Diabetology

Research

11 pages, 545 KiB

Open AccessArticle

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

by Matilde Monteiro-Soares, José Dores, Cristina Alves-Palma, Susana Galrito and Daniela Ferreira-Santos

Diabetology 2024, 5(2), 223-233; https://doi.org/10.3390/diabetology5020017 - 4 Jun 2024

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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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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12 pages, 2718 KiB

Open AccessArticle

Defining the miRnome of Saphenous Vein Smooth Muscle Cells from Patients with Type 2 Diabetes Mellitus

by 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 and Kirsten Riches-Suman

Diabetology 2024, 5(2), 178-189; https://doi.org/10.3390/diabetology5020014 - 11 May 2024

Viewed by 1661

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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9 pages, 258 KiB

Open AccessEditor’s ChoiceCommunication

A Pilot Study on the Glucose-Lowering Effects of a Nutritional Supplement in People with Prediabetes

by Thrasyvoulos Bemplidakis, Ioanna Eleftheriadou, Ourania Kosta, Konstantinos Tentolouris, Ioanna Anastasiou, Christina Agelaki, Dimitrios Lamprinos, Anastasia Papaioannou, Ioanna Kolovou, Vasiliki Kouka, Magdalini Bristianou, Leonidas Lanaras and Nikolaos Tentolouris

Diabetology 2023, 4(4), 418-426; https://doi.org/10.3390/diabetology4040035 - 29 Sep 2023

Viewed by 1637

Abstract

Background and Objectives: Prediabetes is associated with a high risk of developing diabetes and cardiovascular disease. Early treatment with exercise and dietary interventions can reduce the progression of prediabetes to diabetes or even lead to a return of glucose levels to normal. The [...] Read more.

Background and Objectives: Prediabetes is associated with a high risk of developing diabetes and cardiovascular disease. Early treatment with exercise and dietary interventions can reduce the progression of prediabetes to diabetes or even lead to a return of glucose levels to normal. The aim of the study was to evaluate the effect of a dietary supplement with Portulaca oleracea and titrated Cistus creticus extract on the glycemic profile of people with prediabetes. Materials and Methods: Participants were assigned to a dietary supplement with Portulaca oleracea and titrated Cistus creticus extract, along with vitamins and minerals, received once daily for 90 days. Demographics and medical history were obtained, and a complete clinical examination, measurement of somatometric characteristics, and laboratory parameters were performed at baseline. The measurement of somatometric characteristics and laboratory tests were repeated at the end of the study. Results: A total of 26 people with prediabetes participated, 11 females and 15 males. There was a tendency for a decrease in HbA1c after intervention [baseline: 5.9 (5.7–6.1)%; at the end of the study: 5.7 (5.7–6.0)%, p = 0.062] and a significant decrease in fasting glucose levels (from 110.8 ± 7.0 mg/dL to 103.9 ± 10.3, p = 0.005). Fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) decreased significantly [baseline fasting insulin: 20.7 (9.3–34.20) μU/mL; at the end of the study: 15.1 (8.6–19.0) μU/mL, p = 0.028; baseline HOMA-IR: 3.6 (2.5–8.9); at the end of the study: 3.5 (2.0–4.6), p = 0.035]. Significant reductions were observed in alkaline phosphatase and uric acid levels. No significant change was observed in body weight, body mass index, or waist circumference after the intervention. No treatment-emergent adverse events were observed, and all participants completed the study. Conclusions: The dietary supplement from Portulaca oleracea and titrated Cistus creticus extract, along with vitamins and minerals, may improve the metabolic profile of people with prediabetes. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

11 pages, 805 KiB

Open AccessEditor’s ChoiceArticle

Frailty in Older Patients with End-Stage Renal Disease and Undergoing Chronic Haemodialysis in Vietnam

by Tan Van Nguyen, Thu Thi Xuan Pham, Mason Jenner Burns and Tu Ngoc Nguyen

Diabetology 2023, 4(3), 312-322; https://doi.org/10.3390/diabetology4030027 - 1 Aug 2023

Cited by 1 | Viewed by 2134

Abstract

Background: There is limited evidence on the association between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to investigate the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method: This [...] Read more.

Background: There is limited evidence on the association between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to investigate the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method: This is a prospective, observational study performed at two large Dialysis Centres in Vietnam from November 2020 to June 2021. Consecutive older patients diagnosed with end-stage renal disease and on haemodialysis were recruited. Participants’ frailty status was defined by the Clinical Frailty Scale (CFS). The study outcome was all-cause mortality at the sixth month. Results: A total of 175 participants were recruited (mean age 72.4 years, 58.9% female). Using the cut point of CFS ≥ 4, 87.4% of the participants were frail. Mortality at the sixth month was 14.9%, 31.9% in participants with CFS ≥ 7, 12.8% in participants with CFS = 6, 7.5% in participants with CFS from 4 to 5, and 4.5% in participants with CFS ≤ 3 (p = 0.001). Cox regression analysis showed that, compared with the non-frail participants, the probability of death over 6 months was nearly two-fold higher in the mildly frail, three-fold higher in the moderately frail, and nine-fold higher in the severely frail participants. Conclusions: This study demonstrated a very high prevalence of frailty in older patients with end-stage renal disease and dialysis and the significant impact of frailty severity on mortality. Healthcare providers should consider incorporating frailty screening into routine care for older patients with end-stage renal disease and dialysis. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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Review

