People With Diabetes Research Articles

Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication.

The "diabetic lung" has been identified as a possible target organ in diabetes, with abnormalities in ventilation control, bronchomotor tone, lung volume, pulmonary diffusing capacity, and neuroadrenergic bronchial innervation. This review summarizes studies related to diabetic pneumopathy, pathophysiology and a number of pulmonary disorders including type 1 and type 2 diabetes. Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL), Scopus, Elsevier, ScienceDirect, and Google Scholar using standard keywords "diabetes," "diabetes Pneumopathy," "Pathophysiology," "Lung diseases," "lung infection" for review articles published between 1978 to 2023 very few previous review articles based their focus on diabetic pneumopathy and its pathophysiology. Globally, the incidence of diabetes mellitus has been rising. It is a chronic, progressive metabolic disease. The "diabetic lung" may serve as a model of accelerated ageing since diabetics' rate of respiratory function deterioration is two to three-times higher than that of normal, non-smoking people. Diabetes-induced pulmonary dysfunction has not gained the attention it deserves due to a lack of proven causality and changes in cellular properties. The mechanism underlying a particular lung illness can still only be partially activated by diabetes but there is evidence that hyperglycemia is linked to pulmonary fibrosis in diabetic people.

The Plasma Levels of Protein Adiponectin (AdipoQ) and Meteorin-Like (Metrnl) in Newly Diagnosed Type 2 Diabetes Mellitus.

This study aimed to measure the concentrations of the Adiponectin and Meteorin - Like (Metrnl) in newly diagnosed type 2 diabetes patients. A comparative cross-sectional study contained two groups: Group 1 (86 newly diagnosed diabetes mellitus type 2 patients) and group 2 (71 healthy persons). The plasma concentrations of Adiponectin and Metrnl were measured by Enzyme Link Immunosorbent Assay (ELISA). The plasma level of Adiponectin of the newly diagnosed diabetes mellitus type 2 group and the healthy group were 1219.82 ng/mL (1132.43-2772.50) and 1187.25 ng/mL (1160.66-3807.50) respectively. The plasma level of Metrnl of two groups were 757.60 pg/mL (564.15-994.00) and 697.60 pg/mL (538.50-986.10) respectively. There were no significant difference between two groups. Metrnl had no correlation with glucose, HbA1c, lipid profile, BMI. Adiponectin had correlation with Metrnl and HDL-cholesterol. Adiponectin had no correlation to glucose, HbA1c, LDL-cholesterol, total cholesterol, triglyceride, BMI. People with the lower Adiponectin concentration had the higher risk of diabetes (OR=6.52; 95% CI: 2.43 -17.55). Adiponectin and Metrnl were not significantly different in newly diagnosed type 2 diabetes and healthy people. The lower concentration of Adiponectin might increase the risk of type 2 diabetes.

Cooking Recipe as a Determinant of Glycemic Index Variation in Commercial and Natural Wheat Flour

An in vivo study was conducted with various cooking recipes to select suitable wheat flour in view point of glycemic index (GI) value from the commercially available whole and plain wheat flour by comparing with natural wheat flour. We assessed the glycemic responses of 10 healthy individuals with reference food (50 g glucose) and cooked wheat roti, equivalent to 50 g carbohydrate, in hot (100°C) and normal water (25°C) recipes. To prevent residual effects, the individuals were kept overnight fasting throughout the study period. Capillary glucose levels at 0, 15, 30, 45, 60, 90 and 120 minutes after consuming the meals were assessed and used to determine the Incremental Area Under Curve (IAUC). Results showed a significant decrease (p<0.001 and p<0.005) in glucose levels of the test foods compared to reference food. The measured GI values of the samples processed with normal water were categorized as low (plain wheat flour, 52), medium (56 for whole wheat flour) and high (natural flour, 73). But all the samples were in low GI class when processed with hot water; GI was 43, 47 and 44 for whole wheat flour, plain wheat flour, and natural wheat flour, respectively. The temperature differences in the recipes are believed to be the primary cause of variation in GI. Hot water treatment provided low GI in the recipes that may be good for both healthy and diabetic people. J Bangladesh Agril Univ 22(2): 257-266, 2024

