Diabetes Health Research Articles

The Effect of Graviola Leaves Extract (Annona muricata L.) on Pharmacokinetic of Metformin in Rats’ Plasma and Pharmacological Activity of their Combination on Breast and Prostate Cancer Cell Lines

Objectives: Metformin is the most widely given medication for type 2 diabetes mellitus (T2DM). Annona muricata L. is a medicinal plant that belongs to the family Annonaceae, popularly known as graviola. Graviola leaves extract was found useful against diabetes, headache, insomnia, cystitis, inflammation, cancer, and other health benefits. The objectives of the current study are to investigate the effect of graviola leaves extract on metformin pharmacokinetics in rat plasma by applying high performance liquid chromatography (HPLC) method as well as its pharmacological effects on breast cancer (MCF-7) cells and prostate cancer (DU-145) cells. Methods: Wistar rats were classified into two groups; the first group (control group) received metformin (20 mg/kg) alone by oral gavage, while the second group, was administered a combination of metformin (20 mg/kg) and graviola leaves extract (20 mg/kg). Blood samples were collected at different time intervals to be analyzed using a validated HPLC method. Plasma profile and pharmacokinetic parameters were determined for each group. In addition, blood glucose levels at 0 hours and after 2 hours of metformin administration were measured in both groups. Breast cancer (MCF-7) cells and prostate cancer (DU-145) cells were used to investigate the anticancer effect of metformin (40 mg/ml), graviola leaves extract (20 mg/ml) and their combination by the standard MTT assay. Results: In the first group, metformin maximum plasma concentration (Cmax) and the area under the curve (AUC0-last) were (1509.25 ng/ml and 8705.59 h*ng/ml) respectively. In the second group, Pre-administration of graviola leaves extract significantly reduced MET (Cmax) and (AUC0-last), (701.88 ng/ml and 3467.72 h*ng/ml), respectively (P ≤0.05). Further, the use of metformin and graviola leaves extract separately showed strong anticancer activity on (MCF-7) cell lines with IC50 values of (10 and 20 mg/ml), respectively as well as on (DU-145) cell lines with IC50 value of (0.3125 and 5 mg/ml), respectively. In addition, the combination of metformin and graviola leaves extract showed a synergistic effect on (MCF-7) cells since the fractional inhibitory concentration value (FIC = 0.375) was less than 0.5, while it showed an additive effect on (DU-145) cells since the fractional inhibitory concentration value (FIC = 1.5) was between (0.5 and 4). Conclusion: In the current study, pre-administration of graviola leaves extract significantly reduced efficacy of metformin In vivo. The combination of metformin and graviola leaves extract showed a synergistic anticancer effect on breast cancer in vitro, while the combination has an additive effect on prostate cancer. The combination could be a potential therapeutic option to help treat breast cancer. The result achieved in this study is very encouraging to be considered for further investigation.

The Association of Total Knee Arthroplasty With Weight Loss in the Look AHEAD (Action for Health in Diabetes) Clinical Trial

BackgroundPatients who have obesity seldom lose weight after total knee arthroplasty (TKA). The Look AHEAD (Action for Health in Diabetes) trial randomized patients with type 2 diabetes who were overweight or had obesity to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). MethodsOf the total 5,145 participants enrolled who had a median 14-year follow-up, a subset of 4,624 met inclusion criteria. The ILI aimed at achieving and maintaining a 7% weight loss and included weekly counseling the first 6 months, with decreasing frequency thereafter. This secondary analysis was undertaken to determine what effects a TKA had on patients participating in a known successful weight loss program and specifically if there was a negative impact on weight loss or their Physical Component Score. ResultsThe analysis suggests that the ILI remained effective for maintaining or losing weight after TKA. Participants in ILI had significantly greater percent weight loss than those in DSE both before and after TKA (ILI-DSE before TKA: −3.6% (−5.0, −2.3); after TKA: −3.7% (−4.1, −3.3); both P < .0001). When comparing percent weight loss before to after TKA, there was no significant difference within either the DSE or ILI group (least square means ± standard error ILI: −0.36% ± 0.3, P = .21; DSE: −0.41% ± 0.29, P = .16). Physical Component Scores improved after TKA (P < .001), but no difference was found between TKA ILI and DSE groups before or after surgery. ConclusionParticipants who had a TKA did not have an altered ability to adhere to intervention goals to maintain weight loss or obtain further weight loss. The data suggest patients who have obesity can lose weight after TKA on a weight loss program.

