Current Diabetes Reviews - Volume 19, Issue 3, 2023

Background: COVID-19 has become extremely dangerous manifesting itself in a variety of forms ranging from a simple flu-like illness to death. COVID-19 associated mucormycosis (CAM) is a global threat with diabetes being a major contributor. Objective: This review aims to give a clear picture of the impact of hyperglycemia in CAM along with its management. Methods: Google and Google Scholar were searched and studies that addressed the impact of diabetes in CAM were considered for this review. We also performed a bibliographic search of the specific article to find additional studies. Results: A series of events such as unregulated activation of innate immune system modification, pro-inflammatory M1 macrophages activation, and the depletion of natural killer cell activity is very common in patients with COVID-19. In addition, the exacerbated cytokine syndrome and hyperinflammatory response may elevate the severity of this condition, which further leads to higher mortality. The impaired immune phase which follows provide the niche for increased infection among diabetic patients making them more prone towards developing mucormycosis and associated infections. Early detection, surgical debridement, and appropriate medical treatment with antifungals and hypoglycaemic agents may help control the infection and associated morbidity and mortality. COVID-19 drugs, hypoglycaemic agents, antifungals, and comorbidities have all been associated with adverse side effects and drug interactions. Conclusion: Clinicians should be well aware of this deadly disease and manage COVID-19, diabetes, and mucormycosis through individualized treatment regimens to improve patient outcomes.

Background: Breastfeeding maintains the maternal-fetal immune link after birth, favors the transmission of immunological competence, and is considered an important contributing factor to the development of the babies’ immune system. Objective: This study aimed to obtain data related to the effects of gestational diabetes on immunoglobulin A (IgA) and cytokines levels in the colostrum, before and during the pandemic of the new coronavirus, in order to study the possible outcomes regarding the immunological characteristics of human milk. Methods: This systematic review was registered in PROSPERO CRD42020212397, and the question elaborated using the PICO strategy was: does maternal hyperglycemia associated or not with Covid-19 influence the immunological composition of colostrum? Electronic searching and reference lists of published reports were used to identify studies that reported the influence of gestational diabetes on colostrum and milk composition. Results: Seven studies were selected from the 51 found, six of them were cross-sectional and one was a case report. Six studies included Brazilian groups and only one was conducted in USA. The mothers with gestational diabetes presented a reduced level of IgA and other immunoreactive proteins in colostrum. Those alterations could be related to changes in macronutrient metabolism and cellular oxidative metabolism. Conclusion: It was possible to conclude that diabetes changes the immunological composition of breast milk; however, data on the impact of the association between gestational diabetes and Covid-19 infection on the composition of antibodies and cytokines present in human milk are still scarce and inconclusive.

Background: Hyperglycemic condition and compromised immune system may contribute to the progression of COVID-19 infection and increase the disease severity, relatively requiring a longer recovery period among diabetic patients. Objective: A systematic review was conducted to examine cytokine levels, the prevalence of risk factors, and other comorbidities in COVID-19 patients with and without diabetes mellitus during the early COVID-19 outbreak. Methods: A systematic literature search was conducted in PubMed central, PMC Europe databases, and Web of Science, evaluating the articles published between Dec 1st, 2019, and June 15th, 2020. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: The systematic search generated 14,960 articles and ended up with 9 articles, of which 8 articles involved data on the comparison of cytokines in diabetic and non-diabetic subjects with COVID-19, while 4 of them involved data on cytokines in the diabetes patients compared either by the severity of diseases or the rate of survival. Among the studied cytokines, interleukin-6, interleukin- 8, and tumor necrosis factor-α may cause the worst prognosis or fatality among diabetic patients. Increased cytokine levels indicate higher mortality and are linked to risk factors and comorbidities, such as hypertension and cardiovascular disease. Management of diabetes by insulin treatment may reduce the rate of mortality among diabetic patients but may be contraindicated in diabetic patients with COVID-19 who had at least one previous comorbidity, especially hypertension and CVD. Conclusion: The pathophysiological mechanisms linked to cytokine storm in diabetic patients may lead to the design of treatment strategies in the future, thus improving early diagnosis of the disease and mitigating cytokine storm-associated morbidity and mortality.

Aims: The goal of this study was to collect the opinions of patients and HCPs who used OneTouch Verio Reflect^® in the United Arab Emirates (UAE). Background: Blood glucose monitoring devices are essential tools that aid healthcare professionals (HCPs) in improving outcomes in people with diabetes. Objectives: To assess the satisfaction of patients and HCPs with the new functionalities of the OneTouch Verio Reflect^® Blood Glucose Meter (BGM). Methods: We conducted a multicenter cross-sectional study that recruited eight HCPs and 100 patients with diabetes who had used OneTouch Verio Reflect^® with OneTouch Verio^® test strips for four weeks in four hospitals in the UAE. Results: Around 98% of patients and HCPs declared their satisfaction with the new features in the OneTouch Verio Reflect^® BGM. Participants’ responses were not associated with the duration of diabetes (p-values >0.05) except for the Results Log feature (p-value=0.016). Patients rated Blood Sugar Mentor^® messages, which include mentor tips, pattern messages, and awards, as the most important features, while HCPs rated ColorSure^® Dynamic Range Indicator as the most helpful feature. Patients and HCPs stated that the “pattern found (high glucose),” which was the most frequently seen message, was the most useful message. All HCPs strongly agreed that the ColorSure^® Dynamic Range Indicator helped them understand results and 98% of patients agreed that automated meter messages helped them to be more confident in following HCP recommendations. Conclusion: Patients and HCPs indicated high levels of satisfaction with the features within the OneTouch Verio Reflect^® meter.

