Current Diabetes Reviews - Volume 19, Issue 7, 2023

Objective: A systematic review of the prevalence and prognosis of posttransplant diabetes mellitus (PTDM) following the transplantation of heart, lung, liver and kidney and a metaanalysis of randomised studies of glucose-lowering treatment is reported. Methods: We searched for publications on solid organ transplants and PTDM in relation to the risk and total mortality of PTDM and randomized controlled trials aiming at reducing glucose levels. Results: PTDM prevalence one year after transplantation was reported to be 9-40%. Ten years after transplantation, 60-85% of people without PTDM and 30-76% of people with PTDM were alive. Following kidney transplantation, we identified six randomized controlled trials on the treatment of PTDM. Intervention ranged from 3 to 12 months. Four studies used intervention with oral glucose-lowering drugs, one used dietician appointments and exercise, and one used insulin treatment. Among the intermediate results reported, a reduction in HbA1c of 2.7 mmol/mol, and an increase in the odds ratio of serious adverse events of 3.0 was significant. Conclusion: In conclusion, information on the prevalence and effect on survival of PTDM is heterogeneous, and the randomized studies on the effect of treatment available are short and lack information on clinically important endpoints, such as mortality or morbidity.

Diabetes mellitus has been a common metabolic disorder in recent years across the world. It has affected approximately 463 million people worldwide, which has tripled in the last two decades. It has been forecasted to show an upward trend through 2030 and 2045 in China, India, and the United States. Few studies have been done to assess the impact of gut microbiota on human. Diabetes mellitus is found to have an association with gut microbiota. Few animal studies are available linking the alteration of gut microbiota in diabetes mellitus. Probiotics have been found to have anti-diabetic properties. If diabetes is treated with diet modification in addition to drugs, it could change the spectrum of intestinal bacteria by boosting commensal bacteria and decreasing the harmful bacteria in the microbiome population of the gastrointestinal tract, which is highly beneficial. This could aid diabetics in managing diabetes mellitus and its complications effectively. This review has been undertaken to address the management of diabetes mellitus with a focus on the gut microbiome in addition to antidiabetic medications.

The current standard method for type 1 diabetes (T1D) management majorly focuses on controlling blood glucose levels with exogeneous insulin administration. Recent developments have focused on finding ways to predict and prevent the development of T1D, as well as finding a curative therapy for T1D. Such developments include β-cell replacement therapy by islet transplantation, non-insulin adjunct therapy, gene and stem cell-based therapies, immunotherapy, and automated treatment with an artificial pancreas. In recent years, non-traditional alternative therapy has also become a popular treatment option for T1D. This review discusses the various therapeutic options for T1D currently under various stages of development, the challenges associated with the present strategies, and their potential to eventually change the way T1D is treated.

Diabetes is one of the main causes of infertility, which impacts the quality of life of couples. These reproductive complications are important issues for all clinicians. The strategies for the treatment of diabetes-induced infertility are limited with the high cost and unsatisfied results. Due to the multi-directional differentiation potential and self-renewal ability of stem cells, these cells have emerged as attractive therapeutic agents in many diseases, including diabetes mellitus. We reviewed the current knowledge on the best available evidence regarding the role of stem cell transplantation in reproductive complications of diabetes.

Background and Aims: Neuropathy is the most prevalent among diabetes-related microvascular complications, of which distal symmetric polyneuropathy is very extensive. This study aimed to evaluate the frequency and risk factors for Diabetic Peripheral Neuropathy (DPN) among Type 2 Diabetes (T2D) in Saudi Arabia. Methods: This study included 238 patients with T2D, between 18 and 80 years of age. Using a structured questionnaire, data on the sociodemographic characters of the study group and laboratory tests were collected. Distal symmetrical peripheral neuropathy in patients with diabetes was identified using the Michigan Neuropathy Screening Instrument (MNSI). Results: In this cohort, 66 patients (27.7%) had positive MNSI questionnaire scores (≥ 7) and 90 (37.8%) patients had positive examination scores (≥ 2.5). From the patient's perception, patients on oral plus insulin treatment exhibited a higher risk for DPN (OR 2.95; p = 0.018) than those who received only oral treatment and an ulcer in an earlier period exhibited a higher risk for DPN (OR: 3.25; p = 0.005). From the health professionals’ perception, more females than males showed a high risk for DPN (OR: 3.92; p = 0004). Likewise, compared to the patients in the age group of <50 years, those in the age group of ≥50 years revealed a high risk for DPN (OR 6.30; p = 0.009). Further, patients on oral and insulin treatments were at greater risk for DPN (OR: 3.71; p = 0.024); patients experiencing complications like prior ulcers, and high-density lipoprotein also exhibited higher risk than the patients who lacked them. Conclusion: Diabetes neuropathy is one of the most common complications of microangiopathy experienced by patients with T2D in Saudi Arabia. The risks for DPN among patients with T2D can be reduced with the implementation of focused and evidence-based interventions.

