Journal of Diabetes Mellitus
ISSN / EISSN : 2160-5831 / 2160-5858
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 326
Latest articles in this journal
Journal of Diabetes Mellitus, Volume 11, pp 10-25; doi:10.4236/jdm.2021.111002
Introduction: Good quality care in Type 2 diabetes mellitus (T2DM), whose prevalence is approximately 10% in Kenya, may prevent or delay diabetes complications. This study determined blood glycemic targets, defined by HbA1c levels (>6.5% [53 mmol/mol]) and associated factors among patients receiving diabetes management at Kenyatta National Hospital in Kenya. Methods: In this cross-sectional study conducted between May to September 2017, we obtained blood samples from 381 consenting T2DM patients attending KNH. The study collected data using a detailed questionnaire while taking glycemic measurements. Factors associated with poor glycemic control (HbA1c levels >6.5%) were determined using Ordinal logistic regression modeling, STATA software version 13. Results: 103 (27.1%) T2DM patients with poor glycemic control were identified. In multivariate analysis, independent risk factors associated with poor glycemic control and their 95% confidence intervals included: concurrent hypertension (aOR 1.6, [1.1, 2.4]), receiving ≥3 oral anti-diabetes medication (aOR 2.4, [1.3, 4.6]) and good adherence to medication based on self-reporting (aOR 6.2, [1.9, 41.3). Independent protective factors included self-monitoring of blood glucose levels (aOR 0.35, [0.2, 0.4]), patients aged 51 to 60 years (aOR 0.5, [0.3, 0.9]), weight between 50 and 70 kgs (aOR 0.5, [0.3, 0.9]) and receiving 1 to 2 diabetes medication (aOR 0.4, [0.3, 0.7]). Conclusion: Significantly high proportion of T2DM patients receiving treatment at KNH had poor glycemic control. Addressing comorbidities and promoting good glycemic control among long-standing T2DM patients receiving ≥3 oral anti-diabetes medication is key to delaying or preventing chronic diabetes complications. Self-monitoring of blood glucose levels needs to be encouraged as suggested by its protective effect. While differences in risk between diverse weights and ages need further studies, innovative ways of authenticating self-reports, e.g., triangulation, are required to ensure credibility. This work supports the Government of Kenya’s Vision 2030 in creating a healthy and productive population contributing to the country’s economic growth.
Journal of Diabetes Mellitus, Volume 11, pp 83-96; doi:10.4236/jdm.2021.113007
Objective: The aim of this study was to develop and validate a questionnaire for patients with diabetes to assess the foot self-care. Methods: A validation study was carried out in a sample of 200 patients with diabetes. Item analyses included the assessment of difficulty index, discrimination capacity and the correlation of items with the total score of the questionnaire. Factor analysis was used to test construct validity. Test-retest reliability was assessed with a sample of 31 patients. Criterion validity was determined by comparing the scores of patients with a history of foot ulcers with the scores of patients without this complication. Results: The internal consistency assessed by the Cronbach’s alpha (0.731) and test-retest reliability (r = 0.714, p = 0.001) for all sections were acceptable. Factor analysis revealed three factors: foot care, footwear and foot-damaging behavior, which explained 54.34% of the variance. All items had factor loading of greater than 0.4. Patients with diabetic neuropathy had a lower score after completing the foot care education questionnaire (Mann-Whitney U, p < 0.001). Conclusion: This questionnaire meets the reliability and validity conditions necessary for its application in our patients with diabetes.
Journal of Diabetes Mellitus, Volume 11, pp 41-51; doi:10.4236/jdm.2021.112004
The correlation between liver enzymes and lipid profile in T2D patients in the Yemeni population has been evaluated. This is a case-control study comprising 142 T2D patients and 142 healthy control subjects were carried out at the outpatient clinics of Ibn-Sina hospital, Mukalla, during the period from January to May 2020. Serum fasting blood glucose (FBG), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were analyzed using the Cobas Integra Plus 400 autoanalyzer. Also, anthropometric and blood pressure measurements were taken from each participant. Independent sample T-test and Pearson correlation coefficient were used. T2D patients had significantly higher FBG (P ≤ 0.0001), total cholesterol (P ≤ 0.0001), LDL-C (P ≤ 0.0001), and GGT (P ≤ 0.0001) while HDL-C was significantly lower in T2D patients (P = 0.021). In correlation analysis, serum GGT was positively associated with FBG (r = 0.216; P ≤ 0.0001), total cholesterol (r = 0.196; P = 0.0001), triglyceride (r = 0.123; P = 0.038), and LDL-C (r = 0.209; P ≤ 0.0001). Also, serum ALT was positively associated with FBG (r = 0.145, P = 0.014) and triglyceride (r = 0.172, P = 0.004). In conclusion, higher levels of ALT and GGT are used as the predictive biomarkers for NAFLD in T2D patients with hyperlipidemia. Thus, routine screening of liver enzymes and lipid profile in T2D patients is recommended for the early detection of liver abnormalities and diminish diabetes complications.
