Diabetes management in the era of artificial intelligence.

Artificial intelligence is growing quickly, and its application in the global diabetes pandemic has the potential to completely change the way this chronic illness is identified and treated. Machine learning methods have been used to construct algorithms supporting predictive models for the risk of getting diabetes or its complications. Social media and Internet forums also increase patient participation in diabetes care. Diabetes resource usage optimisation has benefited from technological improvements. As a lifestyle therapy intervention, digital therapies have made a name for themselves in the treatment of diabetes. Artificial intelligence will cause a paradigm shift in diabetes care, moving away from current methods and toward the creation of focused, data-driven precision treatment.

Effects of Chios mastic gum on cardiometabolic risk factors.

Chios mastic gum (CMG), the resin produced by the trunk of Pistachia lentiscus var Chia, has been used for culinary and medicinal purposes since antiquity. Despite the fact that Pistacia species are widely distributed throughout the Mediterranean basin and in the circum-Mediterranean regions, CMG is a distinctive resin of the mastic trees grown exclusively in the southern part of the island of Chios. CMG has been used for centuries as a spice, a cosmetic, but its most important usage has been as a strong phytotherapeutic therapy, primarily for the management of gastrointestinal diseases. Recently, there are studies demonstrating that CMG has hypolipidemic, cardioprotective and antidiabetic properties. Therefore, the aim of the present review is to summarize the existing literature data regarding the potential beneficial effects of CMG on cardio-metabolic risk factors.

Role of dipeptidyl peptidase 4 inhibitors in the new era of antidiabetic treatment.

The last few years important changes have occurred in the field of diabetes treatment. The priority in the therapy of patients with diabetes is not glycemic control per se rather an overall management of risk factors, while individualization of glycemic target is suggested. Furthermore, regulatory authorities now require evidence of cardiovascular (CV) safety in order to approve new antidiabetic agents. The most novel drug classes, i.e., sodium-glucose transporter 2 inhibitors (SGLT2-i) and some glucagon-like peptide-1 receptor agonists (GLP-1 RA), have been demonstrated to reduce major adverse CV events and, thus, have a prominent position in the therapeutic algorithm of hyperglycemia. In this context, the role of previously used hypoglycemic agents, including dipeptidyl peptidase 4 (DPP-4) inhibitors, has been modified. DPP-4 inhibitors have a favorable safety profile, do not cause hypoglycemia or weight gain and do not require dose uptitration. Furthermore, they can be administered in patients with chronic kidney disease after dose modification and elderly patients with diabetes. Still, though, they have been undermined to a third line therapeutic choice as they have not been shown to reduce CV events as is the case with SGLT2-i and GLP-1 RA. Overall, DPP-4 inhibitors appear to have a place in the management of patients with diabetes as a safe class of oral glucose lowering agents with great experience in their use.

Aspirin in primary prevention of cardiovascular disease in diabetes.

It is well established that people with diabetes are at an increased risk of cardiovascular disease compared with those without diabetes. Although the protective role of aspirin in secondary prevention is well documented, its role in primary prevention of cardiovascular disease in people with diabetes, after the results of major clinical trials and meta-analyses, is unclear. The observed discrepancies might be explained in part in terms of the differences between the background cardiovascular risks, follow-up periods, age and gender of the study populations. Recently, the results of the ASCEND trial in people with diabetes documented the cardiovascular benefit of aspirin for primary prevention, but with an increased risk of bleeding that might outweigh the observed cardiovascular benefit. Therefore, current guidelines recommend its use for primary prevention in people with and without diabetes under specific circumstances. The purpose of the present review is to summarize the existing literature data regarding the place that aspirin has in primary prevention of cardiovascular disease in people with diabetes.

Ketone bodies and the heart.

Ketone bodies are low chain organic substances with four carbon atoms, with ß-hydroxybutyric acid and acetone being the main ketone bodies in blood circulation. Under physiological conditions their levels are low while during conditions of oxidative stress, such as exercise, fasting state and acute illness, ketone body levels are increased. Recent findings have shown that in patients with heart failure their plasma concentration is increased. There is a positive correlation between increased energy metabolism of myocardial cells and the levels of ß-hydroxybutyric acid and acetone. Furthermore, it has been hypothesized that the mild ketosis caused by sodium glucose cotransporter 2 inhibitors is one of the possible pathogenetic mechanisms explaining the significant cardiovascular and renal benefits observed in patients with type 2 diabetes treated with these agents. The aim of the present review is to summarize the role of ketone bodies in both normal and pathological conditions, such as heart failure.

Effects of Glucagon-like Peptide-1 Receptor Agonists and Sodium-glucose Cotransporter 2 Inhibitors on Cardiorenal and Metabolic Outcomes in People Without Diabetes.

