' lives. Many studies have shown that diabetic patients have a higher rate of heart failure and a worse prognosis than non-diabetic people. Sodium and glucose co-transporter receptor-2 (SGLT2) inhibitors are a relatively new class of anti-diabetic drugs. They not only regulate blood sugar but also have positive cardiovascular effects via a variety of mechanisms. This review intends to show that SGLT2 inhibitors, in addition to good glycemic control, possess a cardioprotective role. We conducted a literature review and identified 20 adequately powered clinical trials and animal studies in type 2 DM that investigated the cardiovascular (CV) effects of SGLT2 inhibitors (particularly heart failure and hypertension). These studies looked at the cardiovascular effects of three SGLT2 inhibitors: Empagliflozin, Canagliflozin, and Dapagliflozin. In diabetic patients, these three inhibitors of SGLT2 significantly lowered the risk of heart failure and hypertension, making them valuable therapy for lowering CV risks in high cardiovascular-risk individuals with T2DM. Finally, the use of SGLT2 inhibitors in patients without diabetes mellitus showed positive metabolic outcomes in weight and blood pressure control.

Elderly are high risk for the development of type 2 diabetes due to the combined effects of increasing insulin resistance and impaired pancreatic function with aging. Diabetes mellitus is a chronic disease that causes insulin in the pancreas is not effective one of the treatments that can be done by diabetics to reduce blood sugar levels One of them with physical activity, the activity is taichi exercises.The purpose of this study was to investigate the effect of taichi exercises on reducing blood sugar levels in patients with type II diabetes mellitus.The design of this study was pre-experiment one group pre-test and post-test design with a population of 88 patients and a sample of 44 respondents. Research sampling technique used purposive sampling. Data collection with observation sheets. The intervention was carried out four times during 4 weeks. Before the intervention, sugar levels of type II diabetics were classified as moderate as 24 people (54.5%) and high as many as 20 people (45.5%). After the management of taichi exercises sugar levels experienced changes in the categories of good as many as 16 people (36.4%), moderate as many as 20 people (45.5%) and high as many as 8 people (18.2%). Data analized with Wilcoxon Signed Rank test with a significant level α = 0.05, the result ρ-value = 0.001 means ρ-value

ZusammenfassungEine 69-jährige Patientin mit rezidivierenden schweren Hypoglykämien wurde zur weiteren Diagnostik der Medizinischen Hochschule Hannover zugewiesen. Zuvor hatte die Patientin nach einem Stenting, das aufgrund einer peripheren arteriellen Verschlusskrankheit (pAVK) erforderlich war, mit einer Clopidogreleinnahme begonnen. Das Vorliegen eines Insulinoms und eines paraneoplastischen Syndroms wurde ausgeschlossen. Trotz niedrig normaler Blutzuckerkonzentrationen fanden sich erhöhte Insulin- und Insulinautoantikörperkonzentrationen. Diagnostiziert wurde ein Insulinautoimmunsyndrom, a.e. (am ehesten) ausgelöst durch vorausgegangene Clopidogreleinnahme. Eine Behandlung mithilfe der Immunadsorption wurde initiiert; diese erzielte eine signifikante Reduktion der hypoglykämischen Ereignisse und ein anhaltendes Therapieansprechen über 3 Monate.

