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1.
Front Endocrinol (Lausanne) ; 13: 921287, 2022.
Article in English | MEDLINE | ID: mdl-36082072

ABSTRACT

Background: Cardiac autonomic neuropathy in population with diabetes mellitus (DM) is frequent and linked with high risk of cardiovascular mortality. However, studies on whether blood hemoglobin A1c (HbA1c) levels are related to adverse differences in heart rate variability (HRV) in individuals with DM are scarce. Aim: We aimed to investigate the association of blood HbA1c levels with adverse differences in HRV, which is an indicator of cardiac autonomic control, in adult individuals with and without DM. Methods: Data were collected from the Midlife in the United States (MIDUS) study, and 928 individuals were analyzed for the relationship between blood HbA1c levels and HRV through a cross-sectional analysis. Results: Participants with DM had significantly higher HRV than those without DM. The smooth curve suggested inverse relationships between blood HbA1c levels and HF- and LF-HRV seen in participants with DM but not in those without DM after controlling for all covariates (age, sex, BMI, smoking, number of drinking years and exercise). Furthermore, linear regression analysis demonstrated that elevated blood HbA1c levels did contribute to adverse differences in HF-HRV (Sß= -0.118; 95% CI -0.208, -0.027; P=0.012) and LF-HRV (Sß= -0.097; 95% CI -0.177, -0.017; P=0.019) after controlling for these covariates in participants with DM, while in participants without DM, blood HbA1c was not significantly related to adverse differences in HF-HRV (Sß=0.095; 95% CI -0.059, 0.248; P=0.228) or LF-HRV (Sß=0.043; 95% CI -0.103, 0.189; P=0.565). DM has a significant modifying effect on associations between blood HbA1c and adverse differences in HF-HRV (P for interaction=0.019) and LF-HRV (P for interaction=0.029). Conclusions: We reported strong evidence that elevated blood levels of HbA1c were associated with adverse differences in HRV in the diabetic population but not in the nondiabetic population. This finding supported that long-term hyperglycemia is related to autonomic nerve injury in the diabetic population. Blood HbA1c might be a good indicator of cardiac autonomic neuropathy.


Subject(s)
Autonomic Nervous System , Diabetes Mellitus , Heart Rate , Adult , Autonomic Nervous System/pathology , Cross-Sectional Studies , Diabetes Complications/diagnosis , Diabetes Mellitus/metabolism , /metabolism , Heart Rate/physiology , Humans
2.
Medicine (Baltimore) ; 101(28): e29557, 2022 Jul 15.
Article in English | MEDLINE | ID: mdl-35839026

ABSTRACT

Diabetes is prevalent in patients with coronary artery disease (CAD). Using the oral glucose tolerance test (OGTT), abnormal glucose regulation can be detected early in CAD patients without known diabetes. In the present study, we assessed the impact of abnormal glucose regulation on the long-term cardiovascular outcomes of patients with established CAD. Patients hospitalized for a scheduled angiography due to angina were enrolled in Taichung Veterans General Hospital. Fasting plasma glucose (FPG) and 2-hour postload glucose (2hPG) were assessed using the OGTT. Hemoglobin A1c (HbA1c) and other biochemical analyses were assessed using fasting blood samples. During a median follow-up period of 4.6 years, a composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke was recorded as the primary endpoint. In 682 enrolled patients who completed the follow-up, there were 16 myocardial infarction events, 12 stroke events, and 58 deaths as composite endpoints. According to FPG and 2hPG, patients with newly diagnosed diabetes had a 2-fold higher risk for the composite endpoint than those in the normal glucose group (hazard ratio [HR], 2.011; 95% confidence interval (CI), 1.101-3.673; P = .023); however, prediabetes was not significantly associated with the composite endpoint (HR, 1.452; 95% CI, 0.788-2.675; P = .232). On the other hand, patients with diabetes diagnosed by FPG and HbA1c did not have a significantly higher risk for the composite endpoint than those in the normal glucose group (HR, 1.321; 95% CI, 0.686-2.545; P = .405). A 2hPG ≥7.8 mmol/L was a significant predictor for the composite endpoint (odds ratio, 1.743; 95% CI, 1.060-2.863; P = .028) after adjusting for age, sex, and estimated glomerular filtration rate. Diabetes, but not prediabetes, detected via OGTT is associated with a significantly increased risk for the composite endpoint in patients with established CAD. The 2hPG provided a greater predictive power for the composite endpoint than fasting glucose and HbA1c.


