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Objective To construct a Type 1 diabetes model in miniature pigs and explore postoperative care strategies for effectively prolonging the survival time of the model pigs. Methods Seven Banna miniature pigs were selected for pancreatectomy. Glucose, vitamins, and antibiotics were administered for 3-5 days after surgery to aid recovery. Blood glucose and urine glucose levels were measured twice a day in the morning and evening to adjust insulin supplementation accordingly. The model pigs were observed daily and records were kept, including orexis, psychosis, weakness, skin ulcer, and feces and urine. Body weight was measured weekly until the death of the model animals. Based on the model pigs' condition, glucose injection and Ringer's lactate solution were administered to supplement nutrition and correct electrolyte imbalances. Results All seven Banna miniature pigs showed typical symptoms of diabetes: random blood glucose levels higher than 11.1 mmol/L after pancreatectomy, far exceeding the average blood glucose level of 6.0 mmol/L in normal pigs; positive urine glucose; and progressive weight loss. These features indicated the successful construction of Type 1 diabetes model. Additionally, Type 1 diabetic pigs that survived more than 8 weeks showed progressive hair loss and skin ulceration. Euthanasia was performed on model pigs when they were unable to stand or even eat independently, and pathological examination and HE staining were conducted on tissues collected from affected organs such as the liver, kidneys, and skin. Pathological sections revealed liver congestion, massive glycogen accumulation, ballooning degeneration of hepatocytes, and progressive liver fibrosis, along with glomerular congestion, vacuolar degeneration in renal tubular epithelial cells, proteinuria, dermal congestion, thinning of vascular walls, and varying degrees of parakeratosis and dyskeratosis in the liver, kidneys, and skin tissues due to prolonged hyperglycemia. The average survival time of the constructed Banna miniature pig diabetes model was 44 d, with a maximum survival time of 121 d. Conclusion Type 1 diabetes model can be constructed successfully in Banna miniature pigs through pancreatectomy. With meticulous postoperative care, a long-term Type 1 diabetes model with significant complications can be achieved, providing a stable large-animal model for Type 1 diabetes treatment strategies.

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Abstract Background This study aimed to reveal the association between the gut microbiota (GM) and six diabetic complications: diabetic hypoglycemia; ketoacidosis; nephropathy; neuropathy; retinopathy; and Charcot’s foot. Methods GM data were obtained from the MiBioGen consortium and Dutch Microbiome Project while data on the six diabetic complications were obtained from the FinnGen consortium. Two-sample Mendelian randomization (TSMR) was performed to explore the association between GM and the common diabetic complications. Inverse MR analysis was conducted to examine the effect of diabetic complications on the identified GM. Sensitivity tests were conducted to validate the stability of the results. Finally, multivariate MR (MVMR) was performed to determine whether GM had a direct influence on the diabetic complications. Results After multiple corrections, the inverse variance weighted (IVW) results predicted 61 suggestive markers between GM and six diabetic complications. In particular, the IVW results revealed that the Bacteroidia class and Bacteroidales order were positively associated with diabetic hypoglycemia while the Verrucomicrobiae class and Verrucomicrobiales order were positively associated with diabetic nephropathy. Based on the replication analysis, these results were identified to be stable. MVMR showed that the results remained stable after accounting for traditional risk factors. Conclusion Extensive causal associations were found between GM and diabetic complications, which may provide new insights into the mechanisms of microbiome-mediated complications of diabetes.

This case report describes a 33-year-old woman with type 1 diabetes mellitus complicated by peripheral neuropathy, who developed recurrent painless stress fractures in both feet. The patient's poorly controlled blood glucose levels likely contributed to severe neuropathy and increased fracture risk. While fractures in diabetics are often associated with Charcot's foot (painful), this case highlights the possibility of painless stress fractures due to sensory neuropathy. The case also addresses the issue of skeletal abnormalities that can occur in the course of type 1 diabetes. Understanding the relationship between painless stress fractures of the foot and poorly controlled diabetes underscores the importance of early diagnosis and proper glycaemic control of type 1 diabetes mellitus to prevent such complications. [ABSTRACT FROM AUTHOR]

Background: This study aimed to reveal the association between the gut microbiota (GM) and six diabetic complications: diabetic hypoglycemia; ketoacidosis; nephropathy; neuropathy; retinopathy; and Charcot's foot. Methods: GM data were obtained from the MiBioGen consortium and Dutch Microbiome Project while data on the six diabetic complications were obtained from the FinnGen consortium. Two-sample Mendelian randomization (TSMR) was performed to explore the association between GM and the common diabetic complications. Inverse MR analysis was conducted to examine the effect of diabetic complications on the identified GM. Sensitivity tests were conducted to validate the stability of the results. Finally, multivariate MR (MVMR) was performed to determine whether GM had a direct influence on the diabetic complications. Results: After multiple corrections, the inverse variance weighted (IVW) results predicted 61 suggestive markers between GM and six diabetic complications. In particular, the IVW results revealed that the Bacteroidia class and Bacteroidales order were positively associated with diabetic hypoglycemia while the Verrucomicrobiae class and Verrucomicrobiales order were positively associated with diabetic nephropathy. Based on the replication analysis, these results were identified to be stable. MVMR showed that the results remained stable after accounting for traditional risk factors. Conclusion: Extensive causal associations were found between GM and diabetic complications, which may provide new insights into the mechanisms of microbiome-mediated complications of diabetes. [ABSTRACT FROM AUTHOR]

Abstract Over the past two decades, there has been continuous advancement in the accuracy and complexity of continuous glucose monitoring devices. Continuous glucose monitoring provides valuable insights into blood glucose dynamics, and can record glucose fluctuations accurately and completely. Glycemic variability (GV) is a straightforward measure of the extent to which a patient's blood glucose levels fluctuate between high peaks and low nadirs. Many studies have investigated the relationship between GV and complications, primarily in the context of type 2 diabetes. Nevertheless, the exact contribution of GV to the development of diabetes complications remains unclear. In this literature review, we aimed to summarize the existing evidence regarding the measurement, target level, pathophysiological mechanisms relating GV and tissue damage, and population‐based studies of GV and diabetes complications. Additionally, we introduce novel methods for measuring GV, and discuss several unresolved issues of GV. In the future, more longitudinal studies and trials are required to confirm the exact role of GV in the development of diabetes complications.

