Effect of type 2 diabetic mellitus in the prognosis of acute-onchronic liver failure patients in China

BACKGROUND Acute-on-chronic liver failure(ACLF)patients have a high short-term mortality rate,and the severity evaluation of ACLF is necessary for prognostication.Therefore,it was meaningful to evaluate the association between type 2 diabetic mellitus(DM)and ACLF and further explore the feasibility of using DM as a prognostic indicator in ACLF patients.The association between type 2 DM and the prognosis of patients with severe liver disease remains unclear.AIM To examine the effect of type 2 DM on the prognosis of patients with ACLF.METHODS Clinical data from 222 ACLF patients were collected and analyzed.The patients were categorized into two groups depending on whether they had DM or not,and the clinical data of ACLF patients were measured within 48 h after admission.Complications of ACLF were documented during treatment,such as hepatic encephalopathy,hepatorenal syndrome,acute upper gastrointestinal hemorrhage,and spontaneous peritonitis(SBP).Values of laboratory parameters,complication rates,and hospital mortality rates were compared between two groups.RESULTS Among 222 ACLF patients,38 cases were categorized into DM groups,the mean age was 56.32 years and 73.68%were male.The prognosis of ACLF patients was significantly correlated with DM in univariate[hazard ratio(HR)=2.4,95%confidence interval(CI)=1.5-3.7,P<0.001]and multivariable analysis(HR=3.17,95%CI=1.82-5.523,P<0.001).The incident of SBP(34.21%vs 13.59%,P=0.038)and other infections like lung,urinary,blood,and cholecyst(44.74%vs 28.26%,P=0.046)were higher in DM patients than non-DM counterparts.In addition,the ACLF patients with DM tended to have a high mortality rate(P<0.001).Cumulative survival time was also significantly shorter in the ACLF patients with DM than non-DM.CONCLUSION A significant association between DM and the prognosis of ACLF patients was found in China.The ACLF patients with DM had higher incidence of hospital mortality and infection than those without DM.

Interaction between Cadmium and Zinc Levels in the Biological Samples of Type 1 Diabetic Mellitus Children, Reside in Different Areas of Sindh, Pakistan

Type 1 Diabetes mellitus (T1DM) is one of the familiar childhood immune-mediated onsets and can lead to early mortalities and morbidities. It can arise at any stage, but the peak of occurrence is reported less than 18 years of age. T1DM cases in Pakistan were less than 2% of the total diabetic population. The current work designed to assess the concentration of cadmium (Cd) and zinc (Zn) in blood, scalp hair and serum samples of T1DM children, age ranged 1 - 14 years of both genders. For comparison purpose, the age-matched referent subjects of both genders were tested. The microwave-assisted acid digestion procedure was used to determine the elemental analysis in the biological samples of T1DM children and referent subjects. The resulted data of certified reference material of blood, scalp hair, and serum validated the certainty of the designed method. The analysis of Zn was performed by flame atomic absorption spectrometry, while the Cd contents were determined by electrothermal atomic absorption spectrometry. T1DM affected children of both genders have lower Zn level in the blood, scalp hair, and serum samples. Whereas, the levels of Cd were found to be higher in the biological samples of T1DM affected children as compared to referent subjects. The finding of the current study is a significant hypothesis for medical experts, to diagnose the deficiency of essential (Zn) and toxicity of heavy/toxic element (Cd) in the biological specimen of T1DM affected children.

Heme oxygenase-1 inhibits neuropathic pain in rats with diabetic mellitus

A diabetes mellitus model was established through single intraperitoneal injection of streptozotocin into rats. Seven days later, model rats were intraperitoneally administered zinc protoporphyrin, a heme oxygenase-1 inducer, and cobalt protoporphyrin, a heme oxygenase-1 inhibitor, once every two days, for 5 successive weeks. After administration, the paw withdrawal mechanical threshold of diabetic mellitus rats significantly decreased, the myelin sheath of the sciatic nerve thickened or showed vacuole defects, the number of spinal dorsal horn neurons reduced, some neurons degenerated and were necrotic, and heme oxygenase-1 was visible in the cytoplasm of spinal dorsal hom neurons. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling demonstrated that the number of apoptotic neurons increased, which could be inhibited by cobalt protoporphyrin, however, zinc protoporphyrin led to an opposite effect. Our experimental findings indicate that heme oxygenase-1 attenuates neuropathic pain in diabetic mellitus rats through amelioration of peripheral neuropathy and inhibition of spinal dorsal horn neuron apoptosis.

