Long-standing Diabetes Research Articles

Comparative Analysis of Long-Standing and Newly Diagnosed Diabetes Mellitus in Patients with Pancreatic Ductal Adenocarcinoma: A Tunisian Multicenter Study.

Diabetes mellitus has emerged as a global public health issue due to its increasing prevalence and the increased risk of developing cancers. Pancreatic cancer is believed to be both a consequence of pre-existing diabetes and a potential cause of new-onset diabetes. This study aims to compare the characteristics of patients with pancreatic ductal adenocarcinoma and newly diagnosed or long-standing diabetes mellitus. A multicentric retrospective study was conducted over 13 years at two university hospitals in Sousse, Tunisia. Included patients had whether a newly diagnosed or a long-standing diabetes mellitus with histologically confirmed pancreatic ductal adenocarcinoma. Statistical analysis using appropriate tests was conducted. The prevalence of diabetes mellitus was 44.6% among three hundred and seven patients with pancreatic cancer. The male-to-female ratio in patients with pancreatic ductal adenocarcinoma was 2.6:1. Patients' mean age was 63.9 years, with the majority being over 50 years old. Most patients had no family history of diabetes and exhibited significant weight loss, low body mass index, and uncontrolled diabetes. The comparison between individuals with newly diagnosed diabetes and those with long-standing diabetes revealed numerous similarities, apart from significant differences in drinking patterns (p = 0.03), tumor size (p = 0.018), and smoking in the subgroup of males (p = 0.044). Patients over 50 with newly diagnosed diabetes mellitus, particularly those who consume alcohol occasionally and men who are not heavy smokers, should undergo further evaluation to identify potential early-stage pancreatic ductal adenocarcinoma.

Systemic Predictors of Diabetic Retinopathy and Diabetic Macular Edema in an Adult Veteran Population.

To investigate the influence of systemic and serum measures and hypoglycemic medications on the initial presentation and ongoing development of diabetic retinopathy (DR) and diabetic macular edema (DME). Using Veterans Affairs electronic health records, we identified patients with a diabetes mellitus diagnosis and at least one eye examination between 1997 and 2010. After adjusting for sociodemographic factors, we used multivariable Cox regression models to evaluate the association of hemoglobin A1c (HbA1c) levels, blood pressure, albuminuria, blood urea nitrogen (BUN), and prescribed medications with the subsequent diagnosis of 1) any diabetic eye disease (defined for this analysis as DR and/or DME, 2) diabetic retinopathy, and 3) diabetic macular edema. Of 4089 diabetic Veteran patients, 821 (20%) were subsequently diagnosed with diabetic retinopathy and 88 (2%) had macular edema. Patients were more likely to receive a diabetic retinopathy diagnosis if they presented with HbA1c > 8.5 (HR=2.66, 95% CI 1.88-3.77, p<0.01), systolic blood pressure > 140mmHg (HR=1.45, 95% CI 1.26-1.66, p<0.01), blood urea nitrogen (BUN) > 35 mg/dL (HR=2.17, 95% CI 1.60-2.93, p<0.01), and/or used insulin (HR=2.04, 95% CI 1.74-2.40, p<0.01). Patients were more likely to be diagnosed with diabetic macular edema if they had systolic blood pressure > 140mmHg (HR=2.00, CI 1.29-3.08, p<0.01) and/or used insulin (HR=2.48, CI 1.53-4.03, p<0.01). Markers of systemic health may be useful predictors for incident diabetic retinopathy or diabetic macular edema, evaluated collectively in Veteran patients. Higher HbA1c levels, systolic blood pressure, BUN levels, and insulin use (suggestive of more severe and/or long-standing diabetes) appear to be highly associated with the development of diabetic eye disease, and, in particular, diabetic retinopathy.

Diabetic Mastopathy: A Monocentric Study to Explore This Uncommon Breast Disease.

