Search Results (10,955)

Background and Objectives: Diabetes mellitus is a prevalent chronic disease caused by inadequate insulin secretion or ineffective insulin response, leading to complications such as retinopathy, nephropathy, heart attacks, and strokes. Recently, “diabetes distress (DD)” has emerged as a concept, highlighting the significant emotional burden of managing diabetes, which can impact disease outcomes. Thus, this study evaluates the impact of virtual clinics on diabetes distress and glycemic measures in individuals with diabetes mellitus. Materials and Methods: A cross-sectional study was conducted between May and August 2024 at the Endocrine and Diabetes Center in Alahsa, Saudi Arabia, targeting persons aged 18 and older with diabetes who had engaged in-person clinics, virtual clinics, or both between 2019 and 2024. Data were collected through structured phone interviews, supplemented by laboratory results from clinical records. The survey included demographic details, diabetes information, and the Diabetes Distress Scale. Statistical analyses, including descriptive statistics, were performed to explore the relationships between diabetes distress, clinic visit type, and glycemic control, with Mann–Whitney and Chi-Squared tests used to compare variables between two groups. Results: Of the 108 participants, 55.6% were male, with a mean age of 38.5 years. Type 2 diabetes was reported in 51.9% of individuals, while 48.1% had type 1. High emotional burden (44.4%) and regimen-related distress (28.7%) were prevalent, particularly among individuals with suboptimal glycemic control. While virtual visits were not significantly correlated with lower distress levels, individuals with suboptimal glycemic control exhibited significantly higher diabetes distress across various domains, including emotional and regimen-related distress (p < 0.05). Laboratory analysis showed a median HbA1c of 8.2%, with poor control associated with greater distress. Conclusions: Diabetic individuals with suboptimal glycemic control report higher diabetes distress levels, underscoring the need for integrated psychological support in DM care. Although virtual clinic visits did not significantly reduce distress, they provide a feasible option for individual follow-up. Full article

Numerous factors contribute to COVID-19 symptoms, with individuals who have pre-existing health conditions at the highest risk for severe SARS-CoV-2 infection. This study investigated the socio-demographic and comorbidity profiles within a large Turkish population diagnosed with SARS-CoV-2, including 47,875 patients diagnosed between March 2020 and May 2022 across six hospitals in different Turkish cities. Patients with SARS-CoV-2 confirmed via laboratory tests and presenting symptoms were included. The data collected covered socio-demographic details, infection onset dates, COVID-19 symptoms, pre-existing health conditions, radiological findings, treatments, disease progression, and relevant variables. A total of 47,875 files were included in the analysis. The median age was 43.7 years, with 84.5% testing positive for PCR SARS-CoV-2, often correlating with severe symptoms. Notably, 11.8% of the participants exhibited mild symptoms, and approximately 12.8% had comorbidities, increasing to 17.6% among severe cases. Females with PCR-positive COVID-19 had a comorbidity rate of 13.8%, compared to 12.5% in males. Among the patients with comorbidities, those aged 70 and above had the highest rates, at 22.1% (n = 1103). The most prevalent comorbidity was hypertension, followed by diabetes and cardiovascular diseases. Severe cases had a significantly higher prevalence of comorbidities (58.4%) compared to non-severe cases (27.6%). We hope that the evaluation of our findings will contribute to the research and treatment processes of the COVID-19 outpatients. Full article

Chronic inflammation is a confirmed risk factor for colorectal cancer (CRC). Indicators of systemic inflammatory response (SIR), such as neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR), are easily accessible indicators of the generalized inflammatory response. At the molecular level, inflammation-related carcinogenesis involves proteins from the adamalysin family: ADAM10 and ADAM17. The aim of the study was to assess NLR and PLR and their relationship with selected clinical parameters in CRC patients, as well as the correlation between ADAM10 and ADAM17 in tumor tissue and matched surgical margins with NLR and PLR values. Tumor tissue material matched surgical margins, and blood was collected from 66 patients who underwent surgery because of CRC. The concentrations of ADAM10 and ADAM17 in the collected material were tested using the enzyme-linked immunosorbent assay (ELISA) method. SIR parameters (NLR, PLR) were also determined. The results were statistically analyzed and compared with selected clinical parameters. Results: The study showed that PLR was lower in patients with comorbid cardiovascular diseases (CVD). In patients who underwent preoperative treatment, both the NLR and PLR values were higher than in patients who underwent primary surgery. There was also a negative correlation between ADAM17 concentrations in the surgical margin and PLR values. In conclusion, the presence of additional diseases such as CVD or diabetes mellitus type 2 (DMT2) or the use of preoperative treatment should be taken into account when assessing SIR parameters in CRC patients. Moreover, no clear correlations have been found between ADAM10 and ADAM17 and SIR parameters. Full article

