Adult Diabetic Research Articles

An assessment of perceived patient satisfaction and glycaemic control pattern among adult diabetics attending a tertiary care clinic in north central Nigeria

Background: Patient satisfaction as one of the indicators of patient centered care, has taken a central point in the management of chronic diseases such as diabetes mellitus. Aim/objectives: This study aimed to assess perceived patient satisfaction and glycaemic control among adult diabetics attending the General Out-Patient Clinic. Methodology: This was a cross-sectional study conducted between September 2021 and November 2021 involving 134 adult diabetic patients selected by systematic random sampling. Data was collected by interviewer administered questionnaire. Height, weight, blood pressure measurements and fasting blood glucose assay were done. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Analysis was done at the 5% level of significance with p < 0.05 considered statistically significant. Results: A larger population (81) of the participants were females representing 60.4%. The mean age of the patients was 51.82 ± 12.19 years. The level of perceived patient satisfaction and glycaemic control were 88% and 37.3% respectively. Blood pressure status was the only independent predictor for patient satisfaction. Ethnicity, level of education, occupation and average monthly income showed statistically significant relationship with glycaemic control. Furthermore, comorbidity, perceived patient satisfaction, medication adherence, BMI and blood pressure status also showed statistically significant association with glycaemic control. Conclusion: Less than 40% of participants achieved good glycaemic control despite high level of perceived patient satisfaction (88%) in this study.

P076 FACTORS INFLUENCING POST-COVID HOME BP AND HR FLUCTUATION WITHIN THE URBAN INDIAN DIABETIC POPULATION

Objective: The impact of COVID-19 on cardiovascular health among adult diabetics remains underexplored, particularly concerning home blood pressure (BP) and heart rate (HR) variability. This study aims to elucidate the factors influencing post-COVID home BP and HR fluctuation within the urban Indian diabetic population. Design and Methods: A cross-sectional study was conducted, involving 1000 adult diabetic patients aged 30 to 80 years with prior COVID-19 infection. Home BP and HR readings were recorded twice daily over seven days, generating 28 measurements. Variability in BP and HR was determined using standard deviation calculations between morning and evening readings, as well as between consecutive measurements. Results: Older age (OR: 1.56, 95% CI: 1.23-1.98), cardiovascular comorbidities (OR: 2.09, 95% CI: 1.67-2.62), diabetes (OR: 1.84, 95% CI: 1.43-2.36), and elevated home BP (OR: 2.35, 95% CI: 1.87-2.95) emerged as independent predictors of increased morning-to-evening home BP variability. Similarly, older age (OR: 1.72, 95% CI: 1.34-2.21) and elevated home BP (OR: 2.14, 95% CI: 1.67-2.75) were determinants of heightened day-to-day BP variability, while a combination of older age (OR: 1.98, 95% CI: 1.52-2.58), female sex (OR: 1.43, 95% CI: 1.11-1.84), cardiovascular disease (OR: 1.89, 95% CI: 1.47-2.44), and elevated home BP (OR: 2.56, 95% CI: 1.98-3.31) predicted greater variability between consecutive readings. Conversely, younger age (OR: 0.76, 95% CI: 0.59-0.98) and elevated home HR (OR: 1.92, 95% CI: 1.51-2.44) were associated with increased morning-versus-evening HR variability. Additionally, younger age (OR: 0.67, 95% CI: 0.51-0.88), female sex (OR: 1.34, 95% CI: 1.04-1.73), and elevated home HR (OR: 1.78, 95% CI: 1.39-2.29) were predictive of greater variability between consecutive HR measurements. Conclusion: Understanding the determinants of home BP and HR variability post-COVID infection is crucial for prognostication and clinical management. Clinicians should prioritize counseling incorporating regular home blood pressure measurements, diabetes management, and cardiovascular disease prevention, particularly for high-risk diabetic patients.

Effects of Dexmedetomidine on Perioperative Glycemic Control in Adult Diabetic Patients Undergoing Cardiac Surgery.