Jump to: Research, Other

16 pages, 2460 KiB

Open AccessReview

Melanocortins and Their Potential for the Treatment, Prevention and Amelioration of Complications of Diabetes

by Gardner N. Robinson and Raelene J. Pickering

Diabetology 2024, 5(1), 69-84; https://doi.org/10.3390/diabetology5010006 - 4 Feb 2024

Cited by 1 | Viewed by 2672

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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14 pages, 2311 KiB

Open AccessEditor’s ChoiceReview

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 - 7 Sep 2023

Cited by 1 | Viewed by 4335

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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16 pages, 909 KiB

Open AccessEditor’s ChoiceReview

A Life Course Approach to Understanding Cognitive Impairment in Adults with Type 2 Diabetes: A Narrative Literature Review

by Bohyun Kim, Jimmy T. Efird and Jie Hu

Diabetology 2023, 4(3), 323-338; https://doi.org/10.3390/diabetology4030028 - 14 Aug 2023

Viewed by 2377

Abstract

Diabetes is an independent risk factor for cognitive impairment, with the latter presenting challenges for diabetes self-management and glycemic control in individuals with type 2 diabetes. Predicated on the theory of unpleasant symptoms, the purpose of the current narrative review of the literature [...] Read more.

Diabetes is an independent risk factor for cognitive impairment, with the latter presenting challenges for diabetes self-management and glycemic control in individuals with type 2 diabetes. Predicated on the theory of unpleasant symptoms, the purpose of the current narrative review of the literature was to identify etiologic factors that influence cognitive impairment as a precursor to dementia in individuals with diabetes. Physiological, psychological, and situational factors were recognized as important life course components of cognitive impairment in later adulthood. Developing interventions targeting modifiable factors is warranted in preventing cognitive impairment in adults with diabetes. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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15 pages, 2069 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Achieving Remission in the Era of Clinical Inertia: What Is Preventing Us from Treating Type 2 Diabetes?

by Austen Suits, Ridhi Gudoor and Jay H. Shubrook

Diabetology 2023, 4(1), 93-107; https://doi.org/10.3390/diabetology4010011 - 24 Feb 2023

Cited by 1 | Viewed by 6713

Abstract

Despite evolution in treatment options and improved understanding of pathophysiology, the treatment of type 2 diabetes remains unsatisfactory. Current management guidelines complicated by clinical inertia have resulted in over half of patients failing to meet glycemic targets. Expert consensus has defined a state [...] Read more.

Despite evolution in treatment options and improved understanding of pathophysiology, the treatment of type 2 diabetes remains unsatisfactory. Current management guidelines complicated by clinical inertia have resulted in over half of patients failing to meet glycemic targets. Expert consensus has defined a state of diabetes remission whereby treatment can induce sustained normalization of glucose levels. Evidence suggests that metabolic surgery, intensive lifestyle modification, and pharmacologic approaches are each viable options for achieving remission when implemented early in the disease course. The authors review each of these strategies and include practical considerations to aid in the pursuit of remission. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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Other

Jump to: Research, Review

10 pages, 1664 KiB

Open AccessEditor’s ChoiceBrief Report

Knowledge of Diabetes among Adults at High Risk for Type 2 Diabetes in the Trivandrum District of Kerala, India

by Thirunavukkarasu Sathish, Kavumpurathu Raman Thankappan, Jeemon Panniyammakal and Brian Oldenburg

Diabetology 2023, 4(1), 76-85; https://doi.org/10.3390/diabetology4010009 - 16 Feb 2023

Cited by 1 | Viewed by 4277

Abstract

We aimed to study the knowledge of diabetes among individuals with a high risk for developing type 2 diabetes in the Trivandrum district of the Indian state of Kerala. The baseline data collected from 1007 participants of the Kerala Diabetes Prevention Program were [...] Read more.

We aimed to study the knowledge of diabetes among individuals with a high risk for developing type 2 diabetes in the Trivandrum district of the Indian state of Kerala. The baseline data collected from 1007 participants of the Kerala Diabetes Prevention Program were analyzed. Diabetes knowledge was assessed using a scale adapted from a large nationwide study conducted in India. The composite score of the scale ranged from 0 to 8. The mean age of the participants was 46.0 (SD: 7.5) years, and 47.2% were women. The mean diabetes knowledge score was 6.9 (SD: 2.1), with 59.5% having the maximum possible score of 8. Of the 1007 participants, 968 (96.1%) had heard the term diabetes, and of them, 87.2% knew that the prevalence of diabetes is increasing, 92.9% knew at least one risk factor for diabetes, 79.6% knew that diabetes can cause complications in organs, and 75.9% knew that diabetes can be prevented. While the overall level of knowledge of diabetes about its risk factors, complications, and prevention was generally high, an alarmingly low proportion of participants knew that diabetes can affect key organs such as the eyes (24.0%), heart (20.1%), feet (10.2%), and nerves (2.9%), and nearly a quarter (24.1%) were not aware that diabetes can be prevented. It is essential to educate high-risk individuals about diabetes complications and the importance of and strategies for diabetes prevention in the Trivandrum district of Kerala. Full article

(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)

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