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Objectives: This study aimed to assess the level of illness perception and medication adherence among adult patients with type 2 diabetes mellitus (T2DM) in Jeddah, Saudi Arabia, with a specific focus on understanding how these two factors may be related. Materials and Methods: This descriptive correlation study included all adult patients with T2DM attending the Jeddah Care Centre for Diabetes and Hypertension at King Abdulaziz Hospital between January and April 2022. Data were collected using a questionnaire that elicited sociodemographic and clinical information, and the Arabic versions of the Brief Illness Perception Questionnaire and the Morisky Medication Adherence Scale. Descriptive statistics and Pearson's correlation analysis were used for data analysis. Results: A total of 365 patients were included (mean age: 50.9 ± 15.9 years), with the majority being female (53.4%). Overall, the level of medication adherence was moderate (mean score: 5.36 ± 1.73). Patients with lower medication adherence perceived the consequences of T2DM as more severe, had a stronger association with the illness identity, and experienced more intense emotional responses (for all, P < 0.001). Conversely, patients with higher adherence had a greater sense of personal control, a stronger belief in treatment effectiveness, and a better understanding of the illness (for all, P < 0.001). Conclusion: The study found a correlation between illness perception and medication adherence in patients with T2DM. Addressing patients' perceptions may enhance their ability to manage the condition more effectively. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the effect of mindfulness therapy on treatment adherence, self-efficacy, and emotion regulation in patients with type 2 diabetes. Methods and Materials: This quasi-experimental study utilized a pretest-posttest follow-up design with a control group. Thirty patients with type 2 diabetes, referred to Sari medical centers, were selected through non-random convenience sampling and then randomly assigned to either the experimental group or the control group (15 participants each). Both groups completed measures of treatment adherence (Modanloo, 2013), self-efficacy (Sherer et al., 1982), and emotion dysregulation (Gratz & Roemer, 2004). The experimental group received 90-minute sessions of mindfulness therapy once a week for eight weeks, while the control group did not receive any intervention. Post-intervention assessments were conducted for both groups. Data were analyzed using covariance analysis and SPSS version 22 software. Findings: The results indicated significant improvements in treatment adherence (F=154.84, p<0.001), self-efficacy (F=59.45, p<0.001), and emotion regulation (F=144.42, p<0.001) in patients with type 2 diabetes following mindfulness therapy. Conclusion: Mindfulness therapy appears to enhance treatment adherence, self-efficacy, and emotion regulation in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Acarbose is a potent glycosidase inhibitor widely used in the clinical treatment of type 2 diabetes mellitus (T2DM). Various acarbose analogs have been identified while exploring compounds with improved pharmacological properties. In this study, we found that AcbE from Actinoplanes sp. SE50/110 catalyzes the production of acarbose analogs that exhibit significantly improved inhibitory activity towards α-amylase than acarbose. Recombinant AcbE mainly catalyzed the formation of two new compounds, namely acarstatins A and B, using acarbose as substrate. Using high-resolution mass spectrometry, nuclear magnetic resonance, and glycosidase hydrolysis, we elucidated their chemical structures as O-α-D-maltosyl-(1 → 4)-acarbose and O-α-D-maltotriosyl-(1 → 4)-acarbose, respectively. Acarstatins A and B exhibited 1584- and 1478-fold greater inhibitory activity towards human salivary α-amylase than acarbose. Furthermore, both acarstatins A and B exhibited complete resistance to microbiome-derived acarbose kinase 1-mediated phosphorylation and partial resistance to acarbose-preferred glucosidase-mediated hydrolysis. Therefore, acarstatins A and B have great potential as candidate therapeutic agents for T2DM. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Education & Science is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Epigallocatechin gallate (EGCG) has an effect in reducing sugar levels in the blood by inhibiting α-glucosidase enzyme, which is connected explicitly by hydrogen bonds and modifies the secondary structure and micro-environment of the enzyme reversibly and noncompetitive. This study looks at the activity and interaction of EGCG as α-glucosidase inhibitors in the form of binding affinity and compound bonding profiles with receptors, including toxicity predictions and drug-likeness results. The research was performed in silico with molecular docking on Autodock Vina that integrated through PyRx, then viewed the compound's binding profile with receptor using Discovery Studio 2021 Client, toxicity prediction using ProTox-II and determination of drug-likeness using SwissADME based on Lipinski's rule of five guidelines. The control drugs used were acarbose and miglitol. The molecular docking results obtained that the binding affinity of EGCG is -8.4 kcal/mol while acarbose and miglitol are -13.8 kcal/mol and -5.3 kcal/mol respectively. There are amino acid residues similar to the drug control with various interactions like electrostatic, hydrophobic, and hydrogen bonds; then it has an inactive target for each toxicity parameter and has a molecular weight of 458.37 g/mol; Log P value of 1.01; H-bond donor of 8; and H-bond acceptor of 11 in the determination of drug-likeness. Based on these results, EGCG has effectiveness as α-glucosidase inhibitors predicted to be non-toxic; however, there are violations in determining drug-likeness. [ABSTRACT FROM AUTHOR]

To investigate effects of empagliflozin on plasma amino acids in people with type 2 diabetes. In a randomized, active-controlled, open-label trial, 58 patients with type 2 diabetes were randomized to 10 mg/day empagliflozin (n = 29) or standard treatment without empagliflozin (control group, n = 29) and treated for 12 weeks. We obtained blood samples at baseline and 12 weeks and assessed the plasma amino acid profile by liquid chromatography-mass spectrometry liquid chromatography. We also calculated the Fischer ratio (the ratio of branched-chain to aromatic amino acids). In the empagliflozin group but not in the control group, plasma levels of citrulline, histidine, and α-aminobutyric acid (AABA), the Fischer ratio, and serum high-molecular weight (HMW) adiponectin increased significantly (p = 0.0099, 0.0277, 0.0318, 0.0135, and 0.0304, respectively) and plasma plasminogen activator inhibitor-1 (PAI-1) decreased significantly (p = 0.0014). In the empagliflozin group, the change in plasma citrulline was positively correlated with the changes in HMW adiponectin (r = 0.488, p = 0.0084) and the Fischer ratio (r = 0.393, p = 0.0353) but negatively correlated with the change in ferritin (r= −0.533,p = 0.0051); the change in plasma histidine was negatively correlated with the change in PAI-1 (r= –0.398, p = 0.0397) and urinary albumin creatinine ratio (r= −0.478, p = 0.0088). Empagliflozin significantly increases plasma citrulline, histidine, and AABA in people with type 2 diabetes. identifier is UMIN000025418. [ABSTRACT FROM AUTHOR]

