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At present, non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease worldwide, with obesity recognized as a global epidemic and type 2 diabetes a worldwide disease. In this study, 10 C57BL/6 mice were divided into two groups: the control group (SC) and the high-fat diet (HF) group. Both groups were fed their respective diets for 8 weeks. The animals were analyzed for body weight, glucose/insulin resistance, hepatic steatosis, and fibrosis to diagnose NAFLD. Results showed that the HF group animals had significantly higher body weight (P<0.0001), glucose resistance (P=0.0002), insulin resistance (P=0.0009), and blood glucose levels (P<0.05) compared to the SC group. The HF group exhibited increased hepatic steatosis (P<0.0001) and fibrosis (P<0.0001) compared to the SC group. These findings led to the conclusion that the animals in the HF group had grade and stage 2 NAFLD. Furthermore, the HF group animals were classified as obese, indicating a higher risk for developing insulin resistance and, subsequently, type 2 diabetes mellitus (T2DM). Understanding the risk factors and complications associated with NAFLD, obesity, and T2DM is crucial for preventing and treating metabolic alterations linked to a high-fat diet.

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INTRODUCTION: Type 2 diabetes (T2DM) together (along) with age and the presence of atrial fibrillation, high blood pressure, smoking, dyslipidemia (DLP), carotid stenosis, and an unhealthy lifestyle are risk factors (RF) to develop an ischemic stroke. The objective of this work was to analyze and compare risk factors and evolution of inpatients with ischemic stroke with and without T2DM. MATERIALS AND METHODS: This study was a retrospective and observational analysis. Data on habits, comorbidities, medication and laboratory parameters were collected patients' medical records hospitalized for stroke between January 1, 2022 and December 31, 2022. The sample was divided into patients with and without T2DM. RESULTS: One hundred and ninety three patients experienced stroke. The average age: 73.6 ±11.8 years. Among them, 100 patients had T2DM, displaying a higher prevalence of obesity (p= 0.000), DLP (p=0.000), and chronic kidney disease (p= 0.045). Elevated levels of glycemia (p=0.001), HbA1C (p=0.001), triglycerides (TG) (p=<0.001) and TG/HDL index (p= <0.001) as well as and lower HDL (p=<0.001) were also observed. Patients with T2DM showed lower survival (p= 0.012). DISCUSSION: Patients hospitalized for stroke with T2DM had more risk factors and higher mortality than the population without T2DM.

Introducción: La diabetes tipo 2 (DM2) junto con la edad y la presencia de fibrilación auricular, hipertensión arterial, tabaquismo, dislipidemia (DLP), estenosis carotídea, y un estilo de vida no saludable, son factores de riesgo (FR) para el desarrollo de un accidente cerebrovascular isquémico (ACVi). El objetivo de este trabajo fue analizar y comparar factores de riesgo y evolución de pacientes internados con ACV isquémico con y sin DM2. Materiales y métodos: Estudio retrospectivo y longitudinal. Se recolectaron datos (hábitos, comorbilidades, medicación y laboratorio) de las historias clínicas de pacientes internados por ACVi desde el 1 de enero de 2022 al 31 de diciembre de 2022. Se dividióla muestra en pacientes con y sin DM2. Resultados: Ciento noventa y tres pacientes presentaron ACVi. La edad promedio: 73.6 ±11.8 años; 100 pacientes tenían DM2, quienes presentaron mayor obesidad (p=<0.001, DLP (p=<0.001), enfermedad renal crónica (p=0.045). También se observómayores niveles de glucemia (p=0.001), HbA1C (p=0.001), triglicéridos (TG) (p=<0.001) e índice TG/HDL (p=<0.001) y HDL más bajo (p=<0.001). Los pacientes con DM2 presentaron menor supervivencia (p=0.012). Discusión: Los enfermos hospitalizados por accidente cerebrovascular con DM2 tuvieron más factores de riesgo y mayor mortalidad que la población sin DM2.