To study the effects of dexmedetomidine (DEX) on perioperative blood glucose levels in adult diabetes mellitus (DM) patients undergoing cardiac surgery. A prospective, observational study was conducted on 100 adult diabetic patients aged between 18 and 75 years undergoing cardiac surgery with cardiopulmonary bypass (CPB). The patients were divided into two groups (group D and group C) of 50 each. Group D patients received DEX infusion, whereas the group C patients received 0.9% normal saline infusion. The blood glucose levels, heart rate, mean arterial pressure, and serum potassium levels at different time points were comparable between the two groups (P > 0.05). The mean dose of insulin required in the combined population as well as in both controlled and uncontrolled DM patients was significantly less in group D than in group C (combined population - 36.03 ± 22.71 vs 47.82 ± 30.19 IU, P = 0.0297; uncontrolled DM - 37.36 ± 23.9 IU vs 48.16 ± 25.15 IU, P = 0.0301; controlled DM - 34.7 ± 21.5 IU vs 47.63 ± 35.25 IU, P = 0.0291). Duration of mechanical ventilation and VIS were comparable between the two groups. The incidence of arrhythmias (20% vs 46%, P = 0.0059) and delirium (6% vs 20%, P = 0.0384) was significantly less in group D than in group C. None of the patients in either group had stroke, myocardial ischemia, and mortality. The results suggested that DEX infusion during the intraoperative period was very effective for perioperative glycemic control and reduction of insulin requirement in DM patients undergoing cardiac surgery.

Knowledge, Attitude, and Practice of Adult Diabetics Regarding Diabetic Foot Ulcers: A Cross-Sectional Study in Saudi Arabia.

Background Diabetic foot ulcers (DFUs) are one of the most common and fatal complications of diabetic patients with uncontrolled diabetes mellitus (DM) that may end with their feet amputation. These complications can be prevented through the adherence of diabetic patients to their diabetes management plan and by educating them about risk factors, complications of diabetic foot, and proper foot care. To develop effective health education programs to educate diabetic patients and caregivers regarding diabetic foot and its effective care, we should first identify gaps in patients' knowledge and perception of diabetic foot and evaluate their practice of foot care. Objectives This study aimed to evaluate knowledge and attitude toward DFUs and the practice of foot care among adult diabetic patients attending Al-Qunfudah Diabetes Center, Saudi Arabia, from October 2022 to March 2023. Methods A total of 403 adult diabetic patients were recruited in this cross-sectional study during their attendance at the diabetes center in Al-Qunfudah district, Saudi Arabia. The study researchers conducted a physical face-to-face interview with each diabetic patient using a validated questionnaire with closed-ended questions to collect their responses regarding their knowledge and attitude toward DFUs and their behavior toward foot care. The collected data were analyzed using IBM SPSS Statistics for Windows, version 23 (released 2015; IBM Corp., Armonk, New York, United States). Results Out of 403 diabetics, 50.4% (n = 203) had inadequate knowledge (knowledge score < 80%), 46.4% (n = 187) had negative attitudes (attitude score < 80%) toward DFUs, and the majority could not practice foot care well, with 77.7% (n = 313) giving a practice score less than 80%. Seventy patients (17.4%) self-reported a history of DFUs. Predictors of good knowledge about DFUs among diabetics include age between 30 and 59 years (odds ratio (OR) = 2.942, confidence interval (CI) 95% = 1.695-2.107, p < 0.001), marriage (OR = 3.101, CI 95% = 1.893-5.079, p < 0.001), working (OR = 5.325, CI 95% = 3.019-9.389, p < 0.001), diploma education (OR = 8.205, CI 95% = 3.332-20.203, p < 0.001), managing DM with oral drugs (OR = 2.219, CI 95% = 1.399-3.519, p < 0.001), and having no DFUs (OR = 2.712, CI 95% = 1.557-4.723, p < 0.001). Males were more likely to practice foot care well (OR = 1.925, CI 95% = 1.142-3.245, p = 0.013). Primary education (OR = 3.421, CI 95% = 1.655-7.073, p < 0.001) predicted appropriate foot care. Patients with DM for one to five years (OR = 1.995, CI 95% = 1.139-3.493, p = 0.016) and those on diet and metformin (OR = 2.133, CI 95% = 1.134-4.011, p = 0.019) were expected to have better foot care than other diabetics. Conclusion Diabetic patients in the Al-Qunfudah district of Saudi Arabia had inadequate knowledge and negative attitudes toward DFUs, and their foot care behaviors were inadequate. Furthermore, DFUs were self-reported in around 17% of diabetic patients. Specialized training programs are recommended to enhance knowledge regarding DFUs among diabetics and motivate and train them and caregivers on how to conduct proper foot care. These educational programs should target all diabetics, with an emphasis on those with DFUs, females, non-working patients, individuals who have had DM for a longer time, and illiterate diabetics. To understand the factors behind patients' negative attitudes toward diabetic foot, future qualitative research is required.

