Showing papers in "Diabetology & Metabolic Syndrome in 2018"

Metabolic clustering of risk factors: evaluation of Triglyceride-glucose index (TyG index) for evaluation of insulin resistance.

Abstract: Metabolic syndrome over the years have structured definitions to classify an individual with the disease. Literature review suggests insulin resistance is hallmark of these metabolic clustering. While measuring insulin resistance directly or indirectly remains technically difficult in general practice, along with multiple stability issues for insulin, various indirect measures have been suggested by authorities. Fasting triglycerides-glucose (TyG) index is one such marker, which is recently been suggested as a useful diagnostic marker to predict metabolic syndrome. However, limited data is available on the subject with almost no literature from our region on the subject. 1. To correlate TyG index with insulin resistance, anthropometric indices, small dense LDLc, HbA1c and nephropathy. 2. To evaluate TyG index as a marker to diagnose metabolic syndrome in comparison to other available markers. Place and duration of study-From Jun-2016 to July-2017 at PSS HAFEEZ hospital Islamabad. From a finally selected sample size of 227 male and female subjects we evaluated their anthropometric data, HbA1c, lipid profile including calculated sdLDLc, urine albumin creatinine raito(UACR) and insulin resistance (HOMAIR). TyG index was calculated using formula of Simental-Mendia LE et al. Aforementioned parameters were correlated with TyG index, differences between subjects with and without metabolic syndrome were calculated using Independent sample t-test. Finally ROC curve analysis was carried out to measure AUC for candidate parameters including TyG Index for comparison. TyG index in comparison to other markers like fasting triglycerides, HOMAIR, HDLc and non-HDLc demonstrated higher positive linear correlation with BMI, atherogenic dyslipidemia (sdLDLc), nephropathy (UACR), HbA1c and insulin resistance. TyG index showed significant differences between various markers among subjects with and without metabolic syndrome as per IDF criteria. AUC (Area Under Curve) demonstrated highest AUC for TyG as [(0.764, 95% CI 0.700–0.828, p-value ≤ 0.001)] followed by fasting triglycerides [(0.724, 95% CI 0.656–0.791, p-value ≤ 0.001)], sdLDLc [(0.695, 95% CI 0.626–0.763, p-value ≤ 0.001)], fasting plasma glucose [(0.686, 95% CI 0.616–0.756, p-value ≤ 0.001)], Non-HDLc [(0.640, 95% CI 0.626–0.763, p-value ≤ 0.001)] and HOMAIR [(0.619, 95% CI 0.545–0.694, p-value ≤ 0.001)]. TyG index, having the highest AUC in comparison to fasting glucose, triglycerides, sdLDLc, non-HDLc and HOMAIR can act as better marker for diagnosing metabolic syndrome.

The prevalence and risk factors of peripheral neuropathy among patients with type 2 diabetes mellitus; the case of Jordan

Abstract: Peripheral neuropathy is one of the most common microvascular complication of diabetes mellitus. This study is conducted to determine the prevalence of diabetic peripheral neuropathy (DPN) and its associated factors among patients with type 2 diabetes mellitus in Jordan. A cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics, Jordan. A total of 1003 patients with type 2 diabetes were recruited. Data were collected from participants during a face-to-face structured interview. DPN was assessed using the translated version of Michigan Neuropathy Screening Instrument (MNSI). The overall prevalence of DPN based on MNSI was 39.5%. The most frequently reported symptoms were numbness (32.3%) and pain with walking (29.7%), while the least reported symptoms were the history of amputation (1.3%) and loss of sensation in legs/feet while walking (3.8%). Logistic regression analysis revealed that unemployment, cardiovascular disease, dyslipidemia, diabetic retinopathy and long standing DM (diabetes of ≥ 5 years) were significantly associated with DPN. Peripheral Neuropathy is highly prevalent among Jordanian patients with type 2 diabetes mellitus. DPN was significantly associated with duration of DM, dyslipidemia, diabetic retinopathy, cardiovascular disease, and unemployment. Early detection and appropriate intervention are mandatory among high-risk groups.

Sarcopenia: a chronic complication of type 2 diabetes mellitus.

Abstract: Diabetics are at increased risk for impaired mobility and strength, frequently related to the disease control. Sarcopenia is the reduction of muscle mass associated with the decrease in muscle strength and/or performance, resulting in worse morbidity in chronic diseases. The objectives of this paper was to assess the prevalence of sarcopenia in patients with type 2 diabetes mellitus (T2DM) and determine its association with diabetes characteristics, progression, and complications, as well as changes in bone mineral density. The sample consisted of patients with T2DM followed at the outpatient clinics of the Servico de Endocrinologia e Metabologia do Hospital de Clinicas da Universidade Federal do Parana, from March to August 2016. Participants were men and women above 18 years with T2DM diagnosed at least 1 year earlier. Individuals with chronic diseases, users of any drug that modifies body composition, patients with body mass index (BMI) > 35 or < 18 kg/m2, and users of illicit drugs or hormonal or nutritional supplementation were excluded. The selected patients answered questionnaires about demographics, eating habits, and disease characteristics, and performed a bone densitometry exam in a dual energy absorptiometry (total body; spine and femur (total and neck)), a handgrip test by manual dynamometer, and an evaluation of the abdominal circumference (AC). The medical records were reviewed seeking diabetes data and laboratory test results. Patients were matched for sex, age, and race with healthy controls [Control Group (CG)]. The diagnosis of sarcopenia was conducted according to the criteria of the Foundation for National Institute of Health. The final sample consisted of 83 patients in the DG and 83 in the CG. The DG had higher BMI, WC, past history of fractures and lower calcium and healthy diet intake (p < 0.005), compared to the CG. The DG presented a higher frequency of abnormal BMD (osteopenia in 45 (53%), and osteoporosis in 14 (19%)) and comorbidities than the CG (p < 0.005). Pre-sarcopenia was not different between groups, but muscle weakness was present in 25 diabetics (18 women) and only in 5 controls (4 men) (p = 0.00036). Sarcopenia was diagnosed in 13 (16.2%) patients in the DG and 2 (2.4%) in the CG (p = 0.01168). Pre-sarcopenia and sarcopenia were associated with altered BMD (p < 0.005), with no association with diabetes duration or control. Body mass index and osteoporosis increased the likelihood to have sarcopenia, but hypertension and healthy diet decreased it. The DG had altered BMD associated with worse glycemic control, and a higher prevalence of sarcopenia, suggesting the need to look for their presence in diabetics.

