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Diabetology, Volume 3, Issue 1 (March 2022) – 16 articles

Cover Story (view full-size image): Non-invasive glucose monitoring techniques have the potential to greatly improve the self-management of diabetes. A range of optical spectroscopy technologies have been proposed for glucose sensing. Some of the most promising techniques are infrared spectroscopy, which measures the optical absorption of near infrared or mid infrared radiation by glucose; Raman spectroscopy, which uses inelastic scattering; and optical coherence tomography, an optical interferometry technique. Optical measurements can be affected by spectra from other molecules, high noise levels, and limited penetration depth. Research continues to overcome these challenges and achieve a non-invasive optical sensor with accuracy comparable to that of current invasive glucose sensing devices. View this paper
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8 pages, 232 KiB  
Article
Early Pregnancy Serum Concentration of Secreted Frizzled-Related Protein 4, Secreted Frizzled-Related Protein 5, and Chemerin in Obese Women Who Develop Gestational Diabetes Mellitus
by Rik H. J. Beernink, Joost H. N. Schuitemaker, Marijke M. Faas, Lucilla Poston and Sara L. White
Diabetology 2022, 3(1), 258-265; https://doi.org/10.3390/diabetology3010016 - 16 Mar 2022
Viewed by 2651
Abstract
Background: The aim of this study was to evaluate whether secreted frizzled-related protein 4 (sFRP4), secreted frizzled-related protein 5 (sFRP5), and chemerin serum concentrations in early pregnancy are associated with the development of gestational diabetes mellitus (GDM) in an obese cohort. In previous [...] Read more.
Background: The aim of this study was to evaluate whether secreted frizzled-related protein 4 (sFRP4), secreted frizzled-related protein 5 (sFRP5), and chemerin serum concentrations in early pregnancy are associated with the development of gestational diabetes mellitus (GDM) in an obese cohort. In previous studies, increased sFRP4 and chemerin, and decreased sFRP5 concentrations were associated with the development of GDM in normal and overweight women. Methods: In this exploratory case control study, sFRP4, sFRP5, and chemerin serum concentrations were determined by ELISA in 50 obese women who developed GDM and 100 uncomplicated control pregnancies. Serum samples were obtained between 15+0–18+6 weeks’ gestational age and based on a priori known associations with the development of GDM, body mass index (BMI) and maternal age were selected for adjustment in multivariate analyses. Results: In this obese cohort (median BMI 35.7 kg/m2, IQR 33.2–40.3 kg/m2), the biochemical markers showed no association with GDM: sFRP5 odds ratio (OR) 0.44 (95% confidence interval (CI) 0.01–23.18, p = 0.687), sFRP4 OR 0.55 (95% CI 0.09–3.52, p = 0.528), and chemerin OR 3.47 (95% CI 0.05–227.72, p = 0.560). Adjustment for BMI and maternal age did not influence the association. None of the markers were significantly correlated with insulin resistance (HOMA2-IR). Conclusion: No association was found between sFRP4, sFRP5, or chemerin concentration and the development of GDM in a cohort of obese pregnant women. The absence of the association may indicate that these proteins play a lesser biological role in the pathophysiology of GDM in obese women. Full article
(This article belongs to the Special Issue Novel Diagnosis and Therapeutic Strategies for Gestational Diabetes)
12 pages, 234 KiB  
Article
The Diabetes Team Dynamics Unraveled: A Qualitative Study
by Eefje Van Nuland, Irina Dumitrescu, Kristien Scheepmans, Louis Paquay, Ellen De Wandeler and Kristel De Vliegher
Diabetology 2022, 3(1), 246-257; https://doi.org/10.3390/diabetology3010015 - 10 Mar 2022
Cited by 3 | Viewed by 3189
Abstract
Background: Diabetes is a complex disease requiring a multidisciplinary approach. However, the dynamics of this collaboration and the involvement of healthcare providers remain unclear. Aim(s): To explore the composition, the division of roles/tasks, and the collaboration in a diabetes team. Methods: A qualitative, [...] Read more.
