DM Complications Research Articles

Insulin-Related Skin Lipohypertrophy in Type Two Diabetes: A Clinical Study of a Case Series, with Ultrasonographic and Histopathologic Implications

Introduction: The most frequent local complication of insulin injection is the occurrence of subcutaneous nodules due to incorrect injection technique. Injection into nodules negatively impacts metabolic compensation and the requirement for greater insulin doses due to its partial and erratic absorption. Despite these concepts being accepted by the scientific community, it is not yet clear whether injection into nodules is causally related to worsening chronic diabetes (DM) complications and the morphological nature of such nodules. Aim: This multicenter study aimed to evaluate the associations between structural characteristics of skin nodules and chronic DM complications. A secondary endpoint was to evaluate the histological structure of those nodules, looking for differences between lipohypertrophies (LH) and amyloid nodules (LIDA). Methods: For this purpose, 816 DM patients with LH and 1033 without LH underwent a clinical and ultrasound study comparing metabolic data, injection habits, and frequency of complications. Excisional biopsies of the skin nodules were performed in a small series of eight subjects. Results: Data observed confirm a strong relationship between LH and diabetes chronic complications other than poor glycemic control. Histology of biopsies from the skin nodules showed mild foreign-body-like inflammation, prevailing mega-adipocytes (65%), apoptosis, and fibrosis but could not detect any amyloid fibrils. In four cases, intra-nodular fluid was present with an insulin concentration several times higher than in blood. Conclusions: We confirmed LHs to be significantly associated with insulin administration errors, duration of insulin therapy, greater daily doses and duration of insulin administration, and the presence of micro- and macro-vascular DM complications. LH nodules displayed no typical morphological features and were indistinguishable from LIDA nodules with which they shared several histologic similarities, albeit within the frame of a general picture of LIDA inhomogeneity. Further targeted studies are warranted to clarify the remaining doubts.

Mitochondrial Function and Oxidative Stress Biomarkers in Diabetic Retinopathy Development: An Analytical Cross-Sectional Study.

DR is a complex complication of DM with multiple biochemical pathways implicated in its genesis and progression. Circulating OS and mitochondrial function biomarkers represent potential candidates in the DR staging system. We conducted a comparative cross-sectional study comparing the OS biomarkers: TAC, GR, NOS, CARB, and hydroperoxydes, as well as mitochondrial function biomarkers: ATP synthase and ATPase activity in healthy volunteers, DM w/o DR, Moderate and Severe NPDR, and PDR. TAC is progressively diminished the more DR progresses to its proliferative stages. GR and NOS may function as biomarkers to differentiate the progression from S NPDR to PDR. CARB may correlate with the progression from M NPDR to S NPDR. Hydroperoxide levels were higher in patients with DR compared to DM w/o DR expressing OS in the early development of DR. ATPase activity is increasingly augmented the more DR progresses and may function as a biomarker that reflects the difference between N PDR and PDR, and ATP synthesis was lower the more DR progressed, being significantly lower compared to DM w/o DR. The behavior of OS and mitochondrial function in several stages of DR may aid in the staging and the prognosis of DR.

Diabetes-related distress in a multiethnic primary care population with type 2 diabetes mellitus in Singapore: magnitude and associated risk factors

