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1.
Mayo Clin Proc ; 97(9): 1700-1716, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36058582

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the United States and worldwide. The progressive form of NAFLD, nonalcoholic steatohepatitis (NASH), is a leading indication for liver transplant. Comorbidities associated with NAFLD development and NASH include type 2 diabetes, obesity, metabolic syndrome, and dyslipidemia. Extrahepatic morbidity and mortality are considerable as NAFLD is associated with an increased risk of cardiovascular disease and chronic kidney disease. Once NAFLD is diagnosed, the presence of liver fibrosis is the central determinant of hepatic prognosis. Severe liver fibrosis requires aggressive clinical management. No pharmacologic agents have regulatory approval in the United States for the treatment of NAFLD or NASH. Management is centered on efforts to reduce underlying obesity (lifestyle, medications, surgical or endoscopic interventions) and metabolic derangements (prediabetes, type 2 diabetes, hypertension, hyperlipidemia, and others). Current pharmacologic therapy for NAFLD is limited mainly to the use of vitamin E and pioglitazone, although other agents are being investigated in clinical trials. Cardiovascular and metabolic risk factors must also be assessed and managed. Here, NAFLD evaluation, diagnosis, and management are considered in the primary care setting and endocrinology clinics.


Assuntos
Diabetes Mellitus Tipo 2 , Hepatopatia Gordurosa não Alcoólica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Humanos , Fígado/patologia , Cirrose Hepática/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/terapia , Atenção Primária à Saúde , Estados Unidos
2.
Front Public Health ; 10: 953881, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36062129

RESUMO

Proper management of non-communicable diseases (NCDs) is a severe challenge to China's rural health system. This study investigates what influences the poor medical treatment of NCDs (diabetes and angina) by evaluating the "know-do gap" between provider knowledge and practice. To determine whether low levels of provider knowledge low quality of patient care is the primary constraint on the quality of NCDs diagnosis and treatment in rural China. Providers from Village Clinics (VC) and Township Health Centers (THC), and Standardized Patients (SP) were selected by a multi-stage random sampling method. Clinical vignettes were administered to 306 providers from 103 VCs and 50 THCs in rural Sichuan Province. SPs presented diabetes symptoms completed 97 interactions with providers in 46 VCs and 51 THCs; SPs presented angina symptoms completed 100 interactions with providers in 50 VCs and 50 THCs. Process quality, diagnosis quality, and treatment quality were assessed against national standards for diabetes and angina. Two-tailed T-tests and tests of proportions for continuous outcomes and tests of proportions for binary dependent variables were used to compare vignette and SP results. Differences between vignette and SP data calculated the know-do gap. Regression analyses were used to examine the providers/facility characteristics and knowledge/practice associations. THC providers demonstrated significantly more knowledge in vignettes and better practices in SP visits than VC providers. However, levels of knowledge were low overall: 48.2% of THC providers and 28.2% of VC providers properly diagnosed type 2 diabetes, while 23.8% of THC providers and 14.7% of VC providers properly diagnosed angina. With SPs, 2.1% of THC providers and 6.8% of VC providers correctly diagnosed type 2 diabetes; 25.5% of THC providers and 12.8% of VC providers correctly diagnosed angina. There were significant know-do gaps in diagnosis process quality, diagnosis quality, and treatment quality for diabetes (p < 0.01), and in diagnosis process quality (p < 0.05) and treatment quality for angina (p < 0.01). Providers in rural China display low levels of knowledge when treating diabetes and angina. Despite low knowledge, evidence of the know-do gap indicates that low-quality healthcare is the primary constraint on the quality of NCD diagnosis and treatment in rural China. Our research findings provide a new perspective for the evaluation of the medical quality and a technical basis for the development of new standardized cases in the future.


