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In diabetes, tissue repair is impaired, increasing susceptibility to Staphylococcus aureus infections, a pathogen commonly found in wounds. The emergence of S. aureus strains that are highly resistant to antimicrobial agents highlights the urgent need for alternative therapeutic options. One promising candidate is Cramoll (Cratylia mollis seed lectin), known for its immunomodulatory, mitogenic, and healing properties. However, its efficacy in infected diabetic wounds remains unexplored. This study evaluated the effects of topical Cramoll treatment on diabetic wounds infected by S. aureus. Diabetic Swiss mice (induced by streptozotocin) were subjected to an 8-mm wound on the back and subsequently infected with a suspension of multidrug-resistant S. aureus. During the treatment period, the wounds were clinically evaluated for inflammation and the area of injury. After seven days, samples were collected from the wounds to quantify the bacterial load and histopathological and immunological analyses. Wounds infected by S. aureus exhibited more pronounced areas and severity indices, which were significantly reduced by Cramoll treatment (p < 0.05). Histopathological analysis revealed a reduction in inflammatory cells and an increase in revascularization with Cramoll treatment (p < 0.05). Cramoll also promoted greater collagen production compared to controls (p < 0.05). Furthermore, Cramoll treatment significantly reduced the S. aureus load in wounds (p < 0.0001), decreased TNF-α and IL-6 levels in infected wounds, and increased ERK pathway activation (p < 0.05). In conclusion, Cramoll lectin improves the healing of diabetic wounds, and these results contribute to the understanding of Cramoll healing mechanisms, reinforcing its potential as a healing agent in various clinical conditions. [ABSTRACT FROM AUTHOR]

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.

Purpose: To examine the effects of fresh fruit, dried fruit, raw vegetables, and cooked vegetables on type 2 diabetes (T2D) progression trajectory. Methods: We included 429,886 participants in the UK Biobank who were free of diabetes and diabetes complications at baseline. Food groups were determined using a validated food frequency questionnaire. Outcomes were T2D incidence, complications, and mortality. Multi-state model was used to analyze the effects of food groups on T2D progression. Results: During a follow-up of 12.6 years, 10,333 incident T2D cases were identified, of whom, 3961 (38.3%) developed T2D complications and 1169 (29.5%) died. We found that impacts of four food groups on T2D progression varied depending on disease stage. For example, compared to participants who ate less than one piece of dried fruit per day, the hazard ratios and 95% confidence intervals for those who ate ≥ 2 pieces of dried fruit per day were 0.82 (0.77, 0.87), 0.88 (0.85, 0.92), and 0.86 (0.78, 0.95) for transitions from diabetes-free state to incident T2D, from diabetes-free state to total death, and from incident T2D to T2D complications, respectively. Higher intake of fresh fruit was significantly associated with lower risk of disease progression from diabetes-free state to all-cause death. Higher intake of raw and cooked vegetables was significantly associated with lower risks of disease progression from diabetes-free state to incident T2D and to total death. Conclusions: These findings indicate that higher intake of fresh fruit, dried fruit, raw vegetables, and cooked vegetables could be beneficial for primary and secondary prevention of T2D. [ABSTRACT FROM AUTHOR]

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This case report documents the rapid onset of balanoposthitis in a 58‐year‐old male patient diagnosed with type 2 diabetes mellitus just 2 weeks prior. The patient presented with acute penile pain, swelling, and purulent discharge, necessitating circumcision due to balanoposthitis and phimosis. The diagnosis of type 2 diabetes mellitus 14 days prior highlights the potential for rapid development of balanoposthitis despite practicing proper hygiene. This underscores the importance of healthcare practitioners proactively examining the penile area in newly diagnosed diabetic patients to prevent balanoposthitis and, conversely, screening patients with balanoposthitis for type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

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]

