Symptoms In Diabetic Patients Research Articles

Prevalence and correlates of insomnia and fatigue in patients with type 2 diabetes in Jordan.

Objective: The present study examined the prevalence and correlates of insomnia and fatigue in patients with type-2 diabetes in Jordan.Methods: This was a cross-sectional online study involving a convenience sample of 390 patients with type-2 diabetes. Insomnia was assessed by the Insomnia-Severity Index (ISI-A) and fatigue by the Brief Fatigue Inventory (BFI-A).Results: Severe insomnia was present in 132 patients (33.8%), and was correlated with length of diabetes (diagnosis >5years) (OR = 2.13, 95% CI = 1.19-3.81, P = 0.01), presence of uncontrolled diabetes (OR = 1.97, 95% CI = 1.45-2.69, P < 0.001), taking gabapentin (OR = 2.07, 95% CI = 1.07-4.01, P = 0.003), and age (<40 years) (OR = 0.30, 95% CI = 0.13-0.69, P = 0.005). Significant fatigue was also prevalent and correlated with gender (female) (B = 9.25, t = 4.48, P < 0.001), age (<40years) (B = 7.56, t = 2.56, P = 0.01), a diagnosis of hypertension (B = 4.74, t = 2.03, P = 0.04), uncontrolled diabetes (B = 7.21, t = 4.82, P < 0.001), and taking a sulfonylurea (B = 8.03, t = 3.37, P < 0.001), carbamazepine (B = 10.93, t = 2.65, P = 0.008), or gabapentin (B = 12.60, t = 3.83, P < 0.001).Conclusion: Given the high prevalence of insomnia and fatigue in this population, increased attention by primary healthcare providers to these symptoms in diabetic patients is required, particularly in developing countries such as Jordan.

The associations between dietary flavonoids intake and risk of depressive symptom in diabetic patients: Data from NHANES 2007–2008, 2009–2010, and 2017–2018

BackgroundThe increasing incidence of depressive symptoms in diabetic patients contributes to the global burden of disease, but few epidemiological studies have evaluated the relationship between dietary flavonoids intake and depressive symptoms in diabetic patients in American adults. ObjectiveThis study intended to evaluate the associations of dietary flavonoids intake and depressive symptoms in diabetic patients in American adults. MethodsWe conducted a cross-sectional analysis of 1993 adults aged ≥20 years old who participated in the 2007–2008, 2009–2010, and 2017–2018 National Health and Nutrition Examination Surveys (NHANES). Chi-square test and independent-sample t-test were used to compare subjects' characteristics. Logistic regression model was further used to analyze the relationship between dietary flavonoid intake and depressive symptoms in diabetic patients. Restricted cubic spline (RCS) analysis was used to investigate the non-linear relationship between dietary flavonoid intake and the prevalence of depressive symptoms in diabetic patients. The weighted quartile sum (WQS) regression was used to analyze the effect of 29 flavonoids monomers. ResultsThe results showed that the total flavonoid intake in the third quartile (OR, 0.635; 95 % CI,0.419–0.962; P, 0.032) was significantly associated with a reduced risk of depressive symptoms in diabetic patients compared with the lowest quartile. And there was a U-shaped association between dietary flavonoid intake and risk of depressive symptoms in diabetic patients. Top contributors of flavonoid monomers were eriodictyol, naringenin, and theaflavin-3′-gallate, accounting for a percentage of 30.83 %, 22.17 %, and 6.92 %, respectively. ConclusionModerate (56.07–207.12 mg/day) dietary flavonoid intake was associated with a reduced risk of depressive symptoms in diabetic patients. The important flavonoid monomers were eriodictyol, naringenin, and theaflavin-3′-gallate.

Investigating the Influence of Antidiabetic Medications and Psychosocial Factors.

