The effect of Dulaglutide on glycemic and weight control in patients with type 2 diabetes.

Background and aims: The objectives of type 2 diabetes treatment are to achieve adequate long-term glycemic control and to reduce the risk associated with comorbidities and complications. Once-weekly Dulaglutide showed a reduction in cardiovascular risk associated with diabetes in addition to improved glycemic control and bodyweight reduction in several clinical trials. We aimed to investigate the effect of Dulaglutide 1.5 mg on glycemic and weight control in type 2 diabetes patients inadequately controlled by antihyperglycemic treatment in real-world clinical practice. Methods: We retrospectively reviewed the medical records of 50 patients with type 2 diabetes inadequately controlled by previous treatment and newly initiated on Dulaglutide. The data were collected at 6 months (n=50) and 12 months (n=40) after Dulaglutide therapy initiation. Results: Dulaglutide treatment resulted in significant improvement of glycated hemoglobin (-1.3 %; p<0.001) after 6 months and after 12 months (-2.0 %; p<0.001). Significant bodyweight reduction was found after 6 months (-2.0 kg; p=0.002) and 12 months (-3.5 kg; p=0.001) of Dulaglutide treatment initiation. In addition, a reduction in insulin dose was observed. Conclusions: Our clinical data showed that Dulaglutide 1.5 mg significantly improved glycemic and bodyweight control at 6 and 12 months after treatment initiation in patients with type 2 diabetes inadequately controlled by previous antihyperglycemic treatment.

Variability in Sleep Timing and Dietary Intake: A Scoping Review of the Literature.

The objective of this scoping review was to summarize previous studies which examined the effect of day-to-day variability in sleep timing and social jetlag (SJL) on dietary intake. A systematic literature search was conducted in PubMed, Embase, and Clarivate Analytics Web of Science and we identified 22 records. No difference in caloric and macronutrient intake between SJL groups was observed in studies that enrolled healthy young adults. However, studies that enrolled participants with obesity and obesity-related chronic conditions reported a higher caloric intake and a higher intake of carbohydrates, total fat, saturated fats, and cholesterol in participants with SJL than in those without. Most studies reported a lower quality of diet, a delayed mealtime, and eating jetlag in participants with SJL vs. those without SJL. No correlation of day-to-day variability in sleep timing with average caloric intake was observed, but bed-time variability was negatively associated with diet quality. Methodological issues have been identified in sources assessed including study design, power calculation, population enrolled, and tools/metrics used for sleep timing variability assessment. Future well powered longitudinal studies, with clear protocols, standardized metrics, including all age groups from general population are needed to clarify the dietary intake consequences of variability in sleep timing.

SUDOSCAN, an Innovative, Simple and Non-Invasive Medical Device for Assessing Sudomotor Function.

Diabetic autonomic neuropathy is probably the most undiagnosed but serious complication of diabetes. The main objectives were to assess the prevalence of peripheral and autonomic neuropathy in a population of diabetic patients, analyze it in a real-life outpatient unit scenario and determine the feasibility of performing SUDOSCAN tests together with widely used tests for neuropathy. A total of 33 patients were included in the study. Different scoring systems (the Toronto Clinical Neuropathy Score-TCNS; the Neuropathy Disability Score-NDS; and the Neuropathy Symptom Score-NSS) were applied to record diabetic neuropathy (DN), while the SUDOSCAN medical device was used to assess sudomotor function, detect diabetic autonomic neuropathy and screen for cardiac autonomic neuropathy (CAN). Fifteen (45.5%) patients had sudomotor dysfunction. The SUDOSCAN CAN risk score was positively correlated with the hands' electrochemical sweat conductance (ESC), diastolic blood pressure (DBP), the level of the glycated hemoglobin, as well as with the TCNS, NDS and NSS. Performing SUDOSCAN tests together with other tests for DN proved to be a feasible approach that could be used in daily clinical practice in order to screen for DN, as well as for the early screening of CAN, before more complex and time-consuming tests.