Over the past two decades, there has been continuous advancement in the accuracy and complexity of continuous glucose monitoring devices. Continuous glucose monitoring provides valuable insights into blood glucose dynamics, and can record glucose fluctuations accurately and completely. Glycemic variability (GV) is a straightforward measure of the extent to which a patient's blood glucose levels fluctuate between high peaks and low nadirs. Many studies have investigated the relationship between GV and complications, primarily in the context of type 2 diabetes. Nevertheless, the exact contribution of GV to the development of diabetes complications remains unclear. In this literature review, we aimed to summarize the existing evidence regarding the measurement, target level, pathophysiological mechanisms relating GV and tissue damage, and population‐based studies of GV and diabetes complications. Additionally, we introduce novel methods for measuring GV, and discuss several unresolved issues of GV. In the future, more longitudinal studies and trials are required to confirm the exact role of GV in the development of diabetes complications. The role of glycemic variability (GV) in the development of diabetes complications remains uncertain. In this literature review, we aimed to summarize the existing evidence regarding the measurement, target level, pathophysiological mechanisms relating GV and tissue damage, and population‐based studies of GV and diabetes complications. Additionally, we introduce novel methods for measuring GV, and discuss several unresolved issues of GV. [ABSTRACT FROM AUTHOR]

Diabetes muscle infarction (DMI) is a rare complication of diabetes in which patients who present with DMI more commonly have some form of kidney disease in addition to diabetes mellitus. DMI typically presents with muscle pain and swelling. Diagnosis typically requires imaging (MRI with gadolinium contrast is the gold standard) and a variety of laboratory studies may aid in the diagnosis. Treatment of DMI varies depending on the severity of the case. In general patients recover quickly, though there is a risk of recurrence. This particular case report is a 36 year old female who presented with right lower extremity pain and chronic kidney disease. Case reports like this are important to highlight DMI as it is likely to become more common as diabetes continues to become more prevalent.

Hedysarum, a traditional Chinese herbal medicine and food with a long history of clinical application, is used to improve health conditions and treat various diseases. Hedysarum polysaccharides (HPS), flavonoids, saponins, and alkaloids, are the primary components of Hedysarum. HPS is the most important natural active ingredient of Hedysarum, which has many pharmacological effects. Currently, HPS exhibits significant promise in drug development for various ailments such as tumors, diabetes, cardiovascular diseases, Alzheimer’s disease, and fibrosis. This review paper discusses the extraction, separation, and content determination techniques of HPS, along with the investigation of its chemical constituents. More importantly, we reviewed the anti-inflammatory pharmacological effects of HPS, such as inhibition of inflammatory factors and NF-κB signaling pathway; antitumor activity through apoptosis induction in tumor cells and blocking tumor cell proliferation and metastasis; antioxidant effects; regulation of various cytokines and immune cells; regulation of blood sugar levels, such as in type I and type II diabetes and in diabetic complications; improvement in symptoms of Alzheimer disease; anti-aging and anti-fibrosis properties; and improvement in cerebral ischemia-reperfusion injury. This review paper establishes the theoretical foundation for future studies on the structure, mechanism, and clinical use of HPS. [ABSTRACT FROM AUTHOR]

Objective: In this study, we evaluate small and large nerve fibre pathology in relation to diabetic foot ulceration (DFU) and incident cardiovascular and cerebrovascular events in type 1 diabetes (T1D). Methods: A prospective observational study was conducted on people with T1D without diabetic peripheral neuropathy (DPN) (n = 25), T1D with DPN (n = 28), T1D with DFU (n = 25) and 32 healthy volunteers. ROC analysis of parameters was conducted to diagnose DPN and DFU, and multivariate Cox regression analysis was performed to evaluate the predictive ability of corneal nerves for cardiac and cerebrovascular events over 3 years. Results: Corneal nerve fibre length (CNFL), fibre density (CNFD) and branch density (CNBD) were lower in T1D-DPN and T1D-DFU vs. T1D (all p < 0.001). In ROC analysis, CNFD (sensitivity 88%, specificity 87%; AUC 0.93; p < 0.001; optimal cut-off 7.35 no/mm2) and CNFL (sensitivity 76%, specificity 77%; AUC 0.90; p < 0.001; optimal cut-off 7.01 mm/mm2) had good ability to differentiate T1D with and without DFU. Incident cardiovascular events (p < 0.001) and cerebrovascular events (p < 0.001) were significantly higher in T1D-DPN and T1D-DFU. Corneal nerve loss, specifically CNFD predicted incident cardiovascular (HR 1.67, 95% CI 1.12 to 2.50, p = 0.01) and cerebrovascular (HR 1.55, 95% CI 1.06 to 2.26, p = 0.02) events. Conclusions: Our study provides threshold values for corneal nerve fibre metrics for neuropathic foot at risk of DFU and further demonstrates that lower CNFD predicts incident cardiovascular and cerebrovascular events in T1D. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes-related distress (DRD) has negative emotional effects on the patients' quality of life. This is while the condition often goes undiagnosed despite it being common among diabetic patients. This study investigated the prevalence of DRD and its association with diabetes complications among a group of Iranian type 2 diabetic patients (T2DM). Methods: This descriptive-analytical cross-sectional study was conducted on 186 T2DM patients referred to a diabetes clinic in a teaching hospital from the beginning of May 2019 to the end of April 2020. Two questionnaires on disease-related information and diabetes distress screening scale (DDS) were filled out for each patient. The latter was divided into four domains, emotional burden (EB), diabetes-related interpersonal distress (ID), physician-related distress (PD), and regimen-related distress (RD). In addition to the frequency of DRD and its association with age, sex, body mass index (BMI), hypertension, hemoglobin A1C, duration of disease, and type of medication regimen (oral, insulin, or mix) along with the history of cardiovascular disease (CVDs), retinopathy, nephropathy, and diabetic foot were assessed. Results: DRD was reported in 47% of the patients. Being female, old age, hypertension, high hemoglobin A1C levels, nephropathy, and retinopathy were significantly associated with DRD (P-value = < 0.001, 0.013, 0.014, 0.007, 0.001, and 0.004, respectively). The history of the diabetic foot had a significant relationship with PD and ID (P-value = 0.007 and < 0.001, respectively). Multivariate regression showed gender and the existence of complications to have a direct effect on the development of DRD. Conclusion: DRD prevalence is relatively high and requires screening to identify and treat high-risk patients. Further studies are needed to study diabetes, its complications and their relation with DRD to help reduce such conditions and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and techniques an imperative need. To this end, several sensing and imaging techniques have been developed or employed in the assessment of microangiopathy in patients with diabetes. Herein, we present such techniques; we provide insights into their principles of operation while discussing the characteristics that make them appropriate for such use. Finally, apart from already established techniques, we present novel ones with great translational potential, such as optoacoustic technologies, which are expected to enter clinical practice in the foreseeable future.

