Type 2 Diabetes Mellitus Patient Research Articles

Mitochondrial Dysfunction Associated with Low Expression of Bcl-2: an Inflammatory Mediator in Diabetic Patients with Atherosclerosis

Objective: To investigate mitochondrial dysfunction and pattern of expression of B-cell lymphoma 2 (Bcl-2) and correlate these with cardiovascular diseases (CVD) in type 2 diabetes mellitus (T2DM).   Background: Diabetes mellitus (DM) raises the risk of CVD, which contributes significantly to the high mortality rates associated with the disease. The role of mitochondrial dysfunction and apoptosis in the development of CVD has been suggested, however the mechanisms involved are unknown.   Methods: Type 2 diabetic mellitus patients with atherosclerosis (T2DM + ATHER, n=40), T2DM patients (n=40) and a control group of age-matched non-diabetic individuals (n=35) were enrolled in this study. Blood samples were collected and analysed for the presence of anti-apoptotic-related factors, Bcl-2 in Peripheral mononuclear cells by qPCR as well as mitochondrial dysfunction by immunofluorescence analysis. Serum TNF-α and antioxidant enzymes (SOD) were measured by ELISA.   Result: Bcl-2 expression was significantly decreased in patients with T2DM + ATHER and T2DM (P < 0.05) compared to the control group. MitoSpy Red staining revealed nuclear condensation and fragmentation in T2DM + ATHER and T2DM. There was a significant increase in pro-inflammatory cytokine TNF-α while the levels of SOD were significantly decreased in the T2DM + ATHER and T2DM patient group (P<0.05) compared to the control group.   Conclusion: These results suggest that mitochondrial dysfunction was associated with oxidative stress and inflammation in patients with T2DM +ATHER.

Impact of metabolic disorders on the structural, functional, and immunological integrity of the blood-brain barrier: Therapeutic avenues.

Mounting evidence has linked the metabolic disease to neurovascular disorders and cognitive decline. Using a murine model of a high-fat high-sugar diet mimicking obesity-induced type 2 diabetes mellitus (T2DM) in humans, we show that pro-inflammatory mediators and altered immune responses damage the blood-brain barrier (BBB) structure, triggering a proinflammatory metabolic phenotype. We find that disruption to tight junctions and basal lamina due to loss of control in the production of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) causes BBB impairment. Together the disruption to the structural and functional integrity of the BBB results in enhanced transmigration of leukocytes across the BBB that could contribute to an initiation of a neuroinflammatory response through activation of microglia. Using a humanized in vitro model of the BBB and T2DM patient post-mortem brains, we show the translatable applicability of our results. We find a leaky BBB phenotype in T2DM patients can be attributed to a loss of junctional proteins through changes in inflammatory mediators and MMP/TIMP levels, resulting in increased leukocyte extravasation into the brain parenchyma. We further investigated therapeutic avenues to reduce and restore the BBB damage caused by HFHS-feeding. Pharmacological treatment with recombinant annexin A1 (hrANXA1) or reversion from a high-fat high-sugar diet to a control chow diet (dietary intervention), attenuated T2DM development, reduced inflammation, and restored BBB integrity in the animals. Given the rising incidence of diabetes worldwide, understanding metabolic-disease-associated brain microvessel damage is vital and the proposed therapeutic avenues could help alleviate the burden of these diseases.

Correlation between Very Low-Density Lipoprotein and Trygliseride with Glycated Hemoglobin Levels in Type 2 Diabetes Mellitus Patients

Patients with Type 2 Diabetes Mellitus (T2DM) have an increased prevalence of dyslipidemia, which contributes to ahigher risk of dyslipidemia- related complications in T2DM such as cardiovascular disease and stroke. This study aimed todetermine the correlation between TG and VLDL-C towards HbA1c levels in a person with T2DM. A retrospective study of 74outpatients with T2DM at Sanglah General Hospital, Denpasar, who examined serum HbA1c and lipid profiles were tracedfor serum TG. From the obtained TG profile, a secondary calculation of VLDL was carried out using the Friedewald equation(TG/5). A correlation test was used to determine the relationship between TG and VLDL-C towards HbA1c levels. Serum TG(212.95±147.46 mg/dL) and VLDL (36.69±23.54 mg/dL) were found to be higher in the group with poor glycemic control(HbA1c > 7 mg/dL) compared to serum TG (111.00±39.56 mg/dL) and VLDL (21.05±6.13 mg/dL) in the group with goodglycemic control (HbA1c ≤ 7 mg/dL) (p < 0.05). A positive correlation between serum TG (r=0.512; p < 0.001) and VLDL(r=0.18; p <0.001) towards HbA1c levels in T2DM patient was found. Insulin resistance increases the production of VLDL andApoC-III in the liver and increased chylomicron absorption in the gastrointestinal tract, causing prolonged postprandiallipemia and disruption of VLDL and TG clearance, thereby resulting in increased TG and VLDL in circulation. There is asignificant positive correlation between serum TG and VLDL towards HbA1c levels in a patient with T2DM.

