Editor- In-Chief: Shaw Watanabe, MD, PhD Title proper: Diabetes Research – Open Journal Subject: Pathology Publisher: Openventio Publishers Dates of publication: 2016 Frequency & Medium: Monthly, Online Language: English Country: India Indexed by: CROSSREF , ROAD , THE KEEPERS Title DOI of the Journal: http://doi.org/10.17140/issn.2379-6375
Dietary Supplements: A Survey of the Opinion of First-Year Professional Pharmacy Students
Introduction Pharmacists need to be at the forefront in advising consumers of dietary supplements (DS) about quality, claims, labeling, safety, efficacy, DS-drug interactions, and other aspects. Yet, the knowledge base of pharmacists and pharmacists-in-training about DS appears to be below expectation. Objective The goal of the study is to evaluate pharmacy student opinions about DS. Methodology A survey questionnaire was developed, tested, and distributed among students who were enrolled in the Drug Information class, which is a 2-credit hour mandatory course for all first professional pharmacy students at Howard University, College of Pharmacy. The data was analyzed using SPSS statistical analysis software. Results A total of 42 students (15 male, 27 female) participated in the survey. Of these, 25 respondents (59.5%) felt comfortable about their knowledge of DS, while only 14 (33.4%) reported participation in counselling (p=0.0281). Most respondents (29; 69%) had used DS in the past, while 21 (50%) claimed they used DS at the time of the survey. To a specific query in the questionnaire regarding lycopene-containing food items, 28 (66.7%) agreed they would use such foods in the future for health benefits. Analysis of the survey data revealed no statistical differences between the responses of male and female students (p>0.05 for all the five questionnaire items). Conclusion In a survey of 42 pharmacy students at Howard University College Pharmacy, over half (59.5%) felt comfortable about their knowledge of DS. About one-third students (33%) reported they were involved in patient counseling and interaction. Over two-third respondents (69%) took DS in the past, while half were taking DS at the time of the survey.
Dual Action Mechanism of Insulin Resistance and Insulin Secretion by Imeglimin for Diabetic Treatment
Imeglimin (Twymeeg) is novel oral hypoglycemic agent (OHA) developed in the glimin category. It has dual action mechanisms of reducing insulin resistance and increasing insulin secretion. Trials of imeglimin for efficacy and safety 1 (TIMES 1), TIMES 2 and TIMES 3 were performed with significant clinical efficacy. Among them, HbA1c decrease for 52 weeks showed single imeglimin -0.46%, combined therapy of dipeptidyl peptidase-4i (DPP-4i)-0.92%, Glucagon-like peptide-1 receptor agonists (GLP-1RA)-0.12% and insulin -0.63%. From physiological and pharmacological points of view, the mechanism may include the enhancement action of glucose-stimulated insulin secretion (GSIS). For GSIS progress, transient receptor potential melastatin 2 (TRPM2) channel is activated.
Trials of imeglimin for efficacy and safety 2 (TIMES 2)
Glucose-stimulated insulin secretion (GSIS)
First Year Student Pharmacists’ Views on the Opioid Epidemic
Objective To determine first-year student pharmacists’ views on the opioid epidemic. Methods First-year pharmacy students were asked to complete an online survey to assess their views and opinions on the current opioid crisis using Likert-scale type questions. Results Forty-four pharmacy students were surveyed, and all participants completed survey questions, 100% response rate. Majority of participants were female (N=34, 77.3%), with more than half of participants falling in the age range of 18-24 (N=25, 56.8%). Geographically, most of the participants home residences are in other states out of the DC, Maryland, Virginia (N=25, 56.9%). In addition, majority of participants worked before starting pharmacy school (N=42, 95.5%) and a majority had a pharmacy and healthrelated occupations before pharmacy school (N=36; 81.9%). Most study participants reported an annual income of less than $10,000 (N=17, 38.6%) and obtained a bachelor’s degree (N=26, 59.1%). Majority of participants strongly agree that the opioid epidemic is becoming a severe crisis for society (N=42; 95.5%) and that opioid should be readily available when it is medically necessary to people (N=27; 61.4%). When asked if they know anyone personally who suffers from the opioid crisis, over three-quarter (N=34; 77.3%) said no. However, over two-third (N=29; 65.9%) of participants said that they have taken opioids in the past themselves to relieve pain. Although, almost all of them strongly agree that prescription opioids are addictive (N=42; 95.5.%); about eighty percent (N=35; 79.5%) agree that taking opioids is an effective way to alleviate severe pain. Conclusion Our results indicate that pharmacy students perceive the opioid epidemic as a crisis and despite their views that opioids are addictive and knowing someone who suffers from opioid use disorder, they believe opioids are a clinically effective way to alleviate pain.
