Diabetology, Volume 2, Issue 4 (December 2021) – 10 articles

Diabetic nephropathy (DN) is the main cause of chronic kidney disease in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Renal tubular lysosomal enzyme activities like N-acetyl-β-d-glucosaminidase (NAG) have been shown to increase in patients developing DN. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of NAG, as a preventional biomarker in the early stages of DN in patients with diabetes mellitus. Two impartial reviewers conducted a complete PubMed search until July 2021. A 2 × 2 contingency table was created for each trial and sensitivity and specificity were estimated using a bivariate random effects model. To pool data and estimate the area under the curve (AUC), the hierarchical summary ROC (hsROC) approach was utilized. Deek’s test was used to estimate publication bias. The meta-analysis included 21 studies that evaluated 2783 patients with T1DM and T2DM, as well as 673 healthy individuals. The AUC of urinary NAG (uNAG) ranged from 0.69 (95% CI: 0.65–0.73) to 0.89 (95% CI: 0.86–0.92). According to the results, NAG in urine can be considered as a potential and effective biomarker for predicting DN in diabetic patients (T1DM, T2DM). Full article

Dietary choices play a key role in insulin sensitivity among diabetes patients. An 8-week pilot study was conducted to evaluate whether a mostly plant-based dietary program will lead to improvement in biochemical markers in adults with diabetes. The dietary program included educational presentations, weekly cooking demonstrations and small group discussions. A sample of thirty-two adults with diabetes (types 1 and 2) were recruited and seventeen (53%) completed the study. Matched-pair tests and Fishers exact tests were used to compare the changes in means and proportion of the participants’ responses. There were changes in HbA1c, lipids, CRP (mg/L), cholesterol (mg/dL), HDL (mg/dL), triglycerides (mg/dL), LDL (mg/dL), non-HDL (mg/dL), Insulin (uIU/mL), AST (U/L), ALT (U/L), weight (lbs), systolic blood pressure (mmHg), diastolic (mmHg). The mean (std) age for the matched pair participant is 60.5 (11.35). Five type 1 and twelve type 2 diabetes patients showed a significant improvement in HbA1c (p = 0.001), weight (p = 0.002), intake of vegetables per day (p-value = 0.003), intake of plant-based protein (p-value < 0.001) and self-reported reduction in fatigue and improvement in energy levels. Our 8-week dietary program showed an improvement in biochemical markers and positive attitudes toward the adoption of plant-based diets. Full article

Background: The purpose of this study was to evaluate α-amylase inhibitory effects of hydroethanolic extracts of bark from Daniella oliveri, Sclerocarya birrea, Maranthes polyandra, and Pteleopsis suberosa to fight type-II diabetes. Methods: Compound extractions were performed by hydroethanol maceration followed by liquid-liquid fractionation with solvents. TLC profiling was carried out with different fractions. The inhibitory effects of plant extracts on α-amylase activity were determined using rice starch as a substrate. Results: TLC profiling of different fractions showed different phytochemical compounds. The hydroethanolic plant extracts exhibited dose-dependent inhibition of α-amylase. D. oliveri displayed competitive inhibition, M. polyandra and S. birrea showed uncompetitive inhibition and Pteleopsis suberosa exerted mixed-inhibition. M. polyandra extract exerted the highest inhibitory effect (IC50 = 0.5 mg/mL). Conclusions: The barks of M. polyandra exhibit a remarkable α-amylase inhibitory effect which can be a novel source of antidiabetic molecules. Full article

Background: Simple and less costly screening tools are needed to combat the rising non-communicable diseases epidemic. This study aimed to evaluate the utility of The Finnish Diabetes Risk Score (FINDRISC) as a screening tool for prediabetes, T2D, and metabolic syndrome (MetS) in a population of young adults in urban Mwanza, Tanzania. Methods: A cross-sectional community-based study was conducted among participants aged 18–35 years. The FINDRISC questionnaire was used to collect data and compute the FINDRISC scores for each participant. Socio-demographic, anthropometric, blood glucose, and lipid profiles data were collected accordingly. Results: A total of 259 participants were recruited into the study. The median age was 21 years (IQR 19–27), and more than half 60.2% (156) were females. In total, 32.8% (85) of the participants had at least a slightly elevated risk of developing T2D in 10 years’ time. Compared to the Oral Glucose Tolerance Test (OGTT), FINDRISC had a sensitivity and specificity of 39.1% and 69.2%, respectively (aROC = 0.5). The FINDRISC score significantly correlated with MetS (p = 0.001). Conclusion: In this study, FINDRISC has shown low sensitivity and specificity in the screening of pre-diabetes/T2D. However, it has potential utility in the screening of MetS in a young-adult population. Full article

Blood glucose monitoring systems (BGMS) are essential for the management of diabetic patients. Although International Organization for Standardization (ISO) 15197:2015 criteria require rigorous monitoring of BGMS devices before commercialization, manufacturing quality standards may decline after FDA or EU approval. This work aimed to demonstrate the accuracy and precision of two BGMS devices currently available on the market. A laboratory study was conducted from June to August 2021 using two BGMS devices. One hundred samples were collected and evaluated according to ISO 15197:2015 guidelines. Over 95% accuracy was achieved by both devices using stricter ISO criteria (at least 95% of values within ±10 mg/dL or ±10% of the results of the reference measurement procedure). Analysis of the error grid showed that 99.5% of the results were in zone A. Surveillance of the accuracy and precision of BGMS devices after FDA and EU approval is an essential procedure to help patients and physicians manage glycemia and determine an appropriate outcome and personalized approach to diabetes treatment. Full article