Delay-Independent regulation of blood glucose for type-1 diabetes mellitus patients via an observer-based predictor feedback approach by considering quantization constraints

Diabetes, as a widespread chronic disease, is caused by the increase of blood glucose concentration (BGC) due to pancreatic insulin production failure and/or insulin resistance in the body. The artificial pancreas (AP) known as a closed-loop insulin delivery control system consists of a glucose sensor for BGC measurement, a control algorithm for calculation of exogenous insulin delivery rate (IDR), and an insulin infusion pump. The AP provides a closed-loop glucose-insulin regulatory system for type-1 diabetes mellitus (T1DM) patients in order to effectively reduce the high BGC level. In this paper, we aim to design a controller in order to regulate the BGC of T1DM patients at its basal value with considering meal disturbance in the system. We confront with different problems for glucose control such as sampled and quantized glucose measurement by the sensor, quantized IDR by the insulin infusion pump, and an unknown input delay of the insulin infusion pump as the actuator of the control system. The bergman minimal model (BMM) as the most famous model for describing the glucose-insulin regulatory system is reviewed and the delay-independent observer for the estimation of the system’s state vector from the sensor output (sampled and quantized BGC) is considered. Moreover, the observer works on the basis of an event-triggered strategy in order to avoid unnecessary signal updating. At the end, the IDR calculated by the proposed delay-independent truncated predictor output feedback controller (based on the observer’s output) is delivered to the T1DM patient. A sufficient condition on the insulin infusion pump delay’s upper bound value in order to guarantee the ultimate boundedness of the glucose-insulin regulatory system under the mentioned constraints is derived. Also, the nonoccurrence of Zeno behavior in the proposed control system is proved. Numerical simulation results confirm the effectiveness of the designed controller in the presence of meal disturbance, unknown input delay, and quantization errors for blood glucose regulation of the glucose-insulin regulatory system in T1DM patients. Moreover, a pre-clinical verification of the applicability of the proposed glucose controller is carried out on a large-scale and multi-compartmental model that is the base of the UVA/PADOVA Type-1 Diabetes Simulator.

Diabetic Self-Management Education – Effect on Self-Management Care of Type-2 Diabetic Patients

A common problem of a person with diabetes mellitus was the lack of discipline in implementation of their daily self-care management. Diabetes Self-Management Education (DSME) was a system to help diabetes patients manage their activities to improve their health. DSME is the process which can improve the knowledge, skill, and ability of diabetes self-care. This study aimed to determine the effect of using diabetes self-management education (DSME) intervention and how it affected patients’ self-care management. This research was quasi experiment with one group pretest-posttest among patients with type-2 diabetes. There were 30 participants assigned by using purposive sampling into DSME intervention. Four sessions of DSME were conducted to the participants using illustrative media/fliers. The data were collected by questionnaires of Diabetes Self-Care Management. Then, it was analyzed by using paired t-test. The results showed that self-care management of the respondents before the intervention was 28.8 and it increased to 35.3 after the intervention (mean different=6.5). There were differences in the self-care score before and after the intervention (p=0.001). This study has limited time to do DSME. But, in four sessions, we have tried to explain more about diabetes interactively. Then, better to assess the type-2 diabetes patients with qualitative method or mixed with more participants included for the future researchers. This research was adopting a DSME to found significant improvements in the self-care management in type-2 diabetes mellitus patient. This demonstrates that DSME intervention can be such clinical importance in care of type-2 diabetes mellitus patient.Keywords: Diabetes self-management education, self-care management, type-2 diabetes patients.

