1
|
Khodaie SA, Nikkhah H, Namiranian N, Abotorabi M, Askari M, Khalilzadeh SH, Khatibi Aghda A, Kamalinejad M. Topical Nigella sativa L. product: a new candidate for the management of diabetic peripheral neuropathy. Inflammopharmacology 2024; 32:551-559. [PMID: 37957516 DOI: 10.1007/s10787-023-01338-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2023]
Abstract
BACKGROUND Diabetic neuropathy is one of the most common complications of diabetes. The synthetic drugs available in the market have side effects and limitations for diabetic patients, the vast majority of whom are in the upper age group. In this regard, based on Persian medicinal sources, Nigella sativa (N. sativa) has proved to have beneficial effects on neuropathic pain and neurological disorders. In this study, the effect of N. sativa is investigated topically in patients with diabetic neuropathy. METHODS This study was performed as a double-blind clinical trial on 120 neuropathic patients. The patients were divided into three groups. The first group received a topical N. sativa product as an ointment, the second group was given a topical placebo, and the third received 300 mg gabapentin capsules. The blindness was done in first and second groups. Diabetic neuropathy was assessed before the study using the Michigan Neuropathy Screening Instrument (MNSI). In addition, neuropathy symptoms were evaluated after the trial using the MNSI questionnaire. RESULTS The data were elicited from the patients' answers to a number of questions in the Michigan questionnaire. There were statistically significant differences between the group that received the topical N. sativa product and the other two groups in terms of legs and feet numbness (p value = 0.001), burning pain in feet or legs (p value = 0.001), muscle cramps in feet or legs (p value = 0.001), prickling fleeing in feet or legs (p value = 0.001), hurting of the skin when the bed covers touch it (p value = 0.005), aggravated symptoms at night (p value = 0.001) and hurting feelings in the legs when walking (p value = 0.032). However, the three studied groups were not statistically different in distinguishing hot water from cold water. CONCLUSION According to the results of this study, the topical use of N. sativa, compared to the current drugs, has acceptable improving effects on diabetic neuropathic patients.
Collapse
Affiliation(s)
- Seyed-Ali Khodaie
- Diabetes Research Center, Sahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Haniyeh Nikkhah
- Diabetes Research Center, Sahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Community and Preventive Medicine, Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Maryam Askari
- Genetic and Environmental Adventures Research Center, School of Abarkouh Par Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Amidoddin Khatibi Aghda
- Physical Medicine and Rehabilitation, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Kamalinejad
- School of Pharmacy, Shahid Beheshti University of Medical Science, Tehran, Iran.
| |
Collapse
|
2
|
Salinas LF, Trujillo-Condes VE, Tecuatl C, Delgado-Lezama R, Cuellar CA. Impaired rate-dependent depression of the H-reflex in type-2 diabetes, prediabetes, overweight and obesity: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31046. [PMID: 36316945 PMCID: PMC9622671 DOI: 10.1097/md.0000000000031046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Type-2 diabetes is a chronic metabolic disorder characterized by hyperglycemia, resulting from deficits in insulin secretion or insulin resistance. According to the International Diabetes Federation, approximately 463 million people suffered from this condition in 2019, with a rapidly increasing impact in low-and middle-income countries. Obesity is a well-known risk factor for diabetes, and current data project a continuous increase in diabetes prevalence worldwide in obese individuals. Among the common complications, diabetic peripheral neuropathy (DPN) causes sensory symptoms, including pain that contributes to foot ulceration, and if not controlled, limb amputation may occur. The diagnosis of DPN is a clinical problem. Rate-dependent depression (RDD) of the Hoffmann reflex in the lower limbs has been proposed as a test to determine the presence of neuropathic pain in subjects with type-1 and type-2 diabetes. Recently, impaired RDD has been described in obese and diabetic rodent models. In this study, we characterized the RDD by evaluating the H-reflex at 0.2, 1, 2, 5, and 10 Hz in 39 patients with type-2 Diabetes mellitus (T2DM) and 42 controls without diabetes, subsequently classified as overweight/obese and prediabetic. A significant decrease in the RDD of the H-reflex was found in T2DM subjects at 1, 2, 5, and 10 Hz (P < .001) stimulation frequencies compared to controls, but not at 0.2 Hz (P = .48). A major finding of this study is that impaired RDD was also found in 11/25 overweight and obese subjects in at least 2 stimulation frequencies, being 10 of those classified in prediabetic levels according to their HbA1C values. The RDD of the H-reflex could be used as a quantitative and sensitive tool to study T2DM subpopulations with peripheral neuropathy. RDD could be used as a screening tool in combination with clinical tests to diagnose DPN and evaluate the progression of this condition.
