The effect of blood flow-restrictive resistance training on the risk of atherosclerotic cardiovascular disease in middle-aged patients with type 2 diabetes: a randomized controlled trial.

Introduction: The aim of this study was to investigate the effects of blood flow-restrictive resistance training (BFR-RT) on improving metabolic abnormalities, blood pressure (BP), obesity, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk in middle-aged patients with type 2 diabetes mellitus (T2DM). Method: We conducted a parallel-group, single blind randomized controlled trial. Participants who met the inclusion criteria were randomly divided into control group, BFR-RT group and aerobic exercise (AE) group. Control group received health education and follow-up; Two exercise groups received supervised collective training for a period of six months, three times per week. AE group trained at moderate-intensity for 60 minutes each time, while BFR-RT group trained at low-intensity for 40 minutes each time. The primary outcomes were change in 10-year ASCVD risk index and level, and the secondary outcomes included changes in fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), blood lipids, BP, and obesity level within and across the three groups at baseline, the third and sixth months of intervention. Result: Among 93 individuals (control group, n=31; AE, n=30; BFR-RT, n=32) were analyzed. At baseline, there were no significant differences in various indicators among the three groups (p>0.05). After intervention, the 10-year ASCVD risk index and risk level of both exercise groups significantly decreased compared to the control group and baseline (p<0.05), and the risk reduction became more pronounced over time. In the sixth month of intervention, the 10-year ASCVD risk index in the AE group decreased by 27.40%, and that in the BFR-RT group decreased by 26.78%. Meanwhile, apart from lipoprotein (a) and diastolic blood pressure, both exercise groups showed significant improvements in FPG, HbA1c, dyslipidemia, systolic blood pressure, and obesity indicators compared to the control group and baseline (p<0.05). There was no significant difference in various indicators between the two exercise groups (p>0.05). Conclusion: BFR-RT could reduce the 10-year ASCVD risk in middle-aged T2DM patients for by improving metabolic abnormalities, BP and obesity, and its effect was similar to that of moderate-intensity AE. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=178886, identifier ChiCTR2300074357.

Metabolic syndrome.

The metabolic syndrome (MetS) is a multiplex modifiable risk factor for cardiovascular disease, type 2 diabetes mellitus and other health outcomes, and is a major challenge to clinical practice and public health. The rising global prevalence of MetS, driven by urbanization, sedentary lifestyles and dietary changes, underlines the urgency of addressing this syndrome. We explore the complex underlying mechanisms, including genetic predisposition, insulin resistance, accumulation of dysfunctional adipose tissue and ectopic lipids in abdominal obesity, systemic inflammation and dyslipidaemia, and how they contribute to the clinical manifestations of MetS. Diagnostic approaches vary but commonly focus on abdominal obesity (assessed using waist circumference), hyperglycaemia, dyslipidaemia and hypertension, highlighting the need for population-specific and phenotype-specific diagnostic strategies. Management of MetS prioritizes lifestyle modifications, such as healthy dietary patterns, physical activity and management of excess visceral and ectopic adiposity, as foundational interventions. We also discuss emerging therapies, including new pharmacological treatments and surgical options, providing a forward-looking perspective on MetS research and care. This Primer aims to inform clinicians, researchers and policymakers about MetS complexities, advocating for a cohesive, patient-centred management and prevention strategy. Emphasizing the multifactorial nature of MetS, this Primer calls for integrated public health efforts, personalized care and innovative research to address this escalating health issue.

The Mediating Effect of Physical Performance on Physical Activity and Mild Cognitive Impairment Among Older Adults With Type 2 Diabetes in Rural China.

OBJECTIVES: To investigate the intermediary role of physical performance in the association between physical activity and mild cognitive impairment (MCI) in older adults with type 2 diabetes mellitus (T2DM), residing in rural areas. METHODS: This study employed a random sampling method to select 316 patients aged 65 years and older, all diagnosed with T2DM, from 24 different rural areas in China. The relationships between physical activity, physical performance, and MCI were analyzed using a logistic regression model, and the proposed mediation model was validated through bootstrap test. RESULTS: In this study, the prevalence of MCI in the rural-based older adults with T2DM was 53.48%. A significant correlation was observed between the levels of physical activity and physical performance. Moreover, diminished physical performance was positively correlated with an increased propensity for MCI, even after adjusting for relevant covariates. Physical performance was discerned to exert a partial mediating influence on the relationship between physical activity and MCI. CONCLUSIONS: The empirical evidence generated by this study posits that the impact of physical activity on MCI is partially mediated through physical performance in an aging population with T2DM residing in rural environments. Consequently, interventional strategies aimed at ameliorating physical performance may serve as a viable approach to mitigate the progression of cognitive decline.