Correlation between diabetic peripheral neuropathy and thyroid hormone sensitivity in elderly patients with type 2 diabetes mellitus

BACKGROUND Diabetic peripheral neuropathy(DPN)is a common complication of type 2 diabetes mellitus(T2DM),significantly affecting patients’quality of life and imposing a substantial economic burden.Recent studies have highlighted the role of thyroid hormones in diabetes complications,particularly in elderly patients with T2DM.However,the relationship between thyroid hormone sensitivity and DPN remains unclear.AIM To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.METHODS In a cohort of 256 elderly patients with T2DM,propensity score matching was used to balance age,sex,and diabetes duration.Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN.A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine(FT_(3)/FT_(4))for DPN.RESULTS Patients with DPN had a lower FT_(3)/FT_(4) ratio[(0.302±0.053)vs(0.316±0.049),P=0.040].Quartile stratification showed decreasing DPN prevalence with higher FT_(3)/FT_(4) ratios.Spearman’s correlation analysis showed that a lower FT_(3)/FT_(4) ratio was associated with higher glycated hemoglobin,fasting blood glucose,reduced nerve conduction velocity,and electrical skin conductance.Logistic regression indicated a positive relationship between the median FT_(3)/FT_(4) ratio and bilateral foot electrochemical skin conductance[odds ratio(OR):1.019;95%CI:1.005-1.034;P=0.007]and sural nerve sensory amplitude(OR:1.310;95%CI:1.008-1.703;P=0.043).Receiver operating characteristic analysis using a random forest model showed that incorporating FT_(3)/FT_(4) improved predictive performance for DPN,with an area under the curve of 0.74,sensitivity of 0.79,specificity of 0.64,and accuracy of 0.77.CONCLUSION In elderly patients with T2DM with euthyroidism,a lower FT_(3)/FT_(4) ratio is correlated with increased DPN incidence,affecting both large and small nerve fibers.FT_(3)/FT_(4) is an effective predictor of DPN.

Vitamin D,selenium,and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis

BACKGROUND Diabetes and thyroiditis are closely related.They occur in combination and cause significant damage to the body.There is no clear treatment for type-2 diabetes mellitus(T2DM)with Hashimoto's thyroiditis(HT).While single symptomatic drug treatment of the two diseases is less effective,combined drug treatment may improve efficacy.AIM To investigate the effect of a combination of vitamin D,selenium,and hypoglycemic agents in T2DM with HT.METHODS This retrospective study included 150 patients with T2DM and HT treated at The Central Hospital of Shaoyang from March 2020 to February 2023.Fifty patients were assigned to the control group,test group A,and test group B according to different treatment methods.The control group received low-iodine diet guidance and hypoglycemic drug treatment.Test group A received the control treatment plus vitamin D treatment.Test group B received the group A treatment plus selenium.Blood levels of markers of thyroid function[free T3(FT3),thyroid stimulating hormone(TSH),free T4(FT4)],autoantibodies[thyroid peroxidase antibody(TPOAB)and thyroid globulin antibody(TGAB)],blood lipid index[low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triacylglycerol(TG)],blood glucose index[fasting blood glucose(FBG),and hemoglobin A1c(HbA1c)]were measured pre-treatment and 3 and 6 months after treatment.The relationships between serum 25-hydroxyvitamin D3[25(OH)D3]level and each of these indices were analyzed.RESULTS The levels of 25(OH)D3,FT3,FT4,and LDL-C increased in the order of the control group,test group A,and test group B(all P<0.05).The TPOAB,TGAB,TC,TG,FBG,HbA1c,and TSH levels increased in the order of test groups B,A,and the control group(all P<0.05).All the above indices were compared after 3 and 6 months of treatment.Pre-treatment,there was no divergence in serum 25(OH)D3 level,thyroid function-related indexes,autoantibodies level,blood glucose,and blood lipid index between the control group,test groups A and B(all P>0.05).The 25(OH)D3 levels in test groups A and B were negatively correlated with FT4 and TGAB(all P<0.05).CONCLUSION The combination drug treatment for T2DM with HT significantly improved thyroid function,autoantibody,and blood glucose and lipid levels.

