Search

Background: Diabetic foot ulcers (DFU) pose a significant health risk in diabetic patients, with insufficient revascularization during wound healing being the primary cause. This study aimed to assess microvessel sprouting and wound healing capabilities using vascular endothelial growth factor (VEGF-A) and a modified fibroblast growth factor (FGF1). Methods: An ex vivo aortic ring rodent model and an in vivo wound healing model in diabetic mice were employed to evaluate the microvessel sprouting and wound healing capabilities of VEGF-A and a modified FGF1 both as monotherapies and in combination. Results: The combination of VEGF-A and FGF1 demonstrated increased vascular sprouting in the ex vivo mouse aortic ring model, and topical administration of a combination of VEGF-A and FGF1 mRNAs formulated in lipid nanoparticles (LNPs) in mouse skin wounds promoted faster wound closure and increased neovascularization seven days post-surgical wound creation. RNA-sequencing analysis of skin samples at day three post-wound creation revealed a strong transcriptional response of the wound healing process, with the combined treatment showing significant enrichment of genes linked to skin growth. Conclusion: f-LNPs encapsulating VEGF-A and FGF1 mRNAs present a promising approach to improving the scarring process in DFU., CC BY 4.0 DEED© 2024 by the authors.Correspondence Address: S. Tejedor; Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, 431 50, Sweden; email: sandra.tejedorgascon1@astrazeneca.com; K. Hansson; Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, 431 50, Sweden; email: kenny.m.hansson@astrazeneca.comThis research was partially funded by grants from the Swedish Knowledge Foundation, grant number 20200014.

Metabolic disorders, encompassing diabetes mellitus, cardiovascular diseases, gastrointestinal disorders, etc., pose a substantial global health threat, with rising morbidity and mortality rates. Addressing these disorders is crucial, as conventional drugs often come with high costs and adverse effects. This review explores the potential of royal jelly (RJ), a natural bee product rich in bioactive components, as an alternative strategy for managing metabolic diseases. RJ exhibits diverse therapeutic properties, including antimicrobial, estrogen-like, anti-inflammatory, hypotensive, anticancer, and antioxidant effects. This review's focus is on investigating how RJ and its components impact conditions like diabetes mellitus, cardiovascular disease, and gastrointestinal illnesses. Evidence suggests that RJ serves as a complementary treatment for various health issues, notably demonstrating cholesterol- and glucose-lowering effects in diabetic rats. Specific RJ-derived metabolites, such as 10-hydroxy-2-decenoic acid (10-HDA), also known as the "Queen bee acid," show promise in reducing insulin resistance and hyperglycemia. Recent research highlights RJ's role in modulating immune responses, enhancing anti-inflammatory cytokines, and suppressing key inflammatory mediators. Despite these promising findings, further research is needed to comprehensively understand the mechanisms underlying RJ's therapeutic effects.

Chronic kidney disease (CKD) poses a considerable health challenge, particularly in populations with high-risk factorssuch as diabetes and hypertension. This article proposes a novel and cost-effective approach to address this concern byintegrating proteinuria detection technology into urinals. We suggest the installation of these innovative ‘smart’ urinals inhomes of individuals with diabetes, offering a convenient and proactive means of monitoring kidney health. Furthermore,the deployment of such ‘smart’ urinals in public places could serve as accessible screening facilities, enabling early detectionof CKD in a broader population. The potential cost-benefit ratio of this approach is highlighted, emphasizing the long-termeconomic benefits associated with early intervention. We argue that the proposed technology has the potential to revolutionizeCKD screening, providing a valuable tool for individuals at risk and contributing to the global effort to mitigate the impactof CKD on public health. Further research and pilot programs are warranted to explore the feasibility and effectiveness ofthis innovative screening strategy

Comparative analysis of erythrocyte deformability in individuals with Diabetes Mellitus (DM) and healthy individuals (Control) was represented, focusing on the Elongation index (EI) calculation based on diffraction images. While no statistically significant differences in EI values were observed between the groups, we determined specific points along the deformability curve and revealed the first derivative of deformability curve (dEI / dSS) as a potential metric for quantifying erythrocyte response to deformation, where SS represents shear stress in Pa (Pascal). Statistically significant differences in dEI / dSS at the half maximum value of the deformability curve were identified, suggesting a slower erythrocyte response to shear stress in DM patients. Scatter plot analysis demonstrated a linear declining trend in dEI / dSS index with an increase in shear stress, indicating decaying erythrocyte responsiveness to higher shear stress values, particularly pronounced in DM patients. Although pilot, this study suggests that dEI / dSS can provide valuable insights into the hemorheological aspects of DM pathology and contribute to a comprehensive understanding of erythrocyte mechanobiological behavior in response to varying shear stress levels. Correlations between the proposed measure of RBC mechanical properties and established clinical markers of DM and its complications (serum cholesterol, creatinine, and urea level) are obtained to get preliminary insight into dEI / dSS application for better diagnosis and/or patient management.

Hipoglikemia adalah kondisi di mana terjadi penurunan kadar gula darah (glukosa) di dalam tubuh di bawah level normal. Kadar gula darah normal saat puasa pada orang dewasa berkisar antara 70 hingga 100 miligram per desiliter (mg/dL). Hipoglikemia terjadi ketika kadar glukosa dalam tubuh menurun di bawah batas normal. Kajian literatur ini bertujuan untuk menyelidiki hubungan antara diet dan kejadian hipoglikemia pada individu dengan diabetes mellitus. Pencarian literatur dilakukan menggunakan Google Scholar dan Semantic Scholar, dengan fokus pada artikel yang terkait dengan hipoglikemia, hipoglikemia pada pasien diabetes, dan hipoglikemia dalam konteks diet. Seleksi artikel didasarkan pada kriteria tertentu untuk judul kajian literatur. Melalui tinjauan sistematis terhadap jurnal-jurnal relevan, penelitian ini mengeksplorasi dampak pola makan yang berbeda terhadap kadar glukosa darah dan kejadian hipoglikemia pada individu dengan diabetes mellitus. Dengan menganalisis dan mensintesis temuan dari artikel-artikel yang dipilih, kajian ini bertujuan memberikan wawasan mengenai strategi diet yang efektif untuk mengelola dan mencegah hipoglikemia pada pasien diabetes. Penelitian ini berkontribusi pada pengetahuan yang sudah ada, memberikan panduan bagi para profesional kesehatan dan individu dengan diabetes dalam membuat keputusan yang terinformasi mengenai intervensi diet untuk mengoptimalkan kontrol gula darah dan meningkatkan kesehatan secara keseluruhan.

Highlights:1. The findings of this study indicate that clinicians should remain vigilant, as effective glycemic control, reflected by optimal HbA1c levels, does not necessarily correlate with favorable distal cerebrovascular resistance, as measured by pulsatility index (PI).2. This study recommends that patients with acute thrombotic stroke undergo a comprehensive examination to ensure an accurate diagnosis and appropriate treatment. Abstract Stroke is the second leading cause of death and disability in the world. Diabetes mellitus is a risk factor for stroke with an increase in blood viscosity associated with hyperglycemia, and HbA1c is a well-established biomarker primarily used for the long-term monitoring of glycemic control in patients with diabetes mellitus. The Pulsatility index (PI) parameter of Trans Cranial Doppler (TCD) can measure blood vessel resistance. This study was to prove the correlation between HbA1c and PI in Middle Cerebral Artery (MCA) of acute thrombotic stroke patients. A cross-sectional study was conducted to thrombotic stroke patients treated at the neurological ward of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from March 2019 to April 2020 who met the inclusion and exclusion criteria. Data were obtained from medical records. Statistical analysis was performed using Spearman test for numerical data and Chi-square for categorical data with a significant value of p <0.05. There were 32 subjects who met the inclusion and exclusion criteria. A total of 24 subjects (75%) were males and 8 (25%) females with a mean age of 56.41±13.22 years. PI MCA results were abnormal in 14 subjects (43.75%) with an average of 1.8±0.97 and PI MCA was normal in 18 subjects (56.25%) with an average of 0.87±0.15. The average HbA1c was 6.55±1.9%. There was no statistically significant association observed between HbA1c and PI in MCA examination (r=0.07; p=0.73). In conclusion, the findings of this study indicate the lack of correlation between

Diabetes mellitus It is recognized as a major public health problem. A complication is diabetic foot, a syndrome resulting from neurological diseases (neuropathy), vascular issues (peripheral vascular insufficiency) with or without ischemia, and infectious diseases (local infections and/or osteomyelitis) causing trauma or ulcers in the foot. This complication is particularly concerning because it leads to disability and impacts the patient's life. The objective of this investigation is to identify nursing care in preventing diabetic foot complications, according to Dorothea Orem's theory. Form this, a systematic review of existing literature with a qualitative documentary approach conducted, using advanced search methods through the main MESH and DECS descriptors. Inclusion and exclusion criteria were established for article review. According to the systematic review carried out from the perspective of Dorothea Orem's theory, it is evident that nursing interventions focused on education, self-care, daily foot inspection, glycemic control, and adherence to treatment by patients prevent diabetic foot complications. Nursing plays a vital role in preventing complications such as diabetic foot, not only through direct care but also by educating and empowering patients. This approach is supported by Dorothea Orem's Self-Care Theory, highlighting the importance of patient self-responsibility in managing their illness., La diabetes mellitus “está reconocida como un problema importante de salud pública” (1). Una de las complicaciones es el pie diabético que es un síndrome secundario a enfermedades neurológicas (neuropatía), vasculares (insuficiencia vascular periférica) con o sin isquemia y enfermedades infecciosas (infecciones locales y/u osteomielitis) que provocan traumatismos o úlceras en el pie. Además, la complicación del pie diabético es la más preocupante porque causa discapacidad y afecta a la vida del paciente. El objetivo de esta investigación es identificar la atención de enfermería en la prevención de complicaciones del pie diabético, según la teoría de Dorothea Orem. Para ello se realizó una revisión sistemática de la literatura existente con enfoque documental cualitativo, se utilizaron métodos de búsqueda avanzada a través de los principales descriptores MESH Y DECS. Se establecieron criterios de inclusión y exclusión para la selección de artículos relevantes que responden a la pregunta de investigación. Según la revisión sistemática realizada bajo la perspectiva de la teoría de Dorothea Orem, se evidencia que las intervenciones de enfermería enfocadas en educación, autocuidado, inspección podal diaria, control glucémico, adherencia al tratamiento por parte de los pacientes previenen complicaciones de pie diabético. La enfermería juega un papel vital en la prevención de complicaciones como el pie diabético, no solo a través de la atención directa, sino también educando y empoderando a los pacientes. Este enfoque es apoyado por la Teoría de Autocuidado de Dorothea Orem, que resalta la importancia de la autorresponsabilidad del paciente en el manejo de su enfermedad.

