Quality Of Life In Diabetic Patients Research Articles

Association Between Quality of Life and Drug Adherence Among Patients With Diabetes in India.

Diabetes represents a significant global health concern. Effective diabetes management necessitates substantial behavioral and psychological modifications, including regular glucose monitoring, dietary adjustments, and medication adherence. However, treatment adherence remains suboptimal, particularly in developing countries, leading to poor glycaemic control, increased healthcare costs, and diminished quality of life (QoL). Common factors influencing medication nonadherence include lack of medication knowledge, age, education of patients, polypharmacy, duration of disease, cost of therapy, complexity of dosing regime, and the presence of comorbidities. So, the study aims to assess the adherence status to antidiabetic medication and its association with QoL among diabetes patients in the Anand district of Gujarat state. A study was carried out in Anand district, Gujarat, from 2023 to 2024, focusing on community-based cross-sectional research. In the eight blocks of Anand district, a two-stage cluster sampling method was utilized, with one village or town randomly chosen from each taluka, and 25 diabetes patients interviewed per area. Data collection involved visiting 200 participants' houses, starting with a randomly selected house and continuing until the target was met. The interviews, conducted in the local language, lasted around 45 minutes and utilized a pre-validated and pretested questionnaire. The questionnaire covered demographic details, disease characteristics, and medication adherence using the semi-structured scale from Adherence to Refills and Medications Scale (ARMS-D), as well as the assessment of QoL using the WHOQoL-BREF questionnaire. Descriptive and inferential statistics were used for data analysis. Sociodemographic attributes were presented in terms of percentages (%) and frequencies (N). The means and standard deviation (SD) of health-related QoL and adherence to anti-diabetic medication were reported. Multiple linear regression analysis was used to assess the impact of adherence to antidiabetic medication within each QoL area after adjusting for a few sociodemographic variables. P values below 0.05 were considered statistically significant. The study included predominantly older participants (58.1 years) with 53.5% being male. Most participants (65.5%) had diabetes for more than 5 years, 60.0% had comorbidities, and 29.0% experienced complications. Nonadherence to treatment was observed in 37.0% of patients. The study found that factors like age, education, occupation, family history of diabetes, smoking, alcohol consumption, exercise habits, and medication adherence significantly influenced the QoL in diabetic patients, with medication adherence showing the strongest positive association with all QoL domains. This study shows a high percentage of nonadherence to antidiabetic medications. Poor adherence had significantly lower mean scores across all domains of QoL. Community-based educational programs targeting older and less-educated individuals should promote regular physical activity. Developing strategies to improve medication adherence and ensuring affordable access to essential medications, along with prioritizing enhancements in the QoL through psychosocial support and lifestyle counseling are imperative for diabetic patients.

Psychosocial Well-being among Diabetic Individuals

Background: Quality of life (QoL) assessment is considered an important outcome measure in chronic disease management. With an increase in the prevalence of diabetes in India, it becomes imperative to assess QoL in diabetic patients for their better care and control. The present study aimed to assess the QoL among diabetic patients attending the diabetic outpatient clinic and probe its association with glycemic status and management. Methodology: A cross-sectional study was conducted for 4 months among 185 type 2 diabetes mellitus (T2DM) patients. Information on sociodemographic profile, diabetic history, and current medications was obtained. QoL was assessed using the General Health Questionnaire-28 (GHQ-28). The results were statistically analyzed. Results: Using GHQ-28, the psychosocial components of the patients in the fields related to somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression were assessed. Significantly higher GHQ scores (P < 0.05) were noted in T2DM patients with higher glycated hemoglobin and increased plasma glucose levels, suggesting stronger associations of poorer QoL with compromised glycemic status. Insulin users exhibited higher GHQ scores (higher scores for depression subdomains) compared to noninsulin users. QoL was also found significantly dependent on the duration of diabetes and other comorbidities. Conclusion: The psychosocial well-being of the patients is significantly impacted in cases of chronic ailments like diabetes which adds to the total disease burden eventually. The present study warrants periodic assessment of QoL in diabetic individuals as a part of routine care along with advise of psychiatric counseling for those in need.