Diabetes mellitus is a metabolic syndrome of excess glucose levels in the blood. It may be due to glucose intolerance by the tissues and inadequate insulin production from pancreatic β- cells. However, diabetic complication includes cardiovascular and kidney diseases, eye, skin, and foot complications, and neuropathy. The intention behind writing this article was to gather recent information regarding the use of ancient traditional medicinal plants having recent importance in treating diabetes. Several therapies are available for curing the condition based on severity and type of diabetes. Although pharmacological treatments are effective and economical, drugs are associated with unwanted side effects and physiological complications on long-term use. Interestingly, herbs and herbal plants have been used since ancient times against diabetes worldwide. Its importance still exists due to medicinal plants' effectiveness and safety profile in treating various diseases. In this article, we searched online databases, including PUBMED, SCOPUS, MEDLINE, and traditional resources, for collecting information regarding the use of plants against diabetes. We described the pathophysiology of the disease and incorporated plant sources and their chemical constituents responsible for antidiabetic activity with their mechanism in reducing blood glucose levels. The present article may be very helpful for researchers and professionals whose work is inclined towards diabetes and in search of lead compounds for the development of a suitable drug.

Background: Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes. Methods: A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. Results: Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor’s degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). Conclusion: Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

Background: Skeletal muscle is an endocrine organ that plays an important role in metabolic health by secreting a variety of myokines. Recent studies have shown that exercise significantly decreases interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in patients with type 2 diabetes (T2D). This paper explores the effect of chronic exercise on myokines in patients with T2D and/or obesity. Methods: The author searched for relevant English-language articles in PubMed. A total of 14 randomized controlled studies were found to be eligible for this short review. Results: It has been observed that chronic exercise does not change brain-derived neurotrophic factor (BDNF), irisin, and secreted protein acidic and rich in cysteine levels, whereas it decreases TNF-α levels in patients with T2D. Combined aerobic exercise (AE) and resistance training (RT) or sprint interval training increase insulin-like growth factor 1 (IGF-1) levels and decrease IL-6 and IL-15 levels in patients with T2D. Combined AE and RT may also increase IL-15 levels in obese individuals. In addition, RT alone may increase BDNF, IGF-1, and IL-7 levels in overweight individuals. However, AE alone does not change circulating myokine levels in patients with T2D, while it may increase myonectin levels in obese individuals. Conclusion: This short review demonstrated that exercise appears to have favorable effects on some myokines in patients with T2D and/or obesity. However, it remains inconclusive due to the heterogeneity in subject characteristics and exercise modalities.

The aging process and the concomitant physiological changes that come with increasing age have been a focus of researchers and the general population for centuries. The pursuit of knowledge and understanding of the aging process was famously articulated by Aristotle, stating, “education is the best provision for old age.” This remains true today in our quest to understand the physiological underpinnings of aging and the incessant attempt to slow or reverse many of the processes. The need to understand normal aging physiology is important to guide future targeted interventions to promote autonomy and prevent impairment of functioning. The risk of frailty, “vulnerability to stressors” and impaired or decreased functioning of a multitude of body systems is a major public health consideration for adults 65 years or older. While there has been a plethora of research on the aging effects of different systems throughout the body, the following literature review will focus on our recent understanding of the components of nutrient handling, specifically the endocrine system in older adults. By understanding the normal physiological changes that occur in response to nutrients, future interventions can be targeted to promote an extension of optimal functioning throughout the lifespan.

Background: Autoimmune metabolic diseases generate numerous healthy and social problems. The possible association of SNPs in the ubiquitin-proteasome system (UPS) with human pathology is under intensive study. Objective: In the present study, the genetic variations in PSMB5 (rs11543947), PSMA6 (rs2277460, rs1048990), PSMC6 (rs2295826, rs2295827) and PSMA3 (rs2348071) UPS gene cluster was investigated in type 1 diabetes and healthy donors in the Polish population. Methods: The study comprised 105 patients with type 1 diabetes mellitus (T1DM) and 214 controls. All were genotyped by PCR and restriction digestion analysis or Sanger sequencing. Results: Rs1048990 and rs2348071 were found to be neutral to T1DM (p-value: 0.499 and 0.656, respectively). According to the multiple loci genotype (MLG) analysis, the major homozygote of the tested polymorphisms had a protective effect. The most common MLG in the T1DM group was characterised by simultaneous risk factors at rs11543947, rs2277460, rs2295826 and rs2295827 (pvalue: <0.0001 vs. MGL1). Multiple locus haplotype analysis revealed a similar dependence, with common alleles at all tested loci demonstrating a protective effect, and the rare alleles increasing T1DM risk (p-value: <0.0001 vs. MLH1). Conclusion: Our study suggests that the proteasome gene polymorphisms rs11543947, rs2277460, rs2295826, and rs2295827 could be potential markers for T1DM susceptibility in the Polish population.

