Diabetic Patients Research Articles

Spinal cord stimulation induces Neurotrophin-3 to improve diabetic foot disease.

Low-extremity ischemic disease is a common complication in diabetic patients, leading to reduced quality of life and potential amputation. This study investigated the therapeutic effect of spinal cord stimulation (SCS) on patients with diabetic foot disease and a rat model of diabetic foot injury. SCS was applied to patients with diabetic foot disease, with clinical assessments performed before and after therapy. Blood levels of NGF, BDNF, and NT-3 were determined by ELISA. A rat model of diabetic foot injury was established to validate NT-3's role in SCS therapy. SCS therapy improved the condition of patients with diabetic ischemic foot disease and promoted wound healing in the rat model. NT-3 levels significantly increased after SCS therapy in both patients and rats. Recombinant NT-3 administration improved wound healing and re-vascularization in the rat model, while NT-3 neutralization abrogated SCS's therapeutic effect. SCS improves the condition of patients with diabetic ischemic foot disease by inducing NT-3 production. Both SCS and NT-3 supplementation show therapeutic potential for ameliorating diabetic foot disease.

Prevalence of diabetic retinopathy and its associated risk factors among adults in Ethiopia: a systematic review and meta-analysis.

Diabetic retinopathy is a complication of diabetes mellitus and a leading cause of blindness and visual impairment globally. Limited information existed on the epidemiology of diabetic retinopathy at the national level in Ethiopia. Thus, the objective of this review was to determine the pooled prevalence of diabetic retinopathy and its associated risk factors in Ethiopia. A systematic review and meta-analysis was conducted using previous primary studies that were found in electronic databases such as Web of Science, Scopus, PubMed, CINHAL, Google Scholar, and online African journals. We evaluated the quality of the included studies using the Newcastle-Ottawa Assessment Scale. The random-effects model was applied because heterogeneity was expected. I-Square and the Cochrane Q statistics were used to evaluate heterogeneity. Publication bias was examined using Egger's test and a funnel plot. A random-effect meta-analysis was applied to pool the odds ratios of risk factors to determine the association between the independent and dependent variables. After 598 articles were found, 22 studies that met the eligibility requirements were included. The pooled prevalence of retinopathy among patients with diabetes in Ethiopia was 24.35% (95% CI: 18.88-29.83), with considerable heterogeneity (I2 = 98.18%, p < 0.001). Ten years and longer with diabetes (AOR = 4.36, 95% CI: 1.71-7.01), hypertension (AOR = 2.54, 95% CI: 1.45-3.63), poor glycemic control (AOR = 3.83, 95% CI: 1.62-6.04), and positive proteinuria (AHR = 1.55, 95% CI: 1.02-2.07) were risk factors for diabetic retinopathy. Retinopathy affects one in four patients with diabetes. Diabetic patients with longer duration, hypertension, poor glycemic control, and positive proteinuria should receive special care.

Ascorbic acid and glucose can cause significant interference on quantitative measurement of biochemistry analytes in urine.

Preanalytical errors due to interferences can lead to inaccurate results, necessitating an understanding of potential interferences for each test. This study explores the impact of elevated concentrations of ascorbic acid and glucose on urine analysis, a pivotal diagnostic tool. Conducted at the Clinical Institute of Chemistry, KBC Sestre milosrdnice, the research utilized a 24-hour urine sample. Parameters assessed included total proteins, albumin, amylase, sodium, potassium, chlorides, calcium, phosphates, magnesium, creatinine, urea, and uric acid. Various concentrations of added interferents were prepared for duplicate measurements using statistical analysis in Microsoft Excel. No statistically significant interferences were found in albumin, amylase, sodium, potassium, or phosphate concentrations. However, ascorbic acid interfered with chloride, calcium, and magnesium determinations. Conversely, elevated glucose affected total protein, calcium, magnesium, creatinine, urea, and uric acid determinations. Interference of ascorbic acid with chloride and interference of glucose with total proteins and uric acid displayed a linear relationship. Results suggest cautious analysis interpretation from certain parameters in patients with elevated glucose and/or ascorbic acid in urine. Whereas ascorbic acid interference may go unnoticed due to its infrequent measurement, routine determination of glucose in urine is crucial, especially for diabetes patients.

