Long-term Complications Of Diabetes Research Articles

The Quality of Life and Satisfaction with Continuous Glucose Monitoring Therapy in Children under 7 Years of Age with T1D Using the rtCGM System Integrated with Insulin Pump-A Caregivers Point of View.

Quality of life (QoL) is an important parameter that affects the choice of therapy. Assessment of QoL and satisfaction with therapy using the rtCGM in children with T1D aged < 7 years was conducted. The study group consisted of 38 children with T1D aged < 7 years (34% aged 2–4, 66% aged 5–7 years), HbA1c: 6.53 ± 0.63%, duration of diabetes: 2.6 ± 1.6 years, treated with an rtCGM-augmented insulin pump for 1.92 ± 1.15 years. Two anonymous surveys were conducted: a. PedsQL3.0 diabetes standardized questionnaire—QoL assessment among age groups: 2–4/5–7 years. b. An original survey assessing the CGM use satisfaction. The mean scores in PedsQL3.0: communication 75%, worries 30%, treatment 70%, and problems associated with diabetes 65%. The QoL scale is: 0–19% very low, 20–39% low, 40–59% moderate, 60–79% high, 80–100% very high. The most frequently reported concerns were long-term diabetes complications and prick pain. Satisfaction with CGM use was high (68% in group aged 5–7 and 92% 2–4 years). Twenty-seven (71%) caregivers confirmed the positive effect of CGM on sleep. During the use of rtCGM a high quality of life was reported, and the quality of sleep in their caregivers was increased.

Clinical Application of Time in Range and Other Metrics.

Time in range (TIR) and other continuous glucose monitoring (CGM)-derived metrics have been standardized in international consensus conferences. TIR correlates closely with A1C; a TIR of 70% correlates to an A1C of 6.7-7%. Evidence is emerging on the association of TIR with long-term diabetes complications, and each 10% increase in TIR shows a substantial decrease in risk for long-term complications. Application of TIR to clinical practice can be easily done with a stepped approach to the analysis and interpretation of CGM-derived metrics and the ambulatory glucose profile report. Clinician education and partnership with patients are crucial for successful implementation of TIR and all CGM-derived metrics in clinical practice.

Effects of delta-tocotrienol supplementation on Glycemic Control, oxidative stress, inflammatory biomarkers and miRNA expression in type 2 diabetes mellitus: A randomized control trial.

The study aimed to ascertain the effects of delta-tocotrienol (δT3) supplementation on glycemic control, oxidative stress, inflammation and related micro-ribonucleic acid (miRNA) expression in patients with type 2 diabetes mellitus (T2DM). Total 110 patients of T2DM on oral hypoglycemic agents, were randomly divided into tocotrienol and placebo groups and given 250 mg δT3 or cellulose soft gel capsule once daily respectively for 24 weeks. Glycemic control, oxidative stress, inflammatory biomarkers, and miRNAs expression were measured in serum at baseline and end of the intervention by using standard laboratory methods. Compared to the placebo, δT3 supplementation resulted in a significant (p≤ .05) reduction [mean difference (95% confidence interval)] in plasma glucose [-0.48 (-0.65, -0.30)], insulin [-1.19 (-1.51, -0.87)], homeostatic model assessment of insulin resistance [-0.67 (-0.86, -0.49)], glycosylated hemoglobin [-0.53 (-0.79, -0.28)], malondialdehyde [-0.34 (-0.45, -0.22)], high sensitive-C-reactive protein[-0.35 (-0.54, -0.16)], tumor necrosis factor-alpha [-1.22 (-1.62, -0.83)], and interleukin-6[-2.30 (-2.91, -1.68)]. More than twofold downregulation in miRNA-375, miRNA-34a, miRNA-21, and upregulation in miRNA-126, miRNA-132 expression was observed in the δT3 group compared to the placebo. The study demonstrated that δT3 supplementation in addition to oral hypoglycemic agents, improved glycemic control, inflammation, oxidative stress, and miRNA expression in T2DM without any adverse effect. Thus, δT3 might be considered as an effective dietary supplement to prevent long-term diabetic complications.

