Current Diabetes Reviews - Volume 14, Issue 5, 2018

Introduction: Obesity is a serious, worldwide and growing problem, with associated complications ranging from cardiovascular disease to cancer. It has been suggested that a subgroup of obese patients- the “metabolically healthy” (MH)- would constitute a phenotype whose cardiovascular risk would be closer to that of normal weight individuals and lower than that of obese patients with other risk factors. The definitions of MH obesity are heterogeneous, what makes the estimation of its prevalence quite difficult. Besides that, data are still controversial about the risk of incident cardiovascular disease in these patients and therefore this remains an unresolved matter. In parallel, the possibly lower risk of MH obesity may raise questions about the need for weight loss in MH obese patients. Conclusion: This issue should be carefully addressed, and evidence for a “benign” profile of MH obesity critically evaluated, as obesity is a risk factor for numerous health outcomes, and weight loss in obese people additionally offers protection against these nonmetabolic diseases.

Background: Limited Joint Mobility (LJM) is a dreaded complication of Diabetes Mellitus (DM). During the last half century, LJM has been studied in patients of different age because it has been considered useful for the monitoring of a patient's condition and for the prevention of vascular disease and diabetic foot. Objectives: The main aims of this review are to describe the relationship between DM and joint mobility as well as its prevalence and assessment. We have also investigated the role of LJM in the development of diabetic foot ulcers. Methodology: An in-depth literature search was conducted to identify studies that examined the prevalence and characteristics of LJM in patients with DM of different types, age, durations and chronic complications. Results: Many factors (therapy improvements, population characteristics and different evaluation methods) concur to hinder an exact assessment of the prevalence of LJM. However, it has been confirmed that LJM is widespread among patients with DM and may affect more than two-thirds of them in addition to being a major risk factor for foot ulcer. Its role in the monitoring of a patient's condition is also important for the definition of risk thresholds such as in patients with diabetic foot. The efficacy of exercise therapy for the treatment of LJM, also in patients at risk of foot ulcer, has not been discussed. Conclusion: Difficulties encountered in the definition of the prevalence of LJM may hinder its study and the establishment of preventive interventions. However, LJM plays a key role in the monitoring of patients, especially those at risk for ulcer.

Background: Metabolic syndrome is associated with increased risk for both type 2 diabetes and cardiovascular disease. Development of these pathologies is associated with the disorders of lipid and lipoprotein metabolism. Dyslipidemia leads to the overproduction of potentially atherogenic lipid and lipoproteins. Furthermore, there is a decrease in the levels of high-density lipoproteins and an increase in the levels of remnant and small dense LDL particles. Conclusion: In the current review, we have discussed the pathophysiology of lipoprotein biosynthesis and metabolism in the metabolic syndrome. Finally, we describe regulation of lipoprotein metabolism which may be used as a potential target for treating dyslipidemia in metabolic syndrome.

Background: Although diabetes mellitus is a risk factor for cancer, the relationship of an increased glucose concentration at a non-diabetic glucose level with cancer mortality is yet to be determined. Objective: The aim was to observe whether an increased glucose concentration and/or glucose intolerance at the non-diabetic glucose level can predict cancer mortality. Methods: Population-based prospective cohort studies evaluating cancer mortality at the non-diabetic level (defined as fasting plasma glucose <7.0 mmol/L and two-hour plasma glucose <11.1mmol/L following an oral glucose tolerance test) were collected via a PubMed search with an additional Google scholar search between 1 January 1966 and 31 July 2016. Results: We identified seven studies, which met the defined criteria. Studies examining fasting/casual states indicated an increase in cancer mortality with a slight increase in fasting/casual glucose levels in men in particular. Not all, but some studies using a glucose tolerance test indicated an increase in cancer mortality with impaired glucose tolerance/prediabetes. Concerning cause-cancer mortality, glucose intolerance states appeared to have an increase in mortality, particularly due to the stomach, liver and pancreatic cancers. Conclusion: In these studies reviewed, cancer mortality increased in individuals with an increased glucose concentration and an increased potential was seen in those patients with glucose intolerance even at non-diabetic glucose levels. The outcome of these findings is promising and forms the basis for further studies to directly address the relevance of increased (non-diabetic) glucose and glucose intolerance as a prognostic indicator of cancer mortality.

