Hyperglycaemia has a significant long-term impact on multiple organ systems, including renal, cardiovascular, central nervous, hepatic and ocular systems, leading to the gradual loss of their functional abilities. Numerous studies have elucidated the pathophysiology, etiology, and consequences of hyperglycaemia on these organs. The pulmonary system is also considered as a target of hyperglycaemia, several factors cause lung injury which leads to the development of pulmonary fibrosis, a chronic fibrotic disease with usual interstitial pneumonia patterns. Nevertheless, the effects of hyperglycaemia on the development of pulmonary fibrosis remain poorly understood. We intend to understand the cellular and morphological changes, and the progression of fibrosis in lung epithelial cells subjected to hyperglycaemia. Our experimental data indicate that hyperglycaemia induces fibrotic and inflammatory alterations in cultured lung epithelial cells. These alterations are facilitated by the upregulation of genes related to fibrosis and inflammation, promoting cell proliferation and migration. Further research is required to comprehensively elucidate the impact of hyperglycaemia during lung injury progression of fibrosis, these findings may reveal novel mechanisms that may help in the assessment and treatment of lung ailments in people with hyperglycaemia.

To assess the treatment effects of once-weekly insulin icodec (icodec) versus once-daily basal insulin comparators in individuals with type 2 diabetes (T2D) according to baseline glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) use.

This post hoc analysis of the randomized ONWARDS 1-5 trials of individuals with T2D assessed treatment outcomes by trial according to baseline GLP-1RA and/or SGLT2i use.

At screening, 21.3% (801/3765) and 36.9% (1388/3765) of participants in ONWARDS 1-5 were treated with a GLP-1RA or an SGLT2i, respectively. Baseline characteristics were broadly similar across treatment arms irrespective of GLP-1RA/SGLT2i use; GLP-1RA users had numerically higher body mass indices than non-users. Across trials, there were no statistically significant treatment interactions by GLP-1RA or SGLT2i subgroups with respect to: change in glycated haemoglobin (HbA1c) and body weight from baseline to end of treatment (except for body weight change by SGLT2i use in ONWARDS 5); weekly basal insulin dose during the last 2 weeks of treatment (except SGLT2i use in ONWARDS 5); and achievement of HbA1c less than 7% without clinically significant or severe hypoglycaemia. Irrespective of GLP-1RA/SGLT2i use, the rates of clinically significant or severe hypoglycaemia were less than one episode per patient-year of exposure across all trials except ONWARDS 4 (basal-bolus trial).

The efficacy and hypoglycaemia profile of icodec versus once-daily comparators was generally consistent across ONWARDS trials irrespective of background GLP-1RA and/or SGLT2i use.

Controlling glycated hemoglobin (HbA1c) levels can be challenging for patients with type 2 diabetes mellitus (T2DM). Peer support promotes HbA1c control, and a digital peer-supported app designed for group interactions may enable patients with T2DM to encourage one another to achieve better HbA1c outcomes. However, no studies have investigated the use of digital peer-supported apps to control HbA1c levels in patients with T2DM.

This pilot study aimed to explore the effects of a digital peer-supported app on HbA1c control in patients with T2DM.

This prospective single-arm pilot study enrolled patients with T2DM who owned smartphones and visited medical institutions in Japan. During the 3-month intervention, participants used a digital peer-supported app in addition to receiving standard care. This app allowed participants to share activity logs and concerns via a chat function to improve HbA1c levels through mutual engagement and encouragement. The primary outcome was the change in HbA1c levels, measured at health care facilities at baseline and after 3 months. The secondary outcomes were body weight and blood pressure, with the most recent data obtained from hospitals and clinics. Physical activity (≥1 hour/day) was assessed at the same time points using a self-reported questionnaire.

The study included 21 participants with a median age of 56 (IQR 51-61) years, of which 13 (61.9%) were female. After using the digital peer-supported app for 3 months, the participants' HbA1c levels significantly decreased from 7.1% (SD 0.6%) at baseline to 6.9% (SD 0.1%) (P=.04). Similarly, participants' body weight decreased from 70.7 (SD 12.7) kg to 69.9 (SD 12.4) kg (P =.004) through app use. Although blood pressure decreased slightly from 128.2 (SD 12.5) mm Hg to 126.0 (SD 12.9) mm Hg, this change was not statistically significant (P=.20). Additionally, the proportion of participants engaged in ≥1 hour of daily physical activity significantly increased from 23.5% (n=4) to 58.5% (n=10) (P=.03).

In addition to receiving standard clinical care, the use of a digital peer-supported app may significantly lower HbA1c levels in patients with T2DM by promoting healthy behaviors.

This study evaluated healthcare resource utilization (HCRU) and costs in the USA for people with type 2 diabetes (T2D) who discontinued the injectable glucagon-like peptide 1 receptor agonist (GLP-1 RA) once-daily liraglutide for T2D (with no other glucose-lowering agent added) or switched from liraglutide to the GLP-1 RA once-weekly semaglutide for T2D.

In this observational cohort study, we utilized claims data (Merative MarketScan [Merative, Ann Arbor, MI, USA] Commercial and Medicare Database; January 1, 2017-March 31, 2021) to compare HCRU and costs between individuals who discontinued liraglutide ("discontinuers") and those who switched from liraglutide to semaglutide ("switchers"). Patients were indexed between January 1, 2018 and March 31, 2020. Outcomes were compared between discontinuers and switchers over the 360-day post-index period using stabilized inverse probability of treatment weighting.

Characteristics of the two cohorts were balanced after weighting. Switchers had significantly lower HCRU in inpatient and emergency department (ED) settings compared with discontinuers. Mean [standard deviation] total medical costs were significantly lower for switchers ($8513 [$18,931]) than for discontinuers ($13,585 [$52,011], p < 0.001), driven by reduced inpatient costs (2.6 times lower) and ED costs (1.6 times lower).

This analysis demonstrates that the cohort of people switching from liraglutide to semaglutide was associated with significantly lower HCRU and costs when compared with people discontinuing liraglutide only. These findings imply that switching to semaglutide could be a good option for people with T2D for whom liraglutide is no longer optimal.

Effective diabetes management requires a multimodal approach involving lifestyle changes, pharmacological treatment, and continuous patient education. Self-management demands can be overwhelming for patients, leading to lowered motivation, poor adherence, and compromised therapeutic outcomes. In this context, digital health apps are emerging as vital tools to provide personalized support and enhance diabetes management and clinical outcomes.

This study evaluated the impact of the digital health application Vitadio on glycemic control in patients with type 2 diabetes mellitus (T2DM). Secondary objectives included evaluating its effects on cardiometabolic parameters (weight, BMI, waist circumference, blood pressure, and heart rate) and self-reported measures of diabetes distress and self-management.