Improved Insulin Resistance and Glucose Variability by Super-Low Carbohydrate Diet
Background Diabetes mellitus (DM) has been more prevalent. American Diabetes Association (ADA) proposed the Standards of Medical Care in Diabetes-2022. For nutritional therapy, low carbohydrate diet (LCD) has been recognized for its benefits. Authors have continued diabetic research concerning LCD and meal tolerance test (MTT). Case Presentation The case is 61-year-old male with type 2 diabetes mellitus (T2DM) for years. His hemoglobin A1c (HbA1c) increased to 7.8% in autumn 2021, and further evaluation and treatment was conducted including LCD, daily check of meal and carbohydrate amount, 75 g OGTT, glucagon stimulation test (GST) and others. Results He was on super-LCD method including 12% of carbohydrate. His carbohydrate intake amount and 45-minutes post-prandial blood glucose showed significant correlation. The results of 75 g OGTT twice in May 2020 and December 2021 showed that similar pattern of glucose and insulin responses and insulinogenic index (IGI). In contrast, they showed decreased fasting immuno-reactive insulin (IRI) and Homeostasis model assessment insulin resistance (HOMA-R). For GST, C-peptide showed normal response. Discussion and Conclusion Judging from the results of MTT, OGTT, GST and IGI, he seems to show rather decreased insulin resistance by LCD associated with preserved insulin secretion ability to some degree. Further investigation would be required from pathophysiological point of view.
Homeostasis model assessment insulin resistance (HOMA-R)
Lycopene for Hypertension and Factors Affecting Its Use: A Survey of Pharmacy Students
Purpose To better understand and assess the potential obstacles to the adoption of lycopene for treating high blood pressure. Methods A cross-sectional observational study was conducted by administering a survey to 42 Howard University College of Pharmacy students. Descriptive statistics and risk estimates were calculated using statistical package for social studies (SPSS) software. Results Only 33.3% of students had ever heard of lycopene, and lycopene knowledge score was poor among 88% of respondents. Non- D.C. residence, dietary supplement use and the belief that dietary supplements such as lycopene interact with prescription drugs and should be used cautiously, were all correlated with a lesser risk of having poor lycopene knowledge. Annual income >$40,000 was correlated with a greater risk of being in the poor lycopene knowledge group. Despite this data, 59.5% report that will incorporate more lycopene into their diet. Conclusion Lycopene knowledge is generally poor among the observed cohort; however, this does not seem to be a great obstacle in the path of adoption.
Why 100-Years After the Discovery of Insulin and the Appearance of Insulin-Induced Lipodystrophy: Are We Still Struggling with this Nasty Complication?
Since a century ago, insulin extracted from the animal pancreas has been used for therapeutic purposes. Lipoatrophy (LA) lesions came up first due to the impurities of preparations. However, as technology has progressed, we have had more purified insulin preparations available, now reduced to less than 5%. The 95% of local complications was represented by lipohypertrophy (LH), due to the recourse to narrow areas of skin, reuse of the same needle, injection of cold insulin. The average frequency of LH in the world is 47%, with peaks of 75%, reflecting the inappropriate educational activity of the diabetic teams. In this brief review, the causes of this failure are described, and feasible rehabilitative solutions are proposed.
Can Weight Bearing Aerobic Exercise be Done Safely with an Active Diabetic Plantar Foot Ulcer and Can It Improve Healing Time
Diabetic foot ulcer (DFU) is a huge economic burden on the National Health Service (NHS). Research on the benefits of aerobic exercise on the vascular system in diabetics is vast, however research on the benefits of aerobic exercise on diabetics with active plantar DFU is slim. The purpose of this review is to determine whether weight bearing aerobic exercise can be safely undertaken with an active plantar DFU and whether exercise can in fact improve ulcer healing time. Method Five papers that included patients with active DFU taking part in weight bearing or semi weight bearing aerobic exercise programmes >10-weeks were found and reviewed. Findings Non weight bearing or semi-weight bearing exercise in the presence of DFU alongside severe diabetic neuropathy (DN) is safer and more feasible in the aim to try and stop the regression of diabetic complications. It has not been concluded whether aerobic exercise improves ulcer healing time. Proposal A pre-test, post-test randomized controlled trial (RCT), 30 participants (15 male, 15 female) with type 2 diabetics (T2D) and active plantar DFU, recruited from the Peter Mount Diabetes and Endocrine clinic at the Manchester Royal Infirmary, randomized into an evenly split intervention group/control group. Intervention group will take part in fully supervised 12-week semi weight bearing aerobic/resistance-based exercise programme: 3×per week working at 40-60% heart rate reserve (HRR) (Karvonen method) at the rehabilitation gym, Manchester Royal Infirmary (MRI). Participants will wear a removable air cast walker or equivalent. Monthly motivational interviewing and bi-weekly foot checks will be undertaken. Control group will continue usual wound care plan from the diabetic clinic. Outcome Measures: Baseline, 6, 12-weeks: transparent ruler measurement, toe brachial pressure index (TBPI) toe pressures, SPO2, ankle brachial index (ABI), fasting blood glucose (FBG), blood cholesterol levels, Semmes monofilament test, blood pressure (BP), body mass index (BMI). Statistically analysed by statistical package for social sciences (SPSS) version 28 at p<0.05.
