One Night of Prolonged Fasting Improves Nocturnal Substrate Oxidation
A randomized trial included 11 participants with NAFL and 10 control participants who did either an overnight 9.5-hrs of fasting (short period) or 16-hrs of fasting (extended). Hepatic glycogen levels were not affected by extending overnight fasting time in the NAFL or control group. Extending fasting time led to a lower nocturnal carbohydrate oxidation and higher fat oxidation in both groups.
Severe Hypoglycaemia in Patients Receiving Insulin and Sulphonylureas
A study found that incidence of severe hypoglycaemia was lower in T2D patients treated sulphonylureas than insulin. Risk of SH increased with age, diabetes duration, creatinine, a BMI more than 30 kg/m2 and low HbA1c. The validated prediction tool can identify those at high risk and optimise their treatment to minimise risk by switching of insulin/SU, reducing dose, or changing to Gliclazide MR.
SURMOUNT-1: Safety and Efficacy of Tirzepatide in Adults With Obesity or Overweight
Tirzepatide 15mg reduced body weight in adults with obesity or overweight compared to placebo. Upto 57% of participants achieved the ≥ 20% weight–reduction target withTirzepatide. Of participants who had prediabetes >95% reverted to normoglycemia in Tirazepatide group. There was 0.5% decrease in HbA1c and an improvement in insulin sensitivity with all doses of Tirazepatide at 72 weeks.
Improved Beta Cell Function Following 8 weeks High-intensity Interval Training
HIIT combining rowing and cycling induced beta-cell function in men with T2D, and to a smaller extent in obese and lean controls. No differences were seen in the HIIT induced responses on insulin secretion and insulin sensitivity. However, after the HIIT-protocol, the beta-cell function was still severely impaired in men with T2D, suggesting that this component of T2D is less reversible.
Effects of Different Volumes of Exercise on Beta Cell Function
A study found that 16 weeks of high volume of exercise along with dietary weight loss improves beta-cell function more than standard care or diet alone in adults with T2D. The improvement was mediated by improved insulin sensitivity, whereas adding exercise to the dietary intervention did not seem to increase glucose- or meal-stimulated insulin secretion beyond dietary weight loss alone.
Precision Medicine in Diabetes: How Far Can We Get?
Precision Medicine in diabetes is an approach to reduce hyperinsulinemia, visceral adiposity, improve insulin sensitivity, reduce liver fat content and beta cell protection. Replication of prediabetes clusters, prospective treatment trials, identification of early/predictive biomarkers of the clusters, redefining endotypes help deliver more precise treatment in prediabetics.
Chances and Opportunities With Precision Medicine
Precision medicine involves intelligent analysis of data about a person's biology, behaviors, clinical characteristics or contextual features to reduce error in medical decision making. It should refine the characterization of disease and optimize its prevention, diagnosis, treatment or prognosis. It should be safer, efficacious, accessible and economically viable than contemporary medicine.
Enterovirus Infection is Linked to Type 1 Diabetes
A meta-analysis found that enterovirus infection is associated with type 1 diabetes and islet autoimmunity. The virus may affect the functions of the host cell, inducing β cell death, decreasing insulin mRNA expression and insulin secretion, and disrupting the Golgi apparatus. The study provide a scientific basis for the possible prevention of T1D through vaccines and other means.
Semaglutide Reduces the 10-year T2D Risk in Overweight or Obese People
A study presented by T.W. Garvey at EASD showed that treatment with Semaglutide 2.4 mg reduces the 10-year risk of T2D by nearly 60% regardless of initial glycaemic status. In adults with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight.
Effect of SGLT2i Dapagliflozin on Substrate Metabolism in Humans With Prediabetes
Dapagliflozin treatment for 2 weeks in prediabetics improved fat oxidation. It had significant effects on 24h glucose and free fatty acid levels, and on nocturnal β-hydroxybutyrate levels. Dapagliflozin also improved skeletal muscle mitochondrial oxidative capacity. The study concluded that dapagliflozin elicits metabolic health effects that may mimic the effects of calorie restriction.
Different Effects of SGLT-2i on Subcutaneous and Epicardial Adipose Tissue Metabolome
SGLT-2i elicits different metabolic responses in subcutaneous (SAT) and epicardial (EAT) adipose tissue of heart failure subjects, with SAT showing mainly accented ketogenesis, while the preservation of EAT suggests other functions including potential cardioprotection. The exact role of increased sphingolipids and ether linked lipids in both adipose tissue depots remains to be elucidated.
Association Between Microangiopathic Complications and Cardiac Structure and Function
Valensi P. evaluated the relationship between microangiopathic complications and left ventricle structural and functional alterations in patients with T2D. Multivariate analyses showed that hypertrophy, septal thickness and NT-proBNP were significantly associated with the number of microangiopathic complications, independently from gender, diabetes duration, hypertension and SMI.
Accuracy of a Real-time Continuous Glucose Monitoring System During Cardiac Surgery
A study determined Dexcom G6 CGMS accuracy during cardiac surgery using hypothermic ECC. The mean absolute relative difference between sensor and reference method was 29.1% during surgery and 41.6% during deep hypothermic cardiac arrest. Conditions such as DHCA challenge Dexcom G6 performance. However, the accuracy recovered in most cases with adequate performance in the post-surgery period.
Fully Automated Closed-loop Insulin Delivery vs Standard Insulin Therapy
Dr C.K. Boughton evaluated the safety and efficacy of fully closed-loop insulin delivery compared with standard insulin therapy in adults with T2D. It was found that fully closed-loop insulin delivery reduced HbA1c and improved glucose control without increasing the risk of hypoglycaemia in adults with T2D. The treatment may represent a safe and effective method of achieving glycaemic target.
Cardio-renal-metabolic Interplay: Emerging Notions and Clinical Treatment Strategies
Dr Eberhard described the role of Cardio-Renal-Metabolic specialists in changing cardio–renal metabolic landscape which included assuring early diagnosis of DM, CKD and CVD (HF) by signs, symptoms and biomarkers (eGFR/albuminurea/Natriuretic peptides), assuring compliance with cardio-nephrologic therapy, addressing cardio-renal protection and tailoring personalized glucose lowering therapy.
Mechanistic Insights into the Effects of Empagliflozin in Patients With T2D and Heart Failure
The EFFORT trials, included 63 patients with T2D and HF, showed that the Empagliflozin significantly reduced the biomarker KIM-1 compared to placebo. It had a renal tubular protective effect in HF patients. It also contributed to the reduction of adverse cardiac remodelling. These CV benefits of empagliflozin can most likely not be explained by anti-inflammatory actions.
SGLT2i: Key Treatment Option Beyond T2D Regardless of Cardiac Ejection Fraction
HF Patients are likely to benefit from SGLT2i treatment, regardless of ejection fraction. And its benefits in diabetes prevention seems to be consistent with Dapagliflozin. Treating HF patients with prediabetes by a SGLT2i is an attractive opportunity. Its mechanism involves improvement of insulin sensitivity and secretion, reduction of glucose variability and depression of sympathetic activity.
