Surveillance of risk factors for diabetic foot ulceration with particular concern to local practice

Management of neuropathic pain in patients with diabetic peripheral neuropathy and low back pain in Saudi Arabia: Evidence and gaps

We report existing evidence and gaps in neuropathic pain management in Saudi Arabia, the prevalence and patient management stages in diabetic peripheral neuropathy (DPN) and low back pain (LBP) with a neuropathic component. A semi-systematic approach was adopted to identify data on neuropathic pain. A structured search was conducted through MEDLINE, Embase, and BIOSIS databases to identify articles published in English between January 2010 and December 2019. Unstructured search was conducted through various sources including Google Scholar and Saudi Arabia's Ministry of Health website. Studies including populations ≥18 years and neuropathic pain were included; data gaps were supplemented with anecdotal data from local experts. Weighted or simple means were calculated for overall data; synthesized evidence was represented as an evidence gap map. Of 37 articles retrieved from structured search, none were eligible for final analyses. Thirteen articles from unstructured search and two anecdotal data sources were included for final analyses. The majority of articles included were of cross-sectional design (n = 10) in diabetes patients. The mean (range; number of articles) DPN prevalence was estimated as 33.6% (5.6%-65.3%; n = 8). Data on DPN patient management stages were limited; synthesized evidence indicated that 37.2% (0.41%-80.0%; n = 3) of patients had DPN awareness, 17.8% (n = 1) underwent screening, 22.4% (18.4%-65.3%; n = 2) had DPN diagnosis, and 45.1% (0.0%-62.7%; n = 2) received treatment for pain management. Data on LBP with neuropathic component were scarce (prevalence, 41.0% [n = 1]; diagnosis, 54.7% [n = 1]). Data are limited, so more studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in the country.

Case-Control Study of Risk Factors and Self-Care Behaviors of Foot Ulceration in Diabetic Patients Attending Primary Healthcare Services in Palestine

The purpose of this study is to identify certain sociodemographic, lifestyle, self-care, and foot examination factors that predict the development of diabetic foot ulcers in Palestine. A case-control study was performed in Palestine in 2019. The control group consisted of diabetic patients without foot ulceration (NFU). The case group included diabetic patients who had foot ulcers (DFU) with a size not less than 0.5 cm2. The sample of patients was taken from primary healthcare diabetic clinics in Palestine. Findings of the study showed several independent risk factors for developing DFUs, which were smoking, sensory loss to vibration, sensory loss to monofilament, loss of pedal pulse, presence of calluses, nephropathy, retinopathy, and neuropathy. Also, this study has shown that illiteracy and low income were significantly associated with DFU development. Moreover, the current study demonstrated that poor self-care behaviors were associated with DFU. The information gained from the study will contribute to raising awareness and improving health education for diabetic patients and their families with the aim of reducing the complications of diabetes.

Green synthesis of silver nanoparticles by Nigella sativa extract alleviates diabetic neuropathy through anti-inflammatory and antioxidant effects

Green synthesis of silver nanoparticles has gained great interest among scientists. In view of this data, we conducted this study to identify the ameliorative effect of green synthesis of silver nanoparticles using Nigella sativa extract in diabetic neuropathy induced experimentally. In this study, 50 adult male albino rats were used and they were randomly divided into five groups; the first group was the healthy control group, the second group were the diabetic neuropathy diabetic neuropathy induced, Groups (3-6) diabetic neuropathy induced group and treated with silver nanoparticles, Nigella sativa extract and green synthesized silver nanoparticles using Nigella sativa extract respectively. Biochemical parameters including diabetic, inflammatory and antioxidant biomarkers were evaluated. Brain histopathology was also performed. Results revealed substantial rise in glucose, AGE, aldose reductase with insulin reduction in diabetic neuropathy induced group as compared to healthy control. Also, inflammatory markers increased significantly in diabetic neuropathy induced group. A remarkable change in oxidative status was observed in the same group. Furthermore, significant decline in nitrotyrosin level was observed. Regarding gene expression, we found significant down regulation in brain TKr A accompanied by upregulation of nerve growth factor in diabetic neuropathy group comparing with healthy control. Several treatments for diabetic neuropathy remarkably ameliorate all the investigated biomarkers. Histological findings are greatly relied on for the results achieved in this study. Therefore, it can be established that green synthesis of silver nanoparticles in combination with Nigella sativa extract could be a newly neuroprotective agents against inflammation and oxidative stress characterizing diabetic neuropathy through their antidiabetic, anti-inflammatory and anti-oxidants effects.