In this 6-month, 2-arm, multicenter, unblinded randomized controlled trial, patients aged 18 years or older diagnosed with T2DM were randomly assigned (1:1) to an intervention group (IG) receiving standard diabetes care reinforced by the digital health app Vitadio or to a control group (CG) provided solely with standard diabetes care. Vitadio provided a mobile-based self-management support tool featuring educational modules, motivational messages, peer support, personalized goal setting, and health monitoring. The personal consultant was available in the app to provide technical support for app-related issues. The primary outcome, assessed in the intention-to-treat population, was a change in glycated hemoglobin (HbA1c) levels at 6 months. Secondary outcomes included changes in cardiometabolic measures and self-reported outcomes. Data were collected in 2 study centers: diabetologist practice in Dessau-Roßlau and the University of Dresden.

Between November 2022 and June 2023, a total of 276 patients were screened for eligibility, with 149 randomized to in intervention group (IG; n=73) and a control group (CG; n=76). The majority of participants were male (91/149, 61%). The dropout rate at month 6 was 19% (121/149). While both groups achieved significant HbA1c reduction at 6 months (IG: mean -0.8, SD 0.9%, P<.001; CG: mean -0.3, SD 0.7%, P=.001), the primary confirmatory analysis revealed statistically significant advantage of the IG (adjusted mean difference: -0.53%, SD 0.15, 95% CI -0.24 to -0.82; P<.001; effect size [Cohen d]=0.67, 95% CI 0.33-1). Significant between-group differences in favor of the IG were also observed for weight loss (P=.002), BMI (P=.001) and systolic blood pressure (P<.03). In addition, Vitadio users experienced greater reduction in diabetes-related distress (P<.03) and obtained more pronounced improvements in self-care practices in the areas of general diet (P<.001), specific diet (P<.03), and exercise (P<.03).

This trial provides evidence for the superior efficacy of Vitadio in lowering the HbA1c levels in T2DM patients compared to standard care. In addition, Vitadio contributed to improvements in cardiometabolic health, reduced diabetes-related distress, and enhanced self-management, highlighting its potential as an accessible digital tool for comprehensive diabetes management.

German Clinical Trials Registry DRKS00027405; https://drks.de/search/de/trial/DRKS00027405.

Hemoglobin A1c (HbA1c) has long been the standard for measuring glycemic control; however, it may not be the ideal test to predict complications following total hip (THA) and knee arthroplasty (TKA). While HbA1c measures glycemic control over three months, other markers such as fructosamine (seven to 21 days) and glycated albumin (GA) (14 to 21 days) may be more accurate predictors. The purpose of this study was to assess the utility of GA in predicting complications in patients undergoing primary THA and TKA.

This prospective study enrolled 1,020 patients (633 TKA, 387 THA) at two institutions. The mean age of our cohort was 64 years, and 631 (61.8%) patients were women. There were 131 (12.8%) patients who had a history of type 2 diabetes mellitus. The HbA1c, fructosamine, and GA were measured preoperatively using standardized assays. The HbA1c cutoff of 7.7%, fructosamine cutoff of 270 mmol/L, and GA cutoff of 17.1% were used to define poor glycemic control. The 90-day complications in patients above the threshold for each marker were identified and compared with those below it. Multivariate regressions were utilized to assess the predictive value of each test.

The HbA1c and GA were found to have the strongest correlation with one another (r = 0.63), followed by fructosamine/GA (r = 0.41), and ractopamine/HbA1c (r = 0.23). Upon regression analysis, GA ≥ 17.1% (OR [odds ratio], 4.8 [95% CI (confidence interval), 1.4 to 15.7]; P = 0.011) was identified as an independent risk factor for 90-day complications, while fructosamine (OR, 0.63 [95% CI, 0.13 to 2.13]; P = 0.51), and HbA1c (OR, 1.18 [95% CI, 0.24 to 4.97]; P = 0.83) were not.

The results of our prospective study suggest that GA may more accurately predict short-term (90-day) complications in patients undergoing THA and TKA when compared to fructosamine and HbA1c. Longer follow-up time is necessary in order to identify the optimal GA cutoff for use in this setting and to determine whether any correlation exists between elevated GA levels and PJI.

Type 2 diabetes has become a significant global public health issue. Its increasing prevalence is closely linked to sedentary lifestyles, suboptimal diets and high obesity levels. This article provides an overview of type 2 diabetes epidemiology, pathophysiology, clinical presentation, diagnostic tests, risk factors, complications and management. It also describes the role of nurses, which involves: advising patients on weight management, diet, physical activity, smoking cessation and alcohol reduction; encouraging adherence to care plans and drug treatment regimens; and providing ongoing support, education and monitoring to prevent or delay the onset of complications.

To assess the efficacy and safety of switching from premixed insulin to a once-daily, fixed-ratio combination of insulin glargine 100 U/mL + lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D).

In this phase 4, 24-week, single-arm study, participants switched from once-daily or twice-daily premixed insulin to iGlarLixi (EudraCT number 2021-003711-25). Key inclusion criteria: ≥18 years; premixed insulin therapy for ≥3 months and < 10 years; ± 1-2 oral antidiabetic drugs (OADs); HbA1c ≥7.5% to ≤10.0%. The primary endpoint was the change in HbA1c from baseline to Week 24. Secondary endpoints included: participants achieving HbA1c <7% and change in body weight at Week 24, and safety.

Overall, 162 participants switched to iGlarLixi (89.5% from twice-daily premixed insulin); mean duration of diabetes was 15.7 (standard deviation [SD]: 8.3) years. Mean baseline HbA1c (8.5%) reduced by least squares (LS) mean of 1.2% (95% confidence interval [CI]: -1.4, -1.1) at Week 24, and 37.6% of participants had achieved an HbA1c target of <7% (95% CI: 30.0, 45.7). LS mean body weight change from baseline to Week 24 was -1.0 kg (95% CI: -1.6, -0.5). Fasting and post-prandial plasma glucose decreased from baseline to Week 24 by 45.6 mg/dL (SD ± 52.4) and 67.6 mg/dL (SD ± 65.1), respectively. Confirmed symptomatic hypoglycaemia occurred in 38.3% of participants (ADA level 1: 35.8%; level 2: 15.4%; level 3: 0.0%).

iGlarLixi initiation was associated with improved glycaemic control, without body weight gain or increased hypoglycaemia over 24 weeks.

DBPR108 (prusogliptin) is a novel, orally bioavailable dipeptidyl peptidase-4 (DPP-4) inhibitor. This study investigated the pharmacokinetics and pharmacodynamic characteristics of DBPR108 tablets in patients with type 2 diabetes.

In this randomized, parallel-group, open-label, phase I study, Chinese adults with type 2 diabetes, glycated hemoglobin of 7.0-9.5%, and body mass index of 19-35 kg/m2 were randomized 1:1:1 to once-daily DBPR108 50-, 100-, or 200-mg tablet groups. The primary endpoints included pharmacokinetic and pharmacodynamic characteristics after a single dose and multiple doses of DBPR108.

