Stroke in Patients with Diabetes: Is It Time to Expand Public Health Priority to Encompass High-Risk Patients with Increased Insulin Resistance?

Diabetes and stroke, with an interlinking aetiology, contribute to a growing cardiovascular disease burden and mortality around the world. Given the disproportionate prevalence and the burden of these conditions in the developing world, as well as the high risk of both Type 2 diabetes and cardiovascular disease carried by patients with metabolic syndrome, public health strategies are vital to mitigate the impact. Systematic approaches towards identifying undiagnosed patients in the community and building health systems around those targeted interventions have been implemented. However, growing evidence indicates potential for approaches to capture high-risk patients, such as those who suffer from pre-diabetes or increased insulin resistance, to provide early and optimal treatments, which could translate to population-level benefits, including reduced prevalence, disability, and disease burden.

Socio-demographic Determinants of Attendance in Diabetes Education Centres: A Survey of Patients’ Views

Introduction: Diabetes is a global medical condition associated with a huge human and financial cost. However, early detection and appropriate pharmacological and non-pharmacological interventions, such as structured patient education, are useful measures to reduce its impact. Although the benefits of educational intervention are well recognised as a key component of empowerment, motivating attendance in diabetes education centres remains problematic, and this has a negative impact on healthcare finances. Objective: This survey study sought to identify the socio-demographic determinants of attendance at diabetes education centres. Methods: A questionnaire survey of 207 patients from four diabetes education centres was conducted. Results: In predicting attendance from demographic variables, the regression analysis showed that the participants that were living alone are less likely to attend, while participants who have a flexible working environment are more likely to attend the sessions.

Screening for Heart Failure in Diabetes: A Way to Reduce Its Prevalence? A Proof of Concept of a Risk Assessment Tool

Background: Heart failure (HF) is underdiagnosed among patients with diabetes. Awareness is required to improve its management and to reduce its impact. Objectives: To suggest a risk assessment tool that could facilitate the early diagnosis of HF and even reduce its incidence by facilitating individualised management plans. Methods: Assess current medical literature, searching for parameters that indicate a higher risk of HF among the diabetic population. Results: Twenty-four parameters were found that could be the potential basis for a risk stratification tool. Conclusion: The concept of a risk stratification tool is presented. Work on validating will be required. It has the potential to affect the future management of patients with diabetes and to reduce the incidence and prevalence of HF in this population.

Disparities in Diabetes Care

Disparities in the distribution of diabetes health have been reported by social class, age, gender, and ethnicity and may arise from an interplay of biological, clinical, and non-clinical factors. As well as being morally wrong, these differences in outcome will have a significant adverse effect on a nation’s health. As a result, there have been international efforts to reduce inequalities, from the strategic organisation of healthcare to providers and patients themselves, with mixed effects. This article outlines the disparities in diabetes care and outcomes in different patient groups, and how the approach of integration of health and social care may help to overcome some of the adverse aspects of societal organisation that underpins disparities.

How to Manage Type 2 Diabetes Mellitus During the COVID-19 Pandemic: Let’s Hear the Patient’s Voice

Diabetes is one of the most significant comorbidities associated with COVID-19 susceptibility and severity, and recent statistics have identified that up to half of all individuals with COVID-19 have had diabetes. Over 90% of people with Type 2 diabetes mellitus are overweight or obese, and obesity itself increases the severity of COVID-19 and the risk of needing intensive care and ventilation. Careful glycaemic control improves outcomes for individuals with diabetes and also significantly reduces risks if they become infected with COVID-19. It is, therefore, essential that research focuses on effective ways in which to manage Type 2 diabetes mellitus during this global pandemic. What healthcare professionals focus their attention and resources on is also crucial to its niftiness and, considering that patient self-management is key to effective glycaemic control, it makes sense that healthcare practitioners call on the patient for some advice.

Disorders of Gastrointestinal Motility in Diabetes Mellitus: An Unattended Borderline Between Diabetologists and Gastroenterologists

Gastrointestinal (GI) symptoms represent an important and often poorly appreciated reason of morbidity in diabetes mellitus. Diabetes can affect nearly all parts of the GI tract; however, data on the prevalence of ‘diabetic gastroenteropathy’ are inconsistent. The significance of disturbed GI motility in diabetes across the patient spectrum and pathophysiological basis also remain inadequately defined. Fluctuating glucose levels, altered drug pharmacokinetics, variable absorption of nutrients, and impaired quality of life are important consequences of GI dysfunction. Diabetic gastroparesis is the best characterised manifestation of GI motility disorder in diabetes. Since there is a poor correlation between subjective GI symptoms and objective motility findings, a diagnosis of delayed emptying in diabetes requires a proper measurement of gastric emptying. There are fewer studies on intestinal motility in diabetes than those on the stomach. Several established modalities exist for the assessment of gastroenteropathy but the lack of standardisation, exposure to radiation, advanced data interpretation, and high cost limit their widespread use. While existing therapeutic choices for the management of diabetic gastroenteropathy are suboptimal, many potential novel agents are in progress. Both endocrinology and gastroenterology specialties working together will facilitate screening and treating patients with diabetes and GI dysmotility.

Fast Progression of Diabetic Retinopathy with SARS-CoV-2 Infection

COVID-19 is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has been shown to affect a multitude of organ systems. It is often associated with vasculitis or thromboembolic disease with resultant tissue hypoxia. This report presents a case of fast progression diabetic retinopathy in the case of a SARS-CoV-2 infection. The findings conclude that patients with diabetes should be more frequently monitored for emergence or progression of diabetic retinopathy if they present with COVID-19.

Reproductive Dysfunctions in Males with Type 2 Diabetes Mellitus: An Updated Review

Deterioration in reproductive functions is one of the most serious complications of Type 2 diabetes mellitus (T2DM). Neuropathy, angiopathy, oxidative stress, and psychological deviation are the important causative factors in developing reproductive dysfunctions in diabetes. In males, the principal complications are erectile dysfunction (ED), ejaculatory disorders, and functional hypogonadism. Low serum testosterone is frequently observed in males with T2DM but the neuroendocrine pathophysiology is yet to be defined; this reduction in testosterone levels decreases libido. Evaluation of testosterone levels of male diabetic patients with hypogonadism symptoms is recommended. Hypogonadal males with diabetes might benefit from testosterone replacement therapy. However, there is a need for adequately powered long-term studies in this context. Impairment in sexual function is a common complication in males with diabetes. The pathophysiology of sexual dysfunction in diabetes is multifactorial. Males with diabetes have a >3-fold increase in the risk of ED compared to their nondiabetic counterparts. Phosphodiesterase type 5 inhibitors should be considered as first-line therapy in males with T2DM and ED. Nearly 50% of male diabetic patients presented some degree of subfertility or infertility. Alterations in sperm parameters and hormone levels can contribute to diabetes-related male infertility. Endocrinologists, diabetologists, and physicians should address sexual complaints of their patients since these problems can significantly impair their quality of life.

Metformin: From Immediate Release to Extended Release Formula, Effectiveness, And Safety in Patients With Chronic Kidney Disease

Type 2 diabetes mellitus is currently the main cause of chronic kidney disease, leading to end-stage renal disease in most countries around the world. Metformin is the most commonly prescribed oral antihyperglycaemic in the world and after approval by the U.S. Food and Drug Administration (FDA) in 1994, it is currently recommended as the first-line pharmacological agent for newly diagnosed Type 2 diabetes mellitus by many professional diabetes associations. In this review, the authors analysed efficacy and safety of metformin in patients with chronic kidney disease.