Archive for month: December, 2024

“Elevated depressive symptoms were also associated with poorer diabetes self-management and reduced physical activity, emphasizing the importance of routine depression screening for men with type 1 diabetes,” the researchers wrote in Diabetes Research and Clinical Practice.

The researchers note that depression is more prevalent in diabetes, with 9–17.5% of adults with type 1 diabetes reporting elevated symptoms. Limited studies highlight sex differences, with higher rates in women. Depression negatively impacts insulin use, glucose monitoring, physical activity, and HDL, while increasing HbA1c, BMI, cholesterol, and cardiovascular complications in type 1 diabetes.

Against the above background, Kimberly A. Driscoll, University of Florida Diabetes Institute, University of Florida, Gainesville, FL, United States, and colleagues aimed to examine differences in the prevalence of elevated depressive symptoms between individuals with type 1 diabetes and those without diabetes, both overall and by sex, as well as the associations between depressive symptoms, HbA1c levels, self-management behaviors, and cardiovascular health.

For this purpose, the researchers analyzed data from adults with type 1 diabetes (n = 414; mean age 52 ± 9 years, diabetes duration 38 ± 9 years, mean HbA1c 7.8 ± 1.1 mg/dL, 55% female) and without diabetes (n = 488; mean age 51 ± 9 years, 51% female) from the fourth visit of the CACTI observational study.

Participants completed questionnaires on depressive symptoms and dietary intake, with those having type 1 diabetes also reporting on self-management behaviors. Hierarchical logistic regression models were used to identify demographic and clinical factors associated with depressive symptoms.

The following were the key findings of the study:

• Depressive scores were higher in individuals with type 1 diabetes compared to those without diabetes, overall and across both sexes.
• Men with type 1 diabetes had more than sevenfold increased odds of elevated depressive symptoms compared to men without diabetes (OR 7.4).
• There was no significant increase in odds for women with type 1 diabetes compared to those without diabetes (OR 1.4).
• There was a significant interaction between sex and diabetes status.
• Higher depressive symptoms were linked to lower engagement in self-management behaviors and reduced physical activity.

The researchers report that 10% of adults with type 1 diabetes experience depressive symptoms based on BDI-II assessments.

“There is an urgent need to incorporate routine screening for depressive symptoms in adults with type 1 diabetes as part of standard medical care and to explore interventions aimed at reducing their impact on diabetes outcomes,” the researchers concluded.

Reference:

Driscoll, K. A., Geno Rasmussen, C. R., O’Donnell, H., Trojanowski, P., Alman, A. C., Keshawarz, A., & Snell-Bergeon, J. K. (2024). Men with type 1 diabetes had more than 7-fold odds of elevated depressive symptoms compared to men without diabetes. Diabetes Research and Clinical Practice, 111947. https://doi.org/10.1016/j.diabres.2024.111947

A new study published in the The Journal of Nutrition, found that substituting two tablespoons of pure maple syrup for refined sugars reduced several cardiometabolic risk factors in humans. It was the first placebo-controlled clinical trial exploring potential health benefits of maple syrup in humans.

“We know from decades of research that maple syrup is more than just sugar. It contains over 100 natural compounds, including polyphenols, that are known to prevent disease in part through their anti-inflammatory effects,” remarked Dr. André Marette, PhD, and lead scientist on the study. “Because the fundamental chemistry of maple syrup is unique, I wondered if ingesting maple syrup instead of an equivalent amount of refined sugar would differently impact the cardiometabolic health and the intestinal microbiota in humans. The results were extremely encouraging. I did not expect to see so many improvements of risk factors within a relatively short treatment period.”

The study was conducted by a Laval University team led by Dr. André Marette, PhD, at the Quebec Heart and Lung Institute and Dr. Marie-Claude Vohl, PhD, at the Institute of Nutrition and Functional Foods.

