Uncontrolled Diabetes Mellitus Research Articles

Sino-nasal Mucormycosis in non-compliant insulin-dependent diabetic patient: A case report with an insight on underlying psychological factors

BackgroundMucormycosis is a severe fungal infection manifested mostly in immunocompromised hosts. Underlying causes for Mucormycosis include uncontrolled diabetes mellitus (DM), malignancies, chronic corticosteroid use, and organ transplant. Case reporta 57-year-old Caucasian female, with insulin-dependent DM, presented to otolaryngology casualty complaining about a severe headache and nasal discharge. Clinical, laboratory, imaging, and histopathological investigations confirmed the diagnosis of Mucormycosis due to uncontrolled DM. Mucormycosis was managed pharmacologically, surgically, and by improving glycemic control. Psychological factors leading to non-adherence to insulin therapy were investigated and psychiatric evaluation and counseling were emphasized. Practical implicationsHealthcare providers should be aware of the signs, symptoms, and underlying causes of Mucormycosis and should manage it promptly. Mental health status should be part of the patient's evaluation and treatment plan.

A 17-year-old student with ankle sprain to leg amputation

Abstract Cutaneous mucormycosis with ischemic complications is a life-threatening condition with high mortality rates, particularly in immunocompromised individuals. The incidence of mucormycosis has increased during the COVID-19 pandemic due to reduced immunity. We present the case of a 17-year-old high school student who experienced a sprained left lower extremity, followed by worsening pain and swelling due to the topical application of unknown local herbs. Eighteen days after the injury, she was admitted to our department in a comatose state with left lower limb ischemia. The patient had a history of uncontrolled diabetes mellitus and displayed a necrotic lesion on her left ankle, suggestive of invasive infectious fungi disease. Diagnostic procedures, including tissue staining and molecular analysis, identified Rhizopus oryzae as the causative organism. Administering amphotericin B yielded marked improvement, but the patient necessitated a mid-thigh amputation to curtail the infection’s advance, culminating in her successful discharge post-treatment.

Feline Comorbidities: Hypersomatotropism-induced diabetes in cats.

Diabetes mellitus is the second-most common feline endocrinopathy, affecting an estimated 1/200 cats. While the underlying causes vary, around 15-25% of cats with diabetes mellitus develop the condition secondarily to progressive growth hormone (GH)-induced insulin resistance. This typically results in a form of diabetes that is challenging to manage, whereby the response to insulin is very variable or high doses are required to achieve even minimal diabetic control. Although uncontrolled chronic excessive GH may result in phenotypic changes that raise suspicion for acromegaly, many cats with hypersomatotropism (HST) do not have these changes. In these situations, a clinician's index of suspicion may be increased by the presence of less dramatic changes such as marked polyphagia, stertor or uncontrolled diabetes mellitus. The current diagnostic test of choice is demonstration of a markedly increased serum insulin-like growth factor 1 (IGF1) concentration, but some affected cats will have only a marginal increase; additionally, chronic insulin administration in cats results in an increase in serum IGF1, making the diagnosis less clear cut and requiring additional confirmatory tests. Over the past two decades, HST has increasingly been recognised as an underlying cause of diabetes mellitus in cats. This review, which focuses on diagnosis and treatment, utilises data from observational studies, clinical trials and case series, as well as drawing on the experience of the authors in managing this condition.

Knowledge, Attitude, and Practice of Adult Diabetics Regarding Diabetic Foot Ulcers: A Cross-Sectional Study in Saudi Arabia.

