Effects of anti-diabetic drugs on sarcopenia: Best treatment options for elderly patients with type 2 diabetes mellitus and sarcopenia.

Human life expectancy increases as society becomes more developed. This increased life expectancy poses challenges associated with the rapid aging of the population. Sarcopenia, an age-related disease, has become a worldwide health issue. Patients with sarcopenia experience decreases in muscle mass and function, becoming frail and eventually bedridden. Type 2 diabetes mellitus (T2DM) is also a major health issue; the incidence of T2DM increases with aging. T2DM is associated with reduced muscle strength and poor muscle quality and may contribute to acceleration of the aging process, augmenting age-related sarcopenia. Recent studies indicate that elderly patients with diabetes are at an increased risk for sarcopenia. Therefore, these older diabetic patients with sarcopenia need specific anti-diabetic therapies targeting not only glycemic control but also sarcopenia, with the goal of preventing sarcopenia in pre-sarcopenic patients. Presently, various types of hypoglycemic drugs are available, but which hypoglycemic drugs are better suited for geriatric T2DM patients with sarcopenia remains undetermined. In this review, we discuss the association between diabetes and sarcopenia in geriatric patients, and how anti-diabetic drugs may influence sarcopenia outcomes. This review will guide clinical workers in the selection of drugs best suited for this patient population.

The Relationship between Serum Osteocalcin Concentration and Glucose and Lipid Metabolism in Patients with Type 2 Diabetes Mellitus ­ The Role of Osteocalcin in Energy Metabolism.

BACKGROUND: Recent animal studies have found that the osteocalcin secreted by osteoblasts could participate in glucose and lipid metabolism. Our study aimed to investigate the relationship between serum osteocalcin concentration and glucose and lipid metabolism in patients with type 2 diabetes mellitus. METHODS: 985 patients with type 2 diabetes were divided into the male group (n = 495) and the postmenopausal female group (n = 490). The average ages were 54.42 ± 10.535 and 64.93 ± 9.277, respectively. We collected the parameters of age, duration, fasting plasma glucose, HbA1c, fasting insulin, fasting C peptide, blood lipid, 25 (OH) VD3, parathyroid hormone (PTH), Alkaline phosphatase (ALP), procollagen type 1 N-terminal propeptide (P1NP), ß-C-terminal telopeptide of type I collagen (ß-CTx), osteocalcin, HOMA-IR, HOMA-ß, body mass index (BMI), and waist-to-hip ratio (WHR). The relationship of osteocalcin and these parameters were analyzed by Pearson/Spearman correlation analysis and stepwise multiple regression analysis. RESULTS: Osteocalcin was negatively correlated with HbA1c (p < 0.05) and it was also an independent relevant factor affecting HbA1c in both groups. Osteocalcin was positively correlated with HOMA-ß and it was an independent relevant factor affecting HOMA-ß in male group (p < 0.01). CONCLUSIONS: These findings indicate the association between serum osteocalcin and glucose metabolism and beta cell function. No relationship was found between osteocalcin and insulin resistance and lipid metabolism in type 2 diabetes.

Levels of inflammatory cytokines in type 2 diabetes patients with different urinary albumin excretion rates and their correlation with clinical variables.

Although the pathogenetic mechanism of DN has not been elucidated, an inflammatory mechanism has been suggested as a potential contributor. This study was designed to explore the relationship between low-grade inflammation and renal microangiopathy in T2DM. A total of 261 diabetic subjects were divided into three groups according to UAE: a normal albuminuria group, a microalbuminuria group, and a macroalbuminuria group. A control group was also chosen. Levels of hs-CRP, TNF-α, uMCP-1, SAA, SCr, BUN, serum lipid, blood pressure, and HbA1c were measured in all subjects. Compared with the normal controls, levels of hs-CRP, TNF-α, uMCP-1, and SAA in T2DM patients were significantly higher. They were also elevated in the normal albuminuria group, P < 0.05. Compared with the normal albuminuria group, levels of these inflammatory cytokines were significantly higher in the microalbuminuria and macroalbuminuria group, P < 0.01. The macroalbuminuria group also showed higher levels than the microalbuminuria group, P < 0.01. Also they were positively correlated with UAE, SBP, DBP, LDL-C, and TC. We noted no significance correlated with course, TG, or HDL-C. Only TNF-α; was positively correlated with HbA1c. This study revealed the importance of these inflammatory cytokines in DN pathogenesis. Further studies are needed to fully establish the potential of these cytokines as additional biomarkers for the development of DN.

[Effect of mycophenolate on expression of MCP-1 and fibronectin in human mesangial cells induced by high glucose].