Abstract Introduction: We determined the magnitude and associated risk factors of diabetes-related distress (DRD) in patients with type 2 diabetes mellitus (T2DM) attending primary care clinics. Methods: In this cross-sectional clinic-based study, Singaporean patients with T2DM attending DM complications screening at six polyclinics were recruited. Relevant data were obtained from medical records and questionnaires. ‘Possible’ DRD was indicated by a score of ≥8 on the five-item Problem Areas in Diabetes questionnaire. Multivariable logistic regression was used to examine the sociodemographic, medical, clinical and patient-reported factors associated with possible DRD. Results: Among the 970 participants (median [interquartile range] age 61.0 [55–67] years; 47.1% female, 64.1% Chinese), 171 (17.6%) and 799 (82.3%) had possible DRD and no DRD, respectively. Every 1-year increase in age was associated with a 4% reduction in the odds of having possible DRD (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.94–0.98; P <0.001). Malays had nearly three times the odds of possible DRD compared to Chinese patients. Those with arthritis and any DM complication had two-fold odds of possible DRD. Furthermore, ‘fair/poor’ self-rated health status and ‘poor’ self-rated DM control were independently associated with possible DRD (P <0.05). Conversely, participants who currently consumed alcohol (OR: 0.50, 95% CI: 0.28–0.89; P = 0.019) and those with better health literacy (OR: 0.81, 95% CI: 0.75–0.88; P <0.001) had lower odds of possible DRD. Conclusion: Nearly one in five patients with T2DM had possible DRD in our primary care population. Interventions focusing on improving modifiable factors, together with integration of psychological care, may reduce the levels of DRD in this population.

Characteristics of Urinary Tract Infections in Patients with Diabetes from Timișoara, Romania: Prevalence, Etiology, and Antimicrobial Resistance of Uropathogens.

Background and Objectives: Diabetic patients are more likely to develop infections compared to the general population, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence of UTIs in a population of patients with diabetes (DM) from Romania, to identify the most common uropathogens and their antimicrobial resistance (AMR) patterns, as well as to determine the correlations between resistance behavior and particularities of patients with UTIs according to DM type. Materials and Methods: The hospital records of 1282 type 1 (T1D) and type 2 DM (T2D) adult inpatients who were ordered urine cultures during hospitalization were reviewed, and all 241 patients who presented a positive urine culture were included in the present study analysis. Results: The prevalence of UTIs in diabetic patients was 18.8% and higher in patients with T2D vs. T1D. Patients with UTIs and T2D had a significantly older age, longer duration of DM, higher waist circumference and body mass index, lower levels of estimated glomerular filtration rate, and more frequent chronic complications of DM than patients with T1D. E. coli was the most frequently isolated uropathogen (56.4%), with a significantly higher incidence for T2D, followed by K. pneumoniae (12.9%) and Enterococcus spp. (9.5%). Although the acquired resistance phenotypes were more frequently isolated in T2D patients (over 90% of the multidrug-resistant and extended-spectrum beta-lactamase-producing isolates, respectively, and 75% of the total carbapenem-resistant organisms), no statistically significant correlation was found regarding the distribution of AMR patterns in the two types of DM. Conclusions: The present study brings new data regarding the prevalence of UTIs in diabetic patients from Western Romania. By identifying the spectrum of uropathogens and their AMR pattern, this paper may contribute to improving UTI management in diabetic patients, thus reducing antibiotic overuse and preventing recurrent UTIs.

Endothelial dysfunction in prediabetes and diabetes mellitus in patients with normal coronary arteries

BackgroundDiabetes mellitus (DM) is a global health issue associated with increased cardiovascular disease risk. Endothelial dysfunction is a known precursor to atherosclerosis and cardiovascular disease, and its role in the pathogenesis of DM complications is well-documented. There is limited information in the evaluation of endothelial function in prediabetic patients using flow-mediated dilation (FMD), and studies have not excluded patients with known atherosclerosis or coronary artery disease. Thus, in this study, we aimed to evaluate the endothelial functions using FMD from the brachial artery of DM and prediabetes patients who had normal coronary arteries.MethodsThis study included 73 participants: 25 with DM, 25 with prediabetes, and 23 normoglycemic controls, all with normal coronary arteries on angiography. FMD measurements were conducted following established protocols, and statistical analysis was performed using standard methods to compare FMD levels among groups.ResultsThe groups were comparable in clinical and demographic characteristics, except for fasting plasma glucose levels. Significant differences in FMD levels were observed: 10.1% in the DM group, 16.5% in the prediabetes group, and 14.8% in the control group (P = 0.004). Diabetic patients had significantly lower FMD levels than both prediabetic and normoglycemic individuals. No significant difference in FMD was found between prediabetic and control groups.ConclusionsDiabetic patients exhibited significant endothelial dysfunction compared to normoglycemic individuals, while prediabetic patients did not show similar dysfunction. These findings suggest a window of opportunity in the prediabetic stage for early intervention to prevent advanced endothelial dysfunction.Trial registration numberISRCTN Registry ISRCTN15351014. Registry date: 23/09/2024. Retrospectively registered.

