Long-term Complications Of Diabetes Mellitus Research Articles

The assessment of quality of care of patients with type 2 diabetes mellitus in a population-based cohort in the District of Landeck in Austria

IntroductionStructured diabetes care based on evidence-based guidelines is one of the main strategies to improve glycemic control and to reduce long-term complications in diabetes mellitus. MethodsThis study is based on the “Diabetes-Landeck Cohort”, a population-based cohort of patients with diabetes mellitus type 2 (T2DM). We assessed the quality of diabetes care and compared it between three groups of care units, that is, general practitioners (GP), diabetes specialists in private practice (DSPP), and hospitals (HOSP). ResultsThe total study population comprised 1616 patients with T2DM, including 378 patients of GP, 281 of DSPP, and 957 from HOSP. We identified statistically significant differences: DSPP showed the highest percentage of structured training, sufficient training, eye examinations and foot examinations. The group HOSP showed the highest proportion for increased HbA1c≥ 7.5 and almost all long-term complications surveyed, that is, nephropathy (23.2%), neuropathy (14.4%), diabetic foot (5.1%), and cerebrovascular diseases (10.9%). ConclusionThis population-based cohort study on patients with T2DM in Austria showed significant differences in important quality-of-care process and outcome parameters across different groups of care units. Future research should also include prediction modeling for early warning and monitoring systems as well as adjustment for patient characteristics and duration and severity of disease.

Real-time heart rate variability according to ambulatory glucose profile in patients with diabetes mellitus.

Autonomic neuropathy commonly occurs as a long-term complication of diabetes mellitus (DM) and can be diagnosed based on heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. There are limited data on HRV using real-time ECG and ambulatory glucose monitoring in patients with DM. The aim of this study was to investigate real-time HRV according to ambulatory glucose levels in patients with DM. A total of 43 patients (66.3 ± 7.5 years) with DM underwent continuous real-time ECG monitoring (225.7 ± 107.3 h) for HRV and ambulatory glucose monitoring using a remote monitoring system. We compared the HRV according to the ambulatory glucose profile. Data were analyzed according to the target in glucose range (TIR). There were no significant differences in the baseline characteristics of the patients according to the TIR. During monitoring, we checked ECG and ambulatory glucose levels (a total of 15,090 times) simultaneously for all patients. Both time- and frequency-domain HRVs were lower when the patients had poorly controlled glucose levels (TIR < 70%) compared with well controlled glucose levels (TIR > 70%). In addition, heart and respiratory rates increased with real-time glucose levels (P < 0.001). Poorly controlled glucose levels were independently associated with lower HRV in patients with DM. This was further substantiated by the independent continuous association between real-time measurements of hyperglycemia and lower HRV. These data strongly suggest that cardiac autonomic dysfunction is caused by elevated blood sugar levels.

Correlation between diabetic nephropathy and diabetic retinopathy as a long term complications of diabetes mellitus

Abstract Background/aim: Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by a lack of insulin, with a consequent disordered metabolism of glucose, fats, and proteins. A number of complications, such as diabetic nephropathy and retinopathy, may develop as a result of long-term diabetes. The aim of this study aimed to determine the correlation between diabetic nephropathy and diabetic retinopathy as long-term complications of diabetes mellitus. Materials and methods: Retrospective, descriptive, and analytical research was conducted at the department of Endocrinology, Clinical Center, University of Sarajevo. The study included 158 patients hospitalized in time between 1st of January and 31st of December 2012. Results: New-onset diabetes was found in 38%, and diabetes type 2 patients 132 (83.5%), female 105 (66.5%) while older than 60 years were 100 (63.3%). Upon discharge from hospital 83,7% of patients were discharged with glycemia &lt;10 mmol / l. We found that 47,5% of patients had HbA1c&gt; 10%. Reduced kidney function, different degrees of failure was at 66.5%. More than half (62.7%) patients had proteinuria as a sign of diabetic nephropathy. Diabetic retinopathy was diagnosed with different types in 54.4%. Conclusion: Diabetes leads to an increase in nitrogen compounds, and the development of diabetic nephropathy manifests as various degrees of renal insufficiency. The duration of diabetes and occurrence of diabetic retinopathy were significantly interrelated. The correlation between the degree of renal failure and changes in the ocular fundus has not been proven, but more severe renal insufficiency is associated with a higher incidence of diabetic retinopathy compared to patients with less impaired renal function.

