Type Of Diabetes Complications Research Articles

New Horizons in Diabetic Neuropathies: An Updated Review on their Pathology, Diagnosis, Mechanism, Screening Techniques, Pharmacological, and Future Approaches.

One of the largest problems for global public health is diabetes mellitus (DM) and its micro and macrovascular consequences. Although prevention, diagnosis, and treatment have generally improved, its incidence is predicted to keep rising over the coming years. Due to the intricacy of the molecular mechanisms, which include inflammation, oxidative stress, and angiogenesis, among others, discovering treatments to stop or slow the course of diabetic complications is still a current unmet need. The pathogenesis and development of diabetic neuropathies may be explained by a wide variety of molecular pathways, hexosamine pathways, such as MAPK pathway, PARP pathway, oxidative stress pathway polyol (sorbitol) pathway, cyclooxygenase pathway, and lipoxygenase pathway. Although diabetic neuropathies can be treated symptomatically, there are limited options for treating the underlying cause. Various pathways and screening models involved in diabetic neuropathies are discussed, along with their possible outcomes. Moreover, both medicinal and non-medical approaches to therapy are also explored. This study highlights the probable involvement of several processes and pathways in the establishment of diabetic neuropathies and presents in-depth knowledge of new therapeutic approaches intended to stop, delay, or reverse different types of diabetic complications.

PERCEIVED COGNITIVE FUNCTION: RELATIONSHIPS WITH DIABETES COMPLICATIONS AND SELF-EFFICACY IN LATINX OLDER ADULTS

Abstract Cognitive dysfunction is a concern for individuals with type 2 diabetes (T2DM) and can affect diabetes self-management. However, it is often overlooked clinically and remains relatively understudied in Latinx older adults as a complication of T2DM. This project sought to explore the relationships between perceived cognitive dysfunction and its effects on self-efficacy and complications of T2DM in older Latinx adults. This was part of an analysis of baseline data from a larger randomized controlled trial investigating an cognitive rehabilitation intervention for older adults with T2DM. A total of 87 participants (mean age 67.3 +/- 5.4) completed a survey consisting of the Diabetes Empowerment Scale - short form (self-efficacy); PROMIS Bank v.2 - Cognitive Function (perceived cognitive function); and a self-report of number and type of diabetes complications. Participants had lower perceived cognitive dysfunction than the general population (Mean total score: 36.6 +/- 7.9); low self-efficacy (mean total score: 2.3 +/- 0.7) and reported at least 2 complications related to T2DM. Greater perceived cognitive dysfunction was related to lower self-efficacy (p = 0.04). Diabetes duration was positively associated with self-efficacy (p = 0.03), but not perceived cognitive dysfunction (p = 0.22). Self-efficacy was positively associated with number of diabetes complications (p = 0.03). Irrespective of diabetes duration, patients with more severe perceived cognitive dysfunction reported lower self-efficacy (p = 0.03) than those with lower levels of cognitive dysfunction. Assessment of cognitive function may help inform patient education interventions for Latinx older adults to improve the self-efficacy and potentially reduce complications.

Novel Route of Inhaled Insulin for Diabetes Treatment

Diabetes is a chronic condition characterised by insufficient insulin secretion and hyperglycemia as a result. Microvascular and macrovascular disease are two types of diabetic complications that are affected by good diabetes management. Many diabetics rely on subcutaneous insulin injections or continuous infusions to keep their blood sugar levels under control. Insulin delivery via new routes Since the 1920s, subcutaneous insulin has been used to treat diabetes; nevertheless, despite a variety of formulations, intensive insulin therapy including many daily injections has not acquired universal clinical approval. The search for a successful, well-tolerated nonenteral method for delivering insulin began in the 1920s, and has included ocular, buccal, rectal, vaginal, and other routes. Given that insulin injection therapy is burdensome for many patients, novel insulin administration routes are of interest in the diabetes sector. The use of inhalation to administer insulin to the lungs will be discussed in this review. Inhaled insulin's safety as well as efficacy in contrast to subcutaneous insulin in diverse diabetic populations are discussed. Until recently, many researchers considered that noninvasively given insulin had too low a bioavailability to be useful in clinical practise. Inhaled insulin, on the other hand, appears to be an effective, well-tolerated, and noninvasive alternative to subcutaneous regular insulin, according to a growing body of research. Importantly, inhaled insulin has a more physiological insulin profile than injectable insulin.

