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1.
Health Res Policy Syst ; 22(1): 57, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38741196

RESUMO

BACKGROUND: Indigenous populations have increased risk of developing diabetes and experience poorer treatment outcomes than the general population. The FORGE AHEAD program partnered with First Nations communities across Canada to improve access to resources by developing community-driven primary healthcare models. METHODS: This was an economic assessment of FORGE AHEAD using a payer perspective. Costs of diabetes management and complications during the 18-month intervention were compared to the costs prior to intervention implementation. Cost-effectiveness of the program assessed incremental differences in cost and number of resources utilization events (pre and post). Primary outcome was all-cause hospitalizations. Secondary outcomes were specialist visits, clinic visits and community resource use. Data were obtained from a diabetes registry and published literature. Costs are expressed in 2023 Can$. RESULTS: Study population was ~ 60.5 years old; 57.2% female; median duration of diabetes of 8 years; 87.5% residing in non-isolated communities; 75% residing in communities < 5000 members. Total cost of implementation was $1,221,413.60 and cost/person $27.89. There was increase in the number and cost of hospitalizations visits from 8/$68,765.85 (pre period) to 243/$2,735,612.37. Specialist visits, clinic visits and community resource use followed this trend. CONCLUSION: Considering the low cost of intervention and increased care access, FORGE AHEAD represents a successful community-driven partnership resulting in improved access to resources.


Assuntos
Análise Custo-Benefício , Diabetes Mellitus , Serviços de Saúde do Indígena , Hospitalização , Atenção Primária à Saúde , Humanos , Atenção Primária à Saúde/economia , Feminino , Masculino , Pessoa de Meia-Idade , Hospitalização/economia , Canadá , Serviços de Saúde do Indígena/economia , Diabetes Mellitus/terapia , Atenção à Saúde/economia , Idoso , Acessibilidade aos Serviços de Saúde , Custos de Cuidados de Saúde , Indígenas Norte-Americanos , Povos Indígenas , Adulto , Complicações do Diabetes/terapia , Complicações do Diabetes/economia
2.
Front Endocrinol (Lausanne) ; 15: 1343255, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38681772

RESUMO

Stem cell-based therapies exhibit considerable promise in the treatment of diabetes and its complications. Extensive research has been dedicated to elucidate the characteristics and potential applications of adipose-derived stromal/stem cells (ASCs). Three-dimensional (3D) culture, characterized by rapid advancements, holds promise for efficacious treatment of diabetes and its complications. Notably, 3D cultured ASCs manifest enhanced cellular properties and functions compared to traditional monolayer-culture. In this review, the factors influencing the biological functions of ASCs during culture are summarized. Additionally, the effects of 3D cultured techniques on cellular properties compared to two-dimensional culture is described. Furthermore, the therapeutic potential of 3D cultured ASCs in diabetes and its complications are discussed to provide insights for future research.


Assuntos
Tecido Adiposo , Diabetes Mellitus , Humanos , Tecido Adiposo/citologia , Diabetes Mellitus/terapia , Animais , Técnicas de Cultura de Células/métodos , Células-Tronco Mesenquimais/citologia , Complicações do Diabetes/terapia , Diferenciação Celular , Técnicas de Cultura de Células em Três Dimensões/métodos
3.
Prog Mol Biol Transl Sci ; 203: 287-300, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38360004

