Disorders In Diabetic Patients Research Articles

BIDIRECTIONAL INTERACTION OF BLOOD GLUCOSE AND MENTAL STATUS AND ITS ROLE IN DEVELOPING DIABETES MELLITUS AND PSYCHIATRIC DISORDERS – SYSTEMATIC REVIEW

Blood glucose concentration in certain situations affects current mental status. Anxiety occurring during hunger or lack of concentration associated with hypoglycemia are well-known phenomenon. Variations of glucose levels may also present a long-term impact on mental status and mental health. Moreover, impaired mental status leads to neglecting health-promoting life choices in some individuals, while psychiatric disorders may contribute much more to the development of metabolic diseases. Aims: The aim of this review is to assess the current state of knowledge about the bidirectional interaction of blood glucose levels, including its fluctuations and management, and mental status. Methods: In our publication we used scientific sources such as publications and textbooks. Results: Studies show the most significant correlation between diabetes and psychiatric disorders, mostly depression, but also indicate that healthy individuals may present a correlation of metabolic and mental disorders. Diabetic patients are more prone to develop psychiatric disorders, but also psychiatric patients are more commonly affected by diabetes mellitus. Moreover, those suffering from both diseases show the highest risk of overall mortality. Inflammatory pathology of both diabetes and depression, which is the most common psychiatric disorder in diabetic patients, suggests that chronic inflammation may play the main role in this relationship. Conclusion: Analyzing different risk factors of comorbidity, the significance of reversible ones is indisputable. Taking that into account, some lifestyle changes may be beneficial for metabolic and mental disorders prevention. Further studies could indicate certain pathological relationships and help understand the correlation between blood glucose and mental state in healthy individuals.

The regulatory role of erythropoietin in diabetes mellitus: a focus on oxidative and glycemic statuses

Background and objectives. One of the leading causes of disability and death among the population is type 2 diabetes mellitus (T2DM), which is characterized by persistent hyperglycemia. The disease is associated with disorders including oxidative stress and resistance to insulin action, which are involved in the progression of other diabetic complications. Such complications strongly rationalize the need for advanced treatment strategies. Considering the antioxidant, and anti-inflammatory in addition to cytoprotective properties of erythropoietin (EPO), it may offer a new potential strategy for the management of these disorders in diabetic patients. This review aims to explore the effects of EPO on oxidative stress and insulin resistance and its impact on glucose metabolism to guide healthcare professionals to a novel approach for controlling diabetes complications. Materials and methods. This review was conducted by analyzing studies involved with oxidative stress, resistance to insulin, and glucose metabolism in T2DM published in Cochran Library, PubMed, and Google Scholar until February 2024. Results. EPO shows promising beneficial effects in the management of these diabetes-associated disorders. Conclusion. With this beneficial effect of EPO, it is considered a strong candidate and area of development for the creation of new choices in the management of diabetes.

Transcutaneous vagus nerve stimulation modulates depression-like phenotype induced by high-fat diet via P2X7R/NLRP3/IL-1β in the prefrontal cortex.

Depression is a common psychiatric disorder in diabetic patients. Depressive mood associated with obesity/metabolic disorders is related to the inflammatory response caused by long-term consumption of high-fat diets, but its molecular mechanism is unclear. In this study, we investigated whether the antidepressant effect of transcutaneous auricular vagus nerve stimulation (taVNS) in high-fat diet rats works through the P2X7R/NLRP3/IL-1β pathway. We first used 16S rRNA gene sequencing analysis and LC-MS metabolomics assays in Zucker diabetic fatty (ZDF) rats with long-term high-fat diet (Purina #5008) induced significant depression-like behaviors. Next, the forced swimming test (FST) and open field test (OFT) were measured to evaluate the antidepressive effect of taVNS. Immunofluorescence and western blotting (WB) were used to measure the microglia state and the expression of P2X7R, NLRP3, and IL-1β in PFC. Purina#5008 diet induced significant depression-like behaviors in ZDF rats and was closely related to purine and inflammatory metabolites. Consecutive taVNS increased plasma insulin concentration, reduced glycated hemoglobin and glucagon content in ZDF rats, significantly improved the depressive-like phenotype in ZDF rats through reducing the microglia activity, and increased the expression of P2X7R, NLRP3, and IL-1β in the prefrontal cortex (PFC). The P2X7R/NLRP3/IL-1β signaling pathway may play an important role in the antidepressant-like behavior of taVNS, which provides a promising mechanism for taVNS clinical treatment of diabetes combined with depression.

