Management Of Diabetic Complications Research Articles

The Effect of Stigmatization on Diabetes Health Promotion Self-Care Behaviours and Predictors of Stigma and Self-Care Behaviours in Individuals With Type 2 Diabetes.

Individuals with type 2 diabetes are at risk of delaying or not performing diabetes health promotion self-care behaviours because of their social or self-stigmatization. The study aimed to reveal the effect of stigmatization on diabetes health promotion self-care behaviours and predictors of stigma and diabetes health promotion self-care behaviours in individuals with type 2 diabetes. This cross-sectional study included 235 individuals with type 2 diabetes. The Diabetes Stigma Assessment Scale (DSAS) and Diabetes Health Promotion Self-Care Scale (DHPSCS) were used for data collection. There was a significant, negative correlation between the DSAS and DHPSCS scores. High mean scores on the DSAS and its subscales treated differently, blame/judgement and self-stigma were predictors of a negative effect on diabetes self-care behaviours. Poor health status, alcohol intake and diabetes complications are predictive of stigma. Insulin use and self-monitoring blood glucose are predictors of self-care behaviours. Stigma negatively affects diabetes self-care behaviours in individuals with type 2 diabetes. Nurses could provide education on improvement of health status, harms of alcohol intake and management of diabetes complications. Counselling for coping with stigma and performing self-care could be provided. Nurses could organize interventions to raise awareness about diabetes in society.

Therapeutic Potential of Photobiomodulation in Diabetic Complications.

Diabetes mellitus (DM) and its associated complications, including diabetic kidney disease, neuropathy, and retinopathy, impose significant challenges on healthcare systems due to their high morbidity, mortality, and associated costs. Existing treatments often yield unsatisfactory clinical outcomes, underscoring the need for innovative approaches to mitigate debilitating effects on patients' health-related quality of life. Photobiomodulation (PBM) is a non-invasive treatment that utilizes specific wavelengths of light in the treatment of various medical complications associated with DM. The specific wavelength used during PBM is critical in determining the therapeutic outcomes for managing diabetic complications. This paper aimed to explore the therapeutic potential of PBM in the management of diabetic complications, focusing on blue, red, and near-infrared (NIR) wavelengths. Relevant literature from Google Scholar, PubMed and ClinicalTrials databases from inception to date was searched using the keywords 'photobiomodulation', 'diabetes', 'diabetic complications', 'wound healing', 'neuropathy', 'retinopathy', and 'chronic wounds'. Red and NIR wavelengths are commonly used for a range of complications, while blue light has primarily been explored for treating diabetic wounds due to its antimicrobial nature. PBM treatment parameters for the same diabetic complication vary across clinical trials and preclinical research, with minimal clinical trials conducted on most diabetic complications. This inconsistency hinders the establishment of standardized PBM parameters, particularly concerning the optimal application setting.

A national audit of facilities, human and material resources for the comprehensive management of diabetes in Ghana-A 2023 update.

The human and material resources as well as the systems for managing diabetes in Africa are inadequate. This study or needs assessment, aimed at updating the human and material resources, identifying the gaps and unmet needs for comprehensive diabetes care in Ghana. We conducted a national audit of 122 facilities in all 16 administrative regions of Ghana. Information obtained covered areas on personnel and multidisciplinary teams, access to medications, access to laboratory services, financing, screening services, management of diabetes complications, and availability/use of diabetes guidelines or protocols. Data was analysed using STATA version 16.1. P-values <0.05 were set as significant. Only 85(69.7%) out of the 122 surveyed facilities had a dedicated centre or service for diabetes care. Twenty-eight (23%) had trained diabetes doctors/specialists; and whilst most centres had ophthalmic nurses and dieticians, majority of them did not have trained diabetes educators (nurses), psychologists, ophthalmologists, podiatrists, and foot/vascular surgeons. Also, 13.9% had monofilaments, none could perform urine dipstick for microalbumin; 5 (4.1%) and just over 50% could perform laboratory microalbumin estimation and glycated haemoglobin, respectively. Access to and supply of human insulins was better than analogue insulin in most centres. Nearly 100% of the institutions surveyed had access to metformin and sulphonylurea with good to excellent supply in most cases, whilst access to Sodium Glucose Transporter-2 inhibitors and Glucagon-like peptide-1 analogues were low, and moderate for Dipeptidyl peptidase-4 inhibitors and thiazolidinediones. Majority of the health facilities (95.1%) offered NHIS as payment mechanism for clients, whilst 68.0% and 30.3% of the patients paid for services using out-of-pocket and private insurance respectively. Fifteen facilities (12.3%) had Diabetes Support Groups in their locality and catchment areas. An urgent multisectoral collaboration, including prioritisation of resources at the facility level, to promote and achieve acceptable comprehensive diabetes care is required.

