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1.
Medicine (Baltimore) ; 99(1): e18459, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895776

RESUMO

BACKGROUND: The high incidence of Diabetes mellitus (DM) has become a serious challenge for the global epidemic. Increased blood glucose leads to abnormal ocular surface structure and metabolic disorder in patients. DM is a high-risk factor for dry eye disease (DED), with high incidence and increased difficulty in treatment. The disease can cause discomfort, visual impairment, tear film instability and ocular surface damage, and even cause corneal erosion in severe cases, which has a serious impact on people's daily life. Traditional Chinese Medicine (TCM) plays an important role in the evaluation and treatment of DM and its complications. However, whether TCM treatment could improve the treatment efficacy of DM suffering from DED remains poorly understood. OBJECTIVE: To investigate the curative effect of TCM for the alleviation of clinical symptoms in Diabetic patients with DED, and to evaluate its long-term efficacy. METHODS: This trial is a single-case randomized, single-blind, placebo-controlled study. A total of 12 subjects will be recruited in this trial. The trial is divided into three cycles, and one cycle has 2 treatment periods. There is a washout period at each adjacent treatment stage. TCM individualized treatment and placebo will be randomized during the treatment period. The test period will last for 29 weeks, with 4 weeks for each treatment period and 1 week for each washout period to minimize carryover effects. Subjects will be selected by the researcher strictly in accordance with the inclusion and exclusion criteria. The outcomes will evaluate the efficacy of treatment by changes in the various observation indicators. DISCUSSION: This study will realize a patient-centered outcome approach necessary to provide clinical researchers with the evidence that TCM treatment can effectively improve the objective indicators of the eye and systemic symptoms in Diabetic patients with DED. TRIAL REGISTRATION: This study has been registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, No. ChiCTR1900024481), (October, 2019).


Assuntos
Complicações do Diabetes/terapia , Síndromes do Olho Seco/terapia , Medicina Tradicional Chinesa/métodos , Feminino , Humanos , Masculino , Assistência Centrada no Paciente/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
3.
Undersea Hyperb Med ; 46(5): 719-722, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683373

RESUMO

Introduction: Stingray spine injuries are among the most common marine animal injuries in humans. While most resolve with immersion in warm water, a few become infected and require antibiotics. We present a case report of a presumptive stingray injury that evolved to a major slough and which required prolonged healing in a patient with diabetes mellitus. Our literature review was unable to find a similarly reported case. Materials: A co-author was asked to evaluate and manage an ominous-appearing wound on the right foot of a diabetic. The problem developed after the individual had been wading in shallow ocean beach water. The patient's diabetic sensory neuropathy obscured the immediate association of the problem with a stingray injury, but this became the presumptive diagnosis when pain developed and necessitated that he seek medical care. Findings/Clinical Course: After an initial urgent care visit, increasing pain and worsening appearance of the patient's foot necessitated a visit to our emergency department. The patient was admitted the next day due to symptoms of systemic sepsis. On the fourth hospital day, a large bulla on the lateral side of the right foot was excised. This unroofed a full-thickness slough to the periosteum level of the underlying bones. Not until the 16th hospital day had enough improvement occurred to discharge the patient. Over the next 16 weeks, the wound improved, developed a vascular base and epithelialized. Conclusion: With a dearth of literature about stingray injuries in patients with diabetes mellitus reported, our case is unique: The patient's wound course more closely resembled a toxic inoculation than the typical puncture wound-cellulitis presentations associated with stingray injuries.


Assuntos
Mordeduras e Picadas/complicações , Traumatismos do Pé/terapia , Ferimentos Penetrantes/terapia , Adulto , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/terapia , Vesícula/etiologia , Vesícula/terapia , Complicações do Diabetes/terapia , Diabetes Mellitus , Traumatismos do Pé/etiologia , Humanos , Masculino , Necrose , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Cicatrização , Ferimentos Penetrantes/etiologia
4.
Medicine (Baltimore) ; 98(43): e17718, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651905