A Community Paramedic Clinic at a Day Center for Adults Experiencing Homelessness

Summary People experiencing homelessness have difficulty accessing primary care and are vulnerable to poor health outcomes. Gaps in health care access are particularly apparent in smaller communities, which often lack the large-scale public health investments and infrastructures of metropolitan areas. Community paramedics (CPs) have advanced training in chronic disease management and social determinants of health and can deliver primary care services to patients with medical complexity and residents of medically underserved areas. However, the feasibility of leveraging community paramedicine to deliver acute, chronic, and preventive services to people experiencing homelessness is unknown. The authors evaluated the feasibility of a fixed-site CP clinic at a day center for adults experiencing homelessness in a small metropolitan area of the U.S. Midwest. CPs provided free health services to drop-in patients twice a week with general supervision by a physician medical director. The clinic was developed by the CP team with financial support from Mayo Clinic. The authors’ objectives were to: (1) assess implementation of the program (e.g., feasibility and acceptability); and (2) identify areas for improvement and perceptions of program sustainability. Study outcomes were selected based on their utility for program decision-making. Data sources included metrics on care volumes and services (ascertained from electronic health records and CP patient tracker log) plus surveys and interviews with CPs, day center staff, county partners, and leadership from the ambulance service, hospital, and county; patients/clients were not interviewed as part of this report. Electronic surveys and semi-structured interviews included questions on program acceptability, feasibility, and sustainability. CP surveys included additional questions regarding role clarity, knowledge and skills, beliefs about capabilities, work stress, and safety concerns. Metrics and surveys were analyzed descriptively. Interviews were analyzed by using a rapid template-driven approach organized around core survey/interview constructs. Between January and June 2022, CPs provided care on 38 days and conducted 127 visits (mean [standard deviation], 3.3 [1.6] visits per day). Patients had a mean (standard deviation) of 4.1 (3.3) Elixhauser index conditions, most frequently hypertension, depression, drug or alcohol use, diabetes, and other serious mental health conditions. Vital sign checks, clinical assessment, medication management/education, and wound care were among the most common services provided. Thirty-one program stakeholders completed surveys, and 13 completed interviews. Both survey ratings and qualitative data on program acceptability, appropriateness, and feasibility were favorable across groups. Among sustainability domains, survey ratings were least favorable for the financial stability domain. Interview data also suggest concerns about sustainability and the need for robust community collaboration to support future growth. Mayo Clinic’s experience shows the feasibility and acceptability of CP care, but it also raises questions about long-term sustainability, as well as whether CPs operate in a clear scope of practice and bridge to other health care providers and systems.

Ameliorative Effect of Posidonia oceanica on High Glucose-Related Stress in Human Hepatoma HepG2 Cells.

Metabolic disorders characterized by elevated blood glucose levels are a recognized risk factor for hepatocellular carcinoma (HCC). Lipid dysregulation is critically involved in the HCC progression, regulating energy storage, metabolism, and cell signaling. There is a clear link between de novo lipogenesis in the liver and activation of the NF-κB pathway, which is involved in cancer metastasis via regulation of metalloproteinases MMP-2/9. As conventional therapies for HCC reach their limits, new effective and safe drugs need to be found for the prevention and/or adjuvant therapy of HCC. The marine plant Posidonia oceanica (L.) Delile is endemic to the Mediterranean and has traditionally been used to treat diabetes and other health disorders. The phenol-rich leaf extract of Posidonia oceanica (POE) is known to have cell-safe bioactivities. Here, high glucose (HG) conditions were used to study lipid accumulation and fatty acid synthase (FASN) expression in human HepG2 hepatoma cells using Oil Red O and Western blot assays. Under HG conditions, the activation status of MAPKs/NF-κB axis and MMP-2/9 activity were determined by Western blot and gelatin zymography assays. The potential ameliorative role of POE against HG-related stress in HepG2 cells was then investigated. POE reduced lipid accumulation and FASN expression with an impact on de novo lipogenesis. Moreover, POE inhibited the MAPKs/NF-κB axis and, consequently, MMP-2/9 activity. Overall, these results suggest that P. oceanica may be a potential weapon in the HCC additional treatment.

