scholarly journals Searching for additional markers of impaired iron metabolism in diabetes mellitus

2020 ◽  
Vol 66 (2) ◽  
pp. 61-70
Author(s):  
Nadezhda N. Musina ◽  
Tatiana V. Saprina ◽  
Tatiana S. Prokhorenko ◽  
Anastasia P. Zima
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Chronic Diseases ◽  
Iron Metabolism ◽  
Area Under The Curve

BACKGROUND: It is known that metabolic disorders in diabetes mellitus have a regulating effect on ferrokinetics, and therefore diabetes mellitus is often accompanied by various disorders of iron metabolism, both anemia and secondary iron overload. The main problem is timely and accurate differential diagnosis between anemia of chronic diseases and iron deficiency anemia. It is necessary to establish reliable laboratory markers of anemia of chronic diseases in order to solve this problem, as well as to understand what metabolic disorders can lead to the occurrence and aggravate the course of this type of anemia. AIMS: To study the frequency of occurrence of violations of ferrokinetics in patients with diabetes mellitus, as well as to establish clinical and biochemical correlations that are significant in the differential diagnosis of various disorders of iron metabolism: iron deficiency anemia, anemia of chronic diseases and dysmetabolic iron overload syndrome in diabetes mellitus. MATERIALS AND METHODS: The research design a single-stage observational single-center research. The research was conducted on the basis of the endocrinological clinic of the Federal State Budgetary Educational Institution of Higher Education Siberian State Medical University in Tomsk. The research included 76 patients with type 1 and type 2 diabetes mellitus. We conducted an assessment of all patients as follows: anthropometric data assessment; glycated hemoglobin study; creatinine level study with the calculation of glomerular filtration rate (GFR) using the CKD-EPI formula. We also evaluated the number of erythrocytes, reticulocytes, the hemoglobin concentration, haematocrit level and biochemical parameters of iron metabolism: serum iron and ferritin concentrations; the concentration of hepsidin and non-specific markers of inflammation: erythrocyte sedimentation rate (ESR) and highly sensitive C-reactive protein (CRP). RESULTS: 20 people (26.3%) of the 76 patients included in the study, had type 1 diabetes mellitus and 56 people (73.3%) had type 2 diabetes mellitus. The parameters of ferrokinetics did not significantly differ in patients with type 1 and type 2 diabetes mellitus, while in the group of patients with 20 patients (26.3%) from the 76 ones included into the research had type 1 diabetes mellitus and 56 (73.3%) from them had type 2 diabetes mellitus. The parameters of ferrokinetics did not significantly differ in patients with type 1 and type 2 diabetes mellitus, while in the group of patients with type 2 diabetes mellitus, the levels of CRP (p=0.034) and blood leukocytes (p=0.020) were significantly higher than in patients with type 1 diabetes mellitus. Both in the main group of patients with impaired carbohydrate metabolism, and in patients with type 2 diabetes mellitus, anemia of chronic diseases prevailed in the structure of the anemia syndrome. After dividing the main group of patients into groups by type of anemia syndrome: absence of anemia, anemia of chronic diseases and iron deficiency anemia, a comparative analysis of the average values of markers of inflammation and the level of hepsidin in these groups was performed. It was found that in patients with anemia of chronic diseases, the level of hepsidin is significantly higher than in patients without anemic syndrome (p=0.033). Paired correlation analysis showed a positive correlation of ESR with microalbuminuria (r=0.515; P0.0001), creatinine level (r=0.467; P0.0001) and negative with GFR (r= -0.436; P0.0001) and iron in serum (r=-0.276; p=0.017). As the result of ROC analysis the most informative in the diagnosis of anemia of chronic disease were: ferritin sensitivity 78%, specificity 52% with a diagnostic threshold of 75.5 ng/ml (area under the curve 0,695; p=0.006); ESR sensitivity 67%, specificity 64% with a diagnostic threshold of 15.5 mm/HR (area under the curve of 0.750 in; p=0.040) and the CRP sensitivity 67%, specificity 64% with a diagnostic threshold of 5.2 ng/ml (area under the curve 0,646; р0.0001). CONCLUSION: Thus, the studied markers of inflammation ESR and CRP, as well as hepsidin in combination with the classic diagnostic parameter ferritin, demonstrated high value in the diagnosis of anemia of chronic diseases and can be included in the modified algorithm for differential diagnosis of anemia syndrome in patients with diabetes mellitus.

scholarly journals Impact of diabetes type on treatment and outcome of patients with peripheral artery disease

2018 ◽  
Vol 15 (6) ◽  
pp. 504-510 ◽  
Author(s):  
Lars Richter ◽  
Eva Freisinger ◽  
Florian Lüders ◽  
Katrin Gebauer ◽  
Matthias Meyborg ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease

