The Metabolic Characteristics of Patients at the Risk for Diabetic Foot Ulcer: A Comparative Study of Diabetic Patients with and without Diabetic Foot.

Backgrounds and Objective: Diabetic foot is a relatively severe complication in patients with type 2 diabetes (T2D), with peripheral neuropathy and angiopathy frequently serving as risk factors. However, it is unknown how the other major systemic metabolic factors impacted the profile of these patients, besides glucose management. Thus, we investigated the distinct characteristics of patients with diabetic foot ulcers and their relationships with angiopathy. Materials and Methods: We obtained the laboratory data of 334 diabetic patients at Shanghai Pudong Hospital from 2020 to 2023. The comparisons were performed between the groups with or without diabetic foot, including glucose metabolism, lipids profile, liver and kidney function, thyroid function, and serum iron. The association between metabolic factors and lower extremity computed tomography angiography (CTA) was analyzed. Results: We found significant disparities between groups in relation to age, serum protein content, liver transferase, serum creatinine, estimated glomerular filtration rate (eGFR), serum uric acid (UA), small dense low-density lipoprotein (sdLDL), lipoprotein A (LP(a)), apolipoprotein A1 (APOA1), thyroid function, serum iron, and hemoglobin (Hb) (p<0.05). The Spearman correlational analyses showed that the severity of CTA, categorized by the unilateral or bilateral plaque or occlusion, was positively significantly correlated with UA (r=0.499), triglyceride (TG) (r=0.751), whereas inversely correlated with serum albumin (r=-0.510), alanine aminotransferase (r=-0.523), direct bilirubin (DBil) (r=-0.494), total bilirubin (TBil) (r=-0.550), Hb (r=-0.646). Conclusion: This cross-section investigation showed that compared to T2D only, the patients with diabetic foot ulcer (DFU) might display similar glucose metabolic control context but adverse metabolic profiles, and this profile is associated with macrovascular angiopathy characteristics and their severity.

Prevalence and Factors Associated with Depression in Patients with Diabetes Mellitus and Pulmonary Tuberculosis (DM-PTB): A Hospital-Based Cross-Sectional Study.

Background and Objectives: A high incidence of depression has been reported in patients with pulmonary tuberculosis and diabetes mellitus (DM-PTB). However, the association between depression and DM-PTB is poorly understood and requires further investigation. This study aimed to evaluate the prevalence of depression and the associated factors in patients with DM-PTB. Methods: A cross-sectional study was conducted among DM-PTB patients at the Tuberculosis Department of Shanghai Pulmonary Hospital Affiliated to Tongji University, China, enrolled between June 2021 and October 2021. The depression status, nutritional status, and the quality of life of the patients were evaluated using Patient Health Questionnaire-9 (PHQ-9), Nutritional Risk Screening 2002 (NRS2002), and Quality of Life Instruments for Chronic Diseases-Pulmonary Tuberculosis (QLICD-PT), respectively. Results: A total number of 280 DM-PTB patients were screened, of whom 22 were excluded for missing data. Among the 258 DM-PTB patients subjected to analysis, 199 patients (77.13%) had PHQ-9 scores above 10. The patients with depression are more likely to have a lower monthly income, body mass index (BMI), and QLICD-PT than those without depression. The NRS2002 score and glutamic pyruvic transaminase (GPT) and glutamic oxaloacetic transaminase (GOT) levels in the depression group were more likely to be higher than those in the control group. Multivariate logistic regression analysis showed that physical function [OR = 0.798, 95% confidence interval (CI), 0.716-0.889, P < 0.001] was a protective factor against depression, whereas NRS2002 ≥ 3 (OR = 2.299, 95% CI, 1.095-4.825, P = 0.028), GPT (OR = 1.048, 95% CI, 1.018-1.079, P = 0.002), and social function (OR = 1.103, 95% CI, 1.033-1.179, P = 0.004) were risk factors of depression. Conclusion: Depression in DM-PTB patients may be associated with monthly income, BMI, QLICD-PT scores, NRS2002 scores, GPT, and GOT levels.

A Pilot Study of Modified Mini-Clinical Evaluation Exercises (Mini-CEX) in Rotation Students in the Department of Endocrinology.

