Clinical implications While there is no clearly defined subtype of metabolic frailty, the observation that lean older adults are especially vulnerable to aging-related illness has several clinical implications Assessment of in vivo endogenous insulin reserve (eg fasting or stimulated C-peptide) to assess the functional reserve of the pancreatic -cell, disproportionately decreased by insulin resistance Screen regularly for sarcopenia and frailty, both of which directly influence glucose disposal and metabolic resilience Attempt to avoid hypoglycaemia and overtreatment due to limited physiological reserve and counterregulation Focus on resistance exercise, protein intake, maintenance of muscle mass and functional status These considerations are consistent with principles of geriatric guidelines for diabetes but hold even greater mechanistic importance in the context of age-related decline in insulin secretory reserve and metabolic flexibility These considerations are of particular relevance to older adults with diabetes aged 65 years or older but should be interpreted with caution as biological heterogeneity is further increased beyond age 80 years A summary of the diagnostic and therapeutic procedure in SAGE-DM is presented in Fig
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Both peptides may also affect cytokine expression and reduce inflammatory processes, and Epitalon additionally shows anti-cancer effects in animal studies
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Administration of malvidin-3- O -glucoside was found to attenuate the depressive-like behavior through its ability to cross the BBB and upregulation of Rac1 expression in the nucleus accumbens (Wang et al., 2018), a protein whose depletion contributes to the disturbed synaptic structure in depression (Golden et al., 2013)
Nature 197 , 186 (1963)