Background: In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. Aim: The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. Objective: The main objective was to report the 10-years risk for CHD in a sample of the UAE population. Methods: We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). Results: 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. Conclusion: The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.

Diabetes (Type 1 and Type 2) is the most burdensome condition for the healthcare systems worldwide. Continuous glucose monitoring (CGM) is a powerful tool in the management of diabetes that has helped patients with diabetes to achieve better glycemic control as compared to traditional systems. It helps reduce the frequency as well as the severity of hypoglycemia. Continuous glucose monitoring technology is an integral part of the ‘artificial pancreas’. This review provides an overview of CGM technology and its applications.

Background: Diabetes Mellitus Type 1 is a chronic metabolic disorder, the treatment of which extremely burdens the patient. The lockdown, as a measure to prevent the spreading of the 2019 coronavirus disease, was a major challenge for the general public. People with chronic diseases, such as T1D patients, have complex emotional and psychological needs and are at increased risk for both depressive symptoms and anxiety. Objective: The aim of this study was to evaluate the impact of body mass index of T1D patients on the psychological symptoms and eating habits, as well as the prognostic factors of the psychological symptoms during the lockdown period. Methods: Diabetes mellitus patients were invited to complete this survey from the outpatient Diabetes clinic of the General Hospital of Chania and the “AHEPA” General University Hospital of Thessaloniki in Greece. Psychological symptoms were assessed using the DASS-42 questionnaire, and eating habits were assessed using the EAT-26 questionnaire. Results: Overall, 112 T1D patients were analyzed (response rate: 28.8%). Obese T1D patients appear to be at greater risk of developing psychological symptoms, such as depression, anxiety, and stress. Furthermore, disordered eating behaviors and bulimia and food preoccupation subscale are associated with psychological symptoms. Conclusion: The findings suggest that obese T1D patients are at greater risk of developing psychological symptoms. Moreover, when an eating disorder is triggered, negative psychological symptoms such as depression and anxiety are reduced. The results of this study may guide targeted interventions among T1D patients.

Background: Diabetes Mellitus (DM) is directly associated with cardiovascular dysfunctions and microvascular complications, such as diabetic retinopathy (DR). The association between DR and increased risks of developing cardiovascular diseases has been described. The low activity of the Methylenetetrahydrofolate reductase (MTHFR), an enzyme involved in the metabolism of homocysteine, can lead to hyperhomocysteinemia that has already been related to cardiac outcomes and resistance to insulin. The A1298C and C677T polymorphisms in the MTHFR can reduce enzyme activity. Objective: The study aims to analyze the association between MTHFR genotypes and cardiac parameters in patients with DR. Methods: DM patients diagnosed with DR (n=65) were categorized and compared according to MTHFR genotypes A1298C (AA and AC+CC groups) and C677T (CC and CT+TT) groups; biochemical, cardiological, anthropometric, genetic, lifestyle and vitamin B9 and B12 consumption variables. Fischer's exact test and Poisson regression were performed to assess the relationship between variables. Results: Comparing echocardiographic and electrocardiogram parameters within genotypic groups, we found a significant association between left atrial dilation and C677T polymorphism. Left atrium diameter was higher in the T allele carriers (CT+TT group), with a prevalence ratio of 0.912. This association was confirmed in the regression model, including confounding variables. The other cardiac structural and functional parameters studied were not significantly associated with the A1298C or C677T genotypes. Conclusion: The MTHFR C677T genotype may contribute to atrial remodeling in RD patients. We found an association between the diameter of the left atrium and the T allele of the MTHFR C677T polymorphism in patients with DR.

Aim: This systematic review aimed to appraise and recapitulate all research investigations to elucidate the effects of Sesamum indicum preparations on managing the cardiometabolic syndrome of Diabetes mellitus (DM) and metabolic syndrome (MetS). Methods: A systematic review was carried out in a Cochrane fashion and in compliance with the PRISMA checklist using the published academic works in PubMed/MEDLINE, WOS, SCOPUS, and EMBASE databases that were searched up to June 2021. Abstracts that met PICO criteria for qualitative studies were duplicate reviewed for data extraction to assess the quality and details of the study. Results: Sesamum indicum preparations and its bioactive lignans, such as sesamin, sesamol, and pinoresinol, were found to possess anti-hyperglycemic, anti-hyperlipidemia, anti-inflammatory, antioxidative, anti-hypertensive, cardioprotective, and hepatoprotective effects both in patients with T2DM as well as in experimental animal models with T1DM and MetS. The incorporation of sesame oil as a natural adjuvant can be effective in improving vascular reactivity and aortic permeability, reproductive parameters, and diabetic nephropathy, as well as modification of anthropometry indices. Therefore, sesame oil and bioactive lignans as combination therapy with drugs can exhibit synergistic effects and provide a favorable preference in clinical settings. Conclusion: Sesame oil and lignans present in it act in a dose-dependent manner. The best dosage to improve risk biomarkers of patients with T2DM and MetS is 30-35 ml daily of sesame oil or inclusion of sesame oil in daily dietary patterns up to 30% of total energy for 8-12 weeks and/or 200 mg daily of sesamin supplementation for eight weeks.