Impact of Type I Diabetes Mellitus and Associated Biopsychosocial Stressors on Mental Health on Indian and Hispanic Children
Type 1 diabetes mellitus (T1DM) affects children worldwide, with the highest concentrations in India and the United States (U. S.). Estimates project a potential incidence increase of up to 107% by 2040. Caused by an immune disorder destroying pancreatic cells, T1DM requires strict lifestyle adjustments. This paper focuses on this disease's physical, cultural, and economic challenges to mental health among Indian and Hispanic youth and their families. Evidence Acquisition The authors reviewed recent scholarly literature on type 1 diabetes (T1D) as it relates to mental health among Indian and Hispanic populations aged 18 years or younger. The authors performed a comprehensive search on the PubMed database. After reviewing the retrieved studies, the authors examined 18 fully relevant papers, focusing on the studies’ important quantitative and qualitative findings, methods, results and conclusions. Results Financial and emotional burdens of T1D affect Indian and Hispanic families. Many families spend a significant amount of their income on diabetes care. Depression was prevalent among T1D patients, especially in Latinos/Hispanics, and was associated with suicidal ideation. Hispanic caregivers, in particular, face cultural challenges and social isolation. Conclusion Type 1 diabetes creates multiple challenges for Hispanic/Latino and Indian youth and their families. Economic struggles and high treatment costs increase the risk of hospitalization and frequent doctor visits. Adolescents risk developing eating disorders that exacerbate mental health challenges. The burden typically falls on the whole family rather than just the individual diagnosed, indicating that standard mental health interventions become routine for pre-adult patients and their families.
Effect of GlucoSEB™ Supplement on the Blood Glucose Level in Diabetic Patients: A Case Study
Diabetes is becoming a globally prevalent disease that puts a burden on healthcare systems and poses challenges to risk management. Diabetes leads to microvascular and macrovascular complications. Therefore, maintaining normoglycemia is essential to improving the quality of life and preventing morbidity and mortality in people with diabetes (PwD). A current study was performed to check the effect of GlucoSEB™ supplement on the blood glucose level of Type 2 diabetes mellitus (T2DM) patients. Subjects in this study were blinded to the treatment; they received a placebo for the initial seven days, followed by GlucoSEB™ for the next seven days. Blood glucose was monitored with a continuous glucose monitoring (CGM) device. Administration of GlucoSEB™ caused a decrease in blood glucose level, glucose area under the curve (AUC), and an improvement in time in range (TIR). Also, GlucoSEB™ was well tolerated by all the patients, indicating the safety of the supplement. Thus, GlucoSEB™ supplementation positively influenced blood glucose parameters and helped curb blood glucose excursions.
Elevated White Blood Cell Count is Associated with Higher Hemoglobin A1C in Diabetic Patients from Bangladesh
Background Diabetes mellitus (DM) is associated with altered white blood cell (WBC) and glycated hemoglobin dysfunction. Aim In this study, we were aimed to compare the status of hemoglobin, glycated hemoglobin and WBC level between diabetic and nondiabetic patient’s group. Methods This study was conducted in the medicine department of Women’s Medical College and Hospital, Sylhet, Bangladesh. The number of participants was 142. All the patients enrolled were informed verbally about the study and written consent was taken from each patient. Ethical permission was obtained from the institute. All of the tests were performed according to the procedure adopted in the hospital for routine uses. Among the participants, 71 (male 47, female 24) were diagnosed as type-2 diabetics (T2DM) and the other was non-diabetes (male 32 and female 39). Results During this study, diabetic patients showed increased hemoglobin (Hb) and WBC level in diabetic blood than non-diabetic one. It has been supported by the study that, HbA1c is remarkably greater than that of New Delhi metallo-β-lactamase 1 (NDM-1) patients. So, our assumptions could be concluded as; diabetes mellitus is an inflammatory condition itself, which may play role in increased HbA1c and WBC count. Conclusion Therefore, elevated WBC count is independently associated with worsening of glucose metabolism and HbA1c may ameliorate the chronic low-grade inflammation such as type-2 diabetics (T2DM).
