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Diabetology
Number of Followers: 12  Open Access journalISSN (Online) 2673-4540 Published by MDPI  [258 journals]
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- Diabetology, Vol. 5, Pages 234-245: Overweight and Obesity in Adults with
Type 1 Diabetes: A Growing Challenge
Authors: Sanja Klobučar, Dijana Detel, Miljenka Igrec, Ajda Bergoč, Valentina Rahelić, Dario Rahelić
First page: 234
Abstract: The prevalence of obesity in adults with type 1 diabetes is increasing and reflects the rates of the general adult population. The coexistence of overweight or obesity and type 1 diabetes poses a major challenge to effective glycemic and weight management. In addition, individuals living with T1D and overweight or obesity are at greater cardiometabolic risk and are more prone to develop chronic complications in comparison to normal weight individuals with type 1 diabetes. Although obesity represents a growing challenge in the type 1 diabetes population, awareness of this issue is still low. This review provides a summary of current data on prevalence trends, causes, current strategies, and challenges in managing obesity in adults with type 1 diabetes.
Citation: Diabetology
PubDate: 2024-06-24
DOI: 10.3390/diabetology5030018
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 246-254: Quantitative Analysis of Different
Foveal Avascular Zone Metrics in Healthy and Diabetic Subjects
Authors: Ouafa Sijilmassi
First page: 246
Abstract: The primary aim of this study was to assess the size and shape of the Foveal Avascular Zone (FAZ) in patients with type 2 diabetes mellitus compared to healthy subjects. The study used 80 OCTA images from the FAZID dataset. The FAZ size was measured by its area, perimeter, and maximum/minimum Feret diameters. The shape was assessed using the axial ratio, circularity, roundness, and solidity. These metrics were calculated automatically using Matlab® R2020b. Statistical analysis was performed using SPSS statistical software version 28.0, with a p-value of less than 0.01 considered significant. The results showed that the FAZ area was significantly larger in diabetic eyes (mean = 0.50 mm2) compared to control eyes (mean = 0.37 mm2), with a p-value of less than 0.01. Both the maximum and minimum diameters of the FAZ were also significantly larger in diabetic groups compared to the control group. Parameters associated with FAZ’s shape were significantly smaller in the diabetic groups than in the control group, except for the axial ratio. The main finding of this study is that diabetic eyes without clinically detectable diabetic retinopathy exhibit morphological changes and irregularities at the FAZ border.
Citation: Diabetology
PubDate: 2024-06-30
DOI: 10.3390/diabetology5030019
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 255-270: The Influence of Plant-Based Diets on
Metabolic Syndrome
Authors: Inês Fernandes, Melissa Mariana, Margarida Lorigo, Elisa Cairrao
First page: 255
Abstract: The magnification of Western eating habits has contributed to a large increase in the development of several diseases and conditions, namely cardiovascular disease, obesity, dyslipidemia, and hyperglycemia. These are part of a cluster of metabolic factors involved in metabolic syndrome. However, there are new dietary patterns more focused on the consumption of plant-based foods. Thus, the aim of this review was to investigate the impact of plant-based diets on metabolic syndrome and to achieve the inflammatory mediators and the antioxidant effects involved in this potential health benefits effect. Advanced research was performed for articles published in the last 10 years, which were analyzed and selected according to the defined inclusion and exclusion criteria. Of the articles analyzed, the majority supported the positive impact of plant-based diets on metabolic syndrome. Furthermore, several studies also showed that these diets appear to have an anti-inflammatory and antioxidant role. Thus, plant-based diets appear to have health benefits, contributing to the prevention of metabolic syndrome, and improving the cardiovascular and metabolic markers’ profile, mainly when including healthy foods. The total exclusion of animal source foods (especially meat and fish) from the diet, as well as the consumption of processed and additive plant-based foods, may contribute to an increased prevalence of metabolic syndrome.
Citation: Diabetology
PubDate: 2024-07-03
DOI: 10.3390/diabetology5030020
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 271-285: The Use of Insulin Pen Needles: The
Italian Society of Metabolism, Diabetes, and Obesity (SIMDO) Consensus
Authors: Giancarlo Tonolo, Ariella DeMonte, Maria Antonietta Taras, Alessandro Scorsone, Patrizio Tatti, Battistina Pittui, Salvatore Turco, Riccardo Trentin
First page: 271
Abstract: A correct injection technique is essential in order to ensure the effectiveness of insulin and to achieve good metabolic control, and the use of suitable needles is fundamental. Today, technological evolution has transformed insulin needles into innovative tools able to guarantee an effective and safe administration of insulin, to reduce local complications, such as lipodystrophies that are an obstacle to the effectiveness of the treatment itself, and to minimize the pain of the injection, a crucial factor in the acceptance of therapy and for compliance. The steering committee of the scientific society SIMDO has commissioned the scientific committee and some members of the board to draw up an official SIMDO point of view/consensus on the use of insulin needles. In this way, a group that has combined the experience gained in their field of expertise—diabetologists operating in the public and private sectors, nurses, psychologists, and patients—was set up. The aim is to give indications regarding insulin injection techniques, combining themes such as technology innovation, education in self-management, and psychological support for the patient into a unified approach based on the priority area of patient quality of life. The document will provide operational recommendations that integrate the directions regarding the standards of care for diabetes resulting from the most recent scientific acquisitions with the concept of quality at 360°, as it emerged from the point of view of all the operators involved, but with the patient’s interests as a central focal point.