Does COVID-19 predispose patients to type 1 diabetes mellitus?

.The novel coronavirus disease (COVID-19) has emerged as a global pandemic. This was a prospective, case-control study conducted in Izmir, Turkey. The aim of this study was to assess the relationship between COVID-19 and new-onset T1DM. We included pediatric patients (aged 6 mo–18 yr) with new-onset type-1 diabetes mellitus (T1DM) diagnosed during the COVID-19 pandemic, between April 2020 and January 2021. Polymerase chain reaction was used to diagnose COVID-19 after hospital admission. An enzyme-linked immunoassay for IgM and IgG against SARS-CoV-2 was performed after the diagnosis was confirmed. In the control group, the blood antibody test was conducted as close as possible to the time of the T1DM patient referral. A total of 118 participants were included in the study, comprising 57 (48%) patients with new-onset T1DM and 61 (52%) healthy controls. Of the 57 patients, 36 (63.2%) presented with DKA, 17 (29.7%) with diabetic ketosis, and four (7%) incidentally. The SARS-CoV-2 antibody test was positive in five (8.7%) patients with T1DM and six (10%) controls. The rate of positivity did not differ between the two groups (p = 0.901). It was not possible to demonstrate a clear association between SARS-CoV-2 infection and new-onset T1DM. Whether SARS-CoV-2 increases susceptibility to diabetes by triggering islet cell autoimmunity and affects the timing of overt diabetes in patients with existing autoimmunity should be studied in large cohorts.

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

IntroductionThe prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care.Patients and MethodsTwenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests.ResultsT1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01).ConclusionIn this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.

Type 2 diabetes mellitus duration and obesity alter the efficacy of autologously transplanted bone marrow-derived mesenchymal stem/stromal cells.

Human bone marrow‐derived mesenchymal stem/stromal cells (BM‐MSCs) represent promising stem cell therapy for the treatment of type 2 diabetes mellitus (T2DM), but the results of autologous BM‐MSC administration in T2DM patients are contradictory. The purpose of this study was to test the hypothesis that autologous BM‐MSC administration in T2DM patient is safe and that the efficacy of the treatment is dependant on the quality of the autologous BM‐MSC population and administration routes. T2DM patients were enrolled, randomly assigned (1:1) by a computer‐based system into the intravenous and dorsal pancreatic arterial groups. The safety was assessed in all the treated patients, and the efficacy was evaluated based on the absolute changes in the hemoglobin A1c, fasting blood glucose, and C‐peptide levels throughout the 12‐month follow‐up. Our data indicated that autologous BM‐MSC administration was well tolerated in 30 T2DM patients. Short‐term therapeutic effects were observed in patients with T2DM duration of <10 years and a body mass index <23, which is in line with the phenotypic analysis of the autologous BM‐MSC population. T2DM duration directly altered the proliferation rate of BM‐MSCs, abrogated the glycolysis and mitochondria respiration of BM‐MSCs, and induced the accumulation of mitochondria DNA mutation. Our data suggest that autologous administration of BM‐MSCs in the treatment of T2DM should be performed in patients with T2DM duration <10 years and no obesity. Prior to further confirming the effects of T2DM on BM‐MSC biology, future work with a larger cohort focusing on patients with different T2DM history is needed to understand the mechanism underlying our observation.

Metformin mediates MicroRNA-21 regulated circulating matrix metalloproteinase-9 in diabetic nephropathy: an in-silico and clinical study

