Diabetology

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models. Full article

Glucose, fructose, and galactose are widely used in the food industry as sweeteners and food additives. The over-consumption of these carbohydrates has been identified as a possible trigger of non-communicable diseases. These include insulin resistance, obesity, and type 2 diabetes. These sugars induce an energy overload with consequent adipose tissue (AT) expansion, contributing to the development of obesity. Furthermore, a common feature of these non-communicable diseases is the detrimental, chronic, low-grade inflammation contributing to their onset. In the present review, we identify the most widely used dietary free sugars and their direct impacts on AT metabolism and inflammation, as well as their involvement in systemic inflammation and effects on the immune cell phenotype and function. Additionally, we discuss the capacity of the free sugars to induce immune modulation, enhancing inflammation, an underlying hallmark of insulin resistance, obesity, and T2DM. Dietary sugars have an important and deleterious metabolic impact on AT and also on immune cells. More research is needed to effectively understand the impact of chronic exposure to high levels of individual or combined sugars on metabolism, with the impact on immunomodulation being especially important. Full article

Studies have shown that COVID-19 patients with prediabetes frequently present with high plasma glucose levels on hospital admission. However, whether the glycemic abnormalities are temporary or persist after recovery from the illness is unclear. We conducted a follow-up study of the case series of 69 COVID-19 patients with prediabetes (HbA1c 5.7–6.4%) who were admitted to a tertiary care hospital in Chennai, India, from May to October 2020 and were discharged alive. Over a mean follow-up of 146.6 (SD: 72.5) days, the mean fasting plasma glucose rose significantly by 16.8 mg/dL (from 119.3–136.1 mg/dL), 2-hr post-prandial glucose by 61.0 mg/dL (from 176.2–237.2 mg/dL), and HbA1c by 0.6% (5.9–6.5%). Of the 49 (84.5%) patients who were discharged with glucose-lowering medications, 40 (81.6%) continued taking them at the first follow-up visit (mean of 50.1 days from admission), and 39 (79.6%) continued taking them at the second follow-up visit (mean of 114.3 days from the first follow-up visit). In addition, 12.1% of patients developed new-onset diabetes after recovery from the illness. These findings underscore the importance of regular monitoring of glycemic parameters in COVID-19 patients with prediabetes after recovery. Full article

Type 2 diabetes mellitus (T2DM) is a growing global health issue that is closely linked to the epidemic of obesity. In addition to genetic factors, environmental and health-risk behaviours (i.e., high-carbohydrate diet and physical inactivity) contribute to a variety of pathophysiological disorders. Advanced exercise protocols, such as Moderate-to-intensity (MIT) and High Intensity Interval Training (HIIT), revealed a strategy for mitigating and/or attenuating the DTMII’s harmful effects by controlling glycated haemoglobin (HbA1c) levels. The goals of this review were to summarize the most recent evidence on the impact of HIIT on HbA1c levels. A mini-review protocol was performed through the PubMed/Medline database. The search comprised experimental and randomized controlled trial studies published in English between 2016 and 2021. The terms HbA1c, T2DM, MIT and HIIT, and their analogues were used. A total of seven studies were finally included. Our findings showed that the HIIT protocol is an effective strategy to induce HbA1c balance and improve glycaemic control than moderate training. The HIIT conducted in the laboratory and involving aerobic exercise on a cycle ergometer appears to be more efficient that MIT. Additional findings include improved beta-cell function, decreased low-grade inflammation, and the induction of cardiovascular benefits. More research is required to investigate the feasibility and safety of HIIT protocols in T2DM patients. Full article

Food behaviour is a complex and multifaceted cooperation between physiologic, psychological, social, and genetic factors, influencing meal timing, amount of food intake, food preferences, and food selections. Deregulation of the neurobiological mechanisms controlling food behaviour underlies the development of obesity and type 2 diabetes, two epidemics of the present century. Several brain nuclei are involved in the regulation of the different components of food behaviours; the hypothalamus is the key in controlling appetite and energy homeostasis. In this review, we will explain the role of the hypothalamus in the control of food intake and its interplay with other brain nuclei important in food behaviour. We will also highlight the deregulation of satiety pathways in type 2 diabetes and obesity and the mechanisms behind this deregulation. Finally, knowing that there are different categories of sugars and that they differently impact food behaviours, we will review in a concise manner the studies referring to the effects of sugars in satiety and reward pathways and their impacts on metabolic diseases. Full article

