Frontiers in clinical diabetes and healthcare最新文献

Background: Type 2 diabetes and lower-extremity peripheral artery disease (PAD) are growing global health problems associated with considerable cardiovascular and limb-related morbidity and mortality, poor quality of life, and high healthcare resource use and costs. Diabetes is a well-known risk factor for PAD, which further increases the risk of long-term complications. The primary aim of this systematic review was to ascertain the aggregated prevalence of PAD among individuals diagnosed with type 2 diabetes mellitus (T2DM) residing in sub-Saharan Africa.

Objective: The aim of this study was to determine the pooled prevalence and associated factors of PAD among patients with T2DM in sub-Saharan Africa.

Methods: A systematic review and meta-analysis was performed in alignment with the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To identify papers published in English up to 8 November 2024, the electronic databases of Medline, Web of Science, Science Direct, Excerpta Medica Database, Cochrane Library, African Journals Online, and Google Scholar were searched. A random-effects model was employed to estimate the pooled prevalence and associated factors of PAD.

Results: This study revealed that the pooled prevalence of PAD among patients with T2DM was 35.7% [95% confidence interval (CI) 28.7, 42.7], reflecting the significant impact of DM on vascular health with statistically significant heterogeneity observed between studies (I ² = 94.9%, p < 0.001). Age, elevated low-density lipoprotein, elevated body mass index (BMI), and diabetes illness duration exceeding 10 years were the significant predictors.

Conclusion: The aggregate burden of PAD in individuals with T2DM within the sub-Saharan African region is estimated at 35.7%, suggesting that a considerable segment of the sub-Saharan population has been impacted. Epidemiological studies utilizing precise assessment tools can enhance the early detection and prevention of PAD in T2DM and improve the certainty of findings.

Clinical implication: There is a need for integrated care approaches that prioritize the screening and management of PAD in individuals with T2DM. Given the high prevalence and associated complications, healthcare providers should implement routine PAD assessments in diabetes care protocols. Future research should focus on longitudinal studies that explore the causal relationships between risk factors and the development of PAD in patients with T2DM.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42024611838.

Aims/introduction: Diabetic retinopathy (DR) often remains asymptomatic until it reaches advanced stages, when delayed treatment can lead to irreversible visual impairment. To promote timely ophthalmology visits, this study investigated the utility of a simple nerve conduction device, DPNCheck^®, as a predictor of DR severity. Previous research has established a relationship between diabetic neuropathy (assessed by conventional nerve conduction studies) and DR progression; however, the specialized equipment and expertise required limit its practicality. In contrast, DPNCheck^® is a simpler alternative that quantifies neuropathy severity through the severity of the estimated modified Baba classification (eMBC).

Materials and methods: Using electronic medical records (EHRs), we identified individuals with diabetes who underwent DPNCheck^® and subsequent ophthalmologic assessment for DR. Based on age and sural nerve conduction data, an eMBC was calculated. Meanwhile, DR severity was scored using a modified Davis classification, defining four stages (DR severity scores 0-3).

Results: Of 181 individuals extracted from our hospital's EHRs, 146 were eligible for analysis. Ordinal logistic regression showed that eMBC was significantly associated with DR stage, independent of diabetes duration and HbA1c. Receiver operating characteristic (ROC) curve analyses yielded eMBC cut-off values of 1.11, 1.51, and 1.51 to predict DR severity scores of ≥1, ≥2, and ≥3, respectively. Sensitivities ranged from 0.67 to 0.78, and specificities from 0.66 to 0.81. An eMBC of 1.51 or above was strongly associated with preproliferative or proliferative DR, indicating a need for urgent ophthalmology referral.

Conclusions: DPNCheck^®, a simple nerve conduction measurement device, may help predict DR severity and facilitate timely ophthalmologic care.

Diabetes mellitus is chronic disease with increasing prevalence, and may cause many organ complications, including kidneys. Reduced creatinine clearance and kidney failure are important, but hyperkalemia may be present in diabetic patients even before these problems. There may be many reasons of hyperkalemia in this group of patients. Type IV renal tubular acidosis is important cause of generally mild hyperkalemia, and it is a treatable condition. ''Polypharmacy'' -which is very common in diabetic patients due to accompanying other diseases- may trigger electrolyte imbalance. Underlying causes should be investigated and treatment should be done before it worsens.

Traditionally, Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs), a pivotal class of drug, mimics the actions of endogenous Glucagon-like peptide-1, which have been found to be remarkable in the treatment of type 2 diabetes alongside other comorbidities. GLP-1 receptors being widely available in the different organs and tissues such as the brain, lung, pancreas, stomach, heart, and endometrium has explained the broader therapeutic application of GLP-1RA. The recent studies have explored the physiological effects of GLP-1RA on body organs, establishing them as a potential therapeutic option for a wide range of diseases. Activation of GLP-1 receptors contribute to regulation of blood glucose levels, weight management, cardiovascular health, and potential neuroprotection, while also having a positive influence on musculoskeletal health. This review has emphasized the expanded role of GLP-1RA by highlighting the most significant and notable studies. While GLP-1RA has proven clinical efficacy, the need for more comprehensive studies, to ensure their long-term safety, is essential to optimize their therapeutic role and improve patient outcomes on a global scale. Addressing the significant gap for research on cost effectiveness of these drugs is also crucial for their accessibility in comparison to other drugs. Nevertheless, the limited data available calls for a platform for future research to carry out the expanded therapeutic effects of GLP-1RA.

