The role of pro-inflammatory cytokines – tumor necrosis factor-alpha and interleukin 6 – in the evolution of diabetic nephropathy: A comparative study

Background: Diabetes is highly prevalent and it is responsible for the increased financial burden on healthcare. Type II diabetes is a more prevalent form of diabetes. Uncontrolled and unsupervised type II diabetes may lead to various microvascular and macrovascular complications which are responsible for high morbidity and mortality. Diabetic nephropathy (DN) is a common complication characterized by the expansion of mesangial cells with thickening of the basement and nodular glomerulosis. TNF-alpha and IL-6 play an important role in causing detrimental changes leading to nephropathy. The study of the role of these inflammatory cytokines in patients with DN may help in the early diagnosis and management. Aims and Objectives: The objectives of this study were to compare the levels of proinflammatory cytokines, TNF-?, and IL-6 in the evolution of DN patients. Materials and Methods: The present study was conducted in the Department of Biochemistry, in collaboration with the Department of Medicine (Nephrology unit); Pt. B.D. Sharma, Post Graduate Institute of Medical Sciences, Rohtak after ethical clearance. Forty patients with DN (Stages 3, 4, and 5) and forty patients with diabetes mellitus without nephropathy were taken up for study after taking informed consent. Results: The mean serum TNF-? levels in cases was 33.05 ± 29.22 pg/mL and in controls was 17.67 ± 12.33 pg/mL. On the basis of unpaired t-test, the difference between the groups was statistically highly significant (P < 0.05). The mean serum interleukin-6 levels in cases was 24.92 ± 30.16 pg/mL (2.95–155.55 pg/mL) and in controls was 6.76 ± 5.82 pg/mL (2.22–35.42 pg/mL). On the basis of the t-test, the difference between the groups was statistically highly significant (P < 0.05). Conclusion: TNF-? and IL-6 may serve as potential biomarkers for patients with DN and also in the development of newer therapeutic modalities for the prevention and treatment of DN.

Depressive symptoms among older adults with diabetes mellitus: a cross-sectional study

ABSTRACT BACKGROUND: Diabetes mellitus is a chronic disease with long-term consequences that is often associated with depressive symptoms. This relationship predicts increased morbidity and mortality rates, leading to serious health consequences. OBJECTIVE: To identify the prevalence and health factors associated with depressive symptoms among older adults with diabetes mellitus. DESIGN AND SETTING: An observational cross-sectional study was conducted among 236 older adults in the Basic Healthcare Units of Jequié, Brazil. METHODS: A survey containing sociodemographic, behavioral, and health conditions was used as a data collection instrument, in addition to the Geriatric Depression Scale. The main inclusion criterion was older adults diagnosed with diabetes mellitus. To identify the risk factors associated with depressive symptoms among older adults with diabetes mellitus, logistic regression analysis was conducted for calculating the odds ratio (OR), and a 95% confidence interval (CI) was considered statistically significant. RESULTS: The prevalence of depressive symptoms was 24.2% among older adults with diabetes, corroborating the Brazilian average of 30%. The final multivariate analysis model for the risk of depressive symptoms showed a significant association with diabetes complications [OR = 2.50, 95% CI 1.318-4.74)] and osteoporosis [OR = 2.75, 95% CI 1.285-5.891)]. CONCLUSION: A high prevalence of depressive symptoms was observed among older adults with diabetes. Critically examining older adults with diabetes mellitus is necessary, and screening for depressive symptoms is highly recommended, especially for those with complications resulting from diabetes mellitus and musculoskeletal comorbidities, such as osteoporosis, as it seems to be associated with depressive symptoms.

Application of single cell RNA sequencing in the treatment of diabetes / 中华内分泌代谢杂志

Single-cell RNA sequencing (scRNA-seq) is used for transcriptome profiling at the individual cell level, which is capable of screening in differentially gene expression that results from genetic mutation. Islet-based developmental atlas and heterogeneity characterization are currently the main applications of scRNA-seq in diabetes. scRNA-seq also can be used to mark and purify the functional β cells from resident adult stem cells in the pancreatic islets, which is expected to improve the outcome of islet β cells transplantation in type 1 diabetic patients. In addition, the technique can aid in learning diabetic β cell dedifferentiation and immunomodulatory functions. Although the study of scRNA-seq in diabetic retinopathy, nephropathy, atherosclerosis, and peripheral neuropathy is still at a nascent stage, scRNA-seq has great potential in a wide range of biomedical and clinical applications.