Metformin is commonly used as an oral hypoglycaemic agent in type 2 diabetes mellitus (T2DM). MicroRNA-21 is widely studied in diabetic and diabetic nephropathy (DN) patients. Matrix metalloproteinase-9 (MMP9) is involved in extracellular matrix degradation and tissue repair processes. However, the effect of metformin administration on hsa-miR-21-5p and MMP9 has not been evaluated in T2DM and DN patients. The study subjects were divided into three groups (Healthy controls = 36, T2DM = 38, DN = 35). Anthropometric measurements were taken and biochemical tests were carried out on fasting blood samples. Reverse transcriptase PCR was employed for whole blood gene expression analysis of hsa-miR-21-5p and MMP9. Bioinformatics analyses including drug-gene interaction, protein-protein interaction, functional enrichment analyses and co-expression networks were performed. In the present study, MMP9 and hsa-miR-21-5p levels were downregulated and upregulated respectively in T2DM and DN patients when compared with healthy controls. However, in metformin-treated group, a downregulation of hsa-miR-21-5p and upregulation of MMP9 was observed. In-silico analysis revealed the target genes involved in the miR-21 and MMP9 interaction network. Metformin directly targets miR-21 and regulates MMP9 expression in T2DM patients, influencing the pathogenesis of DN. Highlights MMP-9 and hsa-miR-21-5p were downregulated and upregulated respectively in T2DM and DN patients in a Western Indian population. The patients treated with metformin showed downregulation of hsa-miR-21-5p and upregulation of MMP9. In-silico analysis revealed MMP-9 as well as PTEN to be targets of hsa-miR-21-5p. Metformin regulates MMP9 expression in T2DM and DN patient populations through hsa-miR-21-5p.

Raising the Bar When Assessing Cardiovascular Disease Outcome When Studies with Patients with Type 2 Diabetes Mellitus are Constructed: Revisiting ASCEND

The emergence of Type 2 Diabetes Mellitus (T2DM) as a clinical syndrome deviating from rudimentary models including “glucose-insulin” disparities to a clinical syndrome impinged upon hyperactivation of inflammatory-mediated signaling pathways, maladaptive pathophysiological changes, and pleiotropic sequelae has not only changed the nature of discussions regarding diabetes in academic circles, but also the treatment of T2DM clinically. The new challenges faced in preventing the advancement of T2DM coupled with the management of associated chronic disease states have impelled avenues for innovative treatments for T2DM sequelae while also ensuring glycemic control. For example, Sodium-Glucose Transport 2 inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonist (GLP-1RA), in addition to passing mandated Food and Drug Administration (FDA) Cardiovascular Outcome Trials (CVOT), have displayed positive outcomes with respect to cardiorenal considerations in patients with T2DM. Such performances have recently elevated these pleiotropic medications to higher tiers of recommendations by medical societies such as the American Diabetes Association and the American College of Cardiology. Moreover, the tandem of the notion that pleiotropic pharmacotherapeutic options with an expanded understanding of T2DM on the epigenetic, molecular, and cellular domains have galvanized researchers to explore pharmacologic mechanisms in the context of our ever-changing model in T2DM. In this communication, we would like to use lessons from the “Effects of aspirin for primary prevention in persons with diabetes mellitus” (ASCEND) trial to implore aspiring researchers and practitioners to explore, or at least consider external factors of the T2DM patient populous when reporting findings of cardiovascular clinical endpoints for proper context.

Association of Toxoplasma Gondii Infection With Diabetes Mellitus Using Nested-PCR and Sequencing

Background: Toxoplasmosis is a global public health concern with severe complications, particularly in pregnant women and immunosuppressed patients. Herein, we revealed the first genotypic evidence of Toxoplasma gondii (T. gondii) in diabetic and non-diabetic individuals referred to Imam Sajjad Hospital, Tehran, Iran, using nested-Polymerase Chain Reaction (PCR) and sequencing. Materials and Methods: We collected 98, 95, and 94 blood samples from Type-1 Diabetes Mellitus (T1DM), Type-2 Diabetes Mellitus (T2DM), and control subjects from February to August 2018, and their DNA was extracted. After amplification and visualization of dense granule antigen 6 gene (344 bp) using external and internal primer pairs, the positive samples were sent for sequencing. Results: Among 287 individuals, three T1DM patients (two IgG, one IgM) and one T2DM patient (IgG) were found positive by molecular method, which proved to be type III strain by sequencing. Conclusion: To the best of our knowledge, this is the first genotyping investigation on T. gondii in diabetic individuals. Further research should be done to better realize the association between Toxoplasma genotypes and the outcome of diabetes mellitus.