Hypoglycemia in Geriatric Patients with Diabetes: A Review

The prevalence of diabetes tends to be high, 42% of geriatric patients admitted have a diabetes diagnosis, and 33% of these patients experience hypoglycemia. Hospitalization is necessary for diabetic elderly individuals because their blood glucose levels make them more vulnerable to other complications. The research aims to examine the frequency of hypoglycemia in older individuals, including those with diabetes, which may be caused by the administration of antidiabetic that lower blood sugar levels. This study is a narrative review of publication that discussed hypoglycemic incidence among geriatrics in PubMed and Google Scholars databases. The type of study included the original article, not the abstract or thesis document from 2016–2021. Sulfonylurea and insulin groups are the most frequently prescribed, and they cause hypoglycemia in diabetic older people, with the rate of hypoglycemic incidence of more than 50%. Other groups of antidiabetes that geriatrics received were alpha-glucosidase inhibitors, dipeptyl peptidase-4, glucagon-like peptide-1, and biguanide, which has been prescribed as monotherapy and combined therapy. The prevalence of hypoglycemic in geriatrics is still present, along with their diabetes medication. For geriatric individuals with DM, routine blood glucose monitoring is advised to prevent diabetic complications.

A Cross-sectional Study on Dietary Diversity and Diet Cost in Type 2 Diabetic Population

Background: Globally, Type 2 Diabetes Mellitus is considered a major public health disease, influenced by nutrition and lifestyle patterns. The majority of people worldwide consume nutritionally poor, cereal-based diets. Therefore, assessing dietary diversity, macronutrient intake, and food costs is essential for better diabetes management. Objective: To compare the dietary diversity of the Type 2 diabetic population with estimated dietary costs and other relevant parameters. Methodology: A descriptive cross-sectional study was conducted among 150 adult Type 2 adult diabetic population. A pre-structured questionnaire was used to elicit information on dietary diversity using the Individual Dietary Diversity Score (IDDS), Food Variety Score (FVS) and diet cost estimation using semi-quantitative food frequency questionnaire. FVS was associated with nutrition status, Glycated Haemoglobin (HbA1c), macronutrient consumption, socio economic status and the average daily diet cost of the study population. Results: The majority of the population were overweight. 50% of the population had low dietary diversity and had uncontrolled diabetes with HbA1c of 7-8%. Dietary diversity influenced the nutritional status of diabetic people. There was no difference between socioeconomic and living status, HbA1c and FVS. Females had higher per day cost when compared to males. Mean per day increased with the increase in the macronutrient consumption. Conclusion: Diabetic patients often have low dietary diversity, which affects their nutritional status. Therefore, dietary diversity, along with diet cost, is integral to the effective nutritional care of the diabetic population.

Subacute behavior of glucose and blood pressure of type 1 diabetic people after strength exercise session: Study protocol

Background: Type 1 Diabetes Mellitus (DM1) is characterized as a severe insulin deficiency resulting from the destruction of beta cells in the pancreas, associated with autoimmunity. The clinical picture of a patient with DM1 includes symptoms such as abnormal thirst, dry mouth, sudden weight loss, frequent urination, lack of energy, tiredness, constant hunger and blurred vision. Systemic arterial hypertension (SAH) is characterized by high levels of pressure in the arteries, being associated with risk factors for coronary artery disease; cerebrovascular accident (CVA); myocardial infarction; heart failure and kidney failure. Regular physical activity in these patients is associated with a reduced risk of future cardiovascular disease, better long-term glycemic control, better cardiovascular fitness, better quality of life, reduced daily insulin requirements and better weight control. Furthermore, it plays an important role in the primary and secondary prevention of diabetes cardiovascular disease, improving general health and well-being. Objective: The present study aims to evaluate the effects of strength training on glycemic parameters after an exercise session, in adult type 1 diabetic individuals, through a randomized controlled clinical trial. Methodology: The sample will be made up of 30 participants with DM1, made up of men and women based on the inclusion/exclusion criteria. Discussion: Practicing physical activity reduces the need for hypoglycemic drugs, also improves metabolic control and helps obese patients lose weight, reducing the risk of cardiovascular diseases and improving the quality of life of these patients. The practice of strength and aerobic training as a non-drug treatment is systematically found in the literature as a fundamental strategy for reducing systemic arterial hypertension and maintaining the cardiovascular system. Both resistance exercise and Pilates are effective for individuals with type 1 diabetes, improving metabolic and clinical control, especially when combined with adequate nutrition and amino acid supplementation. Physical activities reduce the need for hypoglycemic medications, help with weight loss and reduce the risk of cardiovascular diseases. Regular exercise, especially intermittent, significantly reduces the risk of acute hypoglycemia. Furthermore, it improves HDL and LDL levels, essential for reducing cardiovascular risks. Strength and aerobic training are essential for controlling high blood pressure and improving quality of life, with three weekly sessions being recommended for satisfactory results.

