Central Diabetes Research Articles

Self-Care Practices Regarding Eating Habits, Knowledge of Diet and Exercise for Type II Diabetic Patients

Background: Diabetes is an incurable condition. Adopting lifestyle modifications, including dietary adjustments and regular physical activity, plays a crucial role in effectively managing type-2 diabetes (T2DM) and preventing its potential long-term consequences. The aim of this article is to assess sociodemographic characteristics and self-care practices with eating habits patterns among T2DM.. Materials and Methods: The study chose a cross-sectional design, and the non-probability (purposive) method was used to identify participants. The total sample consisted of 150 participants who suffer from type 2 diabetes and who have patient records and files within the Diabetes Center at Marjan Medical City from June 20th, 2023, to November 10th, 2023. Results: The study findings indicated that the study showed good knowledge at Mean± SD= 2.35±0.0.46. , according to their levels of education the significance at (p<0.024 ).. Results: The study results indicate that the patients’ adherence increased as the education levels increased and vice versa. while the study showed partial adherence to diet and exercises at Mean± SD= 1.55±0.17 as well the study also found a highly significant association between the self-care practice for patients regarding the diet and exercise and some sociodemographic variables such as education levels, at a statistically significant level (p < 0.006). Conclusion: According to the results, the study concluded There was partial adherence to diet and exercise among patients with type II diabetes. However, factors such as the educational status of participants were found to influence the chance to self-care practice recommendations.

Evaluation of alpha Klotho and fibroblast growth factor-23 levels in Iraqi patients with Graves’ disease

Background & Objective: Graves’ disease (GD) is an autoimmune condition that targets the thyroid gland, resulting in excessive stimulation and synthesis of thyroid hormones. Excessive synthesis of these hormones can lead to symptoms such as loss of body weight, accelerated heart rate, irritability, reduced tolerance to heat, and excessive perspiration. Alpha-Klotho (KL), a protein crucial for physiological processes, is also involved in GD. The defective immunological condition of GD patients may increase Klotho expression, and the enhanced expression of fibroblast growth factor-23 (FGF23) in GD may be linked to the disease pathophysiology. We investigated serum levels of KL and FGF23 in Iraqi patients with Graves’ disease, analyzing correlations with clinical status and evaluating their potential as biomarkers for disease activity. Methodology: We conducted this cross-sectional study at The National Diabetes Center, Mustansiriyah University, between December 2022 and April 2023. The study involved 103 patients diagnosed with GD, and 103 patients, aged 21-70 y, as a control group. Patients with multinodular goiter, single thyroid nodules, thyroiditis, pregnant women, and those on medications or oral contraceptives, were excluded. Result: clinical significance of FGF23 and Klotho (KL) levels in patients with Graves’ disease (GD) compared to a control group. Results indicate that the median of KL levels are significantly higher in GD patients (KL = 6.31) compared to the control group (KL = 2.40), with a highly significant difference (P < 0.001). In contrast, differences in median of FGF23 levels between GD patients (149) and controls (86.05) were not statistically significant (P = 0.07). Furthermore, KL levels were significantly higher in hyperthyroid patients compared to other thyroid statuses (P = 0.023), while FGF23 levels did not significantly differ across thyroid statuses (P = 0.255). Additionally, the study found a strong correlation between TRAb levels and both KL (r = 0.291, P < 0.001) and FGF23 (r = 0.211, P = 0.003), and between KL and FGF23 directly (r = 0.412, P < 0.001). These findings suggest that while KL may be a significant biomarker in GD, FGF23 relevance appears limited in this context. Conclusion: In Graves’ Disease patients have significantly higher levels of KL and FGF23 compared to controls, suggesting a distinct pathophysiological role for these biomarkers in mineral homeostasis and thyroid hormone regulation. Abbreviations: AITD - Autoimmune thyroid diseases; KL - Alpha-Klotho; FGF23 - fibroblast growth factor-23; GD - Graves’ disease; HT - Hashimoto's thyroiditis; IGF-1R - Insulin-like Growth Factor-1 Receptor; Keywords: Autoimmune Thyroid Disorders, Hyperthyroidism, Graves’ disease, Alpha-Klotho Citation: Rashid MF, Alammar HAJ, Rahmah AM. Evaluation of alpha Klotho and fibroblast growth factor-23 levels in Iraqi patients with Graves’ disease. Anaesth. pain intensive care 2024;28(5):836−841. DOI: 10.35975/apic.v28i5.2567 Received: June 16, 2024; Reviewed: July 07, 2024; Accepted: July 18, 2024