Diabetic Mastopathy (DMP) is an uncommon benign fibro-inflammatory condition that occurs in women with long-standing diabetes mellitus (DM), particularly type 1. It often mimics breast cancer (BC) in clinical and imaging presentations, leading to diagnostic challenges. A retrospective monocentric study was conducted, analyzing clinical, radiologic, and pathological data from 28 women diagnosed with DMP over 10 years at the European Institute of Oncology. Data on DM type, age at DMP diagnosis, associated autoimmune conditions, imaging features, and surgical outcomes were collected and compared with the existing literature. The majority (82%) of the patients had type 1 DM, with most diagnosed with DMP before age 40. Common complications included retinopathy (46%) and neuropathy (35%). Imaging often suggested malignancy, necessitating core needle biopsies for diagnosis. Surgical intervention occurred in 55% of cases, with a recurrence rate of 32%. One case of BC was observed. DMP remains challenging due to its resemblance to BC. Conservative management is typical, but the recurrence rate post-surgery highlights the importance of ongoing monitoring. Although DMP does not significantly increase BC risk, caution is advised, especially for immunocompromised patients. Further studies are needed to comprehensively understand DMP's relationship with BC.

Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf.

Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum.

Evaluating Risk Factors and the Burden of Silent Myocardial Ischemia Among Diabetic Patients.

Silent myocardial ischemia (SMI) is a significant concern for diabetic patients, often remaining undetected until severe complications arise. Prolonged hyperglycemia, poor glycemic control, and lifestyle factors contribute to its risk, with older adults and those with long-standing diabetes particularly vulnerable. To assess the prevalence and predictors of SMI in adults with diabetes, emphasizing long-term management and monitoring. A longitudinal observational study was conducted at Nishtar Medical University, Multan, from October 2020 to September 2022, involving 388 adults with diabetes for at least five years. Patients with significant cardiovascular diseases or recent medication-affecting biomarkers were excluded. Data collection included demographics, medical history, and clinical assessments such as HbA1c levels, 12-lead resting ECGs, and treadmill exercise stress tests, with myocardial perfusion imaging (MPI) for those unable to perform stress tests. Statistical analyses using IBM SPSS (version 22) incorporated univariate and multivariate logistic regression to identify predictors of SMI, adjusting for confounders such as age, sex, smoking, and blood pressure. Thresholds included microalbuminuria at 30-300 mg/24 hours and HbA1c ≥7%, with missing data addressed through multiple imputations. Among the participants, the prevalence of SMI was 48%, increasing to 58% in those with microalbuminuria. Significant predictors included the duration of diabetes (OR 1.28, 95% CI: 1.08-1.52, p=0.001), HbA1c levels (OR 1.75, 95% CI: 1.42-2.16, p<0.001), age (OR 1.05, 95% CI: 1.01-1.09, p=0.035), and smoking status (OR 1.42, 95% CI: 1.05-1.92, p=0.025). Smoking status was based on self-report. Notably, microalbuminuria showed a strong association with SMI (OR 2.89, 95% CI: 2.10-3.98, p<0.001). The distribution of participants was balanced in terms of age and gender, with a mean age of 58 years (SD 9.4), and 52% were male. No unexpected findings were observed, and the results aligned with the anticipated relationships between the variables. This study highlights a concerning prevalence of SMI among diabetic patients, emphasizing the importance of monitoring diabetes duration and glycemic control, particularly in individuals with microalbuminuria. Regular follow-up care, including routine ECGs, stress tests, and biomarker assessments, is crucial for improving cardiovascular outcomes in this high-risk population. Limitations such as the observational design and potential self-report bias in smoking status may affect the generalizability of the findings. Future research should focus on large-scale, multicenter studies to validate these findings and explore interventions that could reduce the burden of SMI in diabetic patients.

Diabetic myonecrosis: A rare complication of long-standing diabetes mellitus

BackgroundDiabetes mellitus is a rapidly growing health illness worldwide and its incidence is expected to continue rising. Various complications have been cited including retinopathy, nephropathy, peripheral artery disease and ulceration among others. However, rarer complications such as diabetic myonecrosis are limited in literature. This case report demonstrates the presentation of this complication to allow for earlier detection and treatment by providers. Case reportThis case highlights a 49-year-old man with an extensive past medical history inclusive of diabetes mellitus type 2, who presented with acute onset left thigh pain and swelling. On presentation, the patient has an HbA1c of 8 % and hyperpigmented spots were noted bilaterally on the lower extremities. Initial management was centered around infectious etiologies and management which failed to improve his symptoms. Further work-up included a negative lower extremity duplex ultrasound and a CT scan showing a hypodense lesion in the left lower extremity. Following unsuccessful drainage of the lesion to assess for a possible abscess, MRI of the lower extremities showed bilateral myositis and myonecrosis centered in the left vastus medialis. ConclusionThis case report highlights a rare complication of diabetes mellitus known as diabetic myonecrosis (DMN). The gold-standard diagnostic tool is a muscle biopsy, however, sensitive imaging like MRI and clinical context are sufficient for a diagnosis. Supportive care centered around pain management remains the standard of care. While this remains as a diagnosis of exclusion, early identification may decrease the number of unnecessary treatments and should remain as a differential in patients with this presentation.

