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Background: Assess the intake of carbohydrate quality and their association with cardiovascular risk factors among diabetes subtypes. Methods: Participants of the German Diabetes Study (GDS) (recent-onset diabetes (n = 487) and 5-years thereafter (n = 209)) were allocated into severe autoimmune diabetes (SAID, 35%), severe insulin-deficient diabetes (SIDD, 3%), severe insulin-resistant diabetes (SIRD, 5%), mild obesity-related diabetes (MOD, 28%), and mild age-related diabetes (MARD, 29%). Dietary glycemic index (GI), glycemic load (GL), and intake of higher- (≥ 55) and low-GI (< 55) foods, dietary fiber, and total sugar were derived from a validated food frequency questionnaire and cross-sectionally associated with cardiovascular risk factors (blood lipids, subclinical inflammation, blood pressure, fatty liver index) using multivariable linear regression analysis for subtypes with prevalences ≥ 10%. Results: Intake of carbohydrate quality parameters was broadly comparable between the subtypes. Among SAID higher total sugar intake was associated with lower HDL-cholesterol (ß (95% CI) relative change per 1 SD increment: − 3.4% (− 6.7; − 0.1)). No clear associations were seen among MOD. Among MARD, a higher dietary GL and higher-GI carbohydrate intake were associated with higher serum triglycerides (10.9% (2.4; 20.1), 12.4% (3.9; 21.5)) and fatty liver index (absolute change: 0.18 (0.06; 0.31), 0.17 (0.05; 0.28)) and lower HDL-cholesterol (− 4.1% (− 7.6; − 0.4), − 4.4% (− 7.8; − 0.8)), whilst higher intake of low-GI carbohydrates and dietary fiber were associated with lower high-sensitivity C-reactive protein (− 16.0% (− 25.7; − 5.1), − 13.9% (− 24.2; − 2.2)). Conclusions: Associations of carbohydrate quality parameters with blood lipids, subclinical inflammation, and fatty liver index differed between diabetes subtypes. However, evidence is too preliminary to derive subtype-specific recommendations. Trial registration: Clinicaltrials.gov: NCT01055093. [ABSTRACT FROM AUTHOR]

Abstract Aims Understanding the healthcare access challenges facing diabetic patients in low- and middle-income countries is very important. The present study investigated the association between availability (physical access) and affordability (economic access) to diabetes healthcare services and the frequency of diabetes-related complications. Methods A cross-sectional survey study was conducted between February and May 2023 in Qazvin, Iran. Using convenience sampling, 373 type 2 diabetic patients (mean age = 57.99 years; SD = 11.71) referred to diabetic specialists’ clinics were surveyed. Demographic characteristics, physical access to diabetes healthcare services, economic access to diabetes healthcare services, and frequency of diabetes-related complications (FDRCs) were assessed. Data were assessed using linear regression analysis. Results The mean total access score to healthcare services was 17.71 (out of 30; SD ± 4.21; range 6–30). Patients who had more access to healthcare services had less diabetes-related complications (p

The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target for hemoglobin A1c (HbA1c) of ≤6.5% (48 mmol/mol) is recommended for those who have access to advanced diabetes technologies like continuous glucose monitoring and automated insulin delivery. This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53 mmol/mol). The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target for hemoglobin A1c (HbA1c) of ≤6.5% (48 mmol/mol) is recommended for those who have access to advanced diabetes technologies like continuous glucose monitoring and automated insulin delivery. This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53 mmol/mol). [ABSTRACT FROM AUTHOR]

Introduction Diabetes is a chronic metabolic disorder characterized by impaired insulin secretion and action. Risk factors for diabetes include age, obesity, low physical activity, hypertension, lipid disorders, and genetic predisposition. Symptoms of diabetes typically include frequent urination, weight loss, excessive thirst, weakness, fatigue, susceptibility to fungal infections and recurrent boils. Diabetes is a prevalent and significant societal concern, often causing anxiety, uncertainty and a sense of danger upon diagnosis. Aim of the study The aim of the study is to provide a comprehensive analysis of diabetes, including its classification, characteristic symptoms, the most frequently occurring diabetes-related complications, and preventive strategies. Through a detailed discussion of these issues, our goal is to increase public awareness of diabetes and provide readers with comprehensive knowledge about this disease. Material and method This article presents the current state of knowledge about diabetes. A literature review was conducted using the PubMed, Google Scholar and Web of Science databases, utilizing keywords such as "diabetes", "diabetes mellitus", "diabetes complications". Results The number of people with diabetes has continued to rise. Scientists predict that in a few decades, this number could reach more than half a billion globally. Many individuals may not realize that they are at risk for this civilization disease, often due to unhealthy lifestyle choices such as smoking, obesity, and lack of physical activity. Early initiation of treatment is crucial in preventing serious complications. Despite living with diabetes for years, some patients still report insufficient knowledge about their condition. Therefore, educating patients about the nature of the disease and its treatment is essential for improving their quality of life. [ABSTRACT FROM AUTHOR]

BackgroundTaiwan implemented global hospital budgeting with a floating-point value, which created a prisoner's dilemma. As a result, hospitals increased service volume, which caused the floating-point value to drop to less than one New Taiwan Dollar (NTD). The recent increase in the number of hospital beds and the call to enhance the floating-point value to one NTD raise concerns about the potential for increased financial burden without adding value to patient care if hospitals expand their bed capacity for volume-based competition. The present study aimed to examine the relationship between the supply of hospital beds and hospitalizations following an emergency department (ED) visit (called ED hospitalizations) by using diabetes-related ambulatory care sensitive conditions (ACSCs) that are preventable and discretionary as an example.MethodsThe study was a pooled cross-sectional design analyzing 2011–2015 population-based claims data in Taiwan. The dependent variable was a dummy variable representing an ED hospitalization, with a treat-and-leave ED visit as the reference group. The key independent variable is the number of hospital beds per 1,000 populations. Multivariate logistic regression models with and without a clustering function were used for the analyses.ResultsApproximately 59.26% of diabetes-related ACSCs ED visits resulted in ED hospitalizations. The relationship between the supply of hospital beds and ED hospitalizations was statistically significant (OR = 1.12; 95% CI: 1.09–1.14; P < 0.001) in the model without clustering but was statistically insignificant in the model with clustering (OR = 1.03; 95% CI: 0.94–1.12; P > 0.05). Several social risk factors were positively associated with the likelihood of ED hospitalizations, such as low income and the percentage of the population without a high school diploma. In contrast, other factors, such as female patients and the Charlson comorbidity index, were negatively associated with the likelihood of ED hospitalizations.ConclusionUnder hospital global budgeting with a floating-point value mechanism, increases in hospital beds likely motivate hospitals to admit ED patients with preventable and discretionary conditions. Our study emphasizes the urgent need to add value-based incentive mechanisms to the current global budget payment. The value-based incentive mechanisms may encourage providers to focus on quality of patient care by addressing social risk factors rather than engage in volume-based competition, which would improve population health while reducing preventable ED visits and hospitalizations.