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is estimated to affect upto 70–80% of people with type 2 diabetes mellitus (T2DM). Although several anti-hyperglycemic drugs have been shown to be effective in such patients, there remains an unmet need for newer drugs. The objective of this meta-analysis was to analyze the effect of ipragliflozin on aspartate aminotransferase (AST), alanine transaminase (ALT), and gamma-glutamyl transpeptidase (GGT) levels in patients with T2DM. A literature search on electronic databases was conducted to identify potential randomized clinical trials (RCT) as per predetermined study selection criteria. Mean difference (MD) was calculated using Cochrane review manager. Twelve studies were included in the meta-analysis, including 1349 subjects. Compared to the control group, ipragliflozin as a monotherapy showed a significant reduction in levels of ALT at week 12 (p = 0.02) and at week 24 (p = 0.007), GGT at week 12 (p < 0.00001). Ipragliflozin as an add-on therapy showed significant reduction in levels of AST at week 24 (p < 0.00001), ALT at week 12 (p = 0.002), ALT at week 24 (p < 0.00001), and GGT at week 24 (p < 0.00001). Findings suggest the beneficial effects of ipragliflozin on liver enzymes. Further large-scale RCTs are required to confirm ipragliflozin's role for liver-related conditions in T2DM. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have changed the landscape of type 2 diabetes (T2D) management due to their cardio-renal benefits, their glucose-lowering efficacy and weight loss (WL) maintenance. However, the response to GLP-1 RA monotherapy is heterogeneous. Additionally, the majority of GLP-1 RAs are injectable treatments. Oral GLP-1 RAs and injectable combinations of GLP-1 with other entero-pancreatic hormones (glucose-dependent insulinotropic polypeptide (GIP), glucagon and amylin) are under development for T2D and obesity management. Herein, we review the data on (i) oral GLP-1 RAs (oral semaglutide 25/50 mg and orforglipron) and (ii) dual/triple agonists (tirzepatide, cagrilintide 2.4 mg/semaglutide 2.4 mg, survodutide, mazdutide, retatrutide) that have recently completed phase 3 trials for T2D or are currently in phase 3 clinical trials. Tirzepatide is the first approved dual agonist (GLP-1/GIP) for T2D and obesity management. We are in a new era in T2D management where entero-pancreatic hormone-based treatments can result in ≥15% WL and euglycemia for many people with T2D. Multiple molecules with different mechanisms of action are under development for T2D, obesity and other metabolic complications. Data on their cardio-renal benefits, long-term efficacy and safety as well as their cost-effectiveness will better inform their position in treatment algorithms. [ABSTRACT FROM AUTHOR]

Background and objective: Limited understanding exists regarding the factors affecting the prognosis of surgical treatment for type 2 diabetes mellitus (T2DM), particularly in Chinese patients. In this study, we examined a cohort of early and intermediate obese T2DM patients to explore the potential impact of preoperative lipid metabolism in metabolic surgery on the postoperative remission of T2DM. Methods: Participants with T2DM and obesity underwent metabolic surgery. Clinical data, including baseline body mass index, percentage of excess weight loss, and preoperative biochemical indicators, were collected and analyzed. A multidisciplinary team conducted patient follow-up. Remission was defined as sub-diabetic hyperglycemia (HbA1c < 48 mmol/mol, fasting glucose 100–125 mg/dl) without pharmacological intervention for at least 12 months. Results: Over a median follow-up of 27 months, 96 T2DM patients with metabolic surgery were studied, with no laparotomies required. Among these patients, 61 (63.5%) achieved complete remission, and 85 (88.5%) experienced remission. In multivariable analysis models, preoperative fasting blood glucose (FBG) significantly correlated with all postoperative outcomes. Furthermore, mediation analysis indicated that preoperative triglycerides (TG) mediated 26.31% of the association between preoperative FBG and postoperative remission. Both preoperative FBG and TG were negatively associated with the postoperative remission of T2DM. Conclusion: In summary, our findings suggest that lower preoperative fasting glucose levels enhance the likelihood of postoperative T2DM remission. Moreover, preoperative TG could potentially play a mediating role in the postoperative remission of T2DM. Therefore, evaluating and managing fasting glucose and lipids before the procedure may aid in assessing the prognosis of metabolic surgery. Level of evidence Level III, designed cohort. [ABSTRACT FROM AUTHOR]

Background: Glycemic control is the basis for managing diabetes to prevent chronic complications in diabetes. HbaA1c levels reaching ≤7% is an indicator of achieving good glycemic control. The 3J principles (right type, amount, and schedule) in the pillars of meal management are not easy to apply, causing diabetes to have difficulty achieving glycemic targets. Objectives: Analyzing rice portion restriction and pre-meal fruit with HbA1c levels and abdominal fat in people with diabetes in Malang City. Methods: Experimental study type 'randomized controlled trial' with pre-posttest control group design involved 16 people with diabetes who were active in Prolanis activities at the Malang city health center. Respondents were randomly divided into 2 groups. HbA1c levels were taken 2 times, before and after the intervention. The t test and paired t test with a pvalue<0.05 were used to test the effect of the intervention on HbA1c levels, abdominal fat and abdominal circumference in people with diabetes for 3 months. Results: Both forms of intervention can reduce HbA1c levels in diabetic patients. Limiting the portion of rice significantly reduced HbA1c levels (p=0.003) and visceral fat levels. However, determining the amount of rice with added pre-meal fruit did not significantly decrease visceral fat and abdominal circumference (p>0.05). Conclusions: Limiting the portion of rice eaten by itself or combining it with pre-meal fruit may help diabetics lower their HbA1c levels. [ABSTRACT FROM AUTHOR]

Context Efficacy and safety of tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, have been studied in patients with type 2 diabetes in the global phase 3 SURPASS program. Objective This work aimed to assess the efficacy and safety of tirzepatide in Hispanic/Latino and non-Hispanic/Latino patients in SURPASS-1 to -4 clinical trials. Methods A total of 5679 patients were included, 2895 of self-reported Hispanic/Latino ethnicity, in this exploratory analysis of SURPASS-1 to -4 trial data. Interventions included tirzepatide 5, 10, or 15 mg, placebo, or active comparator (semaglutide 1 mg, insulin degludec, and insulin glargine). Change in glycated hemoglobin A1c (HbA1c) and body weight from baseline to week 40 (SURPASS-1 and -2) and to week 52 (SURPASS-3 and -4), and other efficacy and safety outcomes were evaluated within Hispanic/Latino and non-Hispanic/Latino subgroups. Results Among Hispanic/Latino and non-Hispanic/Latino patients treated with tirzepatide, respectively, HbA1c decreased significantly from baseline, ranging from 1.9% to 2.7% and 1.7% to 2.5%, and body weight decreased significantly from baseline, ranging from 5.3 kg to 12.4 and 6.5 kg to 17.1 kg (both P <.05) vs comparators across all trials. Subgroup trends were consistent with the overall trial populations. Treatment-emergent adverse events were reported in similar proportions across the subgroups and were primarily gastrointestinal disorders. The incidence of hypoglycemia was low. Conclusion Tirzepatide significatively reduced HbA1c and body weight in Hispanic/Latino and non-Hispanic/Latino patients. Tirzepatide was generally well tolerated in both subgroups. Efficacy and safety trends were comparable between subgroups and within the overall trial populations. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The study aims to investigate the association between type 2 diabetes and adipokines, particularly resistin and adiponectin, in insulin resistance. It also explores the potential of the resistin to adiponectin ratio as an indicator for these conditions Methods: This research involved 198 participants, including 100 patients with type 2 diabetes and 98 controls. It focused on measuring various biochemical parameters like HbA1c, fasting plasma glucose, lipid profiles (low-density lipoprotein, oxidized low-density lipoprotein, triglyceride, total cholesterol), and adipokines (resistin and adiponectin). The study utilized the Homeostasis Model Assessment of Insulin Resistance and Triglyceride-Glucose index to evaluate insulin resistance. Results: Type 2 diabetic patients exhibited higher levels of HbA1c, fasting plasma glucose, lipid profiles, and resistin, but lower adiponectin levels compared to controls. Adiponectin showed a negative correlation with insulin resistance, while resistin demonstrated a positive correlation. Both adipokines significantly related to atherogenic markers, with adiponectin offering protection against atherosclerosis and resistin augmenting it. Conclusion: The findings underscore the complex roles of resistin and adiponectin in the pathophysiology of type 2 diabetes, insulin resistance. The resistin to adiponectin ratio could be a useful biomarker for insulin resistance. These insights suggest potential therapeutic strategies for treating diabetes and preventing its complications. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (DMT2) is a metabolic disease due to abnormalities in insulin secretion. Insulin is one of DMT2 therapy. Objective: This study aimed to validate a modified the insulin adherence influence factor questionnaire based on the health belief model (HBM) among Indonesian patients with DMT2. Methods: The Indonesian insulin adherence influence factor questionnaire (IIAIFQ) was developed based on modified some literature reviews and internal expert discussions. The study included 30 participants aged = 17 y.o years old who had been taking insulin in the previous two months. The questionnaire consists of seven dimensions to measure HBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, cues to action and insulin adherence. Results: The construct validity test showed that of the 34 question items in the questionnaire, 10 items were invalid, 24 others were demonstrated valid based on the Pearson Correlation (>r table 0.361; p<0.05; loading factor > 0.5). Furthermore, 24 valid items were tested for reliability at a significance level of 0.05, and the results showed that each size had a Cronbach's Alpa > 0.6 with an overall score was 0.858, indicating that all domains in the questionnaire were reliable. Conclusion: IIAIFQ based The HBM theory is a valid and reliable instrument for assessing insulin adherence in diabetes mellitus patients. [ABSTRACT FROM AUTHOR]