Magnesium status in a population of type 2 diabetes mellitus in Morocco

Background: Type 2 diabetes mellitus (T2DM) contributes to 90% cases of diabetes–the ninth leading cause of death. Magnesium (Mg) levels have been found consistently low in the patients with T2DM around the world. Objective: The objective of our work was to assess the Mg status in the patients with T2DM. Material and methods: A descriptive prospective study including 103 patients with type 2 diabetes mellitus (T2DM) was carried out at Avicenna Military Hospital in Marrakesh over a period of four months (October 2019 - January 2020). The patients with T2DM and age above 35years with no history of Mg supplementation, cancer or autoimmune disease were included in the study. Blood samples were analyzed for fasting glucose, lipid profile, HbA1c, and serum magnesium. The data were analyzed by SPSS version 16, Pearson correlation was performed to establish the relationship between Mg and metabolic variables in T2DM patients. Results: The study included 103 T2DM patients with 56 (54.4%) males and 47 (45.6%) females. Prevalence of hypomagnesemia was 14.56%. Mean age of the patients and duration of diabetes were 59±9 years and 9±4years, respectively. Most common antecedent conditions were dyslipidemia (43.7%), hypertension (42.7%), and retinopathy (25.2%). Hypomagnesemia was significantly associated with HbA1c (P=0.003) and arterial hypertension (P=0.002). Magnesium had negative linear relationship with increased fasting blood sugar and HbA1c. Conclusion: In Morocco, the prevalence of hypomagnesemia in T2DM patient is low, but it has negative linear relationship with fasting blood sugar and HbA1c.

A case study of liraglutide in an obese diabetic patient in a District General Hospital

A case study of liraglutide in an obese diabetic patient in a District General Hospital

The "Early Treatment" Approach Reducing Cardiovascular Risk in Patients with Type2 Diabetes: A Consensus From an Expert Panel Using the Delphi Technique.

IntroductionThere is no consensus on the optimal therapeutic approach to adopt in patients with newly diagnosed type 2 diabetes mellitus (T2DM) to prevent cardiovascular disease (CVD). The study aimed to gather an expert consensus on the hypoglycemic treatment and CV risk management in patients with newly diagnosed T2DM through the Delphi methodology.MethodsTo address this issue, a list of 30 statements concerning the definition of “early T2DM patient”, early treatment, CV risk in T2DM, treat-to-benefit approach, and indications for treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors was developed. Using a two-round Delphi methodology, the survey was distributed to 80 Italian diabetes specialists who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement.ResultsA total of 27/30 statements achieved consensus. A patient was defined as “early” according to pathophysiological or clinical interpretation, and/or the timing of the diagnosis. There was agreement on the importance to reach the lowest possible HbA1c level, since diagnosis, also using combination therapy with hypoglycemic drugs with a proven CV benefit. There was a consensus that a treat-to-benefit approach involves the addition of a glucose-lowering agent with proven CV benefits to metformin since diagnosis. The use of GLP-1RAs and SGLT2 inhibitors was considered a key strategy in this approach and the benefits were recognized also for patients with T2DM without established CVD. GLP-1RAs should be used at an earlier stage than SGLT2 inhibitors to prevent CVD, especially in patients with evidence of subclinical atherosclerotic disease.ConclusionThis Delphi consensus recognized the importance to adopt a tailored hypoglycemic treatment of patients with T2DM according to their CVD risk and the key role of glucose-lowering agents with proven CV efficacy, GLP-1RAs and SGLT2 inhibitors, in the context of an early treat-to-benefit approach.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01045-7.

Genetically Guided Mediterranean Diet for the Personalized Nutritional Management of Type 2 Diabetes Mellitus.

The current consensus for the prevention and management of type 2 diabetes mellitus (T2DM) is that high-quality diets and adherence to a healthy lifestyle provide significant health benefits. Remarkably, however, there is little agreement on the proportions of macronutrients in the diet that should be recommended to people suffering from pre-diabetes or T2DM. We herein discuss emerging evidence that underscores the importance of gene-diet interactions in the improvement of glycemic biomarkers in T2DM. We propose that we can achieve better glycemic control in T2DM patients by coupling Mediterranean diets to genetic information as a predictor for optimal diet macronutrient composition in a personalized manner. We provide evidence to support this concept by presenting a case study of a T2DM patient who achieved rapid glycemic control when adhered to a personalized, genetically-guided Mediterranean Diet.

Association of leukocyte telomere length with metabolic syndrome in type 2 diabetes mellitus.