Ulnar Compression Neuropathy Secondary to Ganglion Cyst at the Elbow Joint: A Case Report

Ulnar neuropathy is a common peripheral neuropathy, with cubital tunnel compression being the second most frequent upper extremity compression syndrome. Ganglion cysts, though rare, can contribute to ulnar nerve compression in the cubital tunnel. Here, we present a case of a 62-year-old farmer with longstanding diabetes and dyslipidemia who experienced progressive pain and numbness in his medial fingers, exacerbated by elbow flexion. Initially misdiagnosed and treated for Hansen’s disease. Clinico-radiological evaluation revealed a multiloculated cystic lesion in the posteromedial aspect of his left elbow, compressing the ulnar nerve. Surgical excision of the ganglion cyst alleviated symptoms, though residual motor deficits persisted postoperatively. This case underscores the importance of considering ganglion cysts in the differential diagnosis of cubital tunnel syndrome, highlighting the diagnostic challenges and therapeutic considerations in managing this rare etiology.

Circadian heart rate fluctuations predict 21-year cardiovascular and all-cause mortality in type 2 and type 1 diabetes

Abstract Background Alterations in circadian heart rate (HR) fluctuations have been associated with cardiovascular events in the general population. This study aimed at defining their long-term prognostic value for cardiovascular and all-cause mortality in patients with diabetes. Methods We examined a cohort of 349 patients with type 2 or type 1 diabetes (52% women, age 57.1±11.9 years, BMI 29.4±5.9 kg/m2, HbA1c 8.6±2.1%, 81% type 2 diabetes) who underwent 24h ambulatory blood pressure and HR monitoring (ABPM) and assessment of diabetic microvascular complications. The median standard deviation (SD) value of ABPM-derived HR measurements was used to define patients with low daily HR fluctuations (low 24h-HR SD), while a &amp;lt;10% decline in average night-time vs day-time HR identified patients with blunted nocturnal HR dip (n=107, 31%). The clinical features and time-dependent prognostic impact of these conditions were evaluated over a 21-year observational follow-up. Results Low 24h-HR SD and blunted nocturnal HR dip were associated with an adverse cardiometabolic risk profile and high prevalence of cardiac autonomic neuropathy and nephropathy. After 6,251 person-years of follow-up (21.0 [14.0-21.0] years), a total of 136 (39%) deaths occurred, of which 100 (68%) of cardiovascular cause. After adjustment for potential confounders, the low 24h-HR SD group had a higher risk for both cardiovascular (hazard ratio 1.99, 95% CI 1.29–3.06, p=0.002) and all-cause mortality (hazard ratio 1.50, 95% CI 1.03–2.18, p=0.033), compared with high 24h-HR SD. Consistently, patients with blunted nocturnal HR dip had a higher adjusted risk for cardiovascular (1.61, 95% CI 1.07–2.43, p=0.023) and all-cause mortality (1.61, 95% CI 1.11–2.34, p=0.012), compared with those with preserved nocturnal HR dip. Conclusions Impaired circadian HR fluctuations are frequent in patients with long-standing diabetes and are associated with microvascular disease and increased long-term cardiovascular and all-cause mortality. Identifying these conditions via 24h-ABPM may provide a cost-effective risk stratification tool in this high-risk population.Kaplan-Meier curves

Prevalence of Diabetic Macular Edema Using Optical Coherence Tomography in Type 2 Diabetics With Nephropathy in Comparison With Type 2 Diabetics Without Nephropathy.

