Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes?

Type 1 diabetes(T1D)is associated with general-and diabetes-specific stress which has multiple adverse effects.Hence measuring stress is of great importance.An algometer measuring pressure pain sensitivity(PPS)has been shown to correlate to certain stress measures in adults.However,it has never been investigated in children and adolescents.The aim of our study was to examine associations between PPS and glycated hemoglobin(HbA1c),salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D.Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits.Salivary cortisol,PPS and questionnaires were collected,measured,and answered on site.HbA1c was collected from medical files.We found correlations between PPS and HbA1c(rho=0.35,P=0.046),cortisol(rho=-0.25,P=0.02)and Perceived Stress Scale(rho=-0.44,P=0.02)in different subgroups based on age.Males scored higher in PPS than females(P<0.001).We found PPS to be correlated to HbA1c but otherwise inconsistent in results.High PPS values indicated either measurement difficulties or hypersensibility towards pain.

Isoform-and cell-state-specific APOE homeostasis and function

Apolipoprotein E is the major lipid transporter in the brain and an important player in neuron-astrocyte metabolic coupling.It ensures the survival of neurons under stressful conditions and hyperactivity by nourishing and detoxifying them.Apolipoprotein E polymorphism,combined with environmental stresses and/or age-related alterations,influences the risk of developing late-onset Alzheimer’s disease.In this review,we discuss our current knowledge of how apolipoprotein E homeostasis,i.e.its synthesis,secretion,degradation,and lipidation,is affected in Alzheimer’s disease.

Gestational Diabetes and Infertility

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications which affect the mother and offspring. In addition to adverse perinatal outcomes, it may lead to permanent health problems for the mother, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), while increasing the risk of future obesity, CVD, T2DM and GDM in the child. Approximately 15% of women seek fertility treatment. Over the last decade, it has come to attention that patients with an infertility history are more prone to having GDM during their pregnancies, and this review examines the relationship between GDM and infertility. The elevated estrogen, progesterone, leptin, placental lactogen and growth hormone are the main reasons for increased insulin resistance during pregnancy. Despite some confounding factors in the mechanism of GDM in patients with an infertility history, infertility treatment increases the risk, according to numerous studies. The obesity epidemic and associated disorders have become a significant public health concern worldwide. Lifestyle modification for weight loss before pregnancy is encouraged, but there is no strong evidence for improvement in perinatal results. GDM, infertility and infertility treatment have a potential risk of alteration in the embryo’s environment and cause epigenetic reprogramming, which may be inherited to the next generation. The fertility treatment impacts the patient’s and offspring’s health. Patients should be informed about the risks so that they consent and get involved in the decision. Infertility treatment may be accepted as a reason for high-risk pregnancy, and patients can be screened for GDM in early pregnancy.

Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai

BACKGROUND Globally,patients with diabetes suffer from increased disease severity and mortality due to coronavirus disease 2019(COVID-19).Old age,high body mass index(BMI),comorbidities,and complications of diabetes are recognized as major risk factors for infection severity and mortality.AIM To investigate the risk and predictors of higher severity and mortality among inhospital patients with COVID-19 and type 2 diabetes(T2D)during the first wave of the pandemic in Dubai(March–September 2020).METHODS In this cross-sectional nested case-control study,a total of 1083 patients with COVID-19 were recruited.This study included 890 men and 193 women.Of these,427 had T2D and 656 were non-diabetic.The clinical,radiographic,and laboratory data of the patients with and without T2D were compared.Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D.RESULTS T2D patients with COVID-19 were older and had higher BMI than those without T2D.They had higher rates of comorbidities such as hypertension,ischemic heart disease,heart failure,and more life-threatening complications.All laboratory parameters of disease severity were significantly higher than in those without T2D.Therefore,these patients had a longer hospital stay and a significantly higher mortality rate.They died from COVID-19 at a rate three times higher than patients without.Most laboratory and radiographic severity indices in non-survivors were high in patients with and without T2D.In the univariate analysis of the predictors of mortality among all COVID-19 non-survivors,significant associations were identified with old age,increased white blood cell count,lymphopenia,and elevated serum troponin levels.In multivariate analysis,only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors.CONCLUSION Patients with COVID-19 and T2D were older with higher BMI,more comorbidities,higher disease severity indices,more severe proinflammatory state with cardiac involvement,and died from COVID-19 at three times the rate of patients without T2D.The identified mortality predictors will help healthcare workers prioritize the management of patients with COVID-19.