A high consumption of sugar leads to an increase in caloric intake, which in turn will lead to a higher risk of developing health issues. Foods contain both naturally occurring sugars and added sugars. The World Health Organization recommends that the daily intake of free sugars be below 10% of the total daily energy intake. Food performs a key role in maintaining an adequate glycaemic control in people with diabetes. However, there is a low compliance to dietary recommendations, namely in the amount of sugar intake. This review article aims to assess and compare the intake of various types of sugars in the general population and among individuals with and without a diabetes diagnosis, identify the food sources that contribute to the intake of free and added sugars, and understand their impact on health. Studies performed on the general population found that the consumption of sugar was high, and that children and teens are more likely to exceed the recommended amounts. It was found that diabetics consume less total and added sugar than non-diabetics, as well as a less sugary drinks. Guidelines and public health policy measures aimed at limiting the intake of free and added sugars are needed in order to minimize the consumption of foods high in empty calories. Full article

Nocturia is a common disease in patients with type 2 diabetes mellitus that can reduce the quality of life. Sodium glucose co-transporter 2 (SGLT2) inhibitors increase the urine volume and are often discontinued when polyuria occurs, although tofogliflozin, which has a short half-life in the blood, may improve nocturia by managing hyperglycemia and hypertension, without aggravating nocturia. As excessive sodium intake worsens nocturia and increases urine volume, sodium restriction is also effective in managing nocturia. This multicenter, open-label, randomized parallel-group trial will examine 80 patients with type 2 diabetes who experienced nocturia. After the baseline examination, the patients are randomly stratified into two groups and receive tofogliflozin treatment with or without sodium restriction for 12 weeks. The primary outcome is nocturia frequency at 12 weeks. The secondary outcomes are the frequency of daytime urine, changes in urine volume, and changes in home blood pressure. Full article

The number of adult individuals with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. The main local complications of insulin injection are lipohypertrophies (LHs), i.e., subcutaneous nodules consisting of aggregates of macro-adipocytes and fibrin. These nodules result from errors repeatedly made by patients while injecting insulin. Despite being very common, LH lesions/nodules due to incorrect insulin injection techniques are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Identifying LHs is crucial, especially in elderly and frail subjects, because they may eventually result in poor diabetes control due to associated unpredictable insulin release patterns. Raising awareness of the adequate detection of LHs and their clinical consequences is crucial and urgent. A call to action is required on this topic at all levels of undergraduate and postgraduate education. Full article

The circadian rhythm is essential in order to maintain metabolic homeostasis and insulin sensitivity. Disruption of circadian mechanisms is associated with the development of metabolic diseases, such as diabetes. Lifestyle changes such as an equilibrated diet and physical activity are known to improve glycaemic control in diabetic patients. One of the mechanisms possibly involved in such an improvement is the restoration of insulin circadian rhythms. There are several available dietary schemes based on circadian rhythms. Some of them are associated with better regulation of daily insulin fluctuations and the improvement of Type 2 Diabetes and metabolic syndrome. In the current review, we aim to explore how the different types of diet can impact glucose metabolism and insulin sensitivity in patients with diabetes, highlighting the interactions with the mechanisms of circadian insulin rhythm and the prevention of hyperinsulinemia. Full article

Glycotoxins include the group of advanced glycation end-products (AGEs) and their precursors, most of them highly reactive intermediary compounds of sugar metabolism. Glycotoxins and products of the Maillard reaction are present in high concentrations in foods rich in sugars and processed at high temperatures and are often associated with the flavour of the food. Proteins undergoing this type of molecular modification are targets for gut peptidases and may be absorbed into circulation. AGEs are associated with the toxic effects of glucose in diabetic patients, and some studies have shown that they also contribute to metabolically unhealthy obesity and prediabetes development. Restriction of dietary glycotoxins was shown to improve insulin resistance in humans. However, the real contribution of dietary AGEs to such mechanisms is still not understood. This review summarizes the current knowledge about glycotoxin formation from dietary sugars, their digestion throughout the gastrointestinal system, and the mechanisms of their intestinal absorption. Full article

Type 2 diabetes (T2D) has increased worldwide at an alarming rate. Metabolic syndrome (MetS) is a major risk factor for T2D development. One of the main reasons for the abrupt rise in MetS incidence, besides a sedentary lifestyle, is the westernized diet consumption, with high content of industrialized foods, rich in added dietary sugars (DS), mainly sucrose and fructose. It has been suggested that a higher intake of DS could impair metabolic function, inducing MetS, and predisposing to T2D. However, it remains poorly explored how excessive DS intake modulates mitochondrial function, a key player in metabolism. This review explores the relationship between increased consumption of DS and mitochondrial dysfunction associated with T2D development, pointing to a contribution of the diet-induced accumulation of advanced glycation end-products (AGEs), with brief insights on the impact of maternal high-sugar diet and AGEs consumption during gestation on offspring increased risk of developing T2D later in life, contributing to perpetuate T2D propagation. Full article