Effect of ertugliflozin on left ventricular function in type 2 diabetes and pre-heart failure: the Ertu-GLS randomized clinical trial.

BACKGROUND: The therapeutic effects of ertugliflozin, a sodium-glucose cotransporter 2 inhibitor, on cardiovascular outcome are not fully understood. This study aimed to evaluate the efficacy and safety of ertugliflozin on cardiac function in people with type 2 diabetes and pre-heart failure. METHODS: We conducted a 24-week randomized, double-blind, placebo-controlled trial involving individuals with type 2 diabetes inadequately controlled with antidiabetic medications. Participants with left ventricular hypertrophy, E/e' >15, or impaired left ventricular global longitudinal strain (LVGLS) were randomized 1:1 to receive either ertugliflozin (5 mg once daily) or a placebo. The primary outcome was the change in LVGLS. Secondary outcomes included changes in left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Prespecified exploratory outcomes, including angiotensin-converting enzyme 2 (ACE2) and angiotensin (1-7) levels, were also assessed. RESULTS: A total of 102 individuals (mean age, 63.9 ± 9.2 years; 38% women) were included. The ertugliflozin group showed a significant improvement in LVGLS (- 15.5 ± 3.1% to - 16.6 ± 2.8%, P = 0.004) compared to the placebo group (- 16.7 ± 2.7% to - 16.4 ± 2.6%, P = 0.509), with a significant between-group difference (P = 0.013). Improvements in LVMI and LVEF were also observed. Additionally, significant reductions in HbA1c, systolic blood pressure, whole-body and visceral fat, uric acid, proteinuria, N-terminal pro-B-type natriuretic peptide, and lipoprotein(a) were noted. ACE2 and angiotensin (1-7) levels significantly increased in the ertugliflozin group compared to the placebo group and correlated with changes in LVGLS [r = 0.456, P < 0.001 for ACE2; r = 0.541, P < 0.001 for angiotensin (1-7)]. Adverse events were similar between the two groups. CONCLUSIONS: This study demonstrated that ertugliflozin has beneficial effects on left ventricular function in individuals with type 2 diabetes and pre-heart failure, and it provided insights into potential underlying mechanisms. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03717194.

Multi-modal characterisation of early-stage, subclinical cardiac deterioration in patients with type 2 diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a major risk factor for heart failure with preserved ejection fraction and cardiac arrhythmias. Precursors of these complications, such as diabetic cardiomyopathy, remain incompletely understood and underdiagnosed. Detection of early signs of cardiac deterioration in T2DM patients is critical for prevention. Our goal is to quantify T2DM-driven abnormalities in ECG and cardiac imaging biomarkers leading to cardiovascular disease. METHODS: We quantified ECG and cardiac magnetic resonance imaging biomarkers in two matched cohorts of 1781 UK Biobank participants, with and without T2DM, and no diagnosed cardiovascular disease at the time of assessment. We performed a pair-matched cross-sectional study to compare cardiac biomarkers in both cohorts, and examined the association between T2DM and these biomarkers. We built multivariate multiple linear regression models sequentially adjusted for socio-demographic, lifestyle, and clinical covariates. RESULTS: Participants with T2DM had a higher resting heart rate (66 vs. 61 beats per minute, p < 0.001), longer QTc interval (424 vs. 420ms, p < 0.001), reduced T wave amplitude (0.33 vs. 0.37mV, p < 0.001), lower stroke volume (72 vs. 78ml, p < 0.001) and thicker left ventricular wall (6.1 vs. 5.9mm, p < 0.001) despite a decreased Sokolow-Lyon index (19.1 vs. 20.2mm, p < 0.001). T2DM was independently associated with higher heart rate (beta = 3.11, 95% CI = [2.11,4.10], p < 0.001), lower stroke volume (beta = -4.11, 95% CI = [-6.03, -2.19], p < 0.001) and higher left ventricular wall thickness (beta = 0.133, 95% CI = [0.081,0.186], p < 0.001). Trends were consistent in subgroups of different sex, age and body mass index. Fewer significant differences were observed in participants of non-white ethnic background. QRS duration and Sokolow-Lyon index showed a positive association with the development of cardiovascular disease in cohorts with and without T2DM, respectively. A higher left ventricular mass and wall thickness were associated with cardiovascular outcomes in both groups. CONCLUSION: T2DM prior to cardiovascular disease was linked with a higher heart rate, QTc prolongation, T wave amplitude reduction, as well as lower stroke volume and increased left ventricular wall thickness. Increased QRS duration and left ventricular wall thickness and mass were most strongly associated with future cardiovascular disease. Although subclinical, these changes may indicate the presence of autonomic dysfunction and diabetic cardiomyopathy.

