The present study aimed to explore the relationship between fear of hypoglycemia and exercise management strategies in active Qatari adults with T1D during the COVID-19 pandemic, and to explore the potential role of continuous glucose monitoring (CGM) devices in promoting safe physical activity practices.
Participants completed the Hypoglycemia Fear Survey (HFS) questionnaire and the International Physical Activity Questionnaire (IPAQ). Out of the 102 participants, 41 were considered "active" and under CGM and were included in the analysis.
Multiple linear regression analysis revealed a significant positive correlation between the behavior dimension of the HFS scores and both vigorous physical activity and MET-minutes per week (R2 adj. = 0.055; β = 0.56; p = 0.05 and R2 adj. = 0.039; β = 0.38; p = 0.04). The results showed a significant positive association between HbA1c levels and the behavior dimension of the HFS (R = 0.39, p = 0.005), as well as between the number of episodes of severe hypoglycemia and the behavior dimension (R = 0.46, p = 0.042).
These findings highlight the need for effective strategies to manage fear of hypoglycemia and promote physical activity in individuals with T1D. The use of CGM devices may provide added safety to physical activity practices by reducing the risk of hypoglycemia.
To investigate the association between serum vitamin D (SVD) level and DFU development and to emphasize the involved pathomechanism.
The search was performed on 12 databases for literature published until 10 March 2023. The protocol has been registered on PROSPERO (CRD42023415744). The selection for the included records followed PRISMA framework. Meta-analyses using random effects model were performed and the data were presented as SMD and 95% CI. Meta-regression was performed to identify factors contributing to the heterogeneity in the pooled analysis.
Twenty-one studies were included in the systematic review with a total number of patients reaching 9,570. Of which, as many as 18 studies were eligible for the meta-analysis. The SDV level is significantly lower in DFU group (p-total=0.0037; SMD= -1.2758; [95% CI: -2.0786 to -0.4730]). Based on the meta-regression, age, study location (based on the continent), and total cholesterol level contribute to the high heterogeneity (p<0.01). In the pooled analysis, inflammatory markers such as serum levels of CRP (n = 4), ESR (n = 3), IL-6 (n = 3), and IL-8 (n = 2) are found significantly higher in DFU group at p<0.01.
Lowered SVD level is associated with DFU, where the pathomechanism for this relationship might involve inflammation and infection susceptibility.
Diabetic foot ulcer (DFU) is a prevalent and serious complication of diabetes, associated with significant morbidity and mortality rates. Platelet-rich plasma (PRP) is a promising therapy for accelerating DFU healing, with numerous randomized controlled trials (RCTs) supporting its efficacy and safety. Therefore, this systematic review aims to identify, critically assess, and synthesize the most recent available RCTs regarding the effectiveness of clinical PRP for treating DFU compared to standard treatment or other alternative therapies.
This study uses a comprehensive review and synthesis of existing research according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched selected databases using a combination of search terms: “((PRP) OR ("platelet-rich plasma")) AND ("diabetic foot ulcer")) OR ("diabetic lower-extremity ulcer"))” from PubMed, ProQuest, ScienceDirect, and Google Scholar in the last five years (2018–2023). Following a systematic review protocol, we selected 9 eligible articles for final analysis. Pertinent data was examined using MedCalc ver 20.215 then the results were displayed visually using forest plots.
The findings from the meta-analysis revealed that PRP exhibited a healing rate that was twice as high as the control group (Relative Effects (REs) = 2.338; 95% Confidence Interval (CI) = 1.056 to 1.857, P = 0.019). Additionally, the healing time was shortened by 2 days (REs = -2.815; 95% CI = -3.252 to -0.576, P = 0.005), and there was a difference of 0.482 cm2 in the reduction of ulcer area between the two groups (REs = 0.482; 95% CI = -2.428 to 4.002, P = 0.630). Importantly, none of the Randomized Controlled Trials (RCT) studies reported any adverse events in the PRP group.
PRP represents a feasible and secure supplementary therapeutic alternative for managing DFU.
Many developed countries, including Canada, have observed reductions in incidence of diabetes. Given the latest improvements in the case definition of diabetes for the younger population in Quebec, Canada, we sought to examine the evolution of diabetes among adults and children in Quebec, between 2001 and 2019.
Crude and age-standardized incidence and prevalence of diabetes among individuals ≥1 year were calculated using data from the Quebec Integrated Chronic Disease Surveillance System (n≈8,351,500 in 2019), using two case definitions for adults and the youth respectively. Age-standardized all-cause hospitalizations and mortality proportions were calculated among the population ≥20 years.
Between 2001 and 2019, age-standardized incidence decreased by 30%, with a crude incidence of 4.6 per 1,000 in 2019. Incidence rates decreased from age group ≥50 years but increased by 25% for the group of 1-19 years. Age-standardized prevalence increased by 42% (crude prevalence in 2019: 8.1%). Males had higher incidence and prevalence of diabetes, with an incremental gap between sexes increasing with age. All-cause hospitalization and mortality proportions among individuals with diabetes declined by 21% and 29% respectively between 2001 and 2019. Age-standardized hospitalizations and mortality ratios for individuals with/without diabetes remained stable and were 2.7 (99% Confidence Intervals [CI]: 2.7-2.8) and 2.2 (99% CI: 2.1-2.3) in 2019, respectively.
Despite the reduction of incidence among adults, diabetes incidence increased among the youth and remained high among adults, especially for males. These results highlight the importance of improving earlier preventive care and initiatives for reducing the diabetes burden in Quebec.