Antioxidant effects of vitamins in type 2 diabetes: A meta-analysis of randomized controlled trials

Abstract: Vitamins are essential micronutrients with antioxidant potential that may provide a complementary treatment for patients with chronic diseases. Our aim was to assess the effect of vitamin supplementation on the antioxidant status and glycemic index of type 2 diabetes mellitus patients. We performed a systematic review with meta-analyses. Electronic searches were conducted in PubMed, Scopus, and Web of Science (December 2017). Randomized controlled trials evaluating the effect of any vitamin or vitamin complex supplementation on antioxidant status as primary outcome were included. The outcomes considered were: reduction of malondialdehyde (MDA); augmentation of glutathione peroxidase (GPx); changes in total antioxidant capacity (TAC), enhance in superoxide dismutase enzyme—SOD, and thiobarbituric acid reactive substances (TBARS). Outcomes of glycemic control were also evaluated. Pairwise meta-analyses were performed using software Review Manager 5.3. Thirty trials fulfilled the inclusion criteria, but only 12 could be included in the meta-analyses of antioxidant outcomes. The most commonly studied vitamins were B, C, D and E. Vitamin E was related to significant reduction of blood glucose as well as glycated hemoglobin compared to placebo, while both vitamins C and E were mainly associated with reducing MDA and TBARS and elevating GPx, SOD and TAC, compared to placebo. However, outcome reports in this field are still inconsistent (e.g. because of a lack of standard measures). Supplementation of vitamin E may be a valuable strategy for controlling diabetes complications and enhancing antioxidant capacity. The effects of other micronutrients should be further investigated in larger and well-designed trials to properly place these complementary therapies in clinical practice.

Effects of incretin treatment on cardiovascular outcomes in diabetic STEMI-patients with culprit obstructive and multivessel non obstructive-coronary-stenosis.

Abstract: No proper data on prognosis and management of type-2 diabetic ST elevation myocardial infarction (STEMI) patients with culprit obstructive lesion and multivessel non obstructive coronary stenosis (Mv-NOCS) exist. We evaluated the 12-months prognosis of Mv-NOCS-diabetics with first STEMI vs.to non-diabetics, and then Mv-NOCS-diabetics previously treated with incretin based therapy vs. a matched cohort of STEMI-Mv-NOCS never treated with such therapy. 1088 Patients with first STEMI and Mv-NOCS were scheduled for the study. Patients included in the study were categorized in type 2 diabetics (n 292) and non-diabetics (n 796). Finally, we categorized diabetics in current-incretin-users (n 76), and never-incretin-users (n 180). The primary end point was all cause deaths, cardiac deaths, and major adverse cardiac events (MACE) at 12 months of follow up. The study results evidenced higher percentage of all cause deaths (2.2% vs. 1.1%, p value 0.05), cardiac deaths (1.6% vs. 0.5%, p value 0.045), and MACE (12.9% vs. n 5.9%), p value 0.001) in diabetic vs. no diabetic patients at 12 months follow up. Among diabetic patients, the current vs never-incretin-users, did not present a significant difference about all cause of deaths, and cardiac deaths through 12-months. The MACE rate at 1 year was 7.4% in diabetic incretin-users STEMI Mv-NOCS patients vs. 12.9% in diabetic never-incretin-users STEMI-Mv-NOCS patients (p value 0.04). In a risk-adjusted hazard analysis, MACE through 12 months were lower in diabetic STEMI-Mv NOCS incretin-users vs never-incretin-users patients (HR 0.513, CI [0.292–0.899], p 0.021). Consequently, lower levels of glucagon-like peptide 1(GLP-1) were predictive of MACE at follow up (HR 1.528, CI [1.059–2.204], p 0.024). In type 2 diabetic patients with STEMI-Mv-NOCS, we observed higher incidence of 1-year mortality and adverse cardiovascular outcomes, as compared to non-diabetic STEMI-Mv-NOCS patients. In diabetic patients, never-incretin-users have worse prognosis as compared to current-incretin-users. Trail registration Clinical trial number: NCT03312179, name of registry: clinicaltrialgov, URL: clinicalltrialgov.com, date of registration: September 2017, date of enrollment first participant: September 2009

The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior

Abstract: Diabetes is a chronic illness which requires lifelong self-care behaviors. The objective of the present research was to investigate the association of self-efficacy, attitude and social support with adherence to diabetes self-care behavior. In this cross-sectional study conducted in 2017, 403 diabetic patients of Zarandieh, Iran participated. They were evaluated by valid and reliable questionnaires comprised of items on diabetes self-care, self-efficacy in dealing with problems, social support and attitude towards self-care. Data were analyzed using SPSS 18 applying t test, ANOVA, and multiple regression analysis. The results indicated that patients with higher self-care scores had better self-efficacy, social support, and attitude towards self-care. Moreover, self-efficacy, social support, and attitude towards self-care variables accounted for 39.5% of the total variance of self-care behavior. Furthermore, social support (β = 0.87), self-efficacy (β = 0.52), and attitude towards self-care (β = 0.42) were respectively the most important predictors of self-care behaviors. Social support, self-efficacy and attitude towards self-care behaviors were associated with self-care behaviors in patient with diabetes. They might suggest that educational programs specifically target these factors.

Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients

Abstract: There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.

The effects of probiotic supplementation on metabolic status in type 2 diabetic patients with coronary heart disease

Abstract: This study was conducted to evaluate the effects of probiotic supplementation on metabolic profiles in diabetic patients with coronary heart disease (CHD). This randomized, double-blind, placebo-controlled trial was performed among 60 diabetic patients with CHD, aged 40–85 years at a cardiology clinic in Kashan, Iran, from October 2017 through January 2018. Patients were randomly divided into two groups to take either probiotic supplements (n = 30) or placebo (n = 30) for 12 weeks. Fasting blood samples were taken at the beginning of the study and after the 12-week intervention to determine related markers. After 12-week intervention, probiotic supplementation significantly decreased fasting plasma glucose (β − 20.02 mg/dL; 95% CI − 33.86, − 6.17; P = 0.005), insulin (β − 2.09 µIU/mL; 95% CI − 3.77, − 0.41; P = 0.01), insulin resistance (β − 0.50; 95% CI − 0.96, − 0.03; P = 0.03) and total-/HDL-cholesterol ratio (β − 0.27; 95% CI − 0.52, − 0.03; P = 0.02), and significantly increased insulin sensitivity (β 0.008; 95% CI 0.001, 0.01; P = 0.02) and HDL-cholesterol levels (β 2.52 mg/dL; 95% CI 0.04, 5.00; P = 0.04) compared with the placebo. Moreover, probiotic supplementation led to a significant reduction in serum high sensitivity C-reactive protein (β − 0.88 mg/L; 95% CI − 1.39, − 0.38; P = 0.001), and a significant elevation in total antioxidant capacity (β 108.44 mmol/L; 95% CI 47.61, 169.27; P = 0.001) and total glutathione levels (β 45.15 µmol/L; 95% CI 5.82, 84.47; P = 0.02) compared with the placebo. Probiotic supplementation did not affect other metabolic profiles. Overall, we found that probiotic supplementation for 12 weeks had beneficial effects on glycemic control, HDL-cholesterol, total-/HDL-cholesterol ratio, biomarkers of inflammation and oxidative stress in diabetic patients with CHD. Trial registration Clinical trial registration number http://www.irct.ir : IRCT2017082733941N5