Awareness of Oral Health in Adult Diabetic Patients in South Chennai – A Questionnaire Study

Awareness of Oral Health in Adult Diabetic Patients in South Chennai – A Questionnaire Study

Prevalence and associated factors of physical inactivity among adult diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Physical inactivity has been viewed as an emerging public health problem in developing countries including Ethiopia. Diabetes mellitus (DM) is a group metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, function, or both. Its prevalence increases with changing lifestyles including physical inactivity across the globe. However, there is limited research, and not yet received attention in Ethiopia. This study aimed to assess the prevalence and associated factors of physical inactivity among adult diabetic patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. An institutional-based cross-sectional study design was conducted among 308 participants from February to June 2018 at Felege Hiwot Referral Hospital. A face-to-face interview was conducted using a structured questionnaire by trained data collectors. Participants were selected through a systematic random sampling technique. Physical inactivity was assessed by the international physical activity questionnaire (IPAQ). Collected data were entered in Epi info version 7 and transferred to SPSS version 20 for analysis. A summary of descriptive statistics and multiple binary logistic regression analyses were computed to identify associated factors of physical inactivity among adult diabetic patients. P < 0.05 with 95% CI was considered statistically significant. The overall prevalence of physical inactivity among diabetic patients was 30.5% ( 95% CI: 22.8–33.5%). Gender (AOR = 1.5, 95% CI: 1.1, 3.62), Old age (AOR = 18.17, 95% CI: 22.7, 61.9) Residence (AOR = 4.24, 95% CI: 1,12,16.028), Low self-efficacy (AOR = 20.59, 95% CI: 10.598, 41.608), Poor attitude (AOR = 2.75, 95%CI: 1.44,5.28), and Lack of social support (AOR = 4.22, 95% CI: 1.28,4.07) were found significantly predictor factors of physical inactivity. The prevalence of physical inactivity in this study was high. Being female, old age, dwelling in an urban, having low efficacy, poor attitude, and lack of social support was greater risk factors for being physically inactive. Diabetic education should focus on engagement in physical activity by overcoming barriers to performing physical activity. Government and health professionals should emphasize that evidence-based physical activity important to change their attitudes and require reaching a consensus on social support by their families.

Clinical Educational Counseling of Adult Diabetes Patients

Diabetes patients are steadily increasing. As such, the importance of diabetes education is being emphasized as the number of diabetic patients continues to increase. Diabetes education is being conducted by experts in most hospitals. Medical social workers are part of the diabetes education team and are conducting educational counseling to help patients manage diabetes. The purpose of this article is to examine educational counseling for adult diabetic patients from the viewpoint of medical social workers.

The impact of COVID-19 lockdown on glycaemic control in young adults with type 1 diabetes mellitus.

BackgroundIn December 2019, a novel coronavirus strain, COVID-19, was identified in Wuhan, China. The first case was reported in the Republic of Ireland that month. Since then, along with many other countries worldwide, Ireland has imposed intermittent strict lockdowns to mitigate the spread of the virus.AimsTo investigate the impact of lockdown on glycaemic control in young adult patients with type 1 diabetes mellitus.MethodsPre- and post-lockdown HbA1c levels were recorded for 118 patients attending the Young Adult Diabetes clinic in Beaumont Hospital, Dublin, and the results were compared. Changes in weight, insulin requirements and incidence of DKA/severe hypoglycaemia were also assessed.ResultsHbA1c results were 3.81 mmol/mol lower post-lockdown. Weight increased by 1.8 kg. Both of these results were statistically significant.ConclusionsLockdown was associated with improved glycaemic control in young adult diabetic patients, and also with an increase in body weight. Changes in lifestyle factors associated with lockdown may explain this finding.