Glucomannan is a polysaccharide with several health benefits such as the ability to lower blood sugar, slow gastric emptying time, accelerate satiety, and modify intestinal microbial metabolism. Therefore it has a potential as an alternative therapy for type 2 diabetes mellitus (T2DM). This study explores the mechanism of action of glucomannan as a potential therapeutic agent for T2DM through network pharmacology and molecular docking simulations. Glucomannan and T2DM target proteins were searched using GeneCard and OpenTarget Platform, respectively. The connectivity between T2DM target proteins and glucomannan were done using Cytoscape and Venny diagrams. Virtual screening was performed using Pyrx software with protein-targeted T2DM and visualization was done using Discovery Studio. There were 9 key targets related to the mechanism of action of glucomannan based on target connectivity construction. From the docking results, the lowest binding affinity of -9.6 kcal/mol was obtained between glucomannan and 3WY1 (PDB ID of GAA/alpha-glucosidase). This binding affinity was comparable to that obtained for the positive controls; acarbose and miglitol, with binding affinity of -9.7 kcal/mol for acarbose-3WY1 complex. The 3D structure visualization showed that glucomannan and acarbose occupy the same active site on the 3WY1 structure. The results of this study indicate that the most probable mechanism of action of glucomannan is inhibition of α-glucosidase, and therefore could be a potential alternative therapeutic agent for T2DM. [ABSTRACT FROM AUTHOR]

Objective: Impairment of immune cell signaling molecules is involved in diseases pathogenesis. The evaluation of signal transducer and activator of transcription (STAT) 4 and protein inhibitor of activated STAT (PIAS) 2 as well as immunoregulatory role of the dipeptidyl peptidase-4 inhibitor, sitagliptin were investigated in type 2 diabetes mellitus (T2DM). Materials and Methods: Peripheral blood mononuclear cells (PBMC) were purified from three study groups including healthy controls, T2DM patients with 6 months of sitagliptin treatment, and T2DM patients without sitagliptin. Expressions of STAT4 and PIAS2 were assessed with real-time polymerase chain reaction (qPCR). Results: The expression of STAT4 in patients without sitagliptin was higher than the healthy controls (p=0.001). Its expression was down- regulated in the sitagliptin treated patient group compared to those without sitagliptin (p=0.005). PIAS2 expression in patients without sitagliptin was lower than the healthy controls (p=0.009). PIAS2 was elevated in the sitagliptin treated group versus patients without sitagliptin (p=0.003). A negative correlation between STAT4 and PIAS2 was found in individuals without sitagliptin (p=0.01). In patients without sitagliptin, fasting plasma glucose was positively and negatively correlated with STAT4 and PIAS2, respectively (p=0.004 and p=0.001). Conclusion: Aberrant expression of STAT4 and reduced expression of PIAS2 were found in the T2DM patients. Sitagliptin may regulate the cell signaling pathways by elevating PIAS2 and reducing STAT4. [ABSTRACT FROM AUTHOR]

Objective: This research was designed and conducted to evaluate propolis supplementation effects on insulin resistance and inflammation in patients with type 2 diabetes. Materials and methods: In the double-blind, randomized controlled study, 60 patients with type 2 diabetes were enrolled. Patients were randomly assigned to receive Iranian propolis (1500 mg/day for 8 weeks) (n = 30) and the placebo (n = 30). The primary endpoint was to detect of changes in the fasting blood glucose (FBG), fasting insulin, the homeostasis model assessment insulin resistance (HOMA-IR) evaluation model, QUICKI, the homeostasis model assessment of β-cell function (HOMA-B), and inflammatory factors including Interleukin 6 and Interleukin 17 from baseline to the end of this study. Results: Eight weeks after intervention, the mean of FBG, fasting insulin and HOMA-IR, were significantly decreased in patients treated with propolis compared with the placebo group. Furthermore, there was a considerable enhancement in the HOMA-B as a measure of β-cell function and QUICKI index after the administration of propolis in treated group. Serum IL-6 and IL-17 were diminished remarkably in the propolis group, while there was no significant change in the placebo group. Conclusions: Based on this study, the daily intake of 1500 mg of bee propolis supplement for 8 weeks results in improvement of glycemic status, reduction in insulin resistance and inflammatory condition in patients with T2D. [ABSTRACT FROM AUTHOR]

Background • With social development, an aging population, and the increasing trend of obesity, type 2 diabetes (T2DM) has become one of the major problems affecting human health across the globe. Methods • Information on controlled trials was retrieved from four databases to obtain the effects of different doses of canagliflozin combined with metformin for treating T2DM. After a rigorous evaluation of the quality of the literature, data analysis was performed using RevMan 5.3 software. Results • We included 8 studies in this meta-analysis. The least square (LS) means of HbA1c and FPG in the test group were statistically lower than the control group. Our analysis revealed that the adverse reactions were not significantly different between the experimental and control groups (OR: 1.03; 95% Cl: 0.94, 1.12; P = .555). Also, we found that the urinary tract infection of the experimental group was not statistically different from the control group (OR: 0.94; 95% Cl: 0.71, 1.24; P = .648). Moreover, we identified that the blood pressure and blood lipids of the experimental group did not statistically differ from the control group. Conclusion • The meta-analysis demonstrates that high doses of canagliflozin combined with metformin may be potentially effective in patients with T2DM, as evidenced by LS means of HbA1c and FPG, and the above conclusions need to be verified by more high-quality studies. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to use docking and pharmacological research to explore phytochemicals as therapeutic candidates for the treatment of type 2 Diabetes Mellitus. Methods: The 100 plant compounds for the study were selected after a thorough review of the most recent literature using PubMed and Google Scholar. Three-dimensional structure in Structure-Data File Format of all phytochemicals was downloaded and collected from the PubChem platform. In parallel, the three-dimensional structure of the target protein dipeptidyl peptidase-4 in Protein Data Bank (PDB) format was obtained from the website of the Research Collaboratory for Structural Bioinformatics-PDB. AutoDock Vina software was used for the docking purpose. SwissADME and the admetSAR web server were used to further examine the top docked compounds for the pharmacological investigation. Results: Out of 100 phytochemicals, only 15 have shown better or comparable binding affinity above the benchmark medication, sitagliptin (−7.9 kcal/mol). All of these compounds were assessed to determine their viability as potential drugs by predicting their Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) properties. Two of these phytochemicals have proven their potential as medication candidates by passing the ADMET requirements. Conclusions: In silico studies help explore and find drug candidates among the enormous pool of phytochemicals and narrow down the screening process, saving time and money on experiments. In vitro and in vivo testing can be used in the future to further validate drug candidature. [ABSTRACT FROM AUTHOR]