Dietary fat stimulates development of NAFLD more potently than dietary fructose in Sprague–Dawley rats

Abstract: In humans and animal models, excessive intake of dietary fat, fructose and cholesterol has been linked to the development of non-alcoholic fatty liver disease (NAFLD). However, the individual roles of the dietary components remain unclear. To investigate this further, we compared the effects of a high-fat diet, a high-fructose diet and a combination diet with added cholesterol on the development of NAFLD in rats. Forty male Sprague–Dawley rats were randomized into four groups receiving either a control-diet (Control: 10% fat); a high-fat diet (HFD: 60% fat, 20% carbohydrate), a high-fructose diet [HFr: 10% fat, 70% carbohydrate (mainly fructose)] or a high-fat/high-fructose/high-cholesterol-diet (NASH: 40% fat, 40% carbohydrate (mainly fructose), 2% cholesterol) for 16 weeks. After 16 weeks, liver histology revealed extensive steatosis and inflammation in both NASH- and HFD-fed rats, while hepatic changes in HFr-rats were much more subtle. These findings were corroborated by significantly elevated hepatic triglyceride content in both NASH- (p < 0.01) and HFD-fed rats (p < 0.0001), elevated hepatic cholesterol levels in NASH-fed rats (p < 0.0001), but no changes in HFr-fed rats, compared to Control. On the contrary, only HFr-fed rats developed dyslipidemia as characterized by higher levels of plasma triglycerides compared to all other groups (p < 0.0001). Hepatic dysfunction and inflammation was confirmed in HFD-fed rats by elevated levels of hepatic MCP-1 (p < 0.0001), TNF-alpha (p < 0.001) and plasma β-hydroxybutyrate (p < 0.0001), and in NASH-fed rats by elevated levels of hepatic MCP-1 (p < 0.01), increased hepatic macrophage infiltration (p < 0.001), and higher plasma levels of alanine aminotransferase (p < 0.0001) aspartate aminotransferase (p < 0.05), haptoglobin (p < 0.001) and TIMP-1 (p < 0.01) compared to Control. These findings show that dietary fat and cholesterol are the primary drivers of NAFLD development and progression in rats, while fructose mostly exerts its effect on the circulating lipid pool.

Association between the expression of vascular endothelial growth factors and metabolic syndrome or its components: a systematic review and meta-analysis

Abstract: Several studies have linked vascular endothelial growth factors (VEGFs) with metabolic syndrome or its components. However, there has been no systematic appraisal of the findings of these studies to date. The current systematic review and meta-analysis was conducted to explore this association. PubMed, EMBASE, the Cochrane library, and clinical trials registries were used to retrieve peer-reviewed clinical studies that had evaluated the association of VEGFs with metabolic syndrome or its components without applying language and date restrictions. The final search was performed on 29 September 2017. We included 32 studies in this systematic review and meta-analysis, of which 16 studies (19 study arms) were included in the meta-analysis and remaining studies were qualitatively assessed. Overall, VEGF-A, VEGF-B and VEGF-C were strongly associated with metabolic syndrome or its components. The components of metabolic syndrome varied in their association. Obesity was not correlated with increased VEGF-A expression (p = 0.12), whereas VEGF-B and VEGF-C expression was significantly higher in those with obesity. In contrast, hyperglycemia in type 1 diabetes was strongly associated with increased VEGF-A levels (p < 0.00001), as was type 2 diabetes (p = 0.0006). The studies included in the qualitative analysis similarly showed an increase in VEGF family expression in people with metabolic syndrome, and with its components. The increased concentrations of vascular endothelial growth factors are variably associated with metabolic syndrome or its components. Each VEGF protein has a unique set of associations with the disease state.

Relationship between "a body shape index (ABSI)" and body composition in obese patients with type 2 diabetes.

Abstract: Obesity is known to be related to the development of type 2 diabetes mellitus (T2D). The most commonly used anthropometric indicator (body mass index [BMI]) presents several limitations such as the lack of possibility to distinguish adipose tissue distribution. Thus, this study examines the suitability of a body shape index (ABSI) for prediction of body composition and sarcopenic obesity in obese or overweight T2D subjects. Cross-sectional study in 199 overweight/obese T2D adults. Anthropometric (BMI, ABSI) and body composition (fat mass [FM], fat-free mass [FFM], fat mass index [FMI] and fat-free mass index, and the ratio FM/FFM as an index of sarcopenic obesity) data was collected, as well as metabolic parameters (glycated haemoglobin [HbA1c], mean blood glucose, fasting plasma glucose [FPG], high-density-lipoprotein cholesterol [HDL], low-density-lipoprotein cholesterol, total cholesterol, and triglycerides [TG] levels; the ratio TG/HDL was also calculated as a surrogate marker for insulin resistance). ABSI was significantly associated with age and waist circumference. It showed a statistically significant correlation with BMI exclusively in women. Regarding body composition, in men, ABSI was associated with FM (%), while in women it was associated with both FM and FFM. Both males and females groups with high ABSI scores were significantly older (men: 59.3 ± 10.8 vs 54.6 ± 10.1, p ≤ 0.05; women: 65.1 ± 9.8 vs 58.1 ± 13.3, p ≤ 0.005) and showed lower FFM values (men: 62.3 ± 9.0 vs 66.2 ± 9.3, p ≤ 0.05; women: 48.7 ± 5.6 vs 54.5 ± 8.9, p ≤ 0.001) compared with low-ABSI groups. Multiple linear regression revealed that ABSI independently predict FMI and the FM/FFM ratio in women. Sarcopenic obesity was identified in 70 (36.5%) individuals according to the FM/FFM ratio. The AUROC of ABSI was 63.1% (95% CI 54.6–71.6%; p = 0.003) and an ABSI value of 0.083 m11/6 kg−2/3 was the optimal threshold in discriminating patients with sarcopenic obesity (sensitivity: 48%, specificity: 73%). Moreover, a significant association between ABSI and FPG was found in men. ABSI could be useful to identify visceral and sarcopenic obesity in overweight/obese adults with T2D, adding some relevant clinical information to traditional anthropometric measures.