The current schemes of insulin therapy: Pro and contra

Insulin regimens have been evolving for a century. The schemes used for type 1 (T1D) and type 2 (T2D) diabetes differ due to differences in pathophysiology but share important features. Insulin is required for both types of diabetes when other means of controlling glucose are insufficient. For T1D this requires multiple daily injections or continuous subcutaneous infusion assisted by CGM, whereas in early T2D basal insulin together with oral agents or GLP-1RA is usually effective. In both cases current schemes typically maintain HbA1c levels between 7 and 8%, a range that limits but does not eliminate the long-term complications of diabetes, but do not restore glycemic control to a fully protective level. Inability to control postprandial hyperglycemia without problematic weight gain and hypoglycemia is a leading obstacle in both T1D and long-duration T2D. A greater share of prandial dosing decisions will have to be provided by smart electronic systems. Further changes in the structure or formulation of insulin are of uncertain potential, but schemes including delivery of amylin, GLP-1, and glucagon show promise. More reliable access to insulins, delivery devices, and capable medical advisors will be needed to optimize replacement of this essential hormone.

Cardioprotective Effect of Glycyrrhizin on Myocardial Remodeling in Diabetic Rats.

Myocardial fibrosis is one of the major complications of long-term diabetes. Hyperglycemia induced cardiomyocyte atrophy is a frequent pathophysiological indicator of diabetic heart. The objective of this study was to investigate the cardioprotective effect of glycyrrhizin (GLC) on myocardial damage in diabetic rats and assess the anti-inflammatory and anti-fibrotic effect of GLC. Our study demonstrates that hyperglycemia can elevate cardiac atrophy in diabetic animals. Type 2 diabetic fatty and the lean control rats were evaluated for cardiac damage and inflammation at 8–12 weeks after the development of diabetes. Western blot and immunohistochemical studies revealed that gap junction protein connexin-43 (CX43), cardiac injury marker troponin I, cardiac muscle specific voltage gated sodium channel NaV1.5 were significantly altered in the diabetic heart. Furthermore, oxidative stress mediator receptor for advanced glycation end-products (RAGE), as well as inflammatory mediator phospho-p38 MAPK and chemokine receptor CXCR4 were increased in the diabetic heart whereas the expression of nuclear factor erythroid-2-related factor 2 (Nrf2), the antioxidant proteins that protect against oxidative damage was reduced. We also observed an increase in the expression of the pleiotropic cytokine, transforming growth factor beta (TGF-β) in the diabetic heart. GLC treatment exhibited a decrease in the expression of phospho-p38 MAPK, RAGE, NaV1.5 and TGF-β and it also altered the expression of CX43, CXCR4, Nrf2 and troponin I. These observations suggest that GLC possesses cardioprotective effects in diabetic cardiac atrophy and that these effects could be mediated through activation of Nrf2 and inhibition of CXCR4/SDF1 as well as TGF-β/p38MAPK signaling pathway.

DYRK1A Inhibitors as Potential Therapeutics for β-Cell Regeneration for Diabetes.

According to the World Health Organization (WHO), 422 million people are suffering from diabetes worldwide. Current diabetes therapies are focused on optimizing blood glucose control to prevent long-term diabetes complications. Unfortunately, current therapies have failed to achieve glycemic targets in the majority of people with diabetes. In this context, regeneration of functional insulin-producing human β-cells in people with diabetes through the use of DYRK1A inhibitor drugs has recently received special attention. Several small molecule DYRK1A inhibitors have been identified that induce human β-cell proliferation in vitro and in vivo. Furthermore, DYRK1A inhibitors have also been shown to synergize β-cell proliferation with other classes of drugs, such as TGFβ inhibitors and GLP-1 receptor agonists. In this perspective, we review the status of DYRK1A as a therapeutic target for β-cell proliferation and provide perspectives on technical and scientific challenges for future translational development.

Are depressive symptoms associated with quality of care in diabetes? Findings from a nationwide population-based study

IntroductionWe investigated whether the presence of depressive symptoms among adults with diagnosed diabetes is associated with adverse quality of diabetes care.Research design and methodsThe study population was drawn from the...