RESUMO

Diabetes is an ongoing global problem as it affects health of more than 537 million people around the world. Diabetes leaves many serious complications that affect patients and can cause death if not detected and treated promptly. Some of the complications of diabetes include impaired vascular system, increased risk of stroke, neurological diseases that cause pain and numbness, diseases related to the retina leading to blindness, and other complications affecting kidneys, heart failure, muscle weakness, muscle atrophy. All complications of diabetes seriously affect the health of patients. Recently, gene therapy has emerged as a viable treatment strategy for various diseases. DNA and RNA are among the target molecules that can change the structure and function of proteins and are effective methods of treating diseases, especially genetically inherited diseases. RNA therapeutics has attracted deep interest as it has been approved for application in the treatment of functional system disorders such as spinal muscular atrophy, and muscular dystrophy. In this review, we cover the types of RNA therapies considered for treatment of diabetes. In particular, we delve into the mechanism of action of RNA therapies for diabetes, and studies involving testing of these RNA therapies. Finally, we have highlighted the limitations of the current understanding in the mechanism of action of RNA therapies.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Atrofia Muscular Espinal , Humanos , RNA , Atrofia Muscular Espinal/genética , Terapia Genética/métodos , Complicações do Diabetes/terapia
4.
Adv Sci (Weinh) ; 11(13): e2307761, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38286650

RESUMO

Delayed wound healing is a major complication of diabetes, and is associated with impaired cellular functions. Current treatments are unsatisfactory. Based on the previous reports on microRNA expression in small extracellular vesicles (sEVs), miR-17-5p-engineered sEVs (sEVs17-OE) and encapsulated them in gelatin methacryloyl (GelMA) hydrogel for diabetic wounds treatment are fabricated. SEVs17-OE are successfully fabricated with a 16-fold increase in miR-17-5p expression. SEVs17-OE inhibited senescence and promoted the proliferation, migration, and tube formation of high glucose-induced human umbilical vein endothelial cells (HG-HUVECs). Additionally, sEVs17-OE also performs a promotive effect on high glucose-induced human dermal fibroblasts (HG-HDFs). Mechanism analysis showed the expressions of p21 and phosphatase and tensin homolog (PTEN), as the target genes of miR-17-5p, are downregulated significantly by sEVs17-OE. Accordingly, the downstream genes and pathways of p21 and PTEN, are activated. Next, sEVs17-OE are loaded in GelMA hydrogel to fabricate a novel bioactive wound dressing and to evaluate their effects on diabetic wound healing. Gel-sEVs17-OE effectively accelerated wound healing by promoting angiogenesis and collagen deposition. The cellular mechanism may be associated with local cell proliferation. Therefore, a novel bioactive wound dressing by loading sEVs17-OE in GelMA hydrogel, offering an option for chronic wound management is successfully fabricated.


Assuntos
Diabetes Mellitus , Vesículas Extracelulares , Gelatina , Metacrilatos , MicroRNAs , Cicatrização , Humanos , Diabetes Mellitus/genética , Diabetes Mellitus/metabolismo , Células Endoteliais , Vesículas Extracelulares/genética , Glucose , Hidrogéis , MicroRNAs/farmacologia , MicroRNAs/uso terapêutico , PTEN Fosfo-Hidrolase/antagonistas & inibidores , PTEN Fosfo-Hidrolase/genética , Cicatrização/genética , Complicações do Diabetes/terapia , Proteínas Proto-Oncogênicas p21(ras)/antagonistas & inibidores , Proteínas Proto-Oncogênicas p21(ras)/genética
5.
Diabet Med ; 41(5): e15255, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-37915229

RESUMO

AIM: People with coexisting severe mental illness (SMI) and type 2 diabetes have a shorter life expectancy and poorer diabetes outcomes than those without SMI. This is partly explained by the separate treatment of diabetes and SMI, which occurs in parallel silos in many healthcare systems. The Steno Diabetes Center Sjaelland and Region Zealand established the Fusion Clinic to offer combined psychiatric and diabetes care delivered by both diabetes and mental healthcare professionals. This study describes how the clinic was established and the initial diabetes outcomes. METHODS: The Fusion Clinic was co-designed by people with diabetes and SMI and healthcare professionals to improve the care of adults with diabetes and SMI. The clinic approach utilised the F-ACT model. The 63 people referred to the Fusion Clinic between 01.02.2020 and 01.01.2022 who attended the clinic for more than 6 months were included in this study. Diabetes outcomes were recorded in the electronic medical records (Sundhedsplatformen EPIC). RESULTS: There was a high prevalence of diabetes complications at baseline. Furthermore, 70% had one or more additional concomitant diseases, as well as SMI and diabetes. Assessment of diabetes complications and measurements of HbA1c and lipid profile improved after referral to the clinic. HbA1c declined during the first 6 months of attendance at the clinic. CONCLUSIONS: This model of service delivery has the potential to improve the quality of care for people with SMI and type 2 diabetes.


