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Chronic Diabetic Complications: Current Challenges and Opportunities

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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: closed (30 September 2021) | Viewed by 45434

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Special Issue Editors

Dr. Ilias Migdalis

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Guest Editor

Director of Diabetes Centre, Lefkos Stavros Hospital, 115 28 Athens, Greece
Interests: chronic complications of diabetes; prevention of diabetes
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Leszek Czupryniak

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Co-Guest Editor

Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
Interests: diabetes; obesity; hypertension; dyslipidemia

Prof. Dr. Nebojsa Lalic

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Co-Guest Editor

University of Belgrade, Belgrade, Serbia
Interests: diabetes; obesity; hypertension; dyslipidemia

Dr. Nikolaos Papanas

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Co-Guest Editor

Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
Interests: diabetes mellitus; diabetic foot; diabetes complications; diabetes mellitus treatment; internal medicine
Special Issues, Collections and Topics in MDPI journals

Prof. Paul Valensi

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Co-Guest Editor

Paris Nord University, Bondy, France
Interests: Diabetes; Obesity; Hypertension; Dyslipidemia

Special Issue Information

Dear Colleagues,

The scale of the chronic complications of diabetes became clear in the late 1920s and 1930s, when detailed descriptions of the syndrome were first made. Much of the impact of chronic diabetes results from the development of tissue complications, mainly microvascular disease (retinopathy, nephropathy, and neuropathy) and macrovascular disease (atherosclerosis). There is strong evidence that microvascular disease is related to the duration and severity of hyperglycemia in both type 1 and type 2 diabetes. There are now specific treatments to slow the progression of established nephropathy, preserve vision in those with established retinopathy, and decrease the chance of neuropathy leading to foot damage. Macrovascular disease affects the coronary arteries, cerebral circulation, and peripheral vessels, and the risk of heart failure is considerably increased in patients with diabetes in addition to being associated with substantial morbidity and mortality. In recent years, major advances have occurred in our understanding of the pathogenesis of diabetic complications. Major theories regarding the development of complications are based on metabolic and vascular changes. For this Special Issue, potential topics include, but are not limited to:

Basic principles and clinical data of diabetic complications
Pathogenesis of diabetic complications
The epidemiology of diabetic complications
Cardiovascular disease in diabetes
Hypertension in diabetes
Diabetic nephropathy
Diabetic eye disease
Diabetes neuropathies
The diabetic foot
Management of diabetic complications

Dr., MD Ilias Migdalis
Prof. Leszek Czupryniak
Prof. Nebojsa Lalic
Prof. Nikolaos Papanas
Prof. Paul Valensi
Guest Editors

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Keywords

diabetes
chronic complications
macrovascular disease
microvascular disease
hypertension
dyslipidemia
obesity

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Published Papers (14 papers)

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Editorial

Jump to: Research, Review

2 pages, 177 KiB

Open AccessEditorial

Chronic Diabetic Complications: Current Challenges and Opportunities

by Ilias N. Migdalis, Leszek Czupryniak, Nebojsa Lalic, Nikolaos Papanas and Paul Valensi

J. Clin. Med. 2022, 11(3), 673; https://doi.org/10.3390/jcm11030673 - 28 Jan 2022

Cited by 2 | Viewed by 1523

Abstract

The Special Issue, “Chronic Diabetic Complications: Current Challenges and Opportunities”, is rich in scientific content, covering a wide field of diabetic complications via both original studies and reviews [...] Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

Research

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9 pages, 535 KiB

Open AccessArticle

Evaluation of Effects of Diabetes Mellitus, Hypercholesterolemia and Hypertension on Bell’s Palsy

by George Psillas, Grigorios G. Dimas, Anastasia Sarafidou, Triantafyllos Didangelos, Vasilios Perifanis, Georgia Kaiafa, Daphne Mirkopoulou, Thomas Tegos, Christos Savopoulos and Jiannis Constantinidis

