Evaluation of Tribulus terrestris Extracts Relative to Metformin on Oxidative Stress and Histopathology of the Liver for Diabetic Male Rats

Insulin-dependent diabetes mellitus (IDDM) is a metabolic condition that induces blood glucose levels to rise due to insulin deficiency and the formation of reactive oxygen species (ROS). The purpose of this study is to assess how efficient the antioxidant extracts Tribulus terrestris (TT) and metformin (MET) are in reducing oxidative stress and histopathology produced by streptozotocin in rat hepatocytes. The 36 male rats weighing 170–190 g of this study were randomly sorted into 6 groups. The first group was considered a normal control group, and the second and third groups were normal and remedy with MET and TT extract, respectively. The fourth group was positive diabetic, and the fifth and sixth groups were diabetic rats that were treated with MET and TT extract, respectively. Lipid peroxidation (LPO), catalase (CAT), glutathione-S-transferase (GST), and glutathione (GSH) were detected, and the histopathology of the liver was evaluated after 8 weeks of treatment. Compared to regulation, morphological changes in the liver were found in diabetic animals, with a rise in LPO and a change in GSH levels as well as CAT and GST activities. The oxidative stress and histological architecture of the hepatocytes caused by hyperglycemia were improved as a result of therapy in the rats with MET and TT extract. Because of its antioxidant activities, diabetic rats with TT extract are more effective than MET in normoglycemia and hepatocyte reconditioning. Beneficial intervention tends to benefit primarily from direct ROS scavenging and CAT, GST, and GSH regeneration.

Fetal adrenal cortex function in pregnancy, complicated by maternal insulin-dependent diabetes mellitus

Fetal adrenal cortex glucocorticoid andfetal hypophysial adrenocorticotropic function in normal pregnancy and pregnancy, complicated with maternal insulin dependent diabetes mellitus were examined in the present study. Statistically significant feta l hypercortisolemia was observed in pregnancies, complicated by insulin-dependent diabetes mellitus. Correlations between vascular complications o f maternal insulin-dependent diabetes mellitus and fetal cortisol andACTG levels were revealed during the investigation. Severe vascular lesions o f maternal diabetes have been associated with delayed feta l lung maturity. Fetal pulmonary maturity was significantly associated with fe ta l cortisol levels.

Diabetes status and postoperative complications for patients receiving open rotator cuff repair

Background Diabetic patients are known to have poor wound healing and worse outcomes following surgeries. The purpose of this study is to evaluate diabetes status and complications for patients receiving open rotator cuff repair. Methods Patients undergoing open rotator cuff repair from 2006 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: no diabetes mellitus, non-insulin dependent diabetes mellitus (NIDDM), and insulin dependent diabetes mellitus (IDDM). Differences in demographics, comorbidities, and complications were assessed with the use of bivariate and multivariate analyses. Results Of 7678 total patients undergoing open rotator cuff repair, 6256 patients (81.5%) had no diabetes, 975 (12.7%) had NIDDM, and 447 (5.8%) had IDDM. Bivariate analyses revealed that IDDM patients had increased risk of mortality, extended length of stay, and readmission compared to non-diabetic patients ( p < 0.05 for all). IDDM patients had higher risks of major complications and readmission relative to NIDDM patients ( p < 0.05 for both). On multivariate analysis, there were no differences in any postoperative complications between the non-diabetic, NIDDM, and IDDM groups. Discussion Diabetes does not affect postoperative complications following open rotator cuff repairs. Physicians should be aware of this finding and counsel their patients appropriately. Level of Evidence: III

Neuronal mechanisms of ginseng on antiobesity effects: implication of its synergistic benefits with physical exercise

Obesity is a chronic disease of increasing prevalence in most countries, which leads to substantial increase in morbidity, and mortality in association with diabetes, hyperlipidaemia, hypertension, and other cardiovascular diseases. Many factors have been attributed to an epidemic of obesity including sedentary lifestyle, high-fat diets (HFD), and consumption of large amount of modern fast foods. Panax ginseng C. A. Meyer (PG) has several pharmacological and physiological effects. In particular, PG and saponin fractions from PG show a variety of efficacies such as antifatigue, hyperlipidemia, hypertension and noninsulin-dependent diabetes mellitus and obesity. We have revealed that ginseng and ginsenosides can decrease food intake energy expenditure by stimulating appetite regulatory hormones and can reduce energy intake. Exercise/physical activity is well known as modality for treating the disease of overweight and obesity. It is suggested that natural products and their combinations with exercise may produce a synergistic activity that increases their bioavailability and action on multiple molecular targets, offering advantages over chemical treatments. This review is aimed at evaluating the antiobesity efficacy of ginseng and ginsenosides and delineating the mechanisms by which they function. Finally, we review information regarding interactions between ginseng and physical exercise in protecting against weight gain and obesity.

CANDIED: A Pan-Canadian Cohort of Immune Checkpoint Inhibitor-Induced Insulin-Dependent Diabetes Mellitus

Immune checkpoint inhibitor (ICI)-induced insulin-dependent diabetes mellitus (IDDM) is a rare but potentially fatal immune-related adverse event (irAE). In this multicentre retrospective cohort study, we describe the characteristics of ICI-induced IDDM in patients treated across five Canadian cancer centres, as well as their tumor response rates and survival. In 34 patients identified, 25 (74%) were male and 19 (56%) had melanoma. All patients received anti-programed death 1 (anti-PD1) or anti-programmed death ligand-1 (anti-PD-L1)-based therapy. From ICI initiation, median time to onset of IDDM was 2.4 months (95% CI 1.1–3.6). Patients treated with anti-PD1/PD-L1 in combination with an anti-cytotoxic T lymphocyte antigen 4 antibody developed IDDM earlier compared with patients on monotherapy (1.4 vs. 3.9 months, p = 0.05). Diabetic ketoacidosis occurred in 21 (62%) patients. Amongst 30 patients evaluable for response, 10 (33%) had a complete response and another 10 (33%) had a partial response. Median overall survival was not reached (95% CI NE; median follow-up 31.7 months). All patients remained insulin-dependent at the end of follow-up. We observed that ICI-induced IDDM is an irreversible irAE and may be associated with a high response rate and prolonged survival.