Correlation Between Thyroid Profile and Glycated Haemoglobin (HbA1c) in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is a global health problem affecting major populations worldwide. It is a group of metabolic disorders characterized by absolute or relative deficiencies in insulin secretion with chronic hyperglycaemia and disturbances of carbohydrate, lipid, and protein metabolism. Thyroid hormones are secreted from thyroid gland. Thyroid hormone replacement is associated with a decrease in Glycated Hemoglobin (HbA1c) level. The present study was undertaken to study correlation between thyroid profile and glycated Haemoglobin (HbA1c) in Type 2 Diabetes Mellitus patients. A hospital based case control study was carried out in Dept. of Biochemistry, North Bengal Medical College, Sirajganj, Bangladesh from July to December 2022. 100 participants were in the study group and 100 participants in control groups were enrolled by following procedure. Patients aged 30 years or more who came to routine health check-up were taken for the study. Basic information, clinical history was taken from the record files. 50 cases of Type 2 Diabetes mellitus and 50 healthy controls were taken. Blood samples were collected and analyzed for thyroid profile, HbA1c, Fasting Blood Sugar and Renal Function Test. We found that there was a positive correlation between TSH (Thyroid stimulating hormone) and HbA1c levels, and a negative correlation between Thyroid hormones [Triiodothyronine (T3) & Thyroxine (T4)] and Glycated Haemoglobin (HbA1c) in cases of type 2 Diabetes Mellitus. There is a significant decrease in TT3 (Total Triiodothyronine) and TT4 (Total Thyroxine) and significantly increased TSH in cases of Diabetes mellitus as compare to healthy Controls. We found that out of 50 cases of type 2 Diabetes Mellitus, 31% patients showed thyroid disorders. There is a high prevalence of thyroid disorders in Diabetic patients. If not diagnosed early, it could negatively affect diabetes and its complications. Therefore, routine screening of thyroid profile in diabetic patients is advisable to improve quality of life and reduce morbidity rate.

Prevalence of Anxiety and Depression Disorders among People with Diabetes Monitored at the Diabcarmet Center in Thiès (Senegal)

Introduction: The association of diabetes and anxiety-depressive disorders in the same person is problematic. The aim of our work was to evaluate the prevalence of depressive and anxiety disorders in diabetic patients and to highlight the link between anxiety and depressive disorders and diabetes. Methodology: In our transversal and descriptive study, with analytical purposes, we studied 50 cases. The study took place over a period of 4 months (from April to July 2022), focusing on diabetic patients. Results: Our study included 50 patients with a mean age of 55 ±13 years with a range from 30 to 80 years. The sex ratio was 1.17. The prevalence of depressive disorders was 28% and of anxiety disorders 36%. On bivariate analysis, age, sex, and occupation were associated with depression, and only age was associated with anxiety. On multivariate analysis, female gender (OR=33.8; CI=3.89-293.32), age over 50 years (OR=6.71; CI=[1.31; 34.38]), occupational inactivity (OR=15.5; CI=[3.47;69.16]) exposed diabetic patients to an additional risk of depression and only age over 50 years (OR=3.97; CI=[1.07; 14.72]) exposed diabetic patients to an additional risk of anxiety. Conclusion: Our study highlights the importance of screening for anxiety and depression in diabetic patients to prevent complications and their progression.

CcpA-Knockout Staphylococcus aureus Induces Abnormal Metabolic Phenotype via the Activation of Hepatic STAT5/PDK4 Signaling in Diabetic Mice.

Catabolite control protein A (CcpA), an important global regulatory protein, is extensively found in S. aureus. Many studies have reported that CcpA plays a pivotal role in regulating the tricarboxylic acid cycle and pathogenicity. Moreover, the CcpA-knockout Staphylococcus aureus (S. aureus) in diabetic mice, compared with the wild-type, showed a reduced colonization rate in the tissues and organs and decreased inflammatory factor expression. However, the effect of CcpA-knockout S. aureus on the host's energy metabolism in a high-glucose environment and its mechanism of action remain unclear. S. aureus, a common and major human pathogen, is increasingly found in patients with obesity and diabetes, as recent clinical data reveal. To address this issue, we generated CcpA-knockout S. aureus strains with different genetic backgrounds to conduct in-depth investigations. In vitro experiments with high-glucose-treated cells and an in vivo model study with type 1 diabetic mice were used to evaluate the unknown effect of CcpA-knockout strains on both the glucose and lipid metabolism phenotypes of the host. We found that the strains caused an abnormal metabolic phenotype in type 1 diabetic mice, particularly in reducing random and fasting blood glucose and increasing triglyceride and fatty acid contents in the serum. In a high-glucose environment, CcpA-knockout S. aureus may activate the hepatic STAT5/PDK4 pathway and affect pyruvate utilization. An abnormal metabolic phenotype was thus observed in diabetic mice. Our findings provide a better understanding of the molecular mechanism of glucose and lipid metabolism disorders in diabetic patients infected with S. aureus.

