Insulin Injection Research Articles

Melanocortins and Their Potential for the Treatment, Prevention and Amelioration of Complications of Diabetes

Diabetes mellitus (type I and II) is an advancing global health problem, concerningly increasing in prevalence in most of the developed and developing world. Current therapies, such as the subcutaneous injection of insulin, are invasive and require a close monitoring of blood glucose levels to prevent hypo- or hyperglycaemia from occurring. Despite an inexorable search for a cure since Banting and Best discovered and purified insulin in 1921, insulin remains a solitary insula, still the gold standard for treatment of type I and late-stage type II diabetes mellitus. Apropos of complications, diabetes causes a myriad of secondary maladies, ranging from diabetic kidney disease, diabetic retinopathy and diabetic neuropathy to erectile dysfunction and peripheral vascular disease. While scientists continue to interminably tinker with perfecting mechanical insulin pumps or dampening the immune response to pancreatic beta cells, an important aspect of the aetiology of diabetes should not be neglected, that of the metabolism. At its heart, diabetes can arguably be considered a metabolic disease, and this review suggests a return to focusing on preventing and treating diabetes by focussing on its metabolic causes. This narrative review summarises the potential of a recent class of synthetic peptides, the melanocortins, to help prevent and treat the complications of diabetes mellitus. The review summarises recent work showing the potential benefits of the melanocortins in treating diabetic complications through various pathways.

Evaluating the effects of permanent subcutaneous insulin infusion versus multiple daily insulin injections on glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes: a systematic review and meta-analysis based on clinical trials

Background. Diabetes is one of the most common chronic and metabolic diseases. This systematic review and meta-analysis study aimed to compare the effects of multiple daily insulin injections against permanent subcutaneous insulin injections on glycated hemoglobin (HbA1c) levels in type 2 diabetic patients. Methods. Studies that compared the impacts of multiple daily insulin injections against permanent subcutaneous insulin injections on HbA1c levels and were published until the end of 2022 in international databases were searched and retrieved (nine randomized clinical trial studies). The Chi-squared test and I2 were used to determine the presence and size of heterogeneity. Results. The results of the analysis demonstrated that compared to the group of multiple daily insulin injections, HbA1c was significantly reduced in the group of permanent subcutaneous insulin injections, so that the standardized mean difference was equal to -0.26 (95% confidence interval: -0.46– -0.06 P=0.025). According to the results of Egger’s (P=0.333) and Begg’s (P=0.667) tests, publication bias was not observed in this study. Conclusion. Based on the available evidence, permanent subcutaneous injection of insulin could be significantly successful in reducing and controlling the level of HbA1c because the patients in the permanent subcutaneous injection group had lower levels of HbA1c. Practical Implications. In patients with type 2 diabetes, insulin treatment with the permanent subcutaneous injection method can better control the level of HbA1c than the multiple daily injection method.

Description of knowledge, attitudes and practices to maintain oral hygiene as well as gingival index and plaque index in children suffering from type 1 diabetes mellitus

Background: Diabetes mellitus is a chronic disease whose incidence continues to increase throughout the world. Periodontal disease is a complication of diabetes. Poor periodontal health can lead to a variety of serious health problems. Therefore, this research is considered important to determine knowledge, attitudes and practices to maintain oral hygiene as well as gingival index and plaque index in children with type 1 diabetes mellitus. Objectives: To determine the description of knowledge, attitudes and practices to maintain oral hygiene as well as gingival index and plaque index in children with type 1 diabetes mellitus. Method: This research is a cross-sectional observational analytical study consisting of 32 respondents from children suffering from T1DM and members of IKADAR Malang. The instrument used was a questionnaire to measure knowledge, attitudes and practices regarding cleaning teeth and mouth; insulin injection compliance, diet, and physical activity. Hba1c to determine DMT-1 status. Gingival and plaque index. Results and discussions: Respondents with controlled diabetes, good knowledge, attitudes and practices all had healthy gingiva and good PI, namely 3 (15.79%). respondents with regular insulin, good diet and low physical activity all had uncontrolled diabetes, namely 2 (7.14%). Conclusion: The majority of respondents have uncontrolled diabetes, knowledge, attitudes, practices to maintain good oral hygiene, healthy gingiva, and good PI in one unit, namely 9. The majority of respondents have regular insulin injection compliance, moderate diet, low physical activity, and uncontrolled diabetes mellitus status in one unit, namely 17.

