Non-insulin-dependent Diabetes Mellitus Patients Research Articles

Peripheral Neuropathy and Cardiac Autonomic Neuropathy among Type II Diabetic Patients: Prevalence and Risk Factors

Background: The two most common chronic complication softype 2 diabetes mellitus (T2DM) are peripheral neuropathy (PN) and Cardiac autonomic neuropathy (CAN).Diagnosing neuropathies at subclinical stage can prevent the morbidity and mortality.
 Objectives: To determine the prevalence of peripheral neuropathy and cardiovascular autonomic neuropathy and their risk factors in type-II diabetic patients attending a tertiary care hospital.
 Methods: An observational cross sectional study was done from December 2019 to November 2020 in the department of General medicine at tertiary care hospital. 273 type II diabetic patients were selected for this study. Toronto clinical scoring system was used for assessing PN and ewings cardiovascular reflex study was used done to assess CAN. To identify the risk factors of PN and CAN, Logistic regression analysis was used.
 Results: The prevalence of PN and CAN was 45.4% and 34.06% respectively, while29.3% participants had both. Smoking (OR: 12.976; 95% CI: 0.052–0.418, P<0.0001) and poor glycaemic control (OR: 27.231; 95% CI: 5.226–38.201, P<0.0001) were independent risk factors of DPN. poorglycaemic control (OR: 26.970; 95% CI: 3.507–16.055, P <0.0001) and Dyslipidimea (OR: 11.792; 95% CI: 0.096–0.526, P ≤ 0.001) were independent predictors of CAN.
 Interpretation and Conclusions: PN and CAN are common among diabetic patients, and thus it is recommended to screen Peripheral Neuropathy and CAN in all diabetic patients for the early diagnosis and preventing the debilitating complications

The role of hyperbaric oxygen to platelet aggregation in noninsulin-dependent diabetes mellitus (NIDDM)

Hyperglycemia in diabetes mellitus (DM) could cause rheological disorder, such as platelet aggregation and blood hyperviscosity. Hyperbaric oxygen (HBO) could decrease collagen as platelet aggregation agonist. This study aimed to explore the effect of HBO treatment to platelet aggregation parameters (latency time(LT), aggregation speed, aggregation index, and aggregation percentage) with the collagen aggregator in the noninsulin dependent diabetes mellitus (NIDDM). The number of subjects in this study were 16 for each group normoxia normobaric (NONB) and HBO. NIDDM patients from DM polyclinic in Rumah Sakit AngkatanLaut (RSAL) Dr Ramelan Surabaya which was fulfilled inclusion criteria would receive HBO Therapy. Control Group/NONB were treated with NONB condition (20% O2 1 ATA) for 90min and treatment group/HBO were treated with hyperoxia hyperbaric condition (100% O2 2.4 ATA) for 3×30min with interval of 2×5min for inhaling fresh air. Subject has been blood taken for platelet aggregation test before and after HBO Therapy. The length of treatment was 5days for both condition (NONB and HBO). The data from both groups, NONB and HBO were tested first by normality test, homogenity test, correlation test, analysis of covariance, and paired t-test. Based on paired t-test, the decrease on platelet aggregation speed, aggregation index, and aggregation percentage after HBO treatment was showed significant difference on the LT and aggregation index while in aggregation speed and aggregation percentage was not significant. NONB group after 5days was showed a significant difference on the aggregation speed and aggregation index while in LT and aggregation percentage was not significant. The utilization of HBO 2.4 ATA 100% O2 3×30min, once a day, for 5days could decrease the platelet aggregation parameters (LT, aggregation speed, aggregation index, and aggregation percentage) in patients with NIDDM.

Postoperative Outcomes in Diabetic Pediatric Orthopaedic Surgery Patients: A National Database Study.

Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a well-studied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM. Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures. Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P>0.05) or reoperation rates (1.2% vs. 1.9%, P>0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P=0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio=3.34; 95% confidence interval=1.21-9.24, P=0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P=0.023), readmission rate (11.1% vs. 1.8%; P=0.043), and reoperation rate (11.1% vs. 1%; P=0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P=0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio=1.49; 95% confidence interval=1.04, 2.14; P=0.028) compared with nondiabetic patients in extremity deformity procedures. The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients. Level III.