The Role of the Adrenal-Gut-Brain Axis on Comorbid Depressive Disorder Development in Diabetes.

Diabetic patients are more affected by depression than non-diabetics, and this is related to greater treatment resistance and associated with poorer outcomes. This increase in the prevalence of depression in diabetics is also related to hyperglycemia and hypercortisolism. In diabetics, the hyperactivity of the HPA axis occurs in parallel to gut dysbiosis, weakness of the intestinal permeability barrier, and high bacterial-product translocation into the bloodstream. Diabetes also induces an increase in the permeability of the blood-brain barrier (BBB) and Toll-like receptor 4 (TLR4) expression in the hippocampus. Furthermore, lipopolysaccharide (LPS)-induced depression behaviors and neuroinflammation are exacerbated in diabetic mice. In this context, we propose here that hypercortisolism, in association with gut dysbiosis, leads to an exacerbation of hippocampal neuroinflammation, glutamatergic transmission, and neuronal apoptosis, leading to the development and aggravation of depression and to resistance to treatment of this mood disorder in diabetic patients.

Evaluation of Posture, Balance and Gait Disorders in Diabetic Patients

Giriş: Diabetes mellitus yaş ve cinsiyet ayırımı gözetmeksizin görülebilen kronik metabolik bir hastalıktır. En sık görülen komplikasyonlarından biri polinöropati (PNP) olup denge, postür ve yürüme bozukluklarına yol açabilmektedir. Diyabetik hastalarda nöropati varlığının postür, denge ve yürüme bozukluklarında olası rolünün belirlenmesi amaçlanmıştır. Yöntem: Çalışmaya Çukurova Üniversitesi Tıp Fakültesi Dahiliye-Endokrinoloji Anabilim Dalı polikliniğinde diabetes mellitus tanısı ile izlenen olgular alınmıştır. Bu olgularda yürüme ve denge statik postürografi (göz açık, göz kapalı, baş sağa, baş sola ve tandem Romberg) ve Tinetti Denge ve Yürüme Skalası ile değerlendirilmiş olup eşlik eden otonomik ve periferik sinir tutulumunu belirlemek için elektronörografi (ENG) ve sempatik deri yanıtlarına (SDY) bakılmıştır. Elde edilen veriler kontrol grubu ile karşılaştırılmıştır. Bulgular: Diabetes mellitus tanılı toplam 29 hasta ve 16 sağlıklı kontrol grubu çalışmaya dahil edilmiş olup ortalama yaş sırası ile 49,9±7,1 ve 47,7±6,6 yıldır. Diyabetiklerde median ve ulnar sinirlerde duyusal iletim hızları ve peroneal ve ulnar sinirlerde ise motor iletim hızları normal kotrollere göre yavaşlamış bulunmuştur. Bu değerler istatistiksel olarak anlamlıdır (p<0.001 ve p<0.003). Klinik tablo ile birlikte yorumlanacak olur ise diyabetiklerin ENG çalışması sonucunda 14’ünde PNP saptanmış, 15’inde ise polinöropatiyi telkin eden bulgular gözlenmemiştir. SDY bakıldığında diyabetiklerde 3 olguda ayakta, 2 olguda ise hem ayak hem de elde SDY’ları elde edilememiştir. Böylece 5 olguda (5/29; % 17,2) otonomik (sudomotor) lif tutuluşu görülmüştür. Bu 5 olguda ENG verileriyle polinöropati tanısı da konmuştur. Tinetti yürüme, denge ve total skor istatistiksel olarak anlamlı olacak şekilde normal kontrol olgularından daha düşük olarak elde edilmiştir (p<0.001). Postürografik çalışma platform üzerinde başın sağ veya sola dönük olduğu pozisyonda ve tandem Romberg testi ile diyabetiklerin normallere göre daha fazla salındığı ve istatistik olarak bu farkın anlamlı olduğu görülmüştür (sırası ile p=0,002; p=0,03 ve p=0,041). Sonuç: Çalışmamız diyabetik hastalarda nöropati varlığı ile doğrudan ilişkili olmakla birlikte polinöropatisi olan ve olmayan olgularda postüral stabilite ve dengenin kontrol grubuna göre bozuk olduğunu ortaya koymuştur.