Evaluation of hybrid closed-loop insulin delivery system in type 1 diabetes in real-world clinical practice:One-year observational study

BACKGROUND In 2016,the Food and Drug Administration approved the first hybrid closed-loop(HCL)insulin delivery system for adults with type 1 diabetes(T1D).There is limited information on the impact of using HCL systems on patient-reported outcomes(PROs)in patients with T1D in real-world clinical practice.In this independent study,we evaluated glycemic parameters and PROs over one year of continuous use of Medtronic’s 670G HCL in real-world clinical practice.AIM To assess the effects of hybrid closed loop system on glycemic control and quality of life in adults with T1D.METHODS We evaluated 71 patients with T1D(mean age:45.5±12.1 years;59%females;body weight:83.8±18.7 kg,body mass index:28.7±5.6 kg/m2,A1C:7.6%±0.8%)who were treated with HCL at Joslin Clinic from 2017 to 2019.We measured A1C and percent of glucose time-in-range(%TIR)at baseline and 12 months.We measured percent time in auto mode(%TiAM)for the last two weeks preceding the final visit and assessed PROs through several validated quality-of-life surveys related to general health and diabetes management.RESULTS At 12 mo,A1C decreased by 0.3%±0.1%(P=0.001)and%TIR increased by 8.1%±2.5%(P=0.002).The average%TiAM was only 64.3%±32.8%and was not associated with A1C,%TIR or PROs.PROs,provided at baseline and at the end of the study,showed that the physical functioning submodule of 36Item Short-Form Health Survey increased significantly by 22.9%(P<0.001).Hypoglycemia fear survey/worry scale decreased significantly by 24.9%(P<0.000);Problem Areas In Diabetes reduced significantly by-17.2%(P=0.002).The emotional burden submodules of dietary diversity score reduced significantly by-44.7%(P=0.001).Furthermore,analysis of Clarke questionnaire showed no increase in awareness of hypoglycemic episodes.WHO-5 showed no improvements in subject’s wellbeing among participants after starting the 670G HCL system.Finally,analysis of Pittsburgh Sleep Quality Index showed no difference in sleep quality,sleep latency,or duration of sleep from baseline to 12 mo.CONCLUSION The use of HCL in real-world clinical practice for one year was associated with significant improvements in A1C,%TIR,physical functioning,hypoglycemia fear,emotional distress,and emotional burden related to diabetes management.However,these changes were not associated with time in auto mode.

Mental Health Consequences among Sudanese Due to the Armed Conflicts and Civil Unrest of 2023: One Year Later

Aim: To investigate depression, anxiety, PTSD, and insomnia levels among Sudanese citizens after a year has passed since the start of Armed Forces conflict in Sudan. Methods: An online survey was distributed. It is composed of five parts, covering the following areas: 1) sociodemographic data;2) depression assessment;3) generalized anxiety disorder assessment;4) post-traumatic stress disorder assessment;and 5) insomnia assessment. Statistical Package for Social Sciences version 27 was used for data analysis;frequency and percentage were used to describe the qualitative variables. Spearman’s correlation analysis and Chi-square test were used for correlation and association analysis;a P-value equal to or less than 0.05 was considered statistically significant. Results: The study included 283 participants, primarily female (76.0%), with a mean age of 35.26 ± 6.96 years. The majority of participants were married (50.5%) and had a university level of education (50.2%). At the start of the war, 70.3% of participants were inside the war zones, and at the time of data collection, 73.5% were outside Sudan. The length of stay in the war zone ranged from 1 to 300 days, with a mean of 48.59 ± 70.284 days. Additionally, 63.3% of participants stated that they did not receive any form of mental health intervention, and the remaining did not provide an answer. There was a high prevalence of moderate-severe depression (50.5%), moderate anxiety (35.3%), PTSD (56.5%), and sub-threshold insomnia (53.4%) among the participants. Correlation analyses revealed associations between demographic factors such as sex, age, marital status, and education and mental health issues. Notably, female participants showed a higher prevalence of PTSD (53.0%) compared to male participants (67.6%). Conclusions: There is a substantial impact of war-related trauma on mental health, revealing a high prevalence of moderate-severe depression, moderate anxiety, PTSD, and sub-threshold insomnia among the participants. This emphasizes the importance of tailored interventions and support systems to address the unique needs of individuals affected by war trauma.

