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PloS One 2023Diabetes is a common chronic condition affecting the many spheres of individuals' lives. It can also lead to severe complications without continuous management....
Exploring diabetes status and social determinants of health influencing diabetes-related complications in a Northwestern community, Ontario, Canada: A mixed method study protocol.
Diabetes is a common chronic condition affecting the many spheres of individuals' lives. It can also lead to severe complications without continuous management. Accordingly, this paper describes a study protocol aimed at 1) determining the status and prevalence of diabetes complications in a Northwestern Ontario community; 2) exploring the internal (e.g., demographic and clinical variables) and external factors (e.g., access to services and resources) affecting diabetes outcomes (e.g., complications, emergency room visits, hospitalizations); 3) critically exploring how the social determinants of health affect self-management for individuals living with diabetes; and 4) identifying individuals' needs, concerns, and challenges to monitor and regulate diabetes. The study uses a cross-sectional design and a social constructivist approach based on qualitative data collection. The proposed study will include patients with type 1 and type 2 diabetes with or without diabetes complications who have been attending the Centre for Complex Diabetes Care (CCDC) in Thunder Bay, Ontario, Canada, since January 2019. Quantitative data related to diabetes complications and other outcomes, diabetes management, and demographic and clinical status will be retrieved from patients' charts using a data extraction form. Analyses of the quantitative data will include the prevalence of diabetes complications, rate of hospitalizations, and their associations with diabetes management, access to services, and social determinants of health. Additionally, interviews will occur with at least 10 participants with or without diabetes complications to understand their needs, concerns, and struggle to self-manage diabetes daily. The results of this study will generate evidence to support future research and policy on the development and implementation of an educational program to improve self-care management and outcomes for individuals living with diabetes and its complications in Northwestern Ontario.
Topics: Humans; Ontario; Diabetes Mellitus, Type 2; Cross-Sectional Studies; Social Determinants of Health; Diabetes Complications
PubMed: 37768913
DOI: 10.1371/journal.pone.0273953 -
Journal of Diabetes and Its... Aug 2023The present meta-analysis aimed to assess the association between carotid ultrasonographic parameters and diabetic microvascular and macrovascular complications. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The present meta-analysis aimed to assess the association between carotid ultrasonographic parameters and diabetic microvascular and macrovascular complications.
METHODS
All published articles were searched in electronic databases including PubMed, Embase, Cochrane Library, and Web of Science databases from the inception to May 27, 2023. Common carotid artery intima-media thickness (CCA-IMT), carotid bifurcation intima-media thickness (CB-IMT), internal carotid artery intima-media thickness (ICA-IMT), carotid plaque, carotid plaque score, plaque number, plaque thickness, carotid atherosclerosis, and resistivity indices (RIs) of ultrasonographic parameters were assessed. The odds ratio (OR), weighted mean difference (WMD), with the 95 % confidence interval (CI) were pooled to estimate the effect. Subgroup analyses were performed in terms of the type of diabetes and study design. Sensitivity analysis was used to evaluate the robustness of the results.
RESULTS
A total of 25 studies involving 12,102 diabetic patients were included in this systematic review and meta-analysis. Our findings suggested the associations between increased CCA-IMT and the risk of diabetic microvascular (WMD: 0.059, 95%CI: 0.026 to 0.091, P < 0.001) and macrovascular complications (WMD: 0.124, 95%CI: 0.061 to 0.187, P < 0.001) including cardiovascular events (OR: 2.362, 95%CI: 1.913 to 2.916, P < 0.001). Subgroup analyses also elaborated an association between CCA-IMT and diabetic microvascular and macrovascular complications. The results of sensitivity analysis show that the association is relatively stable.
CONCLUSION
Our findings revealed associations between carotid ultrasonographic parameters and microvascular and macrovascular complications of diabetes. Application of the carotid ultrasonographic parameters could be a non-invasive method for the early detection of long-term complications of diabetes.