Subject(s)
Coronary Artery Disease , Diabetes Mellitus , Myocardial Infarction , Stroke , Blood Glucose/chemistry , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Diabetes Complications/diagnosis , Diabetes Mellitus/diagnosis , Fasting , Glucose , Glucose Tolerance Test , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Prediabetic State/complications , Prediabetic State/diagnosis , Stroke/diagnosis , Stroke/etiology
3.
Front Endocrinol (Lausanne) ; 13: 925844, 2022.
Article in English | MEDLINE | ID: mdl-35813626

ABSTRACT

Objective: There are still not enough studies on the prediction of non-utilization of a complication test or a glycated hemoglobin test for preventing diabetes complications by using large-scale community-based big data. This study identified the ratio of not taking a diabetes complication test (fundus examination and microprotein urination test) among adult diabetic patients over 19 years using a national survey conducted in South Korea and developed a model for predicting the probability of not taking a diabetes complication test based on it. Methods: This study analyzed 25,811 subjects who responded that they had been diagnosed with diabetes by a doctor in the 2020 Community Health Survey. Outcome variables were defined as the utilization of the microprotein urination test and the fundus examination during the past year. This study developed a model for predicting the utilization of a diabetes complication test using logistic regression analysis and nomogram to understand the relationship of predictive factors on the utilization of a diabetes complication test. Results: The results of this study confirmed that age, education level, the recognition of own blood glucose level, current diabetes treatment, diabetes management education, not conducting the glycated hemoglobin test in the past year, smoking, single-person household, subjectively good health, and living in the rural area were independently related to the non-utilization of diabetes complication test after the COVID-19 pandemic. Conclusion: Additional longitudinal studies are required to confirm the causality of the non-utilization of diabetes complication screening tests.


Subject(s)
COVID-19 , Diabetes Complications , Diabetes Mellitus , Adult , COVID-19/complications , COVID-19/epidemiology , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Humans , Machine Learning , Pandemics
4.
S Afr Fam Pract (2004) ; 64(1): e1-e6, 2022 04 25.
Article in English | MEDLINE | ID: mdl-35532128

ABSTRACT

BACKGROUND: There is a paucity of data on the coverage of diabetes mellitus (DM) complications screening in primary healthcare facilities in South Africa (SA). This study assesses the extent of screening for DM complications among individuals with type 2 DM attending primary health facilities in rural Eastern Cape (EC), SA. METHODS: The study adopted a descriptive, cross-sectional design and obtained data from 372 individuals with type 2 diabetes attending six selected primary healthcare centres (PHCs) in two EC districts. Demographic and clinical data were obtained through questionnaire-based interviews and reviews of medical records. We assessed the extent of screening for estimated glomerular filtration rate (eGFR), fasting lipogram, eye examination, foot examination and glycated hemoglobin (HbA1c) in the past year. RESULTS: Participants mean age was 62 (standard deviation [s.d.] ± 11) years, and their mean duration of diagnosis was 9 (s.d. ± 8) years. In the past year, HbA1c result was available for 71 (19.1%) of the participants; 60 (16.1%) had eGFR results, while only 33 (8.9%) had documented lipid results. In total, 52 (14.0%) had carried out eye examinations, while only 9 (2.3%) had undergone foot examinations in the past year. About two-thirds of the participants (59.9%) had not undergone any form of complication screening in the past year, and none had undergone the complete screening panel. CONCLUSION: The coverage of screening for DM complications was low across all indicators. Studies to understand barriers to and facilitators of DM complications screening at PHCs are required. Also, interventions to improve diabetes complication screening in the region are needed and should target the primary healthcare providers.


Subject(s)
Diabetes Complications , Diabetes Mellitus, Type 2 , Aged , Cross-Sectional Studies , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Humans , Middle Aged , South Africa/epidemiology
5.
J Healthc Eng ; 2022: 5129125, 2022.
Article in English | MEDLINE | ID: mdl-35494508

ABSTRACT

Objective: Diabetic complications have brought a tremendous burden for diabetic patients, but the problem of predicting diabetic complications is still unresolved. Our aim is to explore the relationship between hemoglobin A1C (HbA1c), insulin (INS), and glucose (GLU) and diabetic complications in combination with individual factors and to effectively predict multiple complications of diabetes. Methods: This was a real-world study. Data were collected from 40,913 participants with an average age of 48 years from the Department of Endocrinology of Ruijin Hospital in Shanghai. We proposed deep personal multitask prediction of diabetes complication with attentive interactions (DPMP-DC) to predict the five complication models of diabetes, including diabetic retinopathy, diabetic nephropathy, diabetic peripheral neuropathy, diabetic foot disease, and diabetic cardiovascular disease. Results: Our model has an accuracy rate of 88.01% for diabetic retinopathy, 89.58% for diabetic nephropathy, 85.77% for diabetic neuropathy, 80.56% for diabetic foot disease, and 82.48% for diabetic cardiovascular disease. The multitasking accuracy of multiple complications is 84.67%, and the missed diagnosis rate is 9.07%. Conclusion: We put forward the method of interactive integration with individual factors of patients for the first time in diabetic complications, which reflect the differences between individuals. Our multitask model using the hard sharing mechanism provides better prediction than prior single prediction models.