Citation: Diabetology
PubDate: 2024-07-05
DOI: 10.3390/diabetology5030021
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 286-299: Emotional Eating Is Associated with
Authors: Aleksandra S. Kristo, Kübra İzler, Liel Grosskopf, Jordan J. Kerns, Angelos K. Sikalidis
First page: 286
Abstract: Lifestyle behaviors and their potential effects on diabetes are being investigated for optimal diabetes management. In patients with type 2 diabetes mellitus (T2DM), the necessary dietary modifications extend to psychological components for consideration. This study aimed to determine the eating behavior of T2DM patients with different sociodemographic characteristics in an urban Turkish population. The Dutch Eating Behavior Questionnaire (DEBQ) was distributed via social media and a smartphone application to 108 T2DM patients, 58 males and 50 females, age 26–40 years (20 individuals, 18.6%) and over 40 years (88 individuals, 81.4 %). Basic component factor analysis varimax rotation was used for the item-total correlation coefficient. The 26–40 years age group exhibited high correlation for both restrained and emotional eating behavior (r > 0.8), while participants over 40 years displayed medium correlation for restrained eating and high correlation for emotional eating (r = 0.6–0.8). Compared to married and single participants, participants with “other” marital status showed significant correlation with all eating behavior categories (r > 0.8). Married participants were less correlated with all categories compared to single participants. Participants with lower education levels exhibited high correlation (r > 0.8) for all forms of eating, more so compared to those with higher levels of education attained. Overweight patients demonstrated moderately high (r = 0.4–0.6) restrictive eating correlation, while normal weight and obese patients exhibited higher correlation (r = 0.6–0.8) for emotional and restrained eating compared to overweight patients. Regardless of demographic factors, when all participants were combined, the strongest correlation was found to be with emotional eating compared to other types of eating.
Citation: Diabetology
PubDate: 2024-07-11
DOI: 10.3390/diabetology5030022
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 300-320: Metabolic Syndrome and Pharmacological
Interventions in Clinical Development
Authors: Eugen Javor, David Šarčević, Arnes Rešić
First page: 300
Abstract: Metabolic syndrome prevalence is between 24 and 27% and poses a significant risk for the development of atherosclerotic cardiovascular disease (ASCVD), type 2 diabetes (T2D), or other comorbidities. Currently, no drugs are approved for metabolic syndrome treatment itself, so the risk factors are treated with therapies approved for cardiac and metabolic conditions. These are approved drugs for dyslipidemia treatment such as statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, cornerstone antihypertensive drugs, or novel class glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1 RA) for T2D and overweight or obesity treatment. We have also evaluated new pharmacological interventions in clinical development that have reached Phase 2 and/or Phase 3 randomized clinical trials (RCTs) for the management of the risk factors of metabolic syndrome. In the pipeline are glucose-dependent insulinotropic polypeptide (GIP), GLP-1, glucagon receptor (GCGR), amylin agonists, and a combination of the latter for T2D and overweight or obesity treatment. Non-entero-pancreatic hormone-based therapies such as ketohexokinase (KHK) inhibitor, growth differentiation factor 15 (GDF15) agonists, monoclonal antibodies (mAbs) as activin type II receptors (ActRII) inhibitors, and a combination of anti-α-myostatin (GFD8) and anti-Activin-A (Act-A) mAbs have also reached Phase 2 or 3 RCTs in the same indications. Rilparencel (Renal Autologous Cell Therapy) is being evaluated in patients with T2D and chronic kidney disease (CKD) in a Phase 3 trial. For dyslipidemia treatment, novel PCSK9 inhibitors (oral and subcutaneous) and cholesteryl ester transfer protein (CETP) inhibitors are in the final stages of clinical development. There is also a surge of a new generation of an antisense oligonucleotide (ASO) and small interfering RNA (siRNA)-targeting lipoprotein(a) [Lp(a)] synthesis pathway that could possibly contribute to a further step forward in the treatment of dyslipidemia. For resistant and uncontrolled hypertension, aldosterone synthase inhibitors and siRNAs targeting angiotensinogen (AGT) messenger RNA (mRNA) are promising new therapeutic options. It would be interesting if a few drugs in clinical development for metabolic syndrome such as 6-bromotryptophan (6-BT), vericiguat, and INV-202 as a peripherally-acting CB1 receptor (CB1r) blocker would succeed in finally gaining the first drug approval for metabolic syndrome itself.
Citation: Diabetology
PubDate: 2024-07-23
DOI: 10.3390/diabetology5030023
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 321-332: Potential Impact of Metabolic Syndrome
Control on Cardiovascular Risk in Elderly Patients with Diabetes: A
Cross-Sectional Study
Authors: Tânia Nascimento, Margarida Espírito-Santo, Adriana Gonçalves, Ezequiel Pinto, Ana Luísa De Sousa-Coelho, Maria Dulce Estêvão
First page: 321
Abstract: Metabolic syndrome (MS), a complex pathology with features like abnormal body fat distribution, insulin resistance, and dyslipidaemia, contributes to higher cardiovascular (CV) risk. A cross-sectional study including 87 individuals assessed CV risk score in elderly patients with type 2 diabetes and MS in Algarve, Portugal. The 10-year CV risk score was estimated using the ADVANCE risk score calculator. The reductions in CV risk score were estimated by adjusting the data inputted on the online tool to achieve systolic blood pressure (SBP) <130 or <120 mmHg, and LDL cholesterol <70 mg/dL Beyond waist circumference, the mean number of clinical features of MS was 3.14 ± 0.84, without significant sex differences. The mean CV risk score was 22.5% (CI: 20.3–24.7). Sex-specific analysis showed higher risk score in males (24.2%, CI: 21.3–27.0) vs. females (19.7%, CI: 16.2–23.3; p = 0.028). Hypothetical risk score reductions show that lowering SBP to <130 mmHg could significantly lower the risk score by an average of 9.2% (CI: 7.7–10.7), whereas 34.5% of the participants would be out of the diagnostic criteria for MS. When comparing each potential intervention with current risk score, all interventions significantly reduce the 10-year CV risk score. The study highlights the potential of blood pressure control in reducing CV risk score and the importance of multifaceted risk score reduction strategies.