During the last decade, the results of large-scale, randomized, clinical trials on newer antidiabetic agents, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium glucose cotransporter type 2 (SGLT2) inhibitor, have been published showing promising findings on cardiovascular and renal outcomes. Besides improving glycemic control, GLP-1 receptor agonists have been shown to modify cardiovascular risk factors, such as insulin resistance, body weight, blood pressure (BP), and lipid profile. Additionally, SGLT2 inhibitors except for glycemic control have been shown to induce weight loss and decrease BP. However, there are limited data regarding their effect on patients without diabetes. Therefore, the aim of the present review is to summarize the existing literature data regarding the effects of newer antidiabetic therapies on patients without diabetes.

Diabetes and dementia - the two faces of Janus.

Patients with type 2 diabetes are at high risk for cognitive decline and dementia. Despite the limited data on the possible pathogenetic mechanisms, evidence suggests that cognitive decline, and thus dementia and Alzheimer's disease, might arise from a complex interplay between type 2 diabetes and the aging brain, including decreased insulin signalling and glucose metabolism, mitochondrial dysfunction, neuroinflammation, and vascular disease. Furthermore, there is increasing interest on the effects of antidiabetic agents on cognitive decline. There are many studies showing that antidiabetic agents might have beneficial effects on the brain, mainly through inhibition of oxidative stress, inflammation, and apoptosis. In addition, experimental studies on patients with diabetes and Alzheimer's disease have shown beneficial effects on synaptic plasticity, metabolism of amyloid-ß, and microtubule-associated protein tau. Therefore, in the present review, we discuss the effects of antidiabetic agents in relation to cognitive decline, and in particular dementia and Alzheimer's disease, in patients with type 2 diabetes.

The COVID-19 pandemic and diabetes mellitus.

COVID-19, a disease caused by a novel coronavirus, SARS-CoV-2, has reached the proportion of a pandemic and presents with either mild and moderate symptoms or in severe cases with acute respiratory distress syndrome, multiple organ dysfunction syndrome and even death. Older age, hypertension, cardiovascular disease, diabetes mellitus and obesity significantly increase morbidity and mortality in COVID-19 patients. In the present review we summarize the existing, and daily growing, data on the impact of COVID-19 infection on patients with diabetes, their antidiabetic therapy as well as the extra precautions, apart from good glucose control, they have to take in order not to contract the virus. Social distancing and strict hand hygiene are of great importance in order to help the global goal of eradication of the disease.

The influence of gene polymorphisms on postprandial triglyceride response after oral fat tolerance test meal in patients with diabetes mellitus.

AIMS: We evaluated the influence of CETP (rs5882 and rs708272), APOE (rs7412, rs429358) and LPL (rs328) gene polymorphisms on triglyceride (TG) response to oral fat tolerance test (OFTT) meal in patients with well-controlled type 2 diabetes mellitus (T2DM). METHODS: Fifty-one men underwent OFTT and according to postprandial TG response patients were divided into two subgroups (positive [TG ≥ 220 mg/dL, 31 patients] and negative [TG < 220 mg/dL, 20 patients]). All patients were genotyped, and study variants were detected using polymerase chain reaction (PCR) and restricted fragment length polymorphism (RFLP) analysis. RESULTS: Patients with genotype SS of LPL gene compared with genotype SX had more frequently positive response to OFTT (P = .04) and lower high-density lipoprotein cholesterol (HDL-C) concentration (P = .03). Patients with positive response to OFTT and genotype SS of LPL gene compared with genotype SX had lower AUC (area under the curve)-TG, 1744 (368) vs 1887 (807) mg/dL/h, respectively, P = .04. CETP and APOE gene polymorphisms had no influence on postprandial TG response to OFTT. CONCLUSIONS: In patients with well-controlled T2DM, LPL but not CETP and APOE gene polymorphisms influenced TG postprandial response. Particularly, S447 allele carriers of LPL gene presented more frequently positive postprandial TG response to OFTT compared with 447X allele carriers. No differences were found between allele carriers of patients with negative response to OFTT in any other studied gene polymorphism.

Biomarkers and Gene Polymorphisms in Members of Long- and Short-lived Families: A Longevity Study.