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BACKGROUND: Gestational diabetes is one of the most prevalent diseases in pregnancy, with an incidence of 5 to 18% in Brazil, and is associated with high morbidity rates. The first-line treatment is insulin, although some recent studies have indicated that metformin might also be effective. Metformin is safe in pregnancy and appears to produce better results than insulin, including reduced gestational weight gain (GWG) and smaller gestational-age newborns. Few studies have been conducted on this topic in low- and middle-income countries. METHODS: We designed an open randomized controlled trial comparing two treatments for pregnant women with type II diabetes mellitus (DM) and gestational diabetes (DMG): the metformin group (intervention) and the insulin group (as a routine service). The primary outcome is glycemic control. The secondary outcomes are GWG, the occurrence of hypertensive syndromes, macrosomia, and neonatal hypoglycemia. The sample will comprise 92 pregnant women, 46 per group. The inclusion criteria will be GDM or type II DM requiring medication for glycemic control, singleton pregnancy, and gestational age under 34 weeks. The exclusion criteria will be current treatment with any medication for glycemic control, type I DM, and intolerance to the study medications (metformin or insulin). Women will be routinely followed during antenatal care, childbirth, and the postpartum period. Statistical analyses will include the intention-to-treat approach and a comparison between the two groups. DISCUSSION: Considering the Brazilian socioeconomic reality and the safety of metformin demonstrated in previous trials, we expect that the MevIP study will demonstrate that metformin is an adequate and appropriate medication for GDM treatment in the Brazilian population, representing an alternative to insulin for GDM. TRIAL REGISTRATION: This protocol has been registered prospectively in ReBEC under the ID RBR-3j3cktx in August 11, 2023.

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BACKGROUND: Type 2 diabetes is the fastest-growing global health concern, and its global prevalence is projected to affect 643 million individuals by 2030. Social media platforms, like Facebook, have become crucial channels for healthcare organisations to engage with the public to promote prevention and disease management, especially in low-resource settings like Honduras. This study aims to perform a retrospective analysis of Honduran healthcare organisations' Facebook posts to understand how effectively they engage diabetes-related content with their followers. METHODS: The top 10 followed healthcare organisations' Facebook pages were taken as a sample. Data were retrieved from October 2023 to March 2024. Diabetic-related posts were identified using keywords and categorised based on their contents and features. RESULTS: Findings reveal significant disparities in the frequencies of posts and public engagement among different types of organisations. The majority of posts were classified under the miscellaneous category and text+image feature. Recipes and food-related posts were liked and shared the most among the followers. CONCLUSION: The results of the study found that patients' engagement with diabetes-related content was low in social media. The gap between patients' participation and engagement highlights the need for reassessment and refinement of social media communication strategies for healthcare organisations to empower patients with diabetes through social media and increase public engagement.

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to analyze the vaccination status of individuals with type 1 and type 2 diabetes in Primary Healthcare.cross-sectional, analytical study conducted in 25 Family Health teams with 274 individuals with diabetes. Sociodemographic and clinical variables were evaluated, as well as the full vaccination schedule for each vaccine recommended by the National Immunization Program, through bivariate analysis and logistic regression.among individuals with diabetes mellitus, the following incomplete vaccination rates were found: 69.1% for hepatitis B; 64.6% for diphtheria and tetanus; 74.3% for yellow fever; 87.9% for pneumococcus; 87.9% for varicella; 24.5% for influenza; and 0.7% for COVID-19. The reported reasons for low vaccination rates included not knowing the importance of vaccination and not being informed by healthcare providers. A statistically significant association was found between sociodemographic and clinical profile regarding the full vaccination schedule between the influenza vaccine and age and income; COVID-19 and age, type of diabetes and duration of diabetes.individuals with type 1 and type 2 diabetes treated in Primary Healthcare showed low vaccination rates, which is concerning due to increased vulnerability to vaccine-preventable infections and mortality within this group. BACKGROUND: (1) Individuals with diabetes have low vaccination rates. (2) It is essential to provide vaccination opportunities in health services for individuals with diabetes. (3) Education for vaccine-prescribing professionals is necessary. (4) Young people are less likely to get vaccinated than older adults. (5) It is essential to understand the predisposing factors related to vaccination status.