The relationship between type 2 diabetes mellitus (T2DM) and depression presents a significant area of medical concern, characterized by a higher incidence of depression among T2DM patients compared to the general population. This connection is not only evidenced in the prevalence of depressive symptoms in diabetic patients but also in the way these symptoms impact diabetes management. Furthermore, the influence of antidiabetic medications, especially sodium-glucose cotransporter-2 (SGLT2) inhibitors, on depression risk is a topic of ongoing research, with contrasting findings regarding the effects of drugs like metformin and pioglitazone. The aim of this study is to provide a comprehensive analysis of the relationship between T2DM and depression, focusing on the prevalence of depressive symptoms among diabetic patients, and the role of antidiabetic medications in modulating depression risk. Methods Utilizing data from the National Health and Nutrition Examination Survey (NHANES), we focused on individuals with T2DM. Depression status was assessed using the nine-item Patient Health Questionnaire (PHQ-9), a validated tool for evaluating depressive symptoms. Participants' depression status was categorized based on PHQ-9 composite scores. The analysis included demographic variables and the use of antidiabetic medications, with a focus on SGLT2 inhibitors. Logistic regression models adjusted for age, race/ethnicity, and BMI were employed. Results Our study involved 23,575 participants, of which 7,862 had T2DM. A significant difference in age and BMI was observed between diabetic and non-diabetic groups. Logistic regression analysis indicated that non-diabetic individuals had a significantly lower likelihood of depression compared to diabetic patients not on SGLT2 inhibitors. However, no statistically significant difference in depression levels was found between diabetic patients on SGLT2 inhibitors and those not on these medications. Conclusion These findings highlight the complex relationship between diabetes, antidiabetic medication, and depression. Notably, we found no significant impact of SGLT2 inhibitors on depression in diabetic patients, challenging previous assumptions about the role of specific antidiabetic drugs in mental health. We also revealed that older diabetic individuals reported fewer depressive symptoms, suggesting the influence of psychosocial factors and the need for age-specific depression management strategies. This research underscores the necessity of further studies to explore the nuanced effects of different antidiabetic medications on mental health outcomes, guiding toward more personalized treatment approaches for the mental health challenges in T2DM.

Attention deficit hyperactivity disorder in the diabetic population: relationship with metabolic syndrome and atherogenic index of plasma

Aims: The objective of the current study is to investigate the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) among individuals diagnosed with diabetes mellitus (DM). Additionally, this study aims to evaluate the potential association between ADHD and metabolic syndrome (MetS), atherogenic index of plasma (AIP), and other lipid parameters, considering the different types of DM. Methods: The study comprised 213 adult patients diagnosed with diabetes mellitus, consisting of 120 females and 93 males. Participants completed the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) as a screening tool for symptoms. The study assessed many physiological indicators, including body mass index, waist circumference, blood pressure, glucose levels, cholesterol levels, high-density lipoprotein levels, low-density lipoprotein levels, triglyceride levels, uric acid levels, and glycated hemoglobin levels. Results: The study yielded a prevalence rate of 10.7% for ADHD among diabetes individuals. The prevalence of ADHD was found to be more common in individuals diagnosed with type 1 diabetes mellitus (T1DM) compared to those with type 2 diabetes mellitus (T2DM), with rates of 15.4% and 9.8% respectively. The study revealed that individuals diagnosed with T2DM who also had MetS, organ involvement, concurrent disorders, and stress-related eating had significantly higher scores on the ASRS/T scale. There was a correlation observed between the ASRS-HI and AIP levels in individuals diagnosed with T2DM. The statistical analysis revealed that ADHD-HI and T scores significantly influenced the severity of MetS. A progressive increase in ASRS/T and ASRS/I scores was observed with the duration of DM. Conclusion: In conclusion, by recognizing and treating accompanying neuropsychiatric conditions such as ADHD symptoms in diabetic patients, individuals may exhibit improved adherence to lifestyle modifications and antidiabetic therapies. This approach potentially reduces the risks of acute and chronic complications, including cardiovascular risk, through the enhanced management of DM.

