Early screening for type 2 diabetes is crucial to prevent complications such as peripheral neuropathy and their detrimental effects on quality of life and morbidity. Sudomotor function assessment may play a pivotal role in this regard.
The aim of this study was to evaluate the usefulness of sudomotor function assessment, derived from electrochemical skin conductance (ESC) measurement, for the diagnosis of diabetes in patients.
This case–control study was conducted at the University Hospital of Lomé in Togo and included 304 people with Diabetes and 475 control subjects. Sudomotor function was assessed in both groups using a single device (Sudoscan2, version SU2 01266). The ESC of the left and right hands and feet were measured in each subject and then averaged. A comprehensive examination was performed, and demographic, anthropometric, and clinical data were collected. Consent was obtained from all participants.
The study found that people with Diabetes were significantly older, had a higher body mass index (BMI), and were more frequently male than the control group (median and [interquartile]: 57 [48–65] vs. 41 [30–52] years, p < 0.0001; 27 [24–31] vs. 25 [22–29] kg/m2, p = 0.0042; 28% vs. 14%, p < 0.0001; respectively). Additionally, people with Diabetes had significantly lower averaged hands and feet ESC compared to the control group (hand ESC: 68 [58–75] vs. 57 [47–69] μS, p < 0.0001 and foot ESC: 74 [66–80] vs. 62 [45–71], p < 0.0001 respectively). Similar results were found in both men and women across all age groups. In multiple linear regression analysis, diabetes was found to be independently associated with lower ESC, even after adjusting for age, sex, and BMI. The area under the receiver operating characteristic curves for the diagnosis of diabetes were 0.73 (0.68–0.77) and 0.76 (0.71–0.80) for averaged hand and foot ESC, respectively. The identified thresholds of ESC for diabetes detection were 56 μS (sensitivity = 83%, specificity = 34%) and 66 μS (sensitivity = 86%, specificity = 45%) for hands and feet ESC, respectively.
Sudomotor function is reduced in people with Diabetes, regardless of age, sex, and BMI. The ESC measurement has good sensitivity and may be useful in screening patients at risk of diabetes, potentially leading to earlier diagnosis. However, further investigation is required to determine the relevance of systematic ESC measurement in terms of management and risk stratification for these patients.
This study aimed to assess the possible therapeutic effects of CO2-enriched water on the sensory complications of diabetic neuropathy.
Fifty-eight patients entered the study, each participant received highly concentrated CO2-enriched water once a day for 15 days and then once a week for 3 months. The prevalence of neuropathy-related signs and symptoms was assessed using standard questionnaires and clinical tests.
In all patients, significant reductions were observed in numbness, pain, cramp, fatigue, and other indexes and sensory and functionality tests of feet (p < 0.001).
Immersion of neuropathic limp in CO2-enriched water for 15 days and 3 months improved patients’ symptoms. These improvements occur rapidly at first but slow down over time. Accordingly, CO2 therapy can be used to improve the sensory function of limbs in patients with diabetes.
Monogenic diabetes mellitus (MDM) represents a diverse group of uncommon form of diabetes. Based on the number of reported cases in literatures, it appears that the detection rate of MDM, even in specialized diabetes centers, remains low. This case series provides a comprehensive overview of different MDM cases observed at a single diabetes center, focusing on their clinical features, diagnostic challenges, and management considerations.
We identified 10 cases of MDM by conducting genetic analysis of 77 youth-onset diabetes cases clinically suspected to be MDM. Among these, there were 2 cases of neonatal diabetes mellitus (NDM) [a heterozygous mutation p.Arg825Trp in the ABCC8 gene (transient NDM) and a heterozygous mutation in p.Asp212Tyr in the ABCC8 gene (permanent NDM)], 3 cases of HNF4A MODY (MODY)-1 [a heterozygous promoter mutation 79C/T in the HNF4A gene, a novel heterozygous missense variant in exon 8 of the HNF4A gene that results in the amino acid substitution of serine for arginine at codon 976 (p.Arg326Ser), and a heterozygous mutation p. Arg333Cys in exon 8 of the HNF4A gene], and 4 cases of maternally inherited diabetes and deafness (MIDD) [heteroplasmic missense mutation in the MT-TL1 position (m.3243A>G) encoding for the leucine transfer RNA].
This case series highlights that MDM can be effectively identified in diabetes clinics through careful clinical evaluation and targeted genetic testing. Early detection allows for personalized treatment strategies, optimizing glycemic control, and pre-empt, prevent, or modify associated clinical features to improve patient outcomes.
This study aimed to determine the effect of technology awareness education (TECAwEd) on willingness to use diabetes technologies in participants.
This study is a quasi-experimental study. A total of 185 individuals with diabetes participated in the study. Participants received face-to-face technology awareness education for approximately 45 min. During the education, participants were given a colourful brochure containing visuals of technological devices. The data were evaluated using McNemar chi-square analysis.
There was a statistically significant difference in the want of participating in the study to use technological devices after technology awareness education (p < 0.001). While the rate of individuals who wanted to use an insulin pump before the education was 17.3%, it increased to 39.5% after the education. While the rate of those who wanted to use continuous glucose monitoring (CGM) was 20% before the education, it increased to 40% after the education. When the reasons why participants do not want to use technological devices are examined, it has been determined that the most common economic reasons stand out.
This study determined that technology awareness education increased participants’ desire to use devices. Technology awareness should be included in the main educational subject in diabetes education.
Basal Bolus Insulin (BBI) and Sliding Scale Insulin (SSI) regimens are the two choices for managing uncontrolled hyperglycemia in patients with Type 2 diabetes mellitus (T2DM).