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BACKGROUND: Sodium‒glucose cotransporter 2 (SGLT2) inhibitors have been included in heart failure (HF) guidelines because of their benefits in reducing mortality and hospitalization rates. However, the timing and benefits of initiating SGLT2 inhibitors in patients after myocardial infarction (MI) remain controversial. Therefore, we aimed to perform a systematic review and meta-analysis comparing SGLT2 inhibitors with placebo in patients with MI. METHODS: We performed a systematic review and meta-analysis to determine the impact of SGLT2 inhibitors in patients with recent or previous MI. We systematically searched PubMed, Cochrane, and Embase for RCTs comparing SGLT2 inhibitors versus placebo in patients with MI. The primary outcome was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes: (2) major adverse cardiovascular events (MACE) defined as a composite of cardiovascular (CV) death, MI or stroke; and (3) all-cause mortality. A subgroup analysis was conducted for the primary outcome, comparing patients who had experienced an MI more than 8 weeks prior to study enrolment (previous MI) versus those who had experienced an MI within the preceding 8 weeks (acute MI). Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled with a random effects model. RESULTS: Our meta-analysis included 10 RCTs comprising 22,266 patients, of whom 11,339 (51.2%) had type 2 diabetes. The mean age was 62 years, and the median follow-up was 21 months. According to the pooled analysis, HF hospitalization rates were lower in patients on SGLT2 inhibitors compared with placebo (RR 0.77; 95% CI 0.69, 0.85; p < 0.001)). Differences in MACE were also observed in favor of SGLT2 inhibitors versus placebo (RR 0.88; 95% CI 0.79, 0.97; p = 0.012). There was no statistically significant difference in all-cause mortality between the groups (RR 0.88; 95% CI 0.78, 1.00; p = 0.058). Benefits of SGLT2 inhibitors for the primary outcome were consistent regardless of the timing of last MI, with no treatment by subgroup interaction (p for interaction = 0.56). CONCLUSION: In this meta-analysis of patients who experienced MI, the administration of SGLT2 inhibitors was associated with lower rates of hospitalization for HF. In addition, the treatment effect of SGLT2 inhibitors was consistent regardless of whether they were started in the recent versus previous MI setting.

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Currently, there are several drugs used for the treatment of type 2 diabetes (T2D); however, all of them have adverse effects. Benzothiazoles have a broad spectrum of biological activities such as antidiabetic. This study aimed to evaluate in silico and in vivo two series of 2-aminobenzothiazole derivatives linked to isothioureas (3a-w) or guanidines (4a-z) for the treatment of T2D. The ADMET properties were determined in silico, from which it was possible to select nine compounds (two isothioureas and seven guanidines), and, with molecular docking, it was shown that compounds methyl (E)-N'-(benzo[d]thiazol-2-yl)-N-methylcarbamimidothioate (3b) and 2-(benzo[d]thiazol-2-yl)-1,3-di-tert-butylguanidine (4y) showed a high affinity for PPARγ (ΔG = -7.8 and -8.4 kcal/mol, respectively). In vivo, the LD50 value was estimated in rats based on OECD Guideline 425, being >1750 mg/kg for both compounds. The pharmacological effect of 3b and 4y was evaluated in the T2D rat model, showing that after oral administration in an equimolar ratio to pioglitazone (15 mg/kg) for 4 weeks, both compounds were able to reduce blood glucose levels (<200 mg/dL) and improve the lipid profile. Therefore, 3b and 4y could be used in the future as antidiabetic agents.

