Effects of in vitro supplementation with Syzygium cumini (L.) on platelets from subjects affected by diabetes mellitus

The aim of this study was to assess the in vitro effects of Syzygium cumini (L.) (Sc) incubation on platelets from patients with diabetes, in order to test its efficacy as a potential adjuvant therapy. This study was performed on 77 patients with diabetes [29 in good (DM_gc) and 48 in poor glycemic control (DM_pc)] and 85 controls. In patients, platelets were analyzed at recruitment and after in vitro Sc incubation (final concentration of 200?µg/ml for 3 hours at 37?°C), whereas in controls only basal evaluation was performed. Lipoperoxide and nitric oxide (NO) levels, superoxide dismutase (SOD) and Na⁺/K⁺ ATPase activities, total antioxidant capacity (TAC), and membrane fluidity tested by anisotropy of fluorescent probes 1?-(4-trimethylaminophenyl)-6-phenyl-1,3,5-hexatriene (TMA-DPH) and 1-6-phenyl-1,3,5-hexatriene (DPH) were determined. Collagen-induced platelet aggregation was also evaluated. In vitro Sc activity counteracts oxidative damage, by improving platelet function through augmented membrane fluidity and Na⁺/K⁺ ATPase activity; it also enhances antioxidant system functionality by increasing NO levels, SOD activity, and TAC and by decreasing lipoperoxide levels both in whole samples and in DM_gc and DM_pc. In addition, a slight tendency towards collagen-induced platelet aggregation decrease after Sc was observed. However, all these parameters, even after improvement, did not reach the levels of control subjects. Our results suggest that Sc may have a preventive and protective effect in oxidative damage progression associated with diabetes mellitus and its complications. If our data will be confirmed, Sc supplementation might become a further tool in the management of this disease, especially in view of its easy availability, safety, low cost, and absence of side effects.     

Effects of short-term therapy with glibenclamide and repaglinide on incretin hormones and oxidative damage associated with postprandial hyperglycaemia in people with type 2 diabetes mellitus

Aim

To examine the effects of glibenclamide and repaglinide on glucose stimulated insulin release, incretins, oxidative stress and cell adhesion molecules in patients with type 2 diabetes suboptimally treated with metformin.

Methods

A randomized clinical trial was performed recruiting 27 subjects (HbA_1c between 7.5 and 10.5%) free from cardiovascular and renal disease. Glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), total antioxidant status, F₂-isoprostane, interleukin-6 and cell adhesion molecules were measured during an oral glucose load at baseline and after eight weeks of treatment. The areas under the curve were analysed at 45, 60 and 120 min (AUC₄₅, AUC₆₀, AUC₁₂₀).

Results

Significant improvements in glucose were observed with repaglinide (HBA_1c: −1.5%, fasting glucose: −2.8 mmol/L, 2-h glucose: −3.7 mmol/L, AUC₁₂₀: −18.9%) and glibenclamide (−1.0%, −2.2 mmol/L, −2.5 mmol/L, −17.5%). Repaglinide was also associated with an increase in the AUC₆₀ and AUC₁₂₀ for insulin (+56%, +61%) and C-peptide (+41%, +36%). GLP-1, GIP, IL-6, ICAM-1 and E-selectin levels did not change in either group. No association was observed between GLP-1, GIP-1 and plasma markers of oxidative stress.

Conclusion

Repaglinide is associated with improved postprandial glycaemic control via insulin and C-peptide release. We observed no direct effects of glibenclamide or repaglinide on plasma levels of GLP-1 or GIP. We observed no associations of GLP-1 and GIP with plasma markers of oxidative stress.     