Translation and Psychometric Evaluation of the Partners in Health Scale Among Iranian Adults With Chronic Diseases

Objectives: Characterizing the psychometric attributes of the Persian variant of partners in health (PIH) in multiple sclerosis (MS), Diabetes, and Low Back Pain (LBP) patients. Methods: In this cross-sectional study, 183 MS, diabetes, and LBP patients (70 male, 113 female) were treated with PIH post-forward-backward translation. Confirmatory factor analysis was used for studying the factor structure. Cronbach’s α and McDonald’s Ω coefficients were used to analyze PIH internal consistency. We used an interclass correlation coefficient to evaluate test-retest reliability. Criterion validity was determined by studying the correlation of PIH and Short Form (36) Health Survey (SF-36), Diabetes Self-Management Scale (DSMS), and Self-Efficacy in Chronic Disease Self-Management (SES6G). Results: The median age of the participants was 49.73±15.16 years, 113 (61.75%) of them were female, 64 (35.0%) had MS, 66 (36.1%) had diabetes, and 53 (29.0%) had LBP. Content validity was determined across all areas (clarity, relevancy, simplicity) by a content validity index ≥0.82. Additionally, all items were confirmed via a content validity ratio ≥0.78. The outcome of CFA depicts that the statistics presented as model fit were as follows: CFI= 0.938, NFI= 0.899, and RMSEA= 0.085. All PIH items exhibited valid internal consistency (0.886-0.893). The PIH showed sufficient test-retest reliability regarding its corresponding subscales (0.554-0.679). The construct validity was confirmed by the total scores of PIH correlated with the total score of SF-36, SES6G, and DSMS. Discussion: The Persian variant of the PIH showed sufficient validity and reliability as a measure to assess self-management in patients suffering from chronic disease (MS, diabetes, and LBP).

Adherence to Diabetes Medications and Health Care Use During the COVID-19 Pandemic Among High-Risk Patients.

The COVID-19 pandemic caused potentially disruptive shocks to chronic condition care. We examined how diabetes medication adherence, related hospitalizations, and primary care use changed in high-risk veterans prepandemic and postpandemic. We conducted longitudinal analyses on a cohort of high-risk diabetes patients in the Veterans Affairs (VA) health care system. Primary care visits by modality, medication adherence, and VA acute hospitalizations and emergency department (ED) visits were measured. We also estimated differences for subgroups of patients by race/ethnicity, age, and rural/urban location. Patients were 95% male with mean age 68 years. Prepandemic patients received a mean per quarter of 1.5 in-person primary care visits and 1.3 virtual visits, 0.10 hospitalizations, and 0.22 ED visits, with mean adherence of 0.82. The early pandemic was associated with fewer in-person primary care visits, more virtual visits, fewer hospitalizations and ED visits per patient, and no change in adherence; there were no midpandemic versus prepandemic differences in hospitalizations or adherence. Black and nonelderly patients had lower adherence during the pandemic. Adherence to diabetes medications and primary care use remained high for most patients even though virtual care replaced in-person care. Black and nonelderly patients may require additional intervention to address lower adherence.

Relationship between risk factors for impaired bone health and HR-pQCT in young adults with type 1 diabetes.

In type 1 diabetes, risk factors associated with impaired bone health contribute to increased risk of fracture. The aim of this study was to (1): compare the high-resolution peripheral quantitative computed tomography (HR-pQCT) parameters of young adults with type 1 diabetes with those of healthy controls (2), identify sex differences, and (3) evaluate the association between diabetes and bone health risk factors, with HR-pQCT. This is a cross-sectional study in young Canadian adults with childhood onset type 1 diabetes. Z-scores were generated for HR-pQCT parameters using a large healthy control database. Diet, physical activity, BMI, hemoglobin A1C (A1C) and bone health measures were evaluated, and associations were analyzed using multivariate regression analysis. Eighty-eight participants (age 21 ± 2.2 years; 40 males, 48 females, diabetes duration 13.9 ± 3.4 years) with type 1 diabetes were studied. Low trabecular thickness and elevated cortical geometry parameters were found suggesting impaired bone quality. There were no sex differences. Significant associations were found: Vitamin D (25(OH)D) with trabecular parameters with possible synergy with A1C, parathyroid hormone with cortical parameters, BMI with cortical bone and failure load, and diabetes duration with trabecular area. Our data suggests impairment of bone health as assessed by HR-pQCT in young adults with type 1 diabetes. Modifiable risk factors were associated with trabecular and cortical parameters. These findings imply that correction of vitamin D deficiency, prevention and treatment of secondary hyperparathyroidism, and optimization of metabolic control may reduce incident fractures.