RESUMO

BACKGROUND: Diabetic gastroparesis (DG) is a common complication to diabetes mellitus (DM). A lot of clinical researches have focused on acupoint catgut embedding for diabetic gastroparesis. However, there is no systematic review and meta-analysis has been conducted. We aim to systematically review the effect of acupoint catgut embedding on diabetic gastroparesis. METHODS: The databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Ovid LWW, EMBASE, CNKI, Wanfang Database will be searched. Studies published from the time when the database establishment to July 2019 will be retrieved. Randomized controlled clinical trials and quasi-randomized controlled trials on acupoint catgut embedding for diabetic gastroparesis will be included. The primary outcomes are gastroparesis Cardinal Symptom Index (GCSI) or a similar scale to score dyspeptic symptoms. RevMan V.5.3 software will be used to perform the analyses. RESULTS: This study will provide a high-quality synthesis of the effectiveness and safety of acupoint catgut embedding for diabetic gastroparesis. CONCLUSION: This systematic review will provide a high-quality evidence to judge whether the acupoint catgut embedding is beneficial to treat diabetic gastroparesis. PROSPERO REGISTRATION NUMBER: CRD42019140951.


Assuntos
Terapia por Acupuntura/métodos , Categute , Complicações do Diabetes/terapia , Gastroparesia/terapia , Humanos
5.
Orv Hetil ; 160(40): 1591-1602, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31565976

RESUMO

Introduction: Liver cirrhosis (20-25%), hepatocellular carcinoma (1.5-3%), insulin resistance (30-40%) and type 2 diabetes (25-30%) are common complications in patients with chronic hepatitis C virus (HCV) infection; however, data are missing from Hungary. Aim: To determine the prevalence of diabetes and insulin resistance in Hungarian HCV patients; to evaluate treatment-induced metabolic changes in relation to diabetes/insulin resistance and virological response and to perform a sustained follow-up for hepatocellular carcinoma detection. Method: We enrolled 150 Hungarian HCV genotype 1 patients (mean age: 48.55 ± 8.55 years, male/female ratio: 45/55%) from 2007-2012. We analysed their baseline, week 12, and end of therapeutic follow-up (24 weeks after interferon-based therapy completion) laboratory data. We performed a 5-year follow-up (2012-2017). Results: The prevalence of insulin sensitivity, insulin resistance and diabetes was 37.4%, 35.3% and 27.3%, respectively. Insulin resistant and diabetic patients showed a decrease in fasting glucose from baseline to end of follow-up (5.47 ± 0.66 vs. 5.08 ± 0.60, p<0.001; 7.90 ± 2.67 vs. 7.04 ± 2.75, p = 0.006), as did both the sustained responder and non-responder groups. Treatment efficacy rate was poor in diabetic vs. insulin sensitive and insulin resistant groups (17% vs. 46% and 40%); insulin sensitivity was not a predictor of virological response. Three participants with diabetes were diagnosed with hepatocellular carcinoma during follow-up by regular ultrasound examinations. Conclusion: Hungarian HCV patients showed high prevalence of diabetes and insulin resistance, though antiviral therapy caused favourable changes in their carbohydrate metabolism. Antiviral therapy was less effective in diabetic patients. Follow-up ultrasound examinations are required for hepatocellular carcinoma in HCV patients, especially those with diabetes. Orv Hetil. 2019; 160(40): 1591-1602.


Assuntos
Antivirais/uso terapêutico , Glicemia/metabolismo , Carcinoma Hepatocelular/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/terapia , Resistência à Insulina , Neoplasias Hepáticas/complicações , Adulto , Idoso , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Humanos , Hungria/epidemiologia , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência
6.
Oxid Med Cell Longev ; 2019: 5738368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31485296

RESUMO

Diabetic foot ulcers (DFUs), the most serious complication of diabetes mellitus, can induce high morbidity, the need to amputate lower extremities, and even death. Although many adjunctive strategies have been applied for the treatment of DFUs, the low treatment efficiency, potential side effects, and high cost are still huge challenges. Recently, nanomaterial-based drug delivery systems (NDDSs) have achieved targeted drug delivery and controlled drug release, offering great promises in various therapeutics for diverse disorders. Additionally, the radial extracorporeal shock wave (rESW) has been shown to function as a robust trigger source for the NDDS to release its contents, as the rESW harbors a potent capability in generating pressure waves and in creating the cavitation effect. Here, we explored the performance of oxygen-loaded nanoperfluorocarbon (Nano-PFC) combined with the rESW as a treatment for DFUs. Prior to in vivo assessment, we first demonstrated the high oxygen affinity in vitro and great biocompatibility of Nano-PFC. Moreover, the rESW-responsive oxygen release behavior from oxygen-saturated Nano-PFC was also successfully verified in vitro and in vivo. Importantly, the wound healing of DFUs was significantly accelerated due to improved blood microcirculation, which was a result of rESW therapy (rESWT), and the targeted release of oxygen into the wound from oxygen-loaded Nano-PFC, which was triggered by the rESW. Collectively, the oxygen-saturated Nano-PFC and rESW provide a completely new approach to treat DFUs, and this study highlights the advantages of combining nanotechnology with rESW in therapeutics.