69567 Association between area deprivation index and long-term diabetic complications in a population of diabetic patients’

ABSTRACT IMPACT: To improve care and services for patients with chronic disease, health systems are focusing on evaluating social determinants of health of populations at risk; this information is currently not available in electronic health records (EHR) but we show that it could be accessed by linking area deprivation index to EHR. OBJECTIVES/GOALS: To inform care delivery and policy, health care systems are studying ways of improving social determinants of health (SDoH) in patients with chronic disease such as diabetes (DM). Our goal was to better characterize the SDoH of a cohort of DM patients by using the area deprivation index (ADI). METHODS/STUDY POPULATION: Our study population included DM patients seen in primary care practices in 2013-2017. We integrated ADI levels to data extracted from electronic health records (EHR). ADI ranks neighborhoods by socioeconomic status calculated from income, education, employment and housing quality. ADI has 10 levels that we grouped into 5 categories of 2 levels. Addresses were geocoded using ArcMap to obtain census block groups information. We used multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals [], with diabetic complications as a binary dependent variable, ADI levels as the exposure, and demographics, smoking status and number of comorbidities as confounders. RESULTS/ANTICIPATED RESULTS: Our study population included 8,558 patients: 56% were female, 61% white, 31% black, 28% were on Medicare, 66% on commercial insurance, median age was 55 years, 57% never smoked, 10% had no comorbidities, 42% had 3 or more comorbidities, and 37% developed diabetic-related complications. After evaluating collinearity and adjusting for confounders, our multivariable analysis showed that worsening ADI was associated with higher likelihood of complications. Compared to ADI level 1&amp;2 (least disadvantaged), the ORs for patients residing in neighborhoods with ADI levels 3&amp;4, 5&amp;6, 7&amp;8, 9&amp;10 (most disadvantaged) were respectively 1.01 [0.88-1.16), 1.20 [1.04-1.39], 1.15 [0.99-1.33], 1.30 [1.11-1.52]. DISCUSSION/SIGNIFICANCE OF FINDINGS: Neighborhood ADI could provide precious information to health care providers when associated to the EHR. We found that neighborhoods with ADI level 9&amp;10, which is not collected in the EHR, was significantly associated with a higher burden of disease. ADI could serve as a proxy for evaluating SDoH.

Sociodemographic determinants of glycaemic control among children with type 1 diabetes in South Eastern Nigeria.

Introductiondiabetic complications have been identified as the major causes of morbidity and mortality in persons with type 1 diabetes mellitus (T1DM). Lack of appropriate glycaemic control is a significant risk factor for the onset and progression of long term complications of diabetes. Identifying the determinants of good glycaemic control is therefore imperative.Methodsthis was a cross-sectional, hospital-based study of children aged 3-18 years with T1DM. Subjects were consecutively enrolled after obtaining consent from their parents and assent from children aged ≥7 years. A questionnaire was completed recording their clinical history and sociodemographic variables. Their HbA1c was estimated and values ≤7.5% was defined as the cut-off for optimal glycaemic control.Resultsseventy-one children with T1DM were enrolled for the study. Thirty-eight (53.5%) of them were males. Mean age (years) was 13.7±4. Mean age at onset of diabetes was 11.6 years (range: 3-16 years), mean duration of diabetes was 24.4 months (range: 4-84 months), mean HbA1c value was 10.5% (range: 6.4%-14%); a multivariate logistic regression analysis was performed to identify determinants of optimal glycaemic control. Only caregivers' involvement in diabetes management P<0.016, odd ratio 13.03 (95% CI: 1.60-105.95) was identified as determinant of good glycaemic control.Conclusionour data suggest that of all the sociodemographic factors studied, caregivers' involvement in diabetes management was the only strong determinant for optimal glycaemic control.

Serum uric acid level as a marker of cardiovascular disease in diabetic individuals

