MON-LB112 Socioeconomic Status, Literacy, and Sex Differences in the Progression of Retinopathy in Patients With Type 2 Diabetes in Tokyo, Japan

Abstract Socioeconomic status has profound effects on glycemic control and diabetic complications in patients with type 2 diabetes. Sex differences are one of the most important factors in socioeconomic status and may vary among countries or areas. The study aim was to determine if sex differences are associated with glycemic control and diabetic complications in Tokyo, Japan, one of the most educated countries in the world. This study initially enrolled 3307 patients treated from 2017 to 2019 at the medical school hospital located in Tokyo. All enrolled patients were asked to complete behavioral and socioeconomic surveys. A total of 276 type 2 diabetic patients (175 males, age 64.1 ± 0.88 y, disease duration 15.2 ± 0.78 y, mean ± SE y; 101 females, age 64.0 ± 1.1 y, disease duration 15.6 ± 1.01 y) agreed to participate in the study. The survey questionnaire has been previously reported in detail (Patient Preference and Adherence, 10:2151-2162, 2016). The questionnaire attempted to determine estimations of risk preference regarding things like lottery gambling and accident insurance. After reviewing the patients’ answers, however, it became clear that some were illogical, which suggested that these patients did not understand the context of the questions, the hypothetical economical situations, or even the instructions, probably because of lower literacy skills. Thus, we labeled these patients as the unreasonable (UR) group (n = 81), and the patients who provided appropriate answers, even if extremely risk averse or risk loving, were labeled as the reasonable (R) group (n = 195). The prevalence of UR answers generally increased with age (<50 y, 16%; 50-64 y, 10%; 65-74 y, 37%; ≥75 y, 64%) (p < 0.0001). After age adjustment, there was a significant correlation between the UR answers and educational attainment in both sexes. The prevalence of UR answers was significantly higher in females (38.6%) than in males (24%) (p < 0.01), which may be partly because the average number of educational years was lower for females than for males (males, 13.8 y; females, 12.9 y; p < 0.05), but both averages are very high among all countries. The prevalence of retinopathy was significantly higher in the UR than the R group in males (p < 0.05), but not in females. Job and economic status were not associated with prevalence of retinopathy. These results suggest that effects of literacy skills on progression of diabetic retinopathy may be sex dependent. Although the mechanism underlying this finding is unknown, sex may be an important biological factor beyond socioeconomic status in highly educated high-income countries.

Download Full-text

Molecular mechanisms and the vital roles of resistin, TLR 4, and NF-κB in treating type 2 diabetic complications

Beni-Suef University Journal of Basic and Applied Sciences ◽

10.1186/s43088-020-00078-4 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Venkataiah Gudise ◽

Bimalendu Chowdhury

Keyword(s):

Type 2 Diabetes ◽

Effective Treatment ◽

Diabetic Complications ◽

Molecular Mechanisms ◽

Cellular Proliferation ◽

Vascular Complications ◽

Diabetic Patients ◽

Rapid Progression ◽

Main Body

Abstract Background Type 2 diabetes in obese (≥ 25 and ≥ 30 kg/m2) patients is the foremost cause of cardiovascular complications like stroke, osteoarthritis, cancers (endometrial, breast, ovarian, liver, kidney, colon, and prostate), and vascular complications like diabetic neuropathy, diabetic and retinopathy, and diabetic nephropathy. It is recognized as a global burden disorder with high prevalence in middle-income nations which might lead to a double burden on health care professionals. Hence, this review emphasizes on understanding the complexity and vital signaling tracts involved in diabetic complications for effective treatment. Main body Type 2 diabetes in overweight patients induces the creation of specific ROS that further leads to changes in cellular proliferation, hypothalamus, and fringe. The resistin, TLR4, and NF-κB signalings are mainly involved in the progression of central and fringe changes such as insulin resistance and inflammation in diabetic patients. The overexpression of these signals might lead to the rapid progression of diabetic vascular complications induced by the release of proinflammatory cytokines, chemokines, interleukins, and cyclooxygenase-mediated chemicals. Until now, there has been no curative treatment for diabetes. Therefore, to effectively treat complications of type 2 diabetes, the researchers need to concentrate on the molecular mechanisms and important signaling tracts involved. Conclusion In this review, we suggested the molecular mechanism of STZ-HFD induced type 2 diabetes and the vital roles of resistin, TLR4, and NF-κB signalings in central, fringe changes, and development diabetic complications for its effective treatment. Graphical abstract