Enhanced antioxidation capacity endowed to a mixed type aldose reductase inhibitor leads to a promising anti-diabetic complications agent

A series of 5f-based new compounds has been designed and synthesized. In vitro screening demonstrated that the binding affinity and selectivity on aldose reductase (AR) were positively correlated with its antioxidation capacity. Compound 6d was verified the most active candidate, where its IC50, selective index (SI), and EC50 value was 22.3 ± 1.6 nM, 236.2, and 8.7 μM respectively. 6d was confirmed as both an excellent antioxidant and aldose reductase inhibitor (ARI). It was identified as a mixed type ARI with Ki and Kis values of 23.94 and 1.20 nM. When evaluated by a high-glucose impaired chicken embryo model, it was found that 6d attenuated the incidence of neural tube defect (NTD) and death rate in a dose-dependent manner. It significantly improved the hyperglycemia-induced abnormalities of body weight and morphology of chicken embryos. 6d reversed the hyperglycemia-raised AR activity, sorbitol accumulation, reactive oxygen species (ROS) and malondialdehyde (MDA) levels. It restored the high-glucose-reduced Pax3 protein expression. At the same dose (0.5 μM), 6d showed better effects than 5f in all the above detections. By the way, 6d did not affect hyperglycemia-elevated aldehyde reductase (ALR1) activity. This evidence together with its kinetic properties, implicated that 6d is a high selective ARI without the suspicion of promiscuity. 6d was proved here an effective agent to treat diabetic peripheral neuropathy (DPN). Whether 6d has potential to treat other types of diabetic complications (DC) needs to be further investigation.

Assessment of Neuron Specific Enolase Level and some Related Biochemical Factors in Patients with Diabetic Peripheral Nerve Disorders

Background: the disorder of neuron system by the action of hyperglycemia is Diabetic neuropathyconsiders a common diabetic complication which is associated with a wide scope of clinical cases. Peripheralneuropathy (PN) represents a clinical case, wherein the peripheral nervous system is damaged. Accordingly,biochemical parameters have importance to apply as good predictor factors. Accordingly we attempt toassess the biochemical factors of Neuron Specific Enolase NSE, Calpotectin CALP, Xanthine Oxidase XODin patients suffering from this type of diabetes complications as early predictors and study their correlations.Methods: Fifty eight patients are known to have diabetic mellitus, which is classified into three groups.Group I represents DPN of 30 patients, group II referred to 28 diabetic patients without DPN, in additionto 30 healthy subjects as a control group, with range age (38-70) years old. BMI was determined for all thestudied groups. Levels of FBS, lipid categories and HbA1C were estimated. NSE, CALP and XOD levelswere measured by ELISA method. hs-CRP also determine for patients and control.Results: The results revealed that levels of both FBS and HbA1C are increased significantly (p<0.05)in both patients groups rather than healthy subjects. Moreover, results recorded an important increase ofcholesterol, TGs, LDL and VLDL levels (p<0.05). in contrast the HDL decrease in the two patient groupsrelated to healthy group. Increased levels of NSE, CALP, XOD and hs-CRP in DPN group and diabeticgroup compared with control group. The results of this study showed a direct correlation between BMI andFBS, in addition to BMI and hsCRP which possess the same correlation. Analysis by ROC curve showed thatboth NSE and CALP are representing the strongest markers for diagnosis of diabetic neuropathy followedby XOD and hs-CRP respectively.Conclusion: Levels of the studied factors consider good indicators to use them as suitable markers for earlydetection of diabetic sensory neuropathy. The results of ROC curve analysis revealed that NSE and CALP isthe strongest biomarker for diagnosis of diabetic neuropathy.

Highly bioavailable berberine formulation ameliorates diabetic nephropathy through the inhibition of glomerular mesangial matrix expansion and the activation of autophagy

Glomerular mesangial matrix expansion and cell autophagy are the most important factors in the development of kidney damage under diabetic conditions. The activation of AMPK might be an important treatment target for diabetic nephropathy. Berberine has multiple effects on all types of diabetic complications as an activator of AMPK. However, the poor bioavailability of berberine limits its clinical applications. Huang-Gui Solid Dispersion (HGSD), a new formulation of berberine developed in our lab, has 4-fold greater bioavailability than berberine. However, its therapeutic application and mechanism still need to be explored. In the present study, the effect of HGSD on kidney function in type 2 diabetic rats and db/db mice was investigated. The results demonstrated that HGSD improved kidney function in these two animal models, decreased the glomerular volume and increased autophagy. Meanwhile, AMPK phosphorylation levels and autophagy-related protein expression were significantly increased, and extracellular matrix protein deposition-related protein expression was decreased after treatment. The present study indicated that HGSD protected against diabetic kidney dysfunction by inhibiting glomerular mesangial matrix expansion and activating autophagy. The mechanism of HGSD in the treatment of diabetic nephropathy might be connected to the activation of AMPK phosphorylation.