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People Living with HIV (PLWHIV) present an increased risk of developing non-communicable diseases, such as type 2 diabetes (T2D), making it crucial to optimize glycemic control and assess metabolic markers. HbA1c is considered the gold standard for evaluating glycemic control, while fructosamine (FA) offers advantages in assessing non-glycemic determinants. Discrepancies between HbA1c and FA are common and may be influenced by temporal factors. The Glycation Gap (G-gap) emerges as a tool to clarify these discrepancies. A cross-sectional analytical study was conducted involving PLWHIV with various glycemic statuses, as well as patients with T2D and controls. Sociodemographic data were collected along with blood samples to measure biochemical profiles and FA. HbA1c predicted from FA (pHbA1c) was calculated using a linear regression equation, facilitating G-gap determination. A positive correlation was found between G-gap and levels of VLDL-C and triglycerides (TG). Additionally, a negative correlation was observed between HDL-C levels < 40 mg/dL and a positive G-gap. These associations suggest that the G-gap may be a useful tool for metabolic evaluation in PLWHIV and a preventive method for identifying individuals at risk of developing chronic complications related to T2D.

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AIM: This study aimed determine the prevalence of shoulder pain among Chilean patients with type 2 DM and to characterize their pain intensity and associated disabilities, including an analysis of sex-based differences. METHODS: A total of 151 participants with type 2 DM, aged 18-79, from family health centers in Talca, Chile, were included. Data were collected via telephone interview, capturing demographic details and information about current shoulder pain, including its duration, intensity, using a Numerical Rating Scale (NRS), and disability using the Shoulder Pain and Disability Index (SPADI). Statistical analysis was performed using frequency measures, Chi-squared tests, binary logistic regression, and Student's t-tests with SPSS version 21.0. RESULTS: Out of 1662 eligible patients, 151 participated. The overall prevalence of shoulder pain was 53.6 % (95 % CI: 53.8-53.4), with women showing a higher prevalence (63 %; 95 % CI: 63.2-62.8) compared to men (37 %; 95 % CI: 37.2-36.8), a difference that was statistically significant (chi-square=13.5; p ≤ 0.001). The results showed that neither BMI nor sex was significantly associated with the presence of pain. No significant differences were found between sexes regarding pain intensity and disability (p ≥ 0.05). CONCLUSION: Shoulder pain is highly prevalent among patients with type 2 DM, with a higher prevalence in women. Future research should explore the impact of this condition on patients and develop targeted musculoskeletal rehabilitation programs.

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OBJECTIVE: Calorie restriction and exercise are commonly used first interventions to prevent the progression of prediabetes and alleviate the symptoms of type 2 diabetes. Our study was designed to determine the effect of the energy deficit caused by long-term (12-week) calorie restriction and exercise programs on appetite responses in obese individuals with prediabetes and type 2 diabetes. METHODS: Calorie restriction and exercise programs appropriate for age, gender, and work environment were applied to 22 individuals with prediabetes and 22 with type 2 diabetes participating in the study for a period of 12 weeks. Ghrelin, glucagon-like peptide-1, and peptide tyrosine tyrosine values of samples taken before and after treatment were determined by the enzyme-linked ιmmunosorbent assay method. RESULTS: Appetite hormone levels did not change after calorie restriction and exercise in the prediabetes group (p>0.05). In the diabetes group, calorie restriction and exercise significantly increased ghrelin and peptide tyrosine tyrosine concentrations (p<0.005). Additionally, when all patients were evaluated together, ghrelin, glucagon-like peptide-1 and peptide tyrosine tyrosine levels differed significantly after the intervention (p<0.005). CONCLUSION: The energy deficit created by long-term calorie restriction and exercise did not modulate the appetite hormones in prediabetic and obese individuals. However, increased ghrelin and peptide tyrosine tyrosine levels in individuals with diabetes support that the same treatment program is an effective method to regulate appetite hormones.

