Current Diabetes Reviews - Volume 20, Issue 7, 2024

Background: Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. Methods: The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. Result: In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). Conclusion: Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.

Monoclonal antibodies have been successfully utilized in a variety of animal models to treat auto-immune illnesses for a long time. Immune system responses will either be less active or more active depending on how the immune system is operating abnormally. Immune system hypoactivity reduces the body's capacity to fight off various invading pathogens, whereas immune system hyperactivity causes the body to attack and kill its own tissues and cells. For maximal patient compliance, we will concentrate on a variety of antibody therapies in this study to treat Type 1 diabetes (an autoimmune condition). T-cells are responsible for the auto-immune condition known as T1D, which causes irregularities in the function of β-cells in the pancreas. As a result, for the treatment and prevention of T1D, immunotherapies that selectively restore continuous beta cellspecific self-tolerance are needed. Utilizing monoclonal antibodies is one way to specifically target immune cell populations responsible for the auto-immune-driven disease (mAb). Numerous mAbs have demonstrated clinical safety and varied degrees of success in modulating autoimmunity, including T1D. A targeted cell population is exhausted by mAb treatments, regardless of antigenic specificity. One drawback of this treatment is the loss of obtained protective immunity. Immune effector cell function is regulated by nondepleting monoclonal antibodies (mAb). The antigenfocused new drug delivery system is made possible by the adaptability of mAbs. For the treatment of T1D and T-cell-mediated autoimmunity, different existing and potential mAb therapy methods are described in this article.

This narrative mini-review discusses vitamin E levels in subjects with diabetic foot ulcers (DFUs). Vitamin E may be reduced in subjects with DFUs, but this finding is inconsistent. Its administration appears to benefit patients with DM, delaying the onset of complications, including DFUs. There is also evidence that it may promote DFUs healing. Nonetheless, further studies are required to confirm these promising results and estimate vitamin E administration's costeffectiveness.

Diabetic retinopathy is a common complication of diabetes that affects the eyes and can lead to severe vision loss or blindness if left untreated. Chronic hyperglycemia destroys the blood vessels in the retina, resulting in diabetic retinopathy. The damage can lead to leakage of fluid and blood into the retina, causing edema, hemorrhages, and ischemia. A thorough evaluation by an ophthalmologist is necessary to determine the most appropriate course of treatment for each patient with diabetic retinopathy. The article discusses various surgical treatment options for diabetic retinopathy, including vitrectomy, scleral buckling, epiretinal membrane peeling, retinal detachment repair, and the risk factors of diabetic retinopathy. These surgical techniques can help to address the underlying causes of vision loss and prevent further complications from developing or worsening. To avoid complications and maintain vision, this review emphasizes the significance of early detection and treatment of diabetic retinopathy. Patients with diabetic retinopathy can improve their eyesight and quality of life with the help of some surgical treatments. The article also highlights some case studies in the field of diabetic retinopathy.

Background and Aims: The diabetics' lack of knowledge about self-care and incorrect beliefs in this care are the reasons for their admission to hospitals. The present study aimed to examine the impact of education based on the theory of planned behavior (TPB) on intention, self-care behavior, and glycosylated hemoglobin (HbA1c) levels in patients with Type 2 Diabetes. Methods: The present study was conducted on 60 diabetic patients who were randomly classified into intervention and control groups. In the intervention group, self-care education based on TPB was held, but the control group only received routine care. The data were collected using a fourpart questionnaire including characteristics, items of patients’ knowledge, items of TPB constructs, and items of diabetes self-care. Data were analyzed in SPSS software. Results: In intervention group, mean score of self-care behavior and its domains significantly changed from (total: 52.26±14.75, diabetic diet: 22.20±6.05, exercise: 5.17±4.04, blood sugar testing: 5.03 ± 4.15, medication: 5.40±2.28, foot care: 13.47±8.42) into 76.66±8.87, 29.43±5.48, 7.60±2.60, 8.73±2.31, 6.48±1.09, 23.53±3.09, respectively three months after intervention (p<0.01). In this case, these changes were not seen in the control group. The mean level of HbA1c in the intervention group (6.38±0.16) was significantly lower than before the intervention (7.56±1.08) and the control group (8.02±0.25) three months after intervention (p<0.01). Conclusion: Education based on the TPB was effective in improving the patients' self-care behavior and HbA1c index. Therefore, we suggest all medical centers to use the TPB as an effective and low-cost educational approach to improve diabetics' self-care behavior and health.

Throughout the previous three decades, the secretion of glucagon-like peptide-1 hormone has attracted much attention to attain possible therapy goals for the treatment of both hypoglycaemic along type II diabetes militates and overweight. The pharmaceutical generation of peptides similar to hypoglycaemia-based medicines is exemplified by agonists of the GLP- 1R (Glucagon-like peptide-1 receptors). Pharmacokinetic profiles are continuously being improved, beginning with the native hormone with a two- to three-minute quarter and progressing through growth every day with once-drug combinations. Due to contradictory data that indicate stimulation or inhibition of the Glucagon-like peptide receptor, the Glucose-dependent insulin tropic peptide receptor offers favorable effects on systemic metabolism. The recent Glp-1R (Glucagon-like peptide-1 receptor-) targeting monomolecular drugs has demonstrated therapeutic effectiveness and has stoked interest in Glucose-dependent insulin tropic polypeptide antagonism as a treatment for overweight and diabetes mellitus. These drugs have been shown to dramatically improve carbohydrates with body weight management in sick people who have obesity and type II diabetes mellitus. In this study, recent breakthroughs in compelling therapeutic interventions are discussed, and the biology and pharmacology of the glucose-like peptide are reviewed.

