-
Medicina (Kaunas, Lithuania) Nov 2022Background: There is a link between diabetic peripheral neuropathy (DPN) progression and the increase in the cross-sectional area (CSA) of the tibial nerve at the ankle.... (Review)
Review
Background: There is a link between diabetic peripheral neuropathy (DPN) progression and the increase in the cross-sectional area (CSA) of the tibial nerve at the ankle. Nevertheless, no prior meta-analysis has been conducted to evaluate its usefulness for the diagnosis of DPN. Methods: We searched Google Scholar, Scopus, and PubMed for potential studies. Studies had to report tibial nerve CSA at the ankle and diabetes status (DM, DPN, or healthy) to be included. A random-effect meta-analysis was applied to calculate pooled tibial nerve CSA and mean differences across the groups. Subgroup and correlational analyses were conducted to study the potential covariates. Results: The analysis of 3295 subjects revealed that tibial nerve CSA was 13.39 mm2 (CI: 10.94−15.85) in DM patients and 15.12 mm2 (CI: 11.76−18.48) in DPN patients. The CSA was 1.93 mm2 (CI: 0.92−2.95, I2 = 98.69%, p < 0.01) larger than DPN-free diabetic patients. The diagnostic criteria of DPN and age were also identified as potential moderators of tibial nerve CSA. Conclusions: Although tibial nerve CSA at the ankle was significantly larger in the DPN patients, its clinical usefulness is limited by the overlap between groups and the inconsistency in the criteria used to diagnose DPN.
Topics: Humans; Diabetic Neuropathies; Ultrasonography; Tibial Nerve; Ankle; Ankle Joint; Diabetes Mellitus
PubMed: 36556898
DOI: 10.3390/medicina58121696 -
Frontiers in Endocrinology 2022The role of gut microbiota in diabetes mellitus (DM) and its complications has been widely accepted. However, the alternation of gut microbiota in diabetic microvascular... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The role of gut microbiota in diabetes mellitus (DM) and its complications has been widely accepted. However, the alternation of gut microbiota in diabetic microvascular complications (DC) remains to be determined.
METHODS
Publications (till August 20, 2022) on gut microbiota in patients with DC were retrieved from PubMed, Web of Science, Embase and Cochrane. Review Manager 5.3 was performed to estimate the standardized mean difference (SMD) and 95% confidence interval (CI) and calculate alpha diversity indices and the relative abundance of gut microbiota between patients in DC v.s. DM and DC v.s. healthy controls (HC).
RESULTS
We included 13 studies assessing 329 patients with DC, 232 DM patients without DC, and 241 HC. Compared to DM, patients with DC shared a significantly lower Simpson index (SMD = -0.59, 95% CI [-0.82, -0.36], p < 0.00001), but a higher ACE index (SMD = 0.42, 95% CI[0.11, 0.74], p = 0.009). Compared to HC, DC patients held a lower ACE index (SMD = -0.61, 95% CI[-1.20, -0.02], p = 0.04). The relative abundances of phylum Proteobacteria (SMD = 0.03, 95% CI[0.01, 0.04], p = 0.003, v.s. HC) and genus (SMD = 0.00, 95% CI[0.00, 0.00], p < 0.00001, v.s. HC) were enriched, accompanying with depleted abundances of phylum Firmicutes (SMD = -0.06, 95% CI[-0.11, -0.01], p = 0.02, v.s. HC), genera (SMD = -0.01, 95% CI[-0.02,-0.01], p < 0.0001, v.s. DM), (SMD = -0.01, 95% CI[-0.02, -0.00], p = 0.009, v.s. DM; SMD = -0.02, 95% CI[-0.02, -0.01], p < 0.00001, v.s. HC) and (SMD = 0.00, 95% CI[-0.00, -0.00], p < 0.00001, v.s. HC) in DC.
CONCLUSIONS
Gut microbiota perturbations with the depletion of alpha diversity and certain short-chain fatty acids (SCFAs)-producing bacteria were associated with the pathology of DC. Therefore, gut microbiota might serve as a promising approach for the diagnosis and treatment of DC. Further investigations are required to study the mechanisms by which gut dysbiosis acts on the onset and progression of DC.