Diabetes Mellitus: A Review and Update

Diabetes mellitus is a group of metabolic diseases which are typified by the development of hyperglycaemia which do emanate from defects in insulin secretion, insulin action, or both. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Various types of diabetes mellitus exist which have been discussed in the main part of this article. Many pathogenic processes are involved in the development of diabetes mellitus. These pathogenic processes range from autoimmune destruction of the beta-cells of the pancreas with consequent insulin deficiency to abnormalities which result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action ensues inadequate insulin secretion and / or diminished tissue responses to insulin at one or more points within the complex pathways of hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycaemia. The manifestations of marked hyperglycaemia do include: polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also ensue chronic hyperglycaemia. Acute, life-threatening consequences of diabetes mellitus include: hyperglycaemia with ketoacidosis or the nonketotic hyperosmolar syndrome. Long-term complications of diabetes mellitus do include: diabetic retinopathy with potential loss of vision; diabetic nephropathy which leads to kidney (renal) failure; peripheral neuropathy with risk of foot ulcers, amputation, and Charcot joints; as well as autonomic neuropathy which cause gastrointestinal, genitourinary, as well as cardiovascular symptoms and sexual dysfunction. Glycation of tissue proteins and other macromolecules and excess production of polyol compounds from glucose are among the mechanisms that had been postulated to produce tissue damage from chronic hyperglycaemia. Patients who have diabetes mellitus do have an increased incidence of atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease. Hypertension, abnormalities of lipoprotein metabolism, and periodontal disease are often found in people who have diabetes mellitus. The emotional and social impact of diabetes mellitus as well as the demands of treatment of diabetes and its complications could cause significant psychosocial dysfunction in patients who have diabetes mellitus as well as their families. Even though there are many types of diabetes mellitus, the vast majority of cases of diabetes mellitus do fall into two broad etiopathogenetic categories which have been extensively discussed in the ensuing article below that has been divided into (a) Overview and (b) miscellaneous narrations. In one category of diabetes mellitus type 1 diabetes mellitus, the cause is an absolute deficiency of insulin secretion. Individuals at increased risk of developing this type of diabetes could often be identified by serological evidence of an autoimmune pathological process that occur within the pancreatic islets and by genetic markers. In the other type of diabetes mellitus, which is the much more prevalent category that is referred to as type 2 diabetes mellitus, the cause of the disease is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response. In the latter category, a degree of hyperglycaemia sufficient to cause pathological and functional changes in various target tissues, but without clinical symptoms, could be present for a long period of time before diabetes mellitus is diagnosed. During this asymptomatic period, it is possible to demonstrate an abnormality in carbohydrate metabolism by measurement of plasma glucose in the fasting state or after a challenge with an oral glucose load. Considering that diabetes mellitus is common as well as the symptoms of diabetes mellitus are non-specific symptoms that may simulate diabetes mellitus, a number of individuals who are afflicted by diabetes mellitus do not know they have diabetes mellitus, there is need for a global educational program on the manifestations and approach that is needed for early diagnosis of the disease so that all clinicians and the entire global population would have a high index of suspicion of the disease. There also a global life style education including regular exercise that would delay onset of or reduce the severity of type 2 diabetes and to improve the quality of life of patients who have diabetes mellitus. It is important to dedicate time to read the article carefully which contains documentations related to the World Health Organization’s global effort to reduce the incidence and severity of diabetes mellitus and all individuals globally should follow carefully recommendations of the World Health organization as well as recommendations of other organizations in the world that have devoted their time to health education on diabetes mellitus. and a number of people

Effects of Diabetes Mellitus-Related Dysglycemia on the Functions of Blood-Brain Barrier and the Risk of Dementia.

