Prevalence of Latent Autoimmune Diabetes in Adult Based on the Presence of GAD 65 Antibodies in North-Eastern Uttar Pradesh, India

Objective The objective of this paper was (1) to study the prevalence of latent autoimmune diabetes in adult (LADA) in the region of north-eastern Uttar Pradesh, India, based on the positivity for glutamic acid decarboxylase 65 (GAD65) antibodies and (2) to compare the glycemic profile between GAD65-positive and GAD65-negative subjects. Materials and Methods The subjects were of more than 30 years of age, with either recently diagnosed pre-diabetes/diabetes presenting with the hemoglobin A1c (HbA1c) level of ≥5.7% or already diagnosed cases of type 2 diabetes mellitus (T2DM) who had no requirement of insulin therapy for at least 6 months from the time of their diagnosis. All the patients were natives of north-eastern Uttar Pradesh. The GAD65 test was done by the enzyme-linked immunosorbent assay. Further, the glycemic status of GAD-positive and GAD-negative subjects were compared on the basis of fasting blood sugar (FBS), fasting insulin (FI), and homeostatic model assessment for insulin resistance (HOMA-IR). Statistical Analysis The “unpaired t-test” was used to compare and assess the significance of differences between the glycemic profile of GAD65-positive and GAD65-negative subjects using the GraphPad Prism Scientific Software, San Diego, CA, United States. The p-value of <0.05 was considered to be significant. Results A total of 77 patients were included in the study, with the age group ranging from 30 to 75 years (47.81 ± 12.9 years) with the male–female ratio of 1:2.6. The prevalence of LADA was found to be 51.95%. On comparing GAD65-positive and GAD65-negative groups, a higher value of HbA1c levels and FBS were found in the former, whereas FI and HOMA-IR were found to be higher in the latter. On testing for significance of difference, only FI and HbA1c values were significant (p-value <0.0001). Conclusion LADA can no longer be considered a rare type of diabetes mellitus, with the present study showing a high prevalence of LADA in this north eastern region of Uttar Pradesh. Identification of adult-onset diabetics accurately as LADA or true T2DM is very crucial for the appropriate treatment, as LADA patients require insulin inevitably and much earlier than true T2DM patients, who can be managed mostly on oral hypoglycemic agents with seldom requirement of insulin.

A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

Hypoglycemic Potential of Combined Methanolic Extract of Seeds of Nigella sativa (Black Cumin) and Cicer Arietinum (Chickpea)

In spite of the rapid progress in the field of medicine, humanity still striving for cure of diabetes, a disorder of metabolism. From literature study it is inferred that no one therapeutic agent is isolated and/ or synthesized to treat diabetes, but to manage the disease. Therefore, it is of much importance to address this medical issue with phytochemical synergism for boosting immunity and limiting the severe side effects of synthetic hypoglycemic agents. The antioxidant and hypoglycemic effects of black seeds and chickpea have been determined previously, however the combined hypoglycemic effect of these seeds has not been studied until now. In present study the combined methanolic extract (CME) of Nigella sativa (black cumen) and Cicer arietinum (chickpea) seeds has shown the significant antioxidant potential as revealed by its significantly reduced IC50 value for radical scavenging activity in DPPH assay (-36.39%, p<0.001) compared to the standard compound butylated hydroxyanisole (BHA), and also due to the presence of significant (p<0.001) amount of total phenolic contents (TPC) in the mixture (254.2+2.75 mg GAE/g of dry weight). The CME was also fractionated through column chromatography and based on the phytochemical analysis, the fractions enriched with phenolic compounds were isolated and characterized by FT-IR spectroscopy. The IR-spectra have shown the presence of respective functional groups, indicating the isolation of specific phenol enriched compounds from CME which may be further used for drug development. During the evaluation of antidiabetic potential of CME in alloxan induced diabetic rats, the animals showed non-significant (p>0.05) increase (2.12%) in observed body weights, however, showed the significant decrease in blood glucose levels (-42.24%, p<0.001) compared to the diabetic control rats. Our findings suggest that CME may be used as a potential hypoglycemic herbal medication or might be used in conjunction with the usual synthetic drugs to boost activity and limit the side effects.

In Vitro and In Vivo Antidiabetic Potential of Monoterpenoids: An Update

Diabetes mellitus (DM) is a chronic metabolic condition characterized by persistent hyperglycemia due to insufficient insulin levels or insulin resistance. Despite the availability of several oral and injectable hypoglycemic agents, their use is associated with a wide range of side effects. Monoterpenes are compounds extracted from different plants including herbs, vegetables, and fruits and they contribute to their aroma and flavor. Based on their chemical structure, monoterpenes are classified into acyclic, monocyclic, and bicyclic monoterpenes. They have been found to exhibit numerous biological and medicinal effects such as antipruritic, antioxidant, anti-inflammatory, and analgesic activities. Therefore, monoterpenes emerged as promising molecules that can be used therapeutically to treat a vast range of diseases. Additionally, monoterpenes were found to modulate enzymes and proteins that contribute to insulin resistance and other pathological events caused by DM. In this review, we highlight the different mechanisms by which monoterpenes can be used in the pharmacological intervention of DM via the alteration of certain enzymes, proteins, and pathways involved in the pathophysiology of DM. Based on the fact that monoterpenes have multiple mechanisms of action on different targets in in vitro and in vivo studies, they can be considered as lead compounds for developing effective hypoglycemic agents. Incorporating these compounds in clinical trials is needed to investigate their actions in diabetic patients in order to confirm their ability in controlling hyperglycemia.