Background: Association between Chronic Hepatitis C virus (CHC) infection and type 2 diabetes mellitus has been challenging in recent decades. Despite of extensive research in this area, there is no general agreement on the direct effect of HCV infection on insulin resistance. Patients and Methods: The study was performed in 52 CHC patients (mean age = 39.48) and 52 sex-matched healthy Iranian controls, referred to the Hepatitis Clinic, Department of Gastroenterohepatology, Shiraz University of medical sciences, Shiraz, Iran, from 2012 to 2015. Fasting blood glucose level, fasting insulin level and insulin resistance defined as a Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index were determined and compared between two groups. Results: Insulin resistance was present in 26.9% of CHC patients and 34.62% of healthy controls. Mean HOMA index was 1.93 in patients and 2.18 in controls. There were no statistically significant differences between patient and control groups with regard to fasting insulin level, fasting blood glucose, HOMA index and insulin resistance. HOMA index and fasting insulin level were significantly higher in IR CHC patients relative to IR controls. Fasting blood glucose was also significantly higher in controls younger than 40 years. Conclusion: Results obtained in this study showed that chronic hepatitis C cannot be considered as a risk factor for insulin resistance and diabetes in Iranian population. However, regular screening for insulin resistance is recommended in CHC patients with age ≥ 40 years and fasting blood glucose ≥ 100 mg/dl.

Background: Diabetes is one of the most chronic diseases prevalent in Kingdom of Saudi Arabia. Its number of patients have increased in past few decades. Best efforts to provide world class treatments to patients through public and private hospitals are in hand. However, feedback of practices observed by patients and hospitals is not being achieved to assess the treatment efficacy. Absence of an elaborated questionnaire in Arabic language is a major hurdle to seek information from patients' due to their limited knowledge of English language in which most of the survey questionnaire exist in internationally published literature. Conclusion: In present research one such questionnaire was adapted and translated into Arabic language for survey of patients in a local hospital. A total of 191 patients participated in this investigation. Results of findings are analyzed on the basis of demographics, diagnostics, tests and various aspects of diabetes self-management by patients.

Background: The age is a variable positively related to healthcare expenditures on diabetes (DM), however other factors could also be associated. Physical activity, normal weight and walking habit could be inversely associated to healthcare expenditures related to DM control. The aim of this study was to describe healthcare diabetic-related expenditures and analyze the associations with Body Mass Index (BMI), Physical Activity Level (PAL), and walking habit among the elderly Brazilians. Methods: A cross-sectional analysis was carried out on a population-based study (SABE Study) in Brazil. Healthcare expenditures were estimated for the medicine prescriptions, outpatient service and hospitalization. The sample was classified according to BMI, the PAL, and according to weekly frequency of walking habit.The annual healthcare expenditures were estimated, and the multiple logistic regression was used to analyze the associations between variables. Results: The sample included 295 elderly diabetics, with a mean age 70 years. The excess weight group presented significantly higher annual expenditures with medicine prescriptions, hospitalization, and outpatient services. Absence of walking habit was related to higher costs and inversely associated to higher expenditures to medicine prescriptions (OR 2.82, IC95% 1.48 - 5.40) and hospitalizations (OR 5.79, IC95% 1.10 - 10.93), independent of BMI, sex, age and the presence of hypertension. Conclusion: BMI and insufficient PAL were associated to higher public expenditures related to DM control in elderly people. Walking habit was inversely associated to healthcare expenditures on behalf of the diabetes control among Brazilian elderly population.

