Diabetes Treatment Is Associated With Better Cognitive Function: The Age Disparity

Background: Diabetes mellitus (DM) is a recognised risk factor for cognitive dysfunction. The purpose of this study was to explore the relationship between active treatment for DM and cognitive function in middle-aged (< 60 years) and older adults (≥60 years), respectively.Methods: A total of 13,691 participants (58.55 ± 9.64 years, 47.40% of men) from the Chinese Health and Retirement Longitudinal Study (CHARLS) were included. The participants were classified into three groups according to whether or not they have diabetes and to their diabetes treatment status: diabetes-free, treated-diabetes and untreated-diabetes, in which the diabetes-free group was regarded as reference specially. Cognitive function was assessed by two interview-based measurements for mental intactness and episodic memory.Results: Compared with the participants in the diabetes-free group, the older participants in the treated-diabetes group had better performance in terms of mental intactness (β = 0.37, 95% CI = 0.04–0.70). No significant association was observed in the middle-aged participants. In the subgroup analyses, the lower cognitive score was only observed in people without depression, who had never smoked and drunk, and with a normal weight (body mass index: 18.5–23.9 kg/m2).Conclusion: The cognitive function of actively treated diabetic patients was better than that of patients without diabetes, but the improvement was significant only in elderly people. Depression, smoking, drinking, and an abnormal weight may attenuate this effect.

Antioxidant effect of Arrabideae chica (crajiru) extract on oxidative stress in diabetic rats

Objective: This study aimed to investigate the effects of the antioxidant potential of Arrabideae chica (crajiru) extract on oxidative stress in diabetic rats. Methods: Adult Wistar rats (Rattus norvegicus), weighing 238±12g were divided into three groups of six rats each: CN normal untreated control; DIAB+NS diabetic rats treated with normal saline; and diabetic rats treated with crajiru extract, DIAB+CR. The CN and DIAB+NS groups (control groups) received normal saline solution (NS) orally (gavage); rats in the DIAB+CR group received crajiru extract (300 mg/kg) once a day by gavage for 6 weeks. Measurements of urea and creatinine in serum, and kidney tissue catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were performed. The variables were assessed using the Tukey test, significance p<0.05. Results: All animals survived the experiments. In the CN group, compared with the DIAB+NS group, there was significant difference between the levels of glycemia on the second day of dosing and on the 10th day (p<0.05). No difference was observed on glycemia comparing the 2th and 10th day on the rats of group C+NS (p>0.05). Diabetic animals from DIAB+CR group had a significant reduction in glycemia on 10th day of treatment, comparing the 2nd day (p<0.05). There was a significant reduction in glycemia in the DIAB+CR group, comparing with the DIAB+NS group (p<0.05). There was an increase in urea and creatinine levels in rats DIAB+SN when compared to controls, C+SN (p<0.001). Rats from the DIAB+CR group had a significant reduction in urea and creatinine, compared to the DIAB+NS group (p<0.001). There were no significant differences in urea and creatinine comparing the C+NS and DIAB+CR groups. The rats from the DIAB+NS group had significantly lower levels of CAT, GSH-px and SOD when compared to the normal control rats (p<0.001). In animals from the DIAB+SN group, the levels of these antioxidant enzymes were significantly reduced (p<0.001). The treatment of diabetics with crajiru extract caused a significant increase (p<0.001) in the levels of CAT, GSH-px and SOD, when compared to rats in the BIAB+SN group. Conclusion: The data of the present study confirms that the crajiru extract positively influenced the control of hyperglycemia in diabetic rats. More research is needed to provide a better understanding of the mechanisms of diabetes treatment using crajiru extract and its flavonoids.