Effect of different training modalities on lipid metabolism in patients with type ii diabetes mellitus: a network meta-analysis.

This study to evaluate the effects of different training modalities on blood lipids in type II diabetic patients by Network Meta-analysis, and provide a relevant basis for patients to develop exercise prescriptions to regulate blood lipids. Randomized controlled trials (RCTs) were retrieved from Zhiwang, Wanfang, Wipu, PubMed, EBSCO, Cochrane Library, and Web of Science that were published from the establishment to February 2023. Relevant statistical analyses were performed using Stata 17.0 software and Revman 5.4. A total of 35 randomized controlled trials with 2771 patients with type II diabetes were finally included. The results of Network Meta-analysis showed that, compared with the control group, Chinese traditional fitness exercise (CTF), resistance training (RT), and aerobic training (AT) could reduce total cholesterol (TC) levels; CTF, RT, whole body vibration training (WBV), and AT could reduce triacylglycerol (TG) levels; CTF, WBV and AT could increase High-density lipoprotein cholesterol (HDL) levels; CTF, RT and AT could reduce Low-density lipoprotein cholesterol (LDL) levels. SUCRA probability ranking results showed that CTF was the most effective in reducing TC[SMD= -0.57, 95% CI (-0.83, -0.31), p < 0.001], TG[SMD= -0.24, 95% CI (-0.36, -0.12), p < 0.001], LDL[SMD= -0.52, 95% CI (-0.70, -0.35), p < 0.001]; RT was the most effective in increasing HDL[SMD = 0.14, 95% CI (0.03, 0.26), p < 0.05]. CTF is more effective in improving TC, TG and LDL levels, while RT is most effective in improving HDL levels.

Evaluation of Proteinuria in Diabetic Patients Attending Gitwe District Hospital

Background: Proteinuria is a serious condition in which body proteins leak into urine due to kidney dysfunction nearly always caused by elevated serum glucose due to prolonged diabetes. Proteinuria occurs and affects individuals with diabetes, approximately 25% of diabetic patients may have proteinuria. Aim: The aim of this study is to assess the levels of serum glucose and proteins in urine and their association in diabetic patients attending Gitwe District Hospital. Methodology: The study population mainly comprised of diabetic patients, 110 study participants were included. Blood was drawn from finger for testing serum glucose using glucometer and urine samples were collected from diabetic patients and samples were analyzed in parasitology service using urine chemistry strips for proteins in urine testing. Results: During data analysis, SPSS version 22 was used, the majority were female with 66.4% while 33.6% were male. The highest frequency of participants presented in this study were 27(24.6%) found in [43-52] years old. The mean age was 53 years ± 13.882 SD (ranged from 23 to 86 years). 53.7% had normal serum glucose level while 46.3% had high serum glucose level. However, 63.6% had no proteinuria while 20.0% had trace, 11.8% had mild and 4.6% had moderate proteinuria levels. Association between serum glucose and proteinuria was analyzed for statistical significance with Chi-square test and it was statistically significant as their p values were below 0.05(P-value of 0.000). Conclusion: The study found that high serum glucose level leads to the presence of proteins in the urine. This study recommends regular monitoring of serum glucose levels, as well as routine urine tests to detect proteinuria as essential components of diabetes management and other researchers to study the effects of proteinuria in diabetic patients. Keywords: Proteinuria, serum glucose, proteins, diabetic patients

Autologous cell therapy for ischemic diabetic foot: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