Objective: The aim was to evaluate the cost-effectiveness of oral and subcutaneous semaglutide versus other oral glucose-lowering drugs (i.e., empagliflozin, canagliflozin, and sitagliptin) for the management of type 2 diabetes (T2D) in Denmark using clinically relevant treatment intensification rules. Methods: A Markov-type cohort model for evaluating the cost-effectiveness of treatment pathways for T2D was used to produce cost-effectiveness estimates based on four head-to-head trials. Evidence from PIONEER 2 and 3 trials was used to evaluate the cost-effectiveness of oral semaglutide vs. empagliflozin and sitagliptin. Evidence from SUSTAIN 2 and 8 trials was used to evaluate the cost-effectiveness of subcutaneous semaglutide vs. sitagliptin and canagliflozin. Base case analyses used trial product estimands of treatment efficacy to avoid the confounding effects of rescue medication use during trials. Deterministic scenario analyses and probabilistic sensitivity analyses were conducted to assess robustness of cost-effectiveness estimates. Results: Semaglutide-based treatment regimens were consistently associated with higher lifetime diabetes treatment costs, lower costs of complications, and higher lifetime accumulated QALYs. The PIONEER 2 analysis estimated the cost-effectiveness of oral semaglutide vs. empagliflozin was DKK 150,618/QALY (€20,189). The PIONEER 3 analysis estimated the cost-effectiveness of oral semaglutide vs. sitagliptin was DKK 95,093/QALY (€12,746). The SUSTAIN 2 analysis estimated the cost-effectiveness of subcutaneous semaglutide vs. sitagliptin was DKK 79,982/QALY (€10,721). The SUSTAIN 8 analysis estimated the cost-effectiveness of subcutaneous semaglutide vs. canagliflozin was DKK 167,664/QALY (€22,474). Conclusions: Daily oral and weekly subcutaneous semaglutide are likely to both increase cost and health benefits, but are likely to do so under commonly considered cost-effectiveness thresholds. Trial Registrations: Clinicaltrials.gov: NCT02863328 (PIONEER 2; registered August 11, 2016); NCT02607865 (PIONEER 3; registered November 18, 2015); NCT01930188 (SUSTAIN 2; registered August 28, 2013); NCT03136484 (SUSTAIN 8; registered May 2, 2017). [ABSTRACT FROM AUTHOR]

Objective: A cutting edge potential treatment of type 2 diabetes (T2D) is the use of cellular therapy. One recent method is the use of combination of stromal vascular fraction (SVF) and autologous activated platelet-rich plasma (aaPRP). This study is aimed to evaluate the efficacy of SVF combined with aaPRP to treat T2D. Materials and methods: Patients with T2D who underwent SVF and aaPRP treatment were recruited in this study. The lipoaspirate was digested by H-Remedy enzyme and centrifuged to isolate SVF. Blood was drawn from the patients and the aaPRP was isolated. The combination of autologous SVF and aaPRP was administered intravenously to each patient. Patients’ 1-month and 3-month post-therapy HbA1c level were statistically analyzed to their baseline level. Results: A total of 39 patients, 28 male and 11 female, with T2D with mean age of 59±11 years and baseline HbA1c of 8.31 g/dL were included in this study. Combination of SVF and aaPRP treatment in T2D resulted in a statistically significant decrease in HbA1c level to 7.58 g/dL at 1 month and to 7.63 g/dL at 3 months posttherapy, while a decrease in HbA1c was still observed at 6 and 12 months after therapy. Conclusions: SVF combined with aaPRP may have potential to reduce HbA1c levels in patients with T2D. Further research is needed to confirm the findings of our research. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) represents one of the fastest growing epidemic metabolic disorders worldwide and is a strong contributor for a broad range of comorbidities, including vascular, visual, neurological, kidney, and liver diseases. Moreover, recent data suggest a mutual interplay between T2DM and Corona Virus Disease 2019 (COVID-19). T2DM is characterized by insulin resistance (IR) and pancreatic ß cell dysfunction. Pioneering discoveries throughout the past few decades have established notable links between signaling pathways and T2DM pathogenesis and therapy. Importantly, a number of signaling pathways substantially control the advancement of core pathological changes in T2DM, including IR and ß cell dysfunction, as well as additional pathogenic disturbances. Accordingly, an improved understanding of these signaling pathways sheds light on tractable targets and strategies for developing and repurposing critical therapies to treat T2DM and its complications. In this review, we provide a brief overview of the history of T2DM and signaling pathways, and offer a systematic update on the role andmechanism of key signaling pathways underlying the onset, development, and progression of T2DM. In this content, we also summarize current therapeutic drugs/agents associated with signaling pathways for the treatment of T2DM and its complications, and discuss some implications and directions to the future of this field. [ABSTRACT FROM AUTHOR]

The increasing number of patients with diabetes has recently become a serious problem following changes in diet and lifestyle. Various drugs are used to treat diabetes; however, there are serious concerns regarding their physical and mental side eff ects. Zinc, copper, and nickel are trace elements present in the body that are known to have insulin-like eff ects although nickel is not essential to mammals. Here, we focused on metal complexes with the 2-acetylpyrazine N(4)-phenylthiosemicarbazone (2-APTC) ligand, which has a six-coordinate octahedral structure with an S2N4-type coordination mode. For single oral administration experiments, [Zn(2-APTC)2], zinc sulfate (10 mg Zn/kg) and [Cu(2- APTC)2], and copper sulfate (3 mg Cu/kg) were orally administered to 5-week-old ddy mice fasted for 12 h. Moreover, of [Zn(2-APTC)2] was administered daily to KK-Ay mice, a type 2 diabetes model. In a single oral administration experiment, [Zn(2-APTC)2] showed a signifi cant increase in plasma zinc concentration compared to zinc sulfate. Moreover, the 28-d administration of [Zn(2-APTC)2] resulted in a signifi cant decrease in the blood glucose level. This suggests that [Zn(2-APTC)2] has a higher absorption of the complexes than [Cu(2-APTC)2] after oral administration and is expected to have more antidiabetic activity. However, blood urea nitrogen, aspartate aminotransferase, and alanine transaminase levels increased, suggesting that [Zn(2-APTC)2] administration aff ects liver and kidney functions. Moreover, hematoxylin and eosin staining showed that [Zn(2-APTC)2] ameliorated fatty liver and exerted antidiabetic eff ects. Here, we report for the fi rst time that a zinc complex with a six-coordinated octahedral structure, with 2-APTC as a ligand, exhibits antidiabetic eff ects. [ABSTRACT FROM AUTHOR]

Background and aims: Muscle atrophy is a complication of type 2 diabetes, in which the expression of atrophy-related genes is increased. The present study aimed to investigate the effect of high-intensity interval training (HIIT) and metformin on gene expression of two atrophy-related genes (i.e., FoxO1 and Atrogin-1) in the skeletal muscle of diabetic mice. Methods: A total of 30 mice (C57BL/6) were assigned to two groups: control (n=6), and high-fat diet (HFD) (n=24). The mice in the HFD group were fed a HDF for 16 weeks. Then, diabetes was induced in mice by HFD. Then, they were divided into 4 groups as follows: (i) diabetic control, (ii) diabetes + metformin (DM), (iii) diabetes + HIIT (DH), and (iv) diabetes + metformin + HIIT (DMH). The DM group took metformin, the HIIT group performed a HIIT program, and the DMH group had both HIIT and metformin. The real-time PCR methods were used to measure the mRNA expression of FoxO1 and Atrogin-1. Results: The findings showed that HFD-induced diabetes caused increases in the expression of FoxO1 (P=0.0006) and Atrogin-1 (P=0.0008), and HIIT could restrain these increments (P=0.086, P=0.041). However, the decreasing effect of metformin on the expression of these genes was not significant (P=0.15) and the combined effect of HIIT and metformin on the expression of these genes was not greater than the individual effect of HIIT (P=0.64). Conclusion: These results indicated that HIIT (but not metformin) may prevent type 2 diabetes-induced downregulation of FoxO1 and Atrogin-1 in skeletal muscle, and metformin could not affect the impact of the training on these atrophy-related genes. [ABSTRACT FROM AUTHOR]

