Group Of Diabetic Patients Research Articles

Diyabetik ve Non-Diyabetik Hastalarda Total İntravenöz Anestezi ve Sevofluran Anestezisinin Rokuronyumun Klinik Etki Süresi Üzerine Olan Etkilerinin Retrospektif Olarak Karşılaştırılması: Retrospektif Gözlemsel Çalışma

Objective: Due to the decrease in nerve conduction velocity, the clinical effect of rocuronium may be prolonged in diabetic patients receiving inhalation anesthesia, and its postoperative residual muscle relaxant effect may lead to complications. We compared the effects of total intravenous anesthesia and sevoflurane anesthesia on the clinical duration of action of rocuronium in diabetic and nondiabetic patients. Material and Methods: Patients between the ages of 18-65, who underwent general anesthesia for elective surgery in the general surgery department of our hospital (0.6 mg of rocuronium was used for tracheal intubation), with Type 2 diabetes and with the American Society of Anesthesiologists Physical Condition Classification (ASA) I-II were included in the study. Non-diabetic patients (ASA I-II) of the same age were included in the study as the control group. The duration of the clinical effect of rocuronium between the time of administration of the first dose of rocuronium and the time of administration of the additional rocuronium dose (time recorded in TOFcount 2-TOFc2) was evaluated. Results: The clinical duration of action of rocuronium was longer in both diabetic groups than in nondiabetic groups (p=0.000). When the diabetic patient groups were compared, the clinical duration of action of rocuronium was longer in the diabetic sevoflurane group than in the diabetic group that received total intravenous anesthesia (p=0.012). Conclusion: It was determined that the duration of rocuronium action was longer in diabetic patients who were administered sevoflurane anesthesia than in patients who received total intravenous anesthesia and in non-diabetic patients.

Renin-Angiotensin-Aldosterone Axis Inhibition Improves Outcome of Diabetic Patients with Chronic Hypertension and COVID-19: An Iranian Perspective.

Safe use of drugs such as angiotensin-converting enzyme 2 (ACE2) inhibitors and angiotensin receptor blockers (ARBs) in COVID diabetic patients needs comprehensive studies. This study addressed this issue from the Iranian perspective. Admitted COVID-19 patients were divided into four groups in this historical cohort study. Group 1 included 740 non-diabetic, non-hypertensive patients. Group 2 included 132 non-hypertensive diabetic patients. Group 3 included 154 non-diabetic hypertensive patients. Group 4 included 183 diabetic patients who were under ACE inhibitors or ARBs. Death, intensive care unit (ICU) admission, and length of hospitalization were compared between the groups. After considering associated factors such as age, gender, dyslipidemia, cardiovascular diseases, rheumatoid arthritis (RA), chronic kidney disease (CKD), history of surgery, and corticosteroid use, diabetic patients (group 2) were associated with increased mortality (CI 95%, OR 1.93 [1.11-3.33]). Presence of diabetes (group 2) and hypertension were associated with an increased need for ICU admission (CI 95%, OR 1.69 [1.04-2.76]; CI 95%, OR 1.71 [1.08-2.71], respectively). Group 4 patients although having a similar rate of ICU admission with group 2 and 3 patients, had significantly better ICU survival. The current study suggests that ACE inhibitors and ARBs are associated with decreased mortality, ICU admission, and better ICU survival in the diabetic subgroup of hypertensive patients.

Evaluating the Interrelationship Between Salivary Cortisol and Glycemia in Type 2 Diabetics

Introduction: Diabetes mellitus is a multifactorial metabolic condition marked by high blood sugar levels as well as problems with carbohydrate, lipid, and protein metabolism. Impaired insulin secretion and hepatic gluconeogenesis cause high blood sugar levels. Cortisol in the saliva is the unbound, free hormone, with absolute quantities between 30% and 50% fewer than in blood. The aim of the study was to evaluate the levels of salivary cortisol in normal healthy controls and type 2 diabetics. The objective was to evaluate the morning and evening levels of salivary cortisol in normal and type 2 diabetics by enzyme-linked immunosorbent assay (ELISA). Materials and Methods: 20 patients in the age group of 30 to 60 years with type 2 diabetes with HbA1c <6.5% were included in Group I. Twenty participants in the age group of 30 to 60 years were included in Group II. Salivary samples were collected and centrifuged at –4°C at 3500 rpm and ELISA was performed. Data were analyzed using Statistical Package for the Social Sciences version software version 16. Paired sample t test was used. Results: The mean morning salivary cortisol level of diabetic patients (Group I) was 1.62 mmol/dL and the evening was 1.34 mmol/dL. The difference was statistically significant (P = 0.00001). The mean salivary cortisol level of healthy subjects in the morning was 0.47 mmol/dL and evening was 0.29 mmol/dL, which is statistically significant (P = 0.00001). Conclusion: From this study, we can conclude that the salivary cortisol level is increased in patients with type 2 diabetes when compared to healthy individuals. There are no obvious changes in morning and evening salivary cortisol levels of diabetes patients.