Diabetes mellitus is one of the most common metabolic diseases worldwide, and its long-term complications include neuropathy, referring both to the peripheral and to the central nervous system. Detrimental effects of dysglycemia, especially hyperglycemia, on the structure and function of the blood-brain barrier (BBB), seem to be a significant backgrounds of diabetic neuropathy pertaining to the central nervous system (CNS). Effects of hyperglycemia, including excessive glucose influx to insulin-independent cells, may induce oxidative stress and secondary innate immunity dependent inflammatory response, which can damage cells within the CNS, thus promoting neurodegeneration and dementia. Advanced glycation end products (AGE) may exert similar, pro-inflammatory effects through activating receptors for advanced glycation end products (RAGE), as well as some pattern-recognition receptors (PRR). Moreover, long-term hyperglycemia can promote brain insulin resistance, which may in turn promote Aβ aggregate accumulation and tau hyperphosphorylation. This review is focused on a detailed analysis of the effects mentioned above towards the CNS, with special regard to mechanisms taking part in the pathogenesis of central long-term complications of diabetes mellitus initiated by the loss of BBB integrity.

Prevalence and Associated Risk Factors of Urinary Tract Infection among Diabetic Patients: A Cross-Sectional Study

Urinary tract infections (UTIs) are one of the most common long-term complications of diabetes mellitus (DM). Additionally, various factors, such as socio-demographics, type of DM, fasting blood glucose, regular diabetes monitoring, comorbid chronic diseases, HbA1c, body mass index (BMI), and duration of DM, are also thought to predispose individuals to developing UTIs more frequently when they have DM. This research aims to evaluate the risk factors for UTIs and their prevalence among people with DM in Saudi Arabia (KSA). This cross-sectional study was conducted among 440 adults with type 1, type 2, and gestational DM. The participants had to be at least 18 years old, of both genders, and had been suffering from DM for any period of time. A self-administered questionnaire was utilized to collect data on demographic characteristics, such as sex, age, height, weight, material state, education level, income, and clinical profiles of DM and UTI. The crude (COR) and adjusted odds ratios (AOR) were calculated using logistic regression in the IBM SPSS software. The incidence of types 1 and 2 DM and gestational diabetes reached 34.1, 60.9, and 5%, respectively. Most of the participants had first-degree relatives with DM (65.9%). UTI was common in 39.3% of participants. A chi-squared statistical analysis revealed that the frequency of UTI varied depending (χ2 = 5.176, P = 0.023) on the type of DM. Burning urination and abdominal pain were the most common symptoms. The CORs for sex, marital status, hypertension, and BMI were significant (P < 0.05) and had values of 2.68 (95% CI = 1.78-4.02), 0.57 (95% CI = 0.36-0.92), 1.97 (95% CI = 1.14-3.43), and 2.83 (95% CI = 1.19-2.99), respectively. According to the adjusted model, only sex influenced the occurrence of UTIs. The AOR for sex was 3.45 (95% CI = 2.08-5.69). Based on this study, the authorities related to the health of DM patients can use its findings to guide awareness programs and clinical preparedness.

Prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients in a tertiary hospital in Lagos: a cross-sectional study.

periodontitis is the sixth leading long-term complication of diabetes mellitus which can impair diabetic patients' metabolic control. Patients with both diabetes mellitus and periodontal disease present with the challenge of managing these two chronic diseases, each of which may impact the other. The aim of this study was to determine and compare the prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients attending a large tertiary hospital in Lagos, Nigeria. this was a cross-sectional comparative study involving 110 diabetics and 110 non-diabetic patients aged 40 years and above. They were recruited from the diabetes and general medical out-patient clinics respectively in a large tertiary hospital in Lagos using a systematic sampling method. Data was collected using an interviewer-administered questionnaire. In addition, blood tests for glycated haemoglobin and oral examination using a simplified periodontal examination were conducted. The prevalence and severity of periodontitis and oral hygiene practices were compared between both groups. Data were analyzed with IBM SPSS version 21 Software. the prevalence of periodontitis was higher among the diabetics 100 (90.9%) compared to the non-diabetic patients 79 (71.8%), and this was statistically significant (p<0.001). Severity of periodontitis among both groups was also statistically high 54 (49.1%) vs. 35 (31.8%) p<0.001. the prevalence of periodontitis was higher and more severe among diabetics compared to non-diabetics. Oral hygiene practices in both groups are not statistically significant p>0.05. Oral health education programs targeted at diabetic patients should be carried out to prevent and control periodontitis.