Low muscle strength rather than low muscle mass is associated with cardiovascular autonomic neuropathy in patients with type 2 diabetes.

Several studies have investigated whether sarcopenia is associated with diabetic microvascular complications, but very few have examined associations between sarcopenia and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM). Therefore, we investigated associations of muscle strength (handgrip strength [HGS]) and mass (appendicular skeletal muscle mass index [ASMI]) and CAN in patients with T2DM. We enrolled 342 patients in this retrospective, cross-sectional study. Cardiovascular reflex tests were used to assess CAN according to Ewing's protocol. Relative HGS was determined after normalizing absolute HGS to body weight (HGS/body weight [kg]). We defined low HGS and low ASMI according to a consensus report of the Asian Group for Sarcopenia. Logistic regression analyses were carried out to assess the associations between relative HGS or ASMI quartiles and the presence of CAN in patients with T2DM. The prevalence rates of CAN, low HGS, and low ASMI in the study subjects were 34.8%, 17.3%, and 18.7%, respectively. Low HGS was significantly more prevalent in patients with CAN than those without CAN (23.5% vs. 13.9%, p = 0.025). The CAN scores were significantly and negatively correlated with relative HGS but not with ASMI. Relative HGS was negative correlated with age, glycated hemoglobin, fasting plasma glucose, hsCRP, body mass index, and HOMA-IR and positively correlated with ASMI. The prevalence of CAN gradually increased with decreasing quartile of relative HGS (28.4% in Q4, 31.8% in Q3, 34.2% in Q2, and 45.3% in Q1, p = 0.02 for trend). Multivariable-adjusted prevalence ratios (PRs) for CAN, determined by comparing the first, second, and third quartiles with the fourth quartile of relative HGS, were 4.4 with a 95% confidence interval (95% CI) of [1.1 to 17.3]), 2.3 (95% CI [0.8 to 6.9]), and 1.2 (95% CI [0.4 to 3.7]), respectively. The prevalence of CAN and the PRs (95% [CI]) for CAN based on ASMI were not statistically significant. Our findings suggest that low muscle strength rather than low muscle mass was significantly associated with the presence of CAN. Therefore, HGS testing could help identify patients who would benefit from screening for earlier diagnosis of CAN.

Association of Body Mass Index, Blood Pressure with Fasting Serum Glucose in Female with Type-2 Diabetes Mellitus.

Type-2 diabetes mellitus is a global pandemic with immense social, health and financial consequences. The pathophysiology of type-2 diabetes is significantly influenced by overweight and obesity. Type-2 diabetes often goes hand-in-hand with high blood pressure. One way to check type-2 diabetes is by measuring fasting blood glucose. This cross-sectional analytical study looked at how blood pressure, body mass index (BMI) and fasting serum glucose relate to each other in women with type-2 diabetes in the Mymensingh locality. The research took place at the Physiology Department of Mymensingh Medical College, Bangladesh from Octy 2023 to June 2024. We included 200 participants: 100 apparently healthy women of 30-65 years without diabetes as the control group and 100 women with diabetes of same age group as the study group. The data was analyzed using SPSS software. Weight and height were measured anthropometrically in kilograms and meters, respectively. Blood pressure was checked with an aneroid sphygmomanometer for both systolic and diastolic values. To see if there were significant differences between groups, we used the unpaired Students 't' test and shared results as mean±SD. For relationships among fasting serum glucose, blood pressure and BMI, we used Pearson's correlation coefficient test. The average BMI for those in the control group was 24.19±1.22 kg/m². In contrast, the study group's average BMI was higher at 28.04±1.66 kg/m². The study group also had a greater average systolic blood pressure of 130.65±6.06 mm Hg compared to 115.30±5.07 mm Hg for controls. For diastolic blood pressure, values were also higher in the study group: 85.65±5.71 mm Hg compared to the control's 75.65±5.25 mm Hg. Fasting serum glucose levels showed a positive correlation with both BMI and blood pressure. We recommended from this study that routine evaluation of these parameters is important for preventing complications associated with type-2 diabetes mellitus.