NF-κB pathway as a molecular target for curcumin in diabetes mellitus treatment: Focusing on oxidative stress and inflammation.

Diabetes mellitus (DM) is a collection of metabolic disorder that is characterized by chronic hyperglycemia. Recent studies have demonstrated the crucial involvement of oxidative stress (OS) and inflammatory reactions in the development of DM. Curcumin (CUR), a natural compound derived from turmeric, exerts beneficial effects on diabetes mellitus through its interaction with the nuclear factor kappa B (NF-κB) pathway. Research indicates that CUR targets inflammatory mediators in diabetes, including tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6), by modulating the NF-κB signaling pathway. By reducing the expression of these inflammatory factors, CUR demonstrates protective effects in DM by improving pancreatic β-cells function, normalizing inflammatory cytokines, reducing OS and enhancing insulin sensitivity. The findings reveal that CUR administration effectively lowered blood glucose elevation, reinstated diminished serum insulin levels, and enhanced body weight in Streptozotocin -induced diabetic rats. CUR exerts its beneficial effects in management of diabetic complications through regulation of signaling pathways, such as calcium-calmodulin (CaM)-dependent protein kinase II (CaMKII), peroxisome proliferator-activated receptor gamma (PPAR-γ), NF-κB, and transforming growth factor β1 (TGFB1). Moreover, CUR reversed the heightened expression of inflammatory cytokines (TNF-α, Interleukin-1 beta (IL-1β), IL-6) and chemokines like MCP-1 in diabetic specimens, vindicating its anti-inflammatory potency in counteracting hyperglycemia-induced alterations. CUR diminishes OS, avert structural kidney damage linked to diabetic nephropathy, and suppress NF-κB activity. Furthermore, CUR exhibited a protective effect against diabetic cardiomyopathy, lung injury, and diabetic gastroparesis. Conclusively, the study posits that CUR could potentially offer therapeutic benefits in relieving diabetic complications through its influence on the NF-κB pathway.

Diabetes disrupts osteometric and trabecular morphometric parameters in the Zucker Diabetic Sprague-Dawley rat femur.

Type 2 diabetes mellitus is increasingly becoming more prevalent worldwide together with hospital care costs from secondary complications such as bone fractures. Femoral fracture risk is higher in diabetes. Therefore, this study aimed to assess the osteometric and microarchitecture of the femur of Zucker Diabetic Sprague-Dawley (ZDSD) femur. Ten-week-old male rats (n=38) consisting of 16 control Sprague-Dawley (SD) and 22 ZDSD rats were used. The rats were terminated at 20 weeks and others at 28 weeks of age to assess age, diabetes duration effects and its severity. Bilateral femora were taken for osteometry, bone mass measurements and micro-focus X-ray computed tomography scanning to assess the trabecular number (TbN), thickness (TbTh), spaces (TbSp), bone tissue volume to total volume (BV/TV) and volume (BV). Diabetic rats had shorter (except for 20-weeks-old), lighter, narrower, and less robust bones than SD controls that wered more robust. Although cortical area was similar in all diabatic and control rats, medullary canal area was the largest in ZDSD rats. This means that the diabetic rats bones were short, light and hollow. Diabetic rats aged 20 weeks had reduced BV, BV/TV, TbN with more spacing (TbSp). In contrast, the 28 weeks old diabetic rats only showed reduced BV and TbN. Discriminant function analysis revealed, for the first time, that osteometric parameters and TbTh, TbN, and TbSp were affected by diabetes. This knowledge is valuable in the management of diabetic complications.

