Adult Diabetic Patients Research Articles

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

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

Pattern and predictors of non-adherence to diabetes self-management recommendations among patients in peripheral district of Bangladesh.

This study was designed to determine the extent of non-adherence to the different dimensions of diabetes self-management and to identify the factors influencing non-adherence among peripheral patients in Bangladesh. A cross-sectional study was conducted among 990 adult diabetic patients residing in Thakurgaon district, Bangladesh. Data were collected through face-to-face interviews including socio-demographic information, disease and therapeutic, health services, knowledge and adherence to self-management components. The proportion of non-adherence to drug prescription was 66.7%, dietary regimen (68.9%), physical exercise (58.0%), follow-up visit/blood glucose test (88.2%), stopping tobacco (50.6%), and regular foot care (93.9%). Significant predictors for non-adherence to drug were poorest socio-economic status (OR = 2.47), absence of diabetic complications (OR = 1.43), using non-clinical therapy (OR = 5.61), and moderate level of knowledge (OR = 1.87). Non-adherence to dietary recommendations was higher for women (OR = 1.72), poorest socio-economic status (OR = 3.17), and poor technical knowledge (OR = 4.68). Non-adherence to physical exercise was lower for women (OR = 0.62), combined family (OR = 0.63), middle socio-economic status (OR = 0.54), and moderate knowledge on physical exercise (OR = 0.55). Non-adherence to follow-up visits/blood glucose test was higher among patients who did not have diabetic complications (OR = 1.81) and with own transport (OR = 2.57), and respondents from high-income group (OR = 0.23) were less likely to be non-adherent. Non-adherence to stopping tobacco was higher for older individuals (OR = 1.86); but lower for women (OR = 0.48), individuals with higher education level (OR = 0.17) and patients sick for a longer time (OR = 0.52). Non-adherence to foot care was higher for patients who needed longer time to go to hospital (OR = 4.07) and had poor basic knowledge on diabetes (OR = 17.80). An alarmingly high proportion of diabetic patients did not adhere to diabetes self-management. Major predictors for non-adherence were related to patient's demographic characteristics and their experience with disease, treatment and health care services.

Knowledge and Practice of taking Influenza Vaccine among Adult Diabetic Patients in Bahrain Defense Force Hospital

The objective of this study is to assess the knowledge and practice of taking the annual influenza vaccine among adult diabetic patients in BDF Hospital. The study is a descriptive cross-sectional hospital-based study. Three hundred diabetic patients who were eligible for the study were interviewed, using a structured questionnaire. Results of the survey indicated that males and females included are 48% to 52% respectively, 95.3% of the cohort were doing follow up, but only 55.3% were doing it regularly. Although 65.3% are aware and have heard about the flu vaccine only 10% have taken the flu vaccine in the last 2 years. Only 27.3% were advised to take the flu vaccine, 30% of the study population know that the vaccine helps reduce the flu illness and 47.33% know that it helps prevent seasonal influenza. From our study, it was found that the main reason for not taking the flu vaccine is that they mainly did not know about the vaccine which constituted 49.33% of the study population. So, knowledge and use are lower than optimal compared to the literature but here it is the lowest, which may mostly be due to reduced awareness of the benefits of the vaccine and vaccination. This will most probably increase if there are increased efforts on advising direct contacts with the patients in the diabetic or other PHC clinics or through the media, to have the seasonal flu vaccine. Keywords: Influenza vaccine, diabetes patients

Determinants of diabetic nephropathy among adult diabetic patients on follow-up at public hospitals in Addis Ababa, Ethiopia: A case-control study.

