Diabetes-related Problems Research Articles

HD-MVCNN: High-density ECG signal based diabetic prediction and classification using multi-view convolutional neural network

Diabetes mellitus, also known as diabetes, is a medical condition marked by high blood sugar levels and impacts a large population worldwide. Treating diabetes is not feasible. It can be managed. Hence, it is crucial to promptly identify a diagnosis of diabetes. This study explores the effects of diabetes on the heart, focusing on heart rate variability (HRV) signals, which can offer valuable information about the existence and seriousness of diabetes through the evaluation of diabetes-related heart problems. Extracting crucial data from the irregular and nonlinear HRV signal can be quite challenging. Studying cardiac diagnostics involves a thorough analysis of electrocardiogram (ECG) signals. Traditional electrocardiogram recordings utilize twelve channels, each capturing a complex combination of activities originating from different regions of the heart. Examining ECG signals recorded on the body’s surface may not be an effective method for studying and diagnosing diabetic issues. The study introduces a research proposal utilizing a high-density resolution electrocardiogram (ECG) system with a minimum of 64 channels and multi-view convolutional neural network classification (HD-MVCNN) to address the mentioned challenges. This framework may help identify the hypoglycaemia effects on brain regions, leading to decreased complexity and increased theta and delta power during scalp electrocardiogram procedures. The convolutional architectural model primarily contributes to enhancement and optimization through its Stochastic Gradient Descent (SGD) along with convolutional layers and according to results, the HD-MVCNN demonstrated better stability and accuracy in comparison to traditional classification models. Thus, HD-MVCNN shows promise as a powerful method for classifying features in diabetes clinical data.

GC–MS analysis, molecular docking, and pharmacokinetic studies on Dalbergia sissoo barks extracts for compounds with anti-diabetic potential

Diabetes is a metabolic condition defined by abnormal blood sugar levels. Targeting starch-hydrolyzing enzymes and Dipeptidyl Peptidase 4 (DPP-4) expressed on the surface of numerous cells is one of the key strategies to lower the risk of Type-2 diabetes mellitus (T2DM). Dalbergia sissoo Roxb. bark (DSB) extracts have been reported to have anti-diabetic properties. This study intended to scientifically validate use of alcoholic and hydro-alcoholic extracts of DSB for T2DM by conducting preliminary phytochemical investigations, characterising potential phytochemicals using Fourier transform infrared (FT-IR) spectroscopy and Gas chromatography-mass spectrometry (GC–MS) analysis followed by comprehensive in-silico analysis. A qualitative phytochemical evaluation indicated the presence of alkaloids, phenolics, glycosides, conjugated acids and flavonoids. Ethanolic extracts showed highest total phenolic content (TPC) (127.072 ± 14.08031 μg GAE/g dry extract) and total flavonoid content (106.911 ± 5.84516 μg QE /g dry extract). Further FT-IR spectroscopy also revealed typical band values associated with phenol, alcohol, alkene, alkane and conjugated acid functional groups. The GC–MS analysis identified 139 compounds, 18 of which had anti-diabetic potential. In-silico ADMET analysis of potential compounds revealed 15 compounds that followed Lipinski’s rule and demonstrated drug-like properties, as well as good oral bioavailability. Molecular docking was utilised to analyse their potential to interact with three targets: α-amylase, α-glucosidase, and DPP-4, which are crucial in managing diabetes-related problems. Molecular Docking analysis and membrane permeability test utilising the PerMM platform revealed that compounds in the extracts, such as Soyasapogenol B and Corydine, had better interactions and permeability across the plasma membrane than standard drugs in use. Molecular dynamics simulations also showed that selected compounds remained stable upon interaction with α-amylase. Overall, using the in-silico approaches it was predicted that DSB extracts contain potential phytochemicals with diverse anti-diabetic properties. It further needs to be investigated for possible development as formulation or drug of choice for treating T2DM.

Efficacy and Safety of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor Use during Ramadan Fasting: A Systematic Review.

