Current Diabetes Reviews - Volume 19, Issue 6, 2023

Background: The prevalence of cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM) has increased in Bangladesh. This paper has reviewed published studies on hypertension and T2DM from 2010 to 2020 in Bangladesh and conducted a meta-analysis. Methods: The PubMed database was used for systematic search. Hypertension and T2DM were considered for measuring pooled prevalence by meta-analysis. The random-effects model was used to calculate the pooled prevalence of hypertension (n = 30) and T2DM (n = 21) in relevant studies. The quality of the reviewed studies was determined by sampling strategy, sample size, and outcome assessment. The meta-analysis protocol was registered at PROSPERO (CRD42020206315). Results: The pooled hypertension and T2DM prevalence was 21.6% (95% CI: 18.8%-24.4%) and 13.6% (95% CI: 10.8%-16.5%), respectively. Females were more hypertensive than males (M vs. F: 18.6% vs. 24.8%), and T2DM was higher in females (M vs. F: 12.4% vs. 13.3%). Urban dwellers were more hypertensive and diabetic than rural people (urban vs. rural: 28.5% vs. 20.3% and 18.8% vs. 14.2%, respectively). An 8% increase in the prevalence of hypertension and T2DM became more than double compared to the 1995-2010 period. Conclusion: Future research should focus on the underlying factors that increase the prevalence of these diseases and prevention strategies to reduce the trend of increasing prevalence.

Insulin is an essential factor for mammalian organisms: a regulator of glucose metabolism and other key signaling pathways. Insulin is also a multifunctional hormone whose absence can cause many diseases. Recombinant insulin is widely used in the treatment of diabetes. Understanding insulin, biosimilars, and biobetters from a holistic perspective will help pharmacologically user-friendly molecules design and develop personalized medicine-oriented therapeutic strategies for diabetes. Additionally, it helps to understand the underlying mechanism of other insulindependent metabolic disorders. The purpose of this atlas is to review insulin from a biotechnological, basic science, and clinical perspective, explain nearly all insulin-related disorders and their underlying molecular mechanisms, explore exogenous/recombinant production strategies of patented and research-level insulin/analogs, and highlight their mechanism of action from a structural perspective. Combined with computational analysis, comparisons of insulin and analogs also provide novel information about the structural dynamics of insulin.

Diabetes mellitus is a crucial health issue worldwide. The worldwide ubiquity is 8.8% among adults, which is predicted to rise to 10.4% by 2040. Diabetic neuropathy is a long-term complication associated with the diabetes mellitus condition, which primarily targets Schwann cells, peripheral axons and cell bodies (perikarya) in DRG (dorsal root ganglia). It can be accompanied by different factors such as metabolic factors such as insulin resistance, hypertension, obesity, low HDL level, and hypertriglyceridemia. The etiology of DPN is multifactorial. It is caused by hyperglycemia, micro-angiopathy, HbA1c, duration of diabetes, smoking status, high-density lipoprotein cholesterol and hypertension. Also, increased glucose conditions decrease vitamin D levels. Vitamin D, which is involved in neurotrophins such as NGF (nerve growth factor) and NCH (neuronal calcium homeostasis), plays a neuroprotective role in peripheral nerves. Depletionleads to vitamin D deficiency which further develops peripheral neuropathy in diabetic patients. Accumulation of AGEs (advanced glycation end product) plays a significant role in the pathogenesis of sensory neuronal damage. It contributes to microangiopathy and endoneurial vascular dysfunction in peripheral nerves. With vitamin D supplementation, the neuropathy pain scores were improved.

