Diabetes Peripheral Vascular Disease Research Articles

Diabetes Mellitus and Bacterial Infections: A Review of Main Infections in DM Patients

Millions of single-celled microscopic organism called bacteria reside within the human body. Numerous infectious diseases in humans are caused by some of these pathogen bacteria. One of the major risk factors for bacterial infections is diabetes mellitus. Bacterial infections and diabetes may have a reciprocal relationship in which some illnesses exacerbate insulin resistance. Diabetes may occur as a result of bacteria in the digestive system. Any organ in a human body can become infected by bacteria. The respiratory tract, gastrointestinal tract, urinary tract, skin, and soft tissues are the most frequently infected areas with diabetes. Uncontrolled hyperglycemia increases the risk of bacterial infections by impairing innate and adaptive immune responses. Furthermore, skin ulceration can result from long-term diabetic consequences such peripheral vascular disease and neuropathy (sensorimotor and autonomic). These conditions can also lead to secondary bacterial infections.

Evaluation and Management of Diabetic Neuropathy from the Perspective of People with Diabetes

Diabetic foot ulcers (DFU) and infections are the most common complications of diabetic foot disease. Mortality and financial burdens for both patients and society on the whole are caused by the prevalence of complications. Peripheral neuropathy, peripheral arterial disease, and immune response dysfunction are just a few of the main contributing factors that must be understood in order to effectively treat the condition. In order to treat diabetic foot disease, you must first get a comprehensive physical examination and a detailed history of your condition. Diabetic neuropathy and peripheral vascular disease, as well as any evidence of diabetic foot ulcers or infection, should be examined during this procedure. Patients with diabetes mellitus were studied to see if there was a link between cognitive impairment and the condition of their feet and whether or not they followed their doctor's recommendations for glycemic control. Using a random sample of diabetes patients, researchers conducted a prospective study to see how many people had the condition. The Mini-Mental State Valuation, the Trail Making Judgments, and the Michigan Screening Instrument were used to assess cognitive abilities. In the one-month follow-up, glycated hemoglobin (HB1Ac >7 %) was linked to the MMSE and medication adherence, but no link was seen between cognitive function and neuropathy. According to the results of a ROC curve investigation, HB1Ac and the MNSI score both significantly (p< 0,05) mitigate towards eventual adherence to medicine for foot problems. For the purpose of determining if DFU was associated with cognitive impairment, the Chi square valuation was used in the statistical examination. As a determinant of MMSE and MoCA scores, the researchers used linear regression to come to their conclusion. Diabetic foot issues should be managed with good blood sugar control and less acute neuropathy, and this does not seem to be linked to cognitive dysfunction. More study is required in order to personalize treatments for diseases of the central and peripheral nervous systems appropriately. Cognitive dysfunction should be taken into account by doctors and podiatrists while treating diabetic foot problems

Exploring the potential mechanism of Simiao Yongan decoction in the treatment of diabetic peripheral vascular disease based on network pharmacology and molecular docking technology

The study aims to investigate the potential action targets and molecular mechanisms of Simiao Yongan decoction (SMYAD) in treating diabetic peripheral vascular disease (DPVD) by utilizing network pharmacology analysis and molecular docking technology. The components and targets of SMYAD were screened using the TCMSP database, while DPVD-related genes were obtained from the GeneCards, OMIM, and Disgenet databases. After intersecting the gene sets, a Protein-Protein Interaction (PPI) network was established, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were carried out. The practical chemical components and core targets identified were molecularly docked using AutoDock software. A total of 126 active compounds were screened from which 25 main components included quercetin, rutoside, hesperidin, naringin, and β-sitosterol were determined to be the active components most associated with the core targets. A total of 224 common target genes were obtained. Among them, JUN, AKT1, MAPK3, TP53, STAT3, RELA, MAPK1, FOS, and others are the expected core targets of traditional Chinese medicine. The top-ranked GO enrichment analysis results included 727 biological processes (BP), 153 molecular functions (MF), and 102 cellular components (CC). KEGG pathway enrichment analysis involved mainly 178 signaling pathways, such as cancer signaling pathway, AGE-RAGE signaling pathway, interleukin-17 signaling pathway, tumor necrosis factor signaling pathway, endocrine resistance signaling pathway, cell aging signaling pathway, and so on. The molecular docking results demonstrate that the principal chemical components of SMYAD exhibit considerable potential for binding to the core targets. SMYAD has the potential to treat DPVD through various components, targets, and pathways. Its mechanism of action requires further experimental investigation.