The recent availability in France of two sodium-glucose co-transporter type 2 (SGLT2i) inhibitors, empaglifozine and dapagliflozine, both in the treatment of type 2 diabetes and heart failure with fraction d reduced ejection, is based on very encouraging results from initial trials. They have also shown a protective effect against the progression of renal failure. These trials are consistent with real-life observations in countries where they were marketed earlier, with in particular a reduction in all-cause mortality. [ABSTRACT FROM AUTHOR]

Objective: This work aimed to investigate the effect of the SGLT2 inhibitor, dapagliflozin (DAPA), on cardiac function and the metabolic and hormonal response to moderate exercise in people with type 2 diabetes. Methods: This was a double-blind, placebo-controlled crossover study with a 4-week washout period. Nine participants were randomly assigned to receive either 4 weeks of DAPA or 4 weeks of placebo. After each treatment, they underwent an exercise protocol with 2 consecutive 10- minute stages at a constant load corresponding to 40% and 70% maximal oxygen consumption (VO2max), coupled with hormonal and metabolic analysis. A blinded transthoracic echocardiogram was performed 3 days later. Results: During the exercise protocol, glucose and lactate were lower (P<.0001 and P<.05, respectively) and β-hydroxybutyrate (BOBH) and growth hormone (GH) were higher (P<.0005 and P= .01) following DAPA treatment compared to placebo. There was a trend for lower insulin with DAPA. Adrenalin, noradrenalin, and glucagon were not different. Following DAPA participants demonstrated an increased mean peak diastolic mitral annular velocity (e') in comparison to placebo (P=.03). The indexed left atrial volume and right ventricular e" were reduced following DAPA compared with placebo (P=.045 and P=.042, respectively). Arterial stiffness was not different between treatments (DAPA 9.35±0.60 m/s; placebo 9.07±0.72 m/s). Conclusion: During exercise, GH may be more important than catecholamines in driving the shift from glucose to fatty acid metabolism by SGLT2 inhibitors. The 4-week crossover design showed changes in cardiac function were rapid in onset and reversible. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the impact of Insulin Degludec Aspart on daily insulin dose in comparison with premixed insulin aspart. Methods: It was a Quasi-Experimental study conducted in the Department of Pharmacology, Army Medical College, National University of Medical Sciences, Rawalpindi and the Department of Medicine, Pak Emirates Military Hospital, Rawalpindi. One hundred and twenty participants with documented type 2 diabetes, taking premixed insulin aspart therapy were enrolled in the study. Sixty participants were substituted with insulin degludec aspart from premixed insulin aspart. Daily units of insulin were recorded for 12 weeks and compared for both groups. SPSS version 26 was used for analysing the study results. Results: Participants of the insulin degludec aspart group showed a significant reduction in the daily insulin dose compared to the premixed insulin aspart group. Fifty-two units per day were administered in the participants of the premixed insulin aspart patients while insulin degludec aspart participants received 40 units of median daily insulin dose (p-value<0.001). Conclusion: Insulin degludec aspart proved superior to premixed insulin aspart in a reduction in the daily dose of insulin with insulin degludec aspart. [ABSTRACT FROM AUTHOR]

Objective: This study marked histological features of small intestine neurons in the type-2 diabetes mellitus (T2DM) rat model treated with ethanolic extract red betel leaf nanoparticle (EERbLNp) Methods: Thirty male Wistar rats were allotted into five groups (six rats each). Group I is nondiabetic control; group II is streptozotocin-nicotinamide (STZ-NA)-induced T2DM; group III-V are the STZNA- induced T2DM treated daily per oral with EERbL-Np at the doses 30, 60, and 90 mg/kg, respectively, within 28days. The duodenum, jejunum, and ileum were collected for routine histological staining and cresyl violet special staining to evaluate the feature of neurons in the Meissner (submucosa) and Auerbach (muscular) plexus. Descriptive statistical analysis ANOVA and Tukey HSD were used to compare neuron indexes among groups. Results: The necrotic neuron index in the duodenal and ileal Auerbach plexus, including the degenerative neuron index in the jejunal Auerbach plexus, were significantly decreased with the EERbL-Np treatment at the dosages 60 and 90mg/kg. Conclusions: The 60 mg/kg EERbL-Np administration in the T2DM model may provide a neuroprotectant candidate in duodenal and ileal neuropathy. Dosage of 90mg/kg EERbL-Np is also promising in jejunal neuropathy treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess how short-term personal CGM with professional support would affect treatment decisions and glucose control in people with type 1 (T1D) and 2 (T2D) diabetes treated with insulin in clinical practice. Materials and methods: This was a single-center retrospective cohort study of insulin-treated patients with diabetes who attended the diabetes clinic between March 2021 and March 2022 in Ruttonjee Hospital. It included 90 people with diabetes who were offered a physician-initiated 10 to 14-day CGM (rtCGM or isCGM) in addition to usual care (CGM group), and 90 people with diabetes with usual care alone (control group) after propensity score matching. Upon completion of CGM, the downloaded report was read by physicians for treatment advice (CGM group). Results: The overall mean HbA1c decreased in the CGM group compared with the control group (adjusted group difference, -0.40%; 95% CI, -0.68 to -0.12%; p = 0.005). In T2D, mean HbA1c decreased in the CGM group compared with the control (adjusted group difference, -0.46%; 95% CI, -0.78% to -0.15%; p = 0.005). The mean HbA1c decrease was non-significant in T1D between CGM and control groups. CGM intervention resulted in 69% in the CGM group had an additional pharmacological adjustment, 60% had dietary advice, and 13.3% had corrected matching of insulin doses to carbohydrates. Conclusions: This study demonstrated that a 10 to 14-day CGM with professional support is beneficial in improving glucose control for people with diabetes treated with insulin in the outpatient clinic. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the effects of blended self-management training on the knowledge and self-care behaviors of patients with type 2 diabetes. Materials and methods: One hundred people with diabetes participated in this randomized clinical trial and were randomized into two groups based on the block randomization method (block size = 4). The experimental group (31 men) received a three-hour training workshop plus an education course through a designed website. The control group (32 men) received routine training, which included receiving pamphlets. Researchers used diabetes knowledge and self-care behaviors tools in both groups before and two months after the completion of the intervention. Data were analyzed using SPSS version 16 statistical software. Results: Findings showed self-care behaviors in all dimensions (p <0.001) and knowledge (p < 0.001) in experimental group increase by blended education. Conclusions: The findings indicate that blended training is associated with positive effect on selfmanagement and diabetes knowledge for people with diabetes. So blended training program is highly recommended to improve treatment adherence, with low medical costs for patients. [ABSTRACT FROM AUTHOR]

Background: Heart rate recovery (HRR) after exercise is an independent prognostic tool for cardiovascular (CV) morbidity and mortality. The aim of this study is to detect the determinants of HRR in ischemic heart disease patients undergoing PCI with and without Type II Diabetes (T2D) and to assess its short term prognostic value. Methods: We examined the correlation between HRR and Clinical, Laboratory, Echocardiography, stress test and coronary angiography data in our cohort (100 patients with positive exercise test and PCI within 90 days, age 49 ±10 years, 71 males, 50% with T2D). We followed them up for 6 months and tested how impaired HRR (IHRR) predicts CV morbidity and mortality and compared data between diabetics and non-diabetics. Results: HRR closely correlated with age, presence of T2D, resting HR, METs, Diastolic dysfunction, LA size and number of coronary lesions. A stepwise linear regression model revealed age, T2D, Resting HR and Diastolic dysfunction as predictors of IHRR. In diabetics HRR was strongly correlated with resting HR, METs, LA size and TG level. A stepwise linear regression model showed resting HR, LA size and TG level as predictors of IHRR. In non diabetics only resting HR was strongly correlated with HRR. Kaplan-Meier survival analysis showed IHRR predicted mortality. Cox regression models found that IHRR predicted arrhythmia and CV composite end point. In diabetics IHRR predicted CV composite end point but not in non diabetics. Conclusions: Age, T2D, Resting HR, and Diastolic dysfunction were determinants of HRR among PCI patients. In diabetics resting HR, LA size and TG level its determinants. In non diabetics resting HR was the only determinant. In patients with T2D IHRR predicted CV composite end point but did not predict mortality. In non diabetics IHRR did not predict any of the endpoints. [ABSTRACT FROM AUTHOR]