To assess the efficacy and safety of autologous cell therapy (ACT) in patients with ischemic diabetic foot ulcers (DFU). The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS). A Medline and Embase search were performed up to Feb 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with ischemic foot ulcers comparing ACT with placebo/no therapy/standard of care (SoC), with a duration of at least 26 weeks. Prespecified endpoints were: major amputation (principal) and minor amputation, ulcer healing, time-to-healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), pain, and all-cause mortality (secondary). Any ACT was allowed, irrespective of cell product type and route of administration (intra-arterial and intramuscular). Seven studies fulfilled all inclusion criteria, all using intramuscular transplantation as route of administration, but only 2 had a follow-up greater than 26 weeks. Participants treated with ACT had a significantly lower risk of major amputations in comparison with SoC/placebo (MH-OR 0.47 [0.24, 0.92], p = 0.03). ACT was also associated with a significantly higher rate of ulcer healing (MH-OR: 10.1 [3.5, 29.6], p < 0.001), greater increase of TcPO2 and ABI values (WMD: 17.57 [13.02, 22.12], p < 0.001), and reduction of pain (WMD: -1.83 [-2.32, -1.34], p = 0.003). ACT must be considered as a potential therapy for patients with ischemic diabetic foot ulcers. Further studies are needed to better clarify their role in the treatment and management of DFS.

Antibiotics as adjunct to non-surgical periodontal therapy in diabetic patients.

A comprehensive literature search was performed via MEDLINE/PubMed, Scopus, and Web of Science, including all relevant publications accessed on March 2023 and subsequently updated up to July 2024. Additionally, grey literature was searched, and there was no restriction on publication data and languages. All randomized clinical trials comparing topical/systemic antibiotics as an adjunct to scaling and root planning (SRP) with SRP alone for the treatment of diabetic patients with periodontitis were included. Literature reviews, case reports and series, preclinical studies or studies lacking periodontal data were excluded. Clinical attachment level was considered as the primary outcome. Bleeding on probing, pocket depth, and gingival index were the secondary outcomes. The risk of bias was evaluated using the Cochrane Collaboration Tool, and for each domain, bias risk was judged as low, unclear and high risk of bias. Selection, removing duplicates, screening, extracting data, and assessing the quality of studies were done by two investigators and findings were tabulated. Meta-analysis was conducted, generating forest plots to compare different treatment modalities, time periods, and antibiotic types. Key periodontal parameters such as probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP) were analysed. Upon screening and further evaluation of 690 articles, 43 were considered for full-text eligibility. Finally, 30 studies were included in the systematic review, and 27 were included in meta-analysis. Out of 30 randomized clinical trials, 9 studies focused on topical and antibiotics, and 21 involved systemic administration of antibiotics. Five of the nine studies focussing on topical administration of antibiotics, were classified as having a low risk of bias and four as having a high risk of bias. Out of 21 studies on systemic antibiotics, eight were classified as having a low risk of bias, two were undefined, and eleven showed a high risk of bias. Authors concluded that adjunctive use of antibiotics could lead to improvement in periodontal clinical parameters CONCLUSION: The findings showed that the adjunctive use of antibiotics led to slight improvements in clinical outcomes. However, keeping in mind antibiotic resistance, and side effects of antibiotics, their use should be approached cautiously and only when necessary.

The association between plasma lipidome and diabetic microangiopathy: a mendelian randomization study.

Current studies have identified severe lipid metabolism diseases in diabetic microangiopathy patients, especially in diabetic kidney disease (DKD), diabetic retinopathy (DR) and diabetic neuropathy (DN), with unclear causal relationships. We employed a large-scale dataset containing 179 lipid species as the exposure and large-scale public summary-level datasets of DKD, DR and DN as the outcome. We applied Mendelian randomization (MR) approach to explore causal associations between circulating liposomes and diabetic microangiopathy. A sequence of sensitivity tests was conducted to verify the stability of the MR analysis. We manifest that diacylglycerol (18:1_18:3) (OR = 0.716, 95%CI = 0.559-0.917, P = 0.008), triacylglycerol (OR:0.741-0.763, P < 0.05) and phosphatidylcholine (OR:0.620-1.247, P < 0.05) have a potential association with DKD. And there is a nominal causal effect of phosphatidylinositol (16:0_18:2) (OR = 0.617, 95%CI = 0.401-0.948, P = 0.028), phosphatidylcholine (OR:0.499-0.672, P < 0.05) and sphingomyelin (OR:0.652-1.850, P < 0.05) to DR. In addition, phosphatidylethanolamine (18:1_0:0) (OR = 0.616, 95%CI = 0.405-0.935, P = 0.023), diacylglycerol (16:0_18:1) (OR = 0.675, 95%CI = 0.463-0.984, P = 0.041) and phosphatidylcholine (OR = 0.720-1.619, P < 0.05) nominally associate with DN. It is noteworthy that plasma lipidome of different structures show different effects. We establish a possible causal connection between certain plasma lipidome and major diabetic microangiopathies. Implementing intervention strategies targeting different lipid molecules may provide novel approaches for preventing and treating diabetic microangiopathies.