AIM: To investigate the effect of high glucose and mycophenolate (MMF) on the expression of MCP-1 in human mesangial cells (HMCs) and fibronectin (FN). METHODS: The HMCs were divided randomly into five groups: control group (5 mmol/L glucose), high glucose group (30 mmol/L glucose), mannitol group (5 mmol/L glucose and 25 mmol/L mannitol), high glucose+MMF-10 group (30 mmol/L glucose plus 10 µg/mL mycophenolate) and high glucose+MMF-100 group (30 mmol/L glucose plus 100 µg/mL mycophenolate). We detected the levels of MCP-1 and fibronectin in each group at 24 h, 48 h and 72 h, respectively. The expression levels of the MCP-1 mRNA were detected by RT-PCR, and the protein expression of MCP-1 and fibronectin was measured by ELISA. RESULTS: Compared with the control group, the levels of the MCP-1 and FN in high glucose group were significantly increased with the expression peak at 48 h (P<0.01). The MMF with different concentration could inhibit the expression of MCP-1 and FN in time- and dose-dependent manner (P<0.05). CONCLUSION: Mycophenolate could inhibit the expressions of MCP-1 and FN in human mesangial cells and it might be expected to delay the development and progression of glomerular sclerosis and interstitial fibrosis.

The changes of platelet-derived growth factor-BB (PDGF-BB) in T2DM and its clinical significance for early diagnosis of diabetic nephropathy.

OBJECTIVE: To investigate urinary excretion of platelet-derived growth factor-BB (PDGF-BB) during the different stages of diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) as well as its clinical significance. METHODS: Sixty-five cases with T2DM were divided into three groups: normoalbuminuric group [N-UAlb; urine albumin excretion (UAE) <30 mg/24 h, n=25], microalbuminuric group [M-UAlb; UAE 30-300 mg/24 h, n=20], and macroalbuminuric group [L-UAlb; UAE >300 mg/ 24 h, n=20]. The urinary excretion rates of PDGF-BB were determined by a quantitative sandwich enzyme-linked immunosorbent assay (ELISA) in all the cases and 27 subjects of control. RESULTS: The excretion rates of PDGF-BB in T2DM groups were markedly higher than that in control (P<0.001). Moreover, the excretion rates of PDGF-BB increased with the increase of UAE and there were significant differences among the three groups (P<0.05) except the groups of M-UAlb and L-UAlb. Urinary PDGF-BB was also positively correlated with UAE, triglyceride (TG), cholesterol (CHO), low-density lipoprotein (LDL) and negatively correlated with creatinine clearance (Ccr), high-density lipoprotein (HDL), while had no significance correlated with glycohemoglobin A1c (HbA1c). CONCLUSION: PDGF-BB might play a very important role in the initiation and progression of DN. Measurements of urine PDGF-BB in T2DM could be used for early diagnosis of diabetic renal dysfunction.

Prebiotic oligosaccharides change the concentrations of short-chain fatty acids and the microbial population of mouse bowel.

The purpose of this study was to clarify effects of selected oligosaccharides on concentrations of cecal short-chain fatty acids (SCFAs), total large bowel wet weight and wall weight, and cecal microbiota levels in mice. Mice were respectively given gavage of selected fructooligosaccharides (FOS), galactooligosaccharides (GOS), mannanoligosaccharides (MOS), and chitooligosaccharides (COS) [1000 mg/(kg body weight.d)]. Control group was given physiological saline solution. After 14 d treatment, SCFAs and lactate in mice cecum were significantly increased (P<0.05) by intake of oligosaccharides, especially FOS and GOS. Thus, providing these oligosaccharides as ingredients in nutritional formulas may benefit the gastrointestinal tract.

Clinical significance and different levels of urinary monocyte chemoattractant protein-1 in type 2 diabetes mellitus.

OBJECTIVE: Monocyte chemoattractant protein-1(MCP-1) is a cytokine that exhibits most potent chemotactic activity toward monocytes. It is suggested to be implicated in the development and progression of diabetic nephropathy by playing a role in infiltration of monocyte/macrophage. Recent studies have demonstrated that urinary monocyte chemoattractant protein-1 (uMCP-1) is different at different stages of diabetic nephropathy. Based on these findings, the aim of this study is to examine the level of uMCP-1 and its clinical significance at different stages of diabetic nephropathy and at the same time to describe the relationship between uMCP-1 and the various parameters. METHODS: Fifty-nine cases with type 2 diabetes mellitus (T2DM) were divided into three groups according to urine albumin excretion (UAE): normal albuminuria group, microalbuminuria group and macroalbuminuria group. The levels of uMCP-1, protein excretion, blood urea nitrogen (BUN), serum creatinine (s-Cr), glycohemoglobin A1c (HbA1c), blood pressure and blood fat were measured in 59 patients with T2DM and 27 healthy adults as controls. Results Compared with normal control, levels of uMCP-1 in T2DM were significantly high, which were already elevated in normal albuminuria group. Compared with normal albuminuria group, levels of uMCP-1 in microalbuminuria group and macroalbuminuria group were significantly high. Levels of uMCP-1 in macroalbuminuria group were higher than those in microalbuminuria group. The level of uMCP-1 was positively correlated with UAE, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) in T2DM patients, while it had no significant correlation with HbA1c(,) triglyceride (TG) and high density lipoprotein cholesterol (HDL-C). CONCLUSIONS: MCP-1 is suggested to be implicated in the development and progression of diabetic nephropathy. It is very important to measure the level of uMCP-1 in the diagnosis and intervention of early diabetic nephropathy.