Renin-Angiotensin-Aldosterone axis inhibition improves outcome of diabetic patients with chronic hypertension and COVID-19: An Iranian perspective

Background: Safe use of drugs such as angiotensin-converting enzyme 2 (ACE2) inhibitors and angiotensin receptor blockers (ARBs) in COVID diabetic patients needs comprehensive studies. This study addressed this issue from the Iranian perspective.Materials and Methods: Admitted COVID-19 patients were divided into four groups in this historical cohort study. Group 1 included 740 non-diabetic, non-hypertensive patients. Group 2 included 132 non-hypertensive diabetic patients. Group 3 included 154 non-diabetic hypertensive patients. Group 4 included 183 diabetic patients who were under ACE inhibitors or ARBs. Death, intensive care unit (ICU) admission, and length of hospitalization were compared between the groups.Results: After considering associated factors such as age, gender, dyslipidemia, cardiovascular diseases, rheumatoid arthritis (RA), chronic kidney disease (CKD), history of surgery, and corticosteroid use, diabetic patients (group 2) were associated with increased mortality (CI 95%, OR 1.93 [1.11–3.33]). Presence of diabetes (group 2) and hypertension were associated with an increased need for ICU admission (CI 95%, OR 1.69 [1.04–2.76]; CI 95%, OR 1.71 [1.08–2.71], respectively). Group 4 patients although having a similar rate of ICU admission with group 2 and 3 patients, had significantly better ICU survival.Conclusions: The current study suggests that ACE inhibitors and ARBs are associated with decreased mortality, ICU admission, and better ICU survival in the diabetic subgroup of hypertensive patients.

Clinical characteristics and outcomes of hospitalized COVID-19 patients with diabetes: A multi-center, retrospective study in Turkey

Objective: Diabetes mellitus is known as one of the potential risk factors for severe COVID-19.This study it was aimed to evaluate and compared demographic, clinical and laboratory findings,mortality and outcomes of hospitalized diabetic and non-diabetic COVID-19 patients. Method: The data of all consecutive adult patients admitted to the pandemic units of the participating hospitals’ internal medicine clinics with the diagnosis of Covid-19 disease were gathered between April 20th 2020 and July 23th 2020.Only swab or serological tests positive patients were included in the study.Patients with clinical and/or radiological findings were considered to have Covid-19 disease and those having negative swab tests were excluded.The clinical characteristics, treatment and discharge outcomes and laboratuary tests of the patients at presentation were divided into two groups and compared as diabetic and non-diabetic COVID-19 patients. Results: The median age was 52 years.There were 226 diabetic (21.2 %) and 839 (78.8%) non-diabetic patients.Diabetic patients were older than nondiabetics . Chronic diseases in the group of diabetic patients were found to be significantly higher than non-diabetic patient group (p<0,001).There was no significant difference in major symptoms such as dry cough,fatigue fever between two groups.Percentage of anorexia was significantly elevated in the diabetic group (p<0,001).In diabetic group,baseline (at the time of diagnoses) serum eGFR,hemoglobin levels were decreased and sedimentation,CRP,procalcitonin,D-dimer were elevated than nondiabetic group (p<0,001,p=0,009,p:<0.001,p<0.001,p<0.001,p=0.029 respectively). Admission to the intensive care unit and mortality were increased in diabetic patients group.(p<0.001) Conclusions: Diabetes are associated with increased complications, prolonged hospital stay, and mortality in COVID-19 patients.