Health-related Quality of Life among Patients with Type II Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease that causes considerable morbidity and mortality worldwide, resulting in an impaired quality of life in affected people. Aim: To assess health-related quality of life among patients with type II diabetes mellitus and its associated factors. Methods: A cross-sectional study design was conducted from January to July 2022 at Ribat University Hospital in Khartoum and Abdallah Khalil Diabetic Centre in Omdurman. A total of 400 patients with type II diabetes who visited the referred clinics were enrolled in the study. Data was collected by face-to-face interview using the revised Diabetes Quality of Life instrument to assess the health-related quality of life. Data was analyzed using SPSS version 23.0 and summarized using tables and charts. The association between health-related quality of life and sociodemographic characteristics, clinical factors and lifestyle factors was obtained using chi-square test. Results: The mean score for overall health-related quality of life was 29.3 ± 11.5 while each domain of “satisfaction”, “impact” and “worry” had mean scores of 13.7 ± 4.9, 8.5 ± 4.4 and 7.1 ± 3.7, respectively. Since the scores obtained were only approximately half of the possible range of scores for quality of life, the overall health-related quality of life is considered to be moderate. This study also revealed that 40% of the participants have poor health-related quality of life. The relationship between HbA1c level & health-related quality of life was statistically significant (P value = 0.044) in which high glycosylated hemoglobin levels was associated with poor quality of life. Gender, age, education level, marital status, duration of diabetes and the presence of comorbidities and complications had statistically significant association with health-related quality of life. Conclusion: This study demonstrates a moderate overall health-related quality of life among patients with T2DM. Besides, it also demonstrates a low quality of life among 40% of patients with T2D, suggesting that quality of life should be included in any modality used for treating diabetic patients.

Diabetes Centers’ Participation in the T1D Exchange Quality Improvement Collaborative Advances Health Equity and Clinical Outcomes

As the learning health network known as the T1D Exchange Quality Improvement Collaborative (T1DX-QI) has expanded on a significant scale to provide care for more than 120,000 people since its inception in 2016, assessing the quality improvement (QI) culture and monitoring clinical outcome improvements of participating centers has become vital to understanding the network’s progress and success. Centers participating in the T1DX-QI complete regular QI culture self-assessments to quantify four evidence-based areas of culture: QI team structure, QI foundation, QI capacity, and QI success. This study builds on a previous baseline analysis to demonstrate self-reported improvements in T1DX-QI centers’ QI culture from 2021 to 2022 and summarizes QI successes experienced by participating centers.

Relation between Serum Leptin, Lipid Profiles and other biomarkers levels in patients with type 2 diabetic nephropathy

Background: In advanced diabetes mellitus, serum levels of the most hormones are altered due to several interplaying mechanisms. Objective: To assess the relation of serum leptin and lipid profile in type 2 diabetic nephropathy. Patients and Method: Serum leptin levels and its relation to lipid profile were estimated in 62 patients with type 2 diabetic nephropathy attending the National Diabetes Center in Al- Mustansiriya University, and (26) healthy individuals considered as control group. The diabetic patients were classified into three groups, (24) pathients with normoalbuminuria (21) patients with microalbuminuria and (17) patients with macroalbuminuria. Fasting plasma glucose, serum creatinine, Hb A1c %, lipid profile (Total cholesterol, LDL- Cholesterol, HDL- Cholesterol and Triglyceride) and urinary albumin, were measured to establish the possibility of using these biomarkers as a supplementary to serum leptin to be a diagnostic test for type 2 diabetic nephropathy. Results: Serum leptin levels showed a significant elevation in microalbuminuria (20.08± 4.50 ng/ml) and macroalbuminuria groups (22.35± 6.89 ng/ml) as compared to nondiabetic normal control group (10.64 ± 3.17 ng/ml). There was no significant differences observed in serum leptin levels between the normoalbuminuria group (13.96 ± 5.73 ng/ml) and healthy controls, but a significant positive differences were noticed in the levels of fasting plasma glucose, serum creatinine, Hb A1c% and lipid profile in the three patient groups in comparison with the control group. While no significant correlation was observed between these biomarkers levels and serum leptin values. Conclusion: It might be concluded that serum leptin levels were elevated in type 2 diabetic patients with microalbuminuria and macroalbuminuria, suggesting that renal leptin degradation is impaired in early stage of kidney damage and this impairment increase with the progression of this disease. Leptin hormone may consider according to these results as a risk factor for progression of kidney disease in diabetic patients.

