scholarly journals Better Islet Function and Cardiovascular Autonomic Function in Type 2 Diabetic Patients With Pure Small Fibre Neuropathy Than With Mixed Neuropathy

2021 ◽  
Author(s):  
Chenxi Li ◽  
Weimin Wang ◽  
Wenyu Ni ◽  
Yu Jin ◽  
Simin Guo ◽  
...  
Keyword(s):  
Autonomic Function ◽  
Common Peroneal Nerve ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Small Fibre Neuropathy ◽  
Cardiovascular Autonomic Function ◽  
Small Fibre ◽  
The Common

Abstract BackgroundThe clinical characteristics and outcomes of small fibre neuropathy (SFN) in Chinese patients with type 2 diabetes have not been thoroughly described, and we investigated metabolic and neurological indexes and the prognosis of type 2 diabetic patients based on skin biopsy. MethodsThirty-four healthy Chinese volunteers were recruited for skin biopsy to establish the reference range of intraepidermal nerve fibre density (IENFD). Eighty-nine patients with type 2 diabetes from the Department of Endocrinology at Nanjing Drum Tower Hospital between December 2015 and April 2020 were included in the final study. Metabolic and neurological indexes were evaluated at baseline. Diabetic cardiovascular autonomic function was tested through cardiovascular autonomic reflex tests (CARTs). Seventeen pure SFN subjects and 9 mixed diabetic polyneuropathy (DPN) subjects were reassessed after the follow-up. ResultsLevels of HbA1c and postprandial blood glucose were lower (P=0.005 and P=0.041, respectively), while postprandial C-peptide and insulin were higher (P=0.001 and P=0.019, respectively) in the pure SFN group than in the mixed DPN group. Regarding the CARTs, the mixed DPN group obtained the highest score, indicating the worst cardiovascular autonomic neuropathy (CAN). Among the four CART items, postural BP change was lower while deep breathing max-min was higher in the pure SFN group than in the mixed DPN group (P=0.023 and P=0.040, respectively). A partial correlation showed that there was a negative correlation between IENFD of the distal leg and CART scores (r=-0.513, P=0.001) after adjusting for age and duration of diabetes. Only vitamin B12 (p=0.028) and motor nerve conduction velocity (MCV) of the common peroneal nerve (p=0.045) were increased in the 17 patients with pure SFN after the follow-up. However, MCVs of the common peroneal nerve (p=0.025) and tibial nerve (p=0.047) were decreased at the final visit in the mixed DPN group. ConclusionsBetter islet function and cardiovascular autonomic function were observed in patients with pure SFN compared with mixed DPN. CART scores were negatively correlated with IENFD in the distal leg even after adjusting for age and duration of diabetes. The metabolic and neurological indexes remained relatively stable in the follow-up of pure SFN subjects.

Effectiveness of Dulaglutide in the Real World and in Special Populations of Type 2 Diabetic Patients

2020 ◽  
Vol 105 (7) ◽  
pp. e2617-e2625 ◽  
Author(s):  
Mario Luca Morieri ◽  
Vera Frison ◽  
Mauro Rigato ◽  
Michele D’Ambrosio ◽  
Federica Tadiotto ◽  
...  
Keyword(s):  
Body Weight ◽  
Real World ◽  
Disease Duration ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Body Weight Reduction ◽  
Background Population ◽  
Glucagon Like Peptide 1