Background: Diabetes is a complex disease requiring a multidisciplinary approach. However, the dynamics of this collaboration and the involvement of healthcare providers remain unclear. Aim(s): To explore the composition, the division of roles/tasks, and the collaboration in a diabetes team. Methods: A qualitative, explorative study with six focus groups was conducted, of which four focus groups were with healthcare providers (n = 34) and two with informal caregivers and persons with diabetes (n = 13). In addition, two in-depth interviews with doctors were performed. An iterative process of data analysis took place, guided by the Qualitative Analysis Guide of Leuven (QUAGOL). Results: All participants confirm the importance of patient empowerment and the fact that the person with diabetes should have a central role within the team. However, this has not been achieved yet. This research gives a clear insight into the dynamics of a diabetes team. Roles and tasks are allocated according to the specific expertise and knowledge of the different healthcare providers. Interprofessional collaboration is the ultimate goal. However, the diabetes team is often formed ad hoc depending on the needs of the person with diabetes and the preferences for collaboration of the healthcare providers. Furthermore, this study revealed some important bottlenecks with regard to the knowledge of healthcare providers, persons with diabetes and their informal caregivers, the regulation and reimbursement. Discussion: Our study uncovers the dynamics of a diabetes team and its members. Healthcare providers work mainly alone, except in hospitals, where they can consult other healthcare providers briefly if necessary. Although collaboration proves to be difficult, all healthcare providers ask for a more intensive interprofessional collaboration. Conclusion: In order to improve quality of diabetes care, patient-centered care and the satisfaction of patients, informal caregivers, and healthcare providers, efforts have to be made to facilitate interprofessional collaboration. This can be achieved by sharing information via electronic shared patient records, coordination, overview, local task agreements, simplified legal regulations, and an adjusted financing system. Full article
10 pages, 777 KiB  
Commentary
Availability and Affordability of Medicines for Diabetes and Cardiovascular Disease across Countries: Information Learned from the Prospective Urban Rural Epidemiological Study
by Tu Ngoc Nguyen, Salim Yusuf and Clara Kayei Chow
Diabetology 2022, 3(1), 236-245; https://doi.org/10.3390/diabetology3010014 - 10 Mar 2022
Cited by 1 | Viewed by 3778
Abstract
The global burden of diabetes and cardiovascular disease (CVD) is increasing and, while cardiovascular event incidence is falling in some high-income countries (HICs), increasing rates are being observed in many middle-income countries (MICs) and low-income countries (LICs). There have been discrepancies in the [...] Read more.
The global burden of diabetes and cardiovascular disease (CVD) is increasing and, while cardiovascular event incidence is falling in some high-income countries (HICs), increasing rates are being observed in many middle-income countries (MICs) and low-income countries (LICs). There have been discrepancies in the availability and affordability of medicines for diabetes and cardiovascular disease among countries, of which LICs and MICs have seen low availability and affordability. The Prospective Urban Rural Epidemiological (PURE) study is a large prospective cohort study of over 200,000 people aged 35–70 years from 27 HICs, MICs, and LICs across six geographical regions (Asia, Africa, Europe, South America, North America, and the Middle East). Analyses from this study have contributed greatly to the understanding of the determinants of cardio–metabolic health in LICs and MICs especially. Here, we discuss information learned from the PURE study regarding the availability and affordability of key medicines for diabetes and cardiovascular disease. Full article
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43 pages, 7040 KiB  
Perspective
Deciphering the Neurosensory Olfactory Pathway and Associated Neo-Immunometabolic Vulnerabilities Implicated in COVID-Associated Mucormycosis (CAM) and COVID-19 in a Diabetes Backdrop—A Novel Perspective
by Maryada Sharma, Hari Pankaj Vanam, Naresh K. Panda, Sourabha K. Patro, Rhythm Arora, Sanjay K. Bhadada, Shivaprakash M. Rudramurthy, Mini P. Singh and Purushotham Reddy Koppula
Diabetology 2022, 3(1), 193-235; https://doi.org/10.3390/diabetology3010013 - 4 Mar 2022
Cited by 5 | Viewed by 6083
Abstract
Recent Mucorales-mediated outbreaks of infections and an association of fungal infection with COVID-19 cases, as observed for COVID-19-associated mucormycosis (CAM), have posed new challenges for the management of patients in critical care units. Diabetes and hyperglycemia are integrally linked to the severity of [...] Read more.
