The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023.

B eginning with the 2005 supplement, the Clinical Practice Recommendations contained only the “Standards of Medical Care in Diabetes” and selected other position statements. This change was made to emphasize the importance of the “Standards” as the best source to determine American Diabetes Association (ADA) recommendations. The position statements in the supplement are updated yearly. Position statements not included in the supplement will be updated as necessary and republished when updated. A list of the position statements not included in this supplement appears on p. S98.

Summary of revision for the 2002 Clinical Practice Recommendations

https://doi.org/10.1016/j.expneurol.2022.114142

The neural stem cell secretome across neurodevelopment

Both type 2 diabetes and depression are common and are projected to increase. There is increasing evidence for a bidirectional relationship between the two. Diabetes is a risk factor for depression; contrariwise, individuals with depression are at greater risk of developing diabetes. They are a burden for both the individual and the society. Co-existent depression worsens diabetic control because of obesity, insulin resistance and the adverse metabolic effects of anti-diabetes medicines. In addition, compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet, taking proper medications on time, getting metabolic parameters assessed and maintaining a sleep cycle. Depression occurs in many grades; mild depression is more common in diabetes than frank or full-blown depression leading to suicide. Unfortunately, there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes. Therefore, alternate models for management of mild to moderate depression are required. There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors. INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus. The international study, carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient, the family and the consultant endocrinologist/diabetologist. The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began. It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator. It is possible to scale up the studies to wider geographical areas and health-care organizations.

Can the management of depression in type 2 diabetes be democratized?

Obesity has become an epidemic and has emerged as a serious ailment of global concern. Longstanding obesity may lead to several complications, including type 2 diabetes mellitus (T2DM). Considering the role of the gastrointestinal tract (GIT) in glycemic control, altering it would be relevant to the T2DM management algorithm. Bariatric surgery is a well-known surgical procedure that alters the GIT for managing T2DM among moderate to severely obese patients. T2DM remissions (adequate glycemic control without any other antidiabetic drugs) among the post-bariatric patients are due to weight loss related and weight loss unrelated pathophysiological mechanisms, including caloric intake restriction, increased insulin secretion, sensitivity, and malabsorption. Evidence suggests that bariatric surgeries among T2DM patients improved micro and macrovascular complications. Bariatric surgical procedures have more advantages of post-operative weight loss and glycemic control in biliopancreatic diversions than other available bariatric surgical procedures. Several concerns raised on the short and long-term risks associated with the bariatric surgery were nutritional deficiencies, psychological issues, GIT ulcers, and survival rates. Data related to follow-up of complications related to the above-stated risk are still elusive. According to some of the recently published studies, relapse of T2DM after remission is a worrying phenomenon among post-bariatric surgery patients, requiring more clinical trials and long-term follow-up on the relapsed patients. The effectiveness of reoperation among the relapsed patients also needs to be evaluated. Other unresolved issues related to bariatric surgery are patient compliance, cost-effectiveness, quality of life among post-bariatric patients, and the effectiveness of the post-operative holistic approach to avoid relapse. Future studies, especially randomized controlled trials, are recommended to resolve the existing controversies associated with bariatric surgery.

Bariatric surgery for the management of type 2 diabetes mellitus-current trends and challenges: a review article.

Type 2 Diabetes Mellitus (T2DM) is a health problem of paramount proportions and is associated with significant morbidity and mortality. Our study aims to review data published on the effects of different types of bariatric surgeries on T2DM remission, compared to lifestyle and medical intervention (LMI) exclusively, along with a comprehensive finding of numerous preoperative factors that lead to remission. We used PubMed, PubMed Central (PMC), and MEDLINE to search for literature. Our criteria included peer-reviewed, English language articles published in 2010 and onwards, consisting of adults with T2DM and a body mass index (BMI) of >30 kg/m2 as the population of interest. Twenty-four articles with 5,411 patients were selected for this systematic review, which included nine randomized controlled trials (RCTs) and 15 observational studies. The primary endpoint was T2DM remission. Based on the review, bariatric surgery is superior to LMI in inducing remission in T2DM, especially when employing the Roux-en-Y Gastric Bypass (RYGB) technique. Lower age of onset and shorter duration of T2DM, along with a high BMI are some of the factors that can lead to greater remission rates. Further research in RCTs is needed by incorporating double/triple-blind protocols, a standard definition of T2DM remission, long follow-up periods to evaluate for relapses in remission and any side effects, with a focus on inflammatory markers (eg, osteopontin), scoring systems (eg, DiaRem), and benefits of One-Anastomosis Gastric Bypass (OAGB) over other modalities, to advance our understanding of T2DM remission.

Bariatric Surgery and Type 2 Diabetes Mellitus: Assessing Factors Leading to Remission. A Systematic Review.