Assuntos
Complicações do Diabetes/terapia , Pé Diabético/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Oxigenação Hiperbárica/métodos , Oxigênio/uso terapêutico , Cicatrização/fisiologia , Animais , Humanos , Oxigênio/administração & dosagem , Oxigênio/farmacologia , Ratos
7.
Diabetes Metab Syndr ; 13(4): 2571-2578, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405678

RESUMO

BACKGROUND: Diabetes mellitus is a complex, chronic, metabolic disease manifested in hyperglycemia and associated with various complications, Consequently, people with diabetes have higher rates of hospital admissions than the general population. There is little information about the burden of hospitalizations of diabetic patients in Libya. AIM: The aim was to identify the causes of admission of individual with diabetes and to identify the risk factors for hospitalization. PATIENTS AND METHODS: This is a retrospective case-series study conducted in Tripoli Medical Center, Tripoli. It covers 1037 individual with diabetes admitted between 1 January 2015 and 31 December 2015. All the data were collected from the patient files. RESULTS: The mean age of the patients was 60.7 years ±15.1 standard deviation. The male-to-female ratio was 1:1. Type 2 diabetes accounted for 90.2% of the patients, 56.5% of whom had diabetes for >10 years, 40.5% had no prior chronic illness, 26.7% had hypertension, and 26.4% had multiple co-morbidities. The mean hospital stay was 6.1 days, and 60.8% of the patients were on insulin therapy. The main causes of admission were infection (23%), mainly in the chest, followed by lower extremity disease (22.4%), cardiovascular disease (19.3%), cerebrovascular disease (14.4%) and renal disease (11.8%). CONCLUSIONS: The main causes of hospitalization as shown by this study were infections, and chronic complications of diabetes in the lower extremities and cardiovascular system. Most of the patients were >60 years old, had diabetes type 2 for >10 years, were on insulin treatment, and had no other comorbidity.


Assuntos
Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Hospitalização/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/etiologia , Feminino , Seguimentos , Humanos , /etiologia , Tempo de Internação/estatística & dados numéricos , Líbia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Adulto Jovem
8.
J Hand Surg Asian Pac Vol ; 24(3): 317-322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438802

RESUMO

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.


Assuntos
Complicações do Diabetes/complicações , Mãos , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Desbridamento , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Cicatrização , Infecção dos Ferimentos/diagnóstico , Adulto Jovem
10.
Minerva Endocrinol ; 44(3): 301-309, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31304727

RESUMO

Research on Helicobacter pylori (H. pylori), a pathogenic bacterium that is widespread among humans, is investigating the medical implications of the infection in many fields beyond gastroenterology. Because of the ubiquitous presence of the infection, there is an increasing interest in finding a relationship between this bacterium and diabetes mellitus (DM). It is not clear whether a significant relation between H. pylori and DM exists, whether the infection influences diabetes or vice versa, and the mechanisms underlying such a relationship. This review provides an analysis of new insights from studies published in more recent years. New research on this topic concentrated on the common pathogenic aspects between the bacterium and insulin resistance or autoimmunity, on the role of the bacterial infection in cardiovascular risk and whether the infection worsen glycemic outcomes in patients with DM. Research in this field still has to conclusively assess and explain the existence of a possible relationship between H. pylori and DM. Some studies have reached antithetic conclusions. Unless more robust data from studies using consistent research methods become available in the near future, people with diabetes should be compared to the general population when it comes to investigating and treating the presence of H. pylori.


Assuntos
Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Infecções por Helicobacter/complicações , Helicobacter pylori , Complicações do Diabetes/microbiologia , Infecções por Helicobacter/terapia , Humanos , Fatores de Risco
11.
Rev Med Suisse ; 15(653): 1132-1139, 2019 May 29.
Artigo em Francês | MEDLINE | ID: mdl-31148425

RESUMO

Hemodialysis (HD) centers are facing an increasing number of patients with diabetes. These cases require an intensive multidisciplinary approach of the consequences of renal failure, glycemic control and nutrition and the management of frequent co-morbidities, in particular the diabetic foot. A major challenge is to decrease glycemic variability and the risk of hypoglycemia. Because of increased risk of hypoglycemia-associated mortality, the HbA1C target is loosened in the majority of HD patients. Continuous glucose monitoring technology has identified important glycemic fluctuations during and after dialysis. However, their reliability in HD needs to be improved. New therapeutic pathways that decrease glucose excursions and hypoglycemia, such as GLP1 receptor agonists and sensor-coupled insulin pumps, have yet to be validated in HD.


