Relationship between social isolation and glycaemic control of people previously diagnosed with diabetes: secondary analysis from the CHARLS.

OBJECTIVES: Social isolation may affect diabetes self-management. This study aimed to explore the relations between social isolation and glycaemic control in patients with diabetes and to explore lifestyle differences among individuals with different levels of social isolation. METHODS: The relevant data of 665 people previously diagnosed with diabetes included in the China Health and Retirement Longitudinal Study from 2011 to 2015 were extracted and analysed. The study included patient general information, blood glucose, lipids, glycosylated haemoglobin, social isolation index, health-related lifestyle factors and diabetes-related factors. Differences in metabolic abnormalities and modifiable lifestyles were compared among patients with varying levels of social isolation. RESULTS: Multiple linear regression analysis demonstrated that among men aged 45-64 years, the high social isolation group had significantly higher glycosylated haemoglobin levels compared with the low isolation group (7.29±1.81 vs 6.59±1.63, p=0.026). A positive correlation was observed between social isolation and blood glucose (ß=14.16; 95% CI 2.75 to 25.57; p=0.015) and glycosylated haemoglobin (ß=0.35; 95% CI 0.10 to 0.60; p=0.006), indicating that higher social isolation was associated with higher fasting blood glucose and glycosylated haemoglobin levels. However, no significant associations were observed in other age groups. Notably, men aged 45-65 years with high social isolation had higher depression rates (44.10% vs 24.60%, p=0.024), lower engagement in moderate exercise (5.70% vs 23.50%, p=0.019) and shorter 10-minute walks (17.10% vs 36.80%, p=0.027). Differences in other health-related and diabetes-related factors were not statistically significant. CONCLUSION: Middle-aged men with diabetes with higher social isolation tend to have higher blood glucose and glycosylated haemoglobin levels. This subset of patients requires targeted attention to provide social support from family and friends for improved glycaemic control. If necessary, education on diabetes should be made available to family members and friends.

Family caregiver's willingness to care from the perspective of altruism.

Objectives: The willingness of family members to take care of older relatives directly affects the quality of life of disabled older adults, so it is necessary to understand the status quo of willingness to care and its influencing factors. This has been extensively studied in other countries, but, it is rarely studied in China. Based on the theory of altruism, employing a unique sample from Shanghai, China in 2017 and 2022, we attempt to reveal the influencing factors of the care willingness of family caregivers during the transition period. Methods: To measure caregiver burden and functional disability of the care recipient, we employ the Zarit Burden Interview (ZBI) and the Barthel Index, respectively. Then we utilized the ordinary least squares (OLS) methodology and estimated four regression models. Models 1, 2, and 3 examined the impact of the variables of the caregiver burden, responsibility and love, and the quality of the caregiver-caregiver recipient relationship, respectively, on family caregivers' willingness to care. Model 4 was the full model. To testify whether the caregiver burden is likely to act as a mediator, path analysis was used, and the path was adjusted and verified. Results: According to the survey, in Shanghai, only half of the caregivers had a very high care willingness to care for disabled older relatives, while nearly one-tenth of the caregivers had a low willingness. It was the caregiver burden rather than the functional disability of older adults that harms family caregivers' willingness to care. Responsibility and caring out of love were positively related to care willingness. Relationship quality was the most important influencing factor, explaining 10.2% of the variance in care willingness. Path analysis demonstrated that responsibility, caring out of love, and relationship quality directly and through the mediation of caregiver burden indirectly affected care willingness. Conclusion: Our results revealed that reciprocal altruism presented by the quality of the caregiver-care recipient relationship had a significantly positive impact on family caregivers' willingness to care. In addition, the caregiver burden was found not only directly affected care willingness, but also acted as a mediator. To promote the perfection of laws and policies, comprehensive samples of different types of cities should be included and the measurement of key variables could be further improved in future studies.

Perceptions of exercise and exercise instruction in patients with type 2 diabetes mellitus and sarcopenia : a qualitative study.