Multicenter Survey of the Isometric Lower Extremity Strength in Patients with Type 2 Diabetes (MUSCLE-std): Design and Study Protocol

Background: The lower extremity muscle strength has been shown to be weaker in patients with diabetes mellitus, primarily due to the effects of diabetic polyneuropathy, a common diabetic complication. With respect to assessments of the lower extremity muscle strength, reference values for the knee extension force in healthy Japanese subjects have been reported. The clinical significance of applying knee extension force in the assessment of efficacy of exercise therapy and patient education has also been demonstrated, and the use of an individualized approach in physical exercise based on the quantitative assessment of the lower extremity muscle strength is becoming one of the most important strategies for promoting effective rehabilitation. Methods: The study is a multicenter, cross-sectional investigation. We will measure the knee extension force and evaluate the diabetic polyneuropathy in patients with type 2 diabetes using uniform equipment and methodology at all centers. We will compare the knee extension force between the subjects with and without diabetic polyneuropathy and will investigate the associations between the knee extension force and both glycemic control and exercise habits. The trial registration is UMIN CTR (UMIN000002810). Discussion: The lower extremity muscle strength has been insufficiently investigated in Japanese patients with diabetes. This study was designed to establish reference values for the knee extension force in Japanese diabetic patients with and without diabetic polyneuropathy.

Type 2 diabetes and quality of life

It is true that a primary goal of diabetes early diagnosis and treatment is quality of life(QoL). The term QoL is still confusing but it is agreed that it composes of four components:The physical component, mental, cogitative component, psychological and social component. Many articles have been written addressing those four components. During the last five years 15500 articles and reviews have been written addressing diabetes and coronary arterial disease, 16100 addressing diabetes and renal function, 28900 addressing diabetes and retinopathy, 16800 addressing diabetic foot ulcers and other 26300 addressing diabetic neuropathy. Moreover 17200 articles are dealing with diabetic sexual dysfunction, 24500 with the correlation of diabetes and depression 17500 about diabetes and dementia, only 1 about diabetes and family functioning and 1950000 about diabetes and QoL, indicating the worldwide interest. In order to confront this metabolic anomaly and its consequences, researchers developed numerous generic and disease specific psychometric tools. With the aid of those psychometric tools the scientific community has started to realize the gruesome effect of diabetes on patients' lives. Diabetic's QoL becomes worse when complications start to develop or comorbidities coexist. Dominant amongst complications, in health-related quality of life(HRQoL) lowering, but not related to risk factors(genetic, the weight of birth, or others) is coronary arterial disease followed by renal failure, blindness, and the combination of micro-and macrovascular complications and in some studies by sexual dysfunction. Moreover many are the comorbidities which deteriorate further the effect of diabetes in a patient life. Among them obesity, hypertension, dyslipidemia, depression, arthritis are the most common. Most intriguing field for research is the interaction of diabetes and depression and in some cases the progression to dementia. Many aspects and combinations of actions are under researchers' microscope regarding the improvement of HRQoL scores. Until now, the studies performed, have demonstrated little to moderate benefit. More of them are needed to draw safe conclusions on the topic of the best combination of actions to optimize the HRQoL scores.

More anxious than depressed:prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus

Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited. Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries. Methods People aged 18-65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected. Results A total of 3170 people with type 2 diabetes (56.2% women;with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%;however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India. Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.