Background: In this study, we describe a method by which a patient can independently assess their own periodontitis risk, for example, at home, with a mobile application. The aim of the study is to use active matrix metalloproteinase aMMP-8 mouth rinse cut-off 20 ng/mL point-of-care testing (POCT) and a polynomial function to reveal patients’ statistical risk of periodontitis. Methods: The polynomial function presented in this study was modeled with multiple logistic regression and the function estimates the risk of periodontitis using a probability measure. To investigate variables associated with periodontitis, we used data from adult patients visiting dental clinics in Thessaloniki, Greece. Results: The research results revealed that with appropriate information it is possible to obtain sufficient accuracy about a patient’s potential risk of periodontitis. The function for estimating risk of periodontitis is PERIORISK = (1 + e^{−(3.392×X1+0.002×X2+1.858×X3−9.151)})⁻¹, where X1 = aMMP-8 test result and tobacco smoking status, X2 = age × waist circumference and X3 = patient’s individual and parental history of diabetes. Conclusions: The prediction of periodontitis risk using an aMMP-8 test and a polynomial function seems to be a useful, non-invasive, safe-to-use and cost-effective tool for all people. Overall, in the model created, mouth rinse cut-off 20 ng/mL aMMP-8 test result, age, waist circumference, tobacco smoking status and patient’s individual and parental history of diabetes were found to be good factors explaining the risk of periodontitis. Full article

Extrapulmonary tuberculosis (EPTB) accounts for approximately 17% of all Mycobacterium tuberculosis (M.tb) infections globally. Immunocompromised individuals, such as those with HIV infection or type 2 diabetes mellitus (T2DM), are at an increased risk for EPTB. Previous studies have demonstrated that patients with HIV and T2DM exhibit diminished synthesis of glutathione (GSH) synthesizing enzymes. In a murine model, we showed that the diethyl maleate (DEM)-induced depletion of GSH in the lungs led to increased M.tb burden and an impaired pulmonary granulomatous response to M.tb infection. However, the effects of GSH depletion during active EPTB in the liver and spleen have yet to be elucidated. In this study, we evaluated hepatic GSH and malondialdehyde (MDA) levels, as well as cytokine profiles, in untreated and DEM-treated M.tb-infected wild-type (WT) C57BL/6 mice. Additionally, we assessed hepatic and splenic M.tb burdens and tissue pathologies. DEM treatment resulted in a significant decrease in the levels of the reduced form of GSH and an increase in MDA, oxidized GSH, and interleukin (IL)-6 levels. Furthermore, DEM-induced GSH decrease was associated with decreased production of IL-12 and IL-17 and elevated production of interferon-gamma (IFN-γ), tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β. A significant increase in M.tb growth was detected in the liver and spleen in DEM-treated M.tb-infected mice. Large, disorganized lymphocyte infiltrates were detected in the hepatic tissues of DEM-treated mice. Overall, GSH diminishment impaired the granulomatous response to M.tb in the liver and exacerbated M.tb growth in both the liver and spleen. These findings provide critical insights into the immunomodulatory role of GSH in TB pathogenesis and suggest potential therapeutic avenues for the treatment of extrapulmonary M.tb infections. Full article