Identification of a novel adiponectin receptor and opioid receptor dual acting agonist as a potential treatment for diabetic neuropathy

Diabetic neuropathy (DN) is a long-term complication of diabetes mellitus, affecting different periphery nerve systems including sensory and motor neurons. Hyperglycemia is the major cause of DN with symptoms such as weakness of balance or coordination, insensitivity to sensation, weakness of the muscles as well as numbness and pain in limbs Analgesic drug such as opioids can be effective to relief neuropathy pain but there is no effective treatment. Adiponectin is an anti-diabetic adipokine, which possesses insulin-sensitizing and neuroprotective effects. In this project, we aim to identify an agent which is dual acting to opioid and adiponectin receptors. Within a virtual screening repositioning campaign, a large collection of compounds with different structures comprehensive of adipoRon-like piperidine derivatives was screened by docking. Recently developed opioid receptor benzomorphanic agonists finally emerged as good ligands to adiponectin receptors showing some 2D and 3D structural similarities with AdipoRon. Particularly, we have identified (+)-MML1017, which has high affinity to the same binding domain of AdipoR1 and AdipoR2 as AdipoRon. Our western blot results indicate (+)-MML1017 activates AMPK phosphorylation through both adipoR1 and adipoR2 in neuronal cell line. Moreover, pretreatment of (+)-MML1017 can improve the cell viability with motor neurons under hyperglycermic conditions. The (+)-MML1017 also activates μ-opioid receptor cells in a concentration-dependent manner. Our study identified a novel compound having dual activity on opioid receptors and adiponectin receptors that may have analgesic effects and neuroprotective effects to treat diabetic neuropathy.

Association of serum prolactin and glycemic status with retinopathy among type 2 diabetic male

Diabetic Retinopathy (DR) is one of the long-term complications of Diabetes Mellitus (DM) and constitutes the leading cause of blindness in working-age individuals. Prolactin (PRL) is a peptide hormone that is linked with lactation, but many studies have demonstrated that PRL could have protective value against DR. The aim of this study is to evaluate the role of prolactin in pathophysiology of DR. This study is designed to find an association between PRL level and DR. In this case-control study, a total of 300 subjects were recruited to participate in the study,150 subjects apparently healthy as control group and other 150 patients were diagnosed with type 2 DM who were classified into diabetic patients with DR (75) and diabetic patients without DR (75). Serum PRL was measured by autoanalyzer (TOSOH AIA system), HbA1c was measured by another automated chemical analyzer (Cobas c system). Statistical analysis was performed using SPSS version 21 using an independent samples T-test and Pearson’s correlation. Independent samples of T-test analysis show a significant decrease in PRL level in the diabetic patients with DR in comparison to the diabetic patients without DR (p˂0.05). Person’s correlation revealed that there was an insignificant correlation between PRL level with duration of DM and patients’ age. In conclusion, these findings suggest that low PRL level might be associated with DR.

Glycemic control among children with type 1 diabetes mellitus and its determinants in a resource-limited setting.

Glycemic control is an important parameter that can predict long-term complications of diabetes mellitus. It can be affected by many factors. Hence, identifying those factors for improving disease outcomes is essential. The purpose of this study was to assess glycemic control in children who were treated with a conventional insulin regimen and to identify its associated factors. A retrospective cohort study was conducted among children with type one diabetes mellitus (T1DM) who had follow-up from November 2015 to November 2020 at the pediatric endocrinology clinic of St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Glycemic control was assessed by measuring glycosylated hemoglobin (HbA1C) and children who had HbA1C within three to six months of the data collection were recruited. A total of 106 children with TIDM who were on conventional insulin therapy were included in this study. Their median age at diagnosis was nine years, 47.2% were females, and 57.5% were from urban areas. The average HbA1c of the children was 9.7%. The majority (85.2%) of the children had poor glycemic control (>7.5%). Younger age, longer disease duration, and urban residence were found to be significant predictors of good glycemic control. A significant majority of children with T1DM had poor glycemic control. This calls for the need to create access to intensive diabetes care by health authorities and stakeholders to prevent the long-term complications of T1DM.

