Diabetic Patients Research Articles

Impact of diabetes on recovery after radical gastrectomy for gastric cancer: A retrospective cohort study

BACKGROUND Gastric cancer remains a significant global health concern. Radical gastrectomy is the primary curative treatment. Diabetes mellitus is a common comorbidity in patients undergoing surgery for gastric cancer, including radical gastrectomy. Previous studies have suggested that diabetes can negatively affect postoperative outcomes, such as wound healing, infection rates, and overall recovery. However, the specific impact of diabetes on recovery after radical gastrectomy for gastric cancer remains poorly understood. evaluate the influence of diabetes on postoperative recovery, including hospital stay duration, complications, and readmission rates, in patients undergoing gastrectomy for gastric cancer. Understanding these effects could help optimize perioperative management and improve patient outcomes. AIM To investigate the impact of diabetes on recovery after radical gastrectomy for gastric cancer and associated postoperative outcomes. METHODS This retrospective cohort study was performed at the Endocrinology Department of Xuanwu Hospital, Capital Medical University, Beijing, China. We examined patients who underwent radical gastrectomy for cancer between January 2010 and December 2020. The patients were divided into the diabetes and non-diabetes groups. The main outcomes included length of hospital stay, postoperative complications, and 30-day readmission rate. Secondary outcomes included quality of life indicators. Propensity score matching was used to adjust for potential confounding factors. RESULTS A total of 1210 patients were included in the study, with 302 diabetic patients and 908 non-diabetic patients. After propensity score matching, 280 patients were included in each group. Diabetic patients demonstrated significantly longer hospital stays (mean difference 2.3 days, 95%CI: 1.7-2.9, P < 0.001) and higher rates of postoperative complications (OR 1.68, 95%CI: 1.32-2.14, P < 0.001). The 30-day readmission rate was also higher in the diabetic group as compared to the non-diabetic group (12.5% vs 7.8%, P = 0.02). CONCLUSION Patients with diabetes mellitus undergoing radical gastrectomy for gastric cancer experience prolonged hospital stay, increased postoperative complications, and higher readmission rates, thus requiring optimized perioperative management strategies.

36 Kidney MiRNA expression in BTBR ob/ob mice at a critical time point in disease development and progression

Objectives/Goals: Diabetic kidney disease (DKD) affects 40% of diabetic patients, leading to renal failure, yet the molecular drivers remain elusive. MicroRNAs, noncoding regulators of gene expression, may hold the key. This study aims to identify key miRNAs in DKD, providing crucial insights for early intervention. Methods/Study Population: miRNA sequencing was conducted on kidneys from 8-week old male BTBR wild type and BTBR ob/ob mice. BTBR ob/ob mice lack the hormone leptin and spontaneously develop type 2 diabetes, with morphological renal lesions characteristic of human DKD. Total RNA was extracted from whole kidney sections and processed using the QIAseq miRNA library kit. Sequencing was performed on an Illumina NextSeq 550 platform. GeneGlobe analysis was used to identify differentially expressed miRNA functional pathways, while ingenuity pathway analysis (IPA) was employed to predict master regulators and causal networks involved in DKD. Results/Anticipated Results: miRNA sequencing identified significantly differentially expressed miRNAs (p < 0.05) between 8-week-old BTBR WT and BTBR ob/ob male mice, including miR-34a (-6.86 fold), miR-122 (-5.01 fold), miR-129 (-2.23 fold), miR-142a (+2.78 fold), miR-346 (+4.66 fold), miR-547 (-2.49 fold), miR-592 (+11.81 fold), miR-802 (-6.95 fold), and miR-6539 (-7.93 fold). Qiagen GeneGlobe analysis revealed biological processes potentially targeted by these miRNAs, including endocytosis, phagocytosis, hyperglycemia (p = 7.59e-3), and insulin-dependent diabetes (p = 4.32e-4). IPA predicted activation of RRAS, a small GTPase regulating cell growth and signaling (Z-score +2), with miR-34a and miR-122 targeting MYC, PI3K, and TGF-β in DKD progression in BTBR ob/ob mice. Discussion/Significance of Impact: We identified kidney miRNA expression in BTBR ob/ob mice at a pivotal disease stage. miR-34a, miR-122, and RRAS emerged as key drivers in DKD progression, showing remarkable early biomarker potential. These findings lay the groundwork for early detection and innovative therapies to halt DKD and improve patient outcomes.