Insulin Resistance in Type II Diabetes Mellitus Patients and Their First Degree Relatives- An Observational Study

Type II diabetes (T2DM) is caused by environmental, genetic, metabolic, and unknown variables. In diabetics, insulin resistance is the most of prolonged hyperglycemia. T2DM is induced by insulin resistance and cell dysfunction. The interaction of genetics and environment further complicates T2DM development. Insulin resistance and beta cell dysfunction are two of the most common Type 2 Diabetes Mellitus symptoms. A vicious triangle of cell failure (80% cell function) and insulin resistance in the muscles and liver causes major physiological issues. A group of diabetes patients (Group I), non-diabetic first-degree relatives of diabetic patients (Group II), and a non-diabetic healthy control group (Group III) were studied. The diabetes patients had the greatest systolic and diastolic blood pressures, followed by first degree relatives and healthy controls. We found that people with diabetes had higher fasting (FBS) and postprandial sugar, glycated haemoglobin (HbA1c) than diabetic offsprings and control group. Moreover, fasting insulin levels are higher in first degree relatives than in diabetes patients in the control group. The HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) levels of diabetics and their progeny do not differ much. The HOMA-IR measures insulin resistance severity. Common reference levels for HOMA-IR insulin resistance range from 0.7 - 2. Insulin resistance in diabetics and their first-degree relatives is evident from the results.

Grades of Below-the-Ankle Arterial Occlusive Disease following the Angiosome Perfusion: A New Morphological Assessment and Correlations with the Inframalleolar GVG Stratification in CLTI Patients

To assess a specific classification of the foot atherosclerotic disease concerning the angiosomal source arteries, the connected foot arches and attached collaterals for Rutherford 5, CLTI patients. To compare eventual analogies of this novel grading system with previously reported GLASS/GVG inframalleolar patterns of occlusive disease (P0-P2). A series of 336 ischemic feet (221 diabetics) were selected and retrospectively analyzed. For each angiographic pattern of inframalleolar atherosclerotic disease, 4 severity classes of targeted angiosomal artery path (TAAP), associating 4 other classes concerning linked foot arches (LFA) and collaterals occlusive disease were described. By associating the 4 TAAP with the 4 others parallel LFA and collaterals classes, 4 novel anatomical "Grades" (A-D) of occlusive disease were described. Limb salvage was studied between groups of diabetic and non-diabetic patients. Using a primary endovascular approach, limb preservation comparison of grade A/B proved without significance for diabetics (P=0.032) and non-diabetics (P=0.226). Comparison in diabetics and/or non-diabetics between A/C (P=0.045 and 0.046), A/D (P=0.027 and 0.030,B/C (P=0.009 and 0.038), and B/D (P=0.006 and P=0.042), as well as C/D groups (P=0.048 and P=0.034) proved ponderous. Parallel analysis of similar grades (A/A, B/B, etc.) with, or without diabetes appeared without significance (P > 0.05). Further comparison between grades A+B (assigned as P0/GVG), versus C (P1), and D (P2), proved significant (P < 0.0001). The present grading system proposes a useful correlation between the severity of foot angiosomal arteries, arches, and collaterals disease and limb salvage, confirming the clinical significance of P0-P2 GVG severity score. This analysis also points the limits of EVT to be probably avoided in grade D patients.

Comparison of Postoperative Pain and Analgesia Requirement among Diabetic and Nondiabetic Patients undergoing Lower Limb Fracture Surgery - A Prospective Observational Study.

Background:Diabetic patients usually experience neuropathic pain and have a decreased response to opioids. Fractures are acute conditions and as such, they are very painful. No data is available related to fracture and postoperative pain in diabetics.Aim:This study was conducted to evaluate postoperative pain and analgesics requirement among diabetic and nondiabetic patients undergoing lower limb fracture surgery and the effect of glycosylated hemoglobin (HbA1c) on the postoperative pain.Setting and Design:This was a prospective observational study, conducted on 80 patients comprising of nondiabetic and diabetic, scheduled for elective lower limb fracture surgery under spinal anesthesia.Materials and Methods:HbA1c was done in all the patients who were included in the study. Postoperative Visual Analog Scale (VAS) and analgesic consumption were assessed by an anesthesiologist blinded to the diabetic or nondiabetic status of the patients. VAS was assessed every 2nd hourly, for 24 h and rescue analgesia was given if the VAS was ≥4 and record was maintained. Sedation scores and adverse effects were also recorded postoperatively.Statistical Analysis:The Chi-square test was used for the analysis of categorical variables and Student's t-test was used for continuous variables.Results:Diabetic group of patients had a significantly high VAS score with P ≤ 0.05. Rescue analgesics requirement was significantly different in two groups with diabetic patients requiring more supplementation of analgesia with a P = 0.025. The overall patient satisfaction was lesser in diabetic group (P = 0.004). There was statistically significant correlation between glycosylated hemoglobin and VAS at 2nd, 16th, 18th, 20th, 22nd, and 24th h.Conclusion:Postoperative pain and analgesic requirement was significantly higher in diabetic patients with lower limb fracture. Glycosylated hemoglobin had good correlation with higher VAS.

