Severity Of Diabetic Complications Research Articles

Households catastrophic health expenditure among older people with noncommunicable diseases: A cross-sectional study from Iran.

Noncommunicable diseases are one of the main difficulties faced by older adults in many countries. The study aimed to investigate the households'catastrophic health expenditure (CHE) among older people with noncommunicable diseases. This cross-sectional study was conducted between October and December 2022 in Semnan, Iran, with the participation of 400 older individuals suffering from diabetes and hypertension. The Content Validity Ratio(which is calculated based on necessity criterion) and Content Validity Index(which calculated based on relevance, transparency, and simplicity criteria) values of 0.94 and 0.89, respectively, confirmed the content validity of the researcher-made questionnaire. The occurrence of CHE was estimated using the World Health Organization's rule of "allocating at least 40% of non-food household costs to healthcare."Due to the qualitative nature of the data, the χ 2 test was utilized to assess the statistical association between demographic and background variables and occurrence of CHE. Older people with diabetes and hypertension had an annual direct medical costs of $821 averagely, which includes 9.7% for diagnosis, 23.9% for doctor visits, and 66.4% for treatment. Direct medical costs account for around 0.26 of nonfood costs, with 12.5% of seniors facing high medical charges. Age, marital status, type of basic health insurance, diabetes, the time elapsed since initial diabetes diagnosis, the severity of diabetes complications, and the development of diabetes-related visual impairments, are associated with CHE(p < 0.05). While the prevalence of CHE among elderly individuals with diabetes and hypertension is reasonably manageable, targeted promotional efforts are still necessary to protect those at high risk.

"Hyperglycemic Memory": Observational Evidence to Experimental Inference.

Several epidemiological studies have appreciated the impact of "duration" and "level" of hyperglycemia on the initiation and development of chronic complications of diabetes. However, glycemic profiles could not fully explain the presence/absence and severity of diabetic complications. Genetic issues and concepts of "hyperglycemic memory" have been introduced as additional influential factors involved in the pathobiology of late complications of diabetes. In the extended phase of significant diabetes randomized, controlled clinical trials, including DCCT/EDIC and UKPDS, studies have concluded that the quality of glycemic or metabolic control at the early time around the diabetes onset could maintain its protective or detrimental impact throughout the following diabetes course. There is no reliable indication of the mechanism by which the transient exposure to a given glucose concentration level could evoke a consistent cellular response at target tissues at the molecular levels. Some biological phenomena, such as the production and the concentration of advanced glycation end products (AGEs), reactive oxygen species (ROS) and protein kinase C (PKC) pathway activations, epigenetic changes, and finally, the miRNAs-mediated pathways, may be accountable for the development of hyperglycemic memory. This work summarizes evidence from previous experiments that may substantiate the hyperglycemic memory soundness by its justification in molecular terms.

Investigation of predictors of severity of diabetes complications among hospitalized patients with diabetes in Florida, 2016–2019