Citation: Diabetology
PubDate: 2024-08-01
DOI: 10.3390/diabetology5030024
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 333-343: The Prescription and Safety of Oral
Antidiabetic Drugs in Outpatients with Type 2 Diabetes Mellitus: An
Observational, Retrospective, Multicenter Study on the Role of Adherence
in a Real-Life Primary Care Setting
Authors: Gianmarco Marcianò, Cristina Vocca, Alessandro Casarella, Luca Gallelli, Vincenzo Rania, Caterina De Sarro, Rita Citraro, Caterina Palleria, Rosa Candida Bianco, Iolanda Fera, Antonietta Greco, Lucia Muraca, Giacinto Nanci, Carmelo Luciano Rossi, Michael Ashour, Bruno D’Agostino, Giovambattista De Sarro
First page: 333
Abstract: Introduction: Type 2 diabetes mellitus (T2DM) is a common disease burdened with significant morbidity and mortality. Despite the substantial number of new available drug treatments, adherence to therapy and adverse drug reactions (ADRs) are the major constraint in the management of this disease. We evaluated the use, the adherence, and the safety of antidiabetic drugs in patients with T2DM. Methods: We performed an observational, retrospective, multicenter study on medical records of outpatients referred to general practitioners in Catanzaro (Calabria, Italy). Drug adherence was measured considering the packages of antidiabetic drugs prescribed at the time of admission, after three months, and 1 year later. ADRs were evaluated using the Naranjo probability scale. Collected data were analyzed using the Statistical Package for the Social Sciences. Results: During the study, we evaluated 12,170 medical records of seven general practitioners. The most prescribed drug was metformin alone (28.4%) or with other oral antidiabetics (19.6%) and then insulin (n: 354; men 190, women 164). Logistic regression showed an association between T2DM less than or equal to 5 years and low adherence (p = 0.023). During the study, we recorded 26 ADRs that were correlated with sex (women) and insulin treatment. Conclusions: this real-life study shows that patients with T2DM have a high adherence, probably related to their having a low number of ADRs.
Citation: Diabetology
PubDate: 2024-08-07
DOI: 10.3390/diabetology5030025
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 344-355: Impact of Hyperferritinemia on Immune
Modulation in Septic Diabetic Patients
Authors: Min-Ji Kim, Eun-Jung Choi, In-Kyu Lee
First page: 344
Abstract: Diabetes significantly impacts the immune system; however, its role in worsening sepsis prognosis remains poorly understood. This study investigated the effect of hyperferritinemia on immune modulation in septic diabetic patients. A cohort study at Kyungpook National University Hospital stratified sepsis patients by diabetes status and followed them for 28 days. Additionally, CD4+ T cells from mice were analyzed for proliferation, apoptosis, and metabolic changes under ferritin treatment. Results from the clinical study showed higher ferritin levels in diabetic patients, and those with lower lymphocyte counts had increased mortality. In the mice study, ferritin inhibited T cell activation and proliferation by shifting metabolism from glycolysis to oxidative phosphorylation without increasing cell death. These findings suggest that the suppression of T cell proliferation due to elevated ferritin levels contributes to an immunosuppressive environment, leading to worse outcomes. In conclusion, hyperferritinemia is a biomarker for sepsis severity, particularly in diabetic patients, highlighting potential therapeutic strategies targeting ferritin levels or glycolytic pathways.
Citation: Diabetology
PubDate: 2024-08-08
DOI: 10.3390/diabetology5030026
Issue No: Vol. 5, No. 3 (2024)
- Diabetology, Vol. 5, Pages 141-150: Burden of Infected Diabetic Foot
Ulcers on Hospital Admissions and Costs in a Third-Level Center
Authors: Roberto Da Ros, Roberta Assaloni, Andrea Michelli, Barbara Brunato, Enrica Barro, Marco Meloni, Cesare Miranda
First page: 141
Abstract: Diabetic foot is a common complication of diabetes that affects quality and prognosis of life for patients and often requires hospitalization. Infection, alone or in association with ischemia, is the main cause of hospital admission and impacts prognosis. The aim of this study is to analyze the costs of diabetic foot lesions and assess factors that influence the economic impact, focusing on infection. We included all people with diabetes with a first visit for diabetic foot during 2018 in our diabetic foot center. Database interrogation identified 422 patients. Diabetic foot treatment required hospitalization for 242 patients (58%), while 180 (42%) were treated in outpatient services. Healing time was different between the two groups: it was 136 ± 124 days (mean ± SD) for outpatients and 194 ± 190 days for patients that require hospitalization (p < 0.001). Costs: Treatment of 422 patients for diabetic foot globally costs 2063 million EUR and the mean cost for patients is 4888 EUR, with hospital stay having a high impact on this, accounting for 88% of the costs. Infection impacts hospitalization duration and ischemia impacts healing time. Ischemia and infection prolonged hospitalization duration and costs. Our work underlines that hospital treatment costs have a high impact on total costs.
Citation: Diabetology
PubDate: 2024-04-03
DOI: 10.3390/diabetology5020011
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 151-161: Epidemiology of Diabetes Mellitus in
Adults and Seniors in Rio Branco, Acre, Western Brazilian Amazon
Authors: Yara de Moura Magalhães Lima, Fernanda Andrade Martins, Alanderson Alves Ramalho
First page: 151
Abstract: (1) Background: To analyze the prevalence and factors associated with diabetes mellitus in adults and the elderly in Rio Branco, Acre, Western Brazilian Amazon. (2) Methods: The R software version 4.0.5 was used for estimating the prevalence of diabetes mellitus, odds ratios, and 95% confidence intervals. Multiple analysis was conducted through hierarchical variable selection. (3) Results: 1.095 individuals aged 18 years and older participated in this study, with 6.4% of the respondents showing prevalence of diabetes mellitus. The prevalence of diabetes mellitus was positively associated with a prior medical diagnosis of obesity (OR: 3.2; 95% CI: 1.67–6.12), dyslipidemia (OR: 4.17; 95% CI: 2.08–8.36), and increasing age (OR: 1.07; 95% CI: 1.05–1.09). Conversely, an inverse association was observed with higher education (12 or more years of study; OR: 0.20; 95% CI: 0.07–0.61). (4) Conclusions: The prevalence of diabetes mellitus in the municipality of Rio Branco, Acre, Brazil, has significantly increased with advancing age. Education, obesity, and dyslipidemia were also identified as factors associated with diabetes mellitus in this population. Awareness campaigns regarding dietary patterns and lifestyle choices may serve as preventive and control measures.