Background: Serum Uric acid (SUA) had always been thought of as a metabolically inert end product of purine metabolism without physiological significance except gouty diathesis. However, it has been recently associated with insulin resistance and also considered as a risk marker for the development of diseases like diabetes, coronary heart disease.&#x0D; Aims and Objective: In this study we aim to determine the incidence of hyperuricemia in diabetic individuals and also study the relation of SUA with the other established risk factor of cardiovascular diseases, as it is one of the long term complications of Diabetes.&#x0D; Materials and Methods: The study enrolled 120 subjects. Group I (test group) comprised of 60 known cases of type II DM on oral anti-diabetic drugs. The control group comprised of 60 subjects who were non diabetic and not suffering from any major illness. The protocol of the study was approved by ethical committee of the institute. Total cholesterol, HDL, TG, glucose, SUA was estimated while parameters like LDL and VLDL were calculated.&#x0D; Results: A highly significant increased SUA, total cholesterol, HDL, TG, glucose, LDL and VLDL was seen in type II DM (p&lt;0.0001) when compared with control while a significant (p&lt;0.05) positive correlation was observed between SUA and total cholesterol and TG. In study group a negative correlation though not statistically significant was observed between SUA and fasting blood sugar level.&#x0D; Conclusion: SUA is definitely associated with development of complications of diabetes in the form of cardiovascular disease. This may be due to its influence on the deranged lipid metabolism and hyperglycemia.

Vascular ultrasound for cardiovascular risk stratification in asymptomatic patients with type-2 diabetes

Cardiovascular diseases are among the main long-term complications of type-2 diabetes (T2D). Several tools have been proposed to estimate the cardiovascular (CV) risk in patients with T2D, but their prognostic value requires further investigation. We aimed to identify new independent vascular markers to predict CV events in patients with T2D, and their incremental value compared to the Swedish National Diabetes Register (NDR) risk score. A retrospective cohort study was conducted on 1332 asymptomatic patients with T2D, free from prior CV event, assessed for CV work-up, including 12-lead ECG, ankle-brachial index and carotid and femoral bifurcations ultrasound to detect plaque in any of the 4 territories (right and left carotid and femoral arteries). The extent of atherosclerosis was rated from 0 to 4 and recorded as atherosclerosis burden score (ABS). Patients were followed up to 5 years and the occurrence of CV events (cardiovascular death, stroke/transient ischemic attack, myocardial infarction, unstable angina and cardiac revascularisation) was recorded. A total of 82 patients (6.2%) experienced a cardiovascular event, including 34 (2.6%) with myocardial infarction, 18 (1.4%) with cardiac revascularisation and 17 (1.3%) with stroke. The independent determinants of these events were: male gender (HR = 1.81 [1.13–2.88], P = 0.013) and ABS ≥ 2 (HR = 1.98 [1.21–3.25], P = 0.007). The NDR risk score performed poorly to predict cardiovascular events (area under the curve = 0.56 [0.49–0.63], P = 0.11), whereas screening for atherosclerotic plaques provided significant incremental prognostic value over the NDR score (model χ 2 increase: +231%, P = 0.002). Duplex ultrasonography for atherosclerotic plaques improve the estimation of CV prognosis on top of clinical data. Because of its high availability and safety, it could be routinely used to stratify the cardiovascular risk and implement the guidelines-based interventions.

Diabetic peripheral neuropathy: A systematic review of Nigerian patients

AbstractDiabetes mellitus is associated with microvascular and macrovascular complications. Diabetic neuropathy is the most common long-term complication of diabetes. The study was aimed at determining the prevalence of diabetic peripheral neuropathy and identifying its associated factors. Medical databases, including PubMed, Google Scholar, African Journal Online, and SCOPUS were searched and eligible studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm. The prevalence of diabetic peripheral neuropathy in Nigeria was dependent on the modality used in diagnosing peripheral neuropathy. The overall prevalence of diabetic peripheral neuropathy in Nigeria was 31.2%–97.5%. The modality-dependent prevalences were 37%–97.5% (by biothesiometry), 41.7%–75% (by Michigan Neuropathy Screening Instrument), 31.2%–43.3% (by United Kingdom screening test), and 43.3%–69.9% (by diabetic neuropathic examination score). The associated factors were duration and control of diabetes, the age of the patient, presence of cardiovascular risk factors such as hypertension and dyslipidemia and other microvascular complications (e.g., diabetic retinopathy and nephropathy). The prevalence of diabetic peripheral neuropathy was found to be high in Nigeria and the associated risk factors were age, glycemic control, and cardiovascular risk factors.

Use of ABI to detect peripheral arterial disease in diabetes - A recommendation for primary care physicians.