Background: The role of pharmacists in middle-income countries such as Indonesia is still not optimal. In this study, we developed a program called “Phardiacare”, a specific pharmacist-led program for Type 2 diabetes mellitus (T2DM) patients. Objective: The objective of this study is to assess the effectiveness of the application of the “Phardiacare” program in improving medication adherence and clinical outcomes in T2DM patients. Methods: The study was quasi-experimental, with a pretest-posttest design, and was conducted prospectively from July to October 2019 at the Matraman and Jatinegara District Health Center, Jakarta, Indonesia. The study comprised 33 T2DM patients in an intervention group (IG) who received the “Phardiacare” program and 33 patients in a control group (CG). Assessment was performed of HbA1c, FBG, LDL, HDL, total cholesterol, triglycerides, and blood pressure. Results: HbA1c after intervention in the IG was lower than that of the CG (p <0.05). Intra-group mean differences showed improvement in the clinical parameters of FBG, triglycerides, and diastolic blood pressure in the IG (p <0.05), but not in the CG. Other clinical parameters did not show significant improvement. The results of the multivariate analysis showed that the “Phardiacare” program had a 16 times greater effect in reducing levels of HbA1c in the IG [95% CI 3.995:67.113, p <0.001] compared to the CG, even after controlling for confounding variables. Conclusion: The “Phardiacare” program was effective in improving patient medication adherence by decreasing HbA1c and FBG, but it did not have a significant effect on LDL, HDL, total cholesterol, and systolic blood pressure. Therefore, the implementation of Phardiacare program in the management of chronic diseases, especially T2DM, should be considered.

Background: Diabetes has become a problem that plagues public healthcare systems. Recent studies have shown that intestinal flora exerts positive therapeutic effects on metabolic diseases, and plant-derived secondary metabolites are safe, effective and easy to prepare and also have an impact on intestinal flora and diabetes; these drugs have rarely been reviewed before as a class of drugs for diabetes, especially focusing on the intestinal flora. Therefore, studying the relationship between plant-derived secondary metabolites and diabetes mellitus is crucial. Objective: The objective of this study is to summarize and investigate the therapeutic mechanism of drugs extracted from natural plants effects on type 2 diabetes mellitus. Methods: The relationship between flora and type 2 diabetes was investigated by reviewing the recent experimental literature, and the pathways available for natural plant-derived secondary metabolites in the treatment of type 2 diabetes were summarized. Results: The therapeutic mechanisms of common plant-derived secondary metabolites for type 2 diabetes were summarized with a focus on the prebiotic efficacy of natural plant-derived secondary metabolites and the modulation of intestinal flora, and the mechanisms through which plantderived secondary metabolites treat type 2 diabetes via effects on intestinal flora are further reviewed. Conclusion: Common plant-derived secondary metabolites can play a role in regulating bacteria in the intestinal tract by enriching beneficial bacteria and removing harmful bacteria to achieve their therapeutic effect on type 2 diabetes. In addition, due to their excellent ability to regulate intestinal flora, plant-derived secondary metabolites may also have excellent efficacy in cancer and obesity, among other diseases.

Background: COVID-19 may have an impact on diabetes pathogenesis. For people with COVID-19 infection as well as for healthy individuals, blood glucose control is essential. Nowadays, innovations like telemedicine are helpful in treating diabetic patients. Objectives: We examined the data on the link between diabetes and COVID-19, the pathogenesis of diabetes, and treatment of COVID-19 infection in diabetic patients. Methods: Up until October 2, 2021, the key terms 'COVID-19,' 'SARSCoV2,' 'diabetes,' and 'antidiabetic therapy' were searched in the PubMed database and Google Scholar. The full texts of the articles were accessed. Results: Some diseases, for instance, diabetes, are continuously suggested as risk factor which result in the severity and mortality of COVID-19. However, to date, there are no comprehensive studies aiming to explain the exact relationship between diabetes and COVID-19. COVID-19 has been linked to an increased incidence and severity in diabetic patients. COVID-19 may have an impact on diabetes pathogenesis. Blood glucose control is critical not only for COVID-19-infected patients but also for those who do not have the condition. In today's world, innovations like telemedicine are helpful in treating diabetic patients. Conclusion: Thus, this study aims to summarize the evidence about diabetes and COVID-19 outbreak through a systematic review and meta-analysis approach. COVID-19 has been linked to an increased incidence and severity in diabetic patients.

Artificial sweeteners (AS) were first introduced as food additives or sugar substitutes more than a century ago with the intention of supplying sweet taste without the high caloric content of sugar. AS are employed in place of sucrose (table sugar) with the view of providing sweetness to foodstuffs and bottled drinks. The end-users, along with producers of canned food and drinks, have long been captivated by the idea of replacing sugar in food items with AS. Foods that use AS in place of sugar have become increasingly common during the past decade. Artificial sugars are normally many folds sweeter than normal sugar possessing low or zero calories, which confers to their public appeal for the management of overweight issues. Due to this, they are, at present, employed by many individuals all over the world, without knowing the potential hazards associated with them. The use of AS in obese, diabetic, and/or heart patients or patients with metabolic syndrome has been approved with caution by The American Heart Association and American Diabetes Association (ADA) as a low-calorie option for normal sugar. Judicious use of sugar substitutes can help in maintaining blood glucose, calories and body weight, thus automatically minimizing the risk factors of diabetes and heart disease. Since the day of their discovery and approval, their safety issue has been quite controversial and debated extensively. The article follows an exhaustive review discussing the history, uses, and chemical features of a wide variety of sweeteners with a focus on their association with diabetes and potential adverse effects on the body.