In total, 30 patients were randomized with 10 patients in each group. DBPR108 was quickly absorbed with median time to reach the maximum plasma concentration of 1.5-4 h at steady state. Exposure to DBPR108 at steady-state increased dose proportionally with mean maximum steady-state plasma DBPR108 concentration during dosage intervals of 119, 256, and 567 ng/mL in the 50-, 100-, and 200-mg groups, respectively. Accumulation ratio of DBPR108 ranged from 0.85 to 1.3, and steady state was reached after four continuous daily doses. After multiple doses of DBPR108, maximum inhibitory efficacy of DPP-4 increased with higher dose levels ranging from 62.1 to 89.4%. Active glucagon-like peptide-1 levels increased after DBPR108 administration. In addition, six patients experienced treatment-emergent adverse events without leading to treatment interruption or discontinuation.

DBPR108 was well tolerated in Chinese patients with type 2 diabetes, and both the pharmacokinetic and pharmacodynamic profiles support once-daily dosage regimens of DBPR108 in future studies.

ClinicalTrials.gov (NCT05146869); registered 23 November 2021.

Type 2 diabetes (T2D) is a persistent illness that has a high incidence rate. Still, there is no conclusive evidence on effectively improving blood sugar levels in patients through physical therapy. This study examined the regulatory effects of different intensities of low-intensity pulsed ultrasound (LIPUS) on T2D by stimulating brown adipose tissue (BAT). Eight-week-old C57BL/6J mice were divided into six groups (n = 10 per group): Control sham (C-Sham), Control-LIPUS (C-LIPUS), T2D-sham (T2D-Sham), T2D groups treated with LIPUS at spatial average-temporal-average intensity (Isata) of 60mW/cm² (T2D-L-60), 80mW/cm² (T2D-L-80), and 100mW/cm² (T2D-L-100). T2D models were induced by intraperitoneal injection of 40 mg/kg streptozotocin (STZ) three times after 12 wks of high-fat diet (HFD). The T2D-LIPUS group received LIPUS stimulation for 20 minutes per day for 6 weeks. The LIPUS stimulation had a duty cycle of 20%, a frequency of 1 MHz, and Isata of 60mW/cm², 80mW/cm², 100mW/cm². Subsequently, glucose tolerance tests (GTT) and insulin tolerance tests (ITT) were performed, and body fat content in mice was analyzed using nuclear magnetic resonance (NMR). Metabolic changes were monitored using metabolic cages. The results indicated that 80mW/cm² intensity level significantly improved glucose tolerance, insulin sensitivity, and metabolic function after LIPUS exposure. Significant reductions in body fat content and enhanced thermogenesis were observed, highlighting the potential of LIPUS in T2D management. This provides the basis for the dose study of LIPUS in the treatment of T2D.

Diabetes mellitus (DM) is characterized by high blood glucose levels and abnormalities in metabolism. In 2021, 15.14% of adult Iranians had DM. The purpose of this study is to provide policymakers with actionable insights to enhance resource allocation and improve diabetes care by evaluating the prescription patterns and costs of antidiabetic medications in Iran from 2014 to 2019 in 2.5 million patients.

This descriptive-analytical study used data from Iran's Health Insurance prescriptions database, analyzing approximately 2.5 million diabetic patients from 2014 to 2019. Data included drug types, frequencies, costs, and patient demographics.

The analysis covered 20,233,608 prescriptions. Biguanides, sulfonylureas, and Insulin were the most commonly prescribed medications. Moreover, the 40-64 age group had the highest cost. Prescription patterns varied by age, with insulin in younger patients and Metformin in older ones. General practitioners, internal medicine specialists, and endocrinologists were the primary prescribers of anti-diabetic medications. Insulin Aspart incurred the highest costs, followed by Insulin glargine and metformin. The cost of females' antidiabetic medications was 1.66 times higher than those of males.

Insulin was the primary cost driver for antihyperglycemic medications. These cost disparities and variations in prescription patterns underscore the need for targeted interventions to improve diabetes care and manage resources effectively.

Type 2 diabetes mellitus (T2DM) is associated with comorbidities, particularly in the cardiovascular, renal, and metabolic (CVRM) spectrum. Given the complexity of CVRM spectrum diseases and the treatment landscape, treatment guidelines have been established to assist physicians in selecting the most appropriate treatment based on not only patients' primary disease but also their comorbidities. However, the impact of adherence to treatment guidelines on associated outcomes remains unclear.

A systematic literature review was conducted to evaluate the impact of guideline-based treatment on clinical, economic, and quality-of-life (QoL) outcomes and related comorbidities in the CVRM spectrum or heart failure (HF) alone in individuals with T2DM. The MEDLINE, MEDLINE In-Process, Embase, Cochrane Central Register of Controlled Trials, and EconLit electronic databases were searched to identify relevant peer-reviewed studies published in the United States, Canada, or Germany. The studies were screened and selected for inclusion or exclusion based on populations, interventions, comparators, and study design (PICOS) criteria.

Of the 622 records identified, 28 publications met the inclusion criteria. In total, 11 and 16 studies reported adherence to clinical guidelines for T2DM and HF management, respectively. Adherence to T2DM and HF treatment guidelines decreased all-cause mortality and all-cause hospitalizations; furthermore, adherence to T2DM guidelines decreased hospitalizations due to HF, myocardial infarction, and stroke, and reduced T2DM-related long-term complications, while adherence to HF guidelines reduced hospitalizations due to HF. Evidence gaps were identified, including the need to assess the impact of guideline adherence on economic outcomes, the impact of adherence to diagnosis and monitoring guidelines, and the impact of guideline adherence on QoL outcomes.

Adherence to disease management guidelines improves the outcomes of patients with T2DM or HF and reduces disease-related complications and hospitalizations; however, key evidence gaps exist, particularly regarding patients with T2DM along with comorbidities in the CVRM spectrum.

Diabetes imposes a global healthcare burden, with Type 2 Diabetes Mellitus (T2DM) escalating due to demographic shifts and lifestyle changes. Combination therapies offer promise in managing T2DM, yet patient adherence remains a challenge. This scoping review aims to explore patient adherence to combination therapies in T2DM management.

This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Electronic databases including PubMed, Scopus, and Web of Science were searched until July 10, 2024. Studies focused on patients with T2DM prescribed oral combination therapies were included. Data extraction and synthesis were conducted to identify adherence patterns, influencers, and strategies.