Effect of fermented Panax ginseng extract (GINST) on oxidative stress and antioxidant activities in major organs of aged rats

The intracellular levels of oxidant and antioxidant balances are gradually distorted during the aging process. An age associated elevation of oxidative stress occurring throughout the lifetime is hypothesized to be the major cause of aging. The present study was undertaken to evaluate the putative antioxidant activity of the fermented Panax ginseng extract (GINST) on lipid peroxidation and antioxidant status of major organs of aged rats compared to young rats. Increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine were observed in the serum of aged rats. Increased levels of malondialdehyde (MDA) and significantly lowered activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR) and glutathione-S-transferase (GST) were observed in the liver, kidneys, heart and lungs of aged rats, when compared with those in young rats. Quantitative analysis of the non-enzymatic antioxidants such as reduced glutathione (GSH), ascorbic acid and α-tocopherol levels showed significantly lower values in the liver, kidneys, heart and lungs of aged rats. On the other hand, administration of the fermented Panax ginseng extract (GINST) to aged rats resulted in increased activities of SOD, CAT, GPx, GR and GST as well as elevation in GSH, ascorbic acid and α-tocopherol levels. Besides, the level of MDA, AST, ALT, urea and creatinine were reduced on administration of GINST to aged rats. These results suggested that treatment of GINST can improve the antioxidant status during aging, thereby minimizing the oxidative stress and occurrence of age-related disorders associated with free radicals.     

High risk of failing eradication of Helicobacter pylori in patients with diabetes: A meta-analysis

Aims

Eradication of Helicobacter pylori (HP) is an effective approach to improve intestinal symptoms and prevent gastric cancer. However, there has been concern that the presence of diabetes reduces the effectiveness of antibiotics. We performed this meta-analysis to investigate the effect of diabetes on the risk of failing eradication in patients with diabetes.

Methods

An electronic literature search was conducted using Biosis, MEDLINE, Embase, PASCAL, and SciSearch through November 30, 2012. Selected studies had to provide data on the number of individuals who received treatment for HP infection and on the failure of HP eradication in groups with and without diabetes. Two authors independently extracted relevant data.

Results

Data were obtained from 8 eligible studies (693 total participants including 273 participants with diabetes). Overall, the pooled risk ratio (RR) of failing HP eradication for diabetic patients compared with non-diabetic participants was 2.19 [95%CI, 1.65–2.90] (P < 0.001). Excluding the 2 studies that used a non-standard protocol for HP eradication, individuals with diabetes had a higher risk of failure of eradication compared to those without diabetes (RR = 2.31 [95%CI, 1.72–3.11]).

Conclusions

Current meta-analysis confirmed the higher risk of HP eradication failure in individuals with diabetes compared with those without diabetes, suggesting the necessity of prolonging treatment or developing a new regimen for HP eradication in patients with diabetes.     

Augmented NADPH oxidase activity and p22phox expression in monocytes underlie oxidative stress of patients with type 2 diabetes mellitus

Background

This study was to test the hypothesis that enhanced oxidative stress is induced in monocytes with over-activated NADPH oxidase during the development of type 2 diabetes mellitus.

Methods

Levels of glucose and lipids were analyzed in 73 diabetic patients and 36 controls. Superoxide dismutase (SOD), malondialdehyde (MDA), reactive oxygen species (ROS) and protein carbonylation were tested. Expression of NADPH oxidase was examined and p47phox translocation was assessed.

Results

With the abnormality of glucose and lipid metabolism, diabetic patients showed a higher oxidative stress state indicated by decreased SOD activity but elevated MDA and protein carbonylation level. Monocytes in diabetes also showed elevated ROS generation and protein carbonylation level. Furthermore, NADPH oxidase was highly activated in monocytes represented by p22phox up-regulation and p47phox translocation. Significant positive bivariate correlation was found between glucose and MDA level as well as p22phox expression. In vitro experiments also indicated that glucose could stimulate ROS generation in a NADPH oxidase dependent manner. Moreover, we carried out same measurement in 40 diabetic patients with anti-diabetic intervention and obtained the reinforced results.

Conclusions

Hyperglycemia is the main factor which induces oxidative stress mainly by activation of NADPH oxidase in monocytes of diabetic patients.     