Assuntos
Diabetes Mellitus Tipo 2 , Doenças não Transmissíveis , China , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Dronabinol , Humanos , Doenças não Transmissíveis/terapia , População Rural
3.
ScientificWorldJournal ; 2022: 8263495, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36046813

RESUMO

Background: The ocular complication caused by diabetes is one of the most common reasons of blindness in the world. This study aimed to investigate the effect of educational intervention on eye care practice of type II diabetic patients based on health belief model (HBM) in Fasa city. Methods: This study was a quasi-experimental study on 100 patients with type II diabetes referred to the diabetes center in Fasa city, Fars province, Iran, in 2019. Data were collected using a valid self-reported questionnaire including demographic variables, knowledge, and HBM (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action), and eye care performance (based on self-report) and the level of HbA1cof both groups were measured before and three months after the educational intervention. The experimental group received training in eight sessions; each session lasted for 50 to 55 minutes. In order to analyze the studied data, SPSS 22 software (SPSS Inc., IBM, Chicago, IL, USA), Chi-square, independent t-test, and paired t-test have been used. P < 0.05 was considered as statistically significant. Results: The results showed that the mean scores of knowledge (P < 0.001) and HBM components (P < 0.001) in the experimental and control groups after intervention have a significant difference. After the training program, eye care performance in the experimental group was better than that in the control group (P < 0.001). Furthermore, HbA1c (P < 0.001) improved significantly in the experimental group compared to the control group. Conclusions: Planning and implementing education using the HBM to improve eye care performance in diabetic patients are very effective and beneficial. Moreover, educational programs based on health education and health promotion models for diabetic patients for preventing side effects caused by diabetes should be performed.


Assuntos
Diabetes Mellitus Tipo 2 , Conhecimentos, Atitudes e Prática em Saúde , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Modelo de Crenças de Saúde , Educação em Saúde , Humanos , Irã (Geográfico)/epidemiologia
4.
PLoS One ; 17(9): e0273675, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36048792

RESUMO

Psychological problems commonly experienced by patients with type 2 diabetes mellitus (T2DM) cause diabetes fatigue conditions that can further worsen the treatment prognosis. We conducted this investigation to determine the effectiveness of a resilience-based Islamic program on diabetes fatigue and health-related quality of life (HRQoL) by measuring the biochemical indicators of T2DM. This was a quasi-experimental study performed from May to August 2021, in which 80 respondents aged 18-64 years diagnosed with T2DM were included through purposive sampling at a male:female sex ratio of 1:1 in the control group and 17:23 in the treatment group. A resilience-based Islamic program (a combination of stress management, mindfulness, prayer, and dhikr (the ritual formula of Sufi brotherhood recited devotionally in praise of Allah and as a means of attaining ecstatic experience)) was implemented in the treatment group for six sessions by blended online and offline interventions. Multidimensional Fatigue Inventory-20 and World Health Organization Quality of Life, Brief Form were used to evaluate diabetes fatigue and HRQoL. Blood tests were performed to measure HbA1c, total antioxidant serum, insulin, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) levels from baseline to 3 months. Statistical analyses were conducted using paired t test, Wilcoxon signed-rank test, independent t test, and Mann-Whitney U test. The resilience-based Islamic program had a beneficial impact on the levels of HbA1c (p < 0.001), lipid profile (triglyceride) (p = 0.011), HDL-c (p = 0.01), LDL-c (p < 0.001), total antioxidant serum (p = 0.001), insulin (p < 0.001), diabetes fatigue (p < 0.05), and HRQoL (p < 0.05) in patients of the treatment group. The results of biochemical tests related to T2DM also indicated a reduction in diabetes fatigue and an increase in HRQoL due to the resilience-based Islamic program. Considering that a patient's resilience to diabetes is an important factor in the management of diabetes fatigue, the resilience-based Islamic program can be applied at public health centers and community levels to increase T2DM resilience.


Assuntos
Diabetes Mellitus Tipo 2 , Qualidade de Vida , Antioxidantes , Colesterol , HDL-Colesterol , LDL-Colesterol , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Fadiga/terapia , Feminino , Hemoglobina A Glicada , Humanos , Insulina , Masculino , Triglicerídeos
5.
N Z Med J ; 135(1561): 31-44, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36049788

RESUMO

AIMS: This study investigated differences in illness perceptions and self-care behaviours between Maori and New Zealand (NZ) Europeans with type 2 diabetes mellitus (T2DM), and how these perceptions were related to clinical outcomes. METHODS: Participants were 85 Maori and 85 NZ European adults, recruited from outpatient clinics, who completed a cross-sectional questionnaire on illness perceptions and self-care behaviours. Clinical data, including HbA1c, retinopathy, neuropathy and nephropathy, were collected from medical records. RESULTS: Compared to NZ Europeans, Maori had higher HbA1c, lower adherence to medication and a healthy diet, and were more likely to smoke. Maori reported greater perceived consequences of diabetes on their lives, and more severe symptoms than NZ Europeans did. Maori were more likely to attribute T2DM to food and drink, whereas NZ Europeans were more likely to attribute T2DM to weight. Perceiving that treatment could help control diabetes was associated with lower HbA1c and higher medication adherence in Maori and NZ Europeans independently. CONCLUSIONS: Maori experienced and perceived worse T2DM outcomes than NZ Europeans did. Research is needed to develop and test clinical interventions to address these inequities and improve outcomes, possibly by asking patients about their perceptions, providing tailored and culturally appropriate education, and discussing patients' concerns.