BACKGROUND: Exercise plays a major role in helping patients with type 2 diabetes mellitus and sarcopenia to increase muscle mass and muscle strength. However, little is known about perceptions of exercise and exercise instruction in these patients. This study aimed to explore the perceptions of exercise and exercise instruction from the patient's perspective. METHODS: In a descriptive qualitative study, semi-structured face-to-face in-depth interviews were conducted with 16 patients with type 2 diabetes mellitus and sarcopenia at a tertiary hospital. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed to ensure rigor in the study. The interviews were analysed using a thematic analysis method. RESULTS: Four themes and 13 sub-themes were identified in this study. The four themes were knowledge-attitudes-practices surrounding exercise, motivators and barriers regarding exercise, and attitudes towards professional exercise instruction. CONCLUSION: This study provides a detailed understanding of the knowledge-attitudes-practices, motivators and barriers regarding exercise among patients with type 2 diabetes mellitus and sarcopenia, as well as attitudes related to exercise instruction. The current findings can guide healthcare professionals, patients' families, and policymakers to motivate patients to be physically active through policy initiatives and other types of incentives and programmes, such as providing more health education and holistic support, increasing family and friends' companionship and care, and providing suitable exercise conditions.

Diabetic foot ulcer risk assessment and prevention in patients with diabetes: a best practice implementation project.

INTRODUCTION AND AIM: Diabetic foot ulcer (DFU) is one of the most serious complications in patients with diabetes. Early identification of risk factors can prevent its occurrence and delay its progression. The aim of this project is to conduct an audit of DFU risk assessment protocols at a large tertiary hospital and evaluate the impact of any changes in compliance with the developed evidence-based best practice criteria. METHODS: Preimplementation and postimplementation audits based on JBI's Practical Application of Clinical Evidence System were conducted at the Department of Endocrinology and Metabolism of a tertiary hospital in China. The Getting Research into Practice audit tool was used to analyze the barriers and inadequacies encountered in practice. A total of 12 nurses and 30 patients with diabetes were included in the baseline and follow-up audits. RESULTS: There were 15 baseline audits that indicated deficits in DFU risk assessment by nurses, with 0% compliance for three criteria and 50% compliance or less for seven others. Strategies developed by the project team to address the identified barriers to compliance were adopted, leading to significant improvement in compliance with most criteria at the follow-up audit compared with baseline with 11 criteria achieving at least 90% compliance. CONCLUSION: The project showed that regular audits of foot ulcer risk assessment can help to identify barriers to their implementation. Advising patients of their risk status can support appropriate self-care practices. Further audits are needed to implement evidence-based practices in all aspects of diabetes patient care.

Assessment and management of pain during dressing change in patients with diabetic foot ulcers: a best practice implementation project.

INTRODUCTION: Pain caused by dressing change has adverse effects on patients with a diabetic foot ulcer, including sleep disturbances, immobility, depression and anxiety. It is crucial that healthcare professionals use a standardized tool to assess and document pain during dressing change and then use this information to inform strategies to alleviate the pain. OBJECTIVES: The aim of this project was to implement evidence-based practice in assessment and management of pain during dressing change among patients with diabetic foot ulcers in an endocrinology unit in a tertiary hospital. METHODS: The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool were used for auditing clinical practice and translating evidence into practice. A baseline audit was performed to assess compliance with six criteria, followed by the implementation of evidence-based interventions to improve compliance. The follow-up audit using the same audit criteria was conducted to assess the effect of targeted strategies on compliance with best practice. RESULTS: The baseline audit revealed that compliance with evidence-based practice was low, with only one of the six audit criteria achieving a compliance rate above 60%. After brainstorming and synthesizing the literature, the project team identified barriers and strategies for implementing best practice. The follow-up audit showed improvements in compliance across all six criteria, although there was only a small improvement in one of the criteria. The compliance rate of the other five criteria improved to greater than 67%. CONCLUSION: A best practice implementation project that involved standardizing pain assessment and management, and delivering education materials to nursing staff and patients was completed using JBI PACES and GRiP. The project improved nurses' compliance with best practice. Nurses attach importance to relieving patients' pain when they perform wound care, while patients with a diabetic foot ulcer gain access to high-quality wound care. Future studies will be conducted to address new barriers that emerged during the follow-up audit.