Eating disorders in adolescents with type 1 diabetes:Challenges in diagnosis and treatment

Eating disorders(ED) are characterized by a persistent disturbance of eating that impairs health or psychosocial functioning.They are associated with increased rates of medical complications and mortality.Insulin omission is a unique purging behavior available to individuals with type 1 diabetes mellitus(T1DM).The standard treatment regimen for T1 DM requires a major focus on food andeating patterns.Moreover,intensive insulin therapy is associated with increasing body weight.These factors,combined with the psychological burden of chronic disease management and depression,may contribute to ED.The comorbidity of ED in T1 DM patients is associated with poorer glycemic control and consequently higher rates of diabetes complications.Early recognition and adequate treatment of ED in T1 DM is essential.

LDL,LDL receptors,and PCSK9 as modulators of the risk for type 2 diabetes:a focus on white adipose tissue

Type 2 diabetes(T2D) and cardiovascular disease(CVD) share many risk factors such as obesity,unhealthy lifestyle,and metabolic syndrome,whose accumulation over years leads to disease onset.However,while lowering plasma low-density lipoprotein cholesterol(LDLC) is cardio-protective,novel evidence have recognised a role for common LDLC-lowering variants(e.g.in HMGCR,PCSK9,and LDLR) and widely used hypocholesterolemic drugs that mimic the effects of some of these variants(statins) in higher risk for T2D.As these conditions decrease plasma LDLC by increasing tissue-uptake of LDL,a role for LDL receptor(LDLR)pathway was proposed.While underlying mechanisms remain to be fully elucidated,work from our lab reported that native LDL directly provoke the dysfunction of human white adipose tissue(WAT) and the activation of WAT NLRP3(Nucleotide-binding domain and Leucine-rich repeat Receptor,containing a Pyrin domain 3)inflammasome,which play a major role in the etiology of T2D.However,while elevated plasma numbers of apolipoprotein B(apoB)-containing lipoproteins(measured as apoB,mostly as LDL) is associated with WAT dysfunction and related risk factors for T2D in our cohort,this relation was strengthened in regression analysis by lower plasma proprotein convertase subtilisin/kexin type 9(PCSK9).This supports a central role for upregulated pathway of LDLR and/or other receptors regulated by PCSK9 such as cluster of differentiation 36(CD36) in LDL-induced anomalies.Targeting receptor-mediated uptake of LDL into WAT may reduce WAT inflammation,WAT dysfunction,and related risk for T2D without increasing the risk for CVD.

Nardostachys jatamansi extract protects against cytokine-induced β-cell damage and streptozotocin-induced diabetes

AIM: To investigate the anti-diabetogenic mechanism of Nardostachys jatamansi extract (NJE). METHODS: Mice were injected with streptozotocin viaa tail vein to induce diabetes. Rat insulinoma RINm5F cells and isolated rat islets were treated with interleukin1β and interferon-γ to induce cytotoxicity. RESULTS: Treatment of mice with streptozotocin resulted in hyperglycemia and hypoinsulinemia, which was conf irmed by immunohistochemical staining of the islets. The diabetogenic effects of streptozotocin were completely abolished when mice were pretreated with NJE. Inhibition of streptozotocin-induced hyperglycemia by NJE was mediated by suppression of nuclear factor (NF)-κB activation. In addition, NJE protected against cytokine-mediated cytotoxicity. Incubation of RINm5F cells and islets with NJE resulted in a signif icant reduction in cytokine-induced NF-κB activation and downstream events, inducible nitric oxide synthase expression and nitric oxide production. The protective effect of NJE was further demonstrated by the normal insulin secretion of cytokine-treated islets in response to glucose. CONCLUSION: NJE provided resistance to pancreatic β-cell damage from cytokine or streptozotocin treatment. The β-cell protective effect of NJE is mediated by suppressing NF-κB activation.