Diabetes, A Culprit Against Quality of Life?

Quality of life (QoL) is a very contemporary domain of modern health care practices. Though it has no clear or concise definition, its impact of it is huge for an individual living with diabetes mellitus. Yet, the mention of QoL is restricted to majorly four common domains, such as physical, psychological, social, and environmental, which excludes the major areas that lead to poor QoL among diabetic individuals in rural India, such as, indefinite food restriction and seclusion from the family dining menu or isolation from festivals largely focused on food. Work and role limitation in the Indian setting is also a prevalent precursor to poor QoL, for example, the consciousness of frequent bathroom visits due to polyuria, unaf-fordability of proper storage of insulin in the workplace, and increased absenteeism for doctor visits. The focus on the vague ideas of QoL needs to be changed towards more individualistic, as it is a subjective measure. Nonetheless, the assessment of QoL is non-existent in the treatment protocols of diabetes in rural India, mostly because of the non-availability of specialized institutions, resources, and services. Moreover, as diabetes is a silent disease, the effects of self-care are not immediate, even though, long-term benefits have been proven, leading to poor motivation added to inaccessibility of healthcare ser-vices, creating an environment for detrimental quality of life. Thus, an individualist approach toward QoL is warranted with mandatory evaluation of QoL in every area of the diabetic therapeutic regime.

Action Mechanism of Chinese Medicine Polysaccharides in Prevention and Treatment Diabetes and Its Complications：A Review / 中国实验方剂学杂志

Diabetes is a metabolic disease mainly characterized by hyperglycemia due to inadequate insulin secretion. And persistent hyperglycemia can cause chronic damage or dysfunction of eyes， kidneys， heart， blood vessels and nerves. Polysaccharides are high molecular carbohydrates polymerized by glycosidic bonds from more than 10 monosaccharide molecules of the same or different types. They have the advantages of wide sources， high safety and low toxic and so on. As one of the important effective components of traditional Chinese medicine， polysaccharides have biological activities such as immune regulation， anti-oxidation， anti-tumor， lowering blood sugar and so on. The structure is directly related to biological activities， and the advanced structure of polysaccharides is based on the primary structure. Exploring the primary structure of polysaccharides is the key task of lowering blood sugar and improving diabetic complications. This paper summarizes the monosaccharide composition of the primary structure of Chinese medicine polysaccharides， and the mechanism of Chinese medicine polysaccharides improving diabetes is emphasized by increasing the secretion and release of insulin， increasing the islet β cell number， upregulating insulin receptor level， improving glucose and lipid metabolism， inhibiting inflammatory response， improving oxidative stress and regulating phosphatidylinositol-3-kinase（PI3K）/protein kinase B （Akt）， mitogen activated protein kinase， cyclic adenosine monophosphate（cAMP）/protein kinase A（PKA） and adenosine monophosphate activated protein kinase（AMPK） signaling pathways. At the same time， we also summarized the prevention and treatment of Chinese medicine polysaccharides in diabetic nephropathy， diabetic cardiomyopathy， diabetic ophthalmopathy and diabetic peripheral neuropathy， in order to provide a theoretical basis for new drug development and clinical application of Chinese medicine polysaccharides in the intervention of diabetes and its complications.