Assessment of the knowledge on insulin therapy among adult diabetics patients in Jabir Abuleiz center, Khartoum, Sudan

ABSTRACTObjectives:The objective of the study is to assess the knowledge and practice concerning insulin therapy in adult diabetic Sudanese patients and relate it with their control of diabetes and selected demographic variables.Methods:Personal interview, using a specific pretested designed questionnaire was used to collect data from 200 adult diabetic patients in Jabir Abuleiz center in Khartoum state.Result:The result showed that only 15% of the respondent had adequate knowledge about insulin use. Also, good knowledge was associated with a higher level of education and good glycemic control (P < 0.001).Conclusion:Knowledge about insulin therapy has an important role in the control of diabetes mellitus. Those who are knowledgeable about insulin therapy are more likely to have good control of HbA1c.

The Magnitude, Types, and Roles of Social Support in Diabetes Management among Diabetics' in Southern Ethiopia: a Multilevel, Multicenter Cross-Sectional Study.

IntroductionLifelong medical management is the main intervention to reduce diabetes-related morbidities and premature deaths; yet, social support can be a vital intervention to improve diabetics’ health. Therefore, this study aimed to determine the magnitude, types, and role of social support in diabetes management in southern Ethiopia.MethodsA multi-stage systematic sampling was applied to recruit 634 adult diabetics from the three-tiered healthcare system in the region. We proportionally distributed the sample size between randomly selected ten health-care facilities across the hierarchy. Pretested questionnaires and checklist; Epi-Info, and SPSS software used for data collection; entry, and analyses, respectively, and the statistical significance was determined at a P-value ≤0.05.ResultsA total of 240 females and 356 males completed the study, and the overall magnitude of the social support was 50.20% [95% CI: 46.19%, 54.21%], and it was categorized into non-material and material with 44.13% [95% CI: 40.14%, 48.12%] and 34.23% [95% CI: 30.42%, 38.04%] magnitudes, respectively, and social support was left to the patients’ families and friends whereas formal institutions and the public sectors were rarely offering when the patients needed it. Though sex, educational level, and health-care hierarchy were not significantly associated with the social support, residence, some occupations, presence of diabetic family members, acute medical conditions, blood glucose level, compliance to medical follow-ups, treatment adherence, and taking anti-diabetic drugs a day before the current visit to health-care facility were all statistically significantly associated with social support.ConclusionOne of every two adult diabetic patients in southern Ethiopia was receiving any social support, and social support for diabetic people reduces medical follow-ups absenteeism, improves treatment adherence, glycemic level controlling, and helps lifestyle modifications. Therefore, to keep diabetic people healthy and achieve diabetes management goals, the Ethiopian healthcare system, institutions, and concerned stakeholders should strengthen the social support for diabetic patients.

Renoprotection with sodium-glucose cotransporter-2 inhibitors in children: Knowns and unknowns.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent novel hypoglycemic drugs for the treatment of adult diabetes that have shown considerable potential for cardioprotection and renoprotection. This new drug can inhibit SGLT2 at the proximal tubule, increase glucosuria and natriuresis, and thus decreases the serum glucose level and blood pressure. Furthermore, the tubuloglomerular feedback activated by the natriuresis can decrease glomerular hyperfiltration, acknowledged as the main foundation of renoprotection. Several studies have confirmed the protective effects of SGLT2 inhibitors on the kidneys of adult diabetic patients and those with non-diabetic nephropathy; however, limited researches are seen in paediatric patients. In this review, we have summarized the mechanisms of action of SGLT2 inhibitors, the current experiences in adults, results of exploratory studies in children, and adverse events & obstacles of paediatric use. We further explore the potential and possible future research direction of SGLT2 inhibitors in paediatric diseases.

The Effect of Educational Program on Pain Management, Self-Efficacy Behavior, and Quality of Life among Adult Diabetic Patients with Peripheral Neuropathy Pain: A Randomized Controlled Trial.

Jordan has a high prevalence of painful diabetic peripheral neuropathy (PDPN), leg complications, and amputations due to diabetes. This study evaluated the effect of educational programs on pain management, self-efficacy behaviors, and quality of life (QoL) among adult patients with PDPN. The randomized controlled trial study was conducted at the Jordanian Ministry of Health hospitals between October 2019 - March 2020. Seventy-two adult patients with PDPN were randomized to an experimental group of 36 patients who attended an educational program and a control group who followed routine diabetic care in the study setting. The data were collected using a socio-demographic and diabetes clinical/laboratory data form, the numeric rating scale (NRS), diabetes self-efficacy scale (DSES), and the quality-of-life questionnaire (EQ-5D). The intervention program consisted of four educational sessions at weekly intervals. Pre-test and post-test evaluations were conducted. After the educational intervention, the mean scores of the NRS (p=0.020), DSES (p<0.001), and EQ-5D (p<0.001) in the experimental group improved significantly improved compared to those in the control group. Additionally, while there were no significant correlations between the three study outcomes in the pre-test stage, correlations were observed to be significant after the educational intervention. This study shows that the design and implementation of educational intervention combined with routine diabetic care facilitate effective pain management, self-efficacy behaviors, and QoL of patients with PDPN. The health care providers are recommended to use the educational programs for such patients at various levels of services in both health centers and diabetes clinics.

Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study.

BackgroundAlthough anemia is a common condition among patients with diabetes mellitus, there is little evidence on anemia among this segment of population in Ethiopia at large and in the study setting in particular. Thus, this study aimed at assessing the magnitude of anemia and its associated factors among adult diabetic patients attending a general hospital in Eastern Ethiopia.MethodsA health facility-based cross-sectional study was conducted among 325 randomly selected adult diabetes mellitus patients attending a follow-up clinic at Gelemso General Hospital, Eastern Ethiopia. Data were collected through an interview using a pre-tested and structured questionnaire followed by physical and laboratory measurements. Data were then entered into EpiData Version.3.1 and analyzed by using STATA version 16.0. Binary logistic regression models were fitted to identify factors associated with anemia. All statistical tests were declared significant at p-value < 0.05.ResultsThe magnitude of anemia among adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Anemia was higher in males (36%) than females (20.5%). Male gender (Adjusted Odds Ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM duration of ≥5 years (AOR= 1.9, 95% CI: 1.0, 3.7), presence of comorbidity (AOR= 1.9, 95% CI: 1.0, 3.7), and having diabetic complications (AOR= 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia.ConclusionAnemia was a moderate public health problem among adult DM patients in the study setting. Being male in gender, duration of DM, presence of DM complications, and DM co-morbidities were factors associated with anemia. Therefore, routine screening and appropriate management of anemia targeting males, DM patients with longer duration of DM, and those with complications and co-morbidities should be devised to improve patients’ quality of life. Early diagnosis and regular monitoring of DM could also help to minimize further complications.

Prevalence of Anemia and Its Associated Factors Among Adult Diabetes Mellitus Patients at Debre Tabor General Hospital, Northcentral Ethiopia.

BackgroundDiabetes mellitus is a cluster of metabolic disorders which is characterized by hyperglycemia. The occurrence of anaemia is a significant public health problem among diabetic patients because of complication and dietary modifications. So, this study aimed to assess the magnitude of anaemia among adult diabetes mellitus patients in Debre Tabor General Hospital, Ethiopia.MethodsA cross-sectional study design was conducted. A simple random sampling technique was employed to collect data from 297 adult diabetic mellitus patients. After taking venous blood, the haemoglobin level was determined by using HemoCue 301 machine. Anaemia among diabetic patients was determined by using the haemoglobin level (<13.0g/dL for male and <12.0g/dL for female). Data were entered using EpiInfo version 7.2 and analyzed using SPSS version 21. The binary logistic regression model was used to explore the association of independent variables with anaemia. Finally, p-value <0.05 was used to declare the level of statistical significance.ResultsThe prevalence of anemia among diabetic patient was 29.81% (95% CI: 24.27, 35.35). Diabetic patients unable to read and write (AOR = 3.51, 95% CI: 1.40, 8.75), able to read and write (AOR = 9.76, 95% CI: 3.15, 30.24), ≥4 family size (AOR = 0.53, 95% CI: 0.29, 0.99), intake of flesh meat (AOR=0.19, 95% CI: 0.05, 0.74), and parasitic infections (AOR = 0.26, 95% CI: 0.07, 0.95) were more likely to develop anemia.ConclusionAnemia is a moderate public health problem among diabetic patients. Here, educational status, family size, intake of flesh meat, and intestinal parasite infections were the factors associated with the development of anaemia. So, working on these significant factors by health care providers during routine care is vital to prevent anaemia among diabetic patients.

The magnitude of anemia and associated factors among adult diabetic patients in Tertiary Teaching Hospital, Northern Ethiopia, 2019, cross-sectional study.