Study Protocol

Forty-two volunteers from the greater Québec city area, between the ages of 18-75 in good health, and with a BMI of 23-40, participated in the study. Participants substituted 5% of their daily caloric intake (corresponding to 2 tablespoons) from refined sugars with either Canadian maple syrup or an artificially flavored sucrose syrup. Each phase lasted 8 weeks with participants switching between maple syrup and sucrose syrup groups after a four-week washout period. The cross-over design ensured that the same test subject was his or her own control, consuming both placebo and maple syrup. Primary outcomes focused on the oral glucose tolerance test, the OGTT. Secondary outcomes included changes in blood lipid profile, blood pressure, body fat composition (measured by DEXA scan) and changes in gut microbiota composition.

Maple, the Smarter Sweetener, Improves Multiple Cardiometabolic Risk Factors

Blood Sugar Lowered

Study participants who consumed pure maple syrup had an improved response to the oral glucose tolerance test (OGTT) than those who received a flavored syrup of refined sugar. Their bodies managed blood sugar levels better after eating (-50.59 vs. +29.93).

Blood Pressure Lowered

Blood pressure was also lowered in the subjects who consumed maple syrup during the trial. Systolic blood pressure decreased significantly in the maple syrup group (-2.72 mm Hg) while it increased slightly in the sucrose group (+0.87 mm Hg). “Lowering blood pressure continues to be an important factor in lessening the risk of cardiovascular disease,” Dr. Marette commented. “Natural sweeteners, such as pure maple syrup, when substituted for refined sugars, can be part of an overall solution in helping to prevent metabolic diseases.”

Abdominal Fat Reduced

Visceral fat is the deep fat that wraps around the internal organs in your belly. It can increase an individual’s risk of serious health problems such as heart disease, diabetes and stroke. The maple syrup trial showed that android fat mass, the fat in the abdominal region, significantly decreased in the maple syrup group as compared to an increase in the group consuming the sucrose solution (-7.83 g vs. +67.61 g).

Healthier Gut

An unexpected discovery was the improved levels of potentially beneficial gut bacteria and a decrease in levels of potentially harmful gut bacteria in the maple syrup participants. The study showed a reduction in Klebsiella species and Bacteroides pectinophilus, which are linked to inflammation and metabolic disorders, and the increased growth of beneficial bacteria like Lactocaseibacillus casei and Clostridium beijerinckii.

“Both individually and collectively, the study findings are quite significant,” Dr. Marette noted. “The combined decrease of such key risk factors may help to reduce the risk of diabetes and cardiovascular disease. Making a commitment to lifestyle changes and small adjustments to our everyday diets is important and can be a powerful tool in preventing future diseases.”

According to one participant: “Before the study, I would consume pure maple products regularly but not consistently. I have always enjoyed it. Today my routine is to replace refined sugars with 2 tablespoons of pure Canadian maple syrup daily.”

First Human Trial Builds Upon American Researcher’s Cellular and Animal StudiesNavindra P. Seeram,

Dr. Marette’s clinical study builds upon his own work in animal models of diabetes and previous work on maple syrup and its bioactives by American scientist  PhD, of the University of Rhode Island, College of Pharmacy. Dr. Seeram’s extensive foundational work with maple syrup set the stage for this first human clinical trial. “With each new study, we learn more benefits that natural products from medicinal plants and functional foods, like maple syrup, provide.” noted Dr. Seeram. “The significant promising results of this first human trial provide more reasons for us to educate consumers about maple syrup’s many health benefits. It is truly a ‘smarter sweetener’ and a healthier alternative to refined sugar.”

“While this study was limited to a relatively small sample size (42 men and women) and took place during a relatively short duration of time, the results are still significant,” Dr. Marette remarked. “We now have human evidence to support replacing refined sugars with maple syrup, a natural sweetener, for preventing metabolic diseases. Our next goal is to conduct larger studies with other populations to explore how replacing refined sugars with maple syrup might impact their unique health conditions.”

General nutrition claims for 2 tablespoons of maple syrup:

• Excellent source of manganese (35%).

• Good source of riboflavin (15%).

• Source of calcium (2%), thiamin (2%), potassium (2%) and copper (8%).

• It contains 12% fewer calories than in light corn syrup.

• By comparison, refined sugar requires a large amount of processing and therefore lacks any real nutritional value. 

