Low Levels of Tumor Necrosis Factor-α will Prevent Periodontitis Exacerbation in Type 2 Diabetes Mellitus

Objectives Diabetes mellitus (DM) is a major risk factor for periodontitis. Susceptibility to periodontitis increases approximately three times in people with DM. There is a clear relationship between the degree of hyperglycemia and the severity of periodontitis. This study aimed to analyze the reduction of tumor necrosis factor-α (TNF-α) in diabetics who came for periodontitis examination to prevent exacerbations. Materials and Methods This was an analytic observational study using a cross-sectional approach at health centers in Surabaya, Indonesia. Measurement of periodontal status used the community periodontal index of treatment needs by measuring bleeding at probing and pocket depth. TNF-α was measured using enzyme-linked immunosorbent assay, and behavior and lifestyle using a questionnaire. Statistical Analysis The Kolmogorov–Smirnov test was performed to identify data normality (p < 0.05). A nonparametric test was used to measure the degree of association between different characteristics and the incidence of periodontitis in type 2 DM patients with and without periodontitis. Spearman's test was done to examine the correlation between TNF-α level and severity of periodontitis in diabetics. The significant level was at p <0.05. Results There was a correlation between age, predisposing factors, reinforcing factors, drug consumption, and TNF-α levels in patients with type 2 DM and the incidence of periodontitis. Conclusions Poor glycemic control can induce oxidative stress on the gingiva, thereby aggravating damage to periodontal tissue. An important factor in preventing periodontitis for type 2 DM patients is controlling blood sugar levels through regular consumption of drugs and regular maintenance of oral cavity health. Knowledge is a predisposing factor that affects adherence of people with type 2 DM to consuming drugs regularly, which can be strengthened by family support. These will ultimately play a role in reducing TNF-α levels.

Type 2 Diabetes Increases Risk of Unfavorable Survival Outcome for Postoperative Ischemic Stroke in Patients Who Underwent Non-cardiac Surgery: A Retrospective Cohort Study

Objective: Diabetes mellitus (DM) has been critically associated with unfavorable outcomes in the general population. We aimed to investigate the association between type 2 DM and long-term survival outcomes for postoperative ischemic stroke in patients who underwent non-cardiac surgery.Research Design and Methods: This was a retrospective cohort study of patients with non-cardiac surgery who had suffered from postoperative ischemic stroke between January 2008 and August 2019. Diabetic individuals were included in postoperative ischemic stroke patients with the DM group. The outcome of interest was long-term overall survival (OS). We conducted propensity score matching (PSM) and inverse probability treatment weighting (IPTW) to adjust for baseline characteristic differences between groups. Multivariate Cox regression analysis with stepwise selection was used to calculate the adjusted hazard ratio (HR) of OS and type 2 DM.Results: During a median follow-up of 46.2 month [interquartile range (IQR), 21.1, 84.2], 200 of 408 patients (49.0%) died. The OS rates at 3, 5, and 10 years were significantly lower for postoperative ischemic stroke patients with DM than those without DM (3 years OS: 52.2 vs. 69.5%, p &lt; 0.001; 5 years OS: 41.6 vs. 62.4%, p &lt; 0.001; 10 years OS: 37.2 vs. 56.6%, p &lt; 0.001). All covariates were between-group balanced after using PSM or IPTW. The postoperative ischemic stroke patients with type 2 DM had a shortened OS in primary analysis (HR: 1.947; 95% CI: 1.397–2.713; p &lt; 0.001), PSM analysis (HR: 2.190; 95% CI: 1.354–3.540; p = 0.001), and IPTW analysis (HR: 2.551; 95% CI: 1.769–3.679; p &lt; 0.001).Conclusion: Type 2 DM was associated with an unfavorable survival outcome for postoperative ischemic stroke in patients who underwent non-cardiac surgery. When postoperative ischemic stroke co-occurred with type 2 DM, the potential synergies would have multiplicative mortality risk. Further research to assess the adverse effects of type 2 DM on long-term survival may be warranted.

A Case of Transient Neonatal Diabetes Mellitus Attributable to a Nonspecific Mutation in the ABCC8 Gene

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia that persists for more than 2 weeks and requires insulin therapy. NDM principally occurs before 6 months of age. Transient NDM (TNDM) is a clinical form of NDM that persists for a median of 12 weeks and resolves completely by 18 months. However, it may relapse as type 2 DM during early adulthood. The major causes of TNDM are mutations in chromosome 6q24 or the KCNJ11 or ABCC8 genes; the latter encode the two subunits of the pancreatic adenosine triphosphate (ATP)-sensitive potassium channel (KATP-channel). This condition responds well to oral sulfonylurea therapy. Herein, we report a neonate who was small for gestational age and exhibited TNDM symptoms. Genetic analysis revealed a nonspecific mutation in ABCC8; he was successfully treated with oral sulfonylurea.