Rare Emergency Case of Bowel Ischaemia as a Result of Diabetic Ketoacidosis Complication: A Case Report and Literature Review of an Unusual Entity

Introduction and Importance: Diabetic ketoacidosis (DKA) is a life-threatening situation that if inadequately managed, is related to high fatality risk. It is associated with mesenteric ischaemia that necessitates early detection and intervention to enhance the prognosis for mesenteric ischaemia. Case Presentation: A 58-year-old male patient presented to our hospital with severe generalized abdominal pain, vomiting, and polyurea. On admission, he was newly diagnosed with diabetes mellitus type II (DM II) which is complicated by DKA. Days later, his abdominal pain worsened, and bowel obstruction was confirmed by both X-ray and ultrasonography of the abdomen. Due to the deterioration in the patient’s clinical condition, an emergent diagnostic laparoscopy was decided which was followed by an open laparotomy with bowel resection of the detected dilated and ischaemic bowel loops. The resected specimens, including small bowel and peritoneal wall mass, were sent for histopathological studies. Three re-look laparotomies were also performed, and the postoperative period was uneventful. Clinical Discussion: Intestinal ischaemia is a rare complication of DKA. Bowel ischaemia can be either occlusive or nonocclusive mesenteric types. It is clinically manifested by abdominal symptoms in diabetic patients. Evaluation is mainly by abdominal computed tomography (CT) and the main treatment approach is laparoscopy and/or laparotomy in combination with resection of the affected bowel loops. Conclusion: In our case report, we document an additional unusual case of intestinal ischaemia and necrosis as a DKA consequence, in a recently diagnosed DM II patient, as one of the few non-occlusive mesenteric ischaemia causes.

Kwas alfa-liponowy w prewencji powikłań cukrzycowych

Diabetes is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced (insulin resistance). Chronic hyperglycemia is associated with damage of small and large blood vessels in many tissues and organs (micro- and macroangiopathy). Microvascular complications may contribute to the diabetic retinopathy and neuropathy. Diabetes is strongly associated with increased oxidative stress, which could be a consequence of either increased production of free radicals or reduced antioxidant defenses. Many of the biochemical pathways (e.g., protein glycation, polyol pathway, protein kinase C activation) associated with hyperglycemia can result in increased reactive oxygen species. An ideal therapeutic antioxidant should fulfill several criteria. These include absorption from the diet, conversion in cells and tissues into usable form, a variety of antioxidant actions (including interactions with other antioxidants) in both membrane and aqueous phases, and low toxicity. Alpha-lipoic acid is unique among natural antioxidants in its ability to fulfill all of these requirements. Alpha-lipoic acid has been shown to have diverse beneficial effects suggesting that it acts by multiple mechanisms on oxidative stress parameters. Alpha-lipoic acid’s antioxidant properties consist of the following: 1) its capacity to directly scavenge reactive oxygen species, 2) its ability to regenerate endogenous antioxidants, such as glutathione, vitamins E and C, and 3) its metal chelating activity, resulting in reduced reactive oxygen species production. Alpha-lipoic acid prevents micro-vascular damage through normalized pathways downstream of mitochondrial overproduction of reactive oxygen species. Alpha-lipoic acid inhibits diabetes-induced apoptosis of both endothelial cells and pericytes, signs and predictor of retinopathy, and prevents nerve ischemia and hypoxia whitch could cause neuropathy. Alpha-lipoic acid supplementation is an achievable adjunct therapy to help prevent vision loss and reduce neuropathic symptoms in diabetic patients. Honokiol is a natural polyphenolic compound extracted from the bark, cone and leaves of Magnolia. Honokiol is used in traditional Chinese and Japanese medicine for the treatment of various diseases. This promising bioactive compound presented an wide range of therapeutic and biological activities which include neuroprotective, anti-spasmodic, antidepressant, anti-tumorigenic, antithrombotic, antimicrobial, analgesic properties, and others. Some of its mechanism for exhibiting its pharmacological effects includes inhibition of oxidative stress and suppression of pro-inflammatory cytokines (TNF-α, IL-10 and IL-6). Honokiol might exert its protective effect on hyperglycemia-induced cell damage in human endothelial cells through the inhibition of NF-κB and COX-2 upregulation. Low-dose of honokiol may have the potential to protect endothelial cells from damage associated with elevated glucose.