BackgroundSevere diabetes complications impact the quality of life of patients and may lead to premature deaths. However, these complications are preventable through proper glycemic control and management of risk factors. Understanding the risk factors of complications is important in guiding efforts to manage diabetes and reduce risks of its complications. Therefore, the objective of this study was to identify risk factors of severe diabetes complications among adult hospitalized patients with diabetes in Florida.MethodsHospital discharge data from 2016 to 2019 were obtained from the Florida Agency for Health Care Administration through a Data Use Agreement with the Florida Department of Health. Adapted Diabetes Complications Severity Index (aDCSI) scores were computed for 1,061,140 unique adult patients with a diagnosis of diabetes. Severe complications were defined as those with an aDCSI ≥ 4. Population average models, estimated using generalized estimating equations, were used to identify individual- and area-level predictors of severe diabetes complications.ResultsNon-Hispanic Black patients had the highest odds of severe diabetes complications compared to non-Hispanic White patients among both males (Odds Ratio [OR] = 1.20, 95% Confidence Interval [CI]: 1.17, 1.23) and females (OR = 1.27, 95% CI: 1.23, 1.31). Comorbidities associated with higher odds of severe complications included hypertension (OR = 2.30, 95% CI: 2.23, 2.37), hyperlipidemia (OR = 1.29, 95% CI: 1.27, 1.31), obesity (OR = 1.24, 95% CI: 1.21, 1.26) and depression (OR = 1.09, 95% CI: 1.07, 1.11), while the odds were lower for patients with a diagnosis of arthritis (OR = 0.81, 95% CI: 0.79, 0.82). Type of health insurance coverage was associated with the severity of diabetes complications, with significantly higher odds of severe complications among Medicare (OR = 1.85, 95% CI: 1.80, 1.90) and Medicaid (OR = 1.83, 95% CI: 1.77, 1.90) patients compared to those with private insurance. Residing within the least socioeconomically deprived ZIP code tabulation areas (ZCTAs) in the state had a protective effect compared to residing outside of these areas.ConclusionsRacial, ethnic, and socioeconomic disparities in the severity of diabetes complications exist among hospitalized patients in Florida. The observed disparities likely reflect challenges to maintaining glycemic control and managing cardiovascular risk factors, particularly for patients with multiple chronic conditions. Interventions to improve diabetes management should focus on populations with disproportionately high burdens of severe complications to improve quality of life and decrease premature mortality among adult patients with diabetes in Florida.

Protective Factors and the Pathogenesis of Complications in Diabetes.

Chronic complications of diabetes are due to myriad disorders of numerous metabolic pathways that are responsible for most of the morbidity and mortality associated with the disease. Traditionally, diabetes complications are divided into those of microvascular and macrovascular origin. We suggest revising this antiquated classification into diabetes complications of vascular, parenchymal, and hybrid (both vascular and parenchymal) tissue origin, since the profile of diabetes complications ranges from those involving only vascular tissues to those involving mostly parenchymal organs. A major paradigm shift has occurred in recent years regarding the pathogenesis of diabetes complications, in which the focus has shifted from studies on risks to those on the interplay between risk and protective factors. While risk factors are clearly important for the development of chronic complications in diabetes, recent studies have established that protective factors are equally significant in modulating the development and severity of diabetes complications. These protective responses may help explain the differential severity of complications, and even the lack of pathologies, in some tissues. Nevertheless, despite the growing number of studies on this field, comprehensive reviews on protective factors and their mechanisms of action are not available. This review thus focused on the clinical, biochemical, and molecular mechanisms that support the idea of endogenous protective factors, and their roles in the initiation and progression of chronic complications in diabetes. In addition, this review also aimed to identify the main needs of this field for future studies.

Adapted Diabetes Complications Severity Index and Charlson Comorbidity Index in predicting all-cause and cause-specific mortality among patients with type 2 diabetes

IntroductionAdapted Diabetes Complications Severity Index (aDCSI) is a commonly used severity measure based on the number and severity of diabetes complications using diagnosis codes. The validity of aDCSI in predicting...

The peroxidase-like activity of papain colorimetrically detects H2O2 and glucose with high sensitivity

