Novel Targets and Interventions for Cognitive Complications of Diabetes

Diabetes and cognitive dysfunction, ranging from mild cognitive impairment to dementia, often coexist in individuals over 65 years of age. Vascular contributions to cognitive impairment/dementia (VCID) are the second leading cause of dementias under the umbrella of Alzheimer’s disease and related dementias (ADRD). Over half of dementia patients have VCID either as a single pathology or a mixed dementia with AD. While the prevalence of type 2 diabetes in individuals with dementia can be as high as 39% and diabetes increases the risk of cerebrovascular disease and stroke, VCID remains to be one of the less understood and less studied complications of diabetes. We have identified cerebrovascular dysfunction and compromised endothelial integrity leading to decreased cerebral blood flow and iron deposition into the brain, respectively, as targets for intervention for the prevention of VCID in diabetes. This review will focus on targeted therapies that improve endothelial function or remove iron without systemic effects, such as agents delivered intranasally, that may result in actionable and disease-modifying novel treatments in the high-risk diabetic population.

Association of Oxidative Stress Markers with Vascular Stiffness Parameters in Patients with Diabetic Neuropathy

Introduction: One of the most common chronic complications of diabetes mellitus is diabetic neuropathy. The aim of the study was to elucidate the association between selected markers of oxidative stress and markers of vascular stiffness and to contribute to the understanding of the pathophysiological links between oxidative stress and micro- and macrovascular complications of diabetes. Methods: We enrolled patients with type 2 DM (n = 49), with moderate to severe diabetic polyneuropathy of lower extremities, and a control group without microvascular complications (n = 29). The neuropathy group received alpha-lipoic acid infusion therapy. Sampling was performed before and after treatment to determine the level of oxidative markers (advanced glycation end-products—AGEs, glycation products of AOPP proteins, MDA malondialdehyde and oxidized LDL), parameters of metabolic control and parameters of vascular wall stiffness were measured by sphygmomanometry. Results: After the administration of alpha-lipoic acid, we demonstrated a significant reduction in the level of three selected oxidation markers (AOPP: p < 0.001, AGE: p < 0.001, oxLDL: p < 0.05). In contrast, the level of MDA did not change significantly (p = 0.83). Throughout the group, oxLDL was significantly correlated with central BP (SBP and DBP in the aorta, p < 0.05 and <0.01) and with the augmentation index (AiX/75 bpm, p < 0.01). AOPP significantly correlated with systolic BP in the aorta (p < 0.05). We did not find significant associations in the remaining oxidation markers. Conclusion: In our study, we demonstrated a reduction in the level of oxidative markers after alpha-lipoic acid administration and also an association between markers of oxidative damage to lipids and proteins (oxLDL and AOPP) and some parameters of vascular stiffness.

Pelatihan Uji Sentuh Jari Kaki Sebagai Upaya Peningkatan Ketrampilan Kader Kesehatan Dalam Mendeteksi Gangguan Sensasi Kaki

Background: Increased life expectancy will be followed by increasing problems if health care is not carried out properly. Problems will arise, one of which is endocrine system disorders such as diabetes mellitus which has complications. One of the complications of diabetes mellitus is diabetic ulcers on the feet by 7.5% of patients who experience impaired sensation which ultimately have to undergo amputation. This condition can be prevented early, such as by checking the sensation of the feet. This activity aims to increase the role of health cadres in detecting the incidence of neuropathy. Methods: In order to provide knowledge and skills of the toe touch test to 30 health cadres, the method chosen was training supported by guidebooks, videos and demonstrations. Results: There was an increase in the knowledge of cadres in good categories from 13% to 89% between before and after training. Meanwhile, the skills of the cadres showed that all of the training participants were skilled in doing the toe touch test. Conclusion: Improving the knowledge and skills of cadres can be pursued through training by combining the use of manuals, videos and demonstrations.

Dyslipidemia, Diabetes and Atherosclerosis: Role of Inflammation and ROS-Redox-Sensitive Factors

The prevalence of diabetes is growing at an alarming rate with increased disability, morbidity, and often premature mortality because of the various complications of this disorder. Chronic hyperglycemia, dyslipidemia, and other metabolic alterations lead to the development and progression of macro- and microvascular complications of diabetes including cardiovascular, retinal and kidney disease. Despite advances in glucose and lipid lowering treatments, a large number of diabetic individuals develop one or more types of these complications, ultimately leading to end-organ damage over the time. Atherosclerosis is the major macro-vascular complications of diabetes and the primary underlying cause of cardiovascular disease (CVD) posing heavy burden on the health care system. In this review, we discuss the involvement of dyslipidemia in the progression of atherosclerosis by activating the pro-inflammatory cytokines and oxidative stress-related factors. In addition, we also provide information on various pharmacological agents that provides protection against diabetic atherosclerosis by reducing inflammation and oxidative stress.