Clinical study of different prediction models in predicting diabetic nephropathy in patients with type 2 diabetes mellitus

BACKGROUND Among older adults,type 2 diabetes mellitus(T2DM)is widely recognized as one of the most prevalent diseases.Diabetic nephropathy(DN)is a frequent com-plication of DM,mainly characterized by renal microvascular damage.Early detection,aggressive prevention,and cure of DN are key to improving prognosis.Establishing a diagnostic and predictive model for DN is crucial in auxiliary diagnosis.AIM To investigate the factors that impact T2DM complicated with DN and utilize this information to develop a predictive model.METHODS The clinical data of 210 patients diagnosed with T2DM and admitted to the First People’s Hospital of Wenling between August 2019 and August 2022 were retrospectively analyzed.According to whether the patients had DN,they were divided into the DN group(complicated with DN)and the non-DN group(without DN).Multivariate logistic regression analysis was used to explore factors affecting DN in patients with T2DM.The data were randomly split into a training set(n=147)and a test set(n=63)in a 7:3 ratio using a random function.The training set was used to construct the nomogram,decision tree,and random forest models,and the test set was used to evaluate the prediction performance of the model by comparing the sensitivity,specificity,accuracy,recall,precision,and area under the receiver operating characteristic curve.RESULTS Among the 210 patients with T2DM,74(35.34%)had DN.The validation dataset showed that the accuracies of the nomogram,decision tree,and random forest models in predicting DN in patients with T2DM were 0.746,0.714,and 0.730,respectively.The sensitivities were 0.710,0.710,and 0.806,respectively;the specificities were 0.844,0.875,and 0.844,respectively;the area under the receiver operating characteristic curve(AUC)of the patients were 0.811,0.735,and 0.850,respectively.The Delong test results revealed that the AUC values of the decision tree model were lower than those of the random forest and nomogram models(P<0.05),whereas the difference in AUC values of the random forest and column-line graph models was not statistically significant(P>0.05).CONCLUSION Among the three prediction models,random forest performs best and can help identify patients with T2DM at high risk of DN.

MiRNA-200a and miRNA-200b expression,and vitamin-D level:Prognostic significance in obese non-diabetic and obese type 2 diabetes mellitus individuals