Review Article : The Effect of Quercetin Compounds on Type II Diabetes Mellitus

The immune system of the body targets the insulin-producing pancreatic cells, which results in diabetes mellitus. Synthesized antidiabetic drugs cause side effects of liver and kidney damage. Quercetin are known to have the same mechanism as synthetic antidiabetic drugs, so it can be an alternative treatment for diabetes. This article is a review with a literature search using PubMed, MDPI and Google Scholar. Quercetin activate AMPK which affects the decrease in blood glucose levels, protect cell damage due to free radicals so as to prevent a decrease in insulin levels and repair tissue damage due to hyperglycemia. Quercetin plays a role in reducing the risk of Type II DM complications. Quercetin compounds affect Type II Diabetes Mellitus with various mechanisms.

Comparative Study between Plant Extracts “Lithospermum erythrorhizon” Dressings and Standard Moist Wound Dressings in Management of Diabetic Foot Ulcers

Abstract Background DFU is a common complication of DM that has shown an increasing trend over previous decades. In total, it is estimated that 15% of patients with diabetes will suffer from DFU during their lifetime. Objective To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers. and cost effectiveness in terms of usage of hospital resources and numbers and easiness of dressings between Lithospermum erythrorhizon dressings and standard moist wound therapy (SMWT) in management of diabetic foot ulcers. Patients and Methods This is a prospective observational study involving 34 patients with active diabetic foot ulcers, in a high-volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Lithospermum erythrorhizon wound dressing. Study Period: 6 months from September 2022 to March 2023. Results Analyzing the results of our study, we suggest that Lithospermum erythrorhizon wound dressing has a definitive role in promotion of proliferation of granulation tissue, reduction in the wound size, and rapid clearing of bacterial load. Our data demonstrates that Lithospermum erythrorhizon wound dressings decrease the wound depth more effectively than saline gauze dressings over the first 8 weeks of therapy. It is suggested that Lithospermum erythrorhizon wound dressing is a cost-effective, easy to use and patient- friendly method of treating diabetic foot ulcers which helps in early closure of wounds, preventing complications and hence promising a better outcome. Conclusion Application of Lithospermum erythrorhizon wound dressing over wound bed increases the effectiveness of local circulation, which assists in the proliferation of granulation tissue and epithelialization. We have also found that the patients on Lithospermum erythrorhizon wound dressing therapy had earlier complete granulation.

The Prevalence and Determinants of Anxiety and Depressive Symptoms in Patients with Type II Diabetes Mellitus in Mogadishu, Somalia: A Cross-Sectional Study.