The prevalence of anxiety and depressive disorders in patients with diabetes

Introduction: Diabetes is a common chronic metabolic pathology that affects 7.3% of Moroccans. Many epidemiological studies have shown that diabetes and anxiety-depressive disorders are associated in a non-random way and complicate each other. Materials and methods: We conducted a cross-sectional study to the prevalence of depressive episode and anxiety in diabetic patients, and to trace their sociodemographic and medical profile. The study included 130 patients from the diabetes endocrinology department and the diabetes consultation of the Avicenna Military Hospital of Marrakech. The scale used was the HADS (Hospital Anxiety and Depression Scale) in its Arabic version. Sociodemographic and diabetes characteristics were collected by hetero-questionary. Results: The average age of our patients was 50.5 years, 52% were female. The prevalence of depressive disorder was 43% and that of anxiety disorder 50%. Data analysis showed some significant results by highlighting the factors associated with anxiety and depressive disorders: Factors related to sociodemographic characteristics (age and gender), socioeconomic characteristics (professional activity) and medical characteristics (Comorbidities, toxic antecedents and family antecedents of diabetes) characteristics related to the pathology itself (type and age of diabetes, its acute and chronic complications and the therapeutic regime). Conclusion: The research and treatment of anxiety-depressive disorders in diabetic patients should be systematic in order to improve the management and prognosis of diabetes.

The Color Vision Disorder in Diabetic Patients

Introduction: The visible spectrum (about 400 to 700 nm) with a mosaic of three classes of photoreceptors compose the human visual system. They are sensitive to different wavelength ranges with overlapping. The receivers have high sensitivities at short wavelengths (~440 nm), medium (~535 nm), or longer (~565 nm), which are S, M, and L cones, respectively. The study aimed to determine blue color vision defects in diabetes mellitus.
 Methods: A cross-sectional study was done at an ophthalmology clinic on 200 eyes (right and left) of patients with DM for a period of 5 one years (2021). Ishihara plates were used initially for screening. The D-15 test was performed for the evaluation of color vision.
 Results: The mean age of the sample was 45.66±15.65 years. The most frequent disorder visualized was tritanomaly in 63%, followed by trichromate in 27%, and the least disorder was deuteranomaly in 2%. In addition, mixed disorder is seen in 8% of cases. In relation to laterality, right eye tritanomaly was found in 34%, while the left eye was recorded in 29%. The right eye trichromate was observed in 12%, whereas the left eye was reported in 15%. The left eye deuteranomaly was reported more than the right (1.5% vs. 0.5%).
 Conclusion: Color vision evaluation with good screening color vision test can be detected even before clinically visible diabetic retinopathy. Early detection was helpful in the prevention of vascular changes in the retina. All diabetic patients should be given proper awareness and health education regarding color vision deficiency. Timely assessment of color vision may detect tritanomaly earlier in diabetics.

Sleep and probiotics in diabetes management

In this manuscript, we call attention to the importance of investigating affordable strategies to improve the management of diabetes. Studies indicate that imbalances in the gut microbiota may lead to the development and progression of this disease. At the same time, poor sleep and sleep disorders, which are very prevalent in individuals with diabetes, can be related to a worse prognosis for the disease and can be impacted by changes in the intestinal microbiome. A suggested treatment that may be effective in controlling diabetes and improving sleep quality through increased metabolic regulation is probiotic supplementation. Scientific evidence has shown a relationship between the use of probiotics and improvements in sleep, in glucose concentrations, and in the levels of high density lipoprotein cholesterol. We suggest that probiotic supplementation can play an important role in the management of diabetes and sleep disorders in diabetic patients. Further randomized clinical studies should be undertaken to better understand the impact and effectiveness of the use of probiotics in improving sleep and controlling diabetes.

