Current Diabetes Reviews - Volume 17, Issue 6, 2021

Coronavirus disease 2019 (COVID-19) and diabetes have major impacts on the health of the population across the world. Since the beginning of the COVID-19 pandemic, people with diabetes have been identified to be more vulnerable to infection and at greater risk for hospitalization. As diabetes is one of the major health issues in Saudi Arabia, the current study describes the perspectives of COVID-19 in people with diabetes and the steps taken by the government to minimize its impact. Most patients with COVID-19 in Saudi Arabia experience mild illness, while people with diabetes are at increased risk of disease severity and mortality. The government of Saudi Arabia has taken several measures to control and mitigate the effect of the pandemic, as the Saudi population is gradually returning back to normal life. However, currently, there are limited studies from Saudi Arabia on COVID-19 among people with diabetes and the effectiveness of interventions. We emphasize the necessity for comprehensive research, which would provide a better understanding of the incidence of COVID-19 and its association with diabetes to develop evidence- based programs and policies in the country.

Introduction: Currently, diabetes mellitus (DM), as well as coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are major public health issues worldwide. Background: It has been suggested that patients with DM are more vulnerable to SARS-CoV-2 infection and suffer from more severe forms of the disease. Methods: A literature search was performed using PubMed, Scopus, and Google search engines. Results: Angiotensin-converting enzyme-2 (ACE2) is the major receptor of SARS-CoV-2 in the human host. The differential expression of ACE2 in the lungs of patients with DM makes them more susceptible to COVID-19. Additionally, acute or chronic hyperglycemia renders individuals in an immune-suppressive state, with impaired innate and adaptive immunity function, also contributing to the severity of COVID-19 infection among patients with DM. Other factors contributing to a more severe course of COVID-19 include the coexistence of obesity in T2DM, the endothelial inflammation induced by the SARS-CoV-2 infection, which aggravates the endothelial dysfunction observed in both T1DM and T2DM, and the hypercoagulability presented in COVID-19 infection that increases the thrombotic tendency in DM. Conclusion: This review summarizes the pathophysiologic mechanisms underlying the coexistence of both pandemics as well as the current recommendations and future perspectives regarding the optimal treatment of inpatients and outpatients with DM in the era of SARS-CoV-2 infection. Notably, the currently recommended drugs for the treatment of severe COVID-19, dexamethasone and remdesivir, may cause hyperglycemia, an adverse effect that physicians should bear in mind when caring for patients with DM and COVID-19.

Background: There is a continuous rise in the prevalence of type 2 diabetes mellitus (T2DM) worldwide and most patients are unaware of the presence of this chronic disease at the early stages. T2DM is associated with complications related to long-term damage and failure of multiple organ systems caused by vascular changes associated with glycated end products, oxidative stress, mild inflammation, and neovascularization. Among the most frequent complications of T2DM observed in about 20-40% of T2DM patients is diabetes nephropathy (DN). Methods: A literature search was made in view of highlighting the novel applications of genomics, proteomics and metabolomics, as the new prospective strategy for predicting DN in T2DM patients. Results: The complexity of DN requires a comprehensive and unbiased approach to investigate the main causes of disease and identify the most important mechanisms underlying its development. With the help of evolving throughput technology, rapidly evolving information can now be applied to clinical practice. Discussion: DN is also the leading cause of end-stage renal disease and comorbidity independent of T2DM. In terms of the comorbidity level, DN has many phenotypes; therefore, timely diagnosis is required to prevent these complications. Currently, urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) are gold standards for assessing glomerular damage and changes in renal function. However, GFR estimation based on creatinine is limited to hyperfiltration status; therefore, this makes albuminuria and eGFR indicators less reliable for early-stage diagnosis of DN. Conclusion: The combination of genomics, proteomics, and metabolomics assays as suitable biological systems can provide new and deeper insights into the pathogenesis of diabetes, as well as discover prospects for developing suitable and targeted interventions.

Background: For thousands of years, natural food products have been used as a medicine for treating diseases that affect the human body, including diabetes mellitus (DM). Lately, several investigations have been performed on the flavonoid derivatives of plant origin, and their biological activity has been extensively studied. Methods: Given our need to know more mechanisms for treating DM, we performed a thorough research review on treating diabetes mellitus based on flavonoids, their therapeutic potential, and biological action. Results: Flavonoids reduce complications in addition to their vital role as effective supplements for preventing diabetes mellitus by regulating glucose metabolism, lipid profile, liver enzyme activity, a protein kinase inhibitor, PPAR, and AMPK with NF-ΚB. Conclusion: The articles that we reviewed showed the positive role of flavonoids, which in a certain way reduce diabetes, but their side effects still need to be studied further.This review is focused on describing the different types of dietary flavonoids along with their mechanisms of reducing blood glucose and enhancing insulin sensitivity, as well as their side effects.

