Parental Resilience and Physical Health in Parents of Children With Type 1 Diabetes in Northern Greece.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is the most common endocrine and metabolic disorder in children. On the other hand, little is known regarding the health of parents whose children suffer from T1DM. AIM: The study aims to investigate the mental resilience and physical health of parents of children with type 1 diabetes. METHODS: The sample consisted of 80 parents of children and adolescents with T1DM.The study was conducted with the contribution of associations of parents of children with type 1 diabetes in a large hospital in Northern Greece between April 2021 and September 2021. A demographic and clinical questionnaire, the Wagnild and Young Resilience Scale-14 (RS-14), and the General Health 28 Physical Health Measurement Questionnaire (GHQ-28) were used to collect the research data. RESULTS: Of the parents, 18.8% were male while 65% were female. The mean age of the parents was 44.02±6.71 years while the age of their children with diabetes was 13.13±6.05 years. Almost half of the children followed intensive insulin treatment (47.5%) whereas 22,5% reported that their children received insulin via a pump. A higher percentage of parents reported measuring their children's blood sugar more than six times a day (46,3%) and having their glycated hemoglobin (HbA1c) levels checked four times a year (51.2%). Finally, statistically significant effects on the physical symptoms and severe depression of parents of children with type 1 diabetes were observed. CONCLUSIONS: Additional research is needed to assess the Greek parent population's resilience and physical health. This study will help healthcare providers to expand their knowledge and meet parents' needs.

Contemporary choice of glucose lowering agents in heart failure patients with type 2 diabetes.

INTRODUCTION: There is a bi-directional link between type 2 diabetes mellitus (T2DM) and heart failure (HF) and their co-existence markedly increases an individual's morbidity and mortality. Therefore, it is of major importance to diagnose early (and, even better, prevent) HF in T2DM patients, as well as adequately treat T2DM patients with HF. AREAS COVERED: The present narrative review discusses the effects of different antidiabetic drugs [metformin, pioglitazone, sulphonylureas (SUs), dipeptidyl peptidase 4 inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter 2 inhibitors (SGLT2i) and insulin] on HF incidence, hospitalization and outcomes. Current guidelines of diabetes and cardiology societies on this issue are also commented on. EXPERT OPINION: Metformin (+lifestyle interventions) is the first-line treatment for all T2DM patients and SGLT2i are the preferred drugs (class I, level of evidence A) in patients with T2DM and HF. Pioglitazone is contraindicated in HF, whereas SUs, DPP4i, GLP-1 RAs and insulin are considered as neutral. However, SUs may cause hypoglycemia and weight gain, saxagliptin (a DPP4i) must be avoided in this setting and GLP-1 RAs seem not to affect HF risk. There is an urgent need of increasing guidelines implementation regarding SGLT2i use in clinical practice, to sufficiently tackle the HF burden in T2DM.

The Impact of Comorbid Diabetes Type 2 on Quality of Life in Cancer Patients Undergoing Chemotherapy.

BACKGROUND AND OBJECTIVE: Cancer and diabetes are two highly prevalent diseases worldwide and greatly influence quality of life of those suffering from it. The study aimed to compare quality of life in patients diagnosed with cancer and diabetes with those without diabetes both undergoing chemotherapy and to investigate the factors responsible for the difference between the two groups. METHODS: A convenience sample of 101 participants who had cancer and type 2 diabetes and 99 who had cancer without diabetes were used. RESULTS: Patients with comorbid diabetes were divided based on their diabetes duration and whether they had glycaemic control or not. Diabetic cancer patients without glycaemic control had lower scores in global health status and in physical and emotional functioning compared to diabetic cancer patients with glycaemic control and patients without diabetes (p < .05). After adjusting for demographic characteristics, the differences between the group with diabetes and without glycaemic control and the other two groups regarding global health status were statistically significant (p < .05). Patients with more than a 7-year history of diabetes had a significantly lower emotional functioning than the no diabetes group and lower global health status score than both of the other groups (p < .05). After adjusting for clinical and demographic characteristics, only the difference between the ≥ 7 years diabetes duration group and the no diabetes groups remained significant. CONCLUSION: The presence of diabetes in cancer patients who underwent chemotherapy seems to negatively influence certain domains of quality of life and this may be affected by the duration of diabetes and whether glycaemic control has been achieved or not.