Combination Therapy of Alpha-Lipoic Acid, Gliclazide and Ramipril Protects Against Development of Diabetic Cardiomyopathy via Inhibition of TGF-β/Smad Pathway.

Background: Diabetic cardiomyopathy (DCM) is a major long-term complication of diabetes mellitus, accounting for over 20% of annual mortality rate of diabetic patients globally. Although several existing anti-diabetic drugs have improved glycemic status in diabetic patients, prevalence of DCM is still high. This study investigates cardiac effect of alpha-lipoic acid (ALA) supplementation of anti-diabetic therapy in experimental DCM. Methods: Following 12 h of overnight fasting, 44 male Sprague Dawley rats were randomly assigned to two groups of healthy control (n = 7) and diabetic (n = 37) groups, and fasting blood glucose was measured. Type 2 diabetes mellitus (T2DM) was induced in diabetic group by intraperitoneal (i.p.) administration of nicotinamide (110 mg/kg) and streptozotocin (55 mg/kg). After confirmation of T2DM on day 3, diabetic rats received monotherapies with ALA (60 mg/kg; n = 7), gliclazide (15 mg/kg; n = 7), ramipril (10 mg/kg; n = 7) or combination of the three drugs (n = 7) for 6 weeks while untreated diabetic rats received distilled water and were used as diabetic control (n = 9). Rats were then sacrificed, and blood, pancreas and heart tissues were harvested for analyses using standard methods. Results: T2DM induction caused pancreatic islet destruction, hyperglycemia, weight loss, high relative heart weight, and development of DCM, which was characterized by myocardial degeneration and vacuolation, cardiac fibrosis, elevated cardiac damage markers (plasma and cardiac creatine kinase-myocardial band, brain natriuretic peptide and cardiac troponin I). Triple combination therapy of ALA, gliclazide and ramipril preserved islet structure, maintained body weight and blood glucose level, and prevented DCM development compared to diabetic control (p < 0.001). In addition, the combination therapy markedly reduced plasma levels of inflammatory markers (IL-1β, IL-6 and TNF-α), plasma and cardiac tissue malondialdehyde, triglycerides and total cholesterol while significantly increasing cardiac glutathione and superoxide dismutase activity and high-density lipoprotein-cholesterol compared to diabetic control (p < 0.001). Mechanistically, induction of T2DM upregulated cardiac expression of TGF-β1, phosphorylated Smad2 and Smad3 proteins, which were downregulated following triple combination therapy (p < 0.001). Conclusion: Triple combination therapy of ALA, gliclazide and ramipril prevented DCM development by inhibiting TGF-β1/Smad pathway. Our findings can be extrapolated to the human heart, which would provide effective additional pharmacological therapy against DCM in T2DM patients.

MORPHOFUNCTIONAL CHANGES OF THE BRAIN IN DIABETES MELLITUS

Against the background of the aging population and the rise in the incidence of diabetes mellitus, there is an increase in complications, including those related to the central nervous system. Today, diabetes mellitus remains a socially significant nosology, since the therapy of long-term complications of diabetes mellitus is ineffective due to insufficient study of the mechanisms of multifactorial pathogenesis. The purpose of this literature review is to summarize modern scientific data on morphofunctional changes in the brain in diabetes mellitus.

The synergistic effect of palmitic acid and glucose on inducing endoplasmic reticulum stress-associated apoptosis in rat Schwann cells.