Knowledge Regarding Complications of Diabetes Mellitus Among Diabetic People

Aim: This descriptive cross-sectional study was conducted to assess individual information about diabetes complications in patients with diabetes from questionnaires, and to find a relationship of this information to educational attainment and other sociodemographic profiles. Place and duration: Medical Department of Sharif Medical College, Lahore from January 2021 to June 2021. Methods: A total of 192 patients were enrolled in the study. People older than 16 years and who understand the query guidelines well were selected. All subjects answered the questionnaires given voluntarily and safely. The complete questionnaire was accessible in English language but was carefully translated to the official Pakistani language (Urdu). The enquiries were intended to evaluate how they knew about the diabetes mellitus complications and what those complications were. We use the SPSS 21.0 for data input and analysis. Chi-square test was applied for variables comparison. Results: We institute in this study that 94 people (48.9%) knew that the major impediment of diabetes is heart disease when blood sugar was not properly controlled, trailed by kidney disease (10.4%), and hypertension (7.8%), Eye Disease (2.6%) and cerebrovascular disease 32(16.6%). Regrettably, responsiveness was found about the presence of peripheral neurological problems, diabetic foot disease and unexpected bereavement was found in 1(0.5%) case only. Each of the subjects were inquired if they were concerned about serious complications of diabetes. Conclusions: There was statistical difference in any of the parameters (individual education, residence, monthly income, occupation, family history) depending on the degree of anxiety. The parameters were statistically significant. Further development of diabetes education programs, such as the use of the media and participation in national education programs, can improve the awareness of self-regulation of diabetes, which may decrease the mortality and morbidity of patients with diabetes. Keywords: Diabetic complications, anxiety.

Study of serum uric acid levels in type 2 diabetes mellitus in tertiary care hospital in south Gujarat

Background: The need for early indicators of diabetic complications is essential to prevent late complications and their deleterious effects. There is a need for sensitive serum markers that are associated with diabetes and its complications. Estimation of these parameters helps in early intervention, thereby delaying the chronic complications of diabetes in the early stages. Hyperuricemia has been shown to be linked to a number of diseases and conditions including gout, hypertension, cardiovascular disease, myocardial infarction, stroke and renal disease. Uric acid has long been associated with delayed complications of diabetes mellitus. This study was conducted on 357 patients of diabetes mellitus to investigate the significance of serum uric acid levels and its correlation with it.Methods: This is an observational cross-sectional study carried out amongst 357 patients with T2DM attending out-patient department as well as indoor patients under medicine department at Surat Municipal Institute of Medical Education and Research (SMIMER) Hospital, of south Gujarat.Results: There is highly significant association seen between HbA1c (glycated hemoglobin) and uric acid levels in present study (p<0.001). There is significant association seen between fasting blood sugar (FBS) levels and uric acid levels in the study (p=0.0253).Conclusions: There is increase in uric acid levels in diabetic patients with increased levels of HbA1c. Thus, serum uric acid may serve as a potential biomarker of the deterioration of glucose metabolism.

Relevance of self-control of blood glucose in the aspect of prevention of cardiovascular complications in patients with diabetes mellitus

There is a clear link between diabetes and cardiovascular disease. It is known that cardiovascular diseases in patients with diabetes mellitus occur 2–5 times more often than in people without diabetes. It is cardiovascular outcomes that are the main cause of death in patients with diabetes mellitus in both men and women. Diabetes mellitus has a high risk of coronary heart disease, myocardial infarction, arterial hypertension and acute cerebrovascular accident, and patients with diabetes mellitus may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Various rhythm disturbances are much more common in diabetes mellitus, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. The leading factor in the development of vascular complications of diabetes mellitus is hyperglycemia. In addition, early glycemic disorders - impaired glucose tolerance or impaired fasting glycemia - make a significant contribution to the increased risk of macrovascular complications. Improving glycemic control leads to a significant reduction in the risk of late macro- and microvascular complications of diabetes mellitus. Glycated hemoglobin is the gold standard for monitoring glycemic control, but it does not provide complete information on daily and intraday changes in glucose levels. Regular self-monitoring of glucose levels is important in the prevention of cardiovascular diseases in patients with diabetes mellitus. In addition, during the COVID-19 pandemic, all consensus documents and recommendations for the management of patients with diabetes indicate the need for regular monitoring of glucose levels. An important aspect of the technical impact on patients’ adherence to selfcontrol and diabetes therapy is the presence of a convenient communicative connection between the patient and the doctor, in particular, the possibility of contact remotely via a computer and a mobile phone. In conclusion, the possibilities of the new model of the line of blood glucose meters are considered.