Evaluation of a Stepped Care Approach to Manage Depression and Diabetes Distress in Patients with Type 1 Diabetes and Type 2 Diabetes: Results of a Randomized Controlled Trial (ECCE HOMO Study)

<b><i>Introduction:</i></b> Depression is a common and serious complication of diabetes. Treatment approaches addressing the specific demands of affected patients are scarce. <b><i>Objective:</i></b> The aim of this work was to test whether a stepped care approach for patients with diabetes and depression and/or diabetes distress yields greater depression reduction than treatment-as-usual. <b><i>Methods:</i></b> Two-hundred and sixty patients with diabetes and elevated depressive symptoms (CES-D ≥16) and/or elevated diabetes distress (PAID ≥40) were randomized to stepped care for depression or diabetes treatment-as-usual. The primary outcome was the rate of meaningful depression reduction at the 12-month follow-up according to the HAMD (score &#x3c;9 or reduction by ≥50%). Secondary outcomes were changes in depression scores (HAMD/CES-D), diabetes distress (PAID), diabetes acceptance (AADQ), well-being (WHO-5), quality of life (EQ-5D/SF-36), self-care behavior (SDSCA/DSMQ), HbA_1c, and biomarkers of inflammation. <b><i>Results:</i></b> One-hundred and thirty-one individuals were assigned to stepped care and 129 to treatment-as-usual. Overall, 15.4% were lost to follow-up. Meaningful depression reduction was observed in 80.2 versus 51.2% in stepped care versus treatment-as-usual (<i>p</i> &#x3c; 0.001, intention-to-treat analysis). Of the secondary measures, the HAMD (∆ –3.2, <i>p</i> &#x3c; 0.001), WHO-5 (∆ 1.5, <i>p</i> = 0.007), and AADQ (∆ –1.0, <i>p</i> = 0.008) displayed significant treatment effects, while effects on CES-D (∆ –2.3, <i>p</i> = 0.065), PAID (∆ –3.5, <i>p</i> = 0.109), and SDSCA (∆ 0.20, <i>p</i> = 0.081) were not significantly different. Both groups showed comparable changes in EQ-5D/SF-36, DSMQ, HbA_1c, and biomarkers of inflammation (all <i>p</i> ≥ 0.19). <b><i>Conclusions:</i></b> The stepped care approach improved depression, well-being, and acceptance. The results support that increasing treatment intensity on demand is effective and can help provide more optimal treatment. The inclusion of diabetes-specific interventions may be beneficial for patients with diabetes and elevated depression.

Chemical induction of gut β-like-cells by combined FoxO1/Notch inhibition as a glucose-lowering treatment for diabetes

Lifelong insulin replacement remains the mainstay of type 1 diabetes treatment. Genetic FoxO1 ablation promotes enteroendocrine cell (EECs) conversion into glucose-responsive β-like cells. Here, we tested whether chemical FoxO1 inhibitors can generate β-like gut cells. Pan-intestinal epithelial FoxO1 ablation expanded the EEC pool, induced β-like cells, and improved glucose tolerance in Ins2Akita/+ mice. This genetic effect was phenocopied by small molecule FoxO1 inhibitor, Cpd10. Cpd10 induced β-like cells that released insulin in response to glucose in mouse gut organoids, and this effect was strengthened by the Notch inhibitor, DBZ. In Ins2Akita/+ mice, a five-day course of either Cpd10 or DBZ induced insulin-immunoreactive β-like cells in the gut, lowered glycemia, and increased plasma insulin levels without apparent adverse effects. These results provide proof of principle of gut cell conversion into β-like cells by a small molecule FoxO1 inhibitor, paving the way for clinical applications.

Development and validation of an equation to predict the incidence of coronary heart disease in patients with type 2 diabetes in Japan

Objective In the diabetes treatment policy after the Kumamoto Declaration 2013, it is difficult to accurately predict the incidence of complications in patients using the JJ risk engine. This study was conducted to develop a prediction equation suitable for the current diabetes treatment policy using patient data from Kitasato University Kitasato Institute Hospital (Hospital A) and to externally validate the developed equation using patient data from Kitasato University Hospital (Hospital B). Outlier tests were performed on the patient data from Hospital A to exclude the outliers. Prediction equation was developed using the patient data excluding the outliers and was subjected to external validation. Results By excluding outlier data, we could develop a new prediction equation for the incidence of coronary heart disease (CHD) as a complication of type 2 diabetes, incorporating the use of antidiabetic drugs with a high risk of hypoglycemia. This is the first prediction equation in Japan that incorporates the use of antidiabetic drugs. We believe that it will be useful in preventive medicine for treatment for people at high risk of CHD as a complication of diabetes or other diseases. In the future, we would like to confirm the accuracy of this equation at other facilities.