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm² in non-diabetic patients and 8.92 ± 0.9 mm² in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed. Full article

Chronic diseases have a negative impact on quality of life and perceived well-being. Depression tends to be more frequent in people with chronic diseases than the general population, and, for example, in diabetes, it has an incidence of two to three times higher and often remains under-diagnosed. The inability to control and predict the course of the disease exposes chronic patients to mood fluctuations which are often difficult to manage, also in virtue of the fact that in any chronic pathology a stabilization aimed at attenuating the symptoms or slowing the course is pursued, but it cannot tend to achieve complete healing. This fact of incurability for many subjects means the loss of control over their own body, in which the social and family role is also perceived as compromised and the experienced distress can result in the appearance of underlying disorders, both psychological or psychiatric. In this area, there is currently a great deal of focus on sex/gender differences. The aim of this article is to highlight these differences with regard to the emotional aspects that most affect the management of diabetic pathology. In this paper, we will underline a particularly underestimated eating disorder: diabulimia, then that the perception of itself is not only related to the sex assigned at birth, but also to the gender that is acquired during life, and we will also analyze the three phases related to the acquisition of gender identity during the evolutionary period. Finally, we will talk about the use of technology in diabetic patients (insulin pumps, continuous glucose monitoring variably integrated into each other) that might generate a series of psychological–behavioral reactions related to the integration between technology and body image and the experience of social acceptance of the individual, particularly in the evolution age. Full article

Background: To examine diabetes screening by sugar sweetened beverage (SSB) consumption levels among US adults who fall under the American Diabetes Association’s (ADA) recommended screening guidelines. Methods: Using 2017 Behavioral Risk Factor Surveillance System survey data, we determined screening estimates by SSB consumption levels for US adults who belong to the ADA’s two recommended screening groups: (1) <45 years with body mass index ≥25 kg/m² and (2) ≥45 years. Unadjusted and adjusted screening estimates by SSB consumption levels for each recommended screening group were obtained from logistic regressions. Results: Differences in screening by SSB consumption were primarily observed in the younger screening group (0 drinks/day: 64.5%, between 0 and 1 drink/day: 57.1%, ≥1 drink/day: 57.8%). Unadjusted (between 0 and 1 drink/day OR: 0.73 (95% CI: 0.56–0.96), ≥1 drink/day OR: 0.75 (95% CI: 0.56–1.01)) and adjusted (between 0 and 1 drink/day OR: 0.76 (95% CI: 0.57–1.00), ≥1 drink/day OR: 0.87 (95% CI: 0.64–1.18)) estimates show an association between SSB consumption and lower screening in younger individuals. Conclusions: SSB consumption was associated with lower diabetes screening receipt in the younger screening group. Additional research examining factors contributing to low screening among SSB drinkers in the younger screening group are needed to develop screening interventions for these individuals. Full article

Choline (Ch) is an essential molecule of substantial importance for the optimal development and function of several biological systems. Ch deprivation has been linked with abnormal fat metabolism, insulin resistance, and myocardial dysfunction. The current study provides evidence of an exacerbation of streptozotocin-induced cardiomyopathy in adult diabetic Wistar rats by dietary Ch deprivation through the administration of a Ch-deprived diet (CDD). Twenty-four adult male Wistar rats were randomly separated into four groups: control, diabetic (DM), choline-deprived through choline-deprived diet (CD), and diabetic choline-deprived (DM + CD). After five weeks of dietary intervention, myocardium echocardiographic and histological assessments were performed. Choline-deprived diabetic rats exhibited significantly slower heart rate, significantly higher myocardial ejection velocity and left ventricle wall tension index with a concomitant significant decreased LV posterior wall thickness as compared to diabetic rats fed on a standard diet. Moreover, histopathological evidence demonstrated an exacerbation of myocardial inflammation and fibrosis associated with significant up-regulation of VEGF expression in the diabetic rat myocardium as a result of Ch deprivation. The study’s findings are of particular significance since the examined experimental approach introduces a previously uncharacterised comorbidity simulation with regards to myocardial structure and functional profiling. Full article

Individuals with type 1 diabetes suffer from impaired angiogenesis, decreased capillarization, and higher fatigability that influence their muscular system beyond the detriments caused by decreased glycemic control. In order to combat exacerbations of these effects, the American Diabetes Association recommends that individuals with type 1 diabetes participate in regular resistance exercise. However, traditional resistance exercise only induces hypertrophy when loads of ≥65% of an individual’s one repetition maximum are used. Combining blood flow restriction with resistance exercise may serve as a more efficient means for stimulating anabolic pathways that result in increased protein synthesis and angiogenesis at lower loads, while also promoting better glycemic control. The purpose of this paper is to provide a review on the literature surrounding the benefits of resistance exercise, specifically for individuals with type 1 diabetes, and postulate potential effects of combining resistance exercise with blood flow restriction in this clinical population. Full article