BACKGROUND: The influence of biomarkers in human lifespan has been investigated but with no clear results yet. MATERIALS AND METHODS: Lipids, Uric Acid (UA), Adiponectin (ADIPOQ), Insulin-like Growth Factor (IGF-1), cholesteryl ester transfer protein (CETP) and angiotensin-converting enzyme (ACE) proteins, as well as CETP, ADIPOQ, insulin-like growth factor binding protein-3 (IGFBP3) and ACE-gene polymorphisms were evaluated in 149 Greek individuals. The Long-Lived Families (LON) (n=84) comprised of 3 generations: long-lived aged ≥90 years (P), offspring (FL1) and their grandchildren (FL2), while the Short-Lived Families (EAD) (n=65) where both parents died <75 years, comprised of 2 generations: middle-aged (FD1) and children (FD2). RESULTS: Serum CETP and IGF-1 levels were lower, whereas AdipoQ concentrations were higher in P compared with FL1 and FL2 members (CETP: p = 0.03 for both comparisons; IGF-1 p < 0.001 for both comparisons and ADIPOQ: p = 0.001 and p = 0.004, respectively). Furthermore, serum triglycerides, UA and glucose concentrations were higher in FD1 compared with FD2 subjects (p=0.001, 0.02 and ≤0.001, respectively). In FD2 and FL2, CETP levels were lower in individuals with B2B2 compared with B1B1 genotype (p=0.007). Additionally, ACE concentrations were higher in individuals with DD compared with II genotype in both Families (p=0.001). After adjustment for age and gender, CETP levels were lower in P and FL2 individuals with B2B2 compared with the B1B1 genotype (p=0.004 and 0.007, respectively). CONCLUSION: Increase serum TGs, UA and GL concentrations were higher in the middle-aged individuals compared with their children in families independently of their lifespan. The serum adiponectin concentration was the highest in the oldest old individuals implying beneficial influence on lifespan. Independently of family's lifespan history, the youngest individuals with CETPB2B2 genotype, compared with individuals with CETPB1B1 genotypes, had lower serum CETP concentrations. The knowledge of the unfavourable gene(s)influencing human lifespan may be helpful in encouraging individuals to follow healthier lifestyle habits and better control their high-risk biomarkers.

The Oral Dipeptidyl-Peptidase-4 Inhibitor Sitagliptin Increases Circulating Levels Of Stromal-Derived Factor-1 Alpha.

Recent studies have demonstrated that stromal derived factor-1α (SDF-1α) is a substrate of dipeptidyl-peptidase-4 (DPP-4) inhibitors. It has also been shown that SDF-1α shares anti-apoptotic as well as nephroprotective properties and exerts a beneficial effect in the cardiovascular system. Therefore, the aim of this study was to estimate the effect of treatment with the DDP-4 inhibitor sitagliptin on SDF-1α levels in subjects with type 2 diabetes mellitus (T2D). Overall, 32 patients (16 males) with T2D, mean age (±SD) 67.2±8.3 years, HbA1c 6.4±0.5%, body-mass index (BMI) 29.1±4.9 Kg/m2, T2D duration 8.5±4.0 years receiving metformin monotherapy (17 participants) or metformin plus sitagliptin (15 participants) without known cardiovascular disease were enrolled. Patients on metformin plus sitagliptin exhibited higher plasma levels of SDF-1α compared with those on metformin monotherapy (19.6±4.1 versus 6.9±1.3 pg/ml, respectively, p=0.01). Multivariate regression analysis after controlling for age, sex, body-mass index, smoking, arterial hypertension, dyslipidaemia and other confounders showed that SDF-1α levels were positively correlated with DPP-4 inhibitor treatment (beta=0.91, p=0.001), and negatively with T2D duration (beta=- 0.42, p=0.05), ΗDL-cholesterol levels (beta=- 0.46, p=0.02) and HbA1c (beta=- 0.41, p=0.05). In conclusion, these results suggest that sitagliptin treatment may exert a favourable effect on SDF-1α levels.

Type 2 diabetes and quality of life.

It is true that a primary goal of diabetes early diagnosis and treatment is quality of life (QoL). The term QoL is still confusing but it is agreed that it composes of four components: The physical component, mental, cogitative component, psychological and social component. Many articles have been written addressing those four components. During the last five years 15500 articles and reviews have been written addressing diabetes and coronary arterial disease, 16100 addressing diabetes and renal function, 28900 addressing diabetes and retinopathy, 16800 addressing diabetic foot ulcers and other 26300 addressing diabetic neuropathy. Moreover 17200 articles are dealing with diabetic sexual dysfunction, 24500 with the correlation of diabetes and depression 17500 about diabetes and dementia, only 1 about diabetes and family functioning and 1950000 about diabetes and QoL, indicating the worldwide interest. In order to confront this metabolic anomaly and its consequences, researchers developed numerous generic and disease specific psychometric tools. With the aid of those psychometric tools the scientific community has started to realize the gruesome effect of diabetes on patients' lives. Diabetic's QoL becomes worse when complications start to develop or comorbidities coexist. Dominant amongst complications, in health-related quality of life (HRQoL) lowering, but not related to risk factors (genetic, the weight of birth, or others) is coronary arterial disease followed by renal failure, blindness, and the combination of micro- and macro-vascular complications and in some studies by sexual dysfunction. Moreover many are the comorbidities which deteriorate further the effect of diabetes in a patient life. Among them obesity, hypertension, dyslipidemia, depression, arthritis are the most common. Most intriguing field for research is the interaction of diabetes and depression and in some cases the progression to dementia. Many aspects and combinations of actions are under researchers' microscope regarding the improvement of HRQoL scores. Until now, the studies performed, have demonstrated little to moderate benefit. More of them are needed to draw safe conclusions on the topic of the best combination of actions to optimize the HRQoL scores.

