Insulin Intake Research Articles

Developments in encapsulation of insulin: Is oral delivery now possible?

This review presents the possibilities of oral delivery of insulin. Insulin, being readily destroyed/ transformed by the proteolytic enzymes and first-pass effects in the digestive system, has mainly been administered through injection, such as intravenous injection and transdermal injection. With developments in the material sciences, appropriate encapsulation methodologies have been developed that could be employed to protect insulin from the digestive effects of the human GI system, and thereby have opened a gateway of research exploring the oral route of insulin delivery. One approach is to incorporate insulin into an emulsion with an appropriate oil-phase, which protects the insulin from degradation. Coating with natural or synthetic polymeric materials, or with lipids, followed by size-reduction to 100-1000 nm is applied as another common approaches of insulin encapsulation. Other approaches like liposomes, nanogels, etc. are also being explored. This review gives a summary of methods of preparation as well as in vitro and in vivo bioavailability of insulin through these methods. It is observed that the oral bioavailability of insulin intake has increased from about 0.1% to about 20% for encapsulated insulin.

Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

The economic impact of both continuous glucose monitoring (CGM) and insulin pumps (continuous subcutaneous insulin infusion [CSII]) in type 1 diabetes (T1D) have been evaluated separately. However, the cost-effectiveness of adding CSII to existing CGM users has not yet been assessed. The aim of this study was to evaluate the societal cost-effectiveness of CSII versus continuing multiple daily injections (MDI) in adults with T1D already using CGM. In the second phase of the DIAMOND trial, 75 adults using CGM were randomized to either CGM+CSII or CGM+MDI (control) and surveyed at baseline and 28 weeks. We performed within-trial and lifetime cost-effectiveness analyses (CEAs) and estimated lifetime costs and quality-adjusted life-years (QALYs) via a modified Sheffield T1D model. Within the trial, the CGM+CSII group had a significant reduction in quality of life from baseline (-0.02 ± 0.05 difference in difference [DiD]) compared with controls. Total per-person 28-week costs were $8,272 (CGM+CSII) versus $5,623 (CGM+MDI); the difference in costs was primarily attributable to pump use ($2,644). Pump users reduced insulin intake (-12.8 units DiD) but increased the use of daily number of test strips (+1.2 DiD). Pump users also increased time with glucose in range of 70 to 180 mg/dL but had a higher HbA1c (+0.13 DiD) and more nonsevere hypoglycemic events. In the lifetime CEA, CGM+CSII would increase total costs by $112,045 DiD, decrease QALYs by 0.71, and decrease life expectancy by 0.48 years. Based on this single trial, initiating an insulin pump in adults with T1D already using CGM was associated with higher costs and reduced quality of life. Additional evidence regarding the clinical effects of adopting combinations of new technologies from trials and real-world populations is needed to confirm these findings.

Cabaran Psikologi bagi Remaja yang Menghidap Diabetes Jenis 1

Managing a chronic disease is very challenging and requires effective coping strategies to overcome difficulties for maintaining the health and stability of quality of life. Type 1 diabetes is one of the most common chronic diseases in children and adolescents that requires complex treatment and care. Type 1 diabetes management aspects include insulin intake, checking blood glucose levels, monitoring risk and treatment of disease complications, dietary intake, and physical activity. In addition, the lack of understanding of diabetes among family members and friends also makes them difficult to adapt to the disease and can cause them to experience psychological problems and stress. Hence, this paper aims to identify the psychological challenges faced by children and adolescents with type 1 diabetes. The study is conducted by review the literature on 9 published articles from 2010 to 2017 obtained from the Science Direct, SAGE, PubMed and NIH Public Access. The findings have identified several aspects of psychology often experienced by children and adolescents with type 1 diabetes such as depression, anxiety, stress, and distress. This psychological condition can have a negative effect on life skills, glucose control and ability to deal with diabetes management. It is hoped that proper management in encountering psychological challenges will lead to better results.

Intracranial Transplantation of Pancreatic Islets Attenuates Cognitive and Peripheral Metabolic Dysfunctions in a Rat Model of Sporadic Alzheimer's Disease.