Socio-economic Status and Depressive Symptoms in Diabetes Patients: A Cross-Sectional Study

Socio-economic Status and Depressive Symptoms in Diabetes Patients: A Cross-Sectional Study

Effect of Aerobic Exercise with and without Strengthening Exercises on Neuropathic Symptoms in People with Diabetic Peripheral Neuropathy

Background: The incidence of peripheral neuropathy among chronic diabetic patients is escalating, with a notable rise observed in Pakistan. This trend has been partly attributed to the predominant reliance on pharmacotherapy, while the role of physical exercise in management remains underutilized. Aerobic exercise is widely recommended in clinical guidelines for the treatment and prevention of diabetic complications, and it is hypothesized that the addition of strength training could yield even more benefits. Objective: This study aimed to evaluate the effects of combined aerobic and strength training exercises on neuropathic symptoms in patients with diabetic peripheral neuropathy. Methods: In this randomized clinical trial, 40 patients with diabetic peripheral neuropathy were equally divided into two groups: Group A underwent a combined regimen of aerobic and strength training exercises, whereas Group B engaged in aerobic exercises alone. The effectiveness of these interventions was assessed using the Michigan Neuropathy Screening Instrument (MNSI), Numeric Pain Rating Scale (NPRS), and Clinical Global Impression of Change (CGIC). Data were analyzed using SPSS version 20.0, employing independent t-tests, repeated measures ANOVA, and descriptive statistics for in-depth analysis. Results: Group A demonstrated a significant reduction in MNSI scores with a mean difference of 1.700 and a p-value &lt; 0.001, indicating a substantial improvement in neuropathic symptoms compared to Group B. While both groups showed significant improvements in NPRS and CGIC scores, the differences were not statistically significant, with p-values of 0.599 and 0.330, respectively, and mean differences of 0.1500 and 0.2500 for NPRS and CGIC. The overall statistical analysis revealed a high significance level (p &lt; 0.001) within both groups in all measured outcomes, suggesting considerable improvements post-intervention. Conclusion: The addition of strength training to aerobic exercises significantly enhances the reduction of neuropathic symptoms in diabetic patients. However, for pain relief and overall clinical improvement, both treatment approaches—combined aerobic and strength training or aerobic exercise alone—were equally effective.

A randomized clinical trial of the impacts of vitamin D 5000 IU supplementation on vitamin D levels and neuropathy symptoms in diabetic patients

A randomized clinical trial of the impacts of vitamin D 5000 IU supplementation on vitamin D levels and neuropathy symptoms in diabetic patients

Persistence of Symptoms Following Infection With COVID-19 Among Patients With Type 1 and Type 2 Diabetes Mellitus in Saudi Arabia.

In Saudi Arabia, information on the persistence of COVID-19-related complications in diabetic patients, their associations with the type of diabetes mellitus (DM), and the role of uncontrolled DM in the complications remains elusive. This study aims to fill this gap. This study aimed to examine the persistence of COVID-19 complications in diabetic patients. A simple randomized, cross-sectional, questionnaire-based study among patients with type 1 and 2 DM following infection with COVID-19 in Saudi Arabia. In the present study, a total of 674 participants were included. Among the COVID-19 symptoms, fatigue (65.6%) was reported the most frequently, followed by headache (62.3%) and cough (59.8%). About 44% of patients reported high blood sugar levels, including 25.5% with elevated fasting (>126 mg/dL) and 18.5% with elevated postprandial (>200 mg/dL) glucose levels. We also report that age > 55 years [OR= 1.66 (1.01-2.56), p=0.045], anti-diabetic medications [OR= 2.10 (1.82-3.91), p=0.022], multiple comorbidities [OR= 3.21 (1.98-4.85), p=0.005], chest pain [OR= 2.54 (0.96-3.81), p=0.003], and joint pain [OR= 1.64 (0.73-2.94), p=0.025] were independently associated with COVID-19-related complications in diabetic patients. The most common persistent symptoms in diabetic patients with COVID-19 infection are fatigue, headaches, and cough. Advanced age and use of antidiabetic medications were independently associated with COVID-19-related complications in diabetic patients.