8236 Hepatocyte Vitamin D Receptor (VDR) Regulates Liver Regeneration

Abstract Disclosure: J.E. Gunton: None. Harendran Elangovan [1], Rebecca A. Stokes [1], Jeremy Keane [1], Sarinder Chahal [1], Caroline Samer [1], Miguel Agoncillo [1], Josephine Yu [1], Jennifer Chen [1], Michael Downes 2, Ronald M. Evans 2, Christopher Liddle [1],2, Jenny E. Gunton [1] [1]Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia 2 Salk Institute for Biological Studies, La Jolla, CA. USA Background: Vitamin D signals through the vitamin D receptor (VDR) to induce its end-organ effects. Hepatic stellate cells control development of liver fibrosis in response to stressors and vitamin D signaling decreases fibrogenesis. VDR expression in hepatocytes, however, is low in healthy liver, and the role of VDR in hepatocyte proliferation is unclear. Methods: In these studies, hepatocyte-VDR null mice (hVDR) were used to assess the role of VDR and vitamin D signaling in hepatic regeneration. Mice underwent 2/3 partial hepatectomy and liver regeneration and function were studied. Results: hVDR mice had impaired liver regeneration with impaired hepatocyte proliferation. This was associated with significant differential changes in bile salts. Notably, mice lacking hepatocyte VDR had significant increases in expression of conjugated bile acids after partial hepatectomy, consistent with failure to normalize hepatic function by the 14-day time point tested. CDCA (chenodeoxycholate) is an FXR ligand, which was increased after surgery in controls but not in hVDR mice. FXR signaling is important for hepatocyte proliferation. Real-time PCR of hVDR and control livers showed significant changes in expression of cell cycle genes including cyclins D1 and E1 and cyclin-dependent kinase 2. Gene expression profiling of hepatocytes treated with vitamin D or control showed regulation of groups of genes involved in liver proliferation, hepatitis, liver hyperplasia / hyperproliferation and liver necrosis / cell death. Conclusions: Together these studies demonstrate an important functional role for VDR in hepatocytes during liver regeneration. Combined with the known profibrotic effects of impaired VDR signaling in stellate cells, these studies provide a mechanism whereby vitamin D deficiency would both reduce hepatocyte proliferation and permit fibrosis, leading to significant liver compromise. Presentation: 6/2/2024

12288 Diabetes Wearable Technology In Children Less Than Six Years At A Large Urban Diabetes Center

Abstract Disclosure: K. Citron-Zafrin: None. L. Richter: None. K. Williams: None. R. Gandica: None. I. Vargas: None. N. Leibel: None. Introduction/Background: Type 1 diabetes (T1D) is one of the most common chronic diseases in pediatrics. T1D is particularly challenging to manage in children under 6 years old due to unpredictable eating patterns, rapid growth, and risk of extreme blood glucose levels. Diabetes wearable technology (insulin pumps and continuous glucose monitors (CGMs)) has become increasingly prominent, but its use has not been well described in this age group. Objectives: We sought to characterize our experience with technology use in children with T1D less than 6 years old. Design/Methods: Retrospective chart review of 82 youth diagnosed with T1D before 6 years old, seen at our center from 2019-2023. Data was collected on demographic information, insurance type, use of insulin pump and CGM, hemoglobin A1c (A1c), diabetic ketoacidosis (DKA) and hypoglycemic events. We used chi-square statistics to compare variables in our population with reported national data. Results: In this cohort, 80% used insulin pumps and 100% used CGMs, an increase from previously reported data (56% insulin pump use and 44% CGM use in those less than 6yo, p<0.001). 54% had private insurance. There were more individuals with family members with T1D compared to reported data (35% vs. 22%, p=0.0041). The median age at diagnosis was 34 months, median time from diagnosis to pump start was 3.5 months. After diagnosis, 1 pump user and 1 multiple daily injections (MDI) user had DKA. One MDI user had hypoglycemia requiring intervention. Average A1C 12 months after diagnosis was 7.9% in the pump group and 8.2% in the MDI group. Hybrid closed loop pump users had an average A1C 6 months after placement of 7.7%. Conclusions: At our urban academic diabetes center, there was higher use of diabetes wearable technology as compared with previously reported data in this age group. There were more individuals with relatives with T1D compared to reported averages. The low rates of DKA and hypoglycemic events seen in this population support that these technologies can be used safely and soon after diagnosis. Although improved from national data, tight glycemic control remains a challenge in this very young age group. Presentation: 6/1/2024

7809 Role Of Education In Enhancing Preventative Vaccine Awareness Among Patients With Type 2 Diabetes Mellitus In Saudi Arabia