Abstract Background Religious intermittent fasting for 30 days during Ramadan may increase the risk of dehydration, hypovolemia, and hypoglycemia. These events may also be encountered when using sodium-glucose cotransporter 2 inhibitors (SGLT2is). Objectives This article evaluates the safety of the SGLT2 inhibitors in people with type 2 diabetes during Ramadan. Search Methods We searched PubMed CENTRAL, MEDLINE, and Google Scholar on July 25, 2023 without language restrictions. Selection Criteria All trials assessing the safety of SGLT2 inhibitors during Ramadan were assessed and summarized into preset points. Data Extraction Two authors independently extracted and reviewed the retrieved studies. A third author reviewed the merged summary of the two authors and modified the article when necessary. Results Diabetic ketoacidosis, hospitalization due to diabetes-related problems, and thrombosis were either not significantly related to SGLT2i use or not studied. Estimated glomerular filtration rate (eGFR) dropped significantly in one study; otherwise, it was either not statistically significant or not studied. Hypovolemia and dehydration were significantly increased in one study only. Conclusion From the available evidence, the use of SGLT2 inhibitors in people with diabetes during Ramadan seems to be safe and well tolerated. Hypovolemia and a drop in eGFR were reported in a few studies, with no reported clinical significance.

Phytochemical, Nutritional and Medicinal Profile of <i>Cucumis sativus</i> L. (Cucumber)

Current studies were performed to review the phytochemistry, nutritional benefits, medicinal/therapeutic value, and cosmetic importance of cucumber (Cucumis sativus L.). Cucumber fruits are an important part of the human diet, often used in salads, pickles, and sauces, due to their nutritious qualities and health benefits. They are a good source of vitamins, minerals, soluble carbohydrates, proteins, etc. The leaves, flowers, seeds, fruits, and bark of cucumber are rich in various phytoconstituents, including phenols, glycosides, alkaloids, flavonoids, carotenoids, tannins, steroids, terpenoids, phytosterols, phytoestrogens, saponins, minerals, proteins, carbohydrates, resins, and vitamins. Cucumbers are traditionally used to treat a variety of diseases, including high blood pressure, blood sugar issues, cancer, high cholesterol, kidney stones, constipation, Alzheimer's disease, eczema, hypertension, atherosclerosis, and diabetes-related problems. The therapeutic/pharmaceutical value of cucumbers may be attributed to their laxative, antioxidant, anti-diabetic, analgesic, anti-hepatotoxic, anti-diarrheal, anti-fungal, anti-bacterial, thrombolytic, anti-ulcer, anti-inflammatory, cytotoxic, free radical scavenging, and wound-healing properties. Cucumbers also improve skin quality, promote skin whitening and smoothness, enhance natural beauty, regulate hydration, aid in weight loss, and reduce fat. They are used in cucumber creams, perfumes, face packs, and facials. Cucumber extract is incorporated into several formulations for topical skin treatments. This review article aims to explore the traditional uses, phytochemical contents, nutritional value, cosmetic applications, and pharmacological and therapeutic potential of cucumbers. It will be highly beneficial for a wide range of readers, including the general public, researchers, physicians, farmers, and agricultural stakeholders.

Diabetes-related skin problems and proper cosmetic care as a simple and affordable way to correct them: A review

Diabetes mellitus (DM) is a non-communicable epidemic. The number of people with this pathology is growing every year. DM leads to a decrease in quality and life expectancy due to vascular complications. However, the manifestations of diabetes are varied, including possible skin manifestations, which often receive insufficient attention. This article analyzes and summarizes current knowledge about dermatological complications in patients with DM, with an emphasis on the pathogenetic mechanisms underlying these problems. This article focuses on xerosis, intertrigo and disorders of the skin's protective mechanisms during the development of diabetic foot. The article is aimed at developing practical recommendations for endocrinologists on skin care in patients with diabetes, in order to improve their quality of life and prevent complications. The need to expand patient education on skin care in Diabetes Schools is also discussed.