Insulin dependence increases the risk of postoperative complications and inferior outcome but not the survivorship of total joint arthroplasty among diabetic population: a systematic review and meta-analysis

Diabetes mellitus (DM) has been associated with poorer outcomes in total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, it is not clear if insulin-dependent diabetes mellitus (IDDM) patients display more perioperative complications and a worse clinical outcome compared to patients with non-insulin-dependent diabetes mellitus (NIDDM). Medline, Scopus, and the Cochrane library were systematically searched from inception to December 2020 to identify studies evaluating the results of THA and TKA in IDDM and NIDDM patients. The primary outcomes of the review were the surgical and systemic complications, 30-day mortality and readmission, and revision arthroplasty. Secondary outcomes were the survival of the prosthetic joints and the Knee Society Score (KSS). Thirteen studies with 54,215 patients were included in the review. IDDM patients showed a greater risk for developing periprosthetic joint infection (p = 0.02), wound complications (p = 0.01), 30-day readmission (p <0.01) and mortality (p <0.01), reoperation (p <0.01), revision joint surgery (p = 0.02), and systemic complications (p <0.01) than NIDDM patients. The KSS-knee score was similar in IDDM and NIDDM patients, but the KSS-function score was lower in IDDM patients (p = 0.002). The overall survival rates of the prosthetic joints were similar between the groups. Among diabetic population who undergo THA and TKA, insulin dependence is a risk factor for postoperative complications, and inferior functional outcome but not for shorter survivorship of the prosthetic joints.

Acute Kidney Injury is A Risk Factor among Type 2 Diabetic Patients after UTI due to Extended-Spectrum Beta-Lactamase Producing Organisms

Background: Urinary tract infections (UTIs) are very communal, and patients with diabetics develop UTIs more frequently. Acute kidney injury (AKI) can be a complication of UTI. This study is designed to determine whether Urinary tract infections because of extended-spectrum beta-lactamase (ESBL) could be a risk factor of acute kidney injury in individuals with type-II diabetes mellitus. Methods: This case study was conducted in the Outpatient department of Diabetes Hospital Peshawar and Nishter Hospital Multan for duration of six months from August 2020 to January 2021. People of type II diabetes were assessed with culture confirmed UTI. The cases of UTI patients complicated with AKI were included in the study group, and people without AKI were taken as a control group. ESBLs positivity from isolated organisms have been assessed as risk factors for AKI. A total of 140 subjects were selected with equal distribution in two groups. The group A has UTI complicated with AKI and group B included has patients without AKI but with UTI. Results: UTI was diagnosed in 140 cases among type-II diabetic patients with 2:4 male to female ratio. The duration and mean age of diabetes mellitus were 8.60±5.35and55.80±14.10 years, correspondingly. The strongest common etiological factor was Escherichia coli (60.7%), trailed by Klebsiella pneumoniae (11.4%). In ESBL positive organism; E. coli was present in 81.4% and K. pneumoniae in 10% of individuals. Of the 140 UTI cases, AKI was observed in 70 (50%); out of which 48 (62.5%) were ESBL-positive microorganisms and 22 (22/70, 31.43%) for non-ESBL microorganisms. Conclusions: Nearly50% of the patients with type-II diabetes mellitus and UTI had ESBL-positive microorganisms as etiological mediators in this analysis. Owing to the presence of ESBL-positive microorganisms, UTI was the main cause of AKI and is a strong risk factor. Keywords: ESBL, Acute kidney injury, UTI, type 2 diabetes, risk factor.

SGLT2 Inhibitor Induced Euglycemic DKA (EDKA) With Proximal Renal Tubular Acidosis (RTA) as a Rare Fatal Complication in a Non-Insulin Dependent Diabetic Patient: A Challenging Dilemma