Abstract Disclosure: S.F. Alqifari: None. T. Alrasheed: None. O. Al Komi: None. P. Amirthalingam: None. M.A. Muqresh: None. H.R. Hamad: None. A.A. Khojah: None. N.M. Alshehri: None. B.A. Alhunayhani: None. B.M. AbuAlhasan: None. N.A. Alajlan: None. S.M. Alatawi: None. N.M. Alsabeelah: None. A.S. Wasel: None. Role of Education in Enhancing Preventative Vaccine Awareness among Patients with Type 2 Diabetes Mellitus in Saudi Arabia Abstract Background: Type 2 diabetes mellitus is a major chronic disease that requires lifelong management. It requires multidisciplinary efforts from physicians, pharmacists, dieticians, and diabetic educators. Awareness of the importance of follow-up, management, and preventive vaccination decreases the burden of possible complications. The impact of the level of education of patients with diabetes and awareness of preventive vaccination in Saudi Arabia is unclear. Objectives: This study aims to understand the association of the level of education with preventative vaccine awareness in patients with type 2 diabetes mellitus in Saudi Arabia. Methods: This is an observational retrospective study where the data was collected from 13 diabetes center records in Saudi Arabia from November 2022 to May 2023, the records include education level and vaccination reports among 709 patients with type 2 diabetes mellitus. Results: Participants in this study were between the ages of 46 to 65. Participants aged 18 to 25 and 36 to 45 accounted for 24.3% and 16.2% of the participants, respectively, while those aged 26 to 35 and above 65 represented 11.6% and 5.6% of the participants, respectively. In terms of gender distribution, there were slightly more female participants (55.7%) than male participants (44.3%). Most participants (55.9%) held a bachelor's degree, followed by individuals who had completed school education (31.73%). A smaller proportion had post-graduate education (7.3%) or education levels below primary school (5.1%). Regarding vaccination status, a significant proportion of participants (85.89%) had received the COVID-19 vaccine, while the percentages for other vaccines were lower, such as Influenza (34.83%), Hepatitis B (7.19%), and Pneumococcal (3.94%). A small number of participants reported receiving the Herpes Zoster (2.96%), Tdap (2.11%), or HPV (1.12%) vaccines, and surprisingly, 10.01% of participants reported never receiving any vaccines. Conclusion: The level of education among individuals with type 2 diabetes in Saudi Arabia impacted their uptake of preventive vaccinations. Most participants were vaccinated against COVID-19, followed by influenza, while the rate of other vaccines remained low. These findings highlight the need to increase awareness and education among type 2 diabetes patients regarding the importance of seeking necessary preventive vaccinations. Presentation: 6/3/2024

12420 Effects Of A Continuous Glucose Monitoring (CGM) Optimization Program On Prescribing Behavior And Glycemic Outcomes

Abstract Disclosure: A. Sterbenz: None. J. Fuentes Rosales: None. S. Abraham: None. P. Siroya: None. R. Middelbeek: None. J. Mitri: None. F. Rossitto: None. E. Cabana: None. A. Gharse: None. L. Collins: None. L. Aliaga: None. A. Millan Ferro: None. J. Cifuni: None. A. Schwartz: None. E. Kelley: None. C. Gomez: None. M. Aballay: None. Introduction: Continuous glucose monitoring (CGM) improves glucose control in patients with diabetes, as demonstrated in clinical trials. There is limited information available on the real-world application of CGM adoption in a resource-limited setting or safety net outpatient hospital setting. This intervention's aim was to assess the impact of a multifaceted approach on improving CGM utilization and on glycemic control among patients with diabetes. Methods: Wyckoff Heights Medical Center, located in Brooklyn, NY is a resource-limited setting that in partnership with the Joslin Diabetes Center, Boston, MA launched a CGM Clinical Care Optimization Program. This quality improvement (QI) initiative included establishing a diabetes technology team (DTT) which met weekly (n=24 sessions) to establish a highly specialized interprofessional group. The DTT activities included: 1) Establishing a CGM workflow; 2) Expanding Medical Assistant responsibilities related to diabetes technology and training; 3) Creating five bilingual (English-Spanish) patient handouts; 4) Building CGM vendor relationships; 5) Developing a CGM manual for data download, billing and coding, and education to increase CGM knowledge across the system. Data were collected prior to CGM initiation and at most recent visit. Results: The intervention occurred between February and November 2023. Prior to this intervention, 49 patients had a CGM prescription. After 9 months, CGM prescriptions were written for 333 patients (680% increase) with the following baseline characteristics (mean ± SD): age (61.2 ± 14.7 yrs.); 56% female; 44% male; 71% Latino; Race: 67% Other (63% Hispanic or Latino), 25% Black or African American, 4% White, Asian 2%, American Indian or Alaska Native 2%; 38% Spanish-speaking, 59% English-Speaking, 3% Other; 81% government insurance (63% Medicaid, 18% Medicare), 19% commercial insurance. The majority of patients had been diagnosed with type 2 diabetes (91%) and 9% had type 1 diabetes. Baseline HbA1C was 9.7 ± 1.5%. Of note, prior to CGM, 34% of patients had A1C>9%. The impact of CGM use was evaluated on 116 patients that met the following criteria: baseline A1C value within 60 days before or up-to 30 days after prescription, and a A1C >90 days after. After an average duration of 154 days of CGM use, HbA1c decreased significantly by -0.51% (p=0.001), demonstrating improved glycemic control post-CGM use. In those with A1c >9%, HbA1c decreased from 10.5% to 8.8% (p<0.01). Conclusion: Creating a CGM optimization program in a resource-limited setting is critical in improving patient self-awareness and provider insight in glycemic control in patients diagnosed with type 1 and type 2 diabetes. These data demonstrate the feasibility of implementing a CGM optimization program in a resource-limited setting, which is critically important in improving clinical care for people with diabetes. Presentation: 6/2/2024