THE RELATIONSHIP BETWEEN SELF-MANAGEMENT AND QUALITY OF LIFE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

Background: Diabetes Mellitus (DM) is a metabolic disease characterized by high blood glucose levels as a result of insufficient insulin secretion, impaired insulin activity or both. Patients with diabetes mellitus are at risk for complications that can affect their quality of life. These complications can be minimized through self-management. Objectives: The aim of this study was to determine the relationship between self-management and quality of life in type 2 DM patients. Design: This study was a quantitative research. The design in this study was a cross-sectional analytic with a sample of 75 people who were carried out at the endocrine polyclinic RS Pusat TNI Angkatan Laut (RSPAL) DR. Ramelan Surabaya. Research instrument used the Diabetes Self-Management Questionnaire (DSMQ) developed by Schmitt et al (2013) to determine the self-management of type 2 DM patients and to measure the quality of life using the Diabetes Quality of Life Brief (DQoL Brief) instrument developed by Burrough et al (2008). The sample siza with simple random sampling method, and data analysis using spearman rank test. Results: The results showed that there was a significant relationship between self-management and quality of life in type 2 DM patients (p-value = .000, r = .394). Conclusion: There is a significant positive relationship between the level of self-management and quality of life in type 2 DM patients. From the results of the Spearman test correlation coefficient, there is a positive sign. This means that the higher the patient's self-management, it will also improve the quality of their life. The implication of this study are nurses can increase patient knowledge by providing education that focuses on improving self-management and facilitating the provision of family support as well as supervision and monitoring related to self-management by type 2 DM patients.

Features of acute decompensation of heart failure in patients with type 2 diabetes mellitus with anemia and latent iron deficiency

Objective: to assess the contribution of anemia and latent iron deficiency (LID) to the formation of acute decompensation of chronic heart failure (ADHF) in patients with diabetes mellitus (DM) type 2 in history.Materials and methods: a one‑time screening clinical non‑randomized study was conducted. 98 patients with ADHF were examined according to the criteria for inclusion and non‑inclusion, among which 47 (48%) patients suffered from type 2 DM. Among patients with impaired carbohydrate metabolism, 14 (29.8%) patients had an anemic syndrome verified.Results: the prevalence of anemia among hospitalized patients with ADHF against the background of type 2 DM was 29.8%, LID without anemia – 51.5%. Anemic syndrome in patients with ADHF and type 2 DM was represented by iron deficiency anemia in 85.7% and anemia of chronic conditions in 14.3% of cases. In 2/3 of the patients, anemia corresponded to moderate severity. The relative risk (RR) of the development of ADHF against the background of type 2 DM and anemia increases by 2.4 times, in the presence of LID – by 2.9 times. The presence of coronary artery disease, myocardial infarction in history, atrial fibrillation with a heart rate of more than 110 beats per minute, renal dysfunction, high activity of nonspecific inflammation were risk factors for the formation of ADHF in patients with type 2 DM and anemia. The presence of left ventricular hypertrophy in patients with anemia increased the RR of the development of ADHF by 1.8 times, the presence of chronic kidney disease – by 1.7 times, with an increase in the excretion of albumin/protein in the urine >30 mg/g – by 5.7 times, with tubular dysfunction – by 2.4 times, with an increase in aortic stiffness – by 3.5 times.Conclusion: the prevalence of anemia and LID among patients with ADHF and type 2 DM is high. These conditions were risk factors for the development of ADHF and its progression. ADHF in patients with type 2 DM against the background of anemia and LID was characterized by a more severe course, a more pronounced lesion of the target organs.

Іmmunological disorders and colonic dysbiosis in patients with biliary lesions in type 2 diabetes mellitus and obesity

Background. The microbiome plays a crucial role in maintaining homeostasis. The purpose of the research was to study the peculiarities of changes in immunological status and their relationship with colonic dysbiosis in patients with biliary lesions on the background of type 2 diabetes mellitus (DM) and obesity. Materials and methods. The study included 54 patients with type 2 DM and obesity of varying severity, who underwent a comprehensive examination. Two groups of those examined for type 2 DM and obesity were formed, depending on the type of lesion of the biliary system. Thus, group I included 24 patients with chronic acalculous cholecystitis, and group II consisted of 30 patients with gallstone disease. Results. The results of the analysis of the quantitative and qualitative composition of the colonic microflora indicate dysbiotic changes in patients with type 2 DM, obesity, and lesions of the biliary system. More pronounced disorders in the quantitative and qualitative composition of colonic microflora were diagnosed in patients of group II (with type 2 DM and obesity in combination with gallstone disease). The patients of group II significantly more often developed an increase in the number of Enterobacter (14.2 %; p < 0.05), Citrobacter (31.8 %; p < 0.01), Staphylococcus (16.7 %; p < 0.05), and Clostridium (11.8 %; p < 0.05) compared with the data of group I. More pronounced increase in all immunoglobulin parameters was found in patients with gallstone disease associated with type 2 DM and obesity. At the same time, the increase in IgA and IgG levels, which is indisputable evidence of activation of the humoral part of the body’s immunocompetent system, was found in patients with biliary lesions and type 2 DM and obesity. Conclusions. In patients with type 2 DM and obesity in combination with lesions of the biliary system (mainly gallstone disease), changes in the quantitative and qualitative composition of the colonic microflora (a decrease in the number of Bifidobacterium and Lactobacillus and an increase in the concentration of Clostridium, Staphylococci, Proteus, and Klebsiella) were detected. Impairment of immunological status in patients with type 2 DM and obesity in combination with lesions of the biliary tract was diagnosed, which manifested in increased levels of IgA, IgG, IgM, IgG and a decrease in serum C3 and C4 in patients with gallstone disease. The increase in IgA and IgG directly depends on the change in the number of Bifidobacterium and Lactobacillus, Staphylococcus, Clostridium, Proteus in the microbiological examination of feces in patients with type 2 DM and obesity in combination with the biliary system (mainly gallstone disease).