Assuntos
Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Transtornos Mentais , Adulto , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Atenção à Saúde , Instituições de Assistência Ambulatorial , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Complicações do Diabetes/complicações
6.
Medicine (Baltimore) ; 102(50): e36370, 2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-38115358

RESUMO

INTRODUCTION: A systematic review and meta-analysis were conducted to evaluate the efficacy and the overall safety of Faricimab compared with other anti-vascular endothelial growth factors (VEGF) therapy for neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME). MATERIALS AND METHODS: A systematic literature search of a comprehensive electronic database was performed to identify randomized clinical trials published from January 2013 to January 2023 for Faricimab in AMD and DME. Weighted mean differences and risk ratios were used to integrate the different studies. RESULTS: A total of 4 randomized controlled trials (RCTs) with 1678 AMD patients and 3 RCTs with 20 DME patients were included in the meta-analysis.In patients with AMD, a significant difference was found in the number of injections between Faricimab and other anti-VEGF therapy (MD = -2.42, 95% CI [-3.93 to -0.90], P = .002).No significant difference was found for the change in best corrected visual acuity (BVCA), central subfoveal thickness (CST), and gaining 15 or more letters. Similarly, no significant difference was found for adverse events.In patients with DME, a significant difference was observed for CST (MD = -22.41, 95% CI [-29.95 to -14.86], P < .00001) and the number of injections(MD = -0.93, 95% CI [-1.33 to -0.54], P < .00001). No significant difference was found for BVCA and gaining 15 or more letters, and no significant difference was found for adverse events. CONCLUSIONS: Comprehensive evidence confirms that Faricimab achieves non-inferior or even better CST improvement than other anti-VEGF therapies with extended dosing intervals, but more long-term follow-up studies are needed to support our conclusions.


Assuntos
Anticorpos Biespecíficos , Complicações do Diabetes , Degeneração Macular , Edema Macular , Fator A de Crescimento do Endotélio Vascular , Anticorpos Biespecíficos/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Edema Macular/etiologia , Edema Macular/terapia , Complicações do Diabetes/terapia , Resultado do Tratamento
7.
Tissue Cell ; 85: 102225, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37801960

RESUMO

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood glucose and is associated with high morbidity and mortality among the diabetic population. Uncontrolled chronic hyperglycaemia causes increased formation and accumulation of different oxidative and nitrosative stress markers, resulting in microvascular and macrovascular complications, which might seriously affect the quality of a patient's life. Conventional treatment strategies are confined to controlling blood glucose by regulating the insulin level and are not involved in attenuating the life-threatening complications of diabetes mellitus. Thus, there is an unmet need to develop a viable treatment strategy that could target the multi-etiological factors involved in the pathogenesis of diabetic complications. Stem cell therapy, a regenerative medicine approach, has been investigated in diabetic complications owing to their unique characteristic features of self-renewal, multilineage differentiation and regeneration potential. The present review is focused on potential therapeutic applications of stem cells in the treatment of microvascular diabetic complications such as nephropathy, retinopathy, and polyneuropathy.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Hiperglicemia , Humanos , Glicemia/metabolismo , Medicina Regenerativa , Complicações do Diabetes/terapia , Hiperglicemia/complicações , Hiperglicemia/terapia , Células-Tronco/metabolismo , Diabetes Mellitus/terapia
8.
Acta Pharmacol Sin ; 44(12): 2455-2468, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37596398