This study aims to determine the prevalence of depression, anxiety, and stress among TIIDM patients in Mogadishu, Somalia, and identify predicting factors, as there is limited research on these disorders in Somalia. A hospital-based cross-sectional study was conducted on adult patients with TIIDM from November 2023 to January 2024 at Erdogan Hospital, in the capital city of Somalia. A total of 360 participants were recruited using the systematic sampling technique. Data was collected using questionnaires on sociodemographic, clinical and behavioral characteristics. The depression, anxiety, and stress scale (DASS-21) questionnaire was used to assess symptoms of depression, anxiety, and stress. Bivariate and multivariate logistic regression analyses were performed to identify variables predicted by the outcome variables. Out of the 360 participants included in this study, 44.7%, 55.0%, and 30.3% had depression, anxiety, and stress symptoms, respectively. A lack of regular exercise (AOR = 1.79; 95% CI: 1.14-2.79) and an illness duration of 4-7 years (AOR = 1.94; 95% CI: 1.16-3.23) were statistically associated with depression. Being female (AOR = 2.07; 95% CI: 1.31-3.28), having ≥9 children (AOR = 1.94; 95% CI: 1.07-3.53), and a lack of regular exercise (AOR = 1.57; 95% CI: 1.01-2.45) were statistically associated with anxiety. A lack of regular exercise (AOR = 2.07; 95% CI: 1.31-3.28), having DM complications (AOR = 2.14; 95% CI: 1.01-4.54), an illness duration of 4-7 years (AOR = 2.22; 95% CI: 1.25-3.94), and DM management non-compliance (AOR = 2.74; 95% CI: 1.20-6.26) were statistically associated with stress. This study found that TIIDM patients had moderately high rates of depression, anxiety, and stress symptoms, with a lack of physical activity associated with increased odds of depression, anxiety, and stress symptoms. Healthcare workers should screen for psychological symptoms, provide interventions, monitor sedentary patients, and encourage adherence to treatment and physical exercise to reduce mental health burden.

Boosting Perceptions of the Benefits of Complication Prevention in Reproductive Age Diabetes Mellitus Patients via Self-Talk Affirmation Intervention

Diabetes mellitus is a chronic disease that lasts a long time and requires high adherence and self-discipline to carry out comprehensive self-care management to control blood glucose levels and prevent further complications. The practice of self-management requires knowledge or literacy and a positive mindset that is supported by good self-confidence for DM sufferers to be able to do it. Several studies have only examined aspects of physical intervention, such as providing physical activity (DM gymnastics) and education on medication adherence, but there are still few interventions that provide mindset strengthening in the form of self-talk affirmations in order to form a positive perspective on the perception of the benefits of preventing DM complications in sufferers. The study's objective was to ascertain whether using self-talk affirmations would improve DM patients' perceptions of the benefits of preventing complications in Pekalongan Regency, Central Java, Indonesia. 158 individuals with DM participated in this study using a cross-sectional quantitative research approach and a pre-post test sample design. A questionnaire was utilized for data collection, and a Paired T-test for data analysis, which assessed patients' perceptions of the benefits of preventing DM complications either before and after receiving affirmative self-talk therapies. Patients' perceptions of the benefits of preventing DM complications are influenced by the results of self-talk and self-affirmation interventions; there is a difference in the mean score of perceived benefits before and after the intervention. For patients with DM who are of working age, self-talk affirmations might be included to a list of self-management interventions.

Effectiveness of Diabetes Mellitus Management Training On Health Cadres

The highest prevalence of DM based on diagnosis and symptoms was in the 55-64 year age group, namely 5.5%. Knowledge about DM disease is very necessary for sufferers so that the risk of complications can be minimized. This study aims to analyze the effectiveness of DM management training in preventing DM complications in Kalipare Village, Malang Regency. This research used a Quasi Experimental design carried out in Kalipare Village, Malang Regency. The population of this study was all Kalipare Village Health Cadres totaling 30 people. The research sample was 30 Health Cadres. The sampling technique uses Total Sampling. The independent variable in this research is DM management training while the dependent variable is prevention of DM complications. Data was collected using questionnaires, skills observation and analyzed using the Mann-Whitney test. There is a significant difference with a significance of 0.000 (< 0.05). (p < 0.05) between the treatment group and the control group regarding the results of knowledge and observation of DM management skills after treatment, which means that there is effectiveness of DM management training in preventing DM complications. The more effective the DM management training given to health cadre participants, the better the prevention of DM complications will be.