BACKGROUND Obesity and type 2 diabetes mellitus(T2DM)are frequent co-occurring disorders that affect regular metabolic functions.Obesity has also been linked to an inc-reased risk of developing diabetes.Obesity and diabetes are on the rise,increa-sing healthcare costs and raising mortality rates.Research has revealed that the expression profile of microRNAs(miRNAs)changes as diabetes progresses.Fur-thermore,vitamin D may have an anti-obesity effect and inverse association with body weight and body mass index(BMI).Low vitamin D levels do not solely cause obesity,which could be a factor in the etiology of T2DM.METHODS This study included 210 participants,of which,82 were obese(BMI>30 kg/m2)without T2DM,28 were obese with T2DM,and 100 were healthy controls.BMI was evaluated and both fasting and postprandial blood glucose were used to confirm T2DM.Exosomal miRNA-200a and miRNA-200b expression were analyzed using real-time PCR using Taqman probes,and vitamin-D levels were evaluated using an electrochemiluminescence-based immunoassay technique.All data analyses were performed using SPSS 20.0 and GraphPad Prism 5 software.RESULTS Overall,a 2.20-and 4.40-fold increase in miRNA-200a and miRNA-200b expression was observed among participants compared to healthy controls.MiRNA-200a and miRNA-200b expression among obese participants increased 2.40-fold and 3.93-fold,respectively,while in obese T2DM participants these values were 2.67-fold,and 5.78-fold,respectively,and these differences were found to be statistically significant(P=0.02)(P<0.0001).Obese participants showed a vitamin D level of 34.27 ng/mL,while in obese-T2DM participants vitamin D level was 22.21 ng/mL(P<0.0001).Vitamin D was negatively correlated with miRNA-200a(r=-0.22,P=0.01)and miRNA-200b(r=-0.19,P=0.04).MiRNA-200a sensitivity was 75%,and specificity was 57%,with a cutoff value of 2.07-fold.MiRNA-200b sensitivity was 75%,and specificity was 71%with a cutoff value of 4.12-fold,suggesting that miRNA-200a and miRNA-200b with an increased expression of 2.07-and 4.12-fold could be predictive indicators for the risk of diabetes in obese participants.CONCLUSION MiRNA-200a and miRNA-200b were higher in diabetic obese participants vs non-diabetic obese participants,and insufficient vitamin D levels in obese T2DM participants may be involved in poor clinical outcome.

Diabetic peripheral neuropathy and neuromodulation techniques:a systematic review of progress and prospects

Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition.Diabetic peripheral neuropathy,a common complication of diabetes,is characterized by nerve damage due to high blood sugar levels that lead to symptoms,such as pain,tingling,and numbness,primarily in the hands and feet.The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy,while also examining recent developments in this domain.The investigation encompassed an array of neuromodulation methods,including frequency rhythmic electrical modulated systems,dorsal root ganglion stimulation,and spinal cord stimulation.This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy.Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments.Through these efforts,we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.

Intricacies during pregnancy with gestational diabetes mellitus

The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and absolute quantitation isobaric tags for relative and absolute quantitation and liquid chromatography-mass spectrometry liquid chromatography-mass spectrometry.Their analysis revealed 47 differentially expressed proteins in the GDM group,with retinol-binding protein 4 and angiopoietin-like 8 showing significantly elevated serum levels compared to controls.Although these findings are promising,the study is limited by its small sample size(n=4 per group)and lacks essential details on the reproducibility and reliability of the protein quantification methods used.Furthermore,the absence of experimental validation weakens the interpretation of the protein-protein interaction network identified through bioinformatics analysis.The study's focus on second-trimester biomarkers raises concerns about whether this is a sufficiently early period to implement preventive interventions for GDM.Predicting GDM risk during the first trimester or pre-conceptional period may offer more clinical relevance.Despite its limitations,the study presents valuable insights into potential GDM biomarkers,but larger,well-validated studies are needed to establish their predictive utility and generalizability.

Role of nutrition in diabetes mellitus and infections

In this editorial,we have commented on the article that has been published in the recent issue of World Journal of Clinical Cases.The authors have described a case of unilateral thyroid cyst and have opined that the acute onset of infection may be linked to diabetes mellitus(DM).We have focused on the role of nutrition in the association between DM and infection.Patients with DM are at a high risk of infection,which could also be attributed to nutrition-related factors.Nutritional interventions for patients with diabetes are mainly based on a low-calorie diet,which can be achieved by adhering to a low-carbohydrate diet.However,dietary fiber supplementation is recommended to maintain the diversity of the gut microbiota.Furthermore,high-quality protein can prevent the increased risk of infection due to malnutrition.Supplementation of vitamins C,vitamins A,vitamins D,and folic acid improves blood sugar control and facilitates immune regulation.Mineral deficiencies augment the risk of infection,but the relationship with diabetes is mostly U-shaped and a good intake should be maintained.