Abstract 15747: AMPK Cysteine Oxidation by SOD3-Derived H 2 O 2 Mediates Exercise-Induced Restoration of Skeletal Muscle Angiogenesis in Type2 Diabetes

Background: Exercise restores decreased capillary density in skeletal muscle (SKM) (capillary rarefaction) in type2 diabetes (T2D) that has eNOS uncoupling/excess O 2 - , which is required for treatment of diabetic peripheral vascular disease (PAD) via unknown mechanisms. AMP-activated protein kinase (AMPK) is a key angiogenic/metabolic kinase mainly regulated by phosphorylation and is required for baseline, but not exercise-induced capillary density in SKM under healthy conditions. AMPK senses H 2 O 2 signal to increase its activity via oxidative modification of Cys299/304 in vitro. In addition, extracellular SOD (SOD3) that catalyzes the dismutation of O 2 - to H 2 O 2 is increased in response to exercise. However, the role of AMPK and SOD3 in exercise-induced SKM angiogenesis in T2D has not been reported. Oxidation of Cysteine residues to generate cysteine sulfenic acid (Cys-OH) is a key event in H 2 O 2 -mediated signaling. Results: Here we show that reduced CD31+ capillary density in SKM of high fat diet-induced T2D mice was restored (2.4-fold) by voluntary wheel exercise training (2 weeks) with enhanced SOD3 activity (224%) and extracellular H 2 O 2 levels (3.2-fold). Of note, exercise in T2D mice increased AMPK activity (by p-ACC) via inducing CysOH formation of AMPK (3.6-fold), but not p-AMPK induction, which was inhibited by SOD3 -/- /T2D mice that reduced exercise-induced H 2 O 2 . To demonstrate functional significance of AMPK Cys oxidation, we generated CRISPR/Cas9-genome editing “redox-dead” AMPK-Cys299/304Ala (AMPK-C/A) knock-in (KI) mutant mice and found that AMPK-C/A KI mice showed significant inhibition of exercise-induced angiogenesis (44%) via reducing angiogenic PGC1α and VEGF protein expression in SKM of T2D mice. In vitro, C2C12 skeletal muscles overexpressing SOD3 treated with palmitate (mimic T2D with exercise) induced AMPK-CysOH formation and VEGF secretion. Its conditioned media promoted angiogenic responses such as EC migration (1.8-fold) and tube formation (1.7-fold), which was inhibited by C2C12 cells overexpressing AMPK C/A mutant. Conclusion: Novel exercise-induced AMPK CysOH formation at Cys299/304 restores angiogenesis in SKM of T2D via SOD3-mediated H 2 O 2 , which may contribute to revascularization in diabetic PAD.

Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Total Ankle Replacement

Category: Ankle Arthritis; Other Introduction/Purpose: Patient-reported outcomes (PROs), such as PROMIS, are a key element of evaluating success after total ankle replacement (TAR). To date, most PROs are described using absolute values or parameters like the minimum clinically important difference. However, these interpretations do not explicitly tell the surgeon the most important factor of postoperative success: is the patient satisfied with their outcome after TAR? The patient acceptable symptom state (PASS) is a novel PRO metric that attempts to bridge this gap. PASS represents the symptom threshold above which patients consider themselves well. This study aimed to establish the PROMIS thresholds for PASS in a primary cohort of TAR patients. We hypothesized that TAR patients would meet PASS and that PASS would vary with demographic variables. Methods: This is a single-institution retrospective cohort study of primary TAR patients (n=127; mean age 63.2 years; mean BMI 29.0 kg/m2; 58% male) with preoperative and 2-year postoperative PROMIS scores (domains: Physical Function, Pain Interference, Pain Intensity, Global Mental Health, Global Physical Health, & Depression). At 2 years postoperatively, patients also answered 2 PASS anchor questions with Likert-scale responses: 1) Are you satisfied with the results of your surgery?; and 2) the Delighted- Terrible symptom scale. PASS thresholds with 95% confidence intervals (CI) were calculated using the anchors “Very satisfied” or “Satisfied” for question 1 and “Delighted,” “Pleased,” or “Mostly Satisfied” for question 2. Using bootstrapping technique with 1000 iterations, the Youden Index was then calculated to determine the best coordinates of specificity and sensitivity to maximize the Area Under the Curve (AUC). Finally, we analyzed preoperative variables (demographics, clinical/surgical data, and preoperative PROMIS scores) on the likelihood of achieving PASS. Results: There was a strong association between PASS thresholds and PROMIS domains, especially Physical Function (PASS threshold >44.7, AUC 0.883), Pain Interference (< 56.0, AUC 0.940), and Pain Intensity (< 48.4, AUC 0.936). Covariate stratification demonstrated that the likelihood of achieving PASS was not affected by age, race, gender, ASA score, or BMI. PASS was less likely to be achieved by patients who had undergone prior orthopaedic surgery (P=0.013). Patients with diabetes mellitus and peripheral vascular disease were less likely to meet PASS for Physical Function (P=0.010, P=0.037), but did meet PASS for Pain domains. Patients with worse preoperative Physical Function and Depression scores were less likely to meet PASS for Physical Function postoperatively (P=0.028, P=0.041), but achieved similar PASS for Pain Interference and Pain Intensity domains. Conclusion: After TAR, the ability to reach the postoperative PASS was most strongly associated with postoperative pain scores, as evidenced by the Pain Interference and Pain Intensity domains. However, the thresholds for PASS were generally lower than population means. This demonstrates that TAR patients do not need to reach normal pain or physical function levels in order to have an acceptable symptom state postoperatively. Moreover, the ability to achieve PASS was not affected by demographic variables. Further research on PASS is warranted, and may shift how surgeons and researchers evaluate TAR patients pre- and post-operatively.

Rate of Emergency Lower Extremity Amputations in the United States Among Medicare Beneficiaries.

To determine the rate of emergency versus elective lower extremity amputations in the United States. Lower extremity amputation is a common endpoint for patients with poorly controlled diabetes and multilevel peripheral vascular disease. Although the procedure is ideally performed electively, patients with limited access may present later and require an emergency operation. To what extent rates of emergency amputation for lower extremities vary across the United States is unknown. Evaluation of Medicare beneficiaries who underwent lower extremity amputation between 2015 and 2020. The rate was determined for each zip code and placed into rank order from lowest to highest rate. We merged each beneficiary's place of residence and location of care with the American Hospital Association Annual Survey using Google Maps Application Programming Interface to determine the travel distance for patients to undergo their procedure. Of 233,084 patients, 66.3% (154,597) were men, 69.8% (162,786) were White. The average age (SD) was 74 years (8). There was wide variation in rates of emergency lower extremity amputation. The lowest quintile of zip codes demonstrated an emergency amputation rate of 3.7%, whereas the highest quintile demonstrated 90%. The median travel distance in the lowest emergency surgery rate quintile was 34.6 miles compared with 10.5 miles in the highest quintile of emergency surgery ( P < 0.001). There is wide variation in the rate of emergency lower extremity amputations among Medicare beneficiaries, suggesting variable access to essential vascular care. Travel distance and rate of amputation have an inverse relationship, suggesting that barriers other than travel distance are playing a role.