Type 2 diabetes mellitus (T2DM), a prevalent chronic disease affecting over 400 million people globally, is driven by genetic and environmental factors. The pathogenesis involves insulin resistance and β-cell dysfunction, mediated by mechanisms such as the dedifferentiation of β-cells, mitochondrial dysfunction, and oxidative stress. Treatment should be based on non-pharmacological therapy. Strategies such as increased physical activity, dietary modifications, cognitive-behavioral therapy are important in maintaining normal glycemia. Advanced therapies, including SGLT2 inhibitors and GLP-1 receptor agonists, complement these treatments and offer solid glycemic control, weight control, and reduced cardiovascular risk. Complications of T2DM, such as diabetic kidney disease, retinopathy, and neuropathy, underscore the need for early diagnosis and comprehensive management to improve patient outcomes and quality of life. Full article

Background and Objectives: Urinary tract infection (UTI) is a common comorbidity in diabetic patients, making up one of the causes of sepsis. This study aims to develop a nomogram to predict the risk probability of sepsis in diabetic patients with UTI (DPUTIs). Materials and Methods: This is a retrospective observational study. Clinical data for DPUTIs were extracted from the Medical Information Mart for Intensive Care IV database. Eligible DPUTIs were randomly divided into training and validation cohorts in a 7:3 ratio. Independent prognostic factors for sepsis risk were determined using least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression. A corresponding nomogram based on these factors was constructed to predict sepsis occurrence in DPUTIs. The discrimination of the nomogram was assessed by multiple indicators, including the area under the receiver operating characteristic curve (AUC), net reclassification improvement index (NRI), and integrated discrimination improvement (IDI). In addition, a calibration curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Results: A total of 1990 DPUTIs were included. Nine independent prognostic factors were identified as predictive factors for sepsis risk in DPUTIs. The prognostic factors included urine red blood cell classification (urine RBC cat), urine white blood cell classification (urine WBC cat), blood glucose, age, temperature, white blood cells (WBCs), sequential organ failure assessment (SOFA) score, lymphocytes, and hematocrit. The AUC, NRI, and IDI of the nomogram indicated robust discrimination. The calibration curve and Hosmer–Lemeshow test showed good calibration of the nomogram. The DCA curve demonstrated a better clinical utility of the nomogram. Conclusions: The nomogram established in this study helps clinicians predict the probability of sepsis in DPUTIs, providing evidence for optimizing the management of related risk factors. Full article

Background/Objectives: Obesity is heterogeneous and considered a chronic epidemic with significant un-met needs for management, treatment, and prevention. Methods: In this study, we used LizAI’s software TAITAN (alpha version) for the mega-collection and analysis of clinical data from 10,407 trials addressing obesity and obesity-related diseases and their associated publications, mainly on PubMed. Results: We report an intensive growth of clinical trials until the end of 2024 and highlight the use of the body mass index (BMI) as a critical criterion in clinical participant selection despite its limitations. The significant disparities in races, regions, and the sites of trials across all studies have not been addressed, posing the possibility of research in the far future on the applications of precision medicine in weight management. In the latter parts of this paper, we analyze and discuss the clinical efficacy, mainly focusing on the primary endpoints and benchmarks of the recently FDA-approved once-weekly injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) drugs, including semaglutide and tirzepatide. Both drugs have functioned comparably when considering the 5% weight loss FDA threshold. Tirzepatide outperforms semaglutide and impacts fewer participants as the weight loss level increases from 5 to 20% and has greater effects in different populations, especially in people with type 2 diabetes (T2D). Conclusions: We would, however, like to highlight that (i) the weight loss level should be dependent on the clinically relevant needs of patients, and faster and greater weight loss might not be a win, and (ii) the clinical benefits, safety, and quality of life of patients should be carefully assessed when the weight loss is significant in a short period. In our search, we found that the specificities and impacts of weight loss therapies on organs like the kidneys and heart, different muscle types, bones, and fat accumulation in different parts of body were not investigated or disclosed during the clinical study period and longer term monitoring. In light of scientific needs and remarkable public interest in weight loss, our report provides findings on the buzz around losing weight in clinical trials, and our TAITAN software continues to collect data in real time and enrich its knowledge for future updates. Full article