Abstract Diabetic retinopathy (DR), a well-known microvascular complication of diabetes mellitus, remains the main cause of vision loss in working-age adults worldwide. Up to now, there is a shortage of information in the study regarding the contributing factors of DR in diabetes. Accumulating evidence has identified glycemic variability (GV), referred to fluctuations of blood glucose levels, as a risk factor for diabetes-related complications. Recent reports demonstrate that GV plays an important role in accounting for the susceptibility to DR development. However, its exact role in the pathogenesis of DR is still not fully understood. In this review, we highlight the current landscape and relevant mechanisms of GV in DR, as well as address the mechanism-based therapeutic strategies, aiming at better improving the quality of DR management in clinical practice.

Diabetic retinopathy (DR), a well-known microvascular complication of diabetes mellitus, remains the main cause of vision loss in working-age adults worldwide. Up to now, there is a shortage of information in the study regarding the contributing factors of DR in diabetes. Accumulating evidence has identified glycemic variability (GV), referred to fluctuations of blood glucose levels, as a risk factor for diabetes-related complications. Recent reports demonstrate that GV plays an important role in accounting for the susceptibility to DR development. However, its exact role in the pathogenesis of DR is still not fully understood. In this review, we highlight the current landscape and relevant mechanisms of GV in DR, as well as address the mechanism-based therapeutic strategies, aiming at better improving the quality of DR management in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Utility values are used in health economic modeling analyses of type 2 diabetes (T2D) to quantify the effect of acute and long-term complications on quality of life (QoL). For accurate modeling projections, it is important that the utility values used are up to date, accurate and representative of the simulated model cohort. Methods: A literature review was performed to identify utility values for health states representing acute and chronic T2D-related complications including cardiovascular complications, stroke, renal disease, ophthalmic complications, neuropathy, diabetic foot, amputation and hypoglycemia. Searches were performed using the PubMed, Embase and Cochrane Library databases and limited to articles published since 2010. Supplementary searches were performed to identify data published at congresses in 2019–2023. Results: A total of 54 articles were identified that reported utility values for T2D-related complications. The most frequently used elicitation method/instrument was the EQ-5D (n = 42 studies) followed by the Short Form-6 dimensions (n = 6), time tradeoff (n = 5), the Health Utilities Index Mark 2 or Mark 3 (n = 2), 15D (n = 1), visual analog scale (n = 1) and standard gamble (n = 1). Stroke and amputation were consistently associated with the largest decrements in QoL. There is a lack of published data that distinguishes between severity of several complications including renal disease, retinopathy and neuropathy. Conclusions: Diabetes-related complications can have a profound impact on QoL; therefore, it is important that these are captured accurately and appropriately in health economic models. Recently published utility values for diabetes-related complications that can be used to inform health economic models are summarized here. [ABSTRACT FROM AUTHOR]

Background: Prolonged hyperglycemia causes diabetes-related micro- and macrovascular complications, which combined represent a significant burden for individuals living with diabetes. The growing scope of evidence indicates that hyperglycemia affects the development of vascular complications through DNA methylation. Methods: A genome-wide differential DNA methylation analysis was performed on pooled peripheral blood DNA samples from individuals with type 1 diabetes (T1D) with direct DNA sequencing. Strict selection criteria were used to ensure two age- and sex-matched groups with no clinical signs of chronic complications according to persistent mean glycated hemoglobin (HbA1c) values over 5 years: HbA1c<7% (N=10) and HbA1c>8% (N=10). Results: Between the two groups, 8385 differentially methylated CpG sites, annotated to 1802 genes, were identified. Genes annotated to hypomethylated CpG sites were enriched in 48 signaling pathways. Further analysis of key CpG sites revealed four specific regions, two of which were hypermethylated and two hypomethylated, associated with long non-coding RNA and processed pseudogenes. Conclusions: Prolonged hyperglycemia in individuals with T1D, who have no clinical manifestation of diabetes-related complications, is associated with multiple differentially methylated CpG sites in crucial genes and pathways known to be linked to chronic complications in T1D. [ABSTRACT FROM AUTHOR]

Due to the increasing number of patients suffering from diabetes mellitus scientists raise awareness of different symptoms that patients might present. The disease results from a defect in insulin secretion or action. Chronic hyperglycemia in diabetes causes damage and dysfunction of organs, especially the eyes, kidneys, nerves, heart and blood vessels. Diabetes can occur at any age and always requires treatment. A common non-specific symptom of untreated DM may be osteoarticular complications. Typical symptoms of diabetes include polyuria, increased thirst, dehydration, weakness and drowsiness. Complications of the disease include eyes, kidneys, nerves, microangiopathies, diabetic foot syndrome, bones, joints, skin. In all patients, the most important thing is to control glycemia from the beginning of the disease. The following article is an overview of the current knowledge on the correlation of diabetes with osteoarticular complications, its pathomechanism and metabolic control. The article was based on publications available in the Pubmed and Google Scholar databases. [ABSTRACT FROM AUTHOR]

To assess diabetes-related complications, glycemic levels, and healthcare utilization 12 months after exposure to therapeutic inertia among patients with type 2 diabetes mellitus (T2D). This retrospective cohort study analyzed data from the OneFlorida Clinical Research Consortium (electronic health records from Florida practices/clinics). The cohort included adult patients (≥18 years old) with T2D who had an HbA1c≥7.0% (53 mmol/mol) recorded from January 1, 2014-September 30, 2019. Therapeutic inertia (exposed vs. not exposed) was evaluated during the six months following HbA1c≥7.0% (53 mmol/mol). The outcomes assessed during the 12-month follow-up period included diabetes-related complications (continuous Diabetes Complications and Severity Index (DCSI)), glycemic levels (continuous follow-up HbA1c lab), and healthcare utilization counts. We analyzed data using multivariable regression models, adjusting for covariates. The cohort included 26,881 patients with T2D (58.94% White race, 49.72% female, and mean age of 58.82 (SD=13.09)). After adjusting for covariates, therapeutic inertia exposure was associated with lower DCSI (estimate=−0.14 (SE=0.03), p < 0.001), higher follow-up HbA1c (estimate=0.14 (SE=0.04), p < 0.001), and lower rates of ambulatory visits (rate ratio=0.79, 95% CI=0.75–0.82). Findings communicate the clinical practice implications and public health implications for combating therapeutic inertia in diabetes care. • Therapeutic inertia was studied among nearly 27,000 patients with type 2 diabetes. • Diabetes-related complications/severity scores were associated with therapeutic inertia. • HbA1c lab values were higher among patients exposed to therapeutic inertia. • Patients experiencing therapeutic inertia had lower rates of ambulatory visits. • Findings add timely, real-world evidence from electronic health records. [ABSTRACT FROM AUTHOR]

