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1.
Adv Exp Med Biol ; 1396: 207-214, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36454469

RESUMO

The diabetes types and its complications have varying developmental and metabolic pathways. There is an interplay of nongenetic and genetic components in pathogenesis of diabetes and its complications. There are several established genes such as ABCC8, TCF7L2, SLC2A2, and CAPN10 which are known to influence blood insulin and glucose levels. Current management of diabetes types may include lifetime burdensome use of insulin, insulin sensitizers, insulin secretagogues, etc. There has been increasing interest in improving genetic editing tools such as CRISPR/Cas9 and using genetically edited stem cells to alter diabetes disease course or possibly cure it. Current research on microRNAs and long noncoding RNAs may provide insights into the pathways involved in development of diabetes and its complications. Consequently, developing further understanding of genetics and its messenger pathways in diabetes would enhance our ability to develop precise and accurate genetic editing tools which can translate into clinically useful therapeutics.


Assuntos
Diabetes Mellitus , RNA Longo não Codificante , Humanos , Diabetes Mellitus/genética , Diabetes Mellitus/terapia , Insulina , Edição de Genes , Genômica
2.
Patient Educ Couns ; 106: 68-74, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36371242

RESUMO

OBJECTIVE: To investigate whether patient-physician gender concordance influences the patient's perceptions of interpersonal processes of care and patient outcomes in Muslim patients with diabetes. METHODS: We conducted a cross-sectional telephone survey involving 4152 randomly selected patients using electronic diabetes records. Outcome measures included perceptions of interpersonal processes of care, adherence to medications, and HbA1c. Linear mixed regression models were used to explore the associations between the outcome variables and patient gender and gender concordance. RESULTS: The best processes of care were observed consistently for female concordant dyads. In adjusted mixed models, lower Hurried Communication was associated with female concordant (-0.91, p < 0.001) and female physician-male patient dyads (-0.82, p = 0.007). Higher Elicited Concerns was associated with female concordant (0.65, p = 0.003) and female physician-male patient dyads (0.59, p = 0.013). Higher Explained Results and Compassionate/Respectful were associated with female concordant dyads (0.83, p < 0.001, and 0.55, p = 0.010 respectively). Lower HbA1c was independently linked with female concordant dyads (-0.84, p < 0.001). CONCLUSION: This study highlights the importance of female gender concordance on perceptions of interpersonal processes of diabetes care and glycemic control. PRACTICE IMPLICATIONS: Strengthening physicians' communication skills with female patients should be taken into consideration.


Assuntos
Diabetes Mellitus , Médicos , Humanos , Masculino , Feminino , Estudos Transversais , Hemoglobina A Glicada , Fatores Sexuais , Relações Médico-Paciente , Diabetes Mellitus/terapia
8.
J Diabetes Res ; 2022: 7703520, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36465704

RESUMO

It is well-documented that diabetes is an inflammatory and oxidative disease, with an escalating global burden. Still, there is no definite treatment for diabetes or even prevention of its harmful complications. Therefore, understanding the molecular pathways associated with diabetes might help in finding a solution. p66Shc is a member of Shc family proteins, and it is considered as an oxidative stress sensor and regulator in cells. There are inconsistent data about the role of p66Shc in inducing diabetes, but accumulating evidence supports its role in the pathogenesis of diabetes-related complications, including macro and microangiopathies. There is growing hope that by understanding and targeting molecular pathways involved in this network, prevention of diabetes or its complications would be achievable. This review provides an overview about the role of p66Shc in the development of diabetes and its complications.


Assuntos
Diabetes Mellitus , Humanos , Proteína 1 de Transformação que Contém Domínio 2 de Homologia de Src/genética , Diabetes Mellitus/terapia , Estresse Oxidativo
9.
Front Endocrinol (Lausanne) ; 13: 1027686, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36339446

RESUMO

Diabetes mellitus is a type of metabolic disease characterized by hyperglycemia, primarily caused by defects in insulin secretion, insulin action, or both. Long-term chronic hyperglycemia can lead to diabetes-related complications, causing damage, dysfunction, and failure of different organs. However, traditional insulin and oral drug therapy can only treat the symptoms but not delay the progressive failure of pancreatic beta cells or prevent the emergence of diabetic complications. Mesenchymal stem cells have received extensive attention due to their strong immunoregulatory functions and regeneration effects. Mesenchymal stem cell-derived exosomes (MSC-Exos) have been proposed as a novel treatment for diabetic patients as they have demonstrated superior efficiency to mesenchymal stem cells. This review summarizes the therapeutic effects, mechanisms, challenges, and future prospects of MSC-Exos in treating diabetes mellitus and its related complications. This review supports the potential use of MSC-Exos in future regenerative medicine to overcome the current difficulties in clinical treatment, particularly in treating diabetes.