The feasibility of a social media-based foot self-management education and support program for adults with diabetes: A partially randomized preference trial

AimTo assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention. MethodsA partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention. ResultsThe participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence (p = 0.001, ηp2 = 0.35), preventive foot self-care practice (p = 0.002, ηp2 = 0.33), and physical health status (p < 0.02, ηp2 = 0.23). ConclusionDFCG is feasible and could effectively improve diabetes foot care-related outcomes. InnovationSocial media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities. Trial registrationClinicalTrials.gov, Identifier: NCT04395521

Perspectives and Behaviors of People with Diabetes toward Time in Range and Glucose Control in Diabetes Management: An Online Survey.

This study assessed experiences, attitudes, and behaviors of people with diabetes (PwD) regarding diabetes self-management and glucose control, and their level of awareness, knowledge, and attitudes toward time in range (TIR). This quantitative survey was conducted using an online questionnaire across seven countries. Respondents were PwD classified into three subgroups: type 1 (T1), type 2 insulin (T2 insulin), and type 2 not on insulin (T2 N/insulin). Respondents included 621 people in the T1, 780 people in the T2 insulin, and 735 people in the T2 N/insulin subgroups. Awareness of TIR was low, particularly in the T2 N/insulin subgroup (T1 53%, T2 insulin 29%, T2 N/insulin 9%). Despite a lower current use of continuous glucose monitoring (CGM) among the T2 insulin and T2 N/insulin participants (38% and 9%, respectively), versus T1 participants (64%), most (> 70%) were positive toward utilizing new tools and measures to self-manage blood glucose. Recommendations from their healthcare professionals (HCPs) were cited as a strong motivator to try new measures for analyzing glucose levels. The main barriers cited were limited access to CGM and lack of understanding of TIR benefits. Cost was the main reason given by ≥ 40% of respondents for stopping CGM use. There is an unmet need in diabetes management, and TIR and CGM offer a potential solution. PwD are motivated to manage their blood glucose levels and are positive toward utilizing new tools and measures to achieve this goal. HCPs play a pivotal role in informing and guiding PwD on new measures for analyzing glucose.

THE IMPACT OF BILATERAL VISION STATUS ON VISION-RELATED QUALITY OF LIFE IN PEOPLE WITH DIABETES MELLITUS.

To assess the impact of bilateral vision status on vision-related quality of life (VR-QOL) in patients with Type 2 diabetes in a Chinese cohort. Patients with presenting visual acuity (PVA) and VR-QOL data from the Fushun Diabetic Retinopathy Cohort Study were included. Vision-related quality of life was assessed using the National Eye Institute Visual Function Questionnaire-25. Monocular PVA (Snellen) was categorized into three levels for both the better-seeing eye and worse-seeing eye: 1) high PVA (H, > 6/18); 2) moderate PVA (M, 6/18-6/60); and 3) low PVA (L, < 6/60). Based on the monocular PVAs, six categories of bilateral vision status were defined (H-H, H-M, H-L, M-M, M-L, and L-L). The parameters of VR-QOL were analyzed between the groups. A total of 1,717 patients were enrolled. For better-seeing eyes in the same PVA level, the Visual Function Questionnaire-25 composite score decreased significantly with declining PVA in the worse-seeing eye (H-M vs. H-L: 80.5 ± 17.9 vs. 73.6 ± 22.5, P = 0.01; M-M vs. M-L: 78.7 ± 19.6 vs. 69.1 ± 26.4, P = 0.01). Conversely, for worse-seeing eyes in the same PVA level, there was no significant difference in the Visual Function Questionnaire-25 composite score as PVA changed in the better-seeing eye (H-M vs. M-M, 80.5 ± 17.9 vs. 78.7 ± 19.6, P = 0.30; H-L vs. M-L: 73.6 ± 22.5 vs. 69.1 ± 26.4, P = 0.25). The PVA of the worse-seeing eye in bilateral vision has a greater impact on VR-QOL in diabetic patients. Priority treatment may be considered for the worse-seeing eye for diabetic patients with different bilateral vision statuses, to better improve VR-QOL.

