Current Diabetes Reviews - Volume 16, Issue 1, 2020

Introduction: Type 2 Diabetes (T2D) cases continue to rise dramatically despite efforts to get people to exercise and eat with a view to health and combatting the cluster of 7 issues (central obesity (elevated waist circumference), hyperglycaemia, hypertension, dyslipidemia, pro-thrombotic state, increased oxidation (including Low-density Lipoprotein (LDL)) and the pro-inflammatory state associated with pre- and post-onset T2D. Background: There are numerous medications available to deal with these seven major issues. However, each medication currently available manages a maximum of two cluster members at a time. Consequently, polypharmacy is frequently required to manage the cluster of seven. Polypharmacy brings with it high financial costs for numerous medications, the risk of poor compliance (particularly so in older patients), side effects and drug interactions. Thus, there is a search for new agents that reduce the high costs and risks of polypharmacy while at the same time combatting three or more of the cluster of seven. There is very limited evidence to suggest that one or more lignans may efficaciously and safely, in the short and long term, manage at least three of the cluster of seven, pre- and post-T2D onset, thus reducing polypharmacy. However, multi-centre, large clinical trials are required before any definitive conclusions about these lignans can be reached regarding their safe and efficacious polypharmacy reduction potential, both long and short-term, in pre and post-onset T2D management. Conclusion: It is concluded that some lignans appear to have the potential to manage at least three members of the cluster of seven in pre- or post-T2D onset and hence reduce polypharmacy but much more investigation is required to confirm if such is the case. At the moment, there is not enough evidence that any of the lignans will, in the long or short term, safely and efficaciously manage the cluster of seven via polypharmacy reduction.

Background: Over the past decades, the development and use of an array of prescription medications have considerably improved the clinical management of type 2 diabetes mellitus and the quality of life of patients. However, as our knowledge of the associated risk factors and approaches to its management increases, the increasing roles of diet and the composition of the diet in the etiology and successful management of diabetes mellitus are being illuminated. Presently, a lot of attention is being given to nutraceuticals and certain phytochemicals that are integral parts of the human diet. It is believed that a clearer understanding of their roles may be crucial to ‘non-invasive’ or minimallyintrusive management, with regards to daily living of patients. In this review, an overview of nutraceutical components and phytochemicals that may be of benefit, or had been known to be beneficial in diabetes mellitus is given. Also, how the roles of such dietary components are evolving in the management of this disorder is highlighted. Lastly, the obstacles that need to be overcome before nutraceuticals can be considered as options for the clinical management of diabetes mellitus areconsidered. Conclusion: Despite studies that demonstrate their efficacy, no nutraceutical or food-derived compound has been formally adopted as a direct replacement for any class of antidiabetic drugs.

Background: Diabetic complications are the major contributor in the mortality of diabetic patients despite controlling blood glucose level. In the journey of new drug discovery, animal models have to play a major role. A large number of chemical-induced and genetically modified animal models have been investigated to induce diabetic complications but none of them was found to be mimicking the pathophysiology of the human. Therefore, the search and identification of the appropriate animal model become essential. Objective: In the present review, we have made an attempt to understand the pathophysiology of diabetic complication in the neonatal streptozotocin-diabetic rat model and tried to identify the targets for therapeutic agents. The review will help the researchers to explore the animal model to induce diabetic complications, to identify targets and further to find lead molecules for treatment or prevention of diabetic complications. Methods: We have compiled the available research work from 1974 by using prominent databases, organized the available information and analyzed the data to improve the understanding of the pathophysiology of streptozotocin-induced diabetic complications in neonates of rats. Results: The neonatal streptozotocin-diabetic rat model is frequently used and well-established animal model for type 2 diabetes mellitus. We have found that this model has been used to study the pathogenesis of various micro and macrovascular diabetic complications and also investigated for its effects on the liver, thymus gland, and brain. The underlying pathophysiology for complications had a resemblance to the human. Conclusion: The neonatal streptozotocin-diabetic rat model may demonstrate symptomatic diabetic complications due to persistent hyperglycemia at the age of approximately 18-24 weeks. Critical interpretations of available research work showed that the researcher can explore split dose STZ (90- 100mg/kg b.w) model to induce Type 2 DM in neonates of rats at 2nd or 3rd postnatal day.

Background and Aims: Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation. Methods: This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study. Results: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated. Conclusion: This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.

Introduction: Scientists are considering the possibility of treating diabetes mellitus (DM) using a personalized approach in which various forms of the diseases will be treated based on the causal gene and its pathogenesis. To this end, scientists have identified mutations in certain genes as probable causes of Type 2 diabetes mellitus (T2DM) with diverse mechanisms. Aim: This review was aimed at articulating already identified T2DM genes with their mechanisms of action and phenotypic presentations for the awareness of all stakeholders. Method: The Google search engine was used to retrieve relevant information on the subject from reliable academic databases such as PubMed, Medline, and Google Scholar, among others. Results: At least seventy (70) genes are currently being suspected in the biogenesis of T2DM. However, mutations in, or variants of KCNJ11, PPARG, HNF1B and WFS1 genes, are the most suspected and reported in the pathogenesis of the disease. Mutations in these genes can cause disruption of insulin biosynthesis through the destruction of pancreatic beta cells, change of beta cell morphology, destruction of insulin receptors, among others. These cellular events may lead to insulin resistance and hyperglycemia and, along with environmental triggers such as obesity and overweight, culminate in T2DM. It was observed that each identified gene has its distinct mechanism by which it interacts with other genes and environmental factors to cause T2DM. Conclusion: Healthcare providers are advised to formulate T2DM drugs or treatment by targeting the causal genes along with their mechanisms.