A study of psychiatric comorbidities and quality of life in type 2 diabetes mellitus patients in a tertiary care hospital in Telangana

ABSTRACT Background: Diabetes affects physical and psychological and social health. Sufficient literature exists on management by self and psychosocial methods for diabetes, but there exists a paucity of literature on psychological response and unaddressed emotional distress on overall health. Many studies have shown that diabetes has a bad impact on quality of life (QOL). This study is done for estimating psychiatric morbidity prevalence and its influence on QOL in diabetic patients. Aim: We aimed to study psychiatric comorbidities and QOL in type 2 diabetes mellitus (T2DM) patients in a tertiary care hospital. Methodology: This was a study done cross-sectionally over a period of 18 months on a sample of 108 subjects at the Psychiatry Department and General Medicine Department, Government Medical College and General Hospital, Nizamabad. The Mini International Neuropsychiatric Interview PLUS 5.0 and World Health Organization QOL-BREF scales were the survey tools used. Data analysis was done using statistical methods. Results: The prevalence of psychiatric comorbidities among diabetic patients was found to be 58.3%, with Depression (17.6%) being the most common comorbidity, followed by Dysthymia (13.8%). QOL of patients with T2DM with psychiatric comorbidity was significantly poorer (P = 0.001) in physical health domain (P = 0.04) and psychological domain (P = 0.01), while it was relatively better in environment domain (P = 0.2) and social relationships domain (P = 0.5). Conclusion: This study concludes that psychiatric comorbidities are common comorbidities in persons with T2DM. Moreover, psychiatric comorbidities further reduce QOL in individuals having T2DM.

Acacetin attenuates diabetes-induced cardiomyopathy by inhibiting oxidative stress and energy metabolism via PPAR-α/AMPK pathway

Diabetic cardiomyopathy seriously affects the life quality of diabetic patients and can lead to heart failure and death in severe cases. Acacetin was reported to be an anti-oxidant and anti-inflammatory agent in several cardiovascular diseases. However, the effect of acacetin on diabetic cardiomyopathy was not understood. This study was designed to explore the therapeutic effect of acacetin on diabetic cardiomyopathy and the potential mechanism with in vitro and in vivo experimental techniques. In cultured neonatal rat cardiomyocytes and H9C2 cardiac cells, acacetin (0.3, 1, 3 μM) showed effective protection against high glucose-induced injury in a concentration-dependent manner. Acacetin countered high glucose-induced increase of Bax and decrease of Bcl-2, SOD1, and SOD2. In streptozotocin-induced rat diabetic cardiomyopathy model, treatment with acacetin prodrug (10 mg/kg, s.c., b.i.d.) significantly improved the cardiac function and reduced myocardial injury, and reversed the increase of serum MDA, Ang Ⅱ, and IL-6 levels and myocardial Bax and IL-6, and the decrease of serum SOD, indicating that acacetin plays a cardioprotective effect by inhibiting oxidative stress, inflammation, and apoptosis. In addition, both in vitro and in vivo experimental results showed that acacetin increased the expression of PPAR-α and pAMPK, indicating that PPAR-α and pAMPK are potential targets of acacetin for the protection against diabetic cardiomyopathy. This study demonstrates the new application of acacetin for treating diabetic cardiomyopathy.

Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study.

Background: Type 2 diabetes (T2D) adversely affects health-related quality of life (QoL). However, little is known about the QoL of diabetic patients in Benin, where the disease is a growing concern. Thus, this study aims to assess the QoL and its associated factors among T2D patients in Cotonou, southern Benin. Methods: A total of 300 T2D patients (age > 18 years) were enrolled, and the diabetes-specific quality of life (DQoL) and Natividad self-care behaviors’ (SCB) instruments were used for data collection. DQoL scores were calculated, and factors associated with DQoL explored using logistic regression. Results: The mean of patients’ DQoL was 38.1 ± 4.1, with 43% having low QoL. In terms of DQoL, 56.3% reported a high diabetes impact, followed by low life satisfaction (53%) and high worry about diabetes (32.7%). In the logistic regression analysis, education, marital status, occupation, family history of diabetes, complications, and social support were associated with DQoL. SCB factors, including healthy eating, problem-solving, coping strategies, and risk reduction, were significant predictors of DQoL. Conclusions: Patients’ empowerment, starting with self-management education, is essential to improve the QoL of T2D patients in Cotonou. However, the programs need to target low education, low socioeconomic status, low social support, and overweight patients.