Analisis Biaya Penyakit Diabetes Melitus Sebagai Pertimbangan Perencanaan Pembiayaan Kesehatan

Disease cost analysis is an important element in the decision making process of chronic disease, because it can evaluate the cost of illness and illustrate diseases that require an increase in resources for the prevention or therapy. This study aims to determine the total cost of diabetes mellitus (DM), so it can be used as a health fund planning considerations related to the effectiveness and efficiency of medication costs for patients in Yogyakarta Regional Public Hospital. The method used is observational prevalence. The data were obtained retrospectively with patients primary diagnosed and secondary diagnosed of diabetes mellitus with or without complications in the period January to June 2014 in Yogyakarta Regional Public Hospital. The Financial perspective used is the hospitals perspective as health care providers to take into account the direct medical costs by using a bottom-up approach. Data analysis was performed using Kruskal-Wallis and Mann-Whitney Whitney to determine differences in the direct medical costs of outpatient diabetic patients in terms of age, the number and type of diabetes complications, as well as to determine the direct medical cost differences hospitalized diabetic patients in terms of age, the number of complications, type of diabetes, duration of hospitalization and inpatient classes.The results of the research showed that the patients who entered the inclusion criteria as much as 1.689 episodes of visits, which consisted of 1.531 episodes of outpatients visits and 158 episodes of inpatients visits. The total cost of DM based on hospital perspective Rp1.203.799.389,00 IDR within six months. There is a significant difference in direct medical costs in outpatients in terms of the number of factors of complications (p=0.004) and a significant differences direct medical costs inpatients in terms of the number of factors of complications, length of stay and inpatient class in hospitalization (p=0.000).

Erectile dysfunction: prevalence and determinants among T2DM men attending a tertiary care hospital in northern India

Background: Erectile dysfunction (ED), though an important complication of T2DM is grossly under reported in this part of the world. The present study aimed to determine the prevalence and associated risk factors of ED in T2DM men in northern India.Methods: A cross-sectional study was conducted from January to August 2018 among male patients with T2DM in the medical OPD of a tertiary care teaching hospital in Jammu. IIEF- international index of erectile function was the tool used in the present study.Results: ED prevalence was 62.08%. Among socio-demographic variables, age was significantly associated with ED (p<0.05) while no association was found with education, occupation and family income. Smoking as a life style and hypertension as a co-morbid condition were significantly associated with ED (p<0.05). Duration of diabetes and type of diabetic complications were also found to be statistically significant.Conclusions: Prevalence of ED in T2DM men was quiet high in this region of India. Preventive interventions, early diagnosis and detection of T2DM along with treatment adherence to prevent diabetic complications is strongly recommended. Further research is recommended to establish temporal causality of ED in T2DM.

Complications of Diabetes: An Insight into Genetic Polymorphism and Role of Insulin

Diabetes Mellitus (DM) is an advanced and chronic endocrine disorder characterized by an insufficiency of insulin secretion from pancreatic β-cells and liver, adipose tissues, and skeletal muscles. The main objective of this study is to understand the mechanism and genes which are responsible for the prevalence of diabetes. The study also covers various types of diabetic complications with special reference to insulin role and defects. The scientific literature and patents were reviewed and analyzed based on their suitability and relevance to the theme of the study. The scientific literature was covered from the authentic databases such as Elsevier, Springer, and Bentham Science. The patents were reviewed from http://www.freepatentsonline.com. Glucokinase (ATP: D-glucose-6-phosphotransferase; GCK), initiates glycolysis and acts as a glucose sensor and metabolic signal producer in liver and pancreas. PCR-sequencing showed qualitative differences in diabetic patients in comparison to healthy subjects. Glucokinase is the most important component in glucose detection of pancreatic islet beta cells in diabetes because glucokinase mutations can be one of the most common single gene disorders described. It is known that a genetic variation of a human glucokinase gene, including a point mutation, causes MODY, the concentration of plasma glucose increased and it is supposed to be the cause of diabetes of the present study subjects. Owing to hyperglycemia and individual components of the insulin resistance (metabolic) syndrome, people with Type II DM are prone to the high threat for microvascular complications (including nephropathy, retinopathy, and neuropathy) and macrovascular complications (such as Ischemic Heart Disease). There were also significant differences (P < 0.0001) in glycation levels (0.90, 0.4838mole/mole), random blood sugar (348.8, 105.8mg/dL), cholesterol levels (235.3, 161.8mg/dL), low density lipoprotein in diabetic subjects (155.3, 28.46mg/dL) and in healthy donors. GCK gene mutations were found in 70% of the patients while 30% are non-mutated. In conclusion, lipids, glucose, and protein play an essential role in the initiation of AGE's or diabetic complications (Micro and Macrovascular Complications). The importance of the clinical results should also be recognized in the genetic analysis of heterogeneous disorders as NIDDM/ Type II DM.

Association of Diabetes Related Complications with Heart Rate Variability among a Diabetic Population in the UAE.