Diabetes mellitus merupakan gangguan metabolisme yang bersifat heterogen dan ditandai dengan adanya hiperglikemia karena gangguan sekresi insulin, gangguan kerja insulin atau keduanya. Prevalensi diabetes mellitus di Indonesia pada tahun 2013 adalah sebesar 2,1%. Angka tersebut lebih tinggi dibandingkan dengan tahun 2007 (1,1%). Sebanyak 31 provinsi (93,9%) menunjukkan kenaikan prevalensi diabetes mellitus yang cukup berarti. Prevalensi penyakit diabetes mellitus di Provinsi Maluku adalah 0,7%, sementara berdasarkan diagnosis nakes ditemukan sebesar 0,4%. Prevalensi menurut kabupaten tertinggi di Kabupaten Maluku Tenggara Barat. Persentase kasus diabetes mellitus yang sudah terlayani oleh tenaga kesehatan menurut kabupaten, paling rendah di Seram Bagian Barat dan Kepulauan Aru. Tujuan penelitian ini adalah untuk mengetahui kadar glukosa darah sewaktu pada pasien diabetes melitus tipe 2 di puskesmas siwalima periode februari 2021. Penelitian ini menggunakan metode penelitian deskriptif, subyek penelitian adalah pasien diabetes melitus tipe 2 yang mempunyai hasil pemeriksaan gula darah sewaktu dan dilakukan pemeriksaan di poli umum Puskesmas Siwalima di kota Dobo Kepulauan Aru Maluku pada bulan Februari 2021. Jenis kelamin, Usia, Kadar gula darah sewaktu, Berat badan, Tinggi badan dan Lingkar pinggang dicatat dari data rekam medik. Terdapat 17 pasien yang mengalami diabetes melitus tipe 2, sebagian besar adalah perempuan (52,94%), usia 45–64 tahun (64,70%), kadar gula darah sewaktu terbanyak >180mg/dl (47,05%), indeks massa tubuh kategori overweight (41,17%), lingkar pinggang diatas sama dengan 80 cm pada perempuan (66,67%). Kesimpulan penelitian adalah pasien DMT2 di Puskesmas Siwalima Kota Dobo Kepulauan Aru menunjukkan sebagian besar memiliki rerata kadar glukosa darah sewaktu yang buruk

Cinnamon leaves (Cinnamomum burmanii) are plants that have many pharmacological effects including lowering blood sugar levels, inhibition of bacterial growth, antioxidants and mymetic insulin activity. However, acute toxicity testing has not been carried out on cinnamon leaves before. This study aims to determine the level of toxicity and effect of extract administration on SGOT, SGPT as well as changes in the histopathological form of the liver of test animals. This study used The Complete Randomized Design method with 5 treatment groups with na-CMC administration 0.5% as a negative control, P1 dose 250 mg/kgBB, P2 Dose 500 mg/kgBB, P3 dose 1000 mg/kgBB and P4 at a dose of 2000 mg/kgBB. Each treatment consists of 5 mice. The parameters observed in this study are SGPT, SGOT and histopathological examination of mice liver organs. The data was analyzed using the One Way ANOVA test with duncan's advanced test. The results showed that the administration of cinnamon leaf ethanol extract did not cause death in test animals so it was practically not toxic. SGPT and SGOT values in female white mice test animals showed statistically meaningful differences in SGPT and SGOT values (p

Background. Hatikana is a traditional medicinal plant used to treat inflammation, urolithiasis, goiter, cancer, wounds and sores, gastrointestinal, tumor, tetanus, arthritis, hepatic damage, neurodegeneration, and other ailments. The goal of this study is to investigate the antidiabetic properties of Hatikana extract (HKEx) and to construct the effects of its natural constituents on the genes and biochemical indices that are connected with them. Methods. HKEx was evaluated using GC-MS and undertaken for a three-week intervention in fructose-fed STZ-induced Wistar albino rats at the doses of HKEx50, HKEx100, and HKEx200 mg/kg bw. Following intervention, blood serum was examined for biochemical markers, and liver tissue was investigated for the mRNA expression of catalase (CAT), glutathione peroxidase (GPx), and superoxide dismutase (SOD1) by RTPCR analysis. Most abundant compounds (oleanolic acid, 7α, 28-olean diol, and stigmasterol) from GC-MS were chosen for the network pharmacological assay to verify function-specific gene-compound interactions using STITCH, STRING, GSEA, and Cytoscape plugin cytoHubba. Results. In vivo results showed a significant ( P < 0.05 ) decrease of blood sugar, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine kinase (CK-MB), and lactate dehydrogenase (LDH) and increase of liver glycogen, glucose load, and serum insulin. Out of three antioxidative genes, catalase (CAT) and superoxide dismutase (SOD1) were found to be few fold increased. Oleanolic acid and stigmasterol were noticed to strongly interact with 27 target proteins. Oleanolic acid interacted with the proteins AKR1B10, CASP3, CASP8, CYP1A2, CYP1A2, HMGB1, NAMPT, NFE2L2, NQO1, PPARA, PTGIR, TOP1, TOP2A, UGT2B10, and UGT2B11 and stigmasterol with ABCA1, ABCG5, ABCG8, CTSE, HMGCR, IL10, CXCL8, NR1H2, NR1H3, SLCO1B1, SREBF2, and TNF. Protein-protein interaction (PPI) analysis revealed the involvement of 25 target proteins out of twenty seven. Cytoscape plugin cytoHubba identified TNF, CXCL8, CASP3, PPARA, SREBF2, and IL10 as top hub genes. Pathway analysis identified 31 KEGG metabolic, signaling, and immunogenic pathways associated with diabetes. Notable degree of PPI enrichment showed that SOD1 and CAT are responsible for controlling signaling networks and enriched pathways. Conclusion. The findings show that antioxidative genes have regulatory potential, allowing the HKEx to be employed as a possible antidiabetic source pending further validation.

