Antiplatelet and Antithrombotic Therapy in Type I Diabetes Mellitus: Update on Current Data.

Diabetes mellitus type 1 (T1DM) is an autoimmune disease characterized by a markedly elevated cardiovascular (CV) risk due to premature atherosclerosis. Previous studies have shown that intense glycemic control reduces the incidence of CV disease. Antiplatelet therapy is considered to be a very important therapy for secondary prevention of recurrent atherothrombotic events in patients with DM, while it may be considered for primary prevention in individuals with T1DM with additional CV risk factors.The aim of the present review is to summarize existing literature data regarding the thrombotic risk in T1DM patients and discuss current treatment strategies.

Environmental Factors as Diabetic Mediators–A Mechanistic Approach

Despite substantial investment in research and treatment options, diabetes mellitus remains a pressing public health concern with potential epidemic proportions globally. There are reports that by the end of 2040, 642 million people will be suffering from diabetes. Also, according to an estimation, 1.6 million deaths were caused directly by diabetes in 2016. Diabetes is a metabolic disorder characterized by impaired glucose regulation in the body due to the destruction of pancreatic β-cells or insulin resistance. Genetic propensity, unhealthy and imbalanced diet, obesity and increasing urbanization are the common risk factors for diabetes. Besides this, it has been reported that environmental pollutants like organic pesticides, heavy metals, and air pollutants act as strong predisposing factors for diabetes owing to their highly bio-accumulative nature. These pollutants disturb glucose homeostasis either by up-regulating or down-regulating the expression of diabetic marker genes like insulin (INS), glucokinase (GCK). Unfortunately, the molecular mechanism about the role of pollutants in causing diabetes is not very clear. This mechanistic review provides evidence of different environmental determinants including persistent organic pollutants (POPs), air pollutants, toxic metals, etc. in inducing diabetes and proposes a framework for the possible mechanisms involved. It also illuminates the current status and future challenges which will not only broaden our understanding but can also be a reasonable platform for further investigation.

Precision Medicine in Patients with Differential Diabetic Phenotypes: Novel Opportunities from Network Medicine

Introduction: Diabetes mellitus (DM) comprises differential clinical phenotypes ranging from rare monogenic to common polygenic forms, such as type 1 (T1DM), type 2 (T2DM), and gestational diabetes, which are associated with cardiovascular complications. Also, the high-risk prediabetic state is rising worldwide, suggesting the urgent need for early personalized strategies to prevent and treat a hyperglycemic state. Objective: We aim to discuss the advantages and challenges of Network Medicine approaches in clarifying disease-specific molecular pathways, which may open novel ways for repurposing approved drugs to reach diabetes precision medicine and personalized therapy. Conclusion: The interactome [or protein-protein interactions (PPIs)] is a useful tool to identify subtle molecular differences between precise diabetic phenotypes and predict putative novel drugs. Despite being previously unappreciated as T2DM determinants, the growth factor receptor-bound protein 14 (GRB14), calmodulin 2 (CALM2), and protein kinase C-alpha (PRKCA) might have a relevant role in disease pathogenesis. Besides, in silico platforms have suggested that diflunisal, nabumetone, niflumic acid, and valdecoxib may be suitable for the treatment of T1DM; phenoxybenzamine and idazoxan for the treatment of T2DM by improving insulin secretion; and hydroxychloroquine reduce the risk of coronary heart disease (CHD) by counteracting inflammation. Network medicine has the potential to improve precision medicine in diabetes care and enhance personalized therapy. However, only randomized clinical trials will confirm the clinical utility of network-oriented biomarkers and drugs in the management of DM.