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Introduction: Spanish speakers rely on social media for health information, with varying quality of its content. This study evaluates the reliability, completeness, and quality of type 2 diabetes (T2D) information available in Spanish-language videos on YouTube and Facebook. Methods: Analytical observational study that included Spanish-language videos on TD2 available on Facebook and YouTube. General characteristics, interaction and generating sources are described. Standardized tools were used to assess reliability, completeness and overall quality. Results: We included 172 videos, 90 from Youtube® and 82 from Facebook®. The median number of views was 1725 (IQR 213-10,000), with an average duration of 5.93 minutes (IQR 3.2-16.8) and an internet time of 834 days (IQR 407-1477). Most videos were uploaded by independent users (58.72%). Reliability (evaluated with DISCERN tool) had a median of 3 (IQR 2-3), completeness (content score) had a median of 2 (IQR 1-3), and overall quality, evaluated with the Global Quality Score (GQS) tool had a median of 3 (IQR 3-4). Using a global classification of "subjective reliability" 92.4% of the videos were considered reliable. Better completeness was observed in Facebook videos (p < .001). Reliability was better for videos from government or news organizations. Conclusion: Our results suggest that videos about T2D in Spanish on social media such as YouTube and Facebook have good reliability and quality, with greater exhaustiveness in content in Facebook videos and greater reliability for videos from government or news organizations.

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AIMS: Type 2 diabetes (T2D) is a prevalent metabolic disease linked to obesity and metabolic syndrome (MS). The glucolipotoxic environment (GLT) impacts tissues causing low-grade inflammation, insulin resistance and the gradual loss of pancreatic ß-cell function, leading to hyperglycemia. We have previously shown that Compound A (CpdA), a plant-derived dissociative glucocorticoid receptor-modulator with inflammation-suppressive activity, displays protective effects on ß-cells in type 1 diabetes murine models. This study aimed to evaluate whether the administration of CpdA can attenuate GLT effects and improve pathophysiological parameters in a murine model of T2D/MS. MAIN METHODS: Eight-week-old male C57BL/6NCrl mice were fed either a standard chow diet or a high-fat/high-sucrose diet (HFHS) for 15 weeks. From week 5 of feeding, each group received i.p. injections of CpdA (2.5 µg/g) or vehicle three times a week. We also examined CpdA in vitro effect against GLT using the insulinoma cell line INS-1E and naïve isolated mouse islets. KEY FINDINGS: CpdA administration in HFHS fed mice improved glucose homeostasis and insulin sensitivity with no apparent side effects. CpdA treatment also preserved pancreatic islet architecture and insulin expression, while reducing hepatic steatosis and visceral adipose tissue inflammation induced by HFHS diet. In vitro assays in INS-1E cells and naïve isolated mouse islets demonstrated that CpdA counteracted GLT-induced inhibition of glucose-stimulated insulin secretion and supported the expression of key ß-cell identity genes under GLT conditions. SIGNIFICANCE: These findings highlight the potential protective effect of CpdA in preserving ß-cell functionality and peripheral tissue physiology in the context of T2D/MS.

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OBJECTIVES: to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care. METHODS: this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis. RESULTS: according to the nurses, telemonitoring enhances users' knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges. FINAL CONSIDERATIONS: the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.

