Number Of Diabetic Complications Research Articles

PERCEIVED COGNITIVE FUNCTION: RELATIONSHIPS WITH DIABETES COMPLICATIONS AND SELF-EFFICACY IN LATINX OLDER ADULTS

Abstract Cognitive dysfunction is a concern for individuals with type 2 diabetes (T2DM) and can affect diabetes self-management. However, it is often overlooked clinically and remains relatively understudied in Latinx older adults as a complication of T2DM. This project sought to explore the relationships between perceived cognitive dysfunction and its effects on self-efficacy and complications of T2DM in older Latinx adults. This was part of an analysis of baseline data from a larger randomized controlled trial investigating an cognitive rehabilitation intervention for older adults with T2DM. A total of 87 participants (mean age 67.3 +/- 5.4) completed a survey consisting of the Diabetes Empowerment Scale - short form (self-efficacy); PROMIS Bank v.2 - Cognitive Function (perceived cognitive function); and a self-report of number and type of diabetes complications. Participants had lower perceived cognitive dysfunction than the general population (Mean total score: 36.6 +/- 7.9); low self-efficacy (mean total score: 2.3 +/- 0.7) and reported at least 2 complications related to T2DM. Greater perceived cognitive dysfunction was related to lower self-efficacy (p = 0.04). Diabetes duration was positively associated with self-efficacy (p = 0.03), but not perceived cognitive dysfunction (p = 0.22). Self-efficacy was positively associated with number of diabetes complications (p = 0.03). Irrespective of diabetes duration, patients with more severe perceived cognitive dysfunction reported lower self-efficacy (p = 0.03) than those with lower levels of cognitive dysfunction. Assessment of cognitive function may help inform patient education interventions for Latinx older adults to improve the self-efficacy and potentially reduce complications.

The influence of telemedicine in primary healthcare on diabetes mellitus control and treatment adherence in Riyadh region

Several studies have found that telemedicine has the potential to enhance the outcomes of patients with diabetes. This study aimed to determine the impact of telemedicine on the clinical outcomes of patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia. We conducted a cross-sectional study among T2DM patients in selected primary healthcare centers in Riyadh, Saudi Arabia, from March 1, 2023, to August 20, 2023. We looked at how telemedicine affected HbA1c control, adherence, the number of diabetic complications, and polypharmacy using adjusted multivariable logistic regression models. Among the 583 patients, 140 (24.05 %) received care via telemedicine, while 442 (75.95 %) received in-person care. Patients who utilized telemedicine had significantly better glycemic control than those who received in-person care only (AOR = 5.123, 95 % CI = 3.107–8.447). Telemedicine also showed positive effects on treatment adherence (AOR = 2.552, 95 % CI = 1.6284–4.2414). Telemedicine can effectively reduce diabetic complications (AOR = 0.277, 95 % CI = 0.134–0.571). Regarding polypharmacy, patients with telemedicine use were less likely to report polypharmacy (AOR = 0.559, 95 % CI = 0.361–0.866). Telemedicine is considered one of the factors that improve HbA1c management and might increase therapeutic adherence and reduce diabetic complications and polypharmacy.

IDF21-0542 Sharing “a.ma.dia” Experiences of how the Institution Have Faced COVID-19 Issues