Differences of dietary pattern adherence across the novel diabetes endotypes are unknown. This study assessed adherence to pre-specified dietary patterns and their associations with cardiovascular risk factors, kidney function, and neuropathy among diabetes endotypes. The cross-sectional analysis included 765 individuals with recent-onset (67 %) and prevalent diabetes (33 %) from the German Diabetes Study (GDS) allocated into severe autoimmune diabetes (SAID, 35 %), severe insulin-deficient diabetes (SIDD, 3 %), severe insulin-resistant diabetes (SIRD, 5 %), mild obesity-related diabetes (MOD, 28 %), and mild age-related diabetes (MARD, 29 %). Adherence to a Mediterranean diet score (MDS), Dietary Approaches to Stop Hypertension (DASH) score, overall plant-based diet (PDI), healthful (hPDI) and unhealthful plant-based diet index (uPDI) was derived from a food frequency questionnaire and associated with cardiovascular risk factors, kidney function, and neuropathy using multivariable linear regression analysis. Differences in dietary pattern adherence between endotypes were assessed using generalized mixed models. People with MARD showed the highest, those with SIDD and MOD the lowest adherence to the hPDI. Adherence to the MDS, DASH, overall PDI, and hPDI was inversely associated with high-sensitivity C-reactive protein (hsCRP) among people with MARD (β (95%CI): −9.18 % (−15.61; −2.26); −13.61 % (−24.17; −1.58); −19.15 % (−34.28; −0.53); −16.10 % (−28.81; −1.12), respectively). Adherence to the PDIs was associated with LDL cholesterol among people with SAID, SIRD, and MOD. Minor differences in dietary pattern adherence (in particular for hPDI) and associations with markers of diabetes-related complications (e.g. hsCRP) were observed between endotypes. So far, evidence is insufficient to derive endotype-specific dietary recommendations. Clinicaltrials.gov: NCT01055093. • The diabetes endotypes showed minor differences in adherence to dietary patterns. • Associations of dietary patterns with cardiovascular risk factors varied among them. • Evidence is still insufficient to derive endotype-specific dietary recommendations. [ABSTRACT FROM AUTHOR]

Jie Li,1,2 Xinyu Nan,1 Yixuan Ma,3 Zhen Wang,4 Hui Fang1,2 1Department of Internal Medicine, Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China; 2Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, 063000, People’s Republic of China; 3Graduate School, Hebei North University, Zhangjiakou, 075000, People’s Republic of China; 4Department of Orthopedics, Handan First Hospital, Handan, 056000, People’s Republic of ChinaCorrespondence: Hui Fang, Department of Endocrinology, Tangshan Gongren Hospital, Tangshan, 063000, People’s Republic of China, Tel +86 13831581838, Email fanghui2818@126.comAbstract: Diabetes mellitus is a metabolic disease characterized by elevated blood glucose due to a deficiency of insulin secretion and/or action. Long-term poor blood glucose control may lead to chronic damage and dysfunction of the heart, kidneys, eyes, and other organs. Therefore, it is important to develop treatments for diabetes and its chronic complications. Fingolimod is a structural sphingosine analogue and sphingosine-1-phosphate receptor modulator currently used for the treatment of relapsing-remitting multiple sclerosis. Several studies have shown that it has beneficial effects on the improvement of diabetes and its chronic complications. This paper reviews the therapeutic potential of Fingolimod in diabetes and its chronic complications, aiming to further guide future treatment strategies.Keywords: fingolimod, diabetes mellitus, diabetes-related complications, treatment

BackgroundProlonged hyperglycemia causes diabetes-related micro- and macrovascular complications, which combined represent a significant burden for individuals living with diabetes. The growing scope of evidence indicates that hyperglycemia affects the development of vascular complications through DNA methylation.MethodsA genome-wide differential DNA methylation analysis was performed on pooled peripheral blood DNA samples from individuals with type 1 diabetes (T1D) with direct DNA sequencing. Strict selection criteria were used to ensure two age- and sex-matched groups with no clinical signs of chronic complications according to persistent mean glycated hemoglobin (HbA1c) values over 5 years: HbA1c8% (N=10).ResultsBetween the two groups, 8385 differentially methylated CpG sites, annotated to 1802 genes, were identified. Genes annotated to hypomethylated CpG sites were enriched in 48 signaling pathways. Further analysis of key CpG sites revealed four specific regions, two of which were hypermethylated and two hypomethylated, associated with long non-coding RNA and processed pseudogenes.ConclusionsProlonged hyperglycemia in individuals with T1D, who have no clinical manifestation of diabetes-related complications, is associated with multiple differentially methylated CpG sites in crucial genes and pathways known to be linked to chronic complications in T1D.

Introduction Diabetes is a chronic metabolic disorder characterized by impaired insulin secretion and action. Risk factors for diabetes include age, obesity, low physical activity, hypertension, lipid disorders, and genetic predisposition. Symptoms of diabetes typically include frequent urination, weight loss, excessive thirst, weakness, fatigue, susceptibility to fungal infections and recurrent boils. Diabetes is a prevalent and significant societal concern, often causing anxiety, uncertainty and a sense of danger upon diagnosis. Aim of the study The aim of the study is to provide a comprehensive analysis of diabetes, including its classification, characteristic symptoms, the most frequently occurring diabetes-related complications, and preventive strategies. Through a detailed discussion of these issues, our goal is to increase public awareness of diabetes and provide readers with comprehensive knowledge about this disease. Material and method This article presents the current state of knowledge about diabetes. A literature review was conducted using the PubMed, Google Scholar and Web of Science databases, utilizing keywords such as "diabetes", "diabetes mellitus", "diabetes complications". Results The number of people with diabetes has continued to rise. Scientists predict that in a few decades, this number could reach more than half a billion globally. Many individuals may not realize that they are at risk for this civilization disease, often due to unhealthy lifestyle choices such as smoking, obesity, and lack of physical activity. Early initiation of treatment is crucial in preventing serious complications. Despite living with diabetes for years, some patients still report insufficient knowledge about their condition. Therefore, educating patients about the nature of the disease and its treatment is essential for improving their quality of life.

Aim: The pathogenesis of chronic diabetes complications has oxidative stress as one of the major elements, and single-nucleotide polymorphisms (SNPs) in genes belonging to antioxidant pathways modulate susceptibility to these complications. Considering that melatonin is a powerful antioxidant compound, our aim was to explore, in a longitudinal cohort study of type 1 diabetes (T1D) individuals, the association of microvascular complications and SNPs in the gene encoding melatonin receptor 1A (MTNR1A). Methods: Eight SNPs in MTNR1A were genotyped in 489 T1D individuals. Besides cross-sectional analyses of SNPs with each one of the microvascular complications (distal polyneuropathy, cardiovascular autonomic neuropathy, retinopathy, and diabetic kidney disease), a longitudinal analysis evaluated the associations of SNPs with renal function decline in 411 individuals followed up for a median of 8 years. In a subgroup of participants, the association of complications with urinary 6-sulfatoxymelatonin (aMT6s) concentration was investigated. Results: The group of individuals with a renal function decline ≥ 5 mLmin-1 1.73 m-2 year-1 presented a higher frequency of the A allele of rs4862705 in comparison with nondecliners, even after adjustment for confounding variables (OR = 1.84, 95% CI = 1.20-2.82; p = 0.0046). No other significant associations were found. Conclusions: This is the first study showing an association between a variant in a gene belonging to the melatonin system and renal function decline in the diabetic setting. [ABSTRACT FROM AUTHOR]