The number of available automated insulin delivery (AID) systems is increasing in Austria and people with diabetes (PwD) replace sensor-augmented pump (SAP) therapy more and more frequently. The present study is the two years follow-up of our prior monocentric, retrospective analysis conducted between 2019 and 2021, comparing SAP and open-source AID systems in people with type 1 diabetes. This second-year analysis included 25 PwD and investigated glycemic changes based on ambulatory glucose profiles (AGP). In comparison to the first year, a worsening of mean glucose (125.4 to 135.2 mg/dl, P = 0.038), time in range ((TIR), 84.2 to 77.0%, P = 0.012), time above range ((TAR), 11.6% to 18.5%, P = 0.017) and glycemia risk index ((GRI), 24.8 to 35.0%, P = 0.026) was observed. The reduction of mean glucose and glucose variability with AID in the first year was due to a significant decrease in time in hyperglycemia with resulting higher TIR and lower GRI. In this second-year follow up, TIR and GRI showed a significant deterioration, a familiar phenomenon in diabetology. However, open-source AID systems showed continuous safety, as there was no increase in time below range (TBR) even after two years. Despite the slight deterioration in the glycemic parameters, open-source AID systems were able to demonstrate sufficient glycemic control according to international consensus guidelines while offering the characteristic benefits of a reduced burden of diabetes management. A descriptive comparison of different AID algorithms indicated an improved glycemic control with more advanced features such as basal rate modification, auto bolus function and autotuning.
There is variance in the incidence of lower extremity amputation across and within countries including within the UK. National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotland and Ireland. Lower extremity amputation rate has yet to be documented within Wales. The aim of this cohort study was to examine trends in diabetes and non-diabetes related lower extremity amputation incidence within the Welsh population and to examine the influence of diabetes on the relative risk of amputation.
All first-time amputations between 2008-2018 were extracted from SAIL, a repository of all routine medical data of residents of Wales. People with diabetes were identified using an algorithm utilising data from several clinical and non-clinical sources. Crude and direct age and sex adjusted incidences were estimated over time.
Over the period 3505 major amputations and 4335 minor amputations occurred. The diabetes population greater than 17 years of age increased by 29.4% from 143,595 in 2008 to 206,818 in 2018. There was a statistically significant rate reduction in major amputation in both populations. In the diabetes population the number of major amputations reduced from 6.9 [5.5–8.5]/10 000 person years (PY) in 2008 to 4.9 [5.4–6.2]/10 000 PY in 2018. However, for major amputation, the risk of incident amputation in people with diabetes was 7.3 fold higher [7.1–7.5] than those without diabetes. The relative risk of minor amputation for those with diabetes was higher at 11.9 [11.8 –1.01]. There was no reduction in this risk over the period.
This study found that rates of major amputation decreased over the study period but the risk of amputation for persons with diabetes remained substantial. As the population with diabetes increases so do crude rates of amputation, providing a substantial financial and societal cost to the Welsh Population.
Diabetes epidemiology has evolved rapidly since the 90 s and so are the technologies for diabetes treatment and care. With each new innovation coming to the market, hopes that technologies will solve the numerous, complex, issues related to diabetes are present. However, if it is now demonstrated that, overall, those technologies - when available - bring major benefits to people living with diabetes, they do not make the disease disappear. In this short review, we discuss the interconnections between technologies and diabetes distress, an often underlooked consequence of the continuous demands of diabetes. We define the concept of diabetes distress, discuss which dimensions can be positively impacted thanks to the use of diabetes technologies and what will likely not be solved by them. With the emergence of closed-loop insulin delivery systems, it is of utmost importance to give sufficient space to the assessment of the emotional dimension of diabetes care in clinical routine.
Type 2 diabetes (T2DM) and liver disease, mainly metabolic-associated fatty liver disease (MAFLD), previously named non-alcoholic fatty liver disease (NAFLD), coexist in many patients. While physicians were reluctant to use glucose-lowering agents other than insulin in patients with T2DM and liver disease for many decades, the scene changed in recent years. While metformin gave controversial results in patients with MAFLD, pioglitazone was the first to demonstrate unequivocal positive effects, but its use in clinical practice is limited by safety concerns. New glucose-lowering agents, both glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, raised new hope. Indeed, besides a good safety profile, these agents, which are associated with weight loss, pleitotropic effects and cardiorenal protection, have also proven their efficacy in improving MAFLD. The positive effects on liver fat content, hepatic enzymes used as markers of steatosis and indices of tissue inflammation are now well demonstrated, yet available data on fibrosis are more limited. Thus, more dedicated studies, using liver biopsies, are still warranted to demonstrate the efficacy of these two pharmacological classes in preventing the progression from simple steatosis to fibrosis/cirrhosis and further confirm this new opportunity for the management of patients with T2DM and MAFLD.
Data on the clinical course of patients with cystic fibrosis (CF) from childhood to CF-related diabetes (CFRD) diagnosis in adulthood are limited. We evaluate whether childhood trajectories of parameters of interest in CF are associated with the risk of abnormal glucose tolerance (AGT) in early adulthood.
Pediatric and adult data from 108 subjects with CF followed annually were paired. Participants were grouped according to predominant childhood trajectories for weight, height, body mass index, lung function, glycated hemoglobin levels, fasting glycemia, and 2h post-oral glucose tolerance test glucose levels. Multivariable logistic regression was performed to identify parameters that predict glucose tolerance status in adulthood.
Univariate analyses reveal that the risk of developing an AGT in adulthood is greater in subjects who are homozygous vs. heterozygous for the ΔF508 mutation, have pancreatic insufficiency vs. sufficiency, or have higher fasting glycemia values at 10 years old rising rapidly vs. lower values that are gradually rising until 17 years old. Multivariable logistic regression retains only fasting glycemia as a significant predictor for the occurrence of AGT in adulthood.
Fasting glycemia may be a clinical marker of interest to better target children with CF at risk of developing an AGT in early adulthood.
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