Current Perspectives for Oral Hypoglycemic Agents with Clinical Evidence of Larger Studies
Current reports for oral hypoglycemic agents (OHAs) are described. As to the association of dipeptidyl peptidase-4 inhibitors (DPP- 4i) and bullous pemphigoid (BP), odds ratio (OR) was vildagliptin 5.08, linagliptin 2.87, sitagliptin 1.29 (not significant). Regarding the comparative study between SGLT2i and DPP-4i, SGLT2i group showed lower hazard ratio (HR) as MACE 0.76, myocardial infarction 0.82, cardiovascular death 0.60, heart failure 0.43, all-cause mortality 0.60. Semaglutide showed reduced OR for cardiovascular death than exenatide 0.47, dulaglutide 0.46, albiglutide 0.45, lixisenatide 0.43. SGLT2i showed reduction risk of HR for MACE 0.90, hospitalization for heart failure (HHF)/cardiovascular death 0.78, renal outcomes 0.62.
Sodium glucose cotransporter-2 inhibitor (SGLT-2i)
Major adverse cardiovascular event (MACE)
Skin Autofluorescence a Non-Invasive Biomarker of Advanced Glycation End-Products and Its Association to Metabolic Parameters in a Greek Diabetic Population
This cross-sectional study aims to evaluate the association between advanced glycation end-products (AGEs) accumulation, assessed by skin autofluorescence (SAF) measured using the AGE Reader, and the prevalence of several metabolic variables in a diabetic population. Methods The measurement of SAF has become a non-invasive method of assessing the accumulation of AGEs as a marker of the long-term impact of glycemic and oxidative stress in humans. In contrast to blood glucose and to hemoglobin A1C (HbA1c), which reflect a short period of glucose levels, the AGE is a marker of the metabolic legacy effect and reflect a long period of glucose levels. AGEs play a pivotal role in the development and progression of diabetic complications. SAF has been validated as a simple, non-invasive method for assessment of AGEs accumulation in the body. Results In this study 100 diabetic patients were participated. We non-invasively measured SAF, in all the participants using the AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). We also measured the body mass index (BMI), the blood pressure and the patients underwent arterial duplex sonogram (Doppler examination) in the legs at the level of the ankle and calculated the ankle-branchial index (ABI), which is an important index for diagnosing peripheral artery disease, which is a severe complication of diabetes. The SAF was positive correlated with age, duration of diabetes and systolic blood pressure (BP) and was negative correlated with ABI. Conclusion The measurement of SAF has become a non-invasive and reliable method of assessing the accumulation of AGEs in humans. In contrast to blood glucose and to HbA1c, which reflect a short period of glucose levels, the AGEs reflect a long period of glucose levels, correlate with certain metabolic parameters and with peripheral artery disease.
Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet
Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(<86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research.
Antihyperglycemic Mechanisms of Allium sativum, Citrus sinensis and Persea americana Extracts: Effects on Inhibition of Digestive Enzymes, Glucose Adsorption and Absorption on Yeast Cells and Psoas Muscles
Background Mechanisms by which some plants with antihyperglycemic effects reduce postprandial hyperglycemiaare not fully elucidated. This study was designed to investigate some action mechanisms of extracts from stem bark of Citrus sinensis, seeds of Persea americana and bulbs of Allium sativum including in vitro inhibition of α-amylase and invertase; glucophagic capacity, absorption capacity on yeast cells and psoas tissues. Methods Ethanolic (EE) and aqueous (AE) extracts were tested on α-amylase and invertase activities. Glucose remaining in the medium was measured after direct interactions of: Glucose-extracts; Glucose-yeast-extracts and Glucose-psoas-extracts at different doses 0, 5, 7.5, 10 mg/ml. Results All extracts inhibited invertase with IC50 varying from 1.92 to 4.81 mg/ml for Allium sativum extracts. α-amylase was inhibited by EE C. sinensis (IC50=0.063 vs 2.73 mg/ml for arcabose) and not by EE of A. sativum and EE of P. americana. Glucophagic capacity of extracts varied signicanty from 47.55 % of AE P. americana (5 mg/ml) to 100% with C. sinensis (5 mg/ml). All extracts stimulated glucose uptake (p<0.05) from 2.62 % AE C. sinensis (2.5 mg/ml) to 54.74% for EE of Persea americana (10 mg/ml). All extracts enhanced glucose uptake by psoas tissues increasing absorption capacity to up to 38.56 % with A. sativum (10.45% insulin, p<0.05). Conclusion Cumulative actions of each plant extract on inhibition of carbohydrates’ digestive enzymes, adsorption of glucose in intestine and blood, stimulation of glucose uptake and insulin action on yeast cells and psoas tissues, contribute to lower hyperglycemia and diabetes related complications. Therefore, extracts from the plants could be good candidates for diabetes therapy.