Background: As part of low-income countries, Madagascar is actually at the 186th place as poorest country around the world.Regarding the diabetes context, the specialists are not sufficient. Then, it becomes mandatory for the diabetic person to go to the sanitarian structure which is the most accessible. These structures don’t have the adequate skills for a better follow-up and care of diabetes.A.MA.DIA is the Madagascar diabetes association composed by 47 000 diabetic members for a total of fourteen centers in twelve regions of the island.As a reference, the main activities of A.MA.DIA are: diabetes care and consultation especially for different complications (teeth and mouth, eyes, foot care), hospitalization, therapeutic education, sensitization, diabetes screening and his related complications.The main issues of diabetes in Madagascar during the covid period are the increased number of diabetes complications.A.MA.DIA was forced to receive complicated cases of diabetes and covid despite the few places we had at our Diabetes Clinic in Antananarivo: 21 beds of hospitalization.A.MA.DIA also faced many issues: lack of oxygen, lack of medicines, lack of individual protection equipment.Aim: This study aims to share A.MA.DIA experiences of how our institution have faced covid-19. The goal is to show the importance of having a Diabetes Clinic for a Diabetes association in case of extreme situation.Method: First, we have chosen to study the impacts of covid-19 in medical, social and economical aspects from 2020 to 2021.Second, we have realized some activities as solutions of the burdensFinally, we have observed the results for each aspect.Results:IMPACTS:The number of diabetes complications has increased:•55% of the total consultation get imbalance to their diabetes.•36% of the hospitalization represents chest diseases by virus•18% of the hospitalized diabetics died of covid-19 syndromDue the high cost of medicines and the lack of money:•55% of diabetics coming for consultation missed their treatment•53% of the hospitalized diabetics could not afford the cost of oxygen. The bottle of 10m3 costs 70$.Due to the lack of individual protection equipment:•The price of the equipment increased at about 800%Due to the restriction for moving from a region to another:•Diabetic people do not have access to specialized care and medicinesSOLUTIONS:•90% of public centers for primary care in Antananarivo have received glucometers under help of A.MA.DIA and the world diabetes Foundation project.•Oxygen project was conducted by buying new machines (extractor)•Individual protection was reinforced•The access to diabetes and hypertension medicines was facilitated•10% of diabetics were vaccinatedRESULTS:•The number of diagnosed persons has increased at about 10%•The number of consulted persons has increased at about 30%•After the vaccine period, the chest diseases by virus have decreased at about 50%Discussion: The impacts of covid-19 on diabetics have made diabetes as a priority for Malagasy leaders.The commitment of Diabetic association in the integrated management of diabetes is a major key for the development of the association as well as for the protection of diabetic people.

Dynamic diabetes solutions: physiologic insulin resensitization

Diabetes is a disease currently affecting over 30 million Americans and is a leading cause of amputation, blindness, and chronic kidney disease. Treatment of diabetes with medications and lifestyle modifications alone have not eliminated these complications, because in part they lack the ability to restore the periodic cycles and rest periods of insulin that exist in healthy physiology. Insulin is excreted in a cyclical and oscillatory pattern by the pancreas, that is critical to maintain adequate insulin sensitivity at the insulin receptor level. Administration of exogenous insulin bio identically matching this physiologic profile is more effective at controlling blood glucose level and reducing complications of diabetes than standard drug therapy and lifestyle modifications alone. This matching of physiological insulin helps reduce inflammatory cascades responsible for a number of diabetic complications. In this article, we will review how insulin is secreted and functions physiologically and highlight a dynamic insulin delivery modality that mimics normal secretion profiles. This biomimicry reduces insulin exposure, which appears to reduce the progression to or worsening of insulin resistance. We will review how administration of insulin in this manner has been associated with reduction of diabetic complications.

Chronic Complication Profiles of T2DM in Endocrine Outpatient Clinic, Dr Soetomo General Hospital, Surabaya

Background: Nowdays, the number of diabetic complications is still increasing each year. There are some factors that affect the early appearance of diabetic complications. By knowing these factors, doctors and patients will pay attention and prevent the early appearance. Therefore, diabetic patients will reduce the risk of death. Objectives: The study aimed todeterminethemost frequently occuringprofileofdiabeticmacroangiopathyandmicroangiopathy in peoplewithtype 2 diabetes mellitus.Method: Descriptive qualitativewith a cross-sectionaldesign. Results: Patients who are most commonly diagnosed type 2 diabetes mellituswithdiabeticcomplicationsare in theagegroup 46 – 55 year (32%), male (50.6%), highschool educated (59.9%), privateemployees (36.6%), averageof HbA1c level is 8.68%, controlled HbA1c (54.5%),and durationoftype 2 diabetes mellituswithno data on duration (56.9%). The showncomplications are singlemicroangiopathy (30.6%), singlemacroangiopathy (22%), microangiopathyandmacroangiopathycombination (9.4%), multiplemicroangiopathies (2.7%) andmultiplemacroangiopathies (2.7%). The microangiopathycomplications are retinopathy (22.6%), nephropathy (22.1%), andneuropathicdiabetic (10.3%) whilethe mostmacroangiopathycomplications are coronaryheartdisease (19.2%), peripheralcirculatorycomplication (14.8%), andstroke (11%).