Alzheimer's disease (AD) is often associated with brain insulin resistance and peripheral metabolic dysfunctions. Recently, we developed a model of sporadic AD associated with obesity-related peripheral metabolic abnormalities in Lewis rats using intracerebroventricular administration of streptozotocin (icv-STZ). We aimed to assess the effect of intracranially grafted pancreatic islets on cognitive and peripheral metabolic dysfunctions in the icv-STZ Lewis rats. AD-like dementia associated with obesity was induced in inbred Lewis rats using a single icv-STZ. Two months after icv-STZ, syngeneic islets (100 islets per recipient) were implanted in the cranial subarachnoid cavity of icv-STZ rats. Morris water maze and marble burying tests were used for studying cognitive and behavioral functions. Central and peripheral metabolic alterations were assessed by histological and biochemical assays. The icv-STZ induced increases in food intake, body weight, and blood levels of insulin and leptin without alteration of glucose homeostasis. Grafted islets reduced body weight gain, food consumption, peripheral insulin resistance, and hyperleptinemia. Biochemical and histological analysis of the brain revealed viable grafted islets expressing insulin and glucagon. The grafted islets did not affect expression of brain insulin receptors and peripheral glucose homeostasis. Two months after islet transplantation, cognitive and behavioral functioning in transplanted rats were significantly better than the sham-operated icv-STZ rats. No significant differences in the locomotor activity between transplanted and non-transplanted icv-STZ rats were found. Intracranial islet transplantation attenuates cognitive decline and peripheral metabolic dysfunctions providing a novel therapeutic approach for sporadic AD associated with peripheral metabolic dysfunctions.

Improved General and Oral Health in Diabetic Patients by an Okinawan-Based Nordic Diet: A Pilot Study.

Periodontal disease, periodontitis as well as the preceding gingivitis, has been associated with both obesity and diabetes. Studies have shown that diet changes can lead to a lower incidence of such inflammation. The aim of the present case series over four weeks was to study the effects on medical and dental conditions in patients with type 2 diabetes of the consumption of the Okinawan-based Nordic Diet (OBND®). Medical and dental examinations were performed to estimate the general health and gingivitis/periodontitis. Serum cytokine levels were assessed using Luminex technology. Eight of ten study participants completed the study. All participants lost weight (p = 0.012). Six out of seven that were treated with insulin could reduce their insulin intake after two weeks with OBND®. The reduction was about 16 units which corresponds to a 34% relative reduction compared to the starting point (range 15–63%). Fasting blood glucose values fell (p = 0.035). Hemoglobin A1c (HbA1c) (p = 0.01), triglycerides (p = 0.05), and low-density lipoprotein (LDL) (p = 0.05) were also reduced. Bleeding on probing changed from ~28% before any dietary changes to ~13% after two weeks with OBND® (p = 0.01). The reduction in gingival bleeding was as substantial as might be expected from one session of professional tooth cleaning. Markers of inflammation were also reduced. The OBND® thus showed significant promise in alleviating the impact of diabetes on dental as well as general health.

Plasma levels of the proprotein convertase furin and incidence of diabetes and mortality.

BackgroundDiabetes mellitus is linked to premature mortality of virtually all causes. Furin is a proprotein convertase broadly involved in the maintenance of cellular homeostasis; however, little is known about its role in the development of diabetes mellitus and risk of premature mortality.ObjectivesTo test if fasting plasma concentration of furin is associated with the development of diabetes mellitus and mortality.MethodsOvernight fasted plasma furin levels were measured at baseline examination in 4678 individuals from the population‐based prospective Malmö Diet and Cancer Study. We studied the relation of plasma furin levels with metabolic and hemodynamic traits. We used multivariable Cox proportional hazards models to investigate the association between baseline plasma furin levels and incidence of diabetes mellitus and mortality during 21.3–21.7 years follow‐up.ResultsAn association was observed between quartiles of furin concentration at baseline and body mass index, blood pressure and plasma concentration of glucose, insulin, LDL and HDL cholesterol (|0.11| ≤ β ≤ |0.31|, P < 0.001). Plasma furin (hazard ratio [HR] per one standard deviation increment of furin) was predictive of future diabetes mellitus (727 events; HR = 1.24, CI = 1.14–1.36, P < 0.001) after adjustment for age, sex, body mass index, systolic and diastolic blood pressure, use of antihypertensive treatment, alcohol intake and fasting plasma level of glucose, insulin and lipoproteins cholesterol. Furin was also independently related to the risk of all‐cause mortality (1229 events; HR = 1.12, CI = 1.05–1.19, P = 0.001) after full multivariable adjustment.ConclusionIndividuals with high plasma furin concentration have a pronounced dysmetabolic phenotype and elevated risk of diabetes mellitus and premature mortality.