Multiclass Retinal Image Classification for Diabetic Retinopathy Stages Using DenseNet

Aims: The purpose of this study is to create a deep learning-based method for automatic classification of Diabetic Retinopathy (DR) with the help of convolutional neural networks (CNNs) to facilitate early detection and enhance treatment outcomes. Study Design: Experimental study with model training and testing. Place and Duration of Study: The study was carried out using a dataset of retinal images gathered from publicly available sources Kaggle Datasets. Methodology: The dataset of 2,750 retinal images, labeled into five DR severity grades, was preprocessed using data augmentation methods and divided into training, validation, and test sets. The DenseNet model was trained and tested using performance metrics such as accuracy, precision, recall, and F1-score. Furthermore, a web application was implemented using Streamlit to provide easy-to-use real-time DR classification. Results: Experimental outcomes show that DenseNet-121 exhibited high classification accuracy of 92, 88 percent of validation accuracy and 88.3 percent of recall and precision scores. hence is a robust solution for DR detection in an automated fashion. The efficacy of the model was confirmed using extensive evaluation metrics to ensure its robustness in real-world scenarios. Conclusion: The suggested deep learning model, as part of a web-based application, presents a cost-effective and accessible early DR detection solution. The technique has the capacity to aid medical practitioners in early diagnosis, hence lowering the threat of vision impairment in diabetic patients. It is advisable to carry out further studies to improve the generalization and performance of the model on different datasets.

Barriers and enablers to the uptake of diabetic retinopathy screening at National Hospital Abuja, Nigeria: patients’ perspectives

PurposeTo identify the barriers to and enablers of diabetic retinopathy (DR) screening and their predictors from the perspectives of diabetic patients at the National Hospital, Abuja.MethodsA descriptive, cross-sectional study design was adopted for this study in July 2023. A total of 200 consenting participants scheduled for DR screening were consecutively recruited and interviewed using structured questionnaires. Descriptive statistics were used to summarize the data. A chi-square test was used to determine the associations between barriers/enablers and the sociodemographic characteristics and clinical profiles of the participants. A logistic regression model was used to identify predictors of barriers and enablers of DR screening. A p-value of less than 0.05 was considered significant.ResultsA total of 200 participants was recruited for the study, 105(52.5%) males and 95 (47.5%) females, with a mean age of 54.83 ± 9.6 years. Referral from physician/healthcare providers (43%), self-reporting following visual problems/deterioration (37%), and counselling from healthcare providers (29%) were the main identified enablers of DR screening, while the barriers were long waiting times prior to consultation (48%) and difficulty scheduling appointments (27%). Gender, residence, duration of diabetes, and monthly income were predictors of enablers, while comorbid hypertension was associated with problems with scheduling appointments, a barrier to DR screening (p = 0.01).ConclusionMeasures designed to address long waiting times prior to consultation and ensure flexibility in scheduling appointments are advised to increase the coverage of DR screening services in Abuja. Future research should explore the barriers and enablers of DR screening from the providers' perspectives.

Exploring the impact of glycemic variability on clinical outcomes in critically ill cerebral infarction patients