The effects of exercise on vascular endothelial function in type 2 diabetes: a systematic review and meta-analysis.

Abstract: Vascular endothelial dysfunction induced by hyperglycemia and elevated insulin resistance is a potent risk factor for cardiovascular disease and likely contributes to multiple chronic disease complications associated with aging. The aim of this study was to systematically review and quantify the effects of exercise on endothelial function (EF) in type 2 diabetes (T2D). Five electronic databases were searched (until June 2017) for studies that met the following criteria: (i) randomized controlled trials; (ii) T2D aged ≥ 18 years; (iii) measured EF by brachial artery flow-mediated dilation (FMD); (iv) structured and supervised exercise intervention for ≥ 8 weeks. Thirteen cohorts, selected from eight studies (306 patients, average age 59 years), met the inclusion criteria. Exercise training significantly increased FMD (mean ES = 0.41, 95% CI 0.21–0.62, P < 0.001). Low to moderate intensity subgroups and aerobic exercise (AE) subgroups significantly increased FMD more than moderate to high intensity subgroups and combined AE and resistance exercise subgroups respectively (P < 0.01, P < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments reported that quality of evidence for all outcomes was moderate except shear rate showing low. Egger’s test showed no significant publication bias for all outcomes. Our results suggest that in patients with T2D, lower intensity exercise has physiological meaningful effects on EF, in support of the emerging concept that the lower efforts of exercise are not necessarily less cardioprotective than higher intensity training.

Anti-inflammatory effects of empagliflozin in patients with type 2 diabetes and insulin resistance

Abstract: Inflammation might be a pathological mediator of cardiovascular events in patients with type 2 diabetes and high cardiovascular risk. We investigated whether empagliflozin (EMPA) exerts anti-inflammatory effects that are reflected in decreased high-sensitivity C-reactive protein (hsCRP) values. Patients were allocated to receive a placebo (n = 51) or EMPA (n = 51) as an add-on treatment. Fasting blood samples were collected before and every 3 months after this intervention for 1 year. Empagliflozin tended to elicit reductions in BMI, HbA1c, aspartate aminotransferase, alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase compared with the placebo, but the differences did not reach statistical significance. Levels of LDL-cholesterol, HDL-cholesterol, and triglycerides were unaltered, significantly increased, and decreased, respectively, by EMPA, but the differences were not statistically significant compared with the placebo. Empagliflozin for 12 months notably reduced the homeostatic model assessment of insulin resistance (HOMA-IR), remnant-like particle cholesterol (RLP-C), and hsCRP by 43%, 52% and 54%, respectively. The time courses of these reductions significantly differed from those of the placebo. Systolic and diastolic blood pressure were also significantly reduced by EMPA compared with the placebo. We applied multiple linear regression analysis to determine which factors were associated with changes in hsCRP induced by EMPA. The results revealed that alterations in hsCRP values (log [hsCRP at 12 months] minus log [hsCRP at month 0]) were significantly associated with changes in HOMA-IR, RLP-C, systolic blood pressure, HDL-C and ALT. Empagliflozin decreased hs-CRP and lowered levels of remnant related lipoproteins probably via ameliorating insulin resistance. The cardiovascular benefits conferred by EMPA might be driven at least partly by anti-inflammatory effects, and this mechanism might cooperate with other EMPA-induced changes including reduced blood pressure, to achieve the degree of cardioprotection revealed by the EMPA-REG OUTCOME trial. Trial registration UMIN Clinical Registry (UMIN000021552). Registered 21 March 2016, https://upload.umin.ac.jp/UMIN000021552

The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes

Abstract: Type 2 diabetes is a chronic disease that is expanding at an alarming rate in the world. Research on individuals with type 2 diabetes showed that stressful life events cause problems in the effective management and control of diabetes. This study aimed at investigating the effect of a stress management intervention on blood glucose control in individuals with type 2 diabetes referred to Zarandeh clinic, Iran. In this experimental study, 230 individuals with type 2 diabetes (179 female and 51 male) were enrolled and assigned to experimental (n = 115) and control (n = 115) groups. A valid and reliable multi-part questionnaire including demographics, Perceived Stress Scale, Coping Inventory for Stressful Situations, Coping Self-Efficacy Scale, and multidimensional scale of perceived social support was used to for data collection. The experimental group received a training program, developed based on the social cognitive theory and with an emphasis on improving self-efficacy and perceived social support, during eight sessions of one and a half hours. Control group received only standard care. Data were analyzed using SPSS 15 applying the t test, paired t-tests, Pearson correlation coefficient, and Chi square analysis. The significance level was considered at 0.05. Before the intervention, the mean perceived stress scores of the experimental and control groups were 33.9 ± 4.6 and 35 ± 6.5, respectively, and no significant difference was observed (p > 0.05). However, after the intervention, the mean perceived stress score of the experimental group (26.7 ± 4.7) was significantly less than that of the control group (34.5 ± 7) (p = 0.001). Before the intervention, the mean scores of HbA1c in the experimental and control groups were 8.52 ± 1 and 8.42 ± 1.2, respectively, and there was no significant difference between the two groups. However, after the intervention, the results showed a significant decrease in glycosylated hemoglobin levels in the experimental group (p ≤ 0.05). Moreover, after the intervention, the result showed a significant difference between the mean scores of all aspects of Coping Inventory for Stressful Situations, coping self-efficacy, and perceived social support in the two groups (p < 0.05). Our results suggested that the theory-based stress management intervention based on social cognitive theory may help to decrease stress and increase coping self-efficacy, stress management, perceived social support, and lead to a reduction in the glycosylated hemoglobin levels among patients with diabetes.

Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: the HAT study in Brazil

Abstract: Hypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The Hypoglycemia Assessment Tool study in Brazil aimed to determine the proportion of patients experiencing hypoglycemic events and to characterize patient awareness and fear about hypoglycemia, among insulin-treated T1DM or T2DM patients. This was a non-interventional, multicenter study, with a 6-month retrospective and a 4-week prospective evaluation of hypoglycemic events. Patients completed a questionnaire at baseline and at the end of the study, and also a patient diary. The answers ‘occasionally’ and ‘never’ to the question ‘Do you have symptoms when you have a low sugar level?’ denoted impaired hypoglycemia awareness. Fear was reported on a 10-point scale, from ‘not afraid at all’ to ‘absolutely terrified’. From 679 included patients, 321 with T1DM and 293 T2DM, median age of 33.0 and 62.0 years, 59% and 56% were female, and median diabetes duration was 15.0 and 15.0 years, respectively. Median time of insulin use was 14.0 and 6.0 years. During the prospective period, 91.7% T1DM and 61.8% T2DM patients had at least one hypoglycemic event. In the same period, 54.0% T1DM and 27.4% T2DM patients had nocturnal hypoglycemia, 20.6% T1DM and 10.6% T2DM patients had asymptomatic hypoglycemia, and severe events occurred in 20.0% and 10.3%, respectively. At baseline, 21.4% T1DM and 34.3% T2DM had hypoglycemia unawareness. The mean score of hypoglycemia fear was 5.9 ± 3.1 in T1DM and 5.4 ± 3.9 in T2DM. The most common attitude after hypoglycemic events were to increase calorie intake (60.3%) and blood glucose monitoring (58.0%) and to reduce or skip insulin doses (30.8%). Referred episodes of hypoglycemia were high, in both T1DM and T2DM insulin users. Patient attitudes after hypoglycemia, such as reduction in insulin and increase in calorie intake, can affect diabetes management. These findings may support clinicians in tailoring diabetes education and insulin treatment for patients with diabetes, in order to improve their glycemic control while reducing the risk of hypoglycemic events.

Association between homocysteine level and the risk of diabetic retinopathy: a systematic review and meta-analysis

Abstract: Previous studies have demonstrated that elevated homocysteine (Hcy) level represents an independent risk factor for macrovascular disease. However, the relationship between hyperhomocysteinemia and the progression of diabetic retinopathy in patients remains controversial. Hence, the purpose of this systematic review and meta-analysis was to explore any potential association between Hcy and the risk of diabetic retinopathy. PubMed, Embase, and the Cochrane Library databases were searched to screen studies that fulfilled the inclusion criteria from date of database inception to November 2017. The summary odds ratio (OR) with 95% confidence intervals (CIs) was used to calculate the pooled effect estimate for the relationship between Hcy and diabetic retinopathy risk. Sensitivity, subgroup analyses, and publication bias were also assessed. Eleven studies involving a total of 2184 diabetic patients were included in the meta-analysis. The summary OR suggested that increased Hcy level in diabetic patients was associated with an increased risk of diabetic retinopathy (OR 1.62; 95% CI 1.29–2.03; p < 0.001). Although significant heterogeneity was detected among the included studies, the findings of sensitivity analysis remained statistically significant. Subgroup analyses found a significant association between Hcy and diabetic retinopathy in most subsets, but no significant association was found if the sample size was < 100, participants had type 1 diabetes mellitus, and the study quality was low. The findings of this study suggested that elevated Hcy level was associated with an increased risk of diabetic retinopathy, especially in type 2 diabetic patients. This finding may help diabetic patients to achieve effective management strategy to prevent the progression of diabetic retinopathy.

Markers of metabolic endotoxemia as related to metabolic syndrome in an elderly male population at high cardiovascular risk: a cross-sectional study

Abstract: Metabolic syndrome (MetS) is a cluster of conditions that conjoined represents a 1.5–2.5 fold increased risk of developing cardiovascular disease (CVD). Recent studies have reported that gut dysbiosis and leakage of bacterial components, may contribute to the metabolic disturbances and systemic inflammation observed in subjects with MetS. Chronic exposure to lipopolysaccharide (LPS) has been shown to induce features of MetS in experimental studies. LPS interacts with the innate immune system, facilitated through LPS-binding protein (LBP) and the co-receptor CD14, both regarded as markers of gut leakage. We investigated whether circulating levels of LBP and sCD14 are associated with the presence of MetS and its components, and further any association with systemic inflammation. We examined 482 men, aged between 65 and 75 years, all at high CVD risk. MetS criteria’s according to the US National Cholesterol Education Program Adult Treatment Panel III were met in 182 subjects (38%). Levels of LBP and sCD14 did not differ between individuals with and without MetS. However, a trend towards increased risk of MetS through quartiles of LBP was observed (p = 0.05). Individuals in the highest quartile (Q4), had an increased risk of MetS (OR = 1.76, 95% CI (1.04–3.00), compared to the lowest quartile (Q1) (p = 0.04). With regard to the separate constituents of MetS, patients who met the waist circumference criterion had significant higher concentration of LBP compared to those who did not (p = 0.04). We also found a weak, but significant correlation between LBP and waist circumference (r = 0.10, p = 0.03). Moderate, yet significant correlations were observed between both LBP and sCD14 and several markers of systemic inflammation (r = 0.1–0.23; p < 0.001–0.04). The trend for increased prevalence of MetS observed with increasing quartiles of LBP seems to be mainly driven by central obesity in our male cohort. The associations between LBP, sCD14 and systemic inflammation, indicate a potential role of the innate immune system in MetS. Trial registration CLINICALTRIALS.GOV, NCT00764010. Registered 01 October 2008—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT00764010?term=NCT00764010&rank=1

Association between dietary protein intake and type 2 diabetes varies by dietary pattern.

Abstract: Epidemiological studies have demonstrated that high total protein intake was related to type 2 diabetes mellitus (T2DM) risks. However, few studies considered the impact of dietary pattern. We examined the associations between protein intake and T2DM in different dietary patterns. We used the demographic and dietary information of adults aged 18–75 years from the China Health and Nutrition Survey (2009), consisting of 4113 women and 4580 men. Dietary data was collected by using 24-h recalls combined with a food inventory for 3 consecutive days. Cluster analysis was used to classify subjects into groups, as determined by major sources of protein. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence interval (95% CI) of T2DM according to the energy-adjusted protein intake. All participants were divided into three patterns according to the dietary source of protein (legumes and seafood, red meat, refined grains). Overall, plant protein intake was significantly and inversely associated with T2DM. In the subgroup analysis by dietary patterns, extreme quartile of plant protein intake was also inversely related to T2DM in the “legumes and seafood” group [OR = 0.58, 95% CI (0.33–0.96)]. Total protein intake and animal protein intake were positively related to T2DM in the “red meat” group [OR: 3.12 (1.65–5.91) and 3.48 (1.87–6.60), respectively]. However, the association of animal protein intake was reversed in the “refined grains” group [OR = 0.55, 95% CI 0.32–0.89]. The association between protein intake and T2DM varies by dietary pattern. Dietary pattern may be considered into the recommendation of protein intake for diabetes prevention.

Combination of basal insulin and GLP-1 receptor agonist: is this the end of basal insulin alone in the treatment of type 2 diabetes?

