Euglycemic diabetic ketoacidosis in the era of SGLT-2 inhibitors

BMJ Open Diabetes Research & Care, Год журнала: 2023, Номер 11(5), С. e003666 - e003666

Опубликована: Окт. 1, 2023

Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with increasing use sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. This review highlights the growing incidence EDKA and its diagnostic challenges due to absence hallmark hyperglycemia seen in (DKA). The paper presents a classification system for severity EDKA, categorizing it into mild, moderate, severe based on serum pH bicarbonate levels. Another proposed define stages anion gap ketones at time diagnosis during treatment period. A algorithm guide clinicians managing EDKA. includes monitoring insulin fluid management, slower transition subcutaneous prevent relapse. Increased awareness essential timely because early can improve clinical outcomes.

Язык: Английский

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Autophagy, Pyroptosis and Ferroptosis are Rising Stars in the Pathogenesis of Diabetic Nephropathy

Diabetes Metabolic Syndrome and Obesity, Год журнала: 2024, Номер Volume 17, С. 1289 - 1299

Опубликована: Март 1, 2024

Abstract: Diabetic nephropathy (DN) is one of the most common microvascular complications in diabetes and can potentially develop into end-stage renal disease. Its pathogenesis complex not fully understood. Podocytes, glomerular endothelial cells (GECs), mesangial (GMCs) tubular epithelial (TECs) play important roles normal function glomerulus tubules, their injury involved progression DN. Although our understanding mechanisms leading to DN has substantially improved, we still need find more effective therapeutic targets. Autophagy, pyroptosis ferroptosis are programmed cell death processes that associated with inflammation closely related a variety diseases. Recently, growing number studies have reported autophagy, regulate podocytes, GECs, GMCs TECs. This review highlights contributions pyroptosis, these cells, offering potential targets for treatment. Keywords: diabetic nephropathy, ferroptosis,

Язык: Английский

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Association Between Atherogenic, Thrombogenic, and Lipophilic Indices and the Odds of Diabetic Nephropathy in Type 2 Diabetic Patients: A Case–Control Study

Food Science & Nutrition, Год журнала: 2025, Номер 13(3)

Опубликована: Март 1, 2025

The quality of fats in the diet affects development chronic kidney disease. In this study, we aimed to understand relationship between dietary fat markers and risk diabetic nephropathy (DN) patients with Type 2 diabetes (T2DM).In case retrospective 309 T2DM (151 DN, 158 without DN) were included. A 147 item questionnaire measuring food frequency International Physical Activity Questionnaire (IPAQ) used. Anthropometric indices, biochemical factors measured or recorded from patient's files. Quantitative Insulin Sensitivity Check Index (QUICKI), Homeostatic Model Assessment for Resistance (HOMA-IR), atherogenic, thrombogenic, lipophilic indices calculated. Modified nutritionist IV software USDA composition table Odds ratios (OR) 95% confidence intervals (CI) obtained using a case-control design. Age, BMI, energy 1 physical activity, blood glucose, level insulin, lipid profile, creatinine level, CRP adjusted as interventions 2. Compared control subjects, had significantly higher body mass index (BMI), fasting sugar (FBS), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) well lower intakes energy, carbohydrates, mono-and polyunsaturated fatty acids, fiber, compared controls. After adjustment possible confounders, highest quartile atherogenic (OR: 3.49, CI: 1.65-7.41), thrombogenic 4.3, 1.86-8.72), 3.50, 1.62-7.52) odds DN than those lowest quartile. There was considerable (including indices) chance developing nephropathy.

Язык: Английский

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Controlling nutritional status (CONUT) score is a novel marker of type 2 diabetes mellitus and diabetic microvascular complications

Postgraduate Medicine, Год журнала: 2024, Номер 136(5), С. 496 - 503

Опубликована: Июнь 26, 2024

Type 2 diabetes mellitus (T2DM) and its microvascular complications are characterized by chronic inflammation. The Controlling Nutritional Status (CONUT) score is a tool used to assess nutritional status often associated indirectly with inflammatory processes. We aimed compare the CONUT scores of T2DM patients those healthy volunteers without complications.

Язык: Английский

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Factors associated with treatment responses to pioglitazone in patients with steatotic liver disease: A 3‐year prospective cohort study

Diabetes Obesity and Metabolism, Год журнала: 2024, Номер 26(7), С. 2969 - 2978

Опубликована: Апрель 29, 2024

The response rate to pioglitazone and the predictive factors for its effects on improving liver biochemistry in patients with steatotic disease (SLD) remain elusive, so we aimed investigate these issues.

Язык: Английский

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Lipid Toxicity in the Cardiovascular-Kidney-Metabolic Syndrome (CKMS)

Biomedicines, Год журнала: 2024, Номер 12(5), С. 978 - 978

Опубликована: Апрель 29, 2024

Recent studies of Cardiovascular-Kidney-Metabolic Syndrome (CKMS) indicate that elevated concentrations derivatives phospholipids (ceramide, sphingosine), oxidized LDL, and lipoproteins (a, b) are toxic to kidney heart function. Energy production for renal proximal tubule resorption critical fuels electrolytes is required homeostasis. Cardiac energy ventricular contraction/relaxation preferentially supplied by long chain fatty acids. Metabolism acids accomplished within the cardiomyocyte cytoplasm mitochondria means glycolytic, tricarboxylic acid, electron transport cycles. Toxic lipids excessive lipid may inhibit cardiac contraction requires calcium movement from sarcoplasmic reticulum a high low concentration at relatively cost. relaxation involves return lower higher more consumption. Diastolic dysfunction occurs when conversion inadequate. diminished ATP availability in presence inadequate blood pressure, glycemia, or control lead failure. Similar disruption tubular fuels/electrolytes has been found be associated with phospholipid (sphingolipid) accumulation. Elevated tissue low-density lipoprotein cholesterols loss filtration efficiency level glomerular podocyte. Macroscopically deposits epicardial intra-nephric adipose vascular pathology, fibrosis, inhibition essential functions both kidney. Chronic triglyceride accumulation fibrosis liver, structures. Successful kidney, allograft these vital organs does not eliminate risk toxicity. Lipid lowering therapy assist protecting organ function before after transplantation.