Muscle versus Fascia Free Tissue Transfer for Treatment of Chronic Osteomyelitis in the Comorbid Population.

In patients with chronic lower extremity (LE) wounds, chronic osteomyelitis confers additional complexity to achieving adequate treatment. Previous reviews demonstrate increased rates of osteomyelitis recurrence in patients who receive muscle flaps compared with fasciocutaneous flaps for LE limb salvage; however, these studies were not limited to atraumatic populations who receive exclusively free flaps. Thus, this study compared rates of recurrence in chronic osteomyelitis patients undergoing LE reconstruction with fasciocutaneous versus muscle free flaps. Patients undergoing free tissue transfer (FTT) between July 2011 and July 2021 were retrospectively reviewed. Patients were stratified into fasciocutaneous and muscle free flap groups. Primary outcomes included osteomyelitis recurrence, flap complications, limb salvage, and ambulatory status. Forty-eight patients with pathologic diagnosis of chronic osteomyelitis of the wound bed were identified, of which 58.3% received fasciocutaneous (n = 28) and 41.7% received muscle flaps (n = 20). The most common comorbidities included diabetes mellitus (n = 29, 60.4%), peripheral neuropathy (n = 27, 56.3%) and peripheral vascular disease (n = 24, 50.0%). Methicillin-resistant or methicillin -sensitive Staphylococcus aureus were the most common pathogen in 18.7% (n = 9) of procedures. The majority of patients underwent a median of three debridements followed by negative pressure wound therapy prior to receiving FTT. At a median follow-up of 16.6 months, the limb salvage and ambulatory rates were 79.2 (n = 38) and 83.3% (n = 40), respectively. The overall rate of microsurgical flap success was 93.8% (n = 45). Osteomyelitis recurred in 25% of patients (n = 12) at a median duration of 4.0 months. There were no significant differences in rates of osteomyelitis recurrence, flap complications, limb salvage, ambulation, and mortality. On multivariate analysis, flap composition remained a nonsignificant predictor of osteomyelitis recurrence (odds ratio: 0.975, p = 0.973). This study demonstrates that flap composition may not influence recurrence of osteomyelitis following free flap reconstruction of chronic LE wounds, suggesting that optimal flap selection should be based on wound characteristics and patient goals.

The Clinical Characteristics of Patients With Pyoderma Gangrenosum in a Tertiary Referral Hospital: A Retrospective Cohort Study.

Since pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis, epidemiological and clinical data on the disease are scarce. In this single-center retrospective study, we aim to evaluate the clinical characteristics, underlying systemic associations and treatment modalities in patients with PG in a university hospital between 2014 and 2022. It is known that PG most commonly affects the lower extremities, but extracutaneous involvement should also be kept in mind. PG is usually associated with various comorbidities that share a similar inflammatory pathogenesis with the disease. The prevalence of PG-related comorbidities varies in different studies, arthritis and solid organ malignancies were observed most frequently in the current study. Non-PG-related comorbidities including diabetes mellitus, hypertension and peripheral vascular disease can adversely affect wound healing and limit treatment options; therefore, a holistic approach to patients with PG is crucial. Consistent with literature, the mainstay of treatment for PG is systemic corticosteroids and cyclosporine. However, the implementation of biologic agents in treatment-resistant patients is an increasingly important issue in the literature. Antitumor necrosis factors (anti-TNFs) are the most commonly preferred biological therapies, and these agents seem to have paved the way for a paradigm shift in the treatment of PG. In the present study, a relatively high per cent of (23.3%) patients treated with anti-TNFs, most commonly infliximab (87.5%). Recurrence was observed in 46.7% of our patients in the follow-up period and the relapse rate was found to be higher in patients using multiple systemic agents compared to those using single agents (64.7% vs 23.1%, P < .05). In conclusion, we emphasize that early diagnosis and treatment by considering the patient's comorbidities are important in preventing complications, and biologic treatments seem particularly promising in treatment-resistant patients.