The review identified nine eligible studies spanning from 2004 to 2021, primarily retrospective cohort and cross-sectional designs. Adherence assessment methods varied, with medication possession ratio being the most common. Both dual (loose-dose) and fixed-dose combination therapies were explored. Adherence rates varied across studies and therapies, influenced by factors such as glycemic control, weight management, economic considerations, complexity of regimens, and demographic factors. Bibliometric analysis revealed diverse geographic origins of the included studies and varied adherence assessment methods. Dual therapy regimens demonstrated adherence rates ranging from 49% to 80.8%, while FDC therapies showed adherence rates ranging from 60.3% to 98.9%. Factors influencing adherence included glycemic control, weight management, economic considerations, complexity of regimens, and demographic factors.

Patient adherence to oral combination therapies in diabetes management is complex, affected by clinical, economic, and psychosocial factors. Addressing these issues is crucial for enhancing treatment outcomes and alleviating the burden of diabetes. A patient-centered approach and innovative strategies can empower patients to adhere to medication regimens, improving health outcomes and quality of life.

Dietary micronutrient levels can influence glucose and insulin regulation. Studies show micronutrients can have a positive effect on blood sugar control. This study aimed to investigate the relationship between blood sugar levels and dietary antioxidant minerals (Cr, Mg, Cu, Se, Zn) in children with type 1 diabetes.

This cross-sectional study was conducted on 82 children aged 3-18 with type 1 diabetes. A three-day food record was used to collect dietary information. Fasting blood sugar and 2-hour postprandial glucose were recorded by parents. Dietary data were extracted by N4. SPSS Version 27 was used for all statistical analyses.

The average age of subjects was 10/3 ± 3/3 years. According to the comparison of intake amounts of antioxidant minerals based on age and sex with Recommended Dietary Allowance (RDA), most children reported enough intake. A significant positive relationship was observed between the intake of copper and 2 hours of blood sugar after breakfast (P values < 0.05). We found a significant relationship between intake of chromium, magnesium, selenium, and zinc with blood sugar levels, after adjusting for confounding variables (P values < 0.05).

The amount of dietary antioxidant minerals in most children was within the appropriate range compared with the RDA. There is a significant relationship between dietary antioxidant minerals (chromium, magnesium, selenium, and zinc) and fasting and postprandial blood glucose after adjusting for confounding variables.

Artificial intelligence (AI) tools to support clinicians in providing patient-centered care can contribute to patient empowerment and care efficiency. We aimed to draft potential AI tools for tailored patient support corresponding to patients' needs and assess clinicians' perceptions about the usefulness of those AI tools. To define patients' issues, we analyzed 528,199 patient messages of 11,123 patients with diabetes by harnessing natural language processing and AI. Applying multiple prompt-engineering techniques, we drafted a series of AI tools, and five endocrinologists evaluated them for perceived usefulness and risk. Patient education and administrative support for timely and streamlined interaction were perceived as highly useful, yet deeper integration of AI tools into patient data was perceived as risky. This study proposes assorted AI applications as clinical assistance tailored to patients' needs substantiated by clinicians' evaluations. Findings could offer essential ramifications for developing potential AI tools for precision patient care for diabetes and beyond.

Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist approved in the US for treating type 2 diabetes (T2D) and obesity, has demonstrated significant improvements in glycated hemoglobin A1c (HbA1c) and clinically meaningful weight loss in the SURPASS-1 to -5 clinical trials. This post hoc analysis examined the safety and efficacy results for tirzepatide in older participants with T2D who do not have obesity.

A post hoc analysis was conducted on a subgroup of participants aged ≥ 65 years with a body mass index (BMI) < 30 kg/m2 amongst the pooled SURPASS-1 through -5 clinical trial populations. Primary efficacy endpoints and safety were assessed for both this subgroup and overall pooled populations.

Participants aged ≥ 65 years with BMI < 30 kg/m2 treated with tirzepatide experienced clinically meaningful HbA1c reduction (- 1.97 to - 2.10%) regardless of the assigned randomized maintenance dose. In contrast, a dose-proportional HbA1c decrease was observed in the overall population. Weight reduction in this subgroup was dose-proportional but numerically lower than in the overall population. Older participants without obesity were more likely to discontinue treatment due to adverse events (AEs), although the overall incidence of AEs was low in this subgroup. The incidence of hypoglycemia in this group was consistent with that of the overall cohort, regardless of concurrent insulin or sulfonylurea use.

Tirzepatide may be an effective treatment for older adults without obesity, and in this post hoc analysis, it was associated with clinically relevant HbA1c reduction and dose-proportional weight loss without increasing hypoglycemic risk.

'Healthy Living' is an online self-management intervention for people living with type 2 diabetes rolled out across England from 2019. It was based on the 'HeLP-Diabetes' intervention which demonstrated effectiveness in a randomised controlled trial. However, it is unclear how much people are exposed to intervention content outside of a trial setting.

To analyse exposure to behaviour change techniques and self-management content in routine usage.

Anonymous usage data was obtained for all registered Healthy Living users between May 2020 and September 2023, and linked with previously coded behaviour change technique and self-management content of 895 Healthy Living webpages.

N = 42,689 users registered for a Healthy Living account, of whom n = 27,422 activated it, and n = 19,137 (69.8%) accessed some intervention content. The median number of times users (n = 19,137) were exposed to self-regulatory behaviour change techniques across the intervention was 0 (IQR: 0,0), apart from 'Self-monitoring of outcome(s) of behaviour' (median: 1, IQR: 0,1). Fewer than 30% of users were exposed to behaviour change techniques present after the first section of the curriculum. The median frequency of user (n = 19,137) exposure to medical self-management tasks was 11 (IQR: 4,32), emotional self-management tasks was 4 (IQR: 1,7), and role self-management tasks was 0 (IQR: 0,1).

This is the first analysis to quantify engagement with behaviour change techniques and self-management tasks in a 'real-world' digital type 2 diabetes self-management programme. Future work needs to identify how to encourage usage of key material in online interventions, for example, by allowing users greater flexibility to access content they wish to engage with.

Metformin treatment has a risk factor of reduced serum concentrations of vitamin B12 and zinc, indicating its association with homocysteine metabolism. However, this association remains to be clarified in patients with type 2 diabetes (T2DM) accompanied by kidney dysfunction.

This cross-sectional study was conducted in 149 patients with T2DM (96 men, 53 women), including diabetic kidney disease. Serum concentrations of homocysteine, as well as vitamin B12, folic acid, and zinc, were measured in outpatient T2DM patients. The study subjects were divided into two groups: patients with and without metformin administration (Met [ +], n = 62; Met [ -], n = 87). To explore the effect of kidney function, we also analyzed the data after dividing all the patients according to kidney function (chronic kidney disease [CKD] group, n = 66; non-CKD group, n = 83).