Diabetic nephropathy is defined as patients with diabetes mellitus who have persistent proteinuria for at least three consecutive measurements per year, a high blood creatinine level (>130 mol/l), or a decrease in glomerular filtration rate (<60 ml/min). Limited studies were done in Ethiopia on determinants of diabetic nephropathy among diabetic patients. Therefore, this study aimed to identify determinants of nephropathy among adult diabetic patients on follow-up at public hospitals in Addis Ababa, Ethiopia, 2022. A hospital-based unmatched case-control study design was conducted from 6 September to 9 November 2022, among diabetic patients on follow-up at public health hospitals in Addis Ababa. Using consecutive sampling techniques, a total of 442 (353 controls and 89 cases) were recruited, with a control-to-case ratio of 4:1. The data were collected using a structured and interview-administered questionnaire and variables like high-density lipoprotein, low-density lipoprotein, Glycated hemoglobin, and type of diabetes were extracted from the medical records of the patients using a checklist. The collected data were entered into Epidata 3.1 and analyzed by STATA version 15.0. Variables with a p-value < 0.25 in the bivariable logistic regression were selected for the final model. In multivariable logistic regression model fitting, variables with a p-value < 0.05 with 95% CI adjusted odds ratio have declared statistically significant risk factors of diabetic nephropathy. In this study, out of 442 study participants, 334 controls and 89 cases were included in the analysis, with a response rate of 94.6% and 100%, respectively. The majority of the study participants were 92.13% of cases and 84.13% of controls; 7.87% of cases, and 15.87% of controls were type 2 diabetes mellitus. Age 65 and above years old (AOR: 2.42; 95% CI: 1.28, 4.57); Smoking cigarette (AOR: 2.22; 95% CI: 1.18, 4.16); Non-adherent to diet (AOR: 2.11; 95% CI: 1.15, 3.84); Drinking alcohols (AOR: 1.95; 95% CI: 1.07, 3.52); Duration with diabetes more than 10 years (AOR: 3.39; 95% CI: 1.76, 6.54); Poor glycemic control (AOR: 2.19; 95% CI: 1.23, 4.28); and Low-density lipoprotein (AOR: 2.97; 95% CI: 1.69, 5.28) were found to be statistically significant risk factors of nephropathy among diabetic patients. This study found that old age, smoking cigarettes, non-adherence to diet, duration of diabetes, alcohol drinking, Glycated hemoglobin A1C, and high low-density lipoprotein were risk factors for nephropathy. Hence, continuous health education on lifestyle modifications and diabetic-related complications in each follow-up visit via front-line health professionals are very essential to avert the problem.

Knowledge, attitude and practice towards foot care in adult diabetic patients in Saudi Arabia

Objective: This study aimed to assess knowledge, attitudes, and practice towards foot care among diabetic patients in Saudi Arabia. Methods: This observational descriptive cross-sectional study was conducted across the main regions of Saudi Arabia from March to May, 2023. The sample size was estimated to be 384 using the Raosoft calculator with a 95% confidence level and a 5% margin of error. Results: A total of 665 participants completed the questionnaire, 54.8% of them were females and 30.8% were aged between 20-30 years old. Around 120 (18.2%) participants had a very poor level of knowledge regarding foot care. Almost 615 (93%) had a favorable attitude towards foot care and only eight (1.2%) participants had a good practice. Conclusion: More than half of the patients showed a moderate level of knowledge of diabetic self-foot care. Most participants showed a favorable attitude towards diabetic self-foot care. Most patients showed a moderate level of practice towards diabetic self-foot care. A significant association was found between the level of knowledge and patients\&amp;apos; gender, level of education, and duration of diabetes mellitus. A significant association was revealed between the level of practice and the patient\&amp;apos;s level of knowledge.

Dietary Practices and Associated Factors Among Adult Diabetic Patients at Academic Tertiary-Level Hospitals in Central Ethiopia: Convergent Mixed Study.

Diabetes mellitus (DM) is one of the most common chronic diseases globally. Despite the presence of national strategies to prevent potential sequelae DM has been associated with increased morbidities and mortality in Ethiopia, and the prevalence appears to be on the rise. Although studies have been conducted among DM patients in the country, there is a lack of information that could allow an in-depth understanding of the situation. To assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia. The institution-based concurrent mixed-methods study was conducted from January 01 to 30 2024 involving 420 adult DM patients. Participants were selected using a simple random sampling technique for quantitative study. A purposive sampling technique was used to select 16 participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and an in-depth interview for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data. Of 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (44.2%). The being female, urban residence a family history of DM, and good dietary were significantly associated with the dietary practice. From qualitative analysis, two themes have emerged; Living as before and not adhering to diabetic dietary recommendations and barriers to adherence to effective eating practice. Less than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

Prevalence of depression among diabetic patients attending the Armed Forces Hospital, Southern Region, Saudi Arabia: A prospective cross-sectional study.