Patients with Diabetic Mellitus are at higher risk of different complications. Many previous studies show that anemia among diabetic patients is poorly diagnosed. This study aimed to assess the magnitude and associated factors of anemia among adult diabetes patients having regular follow up at the diabetic clinic of Ayder Comprehensive Specialized Hospital, Tigray, 2018/19. This study was conducted the Diabetic clinic of Ayder comprehensive specialized hospital, Tigray regional state, Northern Ethiopia from January to March 2019. A systematic random sampling technique was used to select study participants. About 5 ml of venous blood was collected by experienced laboratory technologists under a complete aseptic technique. Two ml of the venous blood was used for hemoglobin determination. And three ml of the venous blood was used without any anticoagulant for creatinine determination. The association of variables was assessed using bivariate and multivariable analysis in the logistic regression model with p-value, odds ratio, and 95% CI in the SPSS version 24 software. From a total of 262 diabetes patients, forty-seven (17.9%) were found to be anemic (6.7% males and 11.5% females). Among the related factors, residency (Adjusted Odds Ratio, 7.69, 95% CI, 2.060, 28.69, p = 0.002,), age of the patients (Adjusted Odds Ratio, 4.007, 95%CI, 1.53-10.51, p = 0.005,) and sex (Adjusted Odds Ratio, 3.434, 95% CI, 1.582, 7.458, p = 0.042,) were significantly associated with anemia. According to this study, the magnitude of anemia is high among diabetic patients. Occupation of the participants, residency, HIV status, being female, and age was significantly associated with anemia.

Research Progress of Metformin in the Treatment of Non-alcoholic Fatty Liver Disease

<i>Backgroud</i>: Nonalcoholic fatty liver disease has become the second largest source of chronic liver disease in the urban population. Metformin, a traditional drug, has good prospects for treating the disease in primary health care facilities. <i>Objective</i>: To summarize and grasp the status of metformin in adults, children with diabetes and non-diabetic NAFLD patients. Methods: We reviewed 31 relevant research literatures in PubMed database, and sorted out some preclinical and clinical research results. <i>Results</i>: Metformin was found to have a good effect in improving liver function indicators in both adult diabetic and non-diabetic NAFLD patients, and could benefit liver histology in NAFLD patients with adult diabetes. Metformin treatment did not show a significant advantage over lifestyle interventions in children with NAFLD. Conclusion: Metformin can improve the liver function and histological structure of adult NAFLD patients to a certain extent, and children patients should still be treated mainly with improved lifestyle.

Diabetes Distress and Associated Factors in Patients with Diabetes Mellitus in South East Nigeria

Background: Diabetes distress (DD) is a common worldwide problem in diabetic patients irrespective of age and type of treatment. In the DAWN 2 study (Diabetes Attitudes, Wishes, and Needs), DD was reported by 44.6% of participants. Objectives: The purpose of this study was to assess the prevalence and level of DD and its associated factors among adult diabetic patients in South East Nigeria. Methods: The present study was cross-sectional and descriptive. Patients attending the adult diabetes clinic were enrolled. The questionnaire was administered by the investigators. All patients were eligible. Their demographic and clinical data were obtained. They were screened for DD using the DD Scale (DDS)-2 and DDS-17. Data were tabulated and analyzed using SPSS version 21. Results: There were 110 subjects (38 males and 72 females), aged 36–85 years (60.5 ± 10.0). Only 9 (8.2%) had diabetes mellitus (DM) type 1, while the rest had type 2 DM. Twenty-five subjects (22.7%) were on insulin injection. Hypertension was coexistent in 72%, and they were prescribed 3–10 medications (5.9 ± 1.5) at the time of assessment. The male and female subjects were comparable. Moderate to severe DD was present in 51.9% (DDS-17). The average scores were for DDS-2, 3.1; DDS-17, 2.3; emotional burden, 2.9; physician-related distress, 1.4; regimen-related distress, 2.5, and interpersonal distress, 2.2. Distress was significantly associated with a younger age, T1DM, longer duration of diabetes, use of insulin injection, and HbA_1C level. Conclusion: DD is a common consequence of living with diabetes and impairs diabetes self-care behavior and glycemic control. Active screening for DD should be an integral part of diabetes care. Diabetes self-management education and support should be implemented at diagnosis and as needed thereafter, especially when DD is diagnosed.