Pathogenesis and Drug Intervention of Diabetic Cardiomyopathy： A Review / 中国实验方剂学杂志

Diabetic cardiomyopathy， one of the cardiovascular complications of diabetes， is characterized by cardiac systolic and diastolic dysfunction at the early stage， which can later develop into heart failure. Due to the high incidence and mortality， it has been a hot topic in recent years. The pathogenesis of diabetic cardiomyopathy is complicated. It has been proved related to abnormal glucose and lipid metabolism， cardiac insulin resistance， mitochondrial dysfunction， abnormal calcium homeostasis， activation of renin-angiotensin-aldosterone system， increased oxidative stress， endoplasmic reticulum stress， inflammation， autophagy， and so on. The specific pathogenesis remains unclear. Currently， the diabetic cardiomyopathy is mainly tackled with both western medicine and traditional Chinese medicine （TCM）. Traditional western medicine has no specific remedy for diabetic cardiomyopathy， and the resulting side effect cannot be neglected. In order to improve the efficacy and reduce the side effects， researchers have tried some potential medical treatments， such as vaspin， melatonin， Coenzyme Q10， and non-coding RNA， which still need further clinical trials. Diabetic cardiomyopathy is not recorded in ancient TCM books. According to the symptoms and signs， modern physicians often consider it as a "consumptive disease"， whose main therapeutic principles lie in benefiting Qi， tonifying Yin， activating blood， and removing stasis. The individual Chinese herbs such as Astragali Radix and Salviae Miltiorrhizae Radix et Rhizoma and Chinese herbal compounds like Huotan Jiedu Tongluoyin are effective in protecting the heart. But there are few studies exploring the pharmacodynamic mechanisms of TCM. With the continuous emergence of new drugs， the integration of TCM with western medicine may be a more promising treatment in the future. In conclusion， the pathogenesis of diabetic cardiomyopathy is unclear， and there is a lack of effective prevention and treatment. This paper reviewed the latest findings in pathogenesis and treatment of diabetic cardiomyopathy， in order to provide reference for further research.

Gold nanoparticles as a promising treatment for diabetes and its complications: Current and future potentials

Diabetes and its complications represent a major cause of morbidity and mortality in diabetes patients. This review is aimed to find the potential of gold nanoparticles (AuNPs) to act as therapeutic agents for diabetes and its complications. Here, we outline the literature related to the self-therapeutic effects of AuNPs. The first goal of this review is to highlight and summarize some of the existing studies (10 years ago) in terms of several parameters such as the size of AuNPs, dose, administration route, experimental model, experimental analysis, and findings. The second goal is to describe the self-therapeutic effects of AuNPs against the pathogenesis determinants of diabetic complications. AuNPs have been found to have inhibitory effects on transforming growth factor-ß, antiglycation, antiangiogenic, anti-hyperglycemic, anti-inflammatory, and antioxidant effects. AuNPs treatment effectively disrupts multiple pathogenesis determinants in an animal model of diabetes and diabetic complications. The present review provides insight into the potential applications of AuNPs, which may help reduce the incidence of diabetes and its complications

Application of proteomics in diabetes and its complications / 中国药科大学学报

@#Proteomics is one of the most advanced fields and hotspots in the research of various diseases in recent years. Its development has provided a new research direction for the early diagnosis and treatment of diabetes and has achieved some research results. Early diagnosis is helpful to control the progression of the disease or even avoid surgical treatment, which is of great significance for improving the prognosis of patients. This paper reviews the current status and prospects of proteomic technology and its applications in diabetes as well as its complications with a prospect of the impact of the rapid development of proteomics on diabetes and its positive role in discovering more diabetes biomarkers. In the future research, more attention should be paid to the interconnections between biomarkers.

A prospective and observational study on complications of type 2 diabetes mellitus in correlation with body mass index

Background: The aim of this study is to observe the prevalence of complications of diabetes mellitus (Type 2) among patients and to minimize their occurrence through patient education. The study helps to assess the clinical data of patients with diabetes mellitus (Type 2) along with the analysis of patterns, frequencies and predictive factors of microvascular, macrovascular complications and to educate and minimize the complications of diabetes mellitus among patients.Methods: Prospective and observational study was conducted among the type 2 diabetes mellitus patients at Sree Diabetes Clinic for a period of 6 months. The patients were interviewed using the patient data collection form which included demographic details, chief complaints and different diagnostic tools to detect type of complications. Both micro and macrovascular complications were evaluated.Results: A total of 150 type 2 diabetic cases were collected. Out of these 38(25.33%) patients were having BMI <25, and 112(74.67%) were having BMI ≥25 (overweight and obese). Out of 150 diabetic cases collected, a total of 131 diabetic complications were found. Out of these, 64(42.6%) were neuropathy, 3(2%) were nephropathy, 20(13.3%) were retinopathy and 17(11.3%) were having cardiovascular complications. Out of 112 patients with BMI ≥25, 60(54%) were found to have diabetic complications and out of 38 patients with BMI <25, 18(47%) were found to have diabetic complications. 90 out of 150 patients had a history of hypertension and 17 out of 150 patients had an abnormal lipid level.Conclusions: In this study, author found that obesity is a major risk factor for the development of diabetes mellitus and its complications.