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BACKGROUND: Physical exercise is crucial in type 2 diabetes management (T2D), and training in the aquatic environment seems to be a promising alternative due to its physical properties and metabolic, functional, cardiovascular, and neuromuscular benefits. Research on combined training in aquatic and dry-land training environments is scarce, especially in long-term interventions. Thus, this study aims to investigate the effects of combined training in both environments on health outcomes related to the management of T2D patients. METHODS: This is a randomized, unicentric, single-blinded, comparator clinical trial with two parallel arms. Participants with T2D, of both sexes, aged at 45 to 80 years old, will be randomized into two groups (aquatic combined training (AQUA) and dry-land combined training (LAND)), both performing combined aerobic and resistance training three times a week on alternate days for 24 weeks. Aerobic training will be performed using continuous and pyramidal methods, with linear exercise intensity and duration progression. Intensity will be prescribed by rated effort perception (Borg scale 6 to 20). Resistance training will be performed using exercise for the trunk, upper and lower limbs maximum speed, and target repetition zone in aquatic and dry-land environments, respectively, using multiple sets in a linear dosage progression. Before, at 12 weeks, and after the 24 weeks of training, biochemical analyses, functional capacity, maximum muscle strength, body composition assessments, cardiovascular measures, and the administration of questionnaires to assess mental, cognitive, sleep quality, and quality of life will be conducted. Throughout the 24 weeks, the training load date and acute capillary glucose and blood pressure measurements will also be conducted. The data will be analyzed using the SPSS (29.0) statistical package, using a significance level of 0.05. For intra- and inter-group comparisons, generalized estimating equations will be applied and analyzed by intention-to-treat and per-protocol adopting the Bonferroni post hoc test. DISCUSSION: The obtained results may provide insights to enhance understanding of the benefits of the aquatic and dry-land environment on various health outcomes, as well as acute aspects and safety considerations of the training. Moreover, this could support the development of intervention strategies to optimize the T2D management. TRIAL REGISTRATION: Brazilian Clinical Trial Registry (ReBEC) RBR-10fwqmfy. Registered on April 16, 2024.

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OBJECTIVE: This study aimed to compare the salivary protein profile in individuals with Type 2 Diabetes Mellitus (DM2) and periodontitis and their respective controls. METHODS: Eighty participants were included in the study. The four groups were formed by individuals with DM2 and periodontitis (DM2 + P, n = 20), DM2 without periodontitis (DM2, n = 20), periodontitis without DM2 (P, n = 20) and individuals without periodontitis and without DM2 (H, n = 20). Periodontal clinical examinations were performed and unstimulated saliva was collected. Proteomic analysis was performed by shotgun mass spectrometry. The results were obtained by searching the Homo sapiens database of the UniProt catalog. RESULTS: A total of 220 proteins were identified in saliva samples. In the comparison between DM2 + P and DM2 groups, 27 proteins were up-regulated [e.g. S100-A8 was 6 times up-regulated (humoral immune response pathway)]. The DM2 + P and P groups had 26 up-regulated proteins [e.g. Immunoglobulin lambda constant 7 more than 2 times up-regulated (complement activation pathway)]. The non-DM2 groups (P and H) presented 22 up-regulated proteins [e.g. Glyceraldehyde-3-phosphate dehydrogenase more than 2 times up-regulated (Peptidyl-cysteine S-nitrosylation pathway)]. The groups without periodontitis (DM2 and H) showed 23 were up-regulated proteins [e.g. Hemoglobin subunit alpha that was more than 10 times up-regulated (cellular oxidant detoxification pathway)]. CONCLUSION: The presence of DM2 and periodontitis significantly impacts the salivary proteome. Our proteomic analysis demonstrated that changes in the S100 family proteins (S100A8 and S100 A9) are highly related to the presence of DM2 and periodontitis. CLINICAL RELEVANCE: Diabetes Mellitus (DM) and periodontitis are highly prevalent chronic diseases that present a wide variety of signs and symptoms. They present a bidirectional relationship, where patients with DM have a higher prevalence and severity of periodontitis, and patients with periodontitis have a higher prevalence of DM, worse glycemic control, and more diabetic complications. Diagnosing periodontitis requires specific clinical examinations, which require a highly trained operator. In this study, we used high throughput proteomics in order to evaluate non-invasive biomarkers for periodontitis in type 2 DM subjects. The results can contribute to earlier, more accurate, and less costly diagnosis of periodontitis in diabetic subjects, enabling better diabetes control.