Type 2 Diabetes Mellitus is a condition when blood glucose in the body is not controlled due to impaired sensitivity of pancreatic cells to produce the hormone insulin. The World Health Organization (WHO) states that there are 422 million people in the world who suffer from diabetes mellitus, an increase of about 8.5% in the adult population and an estimated 2.2 million deaths. The purpose of this study was to determine the characteristics of patients with type 2 diabetes at the Sokaraja 1 Health Center and to find out how the relationship between blood sugar levels and blood pressure of type 2 diabetes mellitus patients at the Sokaraja 1 Health Center. The method used is observational analysis in perspective with a cross sectional approach. The results of this study using the Pearson correlation test showed that 46 patients were majority aged 51 to 60 (39.1%), male 13 patients (28.3%) female 33 patients (711.7%), long time to diagnose diabetes mellitus greater than 1-4 years (73.9%) and there is a relationship between blood sugar levels and blood pressure with a significance value of 0.375.

Diabetes Melitus (DM) tipe 2 merupakan sebuah penyakit metabolic yang di tandai dengan adanya kenaikan kadar gula dalam darah yang disebabkan adanya penurunan skresi insulin atau adanya gangguan fungsi insulin. Tujuan penelitian ini untuk mengetahui faktor resiko diabetes melitus tipe 2 berdasarkan usia, jenis kelamin, obesitas, aktifitas fisik, keiasan merokok di Puskesmas Purwokero Selatan Kapaten Banyumas. Metode yang digunakankuantitatif secara prospektif menggunakan rancangan atau desain deksripsi korelasi dengan pendekatan cross sectional. Hasil penelitian ini menggunakan karakteristik responden menunjukan bahwa dari 64 pasien mayoritas bahwa usia responden memiliki usia pada kategori dewasa (20-60 tahun) sebanyak 34 orang (53,1%) dan usia pada kategori lanjut usia (> 60 tahun) sebanyak 30 orang (46,9%) dan tidak ada responden yang usia pada kategori remaja (11-19 tahun). Responden sebagian besar berjenis kelamin perempuan sebanyak 48 orang (75,0%), sedangkan jenis kelamin laki-laki sebanyak 16 orang (25,0%). Responden yang tidak obesitas sebanyak38 orang (59,4%), sedangkan responden obesitas sebanyak26 orang (40,6%). Aktifitas fisik responden sebagian pada kategori tinggi sebanyak 44 orang (68,8%), dan aktifitas sedang sebanyak 20 orang (31,3%). Responden sebagian besar tidak merokok sebanyak 41 orang (64,1%), sedangkan responden yang merokok sebanyak 23 orang (35,9%) dan terdapat hubungan faktor resiko usia, jenis kelamin, obesitas, aktifitas fisik, kebiasaan merokok diabetes melitus tipe 2.