Endovascular Management for Salvage of Failing Arteriovenous Fistula

Background: Failure of arteriovenous access for hemodialysis is a challenging problem. Maintaining the patency of this access is one of the most important corner stones in the care of patients with chronic renal failure. Recently, percutaneous transluminal balloon angioplasty (PTA) is considered the first line of treatment for dealing with this issue. Aim: The purpose of this retrospective observational study was to evaluate the primary and secondary patency rates after initial endovascular intervention to restore and preserve the patency of failing autogenous arteriovenous fistulae and to identify the potential factors that affect the durability of the procedure. Methods:The results of 56 patients with failing autogenous arteriovenous fistulae were retrospectively analyzed after being treated with percutaneous transluminal balloon angioplasty from November 2014 to December 2018. Technical & clinical success rates were reported. The variables, including patients’ demographics, co-morbidities, medications, fistula age, fistula type, site, number of lesions and degree of stenosis were analyzed and correlated with primary and secondary patency rates. Results: The mean age of the fistulae included in the study since their creation was 17.4 ± 9.6 months, most of which were radiocephalic fistulas (64.3%). The most common cause of autogenous access dysfunction was 90-99% stenosis while the most common site of stenosis was juxta-anastomotic. Technical and clinical success rates of the study population were 92.9% and 89.3%, respectively. The mean primary and secondary patency were 12.3 and 19.9 months, respectively. Primary patency rates at 6,12,18 and 24 months were 79%, 64%, 57% and 44% respectively. Secondary patency rates at 6,12,18 and 24 months were 85%, 76%, 68% and 52% respectively. Patient age ≥ 60 years old was associated with reduced post-PTA primary patency (P < 0.001) and secondary patency (P = 0.018). Dyslipidemia showed marked decrease in both primary and secondary patency rates (P < 0.001). Insulin intake (P < 0.001) was a predictor of primary patency decrease while use of antiplatlets was to a less extent predictor of secondary patency loss (P = 0.004). Radiocephalic fistulae had short primary patency (P = 0.016), while stenotic lesions > 90% showed a significant decrease (P < 0.001) in primary patency more obvious than with secondary patency (P = 0.006). Lesions at arteriovenous anastomosis were significantly associated with decrease in primary patency (P < 0.001). Statins were the only medications associated with longer primary patency (P < 0.001). Age of fistula and number of lesions were independent factors. Conclusion: Endovascular treatment is both safe and effective in managing failing autogenous arteriovenous fistulas. Although its technical and success rates are high, primary and secondary patency rates are still questionable. Dyslipidemia, insulin, statin and antiplatelet intake together with age of patient, degree and site of stenosis are potential risk factors that affect these rates.

Studi Karakteristik Tipe Diabetes pada Tikus (Rattus novergicus) yang Diinduksi Deksametason (CHARACTERISTIC STUDY OF THE TYPE OF DIABETES IN RAT (RATTUS NOVERGICUS) MODEL INDUCED BY DEXAMETHASONE)

