Complications In Diabetic Patients Research Articles

Correlation between carotid intima media thickness and TSH in diabetic patients - an analytical cross-sectional study in a tertiary-care hospital

Background: Atherosclerotic cardiovascular disease is one of the major complications in diabetic patients leading to illness and death. Carotid Intima media thickness (CIMT), being simple and non-invasive, is widely used as an indicator of atherosclerosis to identify early atherosclerotic changes. Insulin sensitivity, development of chronic complications in diabetes, as well as alteration in glucose metabolism could be attributed to abnormal thyroid function, and likewise, diabetes itself can alter thyroid function by impairing peripheral conversion of thyroxine and altering thyroid stimulating hormone (TSH) level. This study was conducted to find the correlation between CIMT and TSH in diabetic patients. Methods: In this hospital-based analytical cross-sectional study we enrolled 29 patients with type 2 Diabetes Mellitus. TSH and CIMT were measured. To find the correlation between TSH and CIMT, Pearson correlation analysis was used. Results: Of the 29 patients 34.5% were female and 65.5% were male. A statistically significant correlation was found between HbA1C, FBS with CIMT (p < 0.001); however, whether TSH was an independent factor causing early atherosclerosis in diabetic patients measured using CIMT could not be established. We found a negative correlation between CIMT and TSH Pearson correlation r – 0.213 with a p-value 0.267. Conclusion: Diabetes was associated with early atherosclerotic changes measured using CIMT, and hence, it can be used as a marker for screening early atherosclerosis in diabetic patients. Since no association was found between CIMT and TSH in our study, the role of TSH in predicting atherosclerosis in diabetic patients could not be established. Studies with larger sample size need to be conducted to establish the relationship.

Factors associated with glycaemic control and diabetes complications in patients at Bugando Medical Centre, Mwanza, Tanzania: A cross-sectional study design.

Glycaemic control is essential for improving the quality of life in patients with Diabetes Mellitus (DM). Untreated hyperglycaemia can result in numerous severe and life-threatening complications, such as damage to the eyes, kidneys, nerves, heart, and peripheral vascular system. Appropriate glycaemic control and management is fundamental to prevent and delay diabetes complications. Therefore, this study aims to assess the prevalence of poor glycaemic control, its associated factors, and the prevalence of diabetes-related complications among DM patients. A cross-sectional study was conducted among 340 DM patients treated at Bugando Medical Center from 4th - 30th April 2023 to determine the prevalence of poor glycaemic control and its predictors. Secondary data from 7952 DM patients treated between April 2022 and 30th May 2023 were used to determine DM-related complications. STATA 15 version …was used for analysis. Out of 340 patients, 66.4% had poor glycaemic control with HbA1c or Random Blood Glucose greater than 7% or 7mmol/L, respectively. Older age, duration of DM of more than 10 years, insulin therapy, and those unaware of glycaemic target goals were factors associated with poor glycaemic control. (AOR: 2.46, 95% CI: 1.28-6.01, P = 0.03), (AOR: 3.15, 95% CI: 2.22-6.55, P = 0.016), (AOR: 3.07, 95% CI: 2.10-6.12, P = 0.022) and (AOR: 3.42, 95% CI: 2.17-5.97, P = 0.001), respectively. Of the 7952 patient records reviewed indicated that 44.5% had complications, of which 25.8% had neurological complications and 55.3% had multiple complications. Two-third of DM patients failed to achieve good glycaemic control and about half of the patient's records reviewed indicated they developed diabetic complications. Thus appropriate interventions are necessary to improve glycaemic control and prevent or control complications among DM patients.

