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Cureus Jun 2024Neuropathy is a common and debilitating complication in type 2 diabetes, affecting quality of life and increasing healthcare costs. Identifying risk factors is essential...
INTRODUCTION
Neuropathy is a common and debilitating complication in type 2 diabetes, affecting quality of life and increasing healthcare costs. Identifying risk factors is essential for early intervention and management. This study aims to evaluate the factors influencing the occurrence of neuropathy in patients with type 2 diabetes using artificial neural networks.
METHODS
In this cohort study, data from 371 patients with type 2 diabetes from Fereydunshahr, Iran, were analyzed over a 12-year follow-up period. Participants were selected based on diabetes screenings conducted in 2008 and 2009. Artificial neural networks with varying architectures were trained and validated, and their performance was compared to logistic regression models using receiver operating characteristic (ROC) curve analysis.
RESULTS
The prevalence of neuropathy in this cohort study was 31.2%. The best-fitted artificial neural network and logistic regression model had area under the curve (AUC) values of 0.903 and 0.803, respectively. Significant risk factors identified included gender, race, family history of diabetes, type of diabetes treatment, cholesterol levels, triglyceride levels, high-density lipoprotein (HDL) levels, and duration of diabetes. Notably, women, patients with a family history of diabetes, and those using injectable or combined injectable and oral medications were at higher risk of developing neuropathy.
CONCLUSION
These findings highlight the importance of vigilant monitoring and proactive management of neuropathy risk factors, especially in women, patients with a family history of diabetes, and those using injectable or combined diabetic medications.
PubMed: 38855494
DOI: 10.7759/cureus.61860 -
International Wound Journal Jun 2024Diabetic foot ulcers (DFUs) often become infected and are treated with antimicrobials, with samples collected to inform care. Swab samples are easier than tissue...
Diabetic foot ulcers (DFUs) often become infected and are treated with antimicrobials, with samples collected to inform care. Swab samples are easier than tissue sampling but report fewer organisms. Compared with culture and sensitivity (C&S) methods, molecular microbiology identifies more organisms. Clinician perspectives on sampling and processing are unknown. We explored clinician perspectives on DFU sampling-tissue samples/wound swabs-and on processing techniques, culture and sensitivity or molecular techniques. The latter provides information on organisms which have not survived transport to the laboratory for culture. We solicited feedback on molecular microbiology reports. Qualitative study using semi-structured interview, with analysis using a Framework approach. CODIFI2 clinicians from UK DFU clinics. Seven consultants agreed to take part. They reported, overall, a preference for tissue samples over swabbing. Clinicians were not confident replacing C&S with molecular microbiology as the approach to reporting was unfamiliar. The study was small and did not recruit any podiatrists or nurses, who may have discipline-specific attitudes or perspectives on DFU care. Both sampling approaches appear to be used by clinicians. Molecular microbiology reports would not be, at present, suitable for replacement of traditional culture and sensitivity.
Topics: Diabetic Foot; Humans; Qualitative Research; Specimen Handling; Male; Female; United Kingdom; Middle Aged; Adult; Aged; Wound Infection
PubMed: 38853665
DOI: 10.1111/iwj.14912 -
The Journal of International Medical... Jun 2024Treatment of lower limb ischemia in patients with diabetes is challenging because of the location of the ulcers and the complexity of their pathogenesis. Carbon dioxide...
Use of carbon dioxide fractional laser in the management of lower limb ischemia in patients with diabetes: a case report : CO fractional laser in the treatment of diabetic foot.
Treatment of lower limb ischemia in patients with diabetes is challenging because of the location of the ulcers and the complexity of their pathogenesis. Carbon dioxide fractional laser (COFL) therapy in conjunction with tibial periosteum distraction could become a substitute for conventional methods. We herein describe a patient diagnosed with ischemic diabetic foot with a complex ulcer in the upper third of the tibia. Laser irradiation (Deep FX mode with 30 mJ of energy and 10% density) was applied to the entire region of skin below the knee after surface anesthesia, and this treatment was performed twice a week until the ulcer healed. Computed tomography angiography showed successful establishment of a blood supply to the back of the right foot after treatment. Skin grafting was successfully performed, with only a few wounds remaining on the foot 8 months after treatment. The pain score was significantly decreased at the last follow-up. No complications occurred. This case report provides guidance for the performance of COFL, a fast, easy, accurate treatment in patients with diabetes. COFL can target lower limb arterial occlusive disease accompanied by refractory ulcers, addressing the underlying vascular occlusion and dysfunction as well as promoting microcirculation and wound healing.
Topics: Humans; Diabetic Foot; Lasers, Gas; Ischemia; Male; Lower Extremity; Aged; Middle Aged; Wound Healing; Treatment Outcome
PubMed: 38853406
DOI: 10.1177/03000605241253759 -
Clinical Biomechanics (Bristol, Avon) Jun 2024Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to...
