Management Of Diabetes-related Complications Research Articles

Anemia among adult patients with diabetes attending King Abdulaziz University Hospital: A retrospective study.

The prevalence of anemia in adults with diabetes is of growing importance due to its impact on overall health and the management of diabetes-related complications. This study aimed to determine the prevalence of anemia among adult patients with diabetes at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. A retrospective study was done on 1208 patients with diabetes >18 years who attended the study setting from 2010 to 2022. Data about patients' demographics, body mass index, glycated hemoglobin (HbA1c; %), hemoglobin (Hb), serum ferritin, iron, mean corpuscular Hb, mean corpuscular volume, free thyroxine and triiodothyronine (T3), and serum thyroid-stimulating hormone (TSH) were collected. Of patients, 86.6% had anemia with a prevalence of 30.2%, 47.6%, and 22.2% for mild, moderate, and severe anemias, respectively. The prevalence of anemia was significantly higher among females, those with high serum ferritin, normal serum iron or normal serum T3, lower mean HbA1c level (%), lower serum iron or T3, and higher serum ferritin or TSH. A significant positive correlation was found between Hb level and HbA1c level (%), serum iron, free T3, and body mass index. A significant negative correlation was found between Hb level and mean corpuscular volume, serum ferritin, and serum TSH. Being female, having high serum ferritin, lower mean free T3, and a high TSH were risk factors for anemia. The prevalence of severe anemia was significantly higher among patients with uncontrolled diabetes mellitus. A high prevalence of anemia was found among studied diabetics. Anemia screening should be included in the routine assessment of patients with diabetes. A multidisciplinary approach involving endocrinologists, hematologists, and dietitians is recommended to ensure holistic care and address all aspects of the patient's health. In addition, further research should be supported to better understand the mechanisms linking diabetes and anemia and to establish evidence-based guidelines for managing anemia in diabetics.

Integrating the Health Belief Model and Mobile Applications to Improve Knowledge and Medical Compliance in Diabetic Patients

Background: Standard care for Diabetic foot ulcers (DFU) involves various interventions, but there is limited focus on patients' knowledge and medical compliance. The Health Belief Model (HBM) offers a promising framework to enhance patient knowledge and adherence to medical recommendations by addressing perceived susceptibility, barriers, severity, and benefits. However, its application through mobile technology remains underexplored. Methods: This study conducted a systematic literature review using online databases such as PubMed, ScienceDirect, EBSCO, Springer, Google, and Google Scholar. The search focused on studies published from 2000 to 2022, examining the use of HBM in diabetes care, specifically addressing patient knowledge and medical compliance, and the integration of mobile applications. Keywords included terms such as 'education HBM diabetes patient’s knowledge' and 'mobile application HBM diabetes medical compliance.' After an initial yield of 168 articles, a rigorous screening process resulted in the inclusion of 9 relevant studies. Results: The review indicates that the HBM can effectively promote health behavior changes in diabetes care, improving self-efficacy, knowledge, and medical compliance. Implementing HBM through education has shown benefits in foot care, adherence to medical advice, and the management of diabetes-related complications. However, studies integrating mobile applications with HBM in diabetes care are scarce, highlighting a significant gap in current research. Conclusion: Utilizing the Health Belief Model through mobile applications may offer clinical benefits in diabetes care by preventing severe complications such as DFUs. The role of technology experts is critical in developing effective HBM-based mobile applications.

Management of type 2 diabetes in pregnancy: a narrative review.

The prevalence of type 2 diabetes (T2DM) at reproductive age is rising. Women with T2DM have a similarly high risk for pregnancy complications as pregnant women with type 1 diabetes. To reduce adverse pregnancy and neonatal outcomes, such as preeclampsia and preterm delivery, a multi-target approach is necessary. Tight glycemic control together with appropriate gestational weight gain, lifestyle measures, and if necessary, antihypertensive treatment and low-dose aspirin is advised. This narrative review discusses the latest evidence on preconception care, management of diabetes-related complications, lifestyle counselling, recommendations on gestational weight gain, pharmacologic treatment and early postpartum management of T2DM.