A comparison, for older people with diabetes, of health and health care utilisation in two different health systems on the island of Ireland

BackgroundThere are social and economic differences between Northern Ireland (NI) and the Republic of Ireland (ROI). There are also differences in the health care systems in the two jurisdictions. The aims of this study are to compare health (prevalence of diabetes and related complications) and health care utilisation (general practitioner, outpatient or accident and emergency utilisation) among older people with diabetes in the NI and ROI.MethodsLarge scale comparable surveys of people over 50 years of age in Northern Ireland (NICOLA, wave 1) and the Republic of Ireland (TILDA, wave 1) are used to compare people with diabetes (type I and type II) in the two jurisdictions. The combined data set comprises 1536 people with diabetes. A coarsened exact matching approach is used to compare health care utilisation among people with diabetes in NI and ROI with equivalent demographic, lifestyle and illness characteristics (age, gender, education, smoking status and self-related health, number of other chronic diseases and number of diabetic complications).ResultsThe overall prevalence of diabetes in the 50 to 84 years old age group is 3.4 percentage points higher in NI (11.1% in NI, 7.7% ROI, p-value < 0.01). The diabetic population in NI appear sicker – with more diabetic complications and more chronic illnesses. Comparing people with diabetes in the two jurisdictions with similar levels of illness we find that there are no statistically significant differences in GP, outpatient or A&E utilisation.ConclusionDespite the proximity of NI and ROI there are substantial differences in the prevalence of diabetes and its related complications. Despite differences in the health services in the two jurisdictions the differences in health care utilisation for an equivalent cohort are small.

Predicting the amputation risk for patients with diabetic foot ulceration \u2013 a Bayesian decision support tool

BackgroundDiabetes mellitus is a major global health issue with a growing prevalence. In this context, the number of diabetic complications is also on the rise, such as diabetic foot ulcers (DFU), which are closely linked to the risk of lower extremity amputation (LEA). Statistical prediction tools may support clinicians to initiate early tertiary LEA prevention for DFU patients. Thus, we designed Bayesian prediction models, as they produce transparent decision rules, quantify uncertainty intuitively and acknowledge prior available scientific knowledge.MethodA logistic regression using observational collected according to the standardised PEDIS classification was utilised to compute the six-month amputation risk of DFU patients for two types of LEA: 1.) any-amputation and 2.) major-amputation. Being able to incorporate information which is available before the analysis, the Bayesian models were fitted following a twofold strategy. First, the designed prediction models waive the available information and, second, we incorporated the a priori available scientific knowledge into our models. Then, we evaluated each model with respect to the effect of the predictors and validity of the models. Next, we compared the performance of both models with respect to the incorporation of prior knowledge.ResultsThis study included 237 patients. The mean age was 65.9 (SD 12.3), and 83.5% were male. Concerning the outcome, 31.6% underwent any- and 12.2% underwent a major-amputation procedure. The risk factors of perfusion, ulcer extent and depth revealed an impact on the outcomes, whereas the infection status and sensation did not. The major-amputation model using prior information outperformed the uninformed counterpart (AUC 0.765 vs AUC 0.790, Cohen’s d 2.21). In contrast, the models predicting any-amputation performed similarly (0.793 vs 0.790, Cohen’s d 0.22).ConclusionsBoth of the Bayesian amputation risk models showed acceptable prognostic values, and the major-amputation model benefitted from incorporating a priori information from a previous study. Thus, PEDIS serves as a valid foundation for a clinical decision support tool for the prediction of the amputation risk in DFU patients. Furthermore, we demonstrated the use of the available prior scientific information within a Bayesian framework to establish chains of knowledge.

