Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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13 pages, 1356 KiB  
Article
Patients’ Perspective on Barriers to Utilization of a Diabetic Retinopathy Screening Service
by Bismark Owusu-Afriyie, Theresa Gende, Martin Tapilas, Nicholas Zimbare and Jeffrey Kewande
Diabetology 2023, 4(3), 393-405; https://doi.org/10.3390/diabetology4030033 - 11 Sep 2023
Cited by 2 | Viewed by 1308
Abstract
This study was conducted to determine the barriers to the utilization of diabetic retinopathy (DR) screening in Papua New Guinea (PNG). A list of patients booked for DR screening at Madang Provincial Hospital Eye Clinic (MPHEC) between January 2017 and December 2021 who [...] Read more.
This study was conducted to determine the barriers to the utilization of diabetic retinopathy (DR) screening in Papua New Guinea (PNG). A list of patients booked for DR screening at Madang Provincial Hospital Eye Clinic (MPHEC) between January 2017 and December 2021 who had not been screened was retrieved, and the patients were invited to participate in the study. The data were collected using a structured questionnaire, and IBM Statistical Package for Social Sciences version 26 was used for the analysis. p < 0.05 was considered statistically significant. One hundred and twenty-nine patients (37.4%) did not attend DR screening for the period under study. The study response rate was 80.6%. The mean ± SD age of the respondents was 51.5 ± 10.9 years. The majority of the study respondents were female (62.5%), people living in rural settings (53.8%), and farmers (22.1%). Time constraints, poor knowledge about DR, and long waiting periods at the DR screening center were the main barriers to the uptake of DR screening. Compared to respondents in urban communities, those in rural settings were significantly concerned about cost (p < 0.001), travel distance to the MPHEC (p < 0.001), and poor information about DR screening (p = 0.002). More than half of the respondents (63.5%) had discontinued using pharmacotherapy for DM. There is a high rate of nonadherence to diabetes (DM) and DR treatment in PNG. There is a need for public health campaigns about DM and strategic DR screening at the community level in PNG and similar countries. Full article
(This article belongs to the Special Issue Feature Papers in Diabetology 2023)
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14 pages, 2311 KiB  
Review
Perfecting the Puzzle of Pathophysiology: Exploring Combination Therapy in the Treatment of Type 2 Diabetes
by Ridhi Gudoor, Austen Suits and Jay H. Shubrook
Diabetology 2023, 4(3), 379-392; https://doi.org/10.3390/diabetology4030032 - 07 Sep 2023
Cited by 1 | Viewed by 2007
Abstract
Type 2 diabetes mellitus (T2DM) is a debilitating, lifelong condition with a rising incidence. A wide variety of antihyperglycemic agents are available on the market to treat diabetes. However, the number of patients living with diabetes under suboptimal control remains relatively high. This [...] Read more.
Type 2 diabetes mellitus (T2DM) is a debilitating, lifelong condition with a rising incidence. A wide variety of antihyperglycemic agents are available on the market to treat diabetes. However, the number of patients living with diabetes under suboptimal control remains relatively high. This calls into question whether the application of the current treatment standards is effective and durable to truly manage the disease well. This paper aims to highlight the various classes of antihyperglycemic agents from a pathophysiologic perspective and explore the best possible combination that can have a durable effect on diabetes management. To determine this, an eight-piece pathophysiologic puzzle was created, each piece representing an organ system affected by the disease—liver, pancreas (alpha and beta cells), muscle, adipose tissue, gut, brain, and kidneys. Choosing a combination therapy that is both durable and can effectively address all eight pieces of the puzzle can theoretically create sustainable ameliorating effects. This combination can potentially lead to reduced microvascular and macrovascular complications, as well as work towards creating an ideal long-term, affordable diabetes care plan. Full article
(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)
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17 pages, 3121 KiB  
Article
3D-Printed Insoles for People with Type 2 Diabetes: An Italian, Ambulatory Case Report on the Innovative Care Model
by Marco Mancuso, Rocco Bulzomì, Marco Mannisi, Francesco Martelli and Claudia Giacomozzi
Diabetology 2023, 4(3), 339-355; https://doi.org/10.3390/diabetology4030029 - 17 Aug 2023
Cited by 1 | Viewed by 1785
Abstract
3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is [...] Read more.