Effectiveness of Self-Concept Management of Patients with Depression in Diabetic Ulcer Patients

Background: This study explores the management of self-concept in improving the quality of life of diabetic ulcer patients. Low confidence in the quality of life is a factor causing patients with long-term diabetic disease to believe they cannot be cured properly. Ulcers result from diabetes mellitus complications due to the nervous system and blood vessel damage. Patients with diabetic ulcers experience depression and feel acute stress when the disease has been categorized as a chronic condition. Method: This study uses quantitative methods with a cross-sectional study design approach. The data collection techniques used purposive sampling and had 82 diabetic ulcer sufferers as respondents in the study. Result: This study empirically proves that (p-value ≤ α=0.05), where there is effective management of the concept of self-health applied by diabetic ulcer patients in reducing the level of depression and sufferers can increase their confidence in better health factors. Conclusion: The effectiveness of self-care management is an important indicator in overcoming diabetic ulcer disease. The low management of self-concept for people with diabetes will certainly impact increasing depression and acute stress, decreasing the quality of life for sufferers.

Do Dipeptidyl Peptidase-4 Inhibitors Increase the Risk of Heart Failure in Patients with Type 2 Diabetes?

: Dipeptidyl peptidase-4 inhibitors (DDP-4Is) or gliptins have been extensively studied in recent years. These studies have shown the safety and efficacy of gliptins in managing hyperglycemia in diabetic patients. However, there is ongoing debate on whether DDP-4Is are associated with a higher risk for developing heart failure. It is expected that long-term data from patients who are currently prescribed DDP-4Is will provide a clearer understanding of their potential benefits. This should also help guide the development of future guidelines. The focus of this perspective is on associations between the “use of DPP-4Is” and “increased risk of heart failure”. Thus, we examine several key publications and reviews on clinical trials on this class of oral antidiabetic medications. For this communication, the pertinent literature has been critically analyzed to provide an evidence-based overview of the evolving concept of DPP-4Is-induced risk of heart failure.

Comprehensive Review on Neuro-Degenerative Type 3DM

: Alzheimer disease (AD) is thought to be the metabolic illness raised by defective insulin signaling, insulin resistance, and low insulin levels in the brain, according to a growing body of research. The "Type 3 diabetes" has been postulated for AD because reduced insulin signalling has molecular and physiological consequences that are comparable to Type I and Type 2 diabetes mellitus (Type 1 DM and Type 2 DM, respectively). The similarities between type 2 diabetes and Alzheimer's disease suggest that these clinical trials might yield therapeutic benefits. However, it's important to note that lowering your risk of Alzheimer's dementia, whether you have diabetes or not, is still a multidimensional process involving factors like exercise, smoking, alcohol, food, and mental challenge. The current aim is to show the relationship between T3D and AD being based on both the processing of amyloid-β (Aβ) precursor protein toxicity and the clearance of Aβ are the result of an impaired insulin signaling. The brain's metabolism with its high lipid content and energy needs, places excess demands on mitochondria and appears more susceptible to oxidative damage than the rest of the body. Current data suggests that increased oxidative stress relates to amyloid-β (Aβ) pathology and onset of AD.

Multifaceted Effects of Intermittent Fasting in the Treatment and Prevention of Diabetes, Cancer and Obesity or Other Chronic Diseases

Background: Obesity and diabetes are global epidemics that result in a slew of co-morbid illnesses. Both have been linked to an increased risk of hormonal imbalance, cancer, and other significant disorders, which are a concerning trend for cancer rates in the backdrop of rising obesity and diabetes rates worldwide. Around one in ten persons in the United States and Canada have serious illnesses correlated with type 2 diabetes and early death. It is believed that the US economy alone spends $245 billion annually. Lifestyle modification with intermittent fasting protocol and proper diet helps lower the blood glucose level and maintain the body mass index and reduced the inflammation in the body which is the main cause for all chronic diseases. Methods: We searched case series, clinical trials relating to type 2 diabetes, insulin resistance, cancer, thyroid, cardiovascular disease or other inflammatory diseases in response to intermittent fasting in the PubMed, MEDLINE, and Google Scholar databases. Objective: In this review, we focused on intermittent fasting-based approaches that are becoming more widely accepted for improving health and reducing unwanted effects in patients with type 2 diabetes, cancer, cardiovascular disease, neurodegenerative disease, obesity, thyroid, and hormonal imbalance, which are fasting intermittently and whether intermittent fasting may be considered as a non-medicinal therapeutic option for persons suffering from chronic diseases. Conclusion : Intermittent fasting successfully reversed the diabetes, thyroid, high blood pressure, elevated lipid level, and maintained the body mass index along and also studies has shown that it has been followed or instructed for the treatment and prevention of cancer and neurodegenerative diseases with dietary interventions.