Objective: Describe the self-care strategies implemented by patients with type 2 diabetes mellitus for the prevention of diabetic foot. Methodology: the research has a quantitative approach with a non-experimental, cross-sectional design, descriptive for the sample, the formula of finite populations was used with a confidence level of 95% and a 5% error, having a total of 160 patients who are treated. in the month of November-December. Results: 35.6% belong to the age range of 61-70 years. 56.3% are male and 43.7% female. In the self-management of diabetes, 65.60% rarely recognize when their blood sugar level goes up or down. 51.90% apply and/or consume medications according to medical indications. 49.40% rarely take into account the recommendations of health personnel. Conclusion: it can be analyzed that there is a lack of commitment on the part of the patient, as well as the lack of interventions in correct management in prevention and care by health professionals, to reduce these complications it is important to create support groups where the doctor performs exhaustive examinations of patients' feet at each medical check-up., Objetivo: Describir las estrategias de autocuidado implementadas por pacientes con diabetes mellitus tipo 2 para la prevención del pie diabético. Metodología: la investigación tiene un enfoque cuantitativo de diseño no experimental de corte transversal, descriptiva para la muestra se empleó la fórmula de poblaciones finitas con un nivel de confianza del 95% y un 5% de error teniendo un total de 160 pacientes que son atendidos en el mes de noviembre-diciembre. Resultados: el 35,6% pertenece al rango de edades de 61-70 años. El 56.3% son de sexo masculino y 43.7% femenino. En el automanejo de la diabetes el 65,60% pocas veces reconocen cuando se le sube o baja el nivel de azúcar en la sangre. El 51,90% aplican y/o consumen los medicamentos según las indicaciones médicas. El 49,40% pocas veces tiene en cuenta las recomendaciones del personal de salud. Conclusión: se pueden analizar que existe deficiencia de compromiso por parte del paciente, así como la falta de intervenciones en el manejo correcto en la prevención y cuidado por parte de los profesionales de salud, para reducir estas complicaciones es importante crear grupos de apoyo donde el medico realice exámenes exhaustivos de los pies de los pacientes en cada control médico.

Worldwide, approximately 150 million people are diagnosed with urinary tract infections (UTIs) and asymptomatic bacteriuria each year, which remains a significant cause of morbidity and mortality in patients with Type 2 Diabetes Mellitus. The diagnosis of UTI in diabetic patients is similar to that of other patients with complicated infections, and the most common pathogens include Escherichia coli, Klebsiella spp., Proteus spp., Enterobacter spp., and enterococci. The objective of this study was to identify the causative agents of urinary tract infection in adult patients with Type 2 Diabetes Mellitus at a specific hospital in Salina Cruz, Oaxaca. A retrospective, observational, and descriptive study was conducted using clinical records of diabetic patients with urinary tract infection who were hospitalized at the General Hospital Zone with Family Medicine No. 2 during a specific period in 2020. Sociodemographic data, serum glucose levels, presence of UTI, and isolated pathogens were collected. Material resources were provided by the research group, while the infrastructure used was that of the hospital. The research team included professionals with training in family and internal medicine, with experience in the field of study., En todo el mundo, aproximadamente 150 millones de personas son diagnosticadas con infección de vías urinarias (IVU) y bacteriuria asintomática cada año, lo que sigue siendo una causa importante de morbilidad y mortalidad en pacientes con Diabetes Mellitus tipo 2. El diagnóstico de IVU en pacientes diabéticos es similar al de otros pacientes con infección complicada, y los patógenos más comunes incluyen Escherichia coli, Klebsiella spp., Proteus spp., Enterobacter spp., y enterococos. El objetivo de este estudio fue identificar los agentes causales de la infección del tracto urinario en pacientes adultos con Diabetes Mellitus tipo 2 en un hospital específico en Salina Cruz, Oaxaca. Se llevó a cabo un estudio retrospectivo, observacional y descriptivo utilizando expedientes clínicos de pacientes diabéticos con infección del tracto urinario que estuvieron hospitalizados en el Hospital General de Zona con Medicina Familiar No. 2 durante un período específico en 2020. Se recopilaron datos sociodemográficos, niveles de glucosa en suero, presencia de IVU y los agentes patógenos aislados. Los recursos materiales fueron proporcionados por el grupo de investigadores, mientras que la infraestructura utilizada fue la del hospital. El equipo investigador incluyó profesionales con formación en medicina familiar e interna, con experiencia en el área de estudio.

Objective: To determine the epidemiological profile of patients with type 2 diabetes mellitus in a teaching unit. Method: In this observational, cross-sectional, and descriptive study, data from the medical records of consultations conducted between February 2020 and May 2022 at an endocrinology outpatient clinic in a teaching unit in Northeast Brazil were evaluated. A descriptive analysis of the data was performed, with percentage values, medians, and interquartile ranges (IQRs) reported. Result: Data were collected from the medical records of 118 patients, and the medical records of 95 patients were used for statistical analysis after the exclusion of records with insufficient data. Seventy patients (73.6%) were female, with a median age of 57 years (IQR 51.5-65), a median body mass index (BMI) of 28.9 kg/m2 (IQR 25.7-33.1) and a median age at diagnosis of 47.5 years (IQR 38-55). The median glycated hemoglobin (HbA1c) and fasting blood glucose levels during follow-up were 7.6% (IQR 6.6-9.7) and 132.8 mg/dL (IQR 113.5-201.7), respectively, and only 36.8% (n=35) of patients were within their HbA1C therapeutic target range. Approximately 73.6% (n=70) of the patients used statins, but only 18 (18.9%) had LDL-c within their therapeutic target range. Twenty-seven patients (28.4%) had kidney dysfunction, either albuminuria or a glomerular filtration rate (GFR) reduction, and 6 of them (22.2%) did not use any nephroprotective medication. Fewer than half of the patients underwent fundoscopy, and 32.5% of them showed some degree of retinopathy. Neuropathy was present in 33 patients (34.7%), with 3 patients (3.16%) presenting with amputations.

FUNDAMENTOS // La diabetes mellitus es una enfermedad crónica con alta morbimortalidad que afecta a 537 millones de adultos en el mundo. España es el segundo país europeo en prevalencia, con un 14,8% en población de veinte-setenta y nueve años, con 11,6 casos por cada 1.000 personas/año. La retinopatía diabética (RD) es la quinta causa de pérdida de visión a nivel mundial y la séptima causa de ceguera/discapacidad visual entre afiliados a la Organización Nacional de Ciegos de España (ONCE). La detección precoz de RD previene la ceguera en diabéticos y está condicionada por la hemoglobina glicosilada. El objetivo de este trabajo fue analizar el manejo de los pacientes diabéticos en la comarca del Aljarafe (Sevilla) e identificar oportunidades de mejora en la coordinación de su seguimiento entre el médico de Atención Primaria y el médico oftalmólogo. MÉTODOS // Se realizó un estudio observacional retrospectivo (2016-2019) con los pacientes registrados en el censo de diabéticos de los veintiocho municipios del Aljarafe. Se consultó la historia de salud de Atención Primaria y Hospital, así como el programa de Telemedicina. En cuanto al análisis estadístico, para variables cualitativas se calcularon totales y porcentajes; para variables cuantitativas, media y distribución estándar (si distribución normal), y la mediana y cuartiles (distribución no normal). RESULTADOS // Se registraron 17.175 diabéticos en el Aljarafe (5,7% de población); 14.440 pacientes (84,1%) tenían alguna determinación de hemoglobina durante el periodo, 9.228 (63,9%) las tenían todas en rango adecuado. Tenían control fundoscópico 12.040 diabéticos (70,1%), y de los que no, 346 (10,6%) tenían todas fuera de rango. Hubo 1.878 (10,9%) pacientes sin control fundoscópico ni metabólico, 1.019 (54,3%) eran mujeres, 1.219 (64,9%) menores de sesenta y cinco años, 1.019 (54,3%) con comorbilidad grave. CONCLUSIONES // La mayoría de los pacientes presentan un cribado adecuado y, más de la mitad, determinaciones