Background Diabetic foot ulcers (DFUs) are one of the most common and fatal complications of diabetic patients with uncontrolled diabetes mellitus (DM) that may end with their feet amputation. These complications can be prevented through the adherence of diabetic patients to their diabetes management plan and by educating them about risk factors, complications of diabetic foot, and proper foot care. To develop effective health education programs to educate diabetic patients and caregivers regarding diabetic foot and its effective care, we should first identify gaps in patients' knowledge and perception of diabetic foot and evaluate their practice of foot care. Objectives This study aimed to evaluate knowledge and attitude toward DFUs and the practice of foot care among adult diabetic patients attending Al-Qunfudah Diabetes Center, Saudi Arabia, from October 2022 to March 2023. Methods A total of 403 adult diabetic patients were recruited in this cross-sectional study during their attendance at the diabetes center in Al-Qunfudah district, Saudi Arabia. The study researchers conducted a physical face-to-face interview with each diabetic patient using a validated questionnaire with closed-ended questions to collect their responses regarding their knowledge and attitude toward DFUs and their behavior toward foot care. The collected data were analyzed using IBM SPSS Statistics for Windows, version 23 (released 2015; IBM Corp., Armonk, New York, United States). Results Out of 403 diabetics, 50.4% (n = 203) had inadequate knowledge (knowledge score < 80%), 46.4% (n = 187) had negative attitudes (attitude score < 80%) toward DFUs, and the majority could not practice foot care well, with 77.7% (n = 313) giving a practice score less than 80%. Seventy patients (17.4%) self-reported a history of DFUs. Predictors of good knowledge about DFUs among diabetics include age between 30 and 59 years (odds ratio (OR) = 2.942, confidence interval (CI) 95% = 1.695-2.107, p < 0.001), marriage (OR = 3.101, CI 95% = 1.893-5.079, p < 0.001), working (OR = 5.325, CI 95% = 3.019-9.389, p < 0.001), diploma education (OR = 8.205, CI 95% = 3.332-20.203, p < 0.001), managing DM with oral drugs (OR = 2.219, CI 95% = 1.399-3.519, p < 0.001), and having no DFUs (OR = 2.712, CI 95% = 1.557-4.723, p < 0.001). Males were more likely to practice foot care well (OR = 1.925, CI 95% = 1.142-3.245, p = 0.013). Primary education (OR = 3.421, CI 95% = 1.655-7.073, p < 0.001) predicted appropriate foot care. Patients with DM for one to five years (OR = 1.995, CI 95% = 1.139-3.493, p = 0.016) and those on diet and metformin (OR = 2.133, CI 95% = 1.134-4.011, p = 0.019) were expected to have better foot care than other diabetics. Conclusion Diabetic patients in the Al-Qunfudah district of Saudi Arabia had inadequate knowledge and negative attitudes toward DFUs, and their foot care behaviors were inadequate. Furthermore, DFUs were self-reported in around 17% of diabetic patients. Specialized training programs are recommended to enhance knowledge regarding DFUs among diabetics and motivate and train them and caregivers on how to conduct proper foot care. These educational programs should target all diabetics, with an emphasis on those with DFUs, females, non-working patients, individuals who have had DM for a longer time, and illiterate diabetics. To understand the factors behind patients' negative attitudes toward diabetic foot, future qualitative research is required.

Comparison between amphotericin b and posaconazole as consolidation therapy in invasive fungal sinusitis (mucormycosis)

Aim: To analyse the effects of combination therapy with Injection liposomal Amphotericin B (LAmB) and Tablet Posaconazole in Mucormycosis. Acute invasive fungal sinusitis is an uncommon disease that often has rapid and destructive clinical progression. Priorly, a disease of the immuno-compromised, Invasive fungal sinusitis is typically associated with patients undergoing chemotherapy, stem cell transplantation as well as in patients with uncontrolled diabetes mellitus and patients using corticosteroids. Materials and methods: This retrospective observational study was carried after obtaining institutional ethical committee on a total of 40 patients with history of diabetes mellitus, covid positivity, infusion of steroid injections and immuno-compromised were admitted and treated between May 2021 to July 2021. Results: Any potential combination therapy study under consideration for testing in patients with Mucormycosis should use polyene, as backbone therapy. Injection Amphotericin B remains the only antifungal agent licensed by the US Food and Drug Administration for primary therapy of Mucormycosis. Tablet Posaconazole reported 90% minimum inhibitory concentrations with Mucorales range from 1 to &gt;=4 microgram/ml. In febrile neutropenic patients or those with mucormycosis, Conclusion: Mucormycosis is a disease of increasing frequency. It continues to have a higher mortality rate than most other infections, frequently affects young patients.