Introduction: the increasing prevalence of diabetes (DM) worldwide has resulted in an increase in the morbidity and mortality of DM. This burden is as a result of the development of the chronic complications associated with it. This study determined the burden of occurrence of microvascular and macrovascular complications of subjects with type 2 diabetes attending the out - patient clinic of a tertiary hospital in south west Nigeria. Methods: this cross-sectional study involved 400 consecutive subjects with type 2 diabetes. A study proforma was used to document the socio demographic data. While clinical assessment for anthropometric measurement, blood pressure was done. Laboratory measurement of blood glucose control and lipids were done. Assessment of the occurrence of microvascular and macrovascular complications were performed and documented. Results: four hundred type 2 DM participants made up of 190 males and 210 females with a mean age of 60.35±9.53 years, with a mean age of 60.35(SD 9.53) years for males and 60.81(SD10.29) years for females. Median duration of DM for all subjects was 6.00(IQR 3.00 - 11.00) years. Majority (45%) of the participants were overweight. The prevalence of hypertension was 78% and poor glycaemia using HBA1C was 75.5% and 59.8% had dyslipidaemia. The occurrence of microvascular complications (diabetic neuropathy - 82%, diabetic retinopathy - 46% and diabetic nephropathy - 44%) 69.3% while macrovascular complications (peripheral arterial disease - 42.5%, stroke - 4%, electrocardiographic changes if ischaemic heart disease -9.3% and left ventricular hypertrophy - 22%) in 49%. Regression analyses showed advancing age aOR (1.18 [95%CI 1.01 - 1.38]) and waist circumference (aOR 1.17 [95% CI 1.00 - 1.36]), as significant contributors to the presence of diabetes complications. Conclusion: the risk factors of both microvascular and macrovascular complications remain high in our clinic and this is linked to the high burden of diabetes mellitus and its long duration. [ABSTRACT FROM AUTHOR]

Objective: to produce and validate a Nursing care protocol for people amputated due to diabetic complications. Methods: a methodological research study conducted in Recife-PE between February 2019 and October 2020, comprising the following stages: 1) Theoretical phase: integrative literature review; 2) Production phase; 3) Validation by specialists; and 4) Validation by the target population. The Content Validity Index was used in the validation by specialists. The Agreement Index was employed in the validation by the target population. Results: the items included in the instrument permeate the following care dimensions: Biological, Psychological and Socio-educational. Validation by the evaluators was in charge of 13 specialists. The instrument presented an index of 0.94. Validation by the target population was conducted with 33 participants; all the items achieved an agreement index ≥ 80%. Conclusion: the protocol enables comprehensive and humanized care, encouraging autonomy and assisting in rehabilitation; it also allows for a reflection regarding individualization of Nursing care.

Objective: To relate knowledge, practice and barriers of diabetic foot self-care among people with Type 2 Diabetes Mellitus, according to gender and education. Method: Analytical cross-sectional study with 102 users of 4 basic units in the inland of the state of Piauí, Brazil. Socioeconomic and clinical data were collected between December 2018 and July 2019. Descriptive analysis was performed with the use of the Chi-square test. Results: Women showed greater knowledge and practice of moisturizing (p5cm (p=0.001) and

Background and Aim: The cost of diabetes complication management is always much higher than the cost of diabetes treatment, even with novel and expensive molecules available. Thus, it is better to halt complications in the initial phase of the disease, rather than just treating hyperglycemia. Sodium-glucose co-transporter-2 inhibitor (SGLT-2i) is marking a new era in the management of type 2 diabetes mellitus (T2DM), showing significant benefits for mortality, hospitalization due to heart failure, and renal complications. The usage of SGLT2 inhibitors in clinical practice is still low. The aim of our study to know the prevalence and reasons for not prescribing SGLT-2i among Indian diabetologists. Materials and Methods: A cross-sectional survey was conducted in 10 states of India from 15 March to 31 July 2019. The primary question was asked to a doctor for the next 20 new patients at the clinic, “Was the patient initiated with SGLT-2i treatment?” If it was “Yes” the patient was excluded and if the marked option was “No” then the reason was selected for not prescribing the drug. Results: Out of 1132 patients, 687 (60.69%) patients were not prescribed SGLT2 inhibitors. Among them, the main reason for not prescribing SGLT-2i was cost (41.45%), followed by catabolic state (19.62%). Conclusion: It was found that cost is the major reason for not prescribing SGLT2 inhibitors. In spite of promising glycemic and extra glycemic benefits, it is the need of an hour to increase awareness and abetting physicians to prescribe SGLT-2 inhibitors in all appropriate patients at early stage of the disease to prevent the complications and its higher expenditure at the later stage of the disease.

