Category Archives: Diabetes

More evidence suggests that medications such as Ozempic and Mounjaro, originally developed for diabetes and then approved for obesity, have benefits that go beyond these conditions. Those include lower risk of 10 cancers, protection against heart and kidney diseases, and reduction in systemic inflammation,according to recently published research.

This drug class, known as GLP-1 agonists, includes semaglutideapproved as Ozempic for type 2 diabetes and Wegovy for obesityand tirzepatideapproved as Mounjaro for diabetes and Zepbound for obesity. Some of these protective effects likely result from patients weight loss when taking these medications, but the drugs appear to have othereffects that improve healthindependent of the weight loss.

The cardioprotective effect of semaglutide observed in people with obesity developed within months of drug initiation, well before meaningful weight loss had been achieved in most trial participants inone 2022 trial, Daniel Drucker, a physician-scientist at the Lunenfield-Tanenbaum Research Institute at Mt. Sinai Hospital in Toronto, states in a commentary publishedThursday in Science. The initial chapter of GLP-1 innovation focused on glucose control, and later, weight loss, he writes. Subsequent waves seem likely to improve health outcomes in people with a range of chronic disorders.

Indeed, a recent studyinJAMA Network Openis the first to suggest that even protection from certain cancers could be among the ways these drugs can help improve health.People with obesityhave a higher risk of developing 13 cancers, and the new research found a reduced risk for 10 of these cancers in patients with type 2 diabetes who were prescribed a GLP-1 agonist drug, compared to just insulin.

While the study was large, with more than 1.6 million patients from the United States, it has multiple limitations that warrant cautious optimism, says William Murphy, a cancer immunologist at the University of California Davis School of Medicine who studies obesitys impact.

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Ozempic and Mounjaro may also lower your risk of obesity-linked cancer - National Geographic

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A new prevalence study of the common foodborne bacterium Campylobacter in North Carolina chickens shows it is almost twice as common in backyard flocks than on commercial farms, and isolates are often resistant to antibiotics.

The authors say the findings are significant because chicken is the top consumed meat worldwide, and backyard poultry production is increasing in the United States. The results were published in JAC - Antimicrobial Resistance.

North Carolina State investigators obtained samples from 10 backyard and 10 commercial broiler farms in North Carolina to follow flocks throughout production. They collected fecal and environmental samples at days 10, 31, and 52 days post-hatch in backyard flocks and on days 10, 24, and 38 on commercial farms. Environmental samples were collected from the soil, litter/compost, and feeders and waterers.

Of samples collected from backyard flocks, 21.9% tested positive for Campylobacter, compared with 12.2% of the farm samples. Most of the isolates were identified asC jejuni(70.8%), with the restC coli(29.2%). The breakdown of positive sample locations in backyard farms was 70.2% from fecal samples, 6.4% from soil, 3.5% from litter/compost, and 19.9% from swabs of feeders and waterers. For commercial farms, the rates were 84.2%, 0%, 12.6%, and 3.2%, respectively.

We found a higher proportion of resistant isolates in commercial farms, with unprecedented higher levels inC. jejuniversusC. coli.

Antimicrobial susceptibility testing revealed phenotypic resistance to ciprofloxacin (40.2%), an important treatment drug forCampylobacter, and tetracycline (46.6%). The researchers found a higher proportion of resistance inC jejuniisolates and on the commercial farms.

The authors concluded, "Despite higher prevalence in backyard farms, we found a higher proportion of resistant isolates in commercial farms, with unprecedented higher levels inC. jejuniversusC. coli."

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COVID tied to faster progression from preclinical to clinical type 1 diabetes in kids - University of Minnesota Twin Cities

Through the years, nutrition recommendations have changed numerous times as evidence from the research mounted in one direction or the other. For example, we used to think that the cholesterol in the foods we eat added to the cholesterol in our bodies. We now know that if it affects it at all, its minimal.

And remember the no-fat fad? We now know that some fat in our diets is necessary.

But research on what types and how much fat is necessary is still not totally conclusive. For example, there is evidence that some types of saturated fat arent as harmful as other typeslike the kind in cheese and eggs compared to those in highly processed foods. Or perhaps its actually other components in the food that protect us from any harmful effects of the saturated fat in the foodmore research to come. Either way, this doesnt mean you should eat unlimited amounts of them.

In fact, a new study published on July 11, 2024, in Nature Medicine looked at what happens when saturated animal fats (like butter) are swapped out for plant-based unsaturated fats (like olive oil). Lets see what they found.

This study was conducted differently from typical studies in that it used four different study cohorts instead of one. From the first cohort, which was an original study, researchers established what they called a multi-lipid score (MLS). There are over 100 different types of lipids. Lipid levels are tested via bloodwork. In this study, called the Dietary Intervention and Vascular function (DIVAS) trial, researchers took 113 participants and randomly split them in half. For 16 weeks, one group ate a diet high in saturated animal fats, while the other group ate a diet rich in plant-based unsaturated fats. What they found in this study was that higher MLS correlated with healthier blood fat profiles, higher intakes of plant-based unsaturated fats and lower intakes of animal-based saturated fats.

Researchers then computed participants multi-lipid scores in three other large, long-term studies that had previously been done to see if higher MLS correlated with reduced risk of heart disease and type 2 diabetes. These studies were called the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study, the Nurses Health Study (NHS and NHSII), and the PREDIMED trial.

These three other studies included large cohorts of participants and initially healthy individuals who were followed for several years. This gave researchers a chance to see what participants diets were composed of, what their lipid profiles wereso they could compute multi-lipid scores based on their blood levelsand whether or not they ended up with heart disease and/or diabetes.

What researchers found was that participants with a higher MLSwhich indicates a diet containing lower levels of saturated fat and higher levels of unsaturated fatshad a substantially reduced risk of developing cardiometabolic diseases, including heart disease and diabetes.

Specifically, in the EPIC-Potsdam study, participants with higher MLS had an estimated 32% lower risk of heart disease and 26% lower risk of type 2 diabetes.

The NHS cohort suggests that improving dietary fat quality over 10 years was associated with about a 43% lower risk of developing diabetes.

In considering the PREDIMED study, researchers looked at participants who had low MLS at the beginning of the study, indicating a diet high in saturated fat and low in unsaturated fats. They wanted to know if improving diet qualityspecifically, switching to a Mediterranean diet eating patternwould help prevent disease. They found that switching from a diet high in saturated fat to a Mediterranean diet eating style, which includes lots of unsaturated fats, helped prevent the onset of diabetes.

According to the Centers for Disease Control and Prevention, heart disease is the No. 1 cause of death and disability globally, including in the U.S. And diabetes is a risk factor for heart disease, especially when blood sugar levels are not well-managed.

A Mediterranean diet eating pattern has been shown to have many benefits, including reducing the risk of heart disease, stroke and type 2 diabetes. Engaging in this way of eating also reduces cognitive decline, bone loss and inflammation. Altogether, following a Mediterranean diet may help you live longer.

