Microangiopathy Complications Research Articles

Clinical Outcome of COVID-19 Infection on Chronic Diabetic Complications Patients

Introduction: COVID-19 is an infectious disease resulting from the SARS-CoV-2 virus. The virus targets the respiratory system and leads to a significant number of fatalities worldwide. Consequently, it was officially classified as a pandemic in 2020. The Covid varians is now being monitored by the World Health Organization. Diabetes mellitus is one of the disorders that might deteriorate following an infection. Diabetes mellitus and its associated comorbidities continue to pose a significant health challenge in Indonesia, while it is also a focus of concern of the Sustainable Development Goals (SDGs). The study was aimed to assess the risks and outcomes associated with COVID-19 infection and the long-term consequences of diabetes mellitus.Methods: This was a descriptive study using a retrospective design. Research data were taken from the medical records of patients confirmed positive for COVID-19 infection and also had chronic complications of diabetes mellitus who were treated at Dr Soetomo General Academic Hospital, Surabaya, Indonesia in 2021. There were 156 patients who met the criteria of this research.Results: There were 156 patients (97 males, 59 females). The average age of the patients was 58, while most of the patients (84%) died and the rest of the patients (16%) survived. Most of the patients with fatality (55.8%) were those with critical severity level and complications of microangiopathy, while the patients who survived (10.3%) were those with moderate severity level and complications of microangiopathy. Conclusion: COVID-19 patients with diabetes and comorbidities had a higher mortality rate than those who recovered, while most of the patients with fatality were those with significant COVID-19 and diabetic microangiopathy complications.

Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes in Saudi Arabia: A Cross-sectional Study.

Neuropathy is the most prevalent among diabetes-related microvascular complications, of which distal symmetric polyneuropathy is very extensive. This study aimed to evaluate the frequency and risk factors for Diabetic Peripheral Neuropathy (DPN) among Type 2 Diabetes (T2D) in Saudi Arabia. This study included 238 patients with T2D, between 18 and 80 years of age. Using a structured questionnaire, data on the sociodemographic characters of the study group and laboratory tests were collected. Distal symmetrical peripheral neuropathy in patients with diabetes was identified using the Michigan Neuropathy Screening Instrument (MNSI). In this cohort, 66 patients (27.7%) had positive MNSI questionnaire scores (≥ 7) and 90 (37.8%) patients had positive examination scores (≥ 2.5). From the patient's perception, patients on oral plus insulin treatment exhibited a higher risk for DPN (OR 2.95; p = 0.018) than those who received only oral treatment and an ulcer in an earlier period exhibited a higher risk for DPN (OR: 3.25; p = 0.005). From the health professionals' perception, more females than males showed a high risk for DPN (OR: 3.92; p = 0004). Likewise, compared to the patients in the age group of <50 years, those in the age group of ≥50 years revealed a high risk for DPN (OR 6.30; p = 0.009). Further, patients on oral and insulin treatments were at greater risk for DPN (OR: 3.71; p = 0.024); patients experiencing complications like prior ulcers, and high-density lipoprotein also exhibited higher risk than the patients who lacked them. Diabetes neuropathy is one of the most common complications of microangiopathy experienced by patients with T2D in Saudi Arabia. The risks for DPN among patients with T2D can be reduced with the implementation of focused and evidence-based interventions.