Background: This study examines the correlation between skin autofluorescence (SAF) and blood glucose levels, emphasizing the accumulation of advanced glycation end-products (AGEs). We hypothesize that SAF levels are closely linked to type 1 diabetes complications in children. The aim is to evaluate SAF's relationship with type 1 diabetes progression in children and its potential as a non-invasive tool for disease detection and monitoring complications. The research was registered with PROSPERO (CRD42021284774).

Methods: We conducted a meta-analysis by extracting studies from databases including PubMed, MEDLINE, EMBASE, Cochrane, Science Direct, Scopus, and Web of Science. A random effects model was used to assess if SAF measurement could serve as a non-invasive marker for type 1 diabetes and its complications. SAF values were compared between children with type 1 diabetes and controls, calculating the mean difference and 95% confidence intervals.

Results: The analysis included three case-control studies and one retrospective cohort study, all using the AGE Reader^® (DiagnOptics Technologies). Data analysis showed significant heterogeneity (I² = 82%, P < 0.05). The random effects model revealed a positive correlation between higher SAF levels and type 1 diabetes in children [mean difference = 0.20 (0.16, 0.25)], indicating elevated SAF in diabetic children compared to non-diabetic peers.

Conclusion: This research supports SAF measurement as a non-invasive indicator for type 1 diabetes and its complications in children. However, further studies with larger samples and longer follow-up are needed for definitive conclusions and detailed insights into complications. Additionally, the skin's multifaceted roles require further investigation.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021284774.

Background: Over the last decades, non-communicable diseases such as diabetes have remarkably increased due to rapid urbanization, unhealthy lifestyles, and ageing. The World Health Organization (WHO) indicates that the "diabetes epidemic" will continue in the coming decades, yielding enormous human and economic costs around the world. This study explores healthcare workers' views on social support groups and policy recommendations for managing type 2 diabetes in Ghana.

Method: This study utilized a facility-based cross-sectional qualitative research design to explore healthcare workers' views on social support groups and policy recommendations for managing type 2 diabetes in Ghana between January and May 2023. Health workers who worked in the three selected regional hospitals for at least one year and at the diabetic clinics of the three selected regional hospitals of the respective regions at the time of this study were included. The study used purposive sampling to select 12 health workers (Nurses) as key informants. One (1) facility head of each facility and three (3) health workers, each working in the diabetic clinic of each regional hospital, were selected for key informant interviews. The interviews were recorded and transcribed in English. Notes from the interview were transcribed after the key informant interview. Data was imported into the Nvivo 7 software. The results were presented as prose, analyzed, and discussed in themes.

Results: Major challenges facing people living with diabetes were the cost of medication, limited NHIS coverage, frequent morbidity and the chronic nature of the disease, putting psychological pressure on the patients. The policy recommendation was on mass education and the expansion of NHIS coverage.

Conclusion: The study has noted some significant challenges faced in managing type 2 diabetes mellitus in Ghana. Addressing the diabetes epidemic in Ghana requires a comprehensive and multi-pronged approach, focusing on prevention, early detection, access to care, and diabetes education. Implementing the policy recommendations outlined in this study can significantly improve diabetes management in Ghana, reduce the burden of the disease, and enhance the overall health and well-being of the population.

Background: Diabetic wounds are a serious complication for diabetic patients, characterized by refractoriness, high recurrence rates, and susceptibility to infection. Although current guidelines recommend evidence-based treatment strategies, clinical outcomes remain suboptimal. This paper reviews the current research status and development trends in diabetic wound treatment.

Methods: Articles on diabetic wound treatment published between 2014 and 2023 were identified using the Web of Science Core Collection database, resulting in a total of 9,099 articles. Bibliometric methods were employed to analyze authors, institutions, countries, journals, keywords and references using CiteSpace and VOSviewer.

Results: China has published the most articles in the field, followed by the United States. Shanghai Jiao Tong University is the leading institution in diabetic wound treatment research, and David G. Armstrong from the United States has made significant contributions to this field. "Wound Repair and Regeneration" was identified as the most influential journal. Cluster analysis of keywords revealed four main categories: (1) mechanisms of diabetic wound healing, (2) prognosis, (3) treatment, and (4) management.

Conclusion: This paper systematically reviews the research on diabetic wound treatment from 2014 to 2023, outlining and forecasting global research hotspots and trends. Future research is expected to focus on treatment strategies for diabetic wounds, while interdisciplinary collaboration and advancements in intelligent management technologies have the potential to improve patient outcomes.

Background: As the prevalence of diabetes and its related complications continues to rise, understanding the factors that influence glycemic control is crucial for improving patient outcomes. This study aimed to explore the roles of self-management, social support, and self-efficacy in moderating fasting blood glucose (FBG) levels in individuals with type 2 diabetes mellitus (T2DM).

Methods: A health facility-based cross-sectional study was conducted in Windhoek, Namibia with a sample size of 315 T2DM patients receiving follow-up care. Descriptive statistics and Pearson correlation analysis were conducted to examine the relationship between self-management and FBG. Linear regression and moderation analyses were used to determine the moderating effects.

Results: The study revealed 34.3% engaged in self-monitoring of FBG, while medication adherence was high at an average of 7 days. A significant negative correlation between self-management practices and FBG levels was identified (r = -0.349, p < 0.028). Self-management, self-efficacy, and social support accounted for 43.1% of FBG variation, with self-management emerging as a significant predictor (β = -0.903, p < 0.001). Additionally, social support and self-efficacy significantly moderated the relationship between self-management and FBG levels.

Conclusion: This study showed the significant moderating roles of social support and self-efficacy in the relationship between self-management practices and FBG levels in patients with diabetes. These results highlight the importance of comprehensive diabetes management programs focusing on individual behavioral changes, enhancing social support networks, and boosting self-efficacy.