The Met ( +) group exhibited significantly higher serum zinc levels and lower serum homocysteine levels than the Met ( -) group. In the non-CKD group, metformin administration was positively associated with serum zinc levels, as demonstrated by multiple linear regression analysis adjusted for confounding factors (β = 0.287, p = 0.021). However, no significant association between metformin administration and serum zinc levels was observed in the CKD group. Moreover, there were no associations between serum homocysteine levels and metformin administration.

The relationship between metformin treatment and serum zinc levels differed based on the presence or absence of CKD in patients with T2DM.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for glycemic control and weight loss management in type 2 diabetes. Their use, however, is associated with a wide range of gastrointestinal adverse effects like nausea, vomiting, and abdominal discomfort. This case report presents a 59-year-old woman with a previous Roux-en-Y gastric bypass who was prescribed semaglutide, and subsequently developed intussusception with small bowel obstruction and chemical pancreatitis. The patient presented to the emergency department with nausea, vomiting, and epigastric pain. The patient's laboratory and radiographic studies revealed a long segment of small bowel intussusception, resulting in a small bowel obstruction and likely chemical pancreatitis. Laparoscopic surgical intervention was required, ultimately converted to a laparotomy for successful reduction of the intussusception. This case report underscores a potential complication that may be seen in patients prescribed GLP-1RAs with prior gastric Roux-en-Y surgeries. The adverse effect is likely attributable to altered gastrointestinal motility and delayed gastric emptying, mechanisms that may be exacerbated by the combination of bariatric-induced anatomical changes and the pharmacological actions of GLP-1RAs. Given the increasing prevalence of GLP-1RA use, emergency medicine clinicians must remain vigilant for these potential serious adverse effects, particularly in patients with complex gastrointestinal histories to ensure timely diagnosis and intervention.

Renin angiotensin system (RAS) alters various mechanisms related to muscle wasting. The RAS system consists of classical and non-classical pathways, which mostly function differently. Classical RAS pathway, operates through angiotensin II (AngII) and angiotensin type 1 receptors, is associated with muscle wasting and sarcopenia. On the other hand, the non-classical RAS pathway, which operates through angiotensin 1-7 and Mas receptor, is protective against sarcopenia. The classical RAS pathway might induce muscle wasting by variety of mechanisms. AngII reduces body weight, via reduction in food intake, possibly by decreasing hypothalamic expression of orexin and neuropeptide Y, insulin like growth factor-1 (IGF-1) and mammalian target of rapamycin (mTOR), signaling, AngII increases skeletal muscle proteolysis by forkhead box transcription factors (FOXO), caspase activation and muscle RING-finger protein-1 transcription. Furthermore, AngII infusion in skeletal muscle reduces phospho-Bad (Ser136) expression and induces apoptosis through increased cytochrome c release and DNA fragmentation. Additionally, Renin angiotensin system activation through AT1R and AngII stimulates tumor necrosis factor-α, and interleukin-6 which induces muscle wasting, Last but not least classical RAS pathway, induce oxidative stress, disturb mitochondrial energy metabolism, and muscle satellite cells which all lead to muscle wasting and decrease muscle regeneration. On the contrary, the non-classical RAS pathway functions oppositely to mitigate these mechanisms and protects against muscle wasting. In this review, we summarize the mechanisms of RAS-induced muscle wasting and putative implications for clinical practice. We also emphasize the areas of uncertainties and suggest potential research areas.

Radiation induced structural damage of salivary gland including reducing acinar cell and fibrosis. These changes result in hypofunction of salivary gland which has a significant impact on the quality of life of head and neck cancer patients who treated with radiotherapy. Nevertheless, no preventive method has been found. Metformin, a diabetes drug, has recently attracted considerable attention because it can cause tissue regeneration by anti-inflammatory action and influencing stem cells. This study examined the effects of metformin on salivary gland tissue damage caused by radiation therapy. Cultured human parotid epithelial cells are irradiated with 15 Gy of 4MV X-rays. The analysis including DNA damage, inflammatory markers and proliferation, is conducted to confirm the effect of metformin. Similarly, an in vivo mouse model is established. Histologic and functional analyses, such as salivary flow rate and lag time, are performed. The in vitro experiment revealed irradiation increased DNA damage, NF-кB, IL-6, and apoptosis with reduced proliferation. The treatment with metformin decreased the radiation-induced DNA damage and inflammation, and increased proliferation. The in vivo model also shows the same results. The group taking metformin after irradiation has preserved salivary gland parenchyma compared to irradiation only group, and the functional analysis results are comparable to the normal group. Histologic and functional analysis shows that metformin reduced radiation-induced hypofunction of salivary gland. Hence, metformin can be used to prevent radiation-induced salivary gland dysfunction.

This study aimed to evaluate the relationship between sodium-glucose cotransporter 2 inhibitor (SGLT2i) use and nephrolithiasis risk.

In this real-world cohort study, we analyzed electronic health records from the TriNetX Analytics Network, which includes patients from 64 U.S. healthcare organizations. Adult patients with type 2 diabetes (T2D) who initiated SGLT2is, dipeptidyl peptidase-4 inhibitors (DPP4is), or glucagon-like peptide-1 receptor agonists (GLP-1RAs) between January 2015 and December 2023 were included. Comparisons were made between SGLT2is and DPP4is and between SGLT2is and GLP-1RAs. Patients were followed-up for up to 5 years. A meta-analysis was further conducted to synthesize available evidence.

The cohort study included 500,000 patients (250,000 pairs) for SGLT2is vs. DPP4is comparisons and 482,284 patients (241,142 pairs) for SGLT2is vs. GLP-1Ras comparisons. The risk of nephrolithiasis was significantly lower in SGLT2i users compared with DPP4i (HR: 0.86; 95% CI: 0.83-0.90) and GLP-1RA users (HR: 0.90; 95% CI: 0.86-0.94). A meta-analysis combining our study with four additional real-world studies further supported these findings.

This study suggests that SGLT2is may provide benefits beyond glycemic control by reducing nephrolithiasis risk, offering an advantage when selecting glucose-lowering therapies for patients with T2D.

The aim of this study was to elucidate the potential mechanism of the antihyperglycemic action of the donut-shaped Preyssler-Pope-Jeannin polyanion salt (NH4)14[NaP5W30O110] 31H2O (NaP5W30) and its effect on metabolic disorders associated with diabetes. For this purpose, relevant parameters of blood glucose regulation, lipid profile, and electrolyte status were monitored in streptozotocin (STZ)-induced diabetic rats that were orally treated with 20 mg/kg/day NaP5W30 for three weeks. The serum insulin concentration was increased in diabetic animals treated with NaP5W30 (20 mg/kg/day, per os, three weeks), which could be one of the possible mechanisms of the confirmed antihyperglycemic effect. In addition, the administration of NaP5W30 significantly reduced hyperglycemia and glycated haemoglobin A1c (HbA1c) in STZ-induced diabetic rats, although normoglycemic values were not achieved. Furthermore, a statistically significant 1.3-fold reduction in serum total cholesterol and a 1.7-fold reduction in high-density lipoprotein (HDL) cholesterol were observed in the NaP5W30 treatment group compared to the diabetic control group. In contrast, NaP5W30 had no effect on homeostasis model assessment of insulin resistance (HOMA-IR) index values, electrolyte concentrations, or serum concentrations of low-density lipoprotein (LDL) cholesterol, apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), or total triglycerides. In summary, NaP5W30 effectively improved glycoregulation in diabetic rats via the considerable stimulation of insulin as a putative mechanism. Moreover, NaP5W30 did not affect rat weight or disrupt lipid and electrolyte status, common diabetes-followed side effects and risk factors for various life-threatening complications. Thus, NaP5W30 could be considered a promising antidiabetic drug-candidate that deserves further investigation.