Assuntos
Diabetes Mellitus , Exossomos , Hiperglicemia , Insulinas , Células-Tronco Mesenquimais , Humanos , Exossomos/metabolismo , Células-Tronco Mesenquimais/metabolismo , Hiperglicemia/metabolismo , Diabetes Mellitus/terapia , Diabetes Mellitus/metabolismo
10.
Turk J Med Sci ; 52(4): 873-879, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36326405

RESUMO

BACKGROUND: One of the most important components of treatment for diabetic patients is diet and healthy nutrition therapy. Calorie restriction is effective and without cost increases its appeal for both patients and physicians. Unfortunately, continuous calorie restriction is a difficult method. For this reason, alternative calorie restriction methods, such as intermittent fasting (IF), have been investigated by some researchers. METHODS: IF refers to a wide range of diet programmes covering periods of eating and fasting, which vary according to the different regimens. In this article, first, some general information will enable us to understand the concept of IF, and then scientific evidence with respect to IF applications in diabetes will be discussed in detail. Thereafter our clinical experience will be summarised, finally, the author will try to answer the question "are the IF applications beneficial or harmful for diabetic patients?" RESULTS: Considering animal studies, epidemiological studies, pilot studies, clinical experiences and a small number of randomized controlled trials conducted so far, it seems possible to say that the beneficial effects of IF for diabetes patients are greater than potential harms. However, there are not yet enough studies with a high level of evidence to recommend IF as a routine part of the treatment in patients with diabetes. DISCUSSION: It is necessary to show which IF regimen is safe and effective, how often and for how long, for diabetic patients. This seems possible with well-designed randomized controlled trials focusing on long-term clinical outcomes and eliminating confounding factors. This will make the answer clearer.


Assuntos
Diabetes Mellitus , Jejum , Humanos , Restrição Calórica/métodos , Diabetes Mellitus/terapia , Dieta , Jejum/efeitos adversos , Obesidade
11.
Artigo em Inglês | MEDLINE | ID: mdl-36375862

RESUMO

INTRODUCTION: Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives. RESEARCH DESIGN AND METHODS: This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives. RESULTS: Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients. CONCLUSIONS: This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients' own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.


Assuntos
Diabetes Mellitus , Clínicos Gerais , Humanos , Autocuidado , Atitude do Pessoal de Saúde , Diabetes Mellitus/terapia , Pesquisa Qualitativa
12.
BMJ Health Care Inform ; 29(1)2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36379608

RESUMO

OBJECTIVES: Mobile health applications are instrumental in the self-management of chronic diseases like diabetes. Technology acceptance models such as Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) have proven essential for predicting the acceptance of information technology. However, earlier research has found that the constructs "perceived disease threat" and "trust" should be added to UTAUT2 in the mHealth acceptance context. This study aims to evaluate the extended UTAUT2 model for predicting mHealth acceptance, represented by behavioral intention, using mobile diabetes applications as an example. METHODS: We extended UTAUT2 with the additional constructs "perceived disease threat" and "trust". We conducted a web-based survey in German-speaking countries focusing on patients with diabetes and their relatives who have been using mobile diabetes applications for at least 3 months. We analysed 413 completed questionnaires by structural equation modelling. RESULTS: We could confirm that the newly added constructs "perceived disease threat" and "trust" indeed predict behavioural intention to use mobile diabetes applications. We could also confirm the UTAUT2 constructs "performance expectancy" and "habit" to predict behavioural intention to use mobile diabetes applications. The results show that the extended UTAUT2 model could explain 35.0% of the variance in behavioural intention. DISCUSSION: Even if UTAUT2 is well established in the information technologies sector to predict technology acceptance, our results reveal that the original UTAUT2 should be extended by "perceived disease threat" and "trust" to better predict mHealth acceptance. CONCLUSION: Despite the newly added constructs, UTAUT2 can only partially predict mHealth acceptance. Future research should investigate additional mHealth acceptance factors, including how patients perceive trust in mHealth applications.


