Diffusion Tensor Imaging Evaluates Effects of Acupoint Injection at Zusanli (ST36) for Type 2 Diabetic Peripheral Neuropathy.

BACKGROUND Acupoint injection is a therapeutic method that combines acupuncture and Western medicine and shows good curative effects for neuropathies. This study aimed to explore the efficacy of acupoint injection for treating diabetic peripheral neuropathy (DPN) by magnetic resonance neuroimaging (MRN). MATERIAL AND METHODS Forty patients with DPN were randomly divided into an acupoint injection group (AI; n=20) and intramuscular injection group (MI; n=20). The AI group received an acupoint injection of mecobalamin at acupoint Zusanli (S36); the MI group received intramuscular injection of mecobalamin. The curative effect was evaluated by the Toronto Clinical Neuropathy Score and diffusion tensor imaging (DTI). RESULTS The neuropathy scores of both groups decreased from baseline (AI 9.31±2.36; MI 9.34±2.54) to after the 2-week treatment (AI 7.12±1.87; MI 7.86±2.11); the differences were not significant. The fractional anisotropy (FA) value showed significant differences on the common peroneal nerve (AI 0.36±0.04; MI 0.31±0.05; P<0.05) and tibial nerve (AI 0.38±0.07; MI 0.34±0.06; P<0.05) after treatment. Likewise, apparent diffusion coefficient (ADC) values between groups showed significant differences for the common peroneal nerve (AI 1.44±0.17×10⁻³ mm²/s; MI 1.61±0.20×10⁻³ mm²/s; P<0.05) and tibial nerve (AI 1.54±0.22×10-3 mm²/s; MI 1.60±0.17 10⁻³ mm²/s; P<0.05). CONCLUSIONS Patients with DPN showed lower nerve FA and higher ADC in DTI-MRN. The acupoint injection of mecobalamin could treat DPN and repair the damaged nerves, which was shown by elevated FA and lowered ADC. Our study provides clinical evidence for the application of acupoint injection therapy and the evaluation of DPN by MRN.

Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer.

Objective: The aim of this study is to analyze the microbiological characteristics of diabetic foot ulcer (DFU) and drug resistance of multidrug-resistant organisms (MDROs) and to reveal the potential risk factors for MDROs. This provides a basis for early empiric antibiotic treatment. Methods: This study included 348 patients with diabetic foot ulcer in Chu Hsien-I Memorial Hospital & Metabolic Disease Hospital of Tianjin Medical University between May 2020 and November 2021. A total of 475 strains of bacteria were cultured, among which 240 strains were multidrug-resistant bacteria, accounting for 51%. Binary logistic regression was used to analyze risk factors. First, univariate analysis was used to calculate the p value of variables, and then multivariate analysis was conducted for variables with p < 0.1 to analyze independent risk factors. Risk factors with p < 0.05 in multivariable analysis were considered as independent risk factors. The strength of the association was represented by odds ratio and 95% confidence interval. Results: Univariable logistic regression analysis demonstrated that previous hospitalization, previous antibiotic therapy, ulcer size >4cm2, surgical therapy, D-dimer, and CRP were associated with MDRO infection in patients with DFU. Multivariate logistic regression analysis demonstrated that previous hospitalization (OR = 1.91; 95% CI = 1.11-3.28; p = 0.02), ulcer size >4cm2 (OR = 1.68; 95% CI = 1.03-2.76; p = 0.04), surgical therapy (OR = 2.14; 95% CI = 1.03-4.47; p = 0.04), and CRP (OR = 1.01; 95% CI = 1.00-1.01; p = 0.03) were independent risk factors for MDROs infection in diabetic foot patients. Drug resistance analysis may indicate that the proportion and drug resistance rate of Acinetobacter baumannii in Tianjin, China, have changed. Conclusion: Previous hospitalization, ulcer size >4cm2, surgical therapy and CRP were independent risk factors for MDROs infection in diabetic foot patients. Identifying these risk factors can help us identify the high-risk patients of diabetic foot with MDRO infection early. More attention to high-risk patients and more aggressive isolation precautions may reduce the incidence of MDRO infection in diabetic foot patients.

Internet-Based Medication Management Services Improve Glycated Hemoglobin Levels in Patients with Type 2 Diabetes.

Background: Internet-based medication management services might help improve blood glucose control in patients with diabetes. Introduction: This study is a randomized controlled trial designed to explore the effect of telemedicine patient management on blood glucose control in Chinese patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This study included patients with T2DM from the Department of Integrated Traditional Chinese and Western medicine of Tianjin Medical University Chu Hsien-I Memorial Hospital who consulted between January 2019 and December 2019; 120 patients were randomized to the control group (standard care) and the telemedicine group (in-hospital medication evaluation, drug reorganization, medical monitoring, and advice via telemedicine). The primary endpoint was targeted glycated hemoglobin (HbA1c) <7.0% from baseline to 6 months. The secondary endpoints were the changes in fasting blood glucose (FBG), changes in daily medication cost, changes in the number of drug types taken daily, and hypoglycemic events. Results: Rates of HbA1c <7% improved in the telemedicine groups (p = 0.019), whereas no changes were seen in the control group (p > 0.999). FBG levels decreased (telemedicine: p = 0.001; control: p = 0.007), but the differences were not statistically significant between groups. Daily medication costs decreased in the telemedicine group (p = 0.001), but the costs were similar between groups. The number of medication types decreased in the telemedicine group (p = 0.001). Hypoglycemic events decreased in the telemedicine group (p = 0.032), but not in the control group (p = 0.854). Discussion: Telemedicine could improve the rate of HbA1c <7%. Conclusions: An internet-based medication management model was an effective telemedicine method for patients with T2DM.