Abstract Introduction: Diabetic Ketoacidosis (DKA) is characterized by a triad of hyperglycemia, acidemia, and ketonemia. Rarely, it would present with normal glucose levels making its diagnosis very challenging. The incidence of euglycemic DKA (eDKA) has increased with the introduction of the novel sodium-glucose cotransporter-2 inhibitors (SGLT2i). Currently, the reported incidence of SGLT2i induced DKA is 0.16–0.76 events per 1000 patient-years. We present a rare case of SGLT2i induced eDKA with proximal renal tubular acidosis (RTA). Case Presentation A 69 year-old male with type 2 diabetes mellitus presented to the hospital with severe respiratory distress, nausea and vomiting for 2 days. His home medications include metformin and canagliflozin. He was afebrile with respiratory rate 60 breaths/min. Arterial blood gas: pH 7.21, pCO2 9.2, pO2 223, HCO3 6. Blood glucose level was 120 mg/dl. Urinalysis was positive for large ketonuria &amp;gt;160 mg/dl and glycosuria &amp;gt;500 mg/dl. Serum anion gap and urine anion gap were elevated 29 mEq/L and 105 mEq/L respectively. Serum osmolarity and urine osmolality were elevated 296 mosm/kg and 653 mosm/kg respectively. Lactic acid was 5.3. Acetone was detected in blood. No source of infection was identified. Hemoglobin A1C was 5% and c-peptide was within normal range. Insulin and Islet cells antibodies were negative. DKA protocol was initiated until the anion gap closed. However, non-anion gap metabolic acidosis was persistent with profound hypophosphatemia. Repeat urinalysis showed glycosuria with pH ≤ 5.5, phosphaturia and generalized aminoaciduria. Ultimately, the patient elected to receive hospice care. Discussion: SGLT2i are currently recommended as second-line medications for type 2 diabetes mellitus. Their unique mechanism of action prevents glucose reabsorption from the proximal renal tubules. SGLT2i use is growing significantly, especially after recent clinical trials that demonstrated favorable protective effects. EDKA is precipitated by sepsis, acute illness, dehydration, or starvation. Once the diagnosis is suspected, SGLT2i should be stopped immediately. SGLT2i induced eDKA should be treated in a similar fashion as DKA. It is worth to note that SGLT2i half-life ranges from 11–17 hours, and despite drug discontinuation, glycosuria may persist for several days. What made our case unique and made the diagnosis challenging, was the normal blood glucose level, as well as other differentials that could have easily explained the acidosis including starvation ketosis and lactic acidosis. Also, the state of proximal RTA resembling renal Fanconi syndrome that occurred in correlation with canagliflozin therapy. To the best of our knowledge, this is the fourth reported case of proximal RTA with the use of canagliflozin resulting in life-threatening complications. The diagnosis was very challenging due to lack of awareness of this severe adverse effect.

A quantitative assessment of body iron status and its relationship with glycemic control in patients of type 2 diabetes mellitus in a tertiary care hospital of Kolkata

Background: Diabetes is one of the most common disease which is observed in every household of Indian population. The longevity of the diabetic patients is dependent upon the frequency of complication and comorbidity that they encounter. Serum iron and ferritin, both being the aggravators to the oxidative stress accelerating the development of complications, gives us the reason to venture into the territory exploring the possibility of monitoring the body iron stores and taking prevent measures to control such complication. The current study was designed with an aim to knot the relationship between body iron stores and glycemic control in patients of type-II diabetes mellitus.&#x0D; Aims and Objectives: To measure the levels of serum ferritin, serum Iron, transferrin saturation and HbA1C and finding out the relationship between body iron stores and glycemic control in patients of Type-II Diabetes Mellitus.&#x0D; Materials and Methods: A total of 50 diagnosed cases of type II DM and 50 healthy controls between the age group of 35-65 years were taken following inclusion and exclusion criteria. Body iron stores were assessed by measuring serum ferritin, Serum iron and Transferrin saturation and Glycemic control was assessed by measuring levels of HbA1C.&#x0D; Results: A significant increase in serum ferritin, serum iron and Transferrin saturation (P&lt;0.001) was noted in diabetic patients as compared to controls. There was a positive correlation between serum iron and transferring saturation in the diabetic patients.&#x0D; Conclusion: The co-morbidities and complications in the Diabetic population can be prevented by monitoring Body iron stores as they can significantly contribute to the oxidative stress leading to the complication and decreased life expectancy. Early detection in the abnormality in the body iron store can help us in employing proper measures for a better management of Type-II diabetic patients and thereby improving their survival.