Abstract: Glycemic control has been considered a major therapeutic goal within the scope of diabetes management, as supported by robust observational and experimental evidence. However, the coexistence of micro and macrovascular disease is associated with the highest cardiovascular risks which highlights the importance that pharmacological treatment of type 2 diabetes mellitus provides not only glycemic control, but also cardiovascular safety. Basal insulin is a highly effective treatment in reducing fasting blood glucose, but it is associated with considerable risk of hypoglycemia and weight gain. Glucagon like peptide 1 receptor agonists (GLP-1 RAs) are also effective in terms of glycemic control and associated with weight loss and low risk of hypoglycemia. The potential benefits of combining GLP-1RAs with basal insulin are contemplated in the current position statement of several different position statement and guidelines. This article reviews the efficacy and safety of different strategies to initiate and intensify basal insulin, with focus on new fixed ratio combinations of basal insulin with GLP-1 RAs available for use in a single injection pen (insulin degludec/liraglutide and insulin glargine/lixisenatide).

Antidiabetic efficacy of lactoferrin in type 2 diabetic pediatrics; controlling impact on PPAR-γ, SIRT-1, and TLR4 downstream signaling pathway.

Abstract: The current study aims to investigate the antidiabetic efficacy of camel milk-derived lactoferrin and potential involvement of PPAR-γ and SIRT-1 via TLR-4/NFκB signaling pathway in obese diabetic pediatric population. Sixty young obese patients with type 2 diabetes were selected from the Pediatric Endocrine Metabolic Unit, Cairo University and were randomly divided among two age and sex-matched groups so as to receive either standard therapy without lactoferrin in one arm or to be treated with oral lactoferrin capsules (250 mg/day, p.o) for 3 months in the other arm. Both groups were compared to 50 control healthy volunteers. Measurements of HbA1c, lipid profile, antioxidant capacity (SOD, Nrf2), proinflammatory interleukins; (IL-1β, IL-6, IL-18), Cyclin D-1, lipocalin-2, and PPAR-γ expression levels were done at the beginning and 3 months after daily consumption of lactoferrin. The mechanistic involvement of TLR4-SIRT-1-NFκB signaling cascade was also investigated. The antidiabetic efficacy of lactoferrin was confirmed by significant improvement of the baseline levels of HbA1c, BMI and lipid profile of the obese pediatric cohort, which is evidenced by increased PPAR-γ and SIRT-1 expression. Moreover, the anti-inflammatory effect was evident by the significant decrease in serum levels of IL-1β, IL-6, IL-18, TNF-α, lipocalin 2 in type 2 diabetic post-treatment group, which corresponded by decreased NFκB downstream signaling indicators. The antioxidant efficacy was evident by stimulated SOD levels and NrF2 expression; compared with the pre-treatment group (all at P ≤ 0.001). The consumption of high concentrations of lactoferrin explains its hypoglycemic efficacy and counts for its insulin-sensitizing, anti-inflammatory and immunomodulatory effects via TLR4-NFκB-SIRT-1 signaling cascade. Recommendations on regular intake of lactoferrin could ensure better glycemic control, compared to conventional antidiabetics alone.

Nerve conduction study of the association between glycemic variability and diabetes neuropathy.

Abstract: It remains unclear whether glycemic variability is related to diabetes microvascular disease, especially diabetes peripheral neuropathy (DPN) We investigated the association between glycemic variability and DPN with type 1 or 2 diabetes Forty patients (23 males and 17 females; aged 34–79 years) underwent continuous glucose monitoring (CGM) and a nerve conduction study (NCS) Glycemic variability was estimated by mean amplitude of glycemic excursions (MAGE) in CGM DPN was quantitatively evaluated by NCS in the median, tibial, sural and medial plantar nerves MAGE had a significantly positive correlation with disease duration and low-density lipoprotein cholesterol level (r = 0462, p = 0003; and r = 040, p = 0011, respectively), and a significantly negative correlation with BMI and medial plantar compound nerve action potential amplitude (r = − 039, p = 0012; and r = − 032, p = 0042, respectively) Multivariate linear regression analysis with adjustment for clinical background showed that MAGE (β = − 049, p= 0007) was independently associated with a higher risk of medial plantar neuropathy Glycemic variability may be an independent risk factor for DPN

Predicting type 2 diabetes mellitus: a comparison between the FINDRISC score and the metabolic syndrome.

Abstract: The aim of this study to compare the diagnostic accuracy of the metabolic syndrome (MetS) with the FINDRISC score to screen for type 2 diabetes mellitus T2DM in an overweight/obese population. Subjects 18 years or older visiting the obesity clinic of the Antwerp University Hospital were consecutively recruited between 2012 and 2014. Every patient underwent a standard metabolic work-up including a clinical examination with anthropometry. Glucose status was tested using OGTT and Hba1c. FINDRISC questionnaire and MetS were examined. Of 651 subjects, 50.4% were diagnosed with prediabetes, whereas 11.1% was diagnosed with T2DM. FINDRISC score increased with worsening of glucose status 11 ± 3, 13 ± 4 and 15 ± 5 in respectively, subjects without T2DM, prediabetes and T2DM. 312 subjects had the MetS. The aROC of the FINDRISC to identify subjects with T2DM was 0.76 (95% CI 0.72–0.82), sensitivity was 64% and specificity was 63% with 13 as cutoff point. Adding FPG or HbA1c to FINDRISC, the aROC increased significantly to 0.91(95% CI 0.88–0.95) and 0.93(95% CI 0.90–0.97), respectively (p < 0.001). The aROC of the MetS to identify subjects with diabetes was 0.72 (95% CI 0.65–0.78), sensitivity was 75% and specificity was 55%. The aROC of the FINDRISC + HbA1c was significantly higher than the MetS for predicting T2DM (p < 0.001). Prediction of type 2 diabetes is important for timely intervention and to avoid chronic complications associated with the disease. Our findings suggest, that it may be of good clinical practice to use the FINDRISC score + HbA1c in a two-step screening model for diabetes rather than using the metabolic syndrome.