Optical coherence tomography angiography metrics in diabetes: Focusing on diabetic retinopathy and carotid atherosclerosis

BackgroundTo explore the value of Optical Coherence Tomography Angiography (OCTA) metrics in the early diagnosis of vascular complications in diabetes. MethodsAll participants underwent OCTA with a swept-source OCT device. Automated measurements of the foveal avascular zone (FAZ) area, vessel density (VD), and blood flow density (BFD) of both 3 × 3 and 6 × 6 windows were then obtained after a quality check. ResultsDiagnostic models based on multiple risk factors were developed separately for diabetic retinopathy and carotid atherosclerosis using random forest and multivariate logistic regression methods. The addition of specific OCTA metrics improved the diagnostic prediction of DR compared with the models of risk factors alone (Inner Retinal Blood Flow Density in 3 × 3 window, IRBFD; Brier score 0.124 vs. 0.149; AUC, 0.887 vs. 0.836) (Central Retinal Blood Flow Density in 3 × 3 window, CRBFD; Brier score 0.142 vs. 0.149; AUC, 0.851 vs. 0.836). Adding diabetic peripheral vascular disease (DPVD) indicator improved the prediction of carotid atherosclerosis (Brier score, 0.180 vs. 0.192; AUC, 0.802 vs. 0.781. The FAZ in the 3 × 3 window also achieved this effect when targeting only T2DM patients (AUC, 0.797 vs. 0.766; Brier score, 0.183 vs. 0.195). ConclusionsFocusing on IRBFD and CRBFD in the 3 × 3 window of OCTA allows for a more sensitive prediction of the occurrence of DR in diabetic patients. Meanwhile, the quantitative microvascular information provided by OCTA and the occurrence of DPVD may be crucial for diagnosing carotid atherosclerosis. For T2DM patients, we also propose the possibility of FAZ in the 3 × 3 window as a potential diagnostic indicator.

Machine learning for the prediction of atherosclerotic cardiovascular disease during 3-year follow up in Chinese type 2 diabetes mellitus patients.

Clinical guidelines for the management of individuals with type 2 diabetes mellitus endorse the systematic assessment of atherosclerotic cardiovascular disease risk for early interventions. In this study, we aimed to develop machine learning models to predict 3-year atherosclerotic cardiovascular disease risk in Chinese type 2 diabetes mellitus patients. Clinical records of 4,722 individuals with type 2 diabetes mellitus admitted to 94 hospitals were used. The features included demographic information, disease histories, laboratory tests and physical examinations. Logistic regression, support vector machine, gradient boosting decision tree, random forest and adaptive boosting were applied for model construction. The performance of these models was evaluated using the area under the receiver operating characteristic curve. Additionally, we applied SHapley Additive exPlanation values to explain the prediction model. All five models achieved good performance in both internal and external test sets (area under the receiver operating characteristic curve >0.8). Random forest showed the highest discrimination ability, with sensitivity and specificity being 0.838 and 0.814, respectively. The SHapley Additive exPlanation analyses showed that previous history of diabetic peripheral vascular disease, older populations and longer diabetes duration were the three most influential predictors. The prediction models offer opportunities to personalize treatment and maximize the benefits of these medical interventions.

