Two birds one stone: semaglutide is highly effective against severe psoriasis in a type 2 diabetic patient

Summary Semaglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist, approved for the treatment of type 2 diabetes mellitus (T2DM). GLP-1 analogs exert several biological activities connected not only with an insulinotropic effect but also with immunoregulation and reduction of inflammation. A 73-year-old male patient with class III obesity was referred to us for T2DM, which was not controlled with metformin therapy. He had suffered from plaque psoriasis for some years and was treated with topical therapy and adalimumab, without success. The psoriasis area and severity index (PASI) was 33.2 (indicating severe psoriasis), and the dermatology life quality index (DLQI) was 26.0 (indicating an extremely negative effect on the patient's life). Semaglutide (starting with 0.25 mg/week for 4 weeks, increased to 0.50 mg/week for 12 weeks, and then to 1 mg/week) was added to metformin. After 4 months, glycemic parameters had improved, and his body weight decreased. Unexpectedly, skin lesions of plaque psoriasis improved. PASI decreased by 19% compared with baseline and quality of life, assessed with the DLQI, markedly ameliorated. After 10 months, glycemic and obesity parameters, as well as psoriasis, improved further. HbA1c, BMI, and PASI were reduced by 32, 16.3, and 92%, respectively, compared with the baseline. DLQI declined to 0, meaning there was no effect of plaque psoriasis on the patient’s life. Learning points Psoriasis in patients with type 2 diabetes is often resistant to therapy. We observed an obese patient with type 2 diabetes mellitus who achieved glycemic control and weight loss with the addition of semaglutide to metformin and had a relevant and long-lasting improvement of plaque psoriasis, which was previously resistant to biologic therapy. Therapy with semaglutide may be attempted in eligible patients with difficult to treat plaque psoriasis.

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Sargassum fusiforme fucoidan alleviates diet-induced insulin resistance by inhibiting colon-derived ceramide biosynthesis

Food & Function ◽

10.1039/d1fo01272j ◽

2021 ◽

Author(s):

Ya Zhang ◽

Jian Liu ◽

Jihui Zuo ◽

Genxiang Mao ◽

Shijun Li ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Biological Activities ◽

Sargassum Fusiforme ◽

Causative Factors

Sargassum fusiforme fucoidan (SFF) is a highly sulfated heteropolysaccharide with various biological activities. As one of the causative factors of type 2 diabetes mellitus (T2DM), insulin resistance has become a...

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Pasireotide in an insulin-requiring diabetic acromegalic patient without worsening of hyperglycemia

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-17-0003 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 2

Author(s):

Murray B Gordon ◽

Kellie L Spiller

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

List Type ◽

Effective Treatment Option ◽

Patients With Diabetes ◽

Long Acting ◽

Learning Points

Summary Long-acting pasireotide is an effective treatment option for acromegaly, but it is associated with hyperglycemia, which could impact its use in patients with diabetes. We present a case of a 53-year-old man with acromegaly and type 2 diabetes mellitus (glycated hemoglobin (HbA1c): 7.5%), who refused surgery to remove a pituitary macroadenoma and enrolled in a Phase 3 clinical trial comparing long-acting pasireotide and long-acting octreotide in acromegalic patients. The patient initially received octreotide, but insulin-like growth factor 1 (IGF-1) levels remained elevated after 12 months (383.9 ng/mL; 193.0 ng/mL; reference range: 86.5–223.8 ng/mL), indicating uncontrolled acromegaly. He switched to pasireotide 40 mg and subsequently increased to 60 mg. Within 6 months, IGF-1 levels normalized (193.0 ng/mL), and they were mostly normal for the next 62 months of treatment with pasireotide (median IGF-1: 190.7 ng/mL). Additionally, HbA1c levels remained similar to or lower than baseline levels (range, 6.7% to 7.8%) during treatment with pasireotide despite major changes to the patient’s antidiabetic regimen, which included insulin and metformin. Uncontrolled acromegaly can result in hyperglycemia due to an increase in insulin resistance. Despite having insulin-requiring type 2 diabetes, the patient presented here did not experience a long-term increase in HbA1c levels upon initiating pasireotide, likely because long-term control of acromegaly resulted in increased insulin sensitivity. This case highlights the utility of long-acting pasireotide to treat acromegaly in patients whose levels were uncontrolled after long-acting octreotide and who manage diabetes with insulin. Learning points Long-acting pasireotide provided adequate, long-term biochemical control of acromegaly in a patient with insulin-requiring type 2 diabetes mellitus who was unresponsive to long-acting octreotide. Glycemic levels initially increased after starting treatment with pasireotide but quickly stabilized as acromegaly became controlled. Long-acting pasireotide, along with an appropriate antidiabetic regimen, may be a suitable therapy for patients with acromegaly who also have insulin-requiring type 2 diabetes mellitus.