Topics: Humans; Gastrointestinal Microbiome; Diabetes Mellitus, Type 2; Bacteria
PubMed: 36545341
DOI: 10.3389/fendo.2022.1053900 -
Diabetes Research and Clinical Practice Jan 2023This study sought to provide up-to-date pooled global estimates of diabetes-related amputation incidence from 2010 to 2020. (Meta-Analysis)
Meta-Analysis Review
AIMS/HYPOTHESIS
This study sought to provide up-to-date pooled global estimates of diabetes-related amputation incidence from 2010 to 2020.
METHODS
Embase and Medline databases were searched for studies reporting the incidence rate (IR) of diabetes-related amputations from 2010 to 2020. IR estimates of diabetes-related amputations with associated 95% confidence interval (CI) per 100,000 individuals with diabetes were calculated.
RESULTS
23 studies were included, reporting 505,390 diabetes-related lower extremity amputations. IR of minor amputations was 139.97 (95% CI 88.18-222.16) per 100,000 individuals with diabetes, among patients with type 1 diabetes was 148.59 (95% CI 65.00-339.68) and in type 2 diabetes was 75.53 (95% CI 29.94-190.54). IR of major amputations was 94.82 (95% CI 56.62-158.80) per 100,000 individuals with diabetes, among patients with type 1 diabetes was 100.76 (95% CI 53.71-189.01) and among type 2 diabetes was 40.58 (95% CI 11.03-149.28). There were 83.84 annual amputations (95% CI 41.67-168.65) per 100,000 women with diabetes and 178.04 (95% CI 81.16-390.55) per 100,000 men.
CONCLUSIONS
Globally, annual incidence of diabetes-related amputations from 2010 to 2020 has shown to disproportionately affect men and individuals with type 1 diabetes mellitus, although its incidence is not uniform across countries.
Topics: Male; Humans; Female; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 1; Incidence; Amputation, Surgical; Lower Extremity; Diabetic Foot
PubMed: 36464091
DOI: 10.1016/j.diabres.2022.110194 -
International Wound Journal Aug 2023Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of... (Review)
Review
Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched for trials comparing ESWT plus standard care to standard care alone in participants with DFUs. Search results were reviewed by two independent reviewers. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. The primary outcome was time to healing. The search identified 345 papers after duplicates removed. Six trials consisting of 471 participants were included. There was unclear or high risk of bias across all domains. Time to ulcer healing was probably shorter in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). Patients treated with ESWT were more likely to heal at 20 weeks post-ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). There was significant heterogeneity. ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.
Topics: Humans; Diabetic Foot; Extracorporeal Shockwave Therapy; Treatment Outcome; Wound Healing; Diabetes Mellitus
PubMed: 36461894
DOI: 10.1111/iwj.14035 -
International Journal of Environmental... Nov 2022This systematic review aims at providing an overview of the state of the art regarding smart wearable systems (SWS) applications to monitor the status of patients... (Review)
Review
This systematic review aims at providing an overview of the state of the art regarding smart wearable systems (SWS) applications to monitor the status of patients suffering from vascular disorders of the lower extremity. Peer-reviewed literature has been analyzed to identify employed data collection methods, system characteristics, and functionalities, and research challenges and limitations to be addressed. The Medline (PubMed) and SCOPUS databases were considered to search for publications describing SWS for remote or continuous monitoring of patients suffering from intermittent claudication, venous ulcers, and diabetic foot ulcers. Publications were first screened based on whether they describe an SWS applicable to the three selected vascular disorders of the lower extremity, including data processing and output to users. Information extracted from publications included targeted disease, clinical parameters to be measured and wearable devices used; system outputs to the user; system characteristics, including capabilities of remote or continuous monitoring or functionalities resulting from advanced data analyses, such as coaching, recommendations, or alerts; challenges and limitations reported; and research outputs. A total of 128 publications were considered in the full-text analysis, and 54 were finally included after eligibility criteria assessment by four independent reviewers. Our results were structured and discussed according to three main topics consisting of data collection, system functionalities, and limitations and challenges.
Topics: Humans; Wearable Electronic Devices; Monitoring, Physiologic; Delivery of Health Care; Diabetic Foot; Lower Extremity
PubMed: 36429951
DOI: 10.3390/ijerph192215231 -
Frontiers in Pharmacology 2022In recent years, people pay more and more attention to diabetic peripheral neuropathy (DPN). As a neurotrophic agent, mecobalamin is able to repaire nerves, which has...
The efficacy and safety of mecobalamin combined with Chinese medicine injections in the treatment of diabetic peripheral neuropathy: A systematic review and Bayesian network meta-analysis of randomized controlled trials.