Recommended Exercise Compliance among Noninsulin Dependent Diabetes Mellitus Patients at Jos University Teaching Hospital, Nigeria

Recommended Exercise Compliance among Noninsulin Dependent Diabetes Mellitus Patients at Jos University Teaching Hospital, Nigeria

Association between HOMA-IR with ketoacidosis and lipid profile markers in diabetic nephropathy patients

&nbsp;&nbsp; The study designed to study the relationship between the homeostatic model assessment of insulin resistance (HOMA-IR) with ketoacidosis markers and hyperlipidemia in patients with non-insulin-dependent diabetes mellitus (NIDDM) and chronic kidney disease at end-stage renal disease (ESRD). Disturbance of the mechanisms which maintain normal blood pH and lipid profiles is a defining feature of chronic metabolic diseases such as diabetes and kidney failure. The present research included 90 patients and 30 healthy subjects. Serum insulin, fasting blood sugar (FBS), glycated hemoglobin % (HbA1c %) and HOMA-IR levels, lipid profile parameters and ketoacidosis markers were estimated in all groups. Statistical analysis showed that high HOMA-IR was significantly associated with lipid profiles and ketoacidosis markers in patients' groups when compared with control. Receiver operating characteristic (ROC) curve analysis investigated HOMA-IR as a significant risk factor for diabetic nephropathy (DN) in ESRD patients. The present finding regarding ROC curve analysis observed that IR is dependently associated with ketoacidosis and lipid profile abnormalities in NIDDM, ESRD and DN patients. &nbsp;Also, the study suggested HOMA-IR as a consequence and risk factor in DN at ESRD.

Insulin-Dependent Status Influences Post-Procedural Outcomes in Diabetic Patients Following Lower Extremity Endovascular Intervention for Peripheral Arterial Disease.

Diabetic patients are at increased risk of developing lower extremity peripheral arterial disease (PAD) requiring revascularization. This study assessed the effect of insulin dependence in diabetics on post-procedural outcomes following infra-inguinal endovascular intervention. The American College of Surgeon's National Surgical Quality Improvement Program database was used to identify 8022 patients undergoing infra-inguinal endovascular interventions between 2014 and 2017. Thirty-day post-procedural outcomes for patients without diabetes, with non-insulin-dependent diabetes mellitus (NIDDM), and with insulin-dependent diabetes mellitus (IDDM) were compared. At presentation, IDDM patients were more likely to present with critical limb ischemia compared to NIDDM and non-diabetic patients. In propensity score-weighted logistic regression analysis, IDDM status was an independent predictor for increased renal complication (odds ratio [OR] = 3.08, confidence interval [CI] = 1.44-6.65), sepsis (OR = 1.68, CI = 1.13-2.48), wound complication (OR = 1.57, CI = 1.09-2.25, p = 0.006), UTI (OR = 2.07, CI = 1.09-3.94, p = 0.03), and readmission (OR = 1.21, CI = 1.03-1.42). NIDDM status was an independent predictor for increased risk of renal complications (OR = 2.80, CI = 1.18-6.63). IDDM status is an independent predictor for increased risk of 30-day post-procedural complications and readmission compared to both NIDDM and non-diabetic status in patients undergoing lower extremity endovascular interventions for PAD.

Indications of Liver and Kidney Functions in Non-Insulin Dependent Diabetic Patients

This study aimed at the investigation of abnormal liver and renal functions by biochemical manifestations of underlying metabolic abnormalities in relation to hyperglycemia in non-insulin-dependent diabetic patients. The study comprised 118 diabetic patients (56 males, 62 females) and 60 age-matched healthy non-diabetic controls (30 males, 30 females). All subjects were tested for serum levels of liver enzymatic indicators, which include aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP), as well as non enzymatic parameters, including total bilirubin and total proteins.Also, serum levels of renal function markers, including microalbumin, creatinine, urea, and uric acid were measured.&#x0D; The findings of this study stated that serum ALT, AST, and ALP levels were significantly higher in diabetic males and females with both age ranges (40-59 &amp; 60-80 years). Serum total bilirubin level showed a significant decrease in diabetic males and females of both age groups. However, total proteins level showed a significant increase in diabetic males and females of both age groups. The results also showed that the level of microalbumin in urine as well as those of creatinine, urea, and uric acid in the serum were significantly higher in diabetic males and females. The present study concludes that there is a bidirectional relationship of enzymatic and non enzymatic liver and renal functions markers with the hyperglycemic status in Type 2 diabetes mellitus.

Testosterone Levels in Male Type-II Diabetic Patients and its Association with HBA1C Levels and Duration of the Disease

Testosterone Levels in Male Type-II Diabetic Patients and its Association with HBA1C Levels and Duration of the Disease

Hybrid artificial fish particle swarm optimizer and kernel extreme learning machine for type-II diabetes predictive model.