3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is to deliver more effective solutions with respect to the consolidated processes to reduce compressive risk forces at specific plantar foot sites. Clinical studies are, however, still limited, at least in peer-review journals. Additionally, in Italy, the manufacturing process of these medical devices has not been formally integrated yet into the list of care processes approved for reimbursement by the public healthcare service. Within the Italian DIAPASON project (DIAbetic PAtients Safe ambulatiON), a feasibility pilot study has been conducted in the territory on 21 patients with diabetic foot complications to assess the pros and cons of an innovative process. The process, which relies on in-shoe pressure measurements and on a patented 3D modeling and printing procedure, includes the prescription, design, manufacturing and testing of 3D-printed personalized insoles. The process has been tested in an ambulatory setting and showed the potential to be also implemented in community settings. In this paper, we report a case study on a single volunteer, and we describe and comment on how the whole process has been proven safe and suitable for the purpose. Full article
(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)
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11 pages, 552 KiB  
Article
Diabetes Management in Danish Primary School: A Survey of Experiences of Parents of Children with Type 1 Diabetes
by Mia K. Iken, Nuri C. Mateu, Lise B. Johansen, Kasper A. Pilgaard, Annette K. Mouritsen, Anders J. Schou, Line S. Høst, Anne Ø. Nannsen, Kurt Kristensen, Stine Hangaard, Mette Madsen and Dan Grabowski
Diabetology 2023, 4(1), 108-118; https://doi.org/10.3390/diabetology4010012 - 02 Mar 2023
Cited by 2 | Viewed by 2277
Abstract
Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This [...] Read more.
Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This cross-sectional study surveyed parents of schoolchildren with type 1 diabetes aged 6 to 16 years in Denmark. The parents were identified among members of the Danish Diabetes Association and were invited to complete an online questionnaire. A total of 252 parents of schoolchildren with type 1 diabetes answered the questionnaire. Only 28% of the children had a designated staff member responsible for support in diabetes self-care during school hours. Having a designated staff member responsible for support in self-care was positively associated with parental experiences of better school–parent cooperation (p < 0.001), better experience of diabetes management in school (p < 0.001), and larger proportions of children and parents feeling comfortable in school (p = 0.022 and p = 0.049, respectively). School staff support was positively associated with better parental experience of diabetes management and with some parameters of mental health in schoolchildren with type 1 diabetes and their parents in Denmark. Full article
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12 pages, 419 KiB  
Review
The Lipids and Volume in Satiation and Satiety (LIVES) Hypothesis: A Proposed Alternative Model for the Pathogenesis of Obesity
by Andrew Warrilow, Kate Pumpa, Shawn Somerset and Nenad Naumovski
Diabetology 2023, 4(1), 64-75; https://doi.org/10.3390/diabetology4010008 - 14 Feb 2023
Cited by 1 | Viewed by 2428
Abstract
Obesity is one of the most important factors responsible for the marked increase in both the incidence and prevalence of type 2 diabetes mellitus (T2DM) in recent decades. Addressing the lifestyle factors associated with the progression to T2DM would present a potential rational [...] Read more.
