Hyperglycemia-Induced Complete Left-Sided Hemiballismus Due to Uncontrolled Diabetes in a 70-Year-Old Female: A Case Report.

This report details the presentation of a 72-year-old female with left-sided continuous non-rhythmic involuntary movements persisting for two months. The movements affected the left side of her face, arm, and leg. The patient had a history of multiple hyperglycemic episodes and diabetic ketoacidosis. This report investigates the basal ganglia's involvement in hemiballismus, a movement disorder possibly linked to the patient's hyperglycemia. It discusses the complex management of hyperglycemia-induced hemiballismus and the need for more research to understand the underlying mechanism and optimal treatment strategies.

Severe Acute Pancreatitis Rapidly Developed Into Pulmonary Edema and Diffuse Alveolar Hemorrhage Leading to Respiratory Failure: An Autopsy Case.

Acute pancreatitis often results in life-threatening situations, making a prompt and accurate diagnosis cardinally important. To achieve these, it is crucial to correctly identify characteristic symptoms and test findings. However, when patients do not exhibit distinctive symptoms during a physician's examination, in addition to limited resources, these can become challenging. In this manuscript, we present an instructive case. A male in his twenties, who complained of generalized malaise, was admitted to our hospital. Unfortunately, however, he passed away within two days prior to undergoing detailed examinations or receiving therapeutic interventions. We performed an autopsy in order to ascertain the reasons for this outcome. The findings revealed that pulmonary edema and diffuse alveolar hemorrhage were the causative factors of his demise, with acute pancreatitis observed in the background. The occurrence of acute pancreatitis leading to death in youths is infrequent. Where could we have intervened to halt such an unfortunate course in a young individual? This patient probably had diabetic ketoacidosis and hyperlipidemia, both of which are known to be closely associated with acute pancreatitis. In retrospect, we should have noticed this point. In this case, the condition progressed too rapidly for appropriate therapeutic interventions. We believe that this case would provide educational instruction for similar situations that could arise in the future.

Medication Adherence in Elderly Diabetic Patients: A Cross-Sectional Study From Dakshina Kannada, India.

Diabetes Mellitus (DM) has emerged as a major global healthcare problem. The risk of diabetes can be reduced by maintaining blood glycaemic levels, which can be achieved by stringent adherence to the treatment regime. Therefore, there is a continuing need to assess the level of adherence to medication/self-care activities and the factors that are related to non-adherence to medication and self-care. This would facilitate healthcare professionals to identify subjects with low medication adherence and thereby aid them in planning interventions to improve medication and self-care adherence. In this study, we aimed to estimate the proportion of medication adherence among diabetic patients above 60 years of age attending a tertiary care hospital in Southern India. We found that 72% of type 2 diabetes patients were adherent to the medications prescribed to them and there was a discernible effect of gender and literacy on medication adherence. However, more such regional studies need to be conducted with a larger sample size from diverse hospital setups to obtain a clear and unbiased picture of the drug adherence scenario in India.

The retrospective study of the metabolic patterns of BCG-vaccination in type-2 diabetic individuals in COVID-19 infection.

Background: The cross-protective nature of Bacillus Calmette-Guerin (BCG) vaccine against SARS-CoV-2 virus was previously suggested, however its effect in COVID-19 patients with type 2 diabetes (T2D) and the underlying metabolic pathways has not been addressed. This study aims to investigate the difference in the metabolomic patterns of type 2 diabetic patients with BCG vaccination showing different severity levels of COVID-19 infection. Methods: Sixty-seven COVID-19 patients were categorized into diabetic and non-diabetic individuals who had been previously vaccinated or not with BCG vaccination. Targeted metabolomics were performed from serum samples from all patients using tandem mass spectrometry. Statistical analysis included multivariate and univariate models. Results: Data suggested that while BCG vaccination may provide protection for individuals who do not have diabetes, it appears to be linked to more severe COVID-19 symptoms in T2D patients (p = 0.02). Comparing the metabolic signature of BCG vaccinated T2D individuals to non-vaccinated counterparts revealed that amino acid (sarcosine), cholesterol esters (CE 20:0, 20:1, 22:2), carboxylic acid (Aconitic acid) were enriched in BCG vaccinated T2D patients, whereas spermidine, glycosylceramides (Hex3Cer(d18:1_22:0), Hex2Cer(d18:1/22:0), HexCer(d18:1/26:1), Hex2Cer(d18:1/24:0), HexCer(d18:1/22:0) were higher in BCG vaccinated non- T2D patients. Furthermore, data indicated a decrease in sarcosine synthesis from glycine and choline and increase in spermidine synthesis in the BCG vaccinated cohort in T2D and non-T2D groups, respectively. Conclusion: This pilot study suggests increased severity of COVID-19 in BCG vaccinated T2D patients, which was marked by decreased sarcosine synthesis, perhaps via lower sarcosine-mediated removal of viral antigens.

A Comprehensive Literature Review of Fournier's Gangrene in Females.