Effectiveness of Line application and telephone-based counseling to improve medication adherence: A randomized control trial study among uncontrolled type 2 diabetes patients

Background: More than 4.2 million cases of diabetes mellitus (DM) were reported in Thailand during 2019. Medication adherence is necessary to delay disease progression and prevent complications among uncontrolled type 2 DM patients. The objective of this research was to study how education via the Line application and telephone-based counseling impacted medication adherence knowledge by analyzing the behavior of uncontrolled type 2 diabetic patients. Methods: Uncontrolled type 2 DM patients in Doi Saket Hospital, Doi Saket district, Chiang Mai province, Thailand. were included in the study. The sample was divided into an experimental (n=30) and control group (n=30). Patients who met the inclusion criteria of having uncontrolled type 2 diabetes diagnosed by a physician for at least one year, capable of communicating in Thai, possessing a mobile phone with the Line application and able to partake in activities for eight weeks were recruited in the parallel-group randomized trial. The experimental group participated in the developed education program, while the control group received standard routine health education activities provided by their health care providers. The intervention was based on the 5Rs principle as right medicine, right dose, right route, right patient and right time and included activities via the Line application and telephone-based counseling. Participants were evaluated for their medication adherence knowledge and behavior. Results: After eight weeks of education through the Line application and telephone-based counseling, posttest mean scores of medication adherence knowledge of the experimental and control groups were 18.03 (SD=0.28) and 12.37 (SD=0.62), while posttest mean scores of medication adherence behavior of the experimental and control groups were 49.28 (SD=3.77) and 33.84 (SD=3.81), respectively. Results revealed that the experimental group had statistically significant (P<0.01) higher medication adherence knowledge and behavior mean scores. Conclusion: Education using the Line application and telephone-based counseling program improved medication adherence knowledge and behavior among uncontrolled type 2 DM patients. Other outcomes of social media interactions such as patient engagement, patient behavior and attitudes, and the efficacy of patient-health care provider communication levels are possible areas for future study.

The Study of Correlation of Incidence, Severity of Renal, Cardiovascular Complications with Duration, Severity of Type 2 Diabetes Mellitus in a Tertiary Care Hospital

Background: Type 2 Diabetes Mellitus (DM) is a disorder of the endocrine characterised by hyperglycaemia which results from variable degrees of insulin resistance and insulin deficiency.Chronic hyperglycaemia in diabetes may lead to multi organ damage resulting in renal, cardiovascular and other complications.In our study, we aim to look for correlation between the degree of glycemic control, duration of type 2 DM, incidence, severity of renal, cardiovascular complications in type 2 DM patients. The objective of our study is to analyse the correlation between glycemic control and occurrence of cardiovascular, renal complications in type 2 DM patients. Materials and Methods: 50 type 2 DM patients were selected from the Medicine outpatient of Saveetha Medical College and Hospital from January 2021 to March 2021.The study was explained and informed consent was obtained. Ethical committee clearance was obtained.The duration of the disease, regularity of treatment are recorded, serum HbA1c was done to evaluate the degree of glycemic control.Renal function tests like estimation of urea and creatinine are done to look for renal complications. Echocardiogram was done to evaluate the cardiac status of the patient. Expected Outcome: We expect a direct correlation between the severity of uncontrolled hyperglycaemia, duration of the disease with the incidence of renal and cardiovascular complications. Results: 50 patients who were selected for the study having type 2 Diabetes Mellitus, were made into two groups - people with uncontrolled diabetes (HbA1c >7.5%) were more prone in developing renal and cardiac complications which were assessed by urea, creatinine, urine protein levels and ejection fraction (EF %) values. The significant cut off values to cause complications were taken as for urea (>40mg/dl), creatinine (>1mg/dl), urine protein (+/++/+++), EF value(>50%) and the presence/absence of regional wall motion abnormality (RWMA) was noted. It was also observed that longer age duration of the disease, more was the risk to develop cardiac complications than disease of shorter duration. Hence a poor control of hyperglycaemia made the subject prone to renal and cardiovascular complications. Conclusion: We arrive at a direct correlation between the severity and extent of uncontrolled hyperglycaemia with the incidence of severity and complications in the form of nephropathy and cardiac dysfunction.