Thermal Analysis of Blood Flow Alterations in Human Hand and Foot Based on Vascular-Porous Media Model.

Microvascular and Macrovascular diseases are serious complications of diabetic mellitus, which significantly affect the life quality of diabetic patients. Quantitative description of the relationship between temperature and blood flow is considerably important for non-invasive detection of blood vessel structural and functional lesions. In this study, thermal analysis has been employed to predict blood flow alterations in a foot and a cubic skin model successively by using a discrete vessel-porous media model and further compared the blood flows in 31 diabetic patients. The tissue is regarded as porous media whose liquid phase represents the blood flow in capillaries and solid phase refers to the tissue part. Discrete vascular segments composed of arteries, arterioles, veins, and venules were embedded in the foot model. In the foot thermal analysis, the temperature distributions with different inlet vascular stenosis were simulated. The local temperature area sensitive to the reduction of perfusion was obtained under different inlet blood flow conditions. The discrete vascular-porous media model was further applied in the assessment of the skin blood flow by coupling the measured skin temperatures of diabetic patients and an inverse method. In comparison with the estimated blood flows among the diabetic patients, delayed blood flow regulation was found in some of diabetic patients, implying that there may be some vascular disorders in these patients. The conclusion confirms the one in our previous experiment on diabetic rats. Most of the patients predicted to be with vascular disorders were diagnosed as vascular complication in clinical settings as well, suggesting the potential applications of the vascular-porous media model in health management of diabetic patients.

Fluorometholone inhibits high glucose-induced cellular senescence in human retinal endothelial cells.

Diabetic retinopathy (DR) is a common diabetic complication that severely impacts the life quality of diabetic patients. Recently, cellular senescence in human retinal endothelial cells (HRECs) induced by high glucose has been linked to the pathogenesis of DR. Fluorometholone (FML) is a glucocorticoid drug applied in the treatment of inflammatory and allergic disorders of the eye. The objective of the present study is to investigate the protective function of FML on high glucose-induced cellular senescence in HRECs. The in vitro injury model was established by stimulating HRECs with 30mm glucose. After evaluating the cytotoxicity of FML in HRECs, 0.05% and 0.1% FML were used as the optimal concentration in the entire experiment. It was found that the excessive released inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) in HRECs induced by high glucose were significantly suppressed by FML, accompanied by the inhibitory effects on the expression levels of vascular endothelial growth factor (VEGF) and tissue factor (TF). Declined telomerase activity and enhanced senescence-associated β-galactosidase (SA-β-gal) activity were found in high glucose-challenged HRECs, which were dramatically alleviated by FML, accompanied by the inactivation of the p53/p21 and retinoblastoma (Rb) signaling. Interestingly, FML ameliorated high glucose-induced dephosphorylation of Akt. Lastly, the protective effects of FML against high glucose-induced cellular senescence in HRECs were abolished by the co-treatment of the PI3K/Akt signaling inhibitor LY294002, suggesting the involvement of this pathway. Taken together, these data revealed that FML-inhibited high glucose-induced cellular senescence mediated by Akt in HERCs, suggesting a novel molecular mechanism of FML.