Evaluation of Soft and Hard Tissue Condition After Dental Implant Surgery in Diabetic and Non-diabetic Patients (6 Months Follow up)

Background: Hyperglycemia in diabetic patients can affect the success of many dental treatments. Thus, many dental procedures are contraindicated in patients with uncontrolled diabetes mellitus (DM) due to the consequent delay in wound healing. This study aimed to assess the effect of a long-term control of blood sugar on tissue healing after implant placement. Methods: This cohort study evaluated 20 patients aged 50-60, referring to the School of Dentistry, Mashhad University of Medical Sciences for implant placement. All patients underwent blood sugar test and were divided into two groups of diabetic and non-diabetic patients regarding their HbA1c level. Bone loss, bleeding on probing (BOP), and pocket probing depth (PPD) of patients were measured 1 and 6 months after the implant placement. Data were analyzed using independent t test and chi-square test. Results: Blood sugar control had no significant effect on bone loss, BOP and PPD one and six month(s) after implant placement (P&gt;0.05). Although PPD significantly increased in both groups over time (P=0.016 in the healthy group and P=0.007 in the diabetic group), the difference between the two groups was not significant (P&gt;0.05). Conclusion: According to the results from this study, blood sugar control examined in the age range of our study had no significant effect on tissue healing one and six month(s) after the implant placement. However, further studies are required to explore this subject more thoroughly.

The Alberta Stroke Program Early CT score (ASPECTS): A predictor of mortality in acute ischemic stroke.

Stroke is one of the leading causes of mortality globally and a main cause of disability. The objective of this study was to evaluate the importance and utility of the Alberta Stroke Program Early CT Score (ASPECTS) as a mortality predictor factor in diabetic vs. non-diabetic patients with acute ischemic stroke (AIS), correlated with age, monocyte values, and high-sensitivity cardiac troponin I (hs-cTnI). The prospective longitudinal observational study included 340 patients with AIS divided into two groups: diabetics and non-diabetics. ASPECTS was evaluated within the first 24 h after admission to the center. The ASPECTS was lower in the group of diabetic patients on average 4.9 vs. 6.05 (P<0.0001). As the age of the patients increased, the lower the ASPECTS and the higher infarct size, indicating a statistically significant (P<0.0001) result. The optimal correlation was observed between infarct size (ASPECTS) and hs-cTnI serum level [95% confidence interval (CI): -0.3216 to -0.1193; P<0.0001]. Almost 94% of patients who had an ASPECTS higher than 3 points on admission survived, resulting in a favorable outcome and a very good predictability of the score (95% CI: 0.85 to 0.926, P<0.0001). The ASPECTS is a mortality predictor, its value correlating inversely with the severity and evolution of patients, confirming a good predictability with good specificity, sensitivity and area under the curve.

Investigation of the glutathione S-transferase gene M1/T1 and angiotensin converting enzyme gene I/D polymorphism in type 1 diabetic patients and possible association with diabetic microvascular complications

Objectives: Glutathione S-transferase (GST) polymorphism may play a role in the etiology of type 1 diabetes, as GST is involved to detoxification of reactive oxygen radicals and synthesis of proinflammatory mediators. Genetic polymorphisms in the renin-angiotensin aldosterone system, including angiotensin converting enzyme (ACE) gene insertion-deletion (I/D) polymorphism, can affect the progression of diabetes and diabetic complications. In our study we aimed to investigate the GST and ACE gene I/D polymorphism in type 1 diabetic patients for comparison with population and relationships with diabetic complications. Methods: A total of 116 type 1 diabetic patients were included to study. ACE polymorphism analyzed in the 71 subjects and GST polymorphism analyzed in the 62 subjects as control groups. Polymorphism of DNA samples was studied by PCR technique. Results compared with control groups and studied according the diabetic complications. Results: ACE gene DD genotype and D allele ratio in the patient group were significantly higher than control group. GST T1 and GST M1 ratios were similar between patient and control groups. ACE genotype group distributions and GST M1/T1 genotype ratios were not different in terms of obesity, glycemic control, duration of diabetes and hypoglycemia frequency and not changed according to diabetic complications. Conclusions: DD genotype and D allele ratio in diabetic patient group were found to be significantly higher and so a significant relationship was observed between and ACE I/D gene polymorphism and type 1 diabetes. On the other hand, it was observed that ACE I/D and GST gene polymorphism did not have any significant effect on diabetic microvascular complications.