AimThe pathogenesis of chronic diabetes complications has oxidative stress as one of the major elements, and single-nucleotide polymorphisms (SNPs) in genes belonging to antioxidant pathways modulate susceptibility to these complications. Considering that melatonin is a powerful antioxidant compound, our aim was to explore, in a longitudinal cohort study of type 1 diabetes (T1D) individuals, the association of microvascular complications and SNPs in the gene encoding melatonin receptor 1A (MTNR1A).MethodsEight SNPs in MTNR1A were genotyped in 489 T1D individuals. Besides cross-sectional analyses of SNPs with each one of the microvascular complications (distal polyneuropathy, cardiovascular autonomic neuropathy, retinopathy, and diabetic kidney disease), a longitudinal analysis evaluated the associations of SNPs with renal function decline in 411 individuals followed up for a median of 8 years. In a subgroup of participants, the association of complications with urinary 6-sulfatoxymelatonin (aMT6s) concentration was investigated.ResultsThe group of individuals with a renal function decline ≥ 5 mL min−1 1.73 m−2 year−1 presented a higher frequency of the A allele of rs4862705 in comparison with nondecliners, even after adjustment for confounding variables (OR = 1.84, 95% CI = 1.20–2.82; p = 0.0046). No other significant associations were found.ConclusionsThis is the first study showing an association between a variant in a gene belonging to the melatonin system and renal function decline in the diabetic setting.

Due to the increasing number of patients suffering from diabetes mellitus scientists raise awareness of different symptoms that patients might present. The disease results from a defect in insulin secretion or action. Chronic hyperglycemia in diabetes causes damage and dysfunction of organs, especially the eyes, kidneys, nerves, heart and blood vessels. Diabetes can occur at any age and always requires treatment. A common non-specific symptom of untreated DM may be osteoarticular complications. Typical symptoms of diabetes include polyuria, increased thirst, dehydration, weakness and drowsiness. Complications of the disease include eyes, kidneys, nerves, microangiopathies, diabetic foot syndrome, bones, joints, skin. In all patients, the most important thing is to control glycemia from the beginning of the disease

Early and intensive treatment of type 2 diabetes (T2D) has been associated with lower risk of diabetes-related complications. Control of overweight and obesity, which are strongly associated with T2D and many of its complications, is also key in the management of the disease. New therapies allow for individualised glycaemic control targets with greater safety. Thus, in patients with a higher cardiovascular and renal risk profile, current guidelines encourage early treatment with metformin together with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors with proven cardiovascular benefit. GLP-1 RAs combine highly efficacious glucose-lowering activity with a reduced risk of hypoglycaemia. Recently, tirzepatide, a first-in-class drug that activates both glucose-dependent insulinotropic polypeptide and GLP-1 receptors, has demonstrated very high efficacy in glycated haemoglobin (HbA1c) and weight reduction in clinical trials. Tirzepatide has the potential to help people with T2D reach recommended glycaemic and weight targets (HbA1c < 7% and > 5% weight reduction) and to allow some patients to reach HbA1c measurements close to normal physiological levels and substantial weight reduction. In 2022, tirzepatide was approved by the US Food and Drug Administration and the European Medicines Agency for treatment of people with T2D and is currently in development for chronic weight management. Plain Language Summary: In people newly diagnosed with type 2 diabetes, early and intensive treatment of the disease can help control blood sugar and reduce the risk of later complications. The need to control weight in people with obesity and diabetes has also recently become a priority. New drugs developed in recent years allow for better and more individualised management of blood sugar without the risk of blood sugar levels dropping too low. In patients at risk of kidney or heart disease, the current recommendation is early treatment with metformin and drugs with proven cardiovascular benefit. Tirzepatide is a new drug that has also demonstrated very high efficacy in reducing blood glucose and body weight. It has the potential to help people with type 2 diabetes achieve their goals and prevent other diabetes-related complications. It is likely that some patients will even be able to bring their blood glucose to normal levels and lose substantial amounts of weight. The US and European regulatory agencies approved tirzepatide in 2022 for the treatment of type 2 diabetes and it is currently being tested for chronic weight management. [ABSTRACT FROM AUTHOR]

Introduction: LANDMARC (CTRI/2017/05/008452), a prospective, observational real‐world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan‐India regions over a period of 3 years. Methods: Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. Results: Of the 6234 participants enrolled, 5273 completed 3 years follow‐up. At the end of 3‐years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3‐years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c <7%, respectively. At 3‐years, population with macrovascular and microvascular complications had higher proportion of participants with uncontrolled glycemia (78.2% [79/101] and 70.3% [463/659], respectively) than those without complications (61.6% [1839/2985]). Over 3‐years, majority (67.7%–73.9%) of the participants were taking only OADs (biguanides [92.2%], sulfonylureas [77.2%] and DPP‐IV inhibitors [62.4%]). Addition of insulin was preferred in participants who were only on OADs at baseline, and insulin use gradually increased from 25.5% to 36.7% at the end of 3 years. Conclusion: These 3‐year trends highlight the burden of uncontrolled glycemia and cumulative diabetes‐related complications, emphasizing the importance of optimizing diabetes management in India. The 3‐year data from the longitudinal LANDMARC study provide valuable insights on diabetes‐related complications, disease progression and treatment strategies among people with diabetes in India. In this pan‐India study, at the end of 3‐years, 205 (3.29%) and 1121 (18.02%) participants reported macrovascular and microvascular complications, respectively, with nonfatal myocardial infarction (40.0%; n = 82) and neuropathy (81.98%; n = 919) being the most common complications. Despite a gradual improvement in glycemic levels, the burden of uncontrolled glycemia (HbA1c > 7%) was considerable (63.4%; n = 2344). The LANDMARC study emphasizes the need for optimizing disease management and timely intensification of therapy among people with diabetes in India. [ABSTRACT FROM AUTHOR]

Abstract Introduction LANDMARC (CTRI/2017/05/008452), a prospective, observational real‐world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan‐India regions over a period of 3 years. Methods Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. Results Of the 6234 participants enrolled, 5273 completed 3 years follow‐up. At the end of 3‐years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3‐years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c

BackgroundPublic health faces a significant challenge in reducing rural–urban disparities in diabetes. Since dietary control is part of the medical regimen for diabetes management, how diabetic patients perceive the impact of oral health on their quality of life is critical. The present study aimed to compare the Oral Health-related Quality of Life (OHRQoL) between rural and urban diabetic patients.MethodsThe study design was cross-sectional. The study sample included 831 self-reported diabetic patients, extracted from the first wave of the new-cohort Taiwan Longitudinal Study on Aging survey (NC_TLSA) that comprised a nationally representative sample of community-dwelling adults aged 50 and above in Taiwan. The composite score generated from the Oral Health Impact Profile-7 (OHIP-7), which has seven questions, was used to construct two OHRQoL measures, the severity of perceived poor OHRQoL and the prevalence of poor OHRQoL. These two OHRQoL measures were treated as dichotomous variables. Multivariate logistic regression models were applied for analysis.ResultsRural diabetic patients had a higher likelihood of experiencing the severity of perceived poor OHRQoL than those in urban areas (OR = 2.40, 95% CI: 1.30–4.40). Although rural diabetic patients also had a higher prevalence of poor OHRQoL than urban diabetic patients, the difference was not significant (OR = 1.47, 95% CI: 0.95–2.28). Social determinants, such as education, are essential factors attributed to both OHRQoL measures.ConclusionOverall, rural diabetes community-dwelling patients had a poorer OHRQoL than those in urban areas. Given a bidirectional relationship between oral health and diabetes, improving oral health in rural areas may be a critical avenue to improve the quality of diabetes care in rural areas.