Melanoma Misdiagnosed as Multiple Diabetic Foot Ulcer: A Case Report

Malignant skin ulcerations may mimic diabetic foot ulcers leading to misdiagnosis. In this case report, we discuss an uncommon but severe problem of malignant tumors initially misdiagnosed as diabetic foot ulcers, underlying the need to improve medical awareness, diagnostics, and approaches for therapy once the correct diagnosis is made. We describe the case of an 82-year-old male with diabetes mellitus and melanoma metastases initially misdiagnosed as diabetic foot ulcers. In diabetic patients, several skin disorders may coexist on the same foot, including actual diabetic foot ulcers and skin cancers. Among multiple skin disorders that coexist on the foot of a diabetic patient, the skin metastases may be misdiagnosed as diabetic foot ulcers. Significant efforts should be made to create new non-invasive, rapid diagnostic techniques to eliminate misdiagnoses of skin disorders in diabetic patients.

Intestinal Region-Dependent Alterations of Toll-Like Receptor 4 Expression in Myenteric Neurons of Type 1 Diabetic Rats.

Toll-like receptor 4 (TLR4) can activate pro-inflammatory cascades in the gastrointestinal tract. Our aim was to determine TLR4 expression in myenteric neurons of different gut regions using a type 1 diabetic model. Ten weeks after the onset of hyperglycemia, myenteric whole-mount preparations from the duodenum, ileum and colon of streptozotocin-induced diabetic, insulin-treated diabetic and control rats were prepared for TLR4/peripherin double-labelling fluorescent immunohistochemistry. Immunogold electron microscopy was applied to evaluate TLR4 expression in the myenteric perikaryon and neuropil. Tissue TLR4 levels were measured by enzyme-linked immunosorbent assay. In controls, the number and proportion of the TLR4-immunoreactive myenteric neurons showed an increasing tendency to aboral direction. These values were significantly higher in diabetics compared to controls in the duodenum and ileum, but were significantly lower in the colon. In diabetics, the distribution of TLR4-labelling gold particles between the perikaryon and neuropil of myenteric neurons varied in a different way by intestinal segment. TLR4 tissue concentration changed only in the diabetic duodenum, and it decreased in muscle/myenteric plexus-containing homogenates, while it increased in mucosa/submucosa/submucous plexus-containing samples relative to controls. Insulin had beneficial effects on TLR4 expression. These findings support that chronic hyperglycemia has segment-specific effects on TLR4 expression, contributing to gastrointestinal disorders in diabetic patients.

Machine Learning System for Predicting Cardiovascular Disorders in Diabetic Patients

Introduction. Patients with diabetes are exposed to various cardiovascular risk factors, which lead to an increased risk of cardiac complications. Therefore, the development of a diagnostic system for diabetes and cardiovascular disease (CVD) is a relevant research task. In addition, the identification of the most significant indicators of both diseases may help physicians improve treatment, speed the diagnosis, and decrease its computational costs.Aim. To classify subjects with different diabetes types, predict the risk of cardiovascular diseases in diabetic patients using machine learning methods by finding the correlational indicators.Materials and methods. The NHANES database was used following preprocessing and balancing its data. Machine learning methods were used to classify diabetes based on physical examination data and laboratory data. Feature selection methods were used to derive the most significant indicators for predicting CVD risk in diabetic patients. Performance optimization of the developed classification and prediction models was carried out based on different evaluation metrics.Results. The developed model (Random Forest) achieved the accuracy of 93.1 % (based on laboratory data) and 88 % (based on pysicical examination plus laboratory data). The top five most common predictors in diabetes and prediabetes were found to be glycohemoglobin, basophil count, triglyceride level, waist size, and body mass index (BMI). These results seem logical, since glycohemoglobin is commonly used to check the amount of glucose (sugar) bound to the hemoglobin in the red blood cells. For CVD patients, the most common predictors inlcude eosinophil count (indicative of blood diseases), gamma-glutamyl transferase (GGT), glycohemoglobin, overall oral health, and hand stiffness.Conclusion. Balancing the dataset and deleting NaN values improved the performance of the developed models. The RFC and XGBoost models achieved higher accuracy using gradient descending order to minimize the loss function. The final prediction is made using a weighted majority vote of all the decisions. The result was an automated system for predicting CVD risk in diabetic patients.

Early Prediction of a Pre-Symptomatic Neurodegeneration Disorder by Measuring Macrophage Inhibitory Factor Level in Diabetic Patients.