Understanding the Clinical Relationship Between Diabetic Retinopathy, Nephropathy, and Neuropathy: A Comprehensive Review.

Diabetic retinopathy, nephropathy, and neuropathy are significant microvascular complications of diabetes mellitus, contributing to substantial morbidity and mortality worldwide. This comprehensive review examines the clinical relationship between these complications, focusing on shared pathophysiological mechanisms, bidirectional relationships, and implications for patient management. The review highlights the importance of understanding the interconnected nature of diabetic complications and adopting a holistic approach to diabetes care. Insights gleaned from this review underscore the necessity for early detection, timely intervention, and integrated care models involving collaboration among healthcare professionals. Furthermore, the review emphasizes the need for continued research to elucidate underlying mechanisms, identify novel therapeutic targets, and assess the efficacy of integrated care strategies in improving patient outcomes. By fostering interdisciplinary collaboration and knowledge exchange, future research endeavors hold the potential to advance our understanding and management of diabetic complications, ultimately enhancing patient care and quality of life.

Roles of fibroblast growth factors in the treatment of diabetes.

Diabetes affects about 422 million people worldwide, causing 1.5 million deaths each year. However, the incidence of diabetes is increasing, including several types of diabetes. Type 1 diabetes (5%-10% of diabetic cases) and type 2 diabetes (90%-95% of diabetic cases) are the main types of diabetes in the clinic. Accumulating evidence shows that the fibroblast growth factor (FGF) family plays important roles in many metabolic disorders, including type 1 and type 2 diabetes. FGF consists of 23 family members (FGF-1-23) in humans. Here, we review current findings of FGFs in the treatment of diabetes and management of diabetic complications. Some FGFs (e.g., FGF-15, FGF-19, and FGF-21) have been broadly investigated in preclinical studies for the diagnosis and treatment of diabetes, and their therapeutic roles in diabetes are currently under investigation in clinical trials. Overall, the roles of FGFs in diabetes and diabetic complications are involved in numerous processes. First, FGF intervention can prevent high-fat diet-induced obesity and insulin resistance and reduce the levels of fasting blood glucose and triglycerides by regulating lipolysis in adipose tissues and hepatic glucose production. Second, modulation of FGF expression can inhibit renal and cardiac fibrosis by regulating the expression of extracellular matrix components, promote diabetic wound healing process and bone repair, and inhibit cancer cell proliferation and migration. Finally, FGFs can regulate the activation of glucose-excited neurons and the expression of thermogenic genes.

Retinal imaging for diabetic retinopathy detection through deep learning

The prevalence of diabetes is increasing globally, necessitating efficient methods to enhance the timely identification and treatment of diabetes, Focusing on early detection and effective management strategies for complications is essential. This study presents an integrated solution comprising two modules: diabetic detection and diabetic retinopathy detection. The diabetic detection module employs machine learning techniques like decision trees, random forests, and KNN for forecasting presence of diabetes based on patient data. The diabetic retinopathy detection module utilizes deep learning techniques, specifically the ResNet50 model architecture, to analyze retinal images and identify signs of diabetic retinopathy. A comprehensive implementation of both modules, including data preprocessing, model training, and evaluation, using Python libraries such as TensorFlow, Keras, and scikit- learn. The trained models are then integrated into a web application. This web application allows users to input their medical data and retinal images, and receive real- time predictions regarding their diabetic status and risk of diabetic retinopathy. The integration of these modules into a web application provides an intuitive interface tailored for both healthcare professionals and patients to assess diabetic risks conveniently. Furthermore, it facilitates early intervention and management of diabetic complications, ultimately improving patient outcomes and reducing healthcare burdens.