Sleep disorders and diabetes mellitus. Literature review and own data

The article presents analysis of current research on sleep disorders in patients with type 2 diabetes mellitus (T2DM). The mechanisms underlying the relationship between insomnia and glycemic control are complex, as both DM can cause sleep disorders and insomnia can worsen the course of diabetes. It is well known that both short (< 6 hours) and long (> 8 hours) sleep durations are associated with an elevated risk of diabetes development. The reported prevalence of sleep disorders in diabetes patients ranges between 28.0% and 59.1%. Our investigation performed in Lviv with the use of Pittsburgh Sleep Quality Index (PSQI) questionnaire, identified that 46.2% of T2DM patients experienced sleep disorders. A comprehensive literature review also unveils association between DM and diverse sleep disorders such as insomnia, circadian rhythm disturbances, obstructive sleep apnea (OSA), and restless legs syndrome (RLS). The article furnishes insights into the classification, diagnostic principles, and treatment modalities for these disorders. Referral of patients to sleep specialists for the management of sleep disorders and the integration of sleep hygiene into diabetes care can effectively mitigate symptoms, forestall DM complications, and enhance patients’ quality of life. Circadian molecules like nobiletin, REV‑ERB agonists, and CRY stabilizers have demonstrated efficacy in preclinical studies and hold potential for the development of novel treatments for conditions associated with circadian dysregulation. Considering the frequency of detection of sleep disorders in T2DM patients according to the modern literary sources and own research, the study of this problem is important for the development of an algorithm for the examination of such patients, namely the need for endocrinologists to pay attention to the sleep status of patients and, if necessary, to refer them to somnologists. Further investigation into the etiology of sleep disorders in T2DM patients and their correlation with carbohydrate metabolism indicators exhibits promise. It is imperative to explore avenues to address these causes by complementing the primary therapy for T2DM.

Evaluation of Immunological Levels of IL-37, IL-38, and IL-17A in Iraqi Patients with Diabetic Foot Ulcers

t Diabetes mellitus, a significant cause of mortality around the globe, can result in several secondary complications, including diabetic foot syndrome, which is brought on by diabetic neuropathy and ischemia. Approximately 15% of diabetic patients suffer from diabetic foot complications, which results in high rates of morbidity and mortality of people with Diabetes mellitus. The study's objective is to measure serum levels of IL-37, IL-38 & IL-17A in diabetic mellitus (type 1 & 2) patients with and without diabetic foot ulcer complications and in the control group as well as the possibility of using them as early biomarkers for diagnosis of diabetic mellitus complications & future prevention. Overall, of 193 participants included in this case-control study, they were divided into three groups: the first one contains patients with type 1 diabetes mellitus (29 with diabetic foot ulcer DFU+ 35 non-diabetic foot), the second group includes type 2 diabetes mellitus patients (41 with DFU + 38 Non). The third group includes (50) as apparently healthy controls. Serological techniques of sandwich ELISA did laboratory tests for specific serum human IL-37, IL-38, and IL- 17A. The study revealed that IL-37 and IL-17A levels were significantly high (P<0.01) in all diabetic groups compared to the control healthy group. The results of IL-38 show substantially higher levels of T1DM and T2DM (P<0.05) compared to the control group. In addition, the DFU group of T2DM illustrated higher levels of IL-37, IL-38, and IL-17A compared with other diabetic groups. In conclusion, Iraqi DM subjects with and without complications had higher values of interleukins, IL-37, IL-38, and IL-17A, than healthy controls, which suggests an inflammatory state in these patients. In addition, the DFU of T2DM patients expressed higher levels of interleukins than other diabetic groups. This can be focused on using them as novel therapeutic targets for preventing and treating DM complications. As well as the possibility of using them as markers of inflammation and progression for complications in DM patients.