Download Full-text

CORRELATION BETWEEN SERUM MAGNESIUM AND LIPID PROFILE IN DIABETIC PATIENTS AND ITS ASSOCIATION WITH COMPLICATIONS.

10.36106/ijsr/3729395 ◽

2021 ◽

pp. 14-18

Author(s):

Pankaj Kumar Singh ◽

Dhaval Kumar Bhadja ◽

Mohit Bhatnagar ◽

Mandeep Joshi ◽

Shreya Verma

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Total Cholesterol ◽

Diabetic Complications ◽

Serum Magnesium ◽

Diabetic Patients ◽

Diabetic Population ◽

Inpatient Department

Background and aim: The present study was conducted to evaluate serum Magnesium and lipid prole in diabetic patients and to nd out any correlation between serum magnesium and lipid prole in diabetic patients and its association with complications. Material and Methods: In the present study, 70 diagnosed Type 2 diabetes mellitus patients aged >30 years attending Diabetic Outpatient and Inpatient Department at Vivekananda Polyclinic giving their consent for inclusion were considered to be included in the study as Cases. Results:In present the study, mean S. magnesium levels of patients with diabetic complications were found to be signicantly lower (1.09±0.22 mg/dl) as compared to that of patients in whom no diabetic complications were seen (2.19±0.71) and this difference was signicant statistically.Conclusions: In the diabetic population correlations of serum magnesium and Total cholesterol, triglyceride, LDL and VLDL were Mild while HDL was of moderate level. Among controls correlations of Serum Magnesium with Total cholesterol, triglyceride, LDL, VLDL, and HDL were found to be weak and not found to be statistically signicant.

Download Full-text

Effect of Type 2 Diabetes Mellitus and diabetic medication on Pulmonary Function

Current Respiratory Medicine Reviews ◽

10.2174/1573398x17666210121141412 ◽

2021 ◽

Vol 17 ◽

Author(s):

Alaa M. Hammad ◽

Waleed Qirim ◽

Ameen Alassi ◽

Dana Hyassat

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Pulmonary Function ◽

Disease Duration ◽

Linear Regression Analysis ◽

Forced Expiratory Volume ◽

Control Group

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition with an impairing effect on multiple organs. Numerous respiratory disorders have been observed in patients with T2DM. However, T2DM e ect on pulmonary function is ff inconclusive. Aims: In this study, we investigated the effect of T2DM on respiratory function and the correlation of glycemic control, diabetes duration and insulin intake. Methods: 1500 patients were recruited for this study, 560 having T2DM for at least a year were included in the final data, in addition to 540 healthy volunteers. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), as well as FEV1/FVC ratio values were measured. Results: A two-sample t-test showed that z-scores produced by Al-Qerem et al.’s equations for FEV1, FVC, and FEF 25-75% were significantly lower for the T2DM group than the control group (p < 0.01). FEV1/FVC ratio in T2DM group were significantly higher (p < 0.01). Multiple linear regression analysis found that glycemic control represented by HbA1c as well as disease duration were negatively associated with pulmonary function (p < 0.01). However, insulin intake was found to have no significant correlation with the pulmonary function. Conclusion: T2DM was linked to reduced pulmonary function and was consistent with a restrictive ventilation pattern. HbA1c as well as disease duration were independent risk factors for reduced pulmonary function.

