Placental morphology in different types of diabetes mellitus

2021 ◽  
Vol 70 (2) ◽  
pp. 13-26
Author(s):  
Roman V. Kapustin ◽  
Ekaterina V. Kopteyeva ◽  
Tatyana G. Tral ◽  
Gulrukhsor Kh. Tolibova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Different Types

AIM: The aim of this study was to compare placental morphological features from women with different types of diabetes mellitus considering method of DM correction. MATERIALS AND METHODS: A retrospective, single-center, cohort study was carried out. We analyzed morphological examination results of 3300 placentas, which made uр the following comparison groups: type 1 diabetes mellitus on continuous subcutaneous insulin infusion (n = 60), type 1 diabetes mellitus on multiple subcutaneous insulin injections (n = 446), type 2 diabetes mellitus on diet (n = 95), type 2 diabetes mellitus on insulin therapy (n = 134), gestational diabetes mellitus on diet (n = 1652), gestational diabetes mellitus on insulin therapy (n = 735), preeclampsia (n = 39), and the control group (n = 139). The examined placentas were weighed, with their sizes (two diameters and thickness), cotyledon structure and defects assessed. We determined the umbilical cord junction and external characteristics of extraembryonic membranes. Fragments of the placenta (5 pieces) were fixed in 10% neutral buffered formalin (pH 7.2), processed with the Leica TP1020 tissue processor and embedded in paraffin. Histological sections (3-4 m thick) were prepared and stained with hematoxylin-eosin. Statistical analysis was performed using the SPSS 23.0 and GraphPad Prism 8.0 software. RESULTS: Following characteristics were typical for all types of diabetes mellitus: increased placental mass metrics, chronic placental insufficiency, dissociated villous maturation disorder with prevalent immaturity, as well as involutive-dystrophic and circulatory disorders of varying severity. Placentas from women with type 1 diabetes mellitus had the specific sings: the predominance of intermediate immature villi and stem villi stromal fibrosis. The frequency of placental infarcts and fibrinoid content in the intervillous space were comparable to those in placentas from women with type 2 diabetes mellitus. Inflammatory changes and moderate placental calcification were most consistently associated with type 2 diabetes mellitus, while gestational diabetes mellitus was characterized by soft damages. Placentas with preeclampsia showed higher prevalence of premature villous maturation, compensated placental insufficiency, and fibrinoid depositions in the intervillous and subchorionic spaces. CONCLUSIONS: Understanding relationships between placental histological features and clinical aspects of diabetes mellitus makes it possible not only to clarify the pathophysiological processes occurring in this pathology but also to optimize the algorithm for the rational management of the neonatal period of children from mothers with diabetes mellitus.

scholarly journals Impact of diabetes type on treatment and outcome of patients with peripheral artery disease

2018 ◽  
Vol 15 (6) ◽  
pp. 504-510 ◽  
Author(s):  
Lars Richter ◽  
Eva Freisinger ◽  
Florian Lüders ◽  
Katrin Gebauer ◽  
Matthias Meyborg ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease

Background: The prevalence of diabetes mellitus and its associated complications such as peripheral artery disease is increasing worldwide. We aimed to explore the distinct impact of type 1 diabetes mellitus and type 2 diabetes mellitus on treatment and on short- and long-term outcome in patients with peripheral artery disease. Methods: Retrospective analysis of anonymized data of hospitalized patients covered by a large German health insurance. Assessment of patient’s characteristics (comorbidities, complications, etc.) and outcome using multivariable Cox regression and Kaplan–Meier curves. Results: Among 41,702 patients with peripheral artery disease, 339 (0.8%) had type 1 diabetes mellitus and 13,151 (31.5%) had type 2 diabetes mellitus. Patients with diabetes mellitus had more comorbidities and complications than patients without diabetes mellitus ( p < 0.001). Type 1 diabetes mellitus patients exhibited the highest risk for limb amputation at 4-year follow-up (44.6% vs 35.1%, p < 0.001), while type 2 diabetes mellitus patients had higher mortality than type 1 diabetes mellitus (43.6% vs 31.0%, p < 0.001). Conclusion: Although the fraction of type 1 diabetes mellitus among patients with peripheral artery disease and diabetes mellitus is low, it represents a subset of patients being at particular high risk for limb amputation. Research focused on elaborating the determinants of limb amputation and mortality in peripheral artery disease patients with diabetes mellitus is warranted to improve the poor prognosis of these patients.

scholarly journals Effects of Flash Glucose Monitoring on Dietary Variety, Physical Activity, and Self-Care Behaviors in Patients with Diabetes