Diabetes-associated nephropathy and obesity influence COVID-19 outcome in type 2 diabetes patients

ABSTRACT Coronavirus disease 2019 has rapidly spread around the globe and various comorbidities, such as diabetes have been recognized as risk factors for an unfavorable outcome. We analyzed a cohort of COVID-19 patients (n = 75) treated at a German community hospital. With a focus on diabetes mellitus, we evaluated the impact of distinct comorbidities on the COVID-19 disease course. The duration of hospital stay was prolonged if diabetes was present. An older age was associated with a poor outcome. The percentage of non-survivors increased in the presence of congestive heart failure or chronic kidney disease. In the group of diabetes patients, mortality was increased if any organ complication was present and diabetic nephropathy or the combination of obesity plus diabetes were by far the most important risk factors. Taken together, an older age, congestive heart failure, and chronic kidney disease significantly influenced COVID-19 disease course and survival. Diabetic nephropathy or the combination of obesity plus diabetes had the strongest impact on patients’ outcome.

Можливості фотоплетизмографії у ранній діагностиці діабетичної ангіопатії нижніх кінцівок

Актуальність. У більшості випадків цукрового діабету (ЦД) ускладнення у вигляді діабетичної ангіопатії нижніх кінцівок діагностується досить пізно, при появі клінічних проявів судинної патології. Оздоровчі заходи на цьому етапі носять паліативний характер, не зупиняючи прогресування самої патології. У зв’язку з цим стає актуальною діагностика початкових проявів діабетичної ангіопатії на доклінічному етапі. Мета дослідження: виявити відмінність в стані мікроциркуляції у верхніх і нижніх кінцівках у хворих на ЦД для можливості діагностики початкових стадій діабетичної ангіопатії нижніх кінцівок за допомогою методу фотоплетизмографії. Матеріали та методи. У дослідженні брали участь три групи людей: здорові особи, хворі на ЦД до 5 років і хворі на ЦД понад 10 років, яким проводилася фотоплетизмографія нігтьового ложа пальців кисті і пальців стопи. Результати. Виявлено відсутність різниці в стані мікроциркуляції в руках і ногах здорових людей. Виявлена вірогідна різниця в стані мікроциркуляції верхніх і нижніх кінцівок при ЦД, що збільшується при зростанні тривалості ЦД і декомпенсації вуглеводного обміну. Це дозволяє використовувати фотоплетизмографію нігтьового ложа пальців кистей і стоп для діагностики ранніх етапів формування діабетичної ангіопатії нижніх кінцівок. Висновки. Однією з ранніх ознак початку діабетичної ангіопатії є поява асиметрії в мікроциркуляції між кистями і стопами, що виявляється фотоплетизмографією. Виявлення діабетичної ангіопатії на доклінічному етапі відкриває можливості для активної та ефективної профілактики судинних ускладнень при ЦД, попереджаючи розвиток синдрому діабетичної стопи.

Effect of Exenatide Therapy on Platelet Function in Type 2 Diabetes Mellitus.

The purpose of the present study was to determine the effects of exenatide treatment on platelet function in type 2 diabetes mellitus (DM) patients. Case-control observational study. University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara from October 2016 to October 2018. This study included 50 patients with type 2 DM, who had started exenatide therapy; and age-gender matched 54 control subjects. The biochemical data and BMI of the patients were analysed at the time of admission and after six months of exenatide treatment. PDW (platelet distribution width) and MPV (mean platelet volume) were higher in the diabetic patient group than in the control group (p <0.01 and p=0.036, respectively). Significant positive correlations were determined between PDW and BMI (p<0.001), FPG (p <0.001), and HbA1c (p<0.001). After six months of exenatide treatment, PDW (p = 0.015) values and platelet count (p = 0.003) were significantly decreased. Exenatide causes a decrease in PDW value and platelet count independent of its positive effect on lipid profile, glycemic regulation, and weight loss, which contributes to explain the effect of treatment on the cardiovascular system through a different mechanism. Key Words: Exenatide, Type 2 diabetes mellitus, Platelet count, Platelet distribution width, Mean platelet volume.