Diabetic peripheral neuropathy (DPN) is a common long-term complication of diabetes mellitus accompanied with hyperglycemia and hyperlipidemia. Both high blood glucose and high blood lipids are key pathogenies for DPN. This research aims to investigate whether the combination of glucose (Glu) and palmitic acid (PA) played a synergistic role in the pathogenesis of DPN. The proliferation rate of Rat Schwann cell line RSC96 cells stimulated by different concentrations of Glu and PA were analyzed by CCK-8 assay. After the IC50 was detected for each drug, the RSC96 cells were divided into control, Glu, Glu+PA, PA, and BSA groups. The apoptosis of RSC96 cells in different groups were detected by flow cytometry. The effects of Glu and/or PA on endoplasmic reticulum (ER) stress-associated apoptotic signaling pathways were determined by Western blot and qPCR. Both Glu and PA showed similar inhibition on the proliferation of RSC96 cells in a dose-dependent manner. However, PA induced stronger apoptosis of RSC96 cells than glucose and significantly increased the levels of X-box-binding protein-1 (XBP1), C/EBP homologous protein (CHOP), and eIF2α phosphorylation, which are key proteins regulating endoplasmic reticulum (ER) stress-associated apoptotic signaling pathways. The combination of Glu and PA induced the strongest apoptosis in RSC96 cells and also activated ER stress-associated apoptotic signaling pathways. These results verified the synergistic effect of Glu and PA on inducing ER stress-associated apoptosis in RSC96 cells, and PA even induced stronger apoptosis in RSC96 cells than Glu. The present research indicated that hyperglycemia and hyperlipidemia might exert a synergistic damage during the pathogenesis of DPN, suggesting that blood lipid control is as important as blood glucose control for DPN patients.

Diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study

AimDiabetic kidney disease (DKD) is a major long-term complication of diabetes mellitus (DM). Given the paucity of data on DKD in Jordan, we aimed to evaluate the prevalence, characteristics and correlates of DKD in Jordanian patients with type 2 DM.MethodsThis cross-sectional study included 1398 adult patients with type 2 DM who sought medical advice in the endocrinology clinic between March and September 2019. Demographic, clinical and laboratory data were reviewed. DKD was defined as reduced eGFR, and/or albuminuria. Three regression models were constructed to identify factors associated with CKD stages, albuminuria and DKD.ResultsOverall, 701 (50.14%) patients had DKD, with a median age of 59.71 ± 11.36 years. Older age, high triglycerides, and low high-density lipoprotein were associated with DKD (multivariable odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.03, p < 0.01; OR: 1.1, 95% CI: 1.01–1.2; and OR: 0.98, 95% CI: 0.97–0.99, p < 0.01 respectively). Metformin and renin-angiotensin system blockers were negatively associated with albuminuria and chronic kidney disease stages (p < 0.01).ConclusionOur study demonstrated that approximately one half of patients with type 2 DM had DKD. Further studies are necessary to understand this high prevalence and the underlying factors. Future research are needed to assess implementing targeted community-based intervention.

Look under the sheets – a case report of diabetic foot

Diabetic foot is a long-term complication of diabetes mellitus that results directly from peripheral arterial disease or sensory neuropathy affecting the feet in diabetes mellitus. Diabetic foot is rare, but potentially lethal complication associated with the diabetes. The management of diabetic foot infections requires assessing the microbial etiology, attentive wound management, good nutrition, antimicrobial therapy and glycemic control. In several clinical circumstances, surgical resection is preferable. A 65-year-old patient with 2-month necrosis of the second toe of the left foot and recurrent fever is presented. Diabetic foot developed. Citrobacter koseri was isolated from bone cultures. Intravenous treatment with amoxicillin + clavulanic acid and metronidazole was administered for 2 weeks and the wound was poorly recovered. After a surgical consultation, the patient was qualified for the amputation of the second toe of the left foot.