The World Health Organization (WHO) estimated that in 2016, 1.6 million deaths caused were due to diabetes. Precise and on-time diagnosis of type-II diabetes is crucial to reduce the risk of various diseases such as heart disease, stroke, kidney disease, diabetic retinopathy, diabetic neuropathy, and macrovascular problems. The non-invasive methods like machine learning are reliable and efficient in classifying the people subjected to type-II diabetics risk and healthy people into two different categories. This present study aims to develop a stacking-based integrated kernel extreme learning machine (KELM) model for identifying the risk of type-II diabetic patients based on the follow-up time on the diabetes research center dataset. The Pima Indian Diabetic Dataset (PIDD) and a Diabetic Research Center dataset are used in this study. A min-max normalization is used to preprocess the noisy datasets. The Hybrid Particle Swarm Optimization-Artificial Fish Swarm Optimization (HAFPSO) algorithm used satisfies the multi-objective problem by increasing the Classification Accuracy (CA) and decreasing the kernel complexity of the optimal learners (NBC) selected. At last, the model is integrated by utilizing the KELM as a meta-classifier which combines the predictions of the twenty Base Learners as a whole. The proposed classification method helps the clinicians to predict the patients who are at a high risk of type-II diabetes in the future with the highest accuracy of 98.5%. The proposed method is tested with different measures such as accuracy, sensitivity, specificity, Mathews Correlation Coefficient, and Kappa Statistics are calculated. The results obtained show that the KELM-HAFPSO approach is a promising new tool for identifying type-II diabetes.

Textural Characterization of Dietetic Amrakhand Prepared by using Stevia Leaf Extracts Powder

Background: The name Amrakhand comes from two words ‘aam’ and ‘shrikhand’ literally meaning mango shrikhand. It is popular mango yoghurt in Maharashtra and Gujarat. Amrakhand contains high sugar content, but in the context of health consciousness refined carbohydrate is necessary to curb in the diet of both insulin and non-insulin dependent diabetic patient. Hence dietetic Amrakhand was prepared using stevia to study its effect and suitability as a natural sweetener.Methods: Amrakhand prepared using different proportions of sucrose and powdered stevia leaf extract. The proportions used are 30:70 (T1), 25:75 (T2), 20: 80 (T3), 15:85 (T4), 10:90 (T5) with control sample 100:0 (T0). Textural properties of dietetic Amrakhand such as hardness, consistency, index of viscosity and cohesiveness were evaluated by using a texture analyzer (TA-XT2I, Stable Micro System, UK).Result: Textural parameters reveals that effect of increasing the concentration level of powdered stevia leaf extract, decreases the hardness, consistency, cohesiveness and index of viscosity values of the product. Whereas good sensory results were found at 70% (T1) of sucrose replacement by stevia leaf extract in dietetic Amrakhand. Hence, present paper focused on evaluation of textural characterization of dietetic Amrakhand prepared by using Stevia leaf extracts powder.

Endovascular Treatment for Critical Limb Ischemia in Type II Diabetes Mellitus Involving Femoropopliteal and Infrapopliteal Segments: Revascularization Strategy

PurposeTo determine if further endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization improves the clinical outcomes regarding major amputation rate, rate of secondary interventions, and mortality in diabetic type-II patients presented with critical lower limb ischemia (CLI).Patients and MethodsThis is a retrospective study in which all type-II diabetic patients with CLI at King Abdullah University Hospital between October 2015 and September 2019 were identified. Patients with concomitant femoropopliteal and infrapopliteal vessels atherosclerotic lesions (total occlusion or more than 50% stenosis) who received successful endovascular treatment were included. Patients were divided into 2 groups. Group-I included patients treated for femoropopliteal segment alone, while Group-II included patients treated for both femoropopliteal and infrapopliteal segments. The outcomes of the two groups were compared regarding major amputation rate, rate of secondary interventions, and mortality. In addition, demographic data, atherosclerotic lesions distributions and cardiovascular risk factors were also collected and analyzed.ResultsIn all, 90 patients (65 males and 25 females) with a mean age of 67.5±12 years were included. In Group-I; 44 patients (48.9%) were included (36 males and 8 females) with a mean age of 67±12 years. In group-II; 46 patients (51.1%) were included (29 males and 17 females) with a mean age of 68±13 years. The major amputation rate was higher and statistically significant in Group-I (38.6% vs 17.4%, p-value = 0.034). However, the secondary interventions and the mortality rates showed no statistically significant differences (56.8% vs 39.1%, p-value = 0.139) and (22.7% vs 28.3%, p-value = 0.632), respectively.ConclusionEndovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization in diabetic type-II patients with CLI improves the clinical outcome regarding major amputation rate. However, there were no significant differences regarding the rate of secondary interventions and the mortality rate.