Duplex Color Doppler Evaluation of Intrarenal Resistive Index in Type 2 Diabetic Patients Having Diabetic Nephropathy.

Diabetic nephropathy (DN) is considered the most frequent cause of end-stage renal disease (ESRD). For early diagnosis and follow up of renal function in patient with established DN, Duplex Doppler Sonography can be used as noninvasive tool. The aim and objective of the study was to determine whether resistive index could remain higher in type 2 diabetic patients having nephropathy in comparison with that of non-diabetic controls. This case-control study was done in the department of Radiology and Imaging, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from 1st Octy 2014 to 30th June 2015. Total 65 diabetic nephropathy patients were taken as study group and 65 healthy subjects were included as healthy control subjects. Duplex Color Doppler sonography of interlobar artery was carried out in both groups for the measurement of Peak systolic velocity, end diastolic velocity and arterial Resistive Index (RI). The RI of interlobar artery of left kidney in control group was 0.58±0.08 (mean±SD) and the mean RI of interlobar artery of left kidney in diabetic nephropathy patients was 0.74±0.53 (mean±SD). The difference of RI of interlobar artery of left kidney in the two groups was statistically significant and the RI of right kidney of control and that of case groups were 0.60±0.09 and 0.76±0.031 (mean±SD) respectively. In between control and case groups the RI of right kidney was statistically significant (p = <0.5). So, resistive index of interlobar artery was increased in type 2 diabetic nephropathy patients in comparison to control group. Study findings reveal that resistive index remains significantly higher in patients with diabetic nephropathy than control group. For this reason, RI can be used for early diagnosis of diabetic nephropathy by Duplex Doppler ultrasonography.

Altered Subcortical Brain Volume and Cortical Thickness Related to Insulin Resistance in Type 2 Diabetes Mellitus.

PURPOSE: The objective of this study is to examine the alterations in subcortical brain volume and cortical thickness among individuals diagnosed with Type 2 diabetes mellitus (T2DM) through the application of morphometry techniques and, additionally, to investigate the potential association between these modifications and insulin resistance (IR). MATERIALS AND METHODS: The present cross-sectional study comprised a total of 121 participants (n = 48 with healthy controls [HCs] and n = 73 with T2DM) who were recruited and underwent a battery of cognitive testing and structural magnetic resonance imaging (MRI). FreeSurfer was used to process the MRI data. Analysis of covariance compared discrepancies in cortical thickness and subcortical brain volume between T2DM and HCs, adjusting for the potential confounding effects of gender, age, education, and body mass index (BMI). Exploratory partial correlations investigated links between IR and brain structure in T2DM participants. RESULTS: Compared with HCs, individuals with T2DM demonstrated a cortical thickness decrease in the right caudal middle frontal gyrus, right pars opercularis, left precentral gyrus, and bilateral superior frontal gyrus. Furthermore, this study for T2DM found that the severity of IR was inversely related to the volume of the left putamen and left hippocampus, as well as the thickness of the left pars orbitalis, left pericalcarine, right entorhinal area, and right rostral anterior cingulate gyrus. CONCLUSION: The evidence for structural brain changes in T2DM was observed, and alterations in cortical thickness were concentrated in the frontal lobes. Correlations between IR and frontal cortical thinning may serve as a potential neuroimaging marker of T2DM and lead to various diabetes-related brain complications.

Association between bone microarchitecture and sarcopenia in postmenopausal women with type 2 diabetes.