Depression associated with diabetes is one of major obstacles in diabetic patient management. This study aims to determine the prevalence of depression and its associated risk factors among diabetic patients of both types (I and II). A cross-sectional analytical study was conducted at Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia, among adult diabetic patients attending the diabetic center. An interview-validated questionnaire was utilized to collect data. It consists of three main parts: demographic data, diabetic assessment tool, and patient health questionnaire-9. A total of 386 diabetic patients were included. The age of them ranged between 17 and 95 years with an arithmetic mean of 53.4 years and a standard deviation of ± 18.2 years. Almost two-thirds (62.2%) were males. The prevalence of depression among diabetic patients was 48.2%, mostly of mild (31.4%) or moderate severity (12.7%). Multivariate logistic regression analysis revealed that female diabetic patients were at almost double-fold risk of developing depression compared to males [adjusted odds ratio (AOR) =2.73, 95% confidence interval (CI): 1.70-4.38], P < 0.001. Also, type II diabetic patients were at almost double-fold risk of developing depression compared to type I diabetic patients (AOR = 2.07, 95% CI: 1.16-3.67), P = 0.013. Patients with history of any social issue with the family, relatives, or friends were at about three-fold risk of developing depression compared to those without such history (AOR = 3.45, 95% CI: 2.11-5.66), P < 0.001. Patients who reported compliance to diet were at higher risk for developing depression compared to their peers (AOR = 2.57, 95% CI: 1.25-5.28), P = 0.010, while those compliant to physical activity about 150 min/week or more were at significant lower risk to develop depression (AOR = 0.56, 95% CI: 0.35-0.89), P = 0.015. Patients with nephropathy or neuropathy were more likely to have depression compared to their counterparts (AOR = 2.52. 95% CI: 1.33-4.80, P = 0.005 and AOR = 1.80, 95% CI: 1.11-2.90, P = 0.016, respectively). Depression is a very prevalent problem affecting diabetic patients, particularly those of type II, female patients, and those with nephropathy or neuropathy. Therefore, regular screening of diabetic patients for depression and referral of severe cases to psychiatric care are highly warranted.

Factors associated with diabetes concordant comorbidities among adult diabetic patients in Central Ethiopia: a cross-sectional study.

Diabetes comorbidities are a serious public health issue that raises the risk of adverse health effects and complicates diabetes management. It also harms emotional health, medication adherence, self-management, and general quality of life. However, evidence is scarce in Ethiopia, particularly in the study area. Thus, this study aimed to estimate the prevalence of diabetes concordant comorbidities and identify factors associated with the presence of concordant comorbidities among adult diabetic patients in central Ethiopia. A health facility-based cross-sectional study was conducted among 398 adult diabetic patients. A computer-generated simple random sampling was used to select study participants. Data were collected using a structured data extraction checklist. The collected data were entered into Epi info version 7.2 and exported to SPSS version 27 for analysis. A binary logistic regression model was used to analyze the association between dependent and independent variables. An adjusted odds ratio with the corresponding 95% confidence interval was used to measure the strength of the association and statistical significance was declared at a p-value < 0.05. The prevalence of diabetes-concordant comorbidities was 41% (95% CI: 36.2-46.0). The multivariable logistic regression model showed that age 41-60 (AOR = 2.86, 95% CI: 1.60-5.13), place of residence (AOR = 2.22, 95% CI: 1.33-3.70), having type two diabetes (AOR = 3.30, 95% CI: 1.21-8.99), and having positive proteinuria (AOR = 2.64, 95% CI: 1.47-4.76) were significantly associated with diabetes concordant comorbidities. The prevalence of diabetes-concordant comorbidities was relatively high. Age, place of residence, type of diabetes, and positive proteinuria were factors associated with diabetes-concordant comorbidities. Prevention, early identification, and proper management of diabetes comorbidities are crucial.

Advantages and Limitations of Diabetic Bone Healing in Mouse Models: A Narrative Review.