Clinical Use and Limitation of Hemoglobin A1c Examination

Haemoglobin A1c (HbA1c/A1C) is a part of haemoglobin (Hb) that binds to glucose through non-enzymatic reactions. In general, HbA1c is used as a parameter for diagnosis, target therapy and monitoring or prediction of long-term complications of diabetes mellitus (DM) outcome. However, HbA1c can also be used to predict the incidence of DM and vascular outcomes in those without DM. HbA1c above 6.5% is used as the limit for diagnosing DM, and in general, HbA1c &lt; 7.0% is used as the target limit of therapy in adult DM patients. As a parameter for the diagnosis of DM and long-term monitoring, HbA1c has limitations and advantages over blood glucose testing, because HbA1c is strongly influenced by several conditions that affect the life span of erythrocytes where Hb will remain throughout the life of the cell. Likewise, HbA1c cannot assess the variability of blood glucose levels short-termly and cannot determine the presence of hypoglycaemia. With all its limitations, now HbA1c has been established as a parameter to diagnose DM and the most reliable parameter in predicting the incidence of chronic complications from DM.

Evaluation of convolutional neural network variants for diagnosis of diabetic retinopathy

Diabetic Retinopathy (DR) is a long-term complication of Diabetes Mellitus (DM) that impairs vision. This stage occurs in visual impairment and blindness if treated late. DR identified through scanning fundus images. A technique on classifying DR in fundus images is the deep learning approach, one of the methods of implementing machine learning. In this study, the Convolutional Neural Networks (CNN) method applied with the ResNet-50 and DenseNet-121 architectures. The data adopted in this analysis was generated from DIARETDB1, an online database containing fundus images. Then, the pre-processing stage is carried out on the fundus image to improve model performance, such as selected the green channel from the images and inverted it, converted the images into grayscale images, and applied Contrast Limited Adaptive Histogram Equalization (CLAHE) for uniform contrast in the images. The outcome of this research indicates that the ResNet-50 model is better than DenseNet-121 in detecting DR. The most reliable results from the ResNet-50 model's case testing are accuracy, precision, and recall of 95%, 98%, and 96% respectively.

Knowledge of Complications of Diabetes Mellitus among Patients Visiting the Diabetic Center in Makkah Al-Mukarramah, April to June 2020

Background: Diabetes mellitus (DM) is a major metabolic disorder currently affecting over 350 million people worldwide. Also, another one billion people in the world are pre-diabetic, who may eventually end up with full- blown diabetes. The disorder is rapidly increasing out of proportion in both developed and developing countries, especially T2DM, which is associated with modern lifestyle habits such as reduced physical activity, diet, obesity and genetic factors. If left untreated, DM can lead to a number of diseases and long-term complications leading subsequently to death. In Saudi Arabia national healthcare burden because of diabetes is likely to exceed $0.87 billion; it omits the indirect costs associated with diabetes, such as absenteeism, loss of productivity from disease-related complications, unemployment due to disability and early mortality by disease. Complications of diabetes mellitus include problems that develop rapidly (acute) or over time (chronic) and may affect many organ systems. The complications of diabetes can dramatically impair quality of life and cause long-lasting disability. Aim of the study: To assess the level of knowledge regarding complications of diabetes mellitus and associated factors among type 2 diabetic patients. Method: cross sectional descriptive study conducted at among Patients with diabetes mellitus in the Diabetic Center in Al-Noor Hospital, 2020. The Sample size of diabetic patients attending in the Diabetic Center. Our total participants were (300). Results: most of the participants (26.6%) were in the age group 45-50 years the majority of them were males (81.2%), most of participants married were (81.2%), occupation the majority of participant are working were (78.0%). Knowledge of the participant toward diabetes and Practices average (43.2%, 43.8%) while attitude the majority of participant in negative attitude (93.2%), that is a significant relation between knowledge and demographic data regarding age, gender and duration of diabetes mellitus P-value=<0.001. A significant relation between practices and demographic data regarding age, marital status and duration P-value=<0.001. A significant relation between attitude and demographic data regarding age, gender and duration of diabetes mellitus P-value=<0.001. Conclusion: Chronic complications of DM are caused largely by HG-induced cellular and molecular impairment of neural and vascular structure and function. HG-induced oxidative stress is a major contributor in the development of long-term complications of DM. DM-induced neuropathy and angiopathy, in turn, may lead to the dysfunction of cells, tissues and organ systems.