[Effect of glucagon-like peptide 1 receptor agonists on body fat redistribution and muscle mass in overweight and obese type 2 diabetic patients].

OBJECTIVE: To investigate the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on body fat redistribution and muscle mass in overweight/obese patients with type 2 diabetes (T2DM). METHODS: We retrospectively analyzed the data of 76 patients with body mass indexes (BMI)≥24 kg/m2, who had an established diagnosis of T2DM in our department between December, 2014 and September, 2015. We divided these patients according to their BMI in overweight group (BMI of 24-27.9 kg/m2, n=14), obese group (BMI of 28-31.9 kg/m2, n=35) and severely obese group (BMI≥32 kg/m2, n=27). All the patients received treatment with GLP-1RAs (Exenatide or Liraglutide) for 3.0 to 29.0 weeks (mean 8.9 weeks), and their blood glucose, HbA1c and serum lipids were analyzed. For each patient, the fat and muscle masses were analyzed using a human body composition analyzer (JAWON-IOI353, Korea) before and after GLP-1RAs treatment. RESULTS: Treatment with GLP-1RAs significantly decreased BMI and visceral adiposity index (VAI) in all the patients in the 3 groups (P < 0.05). The treatment significantly decreased the body weight in the overweight group and obese group by 2.70 kg (0.60-4.95 kg) and 2.65 kg (1.45-6.40 kg), respectively (P < 0.05), and significantly decreased the waist-to-hip ratio (WHR) in the overweight group (P < 0.05). The obese and severely obese patients showed significantly decreased percentage body fat (including both subcutaneous and visceral fat) and increased muscle mass after the treatment (P < 0.05). Compared with those in the overweight group, the percentage body fat and VAI were significantly decreased in the obese group after the treatment (P < 0.05), and the percentage of subcutaneous fat reduced and the muscle ratio increased more obviously in the obese and severely obese patients (P < 0.05). CONCLUSIONS: GLP-1RAs treatment can significantly lower BMI and improve body fat distribution in obese patients with T2DM, especially in patients with a greater BMI.

Corrigendum to "Urinary Exosomal MicroRNA Profiling in Incipient Type 2 Diabetic Kidney Disease".

[This corrects the article DOI: 10.1155/2017/6978984.].

Inflammation and Fibrosis in Perirenal Adipose Tissue of Patients With Aldosterone-Producing Adenoma.

The prevalence of primary aldosteronism is much higher than previously thought. Recent studies have shown that primary aldosteronism is related to a higher risk of cardiovascular events. However, the underlying mechanism is not yet clear. Here we investigate the characteristics, including inflammation, fibrosis, and adipokine expression, of adipose tissues from different deposits in patients with aldosterone-producing adenoma (APA). Inflammation and fibrosis changes were evaluated in perirenal and subcutaneous adipose tissues obtained from patients with APA (n = 16), normotension (NT; n = 10), and essential hypertension (EH; n = 5) undergoing laparoscopic surgery. We also evaluated the effect of aldosterone in isolated human perirenal adipose tissue stromal vascular fraction (SVF) cells and investigated the effect of aldosterone in mouse 3T3-L1 and brown preadipocytes. Compared with the EH group, significantly higher levels of interleukin-6 (IL-6) and tumor necrosis factor-α messenger RNA (mRNA) and protein were observed in perirenal adipose tissue of patients with APA. Expression of genes related to fibrosis and adipogenesis in perirenal adipose tissue was notably higher in patients with APA than in patients with NT and EH. Aldosterone significantly induced IL-6 and fibrosis gene mRNA expression in differentiated SVF cells. Aldosterone treatment enhanced mRNA expression of genes associated with inflammation and fibrosis and stimulated differentiation of 3T3-L1 and brown preadipocytes. In conclusion, these data indicate that high aldosterone in patients with APA may induce perirenal adipose tissue dysfunction and lead to inflammation and fibrosis, which may be involved in the high risk of cardiovascular events observed in patients with primary aldosteronism.