Obesity is one of the most important factors responsible for the marked increase in both the incidence and prevalence of type 2 diabetes mellitus (T2DM) in recent decades. Addressing the lifestyle factors associated with the progression to T2DM would present a potential rational early prevention strategy. The current evidence suggests that excessive energy intake is mediated via dietary fat. Biochemical signals released in response to the ingestion of food require supportive signalling from the presence of food in the stomach. The degree of supportive volume signalling emanating from the stomach influences both the satiation and satiety phases. The Lipids and Volume in Satiation and Satiety (LIVES) Hypothesis proposes that the biological feedback from fat intake appears to be influenced by the other macronutrients with which it is consumed. By identifying the various possible macronutrient combinations with fat, it is possible to construct a matrix of food composition/volume scenarios, which may help elucidate dysfunction in the human food energy regulation system within the context of the modern food environment. Full article
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16 pages, 648 KiB  
Article
Transitioning to Telehealth during COVID-19: Experiences and Insights from Diabetes Prevention and Management Program Providers in Los Angeles County
by Sally L. Bullock, Telma Menendez, Liz Schwarte, Lisa Craypo, Jennifer T. Mosst, Gabrielle Green, Noel C. Barragan and Tony Kuo
Diabetology 2023, 4(1), 46-61; https://doi.org/10.3390/diabetology4010006 - 31 Jan 2023
Cited by 3 | Viewed by 2382
Abstract
The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via [...] Read more.
The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2022)
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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 - 07 Feb 2022
Cited by 3 | Viewed by 12305
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
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 18 | Viewed by 7856
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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10 pages, 1486 KiB  
Article
The Potential Role of Polyelectrolyte Complex Nanoparticles Based on Cashew Gum, Tripolyphosphate and Chitosan for the Loading of Insulin
by Janira M. N. A. Bezerra, Antônia C. J. Oliveira, Edson C. Silva-Filho, Patricia Severino, Selma B. Souto, Eliana B. Souto, Mônica F. La R. Soares and José L. Soares-Sobrinho
Diabetology 2021, 2(2), 107-116; https://doi.org/10.3390/diabetology2020009 - 08 Jun 2021
Cited by 7 | Viewed by 3333
Abstract
Polyelectrolytic complexation has stood out due to its application in the development of drug delivery systems using biopolymers as raw materials. The formation of complexes between cashew gum and chitosan can be intermediated by cross-links, mediated by the action of the sodium tripolyphosphate [...] Read more.
Polyelectrolytic complexation has stood out due to its application in the development of drug delivery systems using biopolymers as raw materials. The formation of complexes between cashew gum and chitosan can be intermediated by cross-links, mediated by the action of the sodium tripolyphosphate crosslinking agent. These polymers have been used in the nanotechnological development of formulations to protect peptide drugs, such as insulin, allowing their oral administration. In this work, we describe the development of polyelectrolytic complexes from cashew gum and chitosan as biopolymers for oral administration of insulin. The obtained complexes showed a mean particle size of 234 nm and polydispersity index of 0.2. The complexes were 234 nm in size, PDI 0.2, zeta potential −4.5 mV and 22% trapping. The obtained complexes demonstrated considerable and promising characteristics for use as oral insulin delivery systems. Full article
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15 pages, 664 KiB  
Review
Diabetes Mellitus: Insights from Epidemiology, Biochemistry, Risk Factors, Diagnosis, Complications and Comprehensive Management
by Saruar Alam, Md. Kamrul Hasan, Sharif Neaz, Nazmul Hussain, Md. Faruk Hossain and Tania Rahman
Diabetology 2021, 2(2), 36-50; https://doi.org/10.3390/diabetology2020004 - 16 Apr 2021
Cited by 72 | Viewed by 35971
Abstract
Diabetes mellitus has become a serious and chronic metabolic disorder that results from a complex interaction of genetic and environmental factors, principally characterized by hyperglycemia, polyuria, and polyphagia. Uncontrolled high blood sugar can result in a host of diabetic complications. Prolonged diabetes leads [...] Read more.