The primary vision-threatening complication in patients with diabetic retinopathy (DR) is diabetic macular edema (DME). Diabetic nephropathy (DN) often has DR that threatens their vision and has a risk of developing DME. Hence, the presence of DN could be the only risk factor for developing DME without the presence of other factors. Hence, this study proposes to predict the prevalence of DME using optical coherence tomography (OCT) in type 2 diabetics with nephropathy in comparison with diabetics without nephropathy. This is a cross-sectional study done on patients visiting the Ophthalmology Department at Saveetha Medical College and Hospital, Chennai, for one year. A total of 120 patients were included in the study, with 60 diabetic patients without nephropathy in Group 1 and 60 diabetic patients with nephropathy in Group 2. A detailed history was recorded. Their recent blood reports of fasting blood sugar, postprandial blood sugar, hemoglobin A1c (HbA1c), renal function test, and urine protein/creatinine ratio were all noted. Chronic kidney disease (CKD) staging in nephropathy patients as done by the nephrologist was also documented. The best corrected visual acuity (BCVA) was assessed for distant and near vision. A slit lamp examination and dilated fundus examination were done. Fundus findings were independently graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. OCT was done in all patients to confirm DME. In our study. males and females were 60 each in number. The majority of patients(32.5%) were >70 years old. A small percentage of patients (1.7%) in Group 1 had DM of >10 years, and 41.7% of the patients in Group 2 had DM of >10 years. Meanwhile, 73.3% of the patients in Group 1 had an HbA1c level between 6% and 7.5%, and 83.3% of the patients in Group 2 had an HbA1c level >7.5%. The percentage of patients with DME in Group 1 was 1.7%, and that in Group 2 was 21.7%. The majority of patients who had BCVA of 6/6 were in Group 1. The majority of patients with DME (46.4%) had stage V nephropathy. The coexistence of nephropathy in diabetic patients increases the incidence of DME. With long-standing diabetes and uncontrolled blood sugar levels being risk factors for developing DN and subsequently DME, such patients are to be screened regularly and advised on adequate glycemic control for achieving good visual prognosis and limit retinopathy progression. Moreover, the severity of DN should be kept in mind by nephrologists, and patients are to be promptly referred to the ophthalmology department for complete evaluation.

Prevalence of Adhesive Capsulitis in Patients With Type 2 Diabetes Mellitus: A Single-Center Cross-Sectional Study From Pakistan.

Background An inflammatory condition leading to stiffness and pain in the shoulder joint, adhesive capsulitis is associated with conditions such as diabetes mellitus, cervical spondylosis, thyroid dysfunction, autoimmune rheumatic diseases, and shoulder injury due to trauma, fracture, rotator cuff tear, surgery, or immobilization. Adhesive capsulitis may affect a notable proportion of the diabetic population. There are numerous studies that show that patients with type 2 diabetes mellitus are not only at higher risk of developing adhesive capsulitis but also suffer poor outcomes despite treatment, especially in patients with long-standing diabetes mellitus. Furthermore, there is significant variation in data regarding the prevalence of adhesive capsulitis in Pakistani patients with type 2 diabetes mellitus. Objective To determine the prevalence of adhesive capsulitis among patients with type 2 diabetes mellitus presenting to a tertiary care hospital in Bahawalpur, Pakistan. Methods The present observational cross-sectional study was carried out at the Department of Medicine, Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from February 2024 to August 2024. Type 2 diabetes mellitus was labeled by HbA1c of more than 7.0%, or two random blood glucose levels of 200 mg/dL or more, or an existing diagnosis of diabetes mellitus, and/or use of anti-hyperglycemic therapy. Adhesive capsulitis was diagnosed clinically on the basis of history (gradual onset shoulder pain with limitation of movements) and examination (reduction in active and passive range of motion (ROM) of the shoulder, especially abduction, internal rotation, and external rotation) in the absence of significant abnormalities on shoulder X-ray. After ethical approval and obtaining informed consent, 430 patients with type 2 diabetes mellitus were included in the study using a non-probability consecutive sampling technique. Demographic information, diabetes control, and HbA1c levels were noted, and the patients were assessed for adhesive capsulitis. All the data was recorded and entered into IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA), for analysis. Results Having a female preponderance (266, or 61.9%), the mean age of the participants was 54.0 ± 13.1 years. With regard to occupational status, 126 (29.3%) had a sedentary occupation, 45 (10.5%) were unemployed, and 259 (60.2%) had a non-sedentary occupation. The mean diabetes duration was 6.4 ± 5.3 years, and the majority of patients had poor diabetes control (322, or 74.9%). Adhesive capsulitis was present in 61 (14.2%) patients with type 2 diabetes mellitus. On stratification, no significant statistical association of adhesive capsulitis was seen with gender (p-value: 0.075), age (p-value: 0.465), occupation (p-value: 0.056), diabetes duration (p-value: 0.118), or diabetes control (p-value: 0.090). Conclusion Adhesive capsulitis was not an uncommon finding in our study, reported in almost one-fifth of the 430 patients enrolled. We recommend that treating physicians screen diabetic patients for adhesive capsulitis so that proper pain relief, physiotherapy, and rehabilitation may be provided timely and efficiently, thereby reducing morbidity and improving the quality of life for such patients.