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Older people with type 2 diabetes are at an increased risk for macrovascular (damage to arteries that can lead to myocardial infarction or stroke) and microvascular (damage to small blood vessels including retinopathy and nephropathy) disease. Since 2008, newly approved antidiabetic medications have been required to show cardiovascular safety as part of the US Food and Drug Administration approval process. Since this time, new data have emerged regarding the differences between agents in terms of reducing diabetes-related complications. Older people often are at risk for or currently have one or more diabetes-related complication. When managing antidiabetic medication in older people, it is imperative to consider the risk versus benefit of each medication and to use agents that have proven benefits. [ABSTRACT FROM AUTHOR]

Sifiso Mtshali, Ozayr Mahomed Discipline of Public Health Medicine, University of KwaZulu Natal, Durban, South AfricaCorrespondence: Sifiso MtshaliDiscipline of Public Health Medicine, University of KwaZulu Natal, 227 George Campbell Building, Howard College Campus, Durban 4001, South AfricaTel +27-31 260-4382Fax +2731 2604111Email smtshali@wol.co.zaPurpose: Poor diabetes control can result in short- and long-term neuropathic, microvascular, and macrovascular complications. In addition to the socioeconomic impact that diabetes and its complications has on patients, incremental financial costs are added to health-care systems. This study aimed to assess prevalence, patient-related factors, and referral patterns for patients with diabetes-related complications managed at Inkosi Albert Luthuli Central Hospital (IALCH) betweenJanuary 1, 2014 and December 31, 2015.Methods: The retrospective cross-sectional study was done on all adult patients (aged > 18 years) with diabetes consulted at IALCH. Primary outcome measures were the proportion with diabetes-related complications and the source of referrals. Logistic regression analysis was done to identify predictors of diabetes complications.Results: Of all adult diabetes patients consulted, 7,761 (47.4%) presented with one or more diabetes-related complications and 56% (4,321) had experienced macrovascular complications. Cardiovascular complications (2,576, 33%) were the most common complications, followed by peripheral vascular disease (1,755, 23%). Microvascular complications included retinopathy (1,656, 21%), nephropathy (118, 14%), and neuropathy (702, 9%). After multivariate analysis, all four factors (age > 58 years, male sex, Indian ancestry, and non–insulin dependent diabetes mellitus remained statistically significant for an increased likelihood of developing cardiovascular complications. Indian ancestry was not associated with increased odds of peripheral vascular disease.Conclusion: Macrovascular diseases were the main complications. Older age, male sex, Indian ancestry, and non–insulin dependent diabetes mellitus were associated with macrovascular complications. A combination of health-promotion and behaviour-modification programs is required prior to or early in the disease course. Appropriate and more aggressive management at primary-care level using evidence-based clinical guidelines is essential to prevent complications.Keywords: patient referrals, diabetes-related complications, peripheral vascular disease, amputations

Patients with type 2 diabetes mellitus (T2DM) can be affected by clinical inertia, leading to abysmal results. Studies on a suitable timeframe for treatment intensification remain scarce—especially outside of developed countries. This study aimed to explore the association between time to treatment intensification and diabetes-related complications. A database from a tertiary care hospital in Thailand was retrieved in order to conduct a retrospective cohort study for the years 2011–2017. This study comprised outpatients with T2DM presenting an HbA1c of ≥7.0%. Eligible patients were divided into three groups based on the time of treatment intensification: no delayed treatment intensification, treatment intensification within 6 months, and treatment intensification after 6 months. A Cox proportional hazards model was used to investigate the association between time to treatment intensification and diabetes-related complications. A total of 686 patients were included in the final analysis. During 6.5 years of median follow-up, the group with treatment intensification within 6 months was more strongly associated with diabetic nephropathy compared to the group with no delayed treatment intensification (adjusted HR 2.35; 95%CI 1.35–4.09). Our findings reveal that delaying treatment intensification by even 6 months can increase the likelihood of diabetic nephropathy compared to no delayed treatment intensification. We suggest that patients with T2DM whose blood glucose levels are outside the target range promptly receive treatment intensification. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes Mellitus (DM) is an increasingly prevalent worldwide health condition and is a major part of metabolic disorder. The metabolic alterations in DM significantly impact resting metabolic rate (RMR). This study provides comprehensive information on the current understanding of the influence of RMR in DM, which will be helpful for researchers and policymakers to plan and implement preventive measures. Materials and Methods: The relevant articles needed for this literature review were identified through online databases such as Google Scholar, PubMed, Elsevier, Cochrane and DOAJ. Studies that relate to Resting Metabolic Rate and Diabetes Mellitus and/or its related Complications; English language; Full-text articles, and finding that was between the years 2011 to 2021 were included, whereas review articles, thesis and book chapters were excluded. Keywords such as "resting metabolic rate", "basal metabolic rate", "diabetes mellitus", "type 2 diabetes", "resting energy expenditure" and "complications" were used. The searches yielded 835 articles. Results: This review included 11 articles in which the influence of RMR in DM was evaluated. The majority (8/11) of the papers reported higher RMR levels in T2DM patients compared to normal individuals. However, there are no significant predictors to determine the metabolic state of an individual with DM. Conclusion: In summary, RMR levels in diabetic patients were higher, and RMR correlated well with the severity of T2DM-related complications. Measurement of RMR using simple Bioelectrical Impedance Analyzers (BIA) in diabetic clinics, mainly in places lacking resources, can aid as an easy and inexpensive screening method to detect the risk of diabetic complications in uncomplicated T2DM patients. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on the coverage of diabetes mellitus (DM) complications screening in primary healthcare facilities in South Africa (SA). This study assesses the extent of screening for DM complications among individuals with type 2 DM attending primary health facilities in rural Eastern Cape (EC), SA. Methods: The study adopted a descriptive, cross-sectional design and obtained data from 372 individuals with type 2 diabetes attending six selected primary healthcare centres (PHCs) in two EC districts. Demographic and clinical data were obtained through questionnaire-based interviews and reviews of medical records. We assessed the extent of screening for estimated glomerular filtration rate (eGFR), fasting lipogram, eye examination, foot examination and glycated hemoglobin (HbA1c) in the past year. Results: Participants mean age was 62 (standard deviation [s.d.] ± 11) years, and their mean duration of diagnosis was 9 (s.d. ± 8) years. In the past year, HbA1c result was available for 71 (19.1%) of the participants; 60 (16.1%) had eGFR results, while only 33 (8.9%) had documented lipid results. In total, 52 (14.0%) had carried out eye examinations, while only 9 (2.3%) had undergone foot examinations in the past year. About two-thirds of the participants (59.9%) had not undergone any form of complication screening in the past year, and none had undergone the complete screening panel. Conclusion: The coverage of screening for DM complications was low across all indicators. Studies to understand barriers to and facilitators of DM complications screening at PHCs are required. Also, interventions to improve diabetes complication screening in the region are needed and should target the primary healthcare providers. [ABSTRACT FROM AUTHOR]