Background: The mini-clinical evaluation exercise (mini-CEX) is an excellent tool for assessing the clinical abilities of medical students in intense clinical practice. In this study, the Mini-CEX was adapted to professional questionnaires for Diabetes Mellitus (DM), and examined in medical students completing their clerkship rotation in the department of endocrinology. Methods: From January 2021 to January 2022, all rotating medical students at Shanghai Pudong Hospital completed two mini-CEX exams before and following their rotation under the supervision and guidance of six tutors. The mini-CEX form was modified in this study primarily for inpatient management based on our clinical experience and updated DM guidelines of the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the Chinese Diabetes Society (CDS). Each component of the mini-CEX assessment, including medical interviews, physical examination, clinical judgment, clinical management, and overall clinical competence was evaluated using a nine-item questionnaire. Results: Our findings revealed that the second-round performance on the assessments significantly improved, as indicated by higher scores on each component. The Pearson association analysis revealed that the feedback time of the first examination was markedly associated with improved overall scores (r= 0.391, p<0.001). However, no correlations were discovered between patient age, gender, disease severity disparity, or the interval between examinations (p>0.05). Additional regression analysis revealed that the feedback time during the initial examination was the most significant contributor to the increased overall scores (ß=0.391, p<0.001). Conclusion: This newly designed mini-CEX form based on current ADA and EASD guidelines may assist trainees in more effectively diagnosing and managing DM in inpatients, particularly those with macrovascular, microvascular, or peripheral nerve neuropathy. This study aims to assess the efficacy of administering a modified mini-CEX form to rotating trainees participating in an endocrine clerkship.

Rosiglitazone protects diabetic rats against kidney injury through the suppression of renal matrix metalloproteinase-9 expression.

In this study, the effects of rosiglitazone on renal matrix metalloproteinase-9 (MMP-9) expression and its possible renoprotective mechanisms were investigated in streptozotocin-induced diabetic rats. We examined the urinary excretion rates of albumin (ALB), retinal-binding protein (RBP) and MMP-9 in control healthy rats (group C, n = 8), untreated diabetic rats (group D, n = 8) and diabetic rats treated with rosiglitazone (5mg/kg/day) (group R, n = 8) at eighth week. The renal tissue of diabetic rats was obtained for observing renal pathological changes by electron microscope and examining the expression of renal MMP-9 mRNA by RT-PCR. Our results showed that urinary excretion rates of MMP-9. ALB and RBP were significantly increased concurrently with the expression of renal MMP-9mRNA in group D compared with those of group C. Rosiglitazone significantly reduced urinary excretion rates of ALB, RBP and MMP-9 as well as the expression of renal MMP-9 mRNA. In addition, urinary excretion rate of MMP-9 showed positive relationship with urinary excretion rates of ALB and RBP. In conclusion, rosiglitazone definitely protects diabetic rats against renal injury, which may be partly associated with decreasing expression of renal MMP-9 mRNA and urinary MMP-9 production.

The effect of simvastatin on the serum monocyte chemoattractant protein-1 and intracellular adhesion molecule-1 levels in diabetic rats.

OBJECTIVE: This study aimed to observe the effect of simvastatin on the serum monocyte chemoattractant protein-1 (MCP-1) and intracellular adhesion molecule-1 (ICAM-1) levels and to probe its protective mechanisms on macroangiopathy in diabetic rats. METHODS: Twenty-four Wistar rats were randomly assigned to a normal control group (Group A, n=8), and STZ-induced diabetic group (Group B, n=8), or a simvastatin-treated diabetic group (Group C, n=8). Rats in Group C were treated with simvastatin (20 mg kg(-1) day(-1)) 1 week after the establishment of the diabetic model. Groups A and B were treated with corresponding sodium chloride. Peripheral blood glucose was tested weekly; serum MCP-1, ICAM-1, and HbA1c levels were tested at the eighth week. RESULTS: At the second, fourth, and eighth week, peripheral blood glucose levels in Group B were similar to those of Group C, which were much higher than those of Group A. Serum MCP-1 and ICAM-1 levels in Groups B and C were higher than those of Group A (P<.01), and serum MCP-1 and ICAM-1 levels in Group C were lower than those of Group B (P<.01); HbA1c was not significantly different between Group C and Group B. CONCLUSION: Simvastatin has the effect of anti-inflammation, which may play some protection against the progress of atherosclerosis in diabetic rats.