Diabetes self-management plays a vital role in improving clinical outcomes and the quality of life of individuals living with diabetes. Despite considerable research on its impact on clinical outcomes, diabetes self-management continues to be challenging for many individuals living with the condition. As part of the growth in digital health technologies for diabetes care, smartphone applications present potential opportunities to bridge the existing gaps in self-management and improve patient outcomes.

Participants (N = 3241 people with diabetes) were recruited to answer questions about diabetes self-management, including their use of digital tools, their preferences for smartphone applications for diabetes, and the preferred functions of these applications they found useful. Frequency distributions and chi-square analyses were performed to examine the demographic differences among users of diabetes and general wellness applications.

Among participants, 30.2% reported using health applications specifically made for diabetes management, while 33.9% reported using health applications that were not diabetes-specific. Considerable differences in demographic characteristics were found between users and nonusers of both diabetes-specific and general health applications groups. The most preferred applications provided the opportunity to engage with continuous glucose monitoring data (i.e., continuous measurement; 47.4%) followed by glucose monitoring (i.e., single reading measurement; 20.9%), food intake trackers (23.6%), and fitness goal trackers (22.8%).

These findings suggest that the use of digital health technologies is popular for people living with diabetes, but more needs to be done to ensure wider adoption and sustained use.

Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).

Feasibility multicentre, parallel group, randomised controlled trial (RCT).

Participants were recruited from England and Canada using a decentralised design.

Adults (40-75 years) recently diagnosed with T2D (5-24 months).

Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.

The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.

n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: -5% change from baseline, CI -10 to 2: 12 months: -2% change from baseline, CI -8 to -4; systolic BP: 6 months: -1 mm Hg, CI -5 to 3: 12 months: -4 mm Hg, CI -8 to 1).

Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.

ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.

The gut microbiota is closely associated with the onset and development of type 2 diabetes mellitus (T2DM), characterized by insulin resistance (IR) and chronic low-grade inflammation. However, despite the widespread use of first-line antidiabetic drugs, IR in diabetes and its complications continue to rise. The gut microbiota and its metabolic products may promote the development of T2DM by exacerbating IR. Therefore, regulating the gut microbiota has become a promising therapeutic strategy, with particular attention given to probiotics, prebiotics, synbiotics, and fecal microbiota transplantation. This review first examines the relationship between gut microbiota and IR in T2DM, summarizing the research progress of microbiota-based therapies in modulating IR. We then delve into how gut microbiota-related metabolic products contribute to IR. Finally, we summarize the research findings on the role of traditional Chinese medicine in regulating the gut microbiota and its metabolic products to improve IR. In conclusion, the gut microbiota and its metabolic products play a crucial role in the pathophysiological process of T2DM by modulating IR, offering new insights into potential therapeutic strategies for T2DM.

Objective: This study aimed to review the structural concepts, definition, classification, and macronutrient and food composition of carbohydrate-restricted diets (CRDs) for individuals with type 2 diabetes mellitus (T2DM). Methods: A scoping review was conducted following Joanna Briggs Institute guidelines. Searches were performed in Scopus, PubMed, Web of Science, and Embase, including texts published in Portuguese, English, and Spanish. Official documents from governments, regulatory agencies, and international diabetes organizations were also consulted. Results: In total, 79 articles and 17 official documents were analyzed. The following structural concept was identified: restricted carbohydrate intake decreases the need for endogenous and exogenous insulin, contributing to the maintenance of glycemic control, and justifies its consideration among the nutritional therapy options for individuals with T2DM. CRDs varied in definition, classification, and macronutrient composition. Studies failed to provide detailed information on the food composition of diets, precluding an in-depth understanding of metabolic effects. The existence of several approaches with varying recommendations makes it difficult to generalize the results. International CRD guidelines for T2DM adopt divergent definitions, compromising interpretation, recommendation, and even adherence. Conclusions: Although the concept of CRDs justifies their adoption within the nutritional therapy choices for T2DM, the multiple denominations can hinder understanding and comparison between studies. The lack of information on food composition and carbohydrate types compromises the assessment of the effects and adherence to CRD-based nutritional interventions. We emphasize the need for methodologically consistent studies that evaluate CRDs based on fresh and minimally processed foods with a low glycemic index to support official diabetes guidelines and organizations.

As the prevalence of chronic diseases persists at epidemic proportions, health practitioners face ongoing challenges in providing effective lifestyle treatments for their patients. Even for those patients on GLP-1 agonists, nutrition counseling remains a crucial strategy for managing these conditions over the long term. This paper aims to address the concerns of patients and practitioners who are interested in a low-carbohydrate or ketogenic diet, but who have concerns about its efficacy, safety, and long-term viability. The authors of this paper are practitioners who have used this approach and researchers engaged in its study. The paper reflects our opinion and is not meant to review low-carbohydrate diets systematically. In addressing common concerns, we hope to show that this approach has been well researched and can no longer be seen as a "fad diet" with adverse health effects such as impaired renal function or increased risk of heart disease. We also address persistent questions about patient adherence, affordability, and environmental sustainability. This paper reflects our perspective as clinicians and researchers engaged in the study and application of low-carbohydrate dietary interventions. While the paper is not a systematic review, all factual claims are substantiated with citations from the peer-reviewed literature and the most rigorous and recent science. To our knowledge, this paper is the first to address potential misconceptions about low-carbohydrate and ketogenic diets comprehensively.

Metformin, an oral hypoglycemic agent, is commonly used in patients with type II diabetes mellitus. Studies have shown its use is associated with a reduction in major cardiovascular events (MACE) in patients with type 2 diabetes such as hospitalization for acute myocardial infarction, stroke, transient ischemic attack, or cardiovascular death. There is also a suggestion that metformin may have effects beyond those relating to lowering of blood sugar. The goal of this review is to assess the effects of metformin in coronary artery disease (CAD), but more importantly, its effects on disease states other than CAD.