A review on comparative study between metformin andhesperidin in the management of diabetic complications

Diabetes mellitus (DM) is a highly widespread condition that has a significant negative influence on global health. Typically, they give rise to microvascular and macrovascular challenges like neuropathy, gastropathy, cardiac myopathy, retinopathy, nephropathy etc as well as to an array of comorbidities like depression, cognitive decline, Alzheimer's disease etc. Apart from the use of oral hypoglycemic agent in regulating blood glucose levels that has a role in the development of diabetic complication, flavonoids have been a major research attraction in targeting diabetic complications. Hesperidin a plant-basedflavone glycoside found abundantly in citrus fruits has gained a lot of attention in medical research with its anti-diabetic, antioxidant and hypolipidemic potential being formulated with novel approaches in diabetologicalresearch. This review article not only aims at contrasting the roles of hesperidin and metformin with a systematic approach in various diabetic complications along with associated comorbidities but also provides justifying information for carrying out a study to determine the effectiveness of combinational strategy between the two in fighting of various diabetic complications and to modulate the progression of the disease.

Role of polyphenols in the management of diabetic complications.

Diabetes Mellitus is an endocrine disorder that will affect, about 693 million adults by 2045 worldwide, (>50% increase from 2017). The conventional treatment of the disease, include the oral hypoglycemic drugs which are given in combination with other drugs and are known to possess various adverse effects like gastrointestinal disturbance, nausea, water retention etc. PURPOSE: Due to the urgent need of combating this disorder without side effects, the alternative and complementary therapies should be explored due to their natural origins and comparable safety. Herbal sources serve as new leads, due to the presence of phytoconstituents with potential therapeutic properties, efficacy and safety. In this review, we tried to summarise the polyphenolic phytoconstituents effective in the treatment of diabetic complications. A systematic literature search was conducted using 4 databases (Google scholar, Pubmed, Scopus, Embase) for the identification of relevant data. Search was performed using various key words such as "diabetes", "polyphenols", "marine sources","anti-diabetic polyphenols". The in vitro studies involving the cell lines used in diabetes and animal models were also considered for inclusion. Additional research papers were identified by reviewing abstracts, scrutinizing reference lists, and reviewing previously published review articles. Polyphenols, a group of phytoconstituents are known worldwide for their tremendous antioxidant potential. So, various research groups have explored their mechanism and therapeutic value in diabetic complications, to improve the insulin sensitivity and glucose metabolism, in controlling the glycemic conditions. Polyphenols exhibit effective therapeutic potential in managing diabetic complications through their multifaceted mechanism of action. They exhibit antioxidative, anti-inflammatory, and anti-glycemic properties, which collectively contribute to their beneficial effects in mitigating diabetic complications. Thus, the inclusion of polyphenols into the diet, may be cosidered as an approach of managing diabetes on long term basis. In this review, we have tried to identify polyphenols effective in diabetes and summarize their mechanism of action along with their potential, for the treatment of diabetic complications.

The Effects of Resveratrol Supplementation on the Quality of Life of Diabetic Patients with Neuropathy: Small Randomized Clinical Trial

The diabetic neuropathy complication exerts a considerable decline in the level of patient’s well-being. The main approaches to hamper the progression of diabetic complications and improve patient’s life quality are controlling the glycemic levels and amelioration of the hyperglycemia-induced neuroinflammation, oxidative stress and pain. Supplementation of appropriate anti-inflammatory and anti-oxidants such as resveratrol may therefore be effective in the management of diabetic complications. The aim of this trial was to assess resveratrol’s impact on improving life quality of patients with the neuropathic complication of diabetes. Sixty-one patients with diabetic neuropathy were recruited in this double-blinded placebo-controlled trial. Patients were randomized into the resveratrol (n=31) group; who received a 500mg resveratrol capsule once daily concomitantly with the conventional hypoglycemic agents for three months, and the placebo (n=30) group. From each group 25 patients completed the study. The quality of life (QoL) of the patients was estimated utilizing RAND 36-item survey questionnaire. Fasting blood glucose levels were analyzed at the baseline and on the last day of the 3rd month. There was a significant decrement (p&lt; 0.001) in the fasting serum glucose level of the patients supplemented with resveratrol at the end of the 3rd month, in comparison with the patient using the placebo. There was also a significant improvement in patient’s severity of pain (p&lt;0.001) as shown in the bodily pain score of the RAND 36 scale and a remarkable (p &lt; 0.05) improvement in physical functioning, physical health, social functioning, emotional well-being, energy/fatigue, and health change subscales of the questionnaire. The study concluded that resveratrol is the polyphenol that has a positive effect on reducing pain associated with diabetic neuropathy and improving the overall QoL of the patient.

