Diabetology

3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is to deliver more effective solutions with respect to the consolidated processes to reduce compressive risk forces at specific plantar foot sites. Clinical studies are, however, still limited, at least in peer-review journals. Additionally, in Italy, the manufacturing process of these medical devices has not been formally integrated yet into the list of care processes approved for reimbursement by the public healthcare service. Within the Italian DIAPASON project (DIAbetic PAtients Safe ambulatiON), a feasibility pilot study has been conducted in the territory on 21 patients with diabetic foot complications to assess the pros and cons of an innovative process. The process, which relies on in-shoe pressure measurements and on a patented 3D modeling and printing procedure, includes the prescription, design, manufacturing and testing of 3D-printed personalized insoles. The process has been tested in an ambulatory setting and showed the potential to be also implemented in community settings. In this paper, we report a case study on a single volunteer, and we describe and comment on how the whole process has been proven safe and suitable for the purpose. Full article

Diabetes is an independent risk factor for cognitive impairment, with the latter presenting challenges for diabetes self-management and glycemic control in individuals with type 2 diabetes. Predicated on the theory of unpleasant symptoms, the purpose of the current narrative review of the literature was to identify etiologic factors that influence cognitive impairment as a precursor to dementia in individuals with diabetes. Physiological, psychological, and situational factors were recognized as important life course components of cognitive impairment in later adulthood. Developing interventions targeting modifiable factors is warranted in preventing cognitive impairment in adults with diabetes. Full article

Background: There is limited evidence on the association between chronic kidney disease (CKD) and frailty in older people in Vietnam. This study aimed to investigate the prevalence of frailty and its impact on mortality in older patients with end-stage renal disease. Method: This is a prospective, observational study performed at two large Dialysis Centres in Vietnam from November 2020 to June 2021. Consecutive older patients diagnosed with end-stage renal disease and on haemodialysis were recruited. Participants’ frailty status was defined by the Clinical Frailty Scale (CFS). The study outcome was all-cause mortality at the sixth month. Results: A total of 175 participants were recruited (mean age 72.4 years, 58.9% female). Using the cut point of CFS ≥ 4, 87.4% of the participants were frail. Mortality at the sixth month was 14.9%, 31.9% in participants with CFS ≥ 7, 12.8% in participants with CFS = 6, 7.5% in participants with CFS from 4 to 5, and 4.5% in participants with CFS ≤ 3 (p = 0.001). Cox regression analysis showed that, compared with the non-frail participants, the probability of death over 6 months was nearly two-fold higher in the mildly frail, three-fold higher in the moderately frail, and nine-fold higher in the severely frail participants. Conclusions: This study demonstrated a very high prevalence of frailty in older patients with end-stage renal disease and dialysis and the significant impact of frailty severity on mortality. Healthcare providers should consider incorporating frailty screening into routine care for older patients with end-stage renal disease and dialysis. Full article

Background: Tissue healing consists of four main phases: coagulation, inflammation, proliferation, and remodeling. In diabetic patients, this process is stagnant in the inflammatory stage, leading to chronic wounds. The aim of this study is to evaluate in an animal model the biological evidence related to the use of the Rigenera^® technology (Turin Italy), an innovative mechanical procedure to isolate autologous micrografts (AMG). Methods: Fifty male Wistar rats were divided into four groups: control (C), control treated with micrografts (CM), diabetic (DB), and diabetic treated with micrografts (DBM). The experimental setup involved: the quantification of the total collagen and elastic fibers; histopathological analysis; immunohistochemical analysis for collagen type I (COL1), collagen type III (COL3), vascular endothelial growth factor (VEGF-A), and interleukin 4 (IL4) and 10 (IL10); evaluation of the oxidative stress; measurement of gluthatione (GSH); and, finally, an enzyme-linked immunosorbent assay (ELISA) on tumor necrosis factor-α (TNF-α). Results: The AMG technology induces a faster healing process: VEGF-A, IL4, IL10, and GSH increased, while TNF-α and oxidative stress decreased. Conclusions: Animals treated with micrografts showed more favorable results for healing compared to those that did not receive treatment, demonstrating a positive participation of the micrografts in the treatment of difficult-to-heal wounds. Full article