Factors associated with the use of dental services in diabetic people

The use of dental services prevents oral diseases where its prevalence is associated with chronic diseases such as diabetes mellitus (DM) that also has increased risks with age. Therefore, this observational, analytical and crosssectional study was conducted among 3,882 people. Data used for analysis in this research was collected from the Demographic and Family Health Survey of Peru (ENDES) from 2019 to 2021. Results from poisson regression analysis showed female gender had 1.02 times the probability of going to the dental service; likewise, people who were 91 to 100 years old had 12% more, the probability, like those with secondary education, had 8% more and those with the highest average, richest and richest wealth index had 20% more, 29% more and 29% more, respectively, the probability of going to the dental health service, as opposed to those who were very poor. The study concluded that there are several sociodemographic factors (such as being female, age progressed, natural region, those with high school, wealth index, type of residence) and personal factors (history of hypertension (HTN), physical disability) associated with a lack of access to dental services in people over 60 years old.

Secular Trends in Adherence to Healthy Behaviors Among US Adults with Diabetes, 1999-2018.

Adherence to healthy lifestyle is essential for diabetes management in light of the plateaued metabolic control, diversifying causes of death, and continued excess mortality among people with diabetes (PWD). This study aims to assess the secular trend of adherence to healthy behaviors among PWD in NHANES, a nationally representative survey of Americans using a stratified, multistage probability design in 2-year cycles since 1999. Adherence to healthy lifestyle was estimated using never smoking, moderate drinking, adequate physical activity, and healthy diet, and the score ranged 0-4. Among 7410 participants, adherence to healthy behaviors across time slightly increased from 1.4 (95% CI, 1.3 to 1.5) in 1999-2002 to 1.6 (1.5 to 1.8) in 2015-2018 (Ptrend = 0.002). The non-Hispanic Blacks caught up with the non-Hispanic Whites in overall lifestyle score (1.7 vs. 1.6 in 2015-2018), while large socioeconomic disparities remained in that participants with higher income and education level, and covered by health insurance were more likely to have adherence to healthy behaviors. As the metabolic control plateaued and causes of death have diversified among PWD, our findings suggested a great potential of lifestyle modification in facilitating the long-term health of these patients.

#2103 Accuracy of a continuous glucose monitor in people with diabetes on peritoneal dialysis

Abstract Background and Aims Globally 40% of people receiving peritoneal dialysis (PD) have a diagnosis of diabetes. Good glycaemic control can by complicated by the obligate glucose load associated with PD. Monitoring and treatment of people with diabetes (PwD) on PD has been limited by reduced reliability of traditional markers of glycaemia such as HbA1c in end-stage kidney disease. Continuous glucose monitors (CGMs) have been increasingly used in the care of PwD over the last 20 years. Monitors worn on the upper arm or abdomen measure glucose in interstitial fluid at regular intervals over the 24 hour period. CGMs are currently unlicensed in PD populations as they have not been tested in large scale studies. Concerns remain around accuracy in the presence of potentially interfering substances generated by the breakdown of osmotic agents used in PD fluid (e.g. Icodextrin). We aimed to assess the analytical and clinical accuracy of the FreeStyle Libre(FSL) CGM system in PwD on maintenance PD. Method We conducted a single centre observational study of 10 PwD who had been on PD for at least 3 months. For the 10 day study period participants wore a blinded research model FSL monitor which measured interstitial glucose levels every 15 minutes. Results from the FSL were compared with; Analytical accuracy was assessed using three methods; Clinical accuracy was assessed using the Parkes consensus error grid to assign each pair of readings to one of five risk zones and quantify the clinical implications of any difference between the two measurements. The International Organisation for Standardisation guidelines stipulates 99% of pairs should be in zones A and B, denoting little or no effect on clinical actions. Results Of 11 recruited participants, 10 completed the 10 day study period resulting in 76 paired CGM-YSI measurements and 375 paired CGM-CBG measurements. 7 participants were on APD and 3 on CAPD. All participants were prescribed a PD regime that included one daily dwell with Icodextrin. The aggregate MARD was 9.4% (95% CI 7.9, 10.4) for CGM-YSI matched pairs and 17.6% (95% CI 17, 19.3) for CGM-CBG matched pairs. Spearman's r was 0.94 (p &amp;lt; 0.0001) for CGM-YSI and 0.89 (p &amp;lt; 0.0001) for CGM-CBG. From Bland-Altman analysis, the systematic error of the CGM compared with YSI and CBG was −0.81 mmol/l (SD 0.81) and −1.6 mmol/l (SD 1.9) respectively. Parkes consensus error grid analysis showed that compared with YSI and CBG respectively, 100% and 99.9% of sensor values were in the clinically acceptable zones A and B (Fig. 1). Conclusion We have demonstrated satisfactory performance of the FSL monitoring system by both analytical and clinical metrics in this cohort of PD patients using treatment regimens including Icodextrin based fluids. CGMs provide much more information for the PwD and their clinical care team compared with random CBGs (which in themselves have been shown to exhibit significant between user variability) and time averaged markers such as HbA1c. They allow detection of asymptomatic hypoglycaemia and direct monitoring of the systemic effects of any change to the PD prescription resulting in a larger or smaller glucose load. These results should be reassuring for clinicians wishing to utilise the greater depth of information provided by CGMs to improve clinical care for their patients with diabetes on PD.

