Complications In Diabetic Patients Research Articles

Phenolic Ligand-Metal Charge Transfer Induced Copper Nanozyme with Reactive Oxygen Species-Scavenging Ability for Chronic Wound Healing.

Chronic wounds frequently arise as a complication in diabetic patients, and their management remains a significant clinical hurdle due to their nonhealing nature featured by heightened oxidative stress and impaired healing cells at the wound site. Herein, we present a 2D copper antioxidant nanozyme induced by phenolic ligand-metal charge transfer (LMCT) to eliminate reactive oxygen species (ROS) and facilitate the healing of chronic diabetic wounds. We found that polyphenol ligands coordinated on the Cu3(PO4)2 nanosheets led to a strong charge transfer at the interface and regulated the valence states of Cu. The obtained Cu nanozyme exhibited efficient scavenging ability toward different oxidative species and protected human cells from oxidative damage. The nanozyme enhanced the healing of diabetic wounds by promoting re-epithelialization, collagen deposition, angiogenesis, and immunoregulation. This work demonstrates the LMCT-induced ROS scavenging ability on a nanointerface, providing an alternative strategy of constructing metal-based nanozymes for the treatment of diabetic wounds as well as other diseases.

GLI family zinc finger protein 2 promotes skin fibroblast proliferation and DNA damage repair by targeting the miR-200/ataxia telangiectasia mutated axis in diabetic wound healing.

Diabetic foot ulcer (DFU) is a serious complication of diabetic patients which negatively affects their foot health. This study aimed to estimate the role and mechanism of the miR-200 family in DNA damage of diabetic wound healing. Human foreskin fibroblasts (HFF-1 cells) were stimulated with high glucose (HG). Db/db mice were utilized to conduct the DFU in vivo model. Cell viability was evaluated using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assays. Superoxide dismutase activity was determined using detection kits. Reactive oxygen species determination was conducted via dichlorodihydrofluorescein-diacetate assays. Enzyme-linked immunosorbent assay was used to evaluate 8-oxo-7,8-dihydro-2'deoxyguanosine levels. Genes and protein expression were analyzed by quantitative real-time polymerase chain reaction, western blotting, or immunohistochemical analyses. Luciferase reporter gene and RNA immunoprecipitation assays determined the interaction with miR-200a/b/c-3p and GLI family zinc finger protein 2 (GLI2) or ataxia telangiectasia mutated (ATM) kinase. HG repressed cell proliferation and DNA damage repair, promoted miR-200a/b/c-3p expression, and suppressed ATM and GLI2. MiR-200a/b/c-3p inhibition ameliorated HG-induced cell proliferation and DNA damage repair repression. MiR-200a/b/c-3p targeted ATM. Then, the silenced ATM reversed the miR-200a/b/c-3p inhibition-mediated alleviative effects under HG. Next, GLI2 overexpression alleviated the HG-induced cell proliferation and DNA damage repair inhibition via miR-200a/b/c-3p. MiR-200a/b/c-3p inhibition significantly promoted DNA damage repair and wound healing in DFU mice. GLI2 promoted cell proliferation and DNA damage repair by regulating the miR-200/ATM axis to enhance diabetic wound healing in DFU.

Duration-specific association between plasma IGFBP7 levels and diabetic complications in patients with type 2 diabetes mellitus

ObjectiveInsulin-like growth factor binding protein 7 (IGFBP7) has a strong affinity to insulin. This study aimed to evaluate the relationship between IGFBP7 and complications among type 2 diabetes mellitus (T2DM) patients. DesignA total of 1449 T2DM patients were selected from a cross-sectional study for disease management registered in the National Basic Public Health Service in Changshu, China, and further tested for their plasma IGFBP7 levels. Logistic regressions and Spearman's rank correlation analyses were used to explore the associations of IGFBP7 with diabetic complications and clinical characteristics, respectively. ResultsAmong the 1449 included T2DM patients, 403 (27.81%) had complications. In patients with shorter duration (less than five years), the base 10 logarithms of IGFBP7 concentration were associated with T2DM complications, with an adjusted odds ratio (OR) of 2.41 [95% confidence interval (95%CI) = 1.06–5.48]; while in patients with longer duration (more than five years), plasma IGFBP7 levels were not associated with T2DM complications. Furthermore, in T2DM patients with shorter duration, those with two or more types of complications were more likely to have higher levels of IGFBP7. ConclusionIGFBP7 is positively associated with the risk of complication in T2DM patients with shorter duration.

Silencing of METTL3 prevents the proliferation, migration, epithelial-mesenchymal transition, and renal fibrosis of high glucose-induced HK2 cells by mediating WISP1 in m6A-dependent manner.