Diabetes Monitoring System in Smart Health Cities Based on Big Data Intelligence

Diabetes is a metabolic disorder in which the body is unable to properly regulate blood sugar levels. It can occur when the body does not produce enough insulin or when cells become resistant to insulin’s effects. There are two main types of diabetes, Type 1 and Type 2, which have different causes and risk factors. Early detection of diabetes allows for early intervention and management of the condition. This can help prevent or delay the development of serious complications associated with diabetes. Early diagnosis also allows for individuals to make lifestyle changes to prevent the progression of the disease. Healthcare systems play a vital role in the management and treatment of diabetes. They provide access to diabetes education, regular check-ups, and necessary medications for individuals with diabetes. They also provide monitoring and management of diabetes-related complications, such as heart disease, kidney failure, and neuropathy. Through early detection, prevention and management programs, healthcare systems can help improve the quality of life and outcomes for people with diabetes. Current initiatives in healthcare systems for diabetes may fail due to lack of access to education and resources for individuals with diabetes. There may also be inadequate follow-up and monitoring for those who have been diagnosed, leading to poor management of the disease and lack of prevention of complications. Additionally, current initiatives may not be tailored to specific cultural or demographic groups, resulting in a lack of effectiveness for certain populations. In this study, we developed a diabetes prediction system using a healthcare framework. The system employs various machine learning methods, such as K-nearest neighbors, decision tree, deep learning, SVM, random forest, AdaBoost and logistic regression. The performance of the system was evaluated using the PIMA Indians Diabetes dataset and achieved a training accuracy of 82% and validation accuracy of 80%.

Computer-aided identification of bioactive compounds from Gongronema latifolium leaf with therapeutic potential against GSK3β, PTB1B and SGLT2

The modulation of certain molecular targets via small-molecule ligands has been regarded as a promising approach for the treatment and management of diabetes-related complications. Notable among these targets are the Glycogen synthase kinase (GSK3β), protein tyrosine phosphatase 1B (PTB1B), and sodium-glucose cotransporter 2 (SGLT2), whose inhibitions have been associated with high prognostic patients with diabetic related complications. However, inhibitors capable of exerting co-modulating effects on the three aforementioned proteins are lacking. Therefore, research aimed at the development of small molecule inhibitors capable of co-targeting these proteins remains unfaltering. Consequently, this study investigated the inhibitory potentials of Gongronema latifolium leaf's compounds against these proteins. Molecular docking was employed to screen 134 compounds against these targets; this gave rise to the identification of ten lead compounds (rutin, epigallocatechin-3-gallate, silymarin, hyperoside, luteolin, baicalin, rosmarinic acid, naringin, butein, and isoorientin) based on their high binding affinities. Subsequently, the toxicity profiles of the compounds were assessed while their bioactivities against the proteins were predicted using 2D quantitative structure-activity relationship (QSAR) models. Furthermore, density functional theory (DFT) calculations were employed to study the reactivity and stability of the aforementioned compounds. Ultimately, toxicity assessment revealed epigallocatechin-3-gallate and butein as the compounds with minimal toxicity, while DFT calculations revealed baicalin, rosmarinic acid, and butein as the most reactive among the lead compounds. Conclusively, this study provides insight into the discovery of phytocompounds with promising inhibitory potential that could facilitate the development of regimens for diabetes management after further in vitro and in vivo studies.

Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651

BackgroundPrinted educational materials (PEMs) have long been used to inform clinicians on evidence-based practices. However, the evidence for their effects on patient care and outcomes is unclear. In Ontario, despite widely available clinical practice guidelines recommending antihypertensives and cholesterol-lowering agents for patients with diabetes, prescriptions remain low. We aimed to determine whether PEMs can influence physicians to intensify prescribing of these medications.MethodsA pragmatic, 2 × 2 factorial, cluster randomized controlled trial was designed to ascertain the effect of two PEM formats on physician prescribing: a postcard-sized message (“outsert”) or a longer narrative article (“insert”). Ontario family physician practices (clusters) were randomly allocated to receive the insert, outsert, both or neither. Physicians were eligible if they were in active practice and their patients were included if they were over 65 years with a diabetes diagnosis; both were unaware of the trial. Administrative databases at ICES (formerly the Institute for Clinical Evaluative Sciences) were used to link patients to their physician and to analyse prescribing patterns at baseline and 1 year following PEM mailout. The primary outcome was intensification defined as the addition of a new antihypertensive or cholesterol-lowering agent, or dose increase of a current drug, measured at the patient level. Analyses were by intention-to-treat and accounted for the clustering of patients to physicians.ResultsWe randomly assigned 4231 practices (39% of Ontario family physicians) with a total population of 185,526 patients (20% of patients with diabetes in Ontario primary care) to receive the insert, outsert, both, and neither; among these, 4118 practices were analysed (n = 1025, n = 1037, n = 1031, n = 1025, respectively). No significant treatment effect was found for the outsert (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.98 to 1.04) or the insert (OR 0.99, 95% CI 0.96 to 1.02). Percent of intensification in the four arms was similar (approximately 46%). Adjustment for physician characteristics (e.g., age, sex, practice location) had no impact on these findings.ConclusionsPEMs have no effect on physician’s adherence to recommendations for the management of diabetes-related complications in Ontario. Further research should investigate the effect of other strategies to narrow this evidence-to-practice gap.Trial registrationISRCTN72772651. Retrospectively registered 21 July 2005.