Background: The prevalence of diabetes mellitus and its associated complications such as peripheral artery disease is increasing worldwide. We aimed to explore the distinct impact of type 1 diabetes mellitus and type 2 diabetes mellitus on treatment and on short- and long-term outcome in patients with peripheral artery disease. Methods: Retrospective analysis of anonymized data of hospitalized patients covered by a large German health insurance. Assessment of patient’s characteristics (comorbidities, complications, etc.) and outcome using multivariable Cox regression and Kaplan–Meier curves. Results: Among 41,702 patients with peripheral artery disease, 339 (0.8%) had type 1 diabetes mellitus and 13,151 (31.5%) had type 2 diabetes mellitus. Patients with diabetes mellitus had more comorbidities and complications than patients without diabetes mellitus ( p < 0.001). Type 1 diabetes mellitus patients exhibited the highest risk for limb amputation at 4-year follow-up (44.6% vs 35.1%, p < 0.001), while type 2 diabetes mellitus patients had higher mortality than type 1 diabetes mellitus (43.6% vs 31.0%, p < 0.001). Conclusion: Although the fraction of type 1 diabetes mellitus among patients with peripheral artery disease and diabetes mellitus is low, it represents a subset of patients being at particular high risk for limb amputation. Research focused on elaborating the determinants of limb amputation and mortality in peripheral artery disease patients with diabetes mellitus is warranted to improve the poor prognosis of these patients.

scholarly journals Effects of Flash Glucose Monitoring on Dietary Variety, Physical Activity, and Self-Care Behaviors in Patients with Diabetes

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Satoshi Ida ◽  
Ryutaro Kaneko ◽  
Kanako Imataka ◽  
Kaoru Okubo ◽  
Yoshitaka Shirakura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring

The aim of this study was to evaluate the effects of flash glucose monitoring on dietary variety, physical activity, and self-care behavior in patients with diabetes. This study included outpatients with diabetes using insulin who presented at the Department of Diabetes and Metabolism of the Ise Red Cross Hospital. Before initiating flash glucose monitoring and 12 weeks after its initiation, blood glucose-related parameters were assessed and self-administered questionnaires were completed (Dietary Variety Score (DVS), the International Physical Activity Questionnaire (IPAQ), the Summary of Diabetes Self-Care Activities Measure (SDSCA), and the Diabetes Treatment Satisfaction Questionnaire (DTSQ)) and compared between the two time points. We analyzed 42 patients with type 1 diabetes mellitus and 48 patients with type 2 diabetes mellitus. In patients with type 2 diabetes mellitus, but not type 1 diabetes mellitus, there was an increase in moderate/high category scores for IPAQ (P<0.001) and for treatment satisfaction reported via DTSQ. Furthermore, in patients with type 2 diabetes mellitus, the glycemic excursion index improved significantly and HbA1c decreased significantly (from 7.7 (1.2) to 7.4 (0.8), P=0.025). Results showed that standard deviation and mean amplitude of glycemic excursions significantly decreased in patients with type 1 diabetes mellitus (from 71.2 (20.4) to 66.2 (17.5), P=0.033 and from 124.6 (31.9) to 108.1 (28.4), P<0.001, respectively). Flash glucose monitoring is a useful tool to improve physical activity in patients with type 2 diabetes.

scholarly journals Iron metabolism parameters and inflammatory status in patients with diabetes mellitus and dyslipidemia

2020 ◽  
Vol 17 (3) ◽  
pp. 269-282
Author(s):  
Nadezhda N. Musina ◽  
Tatiana V. Saprina ◽  
Tatiana S. Prokhorenko ◽  
Anastasia P. Zima
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lipid Profile ◽  
Carbohydrate Metabolism ◽  
Iron Metabolism ◽  
Inflammatory Status