Anti-diabetic drug, metformin, and the p38 inhibitor (SB203580) reduces internal organs oxidative stress in non-obese type 2 diabetic rats

Diabetic complications caused by hyperglycemia and oxidative stress, which can activate p38 mitogen-activatedprotein kinase (p38 MAPK), and aggravate complications via the enhancement of reactive oxygen species (ROS)generation. Recently, metformin or p38 MAPK inhibitors could reduce ROS production in particularly proteincarbonylation, in diabetic vessel. However, the combinatorial effect of metformin and SB203580 on internal organoxidative stress in non-obese (lean) type 2 diabetes mellitus (T2DM) is still uncleared. In this study, Goto-Kakizakirats were divided into four groups, including control diabetic group, metformin-treated group, p38 MAPK inhibitor(SB203580)-treated group, and combination between metformin and p38 MAPK inhibitor (SB203580). Internal organprotein from kidney, pancreas, liver, and brain was determined for protein carbonyl (PC) content by spectrophotometric2, 4-Dinitrophenylhydrazine assay. There was an increase in PC content levels in the serum and internal organs ofT2DM. Metformin ameliorated PC content in serum and internal organs. However, SB203580 could only reduce thePC content in the liver. The combination of metformin and SB203580 could synergistically reduce the PC contentlevels in serum but not the internal organs. In summary, metformin provided the greatest potential for reducingoxidative stress, while SB203580 or combined metformin with SB203580 could not reduce oxidative stress in theinternal organs of non-obese type 2 diabetic rats.

Study of Plasma Glycemic Levels and Serum Magnesium Levels in Diabetes Mellitus (DM) and Non-Diabetic Healthy Controls: A Comparative Study

Introduction: Patients of DM are known to have low levelsof serum magnesium levels as compared to non-diabetics.There is a link between the low magnesium levels and poorglycemic controls and subsequently leading to complicationsin diabetic patients. The aim of this study was to assess theserum magnesium levels in relation to glycemic status indiabetic patients as compared to non-diabetics.Material and Methods: 172 cases of previously diagnosedDM were taken along with the age and sex matched controlswho were healthy and non-diabetic and their blood sampleswere analyzed for magnesium and blood sugar fasting andpost prandial.Results: In our study we have found that there is a significanthypomagnesemia in diabetic cases as compared to nondiabetic controls which is in accordance with other studies.There also exists a negative correlation between mean serummagnesium levels (2.08 ± 0.4 mg/dL) and mean fastingplasma sugar (FBS) (159.72 ± 71.60 mg/dL) and mean postprandial sugar (PPS) (222.76 ± 100.86 mg/dL) levels. Nosignificant variation as per age and sex in serum magnesiumlevels amongst diabetic subjects have been found in our study.Conclusion: Hypomagnesemia is common in diabetics ashas been found in our study also, and it helps in regulationof glycemic levels and in turn also affects magnesium levels.Considering estimation of magnesium as a routine laboratorywork up protocol in the management of diabetes may preventvarious complications due to hypomagnesemia with earlytherapeutic intervention.