Short- and Long-Term Effects on Glucose Control of Nonadherence to Insulin Therapy in People With Type 2 Diabetes An In Silico Study.

Strict adherence to multiple daily insulin (MDI) therapy is a cornerstone for the achievement of good glucose control in people with advanced type 2 diabetes (T2D). Here, we aim to in silico assess glucose control in T2D subjects with poor adherence to MDI therapy. We tuned the Padova T2D Simulator, originally describing early-stage T2D physiology, around advanced T2D people. One hundred in silico advanced T2D subjects were generated and equipped with optimal MDI therapy: specifically, basal and bolus insulin amounts and injection times were individualized for each subject by applying titration algorithms that iteratively update insulin dose based on glucose deviation from its target. Then, the effect of nonadhering to MDI therapy was assessed using standard glucose control metrics calculated in two 6-month 3-meal/day in silico scenarios: in Scenario 1, subjects received the optimal basal and prandial insulin bolus at each meal; in Scenario 2, subjects received optimal basal insulin and randomly delayed or skipped the prandial insulin bolus in 3 lunches during working days and 1 dinner during weekends. A statistically significant degradation was found in all glucose control outcome metrics in Scenario 2 versus Scenario 1: e.g., percent time above 180 mg/dL increased by 22.2% and glucose management index by 0.2%. Impaired adherence to MDI therapy in T2D leads to glucose control deteriorations in both short and long terms. Interestingly, short-term hyperglycemia seems being contrasted by residual endogenous insulin secretion, which statistically increased by 3-fold after delayed/skipped insulin boluses compared with optimal ones.

P-26 Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: A case report

Abstract Introduction Factitious disorder (FD) is diagnosed by pretending to be sick with no abnormal examination or paraclinical study in the presence of psychiatric symptoms which also is named Munchausen's syndrome. The prevalence of the disease among hospitalized patients is approximately 9%. Clinical Case A 17-year-old girl with type 1 diabetes mellitus was referred to endocrinology clinic with uncontrolled diabetes, dizziness, abdominal pain, nausea and vomiting. She was treated with multiple daily insulin during 4 years but in last 8 months her self-monitoring of blood glucose ranges was out of control and have BG (blood glucose) different ranges of 40-560mg/dl. She was admitted to control her brittle diabetes with insulin infusion but even with high dose insulin infusion up to 20 IU/hr mostly her BS were above 400mg/dl. The notable point was that BG level was measured by laboratory was lower than glucometer. She also complained of severe abdominal pain and nausea during admission that mimics diabetic ketoacidosis in the presence of hyperglycemia despite the lack of ketonuria and metabolic acidosis. She admitted to hospital several times over the last year to control high level of BG. In psychiatric examination, she has good cooperation in response to questions. Mental Status Examination was not normal. Her mood was depressive and behavior was aggressive. Mild depressive symptoms and borderline features were seen in her Rorschach test. Finally because of high suspicion to associated psychiatric problems, to find the cause of high BG despite high insulin dose prescription, patient behaviors were monitored insensible. We found that she impregnated her finger to the date palm a few minutes before blood glucose check with glucometer devices at times when she is alone in the room. The patient had different deceptive behaviors depending on the method of treatment. But the answer to the question of why the patient was not suffering from hypoglycemia despite high doses of insulin injection is, when insulin infusion by pump was started to control high BG, intravenous cannula secretly separated from insulin infusion set and insulin thrown away. Also she secretly eats fruit juice and jam to prevent hypoglycemic attack for high-dose insulin injection. She took the water into the insulin pen instead of insulin and injected so that the nurses did not notice. Frauds were changed by switching the treatment methods. HbA1c was requested last week of hospitalization which shows 8%. Although all BGwas above 300 mg/dl during this prolonged hospitalization, it did not match with chronic hyperglycemia. Conclusion The main purpose of this article was in relation to a diabetic patient with brittle diabetes, difficulty in control BG level, discrepancies between patient symptoms and sings, factitious disorder or Munchausen syndrome should always be in our mind.