In-situ synthesis of Cu/Cu2+1O/carbon spheres for the electrochemical sensing of glucose in serum

Based on the serious influence of the diabetes and the high need on the efficient monitoring of blood glucose, the development of the simple method for the sensitive and accurate analysis of glucose is extremely desirable and attractive for the life quality of diabetic patients. Herein, a facial method was reported for the synthesis of Cu/Cu 2+1 O nanoparticles modified carbon spheres (Cu/Cu 2+1 O/CSs) via in-situ reduction of the adsorbed Cu 2+ ions onto the surface of carbon spheres. The dependence of the different adsorption amount of Cu 2+ ions and the calcination temperature on the morphology and composition of Cu/Cu 2+1 O/CSs was investigated and characterized by scanning electron microscope (SEM), transmission electron microscopy (TEM), XRD, and Fourier transformed infrared spectroscopy (FTIR). The as-prepared Cu/Cu 2+1 O/CSs was further developed for the analysis of glucose, where the functionalized carbon spheres and the well distributed Cu/Cu 2+1 O nanoparticles with the multivalence copper presented the efficient electrochemical catalytic ability towards glucose, leading to the improved electrochemical behavior. It exhibited a wide concentration range from 0.30 μM to 24.50 mM with the high sensitivity and low detection limit (66 nM). Besides, the Cu/Cu 2+1 O/CSs showed the favorable anti-interference and stability. Moreover, the sensor was successfully applied for the sensing of glucose in human serum samples. This work developed a facial and efficient approach for the functionalization of carbon spheres, and could serve as a reliable platform for the electrochemical analysis and medical diagnostics.

Factors associated with quality of life in patients with Type 2 diabetes of Cotonou, South Benin

Background & Objective Diabetes is known to worsen the health-related Quality of life (QOL). However, little is known about the QOL of diabetic patients in Benin, where the disease is becoming an urgent public health issue. This study aimed to assess QOL and its associated factors among type 2 diabetes (T2D) patients in Cotonou, southern Benin. Methods A cross-sectional study was conducted among 300 T2D patients (age>18 years) selected conveniently from four health centers. The diabetes quality of life's (DQOL) and a revised version of Natividad self-care behaviors' (SCB) instrument were used for data collection. Levels of QOL were determined by calculating the scores, and multivariate logistic regression was used to explore factors associated with QOL scores. Results The mean of patients' overall QOL was 38.1±4.1, with 43% of participants with low QOL. Among the three domains of DQOL, 56.3% of respondents scored higher than the population mean in the impact domain, followed by satisfaction (53%) and worry (32.7%) domains. The logistic regression analysis results showed that education, marital status, occupation, family history of diabetes, complications, and social support were significantly associated with QOL. Among SCB factors, healthy eating, problem solving, coping strategies, and risk reduction were identified as significant predictors of these patients' QOL. Conclusions Self-management education and patient-centered care are needed to improve the QOL of T2D patients in Cotonou, Benin. However, such programs should target primarily at patients with no education, low socioeconomic status, and those lacking social support.

The Effect of Self-Care Training on Blood Sugar Control, HbA1C Level, and Life Quality of Diabetic Patients in Birjand, East of Iran: A Randomized Clinical Trial Study

Background As one of the most important public health problems worldwide, diabetes is closely linked with patients' lifestyles. The optimal approach to treating diabetes is to prevent it. Our aim in this study was to assess the impact of self-care behaviors on quality of life, blood sugar control, and HbA1C level in patients with type 2 diabetes. Methods This randomized clinical trial examined 100 diabetic women referred to Ghadir Comprehensive Health Center in Birjand in 2019. A 5 cc fasting blood sample was taken from each participant. The participants were randomly assigned to experimental and control groups. For the experimental group, a 10-session self-care training workshop was held. Baseline and postintervention fasting blood glucose, HbA1C level, and life quality of the two groups were assessed and compared six months after the intervention. Data were analyzed in SPSS (16). Results In the experimental group, the mean serum HbA1C level decreased from the baseline 7.5 ± 1.5 to 6.3 ± 1.0 (P < 0.001). Fasting blood sugar in the intervention group decreased from 136.3 ± 43.5 to 127.3 ± 22.9, but the reduction was not significant (P=0.322). The mean scores of the quality of life (P=0.002) and the visual analogue scale (P < 0.001P < 0.001) in the experimental group increased significantly compared to the control group. Conclusion Self-care training for diabetic women had positive effects on both life quality and disease control. Therefore, it is recommended that self-care training be delivered and taken more seriously by physicians and health care providers in addition to drug therapy.

