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Type 2 Diabetes and Complications: From Diagnosis to Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 15 February 2025 | Viewed by 8308

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Dr. Matteo Monami

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Guest Editor

Division of Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Via delle Oblate 4, 50141 Florence, Italy
Interests: type 2 diabetes; obesity; diabetic foot ulcer; cardiovascular disease; bariatric surgery; microvascular complications

Special Issue Information

Dear Colleagues,

In 2019, the World Health Organization (WHO) reported that diabetes was the direct cause of 1.5 million deaths and that 48% of all deaths due to diabetes occurred before the age of 70. Another 460,000 kidney disease deaths were caused by diabetes, and raised blood glucose was found to cause around 20% of cardiovascular deaths. Moreover, between 2000 and 2019, there was a 3% increase in age-standardized mortality rates from diabetes. In lower–middle-income countries, the mortality rate due to diabetes increased by 13%. By contrast, the probability of dying from any one of the four main noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, or diabetes) between the ages of 30 and 70 decreased by 22% globally between 2000 and 2019.

To try and reverse this dramatic trend, actions capable of increasing an early diagnosis of diabetes and its complications, together with innovative treatment for ameliorating glycemic control and the prognosis of chronic diabetic complications, are needed.

This Special Issue aims to provide a comprehensive review on these topics by collecting papers from an expert panel of authors.

Dr. Matteo Monami
Guest Editor

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Keywords

type 2 diabetes
diabetic foot ulcer
cardiovascular disease
microvascular complications
glycemic control

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Published Papers (7 papers)

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Research

10 pages, 235 KiB

Open AccessArticle

The Relationship Between Hand Abnormalities and Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus

by Feyzahan Uzun, Hüseyin Fındık, Muhammet Kaim and Murat Yıldırım

J. Clin. Med. 2024, 13(22), 6723; https://doi.org/10.3390/jcm13226723 - 8 Nov 2024

Viewed by 378

Abstract

Background: The link between diabetes mellitus (DM) and pathological conditions of the hand has been previously investigated. Retinopathy is one of the most common microvascular complications of DM. In this study, we aimed to evaluate the relationship between hand abnormalities and retinopathy in patients with type 2 DM. Methods: Patients with type 2 DM were assessed for hand abnormalities using tactile, functional, and sensory tests. The patients were evaluated electrodiagnostically for carpal tunnel syndrome and polyneuropathy (PNP). A comprehensive ophthalmologic examination was performed to diagnose diabetic retinopathy (DR). Subjective disability and quality of life were evaluated using the Quick DASH questionnaire. The duration of the disease and HbA1c levels were noted. Results: A total of 60 patients with type 2 DM (32 female, 28 male) were recruited for this study. The mean age was 55.1 ± 5.6 years. Among the 60 diabetic patients examined, 15 (25%) were diagnosed with DR. The mean duration of DM was 86.86 ± 51.69 months in patients without DR and 144.75 ± 82.96 months in patients with DR. The mean HbA1c level was 8.86% in the DR group and 8.64% in the non-DR group. PNP was the only hand abnormality that showed a significant association with retinopathy (p = 0.011). Conclusions: PNP might be used as a clue to the presence of retinopathy, especially in long-lasting diabetes. Particular attention should be given to hand abnormalities, especially in patients with PNP, due to their association with DR. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

14 pages, 2579 KiB

Open AccessArticle

Clinical and Sociodemographic Profile, Self-Care, Adherence and Motivation for Treatment, and Satisfaction with Social Support in Portuguese Patients with Type 2 Diabetes

by Virginia M. G. Regufe, Manuel A. Lobão, Natália Cruz-Martins, Carla Luís, Pedro von Hafe and Cristina B. Pinto