Background and Objectives: Diabetes is considered as one of the most common endocrine disorders worldwide. The aim of this study was to investigate the factors associated with diabetic complications. Methods: A case-control study was performed on the data of 70089 diabetic patients (4622 cases and 53613 controls) extracted from the SINA Electronic Health Record (SinaEHR®) in a population covered by Mashhad University of Medical Sciences in 2018. The effect of independent variables on the likelihood of diabetic complications was investigated using single-variable and multivariate logistic regression models with the control of the potential confounding effects. Results: Using the multivariate logistic regression, the odds of developing diabetic complications were 0.35 (0.31-0.38) for living in the city, 0.73(0.67-0.79) for living in the suburbs and 0.31(0.28-0.33) for living in rural areas relative to the metropolises, 0.84 (0.78-0.91) for illiterate subjects, 0.70 (0.66-0.75) for physical activity, 1.51(1.34-1.71) for stage 1 hypertension and 1.87 (1.43-2.44) for stage 2 hypertension relative to normal blood pressure, 0.79(0.74-0.85) for uncontrolled low density lipoprotein and 1.42(1.33-1.51) for uncontrolled hemoglobin A1C. Conclusion: Various risk factors were identified to increase the odds ratio of diabetic complications. The most important risk factors were uncontrolled glycosylated hemoglobin and stage 1 and 2 hypertension. Control of these factors can reduce the chance of diabetic complications in diabetic patients.

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Copyright of Cogitare Enfermagem is the property of Cogitare Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Klotho concentration may be considered as a prognostic factor in the development of chronic complications of diabetes. Moreover, decrease in sKlotho concentration may contribute to beta cell apoptosis and type 1 diabetes development. The aim of this study was to evaluate if sKlotho protein concentration in children with type 1 diabetes (T1D) and its correlation with classical risk factors of chronic complications of diabetes: dysglycemia and endothelial dysfunction.Material and methodsIn a cross-section single center study the levels of soluble Klotho protein in 80 T1D (37 boys) and 34 healthy children (controls, 15 boys). Micro- and macroangiopathy were excluded and renal function was normal in all participants. Serum sKlotho, sICAM-1, sVCAM-1 and E-selectin levels were measured.ResultsThe concentration of sKlotho was lower in T1D than in the controls (2041.9 ± 1017.6 pg/mL vs. 2790.3 ± 1423.9 pg/mL, p=0.0113). sICAM-1, sVCAM-1 and E-selectin concentrations were comparable in patients and controls. In T1D, sKlotho was not correlated with the duration of diabetes. Klotho and E-selectin were correlated with HbA1c (r=-0.31, P=0.0066 and r=0.25, P=0.0351, respectively), but not with AVBG and blood glucose SD. Correlations of sKlotho with total cholesterol (r=0.31, P=0.0129), HDL-cholesterol (r=0.43, P=0.0011) and LDL-cholesterol (r=0.28, P=0.0412), but not with triglycerides, were found. Likewise, Klotho was not correlated with sICAM-1, sVCAM-1, and E-selectin concentrations.ConclusionsThis study reports the significantly lower level of s-Klotho in children with type 1 diabetes, correlated with HbA1c and HDL cholesterol, but not with the adhesion molecules concentrations nor the duration of the disease. Negative correlation between the levels of HbA1c and soluble Klotho may suggest its possible involvement in the development of chronic diabetes complications.

Klotho concentration may be considered as a prognostic factor in the development of chronic complications of diabetes. Moreover, decrease in sKlotho concentration may contribute to beta cell apoptosis and type 1 diabetes development. The aim of this study was to evaluate if sKlotho protein concentration in children with type 1 diabetes (T1D) and its correlation with classical risk factors of chronic complications of diabetes: dysglycemia and endothelial dysfunction. Material and methods: In a cross-section single center study the levels of soluble Klotho protein in 80 T1D (37 boys) and 34 healthy children (controls, 15 boys). Micro- and macroangiopathy were excluded and renal function was normal in all participants. Serum sKlotho, sICAM-1, sVCAM-1 and E-selectin levels were measured. Results: The concentration of sKlotho was lower in T1D than in the controls (2041.9 ± 1017.6 pg/mL vs. 2790.3 ± 1423.9 pg/mL, p=0.0113). sICAM-1, sVCAM-1 and E-selectin concentrations were comparable in patients and controls. In T1D, sKlotho was not correlated with the duration of diabetes. Klotho and E-selectin were correlated with HbA1c (r=-0.31, P =0.0066 and r=0.25, P =0.0351, respectively), but not with AVBG and blood glucose SD. Correlations of sKlotho with total cholesterol (r=0.31, P =0.0129), HDL-cholesterol (r=0.43, P =0.0011) and LDL-cholesterol (r=0.28, P =0.0412), but not with triglycerides, were found. Likewise, Klotho was not correlated with sICAM-1, sVCAM-1, and E-selectin concentrations. Conclusions: This study reports the significantly lower level of s-Klotho in children with type 1 diabetes, correlated with HbA1c and HDL cholesterol, but not with the adhesion molecules concentrations nor the duration of the disease. Negative correlation between the levels of HbA1c and soluble Klotho may suggest its possible involvement in the development of chronic diabetes complications. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is one of the World Health Organization's priority diseases under research by the first and second programmes of Innovative Medicines Initiative, with the acronyms IMI1 and IMI2, respectively. Up to October of 2019, 13 projects were funded by IMI for Diabetes & Metabolic disorders, namely SUMMIT, IMIDIA, DIRECT, StemBANCC, EMIF, EBiSC, INNODIA, RHAPSODY, BEAT-DKD, LITMUS, Hypo-RESOLVE, IM2PACT, and CARDIATEAM. In general, a total of €447 249 438 was spent by IMI in the area of Diabetes. In order to prompt a better integration of achievements between the different projects, we perform a literature review and used three data sources, namely the official project's websites, the contact with the project's coordinators and co-coordinator, and the CORDIS database. From the 662 citations identified, 185 were included. The data collected were integrated into the objectives proposed for the four IMI2 program research axes: (1) target and biomarker identification, (2) innovative clinical trials paradigms, (3) innovative medicines, and (4) patient-tailored adherence programmes. The IMI funded projects identified new biomarkers, medical and research tools, determinants of inter-individual variability, relevant pathways, clinical trial designs, clinical endpoints, therapeutic targets and concepts, pharmacologic agents, large-scale production strategies, and patient-centered predictive models for diabetes and its complications. Taking into account the scientific data produced, we provided a joint vision with strategies for integrating personalized medicine into healthcare practice. The major limitations of this article were the large gap of data in the libraries on the official project websites and even the Cordis database was not complete and up to date.