Subject(s)
Cardiovascular Diseases , Diabetes Complications , Multitasking Behavior/physiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/etiology , China , Diabetes Complications/complications , Diabetes Complications/diagnosis , Diabetes Complications/etiology , Diabetic Foot/complications , Diabetic Nephropathies/complications , Diabetic Neuropathies/complications , Diabetic Neuropathies/diagnosis , Female , Humans , Male , Middle Aged
6.
Guatemala; IGSS; 2014. 78 p. ilus.(Guías de práctica clínica basadas en evidencia, 55).
Monography in Spanish | LILACS (Americas), LIGCSA, IGSSMED | ID: biblio-1361633

ABSTRACT

Esta guìa contiene datos generales relacionados con la ceguera la edad en pacientes diabeticos no controlada. hay un incremento de casos por ceguera a nivel mundial que son de alta prevalencia y severidad. algunas clsificaciones de la diabetes mellitus oftalmopatìas; retinopatìa, opacidades del cristalino o cataratas, glaucoma, lesiones de la cornea, paresia o paralisis de musculos extraoculares secundario a neuropatìa. aunque existen alguna medidas de estricto control metabolico.


Subject(s)
Humans , Male , Female , Glaucoma/surgery , Glaucoma, Neovascular/diagnosis , Diabetes Complications/diagnosis , Diabetic Angiopathies/diagnosis , Diabetic Retinopathy/etiology , Blindness/prevention & control , Diabetes Mellitus/drug therapy , Eye Diseases/complications , Corneal Injuries/drug therapy , Lens, Crystalline/pathology
7.
Sci Rep ; 12(1): 1794, 2022 02 02.
Article in English | MEDLINE | ID: mdl-35110602

ABSTRACT

Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80-2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89-2.60) and uncontrolled (AHR 2.28, 95% CI 1.80-2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78-8.05) and mental (AHR 3.97, 95% CI 2.29-6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.


Subject(s)
Diabetes Complications/therapy , Diabetes Mellitus, Type 2/therapy , Disability Evaluation , Disabled Persons , Healthcare Disparities/trends , Hospitalization/trends , Unnecessary Procedures/trends , Adult , Aged , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Female , Health Status , Humans , Incidence , Male , Middle Aged , Persons with Mental Disabilities , Predictive Value of Tests , Republic of Korea/epidemiology , Risk Assessment , Risk Factors , Time Factors , Young Adult
9.
PLoS One ; 17(1): e0262227, 2022.
Article in English | MEDLINE | ID: mdl-34986199

ABSTRACT

BACKGROUND: Chronic kidney disease is often asymptomatic in its early stages but constitutes a severe burden for patients and causes major healthcare systems costs worldwide. While models for assessing the cost-effectiveness of screening were proposed in the past, they often presented only a limited view. This study aimed to develop a simulation-based German Albuminuria Screening Model (S-GASM) and present some initial applications. METHODS: The model consists of an individual-based simulation of disease progression, considering age, gender, body mass index, systolic blood pressure, diabetes, albuminuria, glomerular filtration rate, and quality of life, furthermore, costs of testing, therapy, and renal replacement therapy with parameters based on published evidence. Selected screening scenarios were compared in a cost-effectiveness analysis. RESULTS: Compared to no testing, a simulation of 10 million individuals with a current age distribution of the adult German population and a follow-up until death or the age of 90 shows that a testing of all individuals with diabetes every two years leads to a reduction of the lifetime prevalence of renal replacement therapy from 2.5% to 2.3%. The undiscounted costs of this intervention would be 1164.10 € / QALY (quality-adjusted life year). Considering saved costs for renal replacement therapy, the overall undiscounted costs would be-12581.95 € / QALY. Testing all individuals with diabetes or hypertension and screening the general population reduced the lifetime prevalence even further (to 2.2% and 1.8%, respectively). Both scenarios were cost-saving (undiscounted, - 7127.10 €/QALY and-5439.23 €/QALY). CONCLUSIONS: The S-GASM can be used for the comparison of various albuminuria testing strategies. The exemplary analysis demonstrates cost savings through albuminuria testing for individuals with diabetes, diabetes or hypertension, and for population-wide screening.