RESUMO

Renal tubulointerstitial fibrosis (TIF) is considered as the final convergent pathway of diabetic nephropathy (DN) without effective therapies currently. MiRNAs play a key role in fibrotic diseases and become promising therapeutic targets for kidney diseases, while miRNA clusters, formed by the cluster arrangement of miRNAs on chromosomes, can regulate diverse biological functions alone or synergistically. In this study, we developed clustered miR-23a/27a/26a-loaded skeletal muscle satellite cells-derived exosomes (Exos) engineered with RVG peptide, and investigated their therapeutic efficacy in a murine model of DN. Firstly, we showed that miR-23a-3p, miR-26a-5p and miR-27a-3p were markedly decreased in serum samples of DN patients using miRNA sequencing. Meanwhile, we confirmed that miR-23a-3p, miR-26a-5p and miR-27a-3p were primarily located in proximal renal tubules and highly negatively correlated with TIF in db/db mice at 20 weeks of age. We then engineered RVG-miR-23a/27a/26a cluster loaded Exos derived from muscle satellite cells, which not only enhanced the stability of miR-23a/27a/26a cluster, but also efficiently delivered more miR-23a/27a/26a cluster homing to the injured kidney. More importantly, administration of RVG-miR-23a/27a/26a-Exos (100 µg, i.v., once a week for 8 weeks) significantly ameliorated tubular injury and TIF in db/db mice at 20 weeks of age. We revealed that miR-23a/27a/26a-Exos enhanced antifibrotic effects by repressing miRNA cluster-targeting Lpp simultaneously, as well as miR-27a-3p-targeting Zbtb20 and miR-26a-5p-targeting Klhl42, respectively. Knockdown of Lpp by injection of AAV-Lpp-RNAi effectively ameliorated the progression of TIF in DN mice. Taken together, we established a novel kidney-targeting Exo-based delivery system by manipulating the miRNA-23a/27a/26a cluster to ameliorate TIF in DN, thus providing a promising therapeutic strategy for DN.


Assuntos
Nefropatias Diabéticas , Exossomos , MicroRNAs , Células Satélites de Músculo Esquelético , Animais , Humanos , Camundongos , Diabetes Mellitus/terapia , Nefropatias Diabéticas/genética , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/terapia , Exossomos/metabolismo , Fibrose , MicroRNAs/metabolismo , MicroRNAs/farmacologia , MicroRNAs/uso terapêutico , Células Satélites de Músculo Esquelético/metabolismo , Complicações do Diabetes/terapia
10.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 58(6): 615-620, 2023 Jun 09.
Artigo em Chinês | MEDLINE | ID: mdl-37272009

RESUMO

The number of diabetic patients visiting stomatology for periodontal disease is increasing, and the symptoms are relatively severe, and often complications increase the complexity of periodontal treatment. This article briefly describes the research progress and clinical manifestations of the epidemiology and related pathological mechanisms of periodontitis with diabetes, focusing on the treatment and providing reference for stomatologists in the clinical diagnosis and treatment of patients with diabetic periodontitis.


Assuntos
Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Doenças Periodontais , Periodontite , Humanos , Periodontite/complicações , Periodontite/diagnóstico , Periodontite/terapia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Assistência Odontológica , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Complicações do Diabetes/complicações
11.
Tissue Cell ; 81: 102014, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36621294