In recent years, people pay more and more attention to diabetic peripheral neuropathy (DPN). As a neurotrophic agent, mecobalamin is able to repaire nerves, which has already become a consensus among experts. However, it has been found that mecobalamin has poor effect to increase nerve conduction velocity, which is an important indicator. Clinical data have shown that Chinese medicine injection, combined with mecobalamin injection, can significantly improve nerve conduction velocity of the limbs. Nevertheless, several kinds of Chinese medicine injections have been used to treat DPN. The effect of these Chinese medicine injections for DPN are various. Therefore, it is necessary to evaluate the effectiveness of Chinese medicine injections combined with mecobalamin in the treatment of DPN. All relevant articles published before 12 March 2022 were searched in eight electronic databases. Randomized controlled trials (RCTs) on Chinese medicine injections plus Mecobalamin for DPN were identified according to inclusion criteria, and were assessed using the revised Cochrane risk of bias tool (ROB2.0). R software and stata15 was used to create the ranking probabilities and network meta-analysis. A total of 80 RCTs involving 6,980 patients were included. The results showed that mecobalamin plus Dengzhanxixin injection (ME + DZXX) ranked first in overall response rate [RR = 1.64, 95% CI (1.26, 2.21)] and median motor nerve conduction velocity [MD = 9.46, 95% CI (5.67, 13.28)]. Then, mecobalamin plus Kudiezi Injection (ME + KDZ) had the best effect in median sensory nerve conduction velocity [MD = 10.41, 95% CI (-13.31, -7.52)], and mecobalamin plus Honghua injection (ME + HH) ranked highest in common peroneal motor nerve conduction velocity [MD = 6.8, 95% CI (4.13, 9.49)] and common peroneal sensory nerve conduction velocity [MD = -6.25, 95% CI (-8.85, -3.65)]. This study determined the efficacy of different Chinese medicine injections combined with mecobalamin. DZXX may be the best adjunctive Chinese medicine injection for DPN patients. However, due to potential risk of bias and limited RCTs, our results need to be treated with reservations.
PubMed: 36408262
DOI: 10.3389/fphar.2022.957483 -
Journal of Diabetes and Metabolic... Dec 2022Peripheral sensory and motor nerves are often affected in people with diabetes mellitus (DM), and balance problems are widespread. Diabetic peripheral neuropathy is... (Review)
Review
BACKGROUND
Peripheral sensory and motor nerves are often affected in people with diabetes mellitus (DM), and balance problems are widespread. Diabetic peripheral neuropathy is common. This study investigated the impact of exercise treatment on balance parameters in diabetic peripheral neuropathy patients.
METHOD
Electronic databases, such as PubMed, Web of Science, and Science Direct, were used to perform a search of accessible papers. The search strategy was (exercise therapy OR physical activity) AND (balance OR equilibrium OR postural control OR fall OR fall risk OR static balance OR dynamic balance OR functional balance) AND diabetic peripheral neuropathy. The Physiotherapy Evidence Database (PEDro) scale was used to rate the research in this review for its quality and reliability. Scores ranged from 5 to 9 on the PEDro scale.
RESULT
According to databases, about 9,103 articles were found in August 2021 from March 1984 to February 2020. From 9103 articles, 3872 were deleted for different reasons, including duplicate, non-randomized controlled trial (RCT) articles and after reviewing the title and abstract. About 5,231 articles were found in free full text. In the end, 12 submissions were approved. These studies investigated the effects of exercise treatment on static, dynamic, and functional balance parameters in diabetic peripheral neuropathy patients.
CONCLUSIONS
This study showed the positive effects of balance and strengthening exercise on static balance indices in patients with diabetic peripheral neuropathy.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40200-022-01077-1.