Deep Venous Thrombosis in an Amputated Limb Stump of a Diabetic Patient: A Case Report
Deep venous thrombosis (DVT) in an amputated stump is potentially life-threatening but rarely diagnosed and there are limited data in sub-Saharan Africa. This is aimed at demonstrating an additional vascular risk in patients with lower limb amputation and diabetes. A 74-year-old man who had a right above knee amputation done on account of grade 5 right diabetic foot with post-operative prophylactic anticoagulation. Doppler ultrasound done before the surgery showed bilateral multiple lower limb arteries atherosclerosis but no evidence of deep venous thrombosis. He was discharged home on Zimmer frame. Three months after, he was noticed to have differential swelling of the right amputation stump. Thigh circumference measured at 15 cm below the anterior superior iliac spine was 55 cm and 50 cm on the right and left respectively there was but no differential warmth or tenderness. The vital signs were relatively stable. Doppler ultrasound scan of the lower limbs showed an echogenic thrombus in the right deep femoral vein. He was commenced on therapeutic dose of subcutaneous enoxaparin. DVT in an amputated stump is uncommonly encountered. It may not have classical clinical findings. Poor mobility and pooling of venous blood in the amputated stump are some of the risk factors that have been reported. DVT in an amputated stump in a patient with diabetes is rare and may not present classically. It may be one of the potential reasons for the increased mortality after lower limb amputation.
Profile of Blood Glucose in Diabetic Patient Suffered from Diabetic Foot Osteomyelitis with Effective Low Carbohydrate Diet
The case was 52-year-old female with type 2 diabetes mellitus (T2DM) for 10-years. She complained of the decreased sensation of right lower foot, and revealed diabetic foot infection (DFI) and/or diabetic foot osteomyelitis (DFO) at right 1st proximal phalanx. Various data included body mass index (BMI) 33.3 kg/m2, HbA1c 11.4%, blood glucose 430 mg/dL, WBC 12100 /μL, C-reactive Protein (CRP) 13.5 mg/dL. On admission (day 1), she was started by 4 times of injection (Aspart and Glargin) with glucose profile 200-500 mg/dL. Surgical amputation of the right toe was performed between 1st metatarsal and proximal phalanx (day 17). Then, blood glucose profile decreased moderately. After discharge of the hospital, super-Low Carbohydrate Diet (LCD) was started without Aspart (day 37). Consequently, glucose profile was normalized with HbA1c 6.3% on (day 77). Consequently, LCD was evaluated to be effective for glucose variability in this case and some related discussion was described.
Japanese LCD promotion association (JLCDPA)
International Working Group on the Diabetic Foot (IWGDF)
Recent Tendency of Therapeutic Medical Agents for Diabetic Peripheral Neuropathic Pain
Recently, elder patients tend to have neuropathic pain such as lower back and joints pain, stiff shoulders, besides diabetic neuropathy. Typical peripheral neuropathic pain includes diabetic peripheral neuropathic pain (DPNP), postherpetic neuralgia (PHN) and chronic pain due to herniated disc. Three analgesic agents are described. Pregabalin (Lyrica®) has been prevalent worldwide. However, it has been provided for several diseases for off-label administration, which has been one of the clinical problems.Mirogabalin (Tarlige®) has revealed efficacy for DPNP in a dose-dependent manner. Duloxetine hydrochloride (Cymbalta ®) has efficacy for pain and also depression as serotonin and noradrenaline reuptake inhibitor (SNRI).
Diabetic peripheral neuropathic pain (DPNP).
