insulin glargine (Abasaglar / Basaglar / LY2963016)

Metaphoric medicine: A retrospective clinical audit of glycaemic outcomes associated with an analogy-based consultation framework for insulin-treated type 2 diabetes mellitus.

Omar Muhammad Hanif MH, Zakaria Zainal Fitri ZF, Wan Mohd Nasruddin Wan Nusairi WN, Mokhlis Muzawani M

Poor glycaemic control among patients with insulin-treated type 2 diabetes mellitus (T2DM) in Malaysia remains a major challenge despite increased insulin use. Patient education is limited by complex medical explanations and lack of standardised consultation protocols. Methods: We conducted a retrospective clinical audit of patients with T2DM attending a structured self-monitoring of blood glucose (SMBG) clinic from January to July 2023. Patients on insulin with glycated haemoglobin (HbA1c) levels of >8.5% were consecutively enrolled into a multicomponent care package comprising the Metaphoric Medicine Practical Roadmap for Insulin Management Essentials (M2-PRIME) consultation framework, an analogy-based educational tool employing the 'garbage and lorry' metaphor as well as structured 6-week follow-ups, SMBG review and insulin dose adjustment. The primary outcomes were changes in HbA1c and fasting blood sugar (FBS) levels at 6 months. Eighty-nine patients completed follow-up (mean age=57.2 years; women=57.5%). The mean baseline HbA1c and FBS levels were 11.88% (±1.84) and 12.54 mmol/L (±6.32), respectively. After 6 months, the HbA1c level decreased by 1.57% (95% CI=1.14, 2.00; P<0.001) and the FBS level by 3.32 mmol/L (95% CI=2.21, 4.44; P<0.001). The HbA1c and FBS levels improved in 63 (70.8%) and 59 (66.3%) patients, respectively. Consultations incorporating the M2-PRIME were associated with clinically meaningful pre-post reductions in HbA1c and FBS levels among poorly controlled insulin-treated T2DM cases. However, without a control group, the independent contribution of the M2-PRIME cannot be isolated from concurrent insulin intensification and structured follow-up. These findings are preliminary and hypothesis-generating. A prospective randomised controlled trial is warranted.

Firmicutes/Bacteroidetes ratio of the gut microbiota and its association with abdominal obesity and insulin resistance (METS-IR) in Korean adults.

Park Jae-Min JM, Choi Ja-Eun JE, Kwon Yu-Jin YJ, Lee Ji-Won JW et al.

The gut microbiota has been increasingly implicated in the pathogenesis of obesity and insulin resistance. The Firmicutes/Bacteroidetes (F/B) ratio may serve as a marker of metabolic health; nonetheless, evidence for its association with abdominal obesity and insulin resistance in Asian populations remains scarce. This retrospective cross-sectional study included 186 Korean adults undergoing health check-ups. Gut microbiota composition was assessed by 16S rRNA gene sequencing, and the phylum-level F/B ratio was calculated. Abdominal obesity was defined using waist circumference criteria for Asian populations, and insulin resistance was evaluated using the metabolic score for insulin resistance (METS-IR). Participants were categorized into F/B ratio quartiles. Associations between the F/B ratio, abdominal obesity, and insulin resistance were examined using linear and logistic regression analyses with adjustment for potential confounders. Higher F/B ratios were inversely associated with waist circumference and METS-IR. Abdominal obesity prevalence decreased progressively across increasing F/B ratio quartiles. In multivariable linear regression analyses, the F/B ratio remained independently associated with lower METS-IR (β =  - 0.911, p = 0.040). In fully adjusted logistic regression models, participants in the highest F/B ratio quartile had significantly lower odds of abdominal obesity than did those in the lowest quartile (OR = 0.17, 95% CI 0.05-0.59). In Korean adults, the gut microbial F/B ratio was inversely associated with abdominal obesity and insulin resistance, as assessed by METS-IR, a composite index reflecting adiposity-related metabolic dysfunction. These findings suggest that gut microbiota composition may be metabolically relevant to visceral adiposity-related metabolic dysfunction and that the F/B ratio could serve as a complementary indicator for metabolic risk stratification.

Deconstructing Triglyceride Glucose-Body Mass Index in Normal-Weight Women with Polyendocrine Metabolic Ovarian Syndrome.

Dumesic Daniel A DA, Grogan Tristan R TR, Song Michelle M MM, Singhal Vibha V

To study the biological pathways underlying the triglyceride glucose-body mass index, calculated as natural logarithm (plasma triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2) × body mass index, in normal-weight women with polyendocrine metabolic ovarian syndrome and age-/body mass index-matched normoandrogenic ovulatory (control) women, and to determine whether the triglyceride glucose-body mass index in such women is a useful clinical predictor of reduced in vitro fertilization pregnancy outcome. Retrospective cohort study SUBJECTS: Twenty-one normal-weight women with polyendocrine metabolic ovarian syndrome and 19 age- and body mass index-matched controls. All women underwent fasting circulating metabolic/androgenic determinations. The triglyceride glucose-body mass index was compared between women with polyendocrine metabolic ovarian syndrome and age-/body mass index-matched controls and correlated with metabolic/androgenic outcomes. Serum luteinizing hormone/androgen levels and fasting serum triglyceride/insulin levels were significantly greater in women with polyendocrine metabolic ovarian syndrome than controls (luteinizing hormone/androgen levels, P<0.005 all values; triglyceride, P=0.028; insulin, P=0.037). Adipose insulin resistance also was increased in women with polyendocrine metabolic ovarian syndrome versus controls (P < 0.005). Triglyceride glucose-body mass index and homeostasis model assessment of insulin resistance, however, were not significantly different by female type. In multivariable linear regression, triglyceride glucose-body mass index was unassociated with polyendocrine metabolic ovarian syndrome, serum free testosterone or fasting serum insulin levels. Instead, in all women combined, higher triglyceride glucose-body mass index levels were associated with greater adipose insulin resistance (P=0.01), higher serum non-high-density lipoprotein cholesterol (P=0.02), and lower serum high-density lipoprotein cholesterol (P=0.02) levels. Adipose insulin resistance accompanying altered lipid metabolism underlies the triglyceride glucose-body mass index of normal-weight women with polyendocrine metabolic ovarian syndrome and age-/body mass index-matched controls. The triglyceride glucose-body mass index, however, may have limited utility in predicting reduced in vitro fertilization pregnancy outcome in normal-weight women with polyendocrine metabolic ovarian syndrome, although confirmation in similar cohorts undergoing in vitro fertilization is needed.

Insulin-like growth factor binding protein 4 (IGFBP4)high fibroblasts contribute to extracellular matrix degradation in rheumatoid arthritis.

Liang Yangyang Y, Xue Jing J, Zhu Zeqin Z, Nian Miaomiao M et al.