Reliable IoT-based Health-care System for Diabetic Retinopathy Diagnosis to defend the Vision of Patients

PurposeThe purpose of this paper is to design an Internet-of-Things (IoT) architecture-based Diabetic Retinopathy Detection Scheme (DRDS) proposed for identifying Type-I or Type-II diabetes and to specifically advise the Type-II diabetic patients about the possibility of vision loss.Design/methodology/approachThe proposed DRDS includes the benefits of automatic calculation of clip limit parameters and sub-window for making the detection process completely adaptive. It uses the advantages of extended 5 × 5 Sobels operator for estimating the maximum edges determined through the convolution of 24 pixels with eight templates to achieve 24 outputs corresponding to individual pixels for finding the maximum magnitude. It enhances the probability of connecting pixels in the vascular map with its closely located neighbourhood points in the fundus images. Then, the spatial information and kernel of the neighbourhood pixels are integrated through the Robust Semi-supervised Kernelized Fuzzy Local information C-Means Clustering (RSKFL-CMC) method to attain significant clustering process.FindingsThe results of the proposed DRDS architecture confirm the predominance in terms of accuracy, specificity and sensitivity. The proposed DRDS technique facilitates superior performance at an average of 99.64% accuracy, 76.84% sensitivity and 99.93% specificity.Research limitations/implicationsDRDS is proposed as a comfortable, pain-free and harmless diagnosis system using the merits of Dexcom G4 Plantinum sensors for estimating blood glucose level in diabetic patients. It uses the merits of RSKFL-CMC method to estimate the spatial information and kernel of the neighborhood pixels for attaining significant clustering process.Practical implicationsThe IoT architecture comprises of the application layer that inherits the DR application enabled Graphical User Interface (GUI) which is combined for processing of fundus images by using MATLAB applications. This layer aids the patients in storing the capture fundus images in the database for future diagnosis.Social implicationsThis proposed DRDS method plays a vital role in the detection of DR and categorization based on the intensity of disease into severe, moderate and mild grades. The proposed DRDS is responsible for preventing vision loss of diabetic Type-II patients by accurate and potential detection achieved through the utilization of IoT architecture.Originality/valueThe performance of the proposed scheme with the benchmarked approaches of the literature is implemented using MATLAB R2010a. The complete evaluations of the proposed scheme are conducted using HRF, REVIEW, STARE and DRIVE data sets with subjective quantification provided by the experts for the purpose of potential retinal blood vessel segmentation.

An RP-HPLC Method for Quantitative Analysis of Linagliptin Entrapped in Nanotransfersomes and its Application to Skin Permeation Studies

Background:Linagliptin (LNG) is an oral hypoglycemic agent that acts by inhibiting the enzyme dipeptidyl peptidase - 4 (DPP-4) and reduces blood sugar levels in type-II diabetic patients. To date, the literature presents few analytical methods for the determination of LNG. However, no reversed phase-high performance liquid chromatography (RP-HPLC) method has been reported for the determination of LNG in nanotransfersomes and in vitro skin permeation samples.Objective:The present study involves the development and validation of RP-HPLC method to quantify LNG in both nanotransfersomes and in vitro skin permeation and deposition samples.Methods:The chromatographic analysis was performed on Luna C18 (2) column (250 x 4.6 mm, 5μm particle size) with a mobile phase consisting of a mixture of methanol: 0.2% orthophosphoric acid (50:50, v/v) at a flow rate of 1.0 mL/min, detection wavelength of 227 nm, and column temperature of 40 °C.Results:The method was found to be specific, linear (r2≥ 0.999; 2-12 μg/mL), precise at both intra and inter-day levels (percentage relative standard deviation; % RSD &lt; 2.00), accurate (percentage recovery 100.21-103.83%), and robust. The detection and quantification limits were 0.27 and 0.82 μg/mL, respectively. The mean % entrapment efficiency and the cumulative amount of LNG permeated across the rat skin from different transfersomal formulations ranged between 40.78 ± 2.54 % to 52.26 ± 2.15 % and 79.54 ± 16.67 to 200.74 ± 35.13 μg/cm2respectively.Conclusion:The method was successfully applied to determine the entThe method was successfully applied to determine the entrapment efficiency, in vitro skin permeation and deposition behavior of LNG-nanotransfersomes.rapment efficiency, in vitro skin permeation and deposition behavior of LNG-nanotransfersomes.