The Interrelationship of Menopause and Type 2 Diabetes Mellitus
Menopause is a critical time in a woman’s life which heralds the cessation of reproductive competence. There is body fat redistribution which increases the risk of type 2 diabetes mellitus (T2DM). There is a complex interrelationship between menopause and T2DM; several variables like the timing of the menopause, the type of menopause and the symptomatology impact this relationship. The treatment of vasomotor symptoms with hormone replacement therapy may also impact glycemia both in women with and without pre-existing T2DM. We tried to examine this relationship based on current scientific evidence. We also suggested strategies to reduce the burden of T2DM in menopausal women.
Coronavirus Disease-2019, Diabetes and Dialysis: An Internal Medicine Conundrum Proposal for a Suitable and Easy-to-Handle Prevention Protocol
Background Frail populations burdened with chronic diseases can get more severe forms of coronavirus disease-2019 (COVID-19) and have a higher mortality rate. Aim To test the efficacy of a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) containment protocol in patients with endstage renal disease (ESRD) diabetes mellitus (DM) requiring dialysis, who are a typical example of the above category. Methods The protocol included: (i) daily telephone COVID-19 related triage for patients and their general practitioners (GPs); (ii) social distancing; (iii) environment sanitization, including ambulances, transfer vans, medical equipment, patient/health personnel clothing, and individual protection devices; (iv) adoption of quota systems for patients allowed to the dialysis room, and increased time lags among dialysis shifts. Eight hundred twenty-five (825) patients on dialysis (315 with and 510 without DM), and 381 healthcare providers (HCPs) were monitored continuously from the start of the pandemic until the end of the lockdown. Results No HCPs were infected, while only two patients on dialysis were positive for SARS-CoV-2: one with DM, who died in intensive care, and one without DM, who recovered at home. The adopted contagion containment protocol proved to be effective for both HCPs and patients. Conclusion Therefore, we propose it as a useful model for any internal medicine or ESRD specialized units dealing with patients on dialysisoriented with or without DM.
Coronavirus Disease-2019, Diabetes and Dialysis in Southern Italy: The Second Wave Follow-up
Background After the official coronavirus (severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)) pandemic declaration by the World Health Organization (WHO), Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our National Health Service (NHS) again. Aim To assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium dialysis centers (DCs) as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors. Methods 381 HCP members underwent regular monitoring on April 1 and November 13, 2020. Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean±SD:853±30 per month; range 825 to 873) vs (11.8% in April, and 14.8% in November vs. a pre-coronavirus disease-2019 (COVID-19) 12.0% rate in January). Results More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic’s two periods showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Conclusion The previously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The author, discuss possible reasons and put forward further suggestions for the best handling of any future infection waves.
Effect of Music Therapy as an Adjunct in Management of Diabetic Foot Ulcer
Diabetes mellitus is a chronic debilitating metabolic disorder which, when it involves the foot, is one of the most dreaded complications associated with increased morbidity and mortality. Various treatment modalities are used for the treatment of diabetic ulcer. Better wound care and control of blood sugar levels helps in preventing amputation and limb loss. Here we discuss a case of diabetic foot ulcer in which music therapy was used as an adjunct modality of treatment.
Fatty Acid Escape Hypothesis: The Pathway to Type-2 Diabetes
Background Obesity and Type 2 diabetes mellitus (T2DM) are closely related such that together these are generally called diabesity, the underlying causes of which revolve around the functioning of insulin. Methods PubMed was searched using the following Mesh [(“Adipocytes/classification”[Mesh] OR “Adipocytes/cytology”[Mesh] OR “Adipocytes/ metabolism”[Mesh] OR “Adipocytes/pathology” [Mesh] OR “Adipocytes/physiology”[Mesh]) OR “Fatty acids (FA)” [Mesh]. Results The interaction of insulin with the whole body systems is extensive and resistance to insulin can occur due to multiple reasons including sepsis, Cushing’s syndrome, or even with pregnancy. In this review of literature, our focus is primarily on insulin resistance that is associated with obesity. Insulin promotes lipogenesis in the liver and promotes glucose uptake by skeletal muscles and adipose tissues. Also, insulin inhibits lipolysis in adipose tissue to allow triacylglycerides (TAG) storage in the anhydrous droplet form. When insulin resistance ensues, the delicate balance will tilt to a self-enabling cycle that culminates in the development of T2DM “Diabesity”. Conclusion This review of literature also discusses the hypothetical cascade of defective expansion of adipose tissue due to fatty acids escape, chronic inflammatory state, and ectopic fat deposition in the omentum, liver and skeletal muscles that underlie the pathogenesis of this disease process.