Insulin pump treatment vs. multiple daily insulin injections in patients with poorly controlled Type 2 diabetes mellitus: a comparison of cardiovascular effects

AimsBoth hyperglycaemia and large glycaemic variability are associated with worse outcomes in patients with Type 2 diabetes mellitus (T2DM), possibly causing sympatho-vagal imbalance and endothelial dysfunction. Continuous subcutaneous insulin injection (CSII) improves glycemic control compared to multiple daily insulin injections (MDI). We aimed to assess whether CSII may improve cardiac autonomic and vascular dilation function compared to MDI.MethodsWe enrolled T2DM patients without cardiovascular disease with poor glycaemic control, despite optimized MDI therapy. Patients were randomized to continue MDI (with multiple daily peripheral glucose measurements) or CSII; insulin dose was adjusted to achieve optimal target ranges of blood glucose levels. Patients were studied at baseline and after 6 months by: 1) flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of the brachial artery; 2) heart rate variability (HRV) by 24-hour ECG Holter monitoring (HM). 7-day continuous glucose monitoring (CGM) was performed in 9 and 8 patients of Group 1 and 2, respectively.ResultsOverall, 21 patients were enrolled, 12 randomized to CSII (Group 1) and 9 to MDI (Group 2). The daily dose of insulin and Hb1AC did not differ significantly between the 2 groups, both at baseline and at follow-up. Glucose variability showed some significant improvement at follow-up in the whole population, but no differences were observed between the 2 groups. Both FMD and NMD, as well as HRV parameters, showed no significant differences between the 2 groups at 6-month follow-up.ConclusionsIn this randomized small study we show that, in T2DM patients, CSII achieves a similar medium-term glycemic control compared to MDI, without any adverse effect on the cardiovascular system.

Effectiveness of pharmacotherapies for diabetes on nicotine, food, and water intake in insulin-resistant rats.

The intersectionality between diabetes medications and nicotine consumption was assessed in female and male rats. Briefly, the rats were fed a high-fat diet (HFD) or regular diet (RD) for 4weeks. Then separate groups received vehicle or a low dose of streptozotocin (STZ; 25mg/kg). Three days later, insulin resistance was assessed by measuring plasma glucose levels for 180min following an injection of insulin (0.75U/kg). The rats were then prepared with jugular catheters, and they were given 23h access to nicotine intravenous self-administration (IVSA) in 4days cycles with 3days of forced abstinence in their home cages where they consumed their respective diet. During the IVSA sessions, operant responses for food and water and changes in body weight were recorded. Prior to administration of the pharmacotherapies, the rats were given access to two doses of nicotine (0.015 then 0.03mg/kg for the remainder of the study). Then, daily injections of the pharmacotherapies were given at the onset of dark cycle (6p.m.) in the following order: 1) dapagliflozin (3.0 then 10.0mg/kg), 2) insulin (0.75U/kg twice), and 3) bromocriptine (3.0 then 10.0mg/kg). The results suggest that our HFD+STZ regiment induced insulin resistance in female and male rats. Also, the HFD-fed rats displayed higher nicotine intake than RD controls, regardless of sex. Administration of insulin, but not dapagliflozin or bromocriptine, normalized nicotine intake in HFD-fed rats to control levels. These results have clinical implications regarding the potential efficacy of insulin to control excessive nicotine intake in persons with diabetes.

Isolation and Purification of Protamine from the Cultured Takifugu flavidus and Its Physicochemical Properties.