Fournier gangrene (FG) is a rare but rapidly progressing disease with a higher mortality rate in women as compared to men. This study aims to perform a literature review about FG in females and associated mortality and morbidity. We searched databases including MEDLINE (Ovid), the National Library of Medicine (Medical Subject Headings (MeSH)), the Cochrane Database of Systematic Reviews (Wiley), as well as Embase (Ovid), Scopus, and Global Index Medicus (WHO), and reviewed literature from 2002 to 2022 and selected 22 studies that met our study's inclusion criteria, which included 134 female patients with a mean age of 55±6 years. The perineal abscess was a more common nidus (n=41, 35%; 95%CI 23-39%) than vulvar pathology (n=29, 22%; 95%CI 15-30%). The most common initial presentation was cellulitis (n=62, 46%; 95%CI 38-55%), followed by perineal pain (n=54, 40%; 95%CI 32-50%), fever (n=47, 35%; 95%CI 27-43%), and septic shock (n=38, 28%; 95%CI 21-37%). Escherichia coli was the most frequently identified bacteria (n=48, 36%; 95%CI 28-46%). All patients had treatment with a mean of three (SD 2) debridement and those with negative pressure dressings received fewer debridements than those who received a conventional dressing. However, of those who had surgical intervention, 28 (20%; 95%CI 14-29%) patients underwent diversion colostomy. General surgeons performed 78% (n=104) of cases out of which 20% (n=20) were consulted by obstetrician-gynecologists, 14% (n=18) were treated by urologists, and only 8% (n=10) by plastic surgeons. The mean length of stay in the hospital was 24±11 days, and the gross mortality rate was 27 (20%; 95%CI 14-28%). In conclusion, while females have a low incidence rate of FG, they carry a higher mortality rate. Lack of cardinal signs and delayed presentation to the hospital from the onset of symptoms are some possible causes for the increased mortality rate along with the disease process being under-recognized in women. A high index of clinical suspicion is essential to avoid delay in the definitive management coupled with an early surgical consult and establishing a common general care pathway could minimize mortality and morbidity.

Cerebral endothelial cell derived small extracellular vesicles improve cognitive function in aged diabetic rats.

Small extracellular vesicles (sEVs) mediate cell-cell communication by transferring their cargo biological materials into recipient cells. Diabetes mellitus (DM) induces cerebral vascular dysfunction and neurogenesis impairment, which are associated with cognitive decline and an increased risk of developing dementia. Whether the sEVs are involved in DM-induced cerebral vascular disease, is unknown. Therefore, we studied sEVs derived from cerebral endothelial cells (CEC-sEVs) of aged DM rats (DM-CEC-sEVs) and found that DM-CEC-sEVs robustly inhibited neural stem cell (NSC) generation of new neuroblasts and damaged cerebral endothelial function. Treatment of aged DM-rats with CEC-sEVs derived from adult healthy normal rats (N-CEC-sEVs) ameliorated cognitive deficits and improved cerebral vascular function and enhanced neurogenesis. Intravenously administered N-CEC-sEVs crossed the blood brain barrier and were internalized by neural stem cells in the neurogenic region, which were associated with augmentation of miR-1 and -146a and reduction of myeloid differentiation primary response gene 88 and thrombospondin 1 proteins. In addition, uptake of N-CEC-sEVs by the recipient cells was mediated by clathrin and caveolin dependent endocytosis signaling pathways. The present study provides ex vivo and in vivo evidence that DM-CEC-sEVs induce cerebral vascular dysfunction and neurogenesis impairment and that N-CEC-sEVs have a therapeutic effect on improvement of cognitive function by ameliorating dysfunction of cerebral vessels and increasing neurogenesis in aged DM rats, respectively.

Association Between Insulin-like Growth Factor-1 rs35767 Polymorphism and Type 2 Diabetes Mellitus Susceptibility: A Meta-Analysis.

Background: Insulin-like growth factor-1 (IGF-1) has been demonstrated to increase fatty acid ß oxidation during fasting, and play an important role in regulating lipid metabolism and type 2 diabetes mellitus (T2DM). The rs35767 (T > C) polymorphism, a functional SNP was found in IGF-1 promoter, which may directly affect IGF-1 expression. However, the inconsistent findings showed on the IGF-1 rs35767 polymorphism and T2DM risk. Methods: We performed a comprehensive meta-analysis to estimate the association between the IGF-1 rs35767 and T2DM risk among four genetic models (the allele, additive, recessive and dominant models). Results: A total 49,587 T2DM cases and 97,906 NDM controls were included in the allele model, a total 2256 T2DM cases and 2228 NDM controls were included in the other three genetic models (the additive; recessive and dominant models). In overall analysis, the IGF-1 rs35767 was shown to be significantly associated with increased T2DM risk for the allele model (T vs. C: OR = 1.251, 95% CI: 1.082-1.447, p = 0.002), additive model (homozygote comparisons: TT vs. CC: OR = 2.433, 95% CI: 1.095-5.405, p = 0.029; heterozygote comparisons: TC vs. CC: OR = 1.623, 95% CI: 1.055-2.495, p = 0.027) and dominant model (TT + CT vs. CC: OR = 1.934, 95% CI: 1.148-3.257, p = 0.013) with random effects model. After omitting Gouda's study could reduce the heterogeneity, especially in the recessive model (TT vs. CC + CT: I2 = 38.7%, p = 0.163), the fixed effects model for recessive effect of the T allele (TT vs. CC + CT) produce results that were of borderline statistical significance (OR = 1.206, 95% CI: 1.004-1.448, p = 0.045). And increasing the risk of T2DM in Uyghur population of subgroup for the allele model. Conclusion: The initial analyses that included all studies showed statistically significant associations between the rs35767 SNP and type 2 diabetes, but after removing the Gouda et al. study produced results that were mostly not statistically significant. Therefore, there is not enough evidence from the results of the meta-analysis to indicate that the rs35767 SNP has a statistically significant association with type 2 diabetes.