Role of Mechanoinsensitive Nociceptors in Painful Diabetic Peripheral Neuropathy

: The cutaneous mechanisms that trigger spontaneous neuropathic pain in diabetic peripheral neuropathy (PDPN) are far from clear. Two types of nociceptors are found within the epidermal and dermal skin layers. Small-diameter lightly myelinated Aδ and unmyelinated C cutaneous mechano and heat sensitive (AMH and CMH) and C mechanoinsensitive (CMi) nociceptors transmit pain from the periphery to central nervous system. AMH and CMH fibers are mainly located in the epidermis and CMi fibers are distributed in the dermis. In DPN, dying back intra-epidermal AMH and CMH fibers leads to reduced pain sensitivity and the patients exhibit significantly increased pain thresholds to acute pain, when tested using traditional methods. The role of CMi fibers in painful neuropathies has not been fully explored. Microneurography has been the only tool to access CMi fibers and differentiate AMH, CMH and CMi fiber types. Due to the complexity, its use is impractical in clinical settings. In contrast, a newly developed diode laser fiber selective stimulation (DLss) technique allows to safely and selectively stimulate Aδ and C fibers in the superficial and deep skin layers. DLss data demonstrate that patients with painful DPN have increased Aδ fiber pain thresholds, while C-fiber thresholds are intact because in these patients CMi fibers are abnormally spontaneously active. It is also possible to determine the involvement of CMi fibers by measuring the area of DLss-induced neurogenic axon reflex flare. The differences in AMH, CMH and CMi fibers allow to identify patients with painful and painless neuropathy. In this review, we will discuss the role of CMi fibers in PDPN.

Type 2 Diabetes in Women-Different and Difficult

Background: Lifestyle modification along with medication have improved the quality of life of patients with type 2 diabetes (T2D), but treatment of diabetes in women still lacks a gender-centric approach. Methods: Expert opinions to improve diabetes management in women were collated from the open discussion forum organized by the sixth Jothydev’s Professional Education Forum Diabetes Convention which included global diabetes care experts and general public The review is also based on the studies published in electronic databases such as PubMed and Google Scholar that discussed the problems and challenges faced by the Indian diabetes care sector in treating women with diabetes. Results: The complex interplay of biological, socioeconomic, psychosocial and physiological factors in women with type 2 diabetes has not been well addressed till date. Biological factors such as neurohumoral pathways, sex hormones, genetic predisposition as well as gender based environmental and behavioural differences must be considered for modern personalized diabetes treatment. Most importantly, pregnant woman with diabetes deserves special attention, as this vulnerable phase have a marked impact on the future health of both mother and offspring. Conclusion: The review provides an overview of the challenges and issues existing in the clinical management of diabetes and its complications among women in India. Women-centric clinical approaches should be encouraged for the effective management of diabetes in Indian women.

Impact of COVID 19 Lockdown on Glycemic Control in Patients with Type 2 Diabetes Mellitus in Dubai

Objective: The objective of this study is to evaluate the impact of the COVID-19 lockdown on glycemic control and accompanying laboratory parameters in patients with type 2 Diabetes Mellitus. Research design and methods: This study is a retrospective cohort study that was done on a multicenter level. It was conducted during the lockdown in 341 individuals. HbA1c was tested to measure glycemic control immediately before and after the lockdown period that lasted for 13 weeks. Results: The primary outcome was the improvement of mean HbA1C after 13 weeks of lockdown compared to the pre-lockdown HbA1C. It was found that the mean HbA1C improved from 7.5±1.5 to 7.3±1.5 with a p-value of 0.001. Conclusion: Our study showed that patients with type 2 diabetes mellitus exhibited an improvement in their glycemic control after the period of lockdown.