α-硫辛酸对2型糖尿病氧化应激状态和内皮功能的影响

目的观察α-硫辛酸对2型糖尿病患者氧化应激状态及血管内皮功能的影响。方法30例2型糖尿病患者每日给予α-硫辛酸600mg,治疗2周,检测治疗前后氧化还原系统指标、全血Na -K -ATP酶活力以及血流介导的内皮依赖性血管舒张功能。结果治疗后患者血清丙二醛含量降低、超氧化物歧化酶活力增高,差异有非常显著性(P<0.01),谷胱甘肽、维生素E含量增加,Na -K -ATP酶活力增强,血流介导的内皮依赖性的血管舒张功能增强,但差异无显著性(P>0.05),总体症状评分明显下降(P<0.01)。结论抗氧化剂α-硫辛酸治疗能改善2型糖尿病患者氧化应激状态及血管内皮功能,缓解临床症状。     

2型糖尿病患者氧化应激状况及影响因素分析

目的分析2型糖尿病（T2DM）患者氧化应激的状况及影响因素。方法测定92例T2DM患者和56名非糖尿病对照者的血清活性氧活力、谷胱甘肽（GSH）、超氧化物歧化酶（SOD）、丙二醛（MDA）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）,并测量血压、身高、体重,计算出体质指数（BMI）。比较T2DM组与对照组氧化应激的状况,并对其影响因素进行多元逐步回归分析。结果T2DM组与对照组相比血清活性氧活力增强（P〈0.05）,MDA增高（P〈0.05）,GSH、SOD降低（P均〈0.05）;多元逐步回归分析显示：血脂水平,尤其是TG和HDL-C水平是影响氧化应激的重要因素。结论T2DM患者存在氧化应激的增强,且与高TG相关。     

Laboratory evaluation of aqueous leaf extract of Tephrosia vogelii against larvae of Aedes albopictus (Diptera: Culicidae) and non-target aquatic organisms

Mosquito control using insecticides has been the most successful intervention known to reduce malaria prevalence or incidence. However, vector control is facing a threat due to the emergence of resistance to synthetic insecticides. Insecticides of botanical origin may serve as suitable alternative biocontrol techniques in the future. In this research, the leaf aqueous leachate of Tephrosia vogelii was evaluated for its toxicity against larvae of the most invasive mosquito worldwide, Aedes albopictus (Diptera: Culicidae), and toward adults of the water flea, Daphnia magna (Cladocera: Crustacea) and Oreochromis niloticus, two non-target aquatic organisms that share the same ecological niche of A. albopictus. The leaf aqueous leachate of T. vogelii was evaluated against fourth-instar larvae, non-blood fed 3–5 days old laboratory strains of A. albopictus under laboratory condition. In addition, the objective of the present work was to study the environmental safety evaluation for aquatic ecosystem. Mortality was then recorded after 7 d exposure. The leaf aqueous leachate of T. vogelii showed high mosquitocidal activity against larvae of A. albopictus, with a LC₅₀ = 1.18 μg/mL. However, it had a remarkable acute toxicity also toward adults of the non-target arthropod D. magna, with a LC₅₀ = 0.47 μg/L and O. niloticus with a LC₅₀ = 5.31 μg/L. The present findings have important implications in the practical control of mosquito larvae in the aquatic ecosystem, as the medicinal plants studied are commonly available in large quantities. The extract could be used in stagnant water bodies for the control of mosquitoes acting as vector for many communicable diseases.     

慢性炎症和氧化应激对老年2型糖尿病患者骨骼肌量和肌力的影响

目的:分析老年2型糖尿病患者骨骼肌质量和力量水平,探讨慢性炎症及氧化应激水平对其影响。方法:横断面病例对照研究,入选京西医院120例60岁及以上老年2型糖尿病(糖尿病组)患者和126例老年非糖尿病(非糖尿病组)患者,分别测定其骨骼肌质量、力量及血清慢性炎症因子白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)及氧...     