Prevalence and associated factors of foot ulcer among diabetic patients in Ethiopia: a systematic review and meta-analysis

Background

Diabetes and its complications including foot ulcer constitute a global public health challenge attributing to a significant cause of morbidity and mortality. Foot ulcer is one of the long-term complication of diabetes mellitus which lead to infection and amputation of lower extremities. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the magnitude of foot ulcer in diabetics and factors contributing to it.

Methods

We identified articles through electronic databases such as Medline, Hinari, Pub Med, Cochrane library, the Web of Science and Google Scholar. Accordingly, we identified 95 published and one unpublished article. Finally, eleven studies which fullfilled eligibility criteria were included in final systematic review and meta-analysis. Data were extracted using a standardized data extraction checklist and the analyses were conducted using STATA version 14. The Cochrane Q test statistic and I² tests were used to assess heterogeneity.

Results

The overall magnitude of foot ulcer was 12.98% (95%CI: 7.81–18.15) in diabetic patients in Ethiopia. Sub-group analyses revealed highest prevalence in Addis Ababa (19.31% (95%CI: 2.7. 41.37)). Foot ulcer was significantly associated with rural residence (OR = 2.72, 95%, CI: 1.84–4.01)), presence of callus on the feet ((OR = 12.67, 95%, CI: 6.47–24.79)), a body mass index of ≥24.5 ((OR = 2.68, 95%, CI: 1.58–4.56)), poor self- care practice ((OR = 1.47, 95%CI: 1.25–1.73)), type I diabetes mellitus ((OR = 0.42, 95%, CI: 0.22–0.79)), staying with DM for < 10 years ((OR = 0.23, 95%, CI: 0.11–0.50)), and age < 45 years ((OR = 0.44, 95%, CI: 0.21–0.92)).

Conclusion

The prevalence of diabetic foot ulcers in Ethiopia is relatively low, although its trend is increasing from time to time. Socio-demographic factors, body weight, and healthcare practice contribute to the development of diabetic foot ulcers. Appropriate interventions towards patient self-care practice, lifestyle modification and follow-up are wanted to prevent diabetic foot ulcers.

Lifestyle factors and macro- and micro-vascular complications among people with type 2 diabetes in Saudi Arabia

AIMS

The aim of this study is to identify lifestyle factors that place people with type 2 diabetes in Saudi Arabia at a greater risk of macro- and microvascular complications.

METHODS

A survey was conducted among adults with type 2 diabetes who attended diabetes centres in three major cities in Saudi Arabia. Participants were interviewed and their medical files were reviewed for lab test results and documented comorbidities. Associations between complication and lifestyle factors were assessed using multiple logistic regression analysis.

RESULTS

A total of 1121 participants were recruited. Mean age was 57.6 (±11.1) years. The prevalence of coronary artery disease, diabetic foot, and stroke was 17.0%, 13.1% and 3.7%, and that of neuropathy, renal impairment, and retinopathy was 20.3%, 14.5%, and 42.8% respectively. Lifestyle factors associated with one or more of the complications were inadequate physical activity, longer sitting time, obesity, current or past smoking, passive smoking, hypertension, poor glycaemic control, low HDL and high triglycerides.

CONCLUSIONS

Diabetes complications are common among people with type 2 diabetes in Saudi Arabia. Life style factors such as inadequate physical activity, longer sitting time, obesity, smoking, hypertension, and poor control of blood glucose and lipids should be assimilated into complications prevention program.