AGEs impair osteogenesis in orthodontic force-induced periodontal ligament stem cells through the KDM6B/Wnt self-reinforcing loop.

Diabetes, occasionally diagnosed in orthodontic patients, can impede orthodontic tooth movement (OTM) by accumulating advanced glycation end products (AGEs) in the periodontium. This accumulation impairs the osteogenic differentiation of periodontal ligament stem cells (PDLSCs) due to alterations in the force-loaded microenvironment, yet the underlying mechanisms remain elusive. Bioinformatics analysis of GSE112122 identified alterations in the mechanical regulation of histone methylation enzyme Lysine Demethylase 6B (KDM6B). OTM models were established in healthy and Nicotinamide/ Streptozotocin-induced type II diabetic rats. The impact of AGEs on mechanically induced osteogenesis and its correlation with KDM6B were evaluated by assessing the therapeutic effects of periodontal ligament injections of the AGEs/RAGE inhibitor FPS-ZM1. To investigate transcriptomic changes, we extracted human PDLSCs, which were subjected to RNA sequencing following the overexpression of KDM6B. Experimental validation further identified potential self-reinforcing loops and their associated antioxidative mechanisms. Mechanical forces upregulated KDM6B expression and function in PDLSCs, modulating extensive downstream osteogenesis-related transcriptional changes. Experiments with AGEs-treated and FPS-ZM1-treated samples demonstrated that AGEs impaired osteogenesis by compromising KDM6B mechanical responsiveness. A positive feedback loop between KDM6B and Wnt pathways was identified, inhibited by AGEs. This loop regulated superoxide dismutase 2 (SOD2), facilitating antioxidative stress and preventing stem cell ageing. This study elucidates a novel mechanism by which AGEs influence the osteogenic process and antioxidative capacity of PDLSCs through the KDM6B/Wnt self-reinforcing loop under orthodontic force. Targeting the AGE/RAGE pathway or enhancing KDM6B may enhance orthodontic treatments for diabetic patients.

Tiliroside protects against diabetic nephropathy in streptozotocin-induced diabetes rats by attenuating oxidative stress and inflammation

BACKGROUND Diabetic nephropathy (DN), affecting half of diabetic patients and contributing significantly to end-stage kidney disease, poses a substantial medical challenge requiring dialysis or transplantation. The nuanced onset and clinical progression of kidney disease in diabetes involve consistent renal function decline and persistent albuminuria. AIM To investigate Tiliroside's (Til) protective effect against diabetic nephropathy (DN) in rats under diabetic conditions. METHODS Five groups of six rats each were included in this study: Rats treated with DMSO by intraperitoneal injection as controls, those treated with STZ by intraperitoneal injection, those treated with STZ + Til (25 mg/kg body weight [bwt]) or Til (50 mg/kg bwt), and those treated with anti-diabetic medication glibenclamide (600 μg/kg bwt). Biochemical markers, fasting blood glucose, food intake, kidney weight, antioxidant enzymes, inflammatory and fibrotic markers, and renal injury were monitored in different groups. Molecular docking analysis was performed to identify the interactions between Til and its targeted biomarkers. RESULTS Til significantly reduced biochemical markers, fasting blood glucose, food intake, and kidney weight and elevated antioxidant enzymes in diabetic rats. It also mitigated inflammatory and fibrotic markers, lessened renal injury, and displayed inhibitory potential against crucial markers associated with DN as demonstrated by molecular docking analysis. CONCLUSION These findings suggest Til's potential as a therapeutic agent for DN treatment, highlighting its promise for future drug development.

