Current Diabetes Reviews - Volume 13, Issue 2, 2017

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia. In particular, type 2 diabetes (T2D) represents one of the main causes of death in the world, and those suffering from it have a lower quality of life. Although there are multiple hypotheses about the pathophysiological mechanisms that lead to the development of T2D, the effects of this pathology on pancreatic β-cells are often ignored. We now know that in addition to genetic defects, β-cell organellar dysfunction participates in the earliest stages of the disease; other factors also contribute to this dysfunction, such as excessive production of reactive oxygen species and a decrease in cellular volume and mass. These features usually result from increased apoptosis, which is not adequately compensated for by the characteristic regeneration mechanisms of these cells. In this study, we specifically examine the genetic, epigenetic and metabolic defects that contribute to β-cell dysfunction and lead to the establishment of T2D, particularly the dysregulated insulin synthesis and secretion in these cells.

Background: Extremely young children aged ≤6 years old represent a unique population among patients with type 1 diabetes in terms of glycemic variation, diabetes management and complications. Objective: We describe distinct features of diabetes care and outcomes in preschool age children. Methods: We searched PubMed, Google Scholar, and authors’ bibliographies in order to extract articles specific to type 1 diabetes in preschool age children. Findings: The preschool age group is beset by many challenges to diabetes care, including more frequent hypo- and hyperglycemia, hypoglycemia unawareness, decreased residual beta cell function, and greater long-term neurocognitive effects from severe hypoglycemia and chronic hyperglycemia. Randomized controlled trials show that equally good metabolic control can be obtained with multiple daily injections or an insulin pump. Several non-randomized trials, including an 8 year longitudinal study, show lower hemoglobin A1C and decreased hypoglycemia on insulin pumps. Sensor augmented pump therapy resulted in superior A1C as long as sensors were used regularly. In contrast to adults, continuous glucose monitoring has little to no impact on A1C, although parents appreciate the improved monitoring for hypoglycemia. Children with onset of diabetes prior to age 5 are at risk for younger onset of microalbuminuria, however do not develop earlier onset retinopathy than children diagnosed after 5 years. Both severe hypoglycemia and chronic hyperglycemia have negative impact on neurocognition. Conclusion: Special knowledge about this young population is helpful for practitioners and parents.

Zinc is essential for the proper storage, secretion and action of insulin, while solute carrier family 30 members (SLC30A8) transports Zinc from cytoplasm to insulin secretory granules in the pancreatic beta-cells. Accumulating genetic studies have demonstrated that the common single nucleotide polymorphisms in the SLC30A8 gene confer the risk susceptibility to type 2 diabetes. The rare loss-of-function variants in the gene, however, may have protective effects in the disease. SLC30A8 is highly expressed in the pancreas, particularly in the islets of Langerhans. Clinical investigations have implicated that SLC30A8 acts as a new antigenic target in the patients with type 1 diabetes. Biological experimental evidence has indicated that this gene expression at both mRNA and protein levels is down-regulated in diabetic pancreatic islets. Furthermore, epigenetic analysis showed that DNA methylation levels in the SLC30A8 gene are increased in type 2 diabetes patients, which complies with the decreased gene expression. In this review, biological relevance and bioinformatics of Zinc transport SLC30A8 are described. Genetic and epigenetic effects of the SLC30A8 gene in type 1 and type 2 diabetes are summarized. Further investigation of SLC30A8 interactions with Zinc and other functional partners is discussed.

Diabetes mellitus (DM) is an emerging global healthcare problem and its prevalence is increasing at an alarming rate. Despite improvements in both medical and pharmacological therapies, a complex medical condition may demand a diversified approach, such as: drug therapy, healthy diet and exercises, diabetes education programs, adherence to medical treatment and active participation of the patients in their lifestyle changes, such as stress management. The concept of mindfulness is here defined as the awareness that unfolds from the intention to attentively observe the current experience in a non-judgmental and non-evaluative way. This state of awareness can be enhanced through the use of mindfulness-based interventions (MBIs), which have been associated to many physical and psychological health indicators. The aim of this overview is to offer the rationale and potential benefits of mindfulness in the control of DM and its complications. Methods: a narrative review of the current and updated literature available on online database and which came up using the terms “mindfulness” and “diabetes mellitus”. Mindfulness-based Interventions (MBIs) can be seen as preventive and complementary interventions in DM, particularly for the relief of symptoms related to depression and anxiety in diabetic patients and also in the management of other factors, including mindful eating, physical exercises and treatment adherence. Although many studies only present research protocols, mindfulness seems to have beneficial effects on all aspects of diabetes, including incidence, control and complications. Furthermore, longer term and more carefully controlled trials are necessary in order to draw consistent conclusions on the beneficial role of MBIs on DM.