GlucoSTRESS - Projeto de otimização do controle glicêmico em uma unidade de cuidados intensivos portuguesa nível C (III) / GlucoSTRESS - A project to optimize glycemic control in a level C (III) Portuguese intensive care unit

RESUMO Objetivo: Duplicar a percentagem de tempo no intervalo glicêmico 100 - 180mg/dL nos primeiros 3 meses após implementação faseada de um programa de educação formal e, posteriormente, de um protocolo de insulinoterapia, sem condicionar um aumento da frequência de hipoglicemia. Métodos: Foi feita a avaliação retrospetiva do controle glicêmico pré-intervenção. Foram realizados: implementação de um programa formal de educação; distribuição de algoritmos manuais de insulinoterapia endovenosa - otimizados pelos utilizadores, a partir do protocolo de Yale modificado - e formação informal da equipe de enfermagem. Foi dado apoio à utilização dos sistemas eletrônicos de controle glicêmico e do registo prospetivo dos resultados. Resultados: A primeira fase do programa (educação formal) melhorou o tempo no intervalo euglicêmico (28% para 37%). A segunda fase permitiu atingir 66% do tempo de euglicemia, com diminuição das hipoglicemias. A percentagem de doentes sob perfusão endovenosa de insulina às 48 horas de internamento aumentou (6% para 35%). Conclusão: A implementação faseada de um programa formal de educação que favoreceu a aplicação de protocolos de insulinoterapia eletrônicos e manuais dinâmicos demonstrou ter aderência e ser segura e eficaz no controle glicêmico no doente crítico, com diminuição concomitante das hipoglicemias.

ABSTRACT Objective: To double the percentage of time within the 100 - 180mg/dL blood glucose range in the first three months following a phased implementation of a formal education program, and then, of an insulin therapy protocol, without entailing an increased incidence of hypoglycemia. Methods: The pre-intervention glycemic control was assessed retrospectively. Next, were carried out the implementation of a formal education program, distribution of manual algorithms for intravenous insulin therapy - optimized by the users, based on the modified Yale protocol - and informal training of the nursing staff. The use of electronic blood glucose control systems was supported, and the results were recorded prospectively. Results: The first phase of the program (formal education) lead to improvement of the time within the euglycemic interval (28% to 37%). In the second phase, euglycemia was achieved 66% of the time, and the incidence of hypoglycemia was decreased. The percentage of patients on intravenous insulin infusion at 48 hours from admission increased from 6% to 35%. Conclusion: The phased implementation of a formal education program, fostering the use of electronic insulin therapy protocols and dynamic manuals, received good adherence and has shown to be safe and effective for blood glucose control in critically ill patients, with a concomitant decrease in hypoglycemia.

Estresse Percebido e Autocuidado entre Pessoas com Diabetes e Doenças Cardiovasculares / Perceived Stress and Self-care Among Diabetes Patients with Cardiovascular Diseases

O Diabetes Mellitus tipo 2 (DM2) corresponde de 90 a 95% de todos os casos e apresenta etiologia multifatorial, envolvendo herança genética e fatores ambientais como: alimentação, sedentarismo, obesidade e idade avançada. Portadores de DM2 necessitam de cuidados específicos, autocuidado contínuo e controle do estresse percebido. Busca-se identificar o estresse percebido e o autocuidado de pacientes, quanto às variáveis sociodemográficas, clínicas e hábitos de vida, associar as variáveis de interesse com atividades de autocuidado. Realizou-se estudo transversal, prospectivo, quantitativo, para conhecer o estresse percebido e autocuidado de portadores DM2, internados em um Hospital Cardiovascular de São José do Rio Preto/SP, por meio de dois questionários e uma escala. Verificou-se que a maioria dos pacientes era idosa, cardiopata, hipertensa, não praticava atividade física, não seguia dieta, entre outros aspectos. O nível de estresse percebido representou escore médio de 26,4 pontos, ou seja, menos da metade do valor total, sugerindo uma baixa percepção de estresse na amostra. Em relação ao domínio do autocuidado, identificou-se que, em geral, era baixo, pois os pacientes não realizavam o autocuidado em, pelo menos, seis dias da semana. Os únicos domínios realizados foram: alimentação específica em média 5,2 dias da semana e uso de medicação em média 4,7 dias da semana. Conclui-se que o presente estudo oferece informações para planejamento do tratamento de portadores de DM2, obtenção do melhor controle glicêmico, sugerindo intervenções educativas ou metodologias e promovendo melhora da adesão aos comportamentos de autocuidado e redução do estresse que influenciam os resultados em saúde desses pacientes.

Type 2 Diabetes Mellitus (DM2) corresponds to 90-95% of all cases of DM and has a multifactorial etiology, involving genetic inheritance and environmental factors such as: diet, physical inactivity, obesity, and advanced age. People with DM2 need specific care, continuous self-care, and control of perceived stress. This study aimed to identify the perceived stress and self-care activities of patients associated with socio-demographic, clinical, and lifestyle variables. This cross-sectional, prospective, quantitative study was conducted to understand the perceived stress and self-care of DM2 patients, admitted to a Cardiovascular Hospital in São José do Rio Preto, SP, using two questionnaires and a scale. It was found that most patients were elderly, cardiopathic, hypertensive, did not practice physical activity, did not follow a diet, among other aspects. The perceived stress level represented an average score of 26.4 points, that is, less than half of the total value, suggesting a low perception of stress in the sample. Regarding the self-care domain, it was generally found to be low, as patients did not perform self-care activities on at least six days a week. The only domains performed were specific diet on average 5.2 days a week and medication use on average 4.7 days a week. It is concluded that the present study offers information for planning the treatment of patients with DM2, obtaining the best glycemic control, suggesting educational interventions or methodologies, and promoting improved adherence to self-care activities and reducing stress that influence the health outcomes of these patients.