Survival rate of diabetic-related lower extremity amputees in hospitals in the Eastern Cape

Background: Diabetes mellitus (DM) is a global health concern that has greatly affected South Africa. The gap in the current management of DM has resulted in complications such as lower extremity amputations (LEAs) and death. Eastern Cape province reflects this struggle, with disparities in access to healthcare and poor health outcomes. Understanding survival rates and associated factors between the urban Livingstone Hospital and the rural Nelson Mandela Academic Hospital can improve health interventions and outcomes.Objectives: This study compared the survival rate of patients in urban areas and those in rural areas.Method: This retrospective cohort study was conducted in an urban and a rural hospital by reviewing existing medical records of diabetic patients who underwent an LEA between 2016 and 2019.Results: The retrospective cohort study examined 439 diabetic-related LEA cases. This study found that residing in rural areas significantly decreased the risk of mortality by 62% compared with living in the urban areas. Factors such as haemoglobin A1c (HbA1c) levels, nephropathy, cardiovascular disease, human immunodeficiency virus (HIV), other comorbidities and level of amputation significantly influenced survival probabilities.Conclusion: Survival analysis indicated a significant difference in the 3-year survival probabilities of the two groups, favouring rural residency (p = 0.001). The biggest cause for concern between the two regions was uncontrolled blood glucose levels as this resulted in high mortality rates.Contribution: Insights from this study have shown that introducing podiatry and orthotics at primary healthcare (PHC) could improve foot care and reduce diabetic-related LEAs and mortality.

Simvastatin reduces chronic kidney disease and renal failure risk in type 2 diabetes patients: post hoc ACCORD trial analysis.

Type 2 diabetes mellitus (T2DM) poses a substantial global health concern. Statins are widely used among T2DM patients for managing dyslipidemia, preventing cardiovascular disease (CVD), and offering renal protection. However, the extent to which their renal protective effects contribute to reducing the incidence of severe renal complications, including chronic kidney disease (CKD) and renal failure, is not well-defined. This investigation scrutinizes the impact of simvastatin versus placebo on renal outcomes among T2DM patients utilizing data from the ACCORD trial. It encompasses incidence rate comparisons, Kaplan-Meier estimates, Cox proportional hazards models, and mediation analyses. The study consisted of 3,619 individuals diagnosed with T2DM, among which 2,753 were treated routinely with simvastatin, while 866 did not receive any statin therapy. After adjusting for baseline characteristics and time-dependent covariates, simvastatin treatment was associated with a 71% reduction in the risk of CKD (HR 0.29, 95% CI 0.27-0.31, p < 0.01) and a 47% reduction in the risk of renal failure (HR 0.53, 95% CI 0.44-0.65, p < 0.01) compared to the statin-free group. Further subgroup analysis, accounting for the initial lipid and kidney profiles, indicated variable impacts of simvastatin on CKD and renal failure outcomes. Nevertheless, a consistent reduction in CKD risk was observed across all subgroups within the statin-treated population. Additional mediation analysis revealed that the reduction in low-density lipoprotein cholesterol (LDL-C) may be a potential mediator in the association between simvastatin and CKD, with a mediation effect of 14.9%, (95% CI 0.11-0.19, p < 0.01). Administering statins, specifically simvastatin, to T2DM patients at elevated risk for CVD, is likely to offer augmented renal advantages, notably in lowering the occurrence of CKD and renal failure. This protective effect against CKD manifests regardless of initial lipid profiles, albuminuria, and estimated glomerular filtration rate (eGFR) levels. The association between simvastatin and CKD may be partially mediated by LDL-C reduction.