Background: Effective usage of insulin in the management of diabetes remains a challenge in developing countries like Nigeria. Objective: The objective of this study is to document the pattern of insulin prescription, frequency, storage, common regimen used, and attendant problems associated with its use in patients with type 2 diabetes mellitus (T2DM). Methods: This was a prospective, descriptive study in which consecutive T2DM patients seen at the medical out-patient clinic and medical wards and who fulfilled the criteria for inclusion were recruited. Participants provided information on their demographic characteristics, diabetes history, treatment and problems associated with treatment, type of insulin in use, number of daily injections, storage, method of insulin administration and problems associated with insulin use. Clinical examination was carried out basically to determine the anthropometric indices. Results: About 84.3% have used insulin for less than 5 years. The thigh was the commonest site of insulin administration (95.3%). About 94.3% of subjects in this study store their insulin in a refrigerator. And Insulin dosing regimen ranged from less than once to four times daily while majority of patients (63%) were on twice daily insulin regimen. Insulin administration devices used were Insulin syringes 394 (98.5%) and Insulin pens 6 (1.5%). Thirty three percent of the subjects self inject insulin while about half of the study subjects (50.5%) receive insulin from a healthcare provider. The most common insulin used by patients was Mixed/ Premixed insulin (32.8%) and Regular/ Soluble insulin (38.8%). Hypoglycaemia was the most frequently documented problem encountered by subjects on insulin followed by weight gain. Majority of the study subjects (50.8%) practice self monitoring of blood glucose (SMBG). Discussion: This study has demonstrated that majority of subjects with T2DM were on premixed insulin and that hypoglycaemia is the most common problem reported by patients. Insulin pens were not common among our study population.

Vascular endothelial growth factor (VEGF) is well established as the main agent responsible for vascular leakage and angiogenesis in the diabetic retina. While VEGF can have positive effects on hyperglycemia stressed retinal tissues, it also plays a role in events progressing to the oxygen- stressed, i.e. hypoxic, diabetic retina. Some VEGF makes its way to the retina from systemic sources and some is produced locally within the eye. Hyperglycemia, oxidants, inflammation, and advanced glycation end-products are all stimulants to VEGF production, both in the hypoxic and the pre-hypoxic retina. Endothelial cells, pericytes, Muller cells, microglia, astrocytes, retinal pigment epithelium and neurons have all been known to produce VEGF at some point in retinal development or in disease. Excessive VEGF production in the early diabetic retina can lead to retinal exposure or mechanisms which exacerbate further damage. While Muller cells are likely the most significant producer of VEGF in the pre-hypoxic retina, other VEGF producing cells may also play a role due to their proximity to vessels or neurons. Study of the release of VEGF by retinal cells in hyperglycemia conditions, may help identify targets for early treatment and prevent the serious consequences of diabetic retinopathy.

Objective: To examine the prevalence of foot ulcers, foot at risk, and the associated risk factors among Jordanian diabetics. Methods: A cross-sectional design was applied on 1000 diabetes patients (both type-1 and type-2) aged >20 years. The participants were selected systematically from among every second patient visiting the diabetes clinics at National Center for Diabetes, Endocrinology, and Genetics (NCDEG) in Amman, Jordan. The participants were interviewed, examined, and then their medical records were reviewed. The factors including sensory neuropathy, vibratory neuropathy, painful neuropathy, vascular insufficiency, retinopathy, and dermatological changes were recorded for all patients. Foot at risk was identified based on the risk category classification and foot ulcers were evaluated based on the Wagner’s classification system. Results: A total of 53 (5.3%) patients had foot ulcers, 17 (1.7%) had undergone amputations, and 172 (17.2%) had foot at risk. A total of 62 patients were identified in the risk category-1, 82 in the risk category-2, and 28 in the risk category-3. Loss of protective sensation was detected in 174 (17.4%) patients, loss of vibratory sensation in 162 (16.2%) patients, absence of posterior tibial pulse in 115 (11.5%) patients, absence of dorsalis pedis pulse in 97 (9.7%) patients, and claudication in 72 (7.2%) patients. Loss of protective sensation (p < 0.000), loss of vibratory sensation (p < 0.039), and vascular insufficiency (p = 0.02) were found to be significantly higher in diabetic patients with foot ulcers than in those without foot ulcers. Conclusion: The prevalence of foot ulcer in Jordan was 5.3%, while foot at risk was prevalent in 17.2% patients. Patients with loss of protective sensation, loss of vibratory sensation, and vascular insufficiency of the lower limbs were found to be at a higher risk for the development of foot ulceration.