Objective: the aim of this systematic review study is to evaluate the current services and pharmaceutical care practices for diabetic patients in the UAE. Methods: systematic review coverage conforms to the guidelines of the PRISMA; the search was limited to primary research articles, which describe the term “pharmaceutical diabetes care services in UAE”. The search strategy was developed in collaboration with a health database librarian, and a predetermined protocol was developed in conjunction with the authors for search methods. Results: The findings showed the effect of a prescription treatment system on disease prevention and health-related quality of life in patients with type 2 diabetes in the United Arab Emirates. A retrospective interventional health evaluation was implemented to evaluate existing health procedures and the impact of conventional treatment on type 2 diabetes treatment (T2DM). The findings of this interventional evaluation were largely favorable, and the viability of changing the existing clinical procedure was stressed. The individualized strategy has helped clinicians finding a great result in terms of glycemic and BP, as well as patient satisfaction. The need for more work to clarify the long-term effect of organized strategy in enhancing the consistency of T2DM treatment in the UAE. The findings also showed increase community pharmacy services might further change the opinions of patients on the level of care provided by such pharmacies. The patients’ quality of life would improve by drug treatment efficacy and pharmacist services to mitigate diabetes complications. The findings showed a prescription treatment system on disease prevention and health-related quality of life in patients with type 2 diabetes in the United Arab Emirates. A retrospective interventional health evaluation was implemented to evaluate existing health procedures and the impact of conventional treatment on type 2 diabetes treatment (T2DM). The findings of this interventional evaluation were largely favorable, and the viability of changing the existing clinical procedure was stressed. The individualized strategy has helped clinicians reach a great result in terms of glycemic and BP, as well as patient satisfaction. The need for more work to clarify the long-term effect of organized strategy in enhancing the consistency of T2DM treatment in the UAE. The findings also showed increase community pharmacy services mightfurther change the opinions of patients on the level of care provided by such pharmacies. The patients’ quality of life would improve by drug treatment efficacy and pharmacist services to mitigate diabetes complications. Conclusion: This systematic review reported beneficial pharmacist-led diabetic management services in the UAE. Several care strategies were also highlighted to improve service for type 2 diabetes mellitus patients.

Background: The need for a multidisciplinary team approach to provide physical exercise, diet, behavioral change, and insulin therapy in type 2 diabetes mellitus (T2DM) treatment has long been recognized. However, often patients with T2DM do not have access to a multidisciplinary team. Introduction: In developing countries, most patients with T2DM receive their diabetes care in the office of an internist or family practice physician or in a primary level health center with a general practitioner. Knowledge of healthcare professionals regarding the perceived barriers, attitudes, facilitators, and benefits of a multidisciplinary team approach in T2DM treatment can help facilitate the implementation of multidisciplinary care in T2DM. Methods: A systematic search strategy was performed in six databases (PubMed, Web of Science, CINAHL, EMBASE, MEDLINE, and Cochrane) using different keyword combinations to identify studies describing the healthcare professionals’ views of multidisciplinary team care in T2DM. A textual narrative synthesis was used to analyze data. The Critical Appraisals Skills Programme (CASP) tool for qualitative studies was used to assess the risk of bias and transferability. Results: The views of health professionals about multidisciplinary team care in T2DM were categorized into six major factors, namely working collaboratively to foster supportive relationships; strong committed organizational and team leadership; diversity in expertise, with team members tailored to local circumstances; shared goals and approaches to ensure consistency of message; clear and open communication with the team and with patients; and the patient at the center of decision- making. Conclusion: There is a huge gap in shared roles among health professionals in T2DM therapy. Hence, there is a need for allied health professionals such as physiotherapists, dieticians, and psychologists with expertise in diabetes to explore primary healthcare, barriers and facilitators to the successful integration of multidisciplinary team, seamlessly distributedinto three hierarchal levels, namely health management, health professionals, and diabetic patients.