DIABETES MELLITUS TIPO 2 COMO FATOR DE RISCO PARA O AGRAVO DA COVID-19 NA POPULAÇÃO BRASILEIRA: UMA REVISÃO SISTEMÁTICA

INTRODUCTION: The novel coronavirus, named SARS-CoV-2, is the etiological agent of COVID-19, a highly contagious infectious disease that primarily affects the lower respiratory tract. Type 2 diabetes mellitus may be a factor worsening this condition. OBJECTIVE: To identify the prevalence of diabetes mellitus as a risk factor for COVID-19 in Brazil from 2019 to 2023, assess the severity of cases in different states, analyze the sociodemographic factors affecting prognosis, and clarify the role of pharmacists in monitoring and managing the therapy of these patients. METHODOLOGY: This is a systematic review study using the PRISMA method, divided into four stages. The first stage involved searching for scientific works to answer the question about the frequency of worsening COVID-19 cases associated with type 2 diabetes mellitus in Brazil. The databases consulted were Scielo, PubMed, and the Virtual Health Library (BVS), using keywords such as “Diabetes mellitus,” “COVID-19,” “Brazil,” “Worsening,” and “Death.” RESULTS: Seveteen articles that met the inclusion criteria were selected. The studies indicate that diabetes mellitus is a significant risk factor for the severity and mortality of COVID-19 in Brazil, with mortality rates between 40% and 55% among diabetic patients. Additionally, the disease is associated with other comorbidities, such as hypertension and obesity, contributing to the need for ICU admissions and longer hospital stays. CONCLUSION: Type 2 diabetes mellitus is a significant risk factor for complications and mortality in COVID-19 patients, resulting in higher ICU admission rates and deaths, highlighting the need for rigorous glycemic control. The pharmacist's role is essential in monitoring glycemic levels and educating patients about treatment, contributing to reducing complications and improving clinical outcomes.

Association of Low Protein-to-Carbohydrate Energy Ratio with Cognitive Impairment in Elderly Type 2 Diabetes Patients

Background/Objectives: The relationship between macronutrient intake and cognitive decline in older adults with type 2 diabetes mellitus (T2DM) remains underexplored. Methods: This cross-sectional study aimed to evaluate the association between the protein-to-carbohydrate energy ratio (%E:P) and cognitive impairment among 192 elderly T2DM patients. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Self-Administered Gerocognitive Exam (SAGE), while dietary intake data, including (%E:P), was gathered using a validated semi-quantitative food frequency questionnaire. Results: Participants had a mean age of 71 ± 6 years, 46.4% were female, and the median BMI was 30 ± 4 kg/m2. After adjusting for confounding variables, patients in the highest (%E:P) tertile showed significantly higher MoCA and SAGE scores compared to those in the lowest tertile (p &lt; 0.005). We identified an optimal (%E:P) threshold of 0.375 for predicting cognitive impairment, with a sensitivity of 53% and specificity of 64%. Conclusions: These findings suggest that a lower (%E:P) ratio may be a risk factor for cognitive impairment in elderly T2DM patients. Monitoring this ratio may serve as an early detection tool for cognitive deterioration. Moreover, current protein intake recommendations for older adults with T2DM may be insufficient to prevent cognitive impairment. Further research is needed to establish optimal dietary guidelines for this population.

The prognostic value of cartilage intermediate layer protein 1 (CILP1) in patients with diabetic cardiomyopathy.

To measure the plasma levels of human cartilage intermediate layer protein 1 (CILP1) in patients with diabetic cardiomyopathy (DCM), and to investigate its association with the occurrence of major adverse cardiovascular events (MACE) in DCM. A total of 336 diabetic patients were enrolled and assigned into two groups based on the presence or absence of DCM (DCM group and N-DCM group). The baseline clinical data including glutamic-pyruvic transaminase (ALT), glutamic oxaloacetic acid transferase (AST), albumin, serum creatinine, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and N-terminal pro brain natriuretic peptide (NT-proBNP) were recorded. Subsequently, plasma levels of CILP1 at admission were detected by the enzyme linked immunosorbent assay (ELISA) method. Echocardiographic parameters were also acquired for all patients. The association of CILP1 with LVEF, LVDD and CRP was determined. In addition, the occurrence of MACE was examined during the 12-month follow-up in the DCM group. The concentration of CILP1 in the DCM group was higher than in the N-DCM group [1329.97 (1157.14, 1494.36) ng/L vs. 789.00 (665.75, 937.06) ng/L, P < 0.05], higher in the MACE group than in the non-MACE group [1777.23 (1532.83, 2341.26)ng/L vs. 885.00 (722.40, 1224.91) ng/L, P < 0.05). Correlation analysis revealed that CILP1 expression was associated with LVEF, CRP and LVDD (r = -0.58, 0.29 and 0.44, respectively, P < 0.05). Analysis of a nomogram demonstrated that CILP1, sex, age, BMI, LVEF and LVDD could predict the occurrence of MACE in DCM patients at 12months (P < 0.05). The plasma levels of CILP1 were independently associated with a stronger discriminating power for DCM. Furthermore, inclusion of CILP1 as a covariate in the model caused a significant improvement in risk estimation compared with traditional risk factors for DCM [BASIC: AUC: 0.556, 95%CI: 0.501-0.610; BASIC + CILP1: AUC: 0.913, 95%CI: 0.877-0.941, P < 0.05] and MACE [BASIC: AUC: 0.710, 95%CI: 0.616-0.792; BASIC + CILP1: AUC: 0.871, 95%CI: 0.794-0.928, P < 0.05]. The serum concentration of CILP1 was increased in DCM patients. Elevated fasting plasma CILP1 levels was a robust diagnostic marker of DCM and was independently associated with an increased risk of MACE.