Advanced glycation end-products and methionine sulphoxide in skin collagen of patients with type 1 diabetes

Aims/hypothesis We determined whether oxidative damage in collagen is increased in (1) patients with diabetes; (2) patients with diabetic complications; and (3) subjects from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study, with comparison of subjects from the former standard vs intensive treatment groups 4 years after DCCT completion. Subjects, materials and methods We quantified the early glycation product fructose-lysine, the two AGEs N ^ε-(carboxymethyl)lysine (CML) and pentosidine, and the oxidised amino acid methionine sulphoxide (MetSO) in skin collagen from 96 patients with type 1 diabetes (taken from three groups: DCCT/EDIC patients and clinic patients from South Carolina and Scotland) and from 78 healthy subjects. Results Fructose-lysine was increased in diabetic patients (p<0.0001), both with or without complications (p<0.0001). Controlling for HbA_1c, rates of accumulation of AGEs were higher in diabetic patients than control subjects, regardless of whether the former had complications (CML and pentosidine given as log_e[pentosidine]) or not (CML only) (all p<0.0001). MetSO (log_e[MetSO]) also accumulated more rapidly in diabetic patients with complications than in controls (p<0.0001), but rates were similar in patients without complications and controls. For all three products, rates of accumulation with age were significantly higher in diabetic patients with complications than in those without (all p<0.0001). At 4 years after the end of the DCCT, no differences were found between the previous DCCT management groups for fructose-lysine, AGEs or MetSO. Conclusions/interpretation The findings suggest that in type 1 diabetic patients enhanced oxidative damage to collagen is associated with the presence of vascular complications.     

老年2型糖尿病患者高密度脂蛋白亚类与氧化应激和颈动脉粥样硬化的相关性

目的 探讨老年2型糖尿病患者血清高密度脂蛋白(HDL)亚类的分布特点及其与氧化应激和颈动脉粥样硬化的相关性.方法 老年2型糖尿病患者56例,男40例、女16例;老年健康对照者41例,男31例、女10例.分别测定血清HDL亚类、血清8-异前列腺素F2α及颈动脉超声.结果 老年2型糖尿病组HDL3(0.51±0.21)mmol/L,较健康对照组(0.59±0.15)mmol/L降低(t=1.991,P＜0.05),HDL及HDL2亦较健康对照组降低,分别为(1.07±0.36)mmol/L对(1.18±0.32)mmol/L和(0.56±0.25)mmol/L对(0.64±0.33)mmol/L,但差异无统计学意义(t值分别为1.611和0.614,均为P＞0.05);HDL3与HbA1c负相关(r=-0.503,P=0.005);血清8-异前列腺素F2α吸光度A值较健康对照组降低,分别为0.017±0.004和0.021±0.008(t=2.245,P＜0.05);颈动脉平均内膜-中层厚度(IMT)较健康对照组升高,但差异无统计学意义;颈动脉斑块检出率63.3%,高于对照组的36.0%(x2=4.076,P＜0.05).结论 老年2型糖尿病患者HDL亚类水平存在异常,小颗粒的HDL3水平下降,氧化应激增加,可能是导致其动脉粥样硬化的原因之一.     

尿8-羟基脱氧鸟苷在2型糖尿病及糖尿病合并冠心病患者中的临床意义

目的 观察糖尿病患者及糖尿病合并冠心病患者尿8-羟基脱氧鸟苷(8-OHdG)水平.方法 来自天津医科大学总医院住院患者及健康查体中心体检人群150名,分为糖尿病组(50例,其中男性25例,女性25例),糖尿病合并冠心病组(50例,其中男性25例,女性25例),正常对照组(50名,其中男性25名,女性25名).收集24 h尿,通过竞争酶联免疫吸附法定量检测尿液中8-OHdG含量,苦味酸法测定尿肌酐浓度,采用酶法测定血脂、血糖、肾功能,高效液相法测定糖化血红蛋白(HbA1c),Clauss法测定纤维蛋白原(FIB).结果 与正常对照组[(6.97 ±2.13) ng/mgCr]相比,糖尿病组[(12.26 ±3.57) ng/mgCr]及糖尿病合并冠心病组[(14.41±2.84) ng/mgCr]尿8-OHdG水平较高,同时糖尿病合并冠心病组显著高于糖尿病组(P均＞0.05).糖尿病及糖尿病合并冠心病组收缩压、腰围、体重指数、HbA1c、空腹血糖、负荷后2h血糖、甘油三酯、FIB水平显著高于正常对照组(P均＜0.01),高密度脂蛋白-胆固醇水平低于正常对照组(P＜0.05);糖尿病合并冠心病组HbA1c、负荷后2h血糖、FIB水平显著高于糖尿病组(P均＜0.01);尿8-OHdG水平与收缩压、腰围、体重指数、甘油三酯、FIB、HbA1c、空腹血糖、负荷后2h血糖呈正相关;经多元逐步回归分析,HbA1c对尿8-OHdG水平有显著性影响(P ＜0.001).结论 糖尿病及合并冠心病患者尿8-OHdG水平升高;尿8-OHdG可能成为评价糖尿病性动脉粥样硬化程度的新指标.     