Hereditary Contribution Towards Development of Type 2 Diabetes Mellitus among Indian Population
Objective Diabetes Mellitus Type II is becoming a major disorder. This study describes the inheritance of type 2 diabetes mellitus in families with diabetes. Methods The study was conducted in Manipur in two districts i.e., Imphal-east and Thoubal among Muslim families. These families were considered for the present study in which one or more family members had diabetes and were involved as active participants. Results On tracing the genealogies of each family, a higher percentage of the participants with diabetes inherited the disease from their fathers. Conclusions This finding would be helpful in future research by implementing among different communities.
Latent Autoimmune Diabetes in Adults (LADA) in Recent Clinical Practice
Diabetic patients have been increasing and this tendency has become a medical and social problem worldwide.1 There are some types of diabetes, in which the prevalence of type 2 diabetes mellitus (T2DM) has been higher without requiring insulin treatment. On the other hand, type 1 diabetes mellitus (T1DM) has acute onset due to virus infection. Under such circumstances, there is a disease that has been clinically important in recent years. It is Latent autoimmune diabetes in adults (LADA). As to LADA, there are both clinical and immunological characteristics between T2DM and T1DM. The genesis of T1DM has been the autoimmune destruction of islet β-cells in the pancreas. There are some major anti-islet autoantibodies, such as glutamic acid decarboxylase autoantibody (GADA), and T1DM shows a high prevalence of GADA.
Rationale Diagnostic Criteria of the Metabolic Syndrome
Purpose Metabolic syndrome is a preceding risk of diabetes, hypertension and/or dyslipidemia, so the diagnosis of metabolic syndrome is important for further treatment. In 2005, the international diabetes foundation (IDF) reported a new diagnostic criterion of metabolic syndrome, making abdominal obesity an essential factor required in the diagnosis. Waist circumference (WC) is used as a surrogate marker of abdominal obesity, but it is defined based on the national cutoff point of each country. This study examined the validity of diagnostic criteria ofmetabolic syndrome, especially focusing on the different criteria of WC, for international standardization. Method We compared the efficacy of our previous weight-loss intervention by Japanese and IDF criteria by reanalyzing Saku control obesity program (SCOP). In IDF, the cutoff point of WC for men is 90 cm and 80 cm for women. On the contrary, the cutoff point of WC is 85 cm for men and 90 cm for women in Japan. Factors for diagnosis was evaluated, and the prevalence of metabolic syndrome at baseline and 1 year later was compared by the different diagnostic criteria. Result and Discussion In Japanese criteria, the rate of metabolic syndrome among men decreased from 100% to 97.3%, and among women 96.6% to 88.6%. However, when we applied the IDF criteria, the rate of metabolic syndrome among men decreased from 97.4% to 88.5%, and among women 100% to 100%. These results suggested that the prevalence of metabolic syndrome by IDF criteria is underdiagnosis in men and over-diagnosis in women compared to the Japanese criteria. Japanese cutoff point is calculated by the computed tomography (CT) scan data in which 100 cm2 abdominal fat area corresponds to nearly 100 cm WC. The standardization of diagnostic criteria is important to compare the efficacy of intervention and prevention of diseases between countries.
Rice Function for Disease Prevention and Establishment of Medical Rice Association
When I visited Bangkok in Thailand about five years ago, I saw the label “medical rice” on a package of ‘diabetes and health promotion’ rice, and I was hopeful that the concept could be widened beyond Thailand. On December 10-12, 2014, the “East Asia Functional Standardization of Rice Conference” was held at Kyoto Research Park to promote the idea among related countries. Since then, I am considering what is “medical rice”.1 To say ‘medical rice’ we need evidence from human studies. We have learned of the health effects of unpolished brown rice, genmai in Japanese, from Japanese history. Sagen Ishizuka (1850-1909) was a pioneer doctor in the Imperial Japanese Army who proposed the concepts of shokuiku (eating education) and the macrobiotic diet. He was one of the first to investigate the nutritional value of whole grains as well as kelp, radish, and kudzu.2 In Kenji Miyazawa’s famous poem “Unbeaten by rain, Unbeaten by wind”, his daily intake “With a handful brown rice a day, miso and a small amount of vegetable suffice” was confirmed to contain all necessary daily nutrients by our recalculation
“East Asia Functional Standardization of Rice Conference” was
Attenuated Efficacy of Dulaglutide in Elder Type 2 Diabetes Mellitus (T2DM) Cases
Acute increase of type 2 diabetes mellitus (T2DM) is a serious medical problem. Recently, an agent known as Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was developed for T2DM which has remarkable efficacy and safety profile. In this article, we reported 2 T2DM cases with dulaglutide treatment, showing interesting clinical course. Case 1 is an 88-year-old man with hypertension, arteriosclerosis and mild cognitive impairment (MCI) without difficulties of Quality of Life (QOL)/Activities in Daily living (ADL) in daily life. He has been rather stable on liraglutide with HbA1c 7.2%. After switching from liraglutide to dulaglutide, HbA1c decreased to 6.7% in 2 months, but later increased to 11.3% in 3 months. C-peptide index (CPI) decreased from 2.5 to 0.8. Case 2 is an 83-year-old man and was treated by degludec with CPI 1.35. After switching to dulaglutide, HbA1c decreased to 7.6% in 2 months, but later increased to 10.3% in 2 months. These two cases revealed similar clinical course. Some possibilities might be speculated, including antibody production, differences of GLP-1 RAs from man-origin or lizard-origin, changes in body weight, a possible complication of renal, hepatic inflammatory influences and the subacute decreased ability of insulin secretion in the β cells. The current report would be useful for treatment of GLP-1 RAs in the future.