High Performance for Predicting Diabetic Nephropathy Using Stacking Regression of Ensemble Learning Method

Diabetes may lead to several problems, one of the most prevalent and deadly of which is diabetic nephropathy. Therefore, the condition represents a significant threat to one’s health since it has the potential to cause irreversible harm to the kidneys’ ability to operate. A significant portion of the research that is being conducted now is focused on determining how accurately diabetic people may be predicted to develop kidney illness. Considering this, the research suggests a regression stacking approach for predicting albumin levels. These albumin values will serve as a reference for the incidence of diabetic nephropathy disease. They will be derived from the medical records of patients. The utilization of stacking regression from three different ensemble approaches, using Random Forest and CatBoost regressors, while the Huber algorithm is used as a meta-learner. The accuracy with which the combination of parameters that are employed is determined is a significant factor. It contributes to the high degree of performance that the ensemble approach achieves. Therefore, in this investigation, a grid search was carried out to tune the hyperparameters of both regressor models. We evaluated the performance of the proposed model using accuracy, MAPE, RMSE, and MSE values. The experimental findings demonstrate great performance. Three selected variables including quantitative UACR, semi-quantitative UACR, and urinary creatinine, achieved high performance. Overall, the performance obtained an accuracy rate of more than 98% with an error rate (MAPE, RMSE, and MSE values) of less than 1%. In conclusion, the stack regressor model can be implemented to predict diabetic nephropathy using clinical datasets.

A SURVEY ON PREDICTION OF DIABETIC LEVELS USING MACHINE LEARNING ALGORITHAM

Diabetes is a serious, long-lasting illness that makes blood sugar levels high. It can lead to many health problems. By 2040, it's expected that 1 in 10 adults worldwide will have diabetes, reaching a staggering 642 million people. This is a big concern and needs attention. Scientists are using advanced technology like machine learning to predict diabetes. They studied data from hospital check-ups in Luzhou, China, which had 14 pieces of information about each person. They used two different methods like decision trees, random forests to make predictions. They tested these methods to see how well they worked, using a technique called five-fold cross-validation. To make sure their findings were reliable; they also did separate tests with a large group of healthy people and those with diabetes. Because the data wasn't evenly balanced between healthy and diabetic people, they adjusted it to make it fair. They found that random forests were the best at predicting diabetes accurately, with about 81% accuracy when using all the information available. They also used techniques like principal component analysis and minimum redundancy maximum relevance to make the data easier to work with. KEYWORDS : Diabetes, blood sugar, predictions, hospital, China, methods, tests, data, balance, forests, accuracy, analysis.