The Mediterranean diet includes lots of fruits, vegetables, nuts, seeds, lean proteins, legumes, whole grains and healthy fats. If youre not ready to jump into a full Mediterranean diet eating style, start with simple swaps by trading foods you typically eat that are high in saturated fat with foods that are high in unsaturated fats. For example, instead of slathering butter onto your toast, swap the butter with mashed avocado or peanut butter. Instead of butter and sour cream on your baked potato, try a drizzle of garlic-infused olive oil and a dollop of plain Greek yogurt. Switch out one dinner with red meat each week for a heart-healthy salmon meal. Have a handful of nuts in place of chips for your snack.

This study adds to the evidence suggesting that replacing foods high in saturated fats with foods high in heart-healthy unsaturated fats may help reduce the risk of heart disease and diabetes. A Mediterranean diet eating pattern has consistently been shown to reduce inflammation and disease risk. Instead of trying to overhaul your routine, simply swap some foods that are high in saturated fat with foods that are high in unsaturated fat, like nuts and nut butters, seeds, oils and seafood. Small swaps will eventually add up to big changes that may help reduce your risk of disease, improve your quality of life and increase your chances of living longer.

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The #1 Swap That May Decrease Your Risk of Heart Disease and Diabetes, According to a New Study - EatingWell

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A medication used to treat diabetic neuropathy may make chemotherapy treatments more effective for patients with lung cancer, according to a new study.

Despite surgical and chemotherapy treatment, more than 50% of non-metastatic, non-small lung cancer patients see recurrences, in large part because of drug-resistant cancer cells.

Researchers have identified a way to make these cells more susceptible to chemotherapy, says study author Jussuf Kaifi, a thoracic surgeon at the University of Missouri Health Care and an assistant professor of surgery at the universitys School of Medicine.

Traditional treatments for lung cancer, including chemotherapy, often have little to no effect on the cancer because of drug resistance, Kaifi says.

It is a major cause of mortality in patients, so finding ways to circumvent drug and chemotherapy resistance is vital to improving patient outcomes.

The study examined 10 non-small cell lung cancer tumors, half of which were identified as drug resistant. The drug-resistant tumors showed overexpression of a certain enzyme, AKR1B10. When treated with the diabetic neuropathy medication, epalrestat, the tumors became less drug resistant, causing their sensitivity to chemotherapy to significantly increase.

Epalrestat is available in several countries and well-tolerated by patients, but it is not yet approved for use by the Food and Drug Administration in the United States. The medication is currently in high-level clinical trials as part of the FDAs approval process. If given FDA approval, epalrestat could be fast-tracked as an anti-cancer drug for lung cancer patients.

In general, developing new drugs for cancer treatment is an extremely lengthy, expensive and inefficient process, Kaifi says.

In contrast, repurposing these drugs to other diseases is much faster and cheaper. In view of overcoming drug resistance, epalrestat can rapidly be advanced to the clinic to improve cure rates in lung cancer patients.

The research appears in Clinical Cancer Research.

Source: University of Missouri

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Diabetes drug may make lung cancer treatment more effective - Futurity: Research News

Intermittent fasting can help people with Type 2 diabetes lose weight, lower blood pressure and improve blood sugar levels, a rigorous new study has found.

The new research, published Friday in the journal JAMA Network Open, found that intermittent fasting had striking metabolic benefits that surpassed even the effects of prescription medications for people with newly diagnosed diabetes. Here are the findings:

Courtney Peterson, an expert who was not involved in the study, said the results were exciting.

Often times we assume that drugs are more powerful than lifestyle approaches, said Peterson, an associate professor of nutrition sciences at the University of Alabama at Birmingham. But here they showed that a lifestyle approach was more effective for lowering blood sugar than putting people on drugs. Thats a very powerful statement.

The 5:2 diet was first popularized a decade ago by a BBC documentary and a best-selling book, The Fast Diet: Lose Weight, Stay Healthy, and Live Longer with the Simple Secret of Intermittent Fasting, by British physician Michael Mosley, along with co-writer Mimi Spencer.

The new study of the 5:2 diet took place in China, which has more people with Type 2 diabetes than any other country in the world. At least 141 million adults in China have diabetes and half the population is overweight or obese.

The authors of the new study recruited adults with Type 2 diabetes and then split them into three groups. In the first two groups, participants were assigned to take either metformin or empagliflozin. In the third group, participants were taught to follow the 5:2 diet. Women consumed just 500 calories on each of their two weekly fasting days, while men consumed no more than 600 calories equivalent to about a quarter of their usual caloric intake.

On their fasting days, the participants consumed sparse amounts of food: An egg for breakfast, a couple servings of fruit or vegetables for lunch, and a light salad for dinner. Each meal was paired with a low-calorie meal-replacement drink that contained healthy fats, protein, vitamins, minerals and other nutrients. On their non-fasting days, the participants would eat normally for breakfast and lunch and then have a light dinner with a meal-replacement drink.

In addition to losing weight, the fasting group saw their HbA1c, a long-term measure of their blood sugar levels, drop 1.9 percent significantly more than the groups taking medication. About 80 percent of participants in the fasting group saw their HbA1c fall below 6.5 percent, the cutoff for diabetes, compared to 60 percent of the participants on metformin and 55 percent of the people taking empagliflozin.

Eight weeks after the study ended, the researchers followed up with the participants and found that most of the people in the fasting group had maintained blood sugar levels below the threshold for diabetes, suggesting that the diet significantly and sustainably improves HbA1c levels, the authors wrote.

The researchers found that the fasting group also had greater reductions in their waist circumference, blood pressure levels and triglycerides, a type of fat that circulates in the blood, compared with the participants taking medication.

The researchers cautioned that more studies were needed to examine the long-term effectiveness of the 5:2 diet with meal replacements for Type 2 diabetes. But they said their findings suggest that the diet might be a good initial lifestyle intervention for people with early-stage diabetes.

Peterson said the study was large, rigorous and cleverly designed because it essentially combined two dietary interventions intermittent fasting and meal replacements that have been shown to help people with diabetes.

Many studies have found that diets that incorporate low-calorie meal-replacement shakes, soups and bars help people lose weight and lower their blood sugar levels. A number of studies have also indicated that the 5:2 diet helps people improve their blood sugar control.

Peterson said that one downside of the 5:2 diet is that people often see impressive results in the first few months, but that after about six months to a year on the diet, they start falling off.

It does seem to have an advantage in the short term, but in the long term which is a year or more, it doesnt seem to be better than a standard low-calorie diet, she added.

She also stressed that more long-term research was needed. But in the meantime, she said that people with newly diagnosed Type 2 diabetes might consider discussing with their doctor whether it is worth trying the 5:2 diet in combination with meal replacement shakes like Optifast, Ensure, Soylent or others.

She noted that while participants in the study did not experience many adverse events on the fasting regimen, about 6 percent of people on the diet reported symptoms of low-blood sugar, which can potentially be dangerous.

People should absolutely work with their doctor if they want to try this, Peterson said. They shouldnt try it on their own.

Do you have a question about healthy eating? Email EatingLab@washpost.com and we may answer your question in a future column.