The relationship between diabetes mellitus and neurodegenerative disorders has been of great interest. Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine in which a variety of signaling cascades are activated through it. MIF has been involved in the pathogenesis of several diseases and can predict early pre-symptomatic stages of neurodegeneration in diabetic patients. To investigate whether serum MIF could predict brain neurodegeneration at the early pre-symptomatic stages in diabetic patients. We examined adults with type 2 diabetes mellitus and compared with normal control adults using a short form of the IQCODE and biochemical examination, including assessment of HA1C, fasting blood glucose, lipid profile, and MIF which was measured by ELISA technique. Correlations between parameters were studied. Computational PathLinker bioinformatic tool was used to search for potential pathway reconstructions for the insulin/amyloid-β/MIF signaling. We demonstrated that MIF level was increased in the serum at the early pre-symptomatic stages of neurodegenerative disorder in diabetic patients. In addition, network analysis demonstrates that insulin receptor substrate 1 can ameliorate amyloid-β protein precursor through COP9 signalosome complex subunit 5 that enhances MIF elevation. Diagnosis processes could not be used as routine examinations for still pre-symptomatic neurodegenerative disorders. This may be due to the time constraints and the heavy dependence on the physician's experience. Therefore, serum MIF level could predict brain neurodegeneration at the early pre-symptomatic stages in diabetic patients which may support its potential utility as a clinically useful biomarker.

Case Control Study to Evaluate Tear Film Function and Ocular Surface Disorder in Diabetic Patients

BACKGROUND
 Diabetic retinopathy and early development of cataracts are well-known ocular complications of long-standing diabetes. In recent years various researchers have reported ocular surface disorders, particularly dry eyes in diabetic patients which if left untreated may result in a variety of corneal complications. These ocular surface disorders can be clinically diagnosed by performing a detailed slit lamp examination, Schirmer's test and tear film break-up time. Our study intended at assessing tear film and ocular surface disorders in diabetic patients and study tear film function in them and compare it with non-diabetic patients.
 METHODS
 A comparative cross-sectional study was done on 100 diabetic and 100 non-diabetic patients > 30 years of age visiting OPD of health centre of tertiary care hospital of Central India. Clinical data and detailed clinical history were obtained from all subjects through direct patient interviews and reviewing of their medical records followed by a comprehensive ocular examination that included best-corrected vision, slit lamp examination, and Tear Film break up time (TBUT) & Schirmer test.
 RESULTS
 In our study, mean TBUT was found to be significantly reduced in diabetics (15.94 ± 3.8) as compared to non-diabetics (20.13 ± 6.6). No significant difference was found in the Schirmer test reading between diabetics (17.13 ± 3.20) and non-diabetics (19.20 ± 6.23). Diabetic male patients had significantly decreased mean TBUT & mean Schirmer test readings as compared to diabetic females. Mean Schirmer reading & Mean TBUT were lowest in a patients having > 20 years of DM and highest in patients having < 5 years of DM. No positive correlation was found between HbA1c (Glyosylated Haemoglobin) and diabetic retinopathy with TBUT/ Schirmer test readings.
 CONCLUSIONS
 Our study showed that the tear film stability was found to be affected in diabetic patients, as compared to non-diabetic subjects as evident by the lower level of TBUT in diabetic patients. Significantly reduced TBUT with no significant difference in Schirmer test reading in diabetic as compared to non-diabetic subjects might be due to a decrease in basal secretion with normal overall tear secretion. The absence of subjective symptoms of dryness in spite of decreased TBUT in the diabetic group might be due to a decrease in corneal sensitivity caused by diabetic peripheral neuropathy in diabetic patients. There was an increase in the prevalence of DES with an increasing duration of DM. Rheumatoid arthritis was found to be a risk factor for DES. Diabetic males were found to be at risk for developing dry eye syndrome. Hence it can be concluded from our study that every diabetic patient should undergo a comprehensive eye examination which should include various tests for dry eye assessing multiple tear parameters.