Diabetes is marked by hyperglicemia with severe symptoms included polydipsi, polyuri, polyphagia,weight loss, and decreased of insulin sensitivity index specially at type 2 diabetes mellitus. The objective of this research was to analyze the characteristics of diabetes mellitus in rat (Rattus novergicus) which induced by dexamethason. A total of 24 rats were divided into four groups which divided as follow: (1) aquabidest subcutaneously (K0), (2) subcutaneous dexamethasone 1 mg/kgBW daily (K1), (3) subcutaneous dexamethasone 2.5 mg/kgBW daily (K2) and subcutaneous dexamethasone 5 mg/kgBW daily (K3). The data of fasting blood glucose, fasting blood insulin, body weight and feed intake, urine volume and water intake collected at day 0, 5, 10 and 15 (five days after the last treatment). The result showed that there was a significant elevation of glucose level followed by significant decreased of insulin sensitivity index and the body weight of rats in group wich induced by dexamethasone but there was no change in feed intake, water intake, volume of urine and fasting blood insulin before and after the treatment. There was insignificant different of total beta pancreatic islet between treatment and control grup. Induction of dexamethasone in mice causes reversible hyperglycemia and has not met the characterisics of either type 1 or 2 diabetes mellitus models. The profile of dexamethasone induced diabetes model has their own spesific type.

A Retrospective Cohort Study of Patients with Type 2 Diabetes in China: Associations of Hypoglycemia with Health Care Resource Utilization and Associated Costs.

IntroductionThis study aimed to examine the associations of hypoglycemia with health care resource utilization (HCRU) and health care costs among patients with type 2 diabetes mellitus (T2DM) in China.MethodsThis retrospective cohort study was conducted with 23,680 T2DM patients >18 years old who visited the Second Affiliated Hospital of Nanchang University between 1 January 2011 and 31 December 2015. Univariate descriptive statistics were used to relate the HCRU and associated costs to patient characteristics, and regression analysis was used to examine the association between hypoglycemia and HCRU, controlling for other confounding factors.ResultsIn the T2DM patients with or without insulin treatment, when compared with nonhypoglycemic patients, hypoglycemia was associated with more medical visits (all T2DM patients 19.48 vs. 10.46, insulin users 23.45 vs. 14.12) and higher diabetes-related medical costs (all T2DM patients ¥5187.54 vs. ¥3525.00, insulin users ¥6948.84 vs. ¥3401.15) and medication costs (T2DM patients ¥1349.40 vs. ¥641.92, insulin users: ¥1363.87 vs. ¥853.96). Controlling for age, gender, and Charlson comorbidity index (CCI) score, hypoglycemia and insulin intake were associated with greater health care resource utilization. As compared to nonhypoglycemic patients, hypoglycemic T2DM patients and those on insulin therapy performed more outpatient visits (proportions of hypoglycemic vs nonhypoglycemic T2DM patients performing 3+ visits: 72.69% vs. 65.49%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy performing 3+ visits: 78.26% vs. 71.73%) and were hospitalized more often (proportions of hypoglycemic vs nonhypoglycemic T2DM patients with 3+ admissions 75.90% vs. 50.24%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy with 3+ admissions: 83.19% vs. 58.51%).ConclusionHypoglycemia in diabetes patients was associated with increased healthcare resource utilization and health-related expenditure, especially for patients on insulin treatment. Insulin treatment regimens should be more individualized and account for hypoglycemia risk.

Differential diagnosis of unexplained falls in dementia: Results of “Syncope & Dementia” registry

BackgroundDementia patients have an increased risk of fall, and some of them might suffer from undiagnosed syncope. The present analysis aimed at identifying predictors of differential diagnosis between syncopal and non-syncopal fall in patients with dementia included in the “Syncope & Dementia” registry. MethodsWe enrolled patients aged 65+ with a diagnosis of dementia and a history of syncope and/or unexplained fall. All subjects underwent a comprehensive geriatric assessment, including the syncope protocol of the European Society of Cardiology. Subjects whose syncope diagnosis was confirmed were labeled as “Confirmed Syncope” (CS). Patients with unexplained fall were labeled as “Syncopal Fall” (SF), if a final diagnosis of syncope was performed, or as “Non-Syncopal Fall” (NSF), if syncope was excluded. ResultsWe included 372 subjects (mean age 84, 61% females). Mini Mental State Examination score was higher among SF (18.5±4.9) compared to NSF patients (15.6±5.8, p=0.02). In a multinomial logistic regression model with NSF as the reference group, CS patients less often suffered injuries and more often reported history of syncope, while patients with SF had a better cognitive status and were more often exposed to precipitating factors, including postural changes and neck movements. The absence of prodromes and the intake of benzodiazepines and insulin was highest in NSF patients. A simple score including main clinical predictors showed an 82% sensitivity with a 56% specificity in discriminating SF from NSF patients. ConclusionSimple clinical markers can aid in the differential diagnosis of unexplained falls in dementia, separating syncopal from non-syncopal falls.