Diabetes represents a major risk factor for impaired fracture healing. Type 2 diabetes mellitus is a growing epidemic worldwide, hence an increase in diabetes-related complications in fracture healing can be expected. However, the underlying mechanisms are not yet completely understood. Different mouse models are used in preclinical trauma research for fracture healing under diabetic conditions. The present review elucidates and evaluates the characteristics of state-of-the-art murine diabetic fracture healing models. Three major categories of murine models were identified: Streptozotocin-induced diabetes models, diet-induced diabetes models, and transgenic diabetes models. They all have specific advantages and limitations and affect bone physiology and fracture healing differently. The studies differed widely in their diabetic and fracture healing models and the chosen models were evaluated and discussed, raising concerns in the comparability of the current literature. Researchers should be aware of the presented advantages and limitations when choosing a murine diabetes model. Given the rapid increase in type II diabetics worldwide, our review found that there are a lack of models that sufficiently mimic the development of type II diabetes in adult patients over the years. We suggest that a model with a high-fat diet that accounts for 60% of the daily calorie intake over a period of at least 12 weeks provides the most accurate representation.

Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2022, cross-sectional study

IntroductionDiabetes foot deformity is among the major causes of diabetic foot ulceration, resulting in lower limb amputation. However, the study on the distribution of foot deformity and its risk factor among diabetic patients in Ethiopia is limited. This study determined the overall prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsHospital-based cross-sectional study was conducted among 392 diabetic patients using a systematic random sampling technique at Debre Markos Comprehensive Specialized Hospital. Data were collected by pre-tested, semi-structured questionnaires and diabetic foot assessment format. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the strength of the association, and a variable with a p-value < 0.05 was statistically significant factors of diabetes foot deformity.ResultThe overall prevalence of foot deformity was 33.4% [95% CI: 28.9–38.3]. In the final logistic regression analysis, rural residency [AOR = 2.64, 95% CI: 1.31, 5.31], poor glycemic control [AOR = 2.41; 95% CI: 1.34, 4.33], diabetes duration ≥ 10 years [AOR = 2.74; 95% CI: 1.50, 5.02], inadequate footwear [AOR = 2.11; 95% CI: 1.17, 3.82] and presence of peripheral neuropathy [AOR = 8.21; 95% CI: 4.54, 14.84] were statistically significant associated factors with diabetes foot deformity.ConclusionThe prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic patient follow-ups especially for those with poor glycaemic control, rural residency, long diabetes duration, inadequate footwear, and diabetic peripheral neuropathy.

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

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

Correlation of HbA1c with red cell width distribution and other red cell indices in Type II diabetic females.

Objective: To assess the correlation of HbA1c with hemoglobin concentration, RWD, and other red cell indices in Type II diabetes mellitus female patients. Study Design: Cross-sectional study. Setting: Department of Physiology, Al Nafees Medical College, and Pakistan Institute of Medical Sciences, Islamabad. Period: January 2019 to December 2020. Material &amp; Methods: The study included 70 adult female diabetic patients, adhering to International Diabetes Federation guidelines. Exclusion criteria encompassed uncontrolled diabetes, pregnancy, renal issues, cardiac failure, and hemoglobinopathies. Laboratory tests, such as Complete Blood Count and HbA1c measurements, were conducted. SPSS version 23 was used for statistical analysis, employing mean, standard deviation, and Pearson's correlation to assess relationships among HbA1c, hemoglobin, Red Cell Distribution Width (RDW), and other red cell parameters. Results: A total of 70 female patients with diagnosed Type II diabetes mellitus were included in our study with a mean age of 40.45±12.70 years. The Mean±SD of study variables like HbA1c, hemoglobin, MCV, MCHC, RDW, and FBS of the patients was 5.91±0.89%, 11.23±1.59 gm/dl, 76.32±9.50fl, 31.02±3.39mg/dl, 12.78±1.51 and 100.53±15.52mg/dl respectively. A significant correlation between HbA1c and RDW was found and showed that both variables were positively correlated with each other. (r= 320, p=0.001). Conclusion: RDW correlates with HbA1C in female Type II diabetes patients, suggesting CBC, including RDW, as a cost-effective diagnostic marker alongside HbA1c for glycemic status assessment.