Correlation between Self Efficacy and Coping Mechanism in Patients with Type 2 Diabetes Mellitus

Patients with Diabetes mellitus can experience psychological distress that is stress, depression, and anxiety. Psychological disorders in diabetic patients caused by changes in behavior in everyday life such as physical activity, regular blood glucose control, continuous drug consumption, proper diet, and avoid foot wounds. The patient's response to stress depends on positive coping mechanisms. Positive self-belief or self-efficacy of a patient to the treatment of his illness can increase positive coping mechanisms. This study aims to explain the relationship between self-efficacy with coping mechanisms in patients with type 2 diabetes mellitus. This study used correlation research design with a cross-sectional approach. Sampling technique in this study used consecutive sampling with respondents 36 outpatients type 2 diabetes mellitus in dr. Haryoto Hospital at Lumajang. Data was obtained by giving questionnaires of the Diabetes Management Self Efficacy Scale (DMSES) and the Cope Inventory, analyzed by using Spearman Rank correlation test. This study showed a significant relationship between self-efficacy and coping mechanism (p = 0.001) with a strong and positive correlation (r = 0.673) which shows the higher self-efficacy of the patient then the coping mechanism will better. Patients with type 2 diabetes mellitus who have high self-efficacy in the treatments will have good coping mechanisms in dealing with psychological distress such as stress, depression, and anxiety

Cochleo-vestibular disorders in diabetic patients

Cochleo-vestibular disorders in diabetic patients

The Relationship between Antioxidants Consumption and Insulin Resistance/Insulin Sensitivity in Type 2 Diabetes without and with Coronary Stenosis: A Case-Control Study

Background: Type 2 diabetes (T2D) is known as a common chronic metabolic disease worldwide. Coronary artery diseases are one of the hazardous disorders in diabetic patients. The current study aimed to investigate the relationship between dietary antioxidants intake with insulin resistance and insulin sensitivity among T2D without and with coronary stenosis (CS). Methods: This case-control study was conducted on 247 participants (65 diabetic patients suffered from CS and 172 diabetic patients without CS). Dietary antioxidants intake (vitamin E, Vitamin C, selenium, beta-carotene, and zinc) were assessed with a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ). Blood pressure, weight, and height were measured. Blood sample was collected for glycaemic control assessment. Results: Diabetic patients with CS had significantly higher HbA1c levels (P = 0.004). There was a negative significant association between vitamin E (r = -0.91; P < 0.001) and Beta-carotene (r =-0.88; P < 0.001) with HbA1c among all participants. There was also a positive significant association between vitamin E, vitamin C, and selenium with insulin sensitivity among all the participants; (r = 0.59; P = 0.004) for vitamin E, (r = 0.91; P < 0.001) for vitamin C, and (r = 0.27; P = 0.04) for Beta-carotene. Conclusion: Antioxidants intake especially vitamin C and beta-carotene may have an anti-insulin resistance effect in metabolic disorders.

Endothelial Dysfunction and Diabetic Cardiomyopathy.

The cardiovascular complications contribute to a majority of diabetes associated morbidity and mortality, accounting for 44% of death in those patients with type 1 diabetes mellitus (DM) and 52% of deaths in type 2 DM. Diabetes elicits cardiovascular dysfunction through 2 major mechanisms: ischemic and non-ischemic. Non-ischemic injury is usually under-recognized although common in DM patients, and also a pathogenic factor of heart failure in those diabetic individuals complicated with ischemic heart disease. Diabetic cardiomyopathy (DCM) is defined as a heart disease in which the myocardium is structurally and functionally abnormal in the absence of coronary artery disease, hypertensive, valvular, or congenital heart disorders in diabetic patients, theoretically caused by non-ischemic injury solely. Current therapeutic strategies targeting DCM mainly address the increased blood glucose levels, however, the effects on heart function are disappointed. Accumulating data indicate endothelial dysfunction plays a critical role in the initiation and development of DCM. Hyperglycemia, hyperinsulinemia, and insulin resistance cause the damages of endothelial function, including barrier dysfunction, impaired nitric oxide (NO) activity, excessive reactive oxygen species (ROS) production, oxidative stress, and inflammatory dysregulation. In turn, endothelial dysfunction promotes impaired myocardial metabolism, intracellular Ca2+ mishandling, endoplasmic reticulum (ER) stress, mitochondrial defect, accumulation of advanced glycation end products, and extracellular matrix (ECM) deposit, leads to cardiac stiffness, fibrosis, and remodeling, eventually results in cardiac diastolic dysfunction, systolic dysfunction, and heart failure. While endothelial dysfunction is closely related to cardiac dysfunction and heart failure seen in DCM, clinical strategies for restoring endothelial function are still missing. This review summarizes the timely findings related to the effects of endothelial dysfunction on the disorder of myocardium as well as cardiac function, provides mechanical insights in pathogenesis and pathophysiology of DCM developing, and highlights potential therapeutic targets.