Fasting insulin levels correlate with the frequency of hypoglycemic events in people with type 2 diabetes on treatment with sulfonylureas: A pilot study.

AIMS AND OBJECTIVES: We aimed to explore whether fasting insulin levels correlate with the risk of hypoglycemia in people with Type 2 diabetes (T2D) receiving sulfonylureas (SUs). MATERIALS AND METHODS: Our study included 58 individuals with T2D who had been on treatment with SUs, but not insulin, for more than 2 years. Confirmed hypoglycemic episodes during the past year were self-reported by the patients, and a potential relationship of hypoglycemic event frequency with fasting insulin levels was investigated. RESULTS: Fasting insulin concentrations were found to have a low positive and statistically significant correlation with the number of cases of mild hypoglycemia per year (ρ = 0.279/P = 0.034) and a moderately positive and statistically significant correlation with the number of severe hypoglycemic events per month (ρ = 0.349/P = 0.007) and per year (ρ = 0.39/P = 0.002). CONCLUSION: Our results suggest that fasting insulin levels might be a predictor of the risk of hypoglycemia in people with T2D on treatment with SUs.

A Greek registry of current type 2 diabetes management, aiming to determine core clinical approaches, patterns and strategies.

BACKGROUND: To analyze data in terms of the glycaemic control and therapeutic regimens used for Type-2 Diabetes Mellitus (T2DM) management in Greece, identify factors that influence clinical decisions and determine the level of compliance of T2DM management with the latest international and local guidelines. METHODS: 'AGREEMENT' was a national-multicenter, non-interventional, cross-sectional disease registry. A total of 1191 adult T2DM patients were enrolled consecutively from 59 sites of the National Health System (NHS) or University Hospitals, representing the majority of Diabetes centers or Diabetes outpatient clinics in Greece with a broad geographic distribution. Patients were stratified by gender and analysis was done according to 3 treatment strategies: A (lifestyle changes or use of one oral antidiabetic agent), B (up to 3 antidiabetic agents including injectables but not insulin) and C (any regimens with insulin). RESULTS: Mean (±SD) HbA1c % of the total population was 7.1 (±1.2) while mean (±SD) FPG (mg/dl) was measured at 136 (±42). The proportion of patients who achieved HbA1c < 7% was 53% and ranged from 74.2% for group A, to 60.6% for group B and 35.5% for group C. Median age of the studied population was 65.0 year old (Interquartile Range-IQR 14.0) with an equal distribution of genders between groups. Patients on insulin therapy (treatment strategy C) were older (median age: 67 years vs 63 or 65 for A and B, respectively) with longer diabetes duration (mean duration: 15.3 years vs 5.2 and 10.1 for A and B, respectively). Patients who received insulin presented poor compliance. There was a consensus for a series of decision criteria and factors that potentially influence clinical decisions, used by physicians for selection of the therapeutic strategy among the three groups. Compliance with international and Greek guidelines received a high score among groups A, B and C. No significant differences were presented as per sites' geographic areas, NHS or University centers and physicians' specialty (endocrinologists, diabetologists and internists). CONCLUSIONS: The presented findings suggest the need for improvement of the glycaemic control rate, especially among insulin treated patients as this group seems to achieve low glycaemic control, by setting appropriate HbA1c targets along with timely and individualised intensification of treatment as well as post-therapy evaluation of the compliance with the proposed treatment.

Gestational diabetes mellitus and quality of life during the third trimester of pregnancy.