Abstract Background Tanzania is among the sub-Saharan African countries facing a tremendous increase in the burden of type 2 diabetes mellitus. In order to provide diabetes health care services, the government has established diabetes care clinics in secondary and tertiary healthcare facilities. However, previous studies have demonstrated a disparity in availability of supplies and equipment for provision of diabetes health care services at these healthcare facilities. This study aims to assess the clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania. Methods A cross-sectional study was conducted in Mwanza Region from June to September, 2018.Three hundred and thirty patients were selected by systematic random sampling from three healthcare facilities. A structured questionnaire was utilized to collect information on patient characteristics, health care received and patient perception of care. Patient blood pressure, blood glucose, weight and height were measured during the study. Percentages, chi-square tests and multivariable analysis were conducted to obtain the proportions, make comparisons and determining the correlates of tertiary-level healthcare facility. Results Approximately half of respondents (54.5%) were from secondary healthcare facilities. The prevalence of hypertension (63.3%), hyperglycemia (95.8%) and obesity (93.3%) were high. The prevalence of hyperglycemia was slightly higher at secondary-level healthcare facility (p = 0.005). The proportion of respondents recently diagnosed with diabetes (≤ 10 years) was significantly higher at tertiary-level healthcare facility (p = 0.000). The prevalence of diabetes related complications was higher at tertiary-level healthcare facility (80.7% versus 53.3%, p = 0.000). Assessments of body weight, blood pressure, blood glucose, feet and eye examination were conducted on a monthly basis at all facilities. None of the respondents had undergone lipid profile testing. All of the respondents (100%) received care from a nurse during diabetes clinic visits and half of the respondents (49.7%) also received care from a clinician. Relatively young patients, married and recently diagnosed patients were more likely to attend clinic at tertiary facilities. Tertiary-level healthcare facilities were more likely to have patients with complications and to have a dietitian available at the clinic.

Diabetes mellitus is a known risk factor for the development of multiple subtypes of dementia and mild cognitive impairment. Recent research identifies a cause-specific diabetes-related dementia with a unique set of characteristics. Currently, there is no standard cognitive assessment battery recommended to specifically assess dementia that is a direct consequence of chronic diabetes, and some evaluations have been used for decades with minimal revisions, regardless of appropriateness. We performed a systematic review of the dementia/cognition evaluation methods most commonly used in the literature for assessing diabetic patients and identified which cognitive domains are typically assessed in this setting, and whether cognitive changes were more reflective of a vascular pathology, Alzheimer's pathology, or something else entirely. Search results yielded 1089 articles. After screening for appropriateness, a total of 11 full-text articles were assessed. In general, subjects in the reviewed studies were assessed using a variety of testing methods, examining different combinations of cognitive domains. A standard, clear definition of which cognitive domains are the most important to assess in diabetic patients is needed in order to determine what combination of assessment tools are most pertinent. Given the growing subset of the US population, careful reconsideration of cognitive assessment methods is needed to create self-care plans that take into account a specific collection of cognitive challenges for those with diabetes. [ABSTRACT FROM AUTHOR]

Abstract Background Miniature pigs are attractive animal models for exploring diabetes because they are similar to humans in terms of physiological structure and metabolism. However, little is known about the complications of diabetes in pigs. Methods In this study, a 28‐month observation of a Wuzhishan miniature pig with streptozotocin (STZ)‐induced (120 mg/kg) diabetes was conducted, to investigate diabetes‐related complications and the possibility of self‐recovery in miniature pigs. Blood glucose, serum and urinary biochemistry was measured, and histopathologic examinations of eyes, kidney and pancreas were made. Results During the observation, diabetic complications of eyes and kidney were observed. The eye complications included bilateral cataracts in the 15th month and degeneration of inner retina and microaneurysm in the 28th month. Kidney complications included glomerular mesangial expansion, focal segmental glomerular sclerosis, and renal tubular epithelial degeneration, but no proteinuria was observed. By 28 months after the application of STZ, with no treatment given, blood glucose had recovered and the number of pancreatic islet beta‐cells had increased significantly. Conclusions We showed that the STZ‐induced diabetes model in miniature pigs could accurately mimic the pathological changes of human diabetes, and that pancreatic islet beta‐cell regeneration did occur in an adult miniature pig, providing a new means for exploring diabetic complications and pancreatic islet beta‐cell regeneration.

Background: People with type 1 diabetes often live for many years with different combinations of diabetes-related complications. We aimed to quantify how complication duration and total complication burden affect mortality, using data from national registers.Methods: This study included 33 396 individuals with type 1 diabetes, registered in the Swedish National Diabetes Register at any time between 2001 and 2012. Each individual was followed and classified according to their time-updated diabetes-related complication status. The main outcomes were all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. Poisson models were used to estimate the rate of these outcomes as a function of the time-updated complication duration.Results: Overall, 1748 of the 33 396 individuals died during 198 872 person-years of follow-up. Overall, the time-updated all-cause mortality rate ratio (MRR) was 2.25 [95% confidence interval (CI): 1.99-2.54] for patients with diabetic kidney disease, 0.98 (0.82-1.18) for patients with retinopathy and 4.00 (3.56-4.50) for patients with cardiovascular disease relative to individuals without complications. The excess rate was highest in the first period after a diagnosis of CVD, with an 8-fold higher mortality rate, and stabilized after some 5 years. After diagnosis of diabetic kidney disease, we observed an increase in all-cause mortality with an MRR of around 2 compared with individuals without diabetic kidney disease, which stabilized after few years.Conclusions: In this cohort we show that duration of diabetes-related complications is an important determinant of mortality in type 1 diabetes, for example the MRR associated with CVD is highest in the first period after diagnosis of CVD. A stronger focus on time-updated information and thorough consideration of complication duration may improve risk stratification in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: The problem of type 2 diabetes mellitus and its complications are threateningly increasing in the existing health scenario. The awareness and perception about risk of developing complications and role of self-care practices for glycemic control are very important. This study aimed to develop and validate an educational tool for improving perception about risk of getting complications among patients with diabetes mellitus. Methodology: This mixed method study was conducted in a tertiary hospital. Known risk factors of diabetic complications were identified from literature and drafted based on their strength of association. A panel of eight experts from different departments was constituted to evaluate the risk factors, and the tool was finalised after three rounds using Delphi technique. Content and construct validity of the developed tool were also assessed by the panel. A pilot study among 50 patients with diabetes mellitus was done to assess the effectiveness of the tool. Results: The DiREcT tool developed had 11 risk factors of diabetic complications, each categorised into low, moderate and high risk. On baseline risk assessment, 60% of the participants were in high-risk category for glycemic control. Patient's perception about risk of developing complications increased from 26 to 60% by using the tool. More than 80% of the participants reported that the tool is simple and easy to understand. Conclusion: The DiREcT tool was effective in changing perception of developing complications among patients with diabetes mellitus. It can be used by the healthcare provider at the primary healthcare level for both educating and monitoring of patients with high risk. [ABSTRACT FROM AUTHOR]