Subject(s)
Albuminuria/epidemiology , Cost-Benefit Analysis/methods , Diabetes Complications/diagnosis , Renal Insufficiency, Chronic/diagnosis , Renal Replacement Therapy/economics , Adult , Albuminuria/economics , Blood Pressure , Body Mass Index , Case-Control Studies , Computer Simulation , Diabetes Complications/economics , Diabetes Complications/therapy , Disease Progression , Early Diagnosis , Female , Germany , Glomerular Filtration Rate , Humans , Male , Models, Economic , Quality of Life , Renal Insufficiency, Chronic/economics , Renal Insufficiency, Chronic/therapy , Renal Replacement Therapy/statistics & numerical data
10.
Lancet Glob Health ; 9(11): e1539-e1552, 2021 11.
Article in English | MEDLINE | ID: mdl-34562369

ABSTRACT

BACKGROUND: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. METHODS: We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and health-care costs of diagnosis, treatment, and control of blood pressure, dyslipidaemia, and glycaemia among people with diabetes in LMICs. We used individual participant data-specifically from the subset of people who were defined as having any type of diabetes by WHO standards-from nationally representative, cross-sectional surveys (2006-18) spanning 15 world regions to estimate the baseline 10-year risk of atherosclerotic cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), heart failure (ejection fraction of <40%, with New York Heart Association class III or IV functional limitations), end-stage renal disease (defined as an estimated glomerular filtration rate <15 mL/min per 1·73 m2 or needing dialysis or transplant), retinopathy with severe vision loss (<20/200 visual acuity as measured by the Snellen chart), and neuropathy with pressure sensation loss (assessed by the Semmes-Weinstein 5·07/10 g monofilament exam). We then used data from meta-analyses of randomised controlled trials to estimate the reduction in risk and the WHO OneHealth tool to estimate costs in reaching either 60% or 80% of diagnosis, treatment initiation, and control targets for blood pressure, dyslipidaemia, and glycaemia recommended by WHO guidelines. Costs were updated to 2020 International Dollars, and both costs and DALYs were computed over a 10-year policy planning time horizon at a 3% annual discount rate. FINDINGS: We obtained data from 23 678 people with diabetes from 67 countries. The median estimated 10-year risk was 10·0% (IQR 4·0-18·0) for cardiovascular events, 7·8% (5·1-11·8) for neuropathy with pressure sensation loss, 7·2% (5·6-9·4) for end-stage renal disease, 6·0% (4·2-8·6) for retinopathy with severe vision loss, and 2·6% (1·2-5·3) for congestive heart failure. A target of 80% diagnosis, 80% treatment, and 80% control would be expected to reduce DALYs lost from diabetes complications from a median population-weighted loss to 1097 DALYs per 1000 population over 10 years (IQR 1051-1155), relative to a baseline of 1161 DALYs, primarily from reduced cardiovascular events (down from a median of 143 to 117 DALYs per 1000 population) due to blood pressure and statin treatment, with comparatively little effect from glycaemic control. The target of 80% diagnosis, 80% treatment, and 80% control would be expected to produce an overall incremental cost-effectiveness ratio of US$1362 per DALY averted (IQR 1304-1409), with the majority of decreased costs from reduced cardiovascular event management, counterbalanced by increased costs for blood pressure and statin treatment, producing an overall incremental cost-effectiveness ratio of $1362 per DALY averted (IQR 1304-1409). INTERPRETATION: Reducing complications from diabetes in LMICs is likely to require a focus on scaling up blood pressure and statin medication treatment initiation and blood pressure medication titration rather than focusing on increasing screening to increase diabetes diagnosis, or a glycaemic treatment and control among people with diabetes. FUNDING: None.


Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/economics , Cardiovascular Diseases/therapy , Developing Countries/economics , Diabetes Complications/economics , Diabetes Mellitus/diagnosis , Diabetes Mellitus/economics , Diabetes Mellitus/therapy , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Developing Countries/statistics & numerical data , Diabetes Complications/diagnosis , Diabetes Complications/therapy , Female , Global Health/statistics & numerical data , Humans , Male , Middle Aged , Models, Theoretical , Risk Factors
11.
PLoS One ; 16(9): e0257004, 2021.
Article in English | MEDLINE | ID: mdl-34534230

