ABSTRACT

Diabetes is defined as a disease that has the blood glucose levels are too high. The foods after digestion gets converted to Glucose and then are absorbed in the liver to metabolise. The hormones Insulin secreted from pancreas helps to transport the glucose into the cells and provides energy (Wild , 2004). The term “immunity” was first medically used by a Dutch physician, Van Sweiten in 1775. He used the term “Immunitas” to refer effects seen by early attempts at variolisation (Moulin & Anne-Marie, 1989). The Merriam-Webster dictionary, states the definition of immunity as: “the quality or state of being immune, especially: a condition of being able to resist a particular disease especially through preventing development of a pathogenic microorganism or by counteracting the effects of its products”.

The Innate and Adaptive immune system affects the cellular functions chemotaxis, phagocytosis, and killing of pathogens by monocytes, macrophages, and neutrophils. And improvement in these functions can be seen when the Diabetes Mellitus is controlled and blood glucose levels normalize.

The nutrition is specially to kept in mind to reduce the Hyperglycemia and also immunity boosting foods be added in the daily diet. The present study will describe the Management of Diabetes Mellitus is effective with Nutritional Immunology.

ABSTRACT

Background

Diabetic foot ulcer (DFU) is the main risk factor for nontraumatic lower-limb amputation. We hypothesized that by reversing the offending local tissue factors resulting from the low tissue supply of oxygen, inefficient fuel metabolism and acidosis, we can eradicate the infection and help to promote healing. This might be enhanced with the help of an innovated local preparation (PEDYPHAR®) through its enriched alkaline ointment base and the regenerating growth factors of Royal Jelly (RJ) plus the antimicrobial, immune-modulatory nutritional and other biochemical properties of RJ and Panthenol. We conducted this study to test the safety and efficacy of PEDYPHAR ointment as an adjuvant in limb salvage management for patients with limb-threatening diabetic foot wounds.

Methods

A prospective, randomized, controlled open-label study design with a mean follow-up period of 12 weeks. One hundred and nineteen eligible patients with diabetic foot wounds presenting to 3 outpatient clinics in Egypt were randomized to be treated with the local application of either PEDYPHAR or Panthenol ointment under dressing after conservative debridement of necrotic tissue and irrigation with warm normal saline.

Results

At the end of the 12-week follow-up period, PEDYPHAR showed a higher rate of complete healing of limb-threatening wounds in the intent-to-treat population, 11 of 34 (32.4%) in PEDYPHAR-treated group versus 3/25 (12%) in the Panthenol-treated (control) group (p=0.034* [*indicates it is statistically significant]).

Conclusion

We can conclude that PEDYPHAR could be an effective and safe conservative local adjuvant treatment for cases of diabetic foot infection.

ABSTRACT

Background: The frequency of hyperglycemia in pregnancy is high in Bangladesh, but very little is known about the current knowledge and practice about the hyperglycemia in pregnancy in our practicing doctors.

Objective: To assess the knowledge and practice of the doctors across the country who are involved in the management of hyperglycemia in pregnancy.

Methods: Structured preformed data collection sheets were sent to the doctors who are taking care hyperglycemia in pregnancy (endocrinologists, obstetricians, and others) through email and postage. The questionnaire focused on their knowledge and practice pattern on hyperglycemia in pregnancy. In total, 950 doctors of Bangladesh were invited to join the survey, and 262 (24.89%) responded.

Result: Among the participants, 42.3% (111) were endocrinologists, 27.10% (71) obstetrician/gynecologist, and 30.53% (80) were other physicians, including internists, diabetes family physicians, etc. The majority of our doctors are aware of the adverse outcomes of hyperglycemia in pregnancy and advocates universal screening, follow ADA guideline, use insulin for the management of hyperglycemia in pregnancy, more than half prefer to continue metformin if it has been used for other causes, favored the caesarian section as the preferred method of delivery, half of the GDM mothers are lost to follow up after delivery.