Relationship between complications of type 2 diabetes and thyroid nodules

Objective Recent evidence suggests that diabetes is a risk factor for thyroid nodules. However, the relationship between complications of type 2 diabetes and the risk of thyroid nodules remains unclear. This present study aims to investigate the association between thyroid nodules and complications of type 2 diabetes. Methods This retrospective study collected 4696 adult inpatients with type 2 diabetes between January 2021 and December 2021. The complications examined in this paper included diabetic nephropathy, peripheral neuropathy, eye disorder, and peripheral vascular disease. Results A total of 4696 patients with type 2 diabetes participated in the study, of whom 19.6% had thyroid nodules. Among all the complications, eye disorder had the highest incidence of thyroid nodules (incidence rate, 29.4%; 95% CI, 26.23%–32.51%). The prevalence of thyroid nodules was lower among patients without complications (incidence rate, 14.1%; 95% CI, 12.48% −15.67%) compared to patients who had complications (incidence rate, 23.1%; 95% CI, 21.59%–24.68%) (p < 0.001). Logistic regression revealed that peripheral neuropathy (adjusted OR, 1.6; 95% CI, 1.4–1.9), eye disorder (adjusted OR, 1.8; 95% CI, 1.5–2.2), and peripheral vascular disease (adjusted OR, 1.8; 95% CI, 1.6–2.1) were all significantly associated with an increased risk of thyroid nodules. However, no significant correlation was found between diabetic nephropathy and the risk of thyroid nodules. Conclusion One of the key findings of this study is that type 2 diabetes without complications is negatively correlated with the risk of thyroid nodules, while several complications are associated with a significantly increased risk of thyroid nodules.

O012 Elevated sGP130 characterises dysregulated chronic inflammation in diabetic peripheral vascular disease

Abstract Introduction Chronic systemic inflammation is integral to the pathophysiology of cardiovascular disease and diabetes mellitus. Interleukin 6 (IL-6) is a cytokine which may stimulate either pro- or anti-inflammatory activity depending cell population. Classical IL-6 signalling only occurs in cells expressing membrane-bound IL-6 receptor, and results in anti-inflammatory JAK/STAT3 pathway activation. Trans-signalling, by contrast, involves soluble IL-6 receptor α and soluble glycoprotein 130 (sGP130), and therefore may affect any cell regardless of membrane receptor expression. We designed a study to characterise Interleukin-6 (IL-6) trans-signalling in a diabetic cohort receiving treatment for symptomatic peripheral vascular disease and identify whether IL-6 signalling is correlated to outcomes in this patient group. Methods A single-centre, prospective cohort study of patients with DM undergoing infra-inguinal revascularization was conducted. Pre-operative serum was obtained from patients, who were then followed and observed for major amputation, death, and need for re-intervention as primary outcomes. Quantitative serum assays for IL-6, sIL-6rα, and sGP130 were performed. Results 40 patients (20 controls) were included in the study. Diabetic peripheral vascular disease patients had significantly higher serum IL-6 (p=0.0038), as well as higher serum sGP130 (p=0.0119) at baseline. Significant correlation was found between serum IL-6 and C-reactive Protein (p= 0.02), and serum IL-6 and sGP130 (p=0.02) in the disease group, but not in controls. sGP130 was higher in patients who reached primary outcomes (p=0.0196). Conclusion Systemic IL-6 trans-signalling is dysregulated in diabetic peripheral vascular disease and may be a future therapeutic target or adjunct to surgical management. Elevated sGP130 may be a prognostically-relevant biomarker in this population.

Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis.

Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. "Lead time bias" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used. Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality. Median eGFR was 7(5.3-9.5)mL/min/1.73 m2 , median follow-up time was 30.9(13-50)months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality. In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.

Mechanisms of diabetic foot ulceration: A review.

Diabetic foot ulcers (DFUs) are associated with complex pathogenic factors and are considered a serious complication of diabetes. The potential mechanisms underlying DFUs have been increasingly investigated. Previous studies have focused on the three aspects of diabetic peripheral vascular disease, neuropathy, and wound infections. With advances in technology, researchers have been gradually conducting studies using immune cells, endothelial cells, keratinocytes, and fibroblasts, as they are involved in wound healing. It has been reported that the upregulation or downregulation of molecular signaling pathways is essential for the healing of DFUs. With a recent increase in the awareness of epigenetics, its regulatory role in wound healing has become a much sought-after trend in the treatment of DFUs. This review focuses on four aspects involved in the pathogenesis of DFUs: physiological and pathological mechanisms, cellular mechanisms, molecular signaling pathway mechanisms, and epigenetics. Given the challenge in the treatment of DFUs, we are hopeful that our review will provide new ideas for peers.