770-P: Association between Diet Quality and Glycemic Control in African Americans with Type 2 Diabetes

Literature is lacking on the impact of diet quality on glycemic control in those with type 2 diabetes (T2DM), especially African Americans with T2DM. 211 African American adults with T2DM and A1c ≥ 7.0% were randomized into intervention (26 sessions) and control (2 sessions) for an 18-month randomized community-based control trial, Lifestyle Improvement Through Food and Exercise (LIFE), assessing the impact of culturally-relevant lifestyle education on glycemic control. Participants lived in low-income Chicago-area neighborhoods and had regular medical care. Diet quality was assessed via 24-hour recall and translated into the Alternative Healthy Eating Index 2010 (AHEI-2010). AHEI-2010 total scores (0-110: higher score=healthier pattern) for intervention (n=95) and control (n=92) respectively were baseline: 47.4 ± 1.1 vs. 51.2 ± 1.1, 12 months: 51.4 ± 1.0 vs. 50.5 ± 1.1, 18 months: 50.3 ± 1.2 vs. 51.6 ± 1.2. Using repeated measures ANOVA, the AHEI-2010 18 month increase from baseline was significantly higher in the intervention group, df (2, 370), F (3.18), p=0.043. A1c% decline over 18 months (intervention: 9.1 ± 0.2 to 8.5 ± 0.2; control: 8.9 ± 0.2 to 8.6 ± 0.2, p&amp;lt;0.001) was significant but there was no difference between groups. Absolute AHEI-2010 scores by hierarchical multilinear regression, regardless of study group, accounted for improved glycemic control by 1.6% at 12 months and by 2.3% at 18 months after adjusting for age, insulin use, and number of diabetes complications at baseline. While the impact of higher diet quality on glycemic control was small, overall dietary change in this study was also small. With 41.2% of participants living below the poverty line, limited access to healthy foods might have hampered greater dietary change. Disclosure B. Tahsin: None. K.S. Keim: None. L. Fogelfeld: None. L. Fogg: None. E. Lynch: None. Funding National Institutes of Health

219-LB: Different Associations between Serum Urate and Diabetic Complications in Middle-Aged and Elderly Patients

Aim: The objective of the study was to investigate whether higher serum urate (SUA) level has consistent association with cardiovascular disease (CVD), diabetic kidney disease (DKD) and diabetic retinopathy (DR) in Chinese adults with type 2 diabetes mellitus (T2DM). Methods: 4,767 diabetic participants were enrolled from seven communities in Huangpu and Pudong District, Shanghai, China in 2018. Participants underwent several checkups, which included the measurement of anthropometric parameters, blood pressure, glucose, lipid profiles, SUA and urine albumin/creatinine ratio (ACR). Results: Compared with the first SUA group, the third group increased the prevalence of CVD by 27% (OR 1.27; 95% CI 1.04, 1.55) (P for trend &amp;lt;0.05) and increased the prevalence of DKD by 88% (OR 1.88; 95% CI 1.48, 2.40) for KDOQI definition. Compared with first group, OR (95% CI) of DR ranging from non-retinopathy (NDR) to proliferative diabetic retinopathy (PDR) in ordinal logistic regression associated with SUA level was 0.81 (0.59, 1.10) for the third group, (P for trend=0.086) and OR (95% CI) of the number of diabetic complications ranging from 0 to 2 in ordinal logistic regression associated with SUA level was 1.75 (1.44, 2.12) for the third group (P for trend&amp;lt; 0.01). These associations were all full adjusted. Conclusions: Higher SUA level was associated with increased odds of CVD, DKD and variety of the diabetic complications, not DR, in middle-aged and elderly diabetic Chinese adults, which means lowering SUA level may be critical for prevention and intervention of diabetic complications. Disclosure H. Wan: None. Y. Wang: None. Y. Chen: None. C. Wang: None. W. Zhang: None. F. Xia: None. N. Wang: None. Y. Lu: None.