J. Clin. Med. 2021, 10(11), 2357; https://doi.org/10.3390/jcm10112357 - 27 May 2021

Cited by 13 | Viewed by 3518

Abstract

The aim of this study is to evaluate the effects of diabetes mellitus, hypertension and hypercholesterolemia on the clinical presentation and outcome of Bell’s palsy. The study (comorbidity) group consisted of 50 patients with Bell’s palsy associated with diabetes, hypertension, or hypercholesterolemia; the control group included 46 patients with Bell’s palsy, but without comorbid diseases. The House–Brackmann grading system (I to VI) was used in order to assess the initial and final facial functions. Both groups of patients were treated with steroids and the antiviral agent acyclovir. The mean severity of initial facial paralysis was more significant in diabetes, hypercholesterolemia, and hypertension, in comparison to the control group. Patients suffering from Bell’s palsy and concomitant comorbidities have a poorer prognosis (HB III-VI) compared to patients without comorbidities. Increased glycosylated hemoglobin A1c levels (>6.7%) were significantly correlated with unsatisfactory facial recovery. The pathogenetic mechanisms by which diabetes, hypercholesterolemia, and hypertension affect the vasa nervosum of facial nerve have been described. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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11 pages, 597 KiB

Open AccessArticle

Antidiabetic and Other Therapies Used in Subjects with Diabetes and Chronic Kidney Disease in a Hospital-Based Clinic Population in Greece

by Ilias N. Migdalis, Nikolaos Papanas, Ioannis M. Ioannidis, Alexios E. Sotiropoulos, Athanasios E. Raptis, George D. Dimitriadis and on behalf of the Hellenic Diabetic Nephropathy Study (HDNS)

J. Clin. Med. 2021, 10(10), 2104; https://doi.org/10.3390/jcm10102104 - 13 May 2021

Cited by 2 | Viewed by 2216

Abstract

(1) Background: Type 2 diabetes mellitus (T2DM) is the main cause of chronic kidney disease (CKD). In Greece, in a population from hospital-based diabetes clinics (n = 1759), the overall prevalence of diabetic chronic kidney disease (DCKD) was 45% including mild, moderate, and severe CKD. The aim of this study was to describe and analyze how T2DM patients with mild-to-severe CKD are managed by diabetologists in Greece and assess the achievement rates in glycemic, blood pressure and low-density lipoprotein-cholesterol (LDL-C) control. (2) Methods: This cross-sectional multicenter study took place from June 2015 to March 2016 and collected data from diabetes centers in public hospitals all over Greece. (3) Results: With regard to the anti-diabetes treatment, most participants were on metformin, DPP-4 (Dipeptidyl Peptidase-4 inhibitors) inhibitors and insulin. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were the most prescribed medications for hypertension. For the management of dyslipidemia, most participants were on statins. For patients with DCKD, the levels of HbA1c, blood pressure and LDL-C were 7.2%, 137.7/76.9 mmHg and 95.9 mg/dL, respectively (mean values). (4) Conclusions: The outcomes of this study suggest that management of DCKD can be further improved and should be enhanced. These results may contribute to the whole health care system in Greece. In addition, the better understanding of therapeutic strategies used by diabetologists treating these patients offers educational benefits to primary care physicians, which can result in an overall more successful and efficient management of subjects with T2DM and DCKD. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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13 pages, 287 KiB

Open AccessArticle

Comparison of Premixed Human Insulin 30/70 to Biphasic Aspart 30 in Well-Controlled Patients with Type 2 Diabetes Using Continuous Glucose Monitoring

by Charalampos Margaritidis, Eleni Karlafti, Evangelia Kotzakioulafi, Konstantinos Kantartzis, Konstantinos Tziomalos, Georgia Kaiafa, Christos Savopoulos and Triantafyllos Didangelos