Diabetic nephropathy (DN) is one of the most serious complications in diabetic patients. And m6A modifications mediated by METTL3 are involved multiple biological processes. However, the specific function and mechanism of METTL3 in DN remains unclear. DN model mice were first established with streptozotocin, and WISP1 expression was confirmed by qRT-PCR. Then the influences of WISP1 or/and METTL3 on the proliferation, migration, and epithelial-mesenchymal transition (EMT) and fibrosis-related proteins of high glucose (HG)-induced HK2 cells or HK2 cells were tested through CCK-8, wound healing, and western blot. We first revealed that WISP1 was highly expressed in renal tissues of DN model mice and HG-induced HK2 cells. Functionally, WISP1 or METTL3 silencing could weaken the proliferation, migration, EMT, and fibrosis of HG-treated HK2 cells, and WISP1 or METTL3 overexpression could induce the proliferation, migration, EMT, and fibrosis of HK2 cells. Additionally, METTL3 silencing could decrease WISP1 m6A modification, and silencing of METTL3 also could notably suppress the biological functions of HG-induced HK2 cells by downregulating WISP1. Silencing of METTL3 prevents DN development process by decreasing WISP1 with m6A modification pattern. Therefore, we suggest that METTL3/WISP1 axis might be a novel therapeutic target for DN.

The Evidence for Structured Education in Diabetes Management

Structured Education is of detrimental importance for the management, counseling, and prevention of complications in diabetic patients. Different structured education programs exist that significantly improves the quality of life in diabetic patients as well as improves psychosocial outcomes by enhancing self-empowerment and self-motivation. Improvements have also been noted in bio-medical outcomes as a result of structured education most significantly in HbA1C, total cholesterol and frequency of hypoglycemia. In order to ensure patient satisfaction and improve outcomes related to complications, it is very important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care early in the course of the disease. In this review, we will discuss and highlight the evidence that support the benefits, limitations, and cost effectiveness of structured education in diabetes management

Comparison of the Efficacy of Duloxetine Versus Pregabalin for Pain Relief of Neuropathy in Diabetics

Background: Neuropathy is a common complication in diabetic patients with clinical manifestations of feet and hands paresthesia, pain in the lower legs, and a burning sensation in the soles. A wide variety of medications are used for diabetic neuropathy with varying degrees of pain relief reported. The study objective was to compare the efficacy of duloxetine versus pregabalin for pain relief of neuropathy in diabetics. Methods: The study was a six-week, single-blind, Randomized Controlled Trial conducted at HBS Medical and Dental College and Hospital in Islamabad. Patients were randomly designated to either of the groups (A or B) with 50 participants in each group. Group A received 150mg of pregabalin twice a day while group B received 60mg of duloxetine once a day. Pain relief was the primary outcome which was considered as a ≥ 50% decrease in pain score on the Visual Analog Scale at 6 weeks from baseline. Results: A total of 100 diabetic patients were registered in the study. The mean age in groups A&B was 48.36 and 50.56 (SD± 6.64) years respectively. The majority of the study population were males 39 (78%) and 42 (84%) in both groups. A total of 66% (n=33) in Group A and 74% (n=37) of the patients in Group B achieved pain relief. A comparison of the pain relief achieved between the two groups showed no statistical significance (p-value 0.383). Conclusion: The study revealed that duloxetine and pregabalin are both efficacious in terms of pain relief for diabetic neuropathy in our population.

Evaluation of Wound Healing Complications in Diabetic Patients Undergoing Surgery: A Study in a Surgical Department of a Medical College in Eastern Uttar Pradesh

Diabetic patients undergoing surgery often face challenges in wound healing, leading to increased morbidity and healthcare burden. This study aimed to evaluate the occurrence and risk factors associated with wound healing complications in diabetic patients undergoing surgery in a surgical department of a medical college in Eastern Uttar Pradesh. A retrospective analysis of medical records was conducted, including diabetic patients who underwent various surgical procedures between [study period]. Wound healing complications, such as surgical site infections, dehiscence, and delayed wound healing, were assessed. Patient demographics, diabetes characteristics, perioperative management, and surgical outcomes were analyzed. Statistical analysis, including multivariate regression models, was performed to identify independent risk factors for wound healing complications.

Network Pharmacology and Molecular Modeling Techniques in Unraveling the Underlying Mechanism of Citri Reticulatae Pericarpium aganist Type 2 Diabetic Osteoporosis.

Type 2 diabetic osteoporosis (T2DOP) is a common complication in diabetic patients that seriously affects their health and quality of life. The pathogenesis of T2DOP is complex, and there are no targeted governance means in modern medicine. Citri Reticulatae Pericarpium (CRP) is a traditional Chinese medicine that has a long history and has been used in the treatment of osteoporosis diseases. However, the molecular mechanism for the CRP treatment of T2DOP is not clear. Therefore, this study aimed to explore the underlying mechanisms of CRP for the treatment of T2DOP by using network pharmacology and molecular modeling techniques. By retrieving multiple databases, we obtained 5 bioactive compounds and 63 common targets of bioactive compounds with T2DOP, and identified AKT 1, TP 53, JUN, BCL 2, MAPK 1, NFKB 1, and ESR 1 as the core targets of their PPI network. Enrichment analysis revealed that these targets were mainly enriched in the estrogen signaling pathway, TNF signaling pathway, and AGE-RAGE signaling pathway in diabetics, which were mainly related to oxidative stress and hormonal regulation. Molecular docking and molecular dynamics simulations have shown the excellent binding effect of the bioactive compounds of CRP and the core targets. These findings reveal that CRP may ameliorate T2DOP through multiple multicomponent and multitarget pathways.