PENGARUH DUKUNGAN KELUARGA TERHADAP KEPATUHAN PASIEN MENJALANI PERAWATAN LUKA ULKUS DIABETIK

Diabetic ulcers are open sores on the skin layer to the dermis, which usually occur on the soles of the feet. Wounds that arise in DM patients due to complications of microangiopathy and macroangiopathy. Peripheral neuropathy will cause loss of sensation in the distal area of ​​the foot. The length of time a person suffers from DM will cause microangiopathic complications so diabetic neuropathy will cause ulcers on the feet. This study aims to determine the relationship between family support in the healing process of diabetic ulcers with patient compliance in undergoing treatment at the Asri Wound Care Center clinic in Medan using a descriptive correlation research design with a cross-sectional design. The sample in this study was 36 respondents using an accidental sampling technique. The results of the Spearman rank test (rho) with a p-value = 0.004 with a coefficient value of 0.467 then p-value &lt;a (0.000 &lt;0.05), meaning that there is a relationship between family support in the healing process of diabetic ulcers with patient compliance in undergoing treatment at the Asri Wound clinic. Care Center Medan. For education, it is expected that educational institutions can increase the knowledge of students at the institution regarding the importance of family support in the process of healing diabetic ulcers with patient compliance in undergoing treatment.

Frailty Index was Associated With Adverse Outcomes in Admitted Elderly Patients With Type 2 Diabetes Mellitus.

We aimed to investigate the role of the laboratory frailty index (LFI) in diabetic complications and incident disability in admitted older patients with type 2 diabetes mellitus (T2DM). We retrospectively collected the clinical data of older patients with T2DM from December 2018 to May 2020. Frailty was quantified using the LFI, which considers the accumulation of 27 items of abnormal laboratory outcomes. Univariate and multivariate analyses were performed to evaluate the relationship between LFI and diabetes-related adverse outcomes. In total, 293 consecutive older patients with T2DM were recruited for this study. According to the predefined LFI criteria, 110 (37.5%) participants were non-frail, 131 (44.7%) were prefrail, and 52 (17.8%) were frail. Univariate and multivariate analysis revealed that LFI was associated with the diabetic microangiopathy complications (odds ratio for prefrail [ORprefrail] 1.760, 95% confidence interval for prefrail [CIprefrail] 1.019-3.041, P = .043; ORfrail 4.667, 95% CIfrail 2.012-10.826, P < .001) and activities of daily living (ADL) disability (ORprefrail 2.323, 95% CIprefrail 1.209-4.463, P = .011; ORfrail 9.367, 95% CIfrail 4.030-21.775, P < .001), but not with the diabetic macroangiopathy complications and diabetic peripheral neuropathy. Frailty, as determined by the LFI, was proven to be an effective tool for the prediction of diabetic microangiopathy complications and ADL disability.

ADVANTAGAE OF NEGATIVE PRESSURE WOUND THERAPY (VACUUM ASSISTED CLOSURE) IN DIABETIC FOOT ULCER

Diabetes affects more than a 100 million people worldwide. Around 10.5% of Americans and 10.9-14.2% of Indians are diabetics, and therefore susceptible to its complications of microangiopathy, neuropathy and poor wound healing, all of which contribute to high incidence of ulcers. These ulcers are developed mainly in the lower extremities after minor injuries which worsens due to paraesthesia and negligence. Management of these ulcers require systemic management of diabetes and its complications in these patients.

Analysis Of Factors Affecting Feet Sensitivity Disorders In Type 2 Diabetes Mellitus Patients

Background: Diabetes mellitus is a disease that accounts for the highest number of deaths in the world with complications of microangiopathy that cause sensitivity to the feet. The occurrence of impaired foot sensitivity in patients is the most common and serious condition in Type 2 Diabetes Mellitus.&#x0D; Objective: This study aims to find out the dominant factors among the variables of age, gender, long-suffering from DM, smoking history, and hypertension. This research was conducted at Tejo Agung Lampung Health Center.&#x0D; Methods: The sample in this study amounted to 36 respondents with purposive esampling. Impaired foot sensitivity is performed through the Ipswich Touch Test (IpTT) technique. Bivariate analysis uses the Spearman Rank test and multivariate analysis uses logistic regression tests&#x0D; Result: showed that age is the dominant factor in the occurrence of impaired foot sensitivity with a value of 0.002. Multivariate analysis through regression equations obtained an equation value of 8.5%. This means that if a Type 2 DM patient is ≥ 50 years old and suffers from hypertension, then at risk of 8 times experiencing impaired leg sensitivity.&#x0D; Conclusion: This study is expected to provide education and monitoring in DM patients to perform foot examinations so as to prevent complications such as diabetic ulcers.