Abstract 3031: Novel Therapeutic Approach In Diabetic Wound Healing Using Inducible Mesenchymal Stem Cell-derived Fibroblasts In A Unique Murine Model

Introduction: It is estimated that about 40 to 60 million people in the United States suffer from diabetic foot ulcers (DFUs), one of the most severe DM complications. A significant proportion of affected individuals undergo amputation and are exposed to high mortality risks. Stem cell-based therapies offer a promising therapeutic avenue for these patients. Fibroblasts hold a crucial role in wound healing and angiogenesis, and we further highlighted that activated Notch signaling in fibroblasts derived from diabetic wounds leads to dysregulated fibroblast function. In this study, the potential therapeutic outcomes from genetically modified fibroblasts derived from mesenchymal stem cells (MSC-DF) in treating DFU is assessed, utilizing a unique genetic mouse model. Methods: A fibroblast-specific and inducible diabetic murine model with triple-gene engineering was created via inducible intracellular Notch1 pathway activation (RosaN1IC/Col1a2-Cre/ERT/Leprdb). MSC-DFs harvested from 10-12 week old B6db/ ROSAN1I/ / Cola2-Cre/ERT (LLRRCc) donor mice were cultured in vitro with activation versus silencing of Notch 1 signaling. Recipient LLRRCc mice (8-12-week-old) underwent a 6mm excisional dorsal skin wound and subsequent local injection of 1x10^6 donor syngeneic activated or silenced GOF Notch1 -MSC-DFs (n= 5/group). Wound closure was monitored daily for 9 consecutive days post-injury, and tissue was obtained for histological sectioning. Results: GOF Notch1 -MSC-DFs were characterized by immunostaining based on expression of markers specific to fibroblasts and a panel of Notch signaling genes. LLRRCc murine subjects receiving silenced GOF Notch1 -MSC-DFs treatment (n=5) demonstrated faster rates of wound closure over activated GOF Notch1 -MSC-DFs (n=5) treated mice. Collagen deposition was more abundant in wounds treated with silenced GOF Notch1 -MSC-DFs. Conclusion: MSC-DF deactivated Notch1 signaling therapy improves the rate of wound healing in GOF Notch Diabetic mice. These promising outcomes demonstrate a potential role for this innovative stem cell-based therapy targeting Notch-1-modified MSC-DF in future clinical applications for DFU patients through restoration of impaired fibroblast function.

Impact Of The Covid-19 Pandemic On Glycemic Control In Childhood Type 1 DM Patients

There has been an increase in cases of diabetic ketoacidosis in children aged 1-14 years from 73% in 2019 to 83% in 2020 during the COVID-19 pandemic. An increase in acute complications of type-1 DM can occur due to lack of compliance with glycemic control and activity restrictions which have the impact of reducing the level of glycemic control in children with type-1 DM. Based on these findings, researchers wanted to know the impact of restrictions on community activities during pandemic on the glycemic control of children with type 1 DM. The aims of this study is to determine the impact of the COVID-19 pandemic on glycemic control through HbA1c parameters in children with type 1 DM. Methods of this research is a cross sectional study with a sample size of 26 patients. Results are The average age of respondents was 15.58 years. More than half of respondents were female (73.1%). The average duration of suffering from type 1 DM was 4.77 years. More than half of the respondents had a history of diabetic ketoacidosis, 53.8%, and all respondents were Health Insurance (BPJS) participants (100%). There was a decrease in HbA1c levels during the pandemic compared to before the pandemic, namely 12.17 ± 2.60 to 10.32 ± 2.21. Statistically, this decrease means that there is an impact of the COVID-19 pandemic on glycemic control through the HbA1c parameter in children with type 1 DM (p<0.05). There was a decrease in HbA1c levels during the pandemic compared to before the pandemic.