Mental health matters in community-based diabetic foot care

British Journal of Community NursingVol. 28, No. Sup3 EditorialMental health matters in community-based diabetic foot careSumarno Adi SubrataSumarno Adi SubrataE-mail Address: [email protected]Researcher at Wound Study Center (WOSCE) and Nursing Lecturer, Universitas Muhammadiyah Magelang, IndonesiaSearch for more papers by this authorSumarno Adi SubrataPublished Online:21 Feb 2023https://doi.org/10.12968/bjcn.2023.28.Sup3.S5AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Balikji J, Kiani P, Hendriksen PA, Hoogbergen MM, Garssen J, Verster JC. Impaired wound healing is associated with poorer mood and reduced perceived immune fitness during the COVID-19 pandemic: a retrospective survey. Health Sci Rep. 2022;5(5):e764. https://doi.org/10.1002/hsr2.764 Crossref, Medline, Google ScholarBrognara L, Volta I, Cassano VM, Navarro-Flores E, Cauli O. The association between cognitive impairment and diabetic foot care: role of neuropathy and glycated hemoglobin. Pathophysiology. 2020; 27(1):14-27. https://doi.org/10.3390/pathophysiology27010003 Crossref, Medline, Google ScholarFerrier L, Ski CF, O’Brien C et al.. Bridging the gap between diabetes care and mental health: perspectives of the Mental health IN DiabeteS Optimal Health Program (MINDS OHP). BMC Endocr Disord. 2021; 21, 96. https://doi.org/10.1186/s12902-021-00760-3 Crossref, Medline, Google ScholarFino P, Di Taranto G, Pierro A et al.. Depression risk among patients with chronic wounds. Eur Rev Med Pharmacol Sci. 2019;23(10):4310-4312. https://doi.org/10.26355/eurrev_201905_17936 Medline, Google ScholarJiang FH, Liu XM, Yu HR, Qian Y, Chen HL. The incidence of depression in patients with diabetic foot ulcers: a systematic review and meta-analysis. Int J Low Extrem Wounds. 2022;21(2):161-173. https://doi.org/10.1177/1534734620929892 Crossref, Medline, Google ScholarKamal S, Munahar S, Abbas A, Ito Y, Wahyudi A. Hospital bed for diabetes care: an invention to support professional and hygienic nursing practice. Mechanical Engineering for Society and Industry. 2021;1(1):7–13. https://doi.org/10.31603/mesi.5262 Crossref, Google ScholarKerr M. Diabetic foot care in England: an economic study. London: NICE; 2017. https://is.gd/ilgCoV (accessed 19 January 2023) Google ScholarKumar N, Huda F, Mani R, et al.. Role of hospital anxiety and depression on the healing of chronic leg ulcer: a prospective study. Int Wound J. 2020;17(6):1941-1947. https://doi.org/10.1111/iwj.13485 Crossref, Medline, Google ScholarNash M. Mental health nurses’ diabetes care skills - a training needs analysis. Br J Nurs. 2009;18(10):626, 628-30. https://doi.org/10.12968/bjon.2009.18.10.42472 Link, Google ScholarO’Neill SM, Kabir Z, McNamara G, Buckley CM. Comorbid depression and risk of lower extremity amputation in people with diabetes: systematic review and meta-analysis. BMJ Open Diabetes Research and Care. 2017;5(1):e000366. https://doi.org/10.1136/bmjdrc-2016-000366 Medline, Google ScholarPolikandrioti M, Vasilopoulos G, Koutelekos I et al.. Depression in diabetic foot ulcer: associated factors and the impact of perceived social support and anxiety on depression. Int Wound J. 2020;17(4):900-909. https://doi.org/10.1111/iwj.13348 Crossref, Medline, Google ScholarRazjouyan J, Grewal GS, Talal TK, Armstrong DG, Mills JL, Najafi B. Does physiological stress slow down wound healing in patients with diabetes? J Diabetes Sci Technol. 2017;11(4):685-692. https://doi.org/10.1177/1932296817705397 Crossref, Medline, Google ScholarSeaton PCJ, Cant RP, Trip HT. Quality indicators for a community-based wound care centre: an integrative review. Int Wound J. 2020;17(3):587-600. https://doi.org/10.1111/iwj.13308 Crossref, Medline, Google ScholarSubrata SA, Margono. Holistic care of patients with diabetic foot ulcers during the COVID-19 era: integration of Henderson’s need theory. Br J Nurs. 2022;31(15):S38-S49. https://doi.org/10.12968/bjon.2022.31.15.S38 Link, Google ScholarSubrata SA, Phuphaibul R. A nursing metaparadigm perspective of diabetic foot ulcer care. Br J Nurs. 2019a;28(6):S38-S50. https://doi.org/10.12968/bjon.2019.28.6.S38 Link, Google ScholarSubrata SA, Phuphaibul R. Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice. Scand J Caring Sci. 2019b;33(2):298-310. https://doi.org/10.1111/scs.12645 Crossref, Medline, Google ScholarWounds UK. Best practice recommendations for the implementation of a DFU treatment pathway. 2018. https://www.woundsinternational.com/resources/details/community-based-diabetic-foot-teams-are-they-the-way-forward (accessed 19 January 2023) Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 28Issue Sup3ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 21 February 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Meal-timing patterns and chronic disease prevalence in two representative Austrian studies