Ocular Complications in Diabetic Patients: Prevalence, Impact on Quality of Life, and Implications for Healthcare

Ocular Complications in Diabetic Patients: Prevalence, Impact on Quality of Life, and Implications for Healthcare

Clinical safety and therapeutic efficacy of autologous bone-marrow derived stem cells in restoring glycemic control and treating complications in diabetic patients

Diabetes is one of the most common chronic diseases worldwide, with around 537 million adults aged 20-79 living with the disease. It is a global epidemic and has a rapidly rising incidence. Traditional treatments for diabetes have limited efficacy in achieving long-term disease control. In recent years, the autologous infusion of bone marrow-derived mononuclear cells (BMMNC) has become a novel and effective therapeutic approach in treating autoimmune type 1 diabetes (T1DM). BMMNC contains two important types of stem cells, bone marrow-derived hematopoietic stem cells (BMHSC) and bone marrow-derived mesenchymal stem cells (BMMSC), which are currently used independently or coordinately in the treatment of T1DM. In this review, we summarize the clinical data concerning BMMNC, BMHSC, and BMMSC infusion in patients with diabetes (including type 1, type 2, and secondary diabetes) and diabetes-related complications. Research suggests that the autologous infusion of bone marrow stem cells is safe and effective, offering the potential to be widely used in patients with diabetes.

Characteristics of storage and voiding symptoms in adult patients with type 2 diabetes with lower urinary tract symptoms.

We aimed to assess the relationships between lower urinary tract symptoms (LUTS) and various parameters including diabetes complications in patients with type 2 diabetes. In this single-center cross-sectional study, we enrolled 404 patients hospitalized for diabetes. We ultimately analyzed data from 160 patients. To evaluate LUTS, the International Prostate Symptom Score and overactive bladder symptom score were used. The identified relationships were then analyzed considering parameters such as age, sex, body mass index (BMI), HbA1c, creatinine, and urinary albumin excretion. The prevalences of overactive bladder (OAB), storage symptoms and voiding symptoms were 21.9%, 63.8%, and 39.4%, respectively. In multivariate logistic regression analysis, the coefficient of variation of the R-R interval, indicating autonomic neuropathy, correlated negatively with OAB, while BMI and duration of diabetes correlated positively with storage symptoms. A history of cerebrovascular disease correlated significantly with voiding symptoms in multivariate logistic analysis. Our analysis of diabetic patients with LUTS revealed differences in the characteristics of storage and voiding symptoms. These findings provide evidence that the features of LUTS associated with diabetes may have different pathogenic origins. J. Med. Invest. 71 : 237-245, August, 2024.

Postbiotics: emerging therapeutic approach in diabetic retinopathy.

Diabetic retinopathy (DR) is a prevalent microvascular complication in diabetic patients that poses a serious risk as it can cause substantial visual impairment and even vision loss. Due to the prolonged onset of DR, lengthy treatment duration, and limited therapeutic effectiveness, it is extremely important to find a new strategy for the treatment of DR. Postbiotic is an emerging dietary supplement which consists of the inactivate microbiota and its metabolites. Numerous animal experiments have demonstrated that intervention with postbiotics reduces hyperglycemia, attenuates retinal peripapillary and endothelial cell damage, improves retinal microcirculatory dysfunction, and consequently delays the progression of DR. More strikingly, unlike conventional probiotics and prebiotics, postbiotics with small molecules can directly colonize the intestinal epithelial cells, and exert heat-resistant, acid-resistant, and durable for storage. Despite few clinical significance, oral administration with postbiotics might become the effective management for the prevention and treatment of DR. In this review, we summarized the basic conception, classification, molecular mechanisms, and the advances in the therapeutic implications of postbiotics in the pathogenesis of DR. Postbiotics present great potential as a viable adjunctive therapy for DR.

Effect of Glycemic Control on the Incidence of Dental Implant Complications in Diabetic Patients

Effect of Glycemic Control on the Incidence of Dental Implant Complications in Diabetic Patients

Estimation of the onset time of diabetic complications in type 2 diabetes patients in Thailand: a survival analysis.