IDF23-0514 Overview of DM Complications in Beneficiaries of a Self-Managed Healthcare Provider in Brazil

IDF23-0514 Overview of DM Complications in Beneficiaries of a Self-Managed Healthcare Provider in Brazil

Overview Distress Family to Increase the Quality of Life Communication Disorder in Stroke Patients with Diabetes Mellitus Complication

Communication disorders due to stroke with DM complications negatively impact to self-image, social and emotional well-being and quality of life. On the other hand, not all communication disruptions are reported to have negative impacts. We are interested in examining the picture of family distress in improving the quality of life of sufferers of stroke communication disorders complicated by DM. Objective: This research is important to see whether communication is fully related to the quality of life of stroke sufferers complicated by DM and has an impact on family stress. Method: This research uses a descriptive study design. The sampling technique used was purposive sampling with the plan to involve 30 stroke respondents with DM complications. Quantitative data analysis in the form of univariate and bivariate data. Fisher test is used to see the relationship between variables. Results: The majority of stroke patients with DM complications are women at 63.3%, with a maximum age of 76 years and a minimum age of 40 years. The maximum LAST score result is 15 and the minimum is 3. The highest family stress level result is in the normal category at 70% and the highest quality of life is in the good category at 43.3%. The results of statistical tests on the relationship between family stress levels and the quality of life of sufferers stroke communication disorders with DM complications found that P value = 0.000 < 0.05 Conclusions: Our findings confirm that there are relationship between the level of family stress and the quality of life of sufferers of stroke communication disorders complicated by DM. This is the first time that the research is highlight that family has an important impact on the quality of life stroke sufferers complicated by DM. Improving the quality of life of stroke sufferers complicated by DM by increasing self-care and caring for the family is very important.

The Effect of Diabetes Mellitus Exercises and Neuromuscular Taping (NMT) on Ankle Brachial Index (ABI) in Type 2 Dm Patients

Diabetes mellitus is caused by metabolic disorders characterized by increased blood glucose levels due to insulin secretion. Complications of peripheral arterial DM cause decreased blood flow to the lower extremities, marked by a decrease in ABI. Non-pharmacological therapy requires diabetes exercises and NMT to prevent injury to the feet due to changes in peripheral blood circulation. Objective: research to determine the effect of diabetic foot exercises and NMT on ABI in Type 2 DM patients. Method: Quantitative design, quasi-experimental method, pre-test post-test control group design, sampling technique using purposive sampling. Observations assessed the ABI score before the diabetes exercise intervention in intervention 1 and intervention 2 NMT, and group 3 control. Results: Data analysis using paired tests on ABI in 3 groups showed that in group I the foot exercise intervention resulted in p. 0.001 means there is a change in results before and after the intervention. Likewise, in group II of the NMT intervention, the result was p 0.001, there was a change in results before and after the intervention. Conclusion: Research proves that diabetes foot exercise and NMT interventions can improve ABI values in Type 2 DM patients.

EFFECT OF LOW-DENSITY LIPOPROTEIN (LDL) CHOLESTEROL VALUE ON NON-PROLIFERATIVE DIABETIC RETINOPATHY (NPDR) IN PATIENTS WITH TYPE II DIABETES MELLITUS (T2DM): A SYSTEMATIC REVIEW

Introduction & Objectives : Type 2 Diabetes Mellitus (T2DM) is a metabolic disease in which the body is unable to control blood sugar levels and is characterized by hyperglycemia caused by lack of insulin action. One of the most common microvascular complications of DM that can cause blindness to sufferers is Diabetic Retinopathy (DR). One of the risk factors that can exacerbate the progression of T2DM is the level of Low-Density Lipoprotein (LDL). However, there are still differences of opinion in several studies if LDL has a significant role in the occurrence of DR. This study aimed to determine whether there is a relationship between the value of LDL cholesterol and the occurrence of Non-Proliferative Diabetic Retinopathy.
 Methods : Systematic review utilizing MeSH terminology and PICO methods were done for information extraction of online database, including PubMed, and Google Scholar by utilizing the following keyword “Low-Density Lipoprotein”, “Non-Proliferative Diabetic Retinopathy”, “Diabetes Melitus”. The extracted studies were then analyzed using the New-Castle Ottawa Scale (NOS).
 Results : In total, 2 eligible studies (103 subjects) were found. Dornan et al., stated that total cholesterol levels were higher in NPDR Patients (5.1 +/- 0.7 mmol/l, p ? 0,02) and Mursi et al., shows that in patients with uncontrolled LDL cholesterol, NPDR was found (53,7%, p < 0,015). NOS was used to evaluate the quality of the studies and all studies showed to be in good quality.
 Conclusion : According to the results of this systematic review, there is a significant correlation between the degree of diabetic retinopathy and LDL cholesterol.