Knowledge of ocular complications of diabetes in community-based people with type 2 diabetes: The Fremantle Diabetes Study II

AimsTo assess knowledge of diabetes-related eye disease in Australians with type 2 diabetes and its associations with diabetic retinopathy (DR), other ocular complications and vision-related quality of life.MethodsA random sample from the Fremantle Diabetes Study Phase II cohort (n = 360) was invited to participate. Knowledge was assessed using 10 multiple-choice questions covering how diabetes affects the eyes, frequency of ophthalmic screening, risk factors, prevention, available treatments, and prognosis. DR was assessed from fundus photographs. Multiple linear regression was used to identify independent associates of the knowledge score (KS).ResultsWe included 264 participants (mean ± SD age 72.1 ± 9.2 years, 56.8% male, median [IQR] diabetes duration 15.4 [11.1–22.3] years). The mean ± SD KS out of 10 was 5.3 ± 1.8. Most (67%) participants knew diabetes can affect the eye and lead to blindness. Only 13.6% knew that DR screening intervals depend on risk factors. Those with moderate non-proliferative DR (NPDR) or worse had a better knowledge score (B = 1.37,P = 0.008) after adjusting for age (B = ?0.03, P = 0.004) and education beyond primary school (B = 1.75, P < 0.001).ConclusionsOverall knowledge of diabetes-related ocular complications was suboptimal. Education targeting eye disease may benefit people with type 2 diabetes who are older, less well educated and/or who have no DR/mild NPDR.     

糖耐量正常的2型糖尿病一级亲属氧化应激水平与胰岛素敏感性的相关性研究

目的观察2型糖尿病（T2DM）患者及糖耐量正常的T2DM一级亲属（FDRs）体内氧化应激状态,探讨氧化应激与胰岛素敏感性之间的关系。方法检测外周血清丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH—PX）、超氧化物歧化酶（SOD）、8-异前列腺素F2a（8-isoPGF2a）水平,高胰岛素正葡萄糖钳夹技术评估胰岛素敏感性。结果T2DM组、FDRs组较NC组MDA、8-isoPGF2a水平升高（P〈0．05）,而血GSH—PX、SOD水平降低,差异有统计学意义（P〈0．05）;MDA、8iso—PGF2a与葡萄糖输注速率（GIR）呈明显负相关（r=-0．415和-0．443,P〈0．05）,GSH—PX、SOD与GIR呈明显正相关（r=0．327和0．439,P〈0．05）。结论T2DM患者及糖耐量正常的T2DM一级亲属存在氧化应激状态的改变,且与胰岛素敏感性密切相关。     

Call-to-action: Timely and appropriate treatment for people with type 2 diabetes in Latin America

Latin America faces a unique set of challenges in the treatment of type 2 diabetes mellitus (T2DM). This report identifies these challenges and provides a framework for implementation of the strategies, policies and education programs which are needed to optimize the management of this condition. In order to improve future diabetes care, it will be necessary to address existing problems such as limitation of resources, inadequate management of hyperglycemia, and inappropriate education of healthcare team members and people with diabetes. Achieving these goals will require collaborative efforts by many individuals, groups and organizations. These include policymakers, international organizations, healthcare providers, those responsible for setting medical school curricula, patients and society as a whole. It is anticipated that improved/continuing education of healthcare professionals, diabetes self-management education and development of a team approach for T2DM care will lead to optimization of patient-centered care. Implementation of multicentric demonstration studies and rational use of antidiabetic treatments will be necessary to demonstrate the long-term favorable impact of these strategies upon quality of care, prevention of chronic complications, mortality, healthcare costs and patient quality of life.     