Background:India is considered the diabetes capital of the world. As per current practice, most of the diabetes patients go to primary care physicians for their monitoring and follow up. One of the dreaded complications of long-term diabetes is peripheral arterial disease.Methods:A cross-sectional observational study was conducted in a diabetes workshop. Totally, 48 patients were selected who satisfied the inclusion criteria. All were subjected to ankle-brachial index measurement (ABI) and doppler ultrasound was done to assess patency of the lower extremity arteries. The results were compared. The ankle-brachial index of less than 0.99 was considered abnormal.Results:Out of a total of 48 included patients 26 patients had normal ABI and 22 patients were found to have abnormal ABI. Out of those with normal ABI, 2 patients had features of peripheral arterial disease proved by doppler, whereas 3 patients with abnormal ABI had no feature of peripheral arterial disease in doppler. MedCalc software was used for statistical comparison.Conclusion:In the selected diabetic population prevalence of peripheral arterial disease was found to be 56.25%. Measurement of ABI was found to be quite a sensitive and specific method for diagnosing peripheral arterial disease of diabetics.

Strukturirana edukacija obolelih od dijabetesa - pregled organizaciono-metodoloških strategija I faktora uspeha

All diabetic patients must take part in structured education to acquire the knowledge, skills and abilities needed for self-management, self-control, and change in health behaviors, to achieve ideal glucoregulation. This is of particular importance for patients with type 2 diabetes, which is associated with an inadequate lifestyle and accounts for up to 90% of all diabetes. Structured education must consider the organizational and methodological conditions and criteria of the American Diabetes Association. Education can be realized as an individual, group, or combined form of work, with clearly defined goals and outcomes. The public health approach is focused on working in small groups, due to cost-effectiveness and efficiency, which may reach more participants. The education provider may be one or more healthcare professionals, as a team. Duration of education is an important success factor, with each hour of education are resulting in a 0.04% reduction in HbA1c levels. Consequently, education of more than 10 hours has the best results in the greatest number of participants. Interactive work, active patient involvement in education, problem-solving, and group discussions promote effective education and metabolic control. However, in addition to hiring healthcare professionals, successful education requires patient participation in a constant change in life habits, and this depends on many factors: personal attitudes, health beliefs, awareness of illness and health, skills, life priorities, financial resources, family support, workplace and community. Therefore, there is a need to empower patients, motivate them to act, develop and implement the recommended behavior in daily life, for the maintenance of good health and the prevention of long-term complications of diabetes.

Female Sexual Dysfunction in Asian Women with Diabetes

The prevalence of diabetes is increasing globally, especially in Asia. Prevalence of diabetes in Asia is increasing at a higher rate in comparison to Western countries with an increasing trend reported in the younger generation (20-39 years old). This trend has similarly been reported in our Malaysian diabetic population, of which the general prevalence is 17.5%. This population experiences longer disease duration and are at greater risk of developing complications of diabetes at an earlier stage in life. Sexual dysfunction has been established as a common long-term complication of diabetes, affecting both men and women. Evidence shows that some Asian countries experience greater rates of female sexual dysfunction compared to their Western counterparts and this is likely attributed to cultural differences and other socioeconomic factors. However, these studies are very limited and need to be investigated at a greater scale. The aim of this report is to identify gaps in the literature regarding female sexual dysfunction among Asian women with diabetes. Local cultural and religious values maintain that sexual issues should not be discussed openly, even in a clinical setting. This paper may pave the way for future studies to be carried out, as addressing sexual dysfunction is a vital part of diabetes care. In addition, various studies have identified depression as a conclusive predictor of female sexual dysfunction in diabetic women. There is a possibility of a link between diabetes distress and female sexual dysfunction, which requires further investigation.

Fenugreek Seeds as a Therapeutic Supplement for Patients with Noninsulin Dependent Diabetes Mellitus: A Cross-sectional Study