Low Protein Brown Rice for Preventing Progression of CKD and DKD to End Stage Renal Failure
Chronic kidney disease (CKD) is pervasive into aging society, affecting permanent implications on patients’ life. Approximately 10% of the global population has CKD, and millions die each year. The prevalence of CKD was high in Latin America, Europe, East Asia and the Middle East, where approximately 12% of the population has CKD.1 Diabetic kidney disease (DKD) or diabetic nephropathy (DN) is a part of CKD when the patients have diabetes.2 Both CKD and DKD may progressively fall from a normal estimated glomerular filtration rate (eGFR >90 ml/min/1.73 m2) to less than 15, at which point the patient becomes end-stage kidney disease (ESKD). The status of DKD could be estimated by measuring the amount of urinary protein and the serum creatinine, which can be used to calculate the eGFR.
urinary protein and the serum creatinine
More Significant Life for Diabetic Patients in the Perspectives of Anti-Aging
For the patients with diabetes, basal daily lifestyle would be considered in the light of meal, exercise, rest, alcohol intake, smoking and oral health. These six factors are from the concept as a basic direction of “Health Japan 21” for comprehensive implementation of national health promotion.1 Satisfactory control of lifestyle can lead to protection and treatment of diabetes and successful anti-aging. From this implication, to check up physical and mental condition would be important and helpful in clinical practice.
Ocular Health Screening in a Type 1 Diabetes Mellitus Population
Background: Type 1 Diabetes Mellitus is among the most common conditions worldwide, affecting nearly 95 million children worldwide. One of the detrimental effects of this condition can be vision loss. Comprehensive annual ocular screenings can have an important role in early detection and management of vision-threatening complications. Over 2,200 family members and children with diabetes type 1 (www.childrenwithdiabetes.com) from Australia, Asia, Canada, Europe, Latin America and the United States of America attended an annual meeting where participants wishing to undergo a full ocular wellness screening had to pre-register for this weeklong activity. Methods: Sixteen (16) volunteer screeners made up of second year medical students, allied health care specialist, physician optometrist and ophthalmologist participated in this yearly event since 2007. Ocular wellness screening involved several stations where participants went through 8 stations, which included personal/family health history, visual acuity (Snellen visual chart), non-contact auto-tonometry for measurement of intra-ocular pressure, automated-refractor, and optical coherence tomography angiography (OCT and OCTA). The last station was a Canon non-mydriatic retinal camera used to acquire an anterior segment, as well as 45-degree fundus color and mono-chromatic auto fluorescence images (FAF). Results: Two hundred and sixteen (216) participants or 10% of the attendees (average age 21-years-old) underwent this screening event at the Disney Property in Orlando, Florida. Forty-one (41) participants had some retinal hemorrhages findings including microaneurysms, dot hemorrhages, flame hemorrhages and Intraretinal Microvascular Abnormalities (IrMa). Fifty-six (56) cases had varying levels of nuclear sclerosis. Three on-site readers evaluated all collected data and counseled families on findings. Participants with proliferative diabetic retinopathy findings or macular edema seen on OCT were referred to a remote off-site board-certified ophthalmologist through a secure line following Digital Imaging and Communications in Medicine (DICOM) and Health Insurance Portability and Accountability Act (HIPPA) protocols and recommended for further workup or treatment by the participant’s eye-care professional. Conclusions: Creating a safe and comprehensive yearly ocular screening for children with type 1 diabetes mellitus along with a positive learning experience for can improve the lives of those living with type 1 diabetes and their families. Early detection, prevention and management of vision threatening diseases (VTDs) insures the affected individual can safeguard their vision.