BackgroundGlycemic variability (GV) is a key determinant of outcomes in critically ill patients, yet its impact on cerebral infarction patients in intensive care units (ICUs) remains underexplored. This study evaluates the association between GV and clinical outcomes, including discharge outcomes, 90-day and 1-year mortality, and ICU/hospital length of stay (LOS).MethodsThis retrospective study of 778 cerebral infarction patients from the MIMIC-IV database assessed GV, calculated as the glucose standard deviation-to-mean ratio during ICU stays. Regression models evaluated GV’s impact on discharge outcomes, mortality, and ICU/hospital LOS, with adjustments for confounders. Restricted cubic spline analyses identified risk thresholds, while sensitivity and subgroup analyses validated findings. Predictive performance was assessed using AUC, NRI, and IDI, and multiple imputation methods addressed missing data.ResultsHigher GV was significantly linked to adverse outcomes. Patients in the highest GV quartile had increased risks of poor discharge outcomes (adjusted OR: 1.83; 95% CI: 1.03–3.32; P = 0.042), 90-day mortality (adjusted HR: 1.51; 95% CI: 1.03–2.22; P = 0.036), and 1-year mortality (adjusted HR: 1.53; 95% CI: 1.07–2.18; P = 0.018). RCS analysis identified critical GV thresholds (≥ 11% for 90-day and ≥ 10% for 1-year mortality). Subgroup analysis revealed stronger associations between GV and poor outcomes in non-diabetic patients (adjusted OR: 1.89; 95% CI: 1.24–2.88; P = 0.003) compared to diabetic patients (adjusted OR: 0.81; 95% CI: 0.53–1.25; P = 0.337). Sensitivity analyses confirmed the robustness of findings across imputation methods.ConclusionsGV independently predicts poor outcomes in ICU cerebral infarction patients. Integrating GV metrics into clinical workflows may improve risk stratification and guide interventions. Future research should validate these findings and explore strategies to reduce GV.

Assessment of epicardial adipose tissue thickness as a novel cardiac risk factor in type 2 diabetic patients: a cross-sectional study

BackgroundThe incidence of type 2 diabetes mellitus is gradually growing with its negative impact on public health. Epicardial adipose tissue (EAT), as a visceral fat, is a source of many adipokines affecting the cardiovascular system. The goal of this investigation was to assess the EAT thickness as a cardiac risk factor in type 2 diabetics compared to nondiabetics along with its possible association with left ventricular diastolic function.A total of 100 subjects have been included in this investigation (50 subjects with type 2 diabetes and 50 controls). EAT thickness has been determined utilizing a transthoracic echocardiogram in the parasternal short and long axis views in front of the right ventricle-free wall at end-diastole along with an assessment of left ventricular diastolic function.ResultsThe investigation demonstrated that type 2 diabetic cases have a statistically significant greater EAT thickness than nondiabetic controls (P value < 0.001). EAT thickness was significantly correlated with the duration of T2DM and diastolic dysfunction even in the absence of cardiovascular history.ConclusionEAT thickness is higher among diabetic patients and is significantly related to the diabetes duration. Increased EAT thickness is related to diastolic dysfunction among diabetic than non-diabetic patients.

New interpretation of diabetic nephropathy or diabetic kidney disease from kidney biopsy: review article.

Many nephrologists considered that renal involvement in diabetes patients was seen as nodular glomerulosclerosis (i.e., Kimmelstiel-Wilson lesions). However, they diagnosed diabetic nephropathy or diabetic kidney disease (DKD) from clinical information on diabetes history, and reports of evaluation by kidney biopsy were scarce. Since the publication of the Tervaert classification of diabetic nephropathy in 2010, reports of kidney biopsy in these patients have increased. Analysis of biopsy specimens revealed not only the Tervaert classification (class I to IV) based on glomerular lesions, but also various other pathologies. Besides nodular lesions, findings included paratubular basement membrane insudative lesions (PTBMILs), polar vasculosis, and nephropathy associated with novel drugs (sodium-glucose transport protein 2 inhibitors and dipeptidyl peptidase-4 inhibitors). PTBMILs are unique to diabetic nephropathy. In patients with continuous hyperglycemia and excessive salt intake, elevated blood osmolality (calculated by serum Na × 2 + serum glucose/18 + serum urea nitrogen/2.8) leads to thirst and excessive drinking, which results in fluid overload and generalized edema. The increase in circulating blood volume is thought to induce PTBMILs because of the influx of serum components into the endothelium of glomerular vessels. This case series review presents diverse kidney biopsy findings in patients with diabetic nephropathy or diabetic kidney disease as well as the pathogenesis.