Introduction: Diabetes mellitus is a metabolic disorder, for which there is no known cure except in very specific situations. Management of diabetes is based on keeping blood sugar levels as close to normal as possible, without causing hypoglycaemia. Usually, this can be accomplished with diet, exercise and use of appropriate medications. In India, herbs are used in treatment to maintain normal blood glucose and lipid levels. In any form of management of diabetes with drug or insulin, diet is a common factor. Besides diet, many plants and foods of medicinal value have proved to be very useful in which one of them is fenugreek seed. Aim: The present study was aimed to evaluate the blood glucose modulating effect of Fenugreek Seed Powder (FSP) in patients of Noninsulin Dependent Diabetes Mellitus (NIDDM). Materials and Methods: A cross-sectional study was conducted on 25 patients of NIDDM of age group 40 to 50 years. A 5 gm Fenugreek seed powder was given to the patients on empty stomach early in the morning every day. Before beginning the study and at the end of every month, the blood glucose level (fasting and postprandial) was measured consecutively for three months. Statistics Program for Social Sciences (SPSS, version 17.0) computer software package was used for statistical analysis of the data. Results: Administration of FSP lowered the blood glucose levels in patients of NIDDM and a significant reduction in blood glucose level (fasting and postprandial) was observed in the study. Conclusion: Present study suggested that FSP might have potential to modulate blood glucose level which can serve as an effective supportive therapy in the prevention and management of long-term complications of diabetes.

CROSS-SECTIONAL DISEASE REGISTRY ON INTENSIFICATION OF INSULIN THERAPY IN UNCONTROLLED INSULINIZED T2DM PATIENTS IN CURRENT PRACTICE IN TUNISIA

Ponte Academic JournalDec 2021, Volume 77, Issue 12 CROSS-SECTIONAL DISEASE REGISTRY ON INTENSIFICATION OF INSULIN THERAPY IN UNCONTROLLED INSULINIZED T2DM PATIENTS IN CURRENT PRACTICE IN TUNISIAAuthor(s): Leila Ben Salem ,Ben Aissa Emna, Hsairi Mohamed, Zidi BorniJ. Ponte - Dec 2021 - Volume 77 - Issue 12 doi: 10.21506/j.ponte.2021.12.4 Abstract:Introduction : The aim of this observational study based on a disease registry was to assess the insulin therapy intensification practice in Tunisia and their benefits in patients with T2DM not controlled by basal insulin or mixed insulins. Methods: Multicentre, observational, cross sectional disease registry, non-interventional on the therapeutic strategy, with one planned visit. T2DM adults uncontrolled (HbA1c &amp;gt;7%) with ≥1 OADs and basal insulin or premixed insulin, who provided written informed consent were recruited in this registry. Results: 22 endocrinologists randomly selected from the national list base of 180 Tunisian endocrinologists participated to this study, 20 consecutive patients were included per center, a total of 413 were recruited in this registry. The mean ±SD age was 59.6 ±10.5 years and 53.8% were female. This study revealed that, at the end, 47.2% of T2DM adults included received basal plus or basal bolus regimen. Various strategies of insulin intensification were observed : 42.1% who received at first basal insulin were switched to basal plus or bolus; 3.2% who received at first basal insulin were switched to premix insulin. Among patients who were treated at first with premix insulin, 26.2% were switched to basal plus or basal bolus, while 16.7% were treated with increasing the injections number or the dose of premix insulin. In addition it seems important to underline that 142 of T2DM adults included (34.5% of total patients) had no change of their initial insulin regimen and keeping the same doses. The absence of intensification of insulin was significantly more common among patients with university educational level (p=0.01), very satisfactory socioeconomic level (p&amp;lt;0.001), patients whose insulin initiation started more than two years (p&amp;lt;0.001) and patients with hypertension (p=0.04). The absence of intensification of insulin was significantly lower in patients with lower mean fasting blood glucose (p=0.007) and HbA1c (p&amp;lt;0.001) and in patients initially treated with basal regimen. Good adherence to ADA/EASD recommendations was observed in only 47.8% of cases. Conclusions : Although this study enrolled 413 uncontrolled diabetes patients treated with OADs+ inulines, 34.5% of total patients remain without change of initial insulin regimen and keep the same doses. There is also a suboptimal adherence to the ADA/EASD recomandation as good adherence to ADA/EASD recommendations was observed in less than half of the cases, whren we know that insulin therapy with basal insulin, basal bolus or premixed insulin will eventually need to be optimized, to avoid long-term diabetes complications. Probably, current international guideline recommendations should be adapted to real-life clinical practice. Simplified treatment protocols, associated with patient education, could allow physicians to become efficient prescribers of insulin intensification in clinical practice. Download full text:Check if you have access through your login credentials or your institution Username Password

MiR-203-3p inhibits the oxidative stress, inflammatory responses and apoptosis of mice podocytes induced by high glucose through regulating Sema3A expression.