ASSOCIATION OF LEVEL OF EDUCATION AND OCCUPATION WITH DIABETIC FOOT ULCER IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Diabetic foot ulcer (DFU) is a well-known microvascular complication of Type 2 Diabetes mellitus (T2DM) with several risk factors. This study intended to determine the association of the level of education and occupation with the severity and outcome of DFU in diabetic patients. Materials and Methods: This study was conducted from 1st January 2023 to 25th January 2023 in the Endocrinology Division of the Department of Medical Specialties, Khyber Teaching Hospital, Peshawar. Adult diabetic patients with DFU were enrolled in the study. All the relevant demographic, clinical, and biochemical characteristics were measured. Results: Out of 148 patients, only 50 (33.8%) patients were educated. The study participants had a mean age, BMI, HbA1c, and duration of DM of 56.48 years, 27.3 kg/m2, 10.3 % and 9.4 years, respectively. There was a substantial association between the level of education and occupation with the severity of DFU which was statistically significant (p-value = 0.001 and p-value = 0.01, respectively). Regarding the outcome of DFU, it was found that patients with medium and high levels of literacy and skilled occupation had lower rates of major amputations. These results were statistically non-significant however they were found to be clinically significant. Conclusion: A significant association was observed between the education level and occupation with the severity and outcome of DFU. This underpins the significance of structured education of patients with low and medium literacy levels and those with unskilled and semiskilled jobs regarding their foot care. Keywords: Type 2 Diabetes Mellitus, Diabetic Foot ulcer, Occupation

Impact of preexisting coronary artery and peripheral artery disease on outcomes in diabetic patients after kidney transplant.

Atherosclerotic cardiovascular disease is highly prevalent in patients with end-stage kidney disease (ESKD). Kidney transplant (KT) improves patient survival and cardiovascular outcomes. The impact of preexisting coronary artery disease (CAD) and peripheral artery disease (PAD) on posttransplant outcomes remains unclear. This is a retrospective study utilizing the United States Renal Data System. Adult diabetic dialysis patients who underwent first KT between 2006 and 2017 were included. The study population was divided into four cohorts based on presence of CAD/PAD: (1) polyvascular disease (CAD + PAD); (2) CAD without PAD; (3) PAD without CAD; (4) no CAD or PAD (reference cohort). The primary outcome was 3-year all-cause mortality. Secondary outcomes were incidence of posttransplant myocardial infarction (MI), cerebrovascular accidents (CVA), and graft failure. The study population included 19,329 patients with 64.4% men, mean age 55.4 years, and median dialysis duration of 2.8 years. Atherosclerotic cardiovascular disease was present in 28% of patients. The median follow up was 3 years. All-cause mortality and incidence of posttransplant MI were higher with CAD and highest in patients with polyvascular disease. The cohort with polyvascular disease had twofold higher all-cause mortality (16.7%, adjusted hazard ratio (aHR) 1.5, p < 0.0001) and a fourfold higher incidence of MI (12.7%, aHR 3.3, p < 0.0001) compared to the reference cohort (8.0% and 3.1%, respectively). There was a higher incidence of posttransplant CVA in the cohort with PAD (3.4%, aHR 1.5, p = 0.01) compared to the reference cohort (2.0%). The cohorts had no difference in graft failure rates. Preexisting CAD and/or PAD result in worse posttransplant survival and cardiovascular outcomes in patients with diabetes mellitus and ESKD without a reduction in graft survival.

A Novel Combination Therapy Tβ4/VIP Protects against Hyperglycemia-Induced Changes in Human Corneal Epithelial Cells.

Despite the prevalence of diabetic retinopathy, the majority of adult diabetic patients develop visually debilitating corneal complications, including impaired wound healing. Unfortunately, there is limited treatment for diabetes-induced corneal damage. The current project investigates a novel, peptide-based combination therapy, thymosin beta-4 and vasoactive intestinal peptide (Tβ4/VIP), against high-glucose-induced damage to the corneal epithelium. Electric cell-substrate impedance sensing (ECIS) was used for real-time monitoring of barrier function and wound healing of human corneal epithelial cells maintained in either normal glucose (5 mM) or high glucose (25 mM) ± Tβ4 (0.1%) and VIP (5 nM). Barrier integrity was assessed by resistance, impedance, and capacitance measurements. For the wound healing assay, cell migration was also monitored. Corneal epithelial tight junction proteins (ZO-1, ZO-2, occludin, and claudin-1) were assessed to confirm our findings. Barrier integrity and wound healing were significantly impaired under high-glucose conditions. However, barrier function and cell migration significantly improved with Tβ4/VIP treatment. These findings were supported by high-glucose-induced downregulation of tight junction proteins that were effectively maintained similar to normal levels when treated with Tβ4/VIP. These results strongly support the premise that Tβ4 and VIP work synergistically to protect corneal epithelial cells against hyperglycemia-induced damage. In addition, this work highlights the potential for significant translational impact regarding the treatment of diabetic patients and associated complications of the cornea.