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This study aimed to estimate a socio-spatial vulnerability index for type 2 diabetes mellitus (T2DM) at the municipal level in Mexico for 2020. It incorporated factors such as poverty, social backwardness, marginalization index, and human development index. This retrospective ecological study analyzed 317,011 incident cases of T2DM in 2020. Utilizing multi-criteria decision analysis, weighted values were assigned to each vulnerability criterion. A multiple linear regression model was developed, complemented by cluster and outlier analyses using Moran I's and the high-low clustering method. A clustered spatial autocorrelation of high values was found across 17.65% of Mexico, which was statistically significant (p < 0.001). Conversely, 37.78% of the territory showed a pattern of low values without significant evidence of groupings. The analysis revealed 117 nodes of very high vulnerability forming six focal areas, 172 nodes with high vulnerability across five areas, 168 nodes with medium vulnerability in two areas, 112 nodes with low vulnerability across 16 areas, and 152 nodes with very low vulnerability in 24 focal areas. This method proves to be robust and offers a technical-scientific basis for guiding T2DM prevention strategies and actions using a spatial/epidemiological approach. It is recommended that future strategies take into account factors such as poverty, social backwardness, marginalization index, and human development index to be effective.

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INTRODUCTION: The effects of glucagon-like peptide 1 receptor agonists (GLP-1 RA) in patients with diabetes and established chronic kidney disease (CKD) remain unclear. METHODS: We systematically searched PubMed, Embase, and Cochrane Library from inception to May 2024 for randomized controlled trials (RCTs) and respective post hoc studies comparing GLP-1 RAs versus placebo in patients with type 2 diabetes mellitus (T2DM) and established CKD (as per study definition or otherwise defined as having an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 and/or urine albumin-to-creatinine ratio more than 30 mg/g). We applied a random-effects model to pool risk ratios (RRs), hazard ratios (HRs), and 95% confidence intervals (CIs). RESULTS: We included 10 RCTs and post hoc analyses comprising 18,042 patients, of whom 9,164 (50.8%) were treated with GLP-1 RAs. There were significantly lower rates of major adverse kidney events (RR 0.82; 95% CI: 0.74-0.90; p < 0.001; high certainty) and a slightly lower incidence of all-cause mortality (HR 0.84; 95% CI: 0.71-1.00; p = 0.046; moderate certainty) with the use of GLP-1 RAs relative to placebo. This kidney protection remained consistent in patients with stage 3b CKD (RR 0.78; 95% CI: 0.65-0.94; p = 0.009; high certainty). No significant differences were observed in major adverse cardiovascular events (HR 0.89; 95% CI: 0.78-1.02; p = 0.090; low certainty) or cardiovascular mortality (HR 0.80; 95% CI: 0.60-1.09; p = 0.155; very low certainty), possibly due to a lack of statistical power. CONCLUSION: GLP-1 RAs were tied to a lower incidence of all-cause mortality and major adverse kidney events in patients with T2DM and established CKD.

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Glutamine availability may be reduced in chronic diseases, such as type 2 diabetes mellitus (T2DM)-induced by obesity. Herein, the antioxidant, anti-inflammatory and lipid metabolism effects of chronic oral glutamine supplementation in its free and dipeptide form were assessed in ob/ob mice. Adult male C57BL/6J ob/ob mice were supplemented with L-alanyl-L-glutamine (DIP) or free L-glutamine (GLN) in the drinking water for 40 days, whilst C57BL/6J Wild-type lean (WT) and control ob/ob mice (CTRL) received fresh water only. Plasma and tissue (skeletal muscle and liver) glutamine levels, and insulin resistance parameters (e.g., GTT, ITT, insulin) were determined. Oxidative stress (e.g., GSH system, Nrf2 translocation), inflammatory (e.g., NFkB translocation, TNF-α gene expression) and lipid metabolism parameters (e.g., plasma and liver triglyceride levels, SRBP-1, FAS, ACC, and ChRBP gene expression) were also analyzed. CTRL ob/ob mice showed lower glutamine levels in plasma and tissue, as well as increased insulin resistance and fat in the liver. Conversely, chronic DIP supplementation restored glutamine levels in plasma and tissues, improved glucose homeostasis and reduced plasma and liver lipid levels. Also, Nrf2 restoration, reduced NFkB translocation, and lower TNF-α gene expression was observed in the DIP group. Interestingly, chronic free GLN only increased muscle glutamine stores but reduced overall insulin resistance, and attenuated plasma and liver lipid metabolic biomarkers. The results presented herein indicate that restoration of body glutamine levels reduces oxidative stress and inflammation in obese and T2DM ob/ob mice. This effect attenuated hepatic lipid metabolic changes observed in obesity.