Bone microarchitecture, as assessed using high-resolution peripheral quantitative computed tomography, is adversely affected in postmenopausal women with type 2 diabetes mellitus having sarcopenia/sarcopenic obesity while areal bone mineral density does not differ between those with and without sarcopenia. PURPOSE: Type 2 diabetes (T2D) increases the risk of sarcopenia, which independently contributes to bone fragility. We aimed to explore the association between sarcopenia/sarcopenic obesity and bone quality using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT) in T2D. METHODS: We analyzed the baseline participant characteristics of an ongoing randomized clinical pilot trial (CTRI/2022/02/039978). Postmenopausal women (≥ 50 years) with T2D and high risk of fragility fractures were included. Areal BMD (aBMD), trabecular bone score (TBS), and body composition were measured using DXA. Bone microarchitecture was assessed at distal radius/distal tibia using HR-pQCT. Muscle strength was estimated using dominant handgrip strength (HGS). Sarcopenia was defined as low HGS (< 18.0 kg) and low appendicular skeletal muscle index (ASMI) (< 4.61 kg/m2). Probable sarcopenia was defined as low HGS with normal ASMI. Sarcopenic obesity was classified as co-existence of sarcopenia and obesity (BMI ≥ 25.0 kg/m2). RESULTS: We recruited 129 postmenopausal women (mean age 64.2 ± 6.7 years). Participants were categorized into four mutually exclusive groups: group A (normal HGS and ASMI, n = 17), group B (probable sarcopenia, n = 77), group C (non-obese sarcopenia, n = 18), and group D (obese sarcopenia, n = 18). The four groups did not differ significantly with regard to baseline characteristics, fracture prevalence, HbA1c, aBMD, and TBS. However, HR-pQCT-derived volumetric BMD and cortical/trabecular microarchitecture were significantly poorer in group C/group D than in group A/group B. CONCLUSIONS: Bone quality rather than bone density (quantity) is adversely affected in T2D postmenopausal women with sarcopenia/sarcopenic obesity, which could increase the fracture risk in this patient sub-population.

Oral Intake of Hydrogen Water Improves Retinal Blood Flow Dysregulation in Response to Flicker Stimulation and Systemic Hyperoxia in Diabetic Mice.

Purpose: To examine the effects of hydrogen water on retinal blood flow (RBF) dysregulation in diabetes, we evaluated changes in RBF in response to flicker stimulation and systemic hyperoxia in diabetic mice. Methods: Twelve type 2 diabetic mice were divided into a group that received non-hydrogen water (n = 6, control group) and the other that received hydrogen-rich water (0.6-0.8 mM) (n = 6, HRW group) from six weeks of age. Body weight, blood glucose, intraocular pressure, and blood pressure were evaluated from eight to 14 weeks of age. RBF was measured in the vascular area of the optic disc as mean blur rate using laser speckle flowgraphy in the resting state and response to flicker stimulation and hyperoxia. We evaluated glial activation and oxidative stress based on immunofluorescence expression. Results: At 14 weeks, blood glucose level was significantly lower in the HRW group, though still elevated. RBF changes improved significantly in the HRW group compared with the control group from eight weeks of age and persisted throughout the study. Immunofluorescent expression of glial fibrillary acidic protein, particularly in the outer plexiform layer, was significantly decreased in the HRW group. Among oxidative stress markers, 3-nitrotyrosine was significantly suppressed in the HRW group. Conclusions: Hydrogen-rich water intake significantly improved RBF dysregulation in diabetic mice. Hydrogen may improve impaired neurovascular coupling function in diabetic mice by suppressing gliosis and oxidative stress in the retina. Translational Relevance: This study highlights the potential of oral intake of hydrogen-rich water to mitigate retinal dysfunction in diabetic mice.

The value of concomitant testing of cutaneous silent period with sympathetic skin response and heart rate variability in Type-2 diabetes patients: An electrophysiological study.