ABSTRACT

AIM: To investigate the epidemiology of S. aureus and MRSA nasal carriage among people with diabetes at the Korle Bu Teaching Hospital in Accra, including the prevalence, predictors of carriage, and antibiotic resistance. METHODOLOGY: This study was cross-sectional, involving 300 diabetes patients and 106 non-diabetic individuals. Swab specimens of the nares were obtained from the participants and bacteriologically-cultured. Identification and characterization of S. aureus and MRSA were based on standard bacteriological methods; antimicrobial susceptibility testing was by the Kirby-Bauer method. RESULTS: The prevalence of staphylococcal carriage, the diabetes group relative to the non-diabetes group, were 31.0% and 10.4% (S. aureus), and 3.3% and 0.0% (MRSA). Presence of diabetes predisposed to S. aureus carriage, but not MRSA nor coagulase-negative staphylococci (CoNS) carriage (OR = 3.88; p < 0.0001). Colonization with CoNS was protective of S. aureus (OR = 0.039, p < 0.001) and MRSA (OR = 0.115, p = 0.043) colonization among the diabetics. The antimicrobial resistance patterns recorded among the S. aureus isolated from the diabetic individuals relative to the non-diabetics were as follows: penicillin (95% vs. 91%), tetracycline (37% vs. 27%), cotrimoxazole (30% vs. 36%), erythromycin (17% vs. 0%), norfloxacin (13% vs. 0%), clindamycin (12% vs. 0%), gentamicin (9% vs. 0%), fusidic acid (10% vs. 9%), linezolid (4% vs. 0%), and rifampicin (5% vs. 0%). The proportion of multidrug resistant S. aureus was 41% (n = 38) in the diabetes group and 0% in the non-diabetes group; this difference was statistically significant (p = 0.01). CONCLUSIONS: The presence of diabetes predisposed the participants to S. aureus carriage by almost four folds, but not MRSA carriage. Colonization with CoNS was protective of S. aureus and MRSA carriage in the diabetes group. Finally, linezolid remains a good therapeutic agent for anti-MRSA therapy.


Subject(s)
Diabetes Complications/microbiology , Diabetes Mellitus/microbiology , Drug Resistance, Multiple, Bacterial , Methicillin-Resistant Staphylococcus aureus/drug effects , Staphylococcal Infections/microbiology , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Carrier State , Clindamycin/therapeutic use , Cross-Sectional Studies , Diabetes Complications/diagnosis , Diabetes Complications/drug therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/drug therapy , Erythromycin/therapeutic use , Female , Fusidic Acid/therapeutic use , Gentamicins/therapeutic use , Humans , Linezolid/therapeutic use , Male , Methicillin-Resistant Staphylococcus aureus/growth & development , Microbial Sensitivity Tests , Middle Aged , Nasal Cavity/microbiology , Norfloxacin/therapeutic use , Penicillins/therapeutic use , Rifampin/therapeutic use , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Tetracycline/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
13.
J Diabetes Res ; 2021: 7619610, 2021.
Article in English | MEDLINE | ID: mdl-34917686

ABSTRACT

Fibroblasts are the essential cell type of skin, highly involved in the wound regeneration process. In this study, we sought to screen out the novel genes which act important roles in diabetic fibroblasts through bioinformatic methods. A total of 811 and 490 differentially expressed genes (DEGs) between diabetic and normal fibroblasts were screened out in GSE49566 and GSE78891, respectively. Furthermore, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways involved in type 2 diabetes were retrieved from miRWalk. Consequently, the integrated bioinformatic analyses revealed the shared KEGG pathways between DEG-identified and diabetes-related pathways were functionally enriched in the MAPK signaling pathway, and the MAPKAPK3, HSPA2, TGFBR1, and p53 signaling pathways were involved. Finally, ETV4 and NPE2 were identified as the targeted transcript factors of MAPKAPK3, HSPA2, and TGFBR1. Our findings may throw novel sight in elucidating the molecular mechanisms of fibroblast pathologies in patients with diabetic wounds and targeting new factors to advance diabetic wound treatment in clinic.


Subject(s)
Diabetes Mellitus/physiopathology , Fibroblasts/metabolism , Wounds and Injuries/genetics , Computational Biology/methods , Computational Biology/statistics & numerical data , Diabetes Complications/complications , Diabetes Complications/diagnosis , Diabetes Mellitus/genetics , Humans , Skin/physiopathology , Surveys and Questionnaires , Wounds and Injuries/physiopathology
14.
Sci Rep ; 11(1): 23766, 2021 12 09.
Article in English | MEDLINE | ID: mdl-34887449