Evaluation of Tear Film Osmolarity Among Diabetic Patients Using a TearLab Osmometer.

PurposeThe purpose of the present study is to determine the effects of type 2 diabetes mellitus on tear osmolarity using a TearLab Osmolarity system. Moreover, the relationship between tear film osmolarity and ocular surface discomfort in controlled and uncontrolled diabetic patients was assessed.Materials and MethodsThis study included 20 male type 2 diabetic patients aged 20 to 70 years (mean ± SD 49±12). A control group (18–43 years; 32.2 ± 6.5 years) consisting of 40 male subjects was also enrolled for comparison. The tear osmolarity was measured using the TearLab Osmolarity System. The ocular surface disease index questionnaire (OSDI) was used to assess ocular discomfort symptoms.ResultsThe mean tear osmolarity was 297 ± 8.00 and 296 ± 11 mOsm/L for controlled and uncontrolled diabetic subjects, respectively, while the average osmolarity in the control group was 299 ± 8.00 mOsm/L. No significant differences were detected in tear osmolarity between the control and diabetes groups. The ocular surface disease index questionnaire (OSDI) score was significantly higher in the diabetic patient group. No significant correlation was found between tear osmolarity and OSDI scores.ConclusionThe ocular discomfort symptoms score in diabetic patients was significantly higher compared to normal eye subjects. Tear osmolarity was not significantly different in diabetic patients. This finding may be explained by a lack of relationship between tear film parameters and diabetic severity; tear film parameters may correlate more with diabetic duration rather than severity. Therefore, studies focused on diabetes duration and tear film parameters are recommended.

Evaluation of the relationship between different factors of self-management and control of diabetes in diabetic patients group

Introduction: Diabetes is one of the most common chronic diseases that severely affects the quality of life. Self-Management and glycemic control minimize the development and progression of diabetes’s complications. Objectives: We aimed to evaluate self-care behaviors and their relationship with hemoglobin A1c (HbA1c) level in patients with type 2 diabetes, using the Diabetes Self-Management Questionnaire (DSMQ). Patients and Methods: This is a cross-sectional study conducted on type 2 diabetic patients referred to the Shahid Beheshti hospital of Qom. A total of 325 patients with type-2 diabetes participate in the study. Diabetes self-management parameters were assessed using the translated (Persian) version of the DSMQ. Results: The mean score of self-management (±SD) in patients was 26.82 (±9.43). In addition, the mean HbA1c and fasting blood sugar (FBS) levels of the participants respectively were 8.35 (±1.97) and 187.25 (±77.51). There was a significant inverse correlation between self-management score metabolic control indices. (P&lt;0.001). Health care use subscales have been best associated with better glycemic control (P&lt;0.001) and physical activity had the least effect on it (P&lt;0.001). Conclusion: The findings of this study revealed that there is a significant relationship between self-management indicators and control of diabetes.

Association of diabetes with severity and mortality in hospitalized patients with COVID-19 in Wuhan, China: a single-centered, retrospective study.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide. The aim this study was to investigate the association of diabetes with severity and mortality among hospitalized patients with COVID-19 in Wuhan, China. This retrospective, single-center case study enrolled a total of 564 patients diagnosed with COVID-19 at the Seventh Hospital of Wuhan City, between January 20 and March 15, 2020. Among the 564 patients with confirmed COVID-19, 509 (85.1%) were discharged and 55 (9.8%) died. The median age was 59 years (range, 10-93 years). A total of 85 (15.1%) patients were diagnosed with diabetes on admission (median age, 65.0 [range, 34-91] years). Patients with diabetes had significantly higher proportions of critical cases (24 [28.2%] vs. 66 [13.8%]) and in-hospital mortality (17 [20%] vs. 38 [7.9%]). Moreover, patients with diabetes presented abnormal levels of multiple indicators concerning lymphopenia, inflammation, heart, liver, kidney, and lung function on admission, while diabetic patient group still display higher troponin T (TnT) levels when approaching discharge. The Kaplan-Meier survival curve indicated a trend toward poorer survival in diabetic patients compared to non-diabetic patients, also evidenced by abnormal laboratory biomarker changes regarding multiple system impairments among COVID-19 patients with diabetes with in-hospital death. The detailed clinical investigation of 564 hospitalized patients with COVID-19 indicated a considerable association between diabetes and COVID-19 severity or mortality. Thus, more intensive treatment may be considered for COVID-19 patients with diabetes, especially regarding to cardiac injury.