Type 2 Diabetes mellitus (T2DM) is a syndrome of disorders characterized by hyperglycemia caused due to a relative or absolute deficiency of insulin, decreased glucose utilization. The metabolic derangements in diabetes lead to secondary complications that affect multiple organ systems particularly on kidney. For early detection of kidney damage in T2DM patients are important by using certain type of urinary proteins. We aimed to evaluate the glomerular basement membrane damage and leaking of structural proteins in among different stages of type 2 diabetes mellitus patients. A total 150 type 2 diabetes mellitus patients were included in the present study and again sub classified into 2 types (Normoalbuminuria 50, Microalbuminuria 50) based on their urinary ACR and also included 50 age, gender matched healthy controls. The FBS, PPBS, Urea, Creatinine, HbA1C, Urinary Albumin was analysed by using laboratory standard methods and Urinary Adiponectin was measured by using were collected from the all subjects. A statistical was performed by using SPSS Version 21.0 and P value considers < 0.05 is statistically significant. The significantly elevated levels of plasma FBS, PPBS, Serum Urea, Creatinine, HbA1c, Urinary albuminuria and Urinary Adiponectin observed in two groups of type 2 diabetes mellitus when compared to healthy controls. The Urinary Adiponectin was positively correlated with blood sugar levels and urinary albumin in two groups of diabetes mellitus. The data showed a significantly damaged foot process of podocytes and glomerular basement membrane leads to leaking of certain urinary proteins.The elevated levels of Urinary Proteins and HbA1c, Urinary Albuminuria directly indicate the damage of podocytes and glomerular basement membrane in the kidney. These studies suggest continuous monitoring of these parameters may helpful for progression of type 2 diabetes mellitus complications.

Magnesium is an important macrominerals required for various functions in our body and also as a cofactor for several enzymes. Magnesium deficiency in pregnancy due to decreased intake or increased demands may lead to complications like eclampsia, pre eclampsia, IUGR, gestational diabetes mellitus, low birth weight etc. Hence we aim to estimate magnesium levels in antenatal women attending a tertiary care centre in North Kerala. 1. To estimate the levels of Serum Magnesium in antenatal women. 2. Compare the level of Magnesium with Hb, random blood glucose and Blood Pressure levels. 3. Determine sociodemographic profile of antenatal cases. This observational study was conducted in department of Biochemistry, GMC, Kannur from February 2020. All antenatal cases attending OBG OPD, GMC, Kannur, age between 18-35 years were included in the study while women with comorbidities and pregnancy complications were excluded from the study. Biochemical parameters like blood sugar, hemoglobin, HBA1C, were assayed on fully automated analyser, Se. Magnesium was assayed on a semi automated analyser by calmagite kit method. Patient biodata, history, clinical parameters and other relevant details were collected in prestructured formats.Total 30 patients were selected in this study. The age of patients ranged from 20 to 36 years with mean age 27.83 + 4.53 years. The mean Magnesium level in the study participants was 1 + 0.32 mg/dl. In our study participants reported 0 still birth, and 2 (6.7%) had abortions. Majority of them 90% had oedema of lower limbs. Participants had no history of pre-existing illnesses like hypertension hypercholesterolemia, diabetes mellitus, hypothyroidism, etc. There was a week positive correlation of Magnesium with systolic and diastolic blood pressure, and by comparing the levels of Magnesium with Haemoglobin and Blood pressure, they are not significant. Determination of Magnesium deficiency in the pregnancy can help in initiating appropriate supplementation and prevention of untoward complications, associated with Magnesium deficiency. Also, such studies, have not been conducted in this part of Kerala and will help to provide more information related to the topic.

Background: Iron deficiency anaemia is one of the most common anaemia striking in our country. The level up to which blood sugar level is regulated is measured by HbA1c. HbA1c represents sugar level in the blood for 120 days. HbA1c could be dependent upon an assemblage of factors like variants of haemoglobinopathies, haemolytic anaemia, other deficiency anaemia, acute loss of blood, uraemia, and pregnancy. Thus, it is crucial to determine the role of HbA1c in iron deficiency anemia in diabetics and non-diabetics before treating the patients. Methods: Total of 58 articles were collected and based on our study objective total of 19 articles were included in this study. Iron deficiency anaemia, HbA1c, diabetics and non-diabetics has been added in pub med advanced searches and Google scholar. Original articles which compare the correlation between these two were taken. All the information was gathered from original and review articles. Articles which were qualified for review, their inclusion criteria, exclusion criteria, quality of assessment and data collections were taken into consideration. Structure of heme particle, basic mechanism of HbA1c formation in RBCs is elaborated. Review articles which were taken include RCT, retrospective analysis and observational studies. The results were all compared and concluded of each articles. Basic mechanism of formation of HbA1c in RBCs is shown. Also necessary conclusions were derived from each study. Results: In a wide range of studies, HbA1c was found to be raised in IDA. After iron supplements, studies showed a decrease in HbA1c. Our study showed there is a need to correct anemia in diabetic patients before starting treatment. Conclusions: Strict HbA1c control is not a prerequisite and prior anaemia correction should be done. Nevertheless, a study which will be conducted in representative population matching to the prevalence and incident of disease in our country also which should be interventional is required for the highest correction value of HbA1c in DM and NDM population.