Does the Choice of Treatment of Diabetes Mellitus Change Natural Course of Alzheimer Disease?

Alzheimer disease (AD) is common worldwide and almost every case has comorbidities. One of the most common comorbidities of AD is Diabetes mellitus (DM), with or without metabolic syndrome. Both diseases effect nerve tissue and successful treatment would improve the status of the patient. In patients with Alzheimer disease treatment of DM, the treatment could be harmful to the AD, because of that high insulin intake. This may lead to progression of AD. Insulin is considered the best treatment for DM, but insulin therapy could increase comorbidity with AD. No specific therapy for AD is known up to date, so because of that DM is one of the most important risk for AD, concomitant therapy for DM should be planned very carefully. All options of DM therapy should be considered, and different mechanisms of anti-diabetic drugs are preferable. Treatment of AD is more complex metabolic syndrome is present. Any inflammation causes local tissue damage, including brain tissue during AD. Release of interleukins, primarily TNF-α, IL-6, IL-1β in the presence of adipokine leptin, maintains chronic inflammatory status in local brain tissue. Thus, low doses of immunosuppressant therapy should be considered for treatment of AD in future. To delay apoptosis of nerve tissue cells, brain and nerve tissue defend against free oxygen radicals and improve metabolic status.

Comparative investigation for hypoglycemic effects of polysaccharides from four substitutes of Lonicera japonica in Chinese medicine

The polysaccharide fractions were obtained from flower buds of the four substitutes of Lonicera japonica, L. macranthoides (LMPB), L. hypoglauca (LHPB), L. fulvotomentosa (LFPB) and L. confuse (LCPB), and their hypoglycemic effects were investigated. In study, streptozocin (STZ)-induced diabetic rats were orally administrated once daily with LMPB, LHPB, LFPB and LCPB (each 800 mg/kg) for 42 days. Reduction for food and water intake (p < 0.05, p < 0.01) and levels of sugar and insulin (p < 0.01, p < 0.05) in blood, as well as elevation for contents of liver and skeletal muscle glycogen (p < 0.05) and concentrations of hepatic pyruvate kinase and hexokinase (p < 0.01, p < 0.05) were observed. Together with significant decline of total cholesterol (TC, 45.8 51.0%, p < 0.05), total triglyceride (TG, 50.6–53.8%, p < 0.01), low-density lipoprotein-cholesterin (LDL-C, 71.2–76.3%, p < 0.01) and very-low-density lipoprotein-cholesterin (VLDL-C, 45.2–50.0%, p < 0.01), the significant rise of high-density lipoprotein-cholesterin (HDL-C, 21.6–24.3%, p < 0.05) were also demonstrated. Consequently, the four polysaccharide fractions displayed notable hypoglycemic effects, similar to that of the polysaccharide fraction from L. japonica (LJP), so that they can be also considered as ingredients of functional foods for type-2 diabetes mellitus (T2DM).