J. Clin. Med. 2021, 10(9), 1982; https://doi.org/10.3390/jcm10091982 - 5 May 2021

Cited by 5 | Viewed by 2534

Abstract

Aim: To compare in terms of glycemic variability two premixed insulins, Premixed Human Insulin 30/70 (PHI) and Biphasic Aspart 30 (BiAsp30), using Continuous Glucose Monitoring (CGM) and to estimate the correlation of Glycated Albumin (GA) and Fructosamine (FA) with CGM data. Patients-Data: A total of 36 well-controlled patients with type 2 Diabetes Mellitus (T2DM) underwent 7-day CGM with PHI and subsequently with BiAsp30. GA and FA were measured at the first and last day of each week of CGM. Results: BiAsp30 was associated with lower Average Blood Glucose (ABG) during the 23:00–03:00 period (PHI: 135.08 ± 28.94 mg/dL, BiAsp30: 117.75 ± 21.24 mg/dL, p < 0.001) and the 00:00–06:00 period (PHI: 120.42 ± 23.13 mg/dL, BiAsp30: 111.17 ± 14.74 mg/dL, p = 0.008), as well as with more time below range (<70 mg/dL) (TBR) during the 23:00–03:00 period in the week (PHI: 3.65 ± 5.93%, BiAsp30: 11.12 ± 16.07%, p = 0.005). PHI was associated with lower ABG before breakfast (PHI: 111.75 ± 23.9 mg/dL, BiAsp30: 128.25 ± 35.9 mg/dL, p = 0.013). There were no differences between the two groups in ABG, Time In Range and Time Below Range during the entire 24-h period for 7 days, p = 0.502, p = 0.534, and p = 0.258 respectively, and in TBR for the 00:00–06:00 period p = 0.253. Total daily insulin requirements were higher for BiAsp30 (PHI: 47.92 ± 12.18 IU, BiAsp30: 49.58 ± 14.12 IU, p = 0.001). GA and FA correlated significantly with ABG (GA: r = 0.512, p = 0.011, FA: r = 0.555, p = 0.005). Conclusions: In well-controlled patients with T2DM, BiAsp30 is an equally effective alternative to PHI. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

17 pages, 3496 KiB

Open AccessArticle

Detection and Characterization of Phosphorylation, Glycosylation, and Fatty Acid Bound to Fetuin A in Human Blood

by Markéta Kovářová, Hubert Kalbacher, Andreas Peter, Hans-Ulrich Häring, Triantafyllos Didangelos, Norbert Stefan, Andreas Birkenfeld, Erwin Schleicher and Konstantinos Kantartzis

J. Clin. Med. 2021, 10(3), 411; https://doi.org/10.3390/jcm10030411 - 22 Jan 2021

Cited by 5 | Viewed by 2652

Abstract

The hepatokine fetuin A (Fet A) has been associated with diverse pathological states such as insulin resistance, type 2 diabetes, macrovascular disease, and systemic ectopic and vascular calcification. Fet A may also play a role in tumor growth and metastasis. The biological activity of Fet A may be affected by various modifications, including phosphorylation, O- and N-glycosylation and fatty acid binding. We developed an antibody-based assay for the detection of Fet A phosphorylated at serine 312. Fatty acid pattern was determined by gas chromatography. Using the antibody, we found that the phosphorylation was stable in human plasma or serum at room temperature for 8 h. We observed that Fet A is present in several glycosylation forms in human plasma, but the extent of Ser³¹² phosphorylation was not associated with glycosylation. The phosphorylation pattern did not change during an oral glucose tolerance test (0–120 min). We further found that human Fet A binds preferentially saturated fatty acids (>90%) at the expense of mono- and poly-unsaturated fatty acids. Our results indicate that different molecular species of Fet A are present in human plasma and that these different modifications may determine the different biological effects of Fet A. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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13 pages, 1435 KiB

Open AccessArticle

The Severity of Diabetic Retinopathy Is an Independent Factor for the Progression of Diabetic Nephropathy

by Shi-Chue Hsing, Chia-Cheng Lee, Chin Lin, Jiann-Torng Chen, Yi-Hao Chen and Wen-Hui Fang

J. Clin. Med. 2021, 10(1), 3; https://doi.org/10.3390/jcm10010003 - 22 Dec 2020

Cited by 15 | Viewed by 2642

Abstract

(1) Background: It has rarely been studied whether the severity of diabetic retinopathy (DR) could influence renal disease progression in end-stage renal disease (ESRD) and chronic kidney disease (CKD) in patients with type 2 diabetes. The aim of this study was to evaluate renal disease progression in ESRD and CKD according to DR severity in patients with type 2 diabetes. (2) Methods: We included 1329 patients and divided the cohort into two end-points. The first was to trace the incidence of ESRD in all enrolled participants and the other was to follow their progression to CKD. (3) Results: Significantly higher crude hazard ratios (HRs) of ESRD incidence in all enrolled participants were noted, and this ratio increased in a stepwise fashion. However, after adjustment, DR severity was not associated with ESRD events. Therefore, a subgroup of 841 patients without CKD was enrolled to track their progression to CKD. Compared with no diabetic retinopathy, the progression of CKD increased in a stepwise fashion, from mild nonproliferative diabetic retinopathy (NPDR) to moderate NPDR, to severe NPDR and to proliferative diabetic retinopathy (PDR), both in the crude and adjusted models. (4) Conclusions: The severity of retinopathy appeared to be associated with renal lesions and the development of CKD. Our findings suggest that the severity of DR is a risk factor for progression to CKD. Therefore, diabetic retinopathy is useful for prognosticating the clinical course of diabetic kidney disease. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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12 pages, 249 KiB