Microplastic and nanoplastic exposure and risk of diabetes mellitus

The issue of plastic pollutants has become a growing concern.Both microplastics(MPs)(particle size<5 mm)and nanoplastics(NPs)(particle size<1μm)can cause DNA damage,cytotoxicity,and oxidative stress in various organisms.The primary known impacts of microplastic/nanoplastic are observed in the liver and respiratory system,leading to hepatotoxicity and chronic obstructive pulmonary disease.Although research on the effects of MPs and NPs on diabetes is still in its early stages,there are potential concerns.This editorial highlights the risk to diabetics from co-exposure to contaminants and MPs/NPs,supported by evidence from animal studies and the various chemical compositions of MPs/NPs.

Pelvic floor dysfunction in patients with gestational diabetes mellitus

In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.

Associations between food insecurity with gestational diabetes mellitus and maternal outcomes mediated by dietary diversity:A cross-sectional study

BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both mother and baby.AIM To investigate the relationships between FI and pregnancy outcomes,particularly GDM and PIH,while also examining the mediating role of the dietary diversity score(DDS).METHODS A cross-sectional study was undertaken to examine this relationship,involving 600 pregnant women.Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes.The FI was measured via the Household Food Security Survey Module,with GDM defined as fasting plasma glucose levels of≥5.1 mmol/L or a 2-hour oral glucose tolerance test value of≥8.5 mmol/L.The DDS is determined by evaluating one's food consumption based on nine distinct food groups.A logistic regression model was used to explore the relationship between FI and PIH,and GDM.RESULTS Seventeen percent of participants reported experiencing FI during pregnancy.The study found a significant association between FI and an elevated risk of GDM[odds ratio(OR)=3.32,95%CI:1.2-5.4].Once more,food-insecure pregnant women had higher rates of PIH(OR=0.10,95%CI:0.02-0.45)and they also faced a higher likelihood of neonatal complications,such as neonatal intensive care unit’s admissions and the birth of infants with extremely low birth weight.The FI wasfurther linked to metabolic disruptions,such as elevated fasting blood sugar(FBS),low-density lipoprotein cholesterol,and triglyceride levels.Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM.In particular,the mediation analysis showed that approximately 65%of the effect was mediated through DDS(P=0.002).CONCLUSION These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health.Additionally,the study explored how DDS mediates the relationship between FI and the incidence of GDM.

Effect of SPTLC1 on type 2 diabetes mellitus

BACKGROUND Although numerous single nucleotide polymorphism in multiple genes involve in the risk of type 2 diabetes mellitus(T2D),the single gene defects of T2D with strong family history is not clear yet.SPTLC1 are causative for hereditary sensory and autonomic neuropathy,which is clinical overlapping with diabetic peripheral neuropathy.Mice with adipocyte-specific deletion of SPTLC1 had impaired glucose tolerances and insulin sensitivity.Thus,it is necessary to investigate the SPTLC1 mutations in adult-onset T2D with strong family history.AIM To analyze the role of SPTLC1 mutation on adult-onset T2D with strong family history.METHODS By whole-exome sequence analysis of a patient with T2D and his family members,an uncertain variant in SPTLC1 was identified.Bioinformation analysis was used to evaluate the influence of mutation,rare variant gene-level associations for SPTLC1 in T2D,and the relationship between SPTLC1 mRNA and T2D in human islets from GSE25724.The effect of G371R of SPTLC1 on the characteristics of inflammatory cytokines and apoptosis was also tested on human embryonic kidney(HEK)293 cells.RESULTS A single nucleotide variation in SPTLC1(c.1111G>A:p.G371R)was identified in a family with T2D.The deleterious variant was predicted by functional analysis through hidden Markov models and mendelian clinically applicable pathogenicity software.This pathogenicity might be derived from the different amino acid properties.In HEK 293T cells,p.G371R of SPTLC1 induced the expression of tumor necrosis factor-αand the percent of apoptosis.Meanwhile,rare variant gene-level associations for SPTLC1 also refer to the high risk of T2D(the overall odds ratio=2.4968,P=0.0164).Data from GSE25724 showed that SPTLC1 mRNA was lower in pancreatic islets from T2D human islets(P=0.046),and was as sociated with the decreased level of insulin mRNA expression(Spearman r=0.615,P=0.025).CONCLUSION The study classified SPTLC1 p.G371R mutation as the likely pathogenic mutation from an adult-onset T2D patients with strong family history T2D.