Adiponectin: A Promising Target for the Treatment of Diabetes and Its Complications.

Diabetes mellitus, a chronic metabolic disorder characterized by hyperglycemia, presents a formidable global health challenge with its associated complications. Adiponectin, an adipocyte-derived hormone, has emerged as a significant player in glucose metabolism and insulin sensitivity. Beyond its metabolic effects, adiponectin exerts anti-inflammatory, anti-oxidative, and vasoprotective properties, making it an appealing therapeutic target for mitigating diabetic complications. The molecular mechanisms by which adiponectin impacts critical pathways implicated in diabetic nephropathy, retinopathy, neuropathy, and cardiovascular problems are thoroughly examined in this study. In addition, we explore possible treatment options for increasing adiponectin levels or improving its downstream signaling. The multifaceted protective roles of adiponectin in diabetic complications suggest its potential as a novel therapeutic avenue. However, further translational studies and clinical trials are warranted to fully harness the therapeutic potential of adiponectin in the management of diabetic complications. This review highlights adiponectin as a promising target for the treatment of diverse diabetic complications and encourages continued research in this pivotal area of diabetes therapeutics.

Expert Consensus on the Role of Pharmaco-complementary Medicine for the Management of Diabetic Complications Using Modified Delphi Method

Background: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance and/or deficiency. It is associated with numerous complications, including microvascular and macrovascular complications. Micronutrient deficiencies are commonly observed in individuals with diabetes due to the metabolic changes that occur in the body and the increased renal excretion. Several studies have shown that diabetes patients are at an increased risk of developing micronutrient deficiencies such as vitamin D, thiamine, vitamin B12, folate, magnesium, and zinc. The consequences of micronutrient deficiencies in diabetic patients can be significant. The aim of this study was to achieve a consensus on the use of complementary pharmacological therapies in the management of diabetic complications, through a modified Delphi methodology. Methods: A three-round modified Delphi Procedure was conducted to define recommendations regarding the role of Pharmaco-Complementary medicine in the management of Diabetic complications using a web-based questionnaire. The questionnaire included a set of 65 questions. The level of Consensus was defined based on the level of agreement among the panelists on specific scientific statements. Strong Consensus was defined as ≥80% agreement, Moderate Consensus with Agreement between 65% and up to 79%, and Low Consensus level with statements below 65% agreement. Results: Eighteen experts in the field of diabetes participated in the development of this consensus. Three rounds of voting were held, followed by data analysis and consensus level calculation. Out of 47 statements, a total of 33 statements achieved moderate – strong consensus (moderate: 65% - 79% agreement, strong: ≥80% agreement). Conclusion: Experts concluded that the use of pharmaco-complementary medications such as CoQ10, Benfotiamine, Magnesium, and EPA can potentially improve glycemic control, insulin sensitivity, and manage diabetic complications. This consensus can serve as a valuable tool for clinicians in managing diabetes, and its complications, and can provide direction for future research. Keywords: Diabetes, Consensus; Pharmaco-complementary, Delphi, Complications

Topic Modeling Analysis of Diabetes-Related Health Information during the Coronavirus Disease Pandemic.