Efectos de la depresión y la diabetes en el riesgo de mortalidad de adultos mayores mexicanos / Effects of depression and diabetes on the mortality risk of Mexican older adults / Efeitos da depressão e do diabetes no risco de mortalidade de idosos mexicanos / Effets de la dépression et du diabète sur le risque de mortalité des personnes âgées au Mexique

Resumen Objetivo Estimar los efectos de los síntomas depresivos no diagnosticados y la diabetes mellitus en la mortalidad general de hombres y mujeres adultos mayores. Material y métodos Se utilizó una muestra de personas de 60 y más años del Estudio Nacional de Salud y Envejecimiento en México 2001-2015. Los síntomas depresivos se determinaron con una versión validada de la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D), y la diabetes por autorreporte. La mortalidad se estimó con modelos de riesgos proporcionales de Cox por sexo. Resultados Se estimó un gradiente en el riesgo de mortalidad entre hombres y mujeres adultos mayores: el riesgo más bajo fue para quienes solo tenían síntomas depresivos, seguido por quienes solo padecían diabetes mellitus. Así, el mayor riesgo de muerte se estimó para los individuos con diabetes y síntomas depresivos no diagnosticados. Conclusiones Los síntomas depresivos no detectados incrementan la mortalidad entre hombres y mujeres adultos mayores con diabetes mellitus, e incluso entre los no diabéticos. Se sugiere el desarrollo de programas de detección y tratamiento de la depresión en adultos mayores diabéticos.

Abstract Objective To estímate the effects of undiagnosed depressive symptoms and diabetes on the all-cause mortality of elderly men and women. Methods and materials A sample of people aged 60 and over was used from the Mexican Health and Aging Study 2001-2015. Depressive symptoms were determined with a validated version among older Mexican adults of the Center for Epidemiologic Studies Depression Scale, and diabetes by self-report. Mortality was estimated with Cox proportional hazards models by sex. Results A gradient in mortality risk was estimated between older men and women: the lowest risk was for those who only had depressive symptoms, followed by those who only had diabetes. Thus, the highest risk of death was estimated for individuals with diabetes and undiagnosed depressive symptoms. Conclusion Undiagnosed depressive symptoms increase mortality among older men and women with diabetes, and even among non- diabetics. It is suggested the development of early detection and treatment programs for depression in diabetic elderly people.

Resumo Objetivo Estimar os efeitos de sintomas depressivos não diagnosticados e diabetes mellitus na mortalidade geral de homens e mulheres idosos. Material e métodos Uma amostra de pessoas com 60 anos ou mais de idade foi usada no Estudo Nacional de Saúde e Envelhecimento 2001-2015 no México. Os sintomas depressivos foram determinados com uma versão validada da Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D) e o diabetes por autorrelato. A mortalidade foi estimada usando modelos de riscos proporcionais de Cox por sexo. Resultados Um gradiente no risco de mortalidade foi estimado entre homens e mulheres mais velhas: o menor risco foi para aqueles que apresentaram apenas sintomas depressivos, seguidos por aqueles que tiveram apenas diabetes mellitus. Assim, o maior risco de morte foi estimado para individuos com diabetes e sintomas depressivos não diagnosticados. Conclusões Os sintomas depressivos não detectados aumentam a mortalidade entre homens e mulheres idosas com diabetes mellitus e mesmo entre não diabéticos. É sugerido o desenvolvimento de programas de detecção e tratamento da depressão em idosos diabéticos.

Résumé Objectif Estimer les effets individuels et conjoints de la dépression et du diabète sur le risque global de mortalité des hommes et des femmes âgés. Matériel et méthodes Un échantillon de personnes âgées de 60 ans et plus provenant de l'Étude Nationale sur la Santé et le Vieillissement au Mexique 2001-2015 a été utilisé. La dépression a été déterminée á l'aide d'une version validée de l'Échelle de Dépression du Centre d'Études Épidémiologiques (CES-D), et le diabète avec un rapport d'autoévaluation. La mortalité a été estimée avec les modèles de risques proportionnels de Cox par sexe. Résultats Un gradient dans le risque de mortalité a été estimé entre les hommes et les femmes âgés : le risque le plus faible a été pour les personnes souffrant uniquement de dépression, et ensuite pour celles souffrant uniquement de diabète. C'est ainsi que le risque de décès le plus élevé a été estimé pour les personnes souffrant á la fois de diabète et de dépression. Conclusions La dépression augmente le risque de décès chez les hommes et les femmes âgés atteints de diabète, et même chez ceux qui ne le sont pas. Il est suggéré de développer des programmes de dépistage et de traitement de la dépression chez les personnes âgées atteintes de diabète.

Corneal endothelial cell density during diabetes mellitus and ocular diabetes complications treatment.