Review of the Diagnostic and Prognostic Values of Cardiac Markers in Diabetes

Abstract Introduction Cardiovascular disease is a leading cause of mortality in people with diabetes (PWD). We aimed to explore the role of troponin T (TnT) and probrain natriuretic peptide (proBNP) as screening and prognostic indicators of cardiovascular morbidity and mortality in PWD in the existing literature. Methods This review paper is a focused narrative nonsystematic review of the literature which examined relevant publications pertinent to the significance of cardiac biomarkers. We aimed to investigate the diagnostic value of cardiac TnT (cTnT) and cTnI in addition to proBNP in diabetes and the prognostic value of cTnT and proBNP in diabetic and nondiabetic patients. The process of searching through literature was conducted from December 2022 to April 2023. Searches were done across PubMed and Google Scholar databases to identify relevant articles published from January 2001 to April 2023. The selected were entered into EndNote 20 software to extract the title and abstract. Results A total of 75 articles were identified in Google Scholar in addition to 32 articles from PubMed. After a thorough review, only a total of 22 articles were selected, pointing out those which discussed the pathophysiology and diagnostic, prognostic, and screening values of the types of Tn and proBNP markers. The value of TnT in PWD, specifically T2D, is threefold higher than in healthy patients. Individuals with high levels of high-sensitivity (hs) cTnI or cTnT were at the highest mortality risk. Nonetheless, N-terminal (NT)-proBNP and TnT function independently as predictors of unfavorable outcomes. Conclusions TnT is an important early screening tool prognostic indicator. Elevated TnT was associated with an increased risk of cardiovascular events in PWD. hs-cTn may help diabetes-related clinical care for older persons by identifying those at high mortality risk; furthermore, in diabetic individuals, NT-pro-BNP appears to be 92% sensitive and 90% specific for the diagnosis of heart failure.

Excess Intramyocellular Lipid Does Not Affect Muscle Fiber Biophysical Properties in Mice or People With Metabolically Abnormal Obesity.

Observational studies show correlations between intramyocellular lipid (IMCL) content and muscle strength and contractile function in people with "metabolically abnormal" obesity. However, a clear physiologic mechanism for this association is lacking and causation is debated. We combined immunofluorescent confocal imaging with force measurements on permeabilized muscle fibers from metabolically normal and metabolically abnormal mice and metabolically normal (defined as normal fasting plasma glucose and glucose tolerance) and metabolically abnormal (defined as pre-diabetes and type 2 diabetes) people with overweight/obesity to evaluate relationships among myocellular lipid droplet characteristics (droplet size and density) and biophysical (active contractile and passive viscoelastic) properties. The fiber type specificity of lipid droplet parameters varied between metabolically abnormal and normal mice and among metabolically normal and metabolically abnormal people. However, despite considerable quantities of IMCL in the metabolically abnormal groups, there were no significant differences in peak active tension or passive viscoelasticity between the metabolically abnormal groups and the control group in mice or people. Additionally, there were no significant relationships among IMCL parameters and biophysical variables. Thus, we conclude that IMCL accumulation per se does not impact muscle fiber biophysical properties or physically impede contraction.

Type 2 diabetes post pandemic: enabling your patients to regain control

In the past 80 years, the number of people in the UK with a diabetes diagnosis has risen from 200,000 to around 4.3 million. The COVID-19 pandemic complicated tackling the disease as a public health issue. There are now an estimated five million people living with diabetes in the UK, most have type 2 diabetes. The COVID-19 pandemic affected access to care, led to delays in diagnoses of diabetes and many people with diabetes experienced a deterioration in their diabetes control. This article provides guidance on how nurses can work with people at risk of diabetes to prevent the condition, to induce remission and how to use medication to treat diabetes.

Development of a Real-time Force-based Algorithm for Infusion Failure Detection.

Continuous subcutaneous insulin infusion (CSII) is a common treatment option for people with diabetes (PWD), but insulin infusion failures pose a significant challenge, leading to hyperglycemia, diabetes burnout, and increased hospitalizations. Current CSII pumps' occlusion alarm systems are limited in detecting infusion failures; therefore, a more effective detection method is needed. We conducted five preclinical animal studies to collect data on infusion failures, utilizing both insulin and non-insulin boluses. Data were captured using in-line pressure and flow rate sensors, with additional force data from CSII pumps' onboard sensors in one study. A novel classifier model was developed using this dataset, aimed at detecting different types of infusion failures through direct utilization of force sensor data. Performance was compared against various occlusion alarm thresholds from commercially available CSII pumps. The testing dataset included 251 boluses. The Bagging classifier model showed the highest performance metrics among the models tested, exhibiting high accuracy (96%), sensitivity (94%), and specificity (98%), with lower false-positive and false-negative rate compared with traditional occlusion alarm pressure thresholds. Our study developed a novel non-threshold classifier that outperforms current occlusion alarm systems in CSII pumps in detecting infusion failures. This advancement has the potential to reduce the risk of hyperglycemia and hospitalizations due to undetected infusion failures, offering a more reliable and effective CSII therapy for PWD. Further studies involving human participants are recommended to validate these findings and assess the classifier's performance in a real-world setting.