The metabolic syndrome modifies the mRNA expression profile of extracellular vesicles derived from porcine mesenchymal stem cells

Abstract: Mesenchymal stem cells (MSCs) perform paracrine functions by releasing extracellular vesicles (EVs) containing microRNA, mRNA, and proteins. We investigated the mRNA content of EVs in metabolic syndrome (MetS) and tested hypothesis that comorbidities interfere with the paracrine functionality of MSCs. Mesenchymal stem cells were collected from swine abdominal adipose tissue after 16 weeks of a low- (Lean) or high-calorie (MetS) diet (n = 5 each). We used next-generation mRNAs sequencing to identify mRNAs enriched and depleted in Lean- or MetS-EVs compared to the parent MSCs. We found 88 and 130 mRNAs enriched in Lean-EVs and MetS-EVs, respectively, of which only eight were common genes encoding proteins related to the nucleus, endoplasmic reticulum, and membrane fraction. Lean-EVs were enriched with mRNAs primarily involved in transcription regulation and the transforming growth factor (TGF)-β signaling pathway, but devoid of genes related to regulation of inflammation. In contrast, MetS-EVs contained mRNAs involved in translational regulation and modulation of inflammation mediated by chemokines and cytokines, but lacked mRNAs related to TGF-β signaling. mRNAs enriched in EVs have the potential to target a significant proportion of genes enriched in EVs, but only 4% microRNA target genes overlap between Lean- and MetS-EVs. Co-culture with MetS-EVs also increased renal tubular cell inflammation in-vitro. Metabolic syndrome may affect immunomodulatory function of porcine MSCs by modifying mRNA profiles of the EVs that they produce and post-transcriptional regulation. These observations may have important implications for cell-based therapy, and support development of strategies to improve the efficacy of MSCs and their EVs.

Associations of serum calcium levels and dietary calcium intake with incident type 2 diabetes over 10 years: the Korean Genome and Epidemiology Study (KoGES).

Abstract: Previous evidence regarding the associations between serum calcium concentrations, dietary calcium intake, and type 2 diabetes (T2D) is limited. We investigated the longitudinal associations of serum calcium levels and dietary calcium intake with T2D development. This study used data from the Ansung–Ansan cohort, a community-based, prospective cohort that was followed up for 10 years. Cox regression models adjusted for potential confounders were used to evaluate the associations of serum calcium levels (mean, 9.41 mg/dL) and dietary calcium intake (median, 389.59 mg/day) with T2D incidence. Association between dietary calcium intake and serum calcium levels was assessed using linear regression models. Albumin-adjusted serum calcium levels were not associated with T2D risk (hazard ratio [HR] = 1.07, 95% confidence interval [CI] 0.96, 1.19, p-value = 0.2333). A one-unit increase in log-transformed, energy-adjusted dietary calcium intake was associated with a decreased risk of T2D (HR = 0.88, 95% CI 0.77, 1.00, p-value = 0.0460) and lower albumin-adjusted serum calcium levels (β = − 0.04, 95% CI − 0.07, − 0.02, p-value = 0.0014). The associations did not differ according to sex (all p-values for interaction > 0.10). Serum calcium levels were not associated with T2D risk, while higher dietary calcium intake was associated with a decreased risk of T2D development. These results have public health implications for predicting and preventing T2D development, as well as providing guidelines for diet and calcium supplementation.

Neck circumference and its association with cardiometabolic risk factors: a systematic review and meta-analysis.

Abstract: Recently, neck circumference (NC) has been used to predict the risk of cardiometabolic factors. This study aimed to perform a systematic review and meta-analysis to examine: (i) the sensitivity (SE) and specificity (SP) of NC to predict cardiometabolic risk factors and (ii) the association between NC and the risk of cardiometabolic parameters. A systematic search was conducted through PubMed/Medline, Institute of Scientific Information, and Scopus, until 2017 based on the search terms of metabolic syndrome (MetS) and cardio metabolic risk factors. Random-effect model was used to perform a meta-analysis and estimate the pooled SE, SP and correlation coefficient (CC). A total of 41 full texts were selected for systematic review. The pooled SE of greater NC to predict MetS was 65% (95% CI 58, 72) and 77% (95% CI 55, 99) in adult and children, respectively. Additionally, the pooled SP was 66% (95% CI 60, 72) and 66% (95% CI 48, 84) in adult and children, respectively. According to the results of meta-analysis in adults, NC had a positive and significant correlation with fasting blood sugar (FBS) (CC: 0.16, 95% CI 0.13, 0.20), HOMA-IR (0.38, 95% CI 0.25, 0.50), total cholesterol (TC) (0.07 95% CI 0.02, 0.12), triglyceride (TG) concentrations (0.23, 95% CI 0.19, 0.28) and low density lipoprotein cholesterol (LDL-C) (0.14, 95% CI 0.07, 0.22). Among children, NC was positively associated with FBS (CC: 0.12, 95% CI 0.07, 0.16), TG (CC: 0.21, 95% CI 0.17, 0.25), and TC concentrations (CC: 0.07, 95% CI 0.02, 0.12). However, it was not significant for LDL-C. NC has a good predictive value to identify some cardiometabolic risk factors. There was a positive association between high NC and most cardiometabolic risk factors. However due to high heterogeneity, findings should be declared with caution.

Dapagliflozin improves treatment satisfaction in overweight patients with type 2 diabetes mellitus: a patient reported outcome study (PRO study).

Abstract: The benefits of sodium glucose cotransporters 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus include plasma glucose control, reduction in body weight and blood pressure, and low risk of hypoglycemia, although they may also cause genitourinary infections, polyuria, or volume depletion. It is not clear whether dapagliflozin, an SGLT2 inhibitor, improves treatment satisfaction among patients in a comprehensive way despite the negative side effects. This study assessed the effect of dapagliflozin on glycosylated hemoglobin (HbA1c), body weight, and treatment satisfaction in overweight patients with type 2 diabetes mellitus treated with oral hypoglycemic agents. This multicenter, open-label, single-arm observational study included patients with type 2 diabetes mellitus administering dapagliflozin 5 or 10 mg per day for 14 weeks. Changes in treatment satisfaction were evaluated using a new version of the Oral Hypoglycemic Agent-Questionnaire (OHA-Q ver. 2) consisting of 23 items. Correlation between treatment satisfaction and HbA1c levels and body weight were analyzed using the Spearman’s rank-correlation coefficient. Of the 221 patients enrolled, 188 completed the study. Mean HbA1c decreased from 7.8 ± 0.7% (62.1 ± 7.5 mmol/mol) to 7.3 ± 0.8% (55.9 ± 8.7 mmol/mol) (change − 0.6 ± 0.7%, P < 0.001) and body weight decreased from 82.5 ± 14.6 to 80.7 ± 14.8 kg (change − 2.3 ± 2.8 kg, P < 0.001). OHA-Q ver. 2 was validated as well, the mean OHA-Q ver. 2 total score increased from 44.3 ± 9.4 to 46.6 ± 9.8 (best score 69, worst score 0; change 2.3 ± 6.6, P < 0.001). The change in body weight significantly correlated with the OHA-Q ver. 2 total score (Spearman’s ρ = − 0.17, P = 0.035). The change in HbA1c levels significantly correlated with the satisfaction subscale score (Spearman’s ρ = − 0.19, P = 0.011). Dapagliflozin significantly improved treatment satisfaction among patients with type 2 diabetes mellitus for 14 weeks. Body weight loss significantly correlated with treatment satisfaction. Trial registration UMIN-CTR: UMIN000016304

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study

Abstract: This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents. This nationwide study was conducted in 2015 among 4200 students aged 7–18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case–control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used. The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01–1.66), elevated blood pressure (OR 1.35; 95% CI 1.01–1.81) and MetS (OR 1.33; 95% CI 1.02–1.74). The two other dietary patterns were not associated with MetS and its components. Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits.