Recent Mucorales-mediated outbreaks of infections and an association of fungal infection with COVID-19 cases, as observed for COVID-19-associated mucormycosis (CAM), have posed new challenges for the management of patients in critical care units. Diabetes and hyperglycemia are integrally linked to the severity of COVID-19, and uncontrolled diabetes mellitus and COVID-19 have recently been (independently or in combination) associated with the emergence of aggressive mucormycosis due to attendant defects in innate immune recognition pathways. Therefore, the identification of novel global cellular stressors upregulated during diabetes to understand the contribution of diabetes-associated metabolic vulnerabilities can help build a Metabolic-Stress-Associated Interactome (MSAI). This interactome can help reshape the metabolic inflammation (meta-inflammation) underlying the clinical manifestations of COVID-19 to facilitate the rational design of effective therapies for COVID-19 and CAM. Accordingly, an important area of research in COVID-19 therapeutics is engaged with identifying diabetes-associated pan-cellular stressors to understand their role in immune deregulation during COVID-19 and CAM, including investigating the distant trans-neuro-vascular–endocrine axis’s role in coordinating cellular-stress recognition, transmission, compensation, and decompensation during inter-organ regulation of metabolic homeostasis in diabetes. We reviewed clinico-pathological and laboratory data to propose potential diabetes-linked novel neo-vulnerabilities that can reshape the olfactory mucosal immune landscape during airway infections such as COVID-19 and CAM. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2021)
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17 pages, 266 KiB  
Article
Provider–Patient Interactions as Predictors of Lifestyle Behaviors Related to the Prevention and Management of Diabetes
by Brenda Robles and Tony Kuo
Diabetology 2022, 3(1), 176-192; https://doi.org/10.3390/diabetology3010012 - 1 Mar 2022
Cited by 4 | Viewed by 2953
Abstract
Growing evidence suggests that healthcare provider advice may reduce alcohol use, increase physical activity, and improve the adoption of other desirable lifestyle behaviors among patients. However, how brief interventions and other provider–patient interactions can shape the cumulative adoption of multiple modifiable behaviors is [...] Read more.
Growing evidence suggests that healthcare provider advice may reduce alcohol use, increase physical activity, and improve the adoption of other desirable lifestyle behaviors among patients. However, how brief interventions and other provider–patient interactions can shape the cumulative adoption of multiple modifiable behaviors is less well studied for diabetes prevention and control. Using weighted Internet panel survey data from a large socio-demographically diverse urban population in the United States (n = 1003), the present study describes differences in group characteristics among those who ‘had been ever diagnosed’ with prediabetes/diabetes versus those who had not. It also examines the associations between the cumulative adoption of lifestyle behaviors and each of the following: (a) lifetime prediabetes/diabetes diagnosis; (b) brief lifestyle intervention exposure (i.e., ever received provider encouragement to modify lifestyle behaviors); and (c) recent provider–patient communication about diabetes. There were several group differences among those who ‘had been ever diagnosed’ with prediabetes/diabetes versus those who had not, by age, employment status, health status, nutrition knowledge, blood pressure/hypertension diagnosis, and diabetes-related health behaviors (p < 0.05). Each of the three provider–patient interactions of interest were positively associated with a higher cumulative sum of adopted modifiable lifestyle behaviors for diabetes prevention and management. The results suggest that provider advice/provider–patient interactions of any type can have a salutary impact on whether individuals with prediabetes or type 2 diabetes will engage in recommended lifestyle behavior modifications. Full article
17 pages, 3263 KiB  
Article
Diabetic Retinopathy: An Overview on Mechanisms, Pathophysiology and Pharmacotherapy
by Prawej Ansari, Noushin Tabasumma, Nayla Nuren Snigdha, Nawfal Hasan Siam, Rachana V. N. R. S. Panduru, Shofiul Azam, J. M. A. Hannan and Yasser H. A. Abdel-Wahab
Diabetology 2022, 3(1), 159-175; https://doi.org/10.3390/diabetology3010011 - 15 Feb 2022
Cited by 38 | Viewed by 18547
Abstract
Diabetes mellitus is one of the most frequently occurring metabolic disorders (DMs), impairing healthy life around the globe, with mild-to-severe secondary complications. DM is associated with secondary complications, including diabetic retinopathy (DR), which damages the retina and can lead to vision loss. Diabetic [...] Read more.