Diabetes Status Affects Odds of Body Mass Index-dependent Adverse Outcomes After Total Hip Arthroplasty.

Obesity and diabetes have independently been shown to predispose to adverse outcomes after total hip arthroplasty (THA). These may have a coupled effect on perioperative risks. The purpose of this study was to evaluate the effect of body mass index (BMI) on adverse outcomes in nondiabetic (ND), non-insulin-dependent diabetes mellitus (NIDDM), and insulin-dependent diabetes mellitus (IDDM) patients. Patients undergoing primary THA were selected from the National Surgical Quality Improvement Program Database from 2012 to 2016 and categorized as ND, NIDDM, and IDDM. BMI, demographics, and 30-day perioperative outcomes were assessed for each group. Multivariate logistic regressions controlling for demographics, functional status, and American Society of Anesthesiologists were used to determine the odds ratio of serious adverse event (SAE) in each diabetes group for patients with BMI ≥ 40 kg/m compared with a control group of ND patients with a normal BMI (18.5 to 24.9 kg/m). A total of 108,177 patients were included. The results demonstrate that ND (odds ratio 1.65; P < 0.001) and NIDDM (odds ratio 1.75; P = 0.007) patients have similar risks of SAE, whereas IDDM (odds ratio 2.79; P < 0.001) patients have a greater risk of adverse events, particularly at BMIs greater than 40 kg/m. Consistent with previous reports, ND (odds ratio 1.65; P < 0.001) and NIDDM (odds ratio 1.75; P = 0.007) morbidly obese patients (BMI > 40 kg/m) had an increased odds of SAEs after THA, but for IDDM (odds ratio 2.79; P < 0.001) patients this increased odds was notably higher. Although patients with IDDM have increased rates of adverse events compared with ND and NIDDM patients, these findings should not be used to establish strict BMI cutoffs in patients with IDDM. Nonetheless, the results suggest additional factors, such as patient medical history and diabetes control, should be considered when evaluating patients with IDDM for THA. Level III.

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.

The French Reconnection: A Conservative Surgical Treatment of Disconnected Pancreatic Duct Syndrome

Background: Disconnected pancreatic duct syndrome (DPDS), a severe complication of acute necrotizing pancreatitis (ANP) can require surgery, usually by distal pancreatectomy, but frequently exposing to diabetes. We describe a new technique reconnecting the distal pancreas to the digestive tract. Methods: This technique was proposed for DPDS in non-diabetic or non-insulin dependent diabetic patients with a distal pancreas exceeding 5 cm. The ruptured zone was identified and the distal side was anastomosed to the stomach or the jejunum. Results: From 2013 to June 2019, 36 patients (median=49 years), underwent the “French reconnection”, indicated for chronic pain/recurrent pancreatitis (35;97%), persistent pancreatic fistula (33; 92%), or digestive compression/fistulisation (9; 25%). Preoperatively, median weight loss was 10 kg (4-27), median number of hospitalisation per patient was 5(1-8) and 24(67%) patients received endoscopic/percutaneous treatment. Surgery was performed after a median delay of 279(90-2000) days after ANP, through laparoscopy in 9 (25%) patients. The remnant pancreas (median length=70mm; 50-130) was anastomosed to the stomach (n=30) or the jejunum (n=6). Postoperatively, there were 13(39%) grade B/C pancreatic fistulas and 3 (10%) bleedings including one lethal (mortality=3%). Median hospital stay was 18(7-121) days. With a median follow up of 24(4-53) months, all pancreatic fistulas healed and the clinical success rate was 91%. Median BMI increased from 22 to 25 kg/m2. Postoperative endocrine and severe exocrine insufficiencies were observed in 4 (15%) and 7(32%) patients, respectively. Conclusions: The “French reconnection” is a good alternative to distal pancreatectomy for DPDS, allowing excellent control of symptoms and preserving pancreatic function.