High-protein diets have been recognized as a potential strategy in the nutritional management of type 2 diabetes (T2D). Mycoprotein is a high-fibre, high-protein food ingredient previously shown to improve acute glycaemic control. We determined whether incorporating mycoprotein into a high-protein vegan diet would improve glycaemic control to a greater extent than an isonitrogenous omnivorous diet in people with T2D.

Seventeen adults (f = 5, age = 58.3 ± 8.3 years, BMI = 32.9 ± 4.7 kg∙m-2, HbA1c = 60 ± 15 mmol∙mol-1) with T2D were randomly allocated to a 5-week eucaloric high-protein (30% energy from protein) diet, either an omnivorous diet (OMNI; 70% protein from omnivorous sources) or an isonitrogenous, mycoprotein-rich, vegan diet (VEG; 50% protein from mycoprotein). Glycaemic control was assessed using a two-step hyperinsulinaemic-euglycaemic clamp (HEC) with D-[6,6-2H2] glucose infusion, a mixed-meal tolerance test (MMTT) and continuous glucose monitoring.

The rate of glucose disappearance (RdT), glucose disposal rate and endogenous glucose production, as well as postprandial time-course of blood glucose, serum insulin and C-peptide were assessed during the HEC and MMTT, respectively. Both groups had improved peripheral insulin sensitivity (intervention effect, p = 0.006; increased RdT/Insulin of 1.0 ± 0.6 and 1.0 ± 0.3 mg kg-1 min-1 in OMNI and VEG, respectively), HbA1c (intervention; p = 0.001) and glycaemic variability (intervention; p = 0.040; increased time in-range of 11.8 ± 9.3% and 23.3 ± 12.9% in OMNI and VEG). There were no improvements in hepatic insulin sensitivity or in postprandial blood glucose and serum C-peptide (p > 0.05) during the MMTT.

High-protein diets, whether predicated on vegan or omnivorous proteins, can improve glycaemic control by increasing peripheral insulin sensitivity in people with T2D.

Diabetes mellitus is a chronic disease and a public health challenge worldwide, associated with numerous complications, including genitourinary infections and sexual dysfunction in women, particularly in menopause. The vaginal microbiome, which comprises beneficial and pathogenic bacteria, their genomes, and the surrounding environment, plays a crucial role in maintaining genitourinary health. Chronic hyperglycemia disrupts immune functions, exacerbates oxidative stress, and alters the vaginal microbiome, increasing the risk of genitourinary infections. Recent advances in microbial analysis, including 16S rRNA sequencing, have provided insights into the complex composition of the vaginal microbiome and its dysbiosis in diabetes mellitus. Some glucose-lowering drugs, such as sodium-glucose cotransporter 2 inhibitors, may increase the risk of genitourinary infections. Additionally, psychological distress, hormonal imbalances, and diabetes-related genitourinary symptoms contribute to sexual dysfunction in diabetic women. Healthcare for diabetic women requires a multidisciplinary approach, including not only glycemic control but also vaginal and sexual health assessment. A holistic approach is essential to advance personalized strategies, including medications and psychological support.

Endocrinologists, nephrologists, and cardiologists care for people with type 2 diabetes (T2D) and coexisting cardiovascular disease (CVD), heart failure (HF), and/or chronic kidney disease (CKD). Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) should be preferentially used, but are underutilized. We examine patient and physician factors associated with GLP-1RA/SGLT2i use by patients treated by these subspecialists.

Retrospective cohort study using linked 2022 Medicare and American Board of Internal Medicine data for adults >65 years with T2D and coexisting CVD, HF, and/or CKD and their treating endocrinologists, nephrologists, and cardiologists.

We identified 246,106/254,425/435,773 patients treated by 5,661/8,233/10,874 endocrinologists/nephrologists/cardiologists in 2022. Overall, 73.2 % of endocrinologist-treated patients filled diabetes medications prescribed by endocrinologists; 41.9 % filled GLP-1RA/SGLT2i. Patients of nephrologists and cardiologists were rarely prescribed diabetes medications by these subspecialists (9.8 % and 6.1 %, respectively); however, conditional on filling any diabetes medication, they were more likely to fill a GLP-1RA/SGLT2i (59.5 % and 48.2 %, respectively). Older patients of endocrinologists and nephrologists, and patients of older nephrologists and cardiologists, were less likely to fill GLP-1RA/SGLT2i.

Many, particularly older, patients with T2D treated by endocrinologists, nephrologists, and cardiologists should be, but are not, prescribed GLP-1RA/SGTL2i. Physician training may improve these statistics.

This study aimed to evaluate the effectiveness and safety of 2 glucagon-like peptide-1 receptor agonists (GLP-1 RAs) liraglutide and dulaglutide, in patients with type 2 diabetes mellitus (T2DM) at various stages of chronic kidney disease (CKD). In addition to analyzing Major Adverse Cardiovascular Events (MACE) as the primary outcome, kidney function deterioration, renal disease, and other drug-related safety events, such as urinary tract infections, pancreatitis, amputations, and cancers were measured.

This retrospective analysis included 362 842 T2DM patients from the Chang Gung Research Database between 2011 and 2019, identifying 2830 GLP-1 RAs users. After applying exclusion criteria, 1572 patients (945 on liraglutide, 627 on dulaglutide) were included. The primary outcome was MACE incidence across CKD stages.

Of the included patients, 945 used liraglutide, and 627 used dulaglutide. This study found no significant difference in the incidence of MACE between the 2 drugs across varying kidney function levels. However, in patients using liraglutide, a significant increase in MACE incidence was observed with deteriorating kidney function, from an HR of 1.401 (95% CI 0.663-2.958) at an eGFR of 60-89 ml/min/1.73 m2 to an HR of 4.078 (95% CI 1.111-14.971, P = .0079) at an eGFR of <15 ml/min/1.73 m2, a trend not observed in dulaglutide users (P = .1906).

Both liraglutide and dulaglutide are effective GLP-1 RAs in T2DM patients, but their impact on cardiovascular outcomes varies with CKD stage in liraglutide users. In contrast, this trend was not observed with dulaglutide, suggesting a potentially greater cardiovascular benefit of dulaglutide at more advanced CKD stages.

This study evaluates the risk of ocular adverse events (AEs) associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) using data from the FDA Adverse Event Reporting System (FAERS) and network pharmacology methods.

FAERS data from 2004 to 2024 were analyzed for ocular AEs linked to GLP-1 RA treatments. Disproportionality analysis (Reporting Odds Ratio, ROR) was used to identify signals, and a drug-gene interaction network explored potential mechanisms.

Among 17,785,793 FAERS reports, semaglutide and lixisenatide were significantly associated with ocular AEs, with RORs of 1.25 (95% CI, 1.20-1.31) and 1.96 (95% CI, 1.70-2.27), respectively. Commonly reported AEs included blurred vision, visual impairment, and diabetic retinopathy, with some AEs occurring as early as 10 days after treatment initiation. Gene enrichment analysis highlighted potential links between GLP-1-related genes and ocular AEs.