To date, several glucometer methods are available for patient-guided glycemic control, which diminishes the onset and severity of diabetic complications. In a dipstick urine glucose test, horseradish peroxidase (HRP) oxidizes tetramethylbenzidine (TMB) in the presence of hydrogen peroxide (H2O2) to quantitatively produce a colorimetric signal and predict glucose concentration. Papain, a sulfhydryl protease secreted by the latex of Carica papaya, displays HRP-like activity with high selectivity. However, the current papain-based glucometer method lacks sensitivity. We hypothesized that catalyzing the oxidation of papain under varying buffer conditions (e.g., papain, TMB, and acetic acid concentrations) would improve glucose detection sensitivity. To test this, we performed glucose oxidase (GOx)-mediated glucose oxidation and papain-mediated TMB oxidation under varying sample conditions in vitro and spontaneously coupled them. The aims of this study were to validate the coupling of GOx-mediated glucose oxidation and papain-mediated TMB oxidation and identify the optimized conditions that maximize catalytic activity. We confirmed that glucose oxidase quantitatively produces H2O2 (in a glucose concentration-dependent manner), the presence of which catalyzes papain-mediated production of a colorimetric signal. When two oxidation reactions were coupled, we identified that the sensitivity of papain’s glucose detection increased by ten-fold compared to previous studies with a markedly high correlation (R2 = 0.99). In particular, substituting sodium acetate-acetic acid (HAc-NaAc) buffer with acetic acid and increasing the sample incubation time and papain concentration markedly increased the sensitivity of colorimetric signals. The optimized protocols can be integrated into emerging hydrogel technology to develop a non-invasive glucometer patch predicting blood glucose from the patient’s produced sweat.

Senolytics: Potential for Alleviating Diabetes and Its Complications.

Therapeutics that target cellular senescence, including novel “senolytic” compounds, hold significant promise for treating or preventing obesity-induced metabolic dysfunction, type 2 diabetes, and the multiple complications of diabetes and obesity. Senolytics selectively clear senescent cells, which accumulate with aging and obesity and represent a fundamental mechanism of aging that contributes to metabolic dysfunction and diabetes pathogenesis. In addition to improving metabolic function, targeting senescent cells holds promise as a preventive strategy to reduce the incidence and severity of diabetes complications. The intermittent administration schedule used for senolytic therapy may confer benefits in terms of improving adherence and limiting adverse effects. It is necessary to design effective clinical trials that will safely translate discoveries from preclinical models into human studies that may pave the way for a novel therapeutic class for treating obesity, diabetes, and their complications. In this review, we outline what is known regarding the role of cellular senescence in the pathogenesis of type 2 diabetes and its complications, present evidence from preclinical models that targeting cellular senescence is beneficial, review senolytic drugs, and outline the features of clinical trials investigating the role of targeting senescent cells for diabetes.

Evaluation of 1,5-Anhydroglucitol as a Biomarker for Type 2 Diabetes Mellitus in Patients without Overt Nephropathy

1,5-Anhydroglucitol (1,5-AG) is a non-fasting glycemic marker that responds to hyperglycemia excursions. The reduction in serum levels of 1,5-AG is associated with an increase in postprandial glycemia and glycosuria, phenomena that increase the risk and severity of diabetic complications. The objective is to assess the ability of 1,5-AG to discriminate type 2 diabetes (T2D) patients without overt kidney disease, for screening or diagnostic purposes. The Human Research Ethics Committee of Universidade Federal do Parana (UFPR) approved the project. Serum samples from 567 individuals classified as healthy subjects (n = 291) and T2D (n = 276) with moderate glycemic control (HbA1c of 7-8%), matched by gender, were analyzed. Serum 1,5-AG levels were measured using an automated enzymatic method (GlycoMark, Inc.). Receiver Operating Characteristic (ROC) curve analysis for 1,5-AG showed sensibility of 65.3% and specificity of 91.1% to detect T2D at cut-off point of 92 µmol/L. The results were similar to the groups’ discrimination by glycemia (sensibility/specificity, 62.2%; 89.0%) at cut-off point of 6.3 mmol/L. HbA1c was the best discriminator (sensibility/specificity, 87.4%; 94.2%) at a cut-off point of 5.8% (40 mmol/mol). The serum 1,5-AG concentration was not able to discriminate T2D in the presence of moderate glycemic control with no overt nephropathy.

Educational Needs Associated with the Level of Complication and Comparative Risk Perceptions in People with Type 2 Diabetes.