PURPOSE: The primary aim of this study was to investigate the effect of gestational diabetes mellitus (GDM) on the quality of life (QoL) of pregnant women during the third trimester of pregnancy. The secondary aim was to compare the QoL of pregnant women with GDM according to their therapeutic approach. This is the first study of this kind conducted in Greece. METHODS: A case-control study with 62 pregnant women (31 with GDM and 31 with uncomplicated pregnancy), during the third trimester of pregnancy. QoL and Health Related QoL were studied with the use of three questionnaires (EQ-5D-5L, WHOQOL-BREF and ADDQoL). RESULTS: A decrease in the QoL was found in pregnant women with GDM compared with pregnant women with uncomplicated pregnancy (p < 0.05) regarding both social life and health scales. On the contrary, there was no difference in the QoL between pregnant women with GDM who followed different treatment approaches (diet or insulin). CONCLUSIONS: The diagnosis of GDM is associated with a reduction in the QoL of pregnant women during the third trimester of pregnancy, while the type of treatment does not seem to further affect it. More studies should be conducted so that the modifiers of this association can be clarified.

The Intervention of Parents in Supporting of Diabetes Type 1 in Adolescents.

INTRODUCTION: The presence of parents is very important as it enhances the psychology of adolescents resulting to the normal course of the disease. AIM: Investigate the perceptions of adolescents in order to support families in the management of T1D. MATERIAL & METHODS: It is a descriptive study and 56 patients participated. The Diabetes Social Support Questionnaire-Family Version (DSSQ-Family) and some demographic and clinical characteristics were used. The study conducted in the outpatient unit for pediatric diabetology of the 4th Department of Pediatrics in one tertiary General Hospital in a major city of Northern Greece. RESULTS: Younger adolescents felt more supported by their families. Overweight adolescents experienced less support with respect to insulin injections (p = -.333, r = .018), as did the taller respondents (p = -.323, r = .022). Respondents taking more insulin units felt less supported in general (p = -.268, r = .047) and with respect to blood tests (p = -.290, r = .034). Adolescents carrying out more blood glucose measurements felt less supported concerning their meal plan (p =-.307, r = .028), which they rarely complied with (p =-.322, r = .023). CONCLUSIONS: The parental presence is very important enhancing a positive mindset on the part of adolescents and helps achieve the desired treatment results.

Depression and Self-Efficacy in Patients with Type 2 Diabetes in Northern Greece.

BACKGROUND: Depression represents one of the most common disorders in diabetic patients and frequently complicates the health care of this population. Poor self-efficacy has been associated with increased depressive symptoms as well as poor glycemic control. OBJECTIVE: To assess depression and self-efficacy in adults with type 2 diabetes in Northern Greece and to explore the factors which may affect them in this group of population. METHOD: A descriptive study was conducted in a tertiary hospital in the largest city of Northern Greece. The study group included a convenience sample of 170 adults with type 2 diabetes mellitus who completed the General Health Questionnaire-28 (GHQ-28) and the Diabetes Empowerment Scale- short form (DES) questionnaire. RESULTS: The overall rate of diabetic patients showing psychological distress in the present study was 50.6%. Adults with low and moderate income experienced higher levels of depression and anxiety, compared to those with high economical status (p<0,001). Also, adults who graduated elementary education experienced higher levels of depressive and anxiety symptoms than those with a higher educational level (p =0,038). There was a statistically significant difference between age (p<0.001), type of residence (p=0.019), family status (p=0,002), financial status (p<0.001) and self-efficacy. Also, there was a negative correlation between BMI and self-efficacy (r=-0.206, p<0.001) and a negative correlation between depression and self-efficacy scale (r=-0.439, p<0.001). CONCLUSION: The results of the present study highlight the importance of well-planned interventions in order to reduce depression and increase self-efficacy in diabetic adults and to help them further improve their quality of life.

Once-weekly dipeptidyl peptidase-4 inhibitors for type 2 diabetes: a systematic review and meta-analysis.