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Significant polar vasculosis in a patient with a 30-year history of type 2 diabetes

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-19-0092 ◽

2019 ◽

Vol 2019 ◽

Author(s):

Yasuhiro Oda ◽

Masayuki Yamanouchi ◽

Hiroki Mizuno ◽

Rikako Hiramatsu ◽

Tatsuya Suwabe ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Endothelial Damage ◽

Diabetic Patients ◽

List Type ◽

History Of ◽

Intraglomerular Pressure ◽

Vascular Formation

Summary We report the renal histology of a 66-year-old man with hypertension, cardiovascular disease, and a 30-year history of type 2 diabetes mellitus with proliferative diabetic retinopathy, diabetic neuropathy, and diabetic foot status post toe amputation. Urinary protein excretion was 1.4 g/gCr, serum creatinine level 0.86 mg/dL, estimated glomerular filtration rate 69 mL/min/1.73 m2, and HbA1c 13–15%, despite using insulin. Light microscopy showed global glomerulosclerosis in 37% of the glomeruli, but the remaining glomeruli were intact. Significant polar vasculosis was present, while arteriolar sclerosis was mild. Electron microscopy revealed a thickened glomerular basement membrane, which is compatible with the early stage of diabetic glomerulopathy. The presented case was unique because glomerular changes seen typically in diabetes were not seen in the patient, despite the long-standing history of diabetes and diabetic comorbidities, while prominent polar vasculosis was found. Polar vascular formation helps preserve the glomeruli by allowing hyperosmotic blood bypass the glomeruli; this decreases intraglomerular pressure and minimizes glomerular endothelial damage. Learning points: A 66-year-old man with a 30-year history of type 2 diabetes mellitus with poor glycemic control underwent renal biopsy, which showed scarce glomerular changes typically seen in diabetic kidney disease and instead revealed significant polar vasculosis. Past studies demonstrated that the increased small vessels around the vascular hilus in diabetic patients originated from the afferent arterioles and drained into the peritubular capillaries. Polar vascular formation may preserve glomerular function by allowing the blood flow to bypass the glomeruli and decreasing the intraglomerular pressure, which minimizes endothelial damage of the glomerular tufts.

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DKA in patients with pre-existing type 2 diabetes mellitus related to COVID-19: a case series

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0148 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Anthony Ramos-Yataco ◽

Kelly Meza ◽

Reyna Cecilia Farfán-García ◽

Solange Ortega-Rojas ◽

Isaac Salinas-Mamani ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Case Series ◽

Blood Analysis ◽

List Type ◽

Metabolic Complications ◽

Arterial Blood ◽

First Case

Summary The first case of the novel coronavirus infection (COVID-19) in Peru was reported on March 6, 2020. As of September 7, 2020, about 700 000 cases of COVID-19 resulting in 29,976 deaths have been confirmed by the Ministry of Health. Among COVID-19 patients with co-morbidities, type 2 diabetes mellitus (T2DM) has been recognized as a risk factor for severe disease. Patients with T2DM may experience diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic (HHS) if infected with the coronavirus 2 (SARS-CoV-2). Regular blood analysis including arterial blood gas is essential in monitoring the care of patients with T2DM infected with COVID-19. We report five cases of DKA in patients with underlying T2DM that presented with severe COVID-19 infection. Learning points COVID-19 may cause acute metabolic dysregulations in patients with T2DM. It is important to monitor basic metabolic panel (BMP) and arterial blood gases (ABGs) in patients with COVID-19 since metabolic complications can develop unexpectedly. Patients with T2DM develop an inflammatory syndrome characterized by severe insulin resistance and B cell dysfunction that can lead to DKA.

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Potential Role of Natural Plant Medicine Cyclocarya paliurus in the Treatment of Type 2 Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2021/1655336 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Han Wang ◽

Cheng Tang ◽

Zezheng Gao ◽

Yishan Huang ◽

Boxun Zhang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Biological Activities ◽

Intestinal Flora ◽

Natural Plant ◽

Cyclocarya Paliurus ◽

Plant Medicine ◽

Treatment Research

Type 2 diabetes mellitus (T2DM) is a common chronic metabolic disease that has become increasingly prevalent worldwide. It poses a serious threat to human health and places a considerable burden on global social medical work. To meet the increasing demand for T2DM treatment, research on hypoglycemic drugs is rapidly developing. Cyclocarya paliurus (Batal.) Iljinskaja is a medicinal plant that grows in China. The leaves of C. paliurus contain polysaccharides, triterpenoids, and other chemical components, which have numerous health benefits. Therefore, the use of this plant has attracted extensive attention in the medical community. Over the past few decades, contemporary pharmacological studies on C. paliurus extracts have revealed that it has abundant biological activities. Multiple in vitro and in vivo experiments have shown that C. paliurus extracts are safe and can play a therapeutic role in T2DM through anti-inflammatory and antioxidation activities, and intestinal flora regulation. Its efficacy is closely related to many factors, such as extraction, separation, purification, and modification. Based on summarizing the existing extraction methods, this article further reviews the potential mechanism of C. paliurus extracts in T2DM treatment, and we aimed to provide a reference for future research on natural plant medicine for the prevention and treatment of T2DM and its related complications.