CITICOLINE AS A SUGGESTED NOVEL ADJUVANT FOR PAINFUL DIABETIC POLYNEUROPATHY

The purpose of this paper is to review the effectiveness of citicoline as suggested adjuvant therapy for painful diabetic polyneuropathy based on evidences. Pain is one of the most common symptoms that make patients consult with a doctor, especially chronic pain. One of the examples is painful diabetic polyneuropathy, which prevalence is increasing by global development. Diabetic polyneuropathy is the most common cause of neuropathic pain caused by long-term complications of microangiopathy. Affect not only individual socioeconomic status but also the psychological aspect of the patient. Neuropathic pain is one of the most common causes of long-term disability. Some medicines already recommended as the drug of choice, but not all of them give maximum results. Adjuvant neuroprotector therapy is often considered to help manage painful diabetic polyneuropathy, such as citicoline, which has been proven in some studies. Painful diabetic polyneuropathy is very challenging because of its pathophysiology, which has not fully understood. The different mechanism of pain sensation is still unknown but it is thought that the oxidative stress after microangiopathy triggers the discharge of abnormal load from damaged neurons. Some analgetics have not given the expected result. Conclusion. Citicoline may be suggested as adjuvant therapy based on evidences with animal subject, but further studies with human subject are still needed.

Comparison of Intraocular Pressure (IOP) Value Before and After Vitrectomy in Diabetic Retinopatic Patients

Background: Diabetic retinopathy is one of the second highest complications of microangiopathy in Indonesia due to diabetes mellitus in the form of damage to retina of the eye and can cause blindness in adults. The management of diabetic retinopathy is done by operative measure, one of which vitrectomy. However, this procedure can lead to an increase in the value of intraocular pressure after surgery. In this study, analysis of differences in intraocular pressure values before and after vitrectomy was carried out in patients with diabetic retinopathy.Research Purpose: To know, compare, and analyze the intraocular pressure values before and after vitrectomy in patients with diabetic retinopathy.Method: The study design was an analytic observation with a study design cross-sectional. Sampling using method consecutive sampling obtained from medical record of 45 diabetic retinopathy patients who underwent vitrectomy at the RSND for the period July-December 2019. After the data was collected, the data were analyzed using the difference Wilcoxon rank test.Result: A total of 45 diabetic retinopathy patients underwent vitrectomy from medical records were dominated by 24 people aged &gt;69 years and 26 female patients. The mean values of intraocular pressure before and one week after vitrectomy were 20.32 + 2.57 mmHg and 23.89 + 9.24 mmHg. The results showed that there was a higher intraocular pressure value after vitrectomy than before vitrectomy in diabetic retinopathy patients (p=0.021) or p,0.05

Vaccum assisted closure of diabetic ulcers

Diabetes affects more than a 100 million people worldwide. Around 10.5% of Americans and 10.9-14.2% of Indians are diabetics, and therefore susceptible to its complications of microangiopathy, neuropathy and poor wound healing, all of which contribute to high incidence of ulcers, particularly of the distal extermities, even after trivial trauma. Management of these ulcers require systemic management of diabetes and its complications in these patients. Vaccum assisted closure of Diabetic Ulcers, by application of its principle of Negative Pressure to the wound has gained popularity due to early appearance of granulation tissue, facilitation of secondary wound closure and decreased duration of hospital stay. We studied 80 patients with diabetic ulcers from December 2017 to November 2019, randomly assigning them to two groups, Vaccum Assisted Closure versus conventional moist wound dressing to ascertain any possible benefit of Negative Pressure wound therapy with respect to appearance of granulation tissue, secondary closure after the therapy, interval for skin grafting, duration of hospital stay.