OBJECTIVE: To assess the efficacy and safety of omarigliptin and trelagliptin, novel dipeptidyl peptidase-4 inhibitors administered once-weekly (DPP-4i QW). METHODS: We systematically searched for placebo- and active-controlled randomized trials in adults with type 2 diabetes mellitus. RESULTS: Fifteen primary studies with 5709 participants were included. DPP-4i QW were more effective than placebo in reducing hemoglobin A1c (HbA1c) (Weighted Mean Difference (WMD) -0.63%; 95% CI -0.80, -0.46; I2 = 84%) and had a similar glucose-lowering effect with daily DPP-4i (WMD 0.01%; -0.08, 0.11%; I2 = 34%). Omarigliptin was less effective compared with oral antidiabetic agents, other than daily DPP-4i, (WMD 0.24%; 0.10, 0.38; I2 = 12%). Omarigliptin did not affect body weight (WMD versus placebo 0.60 kg; 0.25, 0.96; I2 = 0%). Risk for any hypoglycemia was similar between DPP-4i QW and placebo (Odds Ratio 1.32; 0.78, 2.22; I2 = 0%). Incidence of other adverse events did not differ between DPP-4i QW and control. CONCLUSIONS: DPP-4i QW were superior to placebo and similar to daily DPP-4i in terms of glycemic control, and were not associated with any specific adverse events. There is limited comparative effectiveness evidence against other agents, while their effect on hard clinical safety outcomes is unknown.

Fixed ratio combinations of glucagon like peptide 1 receptor agonists with basal insulin: a systematic review and meta-analysis.

PURPOSE: Basal insulin controls primarily fasting plasma glucose but causes hypoglycaemia and weight gain, whilst glucagon like peptide 1 receptor agonists induce weight loss without increasing risk for hypoglycaemia. We conducted a systematic review and meta-analysis of randomised controlled trials to investigate the efficacy and safety of fixed ratio combinations of basal insulin with glucagon like peptide 1 receptor agonists. METHODS: We searched Medline, Embase, and the Cochrane Library as well as conference abstracts up to December 2016. We assessed change in haemoglobin A1c, body weight, and incidence of hypoglycaemia and gastrointestinal adverse events. RESULTS: We included eight studies with 5732 participants in the systematic review. Switch from basal insulin to fixed ratio combinations with a glucagon like peptide 1 receptor agonist was associated with 0.72% reduction in haemoglobin A1c [95% confidence interval -1.03 to -0.41; I 2 = 93%] and 2.35 kg reduction in body weight (95% confidence interval -3.52 to -1.19; I 2 = 93%), reducing also risk for hypoglycaemia [odds ratio 0.70; 95% confidence interval 0.57 to 0.86; I 2 = 85%] but increasing incidence of nausea (odds ratio 6.89; 95% confidence interval 3.73-12.74; I 2 = 79%). Similarly, switching patients from treatment with a glucagon like peptide 1 receptor agonist to a fixed ratio combination with basal insulin was associated with 0.94% reduction in haemoglobin A1c (95% confidence interval -1.11 to -0.77) and an increase in body weight by 2.89 kg (95% confidence interval 2.17-3.61). CONCLUSIONS: Fixed ratio combinations of basal insulin with glucagon like peptide 1 receptor agonists improve glycaemic control whilst balancing out risk for hypoglycaemia and gastrointestinal side effects.

ADHERENCE AND QUALITY OF LIFE IN PATIENTS WITH TYPE II DIABETES MELLITUS IN NORTHERN GREECE.

INTRODUCTION: Adherence as a concept includes various types of health-related behavior. Better medical adherence leads to improved disease control and fewer diabetes-related complications. Quality of life and medication adherence are interrelated. Patients with diabetes who adhere to their treatment can experience an improvement in quality of life and vice versa. AIM: To assess treatment adherence in patients with type II diabetes, as well as the connection between adherence and quality of life. METHODOLOGY: A descriptive non-experimental study was conducted in a provincial hospital in Northern Greece. The sample examined was a convenience sample consisting of 108 patients with type II diabetes mellitus. They completed the "Diabetes Self-Care Activities Questionnaire" and SF-36 "Quality of Life Questionnaire". RESULTS: Participants demonstrated good adherence to diet and blood test / blood glucose test routines, but did not experience high levels of quality of life. The type of treatment affected the adherence to blood tests with a statistically significant difference (p=0,000). Also, marital status affected mental health with a statistically significant difference (p=0,032). The adherence sub scales are correlated with the all domains of quality of life. CONCLUSIONS: According to our findings, it is important to plan interventions to enhance adherence to other types of treatment and to help patients to further improve their quality of life.