[Surgical correction of conjunctival sac narrowing after orbital implantation using polyester fiber heart patches].

OBJECTIVE: To test the feasibility of correcting conjunctival sac narrowing following orbital implantation using polyester fiber heart patches instead of the skin autograft. METHODS: Twelve patients of conjunctival sac narrowing after orbital implantation (including 3 with orbital implant exposure) admitted in Nanfang Hospital between 2012 and 2016 received surgical correction of the conjunctival sac using polyester fiber heart patches. During the surgery, the central conjunctival sac was opened, the exposed area was covered with suitable polyester fiber heart patches, and the palpebral margin was sutured. RESULTS: Three months after the operation, 10 patients showed improved appearance after implantation of the prosthetic eye. Two patients received a second operation to remove the patches due to graft rejection and infections and skin autograft was implanted for reconstruction of the conjunctival sac. CONCLUSION: Polyester fiber heart patches are ideal materials for repairing Conjunctival sac narrowing and orbital implant exposure, but this approach is not suitable in cases of severe narrowing or occlusion of the conjunctival sac.

Thickness of Extraocular Muscle and Orbital Fat in MRI Predicts Response to Glucocorticoid Therapy in Graves' Ophthalmopathy.

33 patients with active, moderate-severe Graves' ophthalmopathy (GO) received 4.5 g methylprednisolone for 12 weeks and were divided by efficacy into two groups (responsive and unresponsive). All patients and 10 controls underwent orbital MRI examination at baseline. No significant difference was seen in baseline clinical characteristics between the two GO groups. The values of exophthalmos were higher in both GO groups than in the control and were higher in the responsive group versus the unresponsive group. Compared to the unresponsive group, the responsive group had a thicker inferior rectus as well as thinner orbital fat. The inferior rectus/fat ratio was significantly higher in the responsive group versus the unresponsive group. Multivariate logistic regression analysis showed that the exophthalmos value and inferior rectus/fat ratio were significantly associated with the response to glucocorticoid (GC). ROC analysis revealed that the cut-off points of the inferior rectus/fat ratio combined with the exophthalmos value to indicate efficacy were 1.42 and 20.78. For moderate-severe GO patients with CAS > 3, the combined inferior rectus/fat ratio and exophthalmos value in MRI may be a valuable indicator to predict the response to GC therapy.

Effect of high-fat diet on peripheral neuropathy in C57BL/6 mice.

Objective. Dyslipidemia may contribute to the development of peripheral neuropathy, even in prediabetics; however, few studies have evaluated vascular dysfunction and oxidative stress in patients with peripheral neuropathy. Methods. Using high-fat diet- (HFD-) induced prediabetic C57BL/6 mice, we assessed motor and sensory nerve conduction velocity (NCV) using a BIOPAC System and thermal algesia with a Plantar Test (Hargreaves' method) Analgesia Meter. Intraepidermal nerve fiber density and mean dendrite length were tested following standard protocols. Vascular endothelial growth factor-A (VEGF-A) and 12/15-lipoxygenase (12/15-LOX) were evaluated by immunohistochemistry and Western blot, respectively. Results. HFD-fed mice showed deficits in motor and sensory NCV, thermal hyperalgesia, reduced mean dendrite length, and VEGF-A expression in the plantar skin and increased 12/15-LOX in the sciatic nerve (P < 0.05 compared with controls). Conclusion. HFD may cause large myelinated nerve and small sensory nerve fiber damage, thus leading to neuropathy. The mean dendrite length may be a more sensitive marker for early detection of peripheral neuropathy. Reduced blood supply to the nerves and increased oxidative stress may contribute to the development and severity of peripheral neuropathy.

Circulating levels of miR-146a and IL-17 are significantly correlated with the clinical activity of Graves' ophthalmopathy.