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Intermittent fasting over two days can help people with Type 2 diabetes - The Washington Post

International Diabetes Federation. IDF Diabetes Atlas Reports. 2023. https://diabetesatlas.org/atlas/diabetes-and-kidney-disease/.

Oshima M, Shimizu M, Yamanouchi M, Toyama T, Hara A, Furuichi K, et al. Trajectories of kidney function in diabetes: a clinicopathological update. Nat Rev Nephrol. 2021;17:74050.

Article PubMed Google Scholar

Carvalho-Santos Z, Cardoso-Figueiredo R, Elias AP, Tastekin I, Baltazar C, Ribeiro C. Cellular metabolic reprogramming controls sugar appetite in Drosophila. Nat Metab. 2020;2:95873.

Article PubMed Google Scholar

Hou Y, Tan E, Shi H, Ren X, Wan X, Wu W, et al. Mitochondrial oxidative damage reprograms lipid metabolism of renal tubular epithelial cells in the diabetic kidney. Cell Mol Life Sci. 2024;81:23.

Article CAS PubMed PubMed Central Google Scholar

Linnan B, Yanzhe W, Ling Z, Yuyuan L, Sijia C, Xinmiao X, et al. In situ metabolomics of metabolic reprogramming involved in a mouse model of type 2 diabetic kidney disease. Front Physiol. 2021;12:779683.

Article PubMed PubMed Central Google Scholar

Song C, Wang S, Fu Z, Chi K, Geng X, Liu C, et al. IGFBP5 promotes diabetic kidney disease progression by enhancing PFKFB3-mediated endothelial glycolysis. Cell Death Dis. 2022;13:340.

Article CAS PubMed PubMed Central Google Scholar

Cai T, Ke Q, Fang Y, Wen P, Chen H, Yuan Q, et al. Sodium-glucose cotransporter 2 inhibition suppresses HIF-1-mediated metabolic switch from lipid oxidation to glycolysis in kidney tubule cells of diabetic mice. Cell Death Dis. 2020;11:390.

Article CAS PubMed PubMed Central Google Scholar

Zhu H, Bai M, Xie X, Wang J, Weng C, Dai H, et al. Impaired amino acid metabolism and its correlation with diabetic kidney disease progression in type 2 diabetes mellitus. Nutrients. 2022;14:3345.

Article CAS PubMed PubMed Central Google Scholar

Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet. 2019;394:1318.

Article CAS PubMed Google Scholar

Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295306.

Article CAS PubMed Google Scholar

Spinelli JB, Haigis MC. The multifaceted contributions of mitochondria to cellular metabolism. Nat Cell Biol. 2018;20:74554.

Article CAS PubMed PubMed Central Google Scholar

Martnez-Reyes I, Chandel NS. Mitochondrial TCA cycle metabolites control physiology and disease. Nat Commun. 2020;11:102.

Article PubMed PubMed Central Google Scholar

Song Y, Liu J, Zhao K, Gao L, Zhao J. Cholesterol-induced toxicity: an integrated view of the role of cholesterol in multiple diseases. Cell Metab. 2021;33:191125.

Article CAS PubMed Google Scholar

Houten SM, Violante S, Ventura FV, Wanders RJ. The biochemistry and physiology of mitochondrial fatty acid -oxidation and its genetic disorders. Annu Rev Physiol. 2016;78:2344.

Article CAS PubMed Google Scholar

Forbes JM. Prolyl hydroxylase inhibitors: a breath of fresh air for diabetic kidney disease? Kidney Int. 2020;97:8557.

Article CAS PubMed Google Scholar

Pagliarini DJ, Calvo SE, Chang B, Sheth SA, Vafai SB, Ong SE, et al. A mitochondrial protein compendium elucidates complex I disease biology. Cell. 2008;134:11223.

Article CAS PubMed PubMed Central Google Scholar

Wang Z, Ying Z, Bosy-Westphal A, Zhang J, Schautz B, Later W, et al. Specific metabolic rates of major organs and tissues across adulthood: evaluation by mechanistic model of resting energy expenditure. Am J Clin Nutr. 2010;92:136977.

Article CAS PubMed PubMed Central Google Scholar

Sas KM, Kayampilly P, Byun J, Nair V, Hinder LM, Hur J, et al. Tissue-specific metabolic reprogramming drives nutrient flux in diabetic complications. JCI Insight. 2016;1:e86976.

Article PubMed PubMed Central Google Scholar

Kanasaki K. The aberrant glycolysis in kidney proximal tubule: potential therapeutic target for DKD. Kidney Int. 2023;104:10569.

Article CAS PubMed Google Scholar

Mitrofanova A, Burke G, Merscher S, Fornoni A. New insights into renal lipid dysmetabolism in diabetic kidney disease. World J Diabetes. 2021;12:52440.

Article PubMed PubMed Central Google Scholar

Prez-Mart A, Ramakrishnan S, Li J, Dugourd A, Molenaar MR, De La Motte LR, et al. Reducing lipid bilayer stress by monounsaturated fatty acids protects renal proximal tubules in diabetes. Elife. 2022;11:e74391.

Article PubMed PubMed Central Google Scholar

Herman-Edelstein M, Scherzer P, Tobar A, Levi M, Gafter U. Altered renal lipid metabolism and renal lipid accumulation in human diabetic nephropathy. J Lipid Res. 2014;55:56172.

Article CAS PubMed PubMed Central Google Scholar

Lewis S, Chen L, Raghuram V, Khundmiri SJ, Chou CL, Yang CR, et al. SLC-omics of the kidney: solute transporters along the nephron. Am J Physiol Cell Physiol. 2021;321:C50718.

Article CAS PubMed PubMed Central Google Scholar

Felig P, Marliss E, Cahill GF Jr. Plasma amino acid levels and insulin secretion in obesity. N Engl J Med. 1969;281:8116.

Article CAS PubMed Google Scholar

Xu J, Kitada M, Koya D. NAD(+) homeostasis in diabetic kidney disease. Front Med. 2021;8:703076.

Article Google Scholar

Kwiatkowska I, Hermanowicz JM, Mysliwiec M, Pawlak D. Oxidative storm induced by tryptophan metabolites: missing link between atherosclerosis and chronic kidney disease. Oxid Med Cell Longev. 2020;2020:6656033.

Article PubMed PubMed Central Google Scholar

Thaiss CA, Levy M, Grosheva I, Zheng D, Soffer E, Blacher E, et al. Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection. Science. 2018;359:137683.

Article CAS PubMed Google Scholar

Descamps HC, Herrmann B, Wiredu D, Thaiss CA. The path toward using microbial metabolites as therapies. EBioMedicine. 2019;44:74754.

Article CAS PubMed PubMed Central Google Scholar

Cha Y, Kim T, Jeon J, Jang Y, Kim PB, Lopes C, et al. SIRT2 regulates mitochondrial dynamics and reprogramming via MEK1-ERK-DRP1 and AKT1-DRP1 axes. Cell Rep. 2021;37:110155.

Article CAS PubMed PubMed Central Google Scholar

Morita M, Prudent J, Basu K, Goyon V, Katsumura S, Hulea L, et al. mTOR controls mitochondrial dynamics and cell survival via MTFP1. Mol Cell. 2017;67:92235.e5.