Fungsi Kognitif Penderita Diabetes Mellitus Pra-Lansia dan Lansia di Puskesmas Kalumata

<div>Almost every country is experiencing an increase in the number of elderly people. As we</div><div>age, individuals become more susceptible to Diabetes Mellitus / DM. One of the</div><div>complications of DM is cognitive impairment that threatens the welfare of the elderly</div><div>population. The purpose of this study is to determine the relationship between DM and</div><div>cognitive function of pre-elderly and elderly patients. This study is a cross sectional research</div><div>with accidental sampling techniques on samples amounted to 97 samples and used medical</div><div>records to determine DM status and Mini Mental State Examination questionnaire to assess</div><div>cognitive function of the sample. The sample in this study was dominated by patients aged 45-</div><div>59 years (63,9%), female gender (58,8%), Junior High School (25,8%). There were 62 pre-</div><div>elderly patients with 17 people (27,4%) have Mild Cognitive Impairment / MCI, and 35</div><div>elderly patients with 20 people (57,1%) have MCI. The result of chi-square test obtained a p-</div><div>value = 0,000 indicating that DM has a significant relationship with cognitive function and</div><div>an OR value of 5,27, which means that DM patients are at risk of 5,27 times greater for</div><div>cognitive impairment compared to non-DM patients.</div>

Clinical study of different prediction models in predicting diabetic nephropathy in patients with type 2 diabetes mellitus.

Among older adults, type 2 diabetes mellitus (T2DM) is widely recognized as one of the most prevalent diseases. Diabetic nephropathy (DN) is a frequent complication of DM, mainly characterized by renal microvascular damage. Early detection, aggressive prevention, and cure of DN are key to improving prognosis. Establishing a diagnostic and predictive model for DN is crucial in auxiliary diagnosis. To investigate the factors that impact T2DM complicated with DN and utilize this information to develop a predictive model. The clinical data of 210 patients diagnosed with T2DM and admitted to the First People's Hospital of Wenling between August 2019 and August 2022 were retrospectively analyzed. According to whether the patients had DN, they were divided into the DN group (complicated with DN) and the non-DN group (without DN). Multivariate logistic regression analysis was used to explore factors affecting DN in patients with T2DM. The data were randomly split into a training set (n = 147) and a test set (n = 63) in a 7:3 ratio using a random function. The training set was used to construct the nomogram, decision tree, and random forest models, and the test set was used to evaluate the prediction performance of the model by comparing the sensitivity, specificity, accuracy, recall, precision, and area under the receiver operating characteristic curve. Among the 210 patients with T2DM, 74 (35.34%) had DN. The validation dataset showed that the accuracies of the nomogram, decision tree, and random forest models in predicting DN in patients with T2DM were 0.746, 0.714, and 0.730, respectively. The sensitivities were 0.710, 0.710, and 0.806, respectively; the specificities were 0.844, 0.875, and 0.844, respectively; the area under the receiver operating characteristic curve (AUC) of the patients were 0.811, 0.735, and 0.850, respectively. The Delong test results revealed that the AUC values of the decision tree model were lower than those of the random forest and nomogram models (P < 0.05), whereas the difference in AUC values of the random forest and column-line graph models was not statistically significant (P > 0.05). Among the three prediction models, random forest performs best and can help identify patients with T2DM at high risk of DN.