Distinct molecular processes are engaged during histogenesis, and Epithelial to Mesenchymal Transition (EMT) is one of the key evolutionarily conserved processes that facilitates organ development. Molecular pathways governing EMT are embedded within developmental programs and operate in cells of different tissues. Among varied cell types, EMT in pancreatic β-cells is of greater interest as the existence of EMT in these cells is highly debated. Although in vitro generation of human islet-derived mesenchymal progenitor cells has been proven beyond doubt, the existence of EMT in pancreatic β-cells in vivo remains enigmatic. Understanding the in-depth process of EMT in in vivo human β-cells is challenged by the limitations of lineage-tracing studies, which are otherwise feasible in mice. Exploring EMT of β-cells would greatly facilitate the generation of clinically relevant β-cells either by enhancing long-term in vitro culture of endogenous islets or by differentiation of pluripotent stem cells to mature β-cells. This review is an update on the recent progress in understanding the EMT process of β-cells and how the investigations have helped to resolve the mystery of the existence of EMT in pancreatic β-cells.

There is a rise in the number of individuals diagnosed with type 2 diabetes mellitus (T2DM) in South Africa. Cardiovascular disease is among the macrovascular complication of type 2 diabetes mellitus and accounts for the high mortality rate in patients with T2DM. The disease is characterized by insulin resistance, hyperglycaemia, oxidative stress, inflammation, hypofibrinolysis and hypercoagulation. The impairment of fibrinolysis, hyperactivation of coagulation and the inflammatory pathways result in an increased risk of developing coronary heart disease. Factor XIII-A is one of the key coagulation factors that play a crucial role in the last stage of the coagulation cascade, and it has been shown to play a critical role in the development of thrombotic diseases. In addition, several studies show the influence of FXIII-A polymorphisms on thrombotic diseases. The influence of genetic variations such as single nucleotide variants and gene expression regulators (micro-RNAs) are important factors involved in the hyperactivation of coagulation and hypofibrinolysis. Thus, this review aims to summarise key aspects of coagulation, FXIII-A expression, potential FXIII-A genetic variations and epigenetic mediators (micro-RNA-155) in T2DM and patients with coronary artery disease.

Objective: This systematic review looked at different clinical trials that explored the beneficial effect of a ketogenic diet on insulin sensitivity in Type 2 Diabetics, both with and without exercise. It was hypothesized that a ketogenic diet is effective in improving insulin sensitivity in individuals with Type 2 Diabetes, with the greatest effect resulting from a ketogenic diet paired with exercise. Methods: The databases used when searching were the Directory of Open Access Journals and PubMed for randomized control trials, non-randomized control trials, and prospective longitudinal studies. Results were summarized in an evidence table found in the Appendix. Studies were not limited by study type, age of study participants, gender, ethnicity, language, journal in which the studies were published, or geographic location. One study utilized mouse models. Statistical analysis was not performed. Results: Twelve trials were studied. Three trials studied the role of exercise and a ketogenic diet in the treatment of Type 2 Diabetes. Five trials studied a ketogenic diet compared to another diet in the treatment of Type 2 Diabetes. Two trials studied a ketogenic diet alone in the treatment of Type 2 Diabetes. One trial studied a ketogenic diet in those with pre-diabetes. One trial studied a ketogenic diet in those with pre-diabetes and those diagnosed with Type 2 Diabetes. Every trial utilizing a ketogenic diet showed marked improvement in glycemic control among participants in support of the hypothesis. One study noted that while a ketogenic diet greatly improved glycemic control, it created problems with lipid metabolism and the liver. When pairing a ketogenic diet with exercise, hepatic steatosis was avoided. Eleven studies used adult participants, one used mouse models. One study was a prospective longitudinal study, nine randomized control trials, one nonrandomized control trial, and one observational cohort study. Conclusions: The studies provide encouraging results. A ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes. However, the studies are limited in their lack of exploration of the effects of a long-term ketogenic diet on the liver, with only one study including this data. Randomized trials looking at the effect of a ketogenic diet on the liver are needed. In addition, there were very few studies found when researching that paired a ketogenic diet with exercise to study both the effect on glycemic control, as well as avoiding potential hepatic steatosis.