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BACKGROUND: There is no strong evidence demonstrating whether or not aerobic exercise in conjunction with resistance exercise improves metabolic diabetes markers in postmenopausal women. OBJECTIVE: To evaluate the effect of aerobic exercise and resistance training on metabolic markers in postmenopausal women with type 2 diabetes mellitus (T2DM) by means of a systematic review and meta-analysis. METHODS: The searches were completed using EMBASE, MEDLINE/PubMed, Scopus and Web of Science databases. This study included non-blinded, single or double-blinded randomized control trials and postmenopausal women diagnosed with T2DM. The imposed intervention was aerobic exercise plus any training protocol to strengthen muscle groups for resistance intervention. The outcomes of interest were the blood glucose levels, insulin secretion, homeostasis model assessment-insulin resistance index (HOMA-IR) and glycated hemoglobin (HbA1c). Risk of Bias tools and GRADE were obligatory. RESULTS: Three studies were included (83 participants). Exercise intervention ranged between two to four days per week. Compared to the control group, in the group submitted to aerobic exercise + resistance training, no significant change was noted for HbA1c (subtotal = mean difference - 0.35 [95% CI: -0.85, 0.15], p = .17, and heterogeneity = 0%) (GRADE: very low), nevertheless, HOMA-IR index was significantly improved (subtotal = mean difference -0.52 [95% CI: -0.99, -0.05], p = .03, and heterogeneity = 0%) (GRADE: very low). CONCLUSION: Despite the very low certainty found in the quality of evidences, our analysis showed that aerobic exercise along with strength exercise seems to improve some metabolic diabetes markers in postmenopausal women with T2DM. There is a need for further studies to support our preliminary findings.

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Genetic and environmental factors have important role in the pathogenesis of obesity and metabolic diseases. We hypothesized that genes involved in energy intake, cellular lipid metabolism and pro-inflammatory adipokines influence obesity-related metabolic disturbances and food intake. We explored the association of GHRL (rs26311G>C and rs4684677A>T), PLIN1 (rs2289487G>A and rs894160G>A), RETN (rs3745367C>T and rs7408174G>A), and NAMPT (rs1319501T>C) variants with obesity, metabolic and inflammatory markers, and food intake composition. Clinical, anthropometric, and laboratory data were obtained from 237 adults. Genomic DNA was extracted and genetic variants were analyzed by real-time polymerase chain reaction. Food intake was assessed in 81 subjects with obesity, who underwent a 9-week nutritional orientation program. Multivariate logistic regression analysis adjusted by covariates showed association of GHRL rs26311-G and rs4684677-A alleles with risk of type 2 diabetes (T2D) and/or metabolic syndrome (P < .05), and RETN rs7408174-C allele with risk of T2D and obesity (P < .05). Covariate-adjusted multivariate linear regression analysis showed association of PLIN1 rs894160-G allele with increased waist-to-hip ratio (P = .003). The nutritional orientation program reduced carbohydrate and total fat intake, in subjects with obesity (P < .05). Analysis of basal data revealed associations of PLIN1 rs894160-G with increased body mass index, PLIN1 rs2289487-A with reduced intake of total fat, monosaturated fatty acids and cholesterol, and RETN rs3745367-A with increased intake of protein and saturated fatty acids (P < .05). GHRL rs26311-G was associated with increased postprogram protein intake (P = .044). In conclusion, variants in GHRL, RETN, and PLIN1 are associated with obesity, T2D, metabolic syndrome, and increased waist-to-hip ratio, and influence food consumption in adults with obesity.