B-mode ultrasound assessment of carotid intima–media thickness among adult diabetics and normal adults in Gombe, Northeastern Nigeria

Background: The carotid intima–media thickness (CIMT) has been established as an early predictor of general arteriosclerosis in patients with diabetes. However, there is a paucity of information on CIMT of the common carotid artery (CCA) in healthy patients and in patients with risk factors for cardiovascular diseases such as diabetics, hypertension, and obesity in our environment. The aim of this study was to compare the CIMT in adult patients with diabetes and normal subjects in our institution in Gombe, Northeastern Nigeria. Materials and Methods: This case–control study was conducted over a period of 8 months (from April 2015 to December 2015) at Federal Teaching Hospital, Gombe, on 105 adult diabetic patients and 105 normal adults aged 18 years and above. The CCA was scanned with a PHILIPS HD-9 ultrasound scanner equipped with Doppler facility using a 7.5 MHz linear transducer. Three measurements of the CIMT were obtained at 1 cm proximal to the right and left carotid bulbs and the mean value of the measurements was recorded. Results: The age range of the diabetics comprising 54% of males and 46% of females was 23–79 years, while the range of control group comprising of 53% of males and 47% of females was 18–68 years. The overall mean CIMT (MCIMT) was 0.97 ± 0.4 mm and 0.73 ± 0.1 mm for diabetics and nondiabetic subjects, respectively. MCIMT was significantly higher in diabetics compared to nondiabetic subjects (P = 0.000). In diabetics, overall MCIMT values were 0.96 ± 0.2 mm and 0.91 ± 0.2 mm on the right and left sides, respectively, with a statistically significant difference between the two sides (P = 0.000), while in the normal group, the overall MCIMT values on the right and left sides were 0.75 ± 0.1 mm and 0.73 ± 0.1 mm, respectively, with a statistically significant difference between the two sides (P = 0.021). Furthermore, CIMT correlated positively with age in both diabetic and control groups. Conclusion: This study has shown a statistically significant increase in CIMT in diabetics compared to nondiabetics and age shows a significant correlation with CIMT. Reference value for CIMT in nondiabetic subjects in Northeastern Nigeria has been obtained.

Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects

BACKGROUNDNeuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.AIMTo evaluate the cross-sectional area (CSA) of the median nerve using B-mode ultrasonography (USS) and the presence of peripheral neuropathy (PN) in a cohort of adult diabetic Nigerians.METHODSDemographic and anthropometric data of 85 adult diabetes mellitus (DM) and 85 age- and sex-matched apparently healthy control (HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument (MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile (FLP), fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) while their MN CSA was evaluated at a point 5 cm proximal to (5cmCATL) and at the carpal tunnel (CATL) by high-resolution B-mode USS. Data was analysed using SPSS version 22.RESULTSThe mean MN CSA was significantly thicker in DM subjects compared to the HC at 5cmCATL (P < 0.01) and at the CATL (P < 0.01) on both sides. The presence of diabetic peripheral neuropathy (DPN) further increased the MN CSA at the CATL (P < 0.05) but not at 5cmCATL (P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.CONCLUSIONThickening of the MN CSA at 5cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at 5cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.

Targeting miRNA for Therapy of Juvenile and Adult Diabetic Cardiomyopathy.

Prevalence of diabetes mellitus (DM), a multifactorial disease often diagnosed with high blood glucose levels, is rapidly increasing in the world. Association of DM with multi-organ dysfunction including cardiomyopathy makes it a leading cause of morbidity and mortality. There are two major types of DM: type 1 DM (T1D) and type 2 DM (T2D). T1D is diagnosed by reduced levels of insulin and high levels of glucose in the blood. It is caused due to pancreatic beta cell destruction/loss, and mostly found in juveniles (juvenile DM). T2D is diagnosed by increased levels of insulin and glucose in the blood. It is caused due to insulin receptor dysfunction, and mostly found in the adults (adult DM). Both T1D and T2D impair cardiac muscle function, which is referred to as diabetic cardiomyopathy. We and others have reported that miRNAs, a novel class of tiny non-coding regulatory RNAs, are differentially expressed in the diabetic heart and they contribute to diabetic cardiomyopathy. Here, we elaborated the biogenesis of miRNA, how miRNA regulates a gene, cardioprotective roles of different miRNAs including miRNAs present in exosomes, underlying molecular mechanisms by which miRNA ameliorates diabetic cardiomyopathy, and the role of miRNA as a potential therapeutic target for juvenile and adult diabetic cardiomyopathy.