ApoE isoforms,treatment of diabetes and the risk of coronary heart disease

AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age 45-64 years,mean age,53.9±5.5 years)with T2DM and without atherosclerotic cardiovascular events who underwent typing to determine their apolipoprotein E(apoE)isoforms.The apoE isoforms were determined using isoelectric focusing,followed by immunoblotting.We retrospectively evaluated the charts of the 269 patients,recorded between their first visit to the hospital(the study's start point,between 1987 and 1992)and the occurrence of an atherosclerotic cardiovascular event(the study's endpoint)or January 2004,whichever came first.The age-adjusted mean values and the prevalences of covariates were calculated to compare the laboratory data among the apoE phenotypes.To investigate the association of risk factors with the incidence of coronary heart disease during the follow-up period,monovariate and multivariate Cox regression models were used.RESULTS:At enrollment,the mean serum low density lipoprotein(LDL)cholesterol levels were lowest(2.92± 0.89 mmol/L)among the subjects with apoE2(apoE2/2 or apoE2/3)and highest(3.52±0.77 mmol/L)among the subjects with apoE4(apoE3/4 or apoE4/4).No significant differences in mean age or the percentage of smokers were observed among the three groups.Furthermore,no significant differences were observed in the systolic and diastolic blood pressures,body mass index,HbA1c level or serum triglyceride levels among the three groups.There were 47 cases of coronary heart disease over 3285 person-years of follow-up.An age-adjusted multivariate Cox proportional model identified diabetic retinopathy(hazard ratio,2.38,95% CI:1.28-4.43,P=0.006),a high systolic blood pressure(hazard ratio,1.04,95%CI:1.02-1.06,P<0.001) and high HbA1c values(hazard ratio,1.19,95%CI:1.02-1.38,P=0.0029),but not the LDL cholesterol value at enrollment(hazard ratio,1.01,95%CI:0.97-1.05,P=0.77)nor the specific apoE isoform,as significant predictors of coronary heart disease.CONCLUSION:Under standard medical treatment of diabetes,including the control of LDL cholesterol levels,the apoE4 isoform was not associated with coronary heart disease among T2DM patients.

Epidemiology and phenotypes of diabetes in children and adolescents in non-European-origin populations in or from Western Pacific region

BACKGROUND Type 1 diabetes(T1D)incidence varies substantially between countries/territories,with most studies indicating increasing incidence.In Western Pacific region(WPR),reported rates are much lower than European-origin populations.In contrast,there are reports of substantial numbers of young people with type 2 diabetes(T2D).A deeper understanding of T1D and T2D in the WPR may illuminate factors important in pathogenesis of these conditions.Furthermore,with varying resources and funding for diabetes treatment in this region,there is a need to more clearly determine the current burden of disease and also any gaps in knowledge.AIM To compile and summarise published epidemiologic and phenotypic data on childhood diabetes in non-European populations in and from WPR.METHODS Research articles were systematically searched from PubMed(MEDLINE),Embase,Cochrane library,and gray literature.Primary outcome measures were incidence and prevalence,with secondary measures including phenotypic descriptions of diabetes,including diabetes type categorization,presence of diabetic ketoacidosis(DKA)at onset,autoantibody positivity,Cpeptide levels,and human leucocyte antigen phenotype.Extracted data were collected using a customized template.Three hundred and thirty relevant records were identified from 16 countries/territories,with analysis conducted on 265(80.3%)records published from the year 2000.RESULTS T1D incidence ranged from<1-7.3/100000 individuals/year,rates were highest in emigrant/mixed populations and lowest in South-East Asia,with most countries/territories(71.4%)having no data since 1999.Incidence was increasing in all six countries/territories with data(annual increases 0.5%-14.2%,highest in China).Peak age-of-onset was 10-14 years,with a female case excess.Rate of DKA at onset varied from 19.3%-70%.Pancreatic autoantibodies at diagnosis were similar to European-origin populations,with glutamic acid decarboxylase-65 autoantibody frequency of 44.1%-64.5%,insulinoma-associated 2 autoantibody 43.5%-70.7%,and zinc transporter-8 autoantibody frequency 54.3%(one study).Fulminant T1D also occurs.T2D was not uncommon,with incidence in Japan and one Chinese study exceeding T1D rates.Monogenic forms also occurred in a number of countries.CONCLUSION T1D is less common,but generally has a classic phenotype.Some countries/territories have rapidly increasing incidence.T2D is relatively common.Registries and studies are needed to fill many information gaps.

Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors

AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P &#x0003c; 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P &#x0003c; 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c &#x02265; 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) &#x0003c; 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI &#x0003c; 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI &#x0003c; 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.

Reproductive disturbances among Saudi adolescent girls and young women with type 1 diabetes mellitus

AIM To identify reproductive disturbances among adolescent girls and young women with type 1 diabetes mellitus(T1 DM) in Saudi Arabia.METHODS This cross sectional study was conducted among 102 female with T1 DM,(aged 13-29 years) who attended the Diabetes Clinic at Diabetes Treatment Center, Prince Sultan Military Medical City, Saudi Arabia between April 2015 to March 2016. Clinical history, anthropometric characteristics and reproductive disturbance were collected through a questionnaire.RESULTS Of 102 patients included in this analysis, 26.5%(27/102) were reported that they experienced an irregular menses. Of these patients, when compared to whose diabetes was diagnosed before menarche(35.4%, 17/48), patients diagnosed with diabetes after menarche(18.5%, 10/54) showed significantly less irregular menses(difference 16.9%, P = 0.04). Similarly, compared to patients diagnosed with diabetes prior to menarche(mean age 12.9 years; n = 48), patients diagnosed with diabetes after menarche(meanage 12.26 years; n = 54) were found to have 0.64 years delay in the age of menarche(P = 0.04). Among the studied patients, 15.7%(16/102) had polycystic ovary syndrome(PCOS). Of these PCOS patients, 37.5%(6/16) had irregular menses, 6.3%(1/16) had Celiac disease, 37.5%(6/16) had Hashimoto thyroiditis and 18.7%(3/16) had acne.CONCLUSION More than one fourth of the study population with T1 DM experiencing an irregular menses. Adolescent girls and young women diagnosed with diabetes prior to menarche showed higher menstrual irregularity and a delay in the age of menarche.

Anti-diabetes effects and mechanisms of a Chinese herbal medicine preparation JQ-R in diabetic KKAy mice and in vitro

OBJECTIVE To investigate the effects and mechanisms by which JQ-R regulated the glucose metabolism and improves insulin sensitivity in diabetic KKAy mice and insulin-resistant L6 myotubes.JQ-R is a mixture of refined extracts from Coptis chinensis,Astragalus membranaceus and Lonicera japonica,three major herbs of JinQi-JiangTang tablet.METHODS Diabetic KKAy mice were adminis.tered JQ-R(100 mg·kg^(-1) or 200 mg·kg^(-1) BW) for 10 weeks.Levels of fasting plasma glucose,lipids,insulin and hemoglobin A1c were monitored.Systemic insulin sensitivity was quantified using the eugly.cemic clamp.The effect of JQ-R on the expressions of the enzymes involved in insulin signaling,oxidative stress and inflammation(Akt,NFκB,IΚBα,JNK,Erk,p38 MAPK) were measured in L6 insulin-resis.tant myotubes.RESULTS JQ-R showed beneficial effects on glucose homeostasis and insulin sensi.tivity in diabetic KKAy mice after 10 weeks treatment.JQ-R also ameliorated the plasma lipid profiles.Moreover,JQ-R can directly reverse the decreased activity of SOD and increased MDA levels as well as activity of iNOS in insulin resistant L6 cell induced with palmitic acid(PA).The expressions of phos.phorylation of NF-κB p65,IκBα,JNK1/2 and Erk1/2 were also decreased after JQ-R treatment.It was also shown that the insulin-stimulated glucose uptake increased significantly after JQ-R treatment,with upregulated expression of phosphorylation of Akt.CONCLUSION JQ-R ameliorated the glucose and lipid metabolism and insulin sensitivity in diabetic KKAy mice.In vitro treatment with JQ-R directly enhanced insulin stimulated glucose uptake in insulin resistant myotubes with improved insulin signal.ling and inflammatory response and oxidative stress state.