Diabetes mellitus is one of the most frequently occurring metabolic disorders (DMs), impairing healthy life around the globe, with mild-to-severe secondary complications. DM is associated with secondary complications, including diabetic retinopathy (DR), which damages the retina and can lead to vision loss. Diabetic patients often suffer from extreme retinal capillary aneurysms, hemorrhage, and edema, which is likely to lead to non-proliferative or proliferative diabetic retinopathy (NPDR or PDR) and diabetic macular edema (DME). Several epidemiological studies have illustrated that the occurrence of DR can vary by age of diabetes onset, diabetes type, and ethnicity. Although DR is very well-known, the complexity of its etiology and diagnosis makes therapeutic intervention difficult and challenging. We have reviewed different pathological aspects of diabetic retinopathy and its underlying mechanism of occurrence. In this review, we aim to provide an in-depth understanding and illustration of the progression of diabetic retinopathy, its pathophysiology, epidemiology, and prospective therapeutic targets. Full article
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42 pages, 15923 KiB  
Review
Insulin Past, Present, and Future: 100 Years from Leonard Thompson
by Stuart J. Brink
Diabetology 2022, 3(1), 117-158; https://doi.org/10.3390/diabetology3010010 - 9 Feb 2022
Cited by 5 | Viewed by 8026
Abstract
Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus pathophysiology, childhood diabetes or what we now call type 1 or autoimmune diabetes mellitus was almost universally fatal. In limited-resource countries (LRC) around the world, this remains sadly [...] Read more.
Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus pathophysiology, childhood diabetes or what we now call type 1 or autoimmune diabetes mellitus was almost universally fatal. In limited-resource countries (LRC) around the world, this remains sadly true because of the expense and unavailability of medical care, medical information, and/or medications. In 1889, Minkowski and Mering identified the pancreas as the likely source of the problem in pancreatectomized dog experiments, and Langerhans, working with Virchow, identified the islands of pancreatic tissue now named after Langerhans as the likely source of the problem. Prior to that, Cawley, Boucherdat, Zuelzer, Gley, de Meyer, Schafer, Scott, Kleiner, and Paulescu all worked on this problem with varying results until Banting, Best, MacLeod, and Collip in Toronto in 1921 successfully treated pancreatectomized dogs with an alcohol-based pancreatic extract and then were the first to do the same with children and adults with diabetes, starting with Leonard Thompson in early 1922. Urinary and blood glucose levels were reduced, and clinical symptoms decreased concurrently. The magnificent medical historical work by Professor Michael Bliss, also from Toronto, as well as an excellent US NPR Television documentary, describes the trials and tribulations of this event that culminated in the “fastest Nobel Prize” awarded. Progressive biopharmaceutical advances have modified insulin from pigs and cows and then genetically engineered insulin to work much faster and also much slower to provide more modernized ways of providing insulin. Insulin pens then replaced vial and syringe administration, and then insulin pumps coupled with continuous blood glucose sensors have made delivery more physiologic in addition to more attention paid to nutrition advice, education, and psychosocial support around the world. Programs to assist delivery of expensive insulin to LRC administered by Insulin for Life, Life for a Child (LFAC), Changing Diabetes in Children (CDIC) coupled with support by ISPAD (International Society for Pediatric and Adolescent Diabetes) have continued to make such advances available thorough wonderful philanthropy in insulin manufacturers and manufacturers of blood glucose monitoring equipment and insulin pump/sensor suppliers. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2021)
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9 pages, 623 KiB  
Article
Examine the Association between Metabolic Syndrome and Frailty in an Older Asian Population
by Hiep Huu Hoang Dao, Anh Trung Nguyen, Huyen Thi Thanh Vu and Tu Ngoc Nguyen
Diabetology 2022, 3(1), 108-116; https://doi.org/10.3390/diabetology3010009 - 8 Feb 2022
Cited by 2 | Viewed by 2972
Abstract
Background: There has been evidence that metabolic syndrome (MetS) may increase the risk of frailty. However, there is limited evidence on this association in Asian populations. Aims: This study aims to identify the association between MetS and frailty in older people in Vietnam. [...] Read more.