Conclusion: Findings of this study may serve a baseline for the management of hyperglycemia in pregnancy. The doctors involved in the management of hyperglycemia in pregnancy require more training for knowledge building and improvement of rational practice.

ABSTRACT

The following principle is very effective for adjusting insulin doses.  Depending on when injected, each component of the insulin regimen has a maximal effect on a specific period of the 24 hour cycle, e.g., overnight, morning, afternoon, evening.  The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting.  A registered nurse trained to adjust insulin doses using this principle reduced HbA1c levels from 11.0% to 7.2% in 111 patients referred by their providers over 9-12 months of clinic visits.  FDA cleared computerized algorithms based on this principle produce a report within 30 seconds after glucose readings are downloaded that provide recommendations for insulin dose adjustments that the provider can modify or accept. These computerized algorithms were utilized in smaller studies in which glucoses were measured either remotely or by continuous glucose monitoring (CGM).  With remote monitoring (no clinic visits), a nurse practitioner lowered HbA1c levels from 10.0% to 7.6% in 6 months.  With CGM, a clinical pharmacist decreased time spent with glucoses >250 mg/dl from 44% to 23% and increased time in the target range of 70-180 mg/dl from 29% to 51% over a mean of 3 months.  HbA1c levels fell from 11.5% to 8.3%.  This innovative approach for adjusting insulin doses should improve diabetes control with subsequent beneficial effects on diabetes complications and resultant lowering of health care costs.

ABSTRACT

The design and effectiveness of m-health mobile-based self-care management and nutrition informatics interventions on type 2 diabetes mellitus at home settings

Methods: A systematic search of PubMed and Scopus) was conducted. Studies globally published in English from 2010 to 2020 and studies done in Type 2 diabetes and ages 18-75 were included in this. The intervention study such as Randomized controlled trials (RCTs) of mobile-based self-management interventions for type 2 diabetes patients and studies where charting of any of the patient-level outcomes was analyzed. The reviewer screened the studies and reviewed them with another reviewer independently. The data was extracted, and the quality of the studies was assessed. The scoping study methodology using the operational framework of Arksey, and O’Malley are used to present study outcomes and twenty-seven pointers PRISMA-SCR checklist is used Mobile based self-management interventions seem to have positive effects on self-care and management and pertinent outcomes for patients with type 2 diabetes mellitus. Overall progress in physiologic indicators, selfcare and improvement in quality of patient life with Type 2 Diabetes. Though, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Moreover, the results indicate a need for further research into self-management which includes nutrition informatics in self-care management regime, and it needs to focus on region wise availability of nutrition informatics. This will also help in the co-management of diabetes and cardiovascular disease. Self-management is an effective means of improving health outcomes in low- and middle-income countries (LMIC) and therefore mobile led selfcare management interventions with nutritional informatic can be advantageous. 