This study aimed to identify factors associated with the onset time of diabetic complications in patients with type 2 diabetes mellitus (T2DM) and determine the best-fitted survival model. A retrospective cohort study was conducted among T2DM patients enrolled from October 1, 2016 to July 15, 2020 at the National Health Security Office (NHSO). In total, 388 T2DM patients were included. Cox proportional-hazard and parametric models were used to identify factors related to the onset time of diabetic complications. The Akaike information criterion, Bayesian information criterion, and Cox-Snell residual were compared to determine the best-fitted survival model. Thirty diabetic complication events were detected among the 388 patients (7.7%). A 90% survival rate for the onset time of diabetic complications was found at 33 months after the first T2DM diagnosis. According to multivariate analysis, a duration of T2DM ≥42 months (time ratio [TR], 0.56; 95% confidence interval [CI], 0.33-0.96; p=0.034), comorbid hypertension (TR, 0.30; 95% CI, 0.15-0.60; p=0.001), mildly to moderately reduced levels of the estimated glomerular filtration rate (eGFR) (TR, 0.43; 95% CI, 0.24-0.75; p=0.003) and an eGFR that was severely reduced or indicative of kidney failure (TR, 0.38; 95% CI, 0.16-0.88; p=0.025) were significantly associated with the onset time of diabetic complications (p<0.05). Patients with T2DM durations of more than 42 months, comorbid hypertension, and decreased eGFR were at risk of developing diabetic complications. The NHSO should be aware of these factors to establish a policy to prevent diabetic complications after the diagnosis of T2DM.

The Relationship Between HBA1C Levels and Diabetic Complications in Patients with Type II Diabetes Mellitus at RSU Royal Prima Medan

North Sumatra is home to a considerable population of Diabetes Mellitus (DM) patients, specifically individuals aged 15 years and above, totaling 49,572. Among the cities in the province, Medan stands out with the highest prevalence of Type II DM patients. The data indicates that in 2018 alone, the number of DM patients in Medan reached 7,826, solidifying its status as the primary contributor to the overall prevalence of DM in North Sumatra. The focal point of this research is to assess the understanding of the connection between HbA1c levels and complications in Type II Diabetes Mellitus patients, particularly those receiving care at Royal Prima Hospital in Medan. Employing a cross-sectional research design, the study involved 85 participants selected through purposive sampling, and data analysis was conducted using SPSS software. The study's outcomes highlight a significant relationship between HbA1c levels and complications in Type II Diabetes Mellitus patients at Royal Prima Hospital in Medan. This association is substantiated by the chi-square test results, yielding a p-value of 0.000, which is less than the significance threshold of 0.05. This statistical significance implies a robust and noteworthy correlation between HbA1c levels and the occurrence of complications in patients with Type II Diabetes Mellitus at the mentioned hospital.

JunB condensation attenuates vascular endothelial damage under hyperglycemic condition.

Endothelial damage is the initial and crucial factor in the occurrence and development of vascular complications in diabetic patients, contributing to morbidity and mortality. Although hyperglycemia has been identified as a damaging effector, the detailed mechanisms remain elusive. In this study, identified by ATAC-seq and RNA-seq, JunB reverses the inhibition of proliferation and the promotion of apoptosis in human umbilical vein endothelial cells treated with high glucose, mainly through the cell cycle and p53 signaling pathways. Furthermore, JunB undergoes phase separation in the nucleus and in vitro, mediated by its intrinsic disordered region and DNA-binding domain. Nuclear localization and condensation behaviors are required for JunB-mediated proliferation and apoptosis. Thus, our study uncovers the roles of JunB and its coacervation in repairing vascular endothelial damage caused by high glucose, elucidating the involvement of phase separation in diabetes and diabetic endothelial dysfunction.

Healing of the Common Interphalangeal Joint Ulcer and Preventing Further Complications in Diabetic Patients.

Healing of the Common Interphalangeal Joint Ulcer and Preventing Further Complications in Diabetic Patients.

Synopsis of the Korean Society of Nephrology 2023 Practical Recommendations for the Management of Diabetic Kidney Disease

Korea has one of the highest rates of end-stage kidney disease (ESKD) worldwide and nearly half of all new cases are attributed to diabetes. Diabetes represents a critical aspect of chronic kidney disease (CKD)-related mortality that entails substantial treatment costs. Given the profound impact of ESKD, it is imperative to initiate robust initiatives to formulate and implement effective preventive and therapeutic strategies. These strategies should target the prevention of CKD development in individuals with diabetes and decelerate the progression of diabetic kidney disease. Recognizing this challenge, the Korean Society of Nephrology (KSN) has introduced the kidney health plan 2033, a comprehensive endeavor designed to alleviate the burdens associated with CKD and ESKD in Korea. As part of this initiative, KSN has undertaken the development of the KSN 2023 practical recommendations for the management of diabetic kidney disease. The hope is that implementation of this guideline will delay the onset of kidney-related complications in diabetic patients throughout the country.