Progress in Hypoglycemic Effect and Mechanism of Polysaccharides / 中国实验方剂学杂志

Diabetes and its relevant complications have been increasing each year. Oral hypoglycemic agents can temporarily control blood sugar within a normal range, but with serious side effects on multiple systems and no significant efficacy on diabetic complications. Polysaccharide, as a natural drug with various activities, has become a hotspot in recent years, because of its safety, efficacy and low toxicity. More and more researches for the relations between polysaccharides and diabetes have demonstrated that polysaccharides have the advantages of a high safety and low toxicity in treating diabetes. In addition, some polysaccharides may show an effect in alleviating diabetic complications. This paper summarizes recent researches on the hypoglycemic mechanism of polysaccharides. Polysaccharides could protect islet β cell, increase the number of islet cells, promote insulin secretion or release, increase insulin sensitivity, improve insulin resistance and improve glucose metabolism. And polysaccharides can be used in alleviating diabetes-related kidney, eye and foot disease. This report proposes shortcomings for the extraction, activity research and multi-target effects of polysaccharides for diabetes treatment. In addition, this report reviews how polysaccharides affect diabetes and complications, so as provide a scientific reference for the hypoglycemic effect of polysaccharides.

Advances in research on microRNA in diagnosis and treatment of diabetic complications / 国际检验医学杂志

Diabetes mellitus can cause a wide variety of complications.A large number of studies have shown that microRNA plays an important role in diabetic complications, and its expression regulation is closely related to the occurence, development and treatment of diabetic complications.In this article, several major complications of diabetes mellitus and their related microRNAs were reviewed, and we hoped to provide some theoretical basis for the diagnosis and treatment of these diseases.

Plasma Cellular Hypoxia, Mitochondrial Dysfunction, Disease Risk and Prognostic Factors in Type 2 Diabetic Patients in Saudi Arabia / Hipoxia celular plasmática, disfunción mitocondrial, riesgo de enfermedad y factores pronósticos en pacientes diabéticos tipo 2 en Arabia Saudita

ABSTRACT Objective: This cross-sectional study evaluated the association of plasma cytochrome c (CytoC) and hypoxia-inducible factor (HIF)-1α, as mitochondrial dysfunction and cellular hypoxia biomarkers, with disease risk factors and prognosis in Type 2 diabetic patients in Saudi Arabia. Methods: A total of 252 patients (94 males and 158 females) were eligible and were matched by socio-economic status, age and body mass index (BMI) with 106 healthy participants (71 males and 35 females). They were subgrouped according to BMI, disease duration and treatment. Lipid and glycaemic control indices were colorimetrically measured to calculate insulin resistance (IR) and atherogenic index of plasma (AIP). Haemoglobin A1c, C-reactive protein (CRP), CytoC and HIF-1α were measured using specific immunoassays. Results: Among the patients, 50% (38.64% of males and 52.53% of females), 40.48% (43.18% of males and 40.51% of females), 4.365% (6.82% of males and 3.80% of females), 2.381% (4.55% of males and 1.90% of females), and ~0.8% (males) suffered from peripheral neuropathy, ophthalmopathy, kidney disease, myocardial infarction and ketoacidosis, respectively. The majority of complicated cases had greater age, BMI, disease duration, plasma insulin and AIP, and were on insulin. The two investigated groups were non-significantly different considering CytoC, but highly significantly different considering lipid profile (as reflected on AIP) and glycaemic control parameters (as reflected on IR, plasma CRP and HIF-1α), with significant correlations among all of them in a group-specific pattern. Conclusion: Patients suffered a high rate of complications that correlated with age, BMI, disease duration, AIP, plasma insulin and insulin treatment due to poor disease control. Reduced HIF-1α and non-significant increased CytoC levels correlated negatively with bad prognostic indicators of the disease pointing to a pathogenetic implication.