Medication, illness duration, and medication adherence among peer support groups of diabetic patients

Medication, illness duration, and medication adherence among peer support groups of diabetic patients

Association of BMI, diabetes, and risk of tuberculosis: a population-based prospective cohort

ObjectiveTo explore whether all individuals with diabetes are at an increased risk of tuberculosis or whether there are high-risk groups of diabetes patients. MethodsA population-based census was conducted in China, including 27 807 individuals. Risk factors for incident tuberculosis were investigated and participants included in the study were linked to the Tuberculosis Management Information System. Cox proportional hazards models adjusting for several variables were constructed in two steps. First, the incident rate of tuberculosis in individuals with/without diabetes was compared without any stratification by high body mass index (BMI). Second, two groups stratified by BMI were compared. ResultsOver 7 years of follow-up, 108 individuals progressed to tuberculosis. In the multivariable Cox regression analysis, participants with diabetes had a 2.26 higher hazard (P = 0.017) of tuberculosis when compared to participants without diabetes. However, participants with a BMI >24 kg/m2 and diagnosed with diabetes had a similar risk as overweight participants without diabetes (P = 0.953), while diabetes with a BMI <24 kg/m2 (adjusted hazard ratio 2.68; P = 0.006) was a risk factor for developing active tuberculosis (compared with non-diabetes with a BMI <24 kg/m2). Among individuals with a low BMI, participants with a Bacille Calmette–Guérin scar showed a decreased tuberculosis risk (adjusted hazard ratio 0.48; P = 0.028). ConclusionsIndividuals with diabetes were found to have a higher risk of developing tuberculosis, but only when they were not overweight, suggesting targeted screening should be considered.

Foetal Organ Implantation into Adult Animals: A Model for In Vivo Culture of stem cells?

Background: Presently stem cell implantations are more and more developed and applied in clinics as alternative and complementary solutions to adult organ transplantation because of the growing demand and capacities to provide these interventions, while lack of donors is patent. But some limitations of stem cell use remain (for instance integration within the recipient organism of engineered tissues and organoids obtained in vitro from stem cells). The use of foetal organ implantation into adult animals may be an alternative for in vivo study of stem cell development and evaluation of the host participation to this process. The objectives of this work were to try different foetal organ implantations into adult animals (part I) and to evaluate their use for repairing experimental lesions of some adult organs (part II). Material and Methods: Part I: In > 650 experiments on rats and mice, different sites of foetal organ syngeneic implantation were proposed. Physiological (electric activity, motor and secretion activity) and morphological (per illumination, ultra sound and magnetic imaging, optic and electron microscopy) methods were used for implant development evaluation during up to 12 months. Part II: Foetal heart and foetal digestive organs were tested for both oesophagus circular defect and heart thermic lesion repair (38 and 29 rats).Trials with foetal pancreas implantation were provided in rats with diabetes induced by Streptozotocin and/or protein deficit and in a small pilot group of diabetic patients. Result: Part I: After a “dedifferentiation” phase, foetal organ implants could grow following ontogenetic pattern but – at least in our experimental conditions - some of them were not able to re-organize as a whole functional adult organ. The factors enhancing or limiting the organoid formation are considered. Part II: Foetal heart implants were proved to enhance heart lesion morphological and functional repair. Foetal oesophagus, stomach or intestine fragments combined with chitosan flaps ensured a complete restoration of the oesophagus wall after oval or segmental resection. Implantation of foetal pancreas was able to reverse Streptozotocin induced diabetes and to prevent chronic glucose disorders following protein deprivation in rats. In patients temporary positive influence was noted. Conclusion: Implantation of different foetal organs into syngeneic adults may constitute a valuable model for theoretical studies of in vivo stem cell differentiation and organoid growth. The ear implantation site deserves special attention. Some interesting applications are possible and worthwhile to be discussed and developed.