Citation: Diabetology
PubDate: 2024-04-10
DOI: 10.3390/diabetology5020012
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 162-177: Do T2DM and Hyperglycaemia Affect the
Expression Levels of the Regulating Enzymes of Cellular O-GlcNAcylation in
Human Saphenous Vein Smooth Muscle Cells'
Authors: Israel O. Bolanle, Gillian A. Durham, James P. Hobkirk, Mahmoud Loubani, Roger G. Sturmey, Timothy M. Palmer
First page: 162
Abstract: Protein O-GlcNAcylation, a dynamic and reversible glucose-dependent post-translational modification of serine and threonine residues on target proteins, has been proposed to promote vascular smooth muscle cell proliferation and migration events implicated in vein graft failure (VGF). Therefore, targeting the enzymes (glutamine fructose-6P amidotransferase (GFAT), O-GlcNAc transferase (OGT), and O-GlcNAcase (OGA)) that regulate cellular O-GlcNAcylation could offer therapeutic options to reduce neointimal hyperplasia and venous stenosis responsible for VGF. However, it is unclear how type 2 diabetes mellitus (T2DM) and hyperglycaemia affect the expression of these enzymes in human saphenous vein smooth muscle cells (HSVSMCs), a key cell type involved in the vascular dysfunction responsible for saphenous VGF. Therefore, our aim was to assess whether T2DM and hyperglycaemia affect GFAT, OGT, and OGA expression levels in HSVSMCs in vitro. Expression levels of GFAT, OGT, and OGA were determined in low-passage HSVSMCs from T2DM and non-T2DM patients, and in HSVSMCs treated for 48 h with hyperglycaemic (10 mM and 25 mM) glucose concentrations, by quantitative immunoblotting. Expression levels of OGT, OGA, and GFAT were not significantly different in HSVSMC lysates from T2DM patients versus non-T2DM controls. In addition, treatment with high glucose concentrations (10 mM and 25 mM) had no significant effect on the protein levels of these enzymes in HSVSMC lysates. From our findings, T2DM and hyperglycaemia do not significantly impact the expression levels of the O-GlcNAcylation-regulating enzymes OGT, OGA, and GFAT in HSVSMCs. This study provides a foundation for future studies to assess the role of O-GlcNAcylation on VGF in T2DM.
Citation: Diabetology
PubDate: 2024-04-25
DOI: 10.3390/diabetology5020013
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 178-189: Defining the miRnome of Saphenous Vein
Smooth Muscle Cells from Patients with Type 2 Diabetes Mellitus
Authors: Alisah Hussain, Yaw Asare-Amankwah, Shehryar Qureshi, M. Julie Thornton, Timothy M. Palmer, Israel O. Bolanle, Ian C. Wood, Neil A. Turner, Karen E. Porter, Andrew Tedder, Kirsten Riches-Suman
First page: 178
Abstract: Type 2 diabetes mellitus (T2DM) patients suffer premature development of cardiovascular disease and commonly require cardiac revascularization using the autologous saphenous vein (SV). Smooth muscle cells (SMCs) are the principal cell type within the vascular wall and are dysfunctional in T2DM SV-SMCs, yet the mechanisms underpinning this are incompletely understood. The purpose of this study was to interrogate differential microRNA (miRNA) expression in SV-SMCs to enhance our understanding of T2DM SV-SMC phenotypic change. miRNA expression in primary human SV-SMCs from T2DM and non-diabetic (ND) donors was determined using an array (n = 6 each of ND and T2DM SV-SMCs). Differentially expressed miRNAs were ranked, and functional annotation of the 30 most differentially expressed miRNAs using DAVID and KEGG analysis revealed pathways related to SMC phenotype, including proliferation, migration, cytokine production and cell signaling. After selecting miRNAs known to be involved in SMC phenotypic regulation, miR-17, miR-29b-2, miR-31, miR-130b and miR-491 were further validated using qRT-PCR (n = 5 each of ND and T2DM SV-SMC), with miR-29b-2 subsequently being removed from further investigation. Potential mRNA targets were identified using mirDIP. Predicted target analysis highlighted likely dysregulation in transcription, epigenetic regulation, cell survival, intracellular signaling and cytoskeletal regulation, all of which are known to be dysfunctional in T2DM SV-SMCs. In conclusion, this paper identified four miRNAs that are dysregulated in T2DM SV-SMCs and are implicated in functional changes in the behavior of these cells. This provides a step forward in our understanding of the molecular and epigenetic regulation of vascular dysfunction in T2DM.