Язык: Английский

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Oxidative stress in diabetes mellitus and its complications: From pathophysiology to therapeutic strategies

Chinese Medical Journal, Год журнала: 2024, Номер unknown

Опубликована: Авг. 8, 2024

Oxidative stress due to aberrant metabolism is considered as a crucial contributor diabetes and its complications. Hyperglycemia hyperlipemia boost excessive reactive oxygen species generation by elevated mitochondrial respiration, increased nicotinamide adenine dinucleotide phosphate oxidase activity, enhanced pro-oxidative processes, including protein kinase C pathways, hexosamine, polyol, advanced glycation endproducts, which exacerbate oxidative stress. plays significant role in the onset of associated complications impairing insulin production, increasing resistance, maintaining hyperglycemic memory, inducing systemic inflammation. A more profound comprehension molecular processes that link new preventive therapeutic strategies. Therefore, this review discusses mechanisms underlying how contributes mellitus We also summarize current approaches for prevention treatment targeting pathways diabetes.

Язык: Английский

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Sodium-Glucose Co-Transporter 2 Inhibitors and Severe Urinary Tract Infections: Real-World Meta-Analysis of Cohort Studies

Annals of Pharmacotherapy, Год журнала: 2025, Номер unknown

Опубликована: Янв. 30, 2025

There is limited knowledge about severe urinary tract infections associated with SGLT2i, despite this being the basis for Food and Drug Administration (FDA) warning. We aim to provide real-world evidence clarify relationship further. A literature review was performed in PubMed Embase cohort studies published up August 2024 using PICO-consistent terms. Cohort English involving new users of SGLT2i that compare glucagon-like receptor agonists (GLP-1RA), DPP4i, other glucose-lowering medications report infection (UTI). The random-effect model determined odds ratio (OR) 95% confidence interval (CI) UTI. Subgroup analysis meta-regression were used identify sources heterogeneity. In 11 679 617 individuals type 2 diabetes mellitus a median age 64 (interquartile range [IQR] = 56-72) 42% (IQR 39%-51%) females, it found use reduced risk UTI compared both composite (OR 0.73, CI 0.60-0.88) DPP4i 0.48, 0.43-0.54). no significant difference GLP-1RA 0.94, 0.78-1.14). lack increased reassures physicians when assessing benefit-risk continue after This may enhance patient adherence improve management. Furthermore, our findings show increase chronic kidney disease (CKD) patients who would benefit significantly from SGLT2i. does not appear pose greater than oral medications. contributes existing on UTI, accounting event's severity. However, more data are needed assess potential association between life-threatening events.

Язык: Английский

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Correlation Between Triglyceride‐Glucose Index and Microvascular Complications in Patients With Early‐ Onset of Type 2 Diabetes Mellitus

Endocrinology Diabetes & Metabolism, Год журнала: 2025, Номер 8(2)

Опубликована: Фев. 13, 2025

ABSTRACT Objective This study aimed to explore the potential correlation between triglyceride‐glucose (TyG) index and diabetic nephropathy (DN) retinopathy (DR) in patients with early‐onset type 2 diabetes mellitus (T2DM). Design cross‐sectional statistically analysed TyG levels across DN DR stages non‐early‐onset T2DM. Patients A total of 1530 T2DM were enrolled January 2017 August 2023 at Tianjin Fourth Central Hospital Tianjin. Measurements Correlation analysis logistic regression used examine association microvascular complications. Kaplan–Meier plots Cox analyses employed evaluate effects on incidence. index's diagnostic ability for was explored using area under receiver operating characteristic curve. Results In T2DM, gradually decreased aggravation increased aggravation, showing a negative positive T2DM; suggested that an independent risk factor (OR = 1.623, 95% CI 1.175–2.242). The higher associated earlier incidence Conclusion could be complications, elevated potentially indicating high insulin– resistance related renal injury.

Язык: Английский

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Repurposing Metformin for the Treatment of Atrial Fibrillation: Current Insights

Vascular Health and Risk Management, Год журнала: 2024, Номер Volume 20, С. 255 - 288

Опубликована: Июнь 1, 2024

Metformin is an orally effective anti-hyperglycemic drug that despite being introduced over 60 years ago still utilized by estimated 120 to 150 million people worldwide for the treatment of type 2 diabetes (T2D). used off-label polycystic ovary syndrome (PCOS) and pre-diabetes weight loss. a safe, inexpensive with side effects mostly limited gastrointestinal issues. Prospective clinical data from United Kingdom Diabetes Study (UKPDS), completed in 1998, demonstrated metformin not only has excellent therapeutic efficacy as anti-diabetes but also good glycemic control reduced risk micro- macro-vascular complications, especially obese patients thereby diabetes-associated cardiovascular disease (CVD). Based on long history use safety record been investigated be repurposed numerous other diseases including anti-aging agent, Alzheimer's dementias, cancer, COVID-19 atrial fibrillation (AF). AF most frequently diagnosed cardiac arrythmia its prevalence increasing globally population ages. The argument repurposing based combination retrospective vivo vitro pre-clinical laboratory studies. In this review, we critically evaluate evidence cardioprotective actions assess whether support reduce treat AF.

Язык: Английский

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