Time in range and complications of diabetes: a cross-sectional analysis of patients with Type 1 diabetes

Background/ objectiveTo evaluate the association of CGM parameters and HbA1c with diabetes complications in patients with Type 1 Diabetes (T1D).MethodsPatients with T1D using the CGM system Freestyle Libre were included in this analysis. The association of CGM-metrics and HbA1c with diabetes complications (any complication, microvascular complications, or macrovascular complications) was assessed using logistic regression unadjusted and adjusted for age, sex, and diabetes duration (model 1), and further adjusted for hypertension and dyslipidemia (model 2).ResultsOne hundred and sixty-one patients with T1D were included. The mean (± SD) age was 37.4 ± 13.4 years old and the median T1D duration was 17.7 ± 10.6 years. Time in range (TIR) was associated with any complication and microvascular complications in the unadjusted model and in the adjusted models. TIR was associated with retinopathy in the unadjusted model as well as in model 1, and was associated with macrovascular complications only in the unadjusted model. HbA1c was associated with any complications, microvascular complications, and retinopathy in the unadjusted model but not in the adjusted models. HbA1c was associated with macrovascular complications in the unadjusted model and in the adjusted model 1.ConclusionsIn this cross-sectional analysis of patients with T1D using intermittent scanned CGM, TIR, and HbA1c were associated with complications of diabetes. TIR may be a better predictor than HbA1c of any complication and microvascular complications, while HbA1c may be a better predictor of macrovascular complications.

Presence of circulatory autoantibodies against glycated histones in diabetic patient in Saudi Arabia

Background: Advanced glycation end products (AGEs) in diabetic patients can trigger several autoimmune responses. This article aims to assess the presence of circulating autoantibodies against glycated histones and their role in complications in diabetic patients in the Saudi population. Methods: A total of one hundred twenty samples were collected from diabetic patients with different age groups and healthy individuals as control. All serum samples were collected from Prince Sultan Military Medical City (PSMMC) in Riyadh City in Saudi Arabia. Glycated H2A was prepared and characterized using different physiochemical techniques. Then, ELISA was performed to assess the presence of circulating autoantibodies against glycated histones in diabetic patients’ samples compared with control healthy individuals in the Saudi population. Results: The glycation of H2A under our experimental conditions appears to be completed in 14 days. also, our data showed high circulating autoantibodies were detected against glycated H2A in all diabetic patients’ plasma with different dilutions. Remarkably, diabetic patients’ group 1 (under 20 years old group) showed highly significant binding activity values in each dilution. However, diabetic patients in groups 2 and 3 showed less binding but still significant values when compared to control healthy individuals. Conclusions: This finding provides novel perspectives into existing of circulating autoantibodies against glycated histones in diabetes patients in Saudi Arabia. Therefore, these circulating autoantibodies might be used as valuable tools for understanding the glycation mechanisms in diabetic patients in addition to providing diagnostic and prognostic knowledge. However, their roles in diabetic complications need further investigation.

A pilot study: Drug utilization pattern and prevalence of micro and macrovascular complication in type 2 diabetes patient