Assuntos
Complicações do Diabetes , Falência Renal Crônica , Diálise Renal , Glicemia , Automonitorização da Glicemia , Complicações do Diabetes/terapia , Diabetes Mellitus/tratamento farmacológico , Hemoglobina A Glicada , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Reprodutibilidade dos Testes
12.
Folia Med Cracov ; 59(1): 49-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180075

RESUMO

INTRODUCTION: Peripheral arterial occlusive disease (PAOD) is a disease with worldwide increasing occurrence. Diabetic patients are greatly exposed on the risk of PAOD and its complications. The aim of the study was to check the influence of preoperative HbA1C on the outcomes of patients with diabetes undergoing PAOD related endovascular treatment. MATERIAL AND METHODS: The study was conducted among 59 patients with PAOD referred from the diabetic foot outpatient for endovascular treatment. They were included in one-year observation based on follow-up visits in 1, 3, 6 and 12 months a er angioplasty and divided into 2 groups basing on their preoperative glycaemia. The clinical condition of the lower limbs was assessed by use of the Rutherford classification, ankle-brachial index (ABI) and toe-brachial index (TBI). Changes in patients' quality of life (QoL) were also evaluated. RESULTS: Reintervention within 12 months were less frequent in patients with HbA1C ≤8.0% than in HbA1C >8.0% patients (9.09% vs. 35.48%, p = 0.03). TBI of the treated limb was lower in patients with elevated than in patients with proper glycaemia at 6 month [0.2 (0.0-0.38) vs. 0.38 (0.31-0.46); p <0.008] and 12 month follow-up [0.17 (0.0-0.27) vs. 0.32 (0.25-0.38); p <0,001]. The rate of healed ulcerations after 6 months was higher in patients HbA1C ≤8.0% (45.0% vs. 16.13%; p = 0.02) and they had significantly greater improvement of QoL. CONCLUSION: Results of this study shows that preoperative level of glycaemia is an important factor for long-term prognosis in diabetic patients with PAOD. Elevated HbA1C level decreases significantly long-term improvement of QoL in DM patients undergoing endovascular treatment.


Assuntos
Angioplastia , Arteriopatias Oclusivas/terapia , Complicações do Diabetes/terapia , Diabetes Mellitus/metabolismo , Hemoglobina A Glicada/metabolismo , Isquemia/terapia , Doença Arterial Periférica/terapia , Idoso , Índice Tornozelo-Braço , Angiografia por Tomografia Computadorizada , Diabetes Mellitus/tratamento farmacológico , Procedimentos Endovasculares , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Qualidade de Vida , Recidiva , Stents , Ultrassonografia Doppler
13.
J Craniofac Surg ; 30(7): 1994-1998, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31232987

RESUMO

The aim of the present study was to evaluate the effects of low-level laser therapy (LLLT) and biphasic alloplastic bone graft material on diabetic bone healing. Induction of diabetes was performed in 14 male Sprague-Dawley rats by intraperitoneal injection of a 50 mg/kg dose of streptozotocin. Two bilaterally symmetrical non-critical-sized bone defects were created in the parietal bones in each rat. Right defects were filled with biphasic alloplastic bone graft. Rats were randomly divided into 2 groups, with 1 group receiving 10 sessions of LLLT (GaAlAs, 78.5 J/cm, 100mW, 0.028 cm beam). The LLLT was started immediately after surgery and once every 3 days during postoperative period. At the end of treatment period, new bone formation and osteoblast density were determined using histomorphometry. Empty (control), graft-filled, LLLT-treated and both graft-filled and LLLT-treated bone defects were compared. New bone formation was higher in the graft treatment samples compared with the control (P = 0.009) and laser samples (P = 0.029). In addition, graft-laser combination treatment samples revealed higher bone formation than control (P = 0.008) and laser (P = 0.026) samples. Osteoblast density was significantly higher in the laser treatment (P <0.001), graft treatment (P = 0.001) and graft-laser combination treatment (P <0.001) samples than control samples. In addition, significantly higher osteoblast density was observed in the graft-laser combination treatment samples compared to the graft treatment samples (P = 0.005). The LLLT was effective to stimulate osteoblastogenesis but failed to increase bone formation. Graft augmentation for treatment of bone defects seems essential for proper bone healing in diabetes, regeneration may be supported by the LLLT to enhance osteoblastogenesis.