Graves' ophthalmopathy (GO) is a common autoimmune disease that is difficult to deal with due to limited clinical evaluation methods. Recently miR-146a and Interleukin-17 (IL-17) have been found to be involved in autoimmune disorders and correlated with disease activity. However, it is unclear whether they are involved in Graves' ophthalmopathy (GO). The aim of this study is to investigate the correlation of circulating levels of miR-146a and IL-17 with clinical activity in GO patients. Fifty-seven study subjects were enrolled in four groups according to the corresponding criteria: active-GO, inactive-GO, Graves disease (GD) without ophthalmopathy, and healthy control group. The circulating levels of miR-146a and IL-17 were determined by qRT-PCR and ELISA, respectively. Serum IL-17 levels of GD, inactive-GO, and active-GO groups were all significantly higher than that of control (all P < 0.001). Active-GO group had significantly higher IL-17 level than inactive-GO and GD groups (P = 0.024 and P = 0.001, respectively). Active-GO and inactive-GO group had significantly lower miR-146a expressions than control (P < 0.05). Active-GO group had significantly lower miR-146a than inactive-GO group (P < 0.05). Serum levels of IL-17 and miR-146a were both significantly correlated with clinical activity score (CAS) in GO patients (P < 0.001, P < 0.001, respectively). There was a significant negative correlation of circulating miR-146a expression with serum IL-17 levels (P < 0.01). These findings indicated that circulating levels of miR-146a and IL-17 may be potential biomarkers of active GO, and may play a key role in the progression of GO.

Increased growth factors play a role in wound healing promoted by noninvasive oxygen-ozone therapy in diabetic patients with foot ulcers.

Management of diabetic foot ulcers (DFUs) is a great challenge for clinicians. Although the oxygen-ozone treatment improves the diabetic outcome, there are few clinical trials to verify the efficacy and illuminate the underlying mechanisms of oxygen-ozone treatment on DFUs. In the present study, a total of 50 type 2 diabetic patients complicated with DFUs, Wagner stage 2~4, were randomized into control group treated by standard therapy only and ozone group treated by standard therapy plus oxygen-ozone treatment. The therapeutic effects were graded into 4 levels from grade 0 (no change) to grade 3 (wound healing). The wound sizes were measured at baseline and day 20, respectively. Tissue biopsies were performed at baseline and day 11. The expressions of vascular endothelial growth factor (VEGF), transforming growth factor-ß (TGF-ß), and platelet-derived growth factor (PDGF) proteins in the pathologic specimens were determined by immunohistochemical examinations. The effective rate of ozone group was significantly higher than that of control group (92% versus 64%, P < 0.05). The wound size reduction was significantly more in ozone group than in control group (P < 0.001). After treatment, the expressions of VEGF, TGF-ß, and PDGF proteins at day 11 were significantly higher in ozone group than in control group. Ozone therapy promotes the wound healing of DFUs via potential induction of VEGF, TGF-ß, and PDGF at early stage of the treatment. (Clinical trial registry number is ChiCTR-TRC-14004415).

[Efficacy and safety evaluation of two insulin treatment protocols using a continuous glucose monitoring system].

OBJECTIVE: To evaluate the efficacy and safety of two insulin treatment protocols using a continuous glucose monitoring system. METHODS: Type 2 diabetic patients mellitus with unsatisfactory control of fasting blood glucose by oral antidiabetic drugs were included in the study. The patients were randomized into two groups to receive bedtime injection of glargine and oral antidiabetic drugs (group A) or injection of Novolin 30 R twice a day (group B) for 12 weeks. The insuline dose was adjusted according to fasting blood glucose till discharge. Continuous glucose monitoring system was used to record the average blood glucose, fasting blood glucose, 2 h postprandial blood glucose, AUCPG ≥ 10.0 mmol/L%, HbA1c and C peptide, bedtime blood glucose, 3:00 AM blood glucose, the incidence of hypoglycemia and body mass index. RESULTS: The average blood glucose, fasting blood glucose, 2 h postprandial blood glucose, AUCPG ≥ 10.0 mmol/L% and HbA1c was significantly decreased and C peptide significantly increased in the two groups after the treatments. The patients in glargine group showed better improvement with a significantly lower incidence of hypoglycemia than those in Novolin 30 R group. BMI underwent no significant changes in the two groups after the treatments. CONCLUSION: Glargine therapy better mimics the physiological insulin secretion patterns, and when combined with oral antidiabetic drugs, can be more effective and safer than premixed insulin.