ABSTRACT

Chronic diabetic complications affect multiple organs causing widespread organ damage. Although there are some commonalities, the phenotype of such changes show tissue specific variation. Given this, we examined whether differences in circular RNA (circRNA) mediated gene regulatory mechanisms contribute to changes in gene expression at the basal level and in diabetes. CircRNAs are single-stranded RNA with covalently closed loop structures and act as miRNA sponges, factors of RNA splicing, scaffolding for proteins, regulators of transcription, and modulators of the expression of parental genes, among other roles. We examined heart and retinal tissue from Streptozotocin-induced diabetic mice with established diabetes related tissue damage and tissue from non-diabetic controls. A custom array analysis was performed and the data were analysed. Two major circRNA mediated processes were uniquely upregulated in diabetic heart tissue, namely, positive regulation of endothelial cell migration and regulation of mitochondria: mitochondrial electron transport. In the retina, circRNAs regulating extracellular matrix protein production and endothelial to mesenchymal transition (EndMT) were found to be upregulated. The current study identified regulatory and potential pathogenetic roles of specific circRNA in diabetic retinopathy and cardiomyopathy. Understanding such novel mechanisms, may in the future, be useful to develop RNA based treatment strategies.


Subject(s)
Biomarkers , Diabetes Complications/genetics , Gene Expression Regulation , RNA, Circular , Animals , Computational Biology/methods , Diabetes Complications/diagnosis , Disease Models, Animal , Epigenomics/methods , Gene Expression Profiling , Gene Ontology , Gene Regulatory Networks , Heart Diseases/diagnosis , Heart Diseases/etiology , Humans , Mice , MicroRNAs/genetics , Molecular Sequence Annotation , RNA Interference
15.
Front Endocrinol (Lausanne) ; 12: 756581, 2021.
Article in English | MEDLINE | ID: mdl-34764939

ABSTRACT

Diabetes mellitus and the associated complications are metabolic diseases with high morbidity that result in poor quality of health and life. The lack of diagnostic methods for early detection results in patients losing the best treatment opportunity. Oral hypoglycemics and exogenous insulin replenishment are currently the most common therapeutic strategies, which only yield temporary glycemic control rather than curing the disease and its complications. Exosomes are nanoparticles containing bioactive molecules reflecting individual physiological status, regulating metabolism, and repairing damaged tissues. They function as biomarkers of diabetes mellitus and diabetic complications. Considering that exosomes are bioactive molecules, can be obtained from body fluid, and have cell-type specificity, in this review, we highlight the multifold effects of exosomes in the pathology and therapy of diabetes mellitus and diabetic complications.


Subject(s)
Diabetes Complications/diagnosis , Diabetes Mellitus/diagnosis , Exosomes/metabolism , Animals , Biomarkers/metabolism , Diabetes Complications/metabolism , Diabetes Complications/therapy , Diabetes Mellitus/metabolism , Diabetes Mellitus/therapy , Humans , Molecular Targeted Therapy
16.
BMC Endocr Disord ; 21(1): 200, 2021 Oct 12.
Article in English | MEDLINE | ID: mdl-34641827

ABSTRACT

BACKGROUND: Diabetes Mellitus (DM) is a common metabolic disease associated with increased risk of mortality. OBJECTIVE: The aim of this study was to examine predictors of mortality among patients with type 2 diabetes in the north of Jordan. METHODS: Electronic data files for diabetes patients admitted between the period of 2014-2018 at a tertiary center in the north of Jordan were reviewed. Patient's characteristics, clinical and laboratory data, use of medications and mortality rate were collected. RESULTS: Mean age of patients (n = 957) was 60.99 ± 0.37 (mean ± sem). Most of patients had multiple risk factors and underlying cardiovascular diseases (CVDs). Mortality rate was 10.1%. Univariate predictors of mortality included age, chronic kidney disease (CKD), acute kidney injury, hypertension, heart failure (HF), coronary artery disease, venous thromboembolism (VTE), stroke, atrial fibrillation (AF), and chronic obstructive pulmonary disease (COPD). As the number of CVDs increases, mortality rate also increases (Odd ratio 2.0, p < 0.0001). Use of insulin, aspirin, ACEi/ARBS, beta blockers, and diuretics were also associated with mortality. Fasting glucose and percentage of glycated hemoglobin were not associated with mortality. By multivariable logistic regression analysis adjusting for confounders and collinearity; age, HF, AF, COPD, VTE, and CKD were associated with mortality. CONCLUSION: Key risk factors of mortality are CVDs and CKD indicating that the primary step of management should focus on optimizing risk factors to prevent diabetes complications and death.