Protamine is a cationic peptide derived from fish sperm and has several important functional properties: antibacterial properties, acting as a carrier for injectable insulin and as a heparin antagonist, combatting fatigue, etc. Thus, it has been widely used in medicinal applications and food products. Cultured Takifugu flavidus is a type of pufferfish with a delicious taste that is popular in China, and its production is increasing significantly. Therefore, protamine was extracted via acid extraction from the sperm of Takifugu flavidus and further isolated and purified via sephadex gel chromatography, ion exchange chromatography, and desalination chromatography. Furthermore, the physicochemical properties of protamine were investigated. The results showed that the sperm of the cultured T. flavidus were non-toxic, and the extracted and purified protamine had high contents of arginine (36.90%) and lysine (27.02%), respectively. The secondary structure of protamine was mainly β-folded and irregularly curled. Additionally, protamine exhibited high thermal stability with a denaturation temperature of 176 °C. This study would provide a theoretical basis for the structural analysis, bioactivity, and resource development of pufferfish protamine and help to promote the development of the pufferfish industry.

Oral nanotherapeutic formulation of insulin with reduced episodes of hypoglycaemia

Injectable insulin is an extensively used medication with potential life-threatening hypoglycaemic events. Here we report on insulin-conjugated silver sulfide quantum dots coated with a chitosan/glucose polymer to produce a responsive oral insulin nanoformulation. This formulation is pH responsive, is insoluble in acidic environments and shows increased absorption in human duodenum explants and Caenorhabditis elegans at neutral pH. The formulation is sensitive to glucosidase enzymes to trigger insulin release. It is found that the formulation distributes to the liver in mice and rats after oral administration and promotes a dose-dependent reduction in blood glucose without promoting hypoglycaemia or weight gain in diabetic rodents. Non-diabetic baboons also show a dose-dependent reduction in blood glucose. No biochemical or haematological toxicity or adverse events were observed in mice, rats and non-human primates. The formulation demonstrates the potential to orally control blood glucose without hypoglycaemic episodes.

Evaluation of the efficiency of estrus synchronization protocols combined with natural service and ultrasonography on ewe reproductive performance during non-breeding season.

Estrus synchronization is an important assisted reproductive technology to improve the reproductive performance in ewes. Various protocols have been used with variable success rates, however; literature regarding field applicable estrus synchronization is meagre. The present study was designed with the aim to evaluate the estrus synchronization protocols on reproductive performance in ewes using different hormones. Experimental ewes were divided randomly into three groups (n=15). Ewes of all groups received intravaginal sponge for 12 days. Subsequently, NP4-GnRH and NP4-eCG groups received 8 µg of buserelin acetate or 200 IU of eCG intramuscularly, respectively on day 12 whereas NP4-Insulin group received insulin 0.2 IU/kg body weight subcutaneously for three consecutive days started on the day of sponge removal. Estrus detection commenced 24 h after sponge removal in NP4-GnRH and NP4-eCG groups and 24 h following last injection of insulin in NP4-Insulin group. The ewes in estrus were separated and pen mated. The conception rate was determined by ultrasonography. The estrus response and conception rates were 71.43, 92.86 and 53.85%, and 70.00, 84.61, and 71.43%, respectively in NP4-GnRH, NP4-eCG, and NP4-Insulin groups. The lambing rates were the same as the conception rates. The single and multiple birth rates were 71.41, 36.36 and 60.0%, and 28.57, 63.64, and 40.0% whereas prolificacy was 128.57, 190.91, and 140.00%, respectively in NP4-GnRH, NP4-eCG, and NP4-Insulin groups. In conclusion, the estrus synchronization protocol including intravaginal progesterone sponge and eCG was found to be more effective under field conditions.

Weekly insulin injection as effective as daily injections in type 1 and type 2 diabetes, research suggests

Weekly insulin injection as effective as daily injections in type 1 and type 2 diabetes, research suggests

Engineered IRES-mediated promoter-free insulin-producing cells reverse hyperglycemia.