Article CAS PubMed Google Scholar

Hu Q, Zhang H, Gutirrez Corts N, Wu D, Wang P, Zhang J, et al. Increased Drp1 acetylation by lipid overload induces cardiomyocyte death and heart dysfunction. Circ Res. 2020;126:45670.

Article CAS PubMed PubMed Central Google Scholar

Wai T, Langer T. Mitochondrial dynamics and metabolic regulation. Trends Endocrinol Metab. 2016;27:10517.

Article CAS PubMed Google Scholar

Guido C, Whitaker-Menezes D, Lin Z, Pestell RG, Howell A, Zimmers TA, et al. Mitochondrial fission induces glycolytic reprogramming in cancer-associated myofibroblasts, driving stromal lactate production, and early tumor growth. Oncotarget. 2012;3:798810.

Article PubMed PubMed Central Google Scholar

Qin X, Zhao Y, Gong J, Huang W, Su H, Yuan F, et al. Berberine protects glomerular podocytes via inhibiting Drp1-mediated mitochondrial fission and dysfunction. Theranostics. 2019;9:1698713.

Article CAS PubMed PubMed Central Google Scholar

Cleveland KH, Brosius FC 3rd, Schnellmann RG. Regulation of mitochondrial dynamics and energetics in the diabetic renal proximal tubule by the (2)-adrenergic receptor agonist formoterol. Am J Physiol Ren Physiol. 2020;319:F7739.

Article CAS Google Scholar

Wang J, Yue X, Meng C, Wang Z, Jin X, Cui X, et al. Acute hyperglycemia may induce renal tubular injury through mitophagy inhibition. Front Endocrinol. 2020;11:536213.

Article Google Scholar

Huang D, Li T, Li X, Zhang L, Sun L, He X, et al. HIF-1-mediated suppression of acyl-CoA dehydrogenases and fatty acid oxidation is critical for cancer progression. Cell Rep. 2014;8:193042.

Article CAS PubMed Google Scholar

Narravula S, Colgan SP. Hypoxia-inducible factor 1-mediated inhibition of peroxisome proliferator-activated receptor alpha expression during hypoxia. J Immunol. 2001;166:75438.

Article CAS PubMed Google Scholar

Kang HM, Ahn SH, Choi P, Ko YA, Han SH, Chinga F, et al. Defective fatty acid oxidation in renal tubular epithelial cells has a key role in kidney fibrosis development. Nat Med. 2015;21:3746.

Article CAS PubMed Google Scholar

Chen L, Sha ML, Chen FT, Jiang CY, Li D, Xu CL, et al. Upregulation of KLF14 expression attenuates kidney fibrosis by inducing PPAR-mediated fatty acid oxidation. Free Radic Biol Med. 2023;195:13244.

Article CAS PubMed Google Scholar

Chung KW, Ha S, Kim SM, Kim DH, An HJ, Lee EK, et al. PPAR/ activation alleviates age-associated renal fibrosis in Sprague Dawley rats. J Gerontol A Biol Sci Med Sci. 2020;75:4528.

CAS PubMed Google Scholar

Proctor G, Jiang T, Iwahashi M, Wang Z, Li J, Levi M. Regulation of renal fatty acid and cholesterol metabolism, inflammation, and fibrosis in Akita and OVE26 mice with type 1 diabetes. Diabetes. 2006;55:25029.

Article CAS PubMed Google Scholar

Yang W, Luo Y, Yang S, Zeng M, Zhang S, Liu J, et al. Ectopic lipid accumulation: potential role in tubular injury and inflammation in diabetic kidney disease. Clin Sci. 2018;132:240722.

Article CAS Google Scholar

Lin S, Wang L, Jia Y, Sun Y, Qiao P, Quan Y, et al. Lipin-1 deficiency deteriorates defect of fatty acid -oxidation and lipid-related kidney damage in diabetic kidney disease. Transl Res. 2024;266:115.

Article CAS PubMed Google Scholar

Feng L, Gu C, Li Y, Huang J. High glucose promotes CD36 expression by upregulating peroxisome proliferator-activated receptor levels to exacerbate lipid deposition in renal tubular cells. Biomed Res Int. 2017;2017:1414070.

Article PubMed PubMed Central Google Scholar

Hou Y, Wang Q, Han B, Chen Y, Qiao X, Wang L. CD36 promotes NLRP3 inflammasome activation via the mtROS pathway in renal tubular epithelial cells of diabetic kidneys. Cell Death Dis. 2021;12:523.

Article CAS PubMed PubMed Central Google Scholar

Hou Y, Wu M, Wei J, Ren Y, Du C, Wu H, et al. CD36 is involved in high glucose-induced epithelial to mesenchymal transition in renal tubular epithelial cells. Biochem Biophys Res Commun. 2015;468:2816.

Article CAS PubMed Google Scholar

Li X, Zhang T, Geng J, Wu Z, Xu L, Liu J, et al. Advanced oxidation protein products promote lipotoxicity and tubulointerstitial fibrosis via CD36/-catenin pathway in diabetic nephropathy. Antioxid Redox Signal. 2019;31:52138.

Article CAS PubMed Google Scholar

Khan S, Gaivin R, Abramovich C, Boylan M, Calles J, Schelling JR. Fatty acid transport protein-2 regulates glycemic control and diabetic kidney disease progression. JCI Insight. 2020;5:e136845.

Article PubMed PubMed Central Google Scholar

Chen J, Wu K, Lei Y, Huang M, Cheng L, Guan H, et al. Inhibition of fatty acid -oxidation by fatty acid binding protein 4 induces ferroptosis in HK2 cells under high glucose conditions. Endocrinol Metab. 2023;38:22644.

Article CAS Google Scholar

Shen S, Ji C, Wei K. Cellular senescence and regulated cell death of tubular epithelial cells in diabetic kidney disease. Front Endocrinol. 2022;13:924299.

See more here:
Mitochondrial metabolic reprogramming in diabetic kidney disease | Cell Death & Disease - Nature.com

On the opening day of the 84th American Diabetes Association Scientific Sessions, the ADA ushered in a new era for their organization with the announcement of the formation of the Obesity Association.

Created more than a decade after the American Medical Association recognized obesity as a disease, the new subdivision of the ADA was created to further the organizations mission of advocating for and advancing treatment for patients. According to a news release, the ADA intends to develop a Standards of Care for Obesity and to leverage education, advocacy and evidence-based support to reduce barriers to optimal care for people affected by diabetes for people with and without diabetes.

Clinical research is opening exciting new frontiers in the understanding and treatment of obesity. The ADA, through the Obesity Association, is uniquely positioned to translate these advances into weight wellness. We are eager to chart a new path in obesity care, said Robert Gabbay, MD, PhD, the chief scientific and medical officer of the ADA.

As part of the on-site coverage of ADA 2024, Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, hosts of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, sat down with Gabbay for more insight into the newly formed Obesity Association, future plans, and how this move reflects the changing landscape of metabolic health.