The Association Between Elevated Thyroid-Stimulating Hormone Levels and Prolonged Length of Stay Among Adult Diabetic Patients Hospitalized in Internal Medicine Departments: A Large Historical Cohort Study

Background/Objectives: Type 2 diabetes mellitus (DM2) and hypothyroidism are two of the most common endocrine disorders in clinical practice. Hospital length of stay (LOS) is a quality metric of the health systems. We evaluated the association between elevated thyroid-stimulating hormone (TSH) levels and prolonged LOS among all adult patients (age ≥ 18 years) with DM admitted to our Internal Medicine departments between 2014 and 2022. Methods: Data on patient characteristics, LOS, and in-hospital mortality were collected. A TSH level &gt; 4.7 μIU/mL was considered as being elevated. A LOS &gt; 75th percentile and in-hospital mortality were defined as being prolonged. Univariate and multivariable analyses were applied, and propensity score matching controlled for differences between patients with normal and those with elevated TSH levels. Results: Of the 19,066 study participants (median age 75.6 years, IQR 75.9–83.3), 1524 (7.9%) had elevated TSH levels, and prolonged LOS was significantly more common among them (before matching: 38.6% vs. 29.1%, p &lt; 0.001; after matching: 38.7% vs. 32.6%, p = 0.001). After adjustment for potential confounders, elevated TSH levels were also associated with prolonged LOS (OR = 1.22, 95% CI 1.07–1.39, p = 0.002). Conclusions: Elevated TSH levels in diabetic patients hospitalized in Internal Medicine departments are associated with prolonged LOS, emphasizing the importance of identifying hypothyroidism among them.

Elevated neutrophil percentage-to-albumin ratio predicts increased all-cause and cardiovascular mortality among individuals with diabetes.

Evidence regarding the neutrophil percentage-to-albumin ratio (NPAR) and mortality risk in diabetes patients is scarce. This study aimed at investigating the prognostic value of NPAR for mortality in patients with diabetes. This retrospective analysis was conducted on 6,962 diabetic patients from the NHANES database. Restricted cubic spline (RCS) was used to visualize the association of the NPAR with mortality risk. Weighted multivariable Cox regression models and subgroup analyses were adopted to assess the association of the NPAR with all-cause and cardiovascular mortality. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to evaluate the accuracy of the NPAR in predicting survival outcomes. Mediation analysis explored the indirect impact of NPAR on mortality mediated through eGFR. During a median follow-up of 6.7 years, there were 1,804 deaths were recorded, including 602 cardiovascular deaths. The RCS regression showed that NPAR has a J-shaped association with all-cause mortality, and a positive linear association with CVD mortality. Each one-unit increase in NPAR was linked with a 14% and 12% increased risk of all-cause and cardiovascular mortality, respectively. The association was consistent in subgroup analyses based on age, sex, race, BMI, hypertension, CKD, and history of CVD. The time-dependent ROC curve showed the area under the curve of were 0.809 for all-cause mortality, and 0.780 for CVD mortality. In mediation analyses, eGFR partially mediated these relationships. An elevated NPAR is independently associated with increased all-cause and cardiovascular mortality in diabetes patients.