Background: Diabetes mellitus is a chronic metabolic disorder resulting from the deficiency of insulin secretion and insulin resistance. Currently, there is a death of nationwide data regarding the prevalence of micro and macro complications and drug utilization patterns. This study will help health-care professionals approach management more aggressively to prevent complications. Objectives: To assess the risk factors associated with complications in diabetes patients, and to determine the pattern of drug prescription among type-2 DM patients patterns at Virudhunagar Medical College &amp; Hospital. Methods: This is a Prospective, prescription-based, and observational study. A sample size of 50 was selected systematically. Data were collected from patient case records and Prescriptions. The obtained data were entered in the structured patient profile form, and the filled forms were analyzed. Results: Out of the total 50 cases evaluated, 60 (60%) were males and 20(40%) were females. The 28 patients (56%) had a family history of diabetes. The prevalence of the associated diabetic complications was as follows viz. Hypertension (17.65%), IHD (1.47%), retinopathy (17.65%), nephropathy (7.35%), Neuropathy (47.06%), Stroke (5.88%) and CHF (2.94%). The overall utilization pattern of drugs were as follows viz. anti-diabetics (28%), anti-hypertensive (9%), antiplatelets (4%), lipid lowering agents (7%), vitamins and minerals (17%),GI drugs (14%), antimicrobials(6%). Among anti-diabetic drugs 48(96%) biguanides and 44(88%) of sulfonylureas classes of antidiabetic drugs were utilized. Likewise, preferred drugs for the management of hypertension, IHD, dyslipidemia, and neuropathy were Diuretics (25.93%), Clopidogrel (66.66%), Atorvastatin (100%), and Acetominophine (67.74%) respectively. Conclusion: The prevalence of micro and macro complications among type 2 diabetic patients was found to be high. Although polypharmacy was observed, drug utilization patterns can be rational owing to the higher prevalence of complications. Patient are not aware of the severity of the disease so complication makes the therapeutic more challenging. Patient education on disease severity and healthcare professionals need more focus on disease complications and severity to treat the disease earlier to improve patient health outcomes.

An Immunomodulatory Hydrogel by Hyperthermia-Assisted Self-Cascade Glucose Depletion and ROS Scavenging for Diabetic Foot Ulcer Wound Therapeutics.

Current therapeutic protocols for diabetic foot ulcers (DFUs), a severe and rapidly growing chronic complication in diabetic patients, remain nonspecific. Hyperglycemia-caused inflammation and excessive reactive oxygen species (ROS) are common obstacles encountered in DFU wound healing, often leading to impaired recovery. These two effects reinforce each other, forming an endless loop. However, adequate and inclusive methods are still lacking to target these two aspects and break the vicious cycle. This study proposes a novel approach for treating DFU wounds, utilizing an immunomodulatory hydrogel to achieve self-cascade glucose depletion and ROS scavenging to regulate the diabetic microenvironment. Specifically, AuPt@melanin-incorporated (GHM3) hydrogel dressing is developed to facilitate efficient hyperthermia-enhanced local glucose depletion and ROS scavenging. Mechanistically, in vitro/vivo experiments and RNA sequencing analysis demonstrate that GHM3 disrupts the ROS-inflammation cascade cycle and downregulates the ratio of M1/M2 macrophages, consequently improving the therapeutic outcomes for dorsal skin and DFU wounds in diabetic rats. In conclusion, this proposed approach offers a facile, safe, and highly efficient treatment modality for DFUs.

Pumpkin seeds and leaves as an alternative medicine for the treatment of hyperglycemia

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia due to unhealthy dietary patterns, sedentary lifestyle behavior, and obesity. Among the two types of diabetes, type 2 is the most common in the world and the drugs used to treat hyperglycemia in type 2 DM cause adverse side effects. Hence, it is important to search for an effective natural anti-diabetic treatment to combat hyperglycemia and its complications in diabetic patients. Among the different herbal plants, pumpkin is very popular in terms of reducing blood glucose levels. Pumpkin is a popular vegetable cultivated all over the world and a rich source of bioactive compounds including phenolic compounds, unsaturated fatty acids, vitamin E and carotenoids. Currently, considerable attention is given to the seeds, leaves, and flesh of pumpkins due to their nutritional value and health benefits. However, this article focuses on the potency of pumpkin seeds and leaves to treat hyperglycemia.

The combined treatment of insulin and naringin improves bone properties in rats with type 1 diabetes mellitus.