Background: There has been evidence that metabolic syndrome (MetS) may increase the risk of frailty. However, there is limited evidence on this association in Asian populations. Aims: This study aims to identify the association between MetS and frailty in older people in Vietnam. Methods: This is a cross-sectional analysis of a dataset that was obtained from an observational study on frailty and sarcopenia in patients aged ≥60 at a geriatric hospital in Vietnam. Frailty was defined by the frailty phenotype. The participants were defined as having MetS if they had ≥3 out of 5 criteria from the definition of the National Cholesterol Education Program (NCEP) Adults Treatment Panel (ATP) III. Multiple logistic regression models were performed to estimate the risk of having frailty in patients with MetS. Results: Of the 669 participants (mean age 71, 60.2% female), 62.3% had MetS and 39.0% were frail. The prevalence of frailty was 42.2% in participants with MetS and 33.7% in participants without MetS (p = 0.029). On the logistic regression models, MetS was associated with an increased likelihood of being frail (adjusted OR 1.52, 95%CI 1.01–2.28), allowing for age, sex, education, nutritional status, history of hospitalization, and chronic diseases. Conclusion: There was a significant association between MetS and frailty in this population. Further longitudinal studies are required to confirm this association. Full article
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11 pages, 279 KiB  
Review
Cutaneous Reactions to Antidiabetic Agents: A Narrative Review
by Aleia Boccardi and Jay H. Shubrook
Diabetology 2022, 3(1), 97-107; https://doi.org/10.3390/diabetology3010008 - 7 Feb 2022
Cited by 5 | Viewed by 14546
Abstract
Diabetes is a common and complex disease affecting multiple organ systems throughout the body. With a consensus in care guidelines emphasizing the importance of glycemic control in determining the disease progression, people with diabetes worldwide have been placed on medication regimens targeting glucose [...] Read more.
Diabetes is a common and complex disease affecting multiple organ systems throughout the body. With a consensus in care guidelines emphasizing the importance of glycemic control in determining the disease progression, people with diabetes worldwide have been placed on medication regimens targeting glucose stability from a variety of pathophysiologic pathways. Each of these medications also possesses its own potential for adverse events. In recent years, there has been increased reports of skin reactions to diabetes medications, adding to the more widely known eruptions such as insulin-induced lipohypertrophy and contact dermatitis of subcutaneous injections. The authors searched PubMed, Google, and Embase for articles including adverse reactions to anti-hyperglycemic medications. Key words and titles searched included, “antidiabetic drugs”, “skin reactions”, “adverse drug reactions”, “allergic reactions”, “diabetes”, “metformin”, “insulin”, “DPP4 inhibitors”, “thiazolindineones”, “sulfonylureas”, “SGLT2 inhibitors”, “GLP-1 agonists”, “diabetic medication”, “injection site reactions”. As a result, a total of 59 papers are included in this review. The great majority were case reports ranging from benign fixed drug eruptions to severe cutaneous reactions that threaten patients’ lives. Increasing physician awareness of both the potential for, and presentation of, such reactions to diabetes medications can reduce hospitalizations and optimize care in an already vulnerable patient population. Full article
18 pages, 1470 KiB  
Review
Novel Insights into the Immunotherapy-Based Treatment Strategy for Autoimmune Type 1 Diabetes
by Sanjay Rathod
Diabetology 2022, 3(1), 79-96; https://doi.org/10.3390/diabetology3010007 - 7 Feb 2022
Cited by 14 | Viewed by 11263
Abstract
Type 1 diabetes (T1D) is an autoimmune disease characterized by the destruction of insulin-producing pancreatic β-cells by their own immune system, resulting in lifelong insulin deficiency. Continuous exogenous insulin replacement therapy is the current standard of care for T1D. Transplantation of primary pancreatic [...] Read more.