Prevalence and factors associated with medication adherence among diabetes patients in rural sub-district health facilities in Bangladesh

IntroductionMedication adherence is critical for improving chronic disease outcomes, particularly diabetes mellitus. The prevalence of medication adherence among people with diabetes in rural communities is largely unknown. This study aimed to identify the prevalence and associated factors of medication adherence across sub-district healthcare facilities in Bangladesh.Research design and methodsThis cross-sectional study included 389 diabetic patients from non-communicable disease corners (NCDsC) of four health facilities in Bangladesh, between September and December 2023. Participants were ≥ 18 years old and diagnosed as DM by a registered physician and/or receiving anti-diabetic medication for at least six months. Independent variables included socio-demographic characteristics, behavioural characteristics, clinical history, and treatment status. Medication adherence was identified using the Morisky medication adherence scale (MMAS-8) (© 2006 Donald E. Morisky), and logistic regression analysis was performed to establish associated factors of medication adherence.ResultsThe prevalence of high medication adherence was 40.4% (95% CI 35.6–45.3), and low medication adherence was 33.2% (95% CI 28.6–38). High medication adherence was significantly associated with recommended exercise (aOR: 1.78, 95% CI 1.12–2.83; p = 0.015), frequent (at least three within preceding three months) NCDsC visits (aOR: 1.86, 95% CI 1.20–2.86; p = 0.005), and blood glucose levels (aOR: 1.84, 95% CI 1.18–2.86; p = 0.005) after adjusting relevant confounders.ConclusionMaintaining a controlled glycaemic status, frequent visits within the preceding three months, and engaging in recommended physical activity are strongly associated with high medication adherence. These findings will help government, and policymakers design strategies for higher medication adherence, mitigating risks, and managing NCDs in rural communities, thus improving health outcomes.

Cost-of-illness analysis of Chronic Kidney Disease (CKD) management in the Philippines

ABSTRACT Aims To conduct the first comprehensive cost-of-illness analysis for chronic kidney disease (CKD) management in the Philippines, estimating direct medical, direct non-medical, and indirect costs across all disease stages and renal replacement therapies (RRT). Methods A combined top-down and bottom-up quantitative approach was employed. Cost data were collected through facility surveys, literature reviews, and expert panel input. The analysis included cost estimated for both non-diabetic and diabetic CKD scenarios across all stages and RRT modalities. Direct medical costs, transportation costs, and productivity losses were calculated for each CKD stage and RRT option. Results Annual costs for CKD management increased progressively with disease advancement, ranging from PHP 44,610.36 to PHP 116,590.24 for non-diabetic patients and PHP 46,451.88 to PHP 120,948.12 for diabetic patients, excluding complication-related expenses. Significant cost increases were observed between stages G2-G3a and G3b-G4. Analysis of RRT showed comparable annual direct medical costs across modalities (∼PHP 401,000–560,000), with differences primarily observed in annual direct non-medical and indirect costs, which were lower in transplant recipients compared to patients on maintenance dialysis (PHP 37,920–246,480 for dialysis; PHP 3,160 for KT recipients). Limitations The study primarily focused on urban and semi-urban healthcare facilities, potentially limiting generalizability to rural areas. Long-term cost trajectories and quality-of-life measures were not captured due to the cross-sectional nature of the data. Conclusions This analysis provides crucial evidence supporting early detection and intervention strategies in CKD management. It suggests the promotion of peritoneal dialysis as a cost-effective first-line therapy and highlights the long-term economic benefits of kidney transplantation. The findings have significant implications for health policy and clinical practice in the Philippines, offering a foundation for evidence-informed decision-making to improve CKD management sustainability and patient outcomes.

Barriers and facilitators of complications risk perception among rural patients with type 2 diabetes mellitus: a qualitative content analysis

BackgroundDiabetes and its complications have emerged as a significant health threat to rural residents. Accurately perceiving the risk of complications may play a crucial role in modifying health behaviors and preventing complications’ occurrence. We aimed to explore the barriers to and facilitators of risk perception of complications in rural patients with type 2 diabetes mellitus, and to provide new perspectives and ideas for the development of relevant interventions in the future.MethodsThis study adopted the qualitative content analysis method. Semi-structured interviews were conducted with 14 rural diabetic patients selected by purposive sampling from July to September 2023, and the interview data were systematically analyzed.ResultsData analysis identified 9 sub-themes falling into the 2 macro-themes: (a) facilitators of complications risk perception (Increased disease knowledge, Low sense of disease control, Risk experiences, Negative mindset); (b) barriers to complications risk perception (Lack of awareness of diabetes or its complications, Information barriers, Optimistic bias, Overconfidence, Disease generalization).ConclusionsThis study explored the barriers and facilitators of complication risk perception among rural patients with type 2 diabetes mellitus, offering new insights into risk perception research, and aiding primary medical staff to develop targeted intervention measures to ensure that rural diabetes patients can accurately and objectively perceive risk.