ObjectivesThis study aimed to identify the educational needs of people with type 2 diabetes according to risk perceptions and the level of severity of complications.MethodsThere were 177 study participants who were outpatients of the internal medicine department at a university hospital located in the Republic of Korea, who consented to participate in the survey from December 10, 2016 to February 10, 2017. The data were analyzed using descriptive statistics, Pearson correlation, ANOVA with post-hoc comparison, and multiple regression analysis. Type 2 diabetes complications were classified into 3 groups: no complications, common complications, and severe complications.ResultsThere were statistically significant positive correlations between educational needs and comparative risk perceptions, and the level of complication and comparative risk perception. Multiple regression analysis revealed that the factor predicting educational needs of type 2 diabetes people was their comparative risk perceptions, rather than the severity of diabetes complications or sociodemographic variables.ConclusionSince risk perception is the factor that indicates the educational needs of people with type 2 diabetes, there is a need to explore factors which increase risk perception, in order to meet educational needs. The findings suggest that a more specific and individualized educational program, which focuses on each person's risk perceptions, should be developed.

Study of hospitalization and mortality in Korean diabetic patients using the diabetes complications severity index

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) is expected to increase from 7.7% in 2017 to 8.4% in 2045 worldwide. Diabetes complications contribute to morbidity and mortality. To evaluate whether the diabetes complications severity index (DCSI) was associated with increased risks of mortality and hospitalization.MethodsA retrospective cohort study was conducted using the National Health Insurance Database (NHID) sample cohort of 1,102,047 patients (2002–2015) in Korea. Diabetes complications were evaluated at 2 years after the initial diagnosis and during the subsequent follow-up period (mean duration 6.56 ± 2.81 years). The type and severity of complications were evaluated on the basis of the International Classification of Disease Ninth (ICD-9) codes used in DCSI with 7 categories and 55 subcategories of complications. The Cox proportional hazard and Poisson regression models were used to evaluate the mortality and hospitalization rates. The incidence and relative risk of diabetes complications as well as the risk of mortality and hospitalization were the main outcome measures.ResultsA total of 27,871 patients were finally included and grouped by the number of complications present at 2 years. Four hundred ninety patients (5.37%) died without complications, 659 (7.31%) died with one complication and 1153 (11.85%) died with two or more complications. As DCSI at index date increased, the risk of additional new diabetes complications increased by 26% [relative risk (RR) 1.26, 95% CI 1.25–1.27]. The risks of mortality and hospitalization were linearly related to DCSI [hazard ratio 1.13 (95% CI 1.11–1.16), relative risk 1.04 (95% CI 1.03–1.06)].ConclusionsPatients with higher incidence and severity of diabetes complications have increased risks of mortality and hospitalization.

Clustering classification of diabetic walking abnormalities: a new approach taking into account intralimb coordination patterns

BackgroundIt is well recognized that diabetes and peripheral neuropathy have a detrimental effect on gait. However, there are large variations in the results of studies addressing this aspect due to the heterogeneity of diabetic population in relation to presence and severity of diabetes complications. The aim of this study is to adopt an unsupervised classification technique to better elucidate the gait changes throughout the entire spectrum of diabetes and neuropathy. MethodsSixty subjects were assessed and classified into four groups using a fuzzy logic model: 13 controls (55 ± 7years), 18 diabetics subjects without neuropathy (59 ± 6 years, 11 ± 7 diabetes years), 7 with mild neuropathy (56 ± 4years, 19 ± 7 diabetes years), and 22 with moderate to severe neuropathy (57 ± 5 years, 14 ± 8 diabetes years). Data were gathered by six infrared cameras at 100 Hz regarding lower limb joint kinematics (angles and angular velocities) and the relative phase for the hip-ankle, hip-knee, and knee-ankle were calculated. The K-means clustering algorithm was adopted to classify subjects considering the whole kinematics time series. A one-way ANOVA test was used to compare both clinical and kinematics parameters across clusters. ResultsOnly the classification based on the intralimb coordination variables succeeded in defining 5 well separated clusters with the following clinical characteristics: controls were grouped mainly in Cluster 2, diabetics in Cluster 4, and neuropathic subjects in Cluster 5 (which included various degrees of severity). Hip-ankle coordination in Clusters 4 and 5 were significantly different (p < 0.05) with respect to Cluster 2, mainly in the stance phase. During the swing phase, differences were observed in the ankle-knee coordination (p < 0.05) across clusters. ConclusionClassification based on intralimb coordination patterns succeeded in efficiently categorize gait alterations in diabetic subjects. It can be speculated that variables extracted from sagittal plane kinematics might be adopted as a support to clinical decision making in diabetes.