Aim and objective Diabetic foot ulcers (DFUs) are a frequent complication of diabetes mellitus, impacting more than one in 10 diabetic patients, with roughly half of these ulcers progressing to infection. Existing literature indicates that these infections are predominantly polymicrobial, with gram-positive isolates being the most common. This microbial profile informs the empiric antibiotic strategies employed in first-world countries, often including highly potent nephrotoxic antibiotics. This retrospective cohort study aims to assess the microbial profile and antibiotic treatment practices in patients with infected DFUs at Ochsner LSU Health Shreveport Academic Medical Center in Shreveport, Louisiana, United States. Materials and methods A total of 115 patients diagnosed with infected DFUs were included in the study. Patient records were reviewed to identify bacterial pathogens cultured from foot wounds, antibiotic treatment regimens administered, and the prevalence of acute kidney injury (AKI). Results The study found a predominance of gram-negative isolates (199; 59.4%), facultative anaerobes (246; 73.4%), and polymicrobial infections (67; 78.8%) in infected DFUs. Vancomycin was administered to 95 patients (82.6%), with only a small number subsequently testing positive for methicillin-resistant Staphylococcus aureus (MRSA). Combination therapy with vancomycin and Zosyn was given to 71 patients (61.7%), which increased the potential risk of antibiotic-induced nephrotoxicity. AKI was prevalent, affecting 58 patients (50.4%). Conclusions This study highlights a discrepancy between the microbial profile of infected DFUs and empiric antibiotic treatment practices at Ochsner LSU Health Shreveport Academic Medical Center. The predominance of gram-negative bacteria underscores the need for a polymicrobial, gram-negative-focused empiric treatment approach. Alternative antibiotics with broad-spectrum coverage and minimal nephrotoxicity, such as ceftriaxone, clindamycin, metronidazole, amoxicillin-clavulanate, and linezolid, should be considered. Tailored antibiotic strategies, guided by local microbial profiles and patient-specific factors, are essential to optimize treatment outcomes in this high-risk population., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Louisiana State University Health Sciences Center Institutional Review Board issued approval STUDY00002245. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Daniel et al.)

BackgroundInsight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.MethodsPubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.ResultsOverall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.ConclusionOverall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.

Background: Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications. Methods: PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias. Results: Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams. Conclusion: Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes. [ABSTRACT FROM AUTHOR]

Early diagnosis and effective management of type 2 diabetes (T2D) are crucial in reducing the risk of developing life-changing complications such as heart failure, stroke, kidney disease, blindness and amputation, which are also associated with significant costs for healthcare providers. However, as T2D symptoms often develop slowly it is not uncommon for people to live with T2D for years without being aware of their condition—commonly known as the undiagnosed missing million. By the time a diagnosis is received, many individuals will have already developed serious complications. While the existence of undiagnosed diabetes has long been recognised, wide-reaching awareness among the general public, clinicians and policymakers is lacking, and there is uncertainty in how best to identify high-risk individuals. In this article we have used consensus expert opinion alongside the available evidence, to provide support for the diabetes healthcare community regarding risk prediction of the missing million. Its purpose is to provide awareness of the risk factors for identifying individuals at high, moderate and low risk of T2D and T2D-related complications. The awareness of risk predictors, particularly in primary care, is important, so that appropriate steps can be taken to reduce the clinical and economic burden of T2D and its complications. [ABSTRACT FROM AUTHOR]

This study aimed to estimate current direct costs for managing type 2 diabetes mellitus (T2DM)-related complications including ischaemic heart diseases (IHD), myocardial infarction (MI), stroke, heart failure (HF), amputation, blindness, renal failure (RF) requiring haemodialysis (end-stage renal disease) and diabetic foot ulcer in the event year and subsequent year. Initially, diabetes-related complications are defined based on the Malaysian Clinical Practice Guidelines (CPGs) or published literatures while each resource unit was valued using local costing obtained from the public hospital or other sources. The interventions for the management of complications were supported by evidence in the Malaysian CPGs or local literature and confirmed by the physicians related to the field who are working at the public hospital. All costs were converted to the value of USD currency in the year 2016. On the whole, macrovascular diseases incurred the highest management cost with MI employing the highest management cost (USD4,528.37) in the event year, while the management of heart, failure disease incurs the highest management cost at USD524.79 for subsequent year management. End-stage renal disease was associated with the highest annual per-patient costs, with mean first year and subsequent year costs for haemodialysis estimated at USD9,905.37 and USD9,233.89. In studying the costs of managing of diabetes-related complications, these data are vital economic evaluation for diabetes interventions, particularly in managing complications to macrovascular and microvascular functions, as it contributes significantly to the economic burden in Malaysia's public healthcare; hence significantly affecting the proportion of the overall healthcare costs. [ABSTRACT FROM AUTHOR]

Background: Tanzania is among the sub-Saharan African countries facing a tremendous increase in the burden of type 2 diabetes mellitus. In order to provide diabetes health care services, the government has established diabetes care clinics in secondary and tertiary healthcare facilities. However, previous studies have demonstrated a disparity in availability of supplies and equipment for provision of diabetes health care services at these healthcare facilities. This study aims to assess the clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania.Methods: A cross-sectional study was conducted in Mwanza Region from June to September, 2018.Three hundred and thirty patients were selected by systematic random sampling from three healthcare facilities. A structured questionnaire was utilized to collect information on patient characteristics, health care received and patient perception of care. Patient blood pressure, blood glucose, weight and height were measured during the study. Percentages, chi-square tests and multivariable analysis were conducted to obtain the proportions, make comparisons and determining the correlates of tertiary-level healthcare facility.Results: Approximately half of respondents (54.5%) were from secondary healthcare facilities. The prevalence of hypertension (63.3%), hyperglycemia (95.8%) and obesity (93.3%) were high. The prevalence of hyperglycemia was slightly higher at secondary-level healthcare facility (p = 0.005). The proportion of respondents recently diagnosed with diabetes (≤ 10 years) was significantly higher at tertiary-level healthcare facility (p = 0.000). The prevalence of diabetes related complications was higher at tertiary-level healthcare facility (80.7% versus 53.3%, p = 0.000). Assessments of body weight, blood pressure, blood glucose, feet and eye examination were conducted on a monthly basis at all facilities. None of the respondents had undergone lipid profile testing. All of the respondents (100%) received care from a nurse during diabetes clinic visits and half of the respondents (49.7%) also received care from a clinician. Relatively young patients, married and recently diagnosed patients were more likely to attend clinic at tertiary facilities. Tertiary-level healthcare facilities were more likely to have patients with complications and to have a dietitian available at the clinic. [ABSTRACT FROM AUTHOR]