Colorectal Adenocarcinoma Post-Operative Treatment with Chinese Herbs

Colorectal cancer is malignancy of the colon or rectum. Adenocarcinoma is the most common colorectal cancer. These malignant cancer cells grow inside the colon and the rectum. Large clusters of these cells form structures known as tumors. Our treated patient is a 48 year old male who has undergone colorectal adenocarcinoma surgery in stage IIIB. During the surgery he was resected part of the colon with a total length of 57 cm. We started the treatment with Chinese herbs immediately after the surgery with no additional chemotherapy and radiotherapy. Herbs used in the treatment are Cordyceps sinensis, Ganoderma broken spores (Reishi) and Yunnan Baiyao. Before the surgery the patient was pale, exhausted, with abdominal pain on the left side under the ribs, Iron (Fe) was very low—7, tumor marker (CEA) was high—39.64 ng/mL, hematochezia was present and with insulin intake of 34 units (the patient is diabetic). Two months after using the herbs daily, the patient blood analysis was improved, Iron (Fe) is elevated, no hematochezia is detected, organs are with normal findings, normal color of the face is restored, post-operative scar healed very well and quickly and insulin intake is reduced from 34 to 6 units. After 6 months of treatment the results are amazing, the patient is in excellent health condition, the treatment is completed and is no longer taking any medications. With the herbal treatment we succeeded to keep the patient in good health, boost the immune system and improve the Qi energy flow.

Prevalence and Factors Influencing Depression among Adolescents with Type-1 Diabetes – A Cross-Sectional Study

International Journal of Medicine and Public Health,2017,7,3,162-165.DOI:10.5530/ijmedph.2017.3.33Published:Aug 2017Type:Original ArticlePrevalence and Factors Influencing Depression among Adolescents with Type-1 Diabetes – A Cross-Sectional Study.Bhavana Naruboina, Kulkarni Praveen, and Nagaraj Rashmi Bhavana N1, Kulkarni Praveen1, Nagaraj Rashmi2 1Department of Community Medicine, JSS Medical College, Jagadguru Sri Shivarathreeshwara University, Mysuru, Karnataka, INDIA. 2Department of Pediatrics, JSS Medical College, Jagadguru Sri Shivarathreeshwara University, Mysuru, Karnataka, INDIA. Abstract:Background: Type 1 diabetes is the third most common paediatric endocrine disease. India accounts for most of the adolescents with T1DM in South-East Asia. Adolescents with diabetes are at higher risk of developing several psychological disorders due to the psychosocial stress posed by the condition. Depression is the commonest among these illnesses and necessitates active and early detection by screening strategies. Materials and Methodology: This Hospital Based Cross sectional study was conducted for the period of six months. All the Adolescents with Type 1 Diabetes visiting the hospital during the study period were included. Details regarding socio-demographic characteristics, diabetes and glycemic status were collected in a pre tested structured questionnaire by interview technique. Symptoms suggestive of depression were collected using Patient Health Questionnaire – 9 (PHQ-9). Results: Among 30 Adolescents with Type 1 Diabetes included in the present study, majority, 18 (60%) were in the age group of less than 14 years and 20 (66.7%) were females. The magnitude of depression among the study subjects was 18 (60%) of which majority of the subjects 12 (80%) were having mild depression. There was a significant association between depression and uncontrolled glycemic status, higher dosage of insulin intake and not strictly following the dietary practices. Conclusion: There was a high burden of depression in adolescents with type 1 diabetes. There was a significant relationship between the preventable factors like glycemic control and dietary practices with depression. Keywords:Adolescents, Depression, Glycaemic Status, Phq-9, Type 1 diabetes mellitusView:PDF (143.38 KB)

SugarMate

Inferring abnormal glucose events such as hyperglycemia and hypoglycemia is crucial for the health of both diabetic patients and non-diabetic people. However, regular blood glucose monitoring can be invasive and inconvenient in everyday life. We present SugarMate, a first smartphone-based blood glucose inference system as a temporary alternative to continuous blood glucose monitors (CGM) when they are uncomfortable or inconvenient to wear. In addition to the records of food, drug and insulin intake, it leverages smartphone sensors to measure physical activities and sleep quality automatically. Provided with the imbalanced and often limited measurements, a challenge of SugarMate is the inference of blood glucose levels at a fine-grained time resolution. We propose Md3RNN, an efficient learning paradigm to make full use of the available blood glucose information. Specifically, the newly designed grouped input layers, together with the adoption of a deep RNN model, offer an opportunity to build blood glucose models for the general public based on limited personal measurements from single-user and grouped-users perspectives. Evaluations on 112 users demonstrate that Md3RNN yields an average accuracy of 82.14%, significantly outperforming previous learning methods those are either shallow, generically structured, or oblivious to grouped behaviors. Also, a user study with the 112 participants shows that SugarMate is acceptable for practical usage.