Investigating Vitamin D Status: A Key Factor in Gestational Diabetes among Pregnant Women

Background: Vitamin D deficiency within the general population suggests the emergence of glucose intolerance. The relationship between insufficient vitamin D levels and gestational diabetes mellitus remains a subject of ongoing discussion. Objectives: The investigation looked into the connection between vitamin D levels and the chances of developing gestational diabetes mellitus. Methodology: This cross-sectional analytic study includes 262 pregnant women who attended the Gestational Diabetes Center and Antenatal Counseling Center at the Maternity Teaching Hospital in Sulaimani City. The study used convenience sampling, and the data was collected from November 1st, 2021, to October 1st, 2022. The study used a specific questionnaire divided into four sections: demographics, medical, and obstetric. Simultaneously, the Roche Elecsys vitamin D3 assay determined serum vitamin D status. Results: Women with gestational diabetes mellitus had a significantly higher prevalence of vitamin D inadequate levels (p =0.000), Significant variance in residency (p =0.000), education (p =0.000), body mass index (p =0.038), age at marriage (p =0.023), history of using the contraceptive pill (p-value =0.000), parity (p =0.001), and gravidity (p =0.014) were additionally identified between the two groups of gestational diabetes mellitus and non-gestational diabetes mellitus. Conclusion: Women with gestational diabetes mellitus had higher rates of vitamin D deficiency than those without, but the differences were not statistically significant.

Impaired Awareness of Hypoglycemia and its Risk Factors among Diabetic Patients in Jazan, Saudi Arabia: A Cross-Sectional Study.

Impaired awareness of hypoglycemia (IAH) is related to a three- to sixfold increase in the risk of severe hypoglycemia in adults with type 1 diabetes mellitus (T1D). This study aimed to assess the prevalence of IAH and its risk factors and determine the frequency of hypoglycemic symptoms. This study aimed to assess the prevalence of IAH and its risk factors and determine the frequency of hypoglycemic symptoms. A cross-sectional study was conducted among T1D patients attending Jazan Endocrine and Diabetes Center in Jazan province, Saudi Arabia. A total of 151 patients participated, using the interview-based Clarke questionnaire, a validated eight-item questionnaire to evaluate IAH. Scoring four or more answers as reduced awareness categorizes the participant as having IAH. The prevalence of IAH was 25.2% among the T1D patients. IAH was significantly associated with body mass index (BMI; p = 0.034), occupation (p = 0.014), and blood glucose monitoring methods (p = 0.027). Shaking and sweating were the most commonly reported symptoms of hypoglycemia. A BMI of <25 kg/m2 was higher linked to hunger and speech difficulty compared to a BMI of ≥25 kg/m2 (p < 0.05). Changing the insulin injection site was associated with confusion, odd behavior, and speech difficulty (p < 0.05). Monitoring blood glucose four times daily was associated with sweating, odd behavior, and incoordination (p = 0.024) compared to monitoring less than four times daily (p < 0.05). A hemoglobin A1c (HbA1c) reading of ≥7 was linked to odd behavior compared to an HbA1c reading of <7 (p = 0.032). Patients committed to insulin injections were more likely to experience palpitations than non-committed patients (p = 0.038). Each one-unit increase in age, monitoring blood glucose, and income was associated with a decrease in the odds of IAH (OR of Age = 0.89, 95% CI: 0.83-0.95) (OR of income = 0.10, 95% CI: 0.01-0.55). Moreover, individuals with a Body Mass Index (BMI) greater than or equal to 25 (OR = 2.99, 95% CI: 1.13-8.25), employed individuals (OR = 18.2, 95% CI: 3.75-105), and diabetes duration of more than ten years (OR = 3.96, 95% CI: 1.31- 13.2) exhibited an increase in the higher risk of IAH. IAH was prevalent among T1D patients attending Jazan Endocrine and Diabetes Center. The main associated factors included BMI, blood glucose monitoring method, and occupation. Future research should investigate the underlying causes of the observed associations and explore strategies to enhance the awareness of hypoglycemia.