Journal of Diabetes Mellitus, Volume 11, pp 52-67; doi:10.4236/jdm.2021.112005
Background: To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. Aims: The aim is to investigate adolescents’ expectations of an outpatient diabetes clinic visit in comparison to what was deemed to be delivered and contrast this outcome in adolescents with self-reported high- and low-diabetes distress respectively. Methods: All adolescents in Sweden with type 1 diabetes, aged 15 to 18 years, were identified via The National Pediatric Diabetes Registry (SWEDIABKIDS) and asked to complete an online questionnaire regarding their expectations and the support received during the outpatient diabetes clinic visit. Results: 453 adolescents completed the survey. Boys’ expectations of discussion topics were mainly met while girls, especially those with diabetes distress, felt their discussion needs were not met regarding quality-of-life aspects. Conclusions: Although adolescents’ expectations are in general met during the diabetes outpatient clinic visit, aspects related to living with diabetes are not being met especially among female adolescents who reported diabetes distress. This study shows a gender difference both regarding expected discussion topics and what was deemed covered. Practice Implications: A multi-professional, individual person-centred care approach is needed at the diabetes outpatient clinic. This paper proposes that agenda setting performed by the adolescent, and agreed by the physician, prior to the outpatient clinic visit could facilitate individualized care and better meet the adolescents’ needs in a shared decision-making process.
Journal of Diabetes Mellitus, Volume 11, pp 69-82; doi:10.4236/jdm.2021.113006
Background: Erectile dysfunction, which is defined as difficult to attain and maintain an erectile function enough to permit sufficient sexual performance, is accepted to be a big problem especially among diabetic patients. Objective To assess the Magnitude and factors contributing to Erectile Dysfunction Among Diabetic men attending the diabetic clinic in Debre Tabor Comprehensive and Specialized hospital, North West Ethiopia. Methods: Hospital based cross-sectional study was conducted on 362 participants in Debre Tabor Comprehensive and Specialized Hospital from August - December 2020 using systematic random sampling technique. Data were analyzed with SPSS Version 23. Binary and multivariable logistic regressions were done to identify factors which were contributing to erectile dysfunction. P-value 10 years), type of diabetes (type II), physical exercise, drinking alcohol, BMI, blood glucose, and blood pressure were associated with erectile dysfunction at 5% level (p ≤ 0.05). Multiple logistic regression analysis revealed that duration of diabetes 10 years (AOR = 6.2, 95% CI: 2.78 - 13.85, p = 0.001), co-existing hypertension (AOR: 3.59, 95% CI: 1.58 - 8.19, p = 0.002), physically inactive (AOR = 2.87, 95% CI: 1.53 - 8.31, p = 0.003), unsafe level alcohol intake (AOR: 3.09; 95% CI 1.45 - 6.59*, p = 0.003) and raised blood glucose (AOR: 15.26, 95% CI: 7.82 - 29.77, p = 0.004) were independent risk factors but no association was found with other variables. Conclusion: The magnitude of erectile dysfunction in this study population was 59.7% and associated with the type of diabetes; duration of diabetic, physical exercise, alcohol drinking, increase in blood pressure, and elevated blood glucose level were independently correlated with erectile dysfunction.
Journal of Diabetes Mellitus, Volume 11, pp 26-39; doi:10.4236/jdm.2021.111003
Background: Gestational diabetes mellitus (GDM) is a common pregnancy disorder screened for between the 24th and 28th weeks of gestation using oral glucose tolerance test. GDM has maternal and fetal health implications. Objective: To assess the relation between folic acid supplementation in pregnant women and the risk of developing GDM. Search Strategy: The search employed topic-based strategies designed for each database in June 2020. Databases searched were Pubmed, Cochrane Library, Embase and Lebanese American University online database. Selection Criteria: Studies eligible were those targeting the association of GDM development and folic acid supplementation, including pregnant women who have developed GDM and pregnant women who were on folic acid supplementation and developed GDM. Both interventional and observational studies were included. Data Collection and Analysis: Two reviewers extracted the data independently. A third reviewer checked the data for consistency and clarity. Data extracted included the sample characteristics, sample size and outcomes. Cohen’s κ was used to assess agreement between reviewers. All tools and processes were piloted prior to use. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data was presented in a tabulated form. Main Results: Six studies showed a proportional relation between folic acid intake and GDM, two reported a protective effect, and one cohort found no association. Conclusion: The inconsistent results made the formulation of a definitive conclusion difficult. Hence, larger studies are needed.
Journal of Diabetes Mellitus, Volume 11, pp 1-9; doi:10.4236/jdm.2021.111001
Diabetes mellitus is a chronic disease that impacts the homeostasis of blood sugar levels caused by loss or defect of insulin-producing β-cells in the Islets of Langerhans. Type 1 diabetes (T1D) is caused by auto-immune mediated destruction of β-cells, whereas in T2D, insulin is produced but used inefficiently. T2D accounts for 90% of people with diabetes worldwide (WHO 1999) and is the fastest increasing disease worldwide (https://diabetesatlas.org/en/). For an improved understanding of the pathomechanism of diabetes, profound knowledge of pancreas organogenesis and the associated gene regulatory networks is required. Therefore, we dissected and profiled the pancreatic endodermal and non-endodermal compartment between the embryonic stages (E) 12.5 and E 15.5 when progenitor cells commit to their different pancreatic lineages. Our associated study mined the global mRNA expression profile to increase the understanding of the secondary transition, endodermal-non-endodermal tissue interaction, and diabetic-related gene regulation. Furthermore, we validated 635 regulated pancreatic genes using the publicly available GenePaint.org, respective gp3.mpg.de to evaluate genes associated with genetic variants in Single-nucleotide polymorphism (SNP) related to T2D.