The International Diabetes Federation is divided into seven regions, Africa (AFR), Europe (EUR), Middle East and North Africa (MENA), North America and Caribbean (NAC), South and Central America (SACA), South East Asia (SEA) and Western Pacific (WP), with the aim of enhancing the work of national diabetes associations and strengthening the collaboration between them. In the MENA region, adult population (aged 20–79 years) was estimated 387 million in 2015 from which 35.4 million were suffering from diabetes and is expected to increase up to 72.1 million in 2040. Of the 35.4 million people affected by diabetes, nearly 40.6% were estimated to be undiagnosed. Therefore, at considerable risk of diabetes complications and poor health outcomes. The importance of glycemic control in preventing and delaying the progression of diabetes complications is well well-known. Diabetes poses extreme financial load to diabetic subjects. Local guidelines help to upgrade management strategies. It provides ideas for health care providers to improve quality of life of patient. Guidelines were prepared reviewing the literature, reviewing the available guidelines, consultative meetings between the experts and country representatives from the region.

The focus on the problem of diabetes mellitus (DM) is associated with the increasing prevalence of the disease and the risk for the development of many vascular complications (nephropathy, retinopathy, lesions of the great vessels of the heart, brain, peripheral vascular disease of the lower limbs), in the development of which chronic hyperglycemia plays a crucial role. In 2011, the WHO decided that glycated hemoglobin (HbA1c) could be used as the diagnostic criterion for diabetes. The role of HbA1c in the choice of hypoglycemic therapy is invaluable. According to the Algorithms of Specialized Medical Care for Diabetes Mellitus Patients, stratification of treatment strategy in patients with newly diagnosed type 2 diabetes is determined by the initial HbA1c.

Background & Objective: Apoptosis plays a major role in the process of diabetes-induced heart disease, but the effects of aerobic intermediate exercises on the status of apoptosis in diabetics’ cardiomyocytes are unclear. The aim of this study was to investigate the effect of 4-week aerobic exercise on apoptosis biomarkers in the cardiomyocytes of Streptozotocin-induced diabetic rats. Material&Methods: 40 adult rats were randomly assigned to 4 groups, including: Control, Control¬+¬Diabetes, Exercise and Exercise + Diabetes. To induce diabetes intraperitoneal injection of Streptozotocin (STZ) solution (55mg/kg) was used. 14 days after STZ injection, the level of fasting blood glucose was measured by a glucometer. After confirming diabetes induction, the exercise protocol was performed for 4 weeks. The training groups ran for 4 weeks (5sessions/week) at a speed of 15-18 m/min and 25 to 44 minutes. 48 hours after the last training session, the subjects were anesthetized and the cardiac muscle was removed. The sFas, FasL and Bcl-2 were measured by ELISA. Results: Induction of diabetes in the control group, resulted in a significant increase in sFas and FasL levels and insignificantly increase in sFas/FasL and also insignificantly decrease in Bcl-2 levels (p

Diabetes mellitus remains one of the most pressing problems in the 21st century. The research objective was to study the level of glycotoxins and oxidation-reduction potential of a serum/cell at the complicated and uncomplicated course of diabetes mellitus type 2 was and find the ways to correct the disorder. Materials and methods. There were three groups of patients aged from 55 up to 70 years, a total of 80 people. The main group (group No. 3) was presented by 40 men suffering from a diabetes mellitus type 2 with a macrovascular disease of the lower extremities. Depending on the chosen remedy and the carried-out therapy, patients of the first group were sectioned into subgroups on 20 people, in the 2nd subgroup additionally N-acetylcysteine solution was introduced in a daily dose of 600 mg once, intravenously, within 7 days. Definition of the studied indicators was made by HPLS methods, prior to therapy, for the third and seventh day. Results. Obtained data confirm activation of polyol pathway of glucose disintegration. Antioxidant potential of the serum and cells decreases. Using N-acetylcysteini in complex therapy reduces implications of carbonyl and oxidative stresses, due to multiple decrease of the final products of glycation. Conclusions. When identifying the presented indicators in patients with diabetic macroangiopathy of the lower extremities, the administration of N-acetylcysteine, intravenously in a daily dose of 600 mg (7 days course) is recommended.