Background:Leukocyte telomere length (LTL) has been revealed to be associated with aging-related diseases such as metabolic syndrome (MetS) and Type 2 diabetes mellitus (T2DM). We aimed to investigate the correlation of LTL with MetS and its components in T2DM patients in this cross-sectional study. Materials and Methods:A total of 344 T2DM patients were enrolled into this study. LTL was measured by Southern blot-based terminal restriction fragment length analysis. MetS was clinically defined by 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. Results:Of 344 T2DM patients, 53% had MetS. T2DM patients with MetS had significantly longer LTL than those without MetS (6451.95 ± 51.10 base pairs vs. 6076.13 ± 55.13 base pairs, P < 0.001), especially when T2DM patients had poor glycemic control (hemoglobin A1c ≥7%). Meanwhile, the trend of longer LTL was associated with the increased components of MetS in T2DM patient. Finally, LTL had a significant association with MetS (odds ratio [OR]: 2.096, 95% confidence interval [CI] 1.337–3.285, P = 0.001), low levels of high-density lipoprotein-cholesterol (HDL-C) (OR: 2.412, 95% CI 1.350–4.308, P = 0.003) in T2DM patients.Conclusion:T2DM patients with MetS had a significantly longer LTL than those without MetS. The longer LTL was especially evident in T2DM patients with poor glycemic control. Longer LTL was positively associated with MetS, particularly low levels of HDL-C in T2DM patients.

Dietary Knowledge, Attitude and Practice (KAP) Among the Family Members of Patients with Type 2 Diabetes Mellitus (T2DM) and Its Influence on the KAP of T2DM Patients.

PurposeTo investigate the dietary knowledge, attitude and practice (KAP) among the family members (FMs) of Chinese type 2 diabetes mellitus (T2DM) patients and its influence on the KAP of T2DM patients.Patients and MethodsTwo hundred thirty-six pairs of hospitalized T2DM patients and their FMs (472 in total) in our hospital were enrolled. A pair of self-designed questionnaires on dietary KAP (Cronbach’s α ≥ 0.763, I-CVI ≥ 0.857, S-CVI = 0.964, 0.958) were used to collect data and assess the KAP towards diabetes diets.ResultsThe mean score for dietary KAP of T2DM patients was 2.33 ± 0.60, 3.03 ± 0.44 and 2.77 ± 0.38, whereas that of their FMs was 2.37 ± 0.55, 3.08 ± 0.48 and 2.82 ± 0.61, respectively. Pearson’s correlation analysis showed that the glycosylated hemoglobin (HbA1c) of T2DM patients was negatively correlated to their dietary practice (r = −0.218, P < 0.01). There was a positive correlation between T2DM patients and their FMs for dietary KAP (r = 0.306, P < 0.05). The dietary practice of T2DM patients was positively correlated with the dietary KAP of their FMs (r = 0.305, 0.252 and 0.136, respectively, P < 0.01). Logistic regression analysis revealed that the score for dietary knowledge and attitude, occupation, residence, family history, complications of the T2DM patient, and the sex and dietary knowledge score of the FM were significantly associated with dietary practice for T2DM patients.ConclusionThe dietary attitude of FMs was moderate but dietary knowledge and practice were poor. Dietary KAP was positively correlated with T2DM patients and their FMs.

Prevalence of organ-specific autoantibodies in children with type 1 DM in south central region of India

Introduction: Type 1 diabetes mellitus (T1DM) is a long-standing metabolic disease caused by autoimmune beta cell destruction leading to absence or lowered insulin production. T1DM is associated with various other autoimmune disorders, including autoimmune thyroid disease, Celiac disease, and Addison disease. Detection of these antibodies is crucial to prevent morbidity related to unrecognized disease. Indian data regarding prevalence of these antibodies in T1DM is lacking, particularly antibodies against 21 hydroxylase. Patients and Methods: Total 100 patients with T1DM were taken into the study, in all patients anti-transglutaminase (anti-tTG) IgA, anti-thyroid peroxidase (anti-TPO) were done, and 21 hydroxylase anti bodies were done in 86 cases. Descriptive statistics were reported using mean, SD, numbers, and percentages. Student's t-test was used to assess the differences between the groups. Results: Fifteen cases were found to be TPOAb positive (eight had hypothyroidism, two had sub-clinical hypothyroidism, and five cases had normal thyroid function). tTGAb were positive in four cases, three were positive for 21-Hyroxylase antibody, and all had normal cortisol levels. Conclusion: Organ-specific autoimmune antibodies were elevated in T1DM when compared to general population. Screening of all these antibodies in T1DM patient should become standard of care.