In-vitro Antioxidant and Antihyperglycemic effect of Muntingia calabura L. fruit extracts

This study investigated the in-vitro antioxidant activity and antidiabetic effect of Muntingia calabura fruit extract by in-vitro α-amylase and α-glucosidase inhibitory activity. Muntingia calabura fruit was extracted with aqueous methanol by soxhlet extraction. The total phenols and total flavonoids contents were estimated and evaluated for antioxidant activities (DPPH, ABTS) and in-vitro antidiabetic activity by measuring their inhibitory activity on α-amylase and α-glucosidase levels. The findings showed that the fruit extract had high content of total phenol and exhibited moderate free radical scavenging activity. The fruit extract showed inhibitory effect on α-amylase [IC50Value =61.43 μg/mL] and α-glucosidase [IC50 Value=140.33 μg/mL] compared to standard acarbose. The fruit extract can be used as a potential source for the development of new hypoglycemic agents may be due to the presence of high phenol content.

Study of role of vitamin C in type 2 diabetes mellitus patients

Background: Diabetes mellitus (DM) is the most common non-communicable diseases in the present millennium which has become a global public health problem. The treatment of type 2 Diabetes mellitus (T2 DM) often is initiated with monotherapy of oral antidiabetic drugs (OADs), which often do not decrease the plasma sugar levels effectively and consistently that will reduce short term and long-term complications associated with T2 DM. Hence the current study is aimed to determine the effectiveness of vitamin C supplementation with standard OADs on glycemic control.Methods: This study consisted of 120 T2 DM patients with 80 males and 40 females with a mean age of 50.88 yrs were divided into four groups with equal number of males and females in each group depending upon the OADs they received in solo or with vitamin C for 12 weeks. After the written consent, a detail clinical history, clinical examination, biochemical investigations including fasting plasma sugar (FPS), post prandial plasma sugar (PPS), glycosylated hemoglobin (HBA1c), serum creatinine, serum electrolytes, chest X-ray PA view and standard ECG were done. Repeat FPS, PPS and HBA1c were done after 4, 8 and 12 weeks of study.Results: After 12 weeks of study FBS, PPS and HBA1c decreased significantly (p<0.01) in study groups (Metformin and teneligliptin with vitamin C) as compared to control groups (OADs without vitamin C). Vitamin C supplementation with OADs found to be effective, well tolerated and devoid of any side effects.Conclusions: OADs are effective and affordable hypoglycemic agents with vitamin C supplementation.

Effects of Melatonin on Diabetic Neuropathy and Retinopathy

Diabetes mellitus (DM) leads to complications, the majority of which are nephropathy, retinopathy, and neuropathy. Redox imbalance and inflammation are important components of the pathophysiology of these complications. Many studies have been conducted to find a specific treatment for these neural complications, and some of them have investigated the therapeutic potential of melatonin (MEL), an anti-inflammatory agent and powerful antioxidant. In the present article, we review studies published over the past 21 years on the therapeutic efficacy of MEL in the treatment of DM-induced neural complications. Reports suggest that there is a real prospect of using MEL as an adjuvant treatment for hypoglycemic agents. However, analysis shows that there is a wide range of approaches regarding the doses used, duration of treatment, and treatment times in relation to the temporal course of DM. This wide range hinders an objective analysis of advances and prospective vision of the paths to be followed for the unequivocal establishment of parameters to be used in an eventual therapeutic validation of MEL in neural complications of DM.

A Snapshot of Risk Stratification of Diabetic Patients Fasting during the Month of Ramadan

Objectives: To get a clinical snapshot of the diabetic patients who planned to fast during the month of Ramadan and to determine the ability of the RRR application to effectively risk-stratify patients. Study Design: Observational study. Place and Duration of Study: Department of Diabetes & Endocrinology, Armed Forces Hospital Al-Hada, Taif, Kingdom of Saudi Arabia from 1st April 2018 to 31st May 2018. Methodology: Ninety six patients over 15 years of age with diabetes mellitus were risk stratified using standardized risk criteria were enrolled. Detailed analysis of the information was performed to paint a clinical landscape of the patients who intended to fast. Results: Seventy four percent of the patients were type 2 diabetics, 11% GDM, 31% were between 60-70 years and 17 % had diabetes for more than 20 years. 17% of participants had serious complications during the last three months before Ramadan including hypoglycemia, Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). 59% had chronic diabetic complications. 28 % of patients were on both insulin and oral hypoglycemic agents (OHA) together and 16 % on high risk medications. 25% of patients had an HbA1C of more than 10%. Pertaining to the previous Ramadan experience 19% disclosed having serious complications in the past. 6 % were categorized as low risk individuals, 76% as moderate, 6% high and 12 % as very high risk. Conclusions: Astonishingly all the patients advised to refrain from fasting insisted on fasting. Considering the latest IDF numbers the above calculated percentages would translate into very huge numbers who are in serious jeopardy. In order to prevent serious consequences it is highly recommends that evidence based and validated risk stratification strategies are implemented in routine clinical practices. Keywords: Diabetes mellitus, Fast, Hypoglycemia, High risk patients