This study aimed to provide diabetes-related health information by analyzing queries posted in the diabetes-related online community required during the COVID-19 pandemic. A total of 9156 queries from the diabetes-related online community, dated between 1 December 2019 and 3 May 2022, were used in the study. The collected data were preprocessed for bidirectional encoder representation from transformer topic modeling analysis. Topics were extracted using the class-based term frequency-inverse document frequency for nouns and verbs. From the extracted verbs, words with common definitions were subject to substitution and unification processes, which enabled the identification of multifrequent verb categories by noun topics. The following nine noun topics were extracted, in this order: dietary management, drug management, gestational and childhood diabetes, management of diabetic complications, use and cost of medical treatment, blood glucose management, exercise treatment, COVID-19 vaccine and complications, and diabetes in older adults. The top three verb categories by noun topics were permission, method, and possibility. This study provided baseline data that can be used by clinical nurses to deliver diabetes-related education and management based on information sought by patients.

1335-P: The Association between Exposure to Famine in Early Life and Risks of Diabetic Complications in Adult Patients with Type 2 Diabetes in China

Background: The historical origin for the T2D pandemic in China may lie in the 1959-1961 Chinese famine. This study is aimed to exam the associations between exposure to famine in early life and risks of diabetic complications in adult patients with T2D in China. Method: The participants in this study were selected from China National HbA1c Surveillance System (2009-2013), and further stratified according to the birth year. The participants born in 1959-1961 were classified as fetal exposed group (70852 participants). The participants born in 1956-1959 were classified as infant/toddler exposed group (93616 participants). The participants born in 1962-1964 were classified as unexposed group (72723 participants). By using the logistic regression approach, we analyzed the association between exposure to famine in early life and risks of diabetic complications. Results: As for diabetic complications, the adjusted model indicated that, compared with T2D without exposure to famine, the risks of coronary heart disease (fetal exposed: OR=1.254, 95%CI: 1.196-1.315; infant/toddler exposed: OR=1.343, 95%CI: 1.286-1.403), cerebrovascular disease (fetal exposed: OR=1.290, 95%CI: 1.200-1.388; infant/toddler: OR=1.342, 95%CI: 1.254-1.436) and diabetic retinopathy (fetal exposed: OR=1.083, 95%CI: 1.036-1.132) were significantly increased while the reduced risk of diabetic kidney disease (infant/toddler exposed:OR=0.885, 95%CI: 0.841-0.932) was observed in adult T2D patients with early-life exposure to famine. Conclusions: Early-life exposure to famine in patients with T2D was associated with increased risks of coronary heart disease, cerebrovascular disease, diabetic retinopathy but reduced risks of diabetic kidney disease in adulthood. Improving early-life nutritional status may promote better risk prevention and management of diabetic complications and comorbidities in patients with T2D. Disclosure C.Lin: None. X.Cai: None. L.Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck &amp; Co., Inc., Bayer Inc., Sanofi-Aventis U.S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics. Funding National Natural Science Foundation of China (81970698, 81970708); Beijing Natural Science Foundation (7202216)

Eine neue Welt: Verbesserung der Diabetestherapie durch digitale und technische Innovationen

Medical progress is increasingly characterized by digital and technical solutions that improve and facilitate treatment of our patients. Especially diabetes therapy is an ideal field for digital and technical solutions. The complexity of insulin therapy with the need to take multiple variables into account is a brilliant example for the use of digital support processes. This article gives an overview of the current state of telemedicine during corona pandemic and diabetes Apps to improve mental health and self support in people with diabetes as well as to simplify documentation. In the field of technical solutions at first continuous glucose monitoring and smart pen technology will be presented with their potential to increase time in range, reduce the frequency of hypoglycemia and improve glycemic management. As next topic automated insulin delivery as current gold standard and possibilities to further improve glycemic control in future. Last wearables in the diabetes field to improve diabetes therapy as well as the management of diabetes complications. All these aspects show the importance of technical and digital supported therapies for treatment and glycemic management in people with diabetes in Germany.

The Antioxidant Properties of Mushroom Polysaccharides can Potentially Mitigate Oxidative Stress, Beta-Cell Dysfunction and Insulin Resistance.