Patients’ knowledge of diabetic foot self-care practice: A cross-sectional study

This study evaluated the patients’ knowledge of diabetic foot self-care practice. A cross-sectional study was conducted to assess patients' understanding of diabetic foot care practices at the diabetic center in Merjan Medical City. The study was conducted from October 15, 2023 to April 1, 2024. An extensive review of relevant literature informed the development of the study instrument, consisting of two sections and 22 items. Data were collected using a developed questionnaire administered through interviews with available contacts who facilitated access to the study sample. Each interview lasted approximately 10 to 15 minutes. The data collection period was extended from December 1, 2023, to January 1, 2024. Most of the respondents (52%) were between 50 and 59 years of age. The sample was predominantly male, comprising 28 patients (56%). A significant portion (84%) were married, and 44% had literacy skills. Most participants were employed (36%), with 72% residing in urban areas. Most respondents (68%) reported inadequate economic status, and a majority (76%) had a family history of diabetes mellitus. Additionally, the highest percentage of the study sample (80%) had been living with the disease for more than one year. Most of the sample (42%) had a fair level of knowledge regarding diabetic foot self-care at the diabetic center in Merjan Medical City. Providing comprehensive education to registered patients who regularly visit the center is essential, focusing on foot self-care activities to enhance their knowledge and practices.

The Role of Arginase and some Parameters in Diabetic Type 2 Patients with and without Retinopathy

Background: Oxidative stress plays a major role in the pathogenesis of diabetes mellitus by damaging cellular organelles and enzymes in blood such as arginase1, insulin and glutathione s-transferase; increasing lipid peroxidation such as malondialdehyde and increasing insulin resistance which can lead to diabetic complications such as diabetic retinopathy. Objectives: To explore the relationship of oxidative stress to the development of diabetic retinopathy by measuring the levels of Arginase1, the activity of glutathione s-transferase enzyme, and the levels of malondialdehyde as a secondary product of lipid peroxidation (biomarker for oxidative stress). Patients and MethodsThis study was conducted from November 2022 to January 2023 at the Ibn Al-Haitham Teaching Eye Hospital in Baghdad, the University of Baghdad / Department of Chemistry and the National Diabetes Centre for Treatment and Research at Al-Mustansyrriah University. This study was conducted on 120 subjects distributed as follows: 40 non-diabetic obese controls, 40 type 2 diabetics with no retinopathy, and 40 type 2 diabetic retinopathy patients, between 30 and 65 years of age. All groups were subjected to tests: measuring fasting blood glucose (FBG), HbA1c, lipid profile (cholesterol, triglycerides, HDL- cholesterol, LDL- cholesterol, and VLDL cholesterol), serum total arginase1, malondialdehyde glutathione s -transferase, body mass index (BMI), and waist-to-hip ratio. Results: Mean arginase1 levels were significantly higher in diabetic patients than in diabetic retinopathy and control groups (p ≤ 0.05). The mean xidative stress marker malondialdehyde concentration was significantly higher in diabetic retinopathy patients than in type 2 diabetics and the control group (P ≤ 0.05). The mean glutathione s-transferase activity in diabetic retinopathy patients was significantly higher than in the control group and type 2 diabetics (P ≤ 0.05). Conclusion: There is a relationship between oxidative stress and the development of diabetic retinopathy, where the levels of arginase1 and malondialdehyde increased and the activity of glutathione s –transferase enzyme increased as a result of oxidative stress and inflammation associated with complications of type 2 diabetes.

Exploring the interconnectedness of depression, anxiety, diabetes distress, and related psychosocial factors in adults with type 2 diabetes: A network analysis

Background and objectiveAnxiety, depression, and diabetes distress are three common psychological distresses among people with type 2 diabetes. Although previous research has explored factors associated with them, most studies have viewed these factors as independent constructs, overlooking the complex interactions between these factors, which can limit our understanding of psychological symptoms and associated factors from an integrated perspective. The purpose of this study was to explore the relationships between psychological distress outcomes and related psychological factors in people with diabetes from a network analysis perspective and further provide evidence for the selection of specific psychological intervention targets. Design and settingA cross-sectional study was conducted in person at diabetes centers of three tertiary hospitals in China. Participants481 adults with type 2 diabetes (62% male; mean age 51.91 ± 13.64 years; mean HbA1c 9.34 ± 2.23%) were recruited between December 2022 and April 2023. MethodsPsychological distress outcomes and related factors analyzed included depression (PHQ-9), anxiety (GAD-7), diabetes distress (DDS), acceptance level (AADQ), cognitive fusion (CFQ), social support (PSSS), and self-efficacy (DMSES). Correlation analyses and network analyses were used to explore complex associations among these variables. ResultsThe network included ten nodes, diabetes-related interpersonal distress, anxiety, and regimen-related distress were the most influential in the network. Significant relationships emerged in networks with five nodes, with both acceptance level and cognitive fusion associated with the general psychological distress and diabetes distress; social support demonstrated stable associations with all three psychological outcomes in each network. ConclusionAfter controlling for other factors, psychological flexibility and social support could still be significantly associated with psychological distress outcomes, indicating the potential to integrate them as transdiagnostic processes into psychological interventions for this population. However, the results of this study are based on the group level, and the dynamic networks of individuals need to be further explored in order to meet the needs of individuals in different contexts.