Biochemical investigation into the influence of telfairia occidentalis on hepatic oxidative stress markers and pro-inflammatory biomarkers induced by streptozotocin

In rat models of diabetes, this research examined the biochemical impact of Telfairia occidentalis (TO) on pro-inflammatory biomarkers and hepatic oxidative stress markers caused by streptozotocin (STZ). There were five experimental groups: G 1 (Normal control) received 0.5 ml of distilled water; G 2 through 5 received 10% fructose for 14 days, after which STZ was administered intraperitoneally once. After the diagnosis of diabetes was confirmed, rats in groups 3 (TO1), 4 (TO2), and 5 (MET) were given 200 mg/kg b.w. TO, 300 mg/kg b.w. TO, and 300 mg/kg b.w. Metformin, respectively, for 28 days. The findings show that STZ significantly (p<0.05) increased malondialdehyde (MDA) levels in diabetic rats relative to the control group and significantly (p<0.05) decreased the activities of liver antioxidant enzymes such as catalase (CAT), reduced glutathione (GSH), glutathione S-transferase (GST), glutathione peroxidase (GPx), and superoxide dismutase (SOD). On the other hand, administration of TO (200 mg/kg and 300 mg/kg) and Metformin (300 mg/kg) resulted in a significant (p<0.05) increase in antioxidant enzyme activities and a significant (p<0.05) decrease in MDA levels. Furthermore, the inflammatory biomarkers myeloperoxidase (MPO), interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) as well as the apoptotic marker caspase-3 were significantly (p<0.05) elevated upon STZ induction; however, these elevations were significantly (p<0.05) attenuated upon TO administration, mirroring the effects of Metformin. In conclusion, Telfairia occidentalis significantly reduces the oxidative stress markers, inflammatory reactions brought on by STZ, and liver antioxidant status in diabetic rats. These results point to TO's possible therapeutic benefit in reducing diabetes-related liver problems via regulating oxidative and inflammatory pathways.

Enzymatic detection of α-hydroxybutyrate, an important marker of insulin resistance, and comparison with LC-MS/MS detection

AimThe metabolite α-hydroxybutyrate (α-HB) is an important marker of insulin resistance and impaired glucose tolerance allowing to identify patients at risk of developing diabetes and related metabolic disorders before any symptoms become apparent. At present, its exact quantification requires mass spectrometry (LC-MS), which is not compatible with routine laboratory use. Accordingly, a simple enzymatic-based method was assessed and its applicability and measuring accuracy compared with LC-MS was investigated. MethodsStandards, serum, and plasma samples containing α-HB were prepared with routine procedures and their α-HB contents measured with the XpressGT® enzymatic test kit photometrically or with LC-MS and multiple reaction monitoring. Resultsα-HB detection with XpressGT® yielded highly linear calibration curves and 102 % recovery of stocks added to commercial samples. Stability of the analyte in serum and plasma samples prepared with various anti-coagulants was >90 % after 46 h for several widely used preparations and recovery after 3 freeze-thaw cycles was ≥95 % with these anti-coagulants. A direct comparison of 75 samples indicated very good agreement of α-HB levels determined by both methods, 86 % of XpressGT® samples being within ±20 % of LC-MS values and even 93 % within ±20 % considering only samples above 30 μM concentration. ConclusionXpressGT®-based detection of α-HB is an easily applicable method which can be used for accurate and reliable quantification of the metabolite in clinical practice. Routine α-HB determination in patients at risk of developing diabetes would allow early establishment of preventive measures or pharmacological intervention reducing the risk for the onset of serious diabetes-related health problems.

Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study.

Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. DERR1-10.2196/54852.

Toxicological Assessment and Anti-diabetic Effects of Combined Extract of Chirata, Fenugreek and Sesame on Regulating TNF-α, TGF-β and Oxidative Stress in Streptozotocin Induced Diabetic Rats.