Alleviating the burden of diabetes with Health Equity Funds: Economic evaluation of the health and financial risk protection benefits in Cambodia.

In Cambodia, diabetes caused nearly 3% of the country's mortality in 2016 and became the fourth highest cause of disability in 2017. Providing sufficient financial risk protection from health care expenditures may be part of the solution towards effectively tackling the diabetes burden and motivating individuals to appropriately seek care to effectively manage their condition. In this study, we aim to estimate the distributional health and financial impacts of strategies providing financial coverage for diabetes services through the Health Equity Funds (HEF) in Cambodia. The trajectory of diabetes was represented using a Markov model to estimate the societal costs, health impacts, and individual out-of-pocket expenditures associated with six strategies of HEF coverage over a time horizon of 45 years. Input parameters for the model were compiled from published literature and publicly available household survey data. Strategies covered different combinations of types of diabetes care costs (i.e., diagnostic services, medications, and management of diabetes-related complications). Health impacts were computed as the number of disability-adjusted life-years (DALYs) averted and financial risk protection was analyzed in terms of cases of catastrophic health expenditure (CHE) averted. Model simulations demonstrated that coverage for medications would be cost-effective, accruing health benefits ($27 per DALY averted) and increases in financial risk protection ($2 per case of CHE averted) for the poorest in Cambodia. Women experienced particular gains in health and financial risk protection. Increasing the number of individuals eligible for financial coverage also improved the value of such investments. For HEF coverage, the government would pay between an estimated $28 and $58 per diabetic patient depending on the extent of coverage and services covered. Efforts to increase the availability of services and capacity of primary care facilities to support diabetes care could have far-reaching impacts on the burden of diabetes and contribute to long-term health system strengthening.

P295 Regular specialist follow-up is essential for early detection and management of diabetes-related complications in patients with Cystic Fibrosis-Related Diabetes

P295 Regular specialist follow-up is essential for early detection and management of diabetes-related complications in patients with Cystic Fibrosis-Related Diabetes

PDB21 - Estimating the Costs of Managing Complications of Diabetes Mellitus in Malaysia

The objective of the study was to estimate the direct costs associated with diabetes-related complications in Malaysia. The complications measured in the study including Ischemic Heart Diseases (IHD), Myocardial Infarction (MI), stroke, Heart Failure (HF), amputation, blindness, Renal Failure (RF) requiring hemodialysis and diabetic foot ulcer. The estimation cost was based on the definition of the described medical conditions either retrieved from local Clinical Practice Guideline(CPG) or from literature. The number of the test and procedure was reconfirmed with a physician. All costs were calculated in Ringgit Malaysia (RM) for the year 2015. The CCEMG-EPPI- Centre Cost converter was used to convert the currency to 2016 USD based on the Purchasing Power Parities (PPP) for the GDP. RF with hemodialysis was associated with the highest annual per patient costs. The costs were RM 42,394.97 (USD 30,176.15) for the event year and RM 39,521.52 (USD 28,130.86) per year thereafter. The highest managing costs among macrovascular diseases was MI with percutaneous coronary intervention (PCI) (RM 19,381.43 [USD 13,795.44]). The other diabetes microvascular complications like blindness (RM 240 [USD 170.83]) and diabetes foot ulcer (RM 276.12 [USD 196.54]) has lower managing costs compared to the macrovascular complications. Among the macrovascular diseases, HF has highest managing costs (RM 2,246.10 [USD 1598.74]) for subsequent year. It shows diabetes is associated with a substantial economic burden in Malaysia, and the management of diabetes related complications is likely to represent a significant proportion of the overall increasing costs.

Diabetes UK evidence‐based nutrition guidelines for the prevention and management of diabetes

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines.

Morphological study of the effects of aqueous leaf extract of Xylopia aethiopica on the pancreas in diabetic rats.