Copyright of Enfermería Nefrológica is the property of Sociedad Espanola de Enfermeria Nefrologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The paper presents the report of the radiologist A. Мangov, who took part in the scientific-practical conference "Recent advances in Clinical Endocrinology." The speaker focused on endocrinology such topical issues as the visualization of diabetes complications, imaging of neuroendocrine tumors and pituitary tumors. The proper choice of imaging technique depends on timely diagnosis and treatment. When choosing a radiological procedure is necessary to know the features of the visualization of various organs and systems, and manifestations of the disease. The article also demonstrated clinical cases, which shows the possibilities of different imaging techniques. The speaker said that the company "Farmak" produces drugs for diagnostic tests with intravenous enhancement for CT (Tomoskan, Tomogeksol) and MRI (Tomovist).

Background: Pathogenesis of diabetes complications is due to systemic microcirculatory disturbances, while there is a deficit in instrumental methods of objective assessment of the microvasculature. Aim: To provide diagnostics of microcirculatory disorders in patients with diabetes mellitus (DM) using laser Doppler flowmetry. Materials and methods: The study included 11 patients with decompensated type 1 and type 2 DM (HbA1c level – 9.1±2.2%), the duration of the disease being more than 5 years. The control group consisted of 11 healthy volunteers. Blood microcirculation in skin was measured using LAKK-02 system. We examined the condition of blood microcirculation during the functional testing (occlusion, heat, cold, orthostatic) in different combinations and durations of action. For analysis of the quantitative data, the mean values and standard deviations were calculated (M±SD), the differences between the groups were tested using the double-sided Student’s test. Results: The diagnostic tests using a combination of thermal and orthostatic effects were developed. The said diagnostic functional testing and transformation of perfusion units into the relative values of microcirculation (by dividing perfusion index by the average value of microcirculation during the base period) revealed significant differences in microcirculation levels between diabetic patients and the control group: for foot testing, relative microcirculation indices were 3.2±1.9 in the study group and 6.3±4.6 in the control group (p=0.05), for hand testing, the relative indexes were 3.3±1.4 and 5.3±2.8, respectively (p

Aim. The aim of this study was to investigate late diabetic complications in patients with Type 1 diabetes mellitus (T1DM) who received simultaneous pancreas-kidney transplantation (SPK). Materials and Methods. The study included 16 patients with T1DM who received SPK. All patients underwent clinical examination and diagnostic investigation. Results. After SPK, 93.75% of the patients had a functioning pancreas transplant, and 100% had a functioning kidney transplant within 4?48 months [mean 21 months (10 is revealed; 36)). All patients had euglycaemia according to daily monitoring. The mean level of glycated haemoglobin (HbA1c) before surgery was 9.1% (range 8.7%?11%) and was 5.7% after surgery (5.55%?5.9%; p < 0.0001). The baseline level of insulin was 12.5 ?IU/ml (11.4?15.3 ?IU/ml) and the baseline level of C-peptide was 2.02 ng/ml (1.07?2.77 ng/ml). Normal renal function was observed (glomerular filtration rate 76 ml/min/1.73 m2 (68?90 ml/min/1.73 m2). Other laboratory findings included haemoglobin 127 g/l (120?130 g/l), serum parathyroid hormone 77.5 pg/ml (61?85 pg/ml), serum phosphate 1.2 mmol/l (1.07?1.3 mmol/l) and blood pressure 110(100?120)/70(64?80) mmHg. In 37.5% of the patients, vitrectomy and additional laser panretinal photocoagulation were performed for proliferative diabetic retinopathy. Other ophthalmological disorders included newly diagnosed cataract (81.25%), secondary cataract (25%) that required YAG discission in three patients, glaucoma (25%) and macular oedema (12.5%). Ulcers of the lower extremities were observed in 31.25% of the patients, and chronic osteoarthropathy was observed in four. One patient underwent amputation of index and ring fingers and resection of the first and third metatarsal heads to treat osteomyelitis. One patient underwent balloon angioplasty and stenting for advanced atherosclerotic stenosis of blood vessels of the lower extremities. Conclusions. Euglycaemia and recovery of renal function 6?48 months after SPK resulted in a significant decrease in diabetic complications without clinical signs of regression in some patients. However, some patients suffered progression of complications, reflecting their multifactorial causes. These findings highlight the need for timely diagnosis, treatment and long-term follow up to improve the quality of life and prognosis in patients with T1DM receiving SPK.

Objective: This study was of patients who underwent liver transplantation has the objective of determining glycemia values in each phase of liver transplant surgery and their relationships with post-operative morbidity and mortality. Materials and Methods: Liver transplant patients were identified in institutional records from 2013 to 2015. The information was taken from operative notes, laboratory records and clinical histories. We searched for differences in blood glucose levels during the three phases of transplantation and compared the incidences of infections and rejections for diabetics and non-diabetics. Results: A total of 73 transplant patients were studied: 54.8% (n = 40) were male, the median age was 59 years (RIQ = 52-53), and 32.9% (n = 24) had histories of Diabetes Mellitus. Differences were found between initial and final serum glucose levels of diabetics (127 mg/dl vs. 212 mg/dl, p = 0.001) as well as in non-diabetics (105 mg/dl vs. 190 mg/dl, p < 0.000). The proportion of rejection was highest among diabetics (14.3%, n = 7). No significant differences were found in the proportions of diabetic and non-diabetic patients who developed infections. Diagnosis of post-transplant diabetes was confirmed in 15.1% of the sample. Conclusions: Adequate monitoring of blood glucose levels during all trans-operative periods of liver transplantation can equalize the rate of infectious complications in diabetic and non-diabetic patients. Rejection continues to be more frequent among diabetic patients. An active search for post-transplant diabetes is necessary for every patient. [ABSTRACT FROM AUTHOR]