Swertia chirayita, Trigonella foenum-gracum and Sesamum indicum are used as traditional medicines to treat diabetes mellitus. A collection of metabolic illnesses known as diabetes mellitus (DM) involves chronic hyperglycemia caused by flaws in insulin secretion, function, or both. Innate immunity and inflammation both play important roles in the etiology of diabetes- related microvascular problems. This study aims to examine the anti-diabetic effects and the acute toxicity of combined extract (1:1:1) of Swertia chirayita, Trigonella foenum-gracum and Sesamum indicum. To address the demand for higher effectiveness and safety, the current effort aims to construct anti-diabetic preparations containing methanolic extract from herbal medications. The OECD 423 method was used to investigate acute toxicity in rats. Rats were used as test subjects, and rats were given a 35 mg/kg BW injection of streptozotocin to develop diabetes. The diabetic control group was given Glibenclamide 0.25 mg/kg BW, while the experimental group's diabetic rats received 125 mg/kg BW and 250 mg/kg BW of a combined methanolic extract of all plants. Among the measurements looked at were acute oral toxicity, behavioral changes, body weight, serum glucose levels, lipid profiles, oxidative stress, renal function tests, and inflammatory mediators. All the rat groups' histopathologies of the kidney, liver, and stomach were compared. The data were evaluated using analysis of variance, and a post hoc test was then carried out. The combined extracts' medium lethal doses (LD50) were higher than 2000 mg/kg, indicating that they are not poisonous under the conditions that can be observed. Streptozotocin-induced diabetic rats' elevated blood glucose was found to be considerably lower (p 0.01) in the treated group of rats. In the treated group of rats, it was discovered that the damage and disarray in the cells typical of Streptozotocin-induced DM had been repaired. The treated group of rats returned to normal levels of the lipid profile, hyperglycemia, decreased serum protein and liver glycogen, increased liver function, and kidney function markers seen in the rats of the DM control group. The evaluated combined methanolic extract can be considered safe for use in rats. Combining methanolic extract from all selected medicinal plants (Swertia chirayita, Trigonella foenum-gracum and Sesamum indicum) has a potential anti-diabetic effect and can be safely developed as an alternative medicine.

The Importance of Type 2 Diabetes and Physical Activity Research Beyond The Covid-19-Pandemia: A Letter to The Editor

Diabetes and diabetes-related diseases or health problems are global issues, and they cause human distress and great expenditures in a society. Therefore, diabetes and physical activity research is remarkable from a viewpoint of individual and public health especially during the COVID-19 pandemic and beyond. In a Corona-changing world it is important to prioritize physical activity in health promotion and strengthen scientific research to highlight the significance and the health benefits of physical activity for improving the management of diabetes (especially type 2), as well as to prevent the increase in global burden of diabetes, other non-communicable diseases and COVID-19. The new research findings could contribute solid scientific-based evidence to the international guidelines on physical activity in preventing and managing type 2 diabetes, and decreasing the diabetes-related risk of morbidity and mortality. Therefore, type 2 diabetes and physical activity research is timely and relevant, focusing on one of the leading health problems that our time is currently facing. Finally, in order to be successful, to change and save lives, the diabetes research requires more funding.

Undiagnosed status and associated factors of diabetes mellitus among adults living in eastern Ethiopia: Unmasking a silent killer of prevalence of diabetes mellitus