Through a partnership with three Federally Qualified Health Centers (FQHCs), the local health department in Los Angeles County implemented a produce prescription program (PPR) to increase fresh fruit and vegetable purchases among patients with diabetes or prediabetes. The PPR, which began in 2020, provided eligible patients with a USD 40 voucher every month for 6 months to promote the purchase of fresh produce at large-chain grocery stores. To address gaps in current practice and program delivery, this qualitative assessment describes staff experiences with the PPR, documenting the facilitators and barriers they encountered while implementing the program. Fifteen clinic staff (i.e., PPR implementers) were interviewed for this assessment. Thematic analysis and coding were conducted using the ATLAS.ti software; the coding was carried out by two separate coders. Interviewees discussed the importance of having preexisting partnerships and programs to support the PPR at their clinic site. Hidden costs related to implementing the program included a large and unexpected amount of staff time devoted to enrolling patients into the program. Collecting quality data and having limited expertise to rigorously evaluate the program were other challenges. Because patients often share their food with their family, the monthly USD 40 incentive was generally not enough to support their needs; interviewees suggested giving a higher inventive amount to those with a larger household. Future PPR efforts and similar food incentive programs should consider these and other facilitators and barriers to implementation and sustainability, especially when making adjustments to these programs to improve services and access to food resources. Full article

Type 2 diabetes (T2D) is a growing global health problem that requires new and effective prevention and management strategies. Recent research has highlighted the role of epigenetic changes in the development and progression of T2D, and the potential of functional foods as a complementary therapy for the disease. This review aims to provide an overview of the current state of knowledge on the preventive epigenetic mechanisms of functional foods in T2D. We provide background information on T2D and its current treatment approaches, an explanation of the concept of epigenetics, and an overview of the different functional foods with demonstrated preventive epigenetic effects in T2D. We also discuss the epigenetic mechanisms by which these functional foods prevent or manage T2D, and the studies that have investigated their preventive epigenetic effects. In addition, we revisit works on the beneficial influence of functional foods against the programming and complications of parentally-triggered offspring diabetes. We also suggest, albeit based on scarce data, that epigenetic inheritance mechanistically mediates the impacts of functional nutrition against the metabolic risk of diabetes in offspring. Finally, our review highlights the importance of considering the preventive epigenetic mechanisms of functional foods as a potential avenue for the development of new prevention and management strategies for T2D. Full article

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been linked to beneficial effects on cardiovascular risk factors, blood pressure, body weight, and lipid profile, according to a substantial body of literature. Significant cardiac and renal benefits with the use of SGLT2 inhibitors have been shown in patients with type 2 diabetes, as well as in those with heart failure and/or chronic kidney disease (CKD), regardless of diabetes status, in subsequent large cardiovascular outcome trials. Thus, SGLT2 inhibitors have become a mainstay of therapy for type 2 diabetes in patients with established cardiovascular disease and CKD due to their benefits for the heart and kidneys. Based on data from randomized controlled trials and meta-analyses, this article attempts to present a thorough review of the mechanism of action, as well as the benefits of SGLT2 inhibitors for cardiac and renal protection. On the basis of a growing body of literature on diabetes and other conditions, clinical practice guidelines have been updated to suggest the use of SGLT2 inhibitors in specific patient populations. These modifications will also be concisely described, based on evidence-based medicine principles. Full article

Obesity and the intake of high-sugar diets have dramatically increased in recent decades. However, it is still uncertain how sugar intake during the critical development phase affects the long-term health of children. In this context, the Developmental Origins of Health and Disease (DOHaD) concept established a correlation between early life environment and the development of cardiometabolic diseases in adulthood. This review summarizes the current knowledge about the consequences of sugar intake during the critical development phase for the onset of non-communicable diseases (NCDs). We found evidence that increased sugar intake during pregnancy contributes to maternal obesity and many cardiometabolic dysfunctions in the offspring. Furthermore, dietary sugar during the suckling period provokes the obese phenotype in adulthood. Finally, high-sugar diet intake during childhood induces metabolic syndrome and depressive-like behavior. Full article