Glycemic Control and Microvascular Complications of Type 2 Diabetes among Saudis

Objective: To study the relation between level of glycemic control and different micovascular complications of type 2 diabetes among Saudis. Patients and Methods: This hospital-based study analyzed the medical records of 343 type 2 diabetic patients attending the “University Diabetes Center” in “King Abdul-Aziz” University Hospital, in Riyadh City within 2006. Inclusion criteria comprised being adult, Saudi, type 2 diabetic, whose disease duration is more than one year, non-pregnant (for females). Results: Half of patients (50.4%) were not controlled (HbA1c > 8%). Vascular complications of diabetes were mainly retinopathy (45.8%) or neuropathy (32.7%). Prevalence of nephropathy was 9.9%. Patients’ sex, age, marital status and occupation were not significant variables as regard their control of diabetes. Patient’s educational status was significantly associated with degree of diabetes control;the higher the patient’s education the better the glycemic control (p = 0.002). Moreover, the longer the duration of diabetes, the worse the glycemic control (p Conclusions: Glycemic control among type 2 diabetics is a real challenge that should the health care team face in tertiary-care diabetes centers in KSA. Microvascular complications are common, especially among poorly controlled cases. Recommendations: The current goal for glycemic control at the University Diabetes Center (HbA1c < 8%) should be revised. Reasons for the high prevalence of failure of diabetes control should be investigated. There should be national campaigns to raise the public awareness as regard diabetes and also screening for hyperglycemia for the sake of early diagnosis of diabetes so as to minimize the incidence of diabetes complications.

Amelioration of type 1 diabetes following treatment of non-obese diabetic mice with INGAP and lisofylline

Type 1 diabetes mellitus results from the autoimmune and inflammatory destruction of insulin-producing islet β cells, rendering individuals devoid of insulin production. Recent studies suggest that combination therapies consisting of anti-inflammatory agents and islet growth-promoting factors have the potential to cause sustained recovery of β cell mass, leading to amelioration or reversal of type 1 diabetes in mouse models. In this study, we hypothesized that the combination of the anti-inflammatory agent lisofylline (LSF) with an active peptide fragment of islet neogenesis associated protein (INGAP peptide) would lead to remission of type 1 diabetes in the non-obese diabetic (NOD) mouse. We treated groups of spontaneously diabetic NOD mice with combinations of LSF, INGAP peptide, or control saline parenterally for up to 6 weeks. Our results demonstrate that the mice receiving combined treatment with LSF and INGAP peptide exhibited partial remission of diabetes with increased plasma insulin levels. Histologic assessment of pancreata in mice receiving combined therapy revealed the presence of islet insulin staining, increased β cell replication, and evidence of Pdx1-positivity in ductal cells. By contrast, diabetic animals showed severe insulitis with no detectible insulin or Pdx1 staining. We conclude that the novel combination treatment with LSF and INGAP peptide has the potential to ameliorate hyperglycemia in the setting of established type 1 diabetes via the recovery of endogenous β cells and warrant further studies.

Global trend and future landscape of intestinal microcirculation research from 2000 to 2021:A scientometric study

BACKGROUND The intestinal microcirculation functions in food absorption and metabolic substance exchanges.Accumulating evidence indicates that intestinal microcirculatory dysfunction is a significant source of multiple gastrointestinal diseases.To date,there has not been a scientometric analysis of intestinal microcirculatory research.AIM To investigate the current status,development trends,and frontiers of intestinal microcirculatory research based on bibliometric analysis.METHODS VOSviewer and CiteSpace 6.1.R2 were used to identify the overall characteristics and knowledge map of intestinal microcirculatory research based on the core literature published from 2000 to 2021 in the Web of Science database.The characteristics of each article,country of origin,institution,journal,cocitations,and other information were analyzed and visualized.RESULTS There were 1364 publications enrolled in the bibliometric analysis,exhibiting an upward trend from 2000 to 2021 with increased participation worldwide.The United States and Dalhousie University took the lead among countries and institutions,respectively.Shock was the most prolific journal,and Nature Reviews Microbiology Clinical had the most citations.The topical hotspots and frontiers in intestinal microcirculatory research were centered on the pathological processes of functional impairment of intestinal microvessels,diverse intestinal illnesses,and clinical treatment.CONCLUSION Our study highlights insights into trends of the published research on the intestinal microcirculation and offers serviceable guidance to researchers by summarizing the prolific areas in intestinal disease research to date.