BackgroundThe global prevalence of diabetes mellitus (DM) is increasing rapidly, with special concern for the entity silent or undiagnosed diabetes; those unaware of their condition. It is important to uncover the hidden extent of diabetes in order to identify diabetes-related problems early. Therefore, this study aimed to assess the prevalence of undiagnosed DM and associated factors in Eastern Ethiopia. MethodsA quantitative, community-based cross-sectional study was conducted among 609 adults not known to be diabetic from January 03 to February 23, 2023. A multi-stage sampling technique and a validated standardized instrument were used. Each participant was interviewed to collect socio-demographic and behavioral characteristics data. Anthropometric measurements were recorded. The fasting blood glucose (FBG) test was assessed by samples taken early in the morning, 8 h after night fasting. Undiagnosed DM was defined as not being diagnosed with Diabetes mellitus and an FBG level of ≥126 mg/dl. To identify factors associated with undiagnosed DM, logistics regression was used. The level of statistical significance was set at a value of p < 0.05. ResultsThe prevalence of undiagnosed diabetes mellitus was 8.64 % (95 % CI: 6.7–11.2). The multivariable analysis showed that sedentary behavior, family history of diabetes mellitus, current hypertension, and fruit consumption of fewer than three servings per week were independently associated with undiagnosed DM in studied participants. ConclusionAlmost one in eleven adults living in the study area had undiagnosed DM, and various associated factors identified were modifiable risk factors that could be useful in planning intervention measures for lifestyle modification.

Perception and attitude of type 2 diabetic patients toward insulin therapy in the primary care of National Guard for Health Affairs (NGHA) in Jeddah, Saudi Arabia.

Our study explores and determines the perception toward insulin among patients with diabetes in the National Guard for Health Affairs (NGHA), Jeddah, the Kingdom of Saudi Arabia (KSA), and aims to gain insight into the causes of refusal. Patients with type 2 diabetes (T2D) are likely to need the use of insulin to keep blood glucose levels within normal range and delay the onset of diabetes-related problems. Individuals with diabetes may be hesitant to begin insulin therapy if they have a negative attitude toward it, which might add to the delay in beginning treatment. A cross-sectional study was conducted in the primary healthcare centers of the NGHA in Jeddah, Saudi Arabia. Data were collected through a validated self-administered questionnaire that was divided into three sections, with a total of 32 questions. The first section concerned demographic data, the second part was directed toward insulin users, and the last section was directed toward non-insulin patients. Our study collected 314 responses. Males constituted 54.8% of participants and insulin users resembled 45.7%. According to our study, important deterrents to starting insulin therapy among non-insulin users included the following: the cost of insulin, the pain associated with injections, the difficulty in maintaining food control while on insulin treatment, scarring at the injection site, and the weight gain impact. Factors that were found to influence compliance to insulin therapy among insulin users included fear of weight gain and self-administration of insulin.

IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the management and prevention of diabetes-related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient-important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This guideline was developed for healthcare professionals involved in diabetes-related foot care to inform clinical care around patient-important outcomes. Two systematic reviews from 2019 were updated to inform this guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations. The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes-related foot problems. We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes-related foot disease.

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the management and prevention of diabetes-related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient-important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This guideline was developed for healthcare professionals involved in diabetes-related foot care to inform clinical care around patient-important outcomes. Two systematic reviews from 2019 were updated to inform this guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations. The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes-related foot problems. We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes-related foot disease.

The Prevalence of Diabetic Retinopathy and Associated Risk Factors among Diabetic Patients in a Tertiary Care Hospital