Pregnancy After Simultaneous Pancreas-Kidney Transplantation in Treatment of End-Stage Diabetes Mellitus: a Review

The majority of patients with simultaneous pancreas and kidney transplant (SPKT) required transplantation owing to a long-standing history of insulin-dependent diabetes mellitus (IDDM). The disease causes multiple organ damage, impairs fertility, and affects quality of life. A successful kidney and pancreas transplant can improve health, ameliorate the consequences of pre-existent diabetes, and restore fertility. Good graft function, without any sign of rejection, and stable doses of immunosuppressant drugs are of utmost importance prior to the planned pregnancy. SPKT recipients who become pregnant may be at an increased risk for an adverse outcome and require meticulous multidisciplinary surveillance. We present experiences with SPKT pregnancies, traditional approaches, and recent considerations. In light of complex interactions between new anatomic relations and the impact of developing pregnancy and immunosuppressive medications, special stress is put on the risk of graft rejection, development of pregnancy complications, and potential harmful effects on fetal development. Recent recommendations in management of SPKT recipients who wish to commence pregnancy are presented as well. Key words: transplantation, pregnancy, pancreas, kidney, simultaneous pancreas and kidney transplantation (SPKT)

Diabetic ketoacidosis as a hallmark of autoimmune diabetes occurring after two cycles of cemiplimab

Introduction Clinical indications of immune checkpoint inhibitors have expanded to a variety of malignancies. Nearly 50% of patients with advanced cutaneous squamous cell carcinoma, respond to the programmed-death 1 inhibitor cemiplimab. To date, insulin-dependent diabetes mellitus has been documented with the use of several immune checkpoint inhibitors but not cemiplimab. Case report We report herein the first case of a patient with cutaneous squamous cell carcinoma who developed diabetic ketoacidosis and insulin-dependent diabetes mellitus following only two cycles of cemiplimab. A score of 6 on the Naranjo nomogram makes the causality relationship between cemiplimab use and the insulin-dependent diabetes mellitus probable. Management and outcome The patient's developed diabetic ketoacidosis was managed with intravenous fluids and intravenous insulin, with a prompt resolution. Cemiplimab was discontinued, and the patient was discharged on long-acting and short-acting insulin therapy, with a follow-up with endocrinology. Discussion/conclusions The mechanism by which cemiplimab caused insulin-dependent diabetes mellitus is most likely due to lack of endogenous insulin production in the setting of immune-mediated loss of pancreatic beta-cells. Patients may benefit from fasting blood glucose monitoring and early immune checkpoint inhibitor discontinuation where elevated serum glucose is detected.

Herbal Drugs with Anti-Diabetic Potential

Diabetes mellitus (DM), also known as insulin-dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM), is a common and serious metabolic condition that affects people all over the world. Traditional herbal plants have been utilized to treat diabetes mellitus all throughout the world. Several herbs have been found to treat and control diabetes among numerous medicines and poly herbal plants; they also have no adverse effects. Diabetes mellitus is a horrible disease that affects people all over the world and is becoming a serious danger to humanity's health. Thus, herbal plants may be a possible source of anti-diabetic medicines, with ethno botanical data indicating that around 800 plants may have anti-diabetic potential. Although synthetic oral hypoglycemic agents/insulin are a popular diabetes therapy and are effective in controlling hyperglycemia, they have significant side effects and do not significantly modify the course of diabetic complications. This is the primary reason why an increasing number of individuals are looking for alternative medicines with fewer or no adverse effects. The botanical name, common name, component, and mechanism of action for anti-diabetic activity were provided in this review study, as well as plant-based commercial poly herbal formulations. Keywords: Diabetes mellitus, Medicinal plants, glucose, poly herbal plants

Use of malondialdehyde (MDA) as a screening tool for vestibulopathy inType2 diabetes mellitus

Introduction and Aim:Diabetes mellitus, especially type II DM is one among the most prevalent metabolic diseases in the global scale. One of the commonest complications of diabetes mellitus is vestibulopathy affecting the inner ear. Malondialdehyde (MDA) obtained from lipid peroxidation of poly unsaturated fatty acids (PUFA) is an important compound that generally serves as one of the key markers for oxidative stress. The aim of the study is to prove the significance of MDA in Vestibulopathy in Type-2 i.e.,non-insulin dependent diabetes mellitus. Methodology: A cross-sectional study of 100 diabetic patients of age group between 35 years and 50 years were tested for vestibular function by electronystagmography(Commonly used test to determine and evaluate vestibular system). Based on the biothermal caloric stimulation the Clausen butterfly chart was generated and thus the code is ascertained. Serum levels of Malon-di-aldehyde were assayed by TBARS method (Thiobarbituric acid Reactive substances). Results: The study proved, that there was a 4 times increased risk of developing vestibulopathy with increasing duration of diabetes. It also proved that there was an increased risk of developing vestibulopathy in diabetic patients, having MDA > 2?mol/L. Conclusion: Thereby the study confirmed the clinical significance of periodic screening of MDA levels, in diabetic patients, particularly those with uncontrolled/poor glycemic control & with longer duration of diabetes. Estimation of their serum MDAlevels and vestibular function by the electronystagmography test, is advised in order to prevent the occurrence of diabetic vestibulopathy at the earliest and also to prevent the worsening of any such, other complications associated with the disease.