Assuntos
Diabetes Mellitus , Aplicativos Móveis , Telemedicina , Humanos , Estudos Transversais , Telemedicina/métodos , Diabetes Mellitus/terapia , Tecnologia
13.
BMC Public Health ; 22(1): 2051, 2022 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352373

RESUMO

BACKGROUND: The management of chronic diseases such as diabetes, obesity and high blood pressure is a major global health challenge, particularly among the most disadvantaged populations. Beyond the biomedical management of these diseases, comprehensive support that takes into account the peoples' economic and social situation is fundamental. The objective of this scoping review is to create an inventory and an analysis of the different types of support for these chronic diseases among disadvantaged, immigrant or minority populations to contribute to a better definition and characterization of what should be global support for these vulnerable populations suffering from these diseases. METHODS: A search of PubMed, PsycINFO, Sages Journals and Web of Science was conducted (between March and May 2021) for articles published between January 2000 and May 2021. Articles were selected after screening titles, abstracts and full texts according to our 5 inclusion criteria. RESULTS: We included 16 articles. The diabetes, obesity and high blood pressure support programs described in these articles operate to improve physical and mental health and access to care. The approaches of these interventions are focused on the training and participation of people and the implementation of support actions adapted to the person. The majority of these interventions have a real attachment to the community. CONCLUSIONS: This review of the literature shows that support for people with chronic diseases such as diabetes, obesity or high blood pressure is based on three pillars: empowerment, peer mediation and holistic and tailor-made support for the individual. The empowerment approach, which considers the capacities and resources of individuals and whose goal is to strengthen their ability to act on their health, appears to be entirely suited to the support of these chronic diseases. This review underlines the importance of moving away from a biomedical approach to a holistic approach truly focused on the person, their capacities and their needs.


Assuntos
Diabetes Mellitus , Hipertensão , Humanos , Populações Vulneráveis , Diabetes Mellitus/terapia , Doença Crônica , Obesidade/terapia
14.
Artigo em Inglês | MEDLINE | ID: mdl-36357008

RESUMO

OBJECTIVE: This study aimed to determine the association of health determinants, lifestyle and socioeconomic variables on healthcare use in people with diabetes in Europe. DESIGN: A cross-sectional study was conducted using data from the European Health Interview Survey wave 2 (ie, secondary analysis). SETTING: The sample included data from 25 European countries. PARTICIPANTS: The sample included 16 270 patients with diabetes aged 15 years or older (49.1% men and 50.9% women). RESULTS: The survey data showed that 58.2% of respondents had seen their primary care physician in the past month and 22.6% had been admitted to the hospital in the past year. Use of primary care was associated with being retired (prevalence ratio (PR) 1.13, 95% CI 1.07 to 1.19) and having very poor self-perceived health (PR 1.80, 95% CI 1.51 to 2.15), long-standing health problems (PR 1.14, 95% CI 1.04 to 1.24), high blood pressure (PR 1.06, 95% CI 1.03 to 1.10) and chronic back pain (PR 1.07, 95% CI 1.04 to 1.11). Hospital admission was associated with very poor self-perceived health (PR 3.03, 95% CI 2.14 to 4.31), accidents at home (PR 1.54, 95% CI 1.40 to 1.69), chronic obstructive pulmonary disease (COPD) (PR 1.34, 95% CI 1.22 to 1.47), high blood pressure (PR 1.08, 95% CI 1.01 to 1.17), chronic back pain (PR 0.91, 95% CI 0.84 to 0.98), moderate difficulty walking (PR 1.33, 95% CI 1.21 to 1.45) and severe difficulty walking (PR 1.67, 95% CI 1.51 to 1.85). CONCLUSIONS: In the European diabetic population, the high cumulative incidences of primary care visits and hospital admissions are associated with labour status, alcohol consumption, self-perceived health, long-standing health problems, high blood pressure, chronic back pain, accidents at home, COPD and difficulty walking.