Introduction: Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. Objectives: To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs. HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the Clinical biochemistry laboratory. Methods: The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). Results: There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. Conclusion: The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.

Aim: The management of type 2 diabetes mellitus is affected by the presence of comorbidities. This meta-analysis aimed to determine how likely it is for individuals with type 2 diabetes in the Middle East and North Africa (MENA) region to be living with additional chronic health conditions. Methods: We searched for studies published from January 2010 to December 2020 in the PubMed, Ovid MEDLINE®, Cochrane CENTRAL, Scopus, and Web of Science databases. Studies of adults with type 2 diabetes in the MENA region were included. We performed a random-effects meta-analysis of single proportions to calculate each comorbidity's overall prevalence/coprevalence. Results: Statistically significant co-prevalence was detected at p < 0.01 for angina (pooled proportion: 0.24, 95% CI: 0.06, 0.49), cerebrovascular accident (pooled proportion: 0.16, 95% CI: 0.08, 0.26), coronary artery disease (pooled proportion: 0.25, 95% CI: 0.16, 0.35), coronary heart disease (pooled proportion: 0.05, 95% CI: 0.01, 0.12), peripheral vascular disease (pooled proportion: 0.19, 95% CI: 0.13, 0.26), hypertension (pooled proportion: 0.56, 95% CI: 0.43, 0.69), renal impairment (pooled proportion: 0.19, 95% CI: 0.10, 0.29), in addition to hyperlipidemia and overweight/ obesity. Conclusion: There is evidence of co-prevalence of several comorbidities in patients with type 2 diabetes, highlighting the importance of enhancing communication among healthcare professionals to develop the optimal management plan for each patient.

Background: Diabetes is a common and deadly chronic disease caused by high blood glucose levels that can cause heart problems, neurological damage, and other illnesses. Through the early detection of diabetes, patients can live healthier lives. Many machine learning and deep learning techniques have been applied for noninvasive diabetes prediction. The results of some studies have shown that the CNN-LSTM method, a combination of CNN and LSTM, has good performance for predicting diabetes compared to other deep learning methods. Method: This paper reviews CNN-LSTM-based studies for diabetes prediction. In the CNNLSTM model, the CNN includes convolution and max pooling layers and is applied for feature extraction. The output of the max-pooling layer was fed into the LSTM layer for classification. Discussion: The CNN-LSTM model performed well in extracting hidden features and correlations between physiological variables. Thus, it can be used to predict diabetes. The CNNLSTM model, like other deep neural network architectures, faces challenges such as training on large datasets and biological factors. Using large datasets can further improve the accuracy of detection. Conclusion: The CNN-LSTM model is a promising method for diabetes prediction, and compared with other deep-learning models, it is a reliable method.

Background: Type 2 diabetes (T2D), a multifaceted metabolic disorder, may cause health tribulations and changes in biochemical blood markers. Other research has examined the relationships between several biomarkers and the risk of T2D. Few studies have examined the relationships between these biomarkers and potential changes to the network of biomarkers associated with diabetes. Method: Glycated hemoglobin, or HbA1c, is used to evaluate and track the blood glucose history throughout the previous two to three months of testing. The ability to reflect the cumulative glycemic history of the previous two to three months makes HbA1c an essential biomarker of long-term glycemic control. HbA1c offers a trustworthy indicator of chronic hyperglycemia and strongly correlates with the likelihood of long-term consequences from diabetes. Result: Additionally, elevated HbA1c has been recognized as a stand-alone risk factor for patients with and without diabetes developing coronary heart disease and stroke. One HbA1c test offers a wealth of information that makes it a reliable biomarker for the diagnosis and prognosis of diabetes. A clinical examination may be required to establish the connection between diabetes, prediabetes, biochemical blood indicators, age, and body mass index (BMI). Conclusion: We observed that diabetes, BMI, age, HbA1c, cholesterol, triglycerides, LDL, VLDL, and HDL were all linked using multivariate analysis.

Bioactive compounds found in various natural sources, such as fruits, vegetables, and herbs, have been studied for their potential benefits in managing obesity and diabetes. These compounds include polyphenols, flavonoids, other antioxidants, fiber, and certain fatty acids. Studies have found that these compounds may improve insulin sensitivity, regulate blood sugar levels, and promote weight loss. However, the effects of these compounds can vary depending on the type and amount consumed, as well as individual factors, such as genetics and lifestyle. Nutraceutical substances have multifaceted therapeutic advantages, and they have been reported to have disease-prevention and health-promoting properties. Several clinically used nutraceuticals have been shown to target the pathogenesis of diabetes mellitus, obesity, and metabolic syndrome and their complications and modulate various clinical outcomes favorably. This review aims to highlight and comment on some of the most prominent natural components used as antidiabetics and in managing obesity.

Insulin's inception dates back to 1921 and was unveiled through a momentous revelation. Diabetes is a dangerous, long-term disease in which the body fails to generate enough insulin or utilize the insulin it creates adequately. This causes hyperglycemia, a state of high blood sugar levels, which can even put a person into a coma if not managed. Activation of the insulin receptor corresponds to two crucial metabolic functions, i.e., uptake of glucose and storage of glycogen. Type 2 diabetes mellitus (T2DM) exists as one of the most challenging medical conditions in the 21^st century. The sedentary lifestyle and declining quality of food products have contributed to the rapid development of metabolic disorders. Hence, there is an urgent need to lay some reliable, significant molecules and modalities of treatment to combat and manage this epidemic. In this review, we have made an attempt to identify and enlist the major phytoconstituents along with the associated sources and existing mechanisms against insulin resistance. The conducted study may offer potential sustainable solutions for developing and formulating scientifically validated molecules and phytoconstituents as formulations for the management of this metabolic disorder.