Relevant disclosures for Dr. Gabbay include American Diabetes Association and Harvard Medical School. Relevant disclosures for Dr. Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. Relevant disclosures for Dr. Pantalone include Novo Nordisk, AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Sanofi, and others. Dr Rodriguez has no disclosures.

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Diabetes Dialogue: ADA Introduces Obesity Association, with Robert Gabbay, MD, PhD - MD Magazine

Novel Drugs Demonstrate Benefits of Once Weekly Drugs for Weight Loss andGlycemic and Blood Pressure Control

ORLANDO, Fla., June 23, 2024 /PRNewswire/ -- Findings from three studies showcase new data on the latest developments in drug therapy innovations to treat obesity including new insights on GLP-1 (Glucagon-like peptide-1) receptor agonists. The data was presented as a late-breaking poster and oral presentations, respectively at the American Diabetes Association (ADA) 84th Scientific Sessions in Orlando, FL.

The studies are part of a host of research and development driven by interest in new GLP-1 drugs and concerns about obesity. Obesity affects about 125 million people in the United States 41.9% of adults and 19.7% of children and adolescents. Notably, 90% of people with diabetes also live with overweight or obesity. Weight gain is a major problem for physicians and patients looking to achieve adequate glycemic, blood pressure and lipid control in patients with diabetes.

"Over the past few years, we have seen the substantial impact of new research working to solve the dual health crisis we are facing, obesity and diabetes," said Dr. Robert Gabbay, chief scientific and medical officer for the ADA. "The studies we are seeing presented at this year's annual meeting show great promise to fuel new solutions and treatment options for patients across the globe living with type 2 diabetes and obesity."

Drug Treatment for Obesity Effectively Reduces Body Weightand Blood Pressure

HRS9531 is a dual GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor agonist, offering a treatment option for individuals with overweight or obesity, as well as type 2 diabetes. This Phase 2 study evaluated the efficacy and safety of HRS9531 in obese adults without diabetes. The research found HRS9531 effectively reduced body weight, blood pressure, blood glucose, and triglycerides, with a favorable safety profile.

The double-blind, randomized, placebo-controlled Phase 2 trial studied a total of 249 Chinese adults with a body mass index of 28-40 kg/m. Participants were randomized into five groups to receive once-weekly subcutaneous injections of HRS9531 (1.0 mg, 3.0 mg, 4.5 mg, and 6.0 mg) or placebo for 24 weeks. The primary endpoint was the percentage change in body weight at week 24.

Greater weight loss was achieved in individuals receiving HRS9531 compared with those receiving placebo. At the end of the 24-week intervention, participants in 1.0 mg, 3.0 mg, 4.5 mg, and 6.0 mg HRS9531 groups achieved weight reductions of 5.4%, 13.4%, 14.0%, and 16.8% respectively, as compared with 0.1% reduction in the placebo group. Moreover, the proportion of participants achieving 5% weight reduction was 52.0%, 88.2%, 92.0%, 91.8%, and 10.2%, respectively. Most adverse events (AEs) were mild or moderate, and the most common AEs were nausea, diarrhea, decreased appetite, and vomiting, occurring primarily during dose escalation. The overall safety and tolerability profile of HRS9531 is consistent with other GLP-1 agonists.

"People living with obesity are at a high risk of developing chronic diseases such as type 2 diabetes and cardiovascular disease. Losing weight significantly reduces the risk of those diseases," said Xiaoying Li, MD, PhD. Professor and Director, Department of Endocrinology and Metabolism, Zhongshan Hospital Fudan University, China, and senior author. "Since dietary and exercise intervention alone is often not enough, we were pleased to see that this could be a potentially promising treatment for weight management, potentially enhancing their overall health and significantly reducing the societal burden of obesity."

The authors of the study note a Phase 3 study with HRS9531 in Chinese overweight or obese individuals is already ongoing and multi-regional studies are being planned.

Experimental Medication, Pemvidutide, Reveals 15.6% Average Total Body Weight Loss for Patients with Overweight and Obesity

The Phase 2 MOMENTUM trial evaluated the potential for pemvidutide, Altimmune's investigational medication, a GLP-1/Glucagon dual receptor agonist, in development for obesity and a liver disease called metabolic-dysfunction associated steatohepatitis (MASH), to help people with overweight and obesity lose weight. The trial revealed promising results - significantly reducing body weight and serum lipids over 48 weeks of treatment. In addition, body composition analysis demonstrated class-leading preservation of lean mass.

This Phase 2, randomized, placebo-controlled trial enrolled 391 subjects with overweight or obesity, but without diabetes, and administered either pemvidutide at three dose levels (1.2, 1.8, 2.4 mg) or a placebo weekly for 48 weeks. Neither the investigators nor the subjects knew what treatment they were receiving.

After 48 weeks, subjects at the highest pemvidutide dose had lost an average of 15.6% of their total body weight, and the treatment appeared to be safe and well-tolerated. Several potential advantages of this approach to weight loss were identified, including a simple dosing regimen and significant decreases in the amount of lipids (such as cholesterol and triglycerides) present in the blood and the liver, which may help reduce the risk of cardiovascular disease. Additionally, results from a body composition sub-study were presented indicating class-leading preservation of lean mass, with only 21.9% attributable to lean mass and 78.1% of weight loss due to fat. Preserving lean mass, which primarily includes muscle, is believed to be critical for maintaining physical function and decreasing the risk of bone fractures.

"Obesity and its associated comorbidities represent a major and growing health challenge. A variety of therapeutic approaches will be required to meet the specific needs of each patient to effectively manage their weight and address other obesity-related conditions they may have," said Louis J. Aronne, MD, FACP, DABOM, Weill Cornell Medicine, New York City, NY, and primary investigator. "These findings demonstrated that the use of pemvidutide may have important effects on the quality of weight loss and cardiometabolic-associated comorbidities of obesity. Furthermore, as the focus shifts to long-term weight management, the preservation of lean mass will be critical for patient care."

The authors of this study are preparing for larger Phase 3 registrational trials intended to demonstrate the safety and clinical benefit of pemvidutide for weight management. In addition, because obesity can lead to the accumulation of excess liver fat and MASH, they are also studying pemvidutide in patients with this condition.

Retatrutide Improves Ability of Insulin to Lower Blood Sugar for People Living with Type 2 Diabetes

Biomarker analyses may help in the understanding of diseases and identifying specific therapeutic targets. A new study evaluated biomarkers to observe how treatment with retatrutide affects pancreatic beta cells that make insulin as well as biomarkers associated with the body's ability to respond to insulin to lower blood sugar. In this study, exploratory biomarker research within phase 2 clinical trials was examined to further understand on the molecular level how retatrutide may work and further help explain primary results.

The research found treatment with retatrutide increased markers of well-functioning insulin-producing beta cells (HOMA2-B) and the ability of insulin to lower blood sugar (adiponectin). The results also demonstrated how retatrutide decreased markers of stress on insulin-producing cells, as assessed by measuring immature insulin (proinsulin) and reduction in a marker of insulin resistance (HOMA2-IR).