RESUMO

AIMS: Oxidative stress also plays an important role in the pathogenesis of diabetic neuropathy (DN). Both resveratrol (RES) and exercise (EX) have potent anti-oxidative benefits. Low levels of nerve growth factor (NGF) and SIRT1 (a member of sirtuin family) have been reported in patients with DN. The current study has been designed to investigate the role of serum NGF and SIRT1 on DN-induced hyperalgesia and motor incoordination and to evaluate the possible protective role of RES and/or EX. MAIN METHODS: A total of 40 male adult albino rats divided into five groups; control, DN, DN + RES, DN + EX, and DN + RES and EX. DN was confirmed by sensorimotor disturbance and diminished nerve conduction velocity (NCV). NGF and SIRT1 levels were measured by western blot. Calcitonin gene-related peptide (CGRP) was measured by PCR. Myofibrillar degeneration and inflammation scores were revealed via H&E microscopic analysis of the gastrocnemius muscle. Immunohistochemical evaluation of caspase3 and TNF-α was performed in the lumber segment of spinal cord and gastrocnemius muscle sections. Ultrastructural evaluation of sciatic nerve axonal degeneration has also been assessed. KEY FINDINGS: DN group showed decreased SIRT1 level, decreased NGF level and correlated with CGRP level and Na+/K+ ATPase. Treatment with RES and/or EX resulted in improvement of sensorimotor disturbance. DN characterized by reduced SOD level, whereas RES and/or EX could limit oxidative damage by up-regulation Bcl2, Akt and GAP-43 and down-regulation of caspase3 and TNF-α. In conclusion, increased level of SIRT1and NGF by incorporation of RES (natural supplementation) and EX (life style modification) could improve the neuroinflammatory state in DN.


Assuntos
Neuropatias Diabéticas , Exercício Físico , Doenças Musculares , Resveratrol , Masculino , Peptídeo Relacionado com Gene de Calcitonina , Neuropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/metabolismo , Neuropatias Diabéticas/terapia , Doenças Musculares/tratamento farmacológico , Doenças Musculares/terapia , Fator de Crescimento Neural/metabolismo , Resveratrol/farmacologia , Sirtuína 1/metabolismo , Fator de Necrose Tumoral alfa , Ratos , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/metabolismo , Complicações do Diabetes/terapia , Proteína GAP-43/metabolismo , Animais
12.
Cardiovasc Diabetol ; 22(1): 18, 2023 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-36717853

RESUMO

BACKGROUND: Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2). METHODS: From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009-2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4). RESULTS: Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5-6.2) years' follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51-0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56-0.70), 0.88 (0.82-0.94), 0.72 (0.62-0.84), and 0.80 (0.73-0.87), respectively, all p < 0.001. CONCLUSIONS: For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.


Assuntos
Fibrilação Atrial , Prestação Integrada de Cuidados de Saúde , Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Estudos de Coortes , Fatores de Risco , Prognóstico , Diabetes Mellitus Tipo 2/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Estilo de Vida Saudável , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia
13.
Diabetes Care ; 46(1): 149-155, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36399714

RESUMO

OBJECTIVE: To estimate medical costs associated with 17 diabetes complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 1 diabetes. RESEARCH DESIGN AND METHODS: With use of the 2006-2017 100% Medicare claims database for beneficiaries enrolled in fee-for-service plans and Part D, we estimated the annual cost of 17 diabetes complications and treatment procedures. Type 1 diabetes and its complications and procedures were identified using ICD-9/ICD-10, procedure, and diagnosis-related group codes. Individuals with type 1 diabetes were followed from the year when their diabetes was initially identified in Medicare (2006-2015) until death, discontinuing plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate costs in the complication occurrence year and subsequent years. The cost proportion of a complication was equal to the total cost of the complication, calculated by multiplying prevalence by the per-person cost divided by the total cost for all complications. All costs were standardized to 2017 U.S. dollars. RESULTS: Our study included 114,879 people with type 1 diabetes with lengths of follow-up from 3 to 10 years. The costliest complications per person were kidney failure treated by transplant ($77,809 in the occurrence year and $13,556 in subsequent years), kidney failure treated by dialysis ($56,469 and $41,429), and neuropathy treated by lower-extremity amputation ($40,698 and $7,380). Sixteen percent of the total medical cost for diabetes complications was for treating congestive heart failure. CONCLUSIONS: Costs of diabetes complications were large and varied by complications. Our results can assist in cost-effectiveness analysis of treatments and interventions for preventing or delaying diabetes complications in Medicare beneficiaries aged ≥65 years with type 1 diabetes.