Microvascular, macrovascular and neurological complications are the key causes of morbidity and mortality among type II diabetes mellitus (T2DM) patients. The aim of this study was to investigate the alterations of cardiac autonomic function of diabetic patients in relation to three types of diabetes-related complications. ECG recordings were collected and analyzed from 169 T2DM patients in supine position who were diagnosed with nephropathy (n = 55), peripheral neuropathy (n = 64) and retinopathy (n = 106) at two hospitals in the UAE. Comparison between combinations of patients with complications and a control diabetic group (CONT) with no complication (n = 34) was performed using time, frequency and multi-lag entropy measures of heart rate variability (HRV). The results show that these measures decreased significantly (p<0.05) depending on the presence and type of diabetic complications. Entropy, (median, 1st- 3rd interquartile range) for the group combining all complications (1.74,1.37–2.09) was significantly lower than the corresponding values for the CONT group (1.77, 1.39–2.24) with lag-1 for sequential beat-to-beat changes. Odds ratios (OR) from the entropy analysis further demonstrated a significantly higher association with the combination of retinopathy and peripheral neuropathy versus CONT (OR: 1.42 at lag 8) and an even OR for the combination of retinopathy and nephropathy (OR: 2.46 at lag 8) compared to the other groups with complications. Also, the OR of low frequency power to high frequency power ratio (LF/HF) showed a higher association with these diabetic-related complications compared to CONT, especially for the patient group combining all complications (OR: 4.92). This study confirms that the type of microvascular or peripheral neuropathy complication present in T2DM patients have different effects on heart rate entropy, implying disorders of multi-organ connectivity are directly associated with autonomic nervous system dysfunction. Clinical practice may benefit from including multi-lag entropy for cardiac rhythm analysis in conjunction with traditional screening methods in patients with diabetic complications to ensure better preventive and treatment outcomes in the Emirati Arab population.

Type 2 Diabetes Mellitus Is Associated with More Serious Small Intestinal Mucosal Injuries.

BackgroundClinical and experimental research has revealed that diabetes mellitus (DM) is characterized by intestinal hypomotility, gut microbial dysbiosis, increased gut permeability, microcirculation disorders, circulatory changes, and dysfunction of intestinal stem cells, which may be linked to inflammation of intestinal mucosa. However, the relationship between type 2 DM (T2DM) and macroscopic small intestinal mucosal injuries is still unclear. Therefore, we retrospectively studied capsule endoscopy data to determine the relationship between T2DM and small intestinal mucosal injuries.Materials and MethodsWe compared the records of 38 T2DM patients with those of 152 non-DM patients for small intestinal mucosal injuries. Different types of mucosal injuries and Lewis scores were compared between T2DM and non-DM patients. The relationships between patients with or without different types of diabetic complications and the Lewis score was assessed. Moreover, the relationships between insulin resistance and Lewis score, between HbA1c and Lewis score, were also both assessed.ResultsThe prevalence of a villous edema in subjects with T2DM was significantly higher than in those without DM (P < 0.001), but incidence of ulcers was not different (P = 1.000). With T2DM, the Lewis score was also significantly higher (P = 0.002). In addition, subjects with diabetic nephropathy showed significantly higher Lewis scores than patients without diabetic nephropathy (P = 0.033). In Pearson’s correlation tests, the homeostasis model assessment of insulin resistance (HOMA-IR) value was correlated positively with the Lewis score (γ = 0.175, P = 0.015), but no statistical correlation was found between HbA1c level and Lewis score (γ = 0.039, P = 0.697).ConclusionsSubjects with T2DM, especially those with diabetic nephropathy, have higher Lewis scores and more serious small intestinal mucosal lesions.

The Pathophysiology of Diabetic Complications: How Much Does the Glucose Hypothesis Explain?

To examine the putative pathogenetic mechanisms of the long-term, specific complications of diabetes mellitus. Literature review relevant to long-term diabetic complications and their pathogenesis. Studies of animal models of diabetes, epidemiologic investigations of diabetes and its long-term complications, and interventional studies examining intensive treatment of diabetes and its effect on the development and progression of complications. Diabetic retinopathy, nephropathy, and neuropathy occur in all clinical forms of diabetes mellitus, regardless of the cause of the diabetes. Hyperglycemia appears to be the major variable shared among these different clinical forms; and epidemiologic data, studies in animal models of diabetes, and the results of recent interventional studies such as the Diabetes Control and Complications Trial, all support an important and perhaps dominant role of hyperglycemia in the pathogenesis of complications. However, the diverse complications may not share the same pathogenesis. Different pathogenetic mechanisms may operate in different types of diabetic complications or at different stages of specific complications, or both. The level of chronic glycemia is the best established concomitant factor associated with diabetic complications. The mechanism by which hyperglycemia might cause complications remains unknown, and evidence for a uniform pathogenetic mechanism is far from established.