OBJECTIVE: To explore the association among cutaneous silent period, sympathetic skin response and heart rate variability in diabetes patients. METHODS: The case-control study was conducted at the Department of Physiology, College of Medicine, Al- Mustansiriyah University, Baghdad, Iraq, from November 1, 2020, to May 20, 2021, and comprised 24 healthy controls in Group I and 49 patients of type 2 diabetes in Group II who were recruited from the neuroelectrophysiological unit of Al-Imamain Al-Kadhmean Teaching Hospital, Baghdad, Iraq. Both groups were subjected to cutaneous silent period, sympathetic skin response and heart rate variability testing. Data was analysed using SPSS 24. RESULTS: Of the 73 subjects, 24(32.9%) were in Group I and 49(67.1%) were in Group II. Cutaneous silent period mean latency values were significantly increased in Group II compared to Group I (p<0.05), and a negative sympathetic skin response in the right lower limb was significantly different between the groups (p<0.001). There was no significant correlation between Cutaneous silent period and sympathetic skin response values (p>0.05). Heart rate variability was significantly increased in diabetic patients with negative sympathetic skin response compared to those with positive sympathetic skin response (p<0.05). CONCLUSIONS: Simultaneous measurement of cutaneous silent period, sympathetic skin response and heart rate variability should be done as there were no strong correlation among the tests in diabetic patients.

Deterioration of Vestibular Motion Perception: A Risk Factor for Postural Instability and Falls in Elderly With Type 2 Diabetes.

AIMS: To assess whether impaired vestibular perception of self-motion is a risk factor for unsteadiness and falls in elderly patients with type 2 diabetes (T2D). MATERIALS AND METHODS: 113 participants (65-75 years old) with T2D underwent tests of roll and pitch discrimination, postural stability (Berg Balance Scale, Modified Romberg Test, and quantitative posturography), clinical examination and blood chemistry analyses. Falls 1-year after enrolment were self-reported. We performed cluster analysis based on the values of the vestibular motion thresholds, and logistic stepwise regression to compare the clinical-biochemical parameters between clusters. RESULTS: We identified two clusters (VC1 n = 65 and VC2 n = 48 participants). VC2 had significantly (p < 0.001) higher (poorer) thresholds than VC1: mean pitch threshold 1.62°/s (95% CI 1.48-1.78) in VC2 and 0.91°/s (95% CI 0.84-0.98) in VC1, mean roll threshold 1.34°/s (95% CI 1.21-1.48) in VC2 and 0.69°/s (95% CI 0.64-0.74) in VC1. Diabetes duration was significantly (p = 0.024) longer in VC2 (11.96 years, 95% CI 9.23-14.68) than in VC1 (8.37 years, 95% CI 6.85-9.88). Glycaemic control was significantly (p = 0.014) poorer in VC2 (mean HbA1c 6.74%, 95% CI 6.47-7.06) than in VC1 (mean HbA1c 6.34%, 95% CI 6.16-6.53). VC2 had a significantly higher incidence of postural instability than VC1, with a higher risk of failing the Modified Romberg Test C4 (RR = 1.57, χ2 = 5.33, p = 0.021), reporting falls during follow-up (RR = 11.48, χ2 = 9.40, p = 0.002), and greater postural sway in the medio-lateral direction (p < 0.025). CONCLUSIONS: Assessing vestibular motion thresholds identifies individuals with T2D at risk of postural instability due to altered motion perception and guides vestibular rehabilitation.

Characteristic Changes of Prefrontal and Motor Areas in Patients with Type 2 Diabetes and Major Depressive Disorder During a Motor Task of Tai Chi Chuan: A Functional Near-Infrared Spectroscopy Study.

AIM: This cross-sectional study aims to identify the characteristic changes of prefrontal and motor areas during a tai chi chuan task in patients with Type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) using wearable functional near-infrared spectroscopy (fNIRS). METHODS: Three parallel groups (T2DM with DD group, T2DM group, and healthy group) were recruited from December 10, 2022, to May 31, 2023. Participants in three groups conducted a motor task of tai chi chuan designed by Eprime 3.0, and fNIRS was used to monitor the brain activation, functional connectivity (FC), and lateralization of prefrontal and motor areas. Correlation analyses were performed to examine the relationship between depressive symptoms and the function of prefrontal and motor areas. RESULTS: Ninety elder adults (aged ≥ 60), including 30 patients with T2DM and MDD, 30 patients with T2DM, and 30 healthy subjects, were enrolled. In contrast with the patients with T2DM and healthy subjects, the patients with T2DM and MDD had decreased activation and abnormal lateralization in prefrontal and motor areas and decreased FC among supplementary motor area, motor area, and dorsolateral prefrontal cortex (DLPFC). Furthermore, the oxyhemoglobin (HbO2) concentration value of DLPFC in patients with T2DM and MDD was negatively associated with scores of Hamilton Depression Scale-24 (HAMD-24). CONCLUSIONS: Patients with T2DM and MDD had characteristic functional changes in prefrontal and motor areas. DLPFC may be a potential target of diagnosis and intervention for patients with T2DM and MDD.