Experiences Faced by Diabetic Teenagers of Diepkloof Soweto: A Systematic Review

Background: Diabetes is a metabolic disorder which presents itself with symptoms such as blurry vision, thirst and weight loss. It is a disease that is more common in childhood whereby the body cannot produce enough insulin. Objectives: To explore the challenges experienced by diabetic teenagers. Results: Checking of sugar levels and injecting of insulin was indicated as one of the major difficulties the teenagers face. Findings demonstrated that they feel abnormal and not part of their peers when they have to check their insulin and inject frequently. Methods: Various literatures from electronic database and manuals were used. The literature review was followed by in-depth semi structured interviews to document the experiences of the diabetic teenagers. Conclusion: Findings demonstrated challenges encountered by diabetic teenagers which affected their adherence to treatment. Some of the challenges were injecting insulin into their body system and further checking the level of sugar in the blood stream. Some teenagers also reported the dislike to gaining weight as they omit insulin intake in order to conform to a certain body shape. Empower the teenagers in regard to embracing their condition so that they can adhere successfully to the treatment without any relapse in order to avoid readmissions at the hospital.

Examining the Effects of Training According to Learning Styles on Self-care among Patients with Type 2 Diabetes

Background: Despite the implementation of new training programs, neglecting individual differences in terms of learning styles can be taken into account as one of the reasons for poor levels of self-care behaviors in patients suffering from diabetes. Aim: The purpose of the present study was to examine the effect of training according to the learning styles on self-care behaviors among individuals suffering from type 2 diabetes. Method: This randomized, controlled clinical trial was performed on 69 diabetic patients referring to Parsian Clinic in Mashhad, Iran, who were divided into experimental (comprised of four aural, visual, read-write, and kinesthetic-sensory groups based on the results of the VARK [Visual, Auditory, Read/Write, Kinesthetic] Learning Styles Questionnaire) and control (lecture-based education). Self-care training was also conducted during two sessions each two weeks on four domains of diet, exercise program adherence, blood glucose monitoring, and insulin intake. To analyze the data, independent samples t-test and Mann-Whitney U test were run, using SPSS version 21. Results: Based on the independent samples t-test, in the experimental and control groups, the total mean scores of self-care behaviors were not significantly different prior to the intervention (135.2±17.6, 129.7±27.6, respectively). However, a statistically significant difference was noted between the experimental and control groups regarding the total mean scores of self-care behaviors (164.1±7.6, 140.5±10.0, respectively; P=0.001).Implications for Practice: It was concluded that self-care training based on learning styles could be improved among patients with diabetes. The VARK Learning Styles Questionnaire could be used to facilitate this type of training through providing information about learning and teaching methods as well as using the media appropriate to individuals’ learning styles.

Quality of life in patients with erectile dysfunction in Shebin El Kom District

Objective This study aimed to assess the risk factors for erectile dysfunction (ED) and the sociodemographic characteristics of patients with ED in Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital. Background ED is a common disorder that affects the quality of life (QoL) of millions of people worldwide. Numerous factors can disrupt erectile function – for example, age, smoking, cardiovascular disease, and diabetes mellitus (DM). Patients and methods This was a cross-sectional study that was conducted on 169 patients with ED from Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital during the period 1 December 2015 to 31 May 2016. Information on sociodemographic data, risk factors for ED, and effect of ED on QoL was collected using self-administered questionnaires: a sociodemographic questionnaire, the International Index of Erectile Dysfunction (IIEF) questionnaire, a risk factors questionnaire, and the shorter version of the World Health Organization Quality of Life questionnaire. Results The main sociodemographic characteristics affecting ED were age of the patient (P = 0.001) and age of the patient's wife (P = 0.0001). The main risk factors for ED were lifestyle risk factors such as smoking (P = 0.000) and obesity (P = 0.005), medical conditions such as DM (P = 0.0001), hypertension (P = 0.0002), heart disease (P = 0.019), dyslipidemia (P = 0.013), lower urinary tract symptoms (P = 0.005), and hypogonadism (P = 0.004), intake of drugs (β-blockers (P = 0.000), insulin (P = 0.016), psychiatric drugs (P = 0.006), and silymarin (P = 0.001)), and penile and pelvis injury (P = 0.032). Pychogenic factor was present in most cases of ED. In patients with ED other domains of IIEF, including orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (89.7%) were reduced. Also ED negatively affected all domains of QoL. Conclusion According to our results, the main risk factors are aging, cardiovascular disease, DM, dyslipidemia, lifestyle issues (such as smoking and obesity), penile or pelvic injury, and side effects from medication. ED has a significant negative impact on other domains of IIEF and on the QoL.

