Prevalence of Misconceptions about Diabetes and their Association with Metabolic and Psychological Variables

Objective: To evaluate misconceptions about diabetes in people who attend the first visit at the CAIPaDi program, as well as its association with metabolic and psychological variables at short and long term. Methods and Analysis: The frequency of misconceptions in diabetes was determined through a true/false survey. We compared sociodemographic, metabolic and psychological variables between people with and without misconceptions at baseline, at 3 months and 1 year after a multidisciplinary educational program. Results: 902 participants answered the survey, with an age of 50 ±10 years old, 54.3% were women, with 1 (0-5) years living with type 2 diabetes. At baseline, 53% of the participants had at least 1 misconception, being more frequent in women (p=0.045) and in population with lower educational level (p<0.001). The most common were "emotional stress and fright cause diabetes" (34.4%), "in the control of my diabetes only matters glucose management" (15.2%) and "women with diabetes should not get pregnant" (11.8%). At basal, patients with misconceptions had higher HbA1c (9.0 ± 2.6 vs 8.4 ± 2.4, p <0.001), lower quality of life (DQOL 95.2 ± 26.2 vs 90.2 ± 23.6, p = 0.03), more problematic areas in diabetes (41.2 [21.2-58.4] vs 35 [17.5-52.6], p = 0.01), more depression (42.6% vs 32.9%, p = 0.003) and anxiety (58.6% vs 40.6%, p = 0.001) compared to patients without misconceptions. With the exception of HbA1c (6.6 ± 1 vs 6.4 ± 0.8, p = 0.025 at 1 year), no differences were observed in the annual visits. Conclusion: We found a high prevalence of people with misconceptions in diabetes. This group had worst glycaemic control, higher scores in PAID questionnaire, lower quality of life and more depression and anxiety symptoms. Participants with misconceptions had lower educational level. An educative program an educational assistance program can minimize differences by eradicating misconceptions.

Obesity Risk Assessment Concept

The obesity risk assessment concept is developed after considering the increased risk of obesity and the concomitant conditions arising due to obesity. The treatment of obesity is very crucial and proper awareness and diagnosis play the important role in treating obesity. WHO declared BMI as a measure of obesity; however BMI and waist circumference as screening tools to estimate obesity and related potential risk have their shortcomings. These parameters lack sensitivity and specificity when applied to individuals to complete risk assessment related to obesity. Edmonton Obesity Staging System (EOSS) is a clinical staging system that effectively captures the severity of obesity and its factors complicating the management. However, EOSS and other such clinical staging systems are not patient-oriented and are difficult to understand for a layperson. The available staging systems do not classify obesity on the basis of the presence and severity of risk factors, comorbidities, and functional limitations. Hence, we developed an obesity risk assessment scale, which is based on EOSS; but, is patient-oriented and allows patients to understand their level of obesity, the risks associated with it and provides the clinical expertise which will guide them to appropriate obesity management. As it is a novel concept, the concept validation is performed along with a Delphi round where the questionnaire and weightage for each respective question is finalized. The strengths of this obesity risk assessment scale include the simple nature of questions, scoring system, patient-facing tool, and treatment guidance. Future studies are required to carry out the clinical efficacy, reliability, and validity of this method.

Comparison of Clinical Characteristics and Outcomes between Outpatients and Hospitalized Patients with Diabetes and COVID-19

Background: Patients with diabetes and COVID-19 have higher rates of complications. Objective: To describe and identify the characteristics and outcomes in patients with diabetes and COVID-19. Methods: From March to June 2020, we included patients with diabetes and probable COVID-19 infection. We compared parameters between outpatients and hospitalized patients. A second analysis compared patients who died vs those who survived. Results: 243 patients, 37.6% women, with 56 ±12 years, and BMI 29.6 ±5.3 kg/m2 were included. Risk factors for hospitalization were oximetry <90% (HR 2.29, 95%CI 1.14-4.58) and mean blood pressure (MBP) <80 mmHg (HR 1.75, 95%CI 1.09-2.81). Age (HR 0.93, 95%CI 0.89-0.97), respiratory rate (RR) (HR 1.05, 95%CI 1.00-1.10) and PaFiO2 (HR 0.99, 95%CI: 0.98-1.00) predicted admission to critical areas. Risk factors for mortality were age ≥65 years (HR 2.88, 95%CI 1.61-5.17), RR ≥25 bpm (HR 3.86, 95%CI 1.33-11.12), heart rate (HR 1.82, 95%CI 0.96-3.42), PaFiO2 <100 (HR 3.70, 95%CI 1.06-6.65) and glucose ≥150 mg/dl (HR 2.57, 95%CI 1.05-6.25). Length of hospitalization was 8.5 (6-14) and 6 (2-10) days for discharged and deceased patients (p=0.003), respectively. Conclusion: Oximetry <90% and MBP <80 mmHg were associated with hospitalization requirement. Glucose concentration >150 mg/dl significantly predicted mortality.