A sulfated galactofucan designated as UpG was obtained from the brown algae Undaria pinnatifida by calcium chloride extraction. Chemical analyses showed that UpG is composed of galactose and fucose at a high sulfation level. Low-molecular weight UpGP-0.5 was prepared from UpG through acid hydrolysis for structure characterization. The backbones of UpG are determined to be α-(1,3)-Fuc, α-(1,4)-Gal, α-(1,3)-Gal, and α-(1,6)-Gal by GC-MS, FT-IR, NMR, and LC-MS analyses. Sulfate groups are modified at C2 and/or C4 of fucose and C3 and/or C4 of galactose. UpG could partially lower blood sugar and serum lipid levels in type 2 diabetic mice. Moreover, UpG treatment regulates the abundance of some specific gut microbiota, such as enriching the abundance of Muribaculum and Christensenellaceae, and reducing that of Bilophila, Tannerellaceae, Candidatus Saccharimonas and Anaerotruncus. The findings characterized the detailed structure of a sulfated galactofucan and investigated its potential for the treatment of type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

In modern lifestyles, high-fat diets and prolonged inactivity lead to more people developing type 2 diabetes (T2D). Based on the modern pathogenesis of T2D, food, and its components have become one of the top concerns for patients. Recent studies have found that dysbiosis and gut-related inflammation are more common in T2D patients. Probiotics and prebiotics play complementary roles in the gut as dietary supplements. Together, they may help improve dysbiosis and intestinal inflammation in people with T2D, increase the production of blood glucose-lowering hormones such as incretin, and help reduce insulin resistance and lower blood glucose. Therefore, changing the dietary structure and increasing the intake of probiotics and prebiotics is expected to become a new strategy for the adjuvant treatment of T2D. [ABSTRACT FROM AUTHOR]

Nano-products are commonly used in pharmaceuticals. This study investigated the in vivo antiglycemic effect of nanocapsules of black rice (Zizania aquatica) yeast aquadest extract in mice (Mus musculus) induced with type 2 diabetes mellitus (T2DM). Black rice yeast was prepared and extracted with distilled water. The black rice yeast extract was used to produce nanocapsules using a poloxamer 88 support matrix. The in vivo antiglycemic effect of black rice yeast extract (BRY-AE) nanocapsules was investigated using T2DM-induced male Swiss mice. The mice were divided into 4 groups, including the positive control group (DM + commercial feed), the negative control group (no DM + commercial feed), the BRY-AE nanocapsule test group (DM + BRY-AE nanocapsules+feed), and the extract test group (DM + BRYAE+ commercial feed). Changes in glucose levels, profiles of glucose tolerance, profiles of insulin resistance, and histological observations of liver tissue were determined. The results showed that blood glucose levels in all groups reduced after the second week, however, some still did not reach normal levels (no DM). The glucose tolerance test for the nano-treatment of BRY-AE at 800 ppm and BRY-AE at 1000 ppm revealed a good profile, indicating that it was comparable to the negative control and metformin. When compared to the negative control, the insulin sensitivity of the nanocapsules from BRY-AE at 800 ppm was relatively low. The findings of this study suggest that the nanocapsules BRY-AE can be used to lower blood glucose levels in mice with T2DM. [ABSTRACT FROM AUTHOR]

Background: The rate of Type 2 diabetes mellitus (T2DM) among Mexican American individuals is 16.3%, about twice that of non-Hispanic White individuals. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized. Objective: This study aimed to describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican American individuals with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican American individuals is a public health priority. Methods: Funded by the National Institute of Nursing Research (National Institutes of Health grant R01 NR015809), this project used a sequential multiple assignment randomized trial and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management educational program called Tomando Control delivered in a group format for 6, biweekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were rerandomized to receive either an augmented version of Tomando Control or a multifamily group treatment focused on problem-solving. The primary outcome measure was the "Summary of Diabetes Self-Care Activities." Evaluations were made at baseline and at 3, 6, and 12 months. Results: This study was funded in June 2016 for a period of 5 years. Institutional review board approval was obtained in November 2016. Between March 2017 and September 2020, a total of 330 patients were recruited from the outpatient primary care clinics of Olive View-UCLA Medical Center, with a brief hiatus between May 2020 and July 2020 due to COVID-19 restrictions. The study interventions were completed in December 2020. Data collection began in March 2017 and was completed in December 2021. Data analysis is expected to be completed in Spring 2023, and results will be published in Fall 2023. Conclusions: The results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM. [ABSTRACT FROM AUTHOR]

Background: Diabetes represents an important public health challenge in India and globally. It affects the quality of life and is one of the leading causes of death and disability. The burden on global health is huge, and about 463 million adults are currently living with diabetes. 77 million people in India in the age group of 20-79 years are affected by this pandemic, and the total cost of health expenditure is 8 billion US dollars. This is a huge burden and a great economic cost to public health. The research aims to explore the concept of diabetes self-management and major research questions would comprise asking what affects self-management in people with diabetes and how mhealth applications and interventions can impact the self-management behaviors in development and the utility of the m-health apps in self-management of people with diabetes. Objective: To design, develop, and assess the impact of an m-health-enabled nutrition informatics intervention for home-based type 2 diabetes self-management in an Indian setting. Methods: The study is divided into three phases, in the first phase a systematic literature review of global and Indian literature using Scoping review method using PRISMA-SCR tool to report on various m-health interventions on Self-care management regimes on type 2 diabetes and Nutrition informatics will evaluate the effectiveness and utility of m-health application developed on Selfcare management with nutrition informatics will be reported. In the second phase m-health application on Selfcare management and nutrition informatics regime will be built in the third phase of the study evaluation of the m-health application will be done using System Usability Scale (SUS) usability and mixed research evaluation with end-users using Diabetes based management system (DBMS)questionnaire. A mixed research study between January 2023 and April 2023. A sample of approximately 250 individuals to be recruited online, enrolled in the m-health application using a nonprobability complete enumeration sampling method from selected urban settings in Delhi & all over India. The inclusion and exclusion criteria for males and females aged 20-79 years old with Type 2 diabetes and access to a smartphone. Results: A sample of 250 individuals will go through a pretested DBMS questionnaire. The data collection will be initiated in June 2022, and the initial results are planned for publication by July 2023. Out of n=250 individuals, at least 120 individuals will be retained in the study. A qualitative study using descriptive analysis of the gathered data will be performed using SPSS V11, and reporting of the results will be done at 95% CIs and P=.0.05. Conclusions: The findings of the study using scoping review would inform the elements essential for the development of m-health to improve self-care management of diabetes at home settings in India and its wider application in the global framework. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a serious and progressive disease that occurs when carbohydrates, fat and protein are not used effectively in the body, but it is a problem that greatly affects the individual when the desired level of control cannot be achieved. In this study, the relationship between Treatment Compliance and Quality of Life in Type 2 DM Patients aged 65 and over was evaluated to inform patients about chronic complications, prevent complications, and maintain appropriate care when complications develop. The research was planned as descriptive and cross-sectional. In the unit with a population of 4000, 90 people aged 65 and over with Type 2 DM were included in the study. The mean age of the participants was 71.99±5.76 years (min-max: 65-94). 55.6% of the patients were women, 84.4% were married and 55.6% were primary school graduates. The mean score of the Elderly Quality of Life Scale was 23.32±6.59, and the mean score of the Patient Compliance Scale in the Treatment of Type 2 DM was 86.67±8.68. In the study, the relationship between Treatment Compliance and Quality of Life in Type 2 DM patients aged 65 and over was evaluated, and a negative and independent significant relationship was found between scale scores. This study will set an example for patients diagnosed with Type 2 DM to adapt to their treatment and determine their quality of life and make future plans. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes Mellitus can affect bone metabolism by many mechanisms and increase the risk of osteoporosis. It has been reported that glucose-lowering treatments, including metformin also have an effect on bone turnover. The aim of this study is to evaluate the effect of metformin treatment on bone formation and resorption in patients with newly diagnosed type 2 Diabetes Mellitus. There were 37 patients in the study population who were newly diagnosed with type 2 Diabetes Mellitus. Fasting plasma glucose level and postprandial plasma glucose level as well as plasma Hemoglobin A1C, calcium, phosphorus, parathyroid hormone, osteocalcin and C-Telopeptide levels were measured before initiation of metformin treatment. The tests were repeated 3 months after the treatment. The levels of fasting plasma glucose and postprandial plasma glucose decreased after 3 months of metformin treatment as expected and the difference was statistically significant. However there was no significant change in-calcium, phosphorus and parathyroid hormone levels. There was also a significant decrease due to Metformin treatment in osteocalcin levels, which is a bone formation marker. Metformin treatment has decreased C-Telopeptide levels as well which is also a bone formation marker. Our results have shown that 3 months of metformin treatment may suppress the bone turno-ver. Another important finding of our study was the reduction in levels of bone formation markers in female patients. Controlledlong-term studies are needed to be conducted in order to manifest the clinical implications of these findings. [ABSTRACT FROM AUTHOR]