Plantamajoside improves type 2 diabetes mellitus pancreaticβ-cell damage by inhibiting endoplasmic reticulum stress through Dnajc1 up-regulation

BACKGROUND Plantamajoside(PMS)has shown potential in mitigating cell damage caused by high glucose(HG)levels.Despite this,the precise therapeutic effects of PMS on type 2 diabetes mellitus(T2DM)and the underlying regulatory mechanisms require further exploration.AIM To investigate PMS therapeutic effects on T2DM in mice and elucidate its mechanisms of action through in vivo and in vitro experiments.METHODS An in vitro damage model of MIN6 cells was established using HG and palmitic acid(PA).PMS's protective effect on cell damage was assessed.Next,transcriptomics was employed to examine how PMS treatment affects gene expression of MIN6 cells.Furthermore,the effect of PMS on protein processing in endoplasmic reticulum and apoptosis pathways was validated.A T2DM mouse model was used to validate the therapeutic effects and mechanisms of PMS in vivo.RESULTS PMS intervention ameliorated cell injury in HG+PA-induced MIN6 cell damage.Transcriptomic analysis revealed that protein processing in the endoplasmic reticulum and apoptosis pathways were enriched in cells treated with PMS,with significant downregulation of the gene Dnajc1.Further validation indicated that PMS significantly inhibited the expression of apoptosis-related factors(Bax,CytC)and endoplasmic reticulum stress(ERS)-related factors[ATF6,XBP1,Ddit3(CHOP),GRP78],while promoting the expression of Bcl-2 and Dnajc1.Additionally,the inhibitory effects of PMS on ERS and apoptosis were abolished upon Dnajc1 silencing.Furthermore,in vivo experiments demonstrated that PMS intervention effectively improved pancreatic damage,suppressed the expression of apoptosis-related factors(Bax,CytC),and ERS-related factors[ATF6,XBP1,Ddit3(CHOP),GRP78],while promoting the expression of Bcl-2 and Dnajc1 in a T2DM model mice.CONCLUSION PMS intervention could alleviate pancreatic tissue damage effectively.The mechanism of action involves Dnajc1 activation,which subsequently inhibits apoptosis and ERS,ameliorating damage to pancreaticβ-cells.

Improving nursing care protocols for diabetic patients through a systematic review and meta-analysis of recent years

BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus.Nursing interventions are crucial for managing the disease and preventing complications.AIM To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.METHODS This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables,such as glycated haemoglobin and fasting plasma glucose.RESULTS After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables,a descriptive analysis of the studies with the most significant changes was conducted.Based on this,an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient’s technological skills.CONCLUSION The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.

Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management

Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.

Investigation and study on the epidemiology of gestational diabetes mellitus in Guizhou

BACKGROUND Gestational diabetes mellitus(GDM)is a growing public health concern,particularly in regions with diverse ethnic populations.Understanding the incidence and risk factors of GDM is crucial for early prevention and management,especially in underrepresented areas like Guizhou Province,China,where geographic and ethnic diversity may influence the disease’s prevalence and risk profiles.AIM To investigate the incidence of GDM and identify its associated risk and protective factors among different ethnic groups in Guizhou Province,providing essential data for early prevention strategies.METHODS A multi-center retrospective study was conducted,dividing participants into GDM and non-GDM groups according to standardized diagnostic criteria.Data were collected from 103629 deliveries across 40 hospitals in Guizhou.Various demographic,clinical,and laboratory parameters were analyzed using logistic regression to identify risk and protective factors for GDM.RESULTS Among the 103629 deliveries,18957 cases of GDM were identified,with an incidence of approximately 18.3%.The risk of GDM was higher in the Han ethnic group compared to minority ethnic groups.The Dong ethnic group had the lowest incidence among the minorities.Key risk factors identified included older age(especially>35 years),higher pre-pregnancy body mass index(BMI),light physical activity,gravidity,family history of diabetes,hemoglobin,aspartate aminotransferase,alanine aminotransferase,and direct bilirubin.Protective factors included higher education level,total protein,and albumin.There were also differences based on blood type,with type A associated with higher risk.CONCLUSION The incidence rate in Guizhou is 18.3%.Older age(especially>35 years),Han ethnicity,lower education level,higher pre-pregnancy BMI,light physical activity,and higher gravidity are the main risk factors for GDM.Laboratory findings indicate that higher hemoglobin,higher liver function parameters(alanine aminotransferase,aspartate aminotransferase,and direct bilirubin),and lower total protein and albumin are associated with a higher risk of GDM.Blood type A has a higher risk of GDM compared to blood types AB and O.

