Effects of vitamin family members on insulin resistance and diabetes complications

The following letter to the editor highlights the article“Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance”in World J Diabetes 2023 Oct 15;14(10):1514-1523.It is necessary to explore the role of vitamin family members in insulin resistance and diabetes complications.

Development of diabetic complications and influencing factors among 32653 type 2 diabetes patients:retrospective cohort study using a multi-state Markov

Background:Patients with type 2 diabetes are at high risk for developing multiple chronic complications.However,there is a lack of studies of the cumulative number of diabetic complications in China.Methods:A retrospective cohort study was performed from 2009 to 2021.Type 2 diabetes patients who were first diagnosed after the age of 35 years between January 1,2009,and December 31,2017,were included.Five states were defined according to the number of chronic complications:no(S0),one(S1),two(S2),three(S3),and four or more complications(S4).A multi-state Markov model was constructed to estimate transition probability,transition intensity,mean sojourn time,and the possible factors for each state.Results:The study included 32653 type 2 diabetes patients(mean age,59.59 years;15929(48.8%)male),and mean follow-up time of 7.75 years.In all,4375 transitions were observed.The 12-year transition probability of from state S0 to S1 was the lowest at 16.4%,while that from S2 to S3 was the highest,at 45.6%.Higher fasting blood glucose,lower high-density lipoprotein cholesterol,higher total cholesterol,and an unhealthy diet were associated with higher risk of progression from S0 to S1.Being female,less than 60 years old,weekly physical activity,and vegetarian diet decreased this risk.Being female and less than 60 years old reduced the likelihood of transition from S1 to S2,whereas lower high-density lipoprotein cholesterol increased this likelihood.Conclusions:Following the occurrence of two complications in type 2 diabetes patients,the risk for accumulating a third complication within a short time is significantly increased.It is important to take advantage of the stable window period when patients have fewer than two complications,strengthen the monitoring of blood glucose and blood lipids,and encourage patients to maintain good living habits to prevent further deterioration.

From Diabetes to Diabetic Complications:Role of Autophagy

Diabetes and its complications reduce quality of life and are life-limiting.At present,diabetes treatment consists of hypoglycemic agents to control blood glucose and the use of insulin-sensitizing drugs to overcome insulin resistance.In diabetes,autophagy is impaired and thus there is poor intracellular environment homeostasis.Pancreaticβ-cells and insulin target tissues are protected by enhancing autophagy.Autophagy decreasesβ-cell apoptosis,promotesβ-cell proliferation,and alleviates insulin resistance.Autophagy in diabetes is regulated by the mammalian target of rapamycin(mTOR)/adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)pathway and others.Autophagy enhancers can likely be used as a treatment for diabetes and its complications.This review examines the evidence linking autophagy to diabetes.

Research progress of artesunate in diabetes and its complications

Diabetes is a metabolic disease characterized by abnormally elevated blood glucose levels.Persistent hyperglycemia leads to diabetic nephropathy,diabetic retinopathy,diabetes with periodontal disease and other diabetic complications.These diseases have become the main causes of disability and death in diabetic patients.Artesunate is well known as an antimalarial drug for controlling malaria symptoms.Current studies have shown that artesunate improves diabetes and its complications by protecting islet cells,improving glucose and lipid metabolism,anti-inflammatory and immune regulation.Based on the research status in recent years,this paper focuses on the mechanism of artesunate in diabetes and its complications,to provide a theoretical basis for future diabetes research.

Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

Licorice and its main components on the treatment of diabetes and its complications:A review of in vivo and in vitro studies

Licorice is one of the oldest herbal medicines for its various ethno pharmacological uses.In both Asian and European countries,it has been recorded for treatment of inflammatory diseases.A large number of ingredients have been isolated from licorice,including triterpene saponins and flavonoids,which are normally being considered to be the main biologically active components.In the last decade,licorice has been proved exert anti-diabetic effect in various in vivo and in vitro models of diabetes mellitus.Furthermore,licorice can also antagonize all sorts of diabetes complications,including diabetic nephropathy,atherosclerosis,diabetic retinopathy and neuropathy.Except anti-inflammation,licorice and its active components show anti-diabetic effects by improving insulin resistance and increasing insulin secretion,regulating lipid metabolism,and anti-oxidation.The useful effects of licorice and its active components are due to regulating different pathways and proteins,including NF-κB,AMPK,insulin signaling pathway,MAPK,etc.In this review,we provide an overview of the beneficial effects and related molecular mechanism of licorice and its effective components on improving diabetes and its complications.