Systematic Review and Meta-Analysis on Quality of Life in Diabetic Patients in Iran.

Background:Diabetes is the fifth leading cause of death in the world, which reduces the patients' quality of life (QOL) and is considered as an important subject especially in medicine and medical community. The present study aimed at investigating the QOL of diabetic patients in Iran through meta-analysis.Methods:The search was conducted using relevant keywords in national and international databases including Iranmedex, SID, Magiran, IranDoc, Medlib, Science Direct, PubMed, Scopus, Cochrane, Embase, Web of Science. Questionnaires WHOQOL, SF-36, SF-20, DQOL, QOL, PedsQL, ADDQOL, D-39, DQOL-BCI, SWED-QUAL, IRDQOL, PHG-2, EQ-5D, and IDQOL-BCI were used to assess the QOL. Heterogeneity of studies was assessed using I2 index. Data were analyzed using STATA version 11.Results:In 96 studies of 17,994 people, the mean score of QOL in diabetic patients was based on the questionnaires WHOQOL [66.55 (95% CI: 45.83, 87.26)], D-39 [129.43 (95%CI: 88.77, 170.10)], SF-36 [65.64 (95% CI: 59.82, 71.46)], SF-20 [46.50 (95% CI: 37.19, 55.81], DQOL [61.19 (95% CI: 35.73, 86.66)], QOL [117.91 (95% CI: -62.97, 298.79)], PedsQL [34.36 (95% CI: -31.49, 100.22)], ADDQOL [41.76 (95% CI: 12.01-71.50)], SWED-QUAL [59.19 (95% CI: 21.15, 97.23)], IRDQOL [105.92 (95% CI: 102.73, 109.10)], PHG-2 [61.00 (95%CI: 59.63, 62.37)], EQ-5D [0.62 (95% CI: 0.61, 0.64)], DQOL-BCI [3.40 (95% CI: 3.31, 3.49)], and IDQOL-BCI [22.63 (95% CI: -2.38, 47.64)].Conclusions:The QOL of diabetic patients was evaluated according to different types of questionnaires and the QOL of diabetic patients was found to be lower than normal population.

Measuring the Quality of Life in Diabetic Patients: A Scoping Review.

Background Diabetes mellitus is a widely diffused chronic condition which impacts on several aspects of patients' lives. In the current clinical practice, the implementation in the clinical routine of monitoring systems of patients' outcomes has led to an increased generation and use of several measures for the assessment of patients' quality of life (QOL). Nevertheless, this construct appears to be particularly complex, and its operationalization is variable across different measures. The purpose of this paper is to offer an updated review of the diabetes-specific QOL measures present in scientific literature with a specific focus on the broad domains assessed. Methods A scoping review was carried out with the purpose of identifying the existing measures in literature and describing their implicit representation of QOL in diabetes care. Five different databases (Scopus; Web of Science Core Collection; Medline; PsycInfo; and Cochrane Central Register of Controlled Trials) were searched with a string including validation studies of adult-only, diabetes-specific QOL measures. Each measure was then qualified according to its structure, a qualitative assessment of the broad domains of QOL it comprises, and finally an overview of the psychometric properties of its first validation. Results 30 scales were identified and assessed. Theme analysis shows that QOL is operationalized with multidimensional surveys comprising of both mental, physical, and social health components. Some scales also consider the impact of societal attitudes, public policies, and context on QOL. Conclusion Several self-report measures of QOL specifically developed for diabetic patients exist in scientific literature. The present scoping review reports scales structure, broad domains of QOL, and development purpose. This may help in understanding the concept of QOL in diabetic patients and may also serve the purpose of guiding the reader in the choice of the most appropriate instrument or in the development of a new one.