Background & Objective: Apoptosis plays a major role in the process of diabetes‐induced heart disease, but the effects of aerobic intermediate exercises on the status of apoptosis in diabetics' cardiomyocytes are unclear. The aim of this study was to investigate the effect of 4‐week aerobic exercise on apoptosis biomarkers in the cardiomyocytes of Streptozotocin‐induced diabetic rats. Material & Methods: 40 adult rats were randomly assigned to 4 groups, including: Control, Control¬+¬Diabetes, Exercise and Exercise + Diabetes. To induce diabetes intraperitoneal injection of Streptozotocin (STZ) solution (55mg/kg) was used. 14 days after STZ injection, the level of fasting blood glucose was measured by a glucometer. After confirming diabetes induction, the exercise protocol was performed for 4 weeks. The training groups ran for 4 weeks (5sessions/week) at a speed of 15‐18 m/min and 25 to 44 minutes. 48 hours after the last training session, the subjects were anesthetized and the cardiac muscle was removed. The sFas, FasL and Bcl‐2 were measured by ELISA. Results: Induction of diabetes in the control group, resulted in a significant increase in sFas and FasL levels and insignificantly increase in sFas/FasL and also insignificantly decrease in Bcl‐2 levels (p<0.05).In non‐diabetic groups, the implementation of 4 weeks of exercise training resulted in a significant decrease in sFas, FasL and a significant reduction of sFas/FasL and a significant increase in Bcl‐2(p<0.05). Performing of 4 weeks of exercise training in diabetic groups also led to a nonsignificant decrease in sFas and sFas/FasL and a significant decrease in FasL and a nonsignificant increase in Bcl‐2. Conclusion: The present study confirms the progressive effect of diabetes‐induced apoptosis on heart. The results suggest that regular aerobic exercises may be used as a non‐pharmacological strategy to reduce the complications of diabetes‐induced apoptosis in the heart tissue of diabetic people. [ABSTRACT FROM AUTHOR]

Patient knowledge about diabetes mellitus (DM) and appropriate timely management with respect to the condition are important factors for limiting the complications of the disease. The aim of this study was to evaluate knowledge and practices regarding DM, its ocular effects and management protocols among privately-funded diabetic patients. A questionnaire containing questions on these issues and certain demographics was provided to 73 self-funding or privately-funded diabetic patients attending an optometric practice in a rural district of the Western Cape. Respondents ages ranged from 33 to 80 years (mean = 57 ± 11.2 years) and included 59% males and 41% females. Above half(56%) of the respondents knew that there were two main types of DM. Less than half (46%) of the respondents reported having Type 2 DM, 4% reported having Type 1 DM and 49% did not knowwhat type of DM they had. Although 82% of the respondents reported owning a glucometer and 98% knew that controlling their blood sugar levels may help reduce diabetic complications, only 29% measured their blood sugar levels on a daily basis. Most respondents (97%) agreed that DM could affect their vision yet only 37% stated that they had annual eye examinations. A significant proportion of the respondents did not know that DM could cause strabismus (57%), colour vision problems (44%), cataracts (41%), retinopathy (37%) and contribute to causing glaucoma (63%). Most respondents took their medication regularly and as prescribed (89%) and underwent regular medical check-ups (82%). However, a large proportion of the respondents did not exercise regularly (61%), had no regular eye testing (63%) nor Body Mass Index (BMI) monitoring (84%) in their manage- ment of DM. This study indicates that, despite access to private health care, these subjects level of knowledge of DM and its ocular effects was sub-optimal. It also indicated poor self-management practices of the diabetic patients towards diabetes care and management. Optometrists should form part of a team of health professionals to assist in the management of DM. (S Afr Optom 2012 71(2) 70-77)

Epidemiological data shows that Diabetes Mellitus (DM) in South Africa is increasing with changes in lifestyles and ageing of the population. Early diagnosis and management of DM is an important factor for limiting visual and physical complications of the disease. The purpose of this study was to establish the level of knowledge about DM, its ocular complications and management protocol amongst diabetic patients. A questionnaire was provided to a total of 106 diabetic patients attending the Tongaat Community Clinic, the University of KwaZulu Natal Eye Clinic and the Diabetic Awareness day in Chatsworth. All patients were receiving treatment for DM. The questionnaire consisted of questions relating to the patients’ knowledge of the disease, its ocular complications and its management. The respondents were mostly females (65%), aged between 30 to 85 years (mean = 52.45 ± 3.75 years). The majority (96%) of respondents knew about the existence of two main types of DM and 77% reported having Type 2 DM, 18% reported having Type 1 DM, and only 5% did not know the type of DM that they had. Many respondents thought that hereditary factors (78%), and diet and lifestyle modifications (77%), were important risk factors in the development of DM. Glucose levelcontrol (84%) and duration (85%) were thought as important risk factors for its complications. Although many subjects (66.1%) were aware of the visual threat that DM posed, only 42%, 44% and 53% knew that DM could result in diabetic retinopathy, cataracts and glaucoma respectively. Less than half (48.3%) of the respondents had their last eye examination more than a year and a half ago. A significant proportion (60.8%) reported that the threat to vision was reason enough for them to have regular eye examinations. A large proportion (76%) of respondents reported that they had adequate knowledge of management of DM. Many (81%) of the respondents reported routinely controlling their DM through diet, 65% through exercise, 84% through sugar monitoring and 76% through regular medical examinations. The participants in this study had a significant knowledge of DM and its management. However, their knowledge of ocular effects was limited. These results highlight the need for educational programmes aimed at improving the knowledge of the effects of DM on the eyes including the need for regular eye examinations.