BACKGROUND
Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed.
METHODS
In-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole.
FINDINGS
Generalized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe.
INTERPRETATION
The new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.
Topics: Humans; Shoes; Heel; Pressure; Foot Orthoses; Male; Female; Middle Aged; Diabetic Foot; Equipment Design; Foot; Aged; Walking
PubMed: 38850882
DOI: 10.1016/j.clinbiomech.2024.106281 -
BMC Endocrine Disorders Jun 2024Meteorin-like (Metrnl), a secreted myokine, is a newly discovered neurotrophic factor. The aim of this study was to determine if there is a correlation between the...
OBJECTIVE
Meteorin-like (Metrnl), a secreted myokine, is a newly discovered neurotrophic factor. The aim of this study was to determine if there is a correlation between the Metrnl level and diabetic peripheral neuropathy (DPN).
METHODS
The investigation was conducted on a sample of 80 patients with type 2 diabetes mellitus (T2DM) and 60 healthy controls. The T2DM patients were categorized into two subgroups based on skin biopsy: the DPN subgroup (n = 20) and the diabetes without neuropathy subgroup (n = 60).
RESULTS
The T2DM groups had higher serum Metrnl concentrations compared with the controls. The serum Metrnl concentration was significantly lower in the DPN group than in T2DM patients without neuropathy. Logistic regression analysis demonstrated a notable correlation between serum Metrnl and DPN (OR: 0.997, 95% CI: 0.995-1.000, P < 0.05). Serum Metrnl level was negatively correlated with age and SBP after a simple logistic regression analysis.
CONCLUSION
Serum Metrnl concentration is independently correlated with DPN.
Topics: Humans; Diabetic Neuropathies; Diabetes Mellitus, Type 2; Male; Female; Middle Aged; Case-Control Studies; Aged; Biomarkers; Adipokines
PubMed: 38849768
DOI: 10.1186/s12902-024-01616-2 -
Annals of Medicine and Surgery (2012) Jun 2024Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 diabetes mellitus (DM). It affects 8-50% of...
BACKGROUND
Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 diabetes mellitus (DM). It affects 8-50% of patients with type 1 diabetes and is also seen in type 2 diabetic patients. Consequently, it can mimic many rheumatological diseases and is often underdiagnosed. The authors present a case of a long-standing poorly controlled diabetes with diabetic cheiroarthropathy and diabetic neuropathy, along with positive ANA in the absence of any correlated autoimmune or rheumatological diseases.
CASE PRESENTATION
A 52-year-old female patient with poorly controlled diabetes (her last HbA1c reading was 9.5%) presented to the Rheumatology clinic with flexion deformities of the fingers. The patient has impaired vibration, two-point discrimination, and pinprick sensation in gloves and stock distribution, indicating peripheral neuropathy, entrapment neuropathy in the forms of bilateral carpal tunnel syndrome, and the diagnosis of diabetic cheiroarthropathy was made. Additionally, she has a positive prayer sign and a tabletop sign. Despite the absence of symptoms and signs of autoimmune disorders, this patient has positive anti-nuclear antibodies global (ANA positive by indirect immuno-fluorescence (IIF) 1\320 nucleolar pattern) with a negative: ANA profile, rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (ACPA).
CONCLUSION
Regular and careful hand examination should be part of clinical assessment for diabetic patients as it could be a very simple and useful screening tool for diabetic cheiroarthropathy. Physicians can use this condition as a mirror for microvascular complications of diabetes. This allows for early detection and appropriate interventions to prevent further progression of diabetes-related complications. It is also essential to consider the presence of positive ANA in diabetic cheiroarthropathy despite the absence of any rheumatological and autoimmune diseases.
PubMed: 38846876
DOI: 10.1097/MS9.0000000000001993 -
Injury Epidemiology Jun 2024Diabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have...
BACKGROUND
Diabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have examined the association between DM and driving safety in older adults based on naturalistic driving data.
METHODS
Data for this study came from a multisite naturalistic driving study of drivers aged 65-79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (HBEs, defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM.
RESULTS
Of the 2856 study participants eligible for this analysis, 482 (16.9%) reported having DM at baseline, including 354 (12.4%) insulin non-users and 128 (4.5%) insulin users. The incidence rates of HBEs per 1000 miles were 1.13 for drivers without DM, 1.15 for drivers with DM not using insulin, and 1.77 for drivers with DM using insulin. Compared to drivers without DM, the risk of HBEs was 48% higher for drivers with DM using insulin (aIRR 1.48; 95% CI: 1.43, 1.53).
CONCLUSION
Older adult drivers with DM using insulin appear to be at increased proneness to vehicular crashes. Driving safety should be taken into consideration in DM care and management.