Description of knowledge, attitudes and practices to maintain oral hygiene as well as gingival index and plaque index in children suffering from type 1 diabetes mellitus

Background: Diabetes mellitus is a chronic disease whose incidence continues to increase throughout the world. Periodontal disease is a complication of diabetes. Poor periodontal health can lead to a variety of serious health problems. Therefore, this research is considered important to determine knowledge, attitudes and practices to maintain oral hygiene as well as gingival index and plaque index in children with type 1 diabetes mellitus. Objectives: To determine the description of knowledge, attitudes and practices to maintain oral hygiene as well as gingival index and plaque index in children with type 1 diabetes mellitus. Method: This research is a cross-sectional observational analytical study consisting of 32 respondents from children suffering from T1DM and members of IKADAR Malang. The instrument used was a questionnaire to measure knowledge, attitudes and practices regarding cleaning teeth and mouth; insulin injection compliance, diet, and physical activity. Hba1c to determine DMT-1 status. Gingival and plaque index. Results and discussions: Respondents with controlled diabetes, good knowledge, attitudes and practices all had healthy gingiva and good PI, namely 3 (15.79%). respondents with regular insulin, good diet and low physical activity all had uncontrolled diabetes, namely 2 (7.14%). Conclusion: The majority of respondents have uncontrolled diabetes, knowledge, attitudes, practices to maintain good oral hygiene, healthy gingiva, and good PI in one unit, namely 9. The majority of respondents have regular insulin injection compliance, moderate diet, low physical activity, and uncontrolled diabetes mellitus status in one unit, namely 17.

Implication of Low Plasma Arginine among Patients with Diabetic Foot Ulcer (DFU).

&lt;b&gt;Background and Objective:&lt;/b&gt; Diabetic foot ulcer (DFU) is a well-recognized vascular complication of uncontrolled diabetes mellitus. Unless immediate measures are taken some patients end up with amputation. The hallmarks of DFU are hyperglycemia, neuropathy, ischemia and infection (Andrew). Recent studies confirmed the role of low serum arginine in the development of foot ulcer in diabetic patients. The current study aimed to investigate the relationship between low serum magnesium and diabetic foot ulcer and to identify the incidence of low plasma arginine levels in diabetic patients with DFU in Sudan. &lt;b&gt;Materials and Methods:&lt;/b&gt; A total of 120 subjects were recruited in this study and were divided into three groups, namely, diabetic with foot ulcer (group-I), diabetic without foot ulcer (group-II) and non-diabetic healthy subjects (group-III). These subjects were investigated for FBS, HbA1c and serum arginine. Data were analysed using SPSS (28th release). &lt;b&gt;Results:&lt;/b&gt; Analysis of the results obtained showed significantly marked reduced plasma arginine levels in group I than the other two groups where mean plasma arginine level was 12.08, 49.25 and 94.1 micromole/L, respectively. There was no statistical difference between the duration of diabetes and DFU in diabetic patients with DFU and diabetic patients without DFU, as well as levels of HbA1c (p-value 0.457, 0.89) respectively. &lt;b&gt;Conclusion:&lt;/b&gt; The low serum arginine levels were significantly associated with foot ulcers in diabetic patients and play an important role in the development of diabetic foot ulcers.