PurposeThis study aimed at describing meal-timing patterns using cluster analysis and explore their association with sleep and chronic diseases, before and during COVID-19 mitigation measures in Austria.MethodsInformation was collected in two surveys in 2017 (N = 1004) and 2020 (N = 1010) in representative samples of the Austrian population. Timing of main meals, nighttime fasting interval, last-meal-to-bed time, breakfast skipping and eating midpoint were calculated using self-reported information. Cluster analysis was applied to identify meal-timing clusters. Multivariable-adjusted logistic regression models were used to study the association of meal-timing clusters with prevalence of chronic insomnia, depression, diabetes, hypertension, obesity and self-rated bad health status.ResultsIn both surveys, median breakfast, lunch and dinner times on weekdays were 7:30, 12:30 and 18:30. One out of four participants skipped breakfast and the median number of eating occasions was 3 in both samples. We observed correlation between the different meal-timing variables. Cluster analysis resulted in the definition of two clusters in each sample (A17 and B17 in 2017, and A20 and B20 in 2020). Clusters A comprised most respondents, with fasting duration of 12–13 h and median eating midpoint between 13:00 and 13:30. Clusters B comprised participants reporting longer fasting intervals and later mealtimes, and a high proportion of breakfast skippers. Chronic insomnia, depression, obesity and self-rated bad health-status were more prevalent in clusters B.ConclusionsAustrians reported long fasting intervals and low eating frequency. Meal-timing habits were similar before and during the COVID-19-pandemic. Besides individual characteristics of meal-timing, behavioural patterns need to be evaluated in chrono-nutrition epidemiological studies.

Evaluation of integrated diabetes and mental health care for type 1 diabetes and disordered eating (T1DE): the ComPASSION service

Type 1 diabetes and disordered eating (T1DE) is often poorly understood and treatment is inadequate in many cases, with little or no co-ordination between physical and mental health teams. In 2019, NHS England launched two pilot programmes to increase understanding of T1DE, and to trial an integrated diabetes and mental health pathway for assessment, referral and treatment. This paper sets out key findings from the independent evaluation of one of these pilots, the ComPASSION service in Wessex, including baseline patient characteristics, clinical outcomes, and patient and staff experience. Among 11 patients with at least 12 months follow-up, the median change in HbA1c was a reduction of 31mmol/mol. Copyright © 2023 John Wiley & Sons.

Abstract P153: Intensive Lifestyle Intervention in Type 2 Diabetes Mellitus Results in a More Favorable Sex Hormone Profile in Both Post-Menopausal Females and Older Males (The Look AHEAD Trial Sex Hormone Study)