PubMed: 38840227
DOI: 10.1186/s40621-024-00508-2 -
Animal Models and Experimental Medicine Jun 2024Diabetes mellitus is one of the world's most prevalent and complex metabolic disorders, and it is a rapidly growing global public health issue. It is characterized by... (Review)
Review
Diabetes mellitus is one of the world's most prevalent and complex metabolic disorders, and it is a rapidly growing global public health issue. It is characterized by hyperglycemia, a condition involving a high blood glucose level brought on by deficiencies in insulin secretion, decreased activity of insulin, or both. Prolonged effects of diabetes include cardiovascular problems, retinopathy, neuropathy, nephropathy, and vascular alterations in both macro- and micro-blood vessels. In vivo and in vitro models have always been important for investigating and characterizing disease pathogenesis, identifying targets, and reviewing novel treatment options and medications. Fully understanding these models is crucial for the researchers so this review summarizes the different experimental in vivo and in vitro model options used to study diabetes and its consequences. The most popular in vivo studies involves the small animal models, such as rodent models, chemically induced diabetogens like streptozotocin and alloxan, and the possibility of deleting or overexpressing a specific gene by knockout and transgenic technologies on these animals. Other models include virally induced models, diet/nutrition induced diabetic animals, surgically induced models or pancreatectomy models, and non-obese models. Large animals or non-rodent models like porcine (pig), canine (dog), nonhuman primate, and Zebrafish models are also outlined. The in vitro models discussed are murine and human beta-cell lines and pancreatic islets, human stem cells, and organoid cultures. The other enzymatic in vitro tests to assess diabetes include assay of amylase inhibition and inhibition of α-glucosidase activity.
PubMed: 38837635
DOI: 10.1002/ame2.12442 -
Renal Failure Dec 2024To determine the efficacy and safety of Astragalus combined with renin-angiotensin-aldosterone system (RAAS) blockers in treating stage III diabetic nephropathy (DN) by... (Meta-Analysis)
Meta-Analysis
Efficacy of astragalus combined with renin-angiotensin-aldosterone system blockers in the treatment of stage III diabetic nephropathy: a systematic review and meta-analysis.
OBJECTIVE
To determine the efficacy and safety of Astragalus combined with renin-angiotensin-aldosterone system (RAAS) blockers in treating stage III diabetic nephropathy (DN) by meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, Wiley, and Web of Science databases were searched for articles published between August 2007 and August 2022. Clinical studies on Astragalus combined with RAAS blockers for the treatment of stage III DN were included. Meta-analysis was performed by RevMan 5.1 and Stata 14.3 software.
RESULTS
A total of 32 papers were included in this meta-analysis, containing 2462 patients from randomized controlled trials, with 1244 receiving the combination treatment and 1218 solely receiving RAAS blockers. Astragalus combined with RAAS blockers yielded a significantly higher total effective rate (TER) (mean difference [MD] 3.63, 95% confidence interval [CI] 2.59-5.09) and significantly reduced urinary protein excretion rate (UPER), serum creatinine (Scr), blood urine nitrogen (BUN) and glycosylated hemoglobin (HbAlc) levels. In subgroup analysis, combining astragalus and angiotensin receptor blocker significantly lowered fasting plasma glucose (FPG) and 24 h urinary protein (24hUTP) levels, compared with the combined astragalus and angiotensin-converting enzyme inhibitor treatment. Meanwhile, the latter significantly decreased the urinary microprotein (β-MG). Importantly, the sensitivity analysis confirmed the study's stability, and publication bias was not detected for UPER, BUN, HbAlc, FPG, or β-MG. However, the TER, SCr, and 24hUTP results suggested possible publication bias.
CONCLUSIONS
The astragalus-RAAS blocker combination treatment is safe and improves outcomes; however, rigorous randomized, large-scale, multi-center, double-blind trials are needed to evaluate its efficacy and safety in stage III DN.
Topics: Humans; Diabetic Nephropathies; Angiotensin-Converting Enzyme Inhibitors; Renin-Angiotensin System; Drug Therapy, Combination; Angiotensin Receptor Antagonists; Astragalus Plant; Randomized Controlled Trials as Topic; Drugs, Chinese Herbal; Treatment Outcome; Creatinine; Glycated Hemoglobin; Proteinuria
PubMed: 38836372
DOI: 10.1080/0886022X.2024.2359033 -
Frontiers in Endocrinology 2024The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health...
INTRODUCTION
The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients.
METHODS
We performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts.
RESULTS
The incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57-1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001).
CONCLUSION
Results suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient's receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic.
Topics: Humans; COVID-19; Amputation, Surgical; Male; Female; Retrospective Studies; Middle Aged; Aged; Social Deprivation; Diabetic Foot; Incidence; Pandemics; SARS-CoV-2; Aged, 80 and over
PubMed: 38836223
DOI: 10.3389/fendo.2024.1304436