O-07 Lipodystrophy: A disease to be considered in diabetes clinics

Abstract Introduction Lipodystrophy syndromes are disorders with no adipose tissue. Lipodystrophy is classified based on the degree of adipose tissue deficiency, distinguishing between partial and generalized forms, and considering if it is inherited or acquired. The condition is characterized by ectopic steatosis, severe dyslipidemia, insulin resistance, and severe comorbidities including uncontrolled diabetes mellitus (DM), acute pancreatitis, hepatic cirrhosis, proteinuria, renal failure, and premature cardiovascular disease. Congenital Generalized Lipodystrophy (CGL, Berardinelli-Seip Syndrome) is inherited autosomal recessively. Four genetic mutations linked to CGL have been identified: AGPAT2, BSCL2, CAV1, and PTRF. This report describes a case of a patient with uncontrolled diabetes and other health conditions. The patient was diagnosed with CGL2 as an adult after admission to our facility. Clinical Case This case involves a 43-year-old female patient seeking help for glycemic control and menstrual cycle irregularities. She was diagnosed with DM at 24 and received care at multiple hospitals. Her mother, older brother, and three sisters were diagnosed with DM before the age of 40. Her BMI was 23.4 kg/m2. The physical examination revealed muscularly prominent lipoatrophy in the upper and lower limbs and acanthosis nigricans in the axilla. Additionally, the person had facial features resembling acromegaly, with enlarged extremities and swelling of soft tissues. Blood pressure was regulated with ramipril, hydrochlorothiazide, and amlodipine. She had used various insulin and OAD regimens in the past. Despite this, euglycemia was challenging to achieve, and she frequently needed to be hospitalized for diabetic ketoacidosis. Anti-glutamic acid decarboxylase, anti-insulin, and islet antibodies were negative. HbA1c level was 13.3% and C-peptide level was 2.5 ng/ml. Moreover, grade 3 hepatosteatosis and hypertriglyceridemia were present. Polyneuropathy and diabetic nephropathy were also identified. Acromegaly and cushing syndrome were excluded. After excluding acquired lipodystrophy syndromes, she was consulted to the genetics department for CGL. Next-gen sequencing found a homozygous missense mutation (c.666G&amp;gt;C; p.Met222Ile) in exon 5 of the BSCL2 gene. Following this result, the patient was diagnosed as CGL2. Caloric and fat restricted dietary was recommended. Fat intake was below 20-30% of total energy. The patient was treated with insulin aspart, glargine U300/mL, metformin, alpha lipoic acid, and fenofibrate. The patient's blood glucose was more regulated, did not apply to the emergency department. Family members were also given genetic counseling. Conclusion Lipodystrophy is rare however medical professionals must exercise caution and consider lipodystrophy as a possible diagnosis for non-obese individuals who have difficulty maintaining euglycemia, fatty liver disease, and elevated triglyceride levels. The physical examination is crucial for diagnosis.

Association of Microalbuminuria with Glycemic Status Among Patients with Diabetes Mellitus

Objectives: To evaluate the association between micro-albuminuria and glycemic status among type 2 diabetic patients in Hyderabad, Sindh.&#x0D; Methods: Cross Sectional study was conducted at the Medical unit of Isra University, Hyderabad from January 2019 to June 2020. All the patients aged between 30 and 50 years, of either genders, with both good controlled as well as uncontrolled diabetes mellitus type II admitted in the medicine ward were included. All the participants were divided into two groups according to their glycemic level. The Group I comprised of patients with poor glycemic control that is HbA1c &gt;7% while Group II comprises of patients with good glycemic control that is HbA1c&lt;7%.&#x0D; Results: Majority (56.4%) of participants in the study were Male while most (31.0%) them belongs to age group 41-45 years. The mean age of all patients was 42.3 ± 4.1 years. The mean HbA1c level in group 1(poorly controlled) and 2 (good control) participants was 8.04± 0.97% and 5.87 ± 0.44%. There was a statistically significant association (p&lt;0.05) between poorly controlled glycemic status and micro-albuminuria.&#x0D; Conclusion: Micro-albuminuria is significantly associated with the poor glycemic status among type 2 diabetic patients.

Prevalence and Factors Associated with Anastomotic Leakage Among Patients Undergoing Bowel Resection and Anastomosis.