J. Clin. Med. 2024, 13(21), 6423; https://doi.org/10.3390/jcm13216423 - 26 Oct 2024

Viewed by 728

Abstract

Objective: This study aimed to characterize the sociodemographic and clinical profiles of Portuguese patients with type 2 diabetes mellitus (T2DM) and to assess their self-care practices, treatment adherence, motivation, and satisfaction with social support. Methods: A cross-sectional observational study was conducted at an endocrinology unit in northern Portugal from January 2021 to December 2022. The sample included 303 adult patients with T2DM who provided informed consent. Data were collected using a structured questionnaire addressing sociodemographic, clinical, and self-care aspects. Validated scales were used to assess diabetes knowledge, self-care activities, treatment adherence, motivation, and social support. Results: Of the 303 patients enrolled, with a median age of 67 years, 51.2% were female and 68.2% retired. Clinical measures showed a median systolic blood pressure of 135 mmHg, abdominal circumference of 104.6 cm, and BMI of 29.3 kg/m². Self-care practices were suboptimal, with only 25.1% of patients consistently following a healthy diet, and 31% engaged in weekly physical activity. Although treatment adherence was generally high, issues like forgetfulness were reported. Satisfaction with social support varied, with 30% of patients feeling isolated. Conclusions: The study identifies significant gaps in diet and physical activity adherence among T2DM patients. There is a need for targeted educational interventions and enhanced support systems to improve self-care and treatment outcomes. Personalized care strategies addressing educational, motivational, and social support factors are crucial to better managing T2DM and improving patient well-being. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

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13 pages, 4732 KiB

Open AccessArticle

Predictive Factors for Altered Quality of Life in Patients with Type 2 Diabetes Mellitus

by Oana Albai, Adina Braha, Bogdan Timar and Romulus Timar

J. Clin. Med. 2024, 13(15), 4389; https://doi.org/10.3390/jcm13154389 - 26 Jul 2024

Viewed by 1036

Abstract

Objectives: To evaluate the quality of life (QoL) in a group of patients with type 2 diabetes (T2DM) and to identify predictive factors to apply the necessary measures to improve it. Methods: For this, 299 patients with T2DM were enrolled in a cross-sectional study, and their QoL was assessed using the EQ-5D-3L questionnaire. All patients underwent clinical exams, routine laboratory tests, and nerve conduction velocity (NCV) at the common peroneal nerve. Results: Patients had a median age of 66 (57; 70) years, median duration of T2DM of 10 (6; 15) years, median HbA1c of 8 (7; 9.3)%, and mean EQ-5D-3L score of 55%. In addition, 9.7% presented extreme difficulty in mobility, 18.5% severe difficulty in self-care, and 16.4% in usual activities. One-third presented with severe pain or discomfort, anxiety, or depression (level 3 EQ-5D-3L). DPN, heart failure (HF), cerebral stroke, and insulin therapy increased the likelihood of a reduced QoL (EQ-5D-3L < 50). The EQ-5D-3L score inversely correlated with serum creatinine, glycemic control, lipid profile, diabetes duration, age, mobility, self-care, pain/discomfort, usual activities, and anxiety/depression and positively correlated with NCV, HDLc, and eGFR. Conclusions: Preventing neuropathic complications, chronic kidney disease, stroke, and HF and obtaining the glycemic and lipid targets could improve the QoL in patients with T2DM. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

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25 pages, 2549 KiB

Open AccessArticle

Impact of Concurrent Exercise Training on Cardiac Autonomic Modulation, Metabolic Profile, Body Composition, Cardiorespiratory Fitness, and Quality of Life in Type 2 Diabetes with Cardiac Autonomic Neuropathy: A Randomized Controlled Trial

by Saima Zaki, Md Farhan Alam, Saurabh Sharma, Said El-Ashker, Mohammad Ahsan and Shibili Nuhmani