Physical activity in a swimming pool attenuates memory impairment by reducing glutamate and inflammatory cytokines and increasing BDNF in the brain of mice with type 2 diabetes

Type 2 diabetes is a risk factor for the development of cognitive impairment. Increasing evidence suggests that regular exercise is beneficial for the treatment of clinical symptoms in diabetic patients. The current study aimed to evaluate whether increasing physical activity through swimming training can reduce memory impairment in an animal model of type 2 diabetes. Diabetes and non-diabetes mice underwent swimming training for four weeks, and then working, spatial, and recognition memory were evaluated using three behavioral tests. Body weight, glucose, and insulin resistance were monitored. We also measured inflammatory cytokines (interleukin (IL)− 6, IL-1β, and tumor-necrosis-factor (TNF)-α), an anti-inflammatory cytokine (IL-10), and brain-derived-neurotrophic-factor (BDNF), and glutamate levels in the hippocampus or prefrontal cortex of mice. The findings showed that diabetes increased body weight, glucose, and insulin resistance, impaired working, spatial and recognition memory, increased levels of IL-6, IL-1β, TNF-α, and glutamate levels, and decreased BDNF in the hippocampus of diabetic mice. While higher physical activity was associated with reduced body weight, glucose, and insulin resistance, attenuated memory impairment, IL-6, IL-1β, TNF-α, and glutamate, and increased BDNF levels in the hippocampus and prefrontal cortex of diabetic mice. This study shows that swimming training can normalize body weight and glucose-insulin axis and reduce inflammation and glutamate in the hippocampus and enhance the neurotrophic system in both the hippocampus and prefrontal cortex of diabetic mice. This study also suggests that higher physical activity through swimming training can improve cognitive impairment in a mouse model of type 2 diabetes.

The Effects of a 10-Week Aerobic and Unilateral Lower Extremity Resistance Training Program on Amplitude and Nerve Conduction Velocity of Sensory and Motor Nerves in Diabetic Patients with Neuropathy.

This study aimed to investigate the effects of 10-week aerobic and unilateral lower extremity resistance training on nerve conduction velocity and amplitude of sensory and motor nerves in diabetic patients with neuropathy. This clinical trial was conducted on twenty women and men (aged 30-60 years old) with diabetic neuropathy. Participants were randomly assigned to one of the two groups: an exercise group (EG; n = 10) and a control group (CG; n = 10). The EG performed a 10-week programme with one session of aerobic exercises (40% to 70% of HR reserve), supplemented with one session of specific lower extremity resistance exercises (60-90 min/day) on the same day for four days per week. The CG subjects performed their regular daily activities. The nerve conduction velocity, amplitude of sensory and motor nerves and glycosylated haemoglobin A1c were measured before and after the intervention. The repeated-measures ANOVA showed a significant increase in the conduction velocity of the sural sensory nerve as well as the peroneal motor nerve (p < 0.01, p < 0.01). The changes in the conduction velocity of the tibial nerve were similar when compared to the control group (p > 0.05). A significantly greater decrease in glycosylated haemoglobin was also observed in the EG group (p < 0.01). Performing 10 weeks of aerobic and specific unilateral lower extremity exercises can improve the function of sensory and motor nerves and improve symptoms in diabetic patients with neuropathy. Given the limited studies in this area, the exact mechanisms of this performance improvement need further examination.

Demographic and Clinical Factors Associated with Depression in 140 Hospitalized Diabetic Patients with Distal Symmetric Polyneuropathy Evaluated Using Beck Depression Inventory and 6-Item Neuropathy Total Symptom Score Questionnaire.

BACKGROUND Diabetic distal symmetric polyneuropathy (DSPN) is one of the most common and costliest long-term complications. The pain and function limitations may lead to depression. This study aimed to assess the influence of demographic and clinical factors on the prevalence of depression among diabetic patients with distal symmetric polyneuropathy (DSPN). MATERIAL AND METHODS A total of 140 patients with diabetic DSPN completed the 21-item Beck Depression Inventory (BDI) measuring characteristic attitudes and symptoms of depression. The intensity of neuropathic complaints was assessed using the Neuropathy Total Symptom Score- 6 items (NTSS-6). Testing for peripheral neuropathy was performed. All patients completed questionnaires, which included anthropometric measures, social parameters, and medical aspects. Statistical analyses were done using STATISTICA 8 PL software. RESULTS Statistically significant relationships were found between the depression symptoms in diabetic patients and the intensity of subjective neuropathy symptoms evaluated by NTSS-6, body mass index (BMI), and education level. On average, each 1-point increase in NTSS-6 predicted a 16% increase in the risk of depression. Each 1 kg/m² increase in the BMI was associated with a 10% increase of depression risk. CONCLUSIONS The study showed the positive quantitative relationship between diabetic DSPN and depression symptoms. The BMI, severity of neuropathy symptoms, and lower level of education had a statistically significant association with the level of depression and may be useful in evaluating the risk of depression among DSPN patients.