Preparation of a flexible glucose electrochemical sensor and its detection in elderly diabetic patients

The study proposes a diabetes detection scheme based on a novel flexible glucose electrochemical sensor for the current situation of diabetes management in China, especially for the elderly diabetic population. The sensor is fabricated using optimized conductive materials and diluents with set printing parameters. It mainly realizes non-invasive monitoring of human blood glucose by detecting human sweat, thus effectively detecting elderly diabetic patients. Simulation experiments showed that the sensor had a detection limit of 7.33 μM (S/N = 3) and a high sensitivity of 23.5 μA mm−2 for simulated sweat, demonstrating good stability and durability. Moreover, in the actual in vitro detection experiments, the sensor detected elderly diabetic patients with an accuracy of more than 98.3%. In addition, the response time of the sensor was very short, only 10.5 s to complete a detection, which was suitable for elderly patients. The above illustrated that the flexible glucose electrochemical sensor prepared in the research had certain feasibility and accuracy in the blood glucose monitoring of elderly diabetic patients. The research results not only provide theoretical basis and technical support for the preparation of flexible glucose electrochemical sensors, but also provide new ideas and methods for blood glucose monitoring and treatment of elderly diabetic patients.

Soy Milk with Cinnamon and Green Grass Jelly: An Alternative Snack for Type 2 Diabetes Patients

ABSTRACT Soy juice or also known as soy milk is in great demand by people who are allergic to cow's milk. Existing soy milk usually smells a little languorous so it is less desirable, to anticipate this by adding pandan leaves when boiling it or by adding synthetic essences. In this research, soy milk will be added with ingredients that have never been used and combined, namely cinnamon and green grass jelly. This research aims to evaluate the acceptability and nutritional benefits of soy milk with cinnamon and green grass jelly as an alternative snack for type 2 diabetes patients. The research design used is an experiment by giving treatment to samples to find out the acceptability of the product after being treated. The product made was carried out 3 treatments on the composition of ingredients (weight) with the ratio of Soy Milk : Cinnamon Powder : Green grass jelly as follows : Formulation 1 (SC01) = 150 : 1 : 50, Formulation 2 (SC02) = 150 : 1,5 : 50, Formulation 3 (SC03) = 150 : 2 : 50. Tests on soy milk with the addition of cinnamon powder and green grass jelly were carried out through 2 types of tests, namely subjective tests and objective tests. Subjective tests (organoleptic tests) were conducted with a target of 30 trained panelists using a hedonic scale to analyze the level of liking based on color, taste, aroma, and texture. As for objective tests using gravimetric tests in the laboratory by looking at the fiber and chromium content in soy milk with the addition of cinnamon powder and green grass jelly. Based on the results of the Organoleptic Test on all formulas, the most preferred is formula SC03 with 17 panelists/56.7%, the aroma of formula SC02 with 18 panelists/60%, the taste of formula SC02 with 14 panelists/46.6%, the viscosity/texture of formula SC02 and SC03 with 15 panelists/50%. INDEX TERMS Acceptability, Type 2 diabetes mellitus, Chromium level, Fiber level, Soy milk, Cinnamon, Green grass jelly