Assuntos
Diabetes Mellitus Tipo 2 , Havaiano Nativo ou Outro Ilhéu do Pacífico , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glicada , Humanos , Nova Zelândia , Autocuidado , Brancos
6.
Zhongguo Zhen Jiu ; 42(9): 1024-8, 2022 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-36075599

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on protein expressions of suppressor of cytokine signaling 3 (SOCS3) and insulin receptor substrate-1 (IRS-1) in hypothalamus and morphology of pancreas islet in Zucker diabetic fatty (ZDF) rats, and to explore its possible mechanism on improving plasma glucose and insulin resistance of type 2 diabetes mellitus (T2DM). METHODS: Twelve SPF male ZDF rats were selected and fed with high-fat diet for 4 weeks to establish the T2DM model, after modeling, the rats were randomly divided into a model group and an EA group, 6 rats in each one. Besides, 6 SPF male Zucker lean rats were selected as a blank group. In the EA group, EA was applied at "Pishu" (BL 20), "Weiwanxiashu" (EX-B 3), "Zusanli" (ST 36) and "Sanyinjiao" (SP 6), with continuous wave, 15 Hz in frequency, 2 mA in intensity, once a day, 20 min each time, 6 times a week for 4 weeks. The fasting plasma glucose (FPG) was measured before and after intervention. The serum level of fasting insulin (FINS) was measured by radioimmunoassay, and the homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated; the morphological change of pancreas islets was observed by HE staining; the protein expressions of SOCS3 and IRS-1 in hypothalamus were detected by Western blot. RESULTS: Before intervention, compared with the blank group, FPG in the model group and the EA group was increased (P<0.01). After intervention, compared with the blank group, FPG, serum level of FINS and HOMA-IR were increased (P<0.01), the protein expression of SOCS3 was increased while IRS-1 was decreased in the hypothalamus in the model group (P<0.01). Compared with the model group, FPG, serum level of FINS and HOMA-IR were decreased (P<0.01), the protein expression of SOCS3 was decreased while IRS-1 was increased in the hypothalamus in the EA group (P<0.01). In the model group, the shape of pancreas islets was irregular, the area of pancreas islets and the number of islet ß cell nuclei were decreased, the nuclei of islet ß cell was compensatory enlargement. In the EA group, the shape and the area of pancreas islets and the number of islet ß cell nuclei were improved, the compensatory increase of islet ß cell nuclei was alleviated compared with the model group. CONCLUSION: Electroacupuncture can reduce the fasting plasma glucose, improve the morphology of pancreas islets, and alleviate the insulin resistance in ZDF rats. The mechanism may relate to the down-regulation of SOCS3 and up-regulation of IRS-1 in the hypothalamus, and improving the function of hypothalamus in regulating peripheral glucose metabolism.


Assuntos
Diabetes Mellitus Tipo 2 , Eletroacupuntura , Resistência à Insulina , Pontos de Acupuntura , Animais , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Hipotálamo/metabolismo , Proteínas Substratos do Receptor de Insulina/genética , Proteínas Substratos do Receptor de Insulina/metabolismo , Masculino , Pâncreas/metabolismo , Ratos , Ratos Zucker , Proteína 3 Supressora da Sinalização de Citocinas/genética , Proteína 3 Supressora da Sinalização de Citocinas/metabolismo
7.
J Assoc Physicians India ; 70(8): 11-12, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36082730