The potential antidepressant effect of antidiabetic agents: New insights from a pharmacovigilance study based on data from the reporting system databases FAERS and VigiBase.

Background: Growing evidence supports a bidirectional association between diabetes and depression; promising but limited and conflicting data from human studies support the intriguing possibility that antidiabetic agents may be used to relieve effectively depressive symptoms in diabetic patients. We investigated the potential antidepressant effects of antidiabetic drugs in a high-scale population data from the two most important pharmacovigilance databases, i.e., the FDA Adverse Event Reporting System (FAERS) and the VigiBase. Material and methods: From the two primary cohorts of patients treated with antidepressants retrieved from FDA Adverse Event Reporting System and VigiBase we identified cases (depressed patients experiencing therapy failure) and non-cases (depressed patients experiencing any other adverse event). We then calculated the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Empirical Bayes Regression-Adjusted Mean (ERAM) for cases versus non-cases in relation with the concurrent exposure to at least one of the following antidiabetic agent: A10BA Biguanides; A10BB Sulfonylureas; A10BG Thiazolidinediones; A10BH DPP4-inhibitors; A10BJ GLP-1 analogues; A10BK SGLT2 inhibitors (i.e., those agents for which preliminary evidence from literature supports our pharmacological hypothesis). Results: For GLP-1 analogues, all the disproportionality scores showed values <1, i.e., statistically significant, in both analyses [from the FAERS: ROR confidence interval of 0.546 (0.450-0.662); PRR (p-value) of 0.596 (0.000); EBGM (CI) of 0.488 (0.407-0.582); ERAM (CI) of 0.480 (0.398-0.569) and VigiBase: ROR (CI) of 0.717 (0.559-0.921); PRR (p-value) of 0.745 (0.033); EBGM (CI) of 0.586 (0.464-0.733); ERAM of (CI): 0.515 (0.403-0.639)]. Alongside GLP-1 analogues, DPP-4 Inhibitors and Sulfonylureas showed the greatest potential protective effect. With regard to specific antidiabetic agents, liraglutide and gliclazide were associated with a statistically significant decrease in all disproportionality scores, in both analyses. Conclusion: The findings of this study provide encouraging results, albeit preliminary, supporting the need for further clinical research for investigating repurposing of antidiabetic drugs for neuropsychiatric disorders.

Microvascular Myocardial Ischemia in Patients With Diabetes Without Obstructive Coronary Stenosis and Its Association With Angina.

To investigate the incidence of microvascular myocardial ischemia in diabetic patients without obstructive coronary artery disease (CAD) and its relationship with angina. Diabetic patients and an intermediate-to-high pretest probability of CAD were prospectively enrolled. Non-diabetic patients but with an intermediate-to-high pretest probability of CAD were retrospectively included as controls. The patients underwent dynamic computed tomography-myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) to quantify coronary stenosis, myocardial blood flow (MBF), and extracellular volume (ECV). The proportion of patients with microvascular myocardial ischemia, defined as any myocardial segment with a mean MBF ≤ of 100 mL/min/100 mL, in patients without obstructive CAD (Coronary Artery Disease-Reporting and Data System [CAD-RADS] grade 0-2 on CCTA) was determined. Various quantitative parameters of the patients with and without diabetes without obstructive CAD were compared. Multivariable analysis was used to determine the association between microvascular myocardial ischemia and angina symptoms in diabetic patients without obstructive CAD. One hundred and fifty-two diabetic patients (mean age: 59.7 ± 10.7; 77 males) and 266 non-diabetic patients (62.0 ± 12.3; 167 males) were enrolled; CCTA revealed 113 and 155 patients without obstructive CAD, respectively. For patients without obstructive CAD, the mean global MBF was significantly lower for those with diabetes than for those without (152.8 mL/min/100 mL vs. 170.4 mL/min/100 mL, P < 0.001). The mean ECV was significantly higher for diabetic patients (27.2% vs. 25.8%, P = 0.009). Among the patients without obstructive CAD, the incidence of microvascular myocardial ischemia (36.3% [41/113] vs. 10.3% [16/155], P < 0.001) and interstitial fibrosis (69.9% [79/113] vs. 33.3% [8/24], P = 0.001) were significantly higher in diabetic patients than in the controls. The presence of microvascular myocardial ischemia was independently associated with angina symptoms (adjusted odds ratio = 3.439, P = 0.037) in diabetic patients but without obstructive CAD. Dynamic CT-MPI + CCTA revealed a high incidence of microvascular myocardial ischemia in diabetic patients without obstructive CAD. Microvascular myocardial ischemia is strongly associated with angina.