There is a need for a modified Global Physical Activity Questionnaire (GPAQ) to estimate physical activity levels more accurately in populations. We aimed to develop a modified GPAQ and examine its construct validity among adults in Kerala, India. We incorporated locality-specific, metabolic equivalent task (MET)-based activities into the original GPAQ and administered this modified GPAQ among randomly selected 451 individuals (age ≥ 20 years) residing in the Trivandrum district of Kerala. Construct validity of the modified GPAQ was assessed using generalized linear models by examining the association of total moderate-to-vigorous physical activity (MVPA) MET-minutes per week with clinical measures. The mean age of participants was 45.4 (SD: 14.1) years, and 52.6% were female. Increasing total MVPA MET-minutes per week was associated with decreasing weight (β = −0.011 kg, 95% CI: −0.020, −0.002), waist circumference (β = −0.013 cm, 95% CI: −0.023, −0.004), and systolic blood pressure (β = −0.009 mmHg, 95% CI: −0.015, −0.002), independent of age, sex, education, occupation, current smoking, current alcohol use, and fruit and vegetable intake. The validity coefficients and associations between total MVPA MET-minutes per week and theoretical constructs of physical activity agreed with those predicted, providing evidence of construct validity for the modified GPAQ. Full article

Plants have been used as sources of medicine since ancient times. Natural products have been used extensively in Chinese, ayurvedic and folk medicine. In addition, a significant portion of the world’s population still utilizes herbal medicine. Diabetes is a common ailment affecting almost 463 million people in the world. However, current medications exert harmful after-effects on patients, while herbal medicines have fewer adverse effects. Plants possess secondary metabolites, such as alkaloids, flavonoids, tannins, steroids, etc., which exert numerous beneficial effects on health. Extensive research has been conducted over the years investigating and proving the hypoglycemic potential of various plants. The present paper reviews 37 such plants that are rich in phytoconstituents that possess a variety of pharmacological activities and have been experimentally proven to possess potentially hypoglycemic properties in animal models: Ficus racemosa, Agremone mexicana, Bombax ceiba, Cajanus cajan, Coccinia cordifolia, Momordica charantia, Syzygium cumini, Neolamarckia cadamba, Mangifera indica, Cocos nucifera, Tamarindus indica, Punica granatum, Azadirachta indica, Costus speciosus, Moringa oleifera, Andrographis paniculata, Ficus benghalensis, Anacardium occidentale, Annona squamosa, Boerhaavia diffusa, Catharanthus roseus, Cocculus hirsutus, Ficus hispida, Terminalia chebula, Terminalia catappa, Amaranthus tricolor, Blumea lacera, Piper betle leaves, Achyranthes aspera, Kalanchoe pinnata, Nelumbo nucifera, Mikania cordata, Wedelia chinensis, Murraya koenigii, Aloe barbadensis, Bryophyllum pinnatum and Asparagus racemosus. These 37 plant extracts exhibit antidiabetic activities through different mechanisms, including α-amylase and α-glucosidase inhibition, increases in glucose uptake and the stimulation of insulin secretion. Full article

Regular consumption of dietary sugars can cause significant damage to the β-cells. Almost a century after the discovery of insulin, it has been suggested that the frequent consumption of certain carbohydrates can damage pancreatic β-cells, causing disturbances in the regulation of insulin secretion. Most noncommunicable diseases, such as diabetes, obesity, and hypertension have a common origin, metabolic dysfunction, which is partly due to β-cell malfunction. In this article, we believed that sugars can lead to an imbalance in cellular metabolism, causing insulin exocytosis to dangerously increase or decrease blood insulin concentrations. In this study, we describe the major mechanism of insulin secretion and discuss the effects of sugar on pancreatic β-cells. Although many environmental factors strongly influence β-cells, occidental diet, including excess sugar, has been found to be the predominant factor that kills or disrupts the functioning of the unique cells that produce, store, and secrete insulin. Full article

Individuals with type 2 diabetes mellitus (T2DM) are at an increased risk of cognitive dysfunction. Growing evidence supports the use of cognitive training to target cognitive dysfunction in T2DM, but only limited evidence exists surrounding its feasibility and acceptability. The primary aim of this research is to determine the feasibility and acceptability of a cognitive training study in T2DM. Adults diagnosed with T2DM were randomly allocated to either a 6-week cognitive training group or a usual care control group. Feasibility outcomes (recruitment, adherence, retention, motivation, data collection, and intervention design) were evaluated using a traffic light progression criterion. Qualitative interviews were conducted to explore study acceptability. Cognition was measured at baseline and post-intervention. Forty-one participants completed the study (age 66 ± 9.8 years; HbA1c 54.0 ± 13.3 mmol.mol). Feasibility was shown in the adherence, retention, and motivation of participants, whilst minor amendments were proposed to the study design, recruitment, and data collection. Participants described cognitive training as highly enjoyable, with study components broadly reported as acceptable. Data signalled improvements in cognition, with large improvements observed in executive function. This study provides evidence for the potential feasibility, acceptability, and efficacy for cognitive training in T2DM. Recommendations for future studies are provided. Full article