Cardiovascular Risk across Glycemic Categories: Insights from a Nationwide Screening in Mongolia, 2022–2023

(1) Background: Diabetes mellitus is a significant risk factor for cardiovascular disease (CVD), a leading cause of death globally. Recent studies have highlighted the role of pre-diabetes, particularly impaired fasting glucose (IFG), in elevating CVD risk even before the onset of diabetes. The objective of this study was to assess cardiovascular disease (CVD) risk across specific glycemic categories, including normoglycemia, impaired fasting glucose (IFG), newly diagnosed diabetes, and long-standing diabetes, in a large Mongolian population sample. (2) Methods: This cross-sectional study utilized data from a nationwide health screening program in Mongolia between 2022 and 2023, involving 120,266 adults after applying inclusion criteria. The participants were categorized based on fasting plasma glucose levels (NGT): normoglycemia, IFG, newly diagnosed diabetes, and long-standing diabetes. CVD risk was assessed using WHO risk prediction charts, considering factors like age, blood pressure, smoking status, and diabetes status. (3) Results: CVD risk varied significantly with glycemic status. Among those with NGT, 62.9% were at low risk, while 31.2% were at moderate risk. In contrast, the IFG participants had 49.5% at low risk and 39.9% at moderate risk. Newly diagnosed diabetes showed 38.1% at low risk and 43.3% at moderate risk, while long-standing diabetes had 33.7% at low risk and 45.9% at moderate risk. Regression analysis indicated that glycemic status was independently associated with moderate to high CVD risk (OR in IFG: 1.13; 95% CI: 1.09–1.18), even after adjusting for age, gender, and central obesity. (4) Conclusions: This study emphasizes the need for early cardiovascular risk assessment and intervention, even in pre-diabetic stages like IFG.

Automated Diabetic Retinopathy Detection Using Convolutional Neural Networks For Feature Extraction And Classification (ADRFEC)

Diabetic Retinopathy (DR) is a significant complication of Diabetes Mellitus, leading to various retinal abnormalities that can impair vision and, in severe cases, result in blindness. Approximately 80% of patients with long-standing diabetes for 10–15 years develop DR. The manual process of diagnosing and detecting DR for timely treatment is both time-consuming and unreliable, mainly due to resource constraints and the need for expert opinion. To address this challenge, computerized diagnostic systems utilizing Deep Learning (DL) Convolutional Neural Network (CNN) architectures have been proposed to learn DR patterns from fundus images and assess disease severity. The proposed model performs an exhaustive analysis of these architectures upon fundus images, and derives the best performing DL architecture for DR feature extraction and fundus image classification. Amongst all the models, ResNet50 has achieved the highest training accu- racy whereas VGG-16 has achieved the lowest training accuracy. Again, VGG-16 has achieved lowest validation accuracy whereas ResNet101 has achieved highest validation accuracy.

Different Associations between Lipid Levels and Risk for Heart Failure according to Diabetes Progression.

