Practical guide: Glucagon-like peptide-1 and dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus.

In 2005, exenatide became the first approved glucagon-like peptide-1 receptor agonist (GLP-1 RA) for type 2 diabetes mellitus (T2DM). Since then, numerous GLP-1 RAs have been approved, including tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA, which was approved in 2022. This class of drugs is considered safe with no hypoglycemia risk, making it a common second-line choice after metformin for treating T2DM. Various considerations can make selecting and switching between different GLP-1 RAs challenging. Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.

Factors associated with glycemic control and diabetes complications in a group of Saudi patients with type 2 diabetes.

Poor glycemic control is a risk factor for micro and macrovascular complications of diabetes. The aim of this study was to assess the prevalence and factors related to suboptimal glycemic control and diabetes complications in a group of patients with type 2 diabetes mellitus (T2DM). This cross-sectional descriptive study conducted in Al Qassim region, Saudi Arabia. Two hundred patients with T2DM were enrolled. Demographic, social, and self-care behavior data were collected. A thorough clinical evaluation was done. Glycated hemoglobin, lipid, and kidney profile results were recorded. Mann-Whitney test was used to compare different groups. For comparing categorical data, Chi-square (χ2) test was performed. Multivariate logistic regression analyses used to detect predictors of poor glycemic control and macrovascular and microvascular complications. The median age of patients was 58 years, and 62% of them were males. Only 22.5% of patients had glycated hemoglobin <7%. Forty-four patients (22%) had evidence of macrovascular complications. Retinopathy, neuropathy, and nephropathy were found in 42.5%, 32.5%, and 12%, respectively. Longer diabetes duration was significantly associated with poor glycemic control (OR = 1.006, P < .005). The age of the patients was independently associated with macrovascular complications (OR = 1.050, P = .029). Hyperlipidemia was significantly associated with neuropathy (OR = 0.229, P = .043) and retinopathy (OR = 12.887, P = .003). Although physical activity was lower in patients with suboptimal glycemic levels (P = .024), cardiovascular disease (P = .030), neuropathy (P < .001), retinopathy (P < .001), and nephropathy (P = .019), multivariate analysis showed that it was only independently associated with neuropathy (OR = 0.614, P = .001). The prevalence of suboptimal glycemic control is high in the studied population. Effective health measures are urgently needed to stop diabetes complications, especially retinopathy and neuropathy. Elderly people with long durations of diabetes, and lower physical activity should be the focus of the interventions. Tailored exercise programs are particularly needed for better diabetes control and for the prevention of complications in patients with T2DM.

Symptoms of depression and stress among migrant workers in Al Qassim, Saudi Arabia.

BACKGROUND: Migrant workers make up a third of the population of Saudi Arabia, approximately 13 million. Mental health disorders among this population are common, but very limited data exist currently. AIMS: To assess the prevalence of moderate to severe symptoms of depression and stress among a sample of migrant workers in Saudi Arabia. To identify whether migrant-specific factors, such as occupation, nationality, duration of migration, and work characteristics, are associated with depressive and stress symptoms. METHODS: A cross-sectional study of 2,123 migrants was conducted in Al Qassim, Saudi Arabia. Depressive and stress symptoms were assessed with the Depression, Anxiety, and Stress Scale (DASS-21). The outcomes were categorized into two levels (i.e. mild or no symptoms versus moderate to severe symptoms). Univariate and multivariate binary logistic regressions were used to assess the relationship with potential covariates. RESULTS: The prevalence of moderate to severe depressive and stress symptoms was 7.3% and 3.6%, respectively. These did not vary by the duration of stay in the country or weekly work hours. However, there was substantial variance in the symptoms by participants' nationality and occupation. Participants from Bangladesh were 3.8 (95% CI [1.50, 9.62]) times more likely, and hospital cleaners were 6.5 (95% CI [2.12, 20.07]) times more likely to have depressive symptoms. Similarly, auto-repair workers were 6.3 times more likely to have symptoms of stress (95% CI [1.55, 25.90]). CONCLUSION: The prevalence of depressive and stress symptoms varied significantly depending on occupation and country of origin. It would behoove employers to screen for these mental health conditions and refer employees to the relevant healthcare services. Future studies could examine the feasibility of mental health screening programs among migrant employees.

The Protective Effect of Bariatric Surgery on the Development of Colorectal Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Obesity is a known risk factor for developing colorectal cancer (CRC) and is associated with the formation of precancerous colonic adenomas. Bariatric surgery (BRS) is considered to reduce the cancer risk in morbidly obese patients. However, the currently available literature yields contradicting results regarding the impact of bariatric surgery on the incidence of CRC. METHODS: A systematic literature search of the Medline, Embase, CENTRAL, CINAHL, Web of Science, and clinicaltrials.gov databases was undertaken following the PRISMA guidelines. A random effects model was selected. RESULTS: Twelve retrospective cohort studies, incorporating a total of 6,279,722 patients, were eligible for inclusion in the final quantitative analysis. Eight studies originated from North America, while four reported on European patients. Patients in the Bariatric Surgery group exhibited a significantly reduced risk for developing colorectal cancer (RR 0.56, 95% CI 0.4-0.8, p < 0.001), while sleeve gastrectomy was found to be significantly associated with a smaller incidence of CRC (RR 0.55, 95% CI 0.36-0.83, p < 0.001), and gastric bypass and banding did not. CONCLUSIONS: A significant protective effect of BRS against the development of CRC is implied. In the present analysis, the incidence rate of colorectal cancer was approximately halved amongst the obese individuals that were operated on.

The Potential Role of CD44 and CD133 in Colorectal Stem Cell Cancer.

Colorectal cancer (CRC) is the most preventable malignancy globally, with a high mortality rate. Cancer stem cells (CSCs) are found previously in multiple types of cancer; CRC is one of them, and it has been correlated with several biomarkers. The two most essential markers related to colorectal CSCs are CD44 and CD133, which play a significant role in diagnosis, treatment, and prognosis. Unfortunately, the CSCs with positive CD44 and CD133 biomarkers illustrated an alarming prognosis. Several trials were trying to target those markers to improve the prognosis and cure. We aimed to review the papers that relate to the two markers in terms of diagnosis, treatment, and prognosis.