Urine-derived stem cells for the therapy of diabetic nephropathy mouse model.

Diabetic nephropathy (DN) is one of the most representative diabetic microangiopathy complications. So far, there have been no satisfactory therapeutic strategies, and the injection of stem cells provides a target for DN therapy. Urine-derived stem cells (USCs) were obtained from 9 healthy men. 24 mice were randomly and equally divided into control group, DN model group, DN+hUSC group (treated with USCs for 3 times). Hematoxylin-eosin (HE) and Masson staining were used to detect histological changes of kidney injury. Creatinine and blood urea nitrogen (BUN) were measured to assess renal function. Besides, myofibroblast accumulation, macrophage infiltration, cell proliferation, and oxidative stress were detected by immunohistochemical analysis. Compared with DN model group, DN+hUSC group showed lower function loss, cell infiltration, and oxidative stress, as well as less renal fibrosis, histological damage, and cell proliferation. USC can alleviate inflammation and oxidative stress, reduce renal interstitial fibrosis, improve renal tissue structure and protect renal function through paracrine effect.

High blood pressure in a type 2 diabetic population of the city of Sidi Bel Abbes, Algeria

The association of type 2 diabetes and high blood pressure (HT) results in increased cardiovascular risk and accelerated degenerative complications of diabetes. We aimed to determine the frequency of HT in type 2 diabetic patients and to evaluate the relationship between this association with the micro-angiopathy complications. A cross sectional study was conducted in 279 type 2diabetic patients (67.7% women, 32.3% men), mean age: 60.16 ± 0.60 years old, diabetes duration: 11 ± 0.47 years, body mass index: 28.70 kg/m 2 ; 47.9% of patients were overweight and 32.3% were obese. HT was found in 58.9% of patients (62.7% women, 50.6% men). This percentage significantly increased with age ( P < 0.001): 20% of patients younger than 40 years old, 40% aged 40–50 years, 47% aged 50–60 years and 74% over 60 years old. HT also significantly increased with duration of diabetes ( P = 0.001): 40% of patients whose duration of diabetes did not exceed 5 years, 55% between 5 and 10 years, 67% between 10 and 20 years, and 74% among those whose duration of diabetes exceeded 20 years. HT occurred in 60% of patients with normal weight, in 55% of overweight patients and in 62% of obese patients without significant difference. HT was found in 59% of patients with normal HDL plasma levels versus 50% of patients with low HDL levels, in 58% with a normal triglyceride vs. 56% in those with high levels of TG. For degenerative complications, retinopathy was found in 34% of patients (36.6% men, 29% women) without significant difference between sexes. Nephropathy was found in 9% of patients, all those were women. Using unvaried analysis, these complications were significantly correlated with HT with P = 0, 013 and 0,011 respectively. Retinopathy was found in 40% of hypertensive diabetics vs. 24% in normotensive diabetics. Nephropathy was found in 13% of hypertensive diabetics vs. 3% in normotensive diabetics. Our study confirms the association between diabetes and HT. We observed a high prevalence of HT in our diabetic population increasing with age and duration of diabetes. High risk of degenerative complications requires intensive management of HT in diabetic patients.

2235-PUB: Detection and Validation of Hidden Driven Networks in Diabetic Microangiopathy