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Anthropometric Measures and Incident Diabetic Nephropathy in Participants With Type 2 Diabetes Mellitus

Frontiers in Endocrinology ◽

10.3389/fendo.2021.706845 ◽

2021 ◽

Vol 12 ◽

Author(s):

Daniel Nyarko Hukportie ◽

Fu-Rong Li ◽

Rui Zhou ◽

Jia-Zhen Zheng ◽

Xiao-Xiang Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Healthy Weight ◽

Class Iii ◽

General Obesity ◽

Anthropometric Measures ◽

Accord Study

BackgroundThe prevalence of diabetes is on the rise globally coupled with its associated complications, such as diabetic nephropathy (DN). Obesity has been identified as a risk factor for the development of DN but it is still unclear which obesity index is the best predictor of incident DN.MethodsData from the participants with type 2 diabetes mellitus (T2DM) in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study were used to examine the sex-specific association between waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) with incident DN risk.ResultsAmong the 8,887 participants with T2DM (5,489 men and 3,398 women), 5,296 participants (3,345 men and 1,951 women) developed the DN composite outcome during a follow-up period of 24302 person-years. Among men, null associations were observed between all anthropometric measures with incident DN in the multivariate analysis although the 3rd quartile of WHtR showed marginally significant results (P = 0.052). However, among women, both central and general obesity measures were associated with increased risks of incident DN. Compared with participants in the WC <88 cm category, the fully adjusted HR and 95% CI for those in the ≥88 cm of WC was 1.35 (95% CI 1.15-1.57). Compared with the lowest quartile, the fully adjusted HRs and 95% CIs for the 2nd to the 4th quartile of WHtR were 1.09 (95% CI 0.96-1.25), 1.12 (95% CI 0.98-1.28), and 1.14 (95% CI 1.00-1.30) respectively; also, compared with the normal BMI category, the fully adjusted HRs and 95% CIs for class I – class III obese were 1.36 (95% CI 1.10 – 1.67), 1.43 (95% CI 1.16 – 1.78) and 1.32 (95% CI 1.05 – 1.66) respectively.ConclusionsAmong participants with T2DM, higher levels of both central and general obesity indexes were associated with DN risk among women but not in men. Women with T2DM should maintain a healthy weight targeted at reducing both central and general obesity to enhance nephroprotection. Trial registration: ClinicalTrials.gov., no. NCT00000620.

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Prediction of risk of development of type 2 diabetes mellitus using Indian diabetic risk score in rural areas of Hassan

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180443 ◽

2018 ◽

Vol 5 (3) ◽

pp. 948

Author(s):

Sumana M. ◽

Hanamantappa Kudachi ◽

M. Sundar

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Risk Score ◽

Rural Areas ◽

Cost Effective ◽

Cross Sectional Study ◽

Class Iii ◽

Cross Sectional

Background: It has been estimated by International Diabetic Federation (IDF) that globally as many as 193million people with diabetes, are unaware of their disease, the use of a simple easy to use, non-invasive and cost effective screening tool for community based screening is the need of the hour. This study was taken with objective to assess the risk of development of type 2 diabetes mellitus using Indian diabetic risk score (IDRS), and to determine the association of IDRS with socio-demographic factors.Methods: Cross sectional study was conducted for 3 months in rural areas of Hassan. 480 subjects were chosen by systematic random sampling considering inclusion and exclusion criterions. Data was collected from individuals who were more than 30 years old and not having diabetes. IDRS components were assessed along with other socio demographic components.Results: Out of 480 participants, 256 (53.4%) were females, mean age of the participants 42.38±18.6. 47% belong to class III socioeconomic status, 63%of them are educated, 49% of participants having BMI ≥25, 41% (>0.8) female and 33% (>0.9) male having abnormal waist hip ratio (WHR), 49% of the participants having IDRS score >50 among these high risk participants 35% were having RBS >200. All 24 (100%) morbid obese individuals were having high IDRS score; among these 66.6% have abnormal RBS. IDRS predicted the risk of DM with sensitivity 81% and specificity 59%.Conclusions: As the study finds that percentage random blood glucose is more among participants of high IDRS, thus a simple IDRS tool can be used in the field for mass screening and early intervention.

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