The widespread use of GLP-1 RAs has raised concerns regarding their ophthalmic safety. This study contributes new evidence from real-world data, suggesting that semaglutide and lixisenatide are associated with significant risks of ocular AEs. Further experimental studies are warranted to elucidate the underlying mechanisms and confirm these associations.

This study aimed to assess the proportions of type 2 diabetes (T2D) subjects meeting cardiovascular outcome trials (CVOTs) criteria for sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and estimate SGLT2i utilization, along with associated demographic and clinical characteristics, in a primary care setting.

T2D patients in Italy were selected between January 1, 2021, and December 31, 2022, from The Health Improvement Network (THIN®) database. Representativeness was determined by dividing patients meeting key inclusion criteria for four CVOTs (CANVAS, DECLARE-TIMI 58, EMPA-REG OUTCOME, VERTIS-CV) to the total T2D population. Demographic and clinical characteristics of eligible T2D subjects and SGLT2i users were compared, and logistic regression models assessed the likelihood of receiving SGLT2i.

Out of 17,102 T2D patients, 8,828 met eligibility criteria for at least one CVOT. DECLARE-TIMI 58 exhibited the highest representativeness (51.1%), compared to CANVAS (21.1%), EMPA-REG OUTCOME (5.5%), and VERTIS-CV (4.9%) trials. Eligible CVOTs patients were older (74.6 vs. 68.3 years), with a longer disease duration (10.2 vs. 9.7 years), and higher established cardiovascular disease (CVD) prevalence (36.0 vs. 27.3%) compared to SGLT2i users. Less than 10% of eligible T2D patients received SGLT2i. Males (OR: 1.43; 95%CI: 1.24-1.66) were more likely to be prescribed SGLT2i than other antidiabetic drugs, while the elderly (80 + vs. 40-64 years, OR: 0.17; 95% CI: 0.14-0.22) were less likely. Eligible T2D patients with CVD reported an increased likelihood of receiving SGLT2is compared to other antidiabetics.

This study highlights significant variability in the proportion of T2D subjects meeting SGLT2i CVOT inclusion criteria, with DECLARE-TIMI-58 being the most represented. Low SGLT2i prescription rates in the Italian primary care setting, along with substantial demographic and clinical differences between SGLT-2i users and T2D eligible patients, emphasize the need for targeted interventions to optimize the use of these medications in primary care settings.

The Prevalence of Atherosclerotic Cardiovascular Disease in Patients with Type 2 Diabetes across the Middle East and Africa (PACT-MEA) study compared cardiovascular disease (CVD) risk and 2021 ESC guidelines adherence between UAE and broader MEA region participants for enhanced type 2 diabetes mellitus (T2D) and atherosclerotic cardiovascular disease (ASCVD).

A survey of 385 physicians explored clinical decision-making factors. Chart reviews of 3726 participants classified ASCVD risk as per 2021 ESC guidelines and compared T2D target achievement in primary and secondary care centers.

The survey highlighted factors influencing T2D management decisions, with most adhering to international guidelines. Among 542 UAE participants, 62.7 % were at high and 37.1 % at very high risk for ASCVD. Target HbA1c was achieved 45 % UAE vs. 37 % in regionally, BP by 41 % vs. 30 %, LDL by 36 % vs. 30 %, BMI <25 kg/m2 by 20 % vs. 15 %, SGLT2is use by 63 % vs. 37 % and GLP-1RAs use by 22 % vs. 13 %, respectively. No participants met all ESC-recommended targets for T2D.

Physicians followed international guidelines, considering patient history, drug efficacy, and HbA1c levels for diabetes and ASCVD risks. In UAE, <50 % of at-risk individuals with T2D met ESC targets. Cardioprotective medication use was higher in UAE.

To evaluate the efficacy of oral semaglutide, either as an add-on or replacement therapy, in improving glycemic control, body weight, and cardiovascular parameters in patients with type 2 diabetes mellitus (T2DM).

This real-world study evaluated changes in glycated hemoglobin (HbA1c), body weight, and parameters of cardiovascular risk from baseline to a 12-month follow-up visit. The primary endpoint was the change in HbA1c between baseline and follow-up. Secondary endpoints included changes in body weight, the proportion of patients achieving HbA1c ≤ 7%, and combined reductions in HbA1c (≥ 1%) and body weight (≥ 5%). Exploratory endpoints were evaluated as well.

Data from 950 patients, predominantly female (63.7%) and with a mean age of 68.3 ± 10.1 years, were included in the study. Prior to starting semaglutide, most patients were on sulfonylureas, either as monotherapy or in combination with metformin or basal insulin. At baseline, mean HbA1c was 8.0 ± 1.3% (64.0 ± 14.2 mmol/mol), and body weight was 82.5 kg. Following 12 months of oral semaglutide treatment, HbA1c decreased significantly of -0.84% (p < 0.001) and 53% of patients achieved HbA1c ≤ 7%. HbA1c reductions were influenced by baseline levels and patient's age. Body weight decreased by 2.28 kg (p < 0.001) and 18.4% of patients achieved both ≥ 1% reduction in HbA1c and ≥ 5% in body weight. Diastolic blood pressure and LDL levels decreased significantly (p < 0.001), while systolic blood pressure and eGFR remained stable.

When used as an add-on or replacement therapy, oral semaglutide significantly improves glycemic control, body weight, renal and cardiovascular risk factors in T2DM patients.

People with type 2 diabetes (T2D) have a 2-3-time higher risk of developing sarcopenia, a musculoskeletal disease marked by a progressive loss of skeletal muscle mass and strength, compared to people without T2D. This narrative review examines the effectiveness of lifestyle interventions in enhancing muscle mass and strength in people with T2D, emphasizing their growing importance with advancements in obesity treatments. PubMed and Google Scholar were utilized to identify the most relevant published studies based on the authors' knowledge. The maintenance of skeletal muscle strength and mass in people with T2D is becoming more prominent due to the advent of weight loss therapies such as low-energy diets, bariatric surgery and pharmacotherapies. Although the weight loss is to be commended, a large proportion (20-50%) of the weight loss comes from lean mass, indicative of a loss in muscle mass. There are currently no pharmacotherapies to increase, or mitigate the loss of, lean mass, with lifestyle strategies prominent in this arena. Resistance exercise is the most effective method to increase muscle mass and strength in people with T2D, but there is some evidence of an anabolic resistance. Aerobic exercise and increased dietary protein intake may result in small increases in muscle mass and strength, with no evidence of an anabolic resistance to these stimuli. Exercise and protein supplementation can increase, or aid in the retention of, muscle strength and mass in individuals with T2D, but further research is needed to explore their benefits in patients undergoing concomitant pharmaceutical and surgical treatments.