"This study matters because many people living with type 2 diabetes are taking multiple diabetes medications to try to reach blood sugar targets, and new medications that have the potential to help simplify treatment regimens are needed," said Melissa K. Thomas, MD, PhD, Vice President, Diabetes and Metabolic Research, Lilly Research Laboratories, Indianapolis, IN, and one of the investigators conducting the study. "We are encouraged to see that people living with either obesity or with type 2 diabetes in our clinical studies had lowered blood sugar and had improved responses to insulin."

Several Phase 3 clinical trials are underway studying retatrutide in people living with type 2 diabetes or obesity without type 2 diabetes including the TRIUMPH and TRANSCEND Phase 3 trials.

Research presentation details:

Dr.Zeng will present the findings at the following late-breaking poster session:

Dr. Aronne will present the findings at the following presentation session:

Dr. Thomas will present the findings at the following oral presentation session:

About the ADA's Scientific SessionsThe ADA's 84th Scientific Sessions, the world's largest scientific meeting focused on diabetes research, prevention, and care, will be held in Orlando, FL on June 21-24. More than 11,000 leading physicians, scientists, and health care professionals from around the world are expected to convene both in person and virtually to unveil cutting-edge research, treatment recommendations, and advances toward a cure for diabetes. Attendees will receive exclusive access to thousands of original research presentations and take part in provocative and engaging exchanges with leading diabetes experts. Join the Scientific Sessions conversation on social media using #ADAScientificSessions.

About the American Diabetes AssociationThe American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For 83 years, the ADA has driven discovery and research to treat, manage, and prevent diabetes while working relentlessly for a cure. Through advocacy, program development, and education we aim to improve the quality of life for the over 136 million Americans living with diabetes or prediabetes. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us atdiabetes.orgor call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Spanish Facebook (Asociacin Americana de la Diabetes), LinkedIn (American Diabetes Association), Twitter (@AmDiabetesAssn), and Instagram (@AmDiabetesAssn).

Media Contact: Amy Robinson [emailprotected]

SOURCE American Diabetes Association

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The American Diabetes Association Highlights Innovations in New Drug Therapies for Patients with Obesity - PR Newswire

Atkinson, M. A., Eisenbarth, G. S. & Michels, A. W. Type 1 diabetes. Lancet 383, 6982 (2014).

Article PubMed Google Scholar

Roep, B. O. The role of T-cells in the pathogenesis of type 1 diabetes: from cause to cure. Diabetologia 46, 305321 (2003).

Article CAS PubMed Google Scholar

Pociot, F. & Lernmark, . Genetic risk factors for type 1 diabetes. Lancet 387, 23312339 (2016).

Article CAS PubMed Google Scholar

Moltchanova, E. V., Schreier, N., Lammi, N. & Karvonen, M. Seasonal variation of diagnosis of type 1 diabetes mellitus in children worldwide. Diabet. Med. 26, 673678 (2009).

Article CAS PubMed Google Scholar

Patterson, C. et al. Seasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 19892008: little short-term influence of sunshine hours or average temperature. Pediatr. Diabetes 16, 573580 (2015).

Article CAS PubMed Google Scholar

Sderstrm, U., Aman, J. & Hjern, A. Being born in Sweden increases the risk for type 1 diabetes a study of migration of children to Sweden as a natural experiment. Acta Paediatr. 101, 7377 (2012).

Article PubMed Google Scholar

Wang, Z., Xie, Z., Lu, Q., Chang, C. & Zhou, Z. Beyond genetics: what causes type 1 diabetes. Clin. Rev. Allerg. Immunol. 52, 273286 (2017).

Article CAS Google Scholar

Olmos, P. et al. The significance of the concordance rate for type 1 (insulin-dependent) diabetes in identical twins. Diabetologia 31, 747750 (1988).

Article CAS PubMed Google Scholar

Peng, H. & Hagopian, W. Environmental factors in the development of type 1 diabetes. Rev. Endocr. Metab. Disord. 7, 149162 (2007).

Article Google Scholar

Patelarou, E. et al. Current evidence on the associations of breastfeeding, infant formula, and cows milk introduction with type 1 diabetes mellitus: a systematic review. Nutr. Rev. 70, 509519 (2012).

Article PubMed Google Scholar

Stene, L. C. & Gale, E. A. M. The prenatal environment and type 1 diabetes. Diabetologia 56, 18881897 (2013).

Article CAS PubMed Google Scholar

van der Werf, N., Kroese, F. G. M., Rozing, J. & Hillebrands, J.-L. Viral infections as potential triggers of type 1 diabetes. Diabetes Metab. Res. Rev. 23, 169183 (2007).

Article PubMed Google Scholar

Nekoua, M. P., Alidjinou, E. K. & Hober, D. Persistent coxsackievirus B infection and pathogenesis of type 1 diabetes mellitus. Nat. Rev. Endocrinol. 18, 503516 (2022). This Review highlights evidence that persistent Coxsackievirus B infection triggers or accelerates islet autoimmunity and T1DM in susceptible individuals.

Article CAS PubMed PubMed Central Google Scholar

Soltesz, G., Patterson, C. & Dahlquist, G.; EURODIAB Study Group. Worldwide childhood type 1 diabetes incidence what can we learn from epidemiology? Pediatr. Diabetes 8, 614 (2007).

Article PubMed Google Scholar

Hober, D. & Sauter, P. Pathogenesis of type 1 diabetes mellitus: interplay between enterovirus and host. Nat. Rev. Endocrinol. 6, 279289 (2010). The interplay between enterovirus infection with -cells, the immune system and host genes in the pathogenesis of T1DM is discussed.

Article PubMed Google Scholar

Lnnrot, M. et al. Respiratory infections are temporally associated with initiation of type 1 diabetes autoimmunity: the TEDDY study. Diabetologia 60, 19311940 (2017). A prospective study of 8,676 newborn babies reporting that viral respiratory infections are associated with an increased risk of islet autoimmunity.

Article PubMed PubMed Central Google Scholar

Rasmussen, T., Wits, E., Tapia, G., Stene, L. C. & Rnningen, K. S. Self-reported lower respiratory tract infections and development of islet autoimmunity in children with the type 1 diabetes high-risk HLA genotype: the MIDIA study. Diabetes Metab. Res. Rev. 27, 834837 (2011).

Article CAS PubMed Google Scholar

Beyerlein, A., Wehweck, F., Ziegler, A.-G. & Pflueger, M. Respiratory infections in early life and the development of islet autoimmunity in children at increased type 1 diabetes risk: evidence from the BABYDIET study. JAMA Pediatr. 167, 800807 (2013).

Article PubMed Google Scholar

Mustonen, N. et al. Early childhood infections precede development of beta-cell autoimmunity and type 1 diabetes in children with HLA-conferred disease risk. Pediatr. Diabetes 19, 293299 (2018).

Article CAS PubMed Google Scholar

Lee, H.-Y., Lu, C.-L., Chen, H.-F., Su, H.-F. & Li, C.-Y. Perinatal and childhood risk factors for early-onset type 1 diabetes: a population-based case-control study in Taiwan. Eur. J. Public Health 25, 10241029 (2015).