[The relationship between diabetes mellitus and non-alcoholic fatty liver disease: a clinical and instrumental paired study].

AIM: To study the impact of type 2 diabetes mellitus (DM2) on the severity of liver steatosis and fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: To conduct a paired case-control study 2989 patients were examined at the Federal Research Center of Nutrition, Biotechnology and Food Safety. Pairs were matched by gender and age and distributed into groups: NAFLD + DM2+ (n=313), NAFLD + DM2- (n=313) and a control group of patients without NAFLD and without DM2 (n=313). The severity of liver steatosis was determined by measuring the controlled attenuation parameter. The severity of liver fibrosis was determined by measuring the liver stiffness measurement. Body composition of the patients was determined using bioimpedance measurements. Indicators of lipid and carbohydrate metabolism, and the serum activity of liver enzymes was determined by standard biochemical methods. RESULTS: In NAFLD + DM2+ group compared to NAFLD + DM2- group, and in NAFLDM + DM2-compared to the control group, weight, BMI, waist and hip circumference, waist-to-hip ratio were higher, while in all. In NAFLD + DM2+ and NAFLD + DM2- groups the volume of fat mass directly correlated with the level of blood triglycerides (r=0.21), HbA1с (r=0.32) and fasting blood glucose (r=0.35), and inversely correlated with high-density lipoproteins (r=-0.19). In NAFLD + DM2+ group versus NAFLD + DM2- group severe steatosis (S3, 78% versus 59.4%; p<0.001) and severe fibrosis (F4, 8% vs 2.6%; p<0.001) was more common; 70% of patients in the NAFLD + DM2- group had no liver fibrosis according to elastography (F0), while in the NAFLD + DM2+ group only 43.2% of patients had no liver fibrosis (p<0.0001). CONCLUSION: When NAFLD is accompanied by DM2, there is an increase in total fat mass, the severity of steatosis and liver fibrosis, and an associated deterioration of lipid metabolism. More than half of these patients have various stages of liver fibrosis, which indicates the progressive nature of the disease.

Intestinal Motility Dysfunction in Goto-Kakizaki Rats: Role of the Myenteric Plexus.

Diabetes mellitus is associated with changes in intestinal morphology and the enteric nervous system. We previously reported constipation in Goto-Kakizaki (GK) rats, a non-obese model for type 2 diabetes mellitus. AIM: The morpho-quantitative analysis of myenteric plexus neurons in the small and large intestines of 120-day-old male GK rats was investigated. METHODS: The diabetes was confirmed by high fasting blood glucose levels. The myenteric plexus was evaluated through wholemount immunofluorescence. The morpho-quantitative analyses included evaluating neuronal density (neurons per ganglion) of the total neuronal population, the cholinergic and nitrergic subpopulations, and enteric glial cells per ganglion. The cell body area of 100 neurons per segment per animal was measured. RESULTS: The total neurons and nitrergic subpopulation were unaltered in the GK rats' small and large intestines. The cholinergic subpopulation exhibited decreased density in the three segments of the small intestine and an increased number in the proximal colon of the GK rats. The number of enteric glial cells increased in the ileum of the GK rats, which could indicate enteric gliosis caused by the intestinal inflammatory state. The area of the cell body was increased in the total neuronal population of the jejunum and ileum of the GK rats. Frequency histograms of the cell body area distribution revealed the contribution of cholinergic neurons to larger areas in the jejunum and nitrergic neurons in the ileum. CONCLUSION: The constipation previously reported in GK rats might be explained by the decrease in the density of cholinergic neurons in the small intestine of this animal model.

Overview of oxidative stress and inflammation in diabetes.