Diabetes mellitus has become a serious and chronic metabolic disorder that results from a complex interaction of genetic and environmental factors, principally characterized by hyperglycemia, polyuria, and polyphagia. Uncontrolled high blood sugar can result in a host of diabetic complications. Prolonged diabetes leads to serious complications some of which are life-threatening. The prevalence of diabetes patients is rising at epidemic proportions throughout the world. Every year, a major portion of the annual health budget is spent on diabetes and related illnesses. Multiple risk factors are involved in the etiopathogenesis of the disease and turning the disease into an epidemic. Diabetes, for which there is no cure, apparently can be kept under control by maintaining self-care in daily living, effective diabetes education, with comprehensive improvements in knowledge, attitudes, skills, and management. In this review, we focused on the biochemical aspects of diabetes, risk factors including both environmental and genetic, disease complications, diagnosis, management, and currently available medications for the treatment of diabetes. Full article
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15 pages, 326 KiB  
Article
Diabetes Awareness, Treatment, and Control among Mexico City Residents
by Simón Barquera, César Hernández-Alcaraz, Alejandra Jáuregui, Catalina Medina, Kenny Mendoza-Herrera, Andrea Pedroza-Tobias, Lizbeth Tolentino Mayo, Luz Elizabeth Guillen Pineda, Ruy López-Ridaura and Carlos A. Aguilar Salinas
Diabetology 2021, 2(1), 16-30; https://doi.org/10.3390/diabetology2010002 - 18 Feb 2021
Cited by 8 | Viewed by 5695
Abstract
Early diagnosis and control of diabetes can reduce premature mortality and disability. We described the diabetes prevalence, awareness, treatment, and control in Mexico City. Data came from the Mexico City Representative Diabetes Survey, conducted between May to June 2015. Participants (20–69 y, n [...] Read more.
Early diagnosis and control of diabetes can reduce premature mortality and disability. We described the diabetes prevalence, awareness, treatment, and control in Mexico City. Data came from the Mexico City Representative Diabetes Survey, conducted between May to June 2015. Participants (20–69 y, n = 1307) reported their diabetes condition, treatment, and outcomes. Fasting blood samples were collected and HbA1c, blood glucose, and blood lipids were determined. We used multivariate logistic regression to identify inequalities in diabetes prevalence and awareness. The overall prevalence of diabetes was 13.6% (95% CI: 11.7, 15.7). Of those living with diabetes, 70.5% were aware of their condition. Among those aware of their diabetes, around 10% to 65% received diabetes care according to international guidelines, and around 30% to 40% achieved HbA1c, LDL cholesterol, or blood pressure targets. Overall, only 4.1% of those aware of their diabetes achieved all treatment targets and 35.4% had never presented a diabetes complication. Diabetes prevalence was higher among older age groups and lower among the most educated. Having access to health care was associated with lower odds for diabetes and diabetes awareness. The low rates of diabetes awareness, treatment, and control highlight the urgent need of strengthening diabetes care in Mexico City. Full article
15 pages, 254 KiB  
Article
Disrupted Self-Management and Adaption to New Diabetes Routines: A Qualitative Study of How People with Diabetes Managed Their Illness during the COVID-19 Lockdown
by Dan Grabowski, Mathilde Overgaard, Julie Meldgaard, Lise Bro Johansen and Ingrid Willaing
Diabetology 2021, 2(1), 1-15; https://doi.org/10.3390/diabetology2010001 - 12 Jan 2021
Cited by 24 | Viewed by 6316
Abstract
When societies went into the COVID-19 lockdown, the conditions under which people with diabetes managed their illness dramatically changed. The present study explores experiences of everyday life during the COVID-19 lockdown among people with diabetes, and how diabetes self-management routines were affected. The [...] Read more.
When societies went into the COVID-19 lockdown, the conditions under which people with diabetes managed their illness dramatically changed. The present study explores experiences of everyday life during the COVID-19 lockdown among people with diabetes, and how diabetes self-management routines were affected. The data consist of 20 interviews with adults with diabetes, focusing on experiences during the COVID-19 lockdown. The analysis showed that experiences of self-management during lockdown were diverse and that participants handled daily life changes in very different ways. The main changes in self-management related to physical activity and food intake, which decreased and increased, respectively, for many participants during lockdown. We found two main and significantly different overall experiences of everyday life while on lockdown: (1) A daily life significantly changed by the lockdown, causing disruption of diabetes self-management routines, and (2) a largely unaffected everyday life, enabling continuance of diabetes routines. Our findings showed that people with diabetes lacked information about strategies to self-manage diabetes during lockdown and would have benefited from guidance and support throughout the pandemic, or any other crisis, to maintain their diabetes self-management routines. Full article
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