Rosiglitazone protects diabetic rats against kidney disease through the suppression of renal moncyte chemoattractant protein-1 expression.

Although the pathogenetic mechanisms of diabetic nephropathy (DN) have not been elucidated thoroughly, an inflammatory mechanism has been suggested to contribute to its development and progression. Moncyte chemoattractant protein (MCP)-1 is a chemokine that can attract macrophages and T cells from the circulation to the local kidney, then activate them, and ultimately injure the renal tissue. Recent studies have demonstrated that thiazolidinediones decrease urinary albumin (ALB) excretion, which may be partly related to its anti-inflammatory action. Therefore, the effects of rosiglitazone on renal inflammation and renal injury were investigated in streptozotocin (STZ)-induced diabetic rats in this study. We examined the urinary excretion rates of ALB, retinal-binding protein (RBP), and MCP-1 of normal control group (Group C, n=8), STZ-induced diabetes mellitus group (Group D, n=8), and diabetes plus rosiglitazone (5 mg x kg-1 x day-1) treatment group (Group R, n=8) at the eighth week. The renal tissues of diabetic rats were obtained for reverse transcriptase-polymerase chain reaction to examine the expression of MCP-1 mRNA. Our results showed that compared to normal control, urinary excretion rates of ALB, RBP, and MCP-1 were significantly increased in untreated diabetic rats at the eighth week. However, rosiglitazone treatment could markedly decrease all the parameters above. In addition, urinary excretion rate of MCP-1 showed positive correlations with urinary ALB excretion, urinary RBP excretion, and kidney/body weight. The expressions of MCP-1 mRNA in renal tissues were markedly up-regulated in untreated diabetic rats, and these could be notably reduced by rosiglitazone treatment. In conclusion, rosiglitazone may have a potential therapeutic target in DN, which may be partly attributed to lowering of the expression of MCP-1 in the local kidney and the urinary excretion of MCP-1.

[Effect of spironolactone on left ventricular remodeling in patients with acute myocardial infarction].

OBJECTIVE: To investigate the effect of spironolactone on left ventricular remodeling (LVRM) in patients with acute myocardial infarction. METHODS: In this multicentric, randomized, controlled study, spironolactone 40 mg/d was randomly administered in addition to the routine treatment for patients with AMI. During the 6 months the serum PIIINP, BNP and echocardiography were examined in all patients to assess myocardial fibrosis, LV function and volume. RESULTS: A total of 88 AMI patients entered the study came from 4 hospitals in Shijiazhuang. There were 43 patients with anterior MI and 45 with inferior MI. In anterior MI group 23 patients received spironolactone and 20 accepted the routine treatment. In inferior MI group 23 received spironolactone and 22 accepted the routine treatment. In anterior MI group: (1) At 3rd, 6th month PIIINP and BNP serum levels were significantly lower in the spironolactone group compared with those in control group [PIIINP (260.2 +/- 59.9) vs (328.0 +/- 70.3) ng/L, P = 0.001, (197.1 +/- 46.3) vs (266.7 +/- 52.4) ng/L, P < 0.001], [BNP (347.4 +/- 84.0) vs (430.1 +/- 62.9) ng/L, P < 0.001, (243.7 +/- 79.7) vs (334.6 +/- 62.8) ng/L, P < 0.001]; (2) There were smaller LVEDD and LVESD in spironolactone group compared with those in control group after 6 months intervention [(51.0 +/- 5.5) vs (55.6 +/- 4.5) mm, P = 0.005, (35.7 +/- 4.6) vs (39.1 +/- 5.6) mm, P = 0.046]. However, in inferior MI group: (1) There were no significant differences in PIIINP and BNP values between the two groups after 6 months intervention; (2) There were no significant differences in the LVEDD, LVESD, LVEF after 6 months treatment. CONCLUSION: (1) In patients with anterior MI, spironolactone combined with the routine treatment could inhibit myocardial fibrosis and left ventricular dilation and prevent LVRM. (2) In patients with inferior MI, no significant difference in prevention of LVRM was found between the spironolactone combined with the routine treatment and the routine treatment alone.