Type 1 diabetes (T1D) is an autoimmune disease characterized by the destruction of insulin-producing pancreatic β-cells by their own immune system, resulting in lifelong insulin deficiency. Continuous exogenous insulin replacement therapy is the current standard of care for T1D. Transplantation of primary pancreatic islets or the entire pancreas is a viable remedy for managing patients with autoimmune T1D. However, this strategy is not feasible due to several obstacles, including a scarcity of donors, islet cells, and poor vascular engraftment of islets post-transplantation, as well as the need for prolonged immune suppression. Innovative approaches must be developed to counteract pancreatic β-cell destruction and salvage endogenic insulin production, thereby regulating blood glucose levels. This review includes an overview of autoimmune T1D, immune cells involved in T1D pathophysiology, and immunotherapy-based strategies to treat and prevent autoimmune T1D. Recent immunotherapy progress toward targeting pancreatic islet-specific immune pathways tangled tolerance has fueled the advancement of therapies that may allow for the prevention or reversal of this autoimmune T1D while avoiding other adverse reactions associated with the previous attempt, which was mostly immunosuppressive. As a result, significant efforts are currently underway to improve the efficacy of immunotherapy-based approaches by leveraging the beneficial actions of immune cells, specifically effector CD4+, CD8+, and regulatory T cells. This review will provide an overview of currently available immune-based therapeutic options for T1D and will examine the growing evidence that supports the use of immune cell-based approaches to improve therapeutic outcomes in the prevention or reversal of autoimmune T1D. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2021)
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7 pages, 232 KiB  
Review
Diet and Management of Type II Diabetes Mellitus in the United Kingdom: A Narrative Review
by Sheeraz A. Rajput, Suhel Ashraff and Muhammad Siddiqui
Diabetology 2022, 3(1), 72-78; https://doi.org/10.3390/diabetology3010006 - 7 Feb 2022
Cited by 10 | Viewed by 12620
Abstract
Diabetes is a major public health problem and is emerging as a pandemic. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories burned up. Physical activity is one of the mainstay clinical interventions for preventing metabolic [...] Read more.
Diabetes is a major public health problem and is emerging as a pandemic. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories burned up. Physical activity is one of the mainstay clinical interventions for preventing metabolic diseases, and dietary habits are the primary factor for the rapidly rising incidence of DM. Reducing weight and maintaining a healthy weight, reducing energy intake, and food intake high in vegetables, fruit, whole grains, legumes, nuts, and dairy products are core parts of management. We performed a narrative literature review, manual-search of reference lists of included articles, and relevant reviews. The main purpose of this review was to discuss the role of psychosocial factors and diet in the control of type II Diabetes. Full article
16 pages, 1527 KiB  
Review
Recent Progress and Perspectives on Non-Invasive Glucose Sensors
by Nicholas B. Davison, Christopher J. Gaffney, Jemma G. Kerns and Qiandong D. Zhuang
Diabetology 2022, 3(1), 56-71; https://doi.org/10.3390/diabetology3010005 - 12 Jan 2022
Cited by 15 | Viewed by 8933
Abstract
Self-monitoring of blood glucose forms an important part of the management of diabetes and the prevention of hyperglycaemia and hypoglycaemia. Current glucose monitoring methods either use needle-prick enzymatic glucose-meters or subcutaneous continuous glucose sensors (CGM) and thus, non-invasive glucose measurements could greatly improve [...] Read more.