The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus. Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5-10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis. During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100-129, 130-159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration. Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Transcriptomic Profile of Lin−Sca1+c-kit (LSK) cells in db/db mice with long-standing diabetes

BackgroundThe Lin−Sca1+c-Kit+ (LSK) fraction of the bone marrow (BM) comprises multipotent hematopoietic stem cells (HSCs), which are vital to tissue homeostasis and vascular repair. While diabetes affects HSC homeostasis overall, the molecular signature of mRNA and miRNA transcriptomic under the conditions of long-standing type 2 diabetes (T2D;>6 months) remains unexplored.MethodsIn this study, we assessed the transcriptomic signature of HSCs in db/db mice, a well-known and widely used model for T2D. LSK cells of db/db mice enriched using a cell sorter were subjected to paired-end mRNA and single-end miRNA seq library and sequenced on Illumina NovaSeq 6000. The mRNA sequence reads were mapped using STAR (Spliced Transcripts Alignment to a Reference), and the miRNA sequence reads were mapped to the designated reference genome using the Qiagen GeneGlobe RNA-seq Analysis Portal with default parameters for miRNA.ResultsWe uncovered 2076 out of 13,708 mRNAs and 35 out of 191 miRNAs that were expressed significantly in db/db animals; strikingly, previously unreported miRNAs (miR-3968 and miR-1971) were found to be downregulated in db/db mice. Furthermore, we observed a molecular shift in the transcriptome of HSCs of diabetes with an increase in pro-inflammatory cytokines (Il4, Tlr4, and Tnf11α) and a decrease in anti-inflammatory cytokine IL10. Pathway mapping demonstrated inflammation mediated by chemokine, cytokine, and angiogenesis as one of the top pathways with a significantly higher number of transcripts in db/db mice. These molecular changes were reflected in an overt defect in LSK mobility in the bone marrow. miRNA downstream target analysis unveils several mRNAs targeting leukocyte migration, microglia activation, phagosome formation, and macrophage activation signaling as their primary pathways, suggesting a shift to an inflammatory phenotype.ConclusionOur findings highlight that chronic diabetes adversely alters HSCs’ homeostasis at the transcriptional level, thus potentially contributing to the inflammatory phenotype of HSCs under long-term diabetes. We also believe that identifying HSCs-based biomarkers in miRNAs or mRNAs could serve as diagnostic markers and potential therapeutic targets for diabetes and associated vascular complications.

Incidence of Various Tuberculous Lesions in Indian Patients with Diabetes Mellitus: A Cross-Sectional Study

Background: Globally, TB is a major health issue, especially in low- and middle-income nations. Diabetes mellitus (DM) increases TB risk and complicates treatment. Due to the greatest worldwide TB burden and rising DM incidence, India faces a double public health problem. This study investigated the incidence and types of tuberculous lesions in Indian patients with diabetes mellitus. Methods: A total of 250 individuals with a history of DM and respiratory symptoms were included. Data were collected through patient interviews, clinical examinations, and diagnostic tests. The association between diabetes-related factors and the incidence of tuberculous lesions was analyzed. Results: Out of 250 patients, 70 (28%) were diagnosed with tuberculous lesions. Pulmonary tuberculosis was the most common type (16%), followed by extrapulmonary tuberculosis (8%) and disseminated tuberculosis (4%). The duration of diabetes and higher HbA1c levels were considerably correlated with an increased risk of tuberculous lesions (p&lt;0.05). Patients commonly presented with cough with sputum (85.7%), weight loss (78.6%), and loss of appetite (71.4%). Sputum examination for Acid-Fast Bacilli (AFB) was positive in 64.3% of cases, and chest X-rays showed lesions in 71.4% of patients. Conclusion: The study highlights a significant incidence of tuberculous lesions among diabetic patients, with pulmonary tuberculosis being the predominant type. Poor glycemic control and longer duration of diabetes are critical risk factors. These findings emphasize the need for regular TB screening and proactive management in diabetic patients to prevent complications and improve outcomes. Recommendation: Healthcare providers should integrate routine TB screening into the care protocols for diabetic patients, particularly those with poor glycemic control and long-standing diabetes. Public health strategies should focus on the dual burden of TB and DM to enhance early detection and treatment, thereby improving patient outcomes. Keywords: Tuberculosis, Diabetes Mellitus, Incidence, Glycemic Control

A case of type 2 diabetes mellitus complicated with IgG4-related retroperitoneal fibrosis and a literature review.

IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that can affect multiple organs throughout the body, predominantly in middle-aged and elderly males, with a male-to-female ratio of 2꞉1 to 3꞉1. IgG4-related retroperitoneal fibrosis (IgG4-RPF), a rare subtype of IgG4-RD, has an unclear etiology, and its comorbidity with type 2 diabetes mellitus is also uncommon. A lack of awareness of this condition in clinical practice can easily lead to misdiagnosis. On July 14, 2016, the Third Xiangya Hospital of Central South University admitted a patient with type 2 diabetes mellitus complicated by IgG4-RPF. Following comprehensive treatment, including blood glucose and blood pressure control, kidney protection, circulation improvement, and the use of prednisone, the patient's condition significantly improved. The retroperitoneal fibrotic mass decreased in size, renal function improved, and serum IgG4 levels decreased. After 8 years of follow-up, the condition did not recur. Analyzing this case in conjunction with a literature review suggests that the development of IgG4-RPF in diabetic patients may be related to chronic inflammation from metabolic syndrome and atherosclerotic plaques associated with long-standing diabetes. This provides valuable clinical ideas for clinicians in diagnosing and treating this rare comorbidity.

Expert opinion on the prescription practice of vildagliptin and its combinations in managing type 2 diabetes mellitus in Indian settings

Background: The aim of the study was to gather expert opinion regarding the use of vildagliptin and its combinations in T2DM in Indian settings. Methods: This cross-sectional study involved 24 questions and collected perspectives of experts across various clinical settings in India regarding the use of vildagliptin and its combinations for the management of type 2 diabetes mellitus (T2DM) in their clinical practice. Results: Among 195 participants, most clinicians (73%) advocated vildagliptin once-daily formulation for newly diagnosed young diabetics, elderly patients with long-standing diabetes, and those with uncontrolled diabetes as an add-on therapy. Around 92% favored vildagliptin for its weight-neutral nature, preservation of beta-cell function, minimal glycemic variation, and low risk of adverse effects. Most clinicians (66%) preferred initiating vildagliptin and metformin combination therapy in diabetic individuals aged 40 to 50 years, with 53% opting for it when HbA1c levels exceeded 8%. Approximately 83% favored this combination for young, elderly, and long-standing diabetic individuals. More than half (54%) of the clinicians preferred prescribing the fixed-dose combination (FDC) of vildagliptin and dapagliflozin to 11-25% of the patients. Conclusions: The survey underscored the effectiveness of vildagliptin and its combinations in managing T2DM. Clinicians widely endorsed vildagliptin once-daily formulation and vildagliptin and metformin therapy for diverse diabetic populations due to their efficacy and tolerability. They also advocated the use of vildagliptin and dapagliflozin therapy, especially in patients with specific comorbidities or higher HbA1c levels, citing its benefits in achieving better glycemic control and reducing disease progression.

Burden and Predictors of Diabetic Nephropathy in an Adult With Diabetes Mellitus Patients on Follow up at Ambo University Referral Hospital Central, Ethiopia

BACKGROUND: Despite the growing evidence of Diabetic Nephropathy in adult patients with long-standing diabetes in sub-Saharan Africa, data on its burden and correlates in adult African patients with diabetes are limited. We, therefore, undertook this study to determine the burden and predictors of Diabetic Nephropathy among adult population with diabetes in Hospital. OBJECTIVE: We, therefore, undertook this study to determine the burden and predictors of Diabetic Nephropathy among adult population with diabetes in Ambo University Referral Hospital Central, Ethiopia. METHODS: A Hospital-based cross-sectional study was conducted from June to August, 2023 and a systematic random sampling method used to recruit participants. A total of 4,300 were interviewed using structured questionnaires to gather data from the study subjects. For data entry and analysis, Epi Data version 3.1.1 and SPSS version 25 were used. Multivariable logistic regression analysis was done after descriptive statistics. 95% confidence intervals (CI) and crude and adjusted odds ratios were presented. RESULTS: Diabetic Nephropathy (DN) was documented in population was 24.9% from the 369 participants (95%; CI 23.37– 26.43) participants among the study). Male sex [AOR = 2.215; 95% CI: 1.34, 3.45, p = 0.002], physically inactive [AOR = 1.983; 95% CI: 1.05, 3.70), P = 0.034], dyslipidaemia [AOR: 1.98, CI: 1.009, 3.5), P = 0.024] and poor controlled glycemia [AOR= 2.70; 1.40, 5.2), P = 0.003] were significant determinants for the development of Diabetic Nephropathy. CONCLUSION: Among DM patients, sex, physical inactivity, dyslipidaemia, and poor glycemic control were discovered to be the predictors of diabetic nephropathy. By enhancing programs for health information, education, and promotion, diabetes management should be better equipped to achieve glycaemic control and prevent diabetic nephropathy.