CLINICAL STUDY OF RETINOPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 1 AND TYPE 2 AND ITS ASSOCIATION WITH RISK FACTORS

Aim: To study the relationship between severity of diabetic retinopathy (PDR or NPDR) and systemic complications of diabetes mellitus such as Neuropathy, Nephropathy or Cardiovascular manifestation as hypertension.&#x0D; Methods and Materials: This prospective observational study of 100 patients suffering from diabetic retinopathy. Such patients were recruited as a part of the study and further examined for any other systemic abnormality as neuropathy, nephropathy or hypertension.&#x0D; Statistical Analysis: Chi square test, univariate and multivariate logistic regression analysis was performed. P value &lt; 0.05 was taken as significant.&#x0D; Results: Male: Female ratio of presence of diabetic retinopathy was 2.13: 1. The rate of proliferative diabetic retinopathy (PDR) was 1.47 % in persons who had diabetes for less than 5 years to 7.35 % in persons who had diabetes more than 15 years.&#x0D; In our study, it was seen that nephropathy was present in 35.71 % cases with PDR as compared to 8.93% of cases with Non proliferative diabetic retinopathy (NPDR).&#x0D; Conclusion: Our study showed that there is a significant correlation between severity of retinopathy and duration in type 2 Diabetes mellitus patients.&#x0D; Maximum number of patients with Diabetes mellitus having cardiovascular involvement, had hypertension (68%).In patients suffering from neuropathy as a complication of DM, maximum number of patients had diabetic foot (56%).It was seen that the severity of diabetic retinopathy had some association with presence of nephropathy.&#x0D; Also it can be postulated that patients with severe NPDR and PDR have high risk of developing nephropathy than patients suffering with mild and moderate NPDR.&#x0D; Hence it can be recommended that all patients of diabetes mellitus suffering from clinically significant neuropathy, nephropathy or hypertension as a complication of diabetes should always be screened for presence of retinopathy.&#x0D; Further studies with larger sample size are to be conducted to further look into this association.&#x0D; Keywords: Diabetic retinopathy, Diabetic nephropathy, diabetic neuropathy, complications

Pregnancy and delivery in a patient with a 40-year history of type 1 diabetes mellitus and antiphospholipid syndrome

Type 1 diabetes mellitus is a condition associated with an increased risk of adverse perinatal outcomes such as spontaneous abortions, preterm birth, placental insufficiency, congenital malformations, and perinatal mortality. Diabetes mellitus combined with cardiovascular diseases in women during pregnancy often leads to hypertensive disorders and pre-eclampsia. The severity of the microvascular diabetic complications and frequency of hypoglycemic episodes, particularly in early pregnancy, are related to the risk of pre-eclampsia. We report the case of pregnancy and delivery of a live newborn in a 42-year-old woman with type 1 diabetes mellitus, pre-existing hypertension, heritable thrombophilia, and antiphospholipid syndrome. She had a 40-year history of type 1 diabetes mellitus with well-controlled diabetic nephropathy and retinopathy. The woman had been receiving continuous subcutaneous insulin therapy for the last five years, which allowed maintaining an appropriate glycemic control during pregnancy. Multidisciplinary supervision of course of pregnancy was carried out from the pre-gravidity stage until delivery and postpartum. In spite of the severe pre-eclampsia and preterm delivery by cesarean section at 36 weeks, she and newborn could avoid the intensive unit care and discharge from perinatal center without any complications.