FUNDAMENTOS // La periodontitis es la sexta complicación de la diabetes tipo 2 (DT2); dependiendo de su severidad puede causar dolor, incomodidad o hasta pérdida dental. El objetivo del estudio fue evaluar el impacto del estado periodontal autorreportado en la Calidad de Vida Relacionada con la Salud Oral (CVRSO) en personas con DT2. MÉTODOS // Se realizó un estudio transversal que incluyó a setenta y nueve adultos con DT2 atendidos en la Clínica de Síndrome Metabólico del Instituto Nacional de Enfermedades Respiratorias Cosío Villegas en la Ciudad de México, entre agosto y noviembre de 2010. La CVRSO se evaluó con el cuestionario Perfil de Impacto en la Salud Bucal acortado (OHIP-EE14). La periodontitis se evaluó por autorreporte, profundidad al sondeo (PS) y pérdida de inserción clínica (PIC). La asociación entre estado periodontal autorreportado y CVRSO se evaluó con modelos de regresión binomial negativa. RESULTADOS // La edad promedio fue de 60,4 años (DE=9,6); la duración de diabetes de 10,1 años (DE=6,6). La CVRSO se asoció con la autopercepción de mal aliento (RR=1,58, p=0,025), autopercepción de mala salud de las encías (RR=1,66, p=0,016), insatisfacción de la habilidad para masticar (RR=2,22, p≤0,001), pérdida de algún diente con movilidad previa (RR=1,74, p=0,019) y 20 dientes presentes o menos (RR=1,57, p=0,045). CONCLUSIONES // La CVRSO se asocia con el autorreporte de mal aliento, mala salud de las encías e insatisfacción de la habilidad para masticar en personas con DT2; esto sugiere que las condiciones bucales autopercibidas representan signos y síntomas de deterioro funcional y psicológico relacionados con la periodontitis severa.

Objective: To determine the association between diabetes mellitus and chronic depression in adults in the Peruvian population. Materials and methods: A quantitative, observational, cross-sectional and correlational study was carried out, based on the data collected by the 2020 Encuesta Demográfica y de Salud Familiar (ENDES – Demographic and Family Health Survey, 2020). The sample was made up of 14,245 adults; depression was considered as a dependent variable (with depression/without depression), and the independent variables were diabetes mellitus (Yes/No), wealth index (the poorest, poor, middle class, rich, the richest), education (kindergarten-preschool and primary, secondary, non-university higher, university higher and graduate), alcoholism (Yes/No), area of residence (urban/rural). The program used for the statistical analysis was IBM SPSS: Release 23. A univariate data analysis was carried out by determining the frequencies and percentages. Subsequently, in the analytical phase, bivariate and multivariate analyses by logistic regression were used to evaluate the strength of the association between the variables (p < 0.05). Results: A total of 15.7 % of adults between 27 and 59 years of age experienced chronic depression. Furthermore, the bivariate analysis revealed an association between the outcome variable and covariates—diabetes mellitus, level of education and wealth index—(p < 0.05). Depression is more common in lower socioeconomic groups, with higher rates among the poor, Objetivo: Determinar la asociación entre diabetes mellitus y depresión crónica en adultos en la población peruana. Materiales y métodos: Se realizó un estudio cuantitativo, de tipo observacional, de corte transversal y correlacional, a partir de los datos recogidos por la encuesta demográfica y de salud familiar del 2020 (Endes 2020). La muestra estuvo conformada por 14 245 adultos. La variable dependiente fue la depresión (con depresión/sin depresión); las variables independientes fueron diabetes mellitus (sí/no), índice de riqueza (los más pobres, pobre, medio, rico, más rico), educación (inicial-preescolar y primaria, secundaria, superior no universitaria, superior universitaria y posgrado), alcoholismo (sí/no) y área de residencia (urbano/rural). Para el análisis estadístico, se empleó el programa SPSS, versión 23, donde se realizó un análisis univariado de los datos mediante la determinación de las frecuencias y porcentajes. Posteriormente, en la fase analítica, se utilizó el análisis bivariado y multivariado por regresión logística para evaluar la fuerza de asociación entre las variables (p < 0,05). Resultados: El 15,7 % de adultos entre los 27 y 59 años presentaron depresión crónica; además, en el análisis bivariado se encontró asociación de la variable resultado y las covariables diabetes mellitus, nivel de educación e índice de riqueza (p < 0,05). La depresión es más frecuente en grupos socioeconómicos más bajos, con tasas más altas entre la población pobre (16,63 %) y menos educada, especialmente en aquellos con educación inicial-preescolar y primaria (18,88 %). En contraste, las clases ricas y más ricas muestran tasas menores de depresión (15,27 % y 12,04 %, respectivamente). Por otro lado, en el análisis multivariado se realizó la estimación del riesgo y se encontró que ser diabético aumentó el riesgo 1,66 veces más de padecer depresión en relación con los no diabéticos. Conclusiones: Existe asociación entre depresión crónica y diabetes mellitus en la po

Objective: To identify the risk factors based on clinical, echocardiographic and therapeutic parameters which predict the development of cardiac complications among patients with diabetes and acute myocardial infarction (AMI). Materials and methods: An observational, analytical, case-control study was conducted at Centro de Cardiología y Cirugía Cardiovascular de Santiago de Cuba, attached to Hospital Provincial Saturnino Lora, from 2019 to 2021. The sample consisted of 266 patients, chosen by simple random sampling 1:2. The study included demographic, clinical– echocardiographic and therapeutic variables. A multivariate analysis was performed with all the variables considered as risk factors; one-way analysis of variance and binary logistic regression were used. Results: The most frequent cardiac complications were atrial fibrillation and heart failure (approximately 12 %). A metabolic control analysis on admission yielded altered results (OR = 6.92; LI: 2.61; LS: 18.32; p = 0.001). The univariate analysis showed that ten factors increased the risk of complications, including the diagnosis of diabetes mellitus ≥ 10 years (OR = 2.50; LI: 1.14; LS: 5.45; p = 0.020). On the other hand, the multivariate analysis revealed six factors that predict the development of cardiac complications: age ≥ 60 years (OR = 5.624; CI = 1.607-19.686; p = 0.007), altered metabolic control on admission (OR = 5.245; CI = 1.491–18.447; p = 0.010), lack of use of thrombolytic therapy (OR = 5.74; CI = 1.46–22.586; p = 0.012), left ventricular ejection fraction (LVEF) ≤ 40 % (OR = 5.245; CI = 1.17–23.433; p = 0.030), left atrial pressure ≥ 15 mmHg (OR = 12.335; CI = 3.45–44.08; p = 0.001) and motility ≥ 1.5 points (OR = 4.702; CI = 1.258–17.575; p = 0.021). Conclusions: The study demonstrated the value of six risk factors of cardiac complications among patients with diabetes and AMI, where glycemic control on admission, decreased LVEF, increased left atrial pressure and no reperfusion therapy, Objetivo: Identificar factores de riesgo, basados en los parámetros clínicos, ecocardiográficos y terapéuticos, para predecir complicaciones cardiacas en pacientes diabéticos con infarto agudo de miocardio (IAM). Materiales y métodos: Se realizó un estudio observacional, analítico, de casos y controles en el Centro de Cirugía Cardiovascular y Cardiología Santiago de Cuba, adjunto al Hospital Provincial Saturnino Lora, durante el periodo comprendido entre los años 2019 y 2021. La muestra quedó constituida por 266 pacientes, elegidos por muestreo aleatorio simple 1:2. Las variables de estudio se agruparon en demográficas, clínico-ecocardiográficas y terapéuticas. Se realizó el análisis multivariado con todas las variables que constituyeron factores de riesgo; se empleó el análisis de la varianza unidireccional y la regresión logística binaria. Resultados: Las complicaciones más frecuentes fueron la fibrilación auricular y la insuficiencia cardiaca en un 12 %, aproximadamente. Las cifras de control metabólico mostraron alteración al ingreso (OR = 6,92; LI: 2,61; LS: 18,32; p = 0,001). El análisis univariado demostró que diez factores incrementaron el riesgo de presentar complicaciones, entre ellos, el diagnóstico de diabetes mellitus ≥10 años (OR = 2,50; LI: 1,14; LS: 5,45; p = 0,020); además, el análisis multivariado reveló que la edad ≥60 años (OR = 5,624; IC = 1,607-19,686; p = 0,007), el control metabólico al ingreso alterado (OR = 5,245; IC = 1,491-18,447; p = 0,010), la no aplicación de terapia trombolítica (OR = 5,74; IC = 1,46-22,586; p = 0,012), la FEVI ≤ 40 % (OR = 5,245; IC = 1,17-23,433; p = 0,030), la presión de la aurícula izquierda ≥15 mmHg (OR = 12,335; IC = 3,45-44,08; p = 0,001) y la motilidad ≥1,5 puntos (OR = 4,702; IC = 1,258-17,575; p = 0,021) incrementaron el riesgo de forma independiente. Conclusiones: El estudio demostró el valor de seis factores de riesgo de complicaciones cardiacas en el paciente diabético con IAM, donde sobresale el control