Kontaktallergie auf Glukosemesssysteme und Insulinpumpen

The design and development of insulin pumps and various glucose sensor systems has an enormous impact on life quality of diabetic patients. Surveillance and therapy of diabetes has improved due to the new diabetic devices, which are affixed to the patients' skin for several days. Since their introduction, irritant and allergic contact dermatitis have been frequently reported. Patients often acquire contact sensitization to isobornyl acrylate, N,N-dimethylacrylamide or formerly to 2‑ethyl-cyanoacrylate. These contact allergens were found in the patch, in the glue to affix the box on the patch or in the casing of the system itself. Development of contact allergy to substances of these systems may result in the need to abandon modern diabetic devices.

Effects of a task-based biofeedback training program on improving sensorimotor function in neuropathic hands in diabetic patients: a randomized controlled trial.

Symptoms of diabetic hands have been gradually elucidated, however the interventions for these hand problems are typically underemphasized. Few studies have discussed intervention effects on sensorimotor problems in hands, which prevent diabetic patients from executing their daily routines and lower their quality of life (QoL). This study has investigated the effects of task-based biofeedback training compared with home-based programs on sensorimotor function and QoL in diabetic patients with neuropathic hands. A single blind randomized controlled trial. Outpatient clinic at a university hospital. Thirty-eight patients with diabetic hand neuropathy whose sensorimotor functions were impaired based on screening with a pinch-holding-up activity (PHUA) test. Participants were randomly assigned to either a computerized evaluation and re-education biofeedback (CERB) (N.=20) or a home-based (tendon gliding exercise in conjunction with resistive exercise) (N.=18) group. The primary outcome was sensorimotor control of a hand using the PHUA test. Secondary outcomes included changes in Semmes-Weinstein monofilament, two-point discrimination, the Purdue Pegboard test and a self-reported QoL questionnaire. The measurements were conducted before and after a 6-week treatment program. The CERB group significantly improved efficiency in pinch force output during the PHUA test by reducing the percentage of maximum pinch strength (change from 34.5±11.66 to 30.7±10.16%, P=0.001), and there was a statistically significant between-group difference (P=0.00, 95% CI: -12.59 to -3.34, F=9.42). The CERB group showed superior treatment effects as compared to the control group on the two-point discrimination results (P=0.01) as well as the pin insertion subtests in the Purdue pegboard test (P=0.01). The QoL results also revealed significant between-group differences in several items of the Diabetes-39 (P<0.05). This study showed that a task-based biofeedback training program provides superior benefits for restoration of hand sensorimotor functioning in diabetic patients as compared to a home-based program combining tendon gliding exercise and resistive exercise. Using task-based biofeedback training as one of the rehabilitation strategies may be an effective approach for restoration of sensory function, precision pinch performance, hand dexterity, and QoL for patients with diabetes-related neuropathy.

Modeling the factors affecting the quality of life in diabetic patients in India using total interpretive structural modeling

Purpose Diabetes mellitus has become a major world health problem that has unenviable impacts on health of the people including quality of life (QOL) also and in which person’s physical and psychological state, social commitments and relationships and his interaction with the environment is affected. This shows that there is an urgent need for behavior change and considerable educational strategies for proper management and rehabilitation (Reddy, 2000). This research has identified and ranked the significant factors which affect the QOL in diabetic patients in India. The paper aims to discuss these issues. Design/methodology/approach In this paper, nine factors which affect the QOL in diabetic patients in India have been identified through review of the literature and evaluated by total interpretive structural modeling (TISM) approach, i.e. an extended version of ISM. In this approach, interpretations of the interrelationship among factors have been discussed. Therefore, TISM approach has been used to develop the model and the mutual interactions among these factors. Findings The results of the model and MICMAC analysis indicate that diet restriction, body pain and satisfaction with treatment are the top-level factors. Practical implications Identification of the factors that have a remarkable effect on the QOL in diabetic patients is very important so that the doctors and other healthcare professionals may handle these factors efficiently and proper rehabilitation can be provided to such patients. Originality/value This paper has used an application of the TISM approach to interpret the mutual relationship by using the tool of interpretive matrix and has developed a framework to calculate the drive and the dependence power of factors using MICMAC analysis. The issues related to QOL are extremely important, as they can strongly anticipate a person’s capability to govern his lifestyle with disease like diabetes mellitus and maintain good health in the long run. This shows the urgent requirement of an optimized model which can predict and interpret the relationships among these factors. In this research, the interrelationships among these factors have been developed and interpretations of these interactions have been given to develop a comprehensive model so that QOL of diabetic patients may be improved.