Skin autofluorescence is associated with vascular complications in patients with type 2 diabetes

AimsTissue accumulatedadvanced glycation end products (AGEs) can be evaluated non-invasively by an autofluorescence reader as skin autofluorescence (skin AF)·The present study investigated whether skin AF is associated with diabetic micro- and macroangiopathies in Japanese patients with type 2 diabetes mellitus (T2DM). MethodsSkin AF was measured in 193 enrolled Japanese patients with T2DM and 24 enrolled healthy non-diabetic subjects by using the AGE reader®. Diabetic micro- and macroangiopathies were evaluated in the T2DM patients. ResultsSkin AF was significantly increased in patients with T2DM than in age- and sex-matched non-diabetic controls (2.35 ± 0.51 [mean ± SD] and 1.91 ± 0.29, respectively, p = 0.001). In subjects with T2DM, skin AF was associated with age, pack-years of smoking, and eGFR (estimated glomerular filtration rate) independently. Skin AF was significantly increased in patients with diabetic retinopathy, neuropathy, nephropathy, and macroangiopathy than in those without them, and significantly associated with the number of diabetic complications. Moreover, skin AF was an independent predictor for diabetic retinopathy, neuropathy, and nephropathy but not macroangiopathy, after adjusting for major traditional risk factors. ConclusionsSkin AF is an independent predictor for diabetic retinopathy, neuropathy and nephropathy in Japanese patients with T2DM.

Oxidative stress in patients with type 2 diabetes mellitus treated with metformin

*** Oxidative stress in patients with type 2 diabetes mellitus treated with metformin ***AIMS: To evaluate oxidative stress parameters in patients with type 2 diabetes mellitus treated with metformin, relating these values to its side effects, plasma levels, glycemic control, diabetic complications, lipid profile, and the influence of pharmacotherapeutic follow-up.METHODS: Patients with type 2 diabetes mellitus, on metformin and in pharmacotherapeutic follow-up for four months, were evaluated. The pharmacotherapeutic follow-up consisted in providing information and answering patients’ questions about medication and disease. In addition, administration times, dosages, and presence or absence of side effects related to the use of metformin were verified. Glycemic and lipid profile, oxidative stress (superoxide dismutase and malondialdehyde) and plasma metformin were evaluated. Pearson’s correlation and Spearman’s correlation were performed to evaluate the relationship between the variables at the beginning of the study. The independent t-test and Mann-Whitney U test were used to assess the difference between the groups with and without diabetic complications. The range of values between the beginning and end of the study was evaluated using Student’s t-test or Wilcoxon U test. The significance level was set at 5%.RESULTS: The initial sample consisted of 49 patients aged 59±9 years with a body mass index of 29.8±5.1 kg/m2, who have had diabetes for a median time of 36 months (interquartile range of 1-240) and have been on metformin for a median time of 36 months (interquartile range of 1-180). Twenty-five patients left the study between the second and fourth meetings. Malondialdehyde levels differed between before and after pharmacotherapeutic follow-up, being positively correlated with blood glucose, glycohemoglobin, and triglyceride level, and negatively correlated with metformin and superoxide dismutase. Blood glucose, glycohemoglobin, and malondialdehyde levels increased, whereas metformin levels decreased in the group with diabetic complications, and there was a correlation between malondialdehyde and the number of diabetic complications per patient.CONCLUSIONS: In this sample of patients with type 2 diabetes mellitus treated with metformin, oxidative stress was more pronounced in those with poor glycemic control and diabetic complications.

Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1c in a prospective study

AimsTo prospectively identify the course of severe fatigue, its predictors and the relationship with HbA1c in patients with type 1 diabetes. Methods214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA1c was retrieved from medical records. After 43months, fatigue severity and HbA1c were reassessed in 194 patients. A logistic regression analysis was used to determine predictors of severe fatigue at follow-up with various cognitive-behavioral and clinical factors as potential predictors. The relationship between fatigue and HbA1c was investigated in a sub-analysis by differentiating between patients with suboptimal glucose control [HbA1c>7% (53mmol/mol)] and optimal glucose control [HbA1c⩽7% (53mmol/mol)]. ResultsThe prevalence of severe fatigue was 40% at baseline and 42% at follow-up. In three out of four severely fatigued patients at baseline (76%), severe fatigue persisted over time. More depressive symptoms, more pain, sleep disturbances, lower self-efficacy concerning fatigue, less confidence in diabetes self-care, more fatigue severity at baseline and more diabetes complications predicted severe fatigue at follow-up. Over time, HbA1c at baseline was positively associated with fatigue severity at follow-up in both groups (suboptimal glucose control: r=.18, p<.05; optimal glucose control: r=.09, p<.05). ConclusionsAbout three quarters of patients with type 1 diabetes suffer from persistent fatigue. Aside from the number of diabetes complications, no clinical factors explained the persistence of fatigue. HbA1c and fatigue were weakly associated in a sub-analysis. Since the strongest predictors of severe fatigue were cognitive-behavioral factors, behavioral interventions might be effective in decreasing fatigue.