PubMed: 36404857
DOI: 10.1007/s40200-022-01077-1 -
Frontiers in Public Health 2022We aimed to determine the pooled prevalence of diabetic foot ulcers in Pakistan. MEDLINE (PubMed), Web of Science, Google scholars, and local databases were... (Meta-Analysis)
Meta-Analysis
We aimed to determine the pooled prevalence of diabetic foot ulcers in Pakistan. MEDLINE (PubMed), Web of Science, Google scholars, and local databases were systematically searched for studies published up to August 10, 2022, on the prevalence of foot among diabetic patients in Pakistan. Random-effects meta-analysis was used to generate summary estimates. Subgroup analysis and meta-regression models were used to address the issue of high heterogeneity. Two authors independently identified eligible articles, collected data, and performed a risk of bias analysis. Twelve studies were included in the meta-analysis (14201, range 230-2199, diabetic patients), of which 7 were of "high" quality. The pooled prevalence of diabetic foot ulcers was 12.16% (95% CI: 5.91-20.23%). We found significant between-study heterogeneity (I = 99.3%; < 0.001) but no statistical evidence of publication bias ( = 0.8544). Subgroup meta-analysis found significant differences in foot ulcer prevalence by publication year and by the duration of diabetes. An increasing trend was observed during the last two decades, with the prevalence of diabetic foot ulcers being the highest in the latest period from 2011 to 2022 (19.54%) than in the early 2000 s (4.55%). This study suggests that the prevalence of diabetic foot ulcers in Pakistan is relatively high, with significant variation between provinces. Further study is required to identify ways for early detection, prevention, and treatment in the population.
Topics: Humans; Diabetic Foot; Prevalence; Pakistan; Diabetes Mellitus
PubMed: 36388315
DOI: 10.3389/fpubh.2022.1017201 -
BMJ Open Nov 2022Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes.
METHODS
We systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the prevalence of five diabetes complications.
RESULTS
In total, 109 studies with a total of 63 890 participants (53.3% being females) were included in the meta-analysis. Most of the studies were conducted in Eastern African countries (n=44, 40.4%). The pooled proportion of attainment of an optimal HbA1c, BP and LDLC goal was 27% (95% CI 24 to 30, I=94.7%), 38% (95% CI 30 to 46, I=98.7%) and 42% (95% CI 32 to 52, I=97.4%), respectively. The pooled prevalence of diabetic peripheral neuropathy, retinopathy, diabetic nephropathy, peripheral arterial disease and foot ulcers was 38% (95% CI 31 to 45, I=98.2%), 32% (95% CI 28 to 36, I=98%), 31% (95% CI 22 to 41, I=99.3%), 19% (95% CI 12 to 25, I=98.1%) and 11% (95% CI 9 to 14, I=97.4%), respectively.
CONCLUSION
Attainment of optimal diabetes treatment goals, especially HbA1c, in adult patients with type 2 diabetes in Africa remains a challenge. Diabetes complications, especially diabetic peripheral neuropathy and retinopathy, are highly prevalent in adult populations with type 2 diabetes in Africa.
Topics: Adult; Female; Humans; Male; Glycated Hemoglobin; Diabetic Neuropathies; Diabetes Mellitus, Type 2; Diabetic Foot; Africa; Retinal Diseases; Peripheral Arterial Disease
PubMed: 36351737
DOI: 10.1136/bmjopen-2022-060786 -
Journal of Nursing Management Nov 2022The aim of this review is to examine the effectiveness of artificial intelligence in predicting multimorbid diabetes-related complications.
AIM
The aim of this review is to examine the effectiveness of artificial intelligence in predicting multimorbid diabetes-related complications.
BACKGROUND
In diabetic patients, several complications are often present, which have a significant impact on the quality of life; therefore, it is crucial to predict the level of risk for diabetes and its complications.
EVALUATION
International databases PubMed, CINAHL, MEDLINE and Scopus were searched using the terms artificial intelligence, diabetes mellitus and prediction of complications to identify studies on the effectiveness of artificial intelligence for predicting multimorbid diabetes-related complications. The results were organized by outcomes to allow more efficient comparison.
KEY ISSUES
Based on the inclusion/exclusion criteria, 11 articles were included in the final analysis. The most frequently predicted complications were diabetic neuropathy (n = 7). Authors included from two to a maximum of 14 complications. The most commonly used prediction models were penalized regression, random forest and Naïve Bayes model neural network.
CONCLUSION
The use of artificial intelligence can predict the risks of diabetes complications with greater precision based on available multidimensional datasets and provides an important tool for nurses working in preventive health care.
IMPLICATIONS FOR NURSING MANAGEMENT
Using artificial intelligence contributes to a better quality of care, better autonomy of patients in diabetes management and reduction of complications, costs of medical care and mortality.
Topics: Humans; Artificial Intelligence; Bayes Theorem; Diabetes Mellitus; Quality of Life
PubMed: 36329678
DOI: 10.1111/jonm.13894