Endogenous insulin supplementation is essential for individuals with type 1 diabetes (T1D). However, current treatments, including pancreas transplantation, insulin injections, and oral medications, have significant limitations. The development of engineered cells that can secrete endogenous insulin offers a promising new therapeutic strategy for type 1 diabetes (T1D). This approach could potentially circumvent autoimmune responses associated with the transplantation of differentiated β-cells or systemic delivery of viral vectors. We utilized CRISPR/Cas9 gene editing coupled with homology-directed repair (HDR) to precisely integrate a promoter-free EMCVIRES-insulin cassette into the 3' untranslated region (UTR) of the GAPDH gene in human HEK-293T cells. Subsequently quantified insulin expression levels in these engineered cells, the viability and functionality of the engineered cells when seeded on different cell vectors (GelMA and Cytopore I) were also assessed. Finally, we investigated the therapeutic potential of EMCVIRES-based insulin secretion circuits in reversing Hyperglycaemia in T1D mice. Our results demonstrate that HDR-mediated gene editing successfully integrated the IRES-insulin loop into the genome of HEK-293T cells, a non-endocrine cell line, enabling the expression of human-derived insulin. Furthermore, Cytopore I microcarriers facilitated cell attachment and proliferation during in vitro culture and enhanced cell survival post-transplantation. Transplantation of these cell-laden microcarriers into mice led to the development of a stable, fat-encapsulated structure. This structure exhibited the expression of the platelet-endothelial cell adhesion molecule CD31, and no significant immune rejection was observed throughout the experiment. Diabetic mice that received the cell carriers reversed hyperglycemia, and blood glucose fluctuations under simulated feeding stimuli were very similar to those of healthy mice. In summary, our study demonstrates that Cytopore I microcarriers are biocompatible and promote long-term cell survival in vivo. The promoter-free EMCVIRES-insulin loop enables non-endocrine cells to secrete mature insulin, leading to a rapid reduction in glucose levels. We have presented a novel promoter-free genetic engineering strategy for insulin secretion and proposed an efficient cell transplantation method. Our findings suggest the potential to expand the range of cell sources available for the treatment of diabetes, offering new avenues for therapeutic interventions.

Nonlinear MPC for Insulin Titratio2shn of Type 2 Diabetes

This paper explores the development and application of both linear and nonlinear model predictive control (MPC) strategies for insulin titration in type 2 diabetes (T2D) subjects. By utilizing daily blood glucose measurements, alongside information on insulin injections and meal intake from the previous day, we adjust the insulin sensitivity parameter of the internal model of the controller. This adjustment is based on the steady-state glucose error between the internal model and the plant model. The performance of these strategies was assessed using a high-fidelity T2D model, demonstrating their potential in enhancing the management of T2D.

Phosphofructokinase family genes in grass carp: Molecular identification and tissue-specific expression in response to glucose, insulin and glucagon.

It is widely acknowledged that glucose serves as the primary energy source for organisms. However, fish exhibit persistent postprandial hyperglycemia and are thought to have low glucose tolerance. Glycolysis serves as the ubiquitous pathway for glucose catabolism, with phosphofructokinase (PFK) acting as a crucial rate-limiting enzyme in this process and playing an indispensable role. PFK is classified into three isoforms based on their major expression sites, i.e., PFKM (skeletal muscle type), PFKL (liver type) and PFKP (platelet type). In this study, grass carp (Ctenopharyngodon idella) was used as animal model and the open reading frame (ORF) sequences of six PFK genetic isoforms of grass carp were cloned. Real-time PCR was used to detect its tissue distribution, and expression changes in oral glucose tolerance test (OGTT), insulin and glucagon injection experiments. The results showed that the ORF of pfkla, pfklb, pfkma, pfkmb, pfkpa and pfkpb genes was 2343, 2340, 2355, 2331, 2364 and 2349bp in length, respectively. The results of tissue distribution showed that pfkla and pfklb, homologous to mammalian pfkl, exhibited low expression levels in the liver of grass carp, but were expressed at the highest level in the brain. Muscle-type pfkma and pfkmb mRNA were found to be highly expressed in both red and white muscle, with pfkmb also exhibiting high expression levels in the heart, while platelet type pfkpa and pfkpb showed high mRNA abundances in the brain and heart. Oral glucose administration stimulated pfkma and pfkmb mRNA expression in the red muscle, and up-regulated pfklb mRNA levels in the liver at 3h post treatment, but it suppressed liver-type and platelet-type PFK genes expression in the brain. The expression of pfkmb in white muscle and pfkmb and pfkpb in heart were promoted by insulin, whereas the expression of pfkla and pfkpb in the brain, pfkma and pfkmb in the red muscle, pfkma in the white muscle, and pfklb in the liver was suppressed by insulin. As for glucagon, it inhibited pfkma and pfkmb mRNA expression in the red muscle, as well as pfklb in the liver, but it up-regulated PFK genes expression in most tissues detected, such as brain (pfklb, pfkpa and pfkpb), white muscle (pfkma and pfkmb), liver (pfkla) and heart (pfkmb and pfkpb). Our results suggest that PFK family genes have different or even opposite expression patterns in response to glucose, insulin and glucagon stimulation in various tissues of grass carp, which may contribute to glucose intolerance in fish.