An evaluation of lower urinary tract symptoms in diabetic patients: a cross-sectional study

BackgroundLower urinary tract symptoms (LUTS) are common among diabetic patients and represent hidden and mysterious morbidity. The pathophysiology of LUTS among diabetes mellitus (DM) patients is multifactorial. Importantly, LUTS is known to cause physical and psychological distress. Thus, this study describes LUTS among DM patients, investigates factors that may associate with it, and assesses the possible relationship between LUTS and the quality of life of diabetics.MethodsOver 6 months, data were collected from 378 diabetic patients in primary health care clinics. Demographic and clinical characteristics, Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7) were used to collect data. Univariate and multivariate analyses were performed.ResultsThree hundred seventy-eight participants were included in this study. (29.9%) were (58–67) years old. 49% were female. Half of the cohort was overweight, and a third were obese. 81% were Type 2 DM. Almost all of them are on medical treatment. A median score of 5.50 (2.00–8.00) for the UDI-6 scale and a median score of 5 (0.00–10.00) for the IIQ-7 scale were reported. Multiple linear regression models showed that residency (p = 0.038) and regular exercise (p = 0.001) were significantly and negatively correlated with the UDI-6 score, while female gender (p = 0.042), insulin use (p = 0.009) and the presence of comorbidities (p = 0.007) were positively correlated with this score. Furthermore, age (p = 0.040) and body mass index (BMI) (p < 0.001) were significantly and positively associated with the IIQ-7 score.ConclusionLUTS is significant morbidity among DM patients. Factors such as age, BMI, and co-morbidities exacerbate LUTS, which can be modified and controlled. On the other hand, regular exercise and weight loss strategies help diabetic patients to improve LUTS.

Metformin for the Improvement of Comorbid Depression Symptoms in Diabetic Patients: A Systematic Review.

Diabetes mellitus and depression are chronic debilitating disorders and can occur comorbidly. They are thought to be linked not only through environmental and behavioral factors but through molecular mechanisms as well. Antidepressant medication and psychological therapy, standard treatments for depressive symptoms in Type 2 diabetes mellitus, are linked to high rates of treatment failure and non-adherence; therefore, understanding the molecular mechanisms linking diabetes and depression could lead to discovering new targets and developing novel therapeutics. Metformin is considered a first-line anti-diabetic medication for Type 2 diabetes mellitus, and several studies have discussed its antidepressant effect. Metformin is thought to promote neurogenesis, enhance spatial memory function and protect the brain against oxidative imbalance. This systematic review aims to compile information on metformin's effect on depression symptoms and assess current knowledge on the relationship between depression and diabetes. After reviewing several studies, we concluded that metformin might help treat comorbid depression in diabetic patients, but before it can be recommended as a depression medication, more extensive and better-designed trials are needed.