Self-monitoring of blood glucose forms an important part of the management of diabetes and the prevention of hyperglycaemia and hypoglycaemia. Current glucose monitoring methods either use needle-prick enzymatic glucose-meters or subcutaneous continuous glucose sensors (CGM) and thus, non-invasive glucose measurements could greatly improve the self-management of diabetes. A wide range of non-invasive sensing techniques have been reported, though achieving a level of precision comparable to invasive meters remains a challenge. Optical sensors, which utilise the interactions between glucose and light, offer the potential for non-invasive continuous sensing, allowing real-time monitoring of glucose levels, and a range of different optical sensing technologies have been proposed. These are primarily based upon optical absorption and scattering effects and include infrared spectroscopy, Raman spectroscopy and optical coherence tomography (OCT), with other optical techniques such as photoacoustic spectroscopy (PAS) and polarimetry also reported. This review aims to discuss the current progress behind the most reported optical glucose sensing methods, theory and current limitations of optical sensing methods and the future technology development required to achieve an accurate optical-based glucose monitoring device. Full article
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10 pages, 1510 KiB  
Article
Evaluation of Tribulus terrestris Extracts Relative to Metformin on Oxidative Stress and Histopathology of the Liver for Diabetic Male Rats
by Rasha A. Al-Eisa, Hend M. Tag, Mohamed Salah ElNaggar, Heba M. A. Abdelrazek and Nahla S. El-Shenawy
Diabetology 2022, 3(1), 46-55; https://doi.org/10.3390/diabetology3010004 - 12 Jan 2022
Cited by 3 | Viewed by 3467
Abstract
Insulin-dependent diabetes mellitus (IDDM) is a metabolic condition that induces blood glucose levels to rise due to insulin deficiency and the formation of reactive oxygen species (ROS). The purpose of this study is to assess how efficient the antioxidant extracts Tribulus terrestris (TT) [...] Read more.
Insulin-dependent diabetes mellitus (IDDM) is a metabolic condition that induces blood glucose levels to rise due to insulin deficiency and the formation of reactive oxygen species (ROS). The purpose of this study is to assess how efficient the antioxidant extracts Tribulus terrestris (TT) and metformin (MET) are in reducing oxidative stress and histopathology produced by streptozotocin in rat hepatocytes. The 36 male rats weighing 170–190 g of this study were randomly sorted into 6 groups. The first group was considered a normal control group, and the second and third groups were normal and remedy with MET and TT extract, respectively. The fourth group was positive diabetic, and the fifth and sixth groups were diabetic rats that were treated with MET and TT extract, respectively. Lipid peroxidation (LPO), catalase (CAT), glutathione-S-transferase (GST), and glutathione (GSH) were detected, and the histopathology of the liver was evaluated after 8 weeks of treatment. Compared to regulation, morphological changes in the liver were found in diabetic animals, with a rise in LPO and a change in GSH levels as well as CAT and GST activities. The oxidative stress and histological architecture of the hepatocytes caused by hyperglycemia were improved as a result of therapy in the rats with MET and TT extract. Because of its antioxidant activities, diabetic rats with TT extract are more effective than MET in normoglycemia and hepatocyte reconditioning. Beneficial intervention tends to benefit primarily from direct ROS scavenging and CAT, GST, and GSH regeneration. Full article
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16 pages, 901 KiB  
Review
Type 2 Diabetes and Impaired Physical Function: A Growing Problem
by Ehtasham Ahmad, Jack A. Sargeant, Tom Yates, David R. Webb and Melanie J. Davies
Diabetology 2022, 3(1), 30-45; https://doi.org/10.3390/diabetology3010003 - 11 Jan 2022
Cited by 20 | Viewed by 9903
Abstract
The focus in diabetes care has traditionally been around the optimisation of the glycaemic control and prevention of complications. However, the prevention of frailty and improvement in physical function have now emerged as new targets of diabetes management. This is mainly driven by [...] Read more.
The focus in diabetes care has traditionally been around the optimisation of the glycaemic control and prevention of complications. However, the prevention of frailty and improvement in physical function have now emerged as new targets of diabetes management. This is mainly driven by the significant adverse impact that early onset frailty and decline in physical function have on health outcomes, functional independence, and quality of life in people with type 2 diabetes (T2D). There is an increasing emphasis in the expert consensus and management algorithms to improve physical function in people with T2D, predominantly through lifestyle interventions, including exercise and the control of modifiable risk factors. Trials of novel glucose-lowering therapies (GLTs) also now regularly assess the impact of these novel agents on measures of physical function within their secondary outcomes to understand the impact that these agents have on physical function. However, challenges remain as there is no consensus on the best method of assessing physical function in clinical practice, and the recognition of impaired physical function remains low. In this review, we present the burden of a reduced physical function in people with T2D, outline methods of assessment used in healthcare and research settings, and discuss strategies for improvement in physical function in people with T2D. Full article
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13 pages, 253 KiB  
Article
Experiences of Diabetes Self-Management: A Focus Group Study among the Middle-Aged Population of Rural Pakistan with Type 2 Diabetes
by Rashid M. Ansari, Mark F. Harris, Hassan Hosseinzadeh and Nicholas Zwar
Diabetology 2022, 3(1), 17-29; https://doi.org/10.3390/diabetology3010002 - 6 Jan 2022
Cited by 8 | Viewed by 5608
Abstract
Objectives: The middle-aged population from rural areas of Pakistan is disproportionately at risk of developing and mismanaging their diabetes. The purpose of this study was to explore the self-management experiences of two focus groups in the middle-aged population with type 2 diabetes mellitus [...] Read more.