Diabetes knowledge among Greek Type 2 Diabetes Mellitus patients / Conocimiento de la diabetes por los pacientes griegos con diabetes mellitus de tipo 2

Background & objective: Diabetes knowledge has been shown to improve glycemic control and associate with several demographic parameters. In Greece, a country with high obesity rates, disease knowledge has never been evaluated in diabetic patients. This cross sectional study aimed to assess diabetes knowledge and its associations between social and demographic parameters, among Greek type 2 diabetes mellitus (T2DM) patients. Methods One hundred fifty nine patients with T2DM were recruited from an urban and a rural clinic in Greece. Diabetes knowledge was assessed with the Brief Diabetes Knowledge Test (DKT). Basic anthropometry was performed. Data regarding glycemic control and sociodemographic characteristics were collected from the patients’ medical files. Results: Greek T2DM patients demonstrated poor disease knowledge (mean DKT score 8.3±2.2/14.0 and mean DKT as a percent of correct answers 59.6±15.8%). No differences were observed between sex, place of residence, or glycemic control, among subjects. Patients with higher education demonstrated greater diabetes knowledge. Simple obesity with concurrent central obesity or suboptimal glycemic control decreased diabetes knowledge among participants. Additionally, waist circumference was inversely correlated to diabetes knowledge. Conclusions: Based on the DKT, Greek patients exhibit poor diabetes knowledge. This study provides evidence for the need for better diabetes education in order to ameliorate disease outcome (AU)

Antecedentes y objetivo: Se ha demostrado que el conocimiento de la diabetes mejora el control de la glucemia y se asocia con varias características demográficas. En Grecia, un país con tasas de obesidad elevadas, no se ha evaluado nunca el conocimiento de la diabetes de quienes la sufren. El objetivo de este estudio transversal es valorar el conocimiento de la diabetes y su asociación con parámetros sociales y demográficos en los pacientes griegos con diabetes mellitus tipo 2 (DMT2). Métodos: Se reclutaron a 159 pacientes con diabetes mellitus tipo 2 (DMT2) de una consulta urbana y otra rural de Grecia. El conocimiento de la diabetes se valoró mediante el Brief Diabetes Knowledge Test (DKT). Se recogieron datos antropométricos básicos. Los datos sobre el control de la glucemia y las características sociodemográficas se recogieron de los historiales médicos de los pacientes. Resultados: Los pacientes griegos con DMT2 mostraron un conocimiento deficiente de la enfermedad (puntuación DKT media de 8,3±2,2/14,0 y DKT media como porcentaje de respuestas correctas 59,6±15,8%). No se observaron diferencias entre los sujetos en función del sexo, del lugar de residencia ni del control de la glucemia. Los pacientes con mayor grado de educación mostraron mayor conocimiento de la diabetes. La obesidad simple con obesidad central o control subóptimo de la glucemia concurrente coincidía con un menor conocimiento de la diabetes por los participantes. Además, había una relación inversa entre el perímetro de la cintura y el conocimiento de la diabetes. Conclusiones: Basándose en el DKT, los pacientes griegos tienen un conocimiento deficiente de la diabetes. Este estudio demuestra la necesidad de una mejor educación sobre la diabetes para mejorar la evolución de la enfermedad (AU)

Diabetes knowledge among Greek Type 2 Diabetes Mellitus patients.

BACKGROUND & OBJECTIVE: Diabetes knowledge has been shown to improve glycemic control and associate with several demographic parameters. In Greece, a country with high obesity rates, disease knowledge has never been evaluated in diabetic patients. This cross sectional study aimed to assess diabetes knowledge and its associations between social and demographic parameters, among Greek type 2 diabetes mellitus (T2DM) patients. METHODS: One hundred fifty nine patients with T2DM were recruited from an urban and a rural clinic in Greece. Diabetes knowledge was assessed with the Brief Diabetes Knowledge Test (DKT). Basic anthropometry was performed. Data regarding glycemic control and sociodemographic characteristics were collected from the patients' medical files. RESULTS: Greek T2DM patients demonstrated poor disease knowledge (mean DKT score 8.3±2.2/14.0 and mean DKT as a percent of correct answers 59.6±15.8%). No differences were observed between sex, place of residence, or glycemic control, among subjects. Patients with higher education demonstrated greater diabetes knowledge. Simple obesity with concurrent central obesity or suboptimal glycemic control decreased diabetes knowledge among participants. Additionally, waist circumference was inversely correlated to diabetes knowledge. CONCLUSIONS: Based on the DKT, Greek patients exhibit poor diabetes knowledge. This study provides evidence for the need for better diabetes education in order to ameliorate disease outcome.