Open AccessArticle

Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications?

by Miklós Kempler, Noémi Hajdú, Zsuzsanna Putz, Ildikó Istenes, Orsolya Vági, Magdolna Békeffy, Karolina Schnabel, Péter Kempler and Anna E. Körei

J. Clin. Med. 2020, 9(10), 3322; https://doi.org/10.3390/jcm9103322 - 16 Oct 2020

Cited by 8 | Viewed by 2245

Abstract

Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus. Cardiovascular reflex tests (CARTs) are the gold standard in the diagnosis of CAN, but the handgrip test is no longer recommended to be performed. Previously, the inverse association between the presence of hypertension and handgrip test abnormality was demonstrated and hypertension as major cause for excessive diastolic blood pressure rise during handgrip testing in diabetic individuals proposed. The aim of the present study is to describe more precisely the association between handgrip test and hypertension by performing ambulatory blood pressure monitoring (ABPM) among diabetic patients. A more comprehensive evaluation of the relationship between cardiovascular autonomic function, hypertension and the handgrip test was targeted using heart rate variability (HRV) analysis. Our study involved 163 patients with diabetes. Cardiovascular autonomic neuropathy was assessed by the CARTs and sustained handgrip test was performed. All patients underwent ABPM and HRV analysis well. CAN was diagnosed in 69 patients. Significant associations were found between the diastolic blood pressure increase in response to handgrip exercise and the 24-h (rho = 0.245, p = 0.003), daytime (rho = 0.230, p = 0.005) and night-time (rho = 0.230, p = 0.006) mean systolic and 24-h diastolic (rho = 0.176, p = 0.034) blood pressure values, systolic blood pressure load (rho = 0.252, p = 0.003) and systolic (rho = 0.236, p = 0.005) and diastolic (rho = 0.165, p = 0.047) hyperbaric impacts. Higher values of ambulatory blood pressure monitoring parameters are associated with greater increases in diastolic blood pressure during isometric handgrip exercise. Diastolic blood pressure elevations during the handgrip test are also correlated, in order to diminished heart rate variability parameters attributable to parasympathetic dysfunction highlighting the pivotal role of sympathetic overactivity in evolving handgrip test results. Our study provides further evidence on the inverse association between handgrip test abnormality and hypertension in diabetic patients. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

12 pages, 852 KiB

Open AccessArticle

Urban–Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis

by Shu-Yu Tai, Jiun-Shiuan He, Chun-Tung Kuo and Ichiro Kawachi

J. Clin. Med. 2020, 9(9), 3012; https://doi.org/10.3390/jcm9093012 - 18 Sep 2020

Cited by 12 | Viewed by 2795

Abstract

Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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8 pages, 601 KiB

Open AccessArticle

Clinical Outcome of Edoxaban vs. Vitamin K Antagonists in Patients with Atrial Fibrillation and Diabetes Mellitus: Results from a Multicenter, Propensity-Matched, Real-World Cohort Study

by Vincenzo Russo, Emilio Attena, Anna Rago, Enrico Melillo, Pierpaolo Di Micco, Andrea Antonio Papa, Giovanni Napolitano, Antonio D’Onofrio, Paolo Golino and Gerardo Nigro