RESUMO

Type 2 diabetes (T2DM) is conventionally considered a progressive disorder, with most patients requiring increasingly intensive therapy to control hyperglycemia over time. Recently, there has been a major paradigm shift towards trying to reverse T2DM. Emerging evidence suggests that remission of T2DM is feasible in a subset of patients. Identification and careful selection of candidates for remission are crucial for the success of these programs. Among various dietary strategies, low-calorie diets (LCDs) and low-carbohydrate diets (LCBDs) have been demonstrated as being effective in facilitating remission of T2DM in a targeted population within a clinical setting. Remission with LCBDs may be maintained in the absence of weight loss, however, long-term evidence is limited and remission may not be maintained without long-term carbohydrate restriction, which poses major challenges. In very low-calorie diets (VLCDs), weight loss of 15 kg or greater and maintenance of weight loss is the main driver and predictor of remission. However, most individuals with T2DM were unable to maintain remission beyond 2 years, despite being on VLCDs. More data are required on the long-term sustainability of remission in an ethnically diverse population like Asian Indians with T2DM who have less obesity and hence less weight to lose. Moreover, "re-reversal" or "relapse" of diabetes can occur in a large percentage of individuals who discontinue the dietary restrictions. Hence, regular follow-up by a multi-disciplinary team to ensure sustainability of the lifestyle modification is crucial to the maintenance of remission of T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Diabetes Mellitus Tipo 2/terapia , Humanos , Estilo de Vida , Obesidade , Indução de Remissão , Resultado do Tratamento , Redução de Peso
8.
S Afr Fam Pract (2004) ; 64(1): e1-e9, 2022 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-36073102

RESUMO

BACKGROUND:  The coronavirus disease 2019 (COVID-19) pandemic exposed the risks of poorly controlled noncommunicable diseases, especially in persons with diabetes. The pandemic outbreak in Cape Town, South Africa, required a rapid reorganisation of primary care services. Community-based measures were activated to ensure continuity of care by implementing home delivery of medication by community health workers. After five months of de-escalated chronic care, observations at an urban primary care facility suggested that noncommunicable disease patients had not overtly decompensated despite suspending regular in-facility services. This study attempted to understand what impact de-escalation of regular care and escalation of community-based interventions had on type 2 diabetes patients at this primary care facility. METHODS:  A mixed methods study design was used, consisting of data captured prospectively from diabetic patients who returned to the facility for routine care post-lockdown, as well as qualitative interviews to ascertain patients' experiences of the home delivery service. RESULTS:  The data set included 331 (72%) patients in the home delivery group and 130 (28%) in the non-home delivery group. Regression analysis demonstrated a statistically significant relationship between home delivery and improved diabetic control (p  0.01), although this may be because of confounding factors. The mean glycaemic control was suboptimal both at baseline and post-lockdown in both groups. Interviews with 83 study patients confirmed the acceptability of the home delivery intervention. CONCLUSION:  The rapid reorganisation of primary care services illustrates the versatility of a functional community-oriented primary care service, although not fully developed yet, to adapt to emerging community healthcare needs in the pandemic era.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Humanos , Pandemias/prevenção & controle , África do Sul/epidemiologia
9.
Contrast Media Mol Imaging ; 2022: 7665483, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36051935

RESUMO

Objective: To investigate the effect of mindfulness training on neurological function and quality of life in patients with type 2 diabetic peripheral neuropathy. Methods: This study selected 120 patients with type 2 diabetic peripheral neuropathy and randomly divided them into three independent subgroups according to different training methods: mindfulness meditation group (MM), aerobic exercise group (AE), and mindfulness combined with aerobic exercise group. (MMAE). The three groups were analyzed for SNCV and MNCV velocities, MAAS and TCSS scores, neurological symptom scores, neurological sign scores, and quality of life. Results: Before treatment, SNCV and MNCV were not significantly significant (P > 0.05), but after treatment, SNCV and MNCV were significantly higher, and the MMAE group changed more significantly (P < 0.05); before treatment, MAAS and TCSS scores were not significant (P > 0.05), but after treatment, MAAS scores were significantly higher, TCSS scores were significantly lower, and more significantly in MMAE; the difference was significant (P < 0.05); before treatment, there was no statistical significance of the neurological signs score (P > 0.05); after treatment, the neurological symptoms score and neurological signs score were significantly reduced, and the changes in the MMAE group were statistically significant (P < 0.05); there was no significant difference in the quality of life score before treatment (P > 0.05), and the quality of life score in the MMAE group was significantly increased (P < 0.05). Conclusion: Mindfulness training combined with aerobic exercise has an ideal therapeutic effect on patients with type 2 diabetic peripheral neuropathy, and has a very important role in improving the neurological function and quality of life of the patients. It is a safe and effective treatment method. Therefore, mindfulness training combined with aerobic exercise is worthy of promotion and application.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Atenção Plena , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/terapia , Exercício Físico , Humanos , Qualidade de Vida
10.
Diabet Med ; 39(10): e14924, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36097326