We have studied the effects of individual and combined treatment of insulin (I) and naringin (NAR) on the bone structure and biomechanical properties of femurs from streptozotocin (STZ)-induced diabetic rats. Male Wistar rats were divided into five groups: (1) controls, (2) STZ-induced diabetic rats, (3) STZ-induced diabetic rats treated with I, (4) STZ-induced diabetic rats treated with NAR, and (5) STZ-induced diabetic rats treated with I+NAR. Bone mineral density (BMD), bone histomorphometry, biomechanical testing, and bone biomarker expressions were accomplished in femur of all animals, as well as serum biochemical analyses. The combined treatment of I+NAR increased the body weight and the femur BMD from STZ-induced diabetic rats. The bone biomechanical properties and the bone morphology of the femurs from STZ-induced diabetic rats were also improved by the combined treatment. The increased number of osteoclasts in STZ-induced diabetic rats was partially prevented by I, NAR, or I+NAR. NAR or I+NAR completely blocked the decrease in the number of osteocalcin (+) cells in the femur from STZ-induced diabetic rats. RUNX family transcription factor 2 immunostaining was much lower in STZ-induced diabetic rats than in control animals; the combination of I+NAR totally blocked this effect. The combined treatment not only ameliorated bone quality and function, but also normalized the variables related to glucose metabolism. Therefore, the combination of I+NAR might be a better therapeutic strategy than the individual I or NAR administration to reduce bone complications in diabetic patients.

A DEVASTATING COMPLICATION OF DENTAL EXTRACTION: LEMIERRE’S SYNDROME WITH NECK AND MEDIASTINAL ABSCESS

A dental extraction is a frequently performed procedure in daily routine. Fatal infections may occur after dental extraction due to the richness of the oropharyngeal flora from aerobic and anaerobic microorganisms. Oropharyngeal infections can extend into the neck and mediastinum via cervical fascia leading to severe inflammation in soft tissues and vessels with life-threatening complications. We present a patient with complications after dental extraction procedure including severe deep neck inflammation, thrombophlebitis of jugular vein (Lemierre’s syndrome), mediastinal abscess, and empyema. A dental extraction is the most frequent cause of the oral infection that may cause coexisting and individually life-threatening complications in diabetic patients.

Hyperlipidemia and lipid-lowering therapy in diabetic retinopathy (DR): A bibliometric study and visualization analysis in 1993–2023

BackgroundDiabetic retinopathy (DR) is a common complication in diabetic patients. DR is also a neurodegenerative disease. Patients with hyperglycemia, hyperlipidemia, and hypertension are vulnerable to retinopathy development. While the roles of blood glucose and blood pressure in the development of retinopathy have been extensively studied, the relationship between body fat and DR pathogenesis and the impact of lipid-reducing drugs on DR has just emerged as a research hotspot in DR study. We aim to visualize the contributions and cooperation of reporters, organizations, and nations, in addition to the research hotspots and trends in DR-related lipid research from 1993 to 2023, by bibliometric analysis. MethodsWe extracted all publications about DR-related lipid research from 1993 to 2023 from the Web of Science Core Collection, and bibliometric features were studied using VOSviewer and the CiteSpace program. Results1402 documents were retrieved. The number of studies has risen consistently for three decades, from an average of 16.8/year in the 1990s to 28.8/year in the 2000s, 64.5/year in 2010s, and reached 112/year in 2020–2022, confirming they are hot research topic in the field. These reports were from 93 nations/regions, with the USA, China, Japan, Australia, and England taking the leading positions. Diabetes Research and Clinical Practice was the journal that published the most studies, and Diabetes Care was the most quoted. We identified 6979 authors, with Wong TY having the most papers and being the most commonly co-cited. The most popular keyword, according to our research, is diabetic retinopathy. Oxidative stress, diabetic macular edema (DME), lipid peroxidation, and other topics have often been investigated. ConclusionDR-related lipid research is conducted mainly in North America, Asia, Oceania, and Europe. Much study has centered on the relationship between lipid-lowering therapy and DR pathogenesis. These studies strongly support using lipid-reducing medications (fenofibrate, statins, and omega-3 PUFAs), combined with hyperglycemia and hypertension therapy, to prevent and treat DR. However, the impact of fenofibrate or statin on retinopathy is not correlated with their action on blood lipid profiles. Thus, more randomized clinical trials with primary endpoints related to DR in T1D or T2D are merited. In addition, the lipid biomarker for DR (lipid aldehydes, ALEs, and cholesterol crystals), the action of lipid-reducing medicines on retinopathy, the mechanism of lipid-lowering medications preventing or curing DR, and ocular delivery of lipid-lowering drugs to diabetic patients are predicted as the research focus in the future in the DR-related lipid research field.