Objective. To evaluate the effects of berberine on insulin resistance, glycemic outcomes, and car-diometabolic risk markers in Iraqi adults with type 2 diabetes (T2D). Material and methods. A 12-week, randomized, double blind, placebo-controlled trial was conducted in 100 adults with T2D receiving stable oral therapy and baseline glycated hemoglobin (HbA1c) between 7% and 10%. Participants were allocated to berberine 500 mg twice daily (n = 50) or matched placebo (n = 50). Outcomes included fasting plasma glucose (FPG), HbA1c, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and safety assessments. Analyses followed an intention-to-treat approach. Results. Baseline characteristics were comparable between groups [homeostatic model assessment of insulin resistance (HOMA-IR) score 4.62 +/- 1.50 vs. 4.50 +/- 1.42]. At week 12, HOMA-IR decreased by-1.60 +/- 1.09 with berberine versus-0.47 +/- 0.92 with placebo [between-group difference-1.13; 95% confidence interval (CI)-1.53 to-0.73]. Berberine also produced larger reductions in FPG (-32.4 +/- 19.8 vs. -11.7 +/- 18.5 mg/dL) and HbA1c (-0.9 +/- 0.5% vs. -0.3 +/- 0.4%). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides improved significantly, and hs-CRP declined more with berberine (-0.9 +/- 1.1 vs. -0.3 +/- 1.0 mg/L; p = 0.02). Treatment was generally well tolerated with mild gastrointestinal symptoms. Conclusions. Over 12 weeks, berberine as an adjunct to standard oral therapy meaningfully improved insulin resistance, glycemic control, and several cardiometabolic markers in Iraqi adults with T2D, with acceptable tolerability
Objective. This study aimed to evaluate the association between glycemic control, circulating irisin levels, and cognitive function in individuals with type 2 diabetes (T2D). Material and methods. This cross-sectional observational study included 120 adults with T2D. Glycemic control was assessed using fasting plasma glucose and glycated hemoglobin (HbA1c). Serum irisin levels were measured by enzyme-linked immunosorbent assay. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Correlation analyses and multivariable linear regression were performed after adjusting for potential confounders. Results. A total of 120 patients with T2D were included in the study. Participants with cognitive impairment were older and had a longer duration of diabetes than cognitively normal individuals. They also had significantly higher fasting plasma glucose (168.9 +/- 41.6 vs. 138.6 +/- 32.4 mg/dL, p < 0.001) and HbA1c levels (8.6 +/- 1.2 vs. 7.2 +/- 0.9%, p < 0.001). Serum irisin levels were significantly lower in the cognitively impaired group (2.89 +/- 0.97 vs. 4.62 +/- 1.21 ng/mL, p < 0.001). Irisin levels correlated positively with the MoCA score (r = 0.54, p < 0.001) and negatively with HbA1c (r = -0.48, p < 0.001). Conclusions. The findings of this study suggest that lower circulating irisin levels may be associated with cognitive dysfunction in individuals with T2D and may serve as a potential biomarker for the early identification of diabetes-related cognitive impairment.
Objective: To compare the effects of a tight glycated hemoglobin (HbA1c) target (< 7.0%) versus a less tight target (< 7.5%) on microvascular complications in adults with poorly controlled type 2 diabetes (T2D) in Egypt. Material and methods: In this parallel-group, randomized controlled trial, 80 adults (18-60 years) with T2D, baseline HbA1c > 7.5%, and mild-to-moderate non-proliferative diabetic retinopathy (NPDR) were randomized by computer-generated simple randomization to a tight target (Group A; n = 33) or a less tight target (Group B; n = 47) and followed for 6 months. Glycemic indices, renal parameters (albumin-to-creatinine ratio and estimated glomerular filtration rate), and neuropathy (Douleur Neuropathique 4 questionnaire) were assessed at baseline and 6 months. Retinopathy worsening was defined as >= 1-step progression on the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. Results: At 6 months, Group A achieved lower HbA1c than Group B [6.23% +/- 0.35 (45 mmol/mol) vs. 7.27% +/- 0.23 (56 mmol/mol); p < 0.001], with lower fasting plasma glucose and 2-hour postprandial glucose (both p < 0.001). Retinopathy worsening occurred more frequently in Group A than Group B (63.6% vs. 14.9%; p < 0.001). Overall new-onset or progressive microvascular complications were higher in Group A (84.8%) than Group B (31.9%; p < 0.001), including albuminuria (36.4% vs. 14.9%; p = 0.026) and neuropathy (39.4% vs. 10.6%; p = 0.002). Conclusions: Although tighter glycemic targets improved glycemic indices, they were associated with substantially higher short-term retinopathy worsening and greater overall microvascular deterioration. Individualized targets and gradual HbA1c reduction with close ophthalmologic follow-up may mitigate early worsening risk.