Comparison of adjunctive therapy with metformin and acarbose in patients with Type-1 diabetes mellitus.

Objective:All the aforementioned data have stimulated interest in studying other potential therapies for T1DM including noninsulin pharmacological therapies. The present study attempts to investigate the effect of adjunctive therapy with metformin and acarbose in patients with Type-1 diabetes mellitus.Method:In a single-center, placebo-controlled study (IRCT201102165844N1) we compared the results of two clinical trials conducted in two different time periods on 40 patients with Type-1 diabetes mellitus. In the first section, metformin was given to the subjects. After six months, metformin was replaced with acarbose in the therapeutic regimen. In both studies, subjects were checked for their BMI, FBS, HbA1C, TGs, Cholesterol, LDL, HDL, 2hpp, unit of NPH and regular insulin variations.Results:Placebo-controlled evaluation of selected factors has showna significant decrease in FBS and TG levels in the metformin group during follow up but acarbose group has shown substantial influence on two hour post prandial (2hpp) and regular insulin intake decline. Moreover, Comparison differences after intervention between two test groups has shown that metformin has had superior impact on FBS and HbA1C decline in patients. Nonetheless, acarbose treatment had noteworthy influence on 2hpp, TGs, Cholesterol, LDL, and regular insulin intake control.Conclusion:The results of this experiment demonstrate that the addition of acarbose or metformin to patients with Type-1 diabetes mellitus who are controlled with insulin is commonly well tolerated and help to improve metabolic control in patients.

Alloimmune Monitoring after Islet Transplantation: A Prospective Multicenter Assessment of 25 Recipients

Islet transplantation is an effective treatment for selected patients with type 1 diabetes. However, an accurate test still lacks for the early detection of graft rejection. Blood samples were prospectively collected in four university centers (Geneva, Grenoble, Montpellier, and Strasbourg). Peripheral blood mononuclear cells were stimulated with donor splenocytes in the presence of interleukin-2. After 24 h of incubation, interferon- (IFN-) ELISpot analysis was performed. After a total of 5 days of incubation, cell proliferation was assessed by fluorescence-activated cell sorting (FACS) analysis for Ki-67. Immunological events were correlated with adverse metabolic events determined by loss of 1 point of -score and/or an increased insulin intake 10%. Twenty-five patients were analyzed; 14 were recipients of islets alone, and 11 combined with kidney. Overall, 76% (19/25) reached insulin independence at one point during a mean follow-up of 30.7 months. IFN- ELISpot showed no detectable correlation with adverse metabolic events [area under the curve (AUC)=0.57]. Similarly, cell proliferation analysis showed no detectable correlation with adverse metabolic events (CD3+/CD4+ AUC=0.54; CD3+/CD8+ AUC=0.55; CD3/CD56+ AUC=0.50). CD3/CD56+ cell proliferation was significantly higher in patients with combined kidney transplantation versus islet alone (6 months, p=0.010; 12 months, p=0.016; and 24 months, p=0.018). Donor antigen-stimulated IFN- production and cell proliferation do not predict adverse metabolic events after islet transplantation. This suggests that the volume of transplanted islets is too small to produce a detectable systemic immune response and/or that alloimmune rejection is not the sole reason for the loss of islet graft function.