Reference:

Arianne Morissette, Anne-Laure Agrinier, Théo Gignac, Lamia Ramadan, Khoudia Diop, Julie Marois, Thibault V Varin, Geneviève Pilon, Serge Simard, Éric Larose, Claudia Gagnon, Benoit J Arsenault, Jean-Pierre Després, Anne-Marie Carreau, Marie-Claude Vohl, André Marette, Substituting Refined Sugars With Maple Syrup Decreases Key Cardiometabolic Risk Factors in Individuals With Mild Metabolic Alterations: A Randomized, Double-Blind, Controlled Crossover Trial, The Journal of Nutrition, https://doi.org/10.1016/j.tjnut.2024.08.014.

Alopecia areata (AA) is a chronic, immune-mediated inflammatory disorder characterized by nonscarring hair loss. The management of Alopecia areata poses challenges due to its unpredictable course and variable response to treatment. In this comparative study, we evaluated the efficacy and safety of oral apremilast, intralesional corticosteroids (ILC) and a combination of both in patients with patchy Alopecia areata. Sixty patients with patchy Alopecia areatawere randomly assigned to three treatment groups: oral apremilast (Group A), ILC (Group B), and a combination of both (Group C). The Severity of Alopecia Tool (SALT) score was used to assess the extent of hair loss before treatment, after 3 months, and at 6 months of follow-up. Adverse events and complications were also monitored. The changes in SALT score from baseline between the three groups were assessed by using non-parametric statistical tests. The statistical significance was judged at 5% level of significance. Results: Findings demonstrated significant higher reduction in median SALT scores after treatment i.e., 2.47 (1.76, 5.07), p < 0.001 as well as after six months follow up 5.08 (3.80, 7.53), p < 0.001 in patients treated with ILC compared to other two groups. Neither apremilast monotherapy nor its combination with ILC demonstrated statistically significant improvement, although individual responses were observed. Complications were minimal, with transient pain and burning sensation reported during ILC injections and a few cases of gastritis and relapse in the oral apremilast group. These findings suggest that ILC remains an effective treatment option for patchy Alopecia areata. This study did not demonstrate statistically significant efficacy of oral apremilast, either as monotherapy or in combination with ILC, though larger studies may be needed to evaluate potential benefits in specific patient subgroups. Further research with larger sample sizes and longer-term follow-up is needed to validate these findings and optimize treatment approaches for Alopecia areata.

Reference:

Awasthi, S., Nijhawan, M., Mishra, A. et al. Comparing the efficacy of oral apremilast, intralesional corticosteroids, and their combination in patients with patchy alopecia areata: a randomized clinical controlled trial. Arch Dermatol Res 317, 129 (2025). https://doi.org/10.1007/s00403-024-03642-5

Keywords:

Intralesional, corticosteroids, remains, effective, treatment, option, patchy, Alopecia areata, reveals, research, Archives of Dermatological Research, Awasthi, S., Nijhawan, M., Mishra, A

Low rectal cancer is a challenging disease to treat because of its anatomical location and high risk of recurrence. Although laparoscopic surgery reduces recovery time and postoperative pain, the long-term oncologic outcome has been a controversy, especially in cases of low rectal cancer. This study compared 3-year disease-free survival and overall survival of laparoscopic versus open surgery for low rectal cancer.

The study included 1,070 patients aged 18–75 years with histologically confirmed low rectal adenocarcinoma within 5 cm from the dentate line. Patients were randomly assigned in a 2:1 ratio to either laparoscopic surgery (685 patients) or open surgery (354 patients). Participants were stratified according to the clinical stage, age, sex, BMI, and ASA classification. The main outcome measure of interest was 3-year disease-free survival, defined as locoregional recurrence, distant metastasis, or death.

Key findings of the study were as follows:

3-Year Disease-Free Survival:

• Laparoscopic surgery: 81.4% (95% CI 78.2 to 84.1).

• Open surgery: 79.8% (95% CI 75.2 to 83.6).

• HR: 0.92 (95% CI 0.69 to 1.23; p = 0.56).

• Non-inferiority margin met with a difference of 1.60% (97.5% CI -3.34 to ∞).