J. Clin. Med. 2024, 13(13), 3910; https://doi.org/10.3390/jcm13133910 - 3 Jul 2024

Cited by 1 | Viewed by 1772

Abstract

Background: Type 2 diabetes mellitus (T2DM) often leads to cardiac autonomic neuropathy (CAN), a severe complication affecting cardiovascular health. Exercise training is a proven intervention for improving metabolic control and cardiovascular health in T2DM, but the effects of concurrent exercise training (CET), combining aerobic and resistance exercises, on CAN are not fully understood. Objective: This randomized controlled trial investigates the impact of a structured CET program on cardiac autonomic modulation, metabolic profile, body composition, cardiorespiratory fitness (CRF), and quality of life (QoL) in individuals with T2DM and CAN. Methods: A total of 96 participants, aged 35–70 years, with T2DM and CAN, were randomized into CET (n = 48) and control (n = 48) groups. The CET group engaged in combined aerobic and resistance training three times per week for 13 weeks, while the control group received standard care. Primary outcomes included heart rate variability (HRV) and heart rate recovery (HRR). Secondary outcomes were metabolic profile, body composition, CRF, and QoL, which were assessed using standardized protocols and validated questionnaires. The trial was registered with the Clinical Trials Registry—India (CTRI/2021/09/036711). Results: Significant improvements were noted in the CET group compared to controls. HRV metrics (SDNN, RMSSD, pNN50, TP, LF power, HF power, and LF/HF ratio) and HRR metrics (HRR30s, HRR1, HRR2, and HRR3) all showed significant enhancements (p < 0.01). The CET group also exhibited substantial reductions in fasting blood glucose, postprandial blood glucose, HbA1c, waist circumference, hip circumference, and percentage body fat (p < 0.01). Improvements were observed in lipid profile markers and CRF (VO_2max) (p < 0.01). QoL scores improved significantly in the CET group as per the ADDQoL-19 (p < 0.01). Conclusions: CET significantly enhances cardiac autonomic modulation, metabolic profile, body composition, CRF, and QoL in individuals with T2DM and CAN. These findings support the integration of CET into standard T2DM management to improve clinical outcomes and QoL. Further research is needed to explore the long-term benefits and broader applicability of CET in diverse diabetic populations. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

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11 pages, 670 KiB

Open AccessArticle

Is Metformin Use Associated with a More Favorable COVID-19 Course in People with Diabetes?

by Giovanni Antonio Silverii, Carlo Fumagalli, Renzo Rozzini, Marta Milani, Edoardo Mannucci and Niccolò Marchionni

J. Clin. Med. 2024, 13(7), 1874; https://doi.org/10.3390/jcm13071874 - 24 Mar 2024

Viewed by 1335

Abstract

Background: Diabetes Mellitus (DM) has been associated with a higher Coronavirus disease-19 (COVID-19) mortality, both in hospitalized patients and in the general population. A possible beneficial effect of metformin on the prognosis of COVID-19 has been reported in some observational studies, whereas other studies disagree. Methods: To investigate the possible effect of metformin on COVID-19 in-hospital mortality, we performed a retrospective study that included all SARS-CoV-2-positive patients with DM who were admitted to two Italian hospitals. In order to adjust for possible confounders accounting for the observed reduction of mortality in metformin users, we adopted the COVID-19 Mortality Risk Score (COVID-19 MRS) as a covariate. Results: Out of the 524 included patients, 33.4% died. A binomial logistic regression showed that metformin use was associated with a significant reduction in case fatality (OR 0.67 [0.45–0.98], p = 0.039), with no significant effect on the need for ventilation (OR 0.75 [0.5–1.11], p = 0.146). After adjusting for COVID-19 MRS, metformin did not retain a significant association with in-hospital mortality [OR 0.795 (0.495–1.277), p = 0.342]. Conclusions: A beneficial effect of metformin on COVID-19 was not proven after adjusting for confounding factors. The use of validated tools to stratify the risk for COVID-19 severe disease and death, such as COVID-19 MRS, may be useful to better explore the potential association of medications and comorbidities with COVID-19 prognosis. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

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12 pages, 253 KiB

Open AccessArticle

Early Treatment of Acute Stage 0/1 Diabetic Charcot Foot Can Avoid Major Amputations at One Year

by Cristina Bittante, Valerio Cerasari, Ermanno Bellizzi, Raju Ahluwalia, Michela Di Venanzio, Laura Giurato, Aikaterini Andreadi, Alfonso Bellia, Luigi Uccioli, Davide Lauro and Marco Meloni