Introduction: The most serious complications of diabetes mellitus are diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Clinical and laboratory alterations are often observed that cover both spectrums and which we call a mixed state. They represent close to 50% of hospitalizations in the service. of emergencies in diabetic patients.Objective: To determine in-hospital complications and outcomes of hyperglycemic states in adult patients admitted to the Hospital Nacional, Itauguá, Paraguay, in the period 2015-2022.Methodology: A retrospective cohort design was applied. Male and female patients with diagnoses of type 1 and type 2 diabetes mellitus, who were over 18 years of age, were selected and grouped into three cohorts that corresponded to each of the acute decompensations of diabetes mellitus. The sample was made up of 180 patients distributed into three cohort groups with 60 patients each.Results: Fifty one percent were male. A greater development of cardiovascular events, hospital-acquired infections, intensive care requirements and mortality were found in the cohort with hyperosmolar state.Conclusion: the cohort with hyperglycemic hyperosmolar state was characterized by the highest number of complications.Keywords: diabetes mellitus, hyperglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar non-ketotic coma, cohort studies, Introducción: las complicaciones más graves de la diabetes mellitus son la cetoacidosis diabética y el estado hiperglucémico hiperosmolar, muchas veces se observan alteraciones clínicas y laboratoriales que abarcan los dos espectros y que denominamos estado mixto, representan cerca del 50% de las hospitalizaciones en el servicio de urgencias en pacientes diabéticos. Objetivo: determinar las complicaciones intrahospitalarias y los desenlaces de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional, Itauguá, Paraguay, en el periodo 2015-2022. Metodología: se aplicó un diseño de cohortes retrospectivas. Se seleccionaron pacientes con diagnósticos de diabetes mellitus tipo 1 y tipo 2, mayores de 18 años, de ambos sexos, agrupados en tres cohortes que corresponden a cada una de las descompensaciones agudas de la diabetes mellitus. La muestra estuvo conformada por 180 pacientes distribuidos en tres grupos de cohortes con 60 pacientes cada una. Resultados: 51% correspondió al sexo masculino. Se halló mayor desarrollo de eventos cardiovasculares, infecciones intrahospitalarias, requerimiento de cuidados intensivos y mortalidad en la cohorte con estado hiperosmolar. Conclusión: la cohorte con estado hiperosmolar hiperglucémico se caracterizó por la mayor cantidad de complicaciones.

Diabetes mellitus is a systemic condition potentially related to an increased risk of progression of various infections such as chronic osteomyelitis by accelerating the inflammatory process with bone tissue necrosis and suppuration. Therefore, if there is no proper management of these infections, they can be life-threatening as they spread to deeper spaces in the head and neck. We describe the case of a 52-year-old male patient with a history of diabetes mellitus and grade III osteoarthritis who was diagnosed with chronic suppurative osteomyelitis of the mandible. He underwent a multidisciplinary surgical intervention in which he underwent a hemimandibulectomy with immediate mandibular reconstruction. The present case highlights the importance of early and radical treatment of patients with chronic suppurative osteomyelitis of the mandible and systemic comorbidities. In addition, this case presents a review of diabetes mellitus and the risk of developing odontogenic infections and complications when invading deeper spaces in the head and neck. Therefore, in this population, careful planning is required for early surgical and pharmacological treatment.

Introduction: Type 2 diabetes mellitus (DM2) is defined as a metabolic disorder characterized by chro-nically elevated blood glucose levels. DM2 represents the paradigm of chronic diseases in which there is a close association between family and environmental factors. Therefore, the purpose of this study is to deter-mine the association of the risk of developing DM2 and non-illicit toxic habits in patients residing in a rural community in Peravia, Dominican Republic. Such habits include alcohol, coffee and tea.Methodology: Observational, cross-sectional, analytical and prospective study. A questionnaire was applied, anthropometric data was collected, and capillary glucose was determined in the study sample (n=304).Results: the prevalence of presenting a high risk of developing DM2 in the population is 35.5%, while the prevalence of presenting low risk is 64.5%. Regarding toxic habits, there was no positive correlation between tea consumption and the development of DM2. However, this result differed between consumption of coffee and alcohol.Conclusions: the inhabitants of Salinas have a low risk of developing DM2 but are subject to modifiable risk factors that increase said prevalence., Introducción: la diabetes mellitus tipo 2 (DM2) se define como un trastorno metabólico caracterizado por niveles de glucosa en sangre crónicamente elevados. La DM2 representa el paradigma de las enfermedades crónicas en las que existe una estrecha asociación entre factores familiares y ambientales. Por este motivo, este estudio tiene como finalidad determinar la asociación del riesgo a desarrollar DM2 y los hábitos tóxicos no ilícitos en pacientes que residen en una comunidad rural de Peravia, República Dominicana. Tales incluyen: alcohol, café y té.Metodología: Estudio observacional, transversal, analí-tico y prospectivo. Se aplicó cuestionario, recolectaron datos antropométricos y se determinó glucosa capilar a la muestra (n=304).Resultados: la prevalencia a presentar un alto riesgo a desarrollar DM2 en la población es de 35.5%, mientras que la prevalencia a presentar riesgo bajo es de 64.5%. En cuanto a hábitos tóxicos, no existió correlación posi-tiva entre consumo de té y desarrollo de DM2. Sin embargo, sí entre el consumo de café y alcohol.Conclusiones: los habitantes de salinas presentan un bajo riesgo a desarrollar DM2, pero utilizan factores de riesgos modificables que aumentan la prevalencia a DM2

Introducción: la enfermedad renal crónica es una agravante afección para el sistema de salud pública. La detección y seguimiento oportuno de los factores desencadenantes y de progresión de la enfermedad son una prioridad en cada sistema de salud. Objetivo: caracterizar la enfermedad renal crónica en pacientes con diabetes mellitus tipo2 con mal control metabólico. Método: se realizó un estudio descriptivo, de corte transversal en pacientes con diabetes mellitus tipo 2 que ingresaron al programa de enfermedad renal crónica del Hospital Dr. Docente Clínico Quirúrgico Dr. Miguel Enríquez desde octubre 2021 a enero 2023. El universo estuvo compuesto por 175 pacientes, de ellos, se seleccionó la muestra, 74 pacientes que cumplieron con los criterios de inclusión luego de firmar el consentimiento informado. Resultados: existió predominio de enfermedad renal crónica en pacientes jóvenes (64 % en 18 a 49 años); así mismo el sexo femenino representó el 65,3 %; y un tiempo de evolución de la diabetes mellitus tipo 2de 1 a 5 años con 49,3 %; las comorbilidades más frecuentes fueron: dislipidemia, hipertensión arterial e insuficiencia cardiaca con una prevalencia de 89,3%; 79,3 % y 41,3 % ; el estadio según el daño renal predominante fue el grado 2 con 20,0 %; el 4 % de los pacientes necesitó tratamiento renal sustitutivo. Conclusiones: la enfermedad renal suele progresar más en mujeres y en pacientes con múltiples factores de riesgo cardiovasculares. Se asocia a la progresión de la enfermedad renal el inadecuado control glucémico. El daño de la función renal depende en gran medida del control metabólico.

Introduction: Obesity, age, sedentary lifestyle, and family history of diabetes mellitus are risk factors for type 2 diabetes mellitus (T2DM). Objective: determine the probable risk of developing T2DM in the next 10 years in working women at a reference hospital in Asunción, Paraguay. Methodology: This cross-sectional observational descriptive study was conducted with physicians, nurses, and administrative staff. Data were collected over three months using the FINDRISK test to assess diabetes risk, which consists of eight questions about age, body mass index, waist circumference, physical activity, fruit and vegetable consumption, history of blood pressure, high blood pressure and high glucose, and diabetes diagnosed in family members. Descriptive statistics in the form of frequencies and percentages, as well as analytical statistics using the Mann-Whitney and Kruskal-Wallis tests, were used to analyze the data. Results: A total of 112 women participated in the study, with more than 40% in the age range of 31–40 years. The waist circumference of 80-88 cm was the most common (38.4%). It was found that 33% of participants were overweight. Almost 60% of the participants did not perform daily physical activities. More than 38% of the first-degree relatives had a history of diabetes. Of the surveyed participants, 67.9%had some risk of developing T2DM in the next 10 years and 22 had a high or very high risk according to the FINDRISK test. Participants aged 35 years had a significantly higher risk (p=0.008). Conclusion: A high prevalence of overweight and obesity was observed, with 67.9% of the respondents showing some degree of risk for developing T2DM in the next 10 years, of which nearly 20% were categorized as high or very high risk., Introducción:la obesidad, la edad, el estilo de vida sedentario y los antecedentes familiares de diabetes mellitus se han descrito como factores de riesgo para la diabetes mellitus tipo 2 (DM2). Objetivo: determinar el riesgo probable de desarrollar DM2 en los próximos 10 años en mujeres trabajadoras de un hospital de referencia en Asunción, Paraguay. Metodología:este estudio descriptivo observacional de corte transversal se llevó a cabo entre médicos, enfermeras y personal administrativo. Se recopilarondatos durante tres meses utilizando la prueba FINDRISK para evaluar el riesgo de diabetes, la cual consta de ocho preguntas sobre la edad, el índice de masa corporal, el perímetro de la cintura, la actividad física, el consumo de frutas y verduras, antecedentes de presión arterial alta y glucosa elevada, y diabetes diagnosticada en familiares. Para el análisis de los datos se utilizaron estadísticas descriptivas en forma de frecuencias y porcentajes, así como estadísticas analíticas con la prueba de Mann Whitney y Kruskal Wallis. Resultados:un total de 112 mujeres participaron en el estudio, con más del 40% en el rango de edad de 31 a 40 años. El perímetro de cintura de 80-88 cm. fue el más común, con 38,4%. Se encontró que el 33% de las participantes tenían sobrepeso. Casi el 60% no realizaba actividad física diaria. Más del 38% tenían antecedentes de diabetes en familiares de primer grado. El 67,9% de las encuestadas tenían algún riesgo de desarrollar DM2 en los próximos 10 años, y 22 de ellas presentaron un riesgo alto o muy alto según la prueba FINDRISK. Las participantes de 35 años o más tenían un riesgo significativamente mayor (Chi; p=0,008). Conclusión:se detectó una alta prevalencia de sobrepeso y obesidad, siendo el 67,9% de las encuestadas quienes mostraron algún grado de riesgo de desarrollar DM2 en los próximos 10 años, de los cuales casi el 20% presentaban un riesgo categorizado como alto o muy alto.