Subject(s)
Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/mortality , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Databases, Factual , Diabetes Complications/diagnosis , Diabetes Complications/etiology , Diabetes Complications/mortality , Diabetes Mellitus, Type 2/therapy , Female , History, 21st Century , Humans , Jordan/epidemiology , Male , Middle Aged , Mortality , Prognosis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/etiology , Risk Factors
17.
Diabetes Metab Syndr ; 15(5): 102240, 2021.
Article in English | MEDLINE | ID: mdl-34403950

ABSTRACT

AIMS: To evaluate calculated total plasma osmolality as a marker of outcome prediction, fluid and metabolic balance, thrombotic risk in severe COVID-19 patients. METHODS: Retrospective data of RT-PCR confirmed hospitalized severe COVID-19 patients (total: n = 175 patients, including diabetic subset: n = 102) were analyzed. Clinically applicable cut-offs were derived using receiver operating characteristic (ROC) curve analysis for calculated total osmolality, eGFR, and D-dimer, and their correlations were studied. RESULTS: Among 175 severe COVID-19 patients, a significant association with mortality was seen with respect to calculated total osmolality (p < 0.001), eGFR (p < 0.001), and D-dimer (p < 0.001). In the total cohort, applicable cut-offs based on ROC curve in predicting outcome were, for total osmolality 299 mosm/kg (area under the curve (AUC)-0.773, odds ratio (OR)-1.09), eGFR 61.5 ml/min/m2 (AUC-0.789, OR-0.96), D-dimer 5.13 (AUC-0.814, OR-2.65) respectively. In diabetic subset, the cut-offs for total osmolality were 298 mosm/kg (AUC-0.794, OR-1.12), eGFR 44.9 ml/min/m2 (AUC-0.774, OR-0.96) and D-dimer 1.59 (AUC-0.769, OR-1.52) respectively. CONCLUSIONS: Applicable cut-offs for calculated total plasma osmolality, eGFR, and D-dimer predicts clinical outcome in severe COVID-19 with and without diabetes. Correlation studies validated calculated total osmolality as a marker of the combined effect of fluid and metabolic imbalance, compromised renal function and hypercoagulability.


Subject(s)
COVID-19/diagnosis , Glomerular Filtration Rate/physiology , Plasma/chemistry , Biomarkers/blood , Blood Coagulation/physiology , COVID-19/blood , COVID-19/physiopathology , COVID-19/therapy , Cohort Studies , Diabetes Complications/blood , Diabetes Complications/diagnosis , Diabetes Complications/physiopathology , Diabetes Complications/therapy , Female , Fibrin Fibrinogen Degradation Products/analysis , Fibrin Fibrinogen Degradation Products/metabolism , Humans , India , Male , Middle Aged , Osmolar Concentration , Patient Admission/statistics & numerical data , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness Index , Thrombosis/blood , Thrombosis/diagnosis , Thrombosis/etiology , Thrombosis/physiopathology , Water-Electrolyte Balance/physiology
18.
Urol Int ; 105(11-12): 935-943, 2021.
Article in English | MEDLINE | ID: mdl-34384079

ABSTRACT

BACKGROUND AND OBJECTIVES: Stem cell therapy is a novel treatment with regenerative ability that can treat erectile dysfunction (ED). This phase 1/2 clinical trial (NCT02945449) using 2 consecutive intracavernous (IC) injections of allogeneic Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) was studied for the first time in the treatment of diabetic patients with ED. The primary outcome was to assess the safety and tolerability, and the secondary outcome was to assess the efficacy of 2 consecutive IC injections of allogeneic WJ-MSCs in diabetic ED. PATIENTS AND METHODS: Twenty-two diabetic patients with refractory ED were included. Two consecutive IC injections of allogeneic WJ-MSCs were performed. Tolerability was assessed immediately, and at 24 h, safety was evaluated for 12 months. Efficacy was assessed using International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS), and Color Duplex Doppler Ultrasound for 12 months. RESULTS: The procedure was well-tolerated. Minimal and transient adverse events were redness and bruising at the site of injections. There were no patient-reported serious adverse effects. There were significant improvements in IIEF-5, EHS, peak systolic velocity (PSV) basal, and 20-min PSV, all over the follow-up time points in comparison to the baseline. CONCLUSION: This is the first human study with proven tolerability, safety, and efficacy of IC injections of allogeneic WJ-MSCs for the treatment of diabetic patients with ED.


Subject(s)
Diabetes Complications/surgery , Erectile Dysfunction/surgery , Mesenchymal Stem Cell Transplantation , Penile Erection , Wharton Jelly/cytology , Adult , Aged , Cells, Cultured , Diabetes Complications/diagnosis , Diabetes Complications/physiopathology , Erectile Dysfunction/diagnosis , Erectile Dysfunction/physiopathology , Humans , Jordan , Male , Mesenchymal Stem Cell Transplantation/adverse effects , Middle Aged , Prospective Studies , Recovery of Function , Time Factors , Transplantation, Homologous , Treatment Outcome
19.
J Postgrad Med ; 67(3): 146-153, 2021.
Article in English | MEDLINE | ID: mdl-34380801