Objective The quality report of the disease management programmes of North Rhine Westphalia 2016 showed prevalences for long-term complications (neuropathy, nephropathy, retinopathy) of less than 30% for people with diabetes type 1 (DM1) and type 2 (DM2). The aim of this study was to assess risk expectations and fear regarding long-term complications of diabetes in people with DM1 and DM2. Methods We assessed risk expectations and fear regarding diabetes complications in people with DM1 (n=110) and DM2 (n=143 without insulin, n=249 with insulin) visiting an University outpatient department of metabolic diseases. Fear of long-term complications was measured with the "Fear of Complications Questionnaire (FCQ)" (range 0–45 points, scores ≥30 suggest elevated fear). Participants were asked to estimate general and personal risks of long-term complications 10 years after developing diabetes in %. Results Elevated fear of complications (FCQ scores ≥30) was observed in 34.5, 25.9, and 43.0% of those with DM1, DM2 without insulin and DM2 with insulin, respectively. Participants estimated a mean general risk of diabetes-related complications after 10 years amounting to 45.9±15.8% (DM1), 49.7±15.4% (DM2 without insulin), and 52.5±16.4% (DM2 with insulin) and personal risk with 52.5±24.4% (DM1), 45.8±22.7% (DM2 without insulin), and 54.1±23.4% (DM2 with insulin), respectively. Higher risk expectations were associated with higher fear of complications (p<0.001). Conclusion Risk estimations regarding long-term complications were exaggerated in people with DM1 and DM2. About one third of the participants reported elevated fear of complications. Participants' risk expectations and fear regarding diabetes complications appear excessive compared to population-based prevalence rates. [ABSTRACT FROM AUTHOR]

L‐serine is classified as a non‐essential amino acid; however, L‐serine is indispensable having a central role in a broad range of cellular processes. Growing evidence suggests a role for L‐serine in the development of diabetes mellitus and its related complications, with L‐serine being positively correlated to insulin secretion and sensitivity. L‐serine metabolism is altered in type 1, type 2, and gestational diabetes, and L‐serine supplementations improve glucose homeostasis and mitochondrial function, and reduce neuronal death. Additionally, L‐serine lowers the incidence of autoimmune diabetes in NOD mice. Dietary supplementations of L‐serine are generally regarded as safe (GRAS) by the FDA. Therefore, we believe that L‐serine should be considered as an emerging therapeutic option in diabetes, although work remains in order to fully understand the role of L‐serine in diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Wiener Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Historically, the lung was not listed and recognized as a major target organ of diabetic injury. The first evidence of diabetic lung involvement was published fifty years ago, with a study conducted in a population of young adults affected by type 1 diabetes (T1D). In recent years, there has been mounting evidence showing that the lung is a target organ of diabetic injury since the beginning of the disease—at the pediatric age. The deeply branched vascularization of the lungs and the abundance of connective tissue, indeed, make them vulnerable to the effects of hyperglycemia, in a way similar to other organs affected by microvascular complications. In this review, we focus on pulmonary function impairment in children and adolescents affected by T1D. We also cover controversial aspects regarding available studies and future perspectives in this field.

Diabetes is now afflicting an expanding population, and it has become a major source of concern for human health. Diabetes affects several organs and causes chronic damage and dysfunction. It is one of the three major diseases that are harmful to human health. Plasmacytoma variant translocation 1 is a member of long non-coding RNA. PVT1 expression profile abnormalities have been reported in diabetes mellitus and its consequences in recent years, suggesting that it may contribute to the disease's progression. Relevant literature from the authoritative database "PubMed" are retrieved and summarized in detail. Mounting evidence reveals that PVT1 has multiple functions. Through sponge miRNA, it can participate in a wide variety of signal pathways and regulate the expression of a target gene. More importantly, PVT1 is crucially implicated in the regulation of apoptosis, inflammation, and so on in different types of diabetes-related complications. PVT1 regulates the occurrence and progression of diabetes-related diseases. Collectively, PVT1 has the potential to be a useful diagnostic and therapeutic target for diabetes and its consequences., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Heavy alcohol consumption in individuals with type 2 diabetes mellitus (T2DM) is related to increased risks of diabetes‐related micro‐ and macrovascular complications. Depressive symptoms may be relevant to this relationship, because high depressive symptoms are associated with an increased risk of complications. This study investigated whether the interaction between depressive symptoms and alcohol frequency was positively related to the development of neuropathy, retinopathy, nephropathy, and coronary artery disease (CAD), such that those with high depressive symptoms and high alcohol frequency will be at increased risk of complications. Methods: Data were from five waves of the Evaluation of Diabetes Treatment annual survey including 1413 adults with T2DM in Quebec. Data on alcohol frequency (number of drinking occasions), depressive symptoms, and complications were collected annually. The development of each complication was investigated using multiple logistic regression analysis with generalized estimating equations. Results: After adjusting for sociodemographic, lifestyle, and diabetes‐related covariates, the interaction between alcohol frequency and depressive symptoms was positively related to the incidence of neuropathy and CAD, such that those with high depressive symptoms who drank the most frequently had the highest risk of neuropathy (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00–1.04; P = 0.04) and CAD (OR 1.02, 95% CI 1.00–1.04; P = 0.04). This interaction was not significantly related to retinopathy or nephropathy. Conclusion: Individuals with high depressive symptoms and high alcohol frequency may have a particularly high risk of neuropathy and CAD. Future prevention efforts should examine both alcohol frequency and depressive symptoms when evaluating the risk of complications. HighlightsThis study examined the interaction between high alcohol frequency and a high number of depressive symptoms on the development of neuropathy, retinopathy, nephropathy, and coronary artery disease in individuals with type 2 diabetes mellitus (T2DM).Individuals with high depressive symptoms who drank the most frequently had the highest risk of incident neuropathy and coronary artery disease.Future prevention efforts should examine both alcohol frequency and depressive symptoms when assessing the risk of neuropathy and coronary artery disease among individuals with T2DM. [ABSTRACT FROM AUTHOR]

Aims: The quality report of patients enrolled in the disease management programmes of North Rhine Westphalia 2016 showed prevalence of long-term complications in diabetes type 2: neuropathy 24.2%, nephropathy 12.5%, retinopathy 8.2%. The aim of this study was to assess expectations and fear of diabetes-related long-term complications in people with diabetes type 2.Methods: We assessed expectations and fear of diabetes-related complications in 104 people with diabetes type 2 (age 67.0J, diabetes duration 6.6J, HbA1c 6.6%/48.6 mmol/mol, neuropathy 20.2%, nephropathy 11.5%, retinopathy 1.9%) in an outpatient healthcare centre at primary care level. Fear of diabetes-related complications was assessed using the "Fear of Complications Questionnaire" (FCQ) with a range of 0-45 points (≥ 30 means clinically meaningful fear, higher scores imply higher level of fear). Furthermore, study participants estimated general and personal risk of suffering from diabetes-related long-term complications after 10 years of diabetes duration on a scale of 0-100%.Results: Mean FCQ score was 22.9 ± 11.5. 34/104 participants (32.7%) scored ≥ 30 points and thus had great fear. Participants estimated general risk of suffering from diabetes-related complications after 10 years of diabetes duration on 55.1% and personal risk on 46.0%. Risk of diabetes-related complications scoring highest was impaired circulation of lower limb (62.1%), eye complications (57.3%) and kidney complications (54.7%).Conclusion: Prevalence of diabetes-related long-term complications was overestimated in people with diabetes type 2. Approximately one third of the participants showed even great fear. Patient expectation and fear about diabetes-associated complications did not correspondent with data on clinical reality. [ABSTRACT FROM AUTHOR]