Download Full-text

The Effect of Health Education on Control Glycemic at Type 2 Diabetes Mellitus Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3371 ◽

2020 ◽

Vol 8 (E) ◽

pp. 133-137

Author(s):

Rusdiana Rusdiana ◽

Maya Savira ◽

Sry Suryani Widjaja ◽

Dedi Ardinata

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Health Care ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Health Education ◽

Diabetic Patients ◽

The Mean ◽

Educational Course

AIM: The aim of this study was to evaluate the effect of short-term education on glycemic control (glycated hemoglobin [HbA1c] and fasting blood sugar [FBS]) among type 2 diabetes mellitus patients attending to primary health care (PHC) in Medan Johor of North Sumatera, Indonesia. METHODS: The study was performed on type 2 diabetes mellitus patients in Johor PHC, Medan of North Sumatera, on 40 patients with type 2 diabetes mellitus. We took the samples of all the patients of type 2 diabetes mellitus who attend PHC in Medan Johor. The patients received for 3 months intervention by education. An educational course of diabetes together with exercise training and nutritional education was designed for the study population in order to increase the patients’ knowledge and attitude toward diabetes and to increase their participation in the self-monitoring of glycemic control. Samples of FBS and HbA1c were recorded for each patient at the time of the baseline survey, then health education was conducted to the diabetic patients of both sexes attending PHC. The patients received standard advice on diet management and variation about activity. We put HbA1c <6.5% as cut limit for the control of diabetes mellitus. RESULTS: All 40 type 2 diabetes patients completed the educational course. The mean of age of the samples is 62.53 years old, the mean of body mass index was 24.81 kg/m, and the mean of waist size was 92.15 cm. Before the education, the mean of FBS level was 238.83 mg/dl and the mean of Hba1c value is 8.90%. After education, the FBS was 216.88 mg/dl, the mean of HbA1c value was 8.74%. CONCLUSION: The effect of health education in Johor Public Health Care Medan city reduced glycemic control (FBS) in type 2 diabetes mellitus patients, North Sumatera, Indonesia.

Download Full-text

Glycaemic Regulation with Zinc Combination in Type 2 Diabetes Mellitus

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i38a32057 ◽

2021 ◽

pp. 33-37

Author(s):

Gangaram Bhadarge ◽

Pratibha Dawande ◽

Nandkishor Bankar ◽

Raunak Kotecha

Keyword(s):

Oxidative Stress ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Zn Deficiency ◽

Diabetic Patients ◽

Chronic Hyperglycemia ◽

Low Levels

Introduction: Zn supplementation improved glutathione peroxidase enzyme activity and decreased malondialdehyde and nitric oxide levels in diabetic rats, revealing Zn's defensive effect against oxidative stress in type 2 diabetes. The investigators have discovered that consuming Zn increased liver function and protected pancreatic tissue from damage caused by diabetes. Since Zn also prevents chronic hyperglycemia, it helps to minimize oxidative stress caused by type 2 diabetes. Diabetes mellitus (DM) is a global health problem that affects more than 3 million people worldwide (16% of population). Chronic hyperglycemia causes oxidative stress in diabetic patients by the development of free radicals (oxidants) and lowering the antioxidant protection mechanism. Aim: Glycaemic Regulation with Zinc Combination in Type 2 Diabetes Mellitus. Materials and Methods: Faculty of Medicine and Diabetic Opd, Datta Meghe Mediсаl Соllege and Shаlinitаi Meghe Hоsрitаl аnd Reseаrсh Сenter, Nаgрur in соllаbоrаtion with Dаttа Meghe Institute оf Mediсаl Sсienсes Deemed to be University, Sаwаngi, Wаrdhа, Mаhаrаshtrа. Results: The mean Zn level was 12.213±2.342in all participants and 9.121±1.782 in the control group, whereas it was significantly low (9.121±1.782) in the diabetic group, and there was statistically significant difference in Zn levels between the controls and the diabetic group (P < 0.001).FBS, HbA1C, serum Zinc mean effects between control and patients showed statistically significant differences in type 2 diabetes mellitus (P <0.0001). Conclusion: Our findings show that people with diabetes have lower levels of Zn than healthy people. The cause and effect of the association between very low levels of Zn and the progression of diabetes, or diabetes that causes Zn deficiency, is still unknown. Low levels of Zn are associated with poor glycemic control, and poor glycemic control is a good indication of Zn deficiency, as there was a negative association between serum Zn and FBS and HBA1C. If diabetic patients have low glycemic regulation, a long history of diabetes, obesity, or are over the age of 50, we look to assess their levels in Zn so that Zn alternative treatment can begin to release oxidative stress in this high-risk group.