Variations in erythrocyte antioxidant levels and lipid peroxidation status and in serum lipid profile parameters in relation to blood haemoglobin A1c values in individuals with type 2 diabetes mellitus

Aims

The present study aimed to evaluate the antioxidant and lipid peroxidation status in erythrocytes and serum lipid profile parameters, in relation to haemoglobin A1c (HbA1c) concentrations, in patients with type 2 diabetes mellitus and in normal healthy individuals.

Methods

Sixty test individuals with diabetes and 15 control individuals were categorized as: Group I, control (non-diabetes); Group II, individuals with diabetes with HbA1c levels ≤7.0% (53 mmol/mol); Group III, individuals with diabetes with HbA1c levels between 7.1 and 8.0% (54 and 64 mmol/mol); Group IV, individuals with diabetes with HbA1c levels between 8.1 and 9.0% (65 and 75 mmol/mol); Group V, individuals with diabetes with HbA1c levels >9.0% (75 mmol/mol). Blood samples were collected to measure: blood glucose and HbA1c levels; haemolysate levels of enzymatic antioxidants and non-enzymatic antioxidants and malondialdehyde (MDA); and serum total cholesterol, triglyceride and high-density lipoprotein (HDL)-cholesterol levels. Correlations between blood HbA1c values and all parameters were sought.

Results

Significantly lower mean activities/levels of antioxidant parameters and significantly higher mean levels of MDA were noted in haemolysate samples from patients with diabetes than in those from control individuals. Significantly higher mean serum concentrations of total cholesterol and triglycerides and significantly lower mean concentrations of HDL-cholesterol were noted in patients with diabetes than in control individuals. Further, moderate to strong correlations were observed between values of antioxidants, MDA and lipid profile parameters and blood concentrations of HbA1c.

Conclusion

These results suggest that HbA1c values may be potentially useful not only to indicate long-term glycemic control to indicate onset of complications at a clinically detectable level and molecular level.     

Use of pain relieving drugs in community-dwelling older people with and without type 2 diabetes

AimsTo analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care.MethodsA total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain status was defined as no pain, nociceptive pain or neuropathic pain. Pain medication (paracetamol, NSAID, opioids, neuropathic pain medication) use was based on electronic patient records and checked by a physician during a health examination.ResultsSome pain was present in 90 (51%) patients without and in 106 (57%) patients with diabetes (p = 0.55). Of the patients without diabetes, 109 (62%) and with diabetes 123 (66%) used some pain medication (p = 0.45). The respective proportions for the regular use were 13% and 11% and for the as needed use 56% and 61%. Diabetes was not associated with any of the pain medications used. The use of pain-relieving drugs was most common for neuropathic pain.ConclusionsThe present study indicated that community-dwelling people with and without diabetes used pain medication similarly. Pain medication was used mostly as needed instead of being regular.     

Barriers and enablers to screening and diagnosing diabetes distress and depression in people with type 2 diabetes mellitus: A qualitative evidence synthesis

AimSynthesise qualitative evidence of healthcare professionals’ (HCP) experiences of diabetes distress and depression screening in people with type 2 diabetes (T2DM) in primary care to identify HCP barriers and enablers to screening implementation.MethodsSearched six electronic databases in October 2020 for qualitative studies exploring HCPs’ experiences of diabetes distress and depression screening in T2DM populations. Applying a best-fit framework synthesis, data were coded to the theoretical domains framework (TDF), followed by thematic analysis of data that did not fit the TDF. Study quality and confidence in findings were assessed using CASP and GRADE-CERQual respectively.FindingsOf 4942 unique records identified, 10 articles were included. We identified fifteen barriers and enablers in 8 TDF domains and 1 new domain; people with T2DM factors. One barrier (poor awareness about the rationale for screening) and 2 enablers (perceived impacts on T2DM care, receiving financial reimbursement) were assessed as findings of high confidence.ConclusionHCPs experience many barriers and enablers to diabetes distress and depression screening among people with T2DM in primary care. Future interventions and policies should ensure HCPs understand the rationale for screening, highlight the benefits of screening, resource screening appropriately and address HCP group specific barriers.