Purpose: This study aimed at giving evidence on prevalence and factors associated with anastomotic leakage among patients undergoing bowel resection and anastomosis at Bugando Medical Centre (BMC) and Sekou Toure Regional Referral Hospital (SRRH).&#x0D; Methodology: A descriptive cross-sectional analytical study was used involving patients undergoing bowel resection and anastomosis at Bugando Medical Centre and Sekotoure regional referral hospital over a four-month period from March 2017 to June 2017 inclusive.&#x0D; Findings: Eight out of 144 patients (5.6%) developed anastomotic leakage. The common indication for surgery was sigmoid volvulus, the common performed anastomosis was ileo-ileo end to end, and double layer continuous anastomotic suture was the common method of anastomosis Anemia (0.012), presence of premorbid illnesses (p=0.003), American association for anesthesia (ASA) greater than II (p=0.001), intraoperative contamination/sepsis (p&lt; 0.001), low ranked operator (p=0.046), prolonged duration of operation (p=0.001), and delayed passage of stool and flatus (p=0.001) were found to be variables associated with anastomotic leakage among study participants. Anastomotic leakage in our setting occurs in approximately 5.6% of patients operated. Several factors such as high American society for Anesthesiologist above III, premorbid condition such as uncontrolled Diabetes Mellitus, intraoperative contamination/sepsis, low ranked operator, prolonged duration of operation above 3 hours and prolonged ileus were among factors that the present study found to be associated with high risk of anastomotic leakage.

Clinical Outcomes of COVID-19 Patients with Controlled and Uncontrolled Diabetes Mellitus¥

Clinical Outcomes of COVID-19 Patients with Controlled and Uncontrolled Diabetes Mellitus¥

Diabetes and chronic kidney disease in Chinese adults: a population-based cohort study

IntroductionCohort evidence of the association of diabetes mellitus (DM) with chronic kidney disease (CKD) is limited. Previous studies often describe patients with kidney disease and diabetes as diabetic kidney disease...

Stem Cells Reprogramming in Diabetes Mellitus and Diabetic Complications: Recent Advances.

The incidence of diabetes mellitus (DM) is dramatically increasing worldwide, and it is expected to affect 700 million cases by 2045. Diabetes influences health care economics, human quality of life, morbidity, and mortality, which were primarily seen extensively in developing countries. Uncontrolled DM, which results in consistent hyperglycemia, may lead to severe life-threatening complications such as nephropathy, retinopathy, neuropathy, and cardiovascular complications. In addition to traditional therapies with insulin and oral anti-diabetics, researchers have developed new approaches for treatment, including stem cell (SC) therapy, which exhibits promising outcomes. Besides its significant role in treating type one DM (T1DM) and type two DM (T2DM), it can also attenuate diabetic complications. Furthermore, the development of insulin-producing cells can be achieved by using the different types of SCs, such as embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and multiple types of adult stem cells, such as pancreatic, hepatic, and mesenchymal stem cells (MSC). All these types have been extensively studied and proved their ability to develop insulin-producing cells, but every type has limitations. This review aims to enlighten researchers about recent advances in stem cell research and their potential benefits in DM and diabetic complications.

Type-2 diabetes prevalence and severity of Parkinson&amp;apos;s disease at a tertiary hospital

Objective: To study the prevalence of type-2 diabetes mellitus (T2DM) in patients diagnosed with Parkinson&amp;apos;s disease (PD) and determine the impact of managing T2DM on the severity of PD symptoms. Methods: A retrospective cohort review was carried out at King Abdulaziz Medical City, Ministry of National Guards-Health Affairs (KAMC-NGHA) in Jeddah, Saudi Arabia, from February to September 2023. The study included all PD patients who were admitted to KAMC-NGHA. The participants were divided into two groups: those with diabetes mellitus (DM) and those without DM. In the diabetes group, the patients were further classified as controlled and uncontrolled diabetes based on glycated hemoglobin (HbA1C) levels, specifically targeting a threshold of 7.0%. Results: Of the 225 total PD patients, 145 (64.4%) had diabetes, while 80 (35.6%) did not. According to the Hoehn and Yahr (H&amp;Y) scale, stage 5 PD was prevalent in both the diabetic and non-diabetic groups. When comparing controlled and uncontrolled diabetic patients, a statistically significant difference in the severity of PD was found (p=0.029). Conclusion: The study showed a significant extent of T2DM among PD patients. Moreover, an obvious difference in the severity of PD was spotted in individuals with diabetes, especially when comparing controlled and uncontrolled DM.