The global prevalence of diabetes has increased significantly, leading to various complications and a negative impact on quality of life. Hyperglycemia hyperglycemic-induced oxidative stress (OS) and inflammation are closely associated with the development and progression of type 2 diabetes mellitus (T2D) and its complications. This review explores the effect of T2D on target organ damage and potential treatments to minimize this damage. The paper examines the pathophysiology of T2D, focusing on low-grade chronic inflammation and OS and on their impact on insulin resistance. The review discusses the role of inflammation and OS in the development of microvascular and macrovascular complications. The findings highlight the mechanisms by which inflammatory cytokines, stress kinases, and reactive oxygen species (ROS) interfere with insulin signaling pathways, leading to impaired glucose metabolism and organ dysfunction. Lifestyle interventions, including a balanced diet and exercise, can help reduce chronic inflammation and OS, thereby preventing and controlling T2D and its associated complications. Additionally, various antioxidants and anti-inflammatory agents show potential in reducing OS and inflammation. Some anti-diabetic drugs, like pioglitazone, metformin, and glucagon-like peptide-1 (GLP-1) agonists, may also have anti-inflammatory effects. Further research, including randomized controlled trials, is needed to evaluate the efficacy of these interventions.

Integrated Yoga and Naturopathy Intervention on Glycemic Profile and Autonomic Variables in Co-Existence of Diabetes Mellitus with Hypertension: A Two-Arm Observational Study.

Background: Diabetes Mellitus coexisting with hypertension has received significant global attention and remains a public health challenge in the past two decades. The states of hyperinsulinemia and insulin resistance have been postulated as causes or consequences of hypertension. Evidence shows that alternative systems of medicine can play a significant role in achieving glycemic control. This study aimed to compare and evaluate the impact of yoga and naturopathy-based lifestyles on patients with diabetes mellitus and diabetes mellitus with hypertension. Methods: Sixty subjects were recruited into two groups, group 1 (diabetes mellitus with hypertension) and group 2 (diabetes mellitus) based on the inclusion and exclusion criteria. Both the groups underwent naturopathy and yoga intervention for ten days. The glycemic profile and heart rate variability (HRV) of the patients were assessed at the baseline and 10 days after the intervention. Results: Study resulted in a significant change in both time domain and frequency domain variables (HRV, FBS, and PPBS) in both group 1 and group 2 (P < .05, for all) but the mean difference was more in group 2 with a significant difference between the two groups, P < .05. The diastolic blood pressure significantly decreased only in group 2, whereas the systolic blood pressure decreased in both groups without any difference between the two groups. Conclusion: The results of the present study show that integrated yoga and naturopathy management significantly help in glycemic control and autonomic functions in both groups.

Stratum corneum hydration levels are negatively correlated with HbA1c levels in the elderly Chinese.

Highlights Stratum corneum hydration levels are negatively correlated with HbA1c levels and positively correlated with skin surface pH. Individuals with type 2 diabetes display lower levels of stratum corneum hydration. Because low stratum corneum hydration levels can increase circulating levels of proinflammatory cytokines, which are linked to the pathogenesis of type 2 diabetes, improvement in stratum corneum hydration can be an alternative approach in the management of type 2 diabetes.

Age-Related Changes in Insulin Resistance and Muscle Mass: Clinical Implications in Obese Older Adults.

The older segment of the global population is increasing at a rapid pace. Advancements in public health and modern medicine lengthened life expectancy and reduced the burden of disease in communities worldwide. Concurrent with this demographic change is the rise in overweight people and obesity, which is evident in all age groups. There is also an aging-related reduction in muscle mass and function, or sarcopenia, that is exacerbated by sedentary lifestyle and poor nutrition. The coexistence of muscle loss and elevated body mass index, termed "sarcopenic obesity", has particularly deleterious consequences in older individuals. Worsening insulin resistance and a proinflammatory state operate at the pathophysiologic level and lead to adverse health outcomes such as a proclivity to cardiovascular disease, type 2 diabetes, and even cognitive dysfunction. Although the concept of sarcopenic obesity as a disease construct is being increasingly recognized, a clearer understanding is warranted in order to define its components and health impact. Research is needed at the molecular-cellular level to tie together derangements in insulin action, cytokines, myokines, and endothelial dysfunction with clinical outcomes. Lifestyle modifications as well as targeted nonpharmacologic approaches, such as supplements and antioxidants, appear to have a promising role in reducing the chronic burden of this emerging disorder. Breakthroughs in drug therapies that retard or even reverse the underlying dynamics of sarcopenia and obesity in older persons are being actively explored.