Quality of Life in Portuguese Patients with Diabetic Foot Ulcer Before and After an Amputation Surgery

Diabetic foot ulcer (DFU) including amputation surgery has serious consequences for patients, the family and healthcare services. DFU affects not only the physical health-related quality of life (HRQoL) of patients but also their mental well-being. The aims of this study were to find the predictors of HRQoL after surgery, to analyse differences in HRQoL, before and after surgery, and to explorethe moderating role of a first versus previous amputation(s) in the relationship between physical and mental HRQoL, before and after surgery, in patients with DFU. A longitudinal study comprising 108 Portuguese patients was conducted during the period of hospitalization before the surgery and at a follow-up consultation. Participants completed a socio-demographic questionnaire and the SF-36 to assess HRQoL. Physical and mental HRQoL before surgery predicted HRQoL after surgery, as well as the number of diabetes complications and having received a re-amputation. Physical HRQoL decreased after surgery, but there were no differences on mental HRQoL. Having a previous amputation was a moderator between physical and mental HRQoL before and after surgery. The results help to identify the most vulnerable patients at risk of having lower HRQoL after surgery, allowing interventions to be tailored to patients' needs in order to promote their quality of life.

Evaluating the sensitivity of EQ-5D in a sample of patients with type 2 diabetes mellitus in two tertiary health care facilities in Nigeria.

BackgroundThe EQ-5D instrument is arguably the most well-known and commonly used generic measure of health status internationally. Although the instrument has been employed in outcomes studies of diabetes mellitus in many countries, it has not yet been used in Nigeria.ObjectiveThis study was carried out to assess the sensitivity of the EQ-5D instrument in a sample of Nigerian patients with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study was conducted using the EQ-5D instrument to assess the self-reported quality of life of patients with T2DM attending two tertiary healthcare facilities in south eastern Nigeria consenting patients completed the questionnaire while waiting to see a doctor. A priori hypotheses were examined using multiple regression analysis to model the relationship between the dependent variables (EQ VAS and EQ-5D Index) and hypothesized independent variables.ResultsA total of 226 patients with T2DM participated in the study. The average age of participants was 57 years (standard deviation 10 years) and 61.1 % were male. The EQ VAS score and EQ-5D index averaged 66.19 (standard deviation 15.42) and 0.78 (standard deviation 0.21) respectively. Number of diabetic complications, number of co-morbidities, patient’s age and being educated predicted EQ VAS score by −6.76, −6.15, −0.22, and 4.51 respectively. Also, number of diabetic complications, number of co-morbidities, patient’s age and being educated predicted EQ-5D index by −0.12, −0.07, −0.003, and 0.06 respectively..ConclusionOur findings indicate that the EQ-5D could adequately capture the burden of type 2 diabetes and related complications among Nigerian patients.

Depression in romanian patients with type 2 diabetes: prevalence and risk factors.

Background and aimsCo-existing major depression was found to have a negative impact on the diabetes outcome and the quality of life. The aim of the present study was to assess the prevalence of depressive symptoms in Romanian diabetes patients and to identify the risk factors associated with depression.MethodsA total of 144 type 2 diabetes patients were included in the study. Five models of presumed predictors were used to assess the risk factors for depressive symptoms, using hierarchical regression analysis. Together with demographics, disease, lifestyle predictors, previous depressive symptoms and diabetes distress were taken into account.ResultsIn our sample the prevalence of depression was 12.6%. Main risk factors for depressive symptoms were previous depressive symptoms which were associated with depression in both Model 4 (β=0.297, p=0.013) and Model 5 (β=0.239, p=0.017) and diabetes distress in Model 5 (β=0.540, p≤0.001). Employment (β =−0.276, p=0.029) and increased number of diabetes complications (β=0.236, p=0.017) became significant when diabetes distress was added to the analysis.ConclusionsThe overall prevalence of depressive symptoms was found to be in range with the prevalence identified in the literature. Previous depression and diabetes distress were both independently associated with depression, confirming the bidirectional relationship between depression and diabetes distress. Due to the consequences for daily living, screening for diabetes distress and depression should be done in primary care units both by physicians and trained nurses.