3-Year Overall Survival:

• Laparoscopic surgery: 91.7% (95% CI 89.3 to 93.5).

• Open surgery: 93.7% (95% CI 90.6 to 95.8).

• HR: 1.34 (95% CI 0.82 to 2.19; p = 0.24).

3-Year Locoregional Recurrence:

• Laparoscopic surgery: 3.7% (95% CI 2.5 to 5.3).

• Open surgery: 2.3% (95% CI 1.1 to 4.3).

• HR: 1.64 (95% CI 0.74 to 3.63; p = 0.22).

5-Year Overall Survival:

• Laparoscopic surgery: 84.6% (95% CI 81.5 to 87.1).

• Open surgery: 86.6% (95% CI 82.5 to 89.8).

• HR: 1.16 (95% CI 0.82 to 1.64; p = 0.41).

This multicenter trial confirms that laparoscopic surgery is non-inferior to open surgery for 3-year disease-free survival in patients with low rectal cancer. These findings provide strong evidence that supports laparoscopic surgery as the effective and minimally invasive alternative to open surgery for low rectal cancer.

Reference:

Jiang, W., Xu, J., Cui, M., Qiu, H., Wang, Z., Kang, L., Deng, H., Chen, W., Zhang, Q., Du, X., Yang, C., Guo, Y., Zhong, M., Ye, K., You, J., Xu, D., Li, X., Xiong, Z., Tao, K., … LASRE trial investigators. (2024). Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial. The Lancet. Gastroenterology & Hepatology. https://doi.org/10.1016/S2468-1253(24)00273-5

The study aimed to investigate the impact of serum Podoplanin levels on diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM). Patients and methods: Between January 2022 and December 2023, the Department of Nephrology at Nantong Second People’s Hospital selected 276 patients with T2DM and 150 healthy controls for this investigation. Systematic data collection was performed to gather information on biomarkers and biochemical parameters. Results: When T2DM patients (n=276) and healthy controls (n=150) were compared, considerably lowered serum Podoplanin levels were observed. In all 276 patients, serum Podoplanin levels were negatively associated with age (r=− 0.127, P=0.035), body mass index (BMI) (r=− 0.292, P< 0.001), duration of diabetes (r=− 0.323, P< 0.001), systolic blood pressure (SBP) (r=− 0.255, P< 0.001), diastolic blood pressure (DBP) (r=− 0.138, P=0.022), fasting blood glucose (FBG) (r=− 0.196, P=0.001), glycated hemoglobin (HbA1c) (r=− 0.095, P=0.117), triglyceride (TG) (r=− 0.157, P=0.009), total cholesterol (TC) (r=− 0.126, P=0.036), low-density lipoprotein cholesterol (LDL-C) (r=− 0.187, P=0.002), serum creatinine (Scr) (r=− 0.500, P< 0.001), neutrophil gelatinase-associated lipocalin (NGAL) (r=− 0.339, P< 0.001), and kidney injury molecule-1 (KIM-1) (r=− 0.568, P< 0.001), and was positively correlated with high-density lipoprotein cholesterol (HDL-C) (r=0.343, P< 0.001) and estimated glomerular filtration rate (eGFR) (r=0.442, P< 0.001). The multivariate logistic regression analysis showed that diabetic patients with DN had lowered levels of serum Podoplanin (OR=0.022, 95% CI=0.005– 0.100; P< 0.001), lower SBP, Scr, NGAL, and KIM-1. The results indicated that diabetic patients with DN have lower levels of serum Podoplanin. A more considerable population-based prospective investigation is essential to validate our findings.

Reference:

Huan F, Jiang X. Serum Podoplanin Levels as a Potential Biomarker for Diabetic Nephropathy Progression: A Cross-Sectional Study. Diabetes Metab Syndr Obes. 2024;17:4701-4710

https://doi.org/10.2147/DMSO.S500608

Keywords:

Lower, levels, serum, Podoplanin, may, predict, diabetic, nephropathy, among, diabetes, patients, study, podoplanin, type 2 diabetes mellitus, diabetic nephropathy, biomarker, Huan F, Jiang X, Diabetes Metabolic Syndrome