Obsessive-compulsive disorder, insulin signaling and diabetes – A novel form of physical health comorbidity: The sweet compulsive brain

BackgroundWhile a growing body of research highlights a bi-directional link between diabetes and mood disorders, little is known about the relationship between diabetes and obsessive-compulsive disorder (OCD). The aim of the present review is to investigate current evidence linking OCD, insulin-signaling and diabetes. MethodsA PubMed search was conducted to review all the available studies assessing diabetes, glucose metabolism and insulin-signaling in OCD patients and vice versa. ResultsSome clinical and epidemiological studies show a higher prevalence of diabetes in OCD and vice versa compared to the general population. Animal and genetic studies suggest a possible role of insulin-signaling in the pathophysiology of OCD. Deep brain stimulation (DBS) studies suggest that abnormal dopaminergic transmission in the striatum may contribute to impaired insulin sensitivity in OCD. While DBS seems to increase insulin sensitivity, a possible protective role of serotonin reuptake-inhibitors on diabetic risk needs further studies. ConclusionDespite their preliminary nature, these data highlight the importance of further investigations aimed at assessing metabolic features in OCD patients and OCD symptoms in diabetes patients to understand the impact of each condition on the pathophysiology and course of the other. Understanding the role of insulin in the obsessive-compulsive brain could open new treatment pathways for OCD.

COVID-19 Risk Prediction for Diabetic Patients Using Fuzzy Inference System and Machine Learning Approaches.

Individuals with pre-existing diabetes seem to be vulnerable to the COVID-19 due to changes in blood sugar levels and diabetes complications. As observed globally, around 20–50% of individuals affected by coronavirus had diabetes. However, there is no recent finding that diabetic patients are more prone to contract COVID-19 than nondiabetic patients. However, a few recent findings have observed that it could be at least twice as likely to die from complications of diabetes. Considering the multifold mortality rate of COVID-19 in diabetic patients, this study proposes a COVID-19 risk prediction model for diabetic patients using a fuzzy inference system and machine learning approaches. This study aimed to estimate the risk level of COVID-19 in diabetic patients without a medical practitioner's advice for timely action and overcoming the multifold mortality rate of COVID-19 in diabetic patients. The proposed model takes eight input parameters, which were found as the most influential symptoms in diabetic patients. With the help of the various state-of-the-art machine learning techniques, fifteen models were built over the rule base. CatBoost classifier gives the best accuracy, recall, precision, F1 score, and kappa score. After hyper-parameter optimization, CatBoost classifier showed 76% accuracy and improvements in the recall, precision, F1 score, and kappa score, followed by logistic regression and XGBoost with 75.1% and 74.7% accuracy. Stratified k-fold cross-validation is used for validation purposes.

Depressive symptoms in diabetic patients; prevalence, correlates, and moderating effect in Taif, Saudi Arabia.

Diabetes is associated with a range of psychosocial stressors that could lead to considerable distress and increased risk of depressive symptoms. There is a pressing need to understand the underpinnings of diabetes-related distress and how it evolves in connection with depressive moods, and fears related to hypoglycaemia. Our current study attempts to fill this knowledge gap and further explore the interconnections between distress, fear, and depression among Saudi diabetic patients. Descriptive questionnaire-based cross-sectional study of type II diabetes patients in a specialist diabetes clinic in Taif, Saudi Arabia. We carried out Poisson regression modelling to evaluate the correlates of depressive and distress symptoms. The study included (n = 365) patients living with type II diabetes. Cronbach's alpha for the DDS-17 was 0.93, and for HABS was 0.84, indicative of excellent internal consistency. Diabetes-related distress affected (n = 114, 22.8%) patients, whereas depressive symptoms affected (n = 190, 52.1%) patients. The mean HABS score was 32.7 points (out of 70 points) (SD = 9.8 points). High physical activity levels were found only in (n = 23, 6.3%) patients and moderate physical activity in (n = 65, 17.8%), whereas patients with low physical activity were (n = 277, 75.9%). Diabetes-related distress was associated with increased HbA1c, presence of eye disease, comorbid mental illness, heart disease, stroke, and low physical activity levels. Depressive symptoms were associated with increased HbA1c, longer diabetes duration, presence of eye disease, comorbid mental illness, comorbid neuropathy, heart disease, and low physical activity levels. Distress and depression levels are worryingly higher than previous estimates from Saudi Arabia among patients with type II diabetes, indicative of an upward trend and/or a pandemic-related jump. One significant finding from our results is the substantial effect of glycaemic control on increased distress, and depression among our type II diabetes patients. This interaction is likely due to effects on self-care and medication adherence. We also confirmed the association between depressive symptoms and the duration of diabetes. Our results indicated a connection between comorbid medical illness with depressive and distress symptoms.