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Archive for the ‘Gestational diabetes’ Category

Weighty Decisions: Drugs or Surgery for Diabetes?

Curator: Dr. Sudipta Saha, Ph. D.

 

A multicenter retrospective cohort study published in The Lancet has evaluated the effectiveness of GLP-1 receptor agonists (GLP-1 RAs), including semaglutide and tirzepatide, versus bariatric surgery in managing type 2 diabetes and obesity. The study was conducted using data from real-world clinical settings involving adults with type 2 diabetes and a body mass index (BMI) over 30.

Patients treated with GLP-1 RAs were found to have significant improvements in glycemic control and weight loss; however, bariatric surgery led to more pronounced and sustained reductions in HbA1c and body weight over a 2-year follow-up. Cardio-metabolic benefits, including blood pressure and lipid profile improvements, were also more prominent in the surgery group.

Despite this, GLP-1 RAs were associated with a lower incidence of early complications and shorter recovery times. Adverse gastrointestinal events were commonly reported in both groups, though surgical complications were more severe but less frequent.

This study suggested that while bariatric surgery remains the most effective intervention for sustained weight and glycemic outcomes, GLP-1 RAs offer a safer, non-invasive alternative with substantial benefit, particularly for patients ineligible or unwilling to undergo surgery. The potential for GLP-1 RA therapy to delay or reduce the need for surgical intervention was also discussed.

These findings have emphasized the importance of personalized treatment strategies based on patient comorbidities, preferences, and risk profiles.

References:

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00145-2/fulltext

https://pubmed.ncbi.nlm.nih.gov/27222544

https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2024

https://pubmed.ncbi.nlm.nih.gov/17715408

https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

https://pubmed.ncbi.nlm.nih.gov/32870301

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Tirzepatide Outperforms Semaglutide in Diabetes Control

Curator: Dr. Sudipta Saha, Ph. D.

In a recent clinical study published in The New England Journal of Medicine, the effectiveness of tirzepatide was compared with that of semaglutide in patients with type 2 diabetes. The trial was conducted to evaluate which of the two medications offers better glycemic control and weight loss benefits when combined with standard care.

It was found that participants treated with tirzepatide achieved significantly greater reductions in both HbA1c levels and body weight than those who received semaglutide. A once-weekly administration of tirzepatide was shown to be more effective across multiple dosages. These findings were consistent even in patients with longstanding diabetes and those previously treated with insulin or oral agents.

Gastrointestinal side effects were commonly observed in both groups, including nausea and diarrhoea, but were generally mild to moderate in severity. No new safety concerns were identified during the study period.

The enhanced dual agonist mechanism of tirzepatide, which targets both GIP and GLP-1 receptors, is believed to have contributed to its superior efficacy. While semaglutide acts only on the GLP-1 pathway, tirzepatide’s dual action is thought to improve insulin sensitivity, promote satiety, and reduce appetite more robustly.

This trial represents a significant advancement in diabetes care and suggests that tirzepatide may become a preferred treatment option in clinical practice. It has been proposed that future studies investigate its long-term cardiovascular effects, impact on diabetic complications, and cost-effectiveness in diverse populations.

References:

https://www.nejm.org/doi/full/10.1056/NEJMoa2416394

https://www.sciencedirect.com/science/article/pii/S154235652400226X

https://pubmed.ncbi.nlm.nih.gov/29364588

https://pubmed.ncbi.nlm.nih.gov/29364588

https://www.who.int/publications/i/item/9789241565257

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Chicoric Acid: A Natural Boost for Glucose Metabolism via AMPK Activation

Reporter: Dr. Sudipta Saha, Ph.D.

The study published in Journal of Functional Foods explores the molecular mechanisms underlying chicoric acid’s (CA) role in glucose metabolism. Chicoric acid, a natural polyphenolic compound found in plants like chicory and basil, has garnered attention for its anti-inflammatory and antidiabetic properties. The researchers investigated its potential to regulate glucose uptake and insulin sensitivity, focusing on the AMP-activated protein kinase (AMPK) pathway.

The experiments demonstrated that chicoric acid significantly enhances glucose uptake in insulin-sensitive and insulin-resistant cells. This effect was primarily mediated through the activation of AMPKα, a key metabolic regulator that responds to energy stress. The phosphorylation of AMPKα triggered downstream signaling cascades, including the activation of Akt, a protein crucial for glucose transporter type 4 (GLUT4) translocation to the cell membrane, thereby facilitating glucose uptake.

Interestingly, the study also noted that inhibiting AMPK activity reduced CA-induced Akt phosphorylation, confirming that AMPK activation is essential for chicoric acid’s metabolic effects. Furthermore, CA showed potential in improving insulin sensitivity, which is impaired in type 2 diabetes, by mitigating cellular oxidative stress and inflammation.