Background: One of the most serious complications of diabetes that places an enormous strain on the patient, the healthcare system, and the world economy is diabetic retinopathy (DR). It includes long-term exposure to the metabolic changes linked to diabetes, which cause damage to the retina's microvasculature. Objectives: The aim of the study was to assess the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in a tertiary care hospital. Methods: This cross-section observational study was carried out in the Department of Ophthalmology, North Bengal medical College. Convenience sampling technique was followed. Face to face interview was done to collect data with a semi-structured questionnaire. After collection, the data were checked and cleaned, followed by editing, compiling, coding and categorizing according to the objectives and variable to detect errors and to maintain consistency, relevancy and quality control. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). The duration of the period from July 2018 to July 2022. A total of 120 patients were participate in the study. Results: About 58.33% respondents were male and 41.67% were female. Majority (33.33%) of the respondents were within the age group of 50-59. 33.33% were service holder, 41.67% were businessman, 12.5 were day labor, 6.67% were farmer. 75% were from urban area and 25% from rural area. The prevalence of DR in this study was 41.1%. About 90% had DM of &lt;5 years, 55% had 6-10 years, 40% had 15-20 Years, 30% had 16-20 years and only 7% had &gt;21 years. About 50% had normal grade of diabetic retinopathy in the worse eye, 15% had Mild NPDR, 8.33% had Moderate NPDR, 6.67% had Mild to moderate NPDR with non-CSME, 2.5% Moderate NPDR with CSME, Severe NPDR with non-CSME Severe NPDR with CSME and Advanced PDR respectively. Mean FBS (mg/dl) was 160.86±70.6, Total cholesterol (mg/dl) was 183.2 ± 2.1, Triglycerides (mg/dl) was 161.2 ± 2.6, Systolic BP was 130.56±15.7 and Diastolic BP was 80.86±13.4. Patients with baseline age of &lt;60 years were three times (AOR = 3.2:95% CI: 1.19–8.63) more likely to develop DR. The odds of DR is about 3 times (AOR = 2.91:95% CI: 1.01–8.35) higher for patients with disease duration of ≥6 years as compared to disease duration of &lt;6 years. Systolic blood pressure also had statistically significant association with patients having blood pressure of &lt;140 mmHg being about 3.6 times (AOR = 0.28:95% CI: 0.09–0.82) less likely to have DR as compared to hypertensive patients with systolic blood pressure of ≥140 mmHg. The other cofactors, history of hypertension, and total cholesterol level were not independent significant factors for the development of DR in our study. Conclusion: Systolic hypertension, being on insulin alone or in combination with OHA, and having diabetes for a longer period of time were all independently linked to the occurrence of DR. The significant DR prevalence our study suggests that routine patient care, including treatment facilities, has to be improved. Healthcare practitioners must make a consistent effort to educate diabetic patients about the importance of blood sugar control and hypertension management in lowering the risk of the start and progression of DR. It is advised that diabetic patients get health education regarding the importance of routine eye exams for the early detection and treatment of diabetes-related eye problems.

Efficacy of a Nursing Skin Care Protocol in the Prevention of Skin-Related Problems Among Newly Diagnosed Diabetic Patients: A Pilot Study.

Introduction Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels, affecting millions worldwide. Among the various complications associated with diabetes, skin-related problems represent a significant concern, particularly for newly diagnosed patients. Altered blood circulation, compromised immune responses and nerve damage increase the risk of skin issues in this vulnerable population. Effective nursing interventions are crucial in managing and preventing diabetes-related skin problems. A nursing skin care protocol tailored to the unique needs of newly diagnosed diabetic patients has the potential to reduce the incidence and severity of skin complications, leading to improved patient outcomes and enhanced quality of life. This study aims to assess the efficacy of a nursing skin care protocol in preventing skin-related problems among newly diagnosed diabetic patients. By analyzing the impact of the protocol on patient outcomes and exploring the significance of early intervention and patient education, this research seeks to provide valuable insights into the importance of proactive skin care management in diabetes care. Methods A randomized controlled trial was conducted at Acharya Vinoba Bhave Rural Hospital in India to evaluate the efficacy of a nursing skin care protocol in preventing skin problems among newly diagnosed diabetic patients. The study included 30 patients who met specific inclusion criteria and excluded those with critical illness or undergoing skin treatment. Data was collected using a questionnaire and standardized tools. Statistical analysis demonstrated the protocol's effectiveness in reducing skin-related issues. The results highlight the importance of early intervention and personalized nursing care in diabetic management, promoting better patient outcomes and overall well-being. Results The results of the study demonstrate the efficacy of the nursing skin care protocol in reducing pruritus and dry skin problems among newly diagnosed diabetic patients. The experimental group showed a substantial improvement, with higher efficacy gains for both pruritus (66.70%) and dry skin (86.70%) compared to the control group (pruritus: 26.70%, dry skin: 33.30%). These findings highlight the potential benefits of implementing the nursing skin care protocol to alleviate skin-related issues in this patient population. The study supports the importance of early intervention and tailored nursing care in managing diabetic skin problems, which could improve patient outcomes and overall well-being. Conclusion In conclusion, the nursing skin care protocol effectively prevented and reduced skin-related problems among newly diagnosed diabetic patients. The experimental group showed significant improvements in pruritus and dry skin compared to the control group. Early intervention and personalized nursing care are crucial in managing diabetic skin issues and enhancing patient well-being. Implementing the nursing skin care protocol can lead to a better quality of life for diabetic patients by addressing skin concerns. Further research and application of this protocol hold promise for managing skin-related complications in diabetes effectively.