A Mobile App for Diabetes Management: Impact on Self-Efficacy Among Patients with Type 2 Diabetes at a Community Hospital.

BACKGROUND Patients with type 2 diabetes upload and review blood glucose data between clinic visits. Many mobile phone applications (apps) that receive data from a "connected" glucometer and that support pattern management are available and have the capacity to make data upload and review less burdensome. The objective of this study was to assess whether the diabetic management app could improve glycemic control and diabetes self-efficacy in a Chinese community hospital by a randomized controlled trial. MATERIAL AND METHODS One-hundred twenty patients with type 2 diabetes registered at the Community Health Service Center of Zhangjiawo Town, Xiqing District, Tianjin City, China were recruited and volunteered to participate in the project. They were randomly divided into the mobile app intervention group (n=60) and the control group (n=60) for a 6-month observation. The control group was given conventional diabetic treatment and the app group was given the mobile app and conventional care. Self-efficacy was measured by the Diabetes Self-Efficacy Scale questionnaire. The differences between the 2 groups in hemoglobin A1c (HbA1c) and diabetes self-efficacy were evaluated at the third and sixth months. RESULTS At the sixth month, patients in the app group showed better HbA1c control (6.71±1.06 vs. 7.22±1.02, P<0.05) and improved self-efficacy score (119.20±9.88 vs. 102.09±10.67, P<0.05). CONCLUSIONS The mobile app helped patients with type 2 diabetes in a community hospital improve therapeutic outcome and self-management behavior. It also provided experiences for prevention and management of other chronic diseases in community hospitals.

Psychometric properties of the Chinese version of the Hypoglycemia Fear SurveyII for patients with type 2 diabetes mellitus in a Chinese metropolis.

PURPOSE: To evaluate the psychometric properties of the Chinese version of the Hypoglycemia Fear SurveyII (HFS-II) in patients with type 2 diabetes mellitus from Tianjin City. METHODS: The original HFS-II was translated and adapted to Chinese.350 inpatients from five hospitals of Tianjin completed the Chinese HFS-II. We examined the validity (content and construct validity) and reliability (internal consistency and test-retest reliability) of the scale. Content validity was evaluated by the content validity index (CVI) and the average agreement CVI(S-CVI/Ave). The construct validity was assessed by exploratory factor analysis. Reliability was measured by intraclass correlation coefficient (ICC) and Cronbach's alpha. RESULTS: The mean age of the 350 patients was 55.5±9.3years. The CVI was 0.71~1.0 and S-CVI/Ave was 0.92 respectively. By exploratory factor analysis, four factors were extracted which accounted for 52.15% of the total variance in the 23-item scale. The Chinese HFS-II displayed good internal consistency (Cronbach's alpha = 0.90) and test-retest reliability (ICC = 0.96). CONCLUSIONS: The Chinese version of HFSII had excellent psychometric properties and it could provide a useful tool for clinicians and nursing staff to assess the fear of hypoglycemia.

BML-111 attenuates high glucose-induced inflammation, oxidative stress and reduces extracellular matrix accumulation via targeting Nrf2 in rat glomerular mesangial cells.

Diabetic nephropathy (DN) is the most paradigmatic complication of diabetes mellitus (DM) and brings about severe social and economic burdens. BML-111 is a potent agonist of Lipoxin A4 and has shown anti-inflammatory function in many diseases. The aim of the study is to investigate the effects of BML-111 on high glucose (HG) -induced mesangial cells. HBZY-1 cells were stimulated by HG with or without BML-111. ML385 was used as an Nrf2 inhibitor. Cell proliferation was measured by CC-K 8 assay. Besides, levels of TNF-α, IL-1, IL-6 and MCP-1 were detected by corresponding ELISA kits. DCFH-DA staining and an available ROS kit were employed to determine the ROS generation. In addition, extracellular matrix (ECM) accumulation was evaluated by immunofluorescence assay and western blot analysis. The protein expressions involved in Nrf2/HO-1 and MAPK pathway were assessed by western blot assay. Results indicated that BML-111 extremely inhibited HBZY-1 cell proliferation induced by HG. Moreover, BML-111 reduced the levels of TNF-α, IL-1, IL-6 and MCP-1, declined intracellular ROS level, and attenuated expression of ECM proteins laminin, fibronectin, collagen IV and TGF-ß1. In addition, BML-111 promoted the activation of Nrf2, HO-1, and NQO1, while suppressed the phosphorylation of p38 and JNK. Further, NRF2 silence reversed the inhibitory effects of BML-111 on HG-induce inflammation, oxidative stress and ECM accumulation, accelerate the MAPK signaling, and diminished the expression of Nrf2 pathway. In summary, BML-111 alleviated HG-induced injury in HBZY-1 cells by repressing inflammatory response, oxidative stress and ECM accumulation via activating Nrf2 and inhibiting MAPK pathway.