Diabetes mellitus is a metabolic disorder that is prima facie a cause for numerous macro and micro vascular complications. A common macroscopic complication associated with diabetes is cardiomyopathy. Cardiomyopathy refers to diseases of the heart muscle, where the heart muscle becomes enlarged, thick, or rigid. As cardiomyopathy worsens, the heart becomes weaker and is unable to conduct the right amount of blood through the body and maintain a normal electrical rhythm. This can lead to heart failure or arrhythmias. Chronic diabetes is one of the instigating factors behind the etiology of this cardiac complication. Type-II diabetes is associated with impaired glucose metabolism that increases the dependence of a diabetic heart on fatty acid oxidation to meet its functional demands, resulting in mitochondrial uncoupling, glucotoxicity, lipotoxicity and initially subclinical cardiac dysfunction that finally gives way to heart failure. The increasing diabetic population with cardiac disorders and the ironically decreasing trend in newer medications to counter this complication leave us at a crossroads for pharmacological management of diabetic cardiomyopathy. Keeping this in view, the present study proclaims a newly developed polyherbal combination (PHC) with three herbs, namely Tinospora cordifolia, Withania somnifera and Boerhavia diffusa based in olive oil and administered in fixed dose (PHC-6 and PHC-10) to screen its cardioprotective potential against a well-established experimental model for diabetic cardiomyopathy. The three herbs mentioned have been known through the traditional literature for their antidiabetic and cardioprotective roles, hence they became the obvious choice. The study follows an experimental model proposed by Reed et al., where the capacity of the β-cell is unobtrusively impeded without totally compromising insulin release, bringing about a moderate disability in glucose resilience. Various sophisticated parameters, namely intraventricular septum thickness of hearts, Western blot of α/β- MHC monoclonal antibody (Ab), cardiac pyruvate dehydrogenase (PDH) activity, medium chain acyl coenzyme A dehydrogenase (MCAD) enzyme, etc. showed promising results where treatment with PHC (PHC-6 and PHC-10) significantly (*** p < 0.001 and **** p < 0.0001) prevented the symptoms of cardiomyopathy in subsequent groups when compared to disease control group. Full article

Excessive sugar consumption is a risk factor for the development of several disorders, including metabolic, cardiovascular, neurological conditions and even some cancers, and has been linked to increased morbidity and mortality. The popularization of the typical Western diet, featured by an excessive intake of saturated fats and added sugars and a low consumption of unprocessed fruits, vegetables and fiber, may directly affect the composition and functionality of the gut microbiota, staggering the balance of the intestinal microbiome that ultimately culminates into gut dysbiosis. Although added sugars in the form of nutritive and non-nutritive sweeteners are generally considered as safe, a growing body of evidence correlate their consumption with adverse effects on gut microbial ecosystem; namely an abnormal synthesis of short-chain fatty acids, altered intestinal barrier integrity and chronic inflammation that often fuel a panoply of metabolic conditions. Accordingly, this work revisited the available preclinical evidence concerning the impact of different types of dietary sugars—nutritive and non-nutritive sweeteners—on gut microbiota and metabolic health. Future research should consider gender and species vulnerability when the impact of such substances on GM community and metabolic health is scrutinized in order to guide their adequate use at doses relevant to human use. Full article

Impaired glucocorticoid signaling in diabetes mellitus and its relation to suppressed immune function and hyperglycemia during acute stroke has been shown to be detrimental. Therefore, the aim of this study was to examine the effect of glucocorticoid receptor (GCR) blockers in a type-2 diabetic mouse model following hypoxia–ischemia (HI). We induced stroke in diabetic db/db and non-diabetic db/+ mice by unilateral common carotid artery ligation followed by 20 min of HI. Mice were pretreated with RU-486, GCRII blocker (40 mg/kg), intraperitoneally, the day before, during stroke and post-HI. Blood and brain samples were collected at 24 h post-HI to measure blood glucose, corticosterone and infarct size. Similarly, another set of mice was pretreated with RU-486 + spironolactone, GCR1 blocker (25 mg/kg) subcutaneously for a week before inducing stroke and during recovery. Samples were collected at 48 h post-HI for various analyses. RU-486 treatment did not lower the blood glucose significantly, but RU-486 + spironolactone decreased the blood glucose in db/db mice post-HI. However, none of the treatment groups decreased the ischemia-induced serum corticosterone level or infarct size. This study suggests that even though GCR blockers improve hyperglycemia, they did not improve the infarct volume. Full article