Understanding suboptimal insulin use in type 1 and 2 diabetes: a cross-sectional survey of healthcare providers who treat people with diabetes

BackgroundThe purpose of this study was to understand the healthcare provider (HCP) perspective on the extent of suboptimal insulin dosing in people with diabetes (PwD), as well as specific challenges and solutions to insulin management.MethodsAn online survey of general practitioners and specialists (N = 640) who treat PwD in Germany, Spain, the United Kingdom, and the United States was conducted. Responses regarding HCP background and their patients, HCP perceptions of suboptimal insulin use, and challenges associated with optimal insulin use were collected. Categorical summary statistics were presented.ResultsOverall, for type 1 diabetes (T1D) and type 2 diabetes (T2D), most physicians indicated < 30% of PwD missed or skipped a bolus insulin dose in the last 30 days (T1D: 83.0%; T2D: 74.1%). The top 3 reasons (other than skipping a meal) HCPs believed caused the PwD to miss or skip insulin doses included they “forgot,” (bolus: 75.0%; basal: 67.5%) “were too busy/distracted,” (bolus: 58.8%; basal: 48.3%), and “were out of their normal routine” (bolus: 57.8%; basal: 48.6%). HCPs reported similar reasons that they believed caused PwD to mistime insulin doses. Digital technology and improved HCP-PwD communication were potential solutions identified by HCPs to optimize insulin dosing in PwD.ConclusionsOther studies have shown that PwD frequently experience suboptimal insulin dosing. Conversely, results from this study showed that HCPs believe suboptimal insulin dosing among PwD is limited in frequency. While no direct comparisons were made in this study, this apparent discrepancy could lead to difficulties in HCPs giving PwD the best advice on optimal insulin management. Approaches such as improving the objectivity of dose measurements for both PwD and HCPs may improve associated communications and help reduce suboptimal insulin dosing, thus enhancing treatment outcomes.

Immunological Implications in Diabetes: A Review on Various Diseases and Conditions

Abstract:: Diabetes Mellitus (DM) is a long-term metabolic condition that has significant social, health, and economic consequences. There are various forms of diabetes mellitus, but the two most common varieties are type I and type II. Insulin-dependent diabetes (IDDM) is one of the most wellknown autoimmune illnesses that cause insulin insufficiency and hyperglycemia by either damaging or destroying Langerhans' beta cells. Available scientific data evidenced the greatest genetic contribution of Human Leukocyte Antigen class II in the IDDM. Hyperglycemia and individual components of the insulin resistance (metabolic) syndrome put people with type II diabetes at increased risk for microvascular consequences (retinopathy, nephropathy, and neuropathy) as well as macrovascular issues (cardiovascular comorbidities). A number of pathophysiological abnormalities, including obesity, poor diet, and physical inactivity, as well as genetic variables, are involved in the disturbed glucose homeostasis associated with type II diabetes. Diseases like lipid abnormalities contribute to the progression of diabetes, whereas obesity and its related medical disorders (such as hypertension, diabetes, insulin resistance, and sleep apnea syndrome) are eventually linked to an elevated cardiovascular risk. Diabetes raises the incidence, intensity, and duration of peri-densities in people with diabetes compared to healthy persons, making it a risk factor for periodontal disease. Diabetes conditions in patients concurrently also increase the progression or risk of other diseases, i.e., cardiovascular- related diseases (hypertension, oxidative stress, hyperlipidemia), nervous system-related diseases, and COVID-19, by increasing the overall infection rate. There is widespread evidence that correlates the direct connection between diabetes and other diseases, including immunity disorders, CVS disorders, etc. This review provides a correlation between diabetes and another disease with an overall impact on the progression of cardiovascular diseases, neurological diseases, COVID-19, and periodontal diseases. This current review focuses on the collation of some plants that show antidiabetic activity, including plant part, family, chemical constituent, mechanism of action, and chemical used for extraction. Studies on the role, causes, clinical management, prevention, and treatment of diabetes heavily rely on epidemiological evidence. This review also explains different factors responsible for diabetes, like genetic factors, environmental factors, and viral infections.