Current Diabetes Reviews - Volume 19, Issue 5, 2023

Type 1 diabetes mellitus (T1DM), an autoimmune disease, involves the destruction of pancreatic β cells. β cells maintain glucose homeostasis by identifying blood glucose and accordingly releasing insulin to maintain normal physiologic glucose levels. Human umbilical cord blood (hUCB) cells pose a lesser risk of viral contamination due to low placental transmission during prenatal life. Additionally, they have advantages such as non-invasive harvest procedure gynecological waste, low immunogenicity, easy expansion in-vitro, and easy ethical access compared to deriving stem cells from other sources. According to the published preclinical data, the infusion of autologous cord blood cells is considered safe as they are non-antigenic. Depending on the degree of differentiation, the ability to regenerate themselves and the origin of many stem cell types can be differentiated. The application of stem cells (SCs) has great potential for managing T1DM due to their regenerative capabilities and promising immunological characteristics. Due to lesser ethical complications and easy procedures of isolation, hUCB has become a precious medical intervention.

Background: Diabetic foot ulcers (DFU) are one of the most serious complications in diabetic health treatment. The treatment for DFUs is more challenging, especially in individuals with a weakened immune system. Furthermore, due to developing antibiotic resistance characteristics among harmful bacteria and fungi, existing antibiotics may not be helpful in combating microbial infections in the wound site. Objective: This review will focus on the newest advances in antimicrobial treatments, such as dressings and topical therapies, as well as drugs and debridement methods. Methods: The English-language publications published on DFU were collected from a variety of sources, including Scopus, Web of Science, Bentham Science, Science Direct, and Google Scholar. Results: DFU therapy necessitates a multidisciplinary strategy including the use of appropriate diagnostic instruments, expertise, and experience. This begins with patient education and the use of new classifications to direct care in order to avoid amputations. To gain a deeper understanding of the microbiota in DFUs, new diagnostic approaches, such as the 16S ribosomal DNA sequence in bacteria, should become usable. Conclusion: DFU is said to have a polymicrobial nature and, depending on its geographical area, some distinct characteristics, such as wound characteristics, antibiograms based on local epidemiology, individualized antimicrobial driven treatment, routine debridement, regular wound examination, and dressing changes. New biological and molecular therapies that have been shown to enhance infection prevention, the management of the local inflammatory profile, and the efficiency of the cicatrizing mechanism often help with the above characteristics.

Background: A number of complexities in compliance with long-term diabetes have been elicited. It has become a global concern without any convincing medicinal, therapeutical methodology. Both hyperglycaemia and oxidative pressure are major notable parts that play a significant role in the initialization of diabetic inconvenience. Natural medications have gained a lot of attention in recent years as expected restorative specialists in the prevention and treatment of diabetic complications due to their many objectives and less poisonous outcomes. This survey means to evaluate the accessible information on therapeutic spices for constriction and the executives of diabetic complications. Materials and Methods: Bibliographic investigation was accomplished by checking old-style course books and papers, directing overall bases of logical information (SCOPUS, PUBMED, SCIELO, Google Scholar, NISCAIR,) to recapture accessible distributed writing. For the assessment of plants with the potential in calming diabetic complications, several inclusion models rely on the numerous medicinal spices as well as their crucial mixes. Furthermore, several models, including plants, have been considered, each of which has a suitable impact on increasing oxidative pressure in diabetes. Results: Different therapeutic plants/plant withdrawals containing alkaloids, terpenoids, phenolic compounds, flavonoids, saponins, and phytosterol-type synthetic constituents were uncovered that are profitable in the administration of diabetic complexities. Results may be attributed to the improvement of oxidative pressure, constant hyperglycemia, and twitch of different metabolic pathways related to the pathogenesis of diabetic confusions. Conclusion: An optimistic approach for new medication terminology to treat diabetic confusion is screening compound competitors from homegrown medication. Investigation of the activity of different plant extracts as well as their potency profile and to determine their job in the treatment of diabetic inconveniences must be there. In addition, an ideal rat model which imitates human diabetic complications ought to be created.

Alzheimer’s disease (AD) is the most common type of dementia that affects the elderly around the world. Chronic type 2 diabetes (T2DM) has been proven to be closely related to neurodegeneration, especially AD. T2DM is characterized by the cell's failure to take up insulin as well as chronic hyperglycemia. In the central nervous system, insulin plays vital regulatory roles, while in chronic hyperglycemia, it leads to the formation and accumulation of advanced glycation end products (AGEs). Inflammation plays a crucial role in development of insulin resistance in AD and T2DM. The microtubule-related protein tau is involved in the pathogenesis of several neurological diseases known as tauopathies, and is found to be abnormally hyperphosphorylated in AD and accumulated in neurons. Chronic neuroinflammation causes the breakdown of the blood-brain barrier (BBB) observed in tauopathies. The development of pro-inflammatory signaling molecules, such as cytokines, chemokines from glial cells, neurons and endothelial cells, decides the structural integrity of BBB and immune cell migration into the brain. This review highlights the use of antidiabetic compounds as promising therapeutics for AD, and also describes several new pathological molecular mechanisms associated with diabetes that increase AD pathogenesis.