The Immediate Effect of Texture Foot Plate on Balance in Diabetic Patients With Neuropathy

Background and Objectives: According to previous studies, balance problems are one of the most critical disorders in diabetic patients with neuropathy. Because diabetic neuropathy may cause sense disorder and decreased balance in these patients. Thus, it seems that using texture insole may help to improve proprioception and lead to a positive effect on balance in this case. Therefore, this study aims to evaluate the effect of texture insole on static and dynamic balance in diabetic patients with neuropathy. Methods: This is a single-group pre-test-post-test design with the participation of 16 patients with neuropathy who were referred by endocrine specialist physicians in terms of inclusion criteria to Firoozgar Hospital. Data were collected using a force plate to evaluate the static balance and the time up and go (TUG) test for dynamic balance. Results: Six men (37.5%) and ten women (62.5%) participated in this study. The results of this study showed that the means of parameters of static and dynamic balance among participants decreased significantly (P&lt;0.05) Conclusion: This study showed that the static and dynamic balance has improved after using the texture foot plate by these patients.

ANALYSIS OF NURSING CARE IN DIABETES MELLITUS PATIENTS THROUGH DIABETIC FOOT EXERCISE INTERVENTION FOR BLOOD CIRCULATION IMPROVEMENT IN TERATAI ROOM, IHC RSU WONOLANGAN PROBOLINGGO

Background: Diabetes mellitus, a chronic metabolic disease, can lead to serious complications, including impaired blood circulation in the extremities, termed diabetic foot, leading to peripheral neuropathy and poor perfusion. Objectives: This study aimed to assess the impact of diabetic foot exercise on improving blood circulation among diabetic patients. Design: This case study utilized a descriptive method on two diabetic patients in Teratai Room, RSU Wonolangan Probolinggo. Foot exercise intervention was implemented three times weekly for 15–20 minutes. Results: Both patients showed improvement in peripheral blood circulation, indicated by Ankle Brachial Index (ABI) scores within the mild obstruction range after consistent foot exercise. Conclusion: Regular diabetic foot exercises may enhance blood circulation and prevent complications among diabetes mellitus patients.

Intention to use short messaging services for promoting drug adherence among individuals with diabetes in Addis Ababa, Ethiopia

Background Suboptimal medication adherence among individuals with diabetes presents a significant challenge in low-income nations. Growing evidence demonstrates the effectiveness of text messaging interventions to enhance medication adherence. This study assesses the intention to use Short Messaging Service (SMS) based reminder services in promoting drug adherence among diabetic patients and associated factors in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted from February 06, 2023, to March 27, 2023, in Addis Ababa, Ethiopia. A sample of 351 patients was selected using systematic random sampling. Structured questionnaires were used for data collection. Binary and multivariable logistic regression models were used to analyze the association between intention to use SMS reminders to promote drug adherence among individuals with diabetes and related factors. Results A total of 333 respondents, with a 94.87% response rate, were interviewed for this study. The majority of respondents, 66.4 % (95% CI [61.9–71.2]), expressed an intention to use SMS-based reminder services to promote their drug adherence. Age &lt; 45 years (AOR = 5.73, 95% CI [2.07–15.73]), higher educational level (AOR = 3.03, 95% CI [1.16–7.90]), type of diabetes (AOR = 3.71, 95% CI [1.16–7.90]), oral medication users (AOR = 2.99, 95% CI [1.42–6.32]), SMS as a preferred medium for communication (AOR = 2.86, 95% CI [1.17–7.00]) were deemed to be important variables linked to intention to use SMS reminders to promote drug adherence among individuals with diabetes. Conclusion The findings suggest the majority of individuals with diabetes have intention to use SMS reminders to enhance adherence. This result indicates the potential for utilization of SMS reminders to enhance adherence to diabetic medications. Furthermore, the findings highlight the importance of tailored interventions that take into account patient characteristics and preferences as factors that influence intention when designing such an intervention.