Diabetes mellitus may affect the cornea at various levels. Ocular surface changes and dry eye had been studied. Researchers are concerned that medical treatment of diabetes or retinal complications may result in endothelial damage and cell loss. This report summarizes the possibility of endothelial cell loss in diabetic patients. A decrease in endothelial cell density (ECD) in diabetic patients has been reported. In addition, corneal thickness may increase in diabetic patients. Significant endothelial cell loss has been demonstrated in long-term disease and in cases of poor metabolic control. No association between the use of oral hypoglycemics and ECD has been reported. There is also no evidence of an association between the use of insulin and corneal endothelial damage. No difference in ECD among the various degrees of retinopathy or with a history of photocoagulation has been shown. Regarding the studies comparing diabetic and non-diabetic patients undergoing cataract surgery, in all cases, the decrease in ECD is higher in diabetic patients than that seen in non-diabetic patients. However, there is no evidence of increased endothelial damage in diabetics compared to non-diabetics during vitreo-retinal surgery in phakic eyes. No significant changes in corneal endothelium after intravitreal anti-VEGF injections have been referenced.

Obesity Connected Metabolic Changes in Type 2 Diabetic Patients Treated With Metformin.

Metformin is widely used in the treatment of Type 2 Diabetes Mellitus (T2DM). However, it is known to have beneficial effects in many other conditions, including obesity and cancer. In this study, we aimed to investigate the metabolic effect of metformin in T2DM and its impact on obesity. A mass spectrometry (MS)-based metabolomics approach was used to analyze samples from two cohorts, including healthy lean and obese control, and lean as well as obese T2DM patients on metformin regimen in the last 6 months. The results show a clear group separation and sample clustering between the study groups due to both T2DM and metformin administration. Seventy-one metabolites were dysregulated in diabetic obese patients (30 up-regulated and 41 down-regulated), and their levels were unchanged with metformin administration. However, 30 metabolites were dysregulated (21 were up-regulated and 9 were down-regulated) and then restored to obese control levels by metformin administration in obese diabetic patients. Furthermore, in obese diabetic patients, the level of 10 metabolites was dysregulated only after metformin administration. Most of these dysregulated metabolites were dipeptides, aliphatic amino acids, nucleic acid derivatives, and urea cycle components. The metabolic pattern of 62 metabolites was persistent, and their levels were affected by neither T2DM nor metformin in obesity. Interestingly, 9 metabolites were significantly dysregulated between lean and obese cohorts due to T2DM and metformin regardless of the obesity status. These include arginine, citrulline, guanidoacetic acid, proline, alanine, taurine, 5-hydroxyindoleacetic acid, and 5-hydroxymethyluracil. Understanding the metabolic alterations taking place upon metformin treatment would shed light on possible molecular targets of metformin, especially in conditions like T2DM and obesity.

Factores que influyen en el comportamiento de adherencia del paciente con Diabetes Mellitus Tipo 2 / Factors influencing adherence behavior of patients with Type 2 Diabetes Mellitus / Fatores influenciadores do comportamento de adesao do doente com Diabetes Mellitus Tipo 2 / Les facteurs influençant le comportement d'adhérence des patients atteints de diabète de type 2

Resumen: Objetivo: Analizar los factores que influyen en el comportamiento de Adherencia al tratamiento del paciente con Diabetes Mellitus tipo 2, en la Unidad de Especialidades de Enfermedades Crónicas en Villahermosa, en un periodo de 6 meses en el año 2018. Materiales y métodos: Se realizó un estudio de tipo cuantitativo, observacional, corte transversal y prospectivo, muestra de 106 pacientes con Diabetes Mellitus tipo 2 en la Unidad de Especialidades de Enfermedades Crónicas (UNEMEs Ec), en Villahermosa Tabasco. Resultados: Predomina el género femenino con 68 %; el rango de edad es de 51 a 55 años con 19.8 %. En cuanto al nivel de escolaridad 70.8% con primaria y 66 % se dedican a las labores del hogar. En cuanto a los factores que influyen en el comportamiento de adherencia, 88 % lo están con el paciente y 77% con el proveedor; 56 % coinciden en que el factor socioeconómico a veces influye y 49 % refieren que los relacionados con la terapia nunca influyen. En cuanto al comportamiento de adherencia, 47 % refieren tener ventaja para adherencia, 41 % en riesgo de no desarrollar comportamientos de adherencia y el nivel de conocimientos de los pacientes, fue intermedio en 49.1 %. Conclusiones: La población estudiada tiene riesgo de no desarrollar comportamientos de adherencia y cuentan con un nivel de conocimientos intermedio, lo cual implica la necesidad de valorar la intervención psicológica, así como el proceso de enseñanza del paciente, para impactar y/o reorientarlos hacia una mayor adherencia como elemento importante en su beneficio.

Summary: Objective: Analyze the factors that influence the behavior of Adherence to the treatment of the patient with Diabetes Mellitus type 2, in the Unit of Specialties of Chronic Diseases in Villahermosa, over a period of 6 months in 2018. Materials and methods: A quantitative, observational, cross-sectional and prospective study was carried out, with a sample of 106 patients with Diabetes Mellitus type 2 in the Unit of Specialties of Chronic Diseases (UNEMEs Ec), in Villahermosa Tabasco. Results: The female gender predominates with 68%; the age range is 51 to 55 years with 19.8%. Regarding the level of schooling, 70.8% have primary education and 66% are dedicated to housework. Regarding the factors that influence the adherence behavior, 88% are with the patient and 77% with the provider; 56% agree that the socioeconomic factor sometimes influences and 49% report that those related to therapy never influence. Regarding the adherence behavior, 47% reported having an advantage for adherence, 41% at risk of not developing adherence behaviors and the level of knowledge of the patients, was intermediate in 49.1%. Conclusions: The population studied has risk of not developing adherence behaviors and have an intermediate level of knowledge, which implies the need to assess the psychological intervention, as well as the patient's teaching process, to impact and / or reorient them towards greater adherence as an important element in their benefit.