Association between urine albumin creatinine ratio and high sensitivity C-reactive protein in patients with type 2 diabetes mellitus

Introduction: Diabetes mellitus is one of the leading causes of morbidity and mortality for its association with complications like nephropathy, neuropathy, retinopathy and cardiovascular diseases. Chronic inflammation plays an important role in the development and progression of late complications of diabetes, and diabetic nephropathy (DN) is one of the major long-term complications of diabetes mellitus. Aims and Objectives: To determine serum high sensitivity C-reactive protein (hs-CRP) and urine albumin creatinine ratio (UACR) in patients with type 2 DM and to evaluate the relationship of hs-CRP with UACR as markers of early kidney damage. Materials and Methods: Cross sectional study which included 95 clinically diagnosed type 2 DM patients of age group 40 to 70 years. Spot urine microalbumin and creatinine were estimated by immunoturbidimetry and Jaffe method respectively, and the results were reported as albumin creatinine ratio (mg/g). The patients were divided into two groups, diabetic with microalbuminuria as cases and without microalbuminuria as controls. hs-CRP was estimated by immunonephelometry method. Statistical analysis was done using SPSS 20.0. Data were analysed using student ‘t’ test for their level of significance. Correlation between variables was carried out using the Pearson correlation co-efficient. Results: The mean hs-CRP was higher in diabetic patients with microalbuminuria (7.28 ± 3.46) comparing to diabetic patients without microalbuminuria (1.04 ± 0.85) and was statistically significant (p Conclusion: Microalbuminuria was accompanied by elevated hs-CRP level suggesting activation of inflammatory pathways in development of kidney disease. So as a screening method, measurement of serum hs-CRP along with urine albumin creatinine ratio helps in diagnosing early stages of diabetic nephropathy. Keywords: Type 2 DM, High sensitivity C-reactive protein, Urine albumin creatinine ratio, Diabetic nephropathy.

Overexpression of Dnmt3a ameliorates diabetic muscle atrophy by modulating the Pten/Akt pathway.

What is the central question of this study? Does Dnmt3a play a crucial role in regulating diabetic muscle atrophy? What is the main finding and its importance? Muscle atrophy is one of the major long-term complications of diabetes mellitus. However, little is known about the molecular mechanism involved. In this paper, we demonstrated that Dnmt3a overexpression effectively improves the diabetic muscle health in mice and documented the underlying mechanisms. DNMT3A might become a promising target to prevent muscle atrophy in patients with diabetes. Muscle atrophy is one of the major long-term complications of diabetes mellitus, which greatly affects the mobility of patients. Epigenetic processes mediated by DNA methyltransferases (DNMTs) play crucial roles in the locomotor system, but little is known about the functions of DNMTs in diabetic muscle atrophy. Here, we investigated the function of Dnmt3a in diabetic muscle atrophy and explored the mechanisms involved. Adeno-associated virus AAV2 overexpressing Dnmt3a or its vector control was injected into the tibialis anterior muscle of streptozotocin-induced diabetic mice. Muscle mass and muscle cross-sectional area were used to evaluate muscle atrophy. In vitro, adeno-associated virus AAV2 overexpressing Dnmt3a or its vector control was transfected into C2C12 myoblasts. Horse serum was used to induce differentiation and palmitate to stimulate the C2C12 myoblasts. The expressions of myogenic regulatory factors were examined by real-time PCR and western blot analysis. Overexpression of Dnmt3a attenuated muscle atrophy in diabetic mice and promoted myotube formation of C2C12 myoblasts. Overexpression of Dnmt3a restored the expressions of myogenic regulatory factors atrogin-1, MuRF1, Pax7, Myod1 and myogenin, both in vivo and in vitro. Moreover, overexpression of Dnmt3a activated the phosphorylation of Akt by inhibiting the activation of Pten. This study demonstrates that overexpression of Dnmt3a prevents diabetic muscle atrophy by modulating the Pten/Akt pathway.