RESUMO

AIMS: To explore participants' experiences with and perspective of a telephone-based, peer-led diabetes self-management intervention targeting adults with type 2 diabetes (T2D) from speciality care settings. We also sought to identify areas for improvement for future iterations of the intervention. METHODS: This study recruited 25 adults with T2D from the intervention arm of a randomized controlled trial of a peer support intervention for diabetes. Individuals took part in semi-structured interviews that explored the following topics: perceived impact of the intervention, relationship with peer leader, desirable characteristics in a peer leader, and suggestions for improving the intervention. Focus groups were recorded, transcribed, quality checked, coded, and analysed to develop themes and subthemes. RESULTS: Four core themes emerged: (1) importance of the 'participant-peer leader' match, (2) peer leader roles and responsibilities, (3) need for flexible support models, and (4) factors affecting intervention implementation and engagement. The quality of the participant-peer leader relationship appeared to be linked to intervention satisfaction. Beyond demographic features such as age and sex, key characteristics for forming a strong match included stage of life, lifestyle, diabetes-related factors, and communication style. CONCLUSIONS: Participants have unique ideas about what support should look like and preferences for how support is best delivered. Future models of peer support need to be customizable to individuals' needs and responsive to changes in life circumstances. If participants are the decision makers in the matching process, they may experience greater satisfaction and derive maximal benefits.


Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Adulto , Autopsia , Diabetes Mellitus Tipo 2/terapia , Humanos , Apoio Social , Telefone
11.
BMJ Open ; 12(9): e059336, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109030

RESUMO

INTRODUCTION: Living with diabetes can be burdensome and lead to serious emotional distress and impaired mental health. Acceptance and commitment therapy (ACT) can support people facing the challenges of living with diabetes. This trial aims to evaluate the effectiveness and cost-effectiveness of the internet-based and mobile-based intervention (IMI) 'ACTonDiabetes' in reducing diabetes distress against enhanced treatment as usual (TAU+) following specialised diabetes care. METHODS AND ANALYSIS: A two-armed pragmatic randomised controlled trial will be conducted to evaluate the guided IMI ACTonDiabetes against TAU+. A total of 210 adults with type 1 or type 2 diabetes and elevated diabetes distress (Problem Areas in Diabetes ≥40) will be recruited at a specialised diabetes centre. The intervention begins 2-4 weeks after hospital discharge and takes about 7-10 weeks to complete. Assessments are performed at baseline and 5 and 10 weeks as well as 6 and 12 months after randomisation. The primary outcome is diabetes distress at a 10-week follow-up (T2). Secondary outcomes are depression (Patient Health Questionnaire-8), psychological well-being (WHO-5), quality of life (Assessment of Quality of Life-8 Dimension), Diabetes-related Self-Management Questionnaire, diabetes acceptance (Acceptance and Action Diabetes Questionnaire) and negative treatment effects (Inventory for the Assessment of Negative Effects of Psychotherapy). All statistical analyses will be performed based on the intention-to-treat principle with additional per-protocol analyses. Changes in outcomes will be evaluated using the general linear model. A health-economic evaluation will be conducted from a societal perspective. Reasons for drop-out will be systematically investigated. ETHICS AND DISSEMINATION: This clinical trial has been approved by the State Medical Chamber of Baden-Württemberg (file no. B-F-2019-010). Trial results will be submitted for publication in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER: DRKS00016738.