Diabetes is a major health issue, and its complications can lead to various health problems. Nephropathy has been recognised since the 1930s, when Kimmelstiel and Wilson first reported the characteristic nodular glomerulosclerosis lesions in diabetic kidneys. Diabetic nephropathy (DN), commonly known as diabetic kidney disease, is a condition in which people with diabetes have excessive quantities of urine albumin excretion, diabetic glomerular lesions, and a reduction in their glomerular filtration rate (GFR). Type 1 diabetes (autoimmune -cell destruction and absolute insulin insufficiency), type 2 diabetes (relative insulin deficit and resistance), and others are the three forms of diabetes (e.g., pancreatic disease). Diabetes nephropathy is the leading cause of chronic kidney disease and end-stage renal failure worldwide. Much research has been conducted in both basic science and clinical therapies to enhance the understanding of the mechanism of diabetic nephropathy and expand available therapeutics. Diabetic nephropathy prevention continues to rely on screening for microalbuminuria and treating hyperglycemia. However, several studies suggest that managing diabetic kidney disease is more challenging. Despite comparable hyperglycemic management, some studies suggest that the incidence of renal problems varies by patient. As a result, there has been a great deal of interest in studying the inherent renal protective effects of various antihyperglycemic drugs. This study aims to provide information about the diabetic kidney disease conceptual model, pathogenesis, screening, and diagnosis. It will also address the treatment and prevention of diabetic nephropathy, focusing on comparing the mechanisms, safety profiles, and efficacy of different antihyperglycemic medications.

Background: The division of care responsibilities between parents and children with type 1 diabetes, and an optimal transfer of responsibilities from parent to child over time are assumed to be key for optimal diabetes outcomes during childhood and adolescence. However, an overview of instruments assessing this division as well as their psychometric qualities is currently lacking. Objective: The study aims to 1) identify all existing instruments, 2) evaluate their psychometric properties, and 3) provide an overview of scoring methods. Methods: Pubmed and PsycINFO were searched using a priori-defined search string. Peerreviewed studies in English using an instrument assessing the division of diabetes care responsibilities between children (6-18 years) and parents were included. In total, 84 of 725 articles qualified, covering 62 unique samples. Results: Thirteen questionnaires were identified. The Diabetes Family Responsibility Questionnaire (DFRQ) was most frequently used across studies. Instructions, content and number of tasks, response options, and scoring methods varied across questionnaires. Recent studies often adapted questionnaires, contributing to the heterogeneity across measures. Overall, reporting and quality of psychometric properties was suboptimal. Conclusion: The division of diabetes care responsibilities can be operationalized with various instruments, each having its strengths and weaknesses but all with limited psychometric support. To measure the division of diabetes care responsibilities more adequately, an updated version of the popular DFRQ or a new scale needs to be developed and evaluated.

Background: Fruits and vegetables play a significant role in the health and nutrition of human beings. Flavanones being the major class of flavonoids are the main phytochemicals in citrus fruits having several favorable effects, particularly in preventing diabetes. Objective: The purpose of this systematic review was to discuss the anti-diabetic potential of citrus flavanones based on in vivo studies. Methods: A search of Google Scholar, PubMed, NCBI, Research Gate, Science Direct, HEC Digital Library databases for articles that have been published since 2010 was conducted using the keywords citrus, flavanones, and diabetes. Results: A total of 10 articles were identified, in which it was reported that 5 flavanones have antidiabetic effects. These flavanones have many benefits, such as they help in glycemic control, regulate the biomarkers of lipid profile, renal function, and modulate the signaling pathways that increase insulin sensitivity and uptake of glucose, thus are responsible for preventing diabetes and complications related to it. Conclusion: Therefore, citrus flavanones are the candidates having promising anti-diabetic potential but their effect needs to be verified through human studies.

Aims: Diabetic patients are significantly stimulated by COVID-19 infection. The dreadful risk of COVID-19 mortality may be affected. In order to preserve precious lives, it is essential to comprehend how diabetes and COVID-19 are related, as well as how to manage diabetes. We aimed to focus on the mechanism, impact, and drug treatment of diabetes in COVID-19 patients. Methods: A comprehensive scrutiny of the published literature in diverse pharmaceutical and medical databases such as Google Scholar, PubMed, Science Direct, DOAJ etc., were successfully conducted and classified accordingly. Results: We discussed the severity of COVID-19 in diabetes patients. A patient with diabetes has a higher risk of COVID-19 mortality by influencing the development and prognosis of the disease. The recommended drugs for diabetes treatment in COVID-19 may reduce COVID-19 mortality. Conclusion: Metabolic syndrome diabetes is a risk factor enhancing the development and diagnosis of COVID-19. In order to treat diabetic patients who have COVID-19 infection, insulin is preferable over oral hypoglycemic medications.