Assessment of advanced glycation end-products as a biomarker of diabetic outcomes

There are substantial differences in the onset and severity of diabetes complications that are not fully explained by HbA1c levels and other risk factors. HbA1c is the gold standard for assessing metabolic control, but has limited value to identify patients at risk of developing diabetic complications. The main disadvantage of HbA1c is that it does not provide information about glycemic variability and does not reflect long-term exposure to hyperglycemia. One of the main pathogenetic mechanisms of diabetic complications is the generation and accumulation of advanced glycation end-products (AGEs). Based on its fluorescence properties, AGEs may be measured in tissues such as the skin or lens. These non-invasive measurements of AGE accumulation may be considered as promising biomarkers of late diabetic complications, and our objective is to summarize the available evidence supporting this statement. However, further translational research and prospective clinical trials are needed before these new biomarkers may be incorporated into clinical practice.

Assessment of advanced glycation end-products as a biomarker of diabetic outcomes

There are substantial differences in the onset and severity of diabetes complications that are not fully explained by HbA1c levels and other risk factors. HbA1c is the gold standard for assessing metabolic control, but has limited value to identify patients at risk of developing diabetic complications. The main disadvantage of HbA1c is that it does not provide information about glycemic variability and does not reflect long-term exposure to hyperglycemia. One of the main pathogenetic mechanisms of diabetic complications is the generation and accumulation of advanced glycation end-products (AGEs). Based on its fluorescence properties, AGEs may be measured in tissues such as the skin or lens. These non-invasive measurements of AGE accumulation may be considered as promising biomarkers of late diabetic complications, and our objective is to summarize the available evidence supporting this statement. However, further translational research and prospective clinical trials are needed before these new biomarkers may be incorporated into clinical practice.

Association of the severity of diabetes-related complications with stage of breast cancer at diagnosis among elderly women with pre-existing diabetes.

This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC. Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004-2011 and pre-existing diabetes (N=7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis. Overall, women with a DCSI=2 and aDCSI≥3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with aDCSI=2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03-1.53). The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis.

Skin Autofluorescence is Associated with Early-stage Atherosclerosis in Patients with Type 1 Diabetes

Aim: Accumulation level of fluorescent advanced glycation end products (AGEs) in the skin can be measured non-invasively as skin autofluorescence (skin AF) by autofluorescence reader. The aim of this study was to assess possible associations between skin AF and diabetic complications, especially early-stage atherosclerosis, in Japanese type 1 diabetic patients.Methods: Skin AF was measured by AGE reader® in 105 Japanese type 1 diabetic patients (34 men and 71 women, aged 37.4 ± 12.4 years (± SD)) and 23 age-matched healthy non-diabetic subjects. Ultrasonic carotid intima-media thickness (IMT), ankle-brachial index (ABI), and brachial ankle pulse wave velocity (baPWV) were evaluated as indices of early-stage diabetic macroangiopathy. Urinary albumin-to-creatinine ratio (UACR), the coefficient of variation of R-R intervals (CVR-R), and presence of retinopathy were also evaluated.Results: Skin AF values were significantly higher in type 1 diabetic patients than in healthy controls (2.07 ± 0.50 (mean ± SD) and 1.90 ± 0.26, respectively, p = 0.024). Skin AF was associated with carotid IMT (r = 0.446, p <0.001) and baPWV (r = 0.450, p <0.001), but not with ABI (r = −0.019, p = 0.8488). Notably, skin AF was an independent risk factor for IMT thickening. Similarly, skin AF was associated with log (UACR) (r = 0.194, p = 0.049) and was an independent risk factor for UACR. Furthermore, skin AF values were significantly higher in patients with diabetic retinopathy than in those without (2.21 ± 0.08 and 1.97 ± 0.06, respectively, p = 0.020).Conclusions: Skin AF was significantly associated with the presence and/or severity of diabetic complications and was an independent risk factor for carotid atherosclerosis.