Background: The therapeutic use of gingival mesenchymal stem cells (GMSCs) as autologous cells may pose the challenge of alterations inflicted by the hyperglycemic environment. Objective: This study aims to assess the effects of hyperglycemia on the characteristics of GMSCs in diabetics. Materials and Methods:10 patients who consented and fulfilled the criteria for inclusion and exclusion were recruited and categorized as test (HbA1c > 6.5) and control (HbA1c < 6.0). Gingival explants were obtained from gingival collar of teeth, washed, digested and cultured. The cells were subjected to microscopic observation to assess phenotype characteristics, and flow cytometry and qRT-PCR to assess differentiation potential. Stem cell markers CD90, CD73, CD105, CD34, CD45, HLA DR & HLA ABC, osteogenic differentiation markers RUNX2 & OCN, adipogenic differentiation markers PPARG2 & FABP4 and chondrogenic differentiation markers SOX9 & AGCN were evaluated. Results: Microscopic appearance of spindle shaped cells was found to be comparable in both groups. Flow cytometry results demonstrated comparable expressions with both groups, samples being positive for CD90, CD73, CD105, HLA ABC and negative for CD34, CD45 & HLA DR. There were variations in the expression of markers when assessed for differentiation potentials. Conclusions: The hyperglycemic environment did not manifest any changes in the phenotypic characteristics of GMSCs among diabetics. However, the expression of certain differentiation markers was significantly altered in the diabetic test population included. Further research is being conducted to understand the GMSCs in a hyperglycemic environment with an aim to develop strategies to optimize its clinical implications., Antecedentes: El uso terapéutico de células madre mesenquimales gingivales (GMSC) como células autólogas puede plantear el desafío de las alteraciones infligidas por el entorno hiperglucémico. Objetivo: Este estudio tiene como objetivo evaluar los efectos de la hiperglucemia sobre las características de las GMSC en diabéticos. Materiales y Métodos: Se reclutaron y categorizaron 10 pacientes que dieron su consentimiento y cumplieron los criterios de inclusión y exclusión como prueba (HbA1c > 6,5) y control (HbA1c < 6,0). Los explantes gingivales se obtuvieron del cuello gingival de los dientes, se lavaron, digirieron y cultivaron. Las células se sometieron a observación microscópica para evaluar las características fenotípicas y a citometría de flujo y qRT-PCR para evaluar el potencial de diferenciación. Se evaluaron los marcadores de células madre CD90, CD73, CD105, CD34, CD45, HLA DR y HLA ABC, marcadores de diferenciación osteogénica RUNX2 y OCN, marcadores de diferenciación adipogénica PPARG2 y FABP4 y marcadores de diferenciación condrogénica SOX9 y AGCN. Resultados: Se encontró que la apariencia microscópica de las células fusiformes era comparable en ambos grupos. Los resultados de la citometría de flujo demostraron expresiones comparables en ambos grupos, siendo las muestras positivas para CD90, CD73, CD105, HLA ABC y negativas para CD34, CD45 y HLA DR. Hubo variaciones en la expresión de los marcadores cuando se evaluaron los potenciales de diferenciación. Conclusiones: El entorno hiperglucémico no manifestó ningún cambio en las características fenotípicas de las GMSC entre los diabéticos. Sin embargo, la expresión de ciertos marcadores de diferenciación se alteró significativamente en la población de prueba de diabetes incluida. Se están realizando más investigaciones para comprender las GMSC en un entorno hiperglucémico con el objetivo de desarrollar estrategias para optimizar sus implicaciones clínicas

Introduction: Diabetes mellitus (DM) is a prevalent chronic metabolic disorder worldwide, with Type II DM (T2DM) emerging as the most widespread variant. In Chile, approximately 11% of adults aged 20 to 79 suffer from this condition. Given its high prevalence, dental surgeons should be trained to evaluate risk factors, particularly the potential complications linked to tooth extraction in individuals with T2DM. Objetive: To describe the available scientific evidence on post-exodontia complications associated with hyperglycemia in patients with Type II diabetes mellitus. Materials and Methods: An exploratory systematic review was conducted following the PRISMA-ScR extension protocols using the databases PubMed, EBSCO, Scopus and the Cochrane Library. The search employed the following algorithms: ((“Diabetic patient complications” AND “Dental extractions”)), ((“Diabetes” AND “tooth extraction”)), ((“Glycemia” AND “Tooth extraction complications”), ((“Blood glucose” AND “Tooth extractions”), ((“Dental extraction sockets” AND “Diabetics”). Results: Out of a total of 973 articles, 25 were included for this review. Six relevance criteria were considered, revealing safety parameters for conducting extractions in patients with T2DM, with capillary blood glucose levels not exceeding 200 mg/dL for elective extractions and 240 mg/dL for emergency extractions. Conclusions: There is limited evidence correlating threshold values of hyperglycemia with post-extraction complications in patients with T2DM. Most authors agree that the primary concern is not T2DM itself, but hyperglycemia. Furthermore, there is minimal consistency in the recommended care protocols for these patients., Introducción: La diabetes mellitus (DM) es un trastorno metabólico crónico. A nivel mundial, la DM tipo II (DM2) resulta ser la más frecuente. En Chile, un 11% de la población adulta entre los 20 y 79 años la padece. Su alta prevalencia, requiere de un cirujano dentista preparado para valorar los factores de riesgo, como las posibles complicaciones asociadas a la extracción dental en estos pacientes. Objetivo: Describir la evidencia científica disponible sobre complicaciones post-exodoncia asociadas a hiperglicemia en pacientes con diabetes mellitus tipo II. Materiales y Métodos: Se realizó una revisión sistemática exploratoria bajo los protocolos de extensión PRISMA-ScR utilizando las bases de datos, PubMed, EBSCO, Scopus y Cochrane Library con los algoritmos de búsqueda ((“Diabetic patient complications“ AND “Dental extractions”)), ((“Diabetes” AND “Tooth extraction”)), ((“Glycemia” AND “tooth extraction complications”)), ((“Blood glucose” AND “Tooth extractions”)), ((“Dental extraction sockets”AND “Diabetics”)). Resultado: De un total de 973 artículos se incluyeron 25 artículos para esta revisión. Se consideraron 6 criterios de pertinencia, los cuales mostraron parámetros de seguridad para realizar exodoncias, en pacientes con DM2, con la glucemia capilar no mayor a 200mg/dl en caso de ser electiva y 240 mg/dl en exodoncia de urgencias. Conclusión: Existe poca evidencia que correlacione valores absolutos de hiperglucemia y complicaciones post exodoncia en pacientes con DM2. La mayoría de los autores concuerda en que el problema no es la DM2, sino la hiperglucemia. Existe poca uniformidad en los protocolos de atención recomendados para estos pacientes.

Introducción: La diabetes mellitus es una enfermedad metabólica caracterizada principalmente por hiperglucemia, genera complicaciones agudas y crónicas; entre las más temidas se encuentra el pie diabético, que es considerada la primera causa de amputación no traumática en miembros inferiores. Objetivo: Evaluar los resultados de una intervención educativa orientada al mejoramiento del nivel de conocimiento sobre la prevención del pie diabético. Método: Se realizó una investigación aplicada, con diseño cuasiexperimental descriptivo. El universo estuvo constituido por 56 paciente de los cuales 50 formaron parte de la muestra de investigación. Se utilizó la prueba de McNemar para identificar cambios en el nivel de conocimiento sobre prevención del pie diabético. Resultados: predominio de pacientes entre 40 y 50 años (48 %), seguido de los que presentaban en el momento del estudio una edad entre 61 y 70 años (38 %). Existe un 64 % de pacientes femeninas, el 46 % de los pacientes se autoidentifica como mestizos y el 52 % refirió nivel educativo medio. Predominio de pacientes con nivel bajo durante el pretest (74,00 %). Después de la intervención se identificó que predominaban los pacientes con nivel medio (52,00 %), seguido de pacientes con nivel alto (38,00 %). Los resultados de la prueba de McNemar muestran valor de Z de 2,95 y significación estadística con p de 0,027. Conclusiones. La intervención educativa aplicada generó cambios positivos en torno al mejoramiento del nivel de conocimiento sobre prevención del pie diabético en los pacientes que participaron en la investigación.