Download Full-text

Comparison of Effectiveness between DPP4 inhibitors combined with Versus Other Oral Hypoglycaemic Agent(s) in Diabetic patients

Bangladesh Journal of Medicine ◽

10.3329/bjmed.v30i2.41532 ◽

2019 ◽

Vol 30 (2) ◽

pp. 63-70

Author(s):

Md Shameem Haidar

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Combination Group ◽

Diabetic Patients ◽

Glycemic Status ◽

Good Glycemic Control ◽

Dpp4 Inhibitor ◽

Number Of Patients ◽

Inhibitor Combination

Background: Diabetes is global health burden of disease that requires life-long pharmacological and non-pharmacological management to prevent complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. Treatment of type 2 diabetes is based on an interplay of patient characteristics, severity of hyperglycemia and available therapeutic options. Metformin, sulfonylureas (SU) and DPP IV inhibitor are the most studied of the oral medications used worldwide. They play a prominent initial role in the type 2 diabetes treatment algorithm recommended by the several guideline. The growing evidence on new technologies and therapeutic interventions is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenge for physicians to select appropriate medication in appropriate dose for optimal patients care. Objectives: To compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors combination with other oral hypoglycaemic agent(s) in patients with type 2 diabetes and inadequate glycemic control. Materials & method: Study was conducted among 600 patients over a period of 24 months. All the patients were adult male and female type 2 diabetic patients who received regular oral anti-diabetic drug(s) and duration of T2DM for one year or more were enrolled for study. Total 150 cases were selected. Patients with Type 1 DM, pregnant women with DM and who was receiving injectable antidiabetic medications were excluded from this study. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Main outcome variable was Glycemic status (HbA1C, FBG, 2HABF). Effectiveness of drugs was evaluated by glycaemic status of the patients. Result: Maximum number of patients (38.5%) was between 31-40 years age group with mean age 37.8±9.5 years. Present study shows that, for good glycemic control, all three results (FBS, 2H ABF and HbA1c) were within targeted level in majority patients of DPP4 Inhibitor combination group. Although FBS was best result in metformin group. About 51.9% of SUs group achieved the glycemic control targets level. In case of metformin group it was in 59.8% of patients, and in combined therapy 67.1% patients shows good glycemic target. So DPP4 Inhibitor combination is better medication than other to maintain good glycemic status in type 2 DM patient, due to maximum number of patients reached all three components of result within target range. Conclusion: Diabetes is chronic illness. Good glycemic control with choosing appropriate anti-diabetic medication is pivotal for DM management. In this study it is observed that DPP4 Inhibitor combination group of drug is better than other anti-diabetic medication to maintain good glycemic status in type 2 DM patients. Bangladesh J Medicine July 2019; 30(2) : 63-70

Download Full-text

Longitudinal effect of depression on glycemic control in patients with type 2 diabetes: A 3-years prospective study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1461 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S404-S405

Author(s):