The Impact of Diabetes mellitus (DM) on Oral Health

Background: Millions of individuals worldwide suffer from diabetes mellitus (DM), a global health crisis. Patients with diabetes are more likely to experience dental caries, periodontal disease, and oral infections, among other oral health problems. In addition to lowering quality of life, these dental issues increase the total health burden for diabetics. There is still little data on how diabetes management affects oral health outcomes, despite the established links between diabetes and dental health. Aim: This study aims to assess the oral health status of individuals with (DM) and examine the relationship between glycemic control (HbA1c levels) and oral health conditions, including dental caries, periodontal disease, and oral infections, in a clinical setting. Methods: From March 2023 to March 2024, a cross-sectional study was carried out at Sadar Hospital in Hajipur, Bihar. 115 individuals with Type 1 and Type 2 diabetes were enrolled in the study. A licensed dentist conducted oral health examinations to examine mouth infections, periodontal disease, and dental caries. The HbA1c values of the subjects were used to calculate their glycemic control, and information about their demographics, length of diabetes, and dental hygiene habits was gathered. SPSS version 23.0 was used to conduct the statistical analysis. Results: The results indicated that 68.7% of participants had dental caries, 53.0% had periodontal disease, and 39.1% exhibited oral infections. A significant positive correlation was found between the duration of diabetes and the incidence of these oral health issues (p &lt; 0.05). Additionally, participants with poorly controlled diabetes (HbA1c ? 7%) exhibited significantly higher rates of periodontal disease and oral infections compared to those with controlled diabetes (HbA1c &lt; 7%) (p &lt; 0.01). No significant differences were observed between Type 1 and Type 2 diabetes patients regarding oral health conditions. Conclusion: (DM) is strongly associated with poor oral health, with longer diabetes duration and poor glycemic control contributing to more severe oral complications. Effective diabetes management, including maintaining controlled blood sugar levels, is crucial for preventing and managing oral health issues in diabetic patients. Recommendations: Clinicians should emphasize the importance of regular oral health check-ups for diabetic patients and integrate dental care into the overall management of diabetes. Improved interdisciplinary collaboration between endocrinologists and dental professionals is essential for the comprehensive care of diabetic individuals. Keywords: Diabetes mellitus, oral health, periodontal disease, glycemic control, dental caries.

Effect of hyaluronic acid gel with and without metronidazole on healing of extraction sockets in diabetic patients—a randomized controlled study

Effect of hyaluronic acid gel with and without metronidazole on healing of extraction sockets in diabetic patients—a randomized controlled study

Subclinical Changes in Type 2 Diabetes Patients with Heart Failure Stage A and B Treated with Oral Semaglutide

Background and Objectives: Heart failure (HF) among patients with type 2 diabetes (T2DM) is linked to significant morbidity and mortality, despite the increased availability of new drug therapy. This study aims to investigate subclinical changes in patients with HF stage A (at risk for HF) and B (Pre-HF) and T2DM treated with oral semaglutide. Materials and Methods: In a prospective, observational, single-center study, 50 T2DM patients were assessed at baseline and one-year follow-up for changes in spectral Doppler, tissue Doppler, and speckle-tracking (2DST) and metabolic parameters. Results: Correlation and regression analyses identified predictors of Δ GLS. In correlation analysis, Δ GLS showed a negative correlation with Δ VAI (rho = −0.3, p = 0.02), Δ LAP (rho = −0.3, p = 0.04), Δ FPG (rho = −0.3, p = 0.009), Δ TG (rho = −0.4, p = 0.004), and Δ TyG (rho = −0.3, p = 0.02). In linear stepwise regression analysis, the most accurate model, with a p-value &lt; 0.001, was M3, explaining 70% of the variance in Δ GLS (adjusted R2 = 0.7); this model included Δ FPG (beta −0.4, p = 0.001), Δ CRR (beta −1.3, p &lt; 0.001), and Δ LDLc (beta 0.6, p = 0.01). Conclusions: These findings show that improved subclinical left ventricular systolic dysfunction is associated with improved glycemic control, visceral adiposity, and reduced insulin resistance, respectively, with improved lipid profiling.