To investigate the histological and immunohistochemical effects of aqueous leaf extract of Xylo- pia aethiopica on the pancreas in streptozotocin-induced diabetic rats, 30 adult Wistar rats were divided into three groups (n=10). Group A was the control (administered with equivalent vol- ume of citrate buffer), group B animals were made diabetic by a single intraperitoneal injection of streptozotocin dissolved in citrate buffer (65 mg/kg), group C animals were made diabetic as above and treated with 200mg/kg body weight of aqueous leave extract of Xylopia aethiop- ica for 25 days. Upon animal sacrifice, the pancreas were excised, fixed in 10% formol saline and processed for light microscopy and immunohistochemistry.. The results revealed destruc- tion of the islet cells in the untreated diabetic group as compared with the controls. The extract treated group was characterized by recovery/regenerative processes indicated by improvement in islet morphology. In untreated diabetic rats immunoreactive P-cells were sparse, at variance from the controls. The group treated with aqueous leaf extract of Xylopia aethiopica revealed more intense staining for insulin and significant (p<0.05) increase in the percentage of immuno- labelled surface area when compared with the untreated diabetic group, suggesting the ability of P-cells to secrete insulin in the extract treated rats. We conclude that the aqueous leaf extract of Xylopia aethiopica improves recovery process of P-cells in streptozotocin-induced diabetic rats and might become useful in the management of diabetes related complications.

Diabetic retinopathy care in India: An endocrinology perspective.

Diabetes is a disease that affects over 65 million persons in India.[1] Diabetes-related eye disease, of which retinopathy is the most important, affects nearly one out of every ten persons with diabetes, according to point prevalence estimates.[2] However, the prevalence increases with increasing duration of diabetes, and it is common in subjects with high-glucose levels and on more complex regimens. For example, in a study of 17,995 subjects with diabetes from across India, the overall prevalence of retinopathy was about 15%. In subjects on diet control, the prevalence of diabetic retinopathy was 4.4%, on oral drugs, the prevalence was 12.5%, and in subjects on insulin, the prevalence was nearly 27%.[3] Clearly, these results show that increasing duration of diabetes associated with glycemic deterioration requiring increased treatment regimen complexity are all associated with a higher prevalence of retinopathy. Retinopathy assessment is more objective and operator-independent than that of other microvascular complications, and is therefore a better marker for monitoring diabetes-related complications. Retinopathy is duration-dependent, and as endocrinologists succeed in taking care of acute co-morbidities, in an aging diabetic population, the burden of retinopathy is bound to increase. This should be limited by early detection and management of retinopathy aided by prompt referrals and teamwork between the endocrinologists and the ophthalmologists. Therefore, the Indian Journal of Endocrinology and Metabolism (IJEM) has embarked on this special supplement – aimed at documenting the current status of diabetic retinopathy and related health-care management scenario in India. It has been clearly shown that glucose control can reduce the onset and progression of diabetic eye disease. The vast majority of diabetes in the country is treated by general physicians, and training them in the management of diabetes-related complications is the need of the hour. Like diabetic neuropathy and nephropathy, retinopathy too can be detected early. Making a dilated fundus examination by trained ophthalmologists is the norm in referral centers specializing in endocrinology and diabetes. But, what about primary care practitioners with little access to such facilities? Simple handheld ophthalmoscopes can, but do not completely supplement the need for a specialist examination. Technology is coming to help, as there are nonmydriatic fundus cameras which screen for retinopathy in a matter of minutes. Mobile eye clinics with the ability to screen for retinal disease are practicable solutions.[4] Mobile diabetes clinics (different from mobile eye clinics) which carry out screening of eye, foot, and kidney disease, bringing diabetes care to the door step, have been another innovation, as they are diabetes-specific and also screen for complications beyond retinopathy.[5] Finally, the stage is set for the arrival of the smartphone as a tool for retinopathy diagnosis, as technology start-ups are increasingly applying point of care; smartphone-based retinal photography to augment the diagnosis.[6] Retinal therapies, consisting of anti-vascular endothelial growth factor agents such as aflibercept, bevacizumab, or ranibizumab, and surgical approaches are all excellent tools in the hands of ophthalmologists.[7] However, as the average reader of IJEM would ask - How best can an endocrinologist prevent diabetic retinopathy? Well, glucose control is probably the most important factor, and keeping the glycated hemoglobin close to 6.5% without hypoglycemia can help. While a sudden control of blood glucose levels may cause a transient deterioration of retinopathy in the long term, strict glucose control will help eventually reduce complication risk. Individuals with type 2 diabetes and pre-existing retinopathy are more prone to such deterioration after intensive glucose control, when compared to subjects without baseline retinopathy.[8] In landmark diabetes intervention studies such as Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, in addition to glucose control, the control of hypertension was shown to be quintessential.[9,10] Studies focusing on lipid control have also shown a trend toward a favorable outcome in retinopathy.[11,12] Given that endocrinologists see tertiary-level cases, which are more likely to represent advanced disease, a prompt referral to an ophthalmologist is very important to prevent and treat diabetic retinopathy. This supplement, designed to document the current status of diabetes-related eye care infrastructure in the country, is a valuable resource for physicians, diabetologists, and endocrinologists. In addition to the estimates of the burden of disease in the country, the document also suggests the need for an increased national focus on this cause of avoidable blindness.