Assuntos
Terapia de Aceitação e Compromisso , Diabetes Mellitus Tipo 2 , Adulto , Diabetes Mellitus Tipo 2/terapia , Humanos , Internet , Questionário de Saúde do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Eur Rev Med Pharmacol Sci ; 26(17): 6290-6299, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36111930

RESUMO

OBJECTIVE: The aim of the study was to analytically compare the therapeutic effect of the addition of diet modification and regular exercise to oral agents. MATERIALS AND METHODS: This cross-sectional study surveyed 1248 participants via online and offline modes by employing a questionnaire about an individual's management of diabetes. Group 1 patients follow Single Approach Management for Type 2 Diabetes Mellitus (T2DM), while Group 2 and Group 3 patients follow Multi-Approach Management for T2DM. Based on the answers, the participants were classified into three groups. The diagnostic criteria of Diabetes Mellitus Type-2 in this study were done by determining morning Fasting Blood Sugar (FBS) and glycated Hemoglobin (HbA1c). RESULTS: The current study found 656 single oral agent users and 592 combination regimens users among all the study participants. The study also found that, among all participants, 511 patients were on mild to moderate diet modification while 325 patients were on moderate to severe diet modification. The study also noted that 232 males and 215 females took Complementary and Alternative Medicines (CAM). Of 447 patients, 12 showed menstrual abnormalities (2.6%), and 18 had mild diarrhoea (4%). The study also found that there is a vital significance of lowering FBS and HbA1c with the management strategies (p=0.000). The study showed a strong association between group 3 and improved FBS and HbA1c (p=0.000). CONCLUSIONS: This study reveals that diet modification and regular exercise improve FBS and HbA1c levels significantly. Hence, diet modification and exercise can be added as adjuvants and should be incorporated into the management guidelines of T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Glicemia/análise , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Inquéritos e Questionários
13.
Lancet Neurol ; 21(10): 922-936, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36115364

RESUMO

Diabetic peripheral neuropathy (DPN) occurs in up to half of individuals with type 1 or type 2 diabetes. DPN results from the distal-to-proximal loss of peripheral nerve function, leading to physical disability and sometimes pain, with the consequent lowering of quality of life. Early diagnosis improves clinical outcomes, but many patients still develop neuropathy. Hyperglycaemia is a risk factor and glycaemic control prevents DPN development in type 1 diabetes. However, glycaemic control has modest or no benefit in individuals with type 2 diabetes, probably because they usually have comorbidities. Among them, the metabolic syndrome is a major risk factor for DPN. The pathophysiology of DPN is complex, but mechanisms converge on a unifying theme of bioenergetic failure in the peripheral nerves due to their unique anatomy. Current clinical management focuses on controlling diabetes, the metabolic syndrome, and pain, but remains suboptimal for most patients. Thus, research is ongoing to improve early diagnosis and prognosis, to identify molecular mechanisms that could lead to therapeutic targets, and to investigate lifestyle interventions to improve clinical outcomes.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Síndrome Metabólica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/etiologia , Neuropatias Diabéticas/prevenção & controle , Humanos , Síndrome Metabólica/complicações , NAD/uso terapêutico , Dor/etiologia , Qualidade de Vida
14.
BMC Endocr Disord ; 22(1): 227, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36096804

RESUMO

BACKGROUND: Diabetes is associated with microvascular and macrovascular complications. Although it is less recognized, diabetes also has an important role in the development of musculoskeletal disorders. Our objective was to evaluate the effect of type 2 diabetes (T2D) on the severity of adhesive capsulitis of the shoulder (AC) and on the efficacy of ultrasound guided hydrodistension treatment. METHODS: We conducted a retrospective longitudinal observational study, of patients with AC who underwent ultrasound guided hydrodistension at our Centre. Severity was measured with DASH (Disabilities of Arm, Shoulder and Hand) score and pain was evaluated with a score between 0 and 10. The association of T2D with baseline characteristics of AC, and with outcomes at 6-12 months was analyzed using linear and logistic regression models. RESULTS: We evaluated 120 ultrasound guided hydrodistension treatments of AC, 85 in patients without diabetes and 35 in patients with T2D. Patients with diabetes had a higher prevalence of dyslipidemia, hypertension and higher HbA1c values. The average duration of diabetes was 4.8 years (2.0, 7.9). The baseline characteristics of AC were not significantly different between patients with and without diabetes. Patients with T2D relapsed more frequently and required more reinterventions than patients without diabetes (20.0% vs 4.7%, p = 0.008), had higher post-intervention pain scale values [4.0 (0.0-5.0) vs 0.0 (0.0-5.0), p = 0.022] and higher post-intervention DASH score [0.8 (0.0-1.8) vs 0.0 (0.0-0.8), p = 0.038]. CONCLUSION: Although baseline characteristics of AC in patients with diabetes were similar to those without diabetes, patients with diabetes had a worse response to treatment, more frequent relapses and a greater need for new interventions.