Assessment of quality of life in type II diabetic patients using the modified diabetes quality of life (MDQoL)-17 questionnaire

Diabetic complications, comorbidities, and cost of treatment affect the quality of life (QoL) of an individual. The QoL assessment is considered an important measure of outcome in chronic disease management. The objective of our study was to assess the quality of life in Type II diabetes mellitus patients with and without complications using the modified diabetes quality of life (MDQoL)-17. A prospective descriptive study was conducted over 6 months, after taking ethical committee approval. As per the inclusion criteria from medicine wards of tertiary care hospital, 250 patients were selected. Demographic characteristics were documented in the data collection form and the patients were administered with the MDQoL questionnaire in different languages. The data was analyzed using IBM SPSS version 20. Majority of the patients were male (64.4%). The average age of the study population was 60.34±12.04 years. Most of the patients had a diabetes history of more than 10 years and HbA1c > 8%. The average QoL score was 65.47±15.07. Majority of the diabetic patients had the QoL score between 70 and 50. Patients without complication had a better QoL. As the number of complications increased, there was a decrease in the QoL. The presence of comorbidity also decreased the QoL. There was a statistically significant correlation with various parameters such as age, duration of diabetes history, HbA1c, number of complications and type of complication verses QoL of diabetic patients (p<0.05). The overall QoL in diabetic patients is reduced. Thus, proper management and strict glycemic control is necessary to prevent progression and occurrence of complications to maintain a better QoL in diabetes patients.

Intervention Program Concerning Quality of Life of Diabetic Patients with Lower Limb Prosthesis

Background: Diabetes and associated amputation are major challenges that threaten patient’s quality of life (QoL). Well fitting prosthesis is considered as a turning point in restoring amputee's life through improving physical functioning, body image, work capacity, and social participation. This study was aiming to evaluate the effect of intervention program on quality of life of diabetic patients with lower limb prosthesis. A quasi experimental design was utilized to meet the aim of the study. The study was conducted on a purposive sample of 60 diabetic patients with lower limb prosthesis who were divided into study and control groups. The study was conducted at Orthopaedic Industries Work Shop’s clinics that is affiliated to Agouza Rehabilitation & Rheumatology Center of the Army. Data were collected using 1) Interviewing Questionnaire including the following parts: A) Socio demographic characteristics, B) Patient’s clinical data sheet, C) Patients' level of knowledge regarding diabetes and prosthesis. 2) Quality of life of diabetic patients with prosthesis questionnaire. The result of this study showed that there were highly statistically significant differences between study and control groups post intervention regarding total knowledge about diabetes and prosthesis, which represent (p < 0.001). Additionally, there were highly statistically significant differences between study and control groups post intervention regarding total dimensions of quality of life, which represent (p < 0.001). As well as, majority of study group had moderate level of quality of life post intervention. This study concluded that the implementation of intervention program had a positive effect on quality of life of diabetic patients with lower limb prosthesis. This study recommended that development of preparatory psycho-educational program for diabetic patients with limb amputation prior to using prosthetic limb to enhance psychosocial adjustment after using prosthesis.

Supramolecular assembly of Cp1-11 peptide and insulin for rapid-acting formulation