Serum magnesium level and its correlation with sensory nerve conduction in type 2 diabetes mellitus patients

Background: Type 2 diabetes mellitus is a major public health problem. Chronic hyperglycemia in uncontrolled diabetes mellitus patients leads to microvascular and macrovascular complications. Diabetic peripheral neuropathy (DPN) has become the most common chronic diabetic complication, affecting about half of diabetic patients. DPN causes debilitating complications like foot ulcers and gangrene, leading to lower limb amputation and reducing the quality of life in diabetic patients. Serum magnesium has a close relationship with T2DM. It has been shown that lower serum magnesium levels are significantly associated with an increased risk of type 2 diabetes mellitus and with various complications of diabetes, including peripheral neuropathy, cardiovascular disease, nephropathy, retinopathy, and foot ulcers. Aim and Objective: The objective of the study is to compare serum magnesium levels and sensory nerve conduction in type 2 diabetes mellitus patients. Materials and Methods: This is a cross-sectional study that includes 75 participants in the age group of 35–45 years. The participants were divided into 2 groups. Group I: newly diagnosed type 2 DM patients, which included 25 female and 20 male patients. Group II: Type 2 DM patients who were taking treatment for more than 5 years, which included 15 female and 15 male patients. Under aseptic precautions, a blood sample was obtained, and the estimation of serum magnesium was determined by photocolorimetry. Sensory nerve conduction (median and sural nerve) was done using recorders and medicare systems EMG EP MARK II. Statistical analysis was done using IBM SPSS version 20.0 software. Pearson correlation analysis was used to check the correlation between sensory nerve conduction and serum magnesium. P &lt; 0.05 was taken as statistically significant. Results: In this study, the range of serum magnesium in group I was 1.5–2.9 mg/dl with a mean of 2.21 ± 0.3. The range of serum magnesium in group II was 1.4–2.5 mg/dl with a mean of 1.94 ± 0.3. The Pearson correlation between the parameters of sensory nerve conduction (median and sural nerve) and serum magnesium in terms of latency, amplitude, and conduction velocity in group I was -0.533, 0.471, 0.094, and -0.28, 0.029, 0.082, respectively; similarly, for group II, it was −0.27, 0.163, 0.607, and −0.071, 0.177, 0.028. The latency of all nerves was negatively correlated with serum magnesium. The amplitude and conduction velocities of all nerves were positively correlated with serum magnesium. Hence, serum magnesium seems to be a very good indicator of the effect of diabetes mellitus on peripheral nerves. Conclusion: In our study, we found out that serum magnesium seems to be a very good indicator of the effect of diabetes mellitus on peripheral nerves.

Nephrotic Syndrome and Acute Kidney Injury Presenting in an Older Adult with Uncontrolled Diabetes Mellitus Following Recent COVID-19 Infection Case Report

Nephrotic Syndrome and Acute Kidney Injury Presenting in an Older Adult with Uncontrolled Diabetes Mellitus Following Recent COVID-19 Infection Case Report

Case report of a person with diabetes mellitus who has tropical diabetic hand syndrome