Diabetic nephropathy is a one of the microvascular complication in patients with type 2 diabetes mellitus due to increased production of free radicals and decreased levels of anti oxidants. The seviority of the disease totally depends on due to damage of foot process of podocytes. Hence, we need to evaluate the altered structural changes of podocytes, glomerular basement membrane in patients with type 2 diabetes mellitus. A total 60 type 2 diabetes mellitus patients were included in the present study and again sub classified into 2 types (Normoalbuminuria 30, Microalbuminuria 30) based on their urinary ACR. Basic laboratory investigations and radio graphical data were collected from the all subjects. A statistical was performed by using SPSS Version 21.0 and P value considers < 0.05 is statistically significant. The significantly elevated levels of plasma FBS, PPBS, Serum Urea, Creatinine, Uric Acid and HbA1c, Urinary albuminuria observed in type 2 diabetes mellitus with microalbuminuria when compared to normoalbuminuria. The radiographical data showed a significantly damaged foot process of podocytes and glomerular basement membrane are observed in patients with microalbuminuria when compared to normoalbuminuria. The increased levels blood sugar and HbA1c, Urinary Albuminuria directly indicates the damage of podocytes and glomerular basement membrane in the kidney. This study suggest continuous monitoring of these parameters may helpful for progression of type 2 diabetes mellitus complications.

The stress response involves the activation of both the sympathetic-adrenal response and the hypothalamic-pituitary-adrenal axis. During times of increased stress, the adrenal gland is stimulated to produce increased levels of hormones. Cortisol, the main hormone involved in the stress response, is secreted in increased amounts within minutes of a perceived stressor. Cortisol secretion can increase as much as 20-fold and has several important physiological effects. Short-term surges in cortisol levels can suppress inflammation and at the same time suppress immune function. Though inflammation control is important, surges of sustained levels of cortisol are not healthy and ultimately lead to premature aging, degenerative disease, and increased susceptibility to cancer. Studies show that psycho-social stress activates the hypothalamus-pituitary-adrenal axis causing an increase in morning cortisol levels, which correlated to the subjects reports of increased fatigue and anxiety. Although this stress response is important for survival during an acute stressor, prolonged activation of the stress response may lead to adrenal exhaustion in which cortisol levels drop to insufficient levels resulting in fatigue or illness. Many herbs have been shown to impact adrenal function. Adaptogens are plants that produce a non-specific response improving the physiological resistance to stressors. These herbs are often used in the context of adrenal support formulas to balance adrenal hormone levels. It is believed that adaptogenic herbs can increase low levels of adrenal hormone or decrease levels that are elevated. Additionally, these herbs provide balancing activity on many body systems that are impacted by stress, such as the immune response and blood sugar control.In the present study, we have evaluated the efficacy of ethanolic extract of Ocimum sanctum 47mg/kg p.o, Withania somnifera 23 mg/kg p.o and Bacopa monnieri 23 mg/kg p.o on plasma cortisol level in mice subjected to swim endurance test and cold restraint stress. The standard group was administered water-soluble root powder of Panax ginseng 100 mg/kg p.o and the stress control group was administered distilled water orally for 7 days. It was found that mice pretreated with ethanolic extracts of Ocimum sanctum, Withania somnifera and Bacopa monnieri showed a fall in the plasma cortisol level. The standard group also showed a significant decrease in the plasma cortisol level compared to the stress and normal control groups.