Introduction: The prevalence of AHT is between 11.9 % and 49 %, and that of DM2 is 10.5 %. The prevalence of depressive disorders in patients with diabetes ranges from 10 to 15%. Objective: To determine the association between the time of illness in patients with hypertension and DM2 with depressive symptoms. Methodology: This was a cross-sectional analytical study. The secondary base analyzed was the Demographic and Health Survey of Peru (ENDES) for 2019, 2020, and 2021. The Patient Health Questionnaire-9 (PHQ-9) was used. The chi-square test was used for each possible factor associated with depression, and the associations of interest were evaluated using Poisson distribution. Results: At the time of the study, 21.59% of patients had symptoms of depression. Of these patients, 51.40 % were female. A total of 16.58 % of the participants were older than 60 years of age. Hypertension was present in 5.9% of the patients, while DM2 was present in 2.09%. In the bivariate analysis, all variables were associated with the presence of depressive symptoms, except for daily smoking (p=0.275). Discussion: The results showed an association between the time of illness since the diagnosis of HT and DM2 and depressive symptoms. In the case of both pathologies, having less than one year since diagnosis increased the probability of depressive symptoms by 51% and 44%, respectively., Introducción: La prevalencia de HTA se encuentra entre 11,9 % y 49 %, la prevalencia de DM2 es de 10,5 %. La prevalencia de trastornos depresivos en diabéticos va en el rango de 10 % a 15 %. Objetivo: determinar la asociación entre el tiempo de enfermedad de los pacientes con HTA y DM2 con los síntomas de depresión. Metodología: Estudio analítico transversal. La base secundaria analizada fue la Encuesta Demográfica y de Salud del Perú (ENDES) de los años 2019, 2020 y 2021. Se utilizó el Cuestionario de Salud del Paciente-9 (PHQ-9). Se utilizó la prueba del chi cuadrado para cada posible factor asociado a la depresión y las asociaciones de interés se evaluaron con una distribución de Poisson. Resultados: El 21,59 % tenían síntomas de depresión al momento del estudio. El 51,40 % eran del sexo femenino. El 16,58 % presentaba mayor a 60 años. La HTA estuvo presente en el 5.9%, mientras que la DM2 en el 2,09 %. En el análisis bivariado, todas las variables se asociaron con la presencia de síntomas depresivos, excepto la variable que fuma a diario (p=0.275). Discusión: Los resultados señalan una asociación entre el tiempo de enfermedad desde el diagnóstico de HTA y DM2 con los síntomas depresivos. En el caso de ambas patologías el tener menos de un año de diagnóstico aumentaban en 51 % y 44 % respectivamente la probabilidad de presentar síntomas depresivos.

2023 Acuerdos transformativos CRUE, Background A systematic review was conducted to investigate the prevalence of onychomycosis in patients with diabetes. The association of onychomycosis with risk factors in patients with diabetic foot syndrome was also examined. Methods The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied, and the included studies were assessed using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) method. Searches were conducted in October 2022 using PubMed (Medline) and Scopus for clinical studies, clinical trials, comparative studies, observational studies, and randomised clinical trials or controlled clinical trials addressing the prevalence and consequences of onychomycosis in patients with diabetes, diagnoses or treatments. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussion with a third reviewer. Results The systematic review included ten studies that met the inclusion criteria, and these studies enrolled 5664 patients with diabetes. Among these patients, 29.18% had onychomycosis that was mainly caused by Trichophyton rubrum. A significant association was found between the occurrence of onychomycosis and the presence of diabetic neuropathy (p = .012) and elevated glycosylated haemoglobin values (p = .039). There was no significant association between onychomycosis and ulceration (p = .185). Eight studies had a grade 4 level of evidence and a grade C recommendation, and one study had a grade 1b level of evidence and a grade A recommendation. Conclusion The information described in the literature is insufficient and heterogeneous regarding the association of risk factors and ulceration in patients with diabetic foot compared with developing onychomycosis. There is also a need to implement onychomycosis diagnostic testing instead of relying only on a clinical diagnosis. Additional pro, Depto. de Enfermería, Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub, APC financiada por la UCM

Introduction: The purpose of this study was to characterize how family influences diabetes self-management in Mexican American adults. Methods: Data were analyzed from previously collected data that included 34 semi-structured interviews with Hispanic adults with diabetes and six focus groups with 37 adults with diabetes and family members. Themes related to family and diabetes management were identified and analyzed using a modified template approach. Results: Family-related facilitators to T2DM self-management were (1) provides support, (2) provides motivation, and (3) desire to protect family from diabetes. Family-related challenges were (1) lack of support, (2) family responsibilities, and (3) stress related to family. Diabetes education was shared with family members. Family member perspectives on T2DM included (1) not knowing how to help, (2) effect on emotional wellbeing, (3) diabetes affects the whole family, and (4) family provides support. Conclusion: Most participants with T2DM felt supported by family, but many desired more social support and support surrounding dietary changes from family. Many felt family did not understand what living with diabetes meant for them. Most family members wished to learn more about how to help. Future interventions should include family members and teach them supportive strategies to support beneficial diabetes self-management behaviors.

BACKGROUND: To investigate the individual profile of each SGLT2 (sodium-glucose cotransoporter-2) inhibitor in patients with different backgrounds. METHODS AND RESULTS: This study included 21 placebo-controlled randomized controlled trials with a total of 96 196 participants, investigating empagliflozin, ertugliflozin, dapagliflozin, canagliflozin, and sotagliflozin. The primary efficacy end point was the composite of cardiovascular death and hospitalizations for heart failure. The secondary efficacy end points were all-cause death, cardiovascular death, hospitalizations for heart failure, kidney disease progression, and acute kidney injury. We conducted subgroup analyses based on the underlying comorbidities, including diabetes and chronic kidney disease. Safety end points were also assessed among SGLT2 inhibitors in the overall cohort. In the overall cohort, there were no significant differences in the primary efficacy outcome among the SGLT2 inhibitors, while empagliflozin (hazard ratio [HR], 0.70 [95% CI, 0.53-0.92]) and dapagliflozin (HR, 0.73 [95% CI, 0.56-0.96]) were associated with lower risk of acute kidney injury than sotagliflozin. The presence or absence of diabetes did not alter the results. In patients with chronic kidney disease, there were no differences in the efficacy outcomes among SGLT2 inhibitors, while in patients without chronic kidney disease, empagliflozin was associated with lower risk of the primary outcome compared with ertugliflozin (HR, 0.77 [95% CI, 0.60-0.98]). For safety outcomes, no significant differences were observed in amputation, urinary tract infection, genital infection, hypoglycemia, and diabetic ketoacidosis. CONCLUSIONS: The differences in reducing cardiovascular and kidney outcomes as well as safety profiles across SGLT2 inhibitors were not consistently significant, although empagliflozin might be preferred in patients without chronic kidney disease. Further investigations are needed to better understand the mechanism and

CD4+ T cells recognize peptide antigens presented on class II major histocompatibility complex (MHC-II) molecules to carry out their function. The remarkable diversity of T cell receptor sequences and lack of antigen discovery approaches for MHC-II make profiling the specificities of CD4+ T cells challenging. We have expanded our platform of signaling and antigen-presenting bifunctional receptors to encode MHC-II molecules presenting covalently linked peptides (SABR-IIs) for CD4+ T cell antigen discovery. SABR-IIs can present epitopes to CD4+ T cells and induce signaling upon their recognition, allowing a readable output. Furthermore, the SABR-II design is modular in signaling and deployment to T cells and B cells. Here, we demonstrate that SABR-IIs libraries presenting endogenous and non-contiguous epitopes can be used for antigen discovery in the context of type 1 diabetes. SABR-II libraries provide a rapid, flexible, scalable and versatile approach for de novo identification of CD4+ T cell ligands from single-cell RNA sequencing data using experimental and computational approaches.

BACKGROUND: Diabetic cardiomyopathy (DbCM) is characterized by asymptomatic stage B heart failure (SBHF) caused by diabetes-related metabolic alterations. DbCM is associated with an increased risk of progression to overt heart failure (HF). The prevalence of DbCM in patients with type 2 diabetes (T2D) is not well established. This study aims to determine prevalence of DbCM in adult T2D patients in real-world clinical practice. METHODS: Retrospective multi-step review of electronic medical records of patients with the diagnosis of T2D who had echocardiogram at UC San Diego Medical Center (UCSD) within 2010-2019 was conducted to identify T2D patients with SBHF. We defined pure DbCM when SBHF is associated solely with T2D and mixed SBHF when other medical conditions can contribute to SBHF. Pure DbCM was diagnosed in T2D patients with echocardiographic demonstration of SBHF defined as left atrial (LA) enlargement (LAE), as evidenced by LA volume index ≥ 34 mL/m2, in the presence of left ventricular ejection fraction (LVEF) ≥ 45%, while excluding overt HF and comorbidities that can contribute to SBHF. RESULTS: Of 778,314 UCSD patients in 2010-2019, 45,600 (5.9%) had T2D diagnosis. In this group, 15,182 T2D patients (33.3%) had echocardiogram and, among them, 13,680 (90.1%) had LVEF ≥ 45%. Out of 13,680 patients, 4,790 patients had LAE. Of them, 1,070 patients were excluded due to incomplete data and/or a lack of confirmed T2D according to the American Diabetes Association recommendations. Thus, 3,720 T2D patients with LVEF ≥ 45% and LAE were identified, regardless of HF symptoms. In this group, 1,604 patients (43.1%) had overt HF and were excluded. Thus, 2,116 T2D patients (56.9% of T2D patients with LVEF ≥ 45% and LAE) with asymptomatic SBHF were identified. Out of them, 1,773 patients (83.8%) were diagnosed with mixed SBHF due to comorbidities such as hypertension (58%), coronary artery disease (36%), and valvular heart disease (17%). Finally, 343 patients met the