Resumo: Objetivo: Analisar os fatores que influenciam o comportamento de adesão ao tratamento de doentes com Diabetes Mellitus Tipo 2, na Unidade de Cuidados de Especialidades Doenças Crónicas em Villahermosa, durante um período de 6 meses em 2018. Materiais e Métodos: Realizou-se um estudo quantitativo, de observado, de coorte transversal e prospetivo, amostra de 106 doentes com Diabetes Mellitus tipo 2 na Unidade de Cuidados de Especialidades de doenças crónicas (UNEMES Ec), em Villahermosa. Resultados: 68% da amostra é do sexo feminino, as idades são compreendidas entre 51 e 55 anos (19,8%). 70,8% da amostra apresenta como grau de escolaridade o ensino básico e 66% são trabalhadoras domésticas. Em relação aos fatores que influenciam o comportamento de adesão, 88% estão relacionados com o doente e 77% relacionados com o provedor de cuidados, 56% concordam que os fatores socioeconómicos influenciam por vezes essa adesão e 49% referem que os relacionados com a terapêutica não influenciam. Em relação à adesão, 47% relataram as vantagens da adesão e 41% os riscos de não desenvolver comportamentos de adesão. O nível de conhecimento dos doentes foi considerado intermediário com 49,1%. Conclusões: La population étudiée est á risque de ne pas développer de comportement d'observance et posséde un niveau de connaissance intermédiaire, ce qui implique la nécessité d'évaluer l'intervention psychologique, ainsi que le processus d'enseignement du patient, de les influencer et / ou de les réorienter vers une plus grande adhésion en tant qu'élément important de leur bénéfice.

Résumé: Objectif: Analyser les facteurs qui influencent sur le comportement de l'adhérence au traitement du patient diabétique de type 2, dans l'unité des spécialités des maladies chroniques á Villahermosa, sur une période de 6 mois en 2018. Matériels et méthodes: Une étude quantitative, observationnelle, transversale et prospective a été réalisée. Avec un échantillon de 106 patients atteints de diabéte sucré de type 2 de l'Unité des spécialités de maladies chroniques (UNEMEs Ec) á Villahermosa Tabasco. Résultats: Le sexe féminin predomine avec 68%; la tranche d'áge est de 51 á 55 ans avec 19,8%. En ce qui concerne le niveau de scolarité, 70,8% ont suivi un enseignement primaire et 66% sont consacrés aux travaux ménagers. En ce qui concerne les facteurs qui influencent le comportement d'adhésion, 88% sont avec le patient et 77% avec le prestataire; 56% sont d'accord pour dire que le facteur socio-économique influence parfois et 49% affirment que ceux liés á la thérapie n'influencent jamais. En ce qui concerne le comportement d'adhérence, 47% ont déclaré avoir un avantage pour l'observance, 41% á risque de ne pas développer de comportements d'adhésion et le niveau de connaissance des patients était intermédiaire chez 49,1%. Conclusions: plus de la moitié de la population étudiée est á risque de ne pas développer de comportement d'observance et posséde un niveau de connaissance intermédiaire, ce qui implique la nécessité d'évaluer l'intervention psychologique, ainsi que le processus d'enseignement du patient, de les influencer et / ou de les réorienter vers une plus grande adhésion en tant qu'élément important de leur bénéfice.

RNA-Seq Revealed Novel Non-proliferative Retinopathy Specific Circulating MiRNAs in T2DM Patients.

Background: Diabetic retinopathy (DR) is a common diabetes complication and was considered as the major cause of blindness among young adults. MiRNAs are a group of small non-coding RNAs regulating the expression of target genes and have been reported to be associated with the development of DR in a variety of molecular mechanisms. In this study, we aimed to identify miRNAs that are differentially expressed (DE) in the serum of DR patients. Methods: We recruited 21 type 2 diabetes mellitus (T2DM) inpatients of Chinese Han ancestry, consisting of 10 non-proliferative DR patients (DR group) and 11 non-DR T2DM patients (NDR group). MiRNA was extracted from fasting peripheral serum and quantified by RNA-seq. The expression levels of miRNA were evaluated and compared between the two groups, with adjustments made for age differences. The validated target genes of miRNAs were subjected to a pathway analysis. We also constructed a weighted polygenic risk score using the DE miRNA and evaluated its predictive power. Results: Five miRNAs were DE between DR and NDR groups (p-Value ≤ 0.01, LFC ≥ 2 or LFC ≤-2). These included miR-4448, miR-338-3p, miR-190a-5p, miR-485-5p, and miR-9-5p. In total, these miRNAs were validated to regulate 55 target genes. Four target genes were found to overlap with the NAD metabolism, sirtuin, and aging pathway, which was thought to control the vascular growth and morphogenesis. The predictive power of our polygenic risk score was apparently high (AUC = 0.909). However, it needs to be interpreted with caution. Conclusion: In this study, we discovered novel DR-specific miRNAs in human serum samples. These circulating miRNAs may represent the pathological changes in the retina in response to diabetes and may serve as non-invasive biomarkers for early DR risk prediction.

[Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases]. / Ketogene Diät: evidenzbasierte therapeutische Anwendung bei endokrinologischen Erkrankungen.

Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases Abstract. Abstract: The ketogenic diet (KD) is a high-fat and very low-carb diet, which has been used primarily for treatment of therapy-resistant epilepsy in children. Implementation of the KD in other target populations is increasingly being discussed. This literature review provides first indications for a clinical benefit of the KD in diabetes mellitus type 2 (T2DM) and polycystic ovarian syndrome (PCOS). In many analysed studies, KD led to significant weight loss and had beneficial effects on lipoprotein profile and insulin resistance. In half of the comparative studies with T2DM, the KD lead to signifiantly greater reductions in HbA1c-levels (HbA1c difference: -0.5 to -1.5 %) compared to reference diets (HbA1c difference: +0.2 to -0.5 %). Nevertheless, study results are too heterogenic for a general recommendation of the KD in this patient population.

Type 2 Diabetes Mellitus (T2DM) "Remission" in Non-bariatric Patients 65 Years and Older.

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) "remission" in non-bariatric Medicare patients 65 years and older. Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in "remission" if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as "remission"). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM "remission." Results: 4.97% of patients studied met the definition of T2DM "remission" in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM "remission" that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05). Conclusion: T2DM "remission" in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.

Prevalence and severity of periodontal disease in type 2 diabetes mellitus patients: a cross-sectional study / Prevalência e severidade da doença periodontal em pacientes portadores de diabete mellitus tipo 2: um estudo transversal

This is a cross-sectional clinical study performed with type 2 diabetes mellitus patients and nondiabetic patients, in the city of Passo Fundo, RS, Brazil, which aimed to verify whether periodontal disease is more prevalent in type 2 diabetes mellitus (DM2) patients. The study sample included 275 patients, wherein 117 were type 2 diabetes patients and 158 were non-diabetic patients, who were assessed between the years of 2007 and 2010. The inclusion criteria of the study were patients older than 35 years with DM2 diagnosed for more than one year through glycemia and glycosylated hemoglobin tests. The same criteria was used for the control group, except for the presence of diabetes. The participants were evaluated by students calibrated for the Periodontal Screening and Recording (PSR) index and through a questionnaire assessing age, gender, oral hygiene conditions, and medications of the patients. Generalized gingivitis was more prevalent in diabetic patients (p<0.001). The level of oral hygiene of the diabetic patients was considered fair and poor (p<0.001) when compared to the non-diabetic patients. More sextants with periodontal health were observed in non-diabetic patients (p<00.1) when compared to type 2 diabetes mellitus patients; tooth loss was also greater in DM2 patients. The study allowed concluding that DM2 patients presented higher prevalence of periodontal disease than the control group. The factors that might have influenced these results were systemic condition (DM2), level of oral hygiene, and age, which justifies the high rate of periodontal disease and tooth loss in these individuals.

O presente estudo realizou um estudo clínico transversal em pacientes com diabete mellitus tipo 2 e não diabéticos na cidade de Passo Fundo/RS - Brasil, com o objetivo de verificar se a doença periodontal é mais prevalente nos pacientes com diabetes mellitus tipo 2 (DM2). A amostra do estudo foi composta por 275 pacientes, sendo 117 portadores de diabete tipo 2 e 158 pacientes sem diabete tipo 2, examinados no período de 2007-2010. Os critérios de inclusão neste estudo foram: pacientes com mais de 35 anos de idade e com DM2 diagnosticada há mais de 1 ano através de exames de glicemia e hemoglobina glicosilada. O mesmo critério foi utilizado para o grupo de controle, exceto a diabete. Os participantes foram avaliados por alunos calibrados para o índice Periodontal Screening and Recording (PSR) e através de um questionário avaliando a idade, gênero, condições de higiene bucal e medicamentos utilizados pelos pacientes. A gengivite generalizada foi observada com maior frequência nos portadores de diabete (p<0,001). O grau de higiene bucal dos diabéticos foi considerado regular e ruim (p<0,001) quando comparado ao dos pacientes não diabéticos. Observou-se mais sextantes com saúde periodontal nos pacientes sem diabete (p<00,1) quando comparados com os pacientes com diabete mellitus tipo 2 e também maior perda dentária nos pacientes com DM2. Conclui-se com o estudo que os pacientes com DM2 apresentaram maior prevalência da doença periodontal quando comparados ao grupo de controle. Os fatores que podem ter influenciado esses resultados foram a sua condição sistêmica (DM2), grau de higiene oral e idade dos mesmos, justificando o alto índice de doença periodontal e perda dentária nesses indivíduos.

Comportamiento de la diabetes mellitus en Costa Rica / Diabetes mellitus behavior in Costa Rica / Comportamento da diabetes mellitus na Costa Rica / Comportement du diabete mellitus au Costa Rica