Assuntos
Diabetes Mellitus , Hipertensão , Doença Pulmonar Obstrutiva Crônica , Masculino , Humanos , Feminino , Estudos Transversais , Limitação da Mobilidade , Europa (Continente)/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Atenção à Saúde
15.
Prim Care ; 49(4): 631-639, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36357067

RESUMO

The care of patients with diabetes is complex and longitudinal. Improved management of diabetic risk factors can decrease long-term complications such as cardiovascular disease, renal failure, vision impairment, and amputation. A variety of telehealth options are available which may improve patient access to needed care as well as a provider understanding of the challenges for an individual patient. Health care teams must be thoughtful about how best to incorporate telehealth into the care of patients with diabetes.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Telemedicina , Humanos , Diabetes Mellitus/terapia
17.
Int J Equity Health ; 21(1): 162, 2022 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384591

RESUMO

BACKGROUND: To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. METHODS: This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients' medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients' health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. RESULTS: With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient's annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient's annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient's annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn't change. CONCLUSION: Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.


Assuntos
Diabetes Mellitus , Gastos em Saúde , Humanos , Assistência Ambulatorial , Diabetes Mellitus/terapia , China , Aceitação pelo Paciente de Cuidados de Saúde , Avaliação de Resultados em Cuidados de Saúde
19.
Artigo em Inglês | MEDLINE | ID: mdl-36361491

RESUMO

The objective of this study was to analyze the indicators of access and use of health services in people with diabetes mellitus. This study used data from the National Health Survey, conducted in Brazil in 2013. The National Health Survey was carried out with adults aged 18 years or older residing in permanent private households in Brazil. Indicators from 492 individuals with self-reported diabetes mellitus living in the Central-West region of the country were analyzed. Item response theory was used to estimate the score for access to and use of health services. Multiple linear regression was used to analyze factors associated with scores of access and use of health services by people with diabetes mellitus. The mean score of access estimated by the item response theory and use estimated was 51.4, with the lowest score of zero (lowest access and use) and the highest 100 (highest access and use). Among the indicators analyzed, 74.6% reported having received medical care in the last 12 months and 46.4% reported that the last visit occurred in primary care. Only 18.9% had their feet examined and 29.3% underwent eye examinations. Individuals of mixed-race/skin color and those residing outside capital and metropolitan regions had lower access and use scores when compared to white individuals and residents of state capitals, respectively. The study shows several gaps in the indicators of access and use of health services by people with diabetes. People of mixed race/skin color and residents outside the capitals and metropolitan regions had lower scores for access and use, suggesting the need to increase health care in these groups.


Assuntos
Diabetes Mellitus , Acesso aos Serviços de Saúde , Adulto , Humanos , Serviços de Saúde , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Inquéritos Epidemiológicos , Brasil/epidemiologia
20.
Int J Mol Sci ; 23(21)2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36361633

RESUMO

Diabetes mellitus (DM) is a complex metabolic disease with many specifically related complications. Early diagnosis of this disease could prevent the progression to overt disease and its related complications. There are several limitations to using existing biomarkers, and between 24% and 62% of people with diabetes remain undiagnosed and untreated, suggesting a large gap in current diagnostic practices. Early detection of the percentage of insulin-producing cells preceding loss of function would allow for effective therapeutic interventions that could delay or slow down the onset of diabetes. MicroRNAs (miRNAs) could be used for early diagnosis, as well as for following the progression and the severity of the disease, due to the fact of their pancreatic specific expression and stability in various body fluids. Thus, many studies have focused on the identification and validation of such groups or "signatures of miRNAs" that may prove useful in diagnosing or treating patients. Here, we summarize the findings on miRNAs as biomarkers in diabetes and those associated with direct cellular reprogramming strategies, as well as the relevance of miRNAs that act as a bidirectional switch for cell therapy of damaged pancreatic tissue and the studies that have measured and tracked miRNAs as biomarkers in insulin resistance are addressed.


Assuntos
Diabetes Mellitus , Resistência à Insulina , MicroRNAs , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Medicina de Precisão , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/genética , Diabetes Mellitus/terapia , Biomarcadores/metabolismo , Resistência à Insulina/fisiologia
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