Familial clustering strongly suggests that the phenotypic variation of the 8344 A>G lys mitochondrial tRNA mutation is encoded in cis.

The maternally inherited 8344 A>G mutation in the mitochondrial Lys tRNA is classically associated with the myoclonic epilepsy, ragged-red muscle fiber (MERRF) syndrome. Multiple lipomatosis (Madelung's disease) is occasionally described. Here we report a large kindred with a statistically significant clustering of very unusual clinical manifestations. We have studied a Greek family that includes seven symptomatic cases of 8344 A>G. Clinical features, glucose tolerance and heteroplasmy in fat, muscle and blood were analyzed. The patients, aged 34-76 at the time of assessment, all suffer from progressive proximal limb-girdle myopathy and extensive lipomatosis. Four of the seven have either impaired glucose tolerance or diabetes but none has had epilepsy, a cardinal feature of MERRF. Heteroplasmy was not higher in adipose tissue than that found in the literature. Compared to literature reports, the familial clustering of this unusual combination of manifestations (lipomatosis in all, epilepsy in none) is statistically significant. The clustering of unusual manifestations in this large kindred strongly suggests that much of the phenotypic variability of 8344 A>G is determined by mitochondrially encoded modifiers in cis.

The incretin effect and secretion in obese and lean women with polycystic ovary syndrome: a pilot study.

BACKGROUND: Insulin resistance is considered to play an important role in the pathogenesis of polycystic ovary syndrome (PCOS) and in the progression to type 2 diabetes. Recent reports concentrate on a possible relationship between incretin secretion and beta-cell function in PCOS. The aim of the present study is to investigate the incretin effect in obese and lean women with PCOS. METHODS: Twenty women with PCOS and ten age-matched healthy women were recruited in the study. The oral glucose tolerance test (OGTT) and isoglycemic test were carried out on each participant after an overnight fast at 2-weeks interval. Plasma levels of insulin, glucose, C-peptide, glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) were assayed. RESULTS: Obese women with PCOS demonstrated lower GIP concentrations (area under the curve [AUC]) in response to OGTT compared to the control group. The incretin effect was found significantly augmented in the obese women with PCOS compared to controls. This finding remained robust in the subgroup analysis including only body mass index (BMI)-matched healthy women. CONCLUSIONS: Increased insulinotropic effect could counteract the blunted GIP response to OGTT in obese women with PCOS. It is suggested that the pathology of PCOS may also include impaired activity of the enteroinsular axis.

Genetic variation in the visfatin (PBEF1/NAMPT) gene and type 2 diabetes in the Greek population.

Visfatin (NAMPT formerly known as PBEF1) is an adipokine that is strongly expressed in visceral fat and has caused much debate among researchers, regarding its involvement in glucose homeostasis and insulin resistance. It was initially isolated from bone marrow cells, and its involvement in inflammatory procedures such as sepsis and acute lung inflammation is now evident. Several studies have also reported an association of plasma visfatin levels with obesity. We undertook an evaluation of the involvement of the NAMPT gene in the development of type 2 diabetes (T2DM) in the Greek population. We studied 178 patients with T2DM and 177 controls that were matched for sex, age and body mass index. We genotyped three tagging SNPs selected from the HapMap II CEPH European population as reference for the Greek population. These three SNPs tag another 12 SNPs over the entire NAMPT gene with a mean r(2) of 0.92. No indications of association with disease status were found with any of the tested variants or the inferred haplotypes. Results were also negative when the quantitative traits of weight and BMI were tested. Although our study covers common variants across the NAMPT gene, the possible involvement of rare variants in T2DM etiology cannot be ruled out and will require the investigation of very large numbers of cases and controls.