The aim. The aim of the work was to establish the feasibility of development, determine the optimal composition and technology, and confirm the pharmacological effectiveness of combined tablets for treating type II diabetes. Materials and methods. Analytical research of the pharmaceutical market of drugs used for the treatment of type II diabetes was carried out using content analysis of official sources of information. The subjects of the study were medicinal products used to treat type II diabetes. A set of physicochemical and technological research methods was used to determine the quality parameters of the tabletting mass and tablets based on them. Results. According to the results of previous studies, similarities in the approaches to the pharmacotherapy of type II diabetes in the countries of Southeast Asia, the Western Pacific region, and Ukraine were established, which became the basis for conducting a market study of drugs with a sugar-lowering effect, namely, based on voglibose, with the aim of further including such drugs in the range of Ukrainian manufacturers. Furthermore, according to the results of physicochemical and technological studies, the composition and rational technology of obtaining tablets were established. Also, pharmacological studies have established that tablets with voglibose and solid dispersion of quercetin significantly prevent the development of glucose metabolism disorders caused by a high-sugar diet. In terms of the expressiveness of the hypocholesterolemic effect of the tablets and their constituent components, they are reliably superior to the comparison drug - metformin. Conclusions. According to the research results, the feasibility and relevance of the development of combined tablets with voglibose and solid dispersion of quercetin have been established. Furthermore, based on the investigated physicochemical and technological indicators, combined tablets' composition and rational technology were developed, and their specific pharmacological activity was proven. [ABSTRACT FROM AUTHOR]

Peroxisome proliferator-activated receptor-gamma (PPARγ) is a transcription factor involved in adipogenesis, and its transcriptional activity depends on its ligands. Thiazolidinediones (TZDs), well-known PPARγ agonists, are drugs that improve insulin resistance in type 2 diabetes. However, TZDs are associated with severe adverse effects. As current therapies are not well designed, novel PPARγ agonists have been investigated in adipocytes. (E)-2-methoxy-4-(3-(4-methoxyphenyl) prop-1-en-1-yl) phenol (MMPP) is known to have anti-arthritic, anti-inflammatory, and anti-cancer effects. In this study, we demonstrated the adipogenic effects of MMPP on the regulation of PPARγ transcriptional activity during adipocyte differentiation in vitro. MMPP treatment increased PPARγ transcriptional activity, and molecular docking studies revealed that MMPP binds directly to the PPARγ ligand binding domain. MMPP and rosiglitazone showed similar binding affinities to the PPARγ. MMPP significantly promoted lipid accumulation in adipocyte cells and increased the expression of C/EBPβ and the levels of p-AKT, p-GSK3, and p-AMPKα at an early stage. MMPP enhanced the expression of adipogenic markers such as PPARγ, C/EBPa, FAS, ACC, GLUT4, FABP4 and adiponectin in the late stage. MMPP also improved insulin sensitivity by increasing glucose uptake. Thus, MMPP, as a PPARγ agonist, may be a potential drug for type 2 diabetes and metabolic disorders, which may help increase adipogenesis and insulin sensitivity. [ABSTRACT FROM AUTHOR]

Background: One of the treatment goals for type II diabetes is to keep blood sugar to normal and inhibition of carbohydrate metabolizing enzymes represents a therapeutic strategy to achieve this aim. While medicinal plants possess a useful resource for therapeutics, combining plants of different species is believed to have a better pharmacological effect. Aim and Objectives: This study reported the antidiabetic potential, in-vitro and in-silico, of a polyherbal mixture which is a combined ethanol extract of Vernonia amygdalina, Allium sativum, and Ocimum gratissimum (which are plants native to tropical Africa). Materials and Methods: The study identified and quantified the phytochemicals present in the extract, its antioxidant and antidiabetic potentials were investigated. Also, the bioactive compounds present in the mixture were profiled with gas chromatography-mass spectroscopy (GC-MS). The resulting compounds were screened for their binding potential into the active site of alpha-glucosidase using consensus scoring molecular docking strategy. Results: The polyherbal mixture was abundant in phenols flavonoids and sterols. Apart from scavenging DPPH radicals, the extract also inhibited alpha-amylase and alpha-glucosidase with better IC50 values of 106.22μg/ml and 128.60μg/ml respectively than the reference drug, acarbose. Out of the bioactive compounds present in the mixture, stigmasterol, gamma-sitosterol, and tocopherol ranked top and are good binders of alpha-glucosidase. It was observed that these compounds possessed better ADMET and drug-like properties than standard acarbose. Conclusion: These features are indicative that the polyherbal mixture of Vernonia amygdalina, Allium sativum, and Ocimum gratissimum contain in part bioactive compounds that can be used for the management/treatment of type II diabetes. [ABSTRACT FROM AUTHOR]

Background and Objectives: As a health emergency of the 21st century, Diabetes is associated with an increased risk of cardiovascular diseases, stroke, diabetic nephropathy, neuropathy, retinopathy, pregnancy complications, psychological problems, lower quality of life experience, as well as a high economic burden and high risk of premature death. This study aimed to develop psychological interventions headings for patients referring to healthcare service centers based on local needs assessment through content analysis method of experts' opinion to provide services in the primary healthcare system. Material and Methods: This study was conducted on 19 mental health specialists, professors, and the health team providing services in healthcare service centers (family doctor and mental health expert) in 2018-19. The data obtained from the semi-structured interviews were analyzed using the directed content analysis technique. Results: The essential finding themes related to the closed headings of psychological interventions in diabetes for improving disease management included "collaborative care," "psychological assessment," the importance of "diabetes coexistence with psychiatric disorders," "creating health behaviors," "self-management training," and "intervention" In crisis" for the management of type 2 diabetes. Conclusion: This qualitative study was conducted with the participation of mental health experts. Therefore, the mentioned themes and categories can be used in developing the headings of psychological intervention programs for type 2 diabetic patients, focusing on the needs of Iranian patients and the structure of the health system. [ABSTRACT FROM AUTHOR]

