Insulin replacement is the current therapeutic option for type-1 diabetes. However, exogenous insulin cannot precisely represent the normal pattern of insulin secretion. Another therapeutic strategy is transplantation of pancreatic islets, but this is limited by immune rejection, intrinsic complications, and lack of donor availability. Stem cell therapy that results in the regeneration of insulin-producing cells represents an attractive choice. However, with advancing age, stem cells also undergo senescence, which leads to changes in the function of various cellular processes that result in a decrease in the regeneration potential of these aging stem cells. In this study, the effect of young and aging mesenchymal stem cells (MSCs) on the regeneration of pancreatic beta cells in streptozotocin (STZ)-induced type-1 diabetic mice was observed after hypoxic preconditioning. Hypoxia was chemically induced by 2, 4-dinitrophenol (DNP). Plasma insulin and glucose levels were measured at various time intervals, and pancreatic sections were analyzed histochemically. The effect of DNP was also analyzed on apoptosis of MSCs by flow cytometry and on gene expression of certain growth factors by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). We observed that hypoxic preconditioning caused changes in the gene expression levels of growth factors in both young and aging MSCs. Young MSCs showed significant regeneration potential compared with the aging cells in vivo. However, hypoxic preconditioning was able to improve the regeneration potential of aging MSCs. It is concluded from the present study that the regeneration potential of aging MSCs into pancreatic β-cells can be enhanced by hypoxic preconditioning, which causes changes in the gene expression of certain growth factors.

IntroductionObesity is a condition in which excess fat accumulate in body to such an extent that it may cause harmful effects on health 1 . Genetic and environmental factors play important role in development of obesity. Together with environmental factors, increased fat intake or decreased physical activities, obesity may result from changes in energy balance i.e. energy storage and harvest 2 . Obesity may be linked to development of several other serious ailments in-

Background: The rate of mortality is increasing in diabetic patients due to diabetes associated complications. The common complications include neuropathy, nephropathy, retinopathy, foot ulcer, slow wound healing, kidney dysfunction, amputation, dysfunction of organs, frequent infections, sepsis, skin diseases, hearing impairment, cardiovascular disorders etc. These complications can be diagnosed following some common symptoms such as increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, irritability, blurred vision, slow-healing sores etc. This survey was designed to study the prevalence of various complications in a group of diabetic patients so that effective treatment options could be developed against the most prevalent complications. Methods: This cross-sectional study was conducted in 2019 in a tertiary care hospital of Karachi after the approval of the ethical committee of the hospital as well as in the University of Karachi. To perform this study, a questionnaire was designed comprised of different questions related to diabetic complications. The consent form was attached to each questionnaire in which the patient agreed to participate voluntarily in this survey. The diabetic patients who visited the General Physician OPD were the subjects of this survey. All designed questions included in the questionnaire were asked either directly from the patients or their attendants. Results: A total of 160 diabetic subjects were part of the study range between the ages of 11 to 90 years. Out of 160 patients, 52 were males and 108 were females. Among all subjects, 124 (78%) patients were type 2 while 57 (36%) were type 1 diabetic patients. 117 (73%) showed confusion of mind, 104 (65%) complained of blood pressure, and 105 (66%) had hypertension, 106 (66%) had eye damage (retinopathy), 96 (60%) were facing trouble focusing vision and 70 (44%) were experiencing seizures, 63 (39%) patients had laser treatment, 68 (43%) showed wounds on foot and slow wounds healing, 49 (31%) were having kidney damage (nephropathy), 79 (49%) had pain in legs or knee, 35 (22%) and 26 (16%) were complained of heart problems and liver damage respectively. Some patients were found to deal with more hunger, i.e., 99 (62%) patients, 118 (74%) were experiencing frequent urine desire, 138 (86%) showed fatigue, 123 (77%) were complained of thirst, 35 (22%) had nausea, 30 (19%) had frequent cold, 36 (23%) had skin problems, 17 (11%) patients showed frequent vomiting, 19 (12%), 13 (8%) and 16 (10%) were experiencing acne formation, stroke and nerve damage (neuropathy) respectively. Conclusion: All age groups showed diabetes-associated complications and different abnormal body conditions. However, the age groups ranging from thirty to eighty years showed more complications. The most prevalent complications reported were retinopathy, nephropathy, diabetic wounds on the foot, slow wound healing, seizures, hypertension, neuropathy, skin infections, cardiovascular disorders, liver damage and stroke in both types of diabetic patients. Our survey may aid in pointing out the most prevalent diabetic complications prevailing in our population so that effective treatment options could be developed to reduce these life-threatening complications.

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