Topics: Humans; Carotid Intima-Media Thickness; Risk Factors; Carotid Arteries; Carotid Artery Diseases; Carotid Artery, Common; Diabetes Complications; Diabetes Mellitus
PubMed: 37418962
DOI: 10.1016/j.jdiacomp.2023.108554 -
Critical Reviews in Food Science and... 2024Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia and impaired islet secretion that places a heavy burden on the global health care... (Review)
Review
Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia and impaired islet secretion that places a heavy burden on the global health care system due to its high incidence rate, long disease course and many complications. Fortunately, garlic (), a well-known medicinal plant and functional food without the toxicity and side effects of conventional drugs, has shown positive effects in the treatment of diabetes and its complications. With interdisciplinary development and in-depth exploration, we offer a clear and comprehensive summary of the research from the past ten years, focusing on the mechanisms and development processes of garlic in the treatment of diabetes and its complications, aiming to provide a new perspective for the treatment of diabetes and promote the efficient development of this field.
Topics: Garlic; Humans; Diabetes Mellitus; Plant Extracts; Diabetes Complications; Phytotherapy; Hypoglycemic Agents; Functional Food; Animals
PubMed: 36503329
DOI: 10.1080/10408398.2022.2153793 -
Diabetes Research and Clinical Practice Oct 2023Using machine learning algorithms and administrative data, we aimed to predict the risk of being diagnosed with several diabetes-related complications after one-, two-...
AIMS
Using machine learning algorithms and administrative data, we aimed to predict the risk of being diagnosed with several diabetes-related complications after one-, two- and three-year post-diabetes diagnosis.
METHODS
We used longitudinal data from administrative registers of 610,019 individuals in Catalonia with a diagnosis of diabetes and checked the presence of several complications after diabetes onset from 2013 to 2017: hypertension, renal failure, myocardial infarction, cardiovascular disease, retinopathy, congestive heart failure, cerebrovascular disease, peripheral vascular disease and stroke. Four different machine learning (ML) algorithms (logistic regression (LR), Decision tree (DT), Random Forest (RF), and Extreme Gradient Boosting (XGB)) will be used to assess their prediction performance and to evaluate the prediction accuracy of complications changes over the period considered.
RESULTS
610,019 people with diabetes were included. After three years since diabetes diagnosis, the area under the curve values ranged from 60% (retinopathy) to 69% (congestive heart failure), whereas accuracy rates varied between 60% (retinopathy) to 75% (hypertension). RF was the most relevant technique for hypertension, myocardial and retinopathy, and LR for the rest of the comorbidities. The Shapley additive explanations values showed that age was associated with an elevated risk for all diabetes-related complications except retinopathy. Gender, other comorbidities, co-payment levels and age were the most relevant factors for comorbidity diagnosis prediction.
CONCLUSIONS
Our ML models allow for the identification of individuals newly diagnosed with diabetes who are at increased risk of developing diabetes-related complications. The prediction performance varied across complications but within acceptable ranges as prediction tools.
Topics: Humans; Diabetes Mellitus; Diabetes Complications; Algorithms; Hypertension; Heart Failure; Machine Learning; Myocardial Infarction; Retinal Diseases
PubMed: 37722566
DOI: 10.1016/j.diabres.2023.110910 -
The Journal of Clinical Endocrinology... Dec 2023MicroRNA-191-5p regulates key cellular processes involved in the pathogenesis of diabetic complications such as angiogenesis, extracellular matrix deposition, and...
CONTEXT
MicroRNA-191-5p regulates key cellular processes involved in the pathogenesis of diabetic complications such as angiogenesis, extracellular matrix deposition, and inflammation. However, no data on circulating microRNA-191-5p in the chronic complications of diabetes are available.
OBJECTIVE
To assess whether serum levels of microRNA-191-5p were associated with micro- and macrovascular disease in a large cohort of subjects with type 1 diabetes mellitus (DM1) from the EURODIAB Prospective Complication Study.
DESIGN AND SETTING
Levels of microRNA-191-5p were measured by quantitative PCR in 420 patients with DM1 recruited as part of the cross-sectional analysis of the EURODIAB Prospective Complication Study. Cases (n = 277) were subjects with nephropathy and/or retinopathy and/or cardiovascular disease (CVD). Controls (n = 143) were patients without complications. Logistic regression analysis was performed to evaluate the potential independent association of microRNA-191-5p levels with chronic complications of diabetes.