Diabetic foot syndrome is a multifactorial disease involving different etiological factors. This syndrome is also insidious, due to frequent lack of early symptoms, and its prevalence has increased in recent years. This justifies the remarkable attention being paid to the syndrome, although the problem of effective early screening for this syndrome, possibly at a patient’s home, is still unsolved. However, some options appear available in this context. First, it was demonstrated that the temperature measurement of the foot skin is an interesting approach, but it also has some limitations, and hence a more effective approach should combine data from temperature and from other sensors. For this purpose, foot skin conductance or bioimpedance measurement may be a good option. Therefore, the aim of this study was to review those studies where skin conductance/bioimpedance measurement was used for the detection of diabetic foot syndrome. In addition, we performed a meta-analysis of some of those studies, where a widely used device was exploited (SUDOSCAN^®) for foot skin conductance measurement, and we found that skin conductance levels can clearly distinguish between groups of patients with and without diabetic neuropathy, the latter being one of the most relevant factors in diabetic foot syndrome. Full article

Type 2 diabetes is a serious health problem worldwide. Metformin as the first-line drug in diabetes treatment mainly inhibits glucose production in the liver. Diabetes is often accompanied by other diseases, so patients may take many medications at the same time and have trouble controlling the therapy. This, in turn, may result in medications being stored in different, sometimes random places in the patient’s home where elevated temperatures or long-term exposure to solar radiation are possible. In this study, we aimed to analyze whether the total hemispherical reflectance and emittance values of metformin extended-release tablets would distinguish tablets stored correctly from those stored inconsistently with the manufacturer’s recommendations. Unexpired and expired extended-release tablets containing 750 mg metformin were tested. Unexpired tablets were analyzed in two ways i.e., 15 randomly selected tablets were stored as recommended (day 0), and the 15 next tablets in the blister were stored on a windowsill, where they were exposed to daylight for several hours during the day in mid-spring 2024 for 20 days (day 20). Total hemispherical reflectance (THR) was measured within seven spectral ranges from 335 nm to 2500 nm with a 410-Solar Reflectometer while emittance was analyzed within six spectral infrared ranges from 1500 nm to 21 microns with an ET 100 emissometer. The day 0 tablets showed the highest THR values in five spectral ranges from 400 to 1700 nm compared to expired and day 20 tablets. In the further infrared ranges, from 1.5 to 21 microns, unexpired tablets on day 0 had the lowest reflectance compared to day 20 tablets and expired tablets. This means that a greater amount of IR beam was absorbed by this type of tablet. Therefore, higher emittance was demonstrated by day 0 tablets than by other analyzed tablets. In addition, the emittance values for day 0 tablets decreased with increasing temperature. In conclusion, the storage of metformin extended-release tablets under unfavorable conditions may affect the physical structure of this drug form, which is manifested by changes in the reflectance and directional and hemispherical thermal emittance. Full article

Introduction and Aim: We performed a systematic review and meta-analysis to investigate the effects of exercise training on body composition and cardiometabolic health in patients with Type 1 diabetes (T1D). Method: A search in three main databases including PubMed, Web of Science, and Scopus was conducted from the inception of this review until June 2024 to identify randomized control trials investigating the effects of exercise training compared to a control on body composition and cardiometabolic risk factors in patients with T1D. The data were pooled using random effects models to calculate weighted mean differences (WMDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs). Results: Overall, 25 studies involving 1120 patients with T1D were included in the meta-analysis. Exercise training decreased body mass index (BMI) [WMD: −0.18 kg.m², p = 0.02], fasting glucose [WMD: −14.97 mg/dl, p = 0.01], and HbA1c [WMD: −0.49%, p = 0.003], and increased VO_2max/peak [WMD: 2.76 mL/kg/min, p = 0.001] as compared with controls. Exercise training had no effect on body fat percentage or lean body mass, lipid profiles, or blood pressure. Subgroup analysis indicated that age, exercise mode, and intervention duration were the main moderators for the beneficial effects of exercise training. Conclusions: In patients with T1D, exercise training is effective for decreasing body weight and cardiometabolic risk factors. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including dulaglutide, liraglutide, semaglutide, and exenatide, are effective treatments for type 2 diabetes mellitus (T2DM) and obesity. These agents mimic the action of the endogenous incretin glucagon-like peptide-1 (GLP-1) by enhancing insulin secretion, inhibiting glucagon release, and promoting weight loss through appetite suppression. GLP-1RAs have recently been suggested to have neuroprotective effects, suggesting their potential as treatment for neurodegenerative disorders, such as Alzheimer’s disease (AD). AD and T2DM share several common pathophysiological mechanisms, including insulin resistance, chronic inflammation, oxidative stress, and mitochondrial dysfunction. These shared mechanisms suggest that therapeutic agents targeting metabolic dysfunction may also be beneficial for neurodegenerative conditions. Preclinical studies on GLP-1RAs in AD models, both in vitro and in vivo, have demonstrated promising neuroprotective effects, including reductions in amyloid-beta accumulation, decreased tau hyperphosphorylation, improved synaptic plasticity, and enhanced neuronal survival. Despite the encouraging results from preclinical models, several challenges need to be addressed before GLP-1RAs can be widely used for AD treatment. Ongoing clinical trials are investigating the potential cognitive benefits of GLP-1RAs in AD patients, aiming to establish their role as a therapeutic option for AD. This review aimed to examine the current literature on preclinical and clinical studies investigating GLP-1 receptor agonists as potential therapeutic agents for AD. Full article

Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach. Full article

Background: Hemorrhoidal disease is a common anorectal condition characterized by the enlargement and distal displacement of the typical vascular structures in the anal canal. The relationship between DM, lipid metabolism, and hemorrhoidal disease remains underexplored. This study aims to investigate the prevalence of hemorrhoids and the association between glycemic control and lipid profile in diabetic patients. Methods: This retrospective cross-sectional study included 752 patients who underwent colonoscopy at Erzurum Regional Training and Research Hospital between June 2021 and August 2024. The study population comprised 452 patients with type 2 diabetes mellitus (mean age 63.4 ± 11.0) and 300 nondiabetic patients (mean age 62.8 ± 10.8). The presence of hemorrhoids was confirmed through colonoscopy. Glycemic control parameters, lipid profile, and other biochemical parameters were analyzed. Results: Hemorrhoids were found in 47.3% (n = 214) of diabetic patients and 17.3% (n = 52) of nondiabetic patients, indicating a significantly higher prevalence in the diabetic group (OR = 4.3, CI = 3.0–6.2, p < 0.001). Diabetic patients with hemorrhoids had significantly higher mean HbA1C (8.1 ± 2.1 vs. 7.5 ± 1.8, p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride levels (p = 0.005) compared to those without hemorrhoids. Additionally, a longer duration of diabetes and higher hypertension prevalence were observed in the hemorrhoid group. Conclusions: The findings suggest that poor glycemic control and dyslipidemia are significantly associated with an increased prevalence of hemorrhoids in diabetic patients. These results highlight the importance of comprehensive management of diabetes, including lipid control, to potentially reduce the risk of hemorrhoidal disease. Full article

Background: Immune-mediated inflammatory diseases (IMIDs) are associated with chronic inflammation that may increase fracture risk; however, their impact within specific populations, such as those with type 2 diabetes mellitus (T2DM), remains unclear. This study aimed to evaluate the association between IMIDs and fracture risk, leveraging a large, high-quality population-based cohort of patients with T2DM. Methods: A total of 2,120,900 patients with T2DM without a previous history of fractures were enrolled from the nationwide health check-up database provided by the Korean National Health Insurance Service. The outcomes were overall, osteoporotic, non-osteoporotic, vertebral and hip fractures. Multivariable Cox proportional hazard regression analysis was performed to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) according to the presence of IMIDs. Results: The presence of ulcerative colitis (aHR: 1.31), rheumatoid arthritis (aHR: 1.19), ankylosing spondylitis (aHR: 1.32), and psoriasis (aHR: 1.14) were significantly associated with the risk of overall fractures. Compared with controls, patients with a single IMID (aHR: 1.18) and at least two IMIDs (aHR: 1.29) had a significantly increased risk of overall fractures, showing a dose–response relationship. Similar results were observed for osteoporotic, vertebral, and hip fractures. Conclusions: The presence of IMIDs in patients with T2DM was associated with an increased risk of fractures, particularly osteoporotic, vertebral, and hip fractures. This study highlights the significant impact of IMIDs on fracture risk within a diabetic population, emphasizing the need for careful monitoring and tailored management strategies. Full article