Efficacy and safety of external therapy of TCM for diabetic peripheral vascular disease: A protocol for systematic review and meta-analysis.

In modern society, the incidence of diabetes is increasing yearly, and poor glycemic control can accelerate the progression and severity of diabetic peripheral vascular disease. External treatment with traditional Chinese medicine (TCM) has been widely used in the treatment of diabetes, but there is no systematic review on the external treatment of TCM for diabetic peripheral vascular disease; therefore, this study aimed to conduct a meta-analysis on the clinical efficacy and safety of external treatment of TCM in the treatment of diabetic peripheral vascular diseases. We searched The Cochrane Library, PubMed, Web of Science, EMBASE, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, and other sources from their respective inception dates to October 20, 2022, to identify potentially eligible studies. We will use Review Manager 5.4 software provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed their outcome measures. Changes in the bilateral femoral artery, popliteal artery, dorsal artery diameter, blood flow, ankle/brachial index, and dorsal foot temperature: An overall reduction in symptoms (a reduction in diabetes-related symptoms that occur only during the intervention or as a result of the intervention, including peripheral vascular disease). The objective of this meta-analysis was to investigate the influence of external treatment of traditional Chinese medicine on diabetic peripheral vascular disease and to provide more methods for the clinical prevention and treatment of diabetic peripheral vascular disease.

Analysis of the factors affecting mortality after non-traumatic major lower extremity amputations.

The aim of this study was to evaluate the prognostic factors affecting mortality after major lower extremity amputations in patients with diabetes mellitus and peripheral vascular disease. For this retrospective study, 484 patients (345 male, 139 female) who were previously diagnosed with diabetes mellitus and peripheral vascular disease and underwent first-time nontraumatic major lower extremity amputations between January 2008 and January 2021 were included. The mean age of the patients was 64.2 ± 13.8 (20-114). In 32.4% of patients, peripheral vascular disease was the underlying cause, whereas diabetes mellitus was responsible for the etiology in 67.6% of patients. About 68.8% of patients had below-knee amputations, whereas 2.9% had bilateral below-knee amputations, 27.1% had above-knee amputations, and 1.2% had hip disarticulation performed. Gender, age, amputation level, amputation etiologies, Charlson comorbidity index, need for blood transfusion, and laboratory findings such as hemoglobin, platelet, albumin, erythrocyte sedimentation rate, C-reactive protein, sodium, potassium, and neutrophil to lymphocyte ratio levels were recorded preoperatively and at the time of discharge. Patients were grouped as died ≤1 month, ≤3 months, ≤6 months, and ≤12 months or alive. Advanced age, female gender, high Charlson comorbidity index, blood transfusion requirement, proximal amputation level, preoperative low platelet, preoperative low albumin, and parameters such as low hemoglobin, low erythrocyte sedimentation rate, high sodium, low platelet, low albumin, high C-reactive protein, and high neutrophil to lymphocyte ratio at time of discharge were seen to have a statistically significant effect on mortality at 1 month, 3 months, 6 months, and 12 months postoperatively. Preoperative high C-reactive protein had a statistically significant effect on mortality at 1 and 3 months postoperatively, whereas low C-reactive protein had a statisti cally significant effect on mortality at 6 months postoperatively. High potassium at the time of discharge was associated with mortality at 6 and 12 months postoperatively. This study has shown us that mortality rates are affected by modifiable parameters at the time of discharge such as hemoglo bin, sodium, potassium, platelet, and albumin, and normalization of these parameters before discharge could reduce the rates of mortality in the postoperative period. Level IV, Prognostic Study.

A novel refined classification system for type 2 diabetes in adults: A Chinese retrospective cohort study.