Epidemiological profile for type 2 diabetic patients in Babylon City: Across sectional study

Background: Diabetes Mellitus (DM) is a multifaceted and enduring metabolic disorder that has become a prominent global health concern. The global impact of this issue is significant, affecting a large population and presenting substantial health risks, thereby placing a considerable strain on healthcare systems. Type 2 diabetes is a significant public health problem responsible for several macro and microvascular complications. This study aimed to describe the epidemiological profile of type 2 diabetic patients how attending to the specialized center for endocrinology and diabetes in Babylon City. Methodology: A sectional study was conducted between 25th of September 2023 to the 18th of April 2024 to determine the epidemiological characteristics of patients with type 2 diabetes who was attending to the Specialized Center for Endocrinology and Diabetes in Marjan Teaching Hospital, it's a referral center for diabetes and other endocrinology diseases and received diabetes patients of different ages and both sexes from the different health facilities as Public Hospitals, PHC, and Private Clinics. Result: - The study included 751 patients; 58.7% were females, and 41.3% were male. 30.8% were in the age group (60-69) years with an average age of 54.2±14.0 for all involved age (18-90) years. The majority, 47.1%, had diabetes duration of less than 10 years. On admission, 87.6 % of patients suffer from a chronic disease other than diabetes, 30.1 % were overweight, and 48.4 % were obese, with the non-significant difference between percentages using the person chi-square test (2-test) at 0.05 level (P= 0.970). On the other hand, 98.8 % of patients had at least one complication on admission: 81.9% had peripheral neuritis, 85 % had eye fatigue, 84.2 % had severe hypoglycemia, 41.3% had high blood pressure, 35.2% had a diabetic foot and lowest percentage 10.1% had brain strokes. Conclusion: - The patients with type 2 diabetes mellitus have an extremely high risk of disease complications.

Molecular Identification of Cryptosporidiosis in Diabetes and Cancer patients

Cryptosporidium spp., a primary intestinal parasite and obligate intracellular parasite, infects a wide range of vertebrates, including human. The current study aimed to determine the infection rate of Cryptosporidium spp. among immunocompromised patients attending the Diabetes and Endocrinology Centre and Oncology Department at Al-Diwaniya Teaching Hospitals in Al-Diwaniya Providence, Iraq. The research period extended from the first of October 2023 until the end of February 2024. Eighty-seven stool samples were obtained from immunocompromised patients of various ages and both genders who attended the hospital. Stool samples were examined using the nested PCR technique. The results showed an overall infection rate of 22.98%. Researchers found that the infection rate was 20.83% among diabetic patients and 25.64% among cancer patients. Male patients had a recorded infection rate of 23.07%, whereas females recorded 22.85%. A high infection rate (60%) was observed among patients under the age of 15 and among those coming from rural areas, reaching 34.88%. Additionally, it was found that 42.42% of the infected individuals had contact with animals.

Impact of Lifestyle and Demographic Factors on Diabetes-Associated Complications; A Cross-Sectional Study

Globally, the prevalence of Diabetes Mellitus (DM), a leading cause of death and morbidity, is rising, adults with DM have the highest prevalence of chronic illness. This study pursuits to assess and evaluate the impact of life style and demographic factors that aggravates the diabetic complications. Methods: A cross-sectional study design was carried out in adult diabetic patients. The study was a nationally based study in Lahore, Pakistan, target population was Medical OPDs and Diabetic Care centers. Participants includes both gender with age 20 year to 70 years who’s diagnosed with type 2 Diabetes Mellitus. The study variables include the demographic information, patient assessment, regarding the life style, face to face interview through self-structured questionnaire and anthropometric measurement were taken from every participant (weight, height). SPSS version 20.0 was used for data analysis. Results: The sample of this study consisted of 189 (51.1%) females and 181(48.9%) male respondents (N=370). The descriptive Statistics of gender of respondents giving standard deviation of 0.501 and variance of 0.251. As all the respondents are diabetic patients so while cross tabulating the gender with Obese scale 167 of the total population fall in normal weight scale, 110 are categorized as overweight and 33 as obese. The people with good knowledge about their life style impact on Diabetes complications were relatively less affected. Conclusions: The findings alert the medical practitioner informed the patients about the significance of impact of sedentary lifestyle on diabetic’s complications. Regular screening for diabetic patient is necessary for the early detection of complications by skilled health professionals.