-Introduction: Diabetes mellitus (DM) is a chronic systemic disease that causes morbidity and mortality. Diabetes often increases the incidence and severity of various infections, especially those caused by bacteria and fungi, where patients have hyperglycemia and poor blood sugar control. Tropical diabetic hand syndrome (TDHS) is a specific hand complication experienced by people with DM in tropical countries. The syndrome involves localized cellulitis, which can be progressive and fulminant to hand sepsis and gangrene. Management of patients with TDHS requires a comprehensive strategy and management to reduce mortality and morbidity. This study aimed to report a rare case of a patient with T2DM who experienced TDHS. Case Presentation: A 45-year-old man came to the emergency department of RSUD Dr. Soetomo, with a chief complaint of a wound on his right hand caused by a rusty nail that had not healed for three days. The patient said that he had uncontrolled DM for six years. In manus dextra examination, an ulcer measuring 0.5x 0.5 cm was found on the back of the hand on the ulnar side, with edema, hyperemia, and active pus discharge. The patient was hospitalized for nine days and discharged when the complaints and the blood sugar level were improved. On the seventh day after discharge, the complaints felt significantly reduced, the wound improved with granulation tissue appearing, and the blood sugar level was within normal limits. The patient was given insulin aspart injection of 10 units thrice daily, basal insulin of 16 units, ciprofloxacin 500 mg twice daily, ibuprofen 400 mg thrice daily, and cilostazol 100 mg twice daily. Conclusion: In this case report, we presented a case of a 45-year-old man with manifestations of TDHS as a complication of uncontrolled DM for six years and delay in obtaining medical services. Management of patients with TDHS includes hospitalization, elevation of the affected hand, optimal blood sugar control, administration of antibiotics, and wound care. Education for T2DM complications remains the most important preventive measure in developing countries.

Empagliflozin alleviates diabetes-induced cognitive impairments by lowering nicotinamide adenine dinucleotide phosphate oxidase-4 expression and potentiating the antioxidant defense system in brain tissue of diabetic rats

BackgroundDiabetes-induced cognitive impairment is a major challenge in patients with uncontrolled diabetes mellitus. It has a complicated pathophysiology, but the role of oxidative stress is central. Therefore, the use of antidiabetic drugs with extra-glycemic effects that reduce oxidative damage may be a promising treatment option. MethodsMale Wistar rats were randomly divided into four groups as normal, normal treated, diabetic and diabetic treated (n = 8 per group). Type 1 diabetes was induced by a single intraperitoneal dose of streptozotocin (STZ) (40 mg/kg). Two treatment groups received empagliflozin for 5 weeks (20 mg/kg/po). Cognitive ability was evaluated using open field, Elevated Plus Maze (EPM) and the Morris Water Maze (MWM) tests at study completion. Blood and brain tissue samples were collected - and analysis for malondialdehyde (MDA) and glutathione (GLT) content and catalase (CAT) and superoxide dismutase (SOD) enzyme activity were performed. Additionally, expression of nicotinamide adenine dinucleotide phosphate oxidase-4 (Nox-4) enzyme in brain tissue was analyzed using RT-PCR. ResultsSTZ increased blood glucose and induced diabetes with oxidative stress by lowering the antioxidant system potency and increasing Nox-4 expression after 5-weeks in brain tissue accompanied by reduction in cognitive performance. Also, diabetes induced anxiety-like behavior and impaired spatial memory in MWM, EPM and open field tests. However, empagliflozin reversed these changes, improving SOD and CAT activity, GLT content and reducing Nox-4 expression and MDA concentration in brain tissue while improving cognitive ability. It reduced anxiety and depression-related activities. It also improved spatial memory in MWM test. ConclusionUncontrolled diabetes negatively impacts mental function and impairs learning and cognitive performance via oxidative stress induction, the Nox-4 enzyme playing a central role. Empagliflozin reverses these effects, improving cognitive ability via promoting the anti-oxidative system and damping Nox-4 free radical generator enzyme expression. Therefore, empagliflozin is a promising treatment, providing both antidiabetic and extra-glycemic benefits for improving brain function in the diabetic milieu.