ABSTRACT

Context: Emphysematous pyelonephritis (EPN) is a dangerous necrotizing infection of the kidney involving the diabetics with a high case fatality rate. Recent medical literature has shown shifting of treatment strategy from conventional radical approach to minimally invasive approach. Aims: The aim of our study was to assess the role of minimally invasive stepwise decompression techniques in the management of EPN and preservation of the renal unit. Settings and Design: : This was a retrospective observational study conducted from June 2017 to April 2020 at a tertiary care centre. Material and Methods: We reviewed the hospital online records of 18 patients diagnosed with EPN for patient demographics, clinical profiles, co-morbidities, laboratory and, radiological investigations, surgical interventions performed and the outcomes. The severity of EPN was graded as per the Huang classification. Patients underwent surgical interventions as per the treatment protocol and response was assessed. Statistical Analysis Used: Descriptive statistics was applied. Results: Diabetes mellitus was present in 15 (83.3%) patients along with urinary tract obstruction in 8 (44.4%) patients. Flank pain (77.7%) was the most common presenting clinical feature while Escherichia coli (55.5%) were the most common causative organism. Most patients (50%) had Type- II EPN, all of which were managed successfully by minimally invasive procedures. In total seventeen patients (94.4%) responded well while one patient (5.5%) underwent nephrectomy with no mortality. Conclusions: Renal salvage in EPN requires multidisciplinary approach including the initial medical management followed by properly selected stepwise decompressive surgical techniques. Conservative management and decompression techniques have shown to improve patient's outcome, reducing the traditional morbidity associated with nephrectomy.


Subject(s)
Decompression, Surgical/methods , Diabetes Complications/diagnosis , Emphysema/surgery , Nephrectomy/methods , Pyelonephritis/surgery , Urinary Tract Infections/microbiology , Abdominal Pain/etiology , Diabetes Complications/therapy , Diabetes Mellitus/diagnosis , Diabetes Mellitus/drug therapy , Drainage/methods , Emphysema/etiology , Humans , Kidney/diagnostic imaging , Minimally Invasive Surgical Procedures , Pyelonephritis/complications , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Urinary Tract Infections/complications
20.
Metabolism ; 123: 154845, 2021 10.
Article in English | MEDLINE | ID: mdl-34364927

ABSTRACT

PURPOSE: Individuals with diabetes/stress hyperglycemia carry an increased risk for adverse clinical outcome in case of SARS-CoV-2 infection. The purpose of this study was to evaluate whether this risk is, at least in part, modulated by an increase of thromboembolic complications. METHODS: We prospectively followed 180 hospitalized patients with confirmed COVID-19 pneumonia admitted to the Internal Medicine Units of San Raffaele Hospital. Data from 11 out of 180 patients were considered incomplete and excluded from the analysis. We analysed inflammation, tissue damage biomarkers, hemostatic parameters, thrombotic events (TEs) and clinical outcome according to the presence of diabetes/stress hyperglycemia. RESULTS: Among 169 patients, 51 (30.2%) had diabetes/stress hyperglycemia. Diabetes/stress hyperglycemia and fasting blood glucose (FBG) were associated with increased inflammation and tissue damage circulating markers, higher D-dimer levels, increased prothrombin time and lower antithrombin III activity. Forty-eight venous and 10 arterial TEs were identified in 49 (29%) patients. Diabetes/stress hyperglycemia (HR 2.71, p = 0.001), fasting blood glucose (HR 4.32, p < 0.001) and glucose variability (HR 1.6, p < 0.009) were all associated with an increased risk of thromboembolic complication. TEs significantly increased the risk for an adverse clinical outcome only in the presence of diabetes/stress hyperglycemia (HR 3.05, p = 0.010) or fasting blood glucose ≥7 mmol/L (HR 3.07, p = 0.015). CONCLUSIONS: Thromboembolism risk is higher among patients with diabetes/stress hyperglycemia and COVID-19 pneumonia and is associated to poor clinical outcome. In case of SARS-Cov-2 infection patients with diabetes/stress hyperglycemia could be considered for a more intensive prophylactic anticoagulation regimen.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hyperglycemia/epidemiology , Thromboembolism/etiology , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Diabetes Complications/diagnosis , Diabetes Complications/epidemiology , Diabetes Complications/therapy , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Hyperglycemia/diagnosis , Hyperglycemia/etiology , Hyperglycemia/therapy , Inflammation/complications , Inflammation/diagnosis , Inflammation/epidemiology , Inflammation/therapy , Italy/epidemiology , Male , Middle Aged , Mortality , Prognosis , Risk Factors , Stress, Psychological/complications , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Thromboembolism/diagnosis , Thromboembolism/epidemiology , Treatment Outcome
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