RESULTS
Levels of microRNA-191-5p were significantly reduced (P < .001) in cases compared with controls even after adjustment for age, sex, and diabetes duration. Logistic regression analysis revealed that microRNA-191-5p was negatively associated with a 58% reduced odds ratio (OR) of chronic diabetes complications, specifically CVD, micro-macroalbuminuria, and retinopathy (OR, 0.42; 95% CI, 0.23-0.77), independent of age, sex, physical activity, educational levels, diabetes duration, glycated hemoglobin, total insulin dose, hypertension, smoking, total cholesterol, albumin excretion rate, estimated glomerular filtration rate, serum vascular cell adhesion molecule-1, and tumor necrosis factor-α. Analyses performed separately for each complication demonstrated a significant independent association with albuminuria (OR, 0.36; 95% CI, (0.18-0.75) and CVD (OR, 0.34; 95% CI, 0.16-0.70).
CONCLUSIONS
In DM1 subjects, microRNA-191-5p is inversely associated with vascular chronic complications of diabetes.
Topics: Humans; Diabetes Mellitus, Type 1; Risk Factors; Diabetic Angiopathies; Prospective Studies; Cross-Sectional Studies; Diabetes Complications; Cardiovascular Diseases; Retinal Diseases; MicroRNAs; Albuminuria; Diabetic Retinopathy
PubMed: 37552780
DOI: 10.1210/clinem/dgad468 -
Frontiers in Endocrinology 2024Diabetic retinopathy (DR) is a highly tissue-specific neurovascular complication of type 1 and type 2 diabetes mellitus and is among the leading causes of blindness... (Review)
Review
Diabetic retinopathy (DR) is a highly tissue-specific neurovascular complication of type 1 and type 2 diabetes mellitus and is among the leading causes of blindness worldwide. Pathophysiological changes in DR encompass neurodegeneration, inflammation, and oxidative stress. Current treatments for DR, including anti-vascular endothelial growth factor, steroids, laser photocoagulation, and vitrectomy have limitations and adverse reactions, necessitating the exploration of novel treatment strategies. This review aims to summarize the current pathophysiology, therapeutic approaches, and available drug-delivery methods for treating DR, and discuss their respective development potentials. Recent research indicates the efficacy of novel receptor inhibitors and agonists, such as aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, peroxisome proliferator-activated receptor alpha agonists, and novel drugs in delaying DR. Furthermore, with continuous advancements in nanotechnology, a new form of drug delivery has been developed that can address certain limitations of clinical drug therapy, such as low solubility and poor penetration. This review serves as a theoretical foundation for future research on DR treatment. While highlighting promising therapeutic targets, it underscores the need for continuous exploration to enhance our understanding of DR pathogenesis. The limitations of current treatments and the potential for future advancements emphasize the importance of ongoing research in this field.
Topics: Humans; Diabetic Retinopathy; Diabetes Mellitus, Type 2; Inflammation; Angiotensin-Converting Enzyme Inhibitors; Steroids
PubMed: 38425757
DOI: 10.3389/fendo.2024.1347864 -
The Journal of Clinical Endocrinology... Jul 2023Type 1 diabetes (T1D) is associated with alterations of the immune response which persist even after the autoimmunity aspect is resolved. Clinical factors that cause...
CONTEXT
Type 1 diabetes (T1D) is associated with alterations of the immune response which persist even after the autoimmunity aspect is resolved. Clinical factors that cause dysregulation, however, are not fully understood.
OBJECTIVE
To identify clinical factors that affect immune dysregulation in people with longstanding T1D.
DESIGN
In this cross-sectional study, 243 participants with longstanding T1D were recruited between February 2016 and June 2017 at the Radboudumc, the Netherlands. Blood was drawn to determine immune cell phenotype and functionality, as well as circulating inflammatory proteome. Multivariate linear regression was used to determine the association between glycated hemoglobin (HbA1c) levels, duration of diabetes, insulin need, and diabetes complications with inflammation.
RESULTS
HbA1c level is positively associated with circulating inflammatory markers (P < .05), but not with immune cell number and phenotype. Diabetes duration is associated with increased number of circulating immune cells (P < .05), inflammatory proteome (P < .05), and negatively associated with adaptive immune response against Mycobacterium tuberculosis and Rhizopus oryzae (P < .05). Diabetes nephropathy is associated with increased circulating immune cells (P < .05) and inflammatory markers (P < .05).
CONCLUSION
Disease duration and chronic complications associate with persistent alterations in the immune response of individuals with long standing T1D.