The Association of Overweight and Obesity With Hypertension and Diabetes Mellitus At Al-Diwaniyah Province

Background: Noncommunicable diseases (NCDs) represent a major concern for public health. and one of the main reasons for the global illness burden. Cardiovascular diseases (CVDs) are still the main reason for mortality worldwide and are a major contributor to both health loss and excessive expenditures on healthcare. Aim of study: to determine the prevalence of overweight and obesity among hypertensive or diabetic patients and identify the effect of these conditions on them. Methods: This observational cross-sectional study applied a convenient sample of 322 patients diagnosed with Hypertension or Type 2 diabetes, or both, who attended the Specialized Center for Diabetes and Endocrinology (SCDE) and Internal medicine consultant at Al-Diwaniyah province. An interview-based questionnaire is composed of several questions that have been gathered by researchers and assessed by a number of professionals. From the tenth of September to the beginning of February, the data was collected. Results: A total of 322 participants enrolled in this study, we found that the prevalence rate of obesity and overweight in groups of patients was 37.3% and 53.1%, respectively. There was a significant association between control of blood pressure in the diabetic group (p = 0.007), and there was a significant difference in mean age among the diabetes group, the hypertensive group, and the group with both diseases: 51.02 ±9.64 years, 50.58 ±12.06 years, and 54.14 ±9.97 years, respectively (p = 0.018). The difference in mean BMI among study groups was significant (p = 0.003); the highest mean BMI was seen in patients with both type 2 DM and hypertension, followed by the hypertension group, and the least mean BMI was noted in the diabetic group. Conclusions: The prevalence rate of obesity was higher than that of overweight among study groups. Age and education level were important risk factors for the development of comorbidity among patients. people with hypertension and type 2 diabetes had the greatest mean BMI, followed by hypertension patients, while diabetic patients had the lowest mean BMI (p = 0.003). The study discovered a substantial inverse connection between HDL-C, triglyceride, serum creatinine, and cholesterol in hypertensive patients, while A favorable association was identified among VLDL-C “and” cholesterol, whereas in diabetic patients, there was a significant favorable relationship between “LDL-C,” “VLDL-C,” “cholesterol,” and “TG” and an inverse connection between “HDL-C,” cholesterol, and blood urea.

The Effect of Sociodemographic Characteristics on The Lifestyle Among Type 2 Diabetic Patients in Mosul City

Introduction: Diabetes Mellitus is a condition that causes persistently increased blood glucose levels in the body. It is the second leading cause of years spent disabled globally and is a major cause of death with high mortality rates. Objective: To identify the effect of sociodemographic characteristics on the lifestyle among type 2 diabetes mellitus in Mosul City. Methods and materials: A non-experimental cross-sectional study design was implemented on a total of 400 Type II Diabetic Patients who make periodic visits to Al-Wafaa Specialized Centre for Diabetes and Endocrinology by A non-probability sample. A developed interviewing questionnaire was used to collect information related to sociodemographic, and lifestyle was assessed by using HPLP-II, from October 15th, 2023, to June 1st, 2024. The collected data were compiled and analysed using percentages, mean, standard deviation, minimum, maximum, Spearman’s Correlation and Chi Square using SPSS version 26. P values of 0.05 were used as a cut-off point for the significance of the statistical test. Results: Majority of participants were female, reside in urban areas, married, unable to read and write, unemployed and never smoked (52.3%, 78.7%, 79.0%, 29.7%, 57.4%, and 44.2%) respectively. In addition to that, there was a significant correlation between the sociodemographic characteristics and lifestyle among the participants. The patients scored highest in the interpersonal relations and scored lowest in the physical activity factors. Finally, most of the patients practiced health-promoting lifestyle pattern moderately (63.5%). Conclusions: The study showed that, there is a significant correlation between lifestyle and sociodemographic characteristics of the study participants.

Association of periodontitis with serum osteoprotegerin level in type 2 diabetic postmenopausal women.

To evaluate the association of periodontitis with serum osteoprotegerin level according to glycaemic state in postmenopausal type 2 diabetic women. The case-control study was conducted from June 2019 to May 2020 at the National Diabetes Centre, Mustansiriyah University, Baghdad, Iraq, and comprised postmenopausal diabetic women with good glycaemic control in group A, diabetic women with poor glycaemic control in group B, and non-diabetic healthy controls in group C. Participants were inducted by using the consecutive sampling technique. Assessment of periodontitis was done by measuring probing pocket depth, gingival recession and clinical attachment level. The ratio between serum osteoprotegerin level and glycated haemoglobin was calculated for all the subjects. Data was analysed using SPSS 24. Of the 150 subjects, 57(38%) were in group A with mean age 57.39±5.89 years, 43(28.7%) were in group B with mean age 58.91±4.95 years, and 50(33.3%) were in group C with mean age 54.92±4.62 years. Probing pocket depth, clinical attachment level and serum osteoprotegerin exhibited higher values in groups A and B compared to group C, and in group B compared to group A (p<0.001). There was a significant positive correlation between Probing pocket depth and serum osteoprotegerin in all groups (p<0.05). Periodontal parameters and serum osteoprotegerin level were significantly higher in diabetic women, especially in those with poor glycaemic control, than in healthy controls, and serum osteoprotegerin level showed a significant positive correlation with probing pocket depth in all the studied groups.