Aim: To find the molecular interact network specific for different diabetic microangiopathy complications that will direct us to research the mechanism involved in the pathological process of those complications. At present, the plentiful multiomics data of microvascular complications allow us to construct multidimentional regulator network for different microvascular complications from a integrated system perspective. In this study, we introduced hierarchical Bayesian Mode, drivenRN, to decode multi-regulation that form inner regulatory networks in different microvascular complications by combining multi-regulator and transcriptional kinetics into one single model framework, drivenRN can naturally integrate gene expression data and regulator-binding signals in order to identify the hidden driven networks and to detect the key function gene signature. Our study finds out the specific driven networks related to diabetic nephropathy, diabetic retinopathy and diabetic feet respectively. These complication specific driven networks not only offer a new kind biomarker for susceptible patients’ identification but also help us to research the pathological process of microvascular complications systematically. Then offer potential therapy targets and forewarning mechanisms for clinical practice. Figure 1. The Specific Driven Networks for Different Microvascular Complications of Diabetes Mellitus. Disclosure Y. Chen: None. H. Li: None. D. Guan: None. Funding National Key Research and Development Program of China (2017YFA0105803); National Natural Science Foundation of China (81770826); Sun Yat-sen University (2015015); Science and Technology Plan Projects of Guangdong Province (2016A050502010); Key Special Projects of Medical and Health Collaborative Innovation of Guangzhou City (201604020016); Special Scientific Research Project of Guangzhou City (2060404)

Myocardial dysfunction identified by three-dimensional speckle tracking echocardiography in type 2 diabetes patients relates to complications of microangiopathy

BackgroundThe clinical effect of diabetic microangiopathy on left ventricular (LV) function is still uncertain. The purpose of this study was to assess the relation between diabetic microvascular complications and comprehensive myocardial deformation measurements using three-dimensional (3D) speckle tracking echocardiography. MethodsSeventy-seven asymptomatic patients with type 2 diabetes mellitus (DM) and 35 age-matched healthy control subjects underwent 3D echocardiography. Patients with coronary artery disease or LV ejection fraction <50% were excluded. Presence of proliferative retinopathy, microalbuminuria as nephropathy, and decreased coefficient of variation of R-R intervals (CVRR) <3% as cardiac autonomic neuropathy were defined as diabetic microvascular complications. ResultsLV ejection fraction, LV mass index, and global radial strain did not differ between control and DM patients. However, global longitudinal and circumferential strain and endocardial area change ratio were lower in patients with DM than in the controls (−12.0±3.0% vs. −16.2±1.9%, −27.7±7.1% vs. 32.2±5.7%, −37.6±7.6% vs. 44.0±6.2%, respectively, p<0.001). In DM patients, longitudinal strain is related to CVRR (R=0.58, p<0.001), retinopathy stage, and nephropathy stage. ConclusionsDiabetic microangiopathy and its accumulated effects significantly related to subclinical LV dysfunction are characterized by impaired longitudinal shortening.

Diabetic Microangiopathy Is an Independent Predictor of Incident Diabetic Foot Ulcer.

Aim. To determine the diabetic foot ulcer incidence and examine its association with microangiopathy complications, including diabetic retinopathy (DR) and albuminuria (Alb), in type 2 diabetes patients. Methods. This was a retrospective cohort study of 1,305 patients with type 2 diabetes who were assigned to the following groups: Category 1, normoalbuminuria without DR (n = 712); Category 2, Alb without DR (n = 195); Category 3, normoalbuminuria with DR (n = 185); and Category 4, Alb with DR (n = 213). Cox proportional hazard models were used to compare the risks of developing diabetic foot ulcers across the categories. Results. During 14,249 person-years of follow-up, 50 subjects developed diabetic foot ulcers, with incidence rates of 1.6/1,000, 1.5/1,000, 3.4/1,000, and 12.5/1,000 person-years in Categories 1, 2, 3, and 4, respectively. After adjusting for the presence of diabetic neuropathy and macroangiopathy, the hazard ratios and 95% confidence intervals (CIs) for the risk of diabetic foot ulcer development were 0.66 (95% CI, 0.18–2.36), 1.72 (95% CI, 0.67–4.42), and 3.17 (95% CI, 1.52–6.61) in Categories 2, 3, and 4, respectively, compared with Category 1. Conclusion. The presence of DR and Alb significantly increases the risk of diabetic foot ulcer development.

Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes

IntroductionPrevalence of partial remission ranges between 20% and 80% in the initial course of type 1 diabetes. In this phase of the disease, a substantial insulin secretion contributes to good metabolic control. The aim of the study was to determine the association between presence of partial remission and occurrence of microangiopathy complications in type 1 diabetes. Material and MethodsNinety-eight consecutive patients with newly diagnosed type 1 diabetes were asked to participate in a cohort study. Partial remission was defined as the time in which all of the following criteria were met: HbA1c below 6.5% (48mmol/mol), daily insulin requirement below 0.3 U/kg body weight and serum Cpeptide concentration above 0.5ng/ml. Patients were divided into those who were in remission at any time during follow-up (remitters) and non-remitters. After 7years of follow-up, the occurrence of microangiopathy complications was analyzed.In statistical analysis, Mann–Whitney test, chi2 test and Fisher test were used for analysis between groups. We applied a Cox's multivariate regression model and univariate regression method. P<0.05 was considered statistically significant. ResultsIn univariate logistic regression, a significant association was found between absence of remission and occurrence of at least one microvascular complication.In the Cox proportional hazards regression model that included clinically significant parameters at diagnosis (presence of ketoacidosis, cigarette smoking and HbA1c value) as covariates, absence of remission was associated with occurrence of chronic complications of diabetes at 7years [HR: 3.65 (95% CI 1.23–4.56), p=0.04].In non-remitters, higher incidence of at least one microvascular complication (46.4% vs. 7.6%), higher incidence of retinopathy (42.8% vs. 5.7%), and neuropathy (21.4% vs. 1.9%) was found. ConclusionsOccurrence of partial remission of diabetes is associated with a reduced risk of chronic microvascular complications at 7-year follow-up.

Incidence and Development of Diabetic Microangiopathy of Fulminant Type 1 Diabetes -Comparison with Non-fulminant Type 1 Diabetes-

The data from the Fulminant Type 1 Diabetes Committee suggested that patients with fulminant type 1 diabetes are a subgroup at high risk for diabetic microangiopathy in the first 5 years after diagnosis associated with the lack of endogenous insulin secretion from the onset of diabetes. The aim of this study was to assess the development of microangiopathy in patients with fulminant type 1 diabetes followed in our diabetes center. Sixteen patients with fulminant type 1 diabetes and 60 age-matched patients with non-fulminant type 1 diabetes were recruited as subjects. The existence or lack of diabetic retinopathy and nephropathy, average HbA(1C) level, serum C-peptide level, average blood pressure, insulin level, whether or not they were taking antihypertensive agents, and smoking history were investigated retrospectively based on medical records. The 5-year incidence of microangiopathy was lower in fulminant than in non-fulminant type 1 diabetes patients; retinopathy cases occurred in 0% vs. 8.3% of patients, and nephropathy occurred in 0% vs. 1.7% of patients. The 10-year incidence of retinopathy was 0% vs. 24.1%, and that of nephropathy was 11.1% vs. 3.4%. The cumulative incidence of microangiopathy did not differ between the fulminant and non-fulminant type 1 diabetes patients. Mean HbA(1C) levels and systolic blood pressure were significantly lower in fulminant type 1 diabetes patients. No difference between the patients visiting the center with fulminant type 1 diabetes and those with non-fulminant type 1 diabetes was observed in the development of microangiopathy complications.

Une rétinopathie diabétique proliférante inaugurant un diabète gestationnel

Introduction Diabetic retinopathy is one of the diabetic microangiopathy complications generally occurring after insulin-dependent diabetes has evolved for a few years. Observation We report a 24-year-old pregnant woman with severe proliferative diabetic retinopathy discovered at the time of the gestational diabetes diagnosis. Argon laser photocoagulation of retinal ischemic territories was initiated. The disease progressed to vitreous haemorrhage in the right eye. Discussion Proliferative diabetic retinopathy is exceptionally present at the time of the gestational diabetes. We did not find any similar case in the literature. Conclusion Fundus examination seems necessary at the onset of gestational diabetes. It can prevent blindness in young women.