BACKGROUNDPreclinical studies suggest that cholesterol accumulation leads to insulin resistance. We previously reported that alterations in a monocyte cholesterol metabolism transcriptional network (CMTN) - suggestive of cellular cholesterol accumulation - were cross-sectionally associated with obesity and type 2 diabetes (T2D). Here, we sought to determine whether the CMTN alterations independently predict incident prediabetes/T2D risk, and correlate with cellular cholesterol accumulation.METHODSMonocyte mRNA expression of 11 CMTN genes was quantified among 934 Multi-Ethnic Study of Atherosclerosis (MESA) participants free of prediabetes/T2D; cellular cholesterol was measured in a subset of 24 monocyte samples.RESULTSDuring a median 6-year follow-up, lower expression of 3 highly correlated LXR target genes - ABCG1 and ABCA1 (cholesterol efflux) and MYLIP (cholesterol uptake suppression) - and not other CMTN genes, was significantly associated with higher risk of incident prediabetes/T2D. Lower expression of the LXR target genes correlated with higher cellular cholesterol levels (e.g., 47% of variance in cellular total cholesterol explained by ABCG1 expression). Further, adding the LXR target genes to overweight/obesity and other known predictors significantly improved prediction of incident prediabetes/T2D.CONCLUSIONThese data suggest that the aberrant LXR/ABCG1-ABCA1-MYLIP pathway (LAAMP) is a major T2D risk factor and support a potential role for aberrant LAAMP and cellular cholesterol accumulation in diabetogenesis.FUNDINGThe MESA Epigenomics and Transcriptomics Studies were funded by NIH grants 1R01HL101250, 1RF1AG054474, R01HL126477, R01DK101921, and R01HL135009. This work was supported by funding from NIDDK R01DK103531 and NHLBI R01HL119962.

Immune checkpoint inhibitor (CPI)-induced diabetes mellitus (CPI-DM) is a rare immune-related adverse event (irAE). Patients and providers fear that continuing CPIs puts patients at risk for additional irAEs and thus may discontinue therapy. Currently, there are little data to inform this decision. Therefore, this study aims to elucidate whether discontinuing CPIs after diagnosis of CPI-DM impacts the development of future irAEs and cancer outcomes such as progression and death. Patients who developed CPI-DM during cancer treatment at UCSF from 1 July 2015 to 5 July 2023 were analyzed for cancer outcomes and irAE development. Fishers exact tests, Student t-tests, Kaplan-Meier methods, and Cox regression were used as appropriate. Of the 43 patients with CPI-DM, 20 (47%) resumed CPIs within 90 days of the irAE, 4 (9%) patients restarted after 90 days, and 19 (44%) patients never restarted. Subsequent irAEs were diagnosed in 9 of 24 (38%) who resumed CPIs and 3 of 19 (16%) who discontinued CPIs (p = 0.17). There was no significant difference in death (p = 0.74) or cancer progression (p = 0.55) between these two groups. While our single-institution study did not show worse cancer outcomes after discontinuing CPIs, many variables can impact outcomes, which our study was not adequately powered to evaluate. A nuanced approach is needed to decide whether to continue CPI treatment after a severe irAE like CPI-DM.

Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.

Evaluating the quality of isolated human islets before transplantation is crucial for predicting the success in treating Type 1 diabetes. The current gold standard involves time-intensive in vivo transplantation into diabetic immunodeficient mice. Given the susceptibility of isolated islets to hypoxia, we hypothesized that hypoxia present in islets before transplantation could indicate compromised islet quality, potentially leading to unfavorable outcomes. To test this hypothesis, we analyzed expression of 39 hypoxia-related genes in human islets from 85 deceased donors. We correlated gene expression profiles with transplantation outcomes in 327 diabetic mice, each receiving 1200 islet equivalents grafted into the kidney capsule. Transplantation outcome was post-transplant glycemic control based on area under the curve of blood glucose over 4 weeks. In linear regression analysis, DDIT4 (R = 0.4971, P < 0.0001), SLC2A8 (R = 0.3531, P = 0.0009) and HK1 (R = 0.3444, P = 0.0012) had the highest correlation with transplantation outcome. A multiple regression model of 11 genes increased the correlation (R = 0.6117, P < 0.0001). We conclude that assessing pre-transplant hypoxia in human islets via gene expression analysis is a rapid, viable alternative to conventional in vivo assessments. This approach also underscores the importance of mitigating pre-transplant hypoxia in isolated islets to improve the success rate of islet transplantation.

Diabetes mellitus (DM) is a chronic endocrine disorder that affects more than 20 million people in the United States. DM-related complications affect multiple organ systems and are a significant cause of morbidity and mortality among people with DM. Of the numerous acute and chronic complications, atherosclerosis due to diabetic dyslipidemia is a condition that can lead to many life-threatening diseases, such as stroke, coronary artery disease, and myocardial infarction. The nuclear erythroid 2-related factor 2 (Nrf2) signaling pathway is an emerging antioxidative pathway and a promising target for the treatment of DM and its complications. This review aims to explore the Nrf2 pathways role in combating diabetic dyslipidemia. We will explore risk factors for diabetic dyslipidemia at a cellular level and aim to elucidate how the Nrf2 pathway becomes a potential therapeutic target for DM-related atherosclerosis.

BackgroundEstimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective of our study was to forecast the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the United States (US) through 2030.Methods and findingsUsing the PEARL model-an agent-based simulation of PWH who have initiated ART in the US-the prevalence of anxiety, depression, stage ≥3 chronic kidney disease (CKD), dyslipidemia, diabetes, hypertension, cancer, end-stage liver disease (ESLD), myocardial infarction (MI), and multimorbidity (≥2 mental or physical comorbidities, other than HIV) were forecasted through 2030. Simulations were informed by the US CDC HIV surveillance data of new HIV diagnosis and the longitudinal North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data on risk of comorbidities from 2009 to 2017. The simulated population represented 15 subgroups of PWH including Hispanic, non-Hispanic White (White), and non-Hispanic Black/African American (Black/AA) men who have sex with men (MSM), men and women with history of injection drug use and heterosexual men and women. Simulations were replicated for 200 runs and forecasted outcomes are presented as median values (95% uncertainty ranges are presented in the Supporting information). In 2020, PEARL forecasted a median population of 670,000 individuals receiving ART in the US, of whom 9% men and 4% women with history of injection drug use, 60% MSM, 8% heterosexual men, and 19% heterosexual women. Additionally, 44% were Black/AA, 32% White, and 23% Hispanic. Along with a gradual rise in population size of PWH receiving ART-reaching 908,000 individuals by 2030-PEARL forecasted a surge in prevalence of most comorbidities to 2030. Depression and/or anxiety was high and increased from 60% in 2020 to 64% in 2030. Hypertension decreased while dyslipidemia, diabetes, CKD, and MI incr

The Diabetes Prevention Program (DPP) randomized controlled trial demonstrated that metformin treatment reduced progression to type 2 diabetes (T2D) by 31% compared to placebo in adults with prediabetes. Circulating micro-ribonucleic acids (miRs) are promising biomarkers of T2D risk, but little is known about their associations with metformin regimens for T2D risk reduction. We compared the change in 24 circulating miRs from baseline to 2 years in a subset from DPP metformin intervention (n = 50) and placebo (n = 50) groups using Wilcoxon signed rank tests. Spearman correlations were used to evaluate associations between miR change and baseline clinical characteristics. Multiple linear regression was used to adjust for covariates. The sample was 73% female, 17% Black, 13% Hispanic, and 50 ± 11 years. Participants were obese, normotensive, prediabetic, and dyslipidemic. Change in 12 miR levels from baseline to 2 years was significantly different in the metformin group compared with placebo after adjusting for multiple comparisons: six (let-7c-5p, miR-151a-3p, miR-17-5p, miR-20b-5p, miR-29b-3p, and miR-93-5p) were significantly upregulated and six (miR-130b-3p, miR-22-3p, miR-222-3p, miR-320a-3p, miR-320c, miR-92a-3p) were significantly downregulated in the metformin group. These miRs help to explain how metformin is linked to T2D risk reduction, which may lead to novel biomarkers, therapeutics, and precision health strategies.

Statin drugs lower blood cholesterol levels for cardiovascular disease prevention. Women are more likely than men to experience adverse statin effects, particularly new-onset diabetes (NOD) and muscle weakness. Here we find that impaired glucose homeostasis and muscle weakness in statin-treated female mice are associated with reduced levels of the omega-3 fatty acid, docosahexaenoic acid (DHA), impaired redox tone, and reduced mitochondrial respiration. Statin adverse effects are prevented in females by administering fish oil as a source of DHA, by reducing dosage of the X chromosome or the Kdm5c gene, which escapes X chromosome inactivation and is normally expressed at higher levels in females than males. As seen in female mice, we find that women experience more severe reductions than men in DHA levels after statin administration, and that DHA levels are inversely correlated with glucose levels. Furthermore, induced pluripotent stem cells from women who developed NOD exhibit impaired mitochondrial function when treated with statin, whereas cells from men do not. These studies identify X chromosome dosage as a genetic risk factor for statin adverse effects and suggest DHA supplementation as a preventive co-therapy.