Effectiveness of gliclazide MR 60 mg in the management of type 2 diabetes: analyses from the EASYDia trial.

Abstract: Although the number of antihyperglycemic agents has expanded significantly, sulfonylureas (in particular gliclazide) remain an important option because of a variety of patient and health system factors. The large, real world, observational, and international EASYDia trial evaluated the effectiveness of gliclazide modified release (MR) 60 mg in individuals with type 2 diabetes with a broad range of diabetes history, body mass index (BMI) and background antihyperglycemic treatment. A total of 7170 participants from eight countries, age ≥ 35 years with HbA1c ≥ 7.5% and not treated with insulin, were prescribed 30–120 mg of gliclazide MR 60 mg once daily. HbA1c goals were individualized and dosing uptitrated, as required, over the 6-month long study. In this post hoc subanalysis, efficacy endpoints were analyzed according to stratified baseline HbA1c levels, weight and glucose-lowering regimens. Episodes of hypoglycemia requiring assistance were documented. At baseline, mean age was 58.9 years, HbA1c 8.8%, BMI 30.1 kg/m2, and diabetes duration 5.1 years. At study end, clinically significant HbA1c improvements (mean change − 1.78%) were noted across all baseline HbA1c strata (> 7.0 to ≤ 8.0%, > 8.0 to ≤ 9.0%, > 9.0 to ≤ 10.0%, and > 10.0%), BMI classifications (18.5 to < 25.0, 25.0 to < 30.0, and ≥ 30.0 kg/m2), and regardless of the original diabetes treatment regimen (P < 0.001 in all cases). In contrast to the subgroups with BMI 25.0–30.0 and ≥ 30.0 kg/m2 that registered weight losses of 0.9 and 2.2 kg, respectively (P < 0.001 vs. baseline weight); the BMI 18.5–24.9 kg/m2 subgroup gained a mean 0.5 kg (P < 0.02 vs. baseline weight). Severe hypoglycemic events were rare (0.06%). Progressive gliclazide MR 60 mg uptitration was well tolerated and lowered HbA1c across a broad range of HbA1c, BMI and background glucose-lowering therapy. Weight loss was noted when BMI was ≥ 25.0 kg/m2. Individuals with the highest baseline HbA1c and BMI experienced the greatest HbA1c and weight improvements. Trial registration ISRCTN Registry ISRCTN00943368 on 1st July 2011

Chikungunya and diabetes, what do we know?

Abstract: Chikungunya (CHIK) is a viral disease transmitted by mosquitoes. The first cases in Brazil were confirmed in 2014. Between 2016 and 2017, over 300,000 cases were identified during this period, with nearly 300 deaths. The clinical manifestations, pathogenesis and risk factors for occurrence of severe cases are not yet well understood, although it is known that the severity of the cases is associated with the presence of comorbidities, especially diabetes mellitus (DM). To review the medical literature for the associations between DM and CHIK and to understand the potential impact on metabolic state and its complications. Literature review was carried out to search for articles (English, Portuguese and Spanish) in Medline and Virtual Health Library databases for the period between 1952 and 2017, with the following keywords: “Chikungunya fever”, “Chikungunya virus”, “diabetes mellitus”, “diabetes”, “diabetes complications “and “multi-morbidities (MeSH) “with interposition of the Boolean operator “AND”. After removal of duplicities and following exclusion criteria, 11 articles were selected. Our results showed that the patients of CHIK with DM had more severe and prolonged symptoms of CHIK and more frequently required hospitalization. No study investigated the biological process to explain how hyperglycemic state worsened the clinical manifestations of Chikungunya in diabetic patients. An important association between DM and the severity of CHIK is observed. Prospective and more rigorous controlled studies are required to generate evidence that might y elucidate the causes of this relationship. Given the fast expanding viral infection of Chikungunya in Central and South America, Asia and Africa in recent years in the context of exponential increase in diabetes globally, the issue deserves global attention.

Metabolic syndrome among overweight and obese adults in Palestinian refugee camps.

Abstract: Metabolic syndrome (MetS) is one of the main reasons for elevated cardiovascular morbidity and mortality worldwide. Obese and overweight individuals are at high risk of developing these chronic diseases. The aim of this study was to characterize and establish sex-adjusted prevalence of metabolic syndrome and its components. A cross-sectional study was conducted in 2015, 689 (329 men and 360 women) aged 18–65 years from three refugee camps in the West Bank. International Diabetes Federation and modified National Cholesterol Education Program-Third Adult Treatment Panel definitions were used to identify MetS. The overall prevalence of obesity and overweight was high, 63.1%; Obesity (42 and 29.2% in women men; respectively and overweight 25.8 and 28.9% in women and men; respectively. The prevalence of MetS among obese and overweight was significantly higher (69.4%) according to IDF than NCEP definition (52%) (p < 0.002) with no significant differences between men and women using both definitions; (IDF; 71.8% men vs. 67.6% women, and (NCEP/ATP III; 51.9% men vs. 52.2% women). The prevalence of MetS increased significantly with increasing obesity and age when NCEP criterion is applied but not IDF. The prevalence of individual MetS components was: high waist circumference 81.3% according to IDF and 56.5% according to NCEP, elevated FBS 65.3% according to IDF and 56% according to NCEP, elevated blood pressure 48%, decreased HDL 65.8%, and elevated triglycerides 31.7%. Based on gender differences, waist circumferences were significantly higher in women according to both criteria and only elevated FBS was higher in women according to IDF criteria. Physical activity was inversely associated with MetS prevalence according to NCEP but not IDF. No significant associations were found with gender, smoking, TV watching, and family history of hypertension or diabetes mellitus. In this study, irrespective of the definition used, metabolic syndrome is highly prevalent in obese and overweight Palestinian adults with no gender-based differences. The contribution of the metabolic components to the metabolic syndrome is different in men and women. With the increase of age and obesity, the clustering of metabolic syndrome components increased remarkably. More attention through health care providers should, therefore, be given to the adult population at risk to reduce adulthood obesity and subsequent cardiovascular diseases.