H. abuhegazy ◽

H. Elkeshishi ◽

A. Kamel ◽

A. Ismail ◽

K. Sherra ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Clinical Sample ◽

Medical Center ◽

Diabetic Patients ◽

Base Line ◽

Diabetes Clinic ◽

Data Set ◽

Co Morbidity

Objectiveto examine the longitudinal effect of depression on glycemic control in a sample of patients with type 2 diabetes.Methodsthe patients were recruited from diabetes clinic in Saudi airlines medical center, in Jeddah, the base line study community consisted from 172 patients with type 2 diabetes. They were assessed for depression using BDI II, and diagnostic interview, and for diabetic control using HbA1c. We created a person-period data set for each patient to cover 6 months intervals up to 3 years. We used generalized estimation equation (GEE) for analysis of longitudinal data. HbA1C was the response variable while depression and time were the main covariates. Variables were included in GEE models based on clinical importance and preliminary analysis. Other variables included as covariates were gender, education, duration of diabetes, co-morbidity and LDL. All statistical analysis used α = 0.05 level of significance and were performed using SPSS software version 21.ResultsUnadjusted HbA1c means were significantly higher in depressed vs. non-depressed subjects at all time points. The adjusted HbA1c means in final GEE model were significantly higher in depressed vs. non-depressed subjects. In all adjusted models depression was a predictor of glycemic control weather it was BDI score (estimate = .049, P = .002), diagnoses of MDD (estimate = 2.038, P = .000), or other depressive diagnosis (estimate = 1.245, P = .000).ConclusionThis study on clinical sample of type 2 diabetic patients demonstrates that there is a significant longitudinal relationship between depression and glycemic control and that depression is associated with persistently higher HbA1c over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Rate of glycemic control and associated factors among type two diabetes mellitus patients in Ethiopia: A cross sectional study

PLoS ONE ◽

10.1371/journal.pone.0251506 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251506

Author(s):

Shambel Nigussie ◽

Nigussie Birhan ◽

Firehiwot Amare ◽

Getnet Mengistu ◽

Fuad Adem ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Glycemic Control ◽

Associated Factors ◽

Cross Sectional Study ◽

Poor Glycemic Control ◽

Diabetic Patients ◽

Sectional Study ◽

Cross Sectional

Objective To assess the rate of glycemic control and associated factors among type 2 diabetes mellitus patients at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia. Methods A cross-sectional study was conducted from 13 May to 16 August 2019. Type 2 diabetic patients on follow up at Dilchora Referral Hospital who fulfilled the inclusion criteria of the study were included. Systematic random sampling was used to select study participants. Data was collected by a face-to-face interview and review of medical records. The primary outcome was the level of blood glucose during three consecutive visits. Poor glycemic control was defined as a blood sugar level of more than 154 mg/dL based on the average of measurements from three consecutive visits. Multivariate logistic regression analysis was used to identify determinants of glycemic control. Result A total of 394 participants responded to the interview and were included in the final analysis. The overall prevalence of poor glycemic control was 45.2% (95%CI: 40.6%-50.0%). Patients who were on oral anti-diabetic drug plus insulin had more than two times greater chance of poor glycemic control than patients on oral anti-diabetic drug alone: 2.177(95%CI:1.10–4.29). The odds of poor glycemic control in patients who did not understand the pharmacist’s instructions was two times higher than patients with good understanding of instructions 1.86(95%CI: 1.10–3.13). Patients who had poor level of practice were found to have poor glycemic control: 1.69(95% CI: 1.13–2.55). Conclusion The overall prevalence of poor glycemic control was high among type 2 diabetes patients. Oral anti-diabetic drugs in combination with insulin, lack of understanding of pharmacist’s advice, and poor practice of diabetic patients were significant factors of poor glycemic control. Pharmacists should reassure the understanding of patients before discharge during counseling. Optimization of the dose of antidiabetic medications and combination of oral hypoglycemic agents should be considered.