We propose a simple type 2 diabetes mellitus (T2DM) classification method based on fasting C-peptide (FCP) levels and examined its feasibility and validity. Adult T2DM patients first diagnosed in our tertiary care centre from January 2009 to January 2020 were included. Patients were followed until January 2021; their clinical characteristics, chronic complications, treatment regimen, and glycaemic control were compared. In total, 5644 T2DM patients were included. Three subgroups were established based on FCP levels: subtype T1 (FCP≤1.0μg/L), 1423 patients (25.21%); subtype T2 (FCP 1.0-2.5μg/L), 2914 patients (51.63%); and subtype T3 (FCP≥2.5μg/L), 1307 patients (23.16%). T1 was characterised by older age, lower body mass indices, higher initial glycosylated haemoglobin (HbA1c) levels, and the lowest homoeostatic model assessment 2 estimates of β-cell function (HOMA2-β) and HOMA2-insulin resistance at baseline. The T3 group's clinical characteristics were opposite to those of T1. T3 patients showed higher incidence rates and risks of diabetic kidney disease, diabetic peripheral vascular disease, and non-alcoholic fatty liver, while the risks of diabetic retinopathy and diabetic peripheral neuropathy were highest in T1. Insulin, glycosidase inhibitors, and thiazolidinedione were the most frequently used drugs, but the use of metformin, dipeptidyl peptidase-4 inhibitor, and insulin secretagogue drugs was slightly lower in T1. T1 maintained higher HbA1c levels throughout follow-up. Overall HbA1c fluctuations were more significant in T3 than in T1 and T2. The new adult T2DM classification is simple and clear and will help classify different T2DM clinical characteristics and guide treatment plans.

Decision‐making for early major amputation in selected diabetic foot ulcer patients with peripheral vascular disease

AbstractObjectiveTo estimate the costs from delaying major amputation in patients with concurrent diabetic foot ulcer and peripheral vascular disease. We seek to model economic benefits from saved costs from promoting timely major amputations among these patients.MethodsRetrospective modeling using data from National University Hospital, Singapore. We identified patients who might have delayed major amputations by applying a hierarchical clustering algorithm. We then modeled the transitions of all patients over time with a Markov process using a number of relevant health states to enable estimation of cost outcomes. We next summarized the expected changes to the bed days used and cost outcomes arising from reassigning some patients who may have had a delayed amputation to timely amputation. The findings from the sample were scaled to reflect national incidence rates for this disease for the years 2014–2019 in Singapore.Results and ConclusionsNine of the 137 patients (6.57%) would be suitable for a major amputation at 3 months, yet in reality, their amputation was delayed. Based on this, and assuming a timely amputation is done for the entire population of patients in Singapore we expect annual savings of 264,791 bed days and $211 million in costs. These findings are preliminary and uncertain. The value of this paper is to show a method for estimating outcomes, report the findings from a small sample, and stimulate future research. New cohort studies might be designed to capture a wider range of outcomes and recruit a larger sample of individuals.

EVALUATION OF EFFICACY OF ACTIVATED PLATELET RICH PLASMA (APRP) IN TREATMENT OF DIABETIC FOOT ULCER

Diabetic foot ulcer is a major complication of diabetes mellitus affecting 15% of all patients with diabetes mellitus. Diabetic neuropathy and peripheral vascular disease are 2 major factors causing diabetic foot ulcers. Due to deficiency of oxygen and nutrients, epithelial cells at wound cannot express essential factors for healing such as VEGF and PDGF resulting in chronic non-healing ulcer. To date, the outcome of management of diabetic foot ulcer is poor. In almost therapies, management of diabetic foot ulcer relates to debridement of the wound, revascularization, off-loading of the ulcer, antibacterial actions, stimulating granulation, epidermisation and angiogenesis. As the therapeutic role of PRP in wound healing has not been clearly addressed previously and as there are not many randomized clinical trials addressing this issue, an attempt has been made in this study to know the therapeutic efficacy of PRP in wound healing while comparing it with the conventional dressing (Normal saline).

Nursing of a patient with diabetic peripheral vascular disease complicated with post-herpetic neuralgia

Nursing of a patient with diabetic peripheral vascular disease complicated with post-herpetic neuralgia