The Effects of Alcohol Consumption in Type 2 Diabetic Mellitus Individuals

There is a considerable increase in the proportion of diabetic mellitus (DM) globally. The prevalence of Type 2 DM (T2DM) is increasing across the all over the world. The consumption of alcohol is also rising globally including among the T2DM individuals. Alcohol drinking, principally the heavier consuming is a significant risk factor for many health problems and, thus, it is a main contributor to the global burden of disease. Therefore, the present review article was intended to investigate the effects of alcohol consumption among T2DM individuals which mainly focused on its effect on glycemic control, cardiovascular disease (CVD), mortality associated with T2DM. Several studies have found that light to moderate alcohol consumption among T2DM patients have the beneficial effects regarding the glycemic control, cardiovascular disease, mortality associated with T2DM. However, heavy alcohol ingestion among these individuals has the critical adverse effects. As suggestions, advice on alcohol use should largely aim at lowering heavy ingestions among T2DM subjects. These individuals should be advised on decreasing heavy alcohol consumption since the consequences of heavy amount of alcohol consumption has a severe and substantial impacts on T2DM patients. Further, more attention is needed regarding to these critical public issues to avoid the complications associated with the heavy alcohol consumption among T2DM patients. Health education programs should be created and also any programs that can improve the awareness of these individuals is required to take place in order to improve their health.

Analysis of Environmental Pollutants as Diabetogenic Agent in the Patient Suffering from Diabetes Mellitus

Diabetes mellitus can be defined as a metabolic disorder which leads to high level of glucose in blood and lead to the diabetic patients to develop various severe and fatal health problems.. If the concentration of glucose in blood will high then it affects various body organs including eyes, nerves, foot, kidneys and heart and ultimately leads to serious complications. In this, the pancreas is not able to produce enough insulin. As a result, body becomes unable to consume nutrients appropriately.Diabetes mellitus was primarily described by Egyptians. The word “Diabetes” which means “to pass through” was 1st time used by a Greek physician Araetus of Cappodocia.According to Araetus, diabetes is associated with polyuria. While the word “Mellitus” is a Latin word which means “Sweet or Honey”. Major signs and symptoms of diabetes mellitus includes Frequent urination, Excessive thirst, Excessive hunger, Sudden loss in weight, Vision problems, Slow healing of wounds, injuries and Sweating etc. Major complications of diabetes are Nephropathy Neuropathy Retinopathy Cardiovascular Disorders Amputation.There are many reasons of diabetes such as genetic factor, age, poor life style but environmental pollutants also have their role in diabetes. There are many environmental pollutant such as lead, zinc, mercury oxide, nitrate,sulphate, cadmium and Arsenic etc. The presence of arsenic (As) in drinking water has become a major public health concern around the world specially in Pakistan.Arsenic inhibits differentiation of adipocyte and mediates insulin resistance with diminutive information on arsenicosis on lipid storage and lipolysis.So the main target of research is to determine the effect of Arsenic and their control in order to decrease the number of diabetic patients.

Diabetes, obesity-associated comorbidities and NIH-Toolbox neurocognitive performance

Background/Objectives: Severe obesity is associated with cognitive deficits in adults without current or past neurological brain disturbances. This study examined the relationship between specific metabolic and vascular risk factors and cognitive performance on a computerized neurocognitive assessment battery in adults with BMI > 35. Subjects/Methods: 123 adults with Class II or III obesity, ages 20-75, were enrolled in a study of the cognitive and brain effects of reduced BMI and improved diabetes mellitus (DM) following bariatric surgery. Baseline clinical/cognitive assessments were conducted with the NIH Toolbox (NIH-TB) cognitive module prior to surgery, and in severely obese controls recruited from the community. Global, Fluid and Crystallized indices were derived from performance across nine tasks. Hierarchical regression analyses examined six obesity-associated clinical factors (BMI, HbA1c, and DM, hypertension, sleep apnea, and osteoarthritis diagnoses) relative to NIH-TB performance. Results: Fluid Cognition deficits were observed, greatest on attention-executive and cognitive processing speed tasks (Flanker and Pattern Comparison). DM diagnosis was most strongly associated with weaker cognitive performance (Global and Fluid Cognition), and with poorer performance on the Flanker, Pattern Comparison, Picture Sequencing, Verbal Learning, and Symbol Coding tasks. Elevated HbA1c was associated with weaker Card Sorting and Symbol Coding performance, hypertension with poorer Fluid Cognition, and osteoarthritis with lower List Sorting performance. Elevated BMI was only associated with Flanker performance, though DM was more strongly associated with this measure. Conclusion: Deficits of fluid cognitive functions (attention-executive, processing speed) exist among adults with Class II and III obesity. DM was most consistently associated with weaker NIH-TB performance. BMI was not as strongly associated with NIH-TB performance, perhaps reflecting the elevated BMI of the entire sample. That cognitive deficits were linked to specific obesity-associated comorbidities support the validity and potential clinical utility of the NIH-TB for the assessment and management of adults with severe obesity.