Download Full-text

Medical care standards for diabetes in the hospital: evolution of views from glycemic control to metabolic surgery

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-6-340-346 ◽

2020 ◽

Vol 4 (6) ◽

pp. 340-346

Author(s):

A.B. Fursov ◽

◽

R.A. Fursov ◽

O.B. Ospanov ◽

◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Medical Care ◽

Metabolic Surgery ◽

The Body ◽

Diabetic Patients ◽

Economic Costs ◽

Number Of Patients ◽

Surgical Methods

A large number of patients with type 2 diabetes (T2D) have a high incidence of complications and disease decompensation, which becomes the reason for therapy inefficacy. In recent years, endocrinologists and diabetologists are increasingly paying attention to surgical methods for treating T2D. The review attempts to study and systematize new trends in the treatment of T2D, as well as to determine the historical vector of changes in diabetologist views on the control, stabilization of the glycemic level in diabetic patients, and surgical methods.A retrospective study of scientific approaches to the treatment of diabetes confirmed the opinion of some researchers that the evolution of treatment methods commonly consisted of improving control and means of insulin delivery to the body. The analysis of scientific papers that confirm that detection of glycemic disorders among those admitted to the surgical hospital has a direct and immediate benefit both in a planned and urgent order. The growth of economic costs associated with insufficient glycemic control in diabetic patients was studied. Over the past decades, medical care standards for diabetes are analyzed in chronological order. Using the American Diabetes Association Guidelines, new trends in the treatment of T2D have been developed, and a stable vector in changing views on the efficacy of surgical bariatric and metabolic methods has been identified.KEYWORDS: medical care standards, type 2 diabetes, glycemia, evolution of diabetes mellitus treatment, economic costs, guidelines, metabolic surgery, endoscopic methods.FOR CITATION: Fursov A.B., Fursov R.A., Ospanov O.B. Medical care standards for diabetes in the hospital: evolution of views from glycemic control to metabolic surgery. Russian Medical Inquiry. 2020;4(6):340–346. DOI: 10.32364/2587-6821-2020-4-6-340-346.

Download Full-text

Glycemic Control in Diabetes Type 2 Patients in Foster Families of Brod-Posavina County During the COVID-19 Pandemic

Collegium Antropologicum ◽

10.5671/ca.45.2.12 ◽

2021 ◽

Vol 45 (2) ◽

pp. 95-102

Author(s):

Blaženka Miškić ◽

Vesna Čosić ◽

Marijana Knezević Praveček ◽

Daniel Rahelić ◽

Blaženka Kljaić Bukvić ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Medical Care ◽

Chronically Ill ◽

Medical Documentation ◽

Diabetic Patients ◽

Adequate Treatment ◽

Foster Families ◽

Significant Difference

COVID-19 pandemic has changed everyday life and medical supervision of chronically ill patients. Epidemiological measures, social distancing, and limited access to medical care impair glycemic control in patients with diabetes. Also, type 2 diabetes is a risk factor for more severe form of coronavirus disease. A large proportion of diabetic patients are placed in foster families who also adapt to the new situation. The purpose of this study was to examine the manner and frequency of glycemic control in patients with type 2 diabetes who are placed in foster families in the region of Brod- Posavina County. We established contact with patients suffering from type 2 diabetes situated in foster families and their caregivers. Measurement of glycemia was performed several times a day with regular notes and the data were supplemented by an insight into the medical documentation of patients in the hospital information system. The study included 33 patients with type 2 diabetes. The relationship between HbA1C with fasting and postprandial glycemia was linear. There were no statistically significant differences in HbA1C regulation by type of therapy. There was a significant difference in the number of complications according to the level of HbA1C (Hi square test = 25.982, p <.001). The number of complications generally increased as HbA1C regulation was poorer. During current COVID-19 pandemic, care for patients with type 2 diabetes is significantly limited. Improved medical care for patients can be achieved by establishing cooperation and daily communication between caregivers, family physicians and, if necessary, diabetologists, especially through the use of online platforms and telephone communication, all with the aim of early detection of diabetes complications and adequate treatment of patients in current conditions.

Download Full-text