Dynamic analysis of a Filippov blood glucose insulin model

<abstract><p>This paper proposed a Filippov blood glucose insulin model with threshold control strategy and studied its dynamic properties. Using Filippov's convex method, we proved the global stability of its two subsystems, the existence and conditions of the sliding region of the system were also given, and different types of equilibrium states of the system were also addressed. The existence and stability of pseudo equilibrium points were thoroughly discussed. Through numerical simulations, we have demonstrated that it is possible to effectively control blood sugar concentrations to achieve more cost-effective treatment levels by selecting an appropriate threshold range for insulin injection.</p></abstract>

Investigation of the hypoglycemic mechanism of the ShenQi compound formula through metabonomics and 16S rRNA sequencing.

Introduction: Herbal formulations are renowned for their complex biological activities, acting on multiple targets and pathways, as evidenced by in vitro studies. However, the hypoglycemic effect and underlying mechanisms of Shenqi Compound (SQ), a traditional Chinese herbal formula, remain elusive. This study aimed to elucidate the hypoglycemic effects of SQ and explore its mechanisms of action, focusing on intestinal flora and metabolomics. Methods: A Type 2 diabetes mellitus (T2DM) rat model was established through a high-fat diet, followed by variable glucose and insulin injections to mimic the fluctuating glycemic conditions seen in diabetes. Results: An eight-week regimen of SQ significantly mitigated hyperglycemia, inflammation, and insulin resistance in these rats. Notably, SQ beneficially modulated the gut microbiota by increasing populations of beneficial bacteria, such as Lachnospiraceae_NK4A136_group and Akkermansia, while reducing and inhibiting harmful strains such as Ruminococcus and Phascolarctobacterium. Metabolomics analyses revealed that SQ intervention corrected disturbances in Testosterone enanthate and Glycerophospholipid metabolism. Discussion: Our findings highlight the hypoglycemic potential of SQ and its mechanisms via modulation of the gut microbiota and metabolic pathways, offering a theoretical foundation for the use of herbal medicine in diabetes management.

The effect of Iranian snake, Naja naja oxiana venom on the blood glucose concentration and some biochemical parameters of experimental diabetic rats

Diabetes is a chronic disease resulting from impaired insulin production and function; leading to hyperglycaemia and long-term complications. The treatment for Type I diabetes treatment involves insulin injections while Type II diabetes treatments include drugs such as metformin and sulfonylureas, along with lifestyle changes. These medicines can be expensive and may have adverse effects. Therefore, the search for new therapeutic agents continues. Venoms from various animals yield numerous pharmacologically active compounds. In this study, we investigated the effects of the venom from an Iranian snake, Naja naja oxiana, on blood glucose concentration and certain serum biochemical parameters in male rats with induced diabetes.Diabetes was induced in male rats using either a single injection of streptozotocin (STZ) alone (55 mg/kg i. p.) or STZ (65 mg/kg i. p.) preceded by nicotinamide (230/kg i. p.) administered 15 min earlier. The diabetic rats produced by either method received a single injection of either vehicle or venom (0.2 or 0.4 mg/kg i. p.). In the STZ rats, this was done 13 days after diabetes induction, while in the STZ-nicotinamide rats, venom was injected 3 days after diabetes induction.The venom from Naja naja oxiana significantly reduced blood glucose levels in male rats with diabetes induced by either method. Additionally, the venom decreased serum cholesterol and triglycerides concentrations. However, the venom had no effect on the blood glucose levels of healthy male rats. Pretreatment with the venom did not prevent the induction of diabetes by STZ. These findings suggest that Naja naja oxiana venom exhibits an anti-diabetic effect and could be a potential candidate for effectively controlling diabetes.