Consensus on the use of DPP4 Inhibitors and SGLT2 Inhibitors in T2DM with Chronic Kidney Disease-from Indian Context

Chronic Kidney Disease and Diabetes are diseases of concern globally including developing countries like India. The delayed intervention of non-communicable disease management, the unique socioeconomic condition, etc makes chronic kidney disease a potential threat in the future. Diabetes in India plays an important role in developing CKD & its associated complications. To treat diabetes, many innovative antidiabetic agents were introduced in the last two decades. Some of these newer anti-diabetic medications have established cardio-renal safety in diabetic patients. Many endocrine and cardiovascular societies have already adopted these anti-diabetic agents into the respective algorithms. Overall for newer anti-diabetic medication, there is no available published guidance in India that has prioritized both renal safety and other parameters related to nephrology practice. A group of Indian nephrologists, after analyzing existing published evidence and guidance from different guidelines, prepared a simple common algorithm to manage diabetes patients with associated CKD. This new algorithm, having both DPP4i and SGLT2i, will surely help Indian health care professionals to manage diabetes in CKD patients, in a more efficient way

Percutaneous Transluminal Angioplasty in the Treatment of Diabetic Foot

Background: Diabetic foot is the foot tissue damage, ulceration, secondary segmental necrosis in diabetic patients. The prevalence of diabetes is predominantly due to long-term high blood sugar, high blood lipids in the state, the systemic arterial prone to atherosclerosis, lower limb arteries are more prone to endometrial damage, and then there is stenosis or occlusion, distal extremity ischemia, Leading to diabetic foot ulcers. Objective: To assess the value of percutaneous transluminal angioplasty (PTA) in the surgical treatment of diabetic foot. Methods: Retrospective analysis of 83 cases of diabetic foot patients, 95 limbs, 95 wounds were conscripted from September 2011 to September 2014 in our hospital. Rendering to whether the PTA treatment is not accepted PTA treatment of the conventional treatment group 43 cases (wound 51) and PTA treatment of PTA group 40 cases (44). The granulation growth rate of the wound was intended at 3, 6, 9, and 12 days after debridement. The spell of wound preparation was logged before operation. According to the Wagner classification, the survival rate of the skin graft and the healing of the suture in the 2 groups were statistically analyzed. Statistics of two groups of patients were followed up for six months, the monthly review of ABI, and ulcer recurrence. Data were processed with χ² test and t test. Results: The good rate of granulation growth of the wound in the conventional treatment group was slower than that of the control group. The good granulation growth rate of the wound was less than 20% on the 12th day after treatment. The granulation growth rate of the wound in the PTA group increased visibly from the 9th day, all grow well. On the 9th and 12th day of treatment, the granulation growth rate of the wound in PTA group was ominously advanced than that in the conventional treatment group (P <0.01). The time of wound preparation was (24 ± 10) days in the conventional treatment group, which was significantly higher than that in the PTA group (15 ± 3) days, t = 5.709, P <0.01. The Wagner 2, 3, 4 grade wounds were suggestively greater in the PTA group than in the conventional treatment group (χ2 = 6.741 ~ 24.498, P <0.01). ABI was significantly higher in the PTA group than in the conventional treatment group (t = 5.411 ~ 9.583, P <0.01). There was no recurrence of ulcer in the 4 months before the follow-up. There were 1 and 2 cases of ulcer recurrence in the 5 and 6 months follow-up. There was no recurrence in the PTA group after 6 months follow-up. Conclusion: PTA is effective in the surgical treatment of diabetic foot patients, and has assured clinical application value.