GLP-1 AGONISTS: EFFECT IN MANAGEMENT OF DIABETES AND WEIGHT LOSS IN OLDER ADULTS WITH OVERWEIGHT AND OBESITY

Abstract Prevalence of Diabetes Mellitus Type 2 in older adults in the US is 33%, incidence of newly diagnosed diabetes is highest among those aged 65-79 years. Obesity in older adults impacts not only the morbidity and mortality, but importantly impacts quality of life and risk of institutionalization. Treatment for diabetes with glucagon like peptide 1 (GLP-1) agonists have demonstrated to reduce weight, control glucose, and reduce major adverse cardiovascular events in older adults. This study aims to describe outcomes in the management of older adults with diabetes and obesity with GLP-1 agonists. A retrospective study of 30 older adults with uncontrolled diabetes, overweight and obesity at a local practice that were started on treatment with GLP-1 agonists, since 2022, with ages 65-84 with diabetes mellitus type 2 with initial HbA1C 9.6%-12.6%, and BMI 27-48.2 that were started on GLP-1 agonists with improved results during treatment with current reduction of HbA1C 5.8%-7.7% and BMI reduction 23-39.8. In conclusion GLP-1 agonists have demonstrated significantly improved management of uncontrolled Diabetes Mellitus in older adults as well as a significant reduction in weight improving outcomes.

Revascularization Outcomes Stratified by Glycemic Control in Patients with Diabetes Mellitus and Chronic Limb-Threatening Ischemia

The prevalence of chronic limb-threatening ischemia (CLTI) has increased alongside rising rates of diabetes mellitus (DM). While diabetic patients with CLTI have worse outcomes compared to patients without diabetes, conflicting data exist on the relationship between the severity of DM and CLTI outcomes. Close inspection of the relationship between DM severity and outcomes in CLTI may benefit surgical decision-making and patient education. We retrospectively reviewed patients who received endovascular intervention or surgical bypass for CLTI at our multidisciplinary Limb Preservation Program from 2013 to 2019 to collect patient characteristics using Society for Vascular Surgery (SVS) reporting standards, arterial lesion characteristics from recorded angiograms, and outcomes, including survival, amputation, wound healing, and revascularization patency. Controlled DM was defined as SVS Grade 1 (controlled, not requiring insulin) and Grade 2 (controlled, requiring insulin), while uncontrolled DM was defined as SVS Grade 3 (uncontrolled), and DM severity was assessed using preoperative hemoglobin A1c (HgbA1c) values. Product-limit Kaplan-Meier was used to estimate survival functions. Univariable Cox proportional hazards analyses guided variable selection for multivariable analyses. Our Limb Preservation Program treated 177 limbs from 141 patients with DM. Patients with uncontrolled DM were younger (60.44±10.67 vs. 65.93±10.89years old, P=0.0009) and had higher HgbA1c values (8.97±1.85% vs. 6.79±1.10%, P<0.0001). Fewer patients with uncontrolled DM were on dialysis compared to patients with controlled DM (15.6% vs. 30.9%, P=0.0278). By Kaplan-Meier analysis, DM control did not affect time to mortality, limb salvage, wound healing, or loss of patency. However, multivariable proportional hazards analysis demonstrated increased risk of limb loss in patients with increasing HgbA1C (hazard ratio (HR)=1.96 [1.42-2.80], P<0.0001) or dialysis dependence (HR=15.37 [3.44-68.73], P=0.0003), increased risk of death in patients with worsening pulmonary status (HR=1.70 [1.20-2.39], P=0.0026), and increased risk of delayed wound healing in patients who are male (HR=0.48 [0.29-0.79], P=0.0495). No independent association existed between loss of patency with any of the variables we collected. Patients with uncontrolled DM, as defined by SVS reporting standards, do not have worse outcomes following revascularization for CLTI compared to patients with controlled DM. However, increasing HgbA1c is associated with a greater risk for early amputation. Before revascularization, specific attention to the level of glycemic control in patients with DM is important, even if DM is "controlled." In addition to aggressive attempts at improved glycemic control, those with elevated HgbA1c should receive careful education regarding their increased risk of amputation despite revascularization. Future work is necessary to incorporate the severity of DM into risk models of revascularization for the CLTI population.