Recent therapeutic targets for the prevention and management of diabetic complications

Diabetes and associated complications represent major global public health issues which are associated with impaired quality of life and premature death.Although some diabetic complications have decreased in the developed world,the majority are still prevalent,with an increasing trend in the developing world.Currently used therapies are mainly‘glucocentric’,focusing on the optimization of glycemic control to prevent,delay or manage diabetes-associated complications-other common comorbidities,such as dyslipidemia and hypertension are often underestimated.Although a number of novel therapeutic approaches have been reported recently,some of them have not received comparable attention in relation to either further studies or potential clinical implementation.This editorial briefly discusses some recent therapeutic approaches to the prevention and management of diabetes and its associated complications,as well as potential directions for future research and development in this area.

Clinical significance of serum miR-129-5p in patients with diabetes mellitus presenting macrovascular complications

BACKGROUND Diabetic macrovascular complications(DMCs)are the most common complications encountered during the course of diabetes mellitus(DM)with extremely high mortality rates.Therefore,there is an urgent need to identify specific and sensitive biomarkers for the early diagnosis of DMCs.AIM To investigate the expression and significance of serum miR-129-5p in patients with DM and macrovascular complications.METHODS Serum samples were collected from 36 healthy controls,58 patients with DM presenting no macrovascular complications,and 62 patients with DMCs.The expression of miR-129-5p was detected using quantitative real-time polymerase chain reaction.Pearson’s correlation assay was performed to analyze the correlation between serum miR-129-5p levels and clinical indicators.Receiver operator characteristic(ROC)analysis was conducted to analyze the diagnostic value of serum miR-129-5p in patients with DM or DMCs.RESULTS There was a 4.378-fold and 7.369-fold increase in serum miR-129-5p expression in the DM(5.346±0.405)and DMCs(8.998±0.631)groups,respectively(P<0.001),compared with the control group(1.221±0.090).In addition,the expression of serum miR-129-5p in patients with DMCs was higher than that in patients with DM,revealing a 1.683-fold increase(P<0.001).Additionally,serum miR-129-5p expression significantly correlated with smoking history,disease duration,and glycated hemoglobin(HbA1c)in patients with DMCs(P<0.001).The area under the ROC curve(AUC)of miR-129-5p as a serum marker was 0.964(95%confidence interval[CI]:0.930-0.997,P<0.001)in distinguishing between patients with DM and healthy controls,whereas the AUC of miR-129-5p as a serum marker was 0.979(95%CI:0.959-0.999,P<0.001)in distinguishing between patients with DMCs and healthy controls.CONCLUSION Elevated serum miR-129-5p expression levels correlate with the development of DMCs and can be utilized as a novel early diagnostic biomarker for DM combined with macrovascular complications.

Comparing the incidence of major cardiovascular events and severe microvascular complications in patients with type 2 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Type 2 diabetes mellitus(T2DM)causes both macrovascular and microvascular complications.However,currently,selection of glycemic measures and their thresholds to diagnose T2DM,and efficacy outcomes in evaluation of anti-diabetic drugs is predominantly informed by the relation of T2DM to microvascular complications.We can be severely mistaken on T2DM by neglecting macrovascular complications which are generally more severe,if they also occur more commonly than microvascular complications.AIM To compare the incidence of major cardiovascular events(MACEs)and severe microvascular complications(SMICs)in T2DM patients.METHODS MEDLINE,EMBASE,and Cochrane Central Register of Controlled Trials were searched from inception to September 2017.Cohort studies or trials of T2DM patients aged 18 years or older that reported incidence of both MACEs and SMICs were included.MACEs were defined as nonfatal myocardial infarction and stroke,and cardiovascular death,while SMICs included serious retinopathy,nephropathy and diabetic disorder.The relative risk(RR)was estimated as the incidence of MACEs divided by that of SMICs in same patients and combined with meta-analysis in a random-effect model.RESULTS Twelve studies with a total of 16 cohorts and 387376 patients were included,and the combined RR was 2.02(95%CI:1.46–2.79).The higher incidence of MACEs remained in various subgroup and sensitivity analyses.CONCLUSION Patients with T2DM are much more likely to develop MACEs than SMICs.By taking more serious consequences and relatively higher incidence into consideration,macrovascular complications deserve more emphasis in developing the diagnostic criteria of T2DM and in evaluating the efficacy of antidiabetic drugs.