Purpose: To determine whether phenotypic clustering of patients with diabetes mellitus (DM) is associated with more advanced diabetic retinopathy (DR). Methods: Retrospective cohort study of 495 patients with no prior DR treatment seen at a tertiary care clinic 2014–2020. Four previously identified clusters from Ahlqvist's 2018 paper were reproduced utilizing baseline hemoglobin A1c, body mass index, and age at DM diagnosis. Age-adjusted Cox proportional hazard ratios were used to compare clusters with reference as the lowest risk cluster. Results: All four type 2 DM clusters were replicated with our cohort. There was a significant difference in racial distribution among clusters (p = 0.018) with severe insulin-resistant diabetes (SIRD) having the higher percentage of Caucasians and lower percentage of Hispanics compared to other groups and a higher percentage of African Americans comprising the severe insulin-deficient diabetes (SIDD) cluster than other groups. Rates of proliferative diabetic retinopathy were higher in mild obesity-related diabetes (MOD) (28%), SIDD (24%), mild age-related diabetes (MARD) (20%), and lowest in SIRD (7.9%), overall p = 0.004. Rates of vitreous hemorrhage were higher in MOD (p = 0.032) and MARD (0.005) compared to SIRD. Conclusion: Baseline clinical measures may be useful in risk stratifying patients for progression to retinopathy requiring intervention. [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.

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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]

Aims: Whether to recommend specifically the glucose‐lowering therapies with cardiovascular benefit only in secondary prevention, or also in patients with multiple risk factors (MRF) but without established atherosclerotic cardiovascular disease (ASCVD), is controversial across the guidelines for diabetes. Materials and Methods: We performed a meta‐analysis of clinical trials with major adverse cardiovascular events (MACE) as an outcome. Results: The definitions of ASCVD and MRF were heterogeneous across trials; nevertheless, the incidence of MACE was 2.8‐fold higher in people with ASCVD in trials with sodium‐glucose cotransporter 2 inhibitors (SGLT2is), and 3.9‐fold in trials with glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA). Both SGLT2i and GLP‐1 RA were associated with a significant reduction in the incidence of MACE in people with previous ASCVD [inverse variance‐odds ratio 0.91, 95% confidence interval (0.86: 0.97) for SGLT2i, Mantel‐Haenszel odds ratio 0.85, 95% confidence interval (0.81: 0.90) for GLP‐1 RA], whereas no significant reduction was detected in those without; on the other hand, no significant difference in effect was found between the two groups as well. The sample of patients without ASCVD enrolled in clinical trials is insufficient to draw reliable conclusions in this population; however, even assuming the same benefit detected in people with ASCVD also in those with MRF, the number needed to treat would differ (35 for secondary, 99 for primary prevention of a MACE with a SGLT2i; 21 for secondary, 82 for primary prevention with a GLP‐1 RA, respectively), given the difference in absolute cardiovascular risk at baseline. Conclusion: The distinction between patients with ASCVD and those without ASCVD and MRF appears therefore justified by available evidence. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva 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.)

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]

There is a growing recognition that sex differences lead to variations in the way that diabetes manifests itself, and that the condition should be managed differently in women compared with men. This article explores some of the ways that women with diabetes are affected across their reproductive lives, such as by complications during pregnancy and risk of early menopause, and the elevated risks of a number of other complications, most notably including a range of cardiovascular diseases. It makes the case for developing a greater understanding of these sex-specific differences in order to provide tailored and effective treatment. Women with diabetes should collaborate with the healthcare professionals providing their care to develop personalised management plans that account for these sex-related differences. [ABSTRACT FROM AUTHOR]

Background and Methods: Asymptomatic coronary artery disease (CAD) is common in people with diabetes mellitus, but there is a lack of consensus regarding appropriate screening for the condition. We performed a 12‐lead electrocardiogram (ECG) on 312 consecutive participants with diabetes mellitus attending for routine annual outpatient review in order to determine the effectiveness of a yearly ECG in screening people with diabetes for asymptomatic CAD. Results: Three of 312 participants (0.96%, 95% CI 0.2%–2.78%) had a newly identified ECG abnormality. One person had newly discovered atrial fibrillation. Two people had abnormalities which prompted further investigation for asymptomatic CAD. One of these participants underwent percutaneous coronary intervention. Seventeen further participants had abnormalities on ECG which had been previously documented, the majority having been present since their diagnosis of diabetes. Conclusion: A low positive yield of routine annual ECG in our study does not support its use as a screening tool for asymptomatic CAD in diabetes. Our findings support advice to perform an ECG at diagnosis of diabetes and to repeat only if a person develops relevant symptoms. [ABSTRACT FROM AUTHOR]