Study of Diabetic Foot Problems Among Patients Attending the Diabetic Foot Clinic at Royal Hampshire County Hospital, United Kingdom: A Single-Centre Experience.

Background Patients with diabetes mellitus (DM) are on the rise all over the world. Simultaneously, the complications of DM are also increasing. Diabetes-related foot problems have been another concern among health professionals, especially foot ulcers, osteomyelitis, and amputations. Objectives We determined the prevalence of gender, age, types of DM including non-diabetics, various foot-related presentations, complications, and their outcomes. Methods A retrospective descriptive cross-sectional study was conducted among new patients attending a diabetic foot clinic over a period of six months, from January 1, 2019 to June 30, 2019. To confirm the outcome of the study, all of them were followed up for at least four months from the date of diagnosis. Results The study showed that most patients were males (65.5%). The most common age group for diabetic foot problems was 81-90 years, and about 80% of the foot problems were diagnosed in patients over 60 years. The study disclosed that 86.2% of the population had type 2 DM, 56.9% had ulcers, and 13.8% had osteomyelitis. The outcome of our study demonstrated that 65.5% of the patients were cured and discharged within four months of the diagnosis, but 10.3% of the population needed amputation. During the four-month follow-up period, 3.4% of our study population died due to non-foot-related causes. A total of 48.1% of our ulcer patients were discharged within eight weeks of diagnosis. However, 26% of ulcer patients and 75% of osteomyelitis patients needed more than four months to be discharged. Peripheral neuropathy and peripheral arterial disease (PAD) were present in 91% of ulcer patients. Among our osteomyelitis group, 100% had peripheral neuropathy, and 87.5% had PAD. About 20% of ulcer patients and none of the osteomyelitis patients were diagnosed with chronic kidney disease (CKD) stages beyond 3b. About 2/3rd of our ulcer and osteomyelitis population had an HbA1C level of more than 7.5%. Conclusion Male patients over 60 years of age with type 2 DM are more at risk of developing diabetes-related foot issues. Ulcer with or without osteomyelitis was the most common complication among our study population. Results showed that a significant amount of osteomyelitis patients underwent foot amputation. Poor glycaemic control of HbA1C of more than 7.5%, peripheral neuropathy, and PAD were the most common risk factors for developing foot-related complications. Prolonged use of antibiotics and a dedicated professional team may be needed to manage these complications successfully.

Diabetes mellitus and anti-oxidative stress

The development of diabetes complications, both microvascular and cardiovascular, is significantly influenced by oxidative stress. Diabetes-related metabolic problems lead to an overproduction of mitochondrial superoxide in the heart, small and large vascular endothelial cells, and both. Five key pathways implicated in the pathophysiology of problems are activated as a result of the increased superoxide generation. The purpose of this review is to highlight new insights into the processes through which hyperglycemia produces oxygen free radicals.