Background: Prior studies showed an association between some adverse cardiometabolic outcomes and lower testosterone in males and higher estrogen in both males and post-menopausal females. However, few studies of sex hormones focused on people with type 2 diabetes (T2DM), assessed hormone changes over time or applied highly sensitive laboratory assays. Given the importance of lifestyle modification (i.e., diet, exercise and weight loss) in preventing cardiometabolic complications in people with T2DM, we examined the impact of an Intensive Lifestyle Intervention (ILI) on sex hormones over time and differences by sex. Methods: The Look AHEAD (Action for Health in Diabetes) Study was a randomized control trial of 5,145 individuals with BMI ≥25 and T2D to evaluate the effect of ILI compared to the Diabetes Support and Education (DSE) control group on incident cardiovascular events. We selected a sample of 472 males and 426 post-menopausal female participants (mean age 60 years [SD 6.3], 20.5% Black) to examine sex hormones (estradiol - E2, total testosterone - T) and sex hormone binding globulin (SHBG) at baseline and year 1. E2 and T were measured using mass spectrometry analysis and SHBG was measured using an immunoassay. Results: In males, ILI increased SHBG by 17.3% and T by 10.6% compared to the DSE group (Table). In postmenopausal females, ILI increased SHBG by 12.0% and decreased E2 by 23.4% compared to the DSE group (Table). The change in the sex hormone levels from baseline to 1-year follow up was attenuated when adjusted for change in BMI. Conclusion: ILI resulting in weight loss increased T in males and decreased E2 in postmenopausal females and increased SHBG in both sexes. We plan further analysis with a larger sample and longer follow-up to examine the role of weight loss either as a co-occurring metabolic process or as a mediator for the change in sex hormones to better understand the impact of lifestyle changes and sex diffrences.

Abstract P193: Sexual Minority Men of Color With HIV Suggest a Virtual Environment May Be Promising to Support Cardiovascular Health: Findings From an Intervention Mapping Study

Introduction: Black and Latinx sexual minority men are disproportionately impacted by chronic conditions, such as HIV. Persons with HIV have a 1.5 to 2 times risk of cardiovascular disease (CVD) when compared to White, HIV-negative persons. By the year 2030, it is estimated that 78% of persons with HIV will have CVD. Patient teaching in the clinical setting has been the traditional modality for prevention education. However, persons at the highest risk, and who are based in the community, may not have access to clinic-based prevention education. Objective: To use mixed methods to assess HIV illness perceptions, HIV-related comorbid conditions of concern, and understand perspectives on the use of an online virtual environment (VE) for CVD prevention education. Methods: The Gaming Protocol Study is a mixed methods study that used Life’s Simple 7 as a framework to map an intervention to support cardiovascular health in sexual minority men of color with HIV, ages 30-65. Data were collected in English, Spanish, and Creole. Using validated measures, HIV illness perceptions, nicotine exposure, and physical activity were assessed. Qualitative interviews explored chronic illnesses of concern outside of HIV and also perceptions about the use of an online VE for CVD prevention education. Results: Thirty participants completed the validated measures and interviews. Quantitative findings suggested that greater than 90% of participants had a strong understanding of their HIV status. More than 50% of participants reported they experienced feelings of anxiety or fear by having HIV. Close to 30% reported having used nicotine and/or e-cigarettes. Less than half of participants met the criteria for engaging in vigorous or moderate physical activity. Qualitative findings suggested concerns about existing and potential future conditions, such as hypertension, diabetes, asthma, obesity, and mental health. Additionally, COVID-19 and Monkeypox were highlighted as important considerations because they pose high risk in the community. Perceptions about using a VE were mostly positive. Concerns were focused on online engagement and digital privacy. Conclusions: Sexual minority men of color are concerned about health conditions beyond HIV. They desire accessible, culturally relevant information to manage their health. Findings provide early evidence about health communication and education preferences for technology tools so they are meaningful and actionable as CVD prevention education.

Anxiety and Depression in Patients with Diabetic Retinopathy

The blinding eye condition known as diabetic retinopathy (DR) is preventable and manageable. DR is becoming more common right now, and both prevention and therapy are extremely difficult. However, the precise mechanism of the association between DR and anxiety and depression has not yet been fully elucidated. Recent studies have demonstrated that DR is linked to negative psychology, and research on DR accompanied by anxiety and depression has also made some headway. In addition to offering fresh perspectives on the multi-factor regulation mechanism of DR, early detection and prevention, and bolstering diabetes health management, this paper examines the clinical, mechanism, and influencing aspects of DR and anxiety and depression in recent years.

Urban living.