Abstract Context In randomized controlled trials (RCTs) on type 2 diabetes (T2D) patients, the glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-RA) dulaglutide reduced HbA1c and body weight, but generalizability of such findings to real-world T2D patients is challenging. Objective We evaluated effectiveness of dulaglutide in routine clinical practice, especially in subgroups of patient that are underrepresented in RCTs. Design Retrospective multicenter study. Setting Diabetes outpatient clinics. Patients and intervention All consecutive patients who initiated dulaglutide between 2015 and 2018. Main outcome measures Changes in HbA1c and body weight were assessed up to 30 months after baseline. Effectiveness was analyzed in patient subgroups according to: prior use of GLP-1RA, persistence on treatment and dose, age, sex, disease duration, renal function, obesity, cardiovascular disease, or concomitant use of insulin or sulphonylurea. Results From a background population of 83,116 patients, 2084 initiated dulaglutide (15.3% switching from another GLP-1RA), 1307 of whom had at least 1 follow-up visit. Overall, dulaglutide reduced HbA1c by 1.0% and body weight by 2.9 kg at the end of observation. These effects were more pronounced in GLP-1RA-naïve patients and in those with shorter disease duration. Improvement in HbA1c was highly significant and consistent across all subgroups, including those aged ≥ 75 years, nonobese, or with chronic kidney disease. Body weight declined in all subgroups and significantly more with the 1.5-mg versus 0.75-mg dose. Conclusions In real-world T2D patients, effectiveness of dulaglutide on HbA1c and body weight reduction was highly consistent and significant even in subgroups of patients poorly represented in RCTs.

Autologous Skin Fibroblast and Keratinocyte Grafts in the Treatment of Chronic Foot Ulcers in Aging Type 2 Diabetic Patients

2011 ◽  
Vol 101 (1) ◽  
pp. 55-58 ◽  
Author(s):  
Matteo Monami ◽  
Maria Vivarelli ◽  
Carla Maria Desideri ◽  
Giulio Ippolito ◽  
Niccolò Marchionni ◽  
...  
Keyword(s):  
Healing Time ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Consecutive Series ◽  
Type 2 Diabetic Patients ◽  
Skin Cell ◽  
Type 2 Diabetic

Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers. Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than 65 years affected by long-standing (>6 months) foot ulcers with an area greater than 15 cm2. Ulcer healing rates and measurements of ulcer area were determined monthly for 12 months. Results: Seven patients with 12 ulcers, nine of which received the described treatment, were enrolled. During 12-month follow-up, all of the ulcers healed except one. In the remaining eight ulcers, the median healing time was 21 weeks (interquartile range, 4–29 weeks). Conclusions: Autologous skin cell grafts are feasible, well tolerated, and apparently effective in the treatment of diabetic ulcers of the lower limbs in advanced age. Age did not seem to moderate healing times. (J Am Podiatr Med Assoc 101(1): 55–58, 2011)

scholarly journals Effectiveness of Diabetes Community Sharp Disposal Education Module in Primary Care: An Experimental Study in North-East Peninsular Malaysia

2019 ◽  
Vol 16 (18) ◽  
pp. 3356
Author(s):  
Ummu Atiyyah Hasan ◽  
Suhaily Mohd Hairon ◽  
Najib Majdi Yaacob ◽  
Aziah Daud ◽  
Anees Abdul Hamid ◽  
...  
Keyword(s):  
Intervention Group ◽  
Knowledge Score ◽  
Peninsular Malaysia ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
North East ◽  
Type 2 Diabetic ◽  
Significant Increment

Background: Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods: This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results: There was a significant increment in the mean knowledge score for intervention group; from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser; F(1.5, 199.7) = 62.38, p < 0.001; effect size (η2) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group; at one month and three months follow up [F(1, 134) = 17.38, p < 0.001; effect size (η2) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X2(2) = 52.061, p < 0.001. Conclusions: The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.

Impaired autonomic function in type 2 diabetic patients during upper gastrointestinal endoscopy

2008 ◽  
Vol 43 (8) ◽  
pp. 603-608 ◽  
Author(s):  
Akihiro Mori ◽  
Takako Maruyama ◽  
Noritsugu Ohashi ◽  
Takashi Shibuya ◽  
Katsuhisa Sakai ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Autonomic Function ◽  
Upper Gastrointestinal Endoscopy ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Upper Gastrointestinal ◽  
Type 2 Diabetic
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