We aimed to compare the glycemic control achieved and the duration of infection recovery in hospitalized Type 2 Diabetic patients with infections treated with SSI and BBI regimens.
A retrospective comparative study was performed for 6 months; a total of 126 patients were divided into 2 groups, the SSI group (n = 63) and the BBI group (n = 63). Fasting Blood Glucose (FBG) levels and duration of antibiotic therapy during hospitalization were used to assess glycemic control and infection recovery duration, respectively.
On the first day, the mean FBG values were 244.75 ± 81.72 in the BBI group and 191.21 ± 90.45 in the SSI group. On the last day, these values decreased to 159.40 ± 79.31 in the BBI group and 167.21 ± 61.81 in the SSI group. The statistical analysis revealed a significant improvement in glycemic control within the BBI group (p < 0.001), while in the SSI group, a statistically significant improvement in glycemic control was not achieved (p = 0.106).
Better glycemic control was seen in the BBI group and overall infection recovery duration was lesser in the SSI group than BBI group.
This study evaluates the accuracy and adequacy of Chat Generative Pre-trained Transformer (ChatGPT) in responding to common queries formulated by primary care physicians based on their interactions with diabetic patients in primary healthcare settings.
Thirty-two frequently asked questions were identified by experienced primary care physicians and presented systematically to ChatGPT. Responses underwent evaluation by two endocrinology and metabolism physicians which utilized a 3-point Likert scale for accuracy (1, inaccurate; 2, partially accurate; 3, accurate) and a 6-point Likert scale for adequacy (1, completely inadequate to 6, completely adequate). Questions were categorized into groups including general information, diagnostic processes, treatment procedures, and complications.
The median accuracy score was 3.0 (IQR, 3.0–3.0), and the adequacy score was 4.5 (IQR, 4.0–5.8). None of the questions received an inaccurate rating, and the lowest accuracy score assigned by both evaluators was 3. Significant agreement was observed between the evaluators, demonstrated by a weighted κ of 0.61 (p < .0001) for accuracy and substantial agreement with a weighted κ of 0.62 (p < 0.0001) for adequacy. The Kruskal–Wallis tests revealed no statistically significant differences among the groups for both accuracy (p = .71) and adequacy (p = .57).
ChatGPT demonstrated commendable accuracy and adequacy in addressing diabetes-related queries in primary healthcare.
Diabetes mellitus is the most common pediatric endocrinal disorder. Diabetic ketoacidosis is one of the most serious life-threatening complications and might be the initial presentation. Poor management, non-compliance and infection are the main triggers for DKA. Infection leads to activation of the hypothalamic-pituitary-adrenal axis leading to the production of cortisol, sometimes excessively which might affect the illness course.
The study aimed to measure basal serum cortisol levels during DKA as a significant predictor of DKA duration and to assess the time to recovery between children with newly diagnosed diabetes compared with known diabetics presenting with and without infection.
This cross-sectional study included 207 pediatric patients presenting with DKA where serum cortisol level was measured on admission.
The mean cortisol level was 41.54 µg/dl ± 21.36 µg/dL. Cortisol levels were inversely associated with serum pH and bicarbonate level with (r = -0.544; p = <0.001) and ( r = -0.520; p = <0.001) respectively. There was a positive association of cortisol levels with the duration of DKA (r = 0.443; p = <0.001). Thirty-four children (16.40%) with cortisol levels < 18 µg/dL showed higher serum pH, and bicarbonate levels and shorter duration of DKA with a statistically significant p value <0.001. One-hundred and fourteen (55.1%) patients with cortisol levels >34 µg/dL had lower pH, bicarbonate level, and longer duration of DKA with a statistically significant p value <0.001.
Cortisol levels on admission higher than 34 µg/dL are associated with a longer duration of DKA while levels lower than 18 ug/dl were associated with a significantly shorter duration. Therefore, it’s recommended to measure basal serum cortisol levels on admission during DKA as significant predictor to DKA duration.
Diabetes mellitus is a prevalent chronic health condition associated with high blood glucose levels. Among its complications, diabetic foot ulcers (DFUs) are particularly concerning due to their potential for infection and lower extremity amputation. In India, where diabetes prevalence is high and rising, understanding the prevalence and risk factors of DFUs is essential for effective healthcare planning and intervention strategies.
A search was conducted across PubMed, Scopus, Embase, and Google Scholar to identify studies reporting the prevalence of DFUs published until December 2023. Statistical analysis was performed using R software, employing a random effects model with a 95% confidence interval. Publication bias was assessed via funnel plot visualization and Egger’s test. Subgroup analyses were conducted based on different variables. Moreover, determinants associated with DFUs were also assessed qualitatively.
Eighteen studies involving a total of 55,988 people with diabetes were included. The pooled prevalence of DFUs in India was estimated at 6.2% (95% CI: 4.0; 9.4%). Subgroup analysis revealed a higher prevalence in males (14.5%) compared to females (7.7%), although not statistically significant (p = 0.17). Regional analysis indicated similar prevalence in the East (9.5%), South (7.4%), and North (5.6%) regions of India (p = 0.42). Hospital-based studies exhibited a higher prevalence (7.5%) compared to community-based studies (2.5%) (p = 0.02). Longer diabetes duration, male gender, older age, comorbidities, and an unhealthy lifestyle were identified as major risk factors for DFUs.
The relatively low yet considerable prevalence of DFUs in India emphasizes the need for preventive strategies. The findings advocate for policymakers to prioritize interventions focusing on patient education, lifestyle modifications, and regular healthcare follow-up to reduce the burden of DFUs and improve outcomes in people with diabetes.
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