Citation: Diabetology
PubDate: 2024-05-11
DOI: 10.3390/diabetology5020014
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 190-205: Prevalence of Peripheral Arterial
Disease and Principal Associated Risk Factors in Patients with Type 2
Diabetes Mellitus: The IDON-Peripheral Arterial Disease Study
Authors: Aliyanet Isamara Porcayo Ascencio, Evangelina Morales Carmona, Jesús Morán Farías, Dulce Stephanie Guzmán Medina, Rebeca Galindo Salas, Leobardo Sauque Reyna
First page: 190
Abstract: The principal purpose of this study is to determine the prevalence of peripheral arterial disease (PAD), as well as the principal associated risk factors, in patients registered in the IDON-PAD database. PAD is a condition characterized by the narrowing or blockage of arteries in the body’s extremities due to plaque buildup, leading to reduced blood flow and tissue ischemia. While PAD primarily affects the lower extremities, it can lead to symptoms such as intermittent claudication and, in severe cases, ulcers and amputations. Risk factors for PAD are numerous and cumulative, including smoking, age over 50, type 2 diabetes mellitus, and hypertension. The prevalence of PAD increases with age, with rates ranging from 2.5% in those over 50 to 60% in those over 85, varying by ethnicity and study population. Diabetic patients face a higher risk of PAD-related complications and have lower success rates with revascularization procedures. The diagnosis of PAD traditionally relied on physical examination and symptoms, but the Ankle–Brachial Index is now a standard diagnostic tool due to its non-invasive nature and reliability. In Mexico, the prevalence of PAD is estimated at 10%, with significant risk factors being the duration of diabetes, hypertension, hypertriglyceridemia, and smoking. Notably, 70% of PAD cases are asymptomatic, emphasizing the importance of proactive screening. This study aimed to determine the prevalence of PAD and associated risk factors in diabetic patients aged 40 and above. The prevalence was found to be 11.2%, with high-risk waist circumference, elevated triglycerides, positive Edinburgh questionnaire, and weak pulses as significant predictors. The detection and management of PAD in diabetic patients require a comprehensive approach, including lifestyle modifications and regular screenings. Prevention strategies should focus on controlling risk factors, including obesity, hypertension, and dyslipidemia. In conclusion, PAD is a prevalent yet underdiagnosed condition in diabetic patients, necessitating proactive screening and comprehensive management to mitigate associated risks and improve patient outcomes. The principal limitation of this study is that, as it uses a cross-sectional methodology and is not an experimental study, although we can establish the prevalence of PAD as well as the associated risk factors, we cannot define causality or determine the hazard ratio for each of these factors. Special thanks to Dr. Leobardo Sauque Reyna and all participants for their contribution to this research.
Citation: Diabetology
PubDate: 2024-05-14
DOI: 10.3390/diabetology5020015
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 206-222: A Resource-Efficient Plantar Pressure
Evaluation System for Diabetic Foot Risk Assessment
Authors: Madison Reddie, Daniel Frey
First page: 206
Abstract: Diabetic foot complications constitute a large and rapidly growing global health problem, causing one million lower-extremity amputations annually. These amputations are typically preceded by preventable diabetic foot ulcers (DFUs). However, 80% of the world’s diabetics now reside in low- and middle-income countries, where many healthcare settings lack the resources required to implement recommended DFU risk assessment and prevention strategies. There is an unmet need for a more resource-efficient DFU risk assessment method. In this study, a low-cost, purely mechanical plantar pressure evaluation device was designed toward this end. The device consists of a grid of plastic bistable compliant mechanisms, which present a visual series of binary outputs in response to applied pressure. By having diabetic patients step on the device, non-specialist healthcare providers can easily assess patients’ plantar pressures, which are predictive of future DFUs. A prototype was fabricated and pilot-tested with 41 healthy subjects. It demonstrated a sensitivity of 25.6%, although sensitivity reached 60% for heavier subjects. Sensitivity could likely be significantly improved by lowering the device’s profile and increasing the sensing area. Strained health systems may then be able to use this device to allocate scarce healthcare resources more efficiently to prevent costly DFUs and amputations.
Citation: Diabetology
PubDate: 2024-05-22
DOI: 10.3390/diabetology5020016
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 223-233: The Utility of Annual Reassessment of
the International Working Group on the Diabetic Foot Diabetes-Related Foot
Ulcer Risk Classification in the Primary Care Setting—A Cohort Study
Authors: Matilde Monteiro-Soares, José Dores, Cristina Alves-Palma, Susana Galrito, Daniela Ferreira-Santos
First page: 223
Abstract: Background: We assessed the pertinence of updating the International Working Group on the Diabetic Foot (IWGDF) risk classification yearly in people with diabetes by quantifying the changes in the risk group and its accuracy in identifying those developing an ulcer (DFU) in a primary care setting. Methods: In our retrospective cohort study, we included all people with diabetes with a foot assessment registry between January 2016 and December 2018 in the Baixo Alentejo Local Health Unit. Foot-related data were collected at baseline after one and two years. DFU and/or death until December 2019 were registered. The proportion of people changing their risk status each year was calculated. Accuracy measures of the IWGDF classification to predict DFU occurrence at one, two, and three years were calculated. Results: A total of 2097 people were followed for three years, during which 0.1% died and 12.4% developed a DFU. After two years, 3.6% of the participants had progressed to a higher-risk group. The IWGDF classification presented specificity values superior to 90% and negative predictive values superior to 99%. Conclusion: Foot risk status can be safely updated every two years instead of yearly, mainly for those at very low risk. The IWGDF classification can accurately identify those not at risk of DFU.
Citation: Diabetology
PubDate: 2024-06-04
DOI: 10.3390/diabetology5020017
Issue No: Vol. 5, No. 2 (2024)
- Diabetology, Vol. 5, Pages 1-11: A Comparative Analysis of Machine
Learning Models for the Detection of Undiagnosed Diabetes Patients
Authors: Simon Lebech Cichosz, Clara Bender, Ole Hejlesen
First page: 1
Abstract: Introduction: Early detection of type 2 diabetes is essential for preventing long-term complications. However, screening the entire population for diabetes is not cost-effective, so identifying individuals at high risk for this disease is crucial. The aim of this study was to compare the performance of five diverse machine learning (ML) models in classifying undiagnosed diabetes using large heterogeneous datasets. Methods: We used machine learning data from several years of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 to identify people with undiagnosed diabetes. The dataset included 45,431 participants, and biochemical confirmation of glucose control (HbA1c) were used to identify undiagnosed diabetes. The predictors were based on simple and clinically obtainable variables, which could be feasible for prescreening for diabetes. We included five ML models for comparison: random forest, AdaBoost, RUSBoost, LogitBoost, and a neural network. Results: The prevalence of undiagnosed diabetes was 4%. For the classification of undiagnosed diabetes, the area under the ROC curve (AUC) values were between 0.776 and 0.806. The positive predictive values (PPVs) were between 0.083 and 0.091, the negative predictive values (NPVs) were between 0.984 and 0.99, and the sensitivities were between 0.742 and 0.871. Conclusion: We have demonstrated that several types of classification models can accurately classify undiagnosed diabetes from simple and clinically obtainable variables. These results suggest that the use of machine learning for prescreening for undiagnosed diabetes could be a useful tool in clinical practice.