The metabolic syndrome (MetS), first introduced by Haller in 1975, was sometimes also known as insulin resistance syndrome, syndrome X, and plurimetabolic syndrome. In 1989, it was rechristened by Kaplan as the “Deadly Quartet” based on a consolidation of central obesity, impaired glucose tolerance, dyslipidemia, and systemic hypertension. MetS is positively associated with a pro-inflammatory and pro-thrombotic state, attributed to increased pro-thrombotic and inflammatory marker activity. Moreover, MetS is frequently associated with increased atherosclerotic cardiovascular disease, impaired glucose tolerance, hyperuricemia, obstructive sleep apnea, and chronic kidney disease. Despite concerted endeavors worldwide, the complexity of the pathophysiology of metabolic syndrome still needs to be clearly understood. Currently, therapeutic possibilities are confined to individual therapy for hyperglycemia, hypertension, hypertriglyceridemia, hyperuricemia, regular physical exercise, and a restricted diet. In this review, progress regarding the understanding and pathophysiology of MetS; recent emerging technologies, such as metabolomics and proteomics; the relation of MetS with obesity, diabetes, and cardiovascular diseases; and the association of MetS with COVID-19 are discussed. Full article

Approximately half of all people with diabetes are women; however, the inclusion of women at all levels of research on diabetes is lacking. Clinical and pre-clinical trials do not have gender equity despite the differing progression of diabetes complications in women, and fewer women sit in academic or clinical leadership positions in diabetes than men. Whilst this scenario is not unique to diabetes, the purpose of this opinion article is to evaluate women’s position in diabetology and focus on why the drive for gender equity at all levels is important. This article serves as a preface to the upcoming Diabetology Women’s Special Issue Series, which aims to highlight and celebrate the achievements of women and people who identify as women in the hope of raising female voices in diabetes research and practice. Full article

The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how to prevent them and minimize their effects, thus contributing to complete rehabilitation. Experts and scientific societies have produced consensus documents and recommendations to spread the culture of LH and its complications among clinicians. However, they should go deeper into LH detection methods. This short article analyzes the recent literature on the best way to explore and find more or less evident LH lesions by using a structured and validated clinical methodology to benefit the many clinicians without access to technological equipment such as ultrasonography. This text also aims to bring awareness that since the last published recommendations on injection techniques, new needles for insulin injection, more technologically advanced and suitable for specific populations, have come to market but still need a thorough evaluation. Full article

Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This cross-sectional study surveyed parents of schoolchildren with type 1 diabetes aged 6 to 16 years in Denmark. The parents were identified among members of the Danish Diabetes Association and were invited to complete an online questionnaire. A total of 252 parents of schoolchildren with type 1 diabetes answered the questionnaire. Only 28% of the children had a designated staff member responsible for support in diabetes self-care during school hours. Having a designated staff member responsible for support in self-care was positively associated with parental experiences of better school–parent cooperation (p < 0.001), better experience of diabetes management in school (p < 0.001), and larger proportions of children and parents feeling comfortable in school (p = 0.022 and p = 0.049, respectively). School staff support was positively associated with better parental experience of diabetes management and with some parameters of mental health in schoolchildren with type 1 diabetes and their parents in Denmark. Full article

Despite evolution in treatment options and improved understanding of pathophysiology, the treatment of type 2 diabetes remains unsatisfactory. Current management guidelines complicated by clinical inertia have resulted in over half of patients failing to meet glycemic targets. Expert consensus has defined a state of diabetes remission whereby treatment can induce sustained normalization of glucose levels. Evidence suggests that metabolic surgery, intensive lifestyle modification, and pharmacologic approaches are each viable options for achieving remission when implemented early in the disease course. The authors review each of these strategies and include practical considerations to aid in the pursuit of remission. Full article