[Epidemiological investigation of diabetes and prediabetes in community residents in the suburbs of Guangzhou].

OBJECTIVE: To identify the prevalence and risk factors of diabetes and prediabetes in the community residents above 18 years old in the suburbs of Guangzhou. METHODS: Between April and May in 2008, the residents above 18 years living in 6 communities of Guangzhou for 5 or more years were sampled with multistage clustering sampling. The sampled residents were surveyed by questionnaires, and physical examination and glucose determination were carried out. RESULTS: A total of 1532 residents were sampled. The incidence of diabetes mellitus in these community residents was 8.46%, and that of impaired glucose regulation was 6.59%. Age, body mass index, family history of diabetes mellitus, case history of hypertension, hyperlipidemia, hypertension and smoking were all the independent risk factors for impaired glucose regulation and diabetes mellitus. CONCLUSION: Diabetes and prediabetes are prevalent in the community residents in Guangzhou. Controlling the risk factors such as obesity, hypertension, lipid metabolism disorder among the residents above 40 years with a family history of diabetes mellitus and hypertension is key to prevention of impaired glucose regulation and diabetes mellitus.

[Dose-effect relationship of irbsartan with the changes in the renal tissue structure in diabetic rats].

OBJECTIVE: To investigate the relationship between the dosage of irbesartan and the renal tissue structure in diabetic rats. METHODS: Male Wistar rats was given a single intraperitoneal dose (mg/kg) of streptozotocin to induce diabetes. The diabetic rats were randomized into 4 groups and received 4 weeks later 25 mg/kg (n=9), 50 mg/kg (n=9), 200 mg/kg (n=9) irbesartan intragastrically, or equal volume of water (model group, n=11) on a daily basis. Seven normal rats receiving with equal volume of water served as the normal control. All the rats were sacrificed after 8 weeks and the 24-hour albumin excretion, renal mass index and the volume of the glomerulus were measured. RESULTS: The 24-hour albumin excretion, renal mass index and volume of the glomerulus in the 3 irbesartan groups were significantly decreased as compare with those in the model group; the reductions in 50 and 200 mg/kg irbesartan groups were significant greater than those in 25 mg/kg irbesartan group. CONCLUSION: Irbesartan can decrease the 24-hour urinary albumin excretion and relive glomerulopathy in diabetic rats. Within a certain dose range, irbesartan produces a dose-dependent protective effect on the renal structures in the diabetic rats.

[Sweat function evaluation for early diagnosis of diabetic peripheral neuropathy].

OBJECTIVE: To evaluate the clinical value of sweat function examination in early diagnosis of diabetic peripheral neuropathy (DPN). METHODS: Ninety-eight hospitalized type 2 diabetic patients with or without DPN (DN and DC groups) according to Michigan Diabetic Neruopathy Score (DNS) and 40 healthy volunteers (NC group) were evaluated for their sweat function of the feet in relation to the peripheral autonomic nerve with sweat printing method using Neuropad. The Neuropad color-changing time was recorded to assess the sensitivity and specificity of sweat printing methods relative to DNS for DNP evaluation, and the correlation of the Neuropad color-changing time to DNS score was analyzed. RESULTS: The average Neuropad color-changing time was 4.0-/+0.6, 4.3-/+1.2 and 23.0-/+6.1 min in NC, DC, and DN groups, respectively, showing significant differences between the 3 groups (P<0.05). The morbidity rate detected by sweat printing method was 62.2%, similar to that detected by DNS (57.1%, P>0.05). The sensitivity of the sweat printing method for DPN diagnosis was 92.8%, with specificity of 78.5%, positive predictive value of 93.2%, and negative predictive value of 78.6%. DNS showed significant positive correlation with the Neuropad color-changing time (r=0.46, P<0.05). CONCLUSION: Sweat printing method provides an objective, simple and reliable method for sweat function evaluation of the feet of type 2 diabetic patients to help in early DPN diagnosis, and quantification of the results of sweat printing method can be indicative of the DPN severity.