Symptomatic Dry Eye Disease and Associated Factors Among Adult Diabetic Patients in Adare General Hospital, Hawassa City, Southern Ethiopia, 2023.

Symptomatic dry eye disease is a multifactorial ocular surface condition caused by disruption of the precorneal tear film and is a common clinical finding in diabetic patients. However, there was no study on the prevalence and associated factors of symptomatic dry eye disease among diabetic patients in Ethiopia or in the study area. This study aimed to investigate the prevalence and associated factors of symptomatic dry eye disease among adult diabetic patients in Adare General Hospital, Hawassa City, Southern Ethiopia, in 2023. A hospital-based cross-sectional study design was conducted on 493 adult diabetic patients who were selected using systematic random sampling, from April 23 to June 8, 2023. Data were collected through a face-to-face interview using an ocular surface disease index questionnaire. Binary logistic regression was performed to identify factors potentially associated with symptomatic dry eye disease. Variable with a P value of <0.05 was considered statistically significant. A total of 488 subjects participated in this study with a response rate of 99%. The prevalence of symptomatic dry eye disease was 34.8% (95% CI = 30.6-39.1). College and university educational status (AOR = 5.88, 95% CI = 2.25-15.38), government employed (AOR = 2.22, 95% CI = 1.05-4.68), use of visual display unit >5 hours (AOR = 4.41, 95% CI = 1.51-12.87), duration of diabetes ≥11 years (AOR = 3.57, 95% CI = 1.28-9.90), poor glycemic control (AOR = 2.13, 95% CI = 1.21-3.75), allergic conjunctivitis (AOR = 1.99, 95% CI = 1.12-3.54), and debris in the tear film (AOR = 3.63, 95% CI = 1.53-8.61) were positively associated with symptomatic dry eye disease. The study revealed a high prevalence of symptomatic dry eye disease. Higher educational status, government employed, use of visual display unit, longer duration of diabetes, poor glycemic control, allergic conjunctivitis, and tear film debris were significantly associated with symptomatic dry eye disease. Breaks in screen use, good glycemic control, and treatment of ocular morbidities such as allergic conjunctivitis and debris in the tear film were recommended for all diabetic patients.

Evaluation of inflammatory biomarkers and oxidative / nitrosative stress in adult or elderly diabetic patients supplemented with açaí juice.

Evaluation of inflammatory biomarkers and oxidative / nitrosative stress in adult or elderly diabetic patients supplemented with açaí juice.

THU260 Development Of Plantar Thermography For Screening Of Diabetic Neuropathy

Abstract Disclosure: V. Panamonta: None. R. Jerawatana: None. P. Ariyaprayoon: None. P. Looareesuwan: None. B. Ongphiphadhanakul: None. C. Sriphrapradang: None. B. Ongphiphadhanakul: None. Background: Diabetic foot ulcers are a major complication of diabetes. They are also the leading cause of nontraumatic lower extremity amputation. The incidence of diabetic foot ulcers is highest in those patients with poor glycemic control and neuropathy. In people with diabetic neuropathy, the feet temperature may change due to decreased blood flow and nerve damage. Thermography has been proposed as a noninvasive modality to identify patients at risk for diabetic foot ulcers. In this study, we used thermography and deep learning to stratify patients with diabetes at risk for developing a foot ulcer. Methods: We prospectively record clinical data and plantar thermogram in adult diabetic patients underwent diabetic foot screening at outpatient clinics at Ramathibodi hospital, Bangkok, Thailand during September to December 2022. Altogether, there were 245 thermal images were analyzed using a deep learning algorithm to determine the risk for diabetic foot ulcers by transfer learning using the pre-trained VGG16 model which is a convolutional neural network for image recognition. Twenty percent of the images were set aside for testing purposes while 20% of the images served as the validation set during training of the neural network. The neural network was trained and weighed more toward higher sensitivity of identifying at risk feet for screening purpose. Results: The study sample consisted of individuals with a mean age of 62.5±12.5 years, 57.1% who had diabetes for more than 10 years. The majority of the participants were females (57.1%). The average body mass index (BMI) was 27.8±9.6 (kg/m2). There were 186 thermal images classified as category 0 and 59 images classified as categories 1 to 3 according to the American Diabetes Association risk classification. The trained neural network achieved 75 % accuracy with 95 % sensitivity and 67 % specificity for classifying thermograms as higher than normal risk in the training dataset. For the testing dataset, the sensitivity and specificity was 75% and 41%, respectively. The accuracy, however, decreased to 50% due mainly to the misclassification of normal thermograms from abnormal. Conclusions: These results suggest that thermography combined with deep learning could potentially be developed for screening purpose to stratify patients at risk of developing diabetic foot ulcers. Further research is needed to validate the results in larger datasets and to explore alternative algorithms for predicting diabetic foot ulcers. Presentation: Thursday, June 15, 2023