Citation: Diabetology
PubDate: 2024-01-03
DOI: 10.3390/diabetology5010001
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 12-25: Diet Supplementation with Rosemary
(Rosmarinus officinalis L.) Leaf Powder Exhibits an Antidiabetic Property
in Streptozotocin-Induced Diabetic Male Wistar Rats
Authors: Zelipha N. Kabubii, James M. Mbaria, Peter Mbaabu Mathiu, John M. Wanjohi, Evans N. Nyaboga
First page: 12
Abstract: Diabetes mellitus is a metabolic disorder that has a high global health burden and causes high mortality and morbidity in humans. Medicinal herbs and plants offer a promising alternative to conventional therapies for the management of diabetes. Rosemary (Rosmarinus officinalis L.) is a traditional medicinal herb that has been used for the management of several diseases. Therefore, the present study investigates the antidiabetic properties of diets supplemented with R. officinalis leaf powder on streptozotocin-induced diabetic Wistar rats. First, the phytochemicals and 2,2-dephenyl-1-picrylhydrazyl (DPPH) free-radical scavenging activity of aqueous R. officinalis leaf extract were determined. Streptozotocin-induced diabetic male Wistar rats were fed a diet supplemented with R. officinalis leaf powder (ROP) at 3%, 6%, and 12%, respectively, for 6 weeks. Investigations of food intake, body weight, rat relative organ weights, blood glucose, lipid profiles, creatinine, bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were estimated according to standard procedures. The results show that ROP aqueous extract contains significant amounts of phenolics, flavonoids, and tannins, which exhibit in vitro DPPH free-radical scavenging activity. Based on an in vivo study, ROP reduced blood glucose levels in streptozotocin-induced diabetic animals (p < 0.05). Dietary supplementation with ROP in diabetic rats significantly (p < 0.05) lowered ALT, AST, bilirubin, creatinine, total triglyceride (TG), total cholesterol (TC), and low-density lipoprotein (LDL) levels while increasing high-density lipoproteins (HDLs) when compared with the diabetic control group. Our findings demonstrate that a diet supplemented with R. officinalis leaf powder exhibits an antidiabetic potential with improved health outcomes, as demonstrated by the improved lipid and liver profile enzymes in our animal model.
Citation: Diabetology
PubDate: 2024-01-04
DOI: 10.3390/diabetology5010002
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 26-39: Does the Efficacy of Semaglutide
Treatment Differ between Low-Risk and High-Risk Subgroups of Patients with
Type 2 Diabetes and Obesity Based on SCORE2, SCORE2-Diabetes, and ASCVD
Calculations'
Authors: Martina Matovinović, Andrej Belančić, Juraj Jug, Filip Mustač, Maja Sirovica, Mihovil Santini, Anja Bošnjaković, Mario Lovrić, Martina Lovrić Benčić
First page: 26
Abstract: Background: Diabetes is the primary contributor to cardiovascular disease risk, and when combined with obesity, it further underscores the significance of cardiovascular risk assessment. Methods: A retrospective study of 64 patients with type 2 diabetes (T2D) and obesity on once-weekly subcutaneous semaglutide stratified by cardiovascular risk categories determined using the SCORE2/SCORE2-OP, SCORE2-Diabetes, and ASCVD score calculations. We compare the differences between groups (ASCVD: low + borderline + intermediate versus high-risk group; SCORE2/SCORE2-OP: low + moderate versus high + very high-risk group and SCORE2-Diabetes: low + moderate versus high + very high-risk group) in terms of change from baseline in body mass index (BMI) and HbA1c and weight loss outcomes. Results: Patients in the high-risk group, according to ASCVD risk score, had statistically better results in weight loss ≥ 3%, ≥5%, and ≥10% compared to ASCVD low + borderline + intermediate and without difference regarding HbA1c. According to SCORE2/SCORE2-OP, the high + very high-risk group had statistically better HbA1c and weight loss results but only for ≥5% versus the low + moderate risk group. Based on the score SCORE2-Diabetes, the high + very high-risk group had statistically significant better results in lowering HbA1c and weight loss but only for ≥5% versus the low + moderate risk group. Conclusions: To the best of our knowledge, this study represents the initial investigation linking glycemic control and weight reduction outcomes in individuals with T2D and obesity treated with once-weekly semaglutide stratified by cardiovascular risk categories determined using the SCORE2/SCORE2-OP, SCORE2-Diabetes and ASCVD score calculations.
Citation: Diabetology
PubDate: 2024-01-04
DOI: 10.3390/diabetology5010003
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 40-59: The Main Risk Factors in Type 2 Diabetes
for Cognitive Dysfunction, Depression, and Psychosocial Problems: A
Systematic Review
Authors: Maarja Randväli, Toomas Toomsoo, Jekaterina Šteinmiller
First page: 40
Abstract: The aim of this study is to analyze the risk factors that lead to cognitive impairment, depression, and psychosocial problems in type 2 diabetes and discern what aspects they have in common. Type 2 diabetes is associated with a higher risk of cognitive impairment, including dementia, which in turn increases the risk of hospitalization, falls, and premature mortality. In this study, we conducted a systematic review to achieve this goal, including searches on electronic databases such as PubMed, Medline, Web of Science, EBSCO Discovery, EBSCO host, Scopus, and ScienceDirect, from 2016 onwards. Additionally, we carried out manual searches in leading journals in the field. After evaluating and analyzing the articles, 60 remained, focusing on the following four main themes: disorders due to biological, psychological, social, and pharmacological causes that lead to neuropsychological complications. Based on the results, consistently analogous risk factors contributing to the onset of cognitive impairments, depression, and psychosocial predicaments encompass comorbid ailments, dysglycemia, gender, heightened levels of apprehension and anxiety, educational attainment, socio-economic standing, and pharmaceutical interventions. Furthermore, in the realm of type 2 diabetes, factors such as disease duration, adiposity, specifically overweight and obesity, and advancing age were also identified as significant contributors to cognitive impairments and depression. Concomitantly, the absence of a robust support system and social network emerged as a shared risk factor, predisposing individuals to psychosocial challenges and depressive states. These findings emphasize that the risk factors for cognitive impairments, depression, and psychosocial issues for type 2 diabetes are similar, highlighting the importance of psychosocial support, education, and patient-centered treatment to optimize outcomes and quality of life.