RESUMEN Objetivo: Este estudio transversal evaluó la asociación del citocromo C del plasma (CitoC) y el factor inducible por hipoxia (HIF)-1α, como la disfunción mitocondrial y los biomarcadores de la hipoxia celular, con los factores de riesgo y pronóstico de enfermedad en pacientes diabéticos de tipo 2 en Arabia Saudita. Métodos: Un total de 252 pacientes (94 varones y 158 mujeres) fueron elegidos y apareados por estado socioeconómico, edad e índice de masa corporal (IMC) con 106 participantes sanos (71 varones y 35 hembras). Se dividieron entonces en subgrupos de acuerdo con el IMC, la duración de la enfermedad y el tratamiento. Se midieron los índices de lípidos y control glucémico para calcular la resistencia a la insulina (RI) y el índice aterogénico de plasma (IAP). la hemoglobina A1C, la proteína C-reactiva (PCR), CitoC y HIF-α fueron medidos usando inmunoensayos específicos. Resultados: Entre los pacientes, el 50% (38.64% de los varones y el 52.53% de las mujeres), 40.48% (43.18% de los varones y 40.51% de las mujeres), 4.365% (6.82% de los varones y 3.80% de las mujeres), 2.381% (4.55% de los varones y 1.90% de las mujeres), y ~ 0.8% (varones) padecían de neuropatía periférica, oftalmopatía, enfermedad renal, infarto de miocardio y cetoacidosis, respectivamente. la mayor parte de los casos complicados tenían mayor edad, IMC, duración de la enfermedad, insulina plasmática e IAP, y recibían tratamiento de insulina. Los dos grupos investigados no fueron significativamente diferentes considerando la CitoC, pero fueron muy significativamente diferentes en cuanto a su perfil lipídico (como se refleja en el IAP) y los parámetros de control glicémico (como se refleja en la RI, el plasma y el HIF-α), con importantes correlaciones entre todos ellos en un patrón específico de grupo. Conclusión: Los pacientes tuvieron un alto índice de complicaciones que se correlacionaron con la edad, el IMC, la duración de la enfermedad, el IAP, la insulina plasmática y el tratamiento de la insulina debido al pobre control de la enfermedad. La reducción del HIF-α y el aumento no significativo de los niveles de CitoC se correlacionaron negativamente con los indicadores de mal pronóstico de la enfermedad, que apuntaban a una implicación patogénica.

Diagnosis and Management of Diabetic Peripheral Neuropathy / 임상당뇨병

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and is diagnosed as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes. The prevalence of DPN was reported at 33.5% of type 2 diabetes patients by the Korean diabetes neuropathy study group. Early diagnosis is recommended to prevent diabetic foot ulcers, amputation, or disability. A questionnaire asking about symptoms and neurologic examination of feet is commonly used as a screening tool. However, complete diagnostic tests for DPN are not well established because of incomplete understanding of the pathogenetic mechanisms leading to the nerve injury, the various clinical manifestations, and the unclear natural history. Therefore, DPN has not been paid sufficient attention by clinicians. The roles of glycemic control and management of cardiovascular risk factors in the prevention and treatment of neuropathic complications are well known. Pathogenetically oriented or symptomatic agents are other options, though such treatments do not always produce a satisfactory outcome. Therefore, DPN remains a challenge for physicians to screen, diagnose, and treat. There have been recent advances in understanding the mechanisms underlying DPN and in the development of new diagnostic modalities and treatments. In this review, diagnosis and management of DPN will be discussed.

Therapeutic Observation of Acupuncture plus Medication for Diabetic Abducens Nerve Palsy / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture plus medication in treating diabetic abducens nerve palsy.Method Twenty-three cases of diabetic abducens nerve palsy were randomized into a treatment group of 12 cases and a control group of 11 cases. The two groups both were intervened by Compound anisodine hydrobromide via para-temporal-superficial-artery injection, based on which, the treatment group received acupuncture at extraocular muscles and body acupoints, while the control group received subconjunctival injection of Dexamethasone beside the endpoint of rectus lateralis. The fasting blood glucose, eye movement and diplopia were observed before and after the intervention for the two groups to evaluate the therapeutic efficacy.Result After the intervention, the two groups didn't show significant intra-group or inter-group differences in fasting blood glucose (P>0.05). The total effective rate was 91.7％ in the treatment group versus 54.5％ in the control group, and the between-group difference was statistically significant (P<0.05).Conclusion Acupuncture plus medication is an effective method in treating diabetic abducens nerve palsy.