Mediterranean diet and diabetes: prevention and treatment.

The aim of the present review is to examine current scientific knowledge on the association between the Mediterranean diet and diabetes mellitus (mostly type 2 diabetes). A definition of the Mediterranean diet and the tools widely used to evaluate adherence to this traditional diet (Mediterranean diet indices) are briefly presented. The review focuses on epidemiological data linking adherence to the Mediterranean diet with the risk of diabetes development, as well as evidence from interventional studies assessing the effect of the Mediterranean diet on diabetes control and the management of diabetes-related complications. The above mentioned data are explored on the basis of evaluating the Mediterranean diet as a whole dietary pattern, rather than focusing on the effect of its individual components. Possible protective mechanisms of the Mediterranean diet against diabetes are also briefly discussed.

A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes

The objective of the study was to determine the effectiveness and cost-effectiveness of primary care and community-oriented interventions in managing HbA 1c, blood pressure, and lipids, and reducing hospitalizations and emergency room visits over 2 years. We describe an ongoing, randomized controlled trial of 542 urban African-Americans with type 2 diabetes ages 25 years and older who are members of a university-affiliated managed-care organization in Baltimore, MD. The participants are 74% female, have a mean age of 58 years, and 35% have yearly incomes greater than US$7500. Participants were randomized to one of two intervention groups for a period of 2 years: (1) usual medical care plus minimal telephone intervention implemented by a trained lay health educator (control group) or (2) usual medical care plus intensive intervention implemented by a nurse case manager (NCM)/community health worker (CHW) team. The intensive NCM/CHW team executes individual plans of care using evidence-based algorithms that focus on traditional diabetes self-management, screening and management of diabetes-related complications, and social issues surrounding diabetes care. Face-to-face NCM visits are conducted in the clinic once per year and CHW visits are conducted in the participant's home one to three times per year, both with additional follow-up contacts as needed. Written and verbal feedback (when necessary) is provided to the participant's primary care physician. All participants are expected to attend a 24-month follow-up visit where data are collected by interviewers blinded to intervention assignment. As of May 1, 2003, recruitment is complete, interventions are being fully implemented, and 24-month follow-up visits are beginning. Baseline sociodemographic characteristics, health-care utilization, health behaviors, and clinical characteristics of the study population are reported. This study is designed to test the hypothesis that a primary-care-based NCM plus CHW team approach is an effective, practical, and economically feasible strategy for translating current knowledge about type 2 diabetes into high-quality health care for urban African-Americans.

The Prevention of Type 2 Diabetes: Are We Ready for the Challenge?

The increase in the prevalence of diabetes during the past 20 years is alarming. Recent data presented by the American Diabetes Association (ADA) reported that 17 million Americans, or 6.2% of the population, now have diabetes. Of these 17 million, 5.9 million, or close to 35%, have undiagnosed diabetes. In the approximately 30 minutes that it would take the average reader to read this entire issue of Clinical Diabetes , about 46 patients will be newly diagnosed with diabetes. Recent research efforts, especially for type 1 diabetes, have been to find a “cure.” Although that would be a wonderful discovery, much of our research to date has focused on the treatment of hyperglycemia and the management of diabetes-related complications. From a public health standpoint, it is clear that prevention of diabetes, both type 1 and type 2, would have even more far-reaching implications than either of these other goals. Diabetes is the leading cause of adult blindness (12,000–24,000 new cases each year), end-stage renal disease (more than 114,000 cases of diabetes-related dialysis or transplantation in 1999), and non-traumatic lower extremity amputation (82,000 diabetes-related amputations between 1997 and 1999). Heart disease is the leading cause of death in people with diabetes, who have a two- to fourfold higher risk for developing it than that of the general population. The costs of care for diabetes and its complications are staggering and difficult to quantify. Conservatively, total costs for diabetes exceed $98 billion per …