Citation: Diabetology
PubDate: 2024-01-11
DOI: 10.3390/diabetology5010004
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 60-68: Effectiveness of Oral versus Injectable
Semaglutide in Adults with Type 2 Diabetes: Results from a Retrospective
Observational Study in Croatia
Authors: Sanja Klobučar, Andrej Belančić, Iva Bukša, Nikolina Morić, Dario Rahelić
First page: 60
Abstract: Background: The number of people with type 2 diabetes is increasing daily, and therefore, effective therapy is needed to successfully regulate glycemia and reduce the risk of associated complications. Recently, an oral formulation of the glucagon-like peptide-1 receptor agonist (GLP-1 RA) semaglutide has become available. Therefore, the aim of our study was to compare the effectiveness of the new oral formulation and the existing injectable formulation of semaglutide in terms of glycemic and body weight control in a real-world setting. Patients and methods: This was a single-center retrospective observational study conducted at the Rijeka Clinical Hospital Centre. A total of 106 patients with inadequately controlled type 2 diabetes (HbA1c ≥ 7%) on different oral or basal insulin supported oral therapy were enrolled in the study, and data from electronic medical records were retrospectively collected and analyzed from May 2021 to November 2022. All subjects were GLP-1 RA-naive and consequently prescribed 0.5 or 1.0 mg of once weekly injectable semaglutide (IS) or 7 mg or 14 mg of once daily oral semaglutide (OS) for at least 6 months. Glycated hemoglobin (HbA1c), body weight, and body mass index (BMI) were assessed prior to semaglutide administration and after a 6-month follow-up period. The primary endpoint was the change from baseline in HbA1c, and secondary endpoints were the change in body weight and the proportion of participants with a reduction in body weight of ≥5% and ≥10%, respectively, 6 months after the initiation of semaglutide treatment. Results: At the 6-month follow-up, no significant difference was observed between the two formulations in terms of HbA1c reduction (IS −1.1% vs. OS −1.4%, p = 0.126) and weight loss (IS −6.50 kg vs. OS −5.90 kg, p = 0.714). Exactly the same proportion of participants in both groups achieved a weight loss of ≥5% (56.7%, n = 30). A weight loss ≥ 10% was observed in 20.7% (n = 11) of participants administered IS and 15.1% (n = 8) of participants administered OS, respectively (p = 0.454). Conclusion: In a real-world setting, oral semaglutide as an add-on therapy to ongoing antihyperglycemic treatment in patients with inadequately controlled type 2 diabetes who had not previously received GLP-1 RA demonstrated a similar effectiveness as injectable semaglutide in terms of glycemic control and weight loss after 6 months of treatment.
Citation: Diabetology
PubDate: 2024-02-02
DOI: 10.3390/diabetology5010005
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 69-84: Melanocortins and Their Potential for
the Treatment, Prevention and Amelioration of Complications of Diabetes
Authors: Gardner N. Robinson, Raelene J. Pickering
First page: 69
Abstract: Diabetes mellitus (type I and II) is an advancing global health problem, concerningly increasing in prevalence in most of the developed and developing world. Current therapies, such as the subcutaneous injection of insulin, are invasive and require a close monitoring of blood glucose levels to prevent hypo- or hyperglycaemia from occurring. Despite an inexorable search for a cure since Banting and Best discovered and purified insulin in 1921, insulin remains a solitary insula, still the gold standard for treatment of type I and late-stage type II diabetes mellitus. Apropos of complications, diabetes causes a myriad of secondary maladies, ranging from diabetic kidney disease, diabetic retinopathy and diabetic neuropathy to erectile dysfunction and peripheral vascular disease. While scientists continue to interminably tinker with perfecting mechanical insulin pumps or dampening the immune response to pancreatic beta cells, an important aspect of the aetiology of diabetes should not be neglected, that of the metabolism. At its heart, diabetes can arguably be considered a metabolic disease, and this review suggests a return to focusing on preventing and treating diabetes by focussing on its metabolic causes. This narrative review summarises the potential of a recent class of synthetic peptides, the melanocortins, to help prevent and treat the complications of diabetes mellitus. The review summarises recent work showing the potential benefits of the melanocortins in treating diabetic complications through various pathways.
Citation: Diabetology
PubDate: 2024-02-04
DOI: 10.3390/diabetology5010006
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 85-95: Evaluating the Use of Web-Based
Technologies for Self-Management among Arabic-Speaking Immigrants Living
with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Saudi Arabia
Authors: Anwar Althubyani, Clarice Tang, Jency Thomas, Sabrina Gupta
First page: 85
Abstract: This study aimed to investigate the use of and willingness to adopt web-based technology for self-management of type 2 diabetes among Arabic-speaking immigrants in Saudi Arabia. Conducted in Taif in 2022, it involved participants with type 2 diabetes mellitus, utilizing a study-specific questionnaire to gather data on demographics, disease specifics, and attitudes towards using this technology for diabetes management. Out of the 109 individuals who responded, 91 completed the survey and reported accessing web-based technology and an average usage of two hours per day. The primary use was for social media (90.1%) and information searching (73.6%). The study found a high willingness to use web-based technology for dietary planning (85.7%), physical activity monitoring (94.5%), and communication with healthcare providers (93.41%). Notably, younger participants, those with higher education, and married individuals showed more inclination towards using such technology, as indicated by significant correlations (p < 0.001, CI = 0.03–0.38; p < 0.039, CI = 1.06–10.26; p = 0.024, CI = 1.23–19.74). Over half of the participants (56%) considered web-based technology beneficial for diabetes management, with many finding it time-saving (61.5%). In conclusion, a significant proportion of participants demonstrated a strong preference for integrating web-based technology into their diabetes self-management routines. This preference was particularly evident in key areas such as diet, physical activity, and glucose monitoring. These findings underscore the potential of web-based technologies in supporting effective diabetes management among Arabic-speaking immigrants, highlighting the need for targeted interventions that leverage these digital tools.