Association between serum retinol-binding protein and lower limb atherosclerosis risk in type 2 diabetes mellitus

BACKGROUND Serum retinol-binding protein(RBP)is the primary transport protein of circulating vitamin A.RBP has a crucial role in maintaining nutrient metabolism and physiologic homeostasis.Several studies have indicated that serum RBP participates in the progression of diabetes and diabetes-related complications.However,the impact of serum RBP on lower limb atherosclerosis has not been determined in individuals with type 2 diabetes mellitus(T2DM).AIM To determine the association between serum RBP and lower limb atherosclerosis in individuals with T2DM.METHODS This retrospective study enrolled 4428 eligible T2DM patients and divided the patients into non-lower limb atherosclerosis(n=1913)and lower limb atherosclerosis groups(n=2515)based on lower limb arterial ultrasonography results.At hospital admission,baseline serum RBP levels were assessed,and all subjects were categorized into three groups(Q1-Q3)based on RBP tertiles.Logistic regression,restricted cubic spline regression,subgroup analysis,and machine learning were used to assess the association between RBP levels and lower limb atherosclerosis risk.RESULTS Among 4428 individuals with T2DM,2515(56.80%)had lower limb atherosclerosis.Logistic analysis showed that lower limb atherosclerosis risk increased by 1%for every 1 unit rise in serum RBP level(odds ratio=1.01,95%confidence interval:1.00-1.02,P=0.004).Patients in the highest tertile group(Q3)had a higher lower limb atherosclerosis risk compared to the lowest tertile group(Q1)(odds ratio=1.36,95%confidence interval:1.12-1.67,P=0.002).The lower limb atherosclerosis risk gradually increased with an increase in RBP tertile(P for trend=0.005).Restricted cubic spline analysis indicated a linear correlation between serum RBP levels and lower limb atherosclerosis risk(non-linear P<0.05).Machine learning demonstrated the significance and diagnostic value of serum RBP in predicting lower limb atherosclerosis risk.CONCLUSION Elevated serum RBP levels correlate with an increased lower limb atherosclerosis risk in individuals with T2DM.

Triglyceride-glucose related indices as predictors for major adverse cardiovascular events and overall mortality in type-2 diabetes mellitus patients

BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the association in TyG-WHtR,TyG-WC,and the risk and prognosis of major adverse cardiovascular events(MACEs)in type 2 diabetes mellitus(T2DM)cases are limited.AIM To clarify the relation in TyG-WHtR,TyG-WC,and the risk of MACEs and overall mortality in T2DM patients.METHODS Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes(ACCORD)/ACCORD Follow-On(ACCORDION)study database.The Cox regression model was applied to assess the relation among TyG-WHtR,TyG-WC and future MACEs risk and overall mortality in T2DM cases.The RCS analysis was utilized to explore the nonlinear correlation.Subgroup and interaction analyses were conducted to prove the robustness.The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.RESULTS After full adjustment for confounding variables,the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality,than the lowest quartile group.Similarly,the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality,respectively.Each 1 SD increase in TyG-WHtR was significantly related to an 11.7%increase in MACEs and a 14.9%enhance in overall mortality.Each 1 SD increase in TyG-WC corresponded to an 11.5%in MACEs and a 16.6%increase in overall mortality.Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.CONCLUSION TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.