Topics: Humans; Diabetes Mellitus, Type 1; Glycated Hemoglobin; Cross-Sectional Studies; Proteome; Diabetes Complications
PubMed: 36800223
DOI: 10.1210/clinem/dgad087 -
Pharmacological Research Feb 2024Diabetes, characterized as a well-known chronic metabolic syndrome, with its associated complications pose a substantial and escalating health and healthcare challenge... (Review)
Review
Diabetes, characterized as a well-known chronic metabolic syndrome, with its associated complications pose a substantial and escalating health and healthcare challenge on a global scale. Current strategies addressing diabetes are mainly symptomatic and there are fewer available curative pharmaceuticals for diabetic complications. Thus, there is an urgent need to identify novel pharmacological targets and agents. The impaired mitochondria have been associated with the etiology of diabetes and its complications, and the intervention of mitochondrial dysfunction represents an attractive breakthrough point for the treatments of diabetes and its complications. Natural products (NPs), with multicenter characteristics, multi-pharmacological activities and lower toxicity, have been caught attentions as the modulators of mitochondrial functions in the therapeutical filed of diabetes and its complications. This review mainly summarizes the recent progresses on the potential of 39 NPs and 2 plant-extracted mixtures to improve mitochondrial dysfunction against diabetes and its complications. It is expected that this work may be useful to accelerate the development of innovative drugs originated from NPs and improve upcoming therapeutics in diabetes and its complications.
Topics: Humans; Biological Products; Diabetes Mellitus; Diabetes Complications; Mitochondria; Mitochondrial Diseases; Multicenter Studies as Topic
PubMed: 38181858
DOI: 10.1016/j.phrs.2023.107054 -
Current Oncology (Toronto, Ont.) Feb 2024Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a...
UNLABELLED
Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds. This retrospective case-control study examined the real-world incidence of acute diabetes-related complications in patients with head and neck cancer receiving CCRT, along with the impact of diabetes on CCRT tolerance and outcomes.
METHODS
Consecutive patients with head and neck squamous cell or nasopharyngeal cancer who underwent definitive or adjuvant CCRT between 2010 and 2019 at two large cancer centers in Australia were included. Clinicopathological characteristics, treatment complications and outcomes were collected from medical records.
RESULTS
Of 282 patients who received CCRT, 29 (10.3%) had pre-existing type 2 diabetes. None had type 1 diabetes. The majority (74.5%) required enteral feeding. A higher proportion of patients with diabetes required admission to a high-dependency or intensive care unit (17.2 versus 4.0%, = 0.003). This difference was driven by the group who required insulin at baseline ( = 5), of which four (80.0%) were admitted to a high-dependency unit with diabetes-related complications, and three (60.0%) required omission of at least one cycle of chemotherapy.
CONCLUSIONS
Patients with diabetes requiring insulin have a high risk of acute life-threatening diabetes-related complications while receiving CCRT. We recommend multidisciplinary management involving a diabetes specialist, educator, dietitian, and pharmacist, in collaboration with the cancer care team, to better avoid these complications.
Topics: Humans; Retrospective Studies; Nasopharyngeal Neoplasms; Case-Control Studies; Diabetes Mellitus, Type 2; Head and Neck Neoplasms; Chemoradiotherapy; Diabetes Complications; Insulins
PubMed: 38392055
DOI: 10.3390/curroncol31020061 -
Folia Microbiologica Apr 2024Diabetes mellitus is a chronic disease affecting glucose metabolism. The pathophysiological reactions underpinning the disease can lead to the development of late... (Review)
Review
Diabetes mellitus is a chronic disease affecting glucose metabolism. The pathophysiological reactions underpinning the disease can lead to the development of late diabetes complications. The gut microbiota plays important roles in weight regulation and the maintenance of a healthy digestive system. Obesity, diabetes mellitus, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy are all associated with a microbial imbalance in the gut. Modern technical equipment and advanced diagnostic procedures, including xmolecular methods, are commonly used to detect both quantitative and qualitative changes in the gut microbiota. This review summarises collective knowledge on the role of the gut microbiota in both types of diabetes mellitus and their late complications, with a particular focus on diabetic foot syndrome.
Topics: Humans; Diabetic Foot; Gastrointestinal Microbiome; Diabetic Nephropathies; Diabetic Retinopathy; Obesity; Diabetes Mellitus
PubMed: 38095802
DOI: 10.1007/s12223-023-01119-y