Aims: The study aims to determine the relationship between blood glucose level control with a vegetarian diet and vegan lifestyle behavior in patients with T2DM. Background: Diabetes prevalence escalates each year. Nutritional therapy is one of its management, by choosing a suitable diet to maintain nutrient intake. Methods: This was a case-control study including 46 patients with T2DM divided into 24 people for the case group and 22 people for the control group selected using purposive sampling method. Data was obtained using a general questionnaire; food intake with the SQFFQ; the 8-item Morisky Scale questionnaire, to assess medication adherence; the IPAQ, to assess physical activity. Blood sugar measurements were observed by measuring the respondents' fasting blood sugar in the last six months. The data was then analyzed using Chi-square statistical test and logistic regression. Results: The results indicate a relationship between a vegetarian diet and a vegan lifestyle behavior that control blood sugar levels in patients with T2DM (P = 0.004). Diabetic patients on a nonvegetarian diet had a six times greater risk of having uncontrolled blood sugar (OR = 6.476). A significant relationship was found between a vegetarian diet and fasting blood sugar control based on bivariate analysis. In multivariate analysis, fiber intake was most significant to blood glucose control (OR=18.824; 95% CI 2.795-126.795). Conclusion: Vegetarian diet affects blood sugar control in T2DM patients. The type of nutritional intake needs to be more considered rather than the vegetarian diet in general, so that nutritional therapy in diabetics can be started by increasing fiber intake.

Background: People with type 1 diabetes (T1D) face heightened risks for morbidity and mortality from the 2019 Coronavirus (COVID-19). They also have elevated risks for disparate psychological outcomes during the COVID-19 pandemic, given their predisposition to mental health disorders, including anxiety and depression, and skyrocketing rates of these conditions among the general population. Methods: To investigate the psychological ramifications of the COVID-19 pandemic on people with T1D globally, we conducted a scoping review of recent literature across eight online databases. Articles were screened via a rigorous process, and data pertaining to psychological outcomes were coded into thematic areas for analysis. Results: Forty articles presenting data from 27 countries and 14 categories of psychological outcomes affecting people with T1D were included in this review. Psychological outcomes, in order of most to least frequently identified, included: stress, anxiety, social factors, worry, distress, fear, sleep habits, quality of life, depression, attitudes regarding COVID-19, other psychological issues, mental health services utilization, burnout, and temperament. Recurring findings demonstrated significant increases in the prevalence of mental health conditions, changes in sleeping habits, reductions of social support, and extensive psychosocial concerns among people with T1D. Associations between patients’ psychological issues and demographic characteristics, diabetes self-management behaviors, glycemic control, and overall wellbeing were evident. Conclusion: During the COVID-19 pandemic, people with T1D experienced pervasive psychological burdens. This review calls for further research examining the long-term impacts of the pandemic and strengthens awareness of the need for interventions to offset psychological challenges affecting people with T1D.

Background: Diabetes is an endocrine chronic condition with a high prevalence rate among the population that needs a complex management process. However, many advanced health care technologies were evolving to help patients achieve their centered care and self-management using real-time proactive techniques through interactive systems to detect early complications and prevent them. The purpose of the current review is to assess the findings of literature reviews of the main interventions that used a real-time partially automated interactive systems to interpret patient’s data including biological information, exercise, and dietary content calculated from a message sent by the patient and respond with actionable findings, helping patients to achieve diabetes self-management. Methods: PubMed\ MEDLINE, CINAHL, Google Scholar, and Research Gate were used to search the literature for studies published between the periods 2015 to 2021. Results: Eleven articles were included in the literature review. The retrieved studies approved the significant effect of achieving diabetic self-management by utilizing Information Technology (IT) with the Natural Language Processing (NLP) methods by sending a real-time, partially automated interactive system to interpret patient's biological information, physical activity, and dietary content calculated using a message sent by patients to achieve their self-management. Conclusion: Improved blood glucose levels, glycemic control, better readings of blood pressure, and lifestyle improvement including dietary intake and physical activity were offered using continuous real-time messages to improve their health outcomes.

Background and Aims: The objective of this study was to assess the knowledge of diabetes- related complications among patients with type 2 diabetes (T2D) in Saudi Arabia. Methods: In this study, 237 patients with T2D, who visited the diabetic clinic at Prince Sultan Military Medical City, Saudi Arabia, from December 2021 to March 2022, were recruited by adopting the non-probability sampling technique. A structured questionnaire was used to collect data on the sociodemographic features of the group in this study and their knowledge regarding T2D-related complications. Results: From the 237 patients with T2D in this study, a higher percentage had hypertension (64.1%), heart disease (67.1%), retinopathy (79.7%), nephropathy (69.7%), diabetic foot (75.9%), and neuropathy (68.4%). Overall, a high number of these patients (122 or 51.5%) expressed inadequate knowledge of complications related to diabetes. Only 40 (16.9%) revealed adequate knowledge of diabetes-related complications, while 75 (31.6%) mentioned genuine ignorance regarding their complications. Patients educational status (p = 0.045), occupation (p = 0.026), and duration of diabetes (p = 0.037) were significantly associated with knowledge of diabetic complications. From the multinomial regression, substantial differences were evident concerning the duration and occupation of the population under study. Conclusion: The knowledge patients with T2D possess concerning diabetes-related complications was generally poor. This study indicates that through improved knowledge of diabetes, the risks of diabetes-related complications among T2D patients can be minimized.