Prevalence and Correlators of Diabetes Distress in Adults with Type 2 Diabetes: A Cross-Sectional Study.

To address the prevalence of diabetes distress (DD) and its correlators in adults with type 2 diabetes. During 2021 and 2022, we conducted a cross-sectional study in three Class A tertiary comprehensive hospitals in China, and received 947 participants who completed a printed survey covering DD, demographic, diabetic, physiological, and psychosocial factors. We used Jonckheere-Terpstra, chi-square, and Fisher's exact tests to assess intergroup differences between different levels of DD. We used ordinal logistic regression analysis to analyze correlators of DD further. The prevalence of DD was 34.64%. In univariate analysis, those with lower satisfaction with financial status, longer durations of diabetes, more complications, higher glycemia, more severe insomnia, treatment by medications only, poorer lifestyle interventions, fewer self-care activities, more types and frequencies of insulin injections, and spending more money and time on treatment were susceptible to DD. Type D personality, negative illness perceptions, negative coping styles, and psychological effects of major life events were related to higher DD. Hope, self-efficacy, positive coping styles, and social support can reduce DD. In ordinal logistic regression analysis, hypoglycemic episode (β=-1.118, p=0.019, "have hypoglycemic" as reference) and Brief Illness Perception Questionnaire (β=0.090, p<0.001) were significant positive correlators for DD, while diet intervention (β=0.803, p=0.022, "have diet intervention" as reference), money spent on diabetes treatment (β<-0.001, p=0.035), and SES (β=-0.257, p<0.001) were significant negative correlators. More than one-third of Chinese adults with type 2 diabetes experience moderate or high levels of DD. DD was associated with financial, diabetic, physiological, and psychosocial status.

Effect of multiple insulin injections on estrus expression in cross bred cows

Effect of multiple insulin injections on estrus expression in cross bred cows

Presence of Co-morbid Depression among Diabetics of Less than 5 Years Duration in a Tertiary Care Institution, Chennai, Tamil Nadu, India: A Cross-sectional Study

Introduction: Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. Aim: To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. Materials and Methods: A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years’ duration. The prevalence of depression was calculated using Beck’s Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value &lt;0.05 was considered statistically significant. Results: The study included 500 participants, of whom the majority (276, 55%) were female, with a mean age of 46.2 years. The prevalence of depression was 55 (11%). It was found that being female, illiterate, and unemployed were significantly associated with depression. Among disease-related factors, diabetes duration of 3-5 years, insulin injection usage, and the presence of diabetic complications were significantly associated with depression. Regarding lifestyle factors, the prevalence of depression was significantly higher among those who were non adherent to dietary modification practices and those with family worries and work-related tension. Multivariable logistic regression analysis revealed that the independent predictors of depression among diabetics were the presence of diabetic complications {Odds Ratio (OR)-2.48 (1.27-4.84)}, family worries {OR-2.54 (1.34-4.80)}, non adherence to follow-up {OR-2.61 (1.37-4.99)}, and non compliance with dietary modifications {OR-2.93 (1.43-5.99)}. Conclusion: The present study revealed that about one in 10 (11%) diabetics with less than five years’ duration have associated depression, with significant independent predictors being non compliant behaviours, the presence of complications, and family issues. Hence, diabetics should be screened simultaneously for depression, giving due attention to those with complications, family issues, and non compliant behaviours.