Journal of Diabetes Mellitus, Volume 10, pp 222-235; doi:10.4236/jdm.2020.104018
Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that is characterized by β-cell dysfunction and resistance for insulin. Vitamin D is necessary for insulin secretion so it is a crucial factor in the development of T2DM. This study was done to investigate the association between serum 25-hydroxy Vitamin D [25(OH)3D], VDR (Vitamin D receptor) and VDBP (Vitamin D binding protein) with type 2 diabetic patients compared to control subjects. Subjects and Methods: This study carried out 110 female patients who were previously diagnosed with type 2 diabetes and 110 age, sex and weight matched as controls. All participants were subjected to full history taking, clinical examination and assessment of fasting blood glucose, HbA1c , lipid profile, 25-hydroxy Vitamin D [25(OH)3D], VDR and VDBP. Results: Results showed that the level of 25(OH)3D was significantly lower in diabetic group compared to controls and was significantly negatively correlated with glycated hemoglobin, serum total cholesterol and low density lipoprotein cholesterol in type 2 DM. Decreasing Vitamin D level was significantly associated with decreasing VDR. No significant association was found between Vit D and VDBP levels. Conclusions: Vitamin D deficiency is frequent in diabetic patients and associated with poor control and outcome. This suggests a role of Vitamin D in the pathogenesis and control of T2DM. Serum VDBP in diabetes may be independent to the level of 25(OH)3D and needs further studies.
Journal of Diabetes Mellitus, Volume 10, pp 51-63; doi:10.4236/jdm.2020.102005
Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication with limited study of its burden, knowledge, determinants and preventive measures adopted by type 2 diabetics. Methods: Patients with type 2 diabetes who presented at Diabetes Clinic of a University teaching hospital and fulfilled selection criteria were recruited. The information obtained included sociodemographic, clinical details with hypoglycaemic symptoms and laboratory measurements. Results: There were 113 participants with a mean age of 60.94 ± 11.95 years. The majority of the patients had fair knowledge of hypoglycaemic symptoms and also knew what actions to take to ameliorate the symptoms when it occurs. The incidence of hypoglycaemia was 45.1% and most commonly occurred in the afternoon before lunch. The commonest symptoms reported by patients were shivering (76.1%), hunger (71.7%) sweatiness (71.5%) and weakness (69.9%). Almost one-fifth (19.6%) of those who reported hypoglycaemia had severe symptoms, of which 16.1% had hospital admission for its management. Use of insulin, duration of diabetes, age and possession of glucometers were some of the determinants of hypoglycaemic symptoms. Conclusions: The burden of reported hypoglycaemia among type 2 diabetics is significant. Hence, diabetics at risk should always be asked about symptoms at each clinic visit. Early recognition of hypoglycaemia risks, self-monitoring of blood glucose (SMBG), appropriate education programs for both health care providers and patients with diabetes are the major ways to minimize risks of hypoglycaemia.
Journal of Diabetes Mellitus, Volume 10, pp 16-25; doi:10.4236/jdm.2020.101002
Background: Diabetic nephropathy is one of the major complications of diabetes. Nephropathy patients must be evaluated for dyslipidemia as it is an established risk factor for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with or without nephropathy and analyzed the factors associated with nephropathy among them. Methods: In this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n = 50); without nephropathy were enrolled in the control group (n = 50). Both groups were matched for age duration of diabetes. After taking informed consent anthropometrical clinical examinations were done. Biochemical investigations (Total cholesterol, TG, HDL, LDL, VLDL, sdLDL-C, S. urea, S. creatinine were done in SCB MCH, Biochemistry department. Urine microalbumin per gm of creatinine was done. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL), and estimated glomerular filtration rate (eGFR) were calculated using equations. Results were analyzed statistically using SPSS version 20. Results: Mean Total cholesterol, TG, LDL, sdLDL are significantly high in nephropathy patients with p values 0.026, 0.012, 0.014, 0.04 respectively. Estimated GFR has a significant positive correlation with TCHOL (r = −0.850, p = 0.01), TG (r = −0.14, p = 0.008), LDL (r = −0.62 p = 0.037). Estimated GFR has a significant negative correlation with S. urea (r = −0.587, p ≤ 0.01), S. creatinine (r = −0.59, p ≤ 0.01), UACR (r = −0.47, p ≤ 0.01). Dyslipidema sdLDL is significantly more in nephropathy group in comparison to diabetic group with p values 0.033, 0.045 respectively. Conclusion: Our study shows that dyslipidemia was highly prevalent among subjects with nephropathy. So cardiovascular risks can be averted by regular screening for dyslipidemia in diabetic nephropathy patients.