Assuntos
Complicações do Diabetes , Diabetes Mellitus Tipo 1 , Idoso , Humanos , Estados Unidos/epidemiologia , Medicare , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Complicações do Diabetes/complicações , Estudos Retrospectivos
14.
Int Wound J ; 20(6): 2346-2359, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36564054

RESUMO

Diabetic chronic wounds cause massive levels of patient suffering and economic problems worldwide. The state of chronic inflammation arises in response to a complex combination of diabetes mellitus-related pathophysiologies. Advanced treatment options are available; however, many wounds still fail to heal, exacerbating morbidity and mortality. This review describes the chronic inflammation pathophysiologies in diabetic ulcers and treatment options that may help address this dysfunction either directly or indirectly. We suggest that treatments to reduce inflammation within these complex wounds may help trigger healing.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Pé Diabético , Dermatopatias , Humanos , Complicações do Diabetes/terapia , Inflamação/terapia , Cicatrização/fisiologia , Pé Diabético/terapia
15.
Gerokomos (Madr., Ed. impr.) ; 34(2): 150-153, 2023. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-221849

RESUMO

En la actualidad, el cuidado de las heridas que deben curar por segunda intención se realiza en ambiente húmedo y empleando la estrategia TIME, las personas que las padecen sufren una disminución de la calidad de vida. El objetivo de este trabajo es presentar un abordaje y tratamiento del borde epitelial con vitamina E acetato nebulizada. Se trata de un paciente de 74 años y con diabetes mellitus tipo 2, que presenta una herida en la cara anterior de la pierna izquierda. El principal diagnóstico de enfermería fue integridad tisular. Como principales resultados se han establecido la hidratación de los bordes perilesionales y la disminución del tamaño de la herida. Como conclusión, la vitamina E acetato ha permitido la conservación y mejora del estado del tejido perilesional y del nuevo formado, así como el ahorro de tiempos de exposición de la lesión al ambiente (AU)


At present, the care of wounds that must heal by secondary intention is carried out in a humid environment and using the TIME strategy, the people who suffer from them suffer a decrease in quality of life. The objective of this work is to present an approach and management of the epithelial border with nebulized vitamin E acetate. The case deals with a 74-year-old patient with type 2 diabetes mellitus who presented a wound on the front of his left leg. The main nursing diagnosis has been tissue integrity. As main results, the hydration of the peri-lesion edges and the reduction in the size of the wound have been established. In conclusion, vitamin E acetate has allowed the conservation and improvement of the state of the peri-injury tissue and of the newly formed tissue, as well as the saving of exposure times of the injury to the environment (AU)


Assuntos
Humanos , Masculino , Idoso , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2 , Acetatos/administração & dosagem , Vitamina E/administração & dosagem , Úlcera da Perna/terapia , Cuidados de Enfermagem , Resultado do Tratamento
17.
Biomed Pharmacother ; 151: 113165, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35609370

RESUMO

OBJECTIVE: To investigate the efficacy of a paeoniflorin-sodium alginate (SA)-gelatin skin scaffold for treating diabetic wound in a rat model. METHODS: Bioinks were prepared using various percentages of paeoniflorin in the total weight of a solution containing SA and gelatin. Skin scaffolds containing 0%, 1%, 3%, 5%, and 10% paeoniflorin were printed using 3D bioprinting technology, and scaffold microstructure was observed with scanning electron microscopy. Skin scaffolds were then used in rats with diabetic wounds. H&E staining, Masson staining, and immunohistochemical staining for IL-1ß and CD31 were performed on days 7 and 14. RESULTS: All skin scaffolds had a mesh-like structure with uniform pore distribution. Wounds healed well in each group, with the 1% and 3% groups demonstrating the most complete healing. H&E staining showed that skin accessory organs had appeared in each group. On day 7, collagen deposition in the 3% group was higher than in the other groups (P<0.05), and IL-1ß infiltration was lower in the 10% group than in the 3% group (P = 0.002). On day 14, IL-1ß infiltration was not significantly different between the 10% and 3% groups (P = 0.078). The CD31 level was higher in the 3% group than in the other groups on days 7 and 14 (P<0.05). CONCLUSION: A 3% paeoniflorin-SA-gelatin skin scaffold promoted the healing of diabetic wounds in rats. This scaffold promoted collagen deposition and microvascular regeneration and demonstrated anti-inflammatory properties, suggesting that this scaffold type could be used to treat diabetic wounds.