Article PubMed Google Scholar

Ruiz, P. L. D. et al. Pandemic influenza and subsequent risk of type 1 diabetes: a nationwide cohort study. Diabetologia 61, 19962004 (2018).

Article PubMed PubMed Central Google Scholar

Kordonouri, O. et al. Infections in the first year of life and development of beta cell autoimmunity and clinical type 1 diabetes in high-risk individuals: the TRIGR cohort. Diabetologia 65, 20982107 (2022).

Article CAS PubMed PubMed Central Google Scholar

Beyerlein, A., Donnachie, E., Jergens, S. & Ziegler, A.-G. Infections in early life and development of type 1 diabetes. JAMA 315, 18991901 (2016).

Article PubMed Google Scholar

Wu, R. et al. Respiratory infections and type 1 diabetes: potential roles in pathogenesis. Rev. Med. Virol. 33, e2429 (2023).

Article CAS PubMed PubMed Central Google Scholar

Ho, D. et al. Identifying the lungs as a susceptible site for allele-specific regulatory changes associated with type 1 diabetes risk. Commun. Biol. 4, 1072 (2021).

Article CAS PubMed PubMed Central Google Scholar

Kim, D. et al. The architecture of SARS-CoV-2 transcriptome. Cell 181, 914921 (2020).

Article CAS PubMed PubMed Central Google Scholar

Liu, Y.-C., Kuo, R.-L. & Shih, S.-R. COVID-19: the first documented coronavirus pandemic in history. Biomed. J. 43, 328333 (2020).

Article PubMed PubMed Central Google Scholar

Liu, J. et al. SARS-CoV-2 cell tropism and multiorgan infection. Cell Discov. 7, 17 (2021).

Article CAS PubMed PubMed Central Google Scholar

Unsworth, R. et al. New-onset type 1 diabetes in children during COVID-19: multicenter regional findings in the U.K. Diabetes Care 43, e170e171 (2020).

Article CAS PubMed Google Scholar

Kamrath, C. et al. Incidence of type 1 diabetes in children and adolescents during the COVID-19 pandemic in Germany: results from the DPV registry. Diabetes Care 45, 17621771 (2022).

Article CAS PubMed Google Scholar

Gesuita, R. et al. Trends and cyclic variation in the incidence of childhood type 1 diabetes in two Italian regions over 33 years and during the COVID-19 pandemic. Diabetes Obes. Metab. 25, 16981703 (2023).

Article CAS PubMed Google Scholar

Rabbone, I. et al. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children? Diabetes Care 43, 28702872 (2020).

Article CAS PubMed Google Scholar

Rahmati, M. et al. The global impact of COVID19 pandemic on the incidence of pediatric newonset type 1 diabetes and ketoacidosis: a systematic review and metaanalysis. J. Med. Virol. 94, 51125127 (2022).

Article CAS PubMed PubMed Central Google Scholar

DSouza, D. et al. Incidence of diabetes in children and adolescents during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Netw. Open 6, e2321281 (2023).

Article PubMed PubMed Central Google Scholar

Ruiz, P. L. D. et al. SARS-CoV-2 infection and subsequent risk of type 1 diabetes in 1.2 million children [abstract 233]. EASD 2022. https://www.easd.org/media-centre/home.html#!resources/sars-cov-2-infection-and-subsequent-risk-of-type-1-diabetes-in-1-2-million-children-3e68c8b2-dde1-43aa-8d75-af7356502994 (2022).

Kendall, E. K., Olaker, V. R., Kaelber, D. C., Xu, R. & Davis, P. B. Association of SARS-CoV-2 infection with new-onset type 1 diabetes among pediatric patients from 2020 to 2021. JAMA Netw. Open 5, e2233014 (2022).

Article PubMed PubMed Central Google Scholar

Qeadan, F. et al. The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: a nationwide cohort from the US using the Cerner Real-World Data. PLoS One 17, e0266809 (2022).

Article CAS PubMed PubMed Central Google Scholar

Lugar, M. et al. SARS-CoV-2 infection and development of islet autoimmunity in early childhood. JAMA 330, 11511160 (2023).

Article CAS PubMed PubMed Central Google Scholar

McKeigue, P. M. et al. Relation of incident type 1 diabetes to recent COVID-19 infection: cohort study using e-health record linkage in Scotland. Diabetes Care 46, 921928 (2023).

Article PubMed Google Scholar

Noorzae, R., Junker, T. G., Hviid, A. P., Wohlfahrt, J. & Olsen, S. F. Risk of type 1 diabetes in children is not increased after SARS-CoV-2 infection: a nationwide prospective study in Denmark. Diabetes Care 46, 12611264 (2023).

Article PubMed Google Scholar

Messaaoui, A., Hajselova, L. & Tenoutasse, S. Anti-SARS-CoV-2 antibodies in new-onset type 1 diabetes in children during pandemic in Belgium. J. Pediatr. Endocrinol. Metab. 34, 13191322 (2021).

Article CAS PubMed Google Scholar

Jia, X. et al. Prevalence of SARS-CoV-2 antibodies in children and adults with type 1 diabetes. Diabetes Technol. Ther. 23, 517521 (2021).

Article CAS PubMed PubMed Central Google Scholar

Rewers, M. et al. SARS-CoV-2 infections and presymptomatic type 1 diabetes autoimmunity in children and adolescents from Colorado, USA, and Bavaria, Germany. JAMA 328, 12521255 (2022).

Article CAS PubMed PubMed Central Google Scholar

Krischer, J. P. et al. SARS-CoV-2 no increased islet autoimmunity or type 1 diabetes in teens. N. Engl. J. Med. 389, 474475 (2023).

Article CAS PubMed PubMed Central Google Scholar

Pietropaolo, M., Hotez, P. & Giannoukakis, N. Incidence of an insulin-requiring hyperglycemic syndrome in SARS-CoV-2-infected young individuals: is it type 1 diabetes? Diabetes 71, 26562663 (2022).

Article CAS PubMed PubMed Central Google Scholar

Rahmati, M. et al. New-onset type 1 diabetes in children and adolescents as postacute sequelae of SARS-CoV-2 infection: a systematic review and meta-analysis of cohort studies. J. Med. Virol. 95, e28833 (2023).

Article CAS PubMed Google Scholar

Kamrath, C., Eckert, A. J., Holl, R. W. & Rosenbauer, J. Impact of the COVID-19 pandemic on children and adolescents with new-onset type 1 diabetes. Pediatr. Diabetes 2023, e7660985 (2023). This meta-analysis, including 40 studies carried out worldwide, reports an increased incidence of T1DM during the COVID-19 pandemic as well as an increased risk of T1DM following SARS-CoV-2 infection.

Article Google Scholar

Zhang, T. et al. Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis. BMC Med. 20, 444 (2022).

Article CAS PubMed PubMed Central Google Scholar

Lai, H. et al. Risk of incident diabetes after COVID-19 infection: a systematic review and meta-analysis. Metabolism 137, 155330 (2022).

Article CAS PubMed PubMed Central Google Scholar

Rubino, F. et al. New-onset diabetes in covid-19. N. Engl. J. Med. 383, 789790 (2020).