J. Clin. Med. 2020, 9(6), 1621; https://doi.org/10.3390/jcm9061621 - 27 May 2020

Cited by 14 | Viewed by 3720

Abstract

Diabetes mellitus (DM) is a chronic metabolic disease which is independently associated with unfavorable clinical outcomes in patients with atrial fibrillation (AF). Few real-world data are available about the clinical performance of non-vitamin K oral anticoagulants (NOACs) among patients with atrial fibrillation and diabetes. The aim of our propensity score-matched cohort study was to compare the safety and effectiveness of Edoxaban versus well-controlled vitamin K antagonists (VKAs) therapy among this population. In this study, we considered patients with AF and diabetes on Edoxaban or VKAs therapy included in the multicenter Atrial Fibrillation Research Database (NCT03760874). The occurrence of major bleedings (MB) and thromboembolic events (a composite of ischemic stroke, transient ischemic attack, systemic embolism) was respectively considered primary safety and effectiveness outcome. We identified 557 AF patients with diabetes who received Edoxaban (n: 230) or VKAs (n: 327) treatment. After propensity score matching analysis, 135 Edoxaban and 135 VKA recipients with similar clinical characteristics were evaluated. The mean follow-up was 27 ± 3 months. The incidence rate of thromboembolic events (TE) was 3.0 per 100 person-years (1.11 in Edoxaban vs. 1.9 in the VKA group, hazard ratio (HR): 0.59; 95% confidence interval (CI), 0.14 to 2.52; p = 0.48). The incidence rate of major bleedings (MB) was 3.7 per 100 person-years (1.2 in Edoxaban vs. 2.7 in the VKA group, HR: 0.43; 95% CI: 0.10 to 1.40; p = 0.14). The incidence rate of intracranial hemorrhage was 0.35 per 100 person-years in Edoxaban vs. 0.74 in the VKA group (HR: 0.49; 95% CI: 0.05 to 5.54; p = 0.56). A positive net clinical benefit (NCB) of Edoxaban over VKAs was found (+1.39). Insulin therapy (HR: 1.76, p = 0.004) and glycated hemoglobin (HR: 1.17, p = 0.002) were found to be independent predictors of TE; moreover, the concomitant use of antiplatelet drugs (HR: 2.41, p = 0.001) was an independent predictor of MB. Conclusions: Our data support the hypothesis of the safety and efficacy of Edoxaban for use in patients with AF and diabetes, justified by a favorable NCB over VKAs. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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Review

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11 pages, 279 KiB

Open AccessReview

Olfactory Dysfunction: A Complication of Diabetes or a Factor That Complicates Glucose Metabolism? A Narrative Review

by Evanthia Gouveri and Nikolaos Papanas

J. Clin. Med. 2021, 10(23), 5637; https://doi.org/10.3390/jcm10235637 - 29 Nov 2021

Cited by 10 | Viewed by 2260

Abstract

The present narrative review presents emerging data regarding the association between diabetes mellitus and olfactory dysfunction and discusses the role of olfactory dysfunction in glucose metabolism. We searched relevant published articles in PubMed and Google Scholar until October 2021. Main key words included “olfactory dysfunction”, “diabetes mellitus”, and “glucose metabolism”. Olfactory dysfunction has been associated with diabetes mellitus. Furthermore, it has been proposed to be a diabetic complication, given that it has been linked with microvascular complications, such as diabetic peripheral neuropathy. Interestingly, it has been suggested that olfactory dysfunction is a manifestation of central neuropathy in diabetes, a hypothesis based on the observation that diabetes, olfactory dysfunction, and cognitive decline often coexist. However, evidence is limited and inconsistent. More importantly, olfactory and endocrine systems are closely linked, and olfactory dysfunction plays a significant role in glucose metabolism and obesity. Indeed, food behaviour and energy balance are influenced by olfaction status. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

19 pages, 874 KiB

Open AccessReview

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

by Theano Penlioglou, Anca Pantea Stoian and Nikolaos Papanas

J. Clin. Med. 2021, 10(19), 4620; https://doi.org/10.3390/jcm10194620 - 8 Oct 2021

Cited by 15 | Viewed by 3595

Abstract

Background: Stroke remains a leading cause of death and disability throughout the world. It is well established that Diabetes Mellitus (DM) is a risk factor for stroke, while other risk factors include dyslipidaemia and hypertension. Given that the global prevalence of diabetes steadily increases, the need for adequate glycaemic control and prevention of DM-related cardiovascular events remains a challenge for the medical community. Therefore, a re-examination of the latest data related to this issue is of particular importance. Objective: This review aims to summarise the latest data on the relationship between DM and stroke, including epidemiology, risk factors, pathogenesis, prevention and biomarkers. Methods: For this purpose, comprehensive research was performed on the platforms PubMed, Google Scholar and EMBASE with a combination of the following keywords: diabetes mellitus, stroke, macrovascular complications, diabetic stroke, cardiovascular disease. Conclusions: Much progress has been made in stroke in people with DM in terms of prevention and early diagnosis. In the field of prevention, the adaptation of the daily habits and the regulation of co-morbidity of individuals play a particularly important role. Simultaneously, the most significant revolution has been brought by the relatively new treatment options that offer protection to the cardiovascular system. Moreover, many prognostic and diagnostic biomarkers have been identified, paving the way for early and accurate diagnoses. However, to date, there are crucial points that remain controversial and need further clarification. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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17 pages, 1584 KiB