Research Progress of Gas6 with Type 2Diabetes Mellitus and Diabetic Complications / 昆明医科大学学报

Growth arrest-specific 6, which is a member of the vitamin K-dependent protein family, is a ligand of TAM (Tyro3, Axl, Mer) belonging to the receptor tyrosine kinase family.Gas6/Axl signaling pathways are involved in pathophysiological processes of cell adhesion, migration, proliferation, apoptosis, platelet aggregation, vascular remodeling, inflammatory and immune responses. In recent years, studies found that Gas6/Axl signaling pathway, Gas6 level and the gene polymorphism of Gas6 were significantly associated with type 2 diabetes, obesity, insulin resistance and diabetic complications.This article reviews the correlation between Gas6 and type 2 diabetes and its complications

Oxidative stress in patients with type 2 diabetes mellitus treated with metformin / Estresse oxidativo em pacientes com diabetes mellitus tipo 2 em tratamento com metformina

AIMS: To evaluate oxidative stress parameters in patients with type 2 diabetes mellitus treated with metformin, relating these values to its side effects, plasma levels, glycemic control, diabetic complications, lipid profile, and the influence of pharmacotherapeutic follow-up. METHODS: Patients with type 2 diabetes mellitus, on metformin and in pharmacotherapeutic follow-up for four months, were evaluated. The pharmacotherapeutic follow-up consisted in providing information and answering patients' questions about medication and disease. In addition, administration times, dosages, and presence or absence of side effects related to the use of metformin were verified. Glycemic and lipid profile, oxidative stress (superoxide dismutase and malondialdehyde) and plasma metformin were evaluated. Pearson's correlation and Spearman's correlation were performed to evaluate the relationship between the variables at the beginning of the study. The independent t-test and Mann-Whitney U test were used to assess the difference between the groups with and without diabetic complications. The range of values between the beginning and end of the study was evaluated using Student's t-test or Wilcoxon U test. The significance level was set at 5%. RESULTS: The initial sample consisted of 49 patients aged 59±9 years with a body mass index of 29.8±5.1 kg/m2 , who have had diabetes for a median time of 36 months (interquartile range of 1-240) and have been on metformin for a median time of 36 months (interquartile range of 1-180). Twenty-five patients left the study between the second and fourth meetings. Malondialdehyde levels differed between before and after pharmacotherapeutic follow-up, being positively correlated with blood glucose, glycohemoglobin, and triglyceride level, and negatively correlated with metformin and superoxide dismutase. Blood glucose, glycohemoglobin, and malondialdehyde levels increased, whereas metformin levels decreased in the group with diabetic complications, and there was a correlation between malondialdehyde and the number of diabetic complications per patient. CONCLUSIONS: In this sample of patients with type 2 diabetes mellitus treated with metformin, oxidative stress was more pronounced in those with poor glycemic control and diabetic complications.

OBJETIVOS: Avaliar parâmetros de estresse oxidativo em pacientes com diabetes mellitus tipo 2 em uso de metformina, relacionando estes valores a seus efeitos adversos, níveis plasmáticos, controle glicêmico, complicações diabéticas, perfil lipídico, e a influência do acompanhamento farmacoterapêutico. MÉTODOS: Foram avaliados pacientes com diabetes mellitus tipo 2, em uso de metformina, em acompanhamento farmacoterapêutico por quatro meses. O acompanhamento farmacoterapêutico consistiu na prestação de informações e no esclarecimento de dúvidas dos pacientes sobre a medicação e a doença. Além disto, foram verificados os horários, as doses e a presença ou não de efeitos adversos relacionados ao uso de metformina. Foram avaliados perfil glicêmico e lipídico, estresse oxidativo (superóxido dismutase e malondialdeído) e metformina plasmática. Foram realizados os testes de correlação de Pearson e de Spearman para avaliar as relações entre as variáveis no início do estudo. Para testar a diferença entre os grupos com e sem complicações diabéticas, foram utilizados o t-teste independente ou o teste U de MannWhitney. A gama de valores entre o início e o final do estudo foi avaliada utilizando o teste t de Student ou o teste de Wilcoxon U. Foi adotado um nível de significância de 5%. RESULTADOS: A amostra inicial foi composta por 49 pacientes com idade de 59±9 anos e índice de massa corporal de 29,8±5,1 kg/m2 , com diabetes por uma mediana de tempo de 36 (intervalo interquartil 1-240) meses e em uso de metformina há uma mediana de 36 (intervalo interquartil 1-180) meses. Vinte e cinco pacientes deixaram o estudo entre a segunda e a quarta reunião. Os níveis de malondialdeído diferiram entre antes e após o acompanhamento farmacoterapêutico, correlacionando-se positivamente com glicemia, glicohemoglobina e triglicerídeos e negativamente com metformina e superóxido dismutase. Encontrou-se elevação da glicemia, glicohemoglobina e malondialdeído, e diminuição da metformina no grupo com complicações diabéticas, e foi identificada correlação entre malondialdeído e o número de complicações diabéticas por paciente. CONCLUSÕES: Nesta amostra de pacientes com diabetes mellitus tipo 2 em tratamento com metformina, o estresse oxidativo foi mais pronunciado nos que apresentavam pior controle glicêmico e complicações diabéticas.