Personalized Therapy by Phenotype and Genotype

Upon the publication of the results of the 20-year-long UK Prospective Diabetes Study (UKPDS) (1), the general recommendation was to achieve, in as many as possible of individuals with type 2 diabetes (T2DM), a target HbA1c value ≤7%, i.e., the average value associated with significant reduction in the risk of micro- and macrovascular complications. This “universal” glycemic target, however, has been challenged by the results of subsequent intervention trials (2–4). Given the critical analysis of the results of these trials, the American Diabetes Association (ADA) and the American Heart Association suggested that an individualized HbA1c target should be identified based on the duration of diabetes, life expectancy, presence and severity of diabetes complications, and propensity for hypoglycemia (5). This suggestion has been endorsed by several international guidelines. They also suggest a selection of glucose-lowering strategies to be individualized in order to ensure the most appropriate risk-to-benefit ratio for all patients. According to the ADA/European Association for the Study of Diabetes position statement for T2DM management (6), this can be achieved through balanced assessment of efficacy, risk of hypoglycemia, effect on body weight, and costs of available glucose-lowering agents and their combination. Although the concept of treatment individualization is appealing, how to pursue it in the clinical setting remains highly debated. To this purpose, careful phenotypic description of the person with T2DM may be appropriate. A few years ago, the ABCD approach was proposed to help physicians in individualizing glycemic target and treatment selection (7). “ABCD” stands for four phenotypic traits that are easy to collect and to factor in: age, body weight, complications and comorbidities, and duration of diabetes. ### Age Age is the strongest risk factor for life expectancy and mortality. The number of elderly people with diabetes is growing, and >70% of the elderly with T2DM …

Recent trends in the use of antidiabetic medications from 2008 to 2013: A nation-wide population-based study from Taiwan.

Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase-4 inhibitors [DPP-4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP-4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs. Cases of type 2 diabetes were derived from Taiwan's National Health Insurance Research Database. Antidiabetic drug use was measured in terms of total quantity of drug exposure and healthcare spending in each calendar year from 2008 to 2103. Multiple logistic regression analysis was used to assess factors associated with drug choice. The use of and healthcare spending on DPP-4i increased significantly from 2008 to 2013, whereas healthcare spending on sulfonylureas decreased. For monotherapy, sulfonylureas were the most common alternatives to metformin, whereas in dual and triple antidiabetic therapies, a DPP-4i was the most common alternative to initial regimens. The use of a DPP-4i was positively associated with the use of beta-blockers, angiotensin II-converting enzyme inhibitors and/or angiotensin receptor blockers, and lipid-lowering agents, but negatively correlated with age, hypertension, severity of diabetes complications, and the use of diuretics and calcium channel blockers. With growing spending on newer antidiabetic drugs, future research on the comparative cost-effectiveness and safety of antidiabetic drugs is anticipated.

Diabetic dermangiopathy - A micrometric study

Aim Diabetes mellitus (DM) is the most common endocrine disorder and cutaneous disorders associated with DM are thought to occur in about one-third of patients. The present study was undertaken to assess the alterations in the small blood vessels. Methods Skin biopsies from 100 type 2 diabetic patients and 15 non-diabetic controls were studied to observe the dermangiopathic changes. The lumen diameter and basement membrane width were measured. Depending on deposition of PAS-positive material in the vessel wall, the dermangiopathic changes were graded as 1 +, 2 + and 3 +. Results 80% of the cases showed 2 + (69%) or 3 + (11%) changes. The other 20% cases showed 1 + change and were not taken as positive evidence of microangiopathy. Mean BMT was measured as 6.06 microns and mean LD was 53.9 microns. The mean BMT:LD ratio was 0.11. No correlation was observed between age, duration of diabetes, severity of disease, diabetic complications and microangiopathy. A positive correlation was observed between the grades of microangiopathy and the basement membrane thickness. Discussion Characteristic angiopathy is demonstrable in vessels of diabetic patients and the vessel basement membrane thickness is an important criterion to grade diabetic dermangiopathy.