SMART FOOT INSOLE FOR REDUCING THE RISK OF FOOT ULCERS IN DIABETIC PATIENTS BY MEASURING PLANTAR PRESSURE

Background of the Study: The prevailing cause of Diabetes is a decline in insulin production, the outcome of which is an elevated glucose level in the blood. The superabundance of glucose in the blood can cause severe complications, damaging other body organs, including kidneys, nerves, heart, and upper and lower limbs. However, the common complication in diabetic patients is foot ulcer, which is directly associated with Diabetic peripheral neuropathy (DPN), which is the extensive cause of this. DPN is the inability of nerves to sense any external change, due to which the foot plantar pressure is altered and evolves because of the high glucose level. Methodology: This paper provides a solution in the form of a portable and cost-effective device based on force sensors for diabetic patients to monitor the change in foot plantar pressure at home and overcome the risk of foot ulceration. The device is implemented on 30 participants to characterize the plantar pressure values with flat foot and normal foot types for the Control group and diabetic group. Results: An evident difference in the value of Mid-foot pressure is observed for both the groups, Control group (Normal foot = 144+2.63 kPa, Flat foot = 150+2.72 kPa) and Diabetic Group (Normal foot = 213+2 kPa, Flat foot = 216+1 kPa). Deviation in these values discriminates the mid-foot pressure for the two groups, thus providing us a range for the individuals of the control group for the alarming situation. Conclusion: Noticing the plantar pressure through the proposed device helps diabetes patients reduce their risk. Keywords: Blood glucose, type 1 diabetes mellitus, flat foot, metatarsal, foot orthosis, diabetic neuropathy, foot ulcers.

Exposure to cadmium and lead is associated with diabetic kidney disease in diabetic patients

BackgroundCadmium (Cd) and lead (Pb) exhibit nephrotoxic activity and may accelerate kidney disease complications in diabetic patients, but studies investigating the relation to diabetic kidney disease (DKD) have been limited. We aimed to examine the associations of Cd and Pb with DKD in diabetic patients.Methods3763 adults with blood metal measurements and 1604 adults with urinary ones who were diabetic from National Health and Nutrition Examination Survey (NHANES) 2007–2016 were involved. Multivariate logistic regression models were used to analyze the associations of blood Cd (BCd), blood Pb (BPb), urinary Cd (UCd), and urinary Pb (UPb) with DKD.ResultsBPb, BCd, and UCd levels were higher among participants with DKD than diabetics without nephropathy, but UPb performed the opposite result. BPb and UCd were significantly associated with DKD in the adjusted models (aOR, 1.17 (1.06, 1.29);1.52 (1.06, 2.02)). Participants in the 2nd and 3rd tertiles of BPb and BCd levels had higher odds of DKD, with a significant trend across tertiles, respectively (all P-trend < 0.005). Multiplication interaction was also identified for BPb and BCd (P for interaction = 0.044).ConclusionBPb, BCd, and UCd were positively associated with the risk of DKD among diabetic patients. Furthermore, there were the dose-response relationship and multiplication interaction in the associations of BPb, BCd with DKD.

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

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

Topical siRNA therapy of diabetic-like wound healing.

Non-healing wounds are a serious complication in diabetic patients. One of the detrimental factors contributing to limited wound healing is the accumulation of metalloproteinase-9 (MMP-9) in the wound. Selective inhibition of MMP-9 is one of the established therapeutic targets for diabetic wound healing. Here, a functional and biocompatible wound dressing is developed to enable a controlled release of a traceable vector loaded with the antisense siRNA against MMP-9 in the wound. The dressing consists of degradable polymer nanofibers embedded with a vector nanosystem - polymer-coated fluorescent nanodiamonds optimized for the binding of siRNA and colloidal stability of nanodiamond-siRNA complexes in a physiological environment. The developed dressing is tested on murine fibroblasts and also applied to wounds in a diabetic murine model to evaluate its suitability in terms of in vivo toxicity, biological efficacy, and handling. The treatment results in significant local inhibition of MMP-9 and a shortening of the wound healing time. The scar formation in treated diabetic-like mice becomes comparable with that in non-treated diabetes-free mice. Our results suggest that the application of our biocompatible dressing loaded with a non-toxic vector nanosystem is an effective and promising approach to gene therapy of non-healing wounds.

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

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

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

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

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

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

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

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

Postbiotics: emerging therapeutic approach in diabetic retinopathy.

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

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

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

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

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

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

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