Background: The Neck Circumference (NC) is an anthropometric measure to evaluate obesity. The FINDRISC predicts the risk of developing type 2 diabetes mellitus. Our aims were to identify the mean value of NC in individuals with higher (≥15 points) and lower FINDRISC and to establish cutoff values that indicate individuals with higher FINDRISC. Methods: It is a population-based, cross-sectional study representative of the city of Curitiba, Brazil. We studied individuals (>18 years), without diabetes mellitus, between August 2013 and August 2014. We evaluated anthropometric parameters, glycaemia, socioeconomic situation, chronic conditions, and their risk factors. In a sex-specific analysis, data are presented as mean and standard deviation. We performed Pearson's and Spearman's correlation between NC and the waist circumference, body mass index and FINDRISC. Receiver Operating Characteristic curves were estimated for NC and higher FINDRISC. Logistic regression models were built to analyze the association between higher FINDRISC and 1-SD increase in NC. Results: We studied 950 individuals (621 women) with a mean age of 47.4 ± 17.6 years and body mass index of 26.2 ± 5.6 kg/m2. The mean NCs were 34.1 ± 3.1 cm in women and 38.2 ± 3.5 cm in men. Mean NC was lower in women (33.7 ± 2.9 cm vs. 35.8 ± 3.2 cm) and men (37.7 ± 3.4 cm vs. 41 ± 3.6 cm) with lower FINDRISC (p <0.001). All the correlations with NC were significant (p ≤ 0.001). The area under the curve for NC and the higher FINDRISC was 0.702 (95% CI 0.653 - 0.752) for women and 0.762 for men (95% CI 0.679 - 0.845), determining the best cutoff value of 34.5 cm for women and 39.5 cm for men to discriminate individuals with higher FINDRISC. Fully adjusted odds ratios for higher FINDRISC per 1-SD increase in NC in women and men were, respectively 1.89 (95% CI 1.53 - 2.33) and 2.86 (95% CI 1.91 - 4.29). Conclusion: NC is positively correlated to the body mass index, waist circumference, glycaemia, and FINDRISC scores in a population-based sample of adults. We identified the mean values of NC in higher and lower FINDRISC and established cutoff values for NC and higher FINDRISC.

Background: Disability is a key indicator implicating both overall morbidity and success of public health efforts to compress the period of morbidity among geriatrics for the overall population. Disabilities are more prevalent among diabetics than among those without diabetes. Objective: This study aimed to determine self-monitoring practices, awareness to dietary modifications and barriers to medication adherence among physically disabled type 2 diabetes mellitus patients. Methods: Interview sessions were conducted at diabetes clinic – Penang general hospital. The invited participants represented three major ethnic groups of Malaysia (Malay, Chinese & Indians). An openended approach was used to elicit answers from participants. Interview questions were related to participant's perception towards self-monitoring blood glucose practices, Awareness towards diet management, behaviour to diabetes medication and cues of action. Results: A total of twenty-one diabetes patients between the ages 35 - 67 years with physical disability (P1-P21) were interviewed. The cohort of participants was dominated by Males (n=12) and also distribution pattern showed that majority of participants were Malay (n=10), followed by Chinese (n=7) and rest Indians (n=4). When the participants were asked in their opinion what was the preferred method of recording blood glucose tests, several participants from low socioeconomic status and either divorced or widowed denied to adapt telemontoring instead preferred to record manually. There were mixed responses about the barriers to control diet/calories. Even patients with high economic status, middle age 35-50 and diabetes history of 5-10 years were influenced towards alternative treatments. Conclusion: Study concluded that patients with physical disability required extensive care and effective strategies to control glucose metabolism.

Background: Type 2 diabetic patients with diabetic nephropathy are associated with multifactorial abnormal energy metabolism. Irisin has been recently introduced as a hormone that is exercise-induced and is secreted by skeletal muscles. It is hypothesized that patients with chronic kidney disease usually have abnormal irisin levels. Aim: We aimed to study the level of Irisin hormone in patients with type 2 diabetes and to document that it is related to diabetic nephropathy. Methods: The current study included 60 subjects with type 2 diabetes and 30 healthy subjects as a control group. Diabetic subjects were divided into 30 without diabetic complications and 30 with diabetic nephropathy (DN). Serum Irisin levels, fasting blood glucose (FBG), 2hours plasma glucose (2hPG), hemoglobin A1c (HbA1c), kidney functions including serum creatinine and albumin/ creatinine ratio were assessed. Results: There was a statistically significant decrease in Irisin levels in diabetic patients compared to controls (34.46 ± 15.28 ng/ml vs. 152.600 ± 39.581 ng/ml, p<0.001). Irisin levels were lower in diabetic patients with DN than in those without complications (20.967 ± 4.476 ng/ml vs. 47.967 ± 8.853 ng/ml, p<0.01). There was a statistically significant negative correlation between irisin and serum creatinine (r=-0.729), systolic blood pressure (r=-0.493), diastolic blood pressure (r=-0.625), duration of diabetes (r=-0.942), BMI(r=-0.396), albumin/creatinine ratio (r=-0.696), and HbA1c (r=-0.305) in all type 2 diabetic patients (p<0.05). On performing multivariate regression analysis, we found that the duration of diabetes was the only independent determinant of irisin level. Conclusion: There is a decrease in serum irisin level in type 2 diabetic patients with even more significant reduction in patients with diabetic nephropathy.