A Palpable Painless Axillary Mass as the Clinical Manifestation of Castleman's Disease in a Patient with Hepatitis C Disease.

Introduction. Castleman's disease (CD) is a rare lymphoproliferative disorder. CD is divided into two clinical subtypes: the most common unicentric and the less usual multicentric subtype. The majority of unicentric CD affects the mediastinum, while neck, abdomen, and axilla are less common locations. Case Presentation. Herein, we describe a rare case of unicentric CD in the right axilla in a 36-year-old white male with a medical history of hepatitis C virus infection admitted to our hospital due to palpation of a painless mass in the right axilla. Complete excision of the lesion was performed and, one year after the diagnosis, patient was free of the disease. Conclusions. Although infrequent, it is important to include CD in the differential diagnosis when evaluating axillary lymphadenopathy particularly in young patients with a low-grade inflammation process and chronic disease even in the absence of an abnormal blood picture or organomegaly.

Diabetes-dependent quality of life (ADDQOL) and affecting factors in patients with diabetes mellitus type 2 in Greece.

BACKGROUND: Diabetes mellitus type 2 (T2D) is a chronic metabolic disease with a great impact on health status and quality of life (QoL) in terms of physical, social, and psychological well-being. The aim of the present study was to measure diabetes-dependent QoL and affecting factors in patients with T2D. METHODS: Study population was consisted by 258 subjects with T2D attending diabetic outpatient clinics of General Hospitals of Piraeus "Tzaneio" and Nikaia "Ag.Panteleimon" during September-December 2014. The Audit of Diabetes-Dependent Quality of Life questionnaire was carried out in all study participants. RESULTS: Diabetes mellitus type 2 had a negative impact to QoL in 37.3 % of the study participants while 32.9 % believed that their life would have been better without the presence of T2D. Diabetes had negative impact on working life (-1.3 ± 0.6), health status (-1.3 ± 0.2), family (-1.3 ± 0.6) and sexual life (-1.3 ± 0.3), future perspectives (-1.3 ± 0.4) and dietary habits (-1.7 ± 0.2). The results of logistic regression analysis showed that QoL was related with age [odds ratio (OR) 0.94, 95 % confidence intervals (CIs) 0.91-1.98, P = 0.008] and marital status (OR 0.43, 95 %CIs 0.21-0.90, P = 0.03). CONCLUSIONS: The results of the present study showed that T2D per se has a negative impact to patient's QoL most of all affecting working life, health status, family and sexual life, future perspectives and dietary habits. Age and marital status were the only determinants of QoL.

Linking pre-diabetes with benign prostate hyperplasia. IGFBP-3: a conductor of benign prostate hyperplasia development orchestra?

Benign prostatic hyperplasia (BPH) represents a pattern of non-malignant growth of prostatic fibromuscular stroma. Metabolic disturbances such us pre-diabetes and metabolic syndrome may have a role in BPH pathophysiology. A potential explanation for the above relationship involves the insulin-like growth factor (IGF) axis as well as IGF binding proteins, (IGFBPs) of which the most abundant form is IGFBP-3. Therefore, the aim of the present study was to investigate the association between intra-prostatic levels of IGF-1, IGF-2 as well as to evaluate the role of locally expressed IGFBP-3 in BPH development in pre-diabetes. A total of 49 patients admitted to the Urology department of a tertiary urban Greek hospital, for transurethral prostate resection, or prostatectomy and with pre-diabetes [impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) or both] were finally included. The majority of the sample consisted of subjects with IGT (51.0%), followed by IFG and IGT (32.7%) and isolated IFG (16.3%). For all participants a clinical examination was performed and blood samples were collected. In addition, total prostate (TP) volume or transitional zone (TZ) volume were estimated by transrectal ultrasonography. The results of the multivariate analysis regarding TP volume showed that higher PSA (p<0.001), larger waist circumference (p=0.007) and higher IGFBP-3 expression levels (p<0.001) independently predicted higher TP volume. The results regarding the volume of the TZ showed that higher PSA (p<0.001), larger waist circumference (p<0.001) and higher IGFBP-3 expression levels (p=0.024) were independently associated with higher TZ volume. Our findings show that intra-prostatic levels of IGFBP-3, PSA and waist circumference, but not overall obesity, are positively associated with prostate volume. IGFBP-3 seems to be a multifunctional protein, which can potentiate or inhibit IGF activity.