Self-care or Selfcare management in Chronic Care Management (CCM) can improve health outcomes and it has potential to reduce risk of diabetic complications. Use of Mobile phone-based technology or m-health interventions for various global programs focusing on selfcare management. There are numerous studies focusing on improving self-efficacy, self-care activities, health-related quality of life and clinical outcomes for patients. However, m-health applications developed are mostly clinical and does not focus on self-care aspect such as nutrition, diet, exercise along with testing of blood glucose level. The m-health application healthcare has the potential to improve support for patients with type 2 diabetes mellitus and it is important to improve patient outcomes by improving selfcare, comprehensive selfcare management and incorporating nutrition informatics, psychological support can assist patient to cope up with diabetes and by adhering to self-care activities. Most studies addressed healthy lifestyle behaviors like physical activity, testing of glucose. However, integrated management diabetes with management of signs and symptom and nutrition regime can the most challenging self-care behaviors for patients and can improve health outcome. Some of the incredible steps in the management and prevention of diabetes encompass turning research into the real world, collaborative efforts that involve physicians, empowering the community, and access to diabetes prevention and management efforts. The other steps include enhancement of healthcare access, collaborative efforts that involve diabetes educators, physicians, public health scientists, and nurses in the prevention and management efforts of the disease (Muralidharan et al., 2017). Mobile phone technology has presented a huge acceptance across different socioeconomic groups and ages and provides distinct prospects in healthcare that include prevention of Type 2 Diabetes and self-management. The future appears to lie within the mobile health applications (mHealth) that utilize entrenched technology to highlight enhanced utilization of smartphones to help in preventing and managing chronic disorders like diabetes type 2. A study conducted by Muralitharan, and co-researchers indicated that the use of mHealth alongside counseling showed a substantial enhancement in the management of Type 2 Diabetes. Additionally, it showed that diabetes coaching via mobile phones along with analyzed data that were presented to the physicians using evidence-based guidelines had a significant implication on glycemic control (Muralitharan et al., 2017). Despite the field of mHealth being new, with its wide adaptability and ubiquitous nature shows an incredible ability to counter the immense burse on costs of healthcare that stem from non-communicable illnesses. There is no doubt that an efficacious platform for diabetes type 2 is supposed to have a user interface that is visually appeasing, involve both the healthcare provider and user, can transfer data in real-time, and have the mean to inspire the users to consistently engage with the app. It has been evident that mHealth technology with the support given by healthcare experts can translate into enhanced patient outcomes for patients diagnosed with Diabetes Type 2. 

ABSTRACT

Conclusion: Serum cystatin C and microalbumin both could be considered as marker for early detection of nephropathy in T2DM patients. The more prominent rise in serum cystatin C values provides an earlier diagnosis of diabetic nephropathy among T2DM patients.

ABSTRACT

Metabolic syndrome is a group of risk factors that cause many diseases such as diabetes and heart disease.

There are many risk factors responsible for this syndrome, and the presence of 3 or more of them speeds up the process of predicting different diseases and the speed of treatment.

In addition to the nature of food and daily activity, metabolic syndrome has hormonal and non-hormonal causes. Among the hormonal causes is an imbalance in some hormones, especially thyroid hormones.

Where the majority of scientific studies have proven that the increased activity of TSH, a hormone secreted by the pituitary gland and stimulates the secretion of thyroid hormones, inhibits the process of metabolism and then leads to the accumulation of many substances, especially sugar, and this explains the close relationship between thyroid dysfunction and diabetes. The correct diagnosis may be the reason for developing a fruitful treatment strategy that addresses this hormonal error, so that will be a reason to get rid of excess glucose and eliminate diabetes, and this is what will be presented in this review.

ABSTRACT

This study was carried out to determine the effect of bee honey on blood glucose level of Sudanese type 2diabetic patients (non- insulin dependent) who were newly discovered. In this study, specific doses of honey or a mixture of sugars that represents the main sugars in honey (fructose, glucose, sucrose) in the same proportions as that found in the honey sample were used. Glucose doses were also given to diabetic patients and the effects on blood glucose levels were compared with honey and sugars mixtures. Forty one diabetic patients and 10 healthy non diabetic volunteers agreed to take part in the study. Blood samples were taken from all subjects before doses of sugars were given to determine the level of glycated hemoglobin (Hb A1c) and fasting blood glucose levels. Subjects were involved in 3 tests; in the first test, 29 patients were given 108g of honey (containing 75g of sugars) after taking fasting blood samples. Further blood samples were taken after 60, 120, and180 min. to determine the blood glucose levels. A week later, the same test was repeated with an equivalent dose, i.e a total of 75g, of sugars mixtures (fructose 41g, glucose 30.8g,sucrose 3.2g) instead of honey and blood glucose levels were determined at the time intervals mentioned above. The same test using honey (36g, which contained 25g sugars), or 25g of sugars mixture (containing 13.7g fructose, 10.3g glucose, and 1.1g sucrose) were repeated on 21 diabetic patients and 10 healthy volunteers enrolled as control. Comparison of the results of the above tests showed that, honey and sugars mixtures at high doses (75g) gave comparable or similar levels of glucose in the blood. After 2 and 3 hours, blood glucose dropped slightly but still higher than the fasting level. However, giving honey and sugars mixture at low doses (25g) did not cause significant rise in blood glucose after 1 hour, and the blood glucose level dropped below the fasting level after 3 hours. Glucose doses were given as 50g or 25g to diabetic patients and to the healthy non-diabetic controls and the blood glucose levels were determined as mentioned above. The comparison of the blood glucose levels, after giving honey (equivalent to 75g sugars), sugars mixture (75g), or glucose (50g) showed that the glucose resulted in sharp peak after 1 hour which remained high 2 hours later as compared to honey and sugars mixtures. When comparing the effects of low doses of honey (equivalent to 25g sugars), sugars mixture (25g), and glucose (25g); it was found that both honey and sugars mixtures did not raise the blood glucose level significantly, up to 3 hours; whereas the dose of glucose alone gave sharp rise after 1 hour and remained relatively higher than the levels obtained by honey and the sugars mixtures. Thus, from this study, it can be concluded that, low doses of pure honey, approximately 3 table spoons can be recommended as a sweetener for diabetic patients in addition to its high nutritional value instead of using the so-called diabetic food which offers no metabolic advantage over moderate amounts of sugars containing counterparts and which often have side effects