Diabetic nephropathy (DN) is the most serious long-term microvascular complication of diabetes, which mainly causes podocyte injury. Many studies have shown that microRNAs play a vital role in the development of DN. Studies have shown that miR-203-3p is involved in mesangial cell proliferation and apoptosis of DN mice. Therefore, we speculated that miR-203-3p might be related to the development of DN, but our study does not provide any evidence. In animal experiments, diabetic mice (db/db) were transfected with iR-203-3p overexpression lentiviral vectors (LV-miR-203-3p) and their control (LV-miR-con), with normal mice (db/m) being used as the control. High glucose (HG)-induced podocytes were used to construct a DN cell model in vitro. The expression levels of miR-203-3p, Semaphorin 3A (Sema3A) and inflammatory cytokines were detected by quantitative real-time polymerase chain reaction. Also, serum creatinine and blood urea nitrogen levels were used to evaluate the degree of renal injury in DN mice. Sema3A and apoptosis-related protein levels were assessed by the western blot analysis. Enzyme-linked immunosorbent assay was used to determine the different oxidative stress-related indicators and inflammatory cytokines. Flow cytometry and caspase-3 activity detection were used to analyze the degree of podocyte apoptosis. Our results suggested that the expression of miR-203-3p was lower in DN mice and in HG-induced podocytes. Overexpression of miR-203-3p reduced the body weight, blood glucose and renal injury of DN mice in vivo, as well as relieve the oxidative stress, inflammatory response and apoptosis of HG-induced podocytes in vitro. Functionally, Sema3A was a target of miR-203-3p, and Sema3A overexpression reversed the inhibitory effect of miR-203-3p on HG-induced podocyte injury. Our findings revealed that miR-203-3p alleviated the podocyte injury induced by HG via regulating Sema3A expression, suggesting that miR-203-3p might be a new therapeutic target to improve the progression of DN.

Glycemic control and its associated factors among patients with diabetes mellitus: a cross-sectional study in Bangladesh

PurposeDiabetes mellitus is becoming a growing concern worldwide. Hence, the purpose of this study is to assess the magnitude of poor glycemic control and to identify the determinants of poor glycemic control among diabetic patients attending a tertiary care hospital in Bangladesh.Design/methodology/approachThis cross-sectional study was conducted among 732 diabetes patients seeking care at the outpatient department of Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. Information, including glycemic status, was collected from patients’ medical records using a structured questionnaire.FindingsAbout 87.6% of the patients were found to have poor glycemic control (glycosylated hemoglobin = 7%). Variables that were significant in bivariate analysis were put into a multivariate model where the factors associated with poor glycemic control were patients aged 41–60 years (odds ratio (OR)=2.26; 95% confidence interval (CI): 1.19–4.32, p = 0.013), suffering from diabetes for > 7 years (OR = 1.84; 95% CI: 1.12–2.99, p = 0.015), using insulin (OR = 2.34; 95% CI: 1.23–4.47; p = 0.010) or diet alone (OR = 0.20; 95% CI: 0.05–0.80, p = 0.023) as a type of diabetes treatment and proper use of medicine (OR = 0.37; 95% CI: 0.17–0.82, p = 0.015).Originality/valueThe high prevalence of poor glycemic control among diabetic patients is evident; therefore, strategic management and proper attention focusing on the predictors of poor glycemic control are necessary to reduce the long-term complications of diabetes.

Non-surgical therapy of diabetic foot infections based on recent guidelines and published data

Abstract Chronic, non-communicable diseases are affecting the lives of more and more people worldwide; due to obesity and inadequate eating habits, the proportion of diabetics is on an increasing trend globally. The development of a number of macro- and microangiopathic pathologies associated with the onset of diabetes affects the life expectancy of patients. Diabetic foot infection (DFI) is one of the most serious long-term complications of diabetes and may be considered an intersection of infectious and non-infectious diseases; these infections can significantly reduce the quality of life of affected patients. The purpose of this review was to summarize the latest recommendations for conservative (non-surgical) therapy for DFIs and diabetic foot osteomyelitis (DFO).