Delhi, truly, is one of the world's great mega-cities. It's fascinating and infuriating, enchanting and exasperating and much more besides. City dwelling brings its own advantages and disadvantages for health and healthcare access, and if you want to read more the WHO fact sheet on urban health is a good place to start (https://www.who.int/news-room/fact-sheets/detail/urban-health#:~:text=Noncommunicable%20diseases%20like%20heart%20disease,walking%2C%20cycling%20and%20active%20living.) As a respiratory clinician, perhaps our first thoughts are around air quality. The majority of those living in urban areas breathe polluted air, and without access to adequate green spaces. Air pollution affects cardiovascular health too. Access to sanitation and clean water may be limited, increasing the prevalence of infectious as well as chronic non-communicable diseases (NCDs). COVID illustrated the potential for spread of infectious diseases among those living in densely populated areas, especially where those populations are systematically disadvantaged for other reasons—migrant workers and immigrants, for example. The risk of injuries and violence is higher in cities too—both road traffic accidents and inter-personal violence. Cities built around road transport make it hard to exercise safely, affecting the risk of obesity, diabetes and poor mental health. The WHO calls the risk of NCDs, infectious diseases and injuries in urban areas a ‘triple threat’. By 2050, more than two thirds of the world's population will live in urban areas, with all the attendant possibilities of economic benefit. However, as major consumers of energy, the future of cities and planetary health is closely intertwined. At its best, healthcare in mega-cities is world class, but generally it is not and variation in access to healthcare, and the quality of that care are most marked in our cities. I recognize this in London. What to do about this? The WHO recommends a ‘strategic, multisectoral and coordinated’ approach to urban health. Recognizing the need for novel solutions the Global Alliance for Chronic Disease has an on-going research call on NCD prevention in cities (https://www.gacd.org/funding/current-call-for-applications/ncd-prevention-in-cities). Meanwhile, what you can do to lobby for better environments and healthcare access where you live and work? And have you considered working away from home to learn and share knowledge? And never turn down an opportunity to visit Delhi—you'll love it. None declared.

Perceptions of diabetic retinopathy-related educational resources in a community in Oman

Background: Diabetic retinopathy (DR) contributes 1% of the total 37 million blind individuals globally. In Oman, 12.3% of the community aged 18 years and older are affected by diabetes mellitus. Health literacy is essential in advancing an individual’s disease-linked knowledge, attitudes and treatment compliance. Effective educational resources would earn positive health outcomes.Aim: This study evaluates the Omani community’s perception of educational resources related to DR.Setting: This is a prospective, cross-sectional, questionnaire-based study.Methods: A self-administered, online questionnaire received responses from 253 participants using a convenient snowball sampling approach. The initial section of the questionnaire gathered information on participant’s demographic information. The second section collected the feedback on the perception of the availed DR material utilising a five-point Likert scale. Descriptive and inferential (chi-square test, Fisher’s exact test and logistic regression analysis) statistics were used to analyse the data.Results: Of the total 253 study participants, 51 (20.2%) were male and 202 (79.8%) were female. Only 155 (61.3%) participants received DR-related health information. Optometrists (30.3%) served as the primary source of information. There was no relationship between perception and socio-economic or educational levels (p 0.05). Of the 155 participants receiving DR-related health information, 47.7% (n = 74) of the survey population is highly satisfied with the received DR-related health promotional resource.Conclusion: Only 61.3% of the members received DR-related health information. Most participants had a positive perception of DR-related health educational resources.Contribution: This study observed positive participant’s perception towards diabetic retinopathy related health educational resources. The study proposes to conduct further health promotional activities using social media platforms.

DIABETES AND ORAL HEALTH CONSIDERATIONS: A REVIEW

Diabetes Mellitus is now a global epidemic. With the rise in oral complications associated with diabetes, the dentists are concerned about the morbidity related to these. Oral health considerations involve those relating to adverse effects on gums, teeth, tongue as well as the delay in wound healing. Many a times, diabetics suffer discomfort and are not able to maintain proper oral hygiene owing to these oral complications thereby leading to significant rise in morbidity and mortality. It is imperative that such patients be made aware of the relationship that exists between oral hygiene and diabetes.

Weight changes during the COVID-19 shutdown in older individuals with type 2 diabetes: the Look AHEAD Study.