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Context Polyphenols have antioxidant, anti-inflammatory, and anti-glycation properties. Objective To assess the effects of dietary polyphenols, from food sources or supplements, on the anthropometric, glycemic, renal, inflammatory, and oxidative stress markers in adults with diabetic nephropathy (DN). Data sources Systematic searches for randomized clinical trials were performed in MEDLINE, Embase, CENTRAL, Web of Science, LILACS, SciELO, opengrey.eu, and ClinicalTrials.gov databases until December 2021. Data extraction Studies with adults with DN were included. Random-effects meta-analyses were conducted. Risk of bias of the studies and Grading of Recommendations, Assessment, Development, and Evaluation assessment were carried out. Data analysis The searches resulted in 5614 unique occurrences, and 34 full-text articles were retrieved. Of these, 17 studies were included in the qualitative synthesis. Most of the studies used soy protein or milk (n = 5; 0.5–1 g/kg of body weight/d of soy protein, or introduction of 240 mL/d of soy milk) or turmeric/curcumin (n = 5; dose range, 80 to 1500 mg/d) as the intervention. The following outcomes were analyzed: body mass index, glycated hemoglobin (HbA1c), proteinuria, creatinine clearance, glomerular filtration rate (GFR), urinary albumin to creatinine ratio, and levels of fasting blood glucose, insulin, serum urea and creatinine, C-reactive protein, serum tumor necrosis factor-α, and serum malondialdehyde (MDA). The polyphenol intervention significantly decreased HbA1c (n = 7 studies; –0.27% [95%CI, –0.51%, –0.04%]), proteinuria (n = 5 studies; –109.10 [95%CI, –216.57, –1.63] mg/24 h), and MDA (n = 5 studies; z-score: –0.41; 95%CI, –0.71, –0.10), and significantly increased GFR (n = 7 studies; 3.65 [95%CI, 0.15–7.15] mL/min/1.73 m2). Overall, studies showed a high risk of bias, and outcomes showed a low or very-low quality in the Grading of Recommendations, Assessment, Development, and Evaluation assessment. Conclusions There is a clinically modest effect of dietary polyphenols intervention in HbA1c, proteinuria, GFR, MDA, and C-reactive protein levels in patients with DN. It is impossible to establish clinical recommendations, because the evidence was of' low or very-low quality and because of the heterogeneity of types and dose regimens used in the studies. Systematic Review Registration PROSPERO registration no. ID245406. [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.

Background: Diabetes mellitus is one of the many metabolic disorders that show a drastic increase in its prevalence with every year. Though there are many literatures available explaining the importance of oral hygiene in preventing complications in diabetes there is a tendency in the patients to ignore their oral hygiene. The role of dentist in resolving or preventing the oral complications is important at the same time, the patient themselves should take an initiative to acquire more knowledge about their condition. Method: A two-page questionnaire was created in accordance with the OHSU guidelines for evaluating the awareness of oral complications in diabetic patients. Results: Majority of the patients, irrespective of being graduates or literate lacked sufficient knowledge on oral complications of Diabetic patients in spite of being aware about the general complications. Conclusion: Awareness is needed for the patients with diabetes in both systemic and dental complications as it can affect their quality of life. Diabetic individuals should be encouraged to get regular dental check-ups done and more frequently than non-diabetic individuals to seek active care for their problems for better prognosis and improved quality of life. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) leads to microvascular, macrovascular, and neurological complications. Less is understood about the mechanisms of this disease that give rise to weak bones. The many molecular mechanisms proposed to explain the damage caused by chronic hyperglycemia are organ and tissue dependent. Since all the different treatments for DM involve therapeutic activity combined with side effects and each patient represents a unique condition, there is no generalized therapy. The alterations stemming from hyperglycemia affect metabolism, osmotic pressure, oxidative stress, and inflammation. In part, hemodynamic modifications are linked to the osmotic potential of the excess of carbohydrates implicated in the disease. The change in osmotic balance increases as the disease progresses because hyperglycemia becomes chronic. The aim of the current contribution is to provide an updated overview of the molecular mechanisms that participate in the development and treatment of diabetes. [ABSTRACT FROM AUTHOR]

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 Acta Medica Croatica is the property of Croatian Academy of Medical Sciences 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.)