Therapeutic Effect of Intragastric Administration of Jiangtang Shuxin Recipe Suspension on Diabetic Heart Failure in Rats and Its Mechanism

[Objectives]To observe the therapeutic effect of intragastric administration of Jiangtang Shuxin recipe on diabetic heart failure(DHF)in rats and to explore its mechanism.[Methods]Fifty SD rats were randomly divided into five groups,with 10 rats in each group.DHF models were prepared in the low-dose group,high-dose group,Western medicine group,and model group except the control group.Rats in the low-dose and high-dose groups were given 1.0 and 1.5 g/(kg·d)Jiangtang Shuxin recipe suspension by gavage,respectively.Rats in the Western medicine group were given gliquidone and benazepril by gavage for 2 months,and were fed with high-fat diet.Rats in the control group were fed with ordinary diet.Fasting blood glucose(FBG),serum triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),pathological morphology of myocardial tissue,NF-κB p65 protein and IκBαprotein were compared among groups.[Results]Compared with the control group,the levels of FBG,serum TG,LDL-C,CRP,IL-6,TNF-α,CK-MB and LDH increased,while the level of serum HDL-C decreased.The myocardial tissue was seriously damaged,and the expression of NF-κB p65 protein increased,while the expression of IκBαprotein decreased in the other four gruops(all P<0.05).Compared with the model group,the levels of FBG,serum TG,LDL-C,CRP,IL-6,TNF-α,CK-MB and LDH decreased,while the serum HDL-C level increased.The myocardial tissue damage was alleviated,and the expression of NF-κB p65 protein decreased,while the expression of IκBαprotein increased in the low-dose group,high-dose group and Western medicine group(all P<0.05).Compared with the Western medicine group,the levels of FBG,serum TG,LDL-C,CRP,IL-6,TNF-α,CK-MB and LDH decreased,and the level of serum HDL-C increased in the high-dose group(all P<0.05).[Conclusions]Jiangtang Shuxin recipe has a therapeutic effect on DHF in rats,with the best effect in the high-dose group.It can not only alleviate high glucose and high fat state,but also reduce myocardial injury and inflammation,and improve the pathological morphology of myocardial cells.The mechanism may be related to its inhibition of NF-кB signaling pathway.

Interstitial lung disease and diabetes

Diabetes mellitus (DM) is a chronic metabolic disease and its prevalence has beensteadily increasing all over the world. DM and its associated micro andmacrovascular complications result in significant morbidity and mortality. Themicrovascular complications are usually manifested as retinopathy, neuropathy,nephropathy and macrovascular complications generally affect the cardiovascularsystem. In addition to these complications, DM also affects the lungs because of itsrich vascularity and abundance in connective tissue (collagen and elastin). DMhas been found to cause microvascular complications and proliferation ofextracellular connective tissue in the lungs, leading to decline in lung function in arestrictive pattern. Interstitial lung disease (ILD) includes a diverse group ofdisease conditions characterized by different degrees of inflammation and fibrosisin the pulmonary parenchyma. Idiopathic pulmonary fibrosis (IPF) is one of thecommon type of idiopathic interstitial pneumonia with a high mortality rate. IPFis characterized by chronic progressive fibrosis leading to progressive respiratoryfailure. In this review we focus on lung as the target organ in DM and theassociation of DM and ILD with special emphasis on IPF.

Psychometric Properties of the Swedish Version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha. Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.

Knowledge, Attitude and Practice on Common Diabetic Patients among Diabetic Complications at Egyptian Hospital in Mogadishu, Somalia