Assuntos
Alginatos , Complicações do Diabetes , Gelatina , Glucosídeos , Pele , Alicerces Teciduais , Alginatos/administração & dosagem , Alginatos/uso terapêutico , Animais , Colágeno/metabolismo , Complicações do Diabetes/complicações , Complicações do Diabetes/terapia , Diabetes Mellitus , Modelos Animais de Doenças , Gelatina/administração & dosagem , Gelatina/uso terapêutico , Glucosídeos/administração & dosagem , Glucosídeos/uso terapêutico , Microvasos/efeitos dos fármacos , Microvasos/fisiologia , Monoterpenos/administração & dosagem , Monoterpenos/uso terapêutico , Impressão Tridimensional , Ratos , Pele/irrigação sanguínea , Pele/efeitos dos fármacos , Pele/lesões , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia
19.
Nefrología (Madrid) ; 42(2)Mar.-Abr, 2022. graf, tab
Artigo em Inglês | IBECS | ID: ibc-204288

RESUMO

Background: The mortality rate of diabetic patients on dialysis is higher than that of non-diabetic patients. Asymmetric dimethylarginine and inflammation are strong predictors of death in hemodialysis. This study aimed to evaluate asymmetric dimethylarginine and C-reactive protein interaction in predicting mortality in hemodialysis according to the presence or absence of diabetes.Methods: Asymmetric dimethylarginine and C-reactive protein were measured in 202 patients in maintenance hemodialysis assembled from 2011 to 2012 and followed for four years. Effect modification of C-reactive protein on the relationship between asymmetric dimethylarginine and all-cause mortality was investigated dividing the population into four categories according to the median of asymmetric dimethylarginine and C-reactive protein.Results: Asymmetric dimethylarginine and C-reactive protein levels were similar between diabetics and non-diabetics. Asymmetric dimethylarginine – median IQR μM – (1.95 1.75–2.54 versus 1.03 0.81–1.55 P=0.000) differed in non-diabetics with or without evolution to death (HR 2379 CI 1.36–3.68 P=0.000) and was similar in diabetics without or with evolution to death. Among non-diabetics, the category with higher asymmetric dimethylarginine and C-reactive protein levels exhibited the highest mortality (69.0% P=0.000). No differences in mortality were seen in diabetics. A joint effect was found between asymmetric dimethylarginine and C-reactive protein, explaining all-cause mortality (HR 15.21 CI 3.50–66.12 P=0.000).Conclusions: Asymmetric dimethylarginine is an independent predictor of all-cause mortality in non-diabetic patients in hemodialysis. Other risk factors may overlap asymmetric dimethylarginine in people with diabetes. Inflammation dramatically increases the risk of death associated with high plasma asymmetric dimethylarginine in hemodialysis. (AU)