Chronic disruption of circadian rhythm with mistimed sleep and appetite - an exploratory research.

This research aimed to explore the relation of social jetlag (SJL) with perceived appetite, and hormones involved in hunger regulation in healthy subjects in free-living conditions (study registration number: ACTRN12618001182280). Eighty normally diurnally active men and women were enrolled in 4 study groups according to the presence of SJL and sleep deprivation (2 groups with SJL with or without sleep deprivations and 2 groups without SJL with or without sleep deprivation) matched 1:1:1:1 for age, gender, and body mass index. Appetite was assessed in fasting state, by measuring acylated ghrelin level and using 100 mm visual analog scales. Persons with SJL had a higher perceived appetite for pork, poultry, fish, eggs, milk, and dairy products and higher acylated ghrelin levels than those without SJL. When considering the presence of sleep deprivation, subjects with SJL, with and without sleep deprivation, reported a higher perceived appetite than group with sleep deprivation alone. They also reported later meal times for lunch and dinner, had more frequently a snack before sleep and reported eating more frequently while watching TV or playing on computer, suggesting poorer eating habits in these subjects. In conclusion, independent of sleep duration, SJL is associated with an increased appetite for caloric dense food, suggesting an increased incentive value of food in these subjects and an anticipated pleasure of ingesting these foods.

Social jetlag and sleep deprivation are associated with altered activity in the reward-related brain areas: an exploratory resting-state fMRI study.

OBJECTIVE: The aim of this research was to assess the effect of social jetlag (SJL) and its interaction with partial sleep deprivation on resting-state brain activity using the fractional amplitude of low-frequency fluctuation (fALFF) during free-living conditions. METHODS: A total of 28 normal weight healthy subjects were enrolled in four study groups (with SJL [with sleep deprivation and without sleep deprivation] and without SJL [with sleep deprivation and without sleep deprivation]), matched 1:1:1:1 for age, gender, and body mass index (BMI). Resting-state functional magnetic resonance imaging (fMRI) scans were collected with SIEMENS 3T scanner while subjects were in a fasting state. RESULTS: Participants with SJL had significantly higher fALFF values in right lingual gyrus and right putamen and significantly lower fALFF values in left and right inferior parietal lobe in comparison with participants without SJL and without sleep deprivation. Subjects with sleep deprivation had significantly higher fALFF in the thalamus and left superior frontal gyrus. In those with both SJL and sleep deprivation, we observed higher fALFF values in right Brodmann Area (BA)18 and lower values in left and right parietal inferior lobe. Subjects with SJL alone had significantly lower fALFF values in left frontal mid gyrus (BA6) than those with sleep deprivation alone. CONCLUSIONS: SJL was associated with altered resting-state brain activity in regions that have been shown to be involved in hedonic feeding. The effect of SJL was independent of effects induced by short sleep duration. These alterations might represent the substrate for the increased risk of obesity observed in those with SJL.

Measurement of current perception thresholds using the Neurometer(®) - applicability in diabetic neuropathy.

The incidence of diabetes mellitus is continuously growing worldwide, while the specific chronic complications that it induces have a negative impact on life expectancy andquality, entailing extremely high costs of healthcare services. Diabetic peripheral neuropathy is one of the most common chronic complications of diabetes, affecting almost half of diabetic people during life. This review aims at summarizing the evidence on the advantages and the usefulness of current perception threshold measurement for peripheral diabetic neuropathy assessment. Among the different methods used for the screening and diagnosis of diabetic neuropathy, measurement of current perception threshold using the Neurometer® has the ability to assess three sub-types of nerve fiber by producing transcutaneous electrical stimuli at frequencies of 2000, 250 and 5 Hz. Current evidence shows that this method provides a useful, noninvasive evaluation technique of patients with peripheral nervous system disorders, being able to detect neuropathy in the earliest and asymptomatic stages.