Background: The diabetic Charcot foot syndrome is a serious and potentially limbthreatening lower-extremity complication of diabetes. Introduction: The present review provides a concise account of the advances made over the last twentyfive years in understanding the pathogenesis and management of Charcot neuroarthropathy (CN). Methods: In this study, the widely known pathogenetic mechanisms underpinning CN are brought into focus, particularly the role of RANKL/RANK/OPG system and advanced glycation end production in the pathogenesis of CN. Furthermore, other potential triggering factors, namely nitric oxide, endothelial dysfunction, macro calcifications and body weight that influence CN have also been discussed. Results: The wide range of diagnostic tools available to clinicians for accurate staging of this pathology has been examined, particularly radiological and nuclear medicine imaging. Additionally, the difficult differential diagnosis between osteomyelitis and CN is also elucidated. Conclusion: The review concludes with the comprehensive summary of the major promising therapeutic strategies, including conservative treatment involving orthopedic devices, pharmacological approach, and the most common surgical techniques currently employed in the diagnosis and treatment of this acute disease.

Background: Type 1 Diabetes Mellitus (T1DM) is a multifactorial autoimmune disease. The Protein Tyrosine Phosphatase Non-receptor 22 (PTPN22) gene is an important negative regulator of signal transduction through the T-cell Receptors (TCR). A PTPN22 polymorphism, C1858T, has been found to be a risk determinant for several autoimmune diseases, including T1DM, in different populations. Objective: The present study was aimed to analyze a possible association between the C1858T polymorphism in Egyptian children with T1DM. Methods: This case-control study included 240 children divided evenly between T1DM patients and controls. The PTPN22 C1858T polymorphism was genotyped using polymerase chain reaction with Restriction Fragment Length Polymorphism (RFLP). Results: Both the 1858C and 1858 genotypes and the 1858T allele were found more frequently in patients (32.5% and 18.7%, respectively) than in controls (10% and 5.0%, respectively), P=0.013 and P=0.007, respectively. Among females, the 1858T allele was more common in patients (18%) than in controls (2.6%), P=0.014. Conclusion: These findings suggest that the PTPN22 1858T allele could be a T1DM susceptibility factor in the Egyptian population and that it might play a different role in susceptibility to T1DM according to gender in T1DM patients.

Objectives: Telephonic health coaching has been studied extensively as an interventional approach for chronic disease management. No studies have been conducted evaluating the outcomes of a multiyear study on health coaching participation and glycated haemoglobin (A1C) changes. Chronic disease has been widespread in physical laborers, with a high onset of type 2 diabetes. The purpose of this study was to establish the efficacy of telephonic health coaching as a means to manage type 2 diabetes in adults with physical labor occupations. Methods: The eligibility criteria were: 1) Adults aged 20-80 during the study entirety; 2) A diagnosis of type 2 diabetes; and 3) Yearly A1C and Body Mass Index (BMI) testing via verified biometric screenings. Participants completing health coaching for at least 2 years during the study period were assigned to the experimental group and participants who only had yearly biometric screening were assigned to the control group. Results: From 2014-2018, 350 participants met the inclusion criteria. The mean age at baseline was 56 years (SD 8.26), with a mean baseline A1C of 7.14% for the test group, and 5.41% for the control group. Pre-post test changes saw an increase in A1C of 0.85% in the test group, and 0.95% in the control group. BMI changes were not statistically significant. Conclusion: Further study is needed to refine current telephonic health coaching programs for disease management. This study suggests that the efficacy of telephonic health coaching in its current form is not enough to improve BMI outcomes in patients with diabetes, and over the phone coaching alone is insufficient to improve patient A1C levels and sustain them for long-term.

Background: The Fat mass and obesity-associated gene (FTO) and its involvement in weight gain and obesity is well-known. However, no reports have been published on the Indian population regarding the relationship between single nucleotide polymorphisms (SNPs) in its intronic region and obesity. The aim of this pilot study was to evaluate the frequency and association of SNPs in intron-1 of the FTO gene in obese and overweight Indian adults. Methods: This study group consisted of 80 adults, aged 23.5 ± 8.9 yr, with a mean BMI of 28.8 ± 6.2 kg/m2. Genomic DNA was isolated, exons1-3 & intron1 of FTO were amplified using polymerase chain reaction and sequenced by ABI sequencing detection system. The reported SNPs rs1420185, rs8050136, rs1121980 and rs55872725 were checked for their presence or absence in this group of the adult Indian population. Results: No mutations were found in the exonic sequence of FTO, however, the association of rs1420185, rs8050136, rs1121980 and rs55872725 SNPs was identified in this population. The genotypic frequency at FTO rs8050136 was 32.2% for C>A, at rs55872725 it was 45.7% for C>T, at rs1420185 it was 27.1% for T>C and at rs1121980 it was 30.5% for G>A. All four SNPs in combination were observed in 6 participants (10.2%), all of whom were found to be either obese or overweight. Conclusion: These findings indicate that Indians with these SNPs are most likely to be at increased risk of obesity.