Neuroplasticity is the brain's ability to transform its shape, adapt, and develop a new neuronal connection provided with a new stimulus. The stronger the electrical stimulation, the robust is the transformation. Neurogenesis is a complex process when the new neuronal blast cells present in the dentate gyrus divide in the hippocampus. We collected articles from the past 11 years for review, using the Medical Subject Headings (MeSH) strategy from PubMed. Quality appraisal was done for each research article using various assessment tools. A total of 24 articles were chosen, applying all the mentioned inclusion and exclusion criteria and reviewed. The reviewed studies emphasized that modifiable lifestyle factors such as diet and exercise should be implemented as an intervention in the elderly for healthy aging of the brain, as the world's aging population is going to be increased, leading to the expansion of health care and cost. Multiple studies have publicized the relation of diet and exercise with cognition function in aging people. A diet consisting of curcumin in its food has its anti-oxidative property, which prevents rapid aging of the brain, other diet patterns such as a caloric restriction diet can influence brain plasticity and preclude the decline of memory. Exercise can increase brain-derived growth factor (BDGF), vascular endothelial growth factor (VEGF), synapsin one, and tyrosine kinase activity that can expand the size of the brain, enhance the plasticity and neurogenesis. This review aimed at exploring lifestyle factors that contribute to neuroplasticity and neurogenesis. Thus, providing a new path for clinicians and researchers to map out the future possible significant benefits for optimal brain aging in a healthy fashion.

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Role of Lifestyle in Neuroplasticity and Neurogenesis in an Aging Brain.

Diabetes is a chronic disease with a high prevalence in the United States. If not treated adequately, it can have serious complications. Furthermore, when depression affects concomitantly, adherence to treatment can be decreased. Therefore, a cascade of complications may develop, affecting the quality of life and increasing the risk of death. Depression is underdiagnosed in patients with diabetes, and even if diagnosed, the treatment for both diabetes and depression is not well established in primary care. This study aims to evaluate if treatment for depression with collaborative care can improve glycemic levels and depression treatment response in diabetic patients with depression. As well, we will investigate if treatment with antidepressants will aid in improving glycemic levels. For this systematic review, we followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and used PubMed, PubMed Central, and MEDLINE as database. Keywords: "diabetes improvement with depression treatment'. For collaborative care intervention, we selected three systematic reviews and meta-analysis. These three studies gave us a total of 1637 patients evaluated for the glycemic outcome and 1793 patients for depression outcomes. For the intervention with antidepressants, we included two articles. One systematic review and meta-analysis that evaluated the effect of selective serotonin reuptake inhibitors (SSRIs) on glycemic levels and the second article involved was a systematic review that assessed the effect of antidepressants on glycemia. A total of 4119 diabetic patients taking antidepressants were evaluated for glucose levels of the outcome. For the collaborative care outcome: two of the three studies showed non-significant improvement of glycemic levels with intervention. However, one study that had a bigger sample size exhibited significant improvement of glycemia with collaborative care. It is necessary to elaborate on new studies to confirm this finding. For the glycemic outcome with antidepressants: SSRIs improve glycemic levels. This class of antidepressants is the most studied, and it would be interesting to perform trials comparing different classes of antidepressants with a bigger sample size and run for a more extended period. According to our review, collaborative care improves glycemia and depression treatment response. At the same time, it improves the adherence to treatment of both oral hypoglycemic drugs and antidepressants. SSRIs demonstrated to be more effective in glycemic control. The most studied and effective SSRIs are fluoxetine, escitalopram, and citalopram.

Does Treatment for Depression With Collaborative Care Improve the Glycemic Levels in Diabetic Patients with Depression? A Systematic Review.

Obesity and obesity-related illnesses (ORIs) constitute a significant burden on the healthcare system, with a very high prevalence in the general population. Atrial fibrillation (AF) is the most common arrhythmia seen by healthcare providers. The risk of AF in obese individuals is reported to be high and in correlation with Body Mass Index (BMI), leading to the high prevalence of AF in the general population and the expected epidemic of AF to come. Greater left atrial dimensions and left atrial remodeling together form the AF substrate in the obese population along with the role of epicardial adipose tissue (EAT) in inducing inflammation and fibrosis of the atrial myocardium and thus facilitating the onset of AF. In our paper, we reviewed the literature published on the link between obesity and AF, as well as the potential behind new management approaches. Multiple studies have explored different approaches, either conventional or novel. Considering the impact of prevention in medicine nowadays, we proposed a screening practice for AF in obese individuals. More research is needed to acquire a comprehensive protocol for the management of AF in the obese population that can be applied by primary healthcare providers to combat this evolving matter.

Liliana Diaz Bustamante

Papers

Bariatric Surgery and Type 2 Diabetes Mellitus: Assessing Factors Leading to Remission. A Systematic Review.

Role of Lifestyle in Neuroplasticity and Neurogenesis in an Aging Brain.

Does Treatment for Depression With Collaborative Care Improve the Glycemic Levels in Diabetic Patients with Depression? A Systematic Review.

Obesity and Atrial Fibrillation: Should We Screen for Atrial Fibrillation in Obese Individuals? A Comprehensive Review.