In order to improve the life quality of diabetic patients, it is very important to develop rapid-acting insulin formulations that can mimic the physiological meal-time secretion profile of insulin in healthy people. Although several insulin analogues have been designed to provide postprandial glycemic control, still there are some serious disadvantages. A supramolecular strategy is presented here to inhibit insulin aggregation and improve its bioactivity by using Cp1-11 peptide. As a fragment of C-peptide in proinsulin, Cp1-11 peptide was found to influence insulin oligomerization by supramolecular interactions. This work demonstrates that the Cp1-11 peptide can interact with oligomeric insulin and facilitate its disaggregation into the physiologically active monomeric form. Computer simulation indicates that Cp1-11 can insert into the space between the C-terminal tail and the N-terminal helix of the B-chain of insulin, causing dissociation of the insulin dimer. The supramolecular assembly of Cp1-11 and insulin can improve the bioavailability and therapeutic effect of insulin on the control of in vivo blood glucose levels. These results suggest that Cp1-11 peptide can modulate the intermolecular interaction of aggregated insulin and prevent the transition from monomeric to multimeric states, and shows great potential for the development of an effective rapid-acting strategy to treat diabetes.

Evaluation of the quality of life and satisfaction with the therapy in patients with type 1 diabetes — is Medtronic MiniMed 640G system able to improve it? Preliminary insights

Introduction. The quality of life (QoL) became a very important parameter in the XXI century which often decides about the type of treatment. The spectrum of treatment possibilities is constantly expanding due to the rapid technological development. Currently most up-to-date MiniMed 640G system which is able to predict hypoglycemia episode, flexibly and transiently stop insulin delivery before approaching programmed low glucose limit and automatically resume it (SmartGuard technology) can become a way to improve the QoL of diabetic patients. Material and methods. The questionnaire survey was conducted among 10 girls and 14 boys at the age of 2–15 (median 8) years with well-controlled DM1 (HbA 1c varied from 5.8 to 8.8%, mean 6.7%). The mean time from diagnosis was 3.7 years. The main inclusion criteria was the therapy with 640G system. Patients were previously treated with insulin pumps with or without hypoblocade (Paradigm® 722/MiniMed® Veo). 3–11 months after introducing 640G system to therapy during the follow-up visit two surveys were conducted simultaneously: PedsQLTM 3.0 Diabetes which measured the QoL in diabetic patients (Survey I) and the authorial questionnaire (Survey II) which measured the satisfaction of 640G therapy (consisted of 11 questions, 2 closed and 9 semi-closed-ended). Results. Considering participants’ answers in Survey I, the mean scores of QoL regarding communication (79%), concerns (60%), treatment (76%) and diabe­tes (69%) which according to our scale (0–19% no impact, 20–39% low impact, 40–59% moderate impact, 60–79% high impact, 80–100% very high impact) proved that QoL was perceived high. The results of Survey II showed gladness and assur­ance of the patients with 640G therapy. Relying on their self-observation, over a half of participants (17 people) certified a serious reduction of both hypo/hyperglycemia episodes. 8 patients/caregivers highlighted a great coherence between blood glucose measured by sensor and glucose meter which enabled them to decrease the frequency of pricking fingers. 11 patients considered management of DM1 to be easier, they also noticed better cooperation with 640G system. Conclusion. Patients with DM1 using 640G system are satisfied with the effects of the therapy, they feel safer and their QoL measured by PedsQL is relatively high.

Decreased spinal endomorphin-2 contributes to mechanical allodynia in streptozotocin-induced diabetic rats

Diabetic neuropathic pain (DNP) plays a major role in decreased life quality of diabetes patients, however, the neural mechanisms underlying DNP remain unclear. Endomorphins are the endogenous ligands for mu-opioid receptor. There is increasing evidence implicating the involvement of spinal endomorphin-2 (EM2) in neuropathic pain. In this study, using a streptozotocin induced diabetic rat model that displayed obvious mechanical allodynia, it was found that the expression of spinal EM2 was significantly decreased in DNP rats. While intrathecal administration of exogenous EM2 attenuated mechanical allodynia in DNP rats, the mu-opioid receptor antagonist β-funaltrexamine facilitated these events. It was found that the reduction in spinal EM2 was mediated by increased activity of dipeptidylpeptidase IV, possibly as a consequence of diabetes-induced oxidative stress. Taken together, our results provide the first evidence that the reduction in the level of an endogenous opioid in primary afferents was significantly associated with DNP. This indicates that the chronic pain associated with DNP might be due to the loss of an inhibitory effect on pain signal transmission.