Single-cell RNA sequencing reveals a new mechanism of endothelial cell heterogeneity and healing in diabetic foot ulcers

Diabetic foot ulcers (DFU) are a common and severe complication among diabetic patients, posing a significant burden on patients’ quality of life and healthcare systems due to their high incidence, amputation rates, and mortality. This study utilized single-cell RNA sequencing technology to deeply analyze the cellular heterogeneity of the skin on the feet ofDFU patients and the transcriptomic characteristics of endothelial cells, aiming to identify key cell populations and genes associated with the healing and progression of DFU. The study found that endothelial cells from DFU patients exhibited significant transcriptomic differences under various conditions, particularly in signaling pathways related to inflammatory responses and angiogenesis. Through trajectory analysis and cell communication research, we revealed the key role of endothelial cell subsets in the development of DFU and identified multiple important gene modules associated with the progression of DFU. Notably, the promoting effect of the SH3BGRL3 gene on endothelial cell proliferation, migration, and angiogenic capabilities under high glucose conditions was experimentally verified, providing a new potential target and theoretical basis for the treatment of DFU. This study not only enhances the understanding of the pathogenesis ofDFU but also provides a scientific basis for the development ofnew therapeutic strategies.

MicroRNA expression profiling in type 2 diabetes patients treated with liraglutide

MicroRNA expression profiling in type 2 diabetes patients treated with liraglutide

Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-to-high-density lipoprotein ratio with diabetic nephropathy.

The aim of this study was to determine the relationship between albuminuria and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-high density lipoprotein-cholesterol ratio (MHR). Patients with type 2 diabetes mellitus diagnosis, aged over 18, had estimated glomerular filtration rate (eGFR) ≥60 mL/dk/1.73 m2 included. Patients were divided into groups according to ACR values: <30 mg/g (group 1), 30-300 mg/g (group 2) and >300 mg/g (group 3). We examined whether there was a significant difference in NLR, PLR, and MHR among the three groups. A total of 360 patients were included in the study. NLR was significantly higher in group 3 than in group 1 (p = 0.016). There was no significant difference in PLR or MHR among the three groups (p = 0.312 and p = 0.687, respectively). A significant difference was detected in NLR in comparison between the groups with and without diabetic nephropathy, but there was no significant difference in PLR or MHR (p = 0.028; p = 0.950 and p = 0.389, respectively). NLR correlated with creatinine and ACR (r: 0.166, p = 0.002; r: 0.144, p = 0.006, respectively). MHR correlated positively with creatinine (r: 0.25.3, p = 0.016, respectively). NLR was significantly higher in the diabetic nephropathy group than in the non-diabetic nephropathy group. This may suggest that NLR can be used as a prognostic marker in diabetic nephropathy. Although there was no significant relationship between MHR and albuminuria, MHR positively correlated with creatinine and negatively correlated with eGFR. Therefore, MHR may be useful in monitoring the development and progression of chronic kidney disease in diabetic patients rather than in the early stages. However, further studies are needed.

Cytotoxic Edema of Bilateral Semicentrum Ovale in Uremic Encephalopathy: A Rare Radiological Entity

Uremic encephalopathy can mimic clinically and radiologically like a stroke. The presence of cytotoxic edema in bilateral semicentrum ovale without involvement of basal ganglion is uncommon in uremic encephalopathy in a diabetic patient. Here we demonstrate the rare white matter radiological subtype of uremic encephalopathy in a 48-year-old woman with chronic kidney disease.

Community perspectives on foot care interventions delivered by community health workers

Diabetic Foot Ulcers (DFUs) were found to have a relatively high prevalence among type 2 diabetic patients and must never be neglected due to the high associated amputation rate. Community health workers (CHWs) showed promising strategies to combat DFUs in several countries. This study aimed to identify community perspectives on foot care intervention delivered by CHWs. Semi-structured interviews were conducted to gather the opinions of key stakeholders’ patients, their family members, CHWs, and health care professionals (HCPs) regarding the acceptability and practicality of FCI by CHWs in the Indonesian context. The recordings of all 29 interviews were transcribed and translated into English. Reflexive thematic analysis (RTA) was used to analyse the qualitative data. The opinions and perceptions of participants in delivering and receiving foot care education in the community were presented in five themes around community experiences in diabetic foot prevention, enhanced healthcare uptakes by extending CHW role, community embeddedness, CHW resources, and community training approach. Overall, the study findings supported the acceptability of CHWs delivering a FCI, albeit some barriers were identified related to the practical aspects of implementing this intervention around the community actors and healthcare policy in the community settings.