Introduction: Type II diabetes is the most common metabolic disorder, the prevalence of which is increasing in Iran. The relationship between metabolic control and preventive behaviors is established. Attitude is an important determinant in preventive behaviors. This study investigated the attitudes of patients with type II diabetes towards preventive behaviors for disease complications. Materials and Methods: This descriptive, analytical, cross-sectional study was performed among 200 patients with type II diabetes referring to diabetes center in Bandar Abbas, Iran. The participants were chosen through convenience sampling. The data was collected through a questionnaire on attitudes towards preventive behaviors for type II diabetes complications. The validity and reliability of this scale were established in a paper by Jahanfar et al. To analyze the data, Pearson correlation coefficient was run in SPSS version 19. Results: In total, 129 patients were female and 71 were male, and the majority of the patients had a positive attitude towards preventive behaviors. Level of education (P=0.04), as well as consumption of fruits and vegetables (P=0.00) were significantly correlated with attitudes towards preventive behaviors. However, no significant relationship was found between duration of disease and attitude (P=0.341). Conclusions: The mentioned relationships emphasize the importance of implementing training programs, providing facilities, and adopting appropriate policies to improve preventive behaviors for diabetes complications in both patients and general population [ABSTRACT FROM AUTHOR]

Background and Aims: Diabetes is increasing rapidly in Turkey as most countries in the world. The prevention of complications which is the main aim in the treatment of diabetes can be accomplished partly with nutrition education. The aim of this study was to assess the relationship between nutrition knowledge (NK) and complications in patients with type 2 diabetes. Materials and Methods: 280 patients with 8-20 years of diabetes duration who applied to diet outpatient clinic were recruited. The questionnaire was prepared by the investigators to assess the NK. A score was calculated on the scale of 100. The complications were determined based on hospital records and patients' selfreport. Results: 63.2% of participants were female and 36.8% were male. The most common complications in participants were retinopathy (56.1%) and neuropathy (42.9%). The mean NK score was 80.2±11.7. At least one complication was seen in 85.0% of the participants. There was no significant difference for having any complication in patients with adequate and inadequate NK. However the risk of diabetic foot, and coronary artery disease was significantly higher in women with inadequate NK. Conclusion: NK is quite high in long term diabetic patients. However no effect of the NK on the development of complications could be shown. The difference of effect between men and women could be due to the fact that food is mostly prepared by women thus not much chance of the knowledge of men to be reflected on his eating habits. The knowledge difference among female patients was seen in the results as; in women with inadequate NK, the prevalence of diabetic foot and CAD was significantly higher. [ABSTRACT FROM AUTHOR]

Background: The ankle-brachial index (ABI) is a screening test for peripheral arterial occlusive disease and it can also be used to assess cardiovascular risk. However, in diabetics it can be difficult to interpret because the index may be excessively high because of calcification of the arterial tunica media. Objective: To determine the frequency of high ABI in diabetics and to test for associations with sociodemographic variables. Methods: This was a descriptive study in which 309 type 2 diabetes patients were interviewed and had their ABI measured. The sample was recruited at a referral center for diabetes and endocrinology (CEDEBA) in Salvador, BA, Brazil. The frequency of excessively high ABI and its relationships with sociodemographic variables such as sex, age and family income were studied. The cutoff point chosen for excessively high ABI was 1.3. Continuous variables were dichotomized. The chi-square test was used for statistical analysis and results with p ≼ 0.05 were considered significant. Results: A total of 309 patients were interviewed, 65% were women, 26% had graduated from secondary education and 77% had a family income equal to or less than three times the minimum salary. The frequency of excessively high ABI (≽ 1.3) was 16.5%. Bivariate analyses detected no statistically significant correlations between excessively high ABI (≽ 1.3) and the sociodemographic variables studied (sex, age, time since diagnosis of diabetes mellitus, family income and educational level). Conclusions: The frequency of high ABI among this sample of diabetics was 16.5%. We did not detect correlations between the sociodemographic variables (sex, age, duration of DM, educational level and family income) and high ABI. [ABSTRACT FROM AUTHOR]

Background: Calcification of the arterial tunica media can falsely elevate the Ankle-Brachial Index (ABI) in diabetics, making it difficult to assess arterial disease. Objective: To compare ABI values in diabetics and non-diabetics with critical ischemia. Methods: A total of 140 patients (60% diabetics) with critical ischemia due to infrainguinal peripheral arterial obstructive disease were recruited from the vascular surgery service at the Complexo Hospitalar Universitário Professor Edgard Santos. Mean ABI values for the two groups of patients were compared and correlated with severity of ischemia, according to the Rutherford Classification. Statistical analysis was conducted using EPI-INFO. Results: A majority of the 140 patients (77%) were classified as Rutherford Category 5,6% as Category 4 and 17% as Category 6. Nine diabetics (11%) and one non-diabetic (2%) exhibited ABI > 1.15 (p = 0.02) and were excluded from the comparative analysis of mean ABIs. For the 130-patient sample, the 75 diabetic patients had a mean ABI for the posterior tibial artery of 0.26, vs. 0.28 for the 55 non-diabetic patients (p = 0.6); while mean ABIs for the dorsalis pedis artery were 0.32 vs. 0.23 respectively (p = 0.06). When the patients were stratified by Rutherford categories, there were no differences in mean ABIs in categories 4 or 5. Only mean ABI for the dorsalis pedis artery in Category 6 patients was significantly higher among diabetics (0.44 vs. 0.16; p = 0.03). Conclusions: The diabetic patients had a higher prevalence of falsely elevated ABI, but when these cases were excluded, mean ABI values were similar to those of non-diabetic patients, with the exception of ABI measured at the dorsalis pedis artery in patients with category 6 ischemia. [ABSTRACT FROM AUTHOR]