Objectives: The middle-aged population from rural areas of Pakistan is disproportionately at risk of developing and mismanaging their diabetes. The purpose of this study was to explore the self-management experiences of two focus groups in the middle-aged population with type 2 diabetes mellitus living in rural Pakistan. Methods: The study design is based on the exploratory research using a qualitative approach. Purposive sampling was used to recruit patients with diabetes from the metabolic outpatient clinics of medical centers in rural areas of Pakistan. The data were collected for two focus groups consisting of 20 persons (10 men and 10 women) with type 2 diabetes mellitus, ranging in age from 40 to 65 years, who were receiving diabetic care at a local health facility. Focus group discussions with a sample size of 10 participants each were all recorded, transcribed, and analyzed. The data were evaluated thematically. Results: Participants described diabetes management as emotionally, physically, and socially taxing. The analysis of the data indicated three major themes: (1) diabetes as a challenging disease; (2) understanding diabetes and its challenges; (3) following diabetes self-management practices. Throughout the session, participants discussed the impact of diabetes on their daily life. This study provided new insights into the experiences of the middle-aged population of Pakistan regarding their self-management of diabetes. Conclusions: Healthcare professionals should become involved in diabetes self-management education as soon as feasible to alleviate patient worry and establish better patient-centered, culturally sensitive professional abilities. Along with monitoring patients’ self-management, healthcare professionals should place a greater emphasis on patients’ understanding of the disease and its challenges and associated complications. It is recommended to establish diabetes support groups to encourage patients to share their experiences of diabetes self-management. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2021)
16 pages, 10165 KiB  
Study Protocol
Implementation and Evaluation of a Mobile Retinal Image Acquisition System for Screening Diabetic Retinopathy: Study Protocol
by Sílvia Rêgo, Matilde Monteiro-Soares, Marco Dutra-Medeiros, Filipe Soares, Cláudia Camila Dias and Francisco Nunes
Diabetology 2022, 3(1), 1-16; https://doi.org/10.3390/diabetology3010001 - 4 Jan 2022
Cited by 7 | Viewed by 4288
Abstract
Screening diabetic retinopathy, a major cause of blindness, is time-consuming for ophthalmologists and has some constrains in achieving full coverage and attendance. The handheld fundus camera EyeFundusScope was recently developed to expand the scale of screening, drawing on images acquired in primary care [...] Read more.
Screening diabetic retinopathy, a major cause of blindness, is time-consuming for ophthalmologists and has some constrains in achieving full coverage and attendance. The handheld fundus camera EyeFundusScope was recently developed to expand the scale of screening, drawing on images acquired in primary care and telescreening made by ophthalmologists or a computer-aided diagnosis (CADx) system. This study aims to assess the diagnostic accuracy of the interpretation of images captured using EyeFundusScope and perform its technical evaluation, including image quality, functionality, usability, and acceptance in a real-world clinical setting. Physicians and nurses without training in ophthalmology will use EyeFundusScope to take pictures of the retinas of patients with diabetes and the images will be classified for the presence or absence of diabetic retinopathy and image quality by a panel of ophthalmologists. A subgroup of patients will also be examined with the reference standard tabletop fundus camera. Screening results provided by the CADx system on images taken with EyeFundusScope will be compared against the ophthalmologists’ analysis of images taken with the tabletop fundus camera. Diagnostic accuracy measures with 95% confidence intervals (CIs) will be calculated for positive and negative test results. Proportion of each category of image quality will be presented. Usability and acceptance results will be presented qualitatively. Full article
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