Resumen Objetivo: Describir el comportamiento de la diabetes en Costa Rica. Materiales y métodos: La población estuvo conformada por casos incidentes de DM a nivel nacional, reportados y procesados en el departamento de Estadística del Ministerio de Salud para un total en el periodo del 2012 al 2015 de 35, 837 personas y las proyecciones de uso de la consulta externa, de la Caja Costarricense del Seguro Social (CCSS) en el periodo del 2012 al 2015, para un total de 1, 781, 164 consultas. Se llevó a cabo un estudio de tipo descriptivo retrospectivo y transversal. Las variables estudiadas fueron, sexo, edad, mortalidad, egreso hospitalario, morbilidad (uso del servicio consulta externa), incidencia. Los datos recolectados fueron anotados en una matriz de datos utilizando el paquete Excel. Resultados: Tanto la incidencia como la mortalidad por Diabetes Mellitus mostró un aumento para el periodo en estudio. Se evidencia que conforme aumenta la edad es mayor la cantidad de casos que se presentan. Según el sexo, hay una relación de 3 mujeres por un hombre con DM. Respecto de la demografía, la provincia de San José presenta un mayor número de egresos. Sin embargo, se debe tomar en cuenta que en San José se concentra la mayor cantidad de población y donde se concentra el mayor número de hospitales clase A (especializados), los cuales reciben traslados de otros hospitales regionales de acuerdo con la condición del paciente. Por su parte, la provincia de Puntarenas presenta un aumentado de los egresos en relación con otras provincias del país. Conclusiones: La incidencia, así como la mortalidad por DM en Costa Rica son variables que muestran un aumento para el periodo en estudio (2012 2015), catalogándose a esta enfermedad como una epidemia a nivel mundial, por lo que se considera un reto para los sistemas de salud debido a las complicaciones que presenta.

Abstract Objective: To describe the behavior of diabetes in Costa Rica. Materials and methods: The population was made up of incident cases of DM nationally reported and processed in the Department of Statistics of the Ministry of Health for a total in the period 2012 to 2015 of 35, 837 people and projections of use of The external consultation, of the Costa Rican Social Security (CCSS) in the period 2012 to 2015, for a total of 1, 781, 164 consultations. A retrospective and cross-sectional descriptive study was carried out. The variables studied were sex, age, mortality, hospital exit, morbidity (use of external consultation service) and incidence. The collected data were annotated in an array of data using the Excel package. Results: Both the incidence and mortality for Diabetes Mellitus showed an increase for the study period. It is evidenced that as the age increases, the number of cases presented increases. According to sex, there is a ratio of 3 women to a man with DM. Regarding demography, the province of San José presents a greater number of discharges. However, it should be taken into account that in San José the largest population is concentrated and where the largest number of class A (specialized) hospitals is concentrated, which receive transfers from other regional hospitals according to the patient's condition. On the other hand, the province of Puntarenas presents an increase in the equity in relation to other provinces of the country. Conclusions: The incidence, as well as mortality by DM in Costa Rica, are variables that show an increase for the study period (2012-2015), cataloging to this disease as an epidemic globally, reason why it is considered a challenge for Health systems due to the complications it presents.

Resumo Objetivo: Descrever o comportamento da diabetes na Costa Rica. Materiais e métodos: A população tem-se revelado conformada com os casos de DM a nivel nacional, reportados y processados pelo Departamento de Estatística do Ministério de Saúde perante um total de 35 837 pessoas entre 2012 e 2015 e as percebes do uso da consulta externa da "Caja Costarricense de Seguro Social" (CCSS) no periodo de 2012 a 2015, para un total de 1 781 164 consultas. Foi desenvolvido um estudo de tipo descritivo retrospetivo e transversal. As variáveis estudadas foram o sexo, a idade, a mortalidade, o ingresso no hospital, a morbilidade (uso do servio de consulta externa) e a incidencia. Os dados recolhidos foram anotados numa matriz de dados utilizando o programa Excel. Resultados: Tanto a incidencia como a mortalidade por Diabetes Mellitus revelou un aumento para o período en estudo. A medida que aumenta a idade aumenta o número de casos. Em termos de sexo, há uma relação de 3 mulheres para um homen com DM. A provincia de San José presenta un maior número de despesas. É em San José que se encontra o maior número de pessoas e onde se concentra o maior número de hospitais de classe A (especializados). Por outro lado, a provincia de Puntarenas apresenta um aumento de despesas quando comparada com as outras provincias do país. Conclusões: A incidencia, assim como a mortalidade por DM na Costa Rica sao variáveis que mostram um aumento no período estudado (2012-2015), sendo uma doença que está relacionada com uma epidemia a nivel mundial, sendo um desafio para os sistemas de saúde, devido as complicações que representa.

Résumé Objectif: Décrire le comportement du diabete au Costa Rica. Matériaux et méthodes: La population était composée des cas incidents de DM, déclarés au niveau national et analysés par le Département de Statistique du Ministere de la Santé durant la période 2012-2015 pour un total de 35,837 personnes, et de l'estimation de consultations externes de la Caisse de Sécurité Sociale du Costa Rica (CCSS) pour la meme période, avec un total de 1,781,164 consultations. Une étude descriptive, rétrospective et transversale a été menée en prenant en compte les variables sexe, age, mortalité, sortie de l'hopital, morbidité (utilisation des services de consultation externe) et incidence. Les données ont été saisies dans une matrice avec le package Excel. Résultats: L'incidence et la mortalité liées au diabete mellitus ont augmenté durant la période a l'étude. Il a été mis en évidence que la quantité de cas augmente avec l'age. La proportion est de 3 femmes pour un homme. En ce qui concerne la démographie, la province de San José a un plus grand nombre de sorties de l'hopital. Cependant, il faut prendre en compte que c'est la que se concentrent la plus grande partie de la population et le plus grand nombre d'hopitaux de classe A (de spécialité), lesquels re9oivent des transferts d'autres hopitaux régionaux quand l'état du patient le justifie. Les dépenses ont augmenté d'avantage dans la province de Puntarenas qu'autre part. Conclusions: L'incidence et la mortalité par DM au Costa Rica ont augmenté durant la période 2012-2015. Cette maladie, cataloguée comme une épidémie mondiale, représente un défi pour les systemes de santé en raison des complications associées.