Article PubMed Google Scholar

Eslami, N. et al. SARS-CoV-2: receptor and co-receptor tropism probability. Curr. Microbiol. 79, 133 (2022).

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The relationship between SARS-CoV-2 infection and type 1 diabetes mellitus - Nature.com

A cross-sectional observational study was conducted on 225 patients (42.2% males and 57.8% females) with type I (2.2%) and type II DM (97.8%), having a diabetic history of fewer than five years in 56% of participants of age ranging from 35-70 years, The study aimed to scrutinize the prevalence of peripheral neuropathy and amputation in patients with DM and evaluate their quality of life by utilizing the Michigan Neuropathy Screening Instrument and the Asian Diabetic Quality of Life Questionnaire. The levels of amputation from toe amputations to hemipelvectomy were observed.

Martin CL et al. in 2014 found that the most common of these neuropathic disorders is chronic diabetic peripheral sensorimotor neuropathy (DPN), which affects up to 50% of persons with DM14. The study's findings revealed a significant prevalence of peripheral neuropathy among the participants, emphasizing the considerable burden of this complication in patients with DM. Our study conducted on 225 patients with DM demonstrates the prevalence of DNP (diabetic peripheral neuropathy) using the Michigan neuropathy screening instrument (MNSI) self-administer questionnaire (SAQ) was 44.4% and 51.1% on the basis of the lower extremity examination part of the MNSI. Whereas, 55.6% and 48.9% were observed for the population without DPN using SAQ and the physical examination part of MNSI, respectively. Peripheral neuropathy is a well-recognized consequence of DM, characterized by nerve damage that can lead to various sensory and motor deficits, including pain, tingling, numbness, loss of sensation, muscle weakness, and impaired balance. The high prevalence rate underscores the need for early detection and effective management strategies to prevent or mitigate its adverse effects on patients well-being.

Hazari et al. (2023) reported that the risk of DPN is ethnic origin-dependent in residents of the United Arab Emirates and is high in Arab-origin residents. According to the findings of MNSI, 62% of the participants were screened with DPN28. The current study's findings are in line with their results in terms of DPN on the basis of MNSI but are limited in terms of information regarding the ethnicity and geographical background of the participants.

Amputation, another severe complication associated with DM, was also found to be prevalent in the study sample. This outcome raises concerns about the impact of DM on vascular health and underscores the significance of comprehensive diabetic foot care programs. Amputations can have profound physical, psychological, and social implications for individuals, leading to long-term disability and reduced quality of life. The identification of factors such as age, duration of DM, and glycemic control as predictors of peripheral neuropathy and amputation provides valuable insights for risk stratification and targeted interventions. In this study, the prevalence of amputations observed in patients with DM in the right and left lower limb are 0.4% and 0% hemipelvectomy, respectively, with short above knee amputation being 0.4%, 2.2%, respectively, standard below the knee in 9.8%, 3.6% respectively, toe disarticulation or amputation in 2.7%, 1.8 respectively, and Symes being 0.4% in both lower limbs. Baumfeld D et al. in 2018 found that in Pakistan, the rate of amputation (number of amputations due to diabetes per year) has been reported to be 21%-48%, despite the prevalence of diabetic foot ulcerations that is comparable to that of other countries29. The total rate of amputation, according to our study among the sample population, is 21.7%, which is similar to other research done before.

Furthermore, the study demonstrated the quality of life of the participants. This finding highlights the multidimensional nature of quality of life and the significant impact that these complications have on various aspects of a patient's well-being. According to the results of our study, DPN and amputation may have a negative association with four components of Asian DQOL in patients with DM. Our study showed that 96.9% of the population had poor QOL (score<45), 2.2% had moderate QOL (score 4550), and 0.9% had good QOL (score 5055). The study concluded results for four components of the Asian DQOL questionnaire with lower scores indicating poor QOL and vice versa. Total energy score 83.6% with (scores of 04) 14.7%, and 1.8% (scores 58 and 912, respectively), total memory scores 04, 58, 912, and 1316 with 30.0%, 34.7%, 20.9%, and 14.2% respectively, total finance score 05, 610, 1115, and 1620 with 51.1%, 39.6%, 6.7%, and 2.7% respectively, and total diet score of 04, 58, 912 with 67.1%, 30.2%, and 2.7% respectively. The mean energy score is 2.811.82 out of 12, which seems to be very low; the mean memory score is 7.974.53 out of 16, appearing as less than half of the total score, mean finance score is 6.384.34 out of 20 which is also very poor, mean diet score is 3.772.17 out of 12 and total score is 20.9510.40 out of 60. Most of the results depict poor quality of life in the study population.

Physical functioning is often compromised due to the sensory and motor deficits associated with peripheral neuropathy, limiting mobility and impairing daily activities. Psychological well-being is affected by chronic pain, anxiety, depression, and the psychological adjustment to the loss of a limb in the case of amputation. Social interactions may also be impacted as individuals may experience social stigma, reduced participation in social activities, and a sense of isolation. Overall, life satisfaction is significantly diminished as a result of the limitations imposed by these complications. According to our findings, numerous studies from different countries have indicated that type II DM has a detrimental effect on QOL30,31,32,33.

While this study provides valuable insights into the prevalence of peripheral neuropathy, amputation, and quality of life in patients with DM, it is important to acknowledge certain limitations. The cross-sectional design of this study limits the ability to establish causal relationships between variables. Longitudinal studies would be beneficial in determining temporal relationships and understanding the long-term effects of these complications.

Healthcare providers should prioritize early detection and screening of peripheral neuropathy in patients with Diabetic mellitus. A multidisciplinary approach involving healthcare professionals from various specialities, such as endocrinology, podiatry, and physical therapy, is recommended, along with long-term follow-up. Collaboration among these specialists can provide comprehensive care, including education, foot care guidance, wound management, and rehabilitation services for individuals with peripheral neuropathy or amputation. Recognizing the impact of peripheral neuropathy and amputation on the quality of life, healthcare providers should offer psychological support and rehabilitation services to affected patients. Access to counselling, prosthetics and mobility aids can help individuals cope with the physical, emotional, and social challenges associated with these complications.

The present study had a few limitations which need to be mentioned here. The study's sample was drawn from patients attending a specific healthcare facility, which may introduce sampling bias and limit the generalizability of the findings to a broader population. Patients seeking care at these facilities may have different characteristics or access to healthcare compared to the general population. Individuals with concurrent chronic illnesses like heart disease, cancer, or renal disorders, with a history of trauma, severe psychiatric conditions, or addiction were excluded due to some ethical limitation. This prevented the analysis from having external validity. Many patients have multiple comorbidities, and it is difficult for neuropathy to be the only complication.

Only MNSI was used, and it could not be compared with nerve conduction study, which is a gold standard for diagnosing patients with peripheral neuropathy. Due to ethical considerations, the interpersonal relationship component of Asian DQOL was not included in this study. The study relied on self-reported data, which was subjected to recall bias. Patients may have inaccurately reported their medical history, symptoms, or quality of life. Additionally, subjective assessments of QoL may be influenced by individual perceptions and experiences.

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Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus | Scientific Reports - Nature.com