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Satoshi Ida ◽  
Ryutaro Kaneko ◽  
Kanako Imataka ◽  
Kaoru Okubo ◽  
Yoshitaka Shirakura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring

The aim of this study was to evaluate the effects of flash glucose monitoring on dietary variety, physical activity, and self-care behavior in patients with diabetes. This study included outpatients with diabetes using insulin who presented at the Department of Diabetes and Metabolism of the Ise Red Cross Hospital. Before initiating flash glucose monitoring and 12 weeks after its initiation, blood glucose-related parameters were assessed and self-administered questionnaires were completed (Dietary Variety Score (DVS), the International Physical Activity Questionnaire (IPAQ), the Summary of Diabetes Self-Care Activities Measure (SDSCA), and the Diabetes Treatment Satisfaction Questionnaire (DTSQ)) and compared between the two time points. We analyzed 42 patients with type 1 diabetes mellitus and 48 patients with type 2 diabetes mellitus. In patients with type 2 diabetes mellitus, but not type 1 diabetes mellitus, there was an increase in moderate/high category scores for IPAQ (P<0.001) and for treatment satisfaction reported via DTSQ. Furthermore, in patients with type 2 diabetes mellitus, the glycemic excursion index improved significantly and HbA1c decreased significantly (from 7.7 (1.2) to 7.4 (0.8), P=0.025). Results showed that standard deviation and mean amplitude of glycemic excursions significantly decreased in patients with type 1 diabetes mellitus (from 71.2 (20.4) to 66.2 (17.5), P=0.033 and from 124.6 (31.9) to 108.1 (28.4), P<0.001, respectively). Flash glucose monitoring is a useful tool to improve physical activity in patients with type 2 diabetes.

scholarly journals Mortality in 98 Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus: Foot Ulcer Location is an Independent Risk Determinant

2021 ◽  
Author(s):  
Heather Schofield ◽  
Samantha Haycocks ◽  
Adam Robinson ◽  
Michael Edmonds ◽  
Simon G Anderson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Foot Ulcer

scholarly journals Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review

2020 ◽  
Vol 24 (28) ◽  
pp. 1-232
Author(s):  
Kirsty Winkley ◽  
Rebecca Upsher ◽  
Daniel Stahl ◽  
Daniel Pollard ◽  
Architaa Kasera ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Meta Analysis ◽  
Glycated Haemoglobin ◽  
Behavioural Therapy

Background For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. Objectives The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. Data sources The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. Review methods Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). Design Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. Setting Settings in primary or secondary care were included. Participants Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. Interventions The interventions used were psychological treatments, including and not restricted to cognitive–behavioural therapy, counselling, family therapy and psychotherapy. Main outcome measures Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. Results A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of –0.13 (95% confidence interval –0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval –0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of –0.21 (95% confidence interval –0.31 to –0.10), equivalent to reduction in glycated haemoglobin levels of –0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive–behavioural therapy are clinically effective and cognitive–behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive–behavioural therapy and counselling are effective and cognitive–behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. Limitations Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40–50% of studies. Conclusions This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. Future work Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. Study registration This study is registered as PROSPERO CRD42016033619. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.

scholarly journals Lung Function in Type 1 and Type 2 Diabetes Mellitus

2019 ◽  
Vol 4 (07) ◽  
Author(s):  
Dr. Srinivas Raju D. ◽  
Dr. Jagadesha CG
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Nasal Congestion ◽  
Adult Population ◽  
Respiratory Illness

Current estimates indicate that 8.3% of the adult population, or 71.4 million people, have diabetes in 2011, 61.3 million of whom are in India. The incidence rate for type 1 diabetes in India was frequently used in extrapolation for other countries in the region and therefore plays a pivotal role in the estimates. We evaluated the ventilatory function of type 1 diabetes mellitus and type 2 diabetes mellitus patients. Spirometry and DLCO conducted in patients who have never smoked, with no history of lower respiratory illness and at examination did not have any respiratory symptoms like nasal itching, nasal congestion, running nose, dry throat, hoarseness, epistaxis, sneezing, pain suggestive of sinusitis, cough, expectoration and dyspnea were included. DLCO <80% is statistically similar in two groups with P=0.431. Mean FEV1/FVC (measured %) according to Diabetic duration, diabetic treatment, diabetic complications and DLCO in Type II DM patents was significant. Spirometric values were consistently lower in subjects with Type 1 diabetes mellitus than in Type 2 diabetics. The effect on the FVC was even more pronounced in diabetics who had duration of disease longer than 5 years, and the effect was not explained by the difference in age alone. Subjects with poorer diabetic control have worse spirometric function. Non-enzymatic glycosylation of connective tissue, especially the collagen, may be responsible for reduced lung functions.

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