Assuntos
Complicações do Diabetes/terapia , Terapia com Luz de Baixa Intensidade , Animais , Regeneração Óssea/efeitos dos fármacos , Transplante Ósseo , Diabetes Mellitus , Masculino , Osteoblastos , Osteogênese , Osso Parietal , Ratos , Ratos Sprague-Dawley , Cicatrização/efeitos dos fármacos
14.
J Tissue Viability ; 28(3): 152-160, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31056407

RESUMO

AIM: This review investigated the current state of knowledge on negative pressure wound therapy (NPWT) used to treat diabetic foot ulceration (DFU), its clinical effectiveness and any current issues in the research. NICE have recommended research into the clinical effectiveness of different dressing types for DFUs since 2015. METHODS: A systematic search of the British Nursing Index, CINAHL, Cochrane Central and PubMed was undertaken. Only primary studies were included and studies investigating a combination of NPWT and other therapies were excluded. All the included studies were published in English between 2008 and 2018 and were peer reviewed. RESULTS: The search yielded seven studies for inclusion in the qualitative analysis. The studies included a variety of methodologies specifically; 3 randomized controlled trials, 2 case series', 1 non-controlled trial and 1 randomized case-control study. Three main themes were identified and formed the focus of the qualitative synthesis. DISCUSSION: All the included studies reported that NPWT led to better clinical outcomes when compared to standard treatment. However, the studies had numerous methodological flaws such as the absence of validated tools for the measurement of outcomes such as wound area and depth; a lack of statistical power calculations to determine adequate sample sizes or the significance of outcome measures. Additionally, there was little consistency in the pressures used for the NPWT devices. Finally, many of the controlled trials did not conform to the standard of reporting trials stipulated by the CONSORT statement.


Assuntos
Pé Diabético/terapia , Tratamento de Ferimentos com Pressão Negativa/normas , Complicações do Diabetes/terapia , Humanos , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Tratamento de Ferimentos com Pressão Negativa/métodos , Pesquisa Qualitativa , Resultado do Tratamento
15.
J Wound Care ; 28(5): 261-266, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31067160

RESUMO

OBJECTIVE: To evaluate the methodological approaches used to assess the cost consequences of diabetic foot ulcers (DFUs) in published scientific papers. METHOD: A systematic literature search was conducted in PubMed, Embase, Scopus, Web of Science and CINAHL. English language papers reporting on the cost of DFUs were identified. Additionally, bibliographies were inspected to identify other relevant cost studies. Following the PRISMA guidance, the review identified the study design, epidemiological approach, analytical perspective and data collection approach in each of the included studies. RESULTS: Relatively few studies of the cost consequences of DFUs were found (n=27). Most studies were conducted in Western countries with only five studies from countries in Asia and Africa. The identified studies used different study designs, epidemiological approaches, data collection strategies, and data sources, which in turn made a systematic comparison of cost estimates difficult. Detailed descriptions of the applied costing method and other methodological aspects were often limited or absent. Many studies only reported costs from a health-care payer's perspective and disregarded the costs to patients, their families and wider society. CONCLUSION: The costs of DFUs have been assessed using a wide range of different methodological approaches often restricted to the healthcare payer's perspective. Therefore, the cost analyses may fail to consider the true societal costs of DFUs.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Complicações do Diabetes/economia , Complicações do Diabetes/terapia , Pé Diabético/economia , Pé Diabético/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Complement Ther Clin Pract ; 35: 348-352, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31003681