Assuntos
Bursite , Diabetes Mellitus Tipo 2 , Bursite/diagnóstico por imagem , Bursite/epidemiologia , Bursite/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Humanos , Dor , Estudos Retrospectivos , Ultrassonografia de Intervenção
16.
Lakartidningen ; 1192022 Sep 14.
Artigo em Sueco | MEDLINE | ID: mdl-36106738

RESUMO

The metabolic syndrome includes: abdominal obesity, insulin resistance, hypertension, and dyslipidemia in various combinations with an increased risk for developing cardiovascular disease, type 2 diabetes, and cancer. All components of the metabolic syndrome are positively affected by increased physical activity, while aerobic physical activity on a moderate to vigorous intensity level or a combination of aerobic and muscle strengthening physical activity are optimal. The physical activity should be individually adapted and in dialogue with the patient, and Physical activity on prescription can be used as a treatment method.


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Síndrome Metabólica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Humanos , Síndrome Metabólica/terapia , Obesidade/complicações , Obesidade/terapia
17.
Nutrients ; 14(16)2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-36014930

RESUMO

The goal of this trial was to investigate whether an eHealth lifestyle coaching programme led to significant weight loss and decreased Haemoglobin A1c (HbA1c) in patients with type 2 diabetes. In an RCT, 170 patients were enrolled from 2018 to 2019 for intervention or control. Inclusion criteria were diagnosed with type 2 diabetes, BMI 30-45 kg/m2, and aged 18-70 years. Exclusion criteria were lacks internet access, pregnant or planning a pregnancy, or has a serious disease. Primary and secondary outcomes were a reduction in body weight and HbA1c. At six months, 75 (75%) patients in the intervention group and 53 (76%) patients in the control group remained in the trial. The mean body weight loss was 4.2 kg (95% CI, -5.49; -2.98) in the intervention group and 1.5 kg (95% CI, -2.57; -0.48) in the control group (p = 0.005). In the intervention group, 24 out of 62 patients with elevated HbA1c at baseline (39%) had a normalized HbA1c < 6.5% at six months, compared to 8 out of 40 patients with elevated HbA1c at baseline (20%) in the control group (p = 0.047). The eHealth lifestyle coaching programme can lead to significant weight loss and decreased HbA1c among patients with type 2 diabetes, compared to standard care.


Assuntos
Diabetes Mellitus Tipo 2 , Tutoria , Telemedicina , Dinamarca , Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glicada/análise , Humanos , Estilo de Vida , Atenção Primária à Saúde , Redução de Peso
18.
Sci Rep ; 12(1): 14482, 2022 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-36008432

RESUMO

Transarterial chemoembolization (TACE) is often used as a locoregional therapy for early hepatocellular carcinoma (HCC) when local ablation or resection are not feasible, but incomplete response and recurrence are commonly observed. In this study, we sought to determine the association between metformin administration and TACE outcomes for single nodular HCC in patients with type 2 diabetes mellitus (T2DM). The retrospective cohort analysis included 164 T2DM patients with single nodular HCC who underwent TACE as an initial treatment, and 91 were exposed to metformin before and after TACE. Propensity score (PS) matching was used to balance covariates. Logistic regression analysis was used to determine the predictors of tumor response after TACE, and Cox regression analysis assessed independent predictors of local tumor recurrence (LTR) in patients with complete response after TACE. Metformin use was associated with significantly higher objective response rate (ORR) in the overall and PS-matched cohort (79.1% vs. 60.3 and 78.7% vs. 57.5%; p = 0.008 and p = 0.029, respectively). Logistic regression analysis showed that metformin use was an independent predictor of ORR in all and PS-matched patients (odds ratio = 2.65 and 3.06; p = 0.016 and 0.034, respectively). Cox regression analysis showed metformin administration was an independent predictor for lower LTR in all and PS-matched patients (hazard ratio = 0.28 and 0.27; p = 0.001 and 0.007, respectively). Metformin administration is associated with better initial response and lower local recurrence after TACE for single nodular HCC in T2DM.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Diabetes Mellitus Tipo 2 , Neoplasias Hepáticas , Metformina , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Metformina/uso terapêutico , Recidiva Local de Neoplasia/terapia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
19.
Int J Mol Sci ; 23(16)2022 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-36012573