Diabetes mellitus is a prevalent metabolic and endocrine illness affecting people all over the world and is of serious health and financial concern. Antidiabetic medicine delivered through pharmacotherapy, including synthetic antidiabetic drugs, are known to have several negative effects. Fortunately, several natural polysaccharides have antidiabetic properties, and the use of these polysaccharides as adjuncts to conventional therapy is becoming more common, particularly in underdeveloped nations. Oxidative stress has a critical role in the development of diabetes mellitus (DM). The review of current literature presented here focusses, therefore, on the antioxidant properties of mushroom polysaccharides used in the management of diabetic complications, and discusses whether these antioxidant properties contribute to the deactivation of the oxidative stress-related signalling pathways, and to the amelioration of β-cell dysfunction and insulin resistance. In this study, we conducted a systematic review of the relevant information concerning the antioxidant and antidiabetic effects of mushrooms from electronic databases, such as PubMed, Scopus or Google Scholar, for the period 1994 to 2021. In total, 104 different polysaccharides from mushrooms have been found to have antidiabetic effects. Most of the literature on mushroom polysaccharides has demonstrated the beneficial effects of these polysaccharides on reactive oxygen and nitrogen species (RONS) levels. This review discuss the effects of these polysaccharides on hyperglycemia and other alternative antioxidant therapies for diabetic complications through their applications and limits, in order to gain a better understanding of how they can be used to treat DM. Preclinical and phytochemical investigations have found that most of the active polysaccharides extracted from mushrooms have antioxidant activity, reducing oxidative stress and preventing the development of DM. Further research is necessary to confirm whether mushroom polysaccharides can effectively alleviate hyperglycemia, and the mechanisms by which they do this, and to investigate whether these polysaccharides might be utilized as a complementary therapy for the prevention and management of DM in the future.

Diabetes self-management education interventions in the WHO African Region: A scoping review.

Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.

Effect of telemedicine on diabetic treatment and complications

Investigations have also reported that the efficacy of telemedicine in the easy delivery of information and provision of regular patient-doctor interaction and therefore, enhancing the quality of care of diabetics and reducing the risk of developing severe complications. In the present study, we aimed to discuss telemedicine use in the management of diabetic complications, depending on information from studies within the literature. Overall, telemedicine assists patients to properly maintain basic and adequate levels of blood glucose levels through continuous reminders. Therefore, the application of this modality requires patients to have home-based assessment devices for the regular monitoring of the blood glucose levels. Moreover, the modality also enhances the connection between the patient and the physicians which make the patient at an ease of being able to communicate with the doctor whenever necessary and therefore, this might have a positive psychological impact on these patients. Moreover, telemedicine can provide patients with adequate treatment schedules that might help patients comply with their drugs. Additionally, it can provide the most appropriate dietary components that can also help in achieving the best intervention, with the necessary supervision. Although there is good evidence about the efficacy of telemedicine as an efficacious modality in the treatment of diabetes and management of complications, the evident application in the healthcare settings is still poor. The main reason behind such lack of proper application is the potential lack of adequate financial support, lack of experienced staff dealing with the modalities and maintaining the best quality of care for the patients.

Pancreas transplantation would be easy if the recipients were not diabetic: A practical guide to post-operative management of diabetic complications in pancreas transplant recipients.

Diabetes mellitus remains a major public health problem throughout the United States with over $300billion spent in total cost of care annually. In addition to being a leading cost of kidney failure, diabetes causes a host of secondary hyperglycemic-related complications including gastroparesis and orthostatic hypotension. While pancreas transplantation has been established as an effective treatment for diabetes, providing long-term normoglycemia in recipients, the secondary complications of diabetes mellitus persist complicating the post-operative course of an otherwise successful pancreas transplantation. This review describes the mechanismand impact of diabetic gastroparesis and orthostatic hypotension in the post-operative course of pancreas transplant patients and analyzes the various treatment modalities, based on current data and extensive experience at our institution, to treat these respective complications. While gastroparesis and orthostatic hypotension remain challenging post-operative conditions, the establishment of institutional protocols and step-up treatment algorithms can help define more effective therapies.