Citation: Diabetology
PubDate: 2024-02-28
DOI: 10.3390/diabetology5010007
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 96-109: Utilizing the Glucose and Insulin
Response Shape of an Oral Glucose Tolerance Test to Predict Dysglycemia in
Children with Overweight and Obesity, Ages 8–18 Years
Authors: Timothy J. Renier, Htun Ja Mai, Zheshi Zheng, Mary Ellen Vajravelu, Emily Hirschfeld, Diane Gilbert-Diamond, Joyce M. Lee, Jennifer L. Meijer
First page: 96
Abstract: Common dysglycemia measurements including fasting plasma glucose (FPG), oral glucose tolerance test (OGTT)-derived 2 h plasma glucose, and hemoglobin A1c (HbA1c) have limitations for children. Dynamic OGTT glucose and insulin responses may better reflect underlying physiology. This analysis assessed glucose and insulin curve shapes utilizing classifications—biphasic, monophasic, or monotonically increasing—and functional principal components (FPCs) to predict future dysglycemia. The prospective cohort included 671 participants with no previous diabetes diagnosis (BMI percentile ≥ 85th, 8–18 years old); 193 returned for follow-up (median 14.5 months). Blood was collected every 30 min during the 2 h OGTT. Functional data analysis was performed on curves summarizing glucose and insulin responses. FPCs described variation in curve height (FPC1), time of peak (FPC2), and oscillation (FPC3). At baseline, both glucose and insulin FPC1 were significantly correlated with BMI percentile (Spearman correlation r = 0.22 and 0.48), triglycerides (r = 0.30 and 0.39), and HbA1c (r = 0.25 and 0.17). In longitudinal logistic regression analyses, glucose and insulin FPCs predicted future dysglycemia (AUC = 0.80) better than shape classifications (AUC = 0.69), HbA1c (AUC = 0.72), or FPG (AUC = 0.50). Further research should evaluate the utility of FPCs to predict metabolic diseases.
Citation: Diabetology
PubDate: 2024-03-01
DOI: 10.3390/diabetology5010008
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 110-128: Food as Medicine: FOODRx for Patients
with Diabetes and Cardiovascular Disease in Central Minnesota—A
PILOT STUDY
Authors: Mónica García-Pérez, Alexandra De Kesel Lofthus, David Tilstra, Kevin Switzer, Kristen Williamson
First page: 110
Abstract: The number of food-insecure individuals with diabetes is on the rise. FOODRx is a supplemental healthy food intervention program that gave disease-appropriate food boxes to food-insecure patients with diabetes at their care clinic and included nutrition and recipe materials in the patient’s preferred language (English, Spanish, or Somali). Implemented over a twelve-month period, we analyze FOODRx participants’ pre and post clinical measures, health care usage, and program/clinic satisfaction, and found that participation was linked to post improvements in fasting glucose and HgbA1c levels, reductions in ER visits and healthcare costs, and a decline in patients choosing between medication and food. Glucose levels decreased from 214 to 187 mg/dL and HgbA1c levels decreased from 9.6% to 9.1%. Average ER visits dropped from 1.21 to 1 visit and the reductions in healthcare costs were reflected in a decrease of an average of USD 250,000 in insurance claims. Patients were less likely to experience food insecurity, as measured in number of meals skipped and levels of hunger. Finally, the program improved patient satisfaction with the cultural responsiveness of the information shared with them.
Citation: Diabetology
PubDate: 2024-03-08
DOI: 10.3390/diabetology5010009
Issue No: Vol. 5, No. 1 (2024)
- Diabetology, Vol. 5, Pages 129-140: Utility of Flash Glucose Monitoring to
Determine Glucose Variation Induced by Different Doughs in Persons with
Type 2 Diabetes
Authors: Maria Antonietta Taras, Sara Cherchi, Ilaria Campesi, Valentina Margarita, Gavino Carboni, Paola Rappelli, Giancarlo Tonolo
First page: 129
Abstract: (1) Background: It has been previously shown that sourdough bread, compared to commercial yeast bread, elicits a lower postprandial glycemic and insulinemic response in patients with impaired glucose tolerance (IGT). Aims: Our aim was to evaluate the following aspects in persons with type 2 diabetes (T2DM): (1) glucose variations induced by three different doughs: X = bread prepared with functional alkaline biocrystal water, Y = sourdough-leavened bread, and W = bakery yeast bread; (2) the utility of flash glucose monitoring (FGM) to measure GL. (2) Methods: Twelve T2DM following diets (six males, diabetes duration 10.9 ± 1.3 years with no complications, Hba1c < 7.0%), after 12 h of fasting, consumed 180 g of the study breads leavened/matured for 48 (X), 8 (Y), and 4 h (W) at room temperature with 200 mL of water, in a random order, in single-blind conditions, on three different days. All patients had FGM running for the entire period of the experiments. Insulin was determined by capillary blood obtained for the basal and peak glucose concentrations. (3) Results: The peak glucose and peak insulin concentrations were significantly (p < 0.05) higher for W versus both X and Y, without significant differences between X and Y. The area under the curve of glucose variations for over 240 min was significantly higher in W than X (p < 0.01) and Y (p < 0.05), without significant differences between X and Y. (4) Conclusions: (1) Bread prepared with biocrystal water has the same lower GL of sourdough bread compared to bakery yeast bread, and it is easier to manage its leavening/maturation period; (2) FGM is a reliable method for determining rapid glucose changes in response to a carbohydrate meal in persons with type 2 diabetes.
Citation: Diabetology
PubDate: 2024-03-12
DOI: 10.3390/diabetology5010010
Issue No: Vol. 5, No. 1 (2024)