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Chronic kidney disease (CKD) is a common complication of type 2 diabetes mellitus (T2DM). Approximately-one-third of patients with T2DM also have CKD. In clinical trial studies, several anti-diabetic medications (ADM) show evidence of preventing the progression of CKD. Biguanides (e.g., metformin) are widely accepted as the first line medication. However, the comparative effectiveness of second line ADMs on CKD outcomes in T2DM is unclear. In addition, results from clinical trials may not generalize into routine clinical practice. In this study, we aimed to investigate the association of second line ADMs with diagnosed incident CKD, CKD hospitalization, and eGFR

Aims: Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, is indicated for glycemic control in type 2 diabetes mellitus (T2DM). In this study, we investigated the changes in neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, in patients with T2DM after the initiation of dapagliflozin. Methods: This retrospective study included patients (aged 18 to 75 years) with T2DM who were prescribed dapagliflozin 10 mg once daily additional to their existing diabetic treatment. Patients with a history of chronic liver disease, chronic renal failure, infection, inflammatory disease, and the use of drugs affecting bone marrow were included. The duration of treatment was set at 12 weeks. Results: The study included 98 patients with a mean age of 54.3±8.0 years, with a female predominance of 61.2%. At 12th week, there was a statistically significant decrease in fasting glucose (199.6 mg/dL vs. 164.3 mg/dL, p<0.001), glycated hemoglobin (HbA1c) (8.92% vs. 8.01%, p<0.001), leukocyte count (7.79 103/mm3 vs. 8.36 103/mm3, p=0.018) and neutrophil count (4.44 103/mm3 vs. 4.84 103/mm3, p=0.027). Lymphocyte count (2.56 103/mm3 vs. 2.72 103/mm3, p=0.150) and NLR (1.86 vs. 1.89, p=0.758) also showed some increase but the difference was not statistically significant. Conclusions: This study showed significant increases in leukocyte and neutrophil counts in T2DM patients taking dapagliflozin, but lymphocyte count and NLR remained unaltered. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a progressive condition requiring long-term medical care and self-management. The ineffective transition from hospital to community or home health care may result in poor glycemic control and increase the risk of serious diabetes-related complications. In China, the most common transitional care model is home visits or telephone interventions led by a single healthcare setting, with a lack of cooperation between specialists and primary care, which leads to inadequate service and discontinuous care. Thus, an integrated hospital-community-home (i-HCH) transitional care program was developed to promote hospital and community cooperation and provide comprehensive and continuous medical care for type 2 diabetes mellitus (T2DM) via mobile health (mHealth) technology. Methods: This protocol is for a multicenter randomized controlled trial in T2DM patients. Hospitalized patients diagnosed with T2DM who meet the eligibility criteria will be recruited. The patients will be randomly allocated to either the intervention or the control group and receive the i-HCH transitional care or usual transitional care intervention. The change in glycated hemoglobin is the primary outcome. Secondary outcome measures are blood pressure, lipids (total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein), body mass index, self-management skills, quality of life, diabetes knowledge, transitional care satisfaction and the rate of readmission. The follow-up period of this study is six months. Discussion: The study will enhance the cooperation between local hospitals and communities for diabetes transitional care. Research on the effectiveness of diabetes outcomes will have potentially significant implications for chronic disease patients, family members, health caregivers and policymakers. Trial registration: Chinese Clinical Trial Registry ChiCTR1900023861: June 15, 2019. [ABSTRACT FROM AUTHOR]

Objective: We examined predictors of early and late loss of glycemic control in individuals with youth-onset type 2 diabetes, as well as predictors of short-term deterioration in youth from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. Methods: Demographic, physical, and biochemical measures at baseline and 48 months, and change over time, were examined in 584 participants separated into those with loss of glycemic control (sustained HbA1c ≥ 8%) before 48 months or at 48 months or later, and those who remained in control until the end of the study (median 6.8 years). Univariate and multivariate models, and receiver operating characteristic curve analyses were performed. Results: Approximately 45% of youth remained in control at 48 months; of these, 30% subsequently lost glycemic control prior to the end of follow-up. Predictors of early loss of glycemic control included baseline HbA1c, C-peptide index, oral disposition index, proinsulin, and proinsulin to insulin ratio. Predictors of late loss included baseline measures of insulin secretion and change in HbA1c and insulin processing at 48 months. A baseline HbA1c cutoff of ≥ 6.2% was optimally predictive of loss of glycemic control at any time, while an absolute rise in HbA1c > 0.5% related to loss of glycemic control within 3 to 6 months. Conclusion: This analysis demonstrates that youth with type 2 diabetes at risk for loss of glycemic control, including impending rapid deterioration, can be identified using available clinical measures, allowing for closer monitoring of at-risk youth, and facilitating the design of research on better therapeutic options. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) is a kind of diabetes marked by high blood sugar, insulin, and insulin insufficiency. Adult-onset diabetes is another name for it. Increased thirst, frequent urination, and unexplained weight loss are common indications and symptoms. Metformin side effects include metallic taste, weakness, diarrhea, stomach upset, lactic acidosis, and vomiting. Two other side effects are asthenia and a Vitamin B12 deficiency. Many recent studies and most health experts recommend basil seed as a better Metformin substitute. The research investigates why patients who consume basil seeds have a similar response to those who take Metformin. The methodology of the study consisted of two main steps, first step is to analyze basil and use HPLC to determine its chemical components. The second step is to compare the broken-down components to Metformin-composed materials, which is done by diluting with methanol/water (50:50 v/v) and removing the fat layer using 20 mL hexane. The findings showed that basil seed and Metformin had the most similar component structure, thus the foundlings concluded that patients had the same responses without the Metformin side effects, implying that basil seed stabilizes blood sugar levels. [ABSTRACT FROM AUTHOR]

Objectives: Recent studies have revealed an association between dipeptidyl peptidase 4 inhibitors (DPP4i) and development of bullous pemphigoid (BP). The main aim of our study is to evaluate the association between DPP4i treatment and BP development. The secondary endpoints were to evaluate clinical characteristics and biochemical parameters of the DPP4i associated BP cases and determine the differences of DPP4i associated BP disease than non-DPP4i associated BP cases. Methods: We designed a retrospective case-control study, comparing type 2 diabetic 58 BP cases to 75 type 2 diabetic controls. Data were collected from three dermatological departments in Istanbul/Turkey, from November 1, 2008, to January 1, 2019. Medical records of each patient's demographic, clinical characteristics, drugs used, and laboratory data were reviewed. Results: There was no statistical difference in age and gender between the patient and control group. The most common prescribed oral antidiabetic for both groups was metformin. The most commonly prescribed DPP4i was vildagliptin. Fourteen (24.1%) out of 58 diabetic patients with BP were using vildagliptin, 12 (20.7%) out of 58 diabetic BP patients were using linagliptin, 6 (10.3%) out of 58 diabetic BP patients were using sitagliptin, and 1 (1.7%) out of 58 diabetic BP patients were using saxagliptin. There was no significant difference between the two groups regarding the DPP4 is use (using DPPi at the time of diagnosis and not). Both groups had similar clinical characteristics, localizations, disease severity, comorbidities, treatment responses, and biochemical parameters. BP patients using DPP4i had statistically less mucosal involvement than BP patients not using DPP4i (p=0.044). Conclusion: Even though there was no difference between two groups, when BP develops in diabetic patients, DPP4 is should be questioned and with cooperation with clinician's consideration of change may be planned. [ABSTRACT FROM AUTHOR]