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Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus

by Ana Maria Dascalu, Anca Pantea Stoian, Alina Popa Cherecheanu, Dragos Serban, Daniel Ovidiu Costea, Mihail Silviu Tudosie, Daniela Stana, Denisa Tanasescu, Alexandru Dan Sabau, Gabriel Andrei Gangura, Andreea Cristina Costea, Vanessa Andrada Nicolae and Catalin Gabriel Smarandache

J. Clin. Med. 2021, 10(16), 3736; https://doi.org/10.3390/jcm10163736 - 22 Aug 2021

Cited by 12 | Viewed by 3587

Abstract

Bariatric surgery is an emerging therapeutic approach for obese type 2 diabetes mellitus (T2DM) patients, with proven benefits for achieving target glucose control and even remission of diabetes. However, the effect of bariatric surgery upon diabetic retinopathy is still a subject of debate as some studies show a positive effect while others raise concerns about potential early worsening effects. We performed a systematic review, on PubMed, Science Direct, and Web of Science databases regarding the onset and progression of diabetic retinopathy in obese T2DM patients who underwent weight-loss surgical procedures. A total of 6375 T2DM patients were analyzed. Most cases remained stable after bariatric surgery (89.6%). New onset of diabetic retinopathy (DR) was documented in 290 out of 5972 patients (4.8%). In cases with DR at baseline, progression was documented in 50 out of 403 (12.4%) and regression in 90 (22.3%). Preoperative careful preparation of hemoglobin A1c (HbA1c), blood pressure, and lipidemia should be provided to minimize the expectation of DR worsening. Ophthalmologic follow-up should be continued regularly in the postoperative period even in the case of diabetic remission. Further randomized trials are needed to better understand the organ-specific risk factors for progression and provide personalized counseling for T2DM patients planned for bariatric surgery. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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21 pages, 1791 KiB

Open AccessReview

Chronic Microvascular Complications in Prediabetic States—An Overview

by Angelika Baranowska-Jurkun, Wojciech Matuszewski and Elżbieta Bandurska-Stankiewicz

J. Clin. Med. 2020, 9(10), 3289; https://doi.org/10.3390/jcm9103289 - 13 Oct 2020

Cited by 22 | Viewed by 3943

Abstract

A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with abnormal glucose metabolism in whom glycaemia is higher than optimal but below diagnostic criteria for diabetes. Prediabetes is a heterogenous nosological unit in which particular types are differently characterized and show different correlations with particular kinds of complications. Analysis of the latest research results shows the need to continue studies in a larger population and can imply the need to verify the currently employed criteria of diagnosing diabetes and chronic complications of diabetes in people with prediabetes. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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25 pages, 803 KiB

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Clinical Management of Diabetes Mellitus in the Era of COVID-19: Practical Issues, Peculiarities and Concerns

by Chrysi Koliaki, Anastasios Tentolouris, Ioanna Eleftheriadou, Andreas Melidonis, George Dimitriadis and Nikolaos Tentolouris

J. Clin. Med. 2020, 9(7), 2288; https://doi.org/10.3390/jcm9072288 - 18 Jul 2020

Cited by 39 | Viewed by 6749

Abstract

The management of patients with diabetes mellitus (DM) in the era of the COVID-19 pandemic can be challenging. Even if they are not infected, they are at risk of dysregulated glycemic control due to the restrictive measures which compromise and disrupt healthcare delivery. In the case of infection, people with DM have an increased risk of developing severe complications. The major principles of optimal care for mild outpatient cases include a patient-tailored therapeutic approach, regular glucose monitoring and adherence to medical recommendations regarding lifestyle measures and drug treatment. For critically ill hospitalized patients, tight monitoring of glucose, fluids, electrolytes, pH and blood ketones is of paramount importance to optimize outcomes. All patients with DM do not have an equally increased risk for severity and mortality due to COVID-19. Certain clinical and biological characteristics determine high-risk phenotypes within the DM population and such prognostic markers need to be characterized in future studies. Further research is needed to examine which subgroups of DM patients are expected to benefit the most from specific antiviral, immunomodulatory and other treatment strategies in the context of patient-tailored precision medicine, which emerges as an urgent priority in the era of COVID-19. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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