The aimsof this study were as follows: 1) examine weight changes in older adults (mean age=76 years) with type 2 diabetes and overweight or obesity during the COVID-19 shutdown; and 2) compare the behavioral and psychosocial effects of the shutdown in those who had large weight losses (>5%), those who had small weight losses (2%-5%), those who remained weight stable (±2%), or those who gained weight (>2%). Look AHEAD (Action for Health in Diabetes) participants (N=2544) were surveyed during the COVID-19 shutdown (2020), and they self-reported their current weight, reasons for weight change, weight-related behaviors, psychosocial measures, and negative and positive effects of the pandemic on their lives. Comparing self-reported weight during the COVID-19 shutdown with earlier measured weight, Look AHEAD participants lost, on average, 2.2 kg during the COVID-19 shutdown: 47% lost >2%, and only 18% gained >2% (p < 0.0001). Decreases in physical activity and increases in screen time were reported frequently in all weight-change categories. Similarly, there were few differences among the categories on standardized psychosocial measures or self-reported effects of the shutdown on participants' lives. However, when differences were seen, the most negative impact was in those who gained weight. Although weight loss appeared more common than weight gain during the shutdown, the weight-change groups did not differ on most psychosocial and behavioral variables.

Influence of Diabetes Mellitus on Oncological Outcomes for Patients Living With Cancer.

The purpose of this meta-analysis was to examine the association between preexisting diabetes in persons living with cancer on diabetes and oncology-related health outcomes. Understanding this association is of priority because the incidence of both cancer and diabetes mellitus is increasing worldwide. A comprehensive review of the literature was conducted in collaboration with an expert health sciences librarian. Two authors independently conducted the screening, data collection, and extraction processes. The risk of bias was assessed using several tools, depending on the study design. Relative risks with 95% confidence intervals were calculated. The alpha threshold was 0.05. All analyses were performed using R statistical software (Metaphor and Demeter packages). A total of 45 studies met the selection criteria, but 23 were excluded from the synthesis because they did not have the ranked outcome or correct comparison (persons with and without diabetes), totaling 22 studies included in the meta-analysis. In comparison to participants without preexisting diabetes, participants with preexisting diabetes and cancer were found to have a significantly higher risk of infection and cardiovascular, neurological, gastrointestinal, hepatic, and renal complications. Concurrent preexisting diabetes and cancer were also associated with increased health care service utilization and length of hospital stay. The findings from this review highlight the importance of optimal concurrent management of both diseases by overcoming the compartmentalization of medical specializations through (1) integrated, multidisciplinary, shared, and coordinated clinical care pathways between oncology and diabetes health care providers/teams and (2) the continued development of evidence-based clinical guidelines.

Polycystic Ovary Syndrome: Challenges and Possible Solutions

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. This syndrome not only impairs female fertility but also increases the risk of obesity, diabetes, dyslipidemia, cardiovascular diseases, psychological diseases, and other health problems. Additionality, because of the high clinical heterogeneity, the current pathogenesis of PCOS is still unclear. There is still a large gap in precise diagnosis and individualized treatment. We summarize the present findings concerning the genetics, epigenetics, gut microbiota, corticolimbic brain responses, and metabolomics of the PCOS pathogenesis mechanism, highlight the remaining challenges in PCOS phenotyping and potential treatment approaches, and explain the vicious circle of intergenerational transmission of PCOS, which might provide more thoughts for better PCOS management in the future.

Factors associated with hemoglobin glycation index in adults with type 1 diabetes mellitus: The FGM-Japan study.

The discrepancy between HbA1c and glucose exposure may have significant clinical implications; however, the association between the hemoglobin glycation index (HGI) and clinical parameters in type 1 diabetes remains controversial. This study aimed to find the factors associated with HGI (laboratory HbA1c - predicted HbA1c derived from the continuous glucose monitoring [CGM]). We conducted a cross-sectional study of adults with type 1 diabetes (n=211, age 50.9 ± 15.2 years old, female sex=59.2%, duration of CGM use=2.1 ± 1.0 years). All subjects wore the CGM for 90 days before HbA1c measurement. Data derived from the FreeStyle Libre sensor were used to calculate the glucose management indicator (GMI) and glycemic variability (GV) parameters. HGI was defined as the difference between the GMI and the laboratory HbA1c levels. The participants were divided into three groups according to the HGI tertile (low, moderate, and high). Multivariate regression analyses were performed. The female sex ratio, HbA1c, and % coefficient of variation (%CV) significantly increased over the HGI tertile, while eGFR and Hb decreased over the HGI tertile. In multivariate analysis, the factors associated with HGI were %CV and eGFR, after adjusting for HbA1c level and sex (R2 =0.44). This study demonstrated that HGI is associated with female sex, eGFR, and some glycemic variability indices, independently of HbA1c. Minimizing glycemic fluctuations might reduce HGI. This information provides diabetic health professionals and patients with personalized diabetes management for adults with type 1 diabetes.