The findings suggest that chicoric acid could serve as a promising therapeutic candidate for managing diabetes and metabolic disorders. By targeting the AMPKα-Akt signaling axis, CA offers a dual benefit of improving glucose metabolism and reducing insulin resistance, highlighting its potential as a natural alternative for metabolic health interventions.

References

https://www.sciencedirect.com/science/article/abs/pii/S1756464619302774

https://pubmed.ncbi.nlm.nih.gov/22436748

https://pubmed.ncbi.nlm.nih.gov/11742412

https://pubmed.ncbi.nlm.nih.gov/12145153

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Reporter and Curator: Dr. Sudipta Saha, Ph.D.

 

Obesity is a global concern that is associated with many chronic complications such as type 2 diabetes, insulin resistance (IR), cardiovascular diseases, and cancer. Growing evidence has implicated the digestive system, including its microbiota, gut-derived incretin hormones, and gut-associated lymphoid tissue in obesity and IR. During high fat diet (HFD) feeding and obesity, a significant shift occurs in the microbial populations within the gut, known as dysbiosis, which interacts with the intestinal immune system. Similar to other metabolic organs, including visceral adipose tissue (VAT) and liver, altered immune homeostasis has also been observed in the small and large intestines during obesity.

 

A link between the gut microbiota and the intestinal immune system is the immune-derived molecule immunoglobulin A (IgA). IgA is a B cell antibody primarily produced in dimeric form by plasma cells residing in the gut lamina propria (LP). Given the importance of IgA on intestinal–gut microbe immunoregulation, which is directly influenced by dietary changes, scientists hypothesized that IgA may be a key player in the pathogenesis of obesity and IR. Here, in this study it was demonstrate that IgA levels are reduced during obesity and the loss of IgA in mice worsens IR and increases intestinal permeability, microbiota encroachment, and downstream inflammation in metabolic tissues, including inside the VAT.

 

IgA deficiency alters the obese gut microbiota and its metabolic phenotype can be recapitulated into microbiota-depleted mice upon fecal matter transplantation. In addition, the researchers also demonstrated that commonly used therapies for diabetes such as metformin and bariatric surgery can alter cellular and stool IgA levels, respectively. These findings suggested a critical function for IgA in regulating metabolic disease and support the emerging role for intestinal immunity as an important modulator of systemic glucose metabolism.

 

Overall, the researchers demonstrated a critical role for IgA in regulating intestinal homeostasis, metabolic inflammation, and obesity-related IR. These findings identify intestinal IgA+ immune cells as mucosal mediators of whole-body glucose regulation in diet-induced metabolic disease. This research further emphasized the importance of the intestinal adaptive immune system and its interactions with the gut microbiota and innate immune system within the larger network of organs involved in the manifestation of metabolic disease.

 

Future investigation is required to determine the impact of IgA deficiency during obesity in humans and the role of metabolic disease in human populations with selective IgA deficiency, especially since human IgA deficiency is associated with an altered gut microbiota that cannot be fully compensated with IgM. However, the research identified IgA as a critical immunological molecule in the intestine that impacts systemic glucose homeostasis, and treatments targeting IgA-producing immune populations and SIgA may have therapeutic potential for metabolic disease.

 

References:

 

https://www.nature.com/articles/s41467-019-11370-y?elqTrackId=dc86e0c60f574542b033227afd0fdc8e

 

https://www.jci.org/articles/view/88879

 

https://www.nature.com/articles/nm.2353

 

https://diabetes.diabetesjournals.org/content/57/6/1470

 

https://www.sciencedirect.com/science/article/pii/S1550413115001047?via%3Dihub

 

https://www.sciencedirect.com/science/article/pii/S1550413115002326?via%3Dihub

 

https://www.sciencedirect.com/science/article/pii/S1931312814004636?via%3Dihub

 

https://www.nature.com/articles/nature15766

 

https://www.sciencedirect.com/science/article/pii/S1550413116000371?via%3Dihub

 

https://www.nature.com/articles/nm.2001

 

https://www.sciencedirect.com/science/article/abs/pii/S1550413118305047?via%3Dihub

 

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Depression in early pregnancy linked to gestational diabetes, NIH study finds

Women with gestational diabetes at risk for postpartum depression.

 

“Of particular note, persistent depression from the first to second trimester set women at even greater risk for gestational diabetes” said the study’s senior author, Cuilin Zhang, M.D., Ph.D, in the Division of Intramural Population Health Research at NICHD.  Women who had the highest scores for depression in the first and second trimesters — about 17 percent — had nearly triple the risk for gestational diabetes when compared to women who had lower depression scores.

“Our results suggest it would be a good idea for clinicians to pay particular attention to women with high depression scores when evaluating the risk of gestational diabetes,” Dr. Zhang added.

SOURCE

https://www.nih.gov/news-events/news-releases/depression-early-pregnancy-linked-gestational-diabetes-nih-study-finds

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