Insulin-Like Growth Factor 1, Glycation and Bone Fragility: Implications for Fracture Resistance of Bone

Despite our extensive knowledge of insulin-like growth factor 1 (IGF1) action on the growing skeleton, its role in skeletal homeostasis during aging and age-related development of certain diseases is still unclear. Advanced glycation end products (AGEs) derived from glucose are implicated in osteoporosis and a number of diabetic complications. We hypothesized that because in humans and rodents IGF1 stimulates uptake of glucose (a glycation substrate) from the bloodstream in a dose-dependent manner, the decline of IGF1 could be associated with the accumulation of glycation products and the decreasing resistance of bone to fracture. To test the aforementioned hypotheses, we used human tibial posterior cortex bone samples to perform biochemical (measurement of IGF1, fluorescent AGEs and pentosidine (PEN) contents) and mechanical tests (crack initiation and propagation using compact tension specimens). Our results for the first time show a significant, age-independent association between the levels of IGF1 and AGEs. Furthermore, AGEs (fAGEs, PEN) predict propensity of bone to fracture (initiation and propagation) independently of age in human cortical bone. Based on these results we propose a model of IGF1-based regulation of bone fracture. Because IGF1 level increases postnatally up to the juvenile developmental phase and decreases thereafter with aging, we propose that IGF1 may play a protective role in young skeleton and its age-related decline leads to bone fragility and an increased fracture risk. Our results may also have important implications for current understanding of osteoporosis- and diabetes-related bone fragility as well as in the development of new diagnostic tools to screen for fragile bones.

Leukocyte telomere length is associated with complications of Type 2 diabetes mellitus

The key goal of diabetes management is to prevent complications. While the patho-physiological mechanisms responsible for diabetes complications have been extensively studied, at present it is impossible to predict which patient with diabetes could develop complications. In recent years, the role of leukocyte telomere length in the pathogenesis of cardiovascular disease and Type 2 diabetes has been investigated. However, studies aiming to investigate the role of telomeres in the development and progression of Type 2 diabetes, as well as diabetic complications, are still lacking. As a consequence, this study aimed to verify whether leukocyte telomere length is associated with the presence and the number of diabetic complications in a sample of patients with Type 2 diabetes. This is a cross-sectional study. Nine hundred and one subjects were enrolled, including 501 patients with Type 2 diabetes, of whom 284 had at least one complication and 217 were without complications, and 400 control subjects. Leukocyte telomere length was measured by quantitative real-time PCR. Patients with diabetes complications had significantly shorter leukocyte telomere length than both patients without diabetes complications and healthy control subjects. Moreover, among patients with diabetes complications, leukocyte telomere length became significantly and gradually shorter with the increasing number of diabetes complications. The magnitude of the effect of the decrease of the abundance of telomeric template vs. a single-copy gene length (T/S ratio) on complications is described by the estimated odds ratio OR=5.44 (95%CI 3.52-8.42). The results of the study support the hypothesis that telomere attrition may be a marker associated with the presence and the number of diabetic complications.

Levels of Acculturation and Effect on Glycemic Control in Mexicans and Mexican Americans with Type 2 Diabetes