Non-alcoholic fatty liver disease (NAFLD) is associated with prediabetes and can be treated by using a combination of metformin and dietary modification. However, people often fail to adhere to dietary modifications and become more dependent on pharmaceutical intervention, and this affects the effectiveness of the drug. In this study, we investigated the effects of rhenium (V) compound with uracil-derived ligands on liver health in diet-induced prediabetic rats in both the presence and absence of dietary modification. Prediabetic male Sprague Dawley rats were treated with the rhenium (V) compound for 12 weeks in both the presence and absence of dietary modification while monitoring fasting blood glucose levels. Antioxidant enzyme activity, inflammation markers and liver enzymes were measured together with liver glycogen and plasma triglycerides after sacrificing. The administration of rhenium (V) compound to prediabetic rats in both the presence and absence of dietary modification resulted in reduced concentrations of fasting blood glucose and triglycerides. There was also reduced liver glycogen, oxidative stress and liver enzymes while increasing antioxidant enzymes. Altogether, the rhenium (V) compound ameliorated liver injury and prevented hepatotoxicity. Full article

The research is based on a clinical observation of the neurological and neuro-cognitive status of 300 patients, belonging to the Partinico Hospital and the Post-Long Covid clinic, which had contracted the SARS-CoV-2 virus in the period between April 2021 and May 2022. In this paper, we present the analysis of the first 100 patients subjected to a neurocognitive screening protocol. The procedure consists of tests that examine the mechanism of different brain domains to check for the presence of cognitive deficits that arose after the negativization of the viral infection. Through a neurocognitive protocol, the research aims to investigate different brain areas and mental functioning. This allowed us to raise the possibility that the presence of cognitive alterations may be related to the evidence of point-like brain alterations (from the cortex to the trunk) visible through neuroimaging techniques. In the article, we highlight the hypothesis that SARS-covid 2, as stated in recently published studies, can produce an alteration of executive functions such as to configure a real dysexecutive syndrome. This research evaluates the symptomatic gender variability within the sample, the presence of important differences in the affective state, and provides a first observation of the impact of SARS-CoV-2 in diabetic pathology as well. Full article

Approximately 40% of patients with type 2 diabetes (T2D) experience an early-morning rise in fasting glucose that is not effectively treated by available oral hypoglycemic agents. This study aimed to determine the acute effect of consuming almond butter as an evening snack on fasting and overnight interstitial glucose, compared to a no-snack control, in people with T2D. Adults with T2D, not taking insulin, were recruited to participate in this two-week randomized, controlled, crossover pilot study. Participants received 2 tbsp of natural almond butter as an evening snack, or a no-snack control, for one week each. Glucose was measured by continuous glucose monitor (CGM). Analyses were performed using linear mixed effect modeling in R. Ten adults (60% female; age: 57 ± 5.6 years) completed the study. The intervention did not significantly influence fasting glucose [4–6 a.m.; β = 5.5, 95% CI = [−0.9, 12.0], p = 0.091; Marginal R2 = 0.001, Conditional R2 = 0.954] or overnight glucose (12–3 a.m.; β = 5.5, 95% CI = [−0.8, 11.8], p = 0.089; Marginal R2 = 0.001, Conditional R2 = 0.958). Significant variability in continuously measured glucose was observed. These findings will inform the design of a larger investigation. Full article

During the COVID-19 pandemic, fewer in-person clinic visits resulted in fewer point-of-care (POC) HbA1c measurements. In this sub-study, we assessed the performance of alternative glycemic measures that can be obtained remotely, such as HbA1c home kits and Glucose Management Indicator (GMI) values from Dexcom Clarity. Home kit HbA1c (n = 99), GMI, (n = 88), and POC HbA1c (n = 32) were collected from youth with T1D (age 9.7 ± 4.6 years). Bland–Altman analyses and Lin’s concordance correlation coefficient (𝜌_c) were used to characterize the agreement between paired HbA1c measures. Both the HbA1c home kit and GMI showed a slight positive bias (mean difference 0.18% and 0.34%, respectively) and strong concordance with POC HbA1c (𝜌_c = 0.982 [0.965, 0.991] and 0.823 [0.686, 0.904], respectively). GMI showed a slight positive bias (mean difference 0.28%) and fair concordance (𝜌_c = 0.750 [0.658, 0.820]) to the HbA1c home kit. In conclusion, the strong concordance of GMI and home kits to POC A1c measures suggest their utility in telehealth visits assessments. Although these are not candidates for replacement, these measures can facilitate telehealth visits, particularly in the context of other POC HbA1c measurements from an individual. Full article