Diabetes is a chronic illness that occurs when the pancreas stops producing insulin or when the body cannot use the produced insulin. Insulin is a hormone produced by the pancreas that helps glucose from meals enters the body’s cells for energy. The overall goal is to assess diabetes patients’ knowledge, attitudes, and behaviors about prevalent diabetic complications. This research used a descriptive qualitative methodology to assess diabetes complication knowledge, attitude, and practice. Ninety-eight diabetic patients were visiting the Egyptian Hospital in Mogadishu for four weeks. The data was collected using questionnaires. Finally, SPSS 20 was utilized for analysis. The research was performed from May to July 2020 with a non-probability sample size of 98 diabetics. The bulk of responders were aged 40 - 60 (36.7%). Type 2 was the most common (47.96%). 44.9% of respondents had diabetes for more than ten years. 60.2% had regular checkups, and 54.1 percent had therapy. 52% of participants were on a diet. 63.3% of respondents do not exercise often. However, most responders know the common issues (75%). Less than half of those polled had problems (41.8%). 22% incidence of Diabetic ketoacidosis. 78.6% of respondents know variables that decrease diabetes complications, whereas 22.4% do not. 37.8% of respondents saw a doctor for diabetes problems, whereas 62.2% did not. Diabetic patients’ knowledge, attitude, and practice were satisfactory for fundamental illness entanglements and self-testing. These findings may also be due to patient notification and, therefore, long-term illness that leads them to get acquainted with things alone. However, the tendency for regular exercise was low, which may produce more specific consequences of illness. Conclusion: We find that DM patients’ KAP was adequate in terms of knowledge of diabetic complications. These results may explain the patients’ long-standing illness, which forces them to discover things independently. At the same time, just a handful of them were familiar with vasculopathy and cardiovascular disorders. However, the researchers discovered low level of attitudes and practice toward regular exercise and insufficient levels of attitudes and practice toward diet management and treatment adherence. In general, this degree of KAP is suboptimal and requires further assessment of KAP obstacles in Somalia.

Minireview:Therapeutic potential of myricetin in diabetes mellitus

Epidemiological studies have demonstrated that diabetes mellitus(DM)is a serious health burden for both governments and healthcare providers.Myricetin,a natural flavonol with hydroxyl groups at 3,5,7,3′,4′and 5′positions,is commonly ingested through human diets such as fruits,vegetables,tea,berries and red wine.Although few epidemiological and clinical studies have reported the health benefits of myricetin on DM,increasing evidences from in vitro and animal studies have confirmed its hypoglycemic effect.Importantly,myricetin has the function to ameliorate insulin resistance.Moreover,myricetin can execute the functions including anti-inflammation,anti-oxidative stress,anti-aldose reductase,antinon-enzymatic glycation and anti-hyperlipidemia.All of these functions may provide the contribution to the prevention of DM and diabetic complications.In this article,a comprehensive discussion to address the potential benefits of myricetin on DM and its underlying mechanisms has been conducted.©2012 Production and hosting by Elsevier B.V.on behalf of Beijing Academy of Food Sciences.

Preoperative diabetes as a protective factor for pancreatic fistula after pancreaticoduodenectomy: a meta-analysis

BACKGROUND： The role of diabetes mellitus （DM） in pancreatic fistula （PF） or clinical relevant PF （CR-PF） after pancreaticoduodenectomy （PD） or pylorus-preserving pancreaticoduodenectomy （PPPD） is unclear. We conducted a meta-analysis to investigate the relationship between DM and PF or CR-PF.DATA SOURCES： Embase, MEDLINE and Cochrane databases were searched systematically for relevant articles from January 2005 to June 2013. The selected studies that examined clinical risk factors of PF or CR-PF were included. We created pooled estimates for our outcomes using the random-effects model. RESULTS： Sixteen observational clinical studies were included. Pooling of PF rates from ten studies revealed that DM was associated with a decreased risk of PF （P=0.01）. CR-PF rates from 8 studies showed no significant difference between DM and control group （P=0.14）. CONCLUSIONS： DM is not a risk factor for PF in patients undergoing PD or PPPD. On the contrary, patients without DM are at a higher risk of PF because the pancreases in these patients have more fatty tissue and the pancreas is soft.

Sitagliptin in treatment of diabetes complicated by chronic hepatitis C

To the Editor: A high prevalence of glucose intolerance in patients with chronic hepatitis C has been reported, [1] and there is a significant association of chronic hepatitis C with diabetes mellitus (DM). [2] But DM has been suggested to be associated with the onset of hepatocellular carcinoma

Paper Clinical Value of Color Doppler Ultrasonography in Diagnosis of Lower Extremity Arterial Disease of Diabetes Patients