BACKGROUND: Type 1 diabetes (T1D) is preceded by a heterogenous pre-clinical phase, islet autoimmunity (IA). We aimed to identify pre vs. post-IA seroconversion (SV) changes in DNAm that differed across three IA progression phenotypes, those who lose autoantibodies (reverters), progress to clinical T1D (progressors), or maintain autoantibody levels (maintainers). METHODS: This epigenome-wide association study (EWAS) included longitudinal DNAm measurements in blood (Illumina 450K and EPIC) from participants in Diabetes Autoimmunity Study in the Young (DAISY) who developed IA, one or more islet autoantibodies on at least two consecutive visits. We compared reverters - individuals who sero-reverted, negative for all autoantibodies on at least two consecutive visits and did not develop T1D (n=41); maintainers - continued to test positive for autoantibodies but did not develop T1D (n=60); progressors - developed clinical T1D (n=42). DNAm data were measured before (pre-SV visit) and after IA (post-SV visit). Linear mixed models were used to test for differences in pre- vs post-SV changes in DNAm across the three groups. Linear mixed models were also used to test for group differences in average DNAm. Cell proportions, age, and sex were adjusted for in all models. Median follow-up across all participants was 15.5 yrs. (interquartile range (IQR): 10.8-18.7). RESULTS: The median age at the pre-SV visit was 2.2 yrs. (IQR: 0.8-5.3) in progressors, compared to 6.0 yrs. (IQR: 1.3-8.4) in reverters, and 5.7 yrs. (IQR: 1.4-9.7) in maintainers. Median time between the visits was similar in reverters 1.4 yrs. (IQR: 1-1.9), maintainers 1.3 yrs. (IQR: 1.0-2.0), and progressors 1.8 yrs. (IQR: 1.0-2.0). Changes in DNAm, pre- vs post-SV, differed across the groups at one site (cg16066195) and 11 regions. Average DNAm (mean of pre- and post-SV) differed across 22 regions. CONCLUSION: Differentially changing DNAm regions were located in genomic areas related to beta cell function, immune c

Cardiorespiratory fitness and mitochondrial oxidative capacity are associated with reduced walking speed in older adults, but their impact on walking speed in older adults with diabetes has not been clearly defined. We examined differences in cardiorespiratory fitness and skeletal muscle mitochondrial oxidative capacity between older adults with and without diabetes, as well as determined their relative contribution to slower walking speed in older adults with diabetes. Participants with diabetes (n = 159) had lower cardiorespiratory fitness and mitochondrial respiration in permeabilized fiber bundles compared with those without diabetes (n = 717), following adjustments for covariates including BMI, chronic comorbid health conditions, and physical activity. Four-meter and 400-m walking speeds were slower in those with diabetes. Mitochondrial oxidative capacity alone or combined with cardiorespiratory fitness mediated ∼20-70% of the difference in walking speed between older adults with and without diabetes. Additional adjustments for BMI and comorbidities further explained the group differences in walking speed. Cardiorespiratory fitness and skeletal muscle mitochondrial oxidative capacity contribute to slower walking speeds in older adults with diabetes.

Atherosclerotic Cardiovascular Disease (ASCVD) remains the leading cause of death in diabetes mellitus (DM) adult patients. I investigated the current status of ASCVD and DM risk factor control for DM adult patients in the UCI health system, stratified by sex, race/ethnicity, and ASCVD status, A total of 34,207 DM adult patients were identified in the UCI electronic health records (EHR) through ICD-10 code during the timeframe of January 1st, 2022 – June 30th, 2023. Of these patients, within a year after their last DM diagnosis, while 91.3% received a blood pressure (BP) measurement, only 55.3% received a hemoglobin A1c (HbA1c) measurement and less than 50% received any kind of lipid profile measurement (total cholesterol, HDL-C, LDL-C, and triglycerides). Only 56.5% of patients were on any kind of DM drugs, with just 34.1% on metformin, even lower (29.6%) for patients with ASCVD. Only 15.6 % and 10.7% were on newer DM therapies of SGLT2i and GLP1-RA drugs, respectively. Only 46.6% were on statins, and non-statin use was infrequent (<3%). Statin usage was much higher in DM patients with ASCVD (72.5%) than those without (38.7%). 84.6% of DM patients reached control for BP. 94.0% of DM patients with ASCVD reached target control for BP, which was significantly higher compared to 81.6% for DM patients without ASCVD (p<0.00001). However, only 48.9% were at target control for HbA1c, 23.0% for LDL-C and 10.1% for composite control (HbA1c + BP + LDL-C). Some of these findings differed by race/ethnicity, such as only 36.4% of Hispanic patients being at target control for HbA1c, compared to 48.9% for the overall sample. A substantial number of DM patients in the UCI EHR are not receiving recommended risk factor measurements and treatment. Improving the frequency of yearly testing and drug therapies in these patients could prove invaluable in optimizing care in DM patients.

OBJECTIVE: Real-time continuous glucose monitoring (CGM) is effective for diabetes management in cases of type 1 diabetes and adults with type 2 diabetes (T2D) but has not been assessed in adolescents and young adults (AYAs) with T2D. The objective of this pilot interventional study was to assess the feasibility and acceptability of real-time CGM use in AYAs with T2D. METHODS: Adolescents and young adults (13-21 years old) with T2D for six months or more and hemoglobin A1c (A1c) greater than 7%, on any Food and Drug Administration-approved treatment regimen, were included. After a blinded run-in period, participants were given access to a real-time CGM system for 12 weeks. The use and acceptability of the real-time CGM were evaluated by sensor usage, surveys, and focus group qualitative data. RESULTS: Participants (n = 9) median age was 19.1 (interquartile range [IQR] 16.8-20.5) years, 78% were female, 100% were people of color, and 67% were publicly insured. Baseline A1c was 11.9% (standard deviation ±2.8%), with median diabetes duration of 2.5 (IQR 1.4-6) years, and 67% were using insulin. Seven participants completed the study and demonstrated statistically significant improvement in diabetes-related quality of life, with the mean Pediatric Quality of Life inventory (PedsQL) diabetes score increasing from 70 to 75 after using CGM (P = .026). Focus group results supported survey results that CGM use among AYAs with T2D is feasible, can improve quality of life, and has the potential to modify behavior. CONCLUSION: Real-time CGM is feasible and acceptable for AYAs with T2D and may improve the quality of life of patients with diabetes. Larger randomized controlled trials are needed to assess the effects on glycemic control and healthy lifestyle changes.

43 p., ill., Refus, surprimes… contracter une assurance solde restant dû n’est pas toujours une sinécure quand on vit avec un problème de santé ! En 2019, la Belgique s’est dotée d’un « droit à l’oubli » qui facilite l’accès à ce type d’assurance pour les personnes atteintes de certaines maladies chroniques ou guéries de certains cancers, à certaines conditions et après certains délais. Le Centre Fédéral d’Expertise des Soins de santé (KCE) a été chargé de réévaluer à intervalles réguliers la liste des pathologies concernées en fonction de l’évolution des connaissances et des progrès de la médecine. Après une première étude consacrée au cancer du sein, qui a débouché en 2023 sur des conditions plus favorables pour certains groupes de patientes, les experts du KCE ont examiné la possibilité d’intégrer le diabète de type 1 à la liste des maladies concernées., PRÉFACE 1 -- SYNTHÈSE 2 -- 1. LA MISSION ‘DROIT À L’OUBLI’ DU KCE 5 -- 1.1. CONTEXTE 5 -- 1.2. MISSION DU KCE 6 -- 2. OBJECTIFS DE CETTE ÉTUDE 7 -- 2.1. POURQUOI LE CHOIX DU DIABÈTE DE TYPE 1 ? 7 -- 2.2. QUESTIONS DE RECHERCHE 7 -- 2.3. MÉTHODOLOGIE 9 -- 2.3.1. Première partie – Question 1 9 -- 2.3.2. Seconde partie – Question 2 9 -- 2.3.3. Protection des données 9 -- 3. LE DIABÈTE DE TYPE 1 10 -- 3.1. UNE MALADIE DONT LES CAUSES SONT ENCORE MAL COMPRISES 10 -- 3.2. ÉPIDÉMIOLOGIE 11 -- 3.2.1. Prévalence et incidence 11 -- 3.2.2. Mortalité 11 -- 3.3. LE RISQUE EST SURTOUT LIÉ AUX COMPLICATIONS 11 -- 3.4. PRINCIPES ET PERSPECTIVES DU TRAITEMENT 12 -- 3.5. QUALITÉ DES SOINS DU DIABÈTE EN BELGIQUE 13 -- 4. ÉTUDE DE LA POPULATION BELGE 14 -- 4.1. SÉLECTION DES PATIENTS 14 -- 4.2. APPROCHE PAR TABLES DE MORTALITÉ PÉRIODIQUES 16 -- 4.2.1. Risques relatifs et absolus de surmortalité dans le diabète de type 1 16 -- 4.2.2. Espérance de vie résiduelle et années de vie perdues en raison du diabète de type 1 20 -- 4.3. APPROCHE PAR TABLE DE MORTALITÉ PROSPECTIVE 21 -- 4.4. QUE RETENIR DES RÉSULTATS DE L’ANALYSE COMBINÉE DES TABLES DE MORTALITÉ ? 21 -- 5. REVUE DE LITTÉRATURE ET MÉTA-ANALYSE 22 -- 5.1. RÉSUMÉ DE LA REVUE DE LITTÉRATURE ET DE LA MÉTA-ANALYSE 23 -- 5.2. COMPARAISON DES RÉSULTATS BELGES AVEC LES DONNÉES D'AUTRES PAYS 24 -- 6. ANALYSE ACTUARIELLE 24 -- 6.1. ENQUÊTE AUPRÈS DES ASSUREURS ET RÉASSUREURS 24 -- 6.2. CALCUL DES PRIMES 25 -- 7. PROPOSITIONS POUR LA GRILLE DE RÉFÉRENCE 28 -- 7.1. CONTEXTE SOCIÉTAL DANS LEQUEL S’INSCRIT CETTE PROPOSITION 32 -- RECOMMANDATIONS 34