Background: Investigating the inflammatory status and iron metabolism in patients with impaired carbohydrate metabolism seems quite relevant, while only few studies are devoted to the relationship between metabolic parameters, including lipid profile, inflammatory status indicators and the state of ferrokinetics in diabetes mellitus types 1 and 2 in a comparative aspect.Aims: To establish the direction of changes in the inflammatory status and the state of ferrokinetics in patients with type 1 and type 2 diabetes mellitus depending on lipid metabolism disorders.Materials and methods: The study included 48 patients with type 1 diabetes, 81 patients with type 2 diabetes; 11 people with obesity without impaired carbohydrate metabolism made up the comparison group, 17 healthy volunteers - the control group. Low-grade inflammation was assessed by the levels of high-sensitive C-reactive protein (CRP), tumor necrosisfactor-а (TNF-а), ferritin, and erythrocyte sedimentation rate (ESR). The state of iron metabolism was evaluated by the main hematological parameters (hemoglobin, red blood cell count, hematocrit), serum iron concentrations, transferrin, ferritin and hepcidin concentrations. In all patients lipid metabolism parameters, glycated hemoglobin, and microalbuminuria were measured.Results: Patients with type 1 and type 2 diabetes mellitus had significantly higher inflammatory markers concentrations-TNF-а, ESR, and CRP - in relation to obese patients without impaired carbohydrate metabolism and those in the control group. The highest production of TNF-а was observed in patients with type 1 diabetes mellitus (15.28 [12.41-24.41] pg/ml), whereas CRP (7.00 [3.00-11.85] ng/ml) and ESR (18.00 [9.00-27.00] mm/h) were higher in patients with type 2 diabetes. In the structure of the examined individuals with diabetes mellitus (regardless of its type), dyslipidemia type IIb in comparison with less atherogenic type IIa dyslipidemia was characterized by a higher production of CRP (6.9 [3.00-12.35] and 3.00 [1.80-8.70] ng/ml, respectively), ESR (20.00 [10.00-30.00] and 15.00 [5.00-24.50] mm/h, respectively) and ferritin (114.80 [48.90-196.45] and 50.90 [19.58-114.10] ng/ml, respectively). Compared to iron deficiency anemia, anemia of chronic diseases in diabetes mellitus patients was more often accompanied by dyslipidemia llb (χ2=2.743; p=0.098) and was characterized by a higher content of atherogenic fractions of cholesterol.Conclusions: Patients with type 2 diabetes mellitus and a more atherogenic dyslipidemia profile (type IIb) have a phenotype of the local inflammatory mesenchymal reaction of the liver with an increase in acute-phase proteins predominantly of hepatic origin (CRP, ferritin), whereas individuals suffering from type 1 diabetes and less atherogenic lipid profile (type IIa) have a phenotype of an autoimmune, genetically determined inflammatory response. It has been established that anemia of chronic diseases developing in the background of diabetes mellitus is associated with a more atherogenic lipid profile, compared with iron deficiency anemia.

scholarly journals Mortality in 98 Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus: Foot Ulcer Location is an Independent Risk Determinant

2021 ◽  
Author(s):  
Heather Schofield ◽  
Samantha Haycocks ◽  
Adam Robinson ◽  
Michael Edmonds ◽  
Simon G Anderson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Foot Ulcer

scholarly journals Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review

2020 ◽  
Vol 24 (28) ◽  
pp. 1-232
Author(s):  
Kirsty Winkley ◽  
Rebecca Upsher ◽  
Daniel Stahl ◽  
Daniel Pollard ◽  
Architaa Kasera ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Meta Analysis ◽  
Glycated Haemoglobin ◽  
Behavioural Therapy

Background For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. Objectives The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. Data sources The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. Review methods Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). Design Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. Setting Settings in primary or secondary care were included. Participants Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. Interventions The interventions used were psychological treatments, including and not restricted to cognitive–behavioural therapy, counselling, family therapy and psychotherapy. Main outcome measures Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. Results A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of –0.13 (95% confidence interval –0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval –0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of –0.21 (95% confidence interval –0.31 to –0.10), equivalent to reduction in glycated haemoglobin levels of –0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive–behavioural therapy are clinically effective and cognitive–behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive–behavioural therapy and counselling are effective and cognitive–behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. Limitations Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40–50% of studies. Conclusions This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. Future work Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. Study registration This study is registered as PROSPERO CRD42016033619. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.

scholarly journals Lung Function in Type 1 and Type 2 Diabetes Mellitus

2019 ◽  
Vol 4 (07) ◽  
Author(s):  
Dr. Srinivas Raju D. ◽  
Dr. Jagadesha CG
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Nasal Congestion ◽  
Adult Population ◽  
Respiratory Illness

Current estimates indicate that 8.3% of the adult population, or 71.4 million people, have diabetes in 2011, 61.3 million of whom are in India. The incidence rate for type 1 diabetes in India was frequently used in extrapolation for other countries in the region and therefore plays a pivotal role in the estimates. We evaluated the ventilatory function of type 1 diabetes mellitus and type 2 diabetes mellitus patients. Spirometry and DLCO conducted in patients who have never smoked, with no history of lower respiratory illness and at examination did not have any respiratory symptoms like nasal itching, nasal congestion, running nose, dry throat, hoarseness, epistaxis, sneezing, pain suggestive of sinusitis, cough, expectoration and dyspnea were included. DLCO <80% is statistically similar in two groups with P=0.431. Mean FEV1/FVC (measured %) according to Diabetic duration, diabetic treatment, diabetic complications and DLCO in Type II DM patents was significant. Spirometric values were consistently lower in subjects with Type 1 diabetes mellitus than in Type 2 diabetics. The effect on the FVC was even more pronounced in diabetics who had duration of disease longer than 5 years, and the effect was not explained by the difference in age alone. Subjects with poorer diabetic control have worse spirometric function. Non-enzymatic glycosylation of connective tissue, especially the collagen, may be responsible for reduced lung functions.

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