Background: Acculturation of Mexican Americans toward the predominant American culture has been shown to influence health outcomes. Little is known about the role of acculturation in diabetes control. Objective: To measure the association between acculturation and diabetes control in Mexicans and Mexican Americans with type 2 diabetes mellitus (T2DM). Design: Cross-sectional survey and chart review. Setting: Ambulatory family medicine clinics. Patients: Sixty-six Mexican and Mexican American adults with T2DM for ≥ 1 year. Instrument and Outcomes: A survey tool was developed that included the General Acculturation Index developed by Balcazar et al to measure acculturation. Basic demographics, psychosocial factors, patient satisfaction, and patients' most recent hemoglobin A1c (HbA1c) levels were also obtained. Results: There was no significant correlation between acculturation score and HbA1c levels. On binary logistic regression, HbA1c levels were associated with patient satisfaction in having their questions answered (odds ratio [OR], 0.44; P < 0.05), interference of diabetes with daily life (OR, 1.4; P < 0.05), male gender (OR, 3.93; P < 0.01), and number of diabetes complications (OR, 1.81; P < 0.05). In the multivariate linear regression model, age (beta, —0.348; P < 0.05) and frequency of physician visits (beta, —0.403; P < 0.05) were the only variables significantly associated with glycemic control. Variables included in the model that were not associated with glycemic control include family history of diabetes and confidence in diabetes treatment efficacy. Conclusions: Acculturation was not associated with glycemic control in this population. Family physicians should not assume that acculturation difficulties explain poor glycemic control in their Mexican American patients with T2DM.

Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study

Objective To test whether depression is associated with an increased risk of incident diabetic foot ulcers. Methods The Pathways Epidemiologic Study is a population-based prospective cohort study of 4839 patients with diabetes in 2000-2007. The present analysis included 3474 adults with type 2 diabetes and no prior diabetic foot ulcers or amputations. Mean follow-up was 4.1 years. Major and minor depression assessed by the Patient Health Questionnaire-9 were the exposures of interest. The outcome of interest was incident diabetic foot ulcers. We computed the hazard ratio and 95% confidence interval (CI) for incident diabetic foot ulcers, comparing patients with major and minor depression with those without depression and adjusting for sociodemographic characteristics, medical comorbidity, glycosylated hemoglobin, diabetes duration, insulin use, number of diabetes complications, body mass index, smoking status, and foot self-care. Sensitivity analyses also adjusted for peripheral neuropathy and peripheral arterial disease as defined by diagnosis codes. Results Compared with patients without depression, patients with major depression by Patient Health Questionnaire-9 had a 2-fold increase in the risk of incident diabetic foot ulcers (adjusted hazard ratio 2.00; 95% CI, 1.24-3.25). There was no statistically significant association between minor depression by Patient Health Questionnaire-9 and incident diabetic foot ulcers (adjusted hazard ratio 1.37; 95% CI, 0.77-2.44). Conclusion Major depression by Patient Health Questionnaire-9 is associated with a 2-fold higher risk of incident diabetic foot ulcers. Future studies of this association should include better measures of peripheral neuropathy and peripheral arterial disease, which are possible confounders or mediators.

Cytotoxic role of methylglyoxal in rat retinal pericytes: Involvement of a nuclear factor-kappaB and inducible nitric oxide synthase pathway

Methylglyoxal (MGO), a cytotoxic metabolite, is produced from glycolysis. Elevated levels of MGO are observed in a number of diabetic complications, including retinopathy, nephropathy and cardiomyopathy. Loss of retinal pericyte, a hallmark of early diabetic retinal changes, leads to the development of formation of microaneurysms, retinal hemorrhages and neovasculization. Herein, we evaluated the cytotoxic role of MGO in retinal pericytes and further investigated the signaling pathway leading to cell death. Rat primary retinal pericytes were exposed to 400 μM MGO for 6 h. Retinal vessels were prepared from intravitreally MGO-injected rat eyes. We demonstrated apoptosis, nuclear factor-kappaB (NF-κB) activation and inducible nitric oxide synthase (iNOS) induction in cultured pericytes treated with MGO and MGO-injected retinal vessels. In MGO-treated pericytes, TUNEL-positive nuclei were markedly increased, and NF-κB was translocalized into the nuclei of pericytes, which paralleled the expression of iNOS. The treatment of pyrrolidine dithiocarbamate (an NF-κB inhibitor) or l-N6-(1-iminoethyl)-lysine (an iNOS inhibitor) prevented apoptosis of MGO-treated pericytes. In addition, in intravitreally MGO-injected rat eyes, TUNEL and caspase-3-positive pericytes were significantly increased, and activated NF-κB and iNOS were highly expressed. These results suggest that the increased expression of NF-κB and iNOS caused by MGO is involved in rat retinal pericyte apoptosis.