Analysis of treatment satisfaction and adherence among patients with type 2 diabetes

Background: Low treatment adherence in patients with type 2 diabetes mellitus (T2DM) hinders the effective use of anti-diabetic agents and the achievement of glycemic control, reducing their quality of life and outcomes. Assessment of treatment adherence can help to identify and manage factors and barriers that affect therapy and treatment satisfaction.Aim: To assess the treatment adherence of patients with T2DM, to identify the main barriers to adherence, and patient satisfaction with the treatment.Materials and methods: FORSIGHT-T2DM was a Russian multiregional, multicenter observational epidemiological study in 2014 patients with T2DM. The patients were assessed with the FORSIGHT- T2DM Patient Questionnaire, Moriski Medication Adherence Scale (MMAS), and Diabetes Treatment Satisfaction Questionnaire (DTSQ).Results: The mean (± SD) treatment adherence estimated using the MMAS was 5.86±1.39 points. The main barriers to adherence were high treatment costs, medication side effects, forgetfulness when taking drugs, complexity of the therapy or treatment regimen. The average number of daily medications was four. There was also a lack of contact with a doctor, poor awareness of the disease and its complications. Ninety (90) per cent of the respondents trusted the recommendations from their doctors, 7.6% followed the advice of relatives or friends. The patient's choice of medication was influenced by information about its effectiveness, its cost, and reimbursement, ease of administration, and information on the absence of side effects. Seventy eight (78) per cent of the respondents were “completely” or “rather” satisfied with their treatment. About 15% of patients rated the quality of care as unsatisfactory.Conclusion: The results of the study identified an intermediate level of treatment adherence in most patients with T2DM, as well as multiple adherence barriers, including comorbidities and the need for continuous intake of various agents. Most patients showed high treatment satisfaction, which could be due to the high availability of outpatient consultations by an endocrinologist and inpatient treatment, free access to anti-diabetic medications. However, it may also be a result of biased assessment of problems due to insufficient patient awareness of the therapy goals and a low level of knowledge about their disease. To study the factors affecting the adherence to medical recommendations among patients with T2DM, it is necessary to develop a specific questionnaire for this patient category, which would allow for an evaluation both drug intake and other aspects of their comprehensive treatment, including the identification and analysis of the main barriers to adherence.

Influence of perceived social support on depression among Type 2 diabetes patients: a concurrent cross-sectional mixed-method study

Background: There is an established relationship between the concept of social support (SS) and depression among Type 2 diabetes mellitus (T2DM) patients, however, the magnitude, direction, and outcomes of the relationship are not well established in Ghana. Objective: This study was conducted to assess the factors influencing social support and further quantify its association with depression among Type 2 diabetic patients. Methods: Three hundred and seven adults diagnosed with T2DM were sampled from four public healthcare facilities in Ghana. Ten respondents from the sample were further selected for in-depth interviews using the convenience sampling technique. A modified negative binomial model was used to determine significant factors influencing SS scores, while the influence of SS on scores for depression was assessed using a modified generalized negative binomial model. All analyses were performed using Stata 15. The qualitative arm of the study was also analyzed using thematic inductive analyses. Results: Overall, the mean[ ±standard deviation (SD)]of SS scores among participants was 46.24(±20.57), while SS domains had mean(±SD) values of 17.69(±9.23), 11.57(±8.93),and 16.97(±9.88) respectively for family support, friends support and significant others. The SS equality of variance test indicated a significant mean difference by sex, educational background, and self-reported income differentials[F-test=6.46, 6.64,and 4.23 respectively; p&lt;0.05]. A unit increase in SS score had a significant negative relationship with depression across all domains. For the focus model, social support significantly decreased the log count score by 0.002 {β[95%confidence interval (CI)]= -0.002(-0.002-0.000). A unit increase of SS significantly decreased the probability count of depression. Themes from the qualitative data also revealed that participants received SS from family and significant others, but not from friends. Support received from family included emotional support and financial aid. Conclusion: Among T2DM patients with depression, SS had a significant decremental association that could contribute to improved health outcomes. Sex, marital status, educational level, working status, and self-rated income level influenced the SS. We recommend routine screening for psychological symptoms and the involvement of psychologists and counselors in T2DM patient management.