RESUMO

OBJECTIVE: To examine the effect of Gua Sha therapy in the treatment of diabetic peripheral neuropathy (DNP). DESIGN: An open-label randomized controlled study was conducted with usual care as the control (60 subjects in Gua Sha group and 59 subjects in usual care group). Outcome measures included Toronto Clinical Scoring System (TCSS), Vibration Perception Threshold (VPT), Ankle Brachial Index (ABI), and fasting plasma glucose (FPG). There were 12 consecutive sessions of Gua Sha, one session per week. RESULTS: After the first cycle of Gua Sha intervention, only performance of sensory function measured by the VPT, and peripheral artery disease symptoms by the ABI were statistically significant differences between the two groups (both P values < 0.01), and the total TCSS score and the FPG level were no group differences (P = 0.14, and 0.25, respectively). At the eight-week and 12-week post intervention assessment, Gua Sha therapy significantly reduced severity of neuropathy symptoms, improved performance of sensory function, reduced peripheral artery disease, and better controlled plasma glucose by comparing with the control group (all P values < 0.01). The changes of mean scores of TCSS, VPT, ABI and the plasma glucose levels in the Gua Sha group showed a significant change from baseline to week 12, indicating that Gua Sha therapy induced progressive improvement in the management of DPN symptoms, sensory function, peripheral artery disease and glucose levels. No serious adverse events were reported in either arm. Gua Sha therapy in this study was effective, safe and well tolerated by patients. CONCLUSION: Gua Sha therapy appears to be effective at reducing the severity of DPN in a clinically relevant dimension, and at improving other health outcomes in patients with DPN. While this study found that Gua Sha therapy is a promising treatment in reducing the symptoms of patients with DPN, further, larger sample studies are required to confirm the effects of Gua Sha therapy in patients with DPN.


Assuntos
Complicações do Diabetes/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Neuralgia/terapia , Modalidades de Fisioterapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Gen Hosp Psychiatry ; 57: 50-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30908962

RESUMO

OBJECTIVE: This study investigated the healthcare service utilisation and expenditure of patients with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) and identified associated factors. METHODS: Healthcare service utilisation and expenditure of patients with T2DM with and without MDD during 2002-2013 were examined using Taiwan's population-based National Health Insurance claims database. Healthcare service utilisation included outpatient visits and inpatient admissions, and health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, non-psychiatric health service utilisation and expenditure were distinguished from total health service utilisation and medical expenditure. RESULTS: Average healthcare service utilisation was significantly higher in those with comorbid MDD (both total and non-psychiatric utilisation). The higher overall costs of the patients with comorbid MDD largely driven by psychiatric costs and non-psychiatric costs between the groups were not significantly different. Gender, age, income, comorbidities and complications, and diabetes complications severity index were significant factors in outpatient visits, medical expenditure, and hospitalisation in those with comorbid MDD. CONCLUSIONS: Type 2 diabetes patients with comorbid MDD were found to have higher costs, and that they appeared to be driven by more visits in the first 6 years and by psychiatric-related costs rather than general medical costs.


Assuntos
Transtorno Depressivo Maior , Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Gastos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Comorbidade , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Complicações do Diabetes/economia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia
18.
J Pak Med Assoc ; 69(3): 440-441, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30890844

RESUMO

The article highlights the need to follow a multifactorial, comprehensive approach while managing diabetes. Apart from glycaemic control, blood pressure, lipid, weight and platelet management are equally important if one is to ensure optimal therapeutic outcomes. The mnemonic SMILE (salute-metabolic interventions for life enhancement) includes all evidence-based therapies which help in improving metabolic health, and in preventing morbidity and mortality. It allows evenhanded addressal of all vasculo metabolic parameters, so as to bring SMILEs on faces of all persons involved in diabetes.


Assuntos
Anti-Hipertensivos/uso terapêutico , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/terapia , Hipoglicemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Comportamento de Redução do Risco , Complicações do Diabetes/terapia , Gerenciamento Clínico , Medicina Baseada em Evidências , Nível de Saúde , Humanos
19.
Int Wound J ; 16(3): 621-633, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30821119

RESUMO

MicroRNAs (miRNAs) are small protected molecules with a length of 18 to 25 nucleotides. Many studies have recently been conducted on miRNAs, illustrating their role in regulating many biological, physiological, and pathological activities, such as maintaining cellular signalling and regulating cellular pathways. The main role of miRNAs is to regulate the expression of genes after translation, which can lead to the destruction or suppression of translation by binding to mRNAs. As any change in the regulation of miRNAs is associated with several physiological abnormalities, such as type 2 diabetes and its complications, these molecules can be used for therapeutic purposes or as biomarkers for the diagnosis of diseases such as diabetes and its complications. In this review article, we will discuss important findings about the miRNAs and the role of these molecules in different phases of the wound-healing process of chronic wounds, especially diabetic ulcer.


Assuntos
Complicações do Diabetes/genética , Complicações do Diabetes/terapia , Pé Diabético/genética , Pé Diabético/terapia , MicroRNAs/genética , MicroRNAs/uso terapêutico , Cicatrização/genética , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade
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