Background: Recognizing and promoting the factors that affect the self-management behaviors of diabetes lead to a reduction in the number of patients and an improvement in the quality of care. The ecological approach focuses on the nature of people's interactions with their physical and socio-cultural environments. Objective: The purpose of this study was to identify the predictors of self-management behaviors with a comprehensive approach in these patients. Methods: The keywords were investigated in the relevant national and international databases, including PubMed, Google Scholar, Science Direct, Scopus, and Scientific Information Database, Magiran, and Iran Medex, to obtain the articles published from 2009 to 2019. The search and article selection strategy was developed based on the Prisma checklist and was carried out in three steps. Results: Most studies have shown that personal factors had the highest prediction power for the self-management of diabetes. The interpersonal factors, society and policy-making factors, and group and organization factors were then the most frequently reported predictors of self-management behaviors in diabetic patients. Conclusion: Self-management of diabetes is necessary for controlling it because 95% of care is done by the patient. When designing self-management interventions, factors are based on the individual level that is to increase self-management behaviors.

Aims: Analysis of the relationship between the methylation profile of miR-9-1 or miRs -9-1 / -9-3 and diabetic retinopathy. Background: Diabetic Retinopathy (DR) is a frequent complication of Diabetes mellitus and it has a decisive impact on the quality of life, as it is one of the biggest causes of blindness in the adult population. Levels of microRNA-9 have been shown to be related to diabetes but little is known about its involvement with DR in humans. Objective: To analyze the relationship between the methylation profile of miR-9-1 or miRs -9-1/-9-3 and DR. Methods: 103 patients diagnosed with diabetes for 5 to 10 years were analyzed. The data were categorized according to clinical, biochemical, lifestyle and anthropometric parameters. DNA extracted from leukocyte samples was used to determine the methylation profile of miRs-9-1 and -9-3 using a specific methylation PCR assay. Results: miR-9-1 methylation was related to diabetic retinopathy, indicating that methylation of this miR increases the chances of presenting retinopathy up to 5 times. In our analyses, diabetics with lower levels of creatinine and CRP showed significant reductions (99% and 97%) in presenting DR. Methylation of both miRs-9-1 and 9-3 methylated increases the chances of presenting DR by 8 times; in addition, a sedentary lifestyle can increase the risk for the same complication by up to 6 times. Conclusion: Our results suggest that both methylation of miR-9-1 and e miRs-9-1 / 9-3 favors DR in patients with diabetes in a period of 5 to 10 years of diagnosis.

Background: Fructose has been widely used for producing lower post-infusion glucose increase than other carbohydrates, but it seems that it promotes an increase in post-infusion triglycerides. Objective: The present study investigated the effects of fructose and glucose in metabolic variables and appetite sensations in patients with type 1 diabetes mellitus (T1DM). Methods: This is a single-blind, randomized, and crossover study (washout of 1-5 weeks), which evaluated 16 adult T1DM patients, accompanied at University Hospital. After eight hours of overnight fasting, there was an assessment of capillary blood glucose, anthropometric variables, appetite sensations, and laboratory tests (glycemia, lipemia, leptin and glucagon) were conducted. Subsequently, they received 200mL of solutions with water and 75g of crystal fructose or glucose. Appetite sensations and capillary blood glucose were evaluated in different post-infusion times. Blood was drawn after 180 minutes for the laboratory tests. Results: Blood glucose increased after the intake of both solutions, but glucose induced a higher elevation. None of them increased triglycerides or glucagon. Glucagon maintenance was similar among the solutions. Furthermore, both solutions reduced leptin and increased fullness, but only fructose increased the lack of interest in eating sweets. Conclusion: Fructose induced a smaller increase in postprandial blood glucose than glucose, without changes in triglycerides and glucagon. In addition, leptin levels and appetite sensations were similar to glucose. Other studies are needed in order to confirm these findings, especially in the long term, so that their use becomes really reliable.

Background: Sodium glucose co-transporter 2 inhibitor (SGLT2i) is a new arment in the prevention and treatment of diabetic kidney disease with a potential effect on reducing and preventing Chronic Kidney Disease (CKD) progression. Objective: To evaluate the effect of SGLT2 inhibitor in comparison to traditional medication in diabetic patients with microalbuminuria. Methods: A total of 60 diabetic patients with microalbuminuria were divided into group I, where 30 patients were treated by traditional medications (RAAS blockers) and group II where 30 patients were treated by Dapagliflozin added to the traditional medications. All patients were followed up for 6 months and their Urine Albumin/Creatinine Ratio (UACR) and eGFR changes were monitered. Results: UACR significantly declined after 6 months of treatment in group II with a p-value <0.001. There were no significant eGFR changes between both groups. Systolic blood pressure decreases in both groups, but the decrease was highly significant in group II (pvalue<0.001). Diastolic blood pressure decreases significantly in both groups (p-value<0.001). Also, bodyweight reduced significantly in group II with a p-value<0.001. Conclusion: Dapagliflozin, when added to traditional medications (RAAS Blockers), leads to a significant reduction in microalbuminuria with no significant eGFR changes.