Synergistic effect of chlorogenic acid and vitamin D3 (cholecalciferol) on in-vitro glycation may assist in prevention of Polycystic Ovarian Syndrome (PCOS) progression - A biophysical, biochemical and in-silico study

Advanced glycation end products (AGEs) are formed through non-enzymatic glycation, that have been linked to various diseases, including polycystic ovarian syndrome (PCOS) playing a critical role leading to secondary comorbidities such as diabetes-related problems, cardiovascular complications, infertility, etc. As a result, there has been a lot of research into AGE-inhibiting phytochemicals for the remediation and obstruct progression of glycation-related illnesses. The current study is based on in-vitro protein model, in which human serum albumin have been used to investigate the cumulative effect of chlorogenic acid (CGA) and cholecalciferol (vitamin D) on glycation and evaluate their inhibitory impact on AGEs production in the presence of methylglyoxal. Through the application of several biochemical and biophysical techniques, we were able to examine the synergistic impact of both the compounds on albumin structure and its biochemical properties during different stages of glycation. According to Nitro-blue tetrazolium assay results indicate that CGA and vitamin D inhibited fructosamine (early glycation product) production. Moreover, free thiol and lysine residues were significantly increased whereas protein carbonyl levels were significantly decreased. Additive effect of CGA and vitamin D were associated with reduced AGEs fluorescence and increased tryptophan and tyrosine fluorescence. Amadori-albumin after treatment showed some evidence of regaining its alpha-helicity as measured by far-UV CD spectrum. Furthermore, secondary structural alterations were confirmed by Fourier transform infrared spectroscopy (FTIR). ANS (1-anilinonaphthalene-8-sulfonic acid) fluorescence spectra also displayed less revelation of hydrophobic patches. Bilirubin binding capacity was also restored which showed functional recovery of HSA. The electrophoretic mobility was also restored which is portrayed by SDS-PAGE. Additionally, to predict the anti-aggregation potential of CGA and vitamin D, congo red assay and ThT fluorescence was performed which reveal low aggregate formation after treatment. These results corroborated with scanning electron microscopy and confocal microscopy. Docking and simulation results also reveal spontaneous binding of CGA and vitamin D on subdomain IIA of HSA favoring their binding thermodynamically. All the findings suggest that chlorogenic acid and cholecalciferol given in combination might help in prevention of PCOS progression and its related complications.

Targeting Anti-Inflammatory Pathways to Treat Diabetes-Induced Neuropathy by 6-Hydroxyflavanone.

It is evident that inflammation and metabolic syndrome instigated by diabetes mellitus can precipitate diabetes-induced neuropathy (DIN) and pain. In order to find an effective therapeutic method for diabetes-related problems, a multi-target-directed ligand model was used. 6-Hydroxyflavanone (6-HF) carrying anti-inflammatory and anti-neuropathic pain potential due to its quadruplicate mechanisms, targeting cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX), and opioid and GABA-A receptors was investigated. The anti-inflammatory potential of the test drug was confirmed utilizing in silico, in vitro, and in vivo tests. A molecular simulation approach was utilized to observe the interaction of 6-HF with the inflammatory enzyme COX-2 as well as opioid and GABA-A receptors. The same was confirmed via in vitro COX-2 and 5-LOX inhibitory assays. In vivo tests were performed to analyze the thermal anti-nociception in the hot-plate analgesiometer and anti-inflammatory action in the carrageenan-induced paw edema model in rodents. The potential anti-nociceptive effect of 6-HF was evaluated in the DIN model in rats. The Naloxone and Pentylenetetrazole (PTZ) antagonists were used to confirm the underlying mechanism of 6-HF. The molecular modeling studies revealed a favorable interaction of 6-HF with the identified protein molecules. In vitro inhibitory studies revealed that 6-HF inhibited the COX-2 and 5-LOX enzymes significantly. The 6-HF at dosages of 15, 30, and 60 mg/kg substantially reduced heat nociception in a hot plate analgesiometer as well as carrageenan-induced paw edema in rodent models. The authors discovered that 6-HF had anti-nociception properties in a streptozotocin-induced diabetic neuropathy model. According to the findings of this study, 6-HF was demonstrated to diminish inflammation caused by diabetes as well as its anti-nociception effect in DIN.