Fundamento: La tasa de mortalidad de los pacientes diabéticos em diálisis se ha referido que es superior a la de los no diabéticos. La dimetilarginina asimétrica y la inflamación son potentes predictores de muerte en hemodiálisis. Este estudio tuvo como objetivo evaluar la interacción de dimetilarginina asimétrica y proteína C reactiva en la predicción de mortalidad en hemodiálisis según la presencia o ausencia de diabetes.Métodos: Se midieron dimetilarginina asimétrica y proteína C reactiva en 202 pacientes en hemodiálisis de mantenimiento reclutados entre 2011 a 2012 y seguidos durante cuatro años. Se investigó la modificación del efecto de la proteína C reactiva en la relación entre dimetilarginina asimétrica y la mortalidad por todas las causas dividiendo la población en cuatro categorías según la mediana de dimetilarginina asimétrica y proteína C reactiva.Resultados: Los niveles de dimetilarginina asimética y proteína C reactiva fueron similares entre diabéticos y no diabéticos. Dimetilarginina asimétrica - mediana IQR μM - (1,95 1,75 - 2,54 versus 1,03 0,81 - 1,55 P = 0,000) difirió en los no diabéticos con o sin evolución a la muerte (OR 2379 IC 1,36 - 3,68 P = 0,000) y fue similar en los diabéticos sin o con evolución a muerte. Entre los no diabéticos, la categoría con niveles más altos de dimetilarginina asimétrica y proteína C reactiva presentó la mayor mortalidad (69,0% P = 0,000). No se observaron diferencias en la mortalidad en los diabéticos. Se encontró un efecto conjunto entre la dimetilarginina asimétrica y la proteína C reactiva, lo que explica la mortalidad por todas las causas (OR 15,21 IC 3,50-66,12 P = 0,000).Conclusiones: La dimetilarginina asimétrica es un predictor independiente de mortalidad por todas las causas en pacientes no diabéticos en hemodiálisis. Otros factores de riesgo pueden superponerse a la dimetilarginina asimétrica en personas con diabetes. ... (AU)


Assuntos
Humanos , Nefrologia , Inflamação , Diálise Renal , Complicações do Diabetes/terapia , Proteína C-Reativa , Estudos de Casos e Controles
20.
Cells ; 11(3)2022 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-35159252

RESUMO

Although some studies have shown that some static magnetic fields (SMFs) can promote wound healing in diabetic mice, it is not clear whether the other diabetes complications, such as liver disease and diabetic nephropathy, can also be alleviated. Here, we constructed two simple magnetic plates using neodymium permanent magnets to examine the comprehensive effects of moderate SMFs on genetically obese leptin receptor-deficient db/db diabetic mice. We found that although the blood glucose was not obviously reduced by these two SMF settings, both of the glycated serum protein (GSP) and malondialdehyde (MDA) levels were significantly decreased (Cohen's d = 2.57-3.04). Moreover, the wound healing, liver lipid accumulation, and renal defects were all significantly improved by SMF treatment (Cohen's d = 0.91-2.05). Wound tissue examination showed obvious nuclear factor erythroid 2-related factor 2 (NRF2) level decrease (Cohen's d = 2.49-5.40) and Ki-67 level increase (Cohen's d = 2.30-3.40), indicating decreased oxidative stress and increased cell proliferation. In vitro cellular studies with fibroblast NIH3T3 cells showed that SMFs could reduce high glucose-induced NRF2 nucleus translocation (Cohen's d = 0.87-1.15) and cellular reactive oxygen species (ROS) elevation (Cohen's d = 0.92), indicating decreased oxidative stress. Consequently, high glucose-induced impairments in cell vitality, proliferation, and migration were all improved by SMF treatment. Therefore, our results demonstrate that these simple SMF devices could effectively reduce oxidative stress in diabetic mice and may provide a cost-effective physical therapy strategy to alleviate multiple diabetic complications in the future.


Assuntos
Complicações do Diabetes , Diabetes Mellitus Experimental , Animais , Glicemia , Complicações do Diabetes/complicações , Complicações do Diabetes/terapia , Diabetes Mellitus Experimental/metabolismo , Campos Magnéticos , Camundongos , Fator 2 Relacionado a NF-E2/metabolismo , Células NIH 3T3 , Estresse Oxidativo , Cicatrização
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