Therapeutic Observation of Moxibustion plus Tuina for Early-stage Diabetic Foot / 上海针灸杂志

Objective To observe the clinical efficacy of moxibustion plus tuina in treating early-stage diabetic foot. Method Seventy patients with early-stage diabetic foot were randomized into a treatment group and a control group, 35 cases each. The control group was intervened by conventional medication, while the treatment group was additionally intervened by moxibustion plus tuina. After 2 treatment courses, the changes of ankle bronchial index (ABI) in the two groups were observed, and the clinical efficacies were compared. Result Patients in the treatment group showed significant improvement in symptoms, and the total effective rate was 96.9%. The total effective rate was 75.8% in the control group. The difference between the two groups was statistically significant (P<0.05). Conclusion Moxibustion plus tuina is safe and effective in treating diabetic foot. With significant Chinese medicine feature and acceptable to patients, this method is a good choice in treating early-stage diabetic foot.

Effect of Acupuncture-moxibustion in Assisting the Treatment of Diabetic Peripheral Neuropathies on the Recovery and Prognosis of Neurological Function / 上海针灸杂志

Objective To observe the effect of acupuncture-moxibustion in assisting the treatment of diabetic peripheral neuropathies (DPN) on the recovery and prognosis of neurological function. Method A total of 170 DPN patients were evenly randomized into two groups. The control group received conventional treatment; the observation group was additionally given acupuncture-moxibustion to assist the treatment. The clinical efficacies and nerve conduction velocity were compared between the two groups, and the occurrence of complications was observed in the 2-month follow-up. Result The total effective rate approached 92.9% in the observation group, significantly higher than 76.5% in the control group (P<0.05). The test of motor nerve conduction velocity showed that, after the treatment, the left median nerve conduction velocity was (44.2±2.3)m/s in the observation group, significantly higher than (33.4±4.1)m/s in the control group; the left ulnar nerve conduction velocity was (44.3±2.4)m/s in the observation group, significantly higher than (33.9±4.1)m/s in the control group; the right tibial nerve conduction velocity was (37.1±4.3)m/s in the observation group, significantly higher than (31.9±2.6)m/s in the control group; the right peroneal nerve conduction velocity was (36.9±2.5)m/s in the observation group, also significantly higher than (35.8±2.6)m/s inthe control group. In comparing the sensory nerve conduction velocity (SCV), the left median nerve conduction velocity was (44.1±3.2)m/s in the observation group, significantly higher than (33.3±4.1)m/s in the control group; the left ulnar nerve conduction velocity was (43.5±2.6)m/s in the observation group, significantly higher than (33.9±2.7)m/s in the control group; the right superficial peroneal nerve conduction velocity was (35.8±2.6)m/s in the observation group, significantly higher than (30.9±3.8)m/s in the control group (P<0.05). The 2-month follow-up study showed that the occurrence rate of complications was 14.1% in the observation group, significantly lower than 28.2% in the control group (P<0.05). Conclusion Acupuncture-moxibustion produces a significant efficacy in assisting the treatment of DPN. It can markedly accelerate the nerve conduction velocity and reduce the occurrence of complications in advanced stage.