ABSTRACT

Background and aims: Type 2 diabetes mellitus (T2DM) is a developing global health problem. Obese females with T2DM are at high risk for cardiovascular disease (CVD) complications due to hyperglycemia and insulin resistance. Leptin and adiponectin that has been related to obesity and the development of metabolic disease complications such as insulin resistance, T2DM, and CVD. Therefore, we aimed to assess the correlation of leptin and adiponectin levels with T2DM biomarkers and its complications in females.

Methods: A cross-sectional study was preformed for 150 women with T2DM aged 30–45 years Tests for blood samples were determined in Madinah Hospital labs to are known risk factors for T2DM and/or associated with adiponectin/leptin. Statistical analysis was done using Graphpad Prism 7. Quantitative data were expressed as mean ± SD for continuous data and number (%) for categories data. One-way ANOVA to compare between study groups and Pearson’s correlation and Multiple Linear Regression analysis to determine the associations between biomarkers that were used to analysis the study data.

Results: Contributors women with T2DM were mean age 55.5 years old, had higher fasting blood glucose (FBG), HbA1c, Triglycerides (TG), BMI, waist circumference (WC), Insulin resistance (IR), hs-CRP and at higher risk of CVD (high AIP) and high leptin level, but lower HDL-cholesterol and low insulin sensitivity with low adiponectin level. The women with T2DM in the high IR group and high BMI (obese group) were more likely to have a higher leptin level with lower adiponectin. The results in the coefficient and regression analysis revealed significant relationship between the leptin levels and IR, BMI and AIP (B= 3.97, P= 0.02), but no relation with WC. Nevertheless, the data analysis indicated negative significant relationship between leptin levels and IS and HDL-c (P< 0.05). The results demonstrated a significant relationship between adiponectin levels and IS as well as HDL-c (P= 0.03, P= 0.04, respectively), but a significant inverse relationship between adiponectin levels and IR, BMI, WC (B=-2.91, P= 0.04) and AIP (P< 0.05) in linear regression analysis. Additionally, the linear regression analysis proved a negative and inverse relationship between leptin and adiponectin levels in T2DM patients.

 Conclusion: Current study demonstrated that increased leptin levels are associated with high IR, which is an essential index of insulin resistance, and with high AIP, which is a critical index of CVD, and with high BMI that is the obesity indicators among female with T2DM populations in Madinah. Likewise, the reducing in adiponectin levels are associated with reduction in IS and HDL-c levels. Individuals with high leptin and low adiponectin levels should be routinely examined in T2DM obese female, and a necessary healthcare would be recommended to prevent or reduce T2DM complications such as CVD.