Advancements in the Treatment of Diabetic Macular Edema: Current Strategies and Future Directions

This narrative review examines current and emerging treatment strategies for diabetic macular edema (DME), a complication of diabetic retinopathy characterised by fluid accumulation in the macula, which can lead to vision impairment. The incidence of DME is particularly high in patients with long-standing diabetes and advanced retinopathy. The current treatment options for DME include anti-vascular endothelial growth factor (anti-VEGF) agents, corticosteroids, and laser therapies. Anti-VEGF agents, including bevacizumab, ranibizumab, aflibercept, and the more recently developed brolucizumab and faricimab, have been demonstrated to reduce macular thickness and improve visual acuity. Brolucizumab offers the advantage of fewer injections due to its longer duration of action, although it carries a higher risk of ocular inflammation compared to other anti-VEGF agents. The dual inhibition of the VEGF and angiopoietin-2 (Ang-2) pathways by faricimab may enhance vascular stability and reduce inflammation, potentially improving patient outcomes. Steroid therapies, including dexamethasone, fluocinolone acetonide, and triamcinolone acetonide, represent an alternative for patients who do not respond adequately to anti-VEGF treatment. Laser therapies, including focal, navigated, and subthreshold laser treatments, remain a crucial component in the management of DME, with the ability to seal leaking vessels and reduce fluid accumulation. In order to achieve the best outcomes for patients, it is essential to continue to advance these treatment modalities and adopt a personalised, multifaceted approach.

Kv7 Channel Activators Flupirtine and ML213 Alleviate Neuropathic Pain Behavior in the Streptozotocin Rat Model of Diabetic Neuropathy.

Chronic peripheral neuropathic pain (PNP) is a debilitating condition that is associated with many types of injury/diseases, including diabetes mellitus. Patients with longstanding diabetes develop diabetic PNP (DPNP), which is resilient to currently available drugs. The underlying molecular mechanisms of DPNP are still illusive, but Kv7 channels that have been implicated in the pathogenesis of various types of chronic pain are likely to be involved. Indeed, using the streptozotocin (STZ) rat model of DPNP, we have previously shown that Kv7 activation with their non-selective activator retigabine attenuated neuropathic pain behavior suggesting that these channels are implicated in DPNP pathogenesis. Here, we evaluated, in the same STZ model, whether the more potent and more selective Kv7 channel openers flupirtine and ML213 attenuate STZ-induced pain hypersensitivity. Male Sprague Dawley rats (250-300 g) were used. The STZ model involved a single injection of STZ (60 mg/kg, i.p.). Behavioral testing for mechanical and heat pain sensitivity was performed using a dynamic plantar aesthesiometer and Hargreaves analgesiometer, respectively. STZ rats exhibited behavioral signs of mechanical and heat hypersensitivity as indicated by significant decreases in the mean paw withdrawal threshold (PWT) and mean paw withdrawal latency (PWL), respectively, at 35 days post-STZ treatment. Single injections of flupirtine (10 mg/kg, i.p.) and ML213 (5 mg/kg, i.p.) to STZ rats (35-days after STZ treatment) caused significant increases in the mean PWT, but not PWL, indicating attenuation of mechanical, but not heat hypersensitivity. Both flupirtine and ML213 were as effective as the positive control gabapentin (10/kg, i.p.), and their anti-allodynic effects were prevented by the Kv7 channel-specific blocker XE991 (3 mg/kg, i.p.). The findings suggest that Kv7 channels are involved in the mechanisms of mechanical but not heat hypersensitivity associated with DPNP, and that their activation may prove to be effective in alleviating DPNP symptoms.