Background: The role of the ABO blood group goes beyond immunohematology as there is accumulating evidence on its association with type 2 diabetes mellitus. However, findings regarding the relation have been contradictory and there is a need to determine the validity of claims. Objective: Evaluate the susceptibility of the ABO blood groups to type 2 diabetes mellitus. Method: The research design is a meta-analysis. An extensive search was done in PubMed, ScienceDirect, ResearchGate, and Google Scholar. Heterogeneity was determined through Cochran’s Q test and I² index. Random-effects model was used to measure the risk ratio and confidence intervals. Evaluation of publication bias was done using the funnel plot method; further supported by Egger’s linear regression test and Begg’s test. Results: The relative susceptibility of ABO blood groups to type 2 diabetes mellitus differs for blood type A (Relative risk [RR] = 1.05, 95% CI, 0.93 to 1.18), blood type B (RR = 1.03, 95% CI, 0.91 to 1.18), blood type AB (RR = 1.25, 95% CI, 0.78 to 1.99), and blood type O (RR = 1.11, 95% CI, 0.82 to 1.48). The highest risk of acquiring the disease was seen in type AB individuals, while the lowest risk was seen in type B individuals. Conclusion: A significant association was found between ABO blood groups and type 2 diabetes mellitus. ABO phenotype can therefore be considered a possible risk factor or potential genetic determinant of the disease, which can be used to improve diagnosis and treatment.

Background: Pregnant women with pre-existing type 2 diabetes mellitus (T2DM) are at risk of poor maternal and neonatal health outcomes. Previous systematic reviews on pregnant women with T2DM have focused on physical activity, blood glucose monitoring, and insulin injections. Objective: The purpose of this scoping review was to examine the barriers and facilitators to diabetes self-management in pregnant women with pre-existing type 2 diabetes mellitus. Methods: PubMed, CINAHL, and EMBASE databases were searched using the PRISMA-ScR guidelines. Inclusion criteria included manuscripts written in English and qualitative studies. Consensus statements were excluded. A metasummary was used to identify patterns in barriers and facilitators across studies. A vote-counting method was used to summarize qualitative findings. Results: A total of ten qualitative publications were selected. This review suggests four themes describing barriers, including barriers to diabetes self-management in pregnancy, stress related to pregnancy with diabetes, a barrier to access to health care, and sensing a loss of control. The fifth theme described facilitators of diabetes self-management in pregnancy. Conclusion: This supports an integrative model of maternity care and culturally relevant practices to overcome critical barriers and optimize key facilitators to enhance diabetes self-management behaviors and improve maternal and neonatal health outcomes.

Background and Aim: The present study aimed to evaluate the anxiety, depression, and fear in people with and without diabetes during the transmission of the SARS-CoV-2 Omicron variant. Methods: In this comparative study (n= 353), people with diabetes (n= 121) and those without diabetes (n= 232) were investigated for physiological aspects of COVID-19 during the SARS-CoV-2 Omicron variant outbreak. This study was performed at the Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. On request, the participants responded to the survey questionnaires, providing data on demographics, Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire-2 (PHQ-2) to screen for anxiety, depression, and COVID-19-related fears. Results: The GAD statement revealed a significantly higher degree of nervousness and anxiety among people with diabetes when compared to people without diabetes (P = 0.001). For the other GAD statements, no statistical difference was observed between the responses of people with and without diabetes, including the overall GAD-7 (P = 0.091). The PHQ-2 statement, concerning a feeling of depression or hopelessness noted a significant escalation among diabetes compared to nondiabetes (P = 0.004). Furthermore, in the overall PHQ-2, a significant escalation (P = 0.011) was noticed among people with diabetes compared to nondiabetes. In addition, people with diabetes had a significantly high (P = 0.037) COVID-19-related fear reported, compared to people without diabetes. Conclusion: The need for comprehensive research is urgent, as it will facilitate a better understanding of the physiological aspects of COVID-19 for patients with diabetes.