J. Clin. Med. 2024, 13(6), 1633; https://doi.org/10.3390/jcm13061633 - 13 Mar 2024

Viewed by 1287

Abstract

Background: If unrecognized, Charcot neuro-osteoarthropathy (CNO) can be a devastating complication of diabetes. Methods: The aim of this retrospective study was to evaluate the outcomes in a cohort of diabetic patients diagnosed with active CNO managed in a tertiary level diabetic foot clinic (DFC). We included consecutive patients with active CNO, stage 0–1, according to the Eichenholtz–Shibata classification, who were referred from 1 January 2019 to 27 September 2022. Diagnosis of CNO was based on clinical signs and imaging (X-rays and magnetic resonance). All patients were completely offloaded by a total-contact cast (TCC) or removable knee-high device. Each patient was closely monitored monthly until CNO remission or another outcome. At 12 months of follow-up, the following outcomes were analyzed: remission, time to remission, major amputations (any above the ankle), and surgical indication. Results: Forty-three patients were included. The mean age was 57.6 ± 10.8 years; 65% were males and 88.4% had type 2 diabetes, with a mean duration of 20.6 ± 9.9 years. At baseline, 32.6% was affected by peripheral artery disease. Complete remission was recorded in 40/43 patients (93%), with a mean time to remission of 5.6 ± 1.5 months; major amputation and surgical indication occurred, respectively in 1/43 patients (2.3%) and 3/43 patients (7%). Conclusions: Early treatment of active Stage 0/1 CNO leads to high rates of remission and limb salvage. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

9 pages, 575 KiB

Open AccessArticle

Higher Prevalence of Cancer in Patients with Diabetic Foot Syndrome

by Chiara Goretti, Alessandro Prete, Alex Brocchi, Elisabetta Iacopi, Letizia Pieruzzi and Alberto Piaggesi

J. Clin. Med. 2024, 13(5), 1448; https://doi.org/10.3390/jcm13051448 - 1 Mar 2024

Viewed by 1139

Abstract

Background: Diabetes mellitus (DM) is associated with a higher prevalence of many forms of cancer. Diabetic foot syndrome (DFS) is associated with higher risk of lower limb amputation and mortality not all explainable with a cardiovascular profile at greater risk compared with DM patients without DFS. DFS could be associated with an increasing cancer incidence. To explore a possible link between DFS and cancer, comparing two cohorts of patients (DFS+ and DFS−) with a cohort of superimposable non-DM controls. Methods: We retrospectively analysed the databases of our department for all consecutive patients admitted between January 2019 and December 2021, selecting all DM pts, and sorting DFS+ pts, admitted for foot complications, from DFS− ones, admitted for other reasons. Cases of pancreatic cancer as well as cancer-related admissions were excluded. Patients were compared to non-DM patients admitted for non-oncological medical problems. The primary endpoint was to compare the prevalence of cancer among the groups, while the secondary endpoint was to look for predictors for cancer in the groups studied. Results: A cohort of 445 consecutive DM inpatients (222 DFS+ and 223 DFS−) and 255 controls were studied. Cancer prevalence in DFS+ group was significantly higher than in DFS− (p = 0.008) and controls (p = 0.031), while no differences were observed between DFS− and the controls. Univariate regression analysis showed a significant association between cancer and DFS (p = 0.007), age at admission (p ≤ 0.001), years of diabetes (p = 0.017) and haemoglobin concentration [Hb] (p = 0.030). In the multivariate regression analysis with DFS, age at admission and [Hb], only DFS (p = 0.021) and age at admission (p ≤ 0.001) persisted as independent factors associated with cancer. Conclusions: A higher prevalence of cancer in DFS+ patients than in DFS− patients and non-diabetic controls is reported. DFS and age can both be considered independent predictors of cancer in patients with DM. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

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