Objective: To evaluate the diagnostic value of color Doppler ultrasound in the diagnosis of diabetic lower extremity vascular diseases. Methods: 48 patients with diabetic lower extremity vascular disease admitted in our hos-pital from September 2018 to September 2019 were included in the study and divided into the observation group, and another 48 patients with the same period of health examination in our hospital were included in the study and divided into the control group. Both groups used color Doppler ultrasound to detect the blood flow of lower extremity vessels. The incidence of blood flow, vascular diameter and stenosis, occlusion and arteriosclerosis of the lower extremity were observed. Results: The blood flow and vascular di-ameter of the lower extremity in the observation group were significantly lower than those in the control group (p < 0.05). The incidence of vascular stenosis, vascular occlusion, thrombus, intimal thickening and plaque in the observation group was 85.42%, 22.92%, 10.42% and 93.75% respectively, which was significantly higher than that in the control group was 10.42%, 0.00%, 0.00% and 14.58% (p < 0.05). The incidence of lower extremity vascular lesions in the observation group was significantly higher than that in the control group (p < 0.05). Conclusion: Color Doppler ultrasound is of high diagnostic value in the diagnosis of diabetic lower extremity vascular diseases, and can be used to determine the blood flow of the lower extremity and the inner diameter of popliteal artery, thigh artery, dorsalis pedis artery and so on. At the same time, it can also clearly show the specific situation of vascular occlusion, arteriosclerosis and thrombosis, which is of great signif-icance for the prevention and diagnosis of lower extremity vascular lesions, and can provide the basis for the treatment of lower extremity vascular lesions.

Comprehensive overview of human serum albumin glycation in diabetes mellitus

The presence of excess glucose in blood is regarded as a sweet hurt for patients with diabetes.Human serum albumin(HSA)is the most abundant protein in human plasma,which undergoes severe non-enzymatic glycation with glucose in patients with diabetes;this modifies the structure and function of HSA.Furthermore,the advanced glycation end products produced by glycated HSA can cause pathological damage to the human body through various signaling pathways,eventually leading to complications of diabetes.Many potential glycation sites on HSA have different degrees of sensitivity to glucose concentration.This review provides a comprehensive assessment of the in vivo glycation sites of HSA;it also discusses the effects of glycation on the structure and function of HSA.Moreover,it addresses the relationship between HSA glycation and diabetes complications.Finally,it focuses on the value of non-enzymatic glycation of HSA in diabetes-related clinical applications.

Adropin as an indicator of T2DM and its complications

Type 2 diabetes mellitus(T2 DM)is one of metabolic diseases with the major inducer of obesity.Due to the change in lifestyle and dietary structure,more and more people are being suffered from T2 DM.Therefore,the prevention and treatment of T2 DM and its complications has become an urgent problem to be solved.As a secreted peptide,adropin is identifi ed as a useful regulator associated with insulin sensitivity and energy homeostasis.It has the potential for regulating metabolic diseases including obesity and T2 DM.It should be noted that the secretion of adropin can be induced by diets,aerobic exercise and other interventions.In this article,the underlying mechanisms of adropin for regulating obesity,T2 DM and its complications including diabetic nephropathy,diabetic retinopathy,diabetic encephalopathy,diabetic vascular disease and diabetic cardiovascular disease were summarized.Meanwhile,the strategies for promoting the secretion of adropin were also discussed,which will provide a target for the prevention and targeted treatment,or a candidate of novel and effective functional food or drug for metabolic diseases in the future.

Virtual screening of flavonoids from Jatropha gossypiifolia L.as potential drugs for diabetic complications

Background:Diabetes mellitus is a chronic metabolic disease that is a risk factor for epidemic pathologies.Under hyperglycemic conditions,the enzyme aldose reductase catalyzes the formation of sorbitol in the metabolism of glucose via polyols,leading to the development of diabetic complications.Therefore,inhibitors of this enzyme are therapeutic targets for the prophylaxis and treatment of these conditions.Methods:In this study,a generalized linear regression model was developed to analyze flavonoids-obtained from a database-that have been tested as inhibitors of aldose reductase.In this sense,the molecular descriptors implemented in DRAGON and MATLAB software were used to determine the correlation between the chemical structure of the inhibitors and their pharmacological activity.The model was validated according to the Organisation for Economic Co-operation and Development Standards and subsequently used for the virtual screening of the flavonoids identified in Jatropha gossypiifolia L.Results:The proposed model showed a good fit for its statistical parameters(R2=0.95).In addition,it showed good predictive power(R2 ext=0.94)and robustness(Q2 LOO=0.92).The experimental chemical space wherein the predictions were reliable(domain of application)was also defined.Finally,the model was used to identify 10 flavonoids from Jatropha gossypiifolia L.as candidates for natural drugs.Compounds with a low probability of oral absorption were identified,among which the elagic acid biflavonoid showed the greatest promise(pIC50 predicted=9.75).Conclusion:The Jatropha gossypiifolia L.species harbors flavonoids with high potential as inhibitors of the aldose reductase enzyme,in which the biflavonoid ellagic acid was shown to be the most promising inhibitor of the aldose reductase enzyme,suggesting its possible use in the treatment of the late complications of diabetes mellitus.