RESUMO

Although the benefits of aerobic exercise on obesity and type 2 diabetes are well-documented, the pathogenesis of type 2 diabetes and the intervention mechanism of exercise remain ambiguous. The correlation between mitochondrial quality and metabolic diseases has been identified. Disruption of the central or peripheral molecular clock can also induce chronic metabolic diseases. In addition, the interactive effects of the molecular clock and mitochondrial quality have attracted extensive attention in recent years. Exercise and a high-fat diet have been considered external factors that may change the molecular clock and metabolic state. Therefore, we utilized a DB/DB (BSK.Cg-Dock7m +/+ Leprdb/JNju) mouse model to explore the effect of chrono-aerobic exercise on the metabolic state of type 2 diabetic mice and the effect of timing exercise as an external rhythm cue on liver molecular clock-mitochondrial quality. We found that two differently timed exercises reduced the blood glucose and serum cholesterol levels in DB/DB mice, and compared with night exercise (8:00 p.m., the active period of mice), morning exercise (8:00 a.m., the sleeping period of mice) significantly improved the insulin sensitivity in DB/DB mice. In contrast, type 2 diabetes mellitus (T2DM) increased the expression of CLOCK and impaired the mitochondrial quality (mitochondrial networks, OPA1, Fis1, and mitophagy), as well as induced apoptosis. Both morning and night exercise ameliorated impaired mitochondrial quality and apoptosis induced by diabetes. However, compared with morning exercise, night exercise not only decreased the protein expression of CLOCK but also decreased excessive apoptosis. In addition, the expression of CLOCK was negatively correlated with the expression of OPA1 and Fis1. In summary, our research suggests that morning exercise is more beneficial for increasing insulin sensitivity and promoting glucose transport in T2DM, whereas night exercise may improve lipid infiltration and mitochondrial abnormalities through CLOCK-mitophagy-apoptosis in the liver, thereby downregulating glucose and lipid disorders. In addition, CLOCK-OPA1/Fis1-mitophagy might be novel targets for T2DM treatment.


Assuntos
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Resistência à Insulina , Animais , Apoptose , Diabetes Mellitus Experimental/terapia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Glucose , Lipídeos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos , Mitofagia
20.
Stem Cell Res Ther ; 13(1): 395, 2022 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922870

RESUMO

BACKGROUND: In diabetes, delayed wound healing was considered as the result of excessive recruitment and retention of pro-inflammatory cells and factors. Hematopoietic prostaglandin D synthase (HPGDS) was identified from differently expressed genes of diabetic human foot skin. HPGDS is responsible for the production of prostaglandin D2 (PGD2), an inflammatory mediator. Therefore, we aim to explore whether HPGDS could be a therapeutic target in the diabetic wound (DW). METHOD: In this study, we compared gene expression profilings of diabetic human foot skin and non-diabetic human foot skin from the Gene Expression Omnibus database. We detected the characteristics of immune components in diabetic mice wound and investigated the role and underlying mechanism of the differently expressed Hpgds for the diabetic wound healing. For in vivo studies, we engineered ADSC to overexpress Hpgds (ADSCHpgds) and evaluated its effects on diabetic wound healing using a full-thickness skin wound model. For in vitro studies, we evaluated the role of ADSCHpgds conditioned medium and PGD2 on Lipopolysaccharide (LPS) induced macrophage. RESULTS: Hpgds was significantly down-regulated in type 2 diabetic mice wound and its deficiency delayed normal wound healing. ADSCHpgds accelerated DW healing by reducing neutrophil and CD8T cell recruitment, promoting M2 macrophage polarization and increasing the production of growth factors. ADSCHpgds conditioned medium showed superior capability in promoting M2 macrophage transition than conditioned medium derived from ADSC alone. CONCLUSION: Our results demonstrated that Hpgds is required for wound healing, and ADSCHpgds could accelerate DW healing by improving anti-inflammatory state and normalizing the proliferation phase of wound healing in mice. These findings provide a new insight in the therapeutic strategy of diabetic wound.


Assuntos
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Células-Tronco Mesenquimais , Animais , Meios de Cultivo Condicionados/farmacologia , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/terapia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Humanos , Oxirredutases Intramoleculares/metabolismo , Camundongos , Prostaglandina D2/metabolismo , Prostaglandina D2/farmacologia , Células-Tronco/metabolismo , Cicatrização/genética
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