Background and Aims: This cross-sectional study aimed to determine potential factors with a strong association with metabolic syndrome (MetS) among obesity and lipid-related parameters, and liver enzymes, fasting blood glucose (FBG), and blood pressure (BP) as well as some sociodemographic factors in elderly over 60 years old from a sample of Birjand Longitudinal Aging Study (BLAS). Methods: A total of 1366 elderly Birjand participants were enrolled and divided into non-MetS (n = 512) and MetS (n = 854) groups based on the status of MetS from January 2018 to October 2018. The anthropometric parameters, blood lipid profiles, liver enzymes, and disease history were evaluated and recorded. Results: 62.5% of the participants from our sample of elderly Birjand have MetS (33.4% in males and 66.6% in females). The prevalence of MetS in females was significantly higher than in males (P < 0.001). The increasing trend in the number of MetS components (from 0 to 5) was observed in females (p < 0.001). Odds ratio showed a strong association between female gender [8.33 (5.88- 11.82)], obesity [8.00 (4.87-13.14)], and overweight [2.44 (1.76-3.40)] with MetS and acceptable association between TG/HDL [(1.85 (1.62-2.12)] with MetS. Conclusion: This study indicated that the female sex, overweight and obesity have a strong association with MetS and TG/HDL has an acceptable association found in the sample of the elderly Birjand population. However, due to the obvious limitations of our study including the homogeneous sex and race of population, and no adjustment for several important confounding factors including sex, different ages, stage in the elderly, alcohol consumption, smoking, married status, physical activity, diet, and family history of CVD, more epidemiological investigations are needed to address this question.

Objective: Muslims with insulin-dependent type 2 diabetes are at high risk for adverse events while fasting during the month of Ramadan. However, advances in pharmacologic therapy coupled with creative strategies of insulin administration can mitigate complications. This narrative literature review investigates which insulin subtypes are likely to prevent hypoglycemic events and reduce hyperglycemia during the Ramadan fasting season for this high-risk population. Design: Narrative literature review Eligibility Criteria: The following MeSH terms were used: “Diabetes Mellitus, Type 2” and “Insulin,” and the “Text Words”: “Ramadan”, “iftar”, “Muslim fast”, and “religious fast.” The primary focus was on adult, non-pregnant, insulin-dependent type 2 diabetes during Ramadan. Anything beyond this focus was excluded. A total of nine pertinent studies were included for narrative review and analysis. Information Sources: PubMed, EMBASE and Medline. Results: The studies identified suggest long-acting insulins reduce the risk of hypoglycemia, and rapid-acting insulin analogues may improve post-iftar hyperglycemia. Moreover, utilizing flexible glycemic targets during Ramadan is a novel strategy that has demonstrated improved outcomes after the fasting season. Conclusion: Certain insulin subtypes and dosing strategies may be advantageous to use during Ramadan. However, a systematic, comprehensive, and updated review, including a critical appraisal of each original study, is needed to improve clinical care of insulin-dependent type 2 diabetes during Ramadan.

Celiac disease is diagnosed more commonly with type 1 diabetes, and the most problematic aspect for a child with type 1 diabetes and celiac disease is that most GFD foods have a high glycemic index, while low glycemic index foods are recommended for type 1 diabetes mellitus. As a result, dietary controls become more difficult. Diet management could improve the elevated HbA1c levels. The aim of this review is to illustrate the clinical features and diagnostic considerations, as well as current knowledge of common pathogenic features such as genetics, environmental risk factors, and the gut microbiome of type 1 diabtes and celiac disease. Also, the importance of diet management on glycemic control and growth rate in patients with type 1 diabetes mellitus and celiac disease has been discussed. PubMed and Google Scholar databases were searched. Reports published from the years 1969 to 2021 focused on the role of type 1 diabetes mellitus and celiac disease, and examined the types of diet on glycemic control, growth rate, and quality of life. Only a few studies on the effects of a carbohydrate count gluten-free diet on glycemic control, growth rate, and quality of life in patients with type 1 diabetes mellitus and celiac disease have been conducted. There have been few studies showing that dietary intervention helps to achieve and maintain normal blood glucose and blood pressure levels, a healthy lipid profile, and a healthy body weight. Studies stated that a low-carbohydrate diet had the greatest effect on improving glycemic control and insulin parameters.