Evaluation of Hepatitis B Vaccine Awareness in Diabetic Patients Admitted to Diabetes Clinic

Aim: This study aimed to evaluate the awareness of diabetic patients about the hepatitis B vaccine, hepatitis B vaccination rates, and the effect of our recommendations on vaccination status. Methods: This is a cross-sectional study carried out in 627 adult diabetic patients who were admitted to our diabetes outpatient clinic between October 2019 and December 2019. We prepared the hepatitis B vaccine awareness questionnaire, consisting of 14 items, and administered it to the patients through face-to-face interviews. Results: The study included 627 diabetic patients (59.8% female, mean age=58.9±9.5). Only 9.3% (n=58) of the patients were previously vaccinated against hepatitis B and 90.7% (n=569) were not. There was a significant difference between the education level and hepatitis B vaccination status of the patients (p&lt;0.001). The most common reason with 94.7% (n=539) for not being vaccinated was the lack of information that diabetics should be vaccinated against hepatitis B. After the patients were informed, the hepatitis B vaccination rates increased from 9.3% to 68.1% at the end of the study. Conclusion: The hepatitis B vaccination rates were found to be quite low in diabetic patients, yet increased seriously after the patients were informed. This result revealed that informing patients and increasing their awareness can positively affect vaccination rates. Keywords: diabetes mellitus, hepatitis B vaccines, awareness

Magnitude and predictors of poor glycemic control in patients with diabetes at Jimma Medical Center, Ethiopia

Despite the development of new medications over the past decade to aid in the control of blood glucose, most diabetic patients often do not reach recommended glycemic targets of glycated hemoglobin (HbA1C) < 7% in daily clinical practice because of many contributing factors. This study was designed to assess the magnitude and predictors of poor glycemic control among adult diabetic patients on ambulatory chronic care follow-up at Jimma Medical Center. A cross sectional study was conducted on 307 adult diabetic patients between January 2 and April 30, 2022. Representative samples were selected using a systematic random sampling technique. Predictors of poor glycemic control were assessed using a binary and multi variable logistic regression. Data analysis was performed using Statistical Package for Social Science version 25 and R in the R studio environment. A total of 307 adult diabetic patients were included in the study making a response rate of 93%. Out of 307 adult diabetic patients, majority (62.5%) were males. Mean age of the patients was 48.91 ± 15.68 years. The majority, 221 (72%), of patients had poor glycemic control. Non-adherence of patients to medications (AOR = 3.36, 95% CI 1.16–9.72, p = 0.04), no formal education (AOR = 3.84, 95% CI (1.06–13.93, p = 0.04), therapeutic inertia (AOR = 3.16, 95% CI 1.61–6.20, p = 0.001) and poor diabetic knowledge (AOR = 4.79, 95% CI 1.56–14.68, p = 0.006) were found to be independent predictors of poor glycemic control. Nearly three fourth of diabetic patients in the present study had poor glycemic control and were at higher risk of developing diabetic complications or already developed it. These results highlight the need for appropriate management of patients focusing on adherence to medications, education, therapeutic inertia and diabetic knowledge to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.