Collapse
Affiliation(s)
- Luisa Fernanda Salinas
- Faculty of Medicine, Universidad Autónoma del Estado de México, Av. Paseo Tollocan, C. Jesús Carranza, Estado DE México, México
| | | | - Carolina Tecuatl
- Center for Neural Informatics, Structures, & Plasticity, Krasnow Institute for Advanced Study; and Department of Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, VA, USA
| | - Rodolfo Delgado-Lezama
- Departamento de Fisiología, Biofísica y Neurociencias, Cinvestav, Av. Instituto Politécnico Nacional 2508, México City, México
| | - Carlos A Cuellar
- School of Sport Sciences, Universidad Anáhuac México, Av. Universidad Anáhuac 46, Estado DE México, México
- *Correspondence: Carlos A Cuellar, School of Sport Sciences, Universidad Anáhuac México, Av. Universidad Anáhuac 46, Lomas Anáhuac, 52786, Huixquilucan, Estado DE México, México (e-mail: )
| |
Collapse
|
3
|
Wu CJ, Huang KJ, Tsai YC, Yeh TP, Hsieh CF, Wang YJ. Peripheral Neuropathy: Comparison of Symptoms and Severity Between Colorectal Cancer Survivors and Patients With Diabetes. Clin J Oncol Nurs 2021; 25:395-403. [PMID: 34269355 DOI: 10.1188/21.cjon.395-403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripheral neuropathy (PN) is a common symptom in colorectal cancer (CRC) survivors and patients with diabetes. However, the differences in PN symptoms between CRC survivors and patients with diabetes are not clear. OBJECTIVES The purpose of this study was to examine the differences in PN between CRC survivors and patients with diabetes. METHODS Secondary data were analyzed from two cross-sectional studies consisting of 81 CRC survivors and 86 patients with diabetes from two hospitals in northern and central Taiwan. Data were analyzed using descriptive statistics, analysis of covariance, and multiple logistic regression. FINDINGS Significant differences in severity and prevalence of PN and neuropathic pain between CRC survivors and patients with diabetes were found. Patients with diabetes had significantly more severe PN and sensory PN compared to CRC survivors. In addition, the prevalence of PN and neuropathic pain was significantly higher in CRC survivors compared to patients with diabetes after control of covariates.
Collapse
Affiliation(s)
| | | | - Yi-Chuan Tsai
- Christian Medical Foundation Lukang Christian Hospital
| | | | | | | |
Collapse
|
4
|
Anastasi JK, Klug C. Diabetic peripheral neuropathy: Person-centered care. Nursing 2021; 51:34-40. [PMID: 33759861 DOI: 10.1097/01.nurse.0000736904.62783.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Patients with diabetes mellitus may experience painful and nonpainful diabetic peripheral neuropathy (DPN). This article offers an overview of DPN and the clinical assessment and management of patients with DPN, as well as the nurse's role in supporting these patients.
Collapse
Affiliation(s)
- Joyce K Anastasi
- At New York University in New York, N.Y., Joyce K. Anastasi is an Independence Foundation endowed professor and founding director and Chloe Klug is a former research assistant
| | | |
Collapse
|
5
|
Lian J, Wang H, Cui R, Zhang C, Fu J. Status of Analgesic Drugs and Quality of Life Results for Diabetic Peripheral Neuropathy in China. Front Endocrinol (Lausanne) 2021; 12:813210. [PMID: 35126315 PMCID: PMC8813762 DOI: 10.3389/fendo.2021.813210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study is to describe the current clinical situation of patients with painful diabetic peripheral neuropathy (DPN) and related anxiety, depression, and the quality of life of patients in mainland China, and to report the current status of the use of analgesics. METHODS Between June 15, 2021, and October 15, 2021, a total of 401 participants participated in the study. Recruitment was carried out using a multi-level sampling method. Participants' demographics, medical history, analgesic use, Michigan Symptom Score (MNSI), Numerical Rating Scale (NRS) pain score, Patient Health Questionnaire 9 (PHQ-9) score, Generalized Anxiety Disorder 7 (GAD) -7) Score, quality of life score (SF-12) and diabetes treatment status were collected. RESULTS Among the participants, there were 236 male patients and female patients. Participants were 322 patients over 40 years old. Regarding the use of analgesics: 132 patients reported using analgesics, 221 patients reported not using analgesics, and 48 patients reported having used analgesics. The results of the scale showed that the scores of NRS, GAD-7, PHQ-9 and SF-12 were 5.12 ± 2.15, 6.33 ± 3.67, 8.46 ± 4.07 and 47.84 ± 19.92 for patients who used analgesics, Compared with patients who did not use analgesics (NRS: 1.99 ± 1.7, GAD-7: 1.81 ± 2.81, PHQ-9: 3.13 ± 4.10, SF-12: 78.34 ± 21.66) there are significant differences (p< 0.001). In addition, patients' NRS scores are also closely related to GAD-7, PHQ-9 and SF-12 scores. CONCLUSION The severity of symptoms, mental status and quality of life of patients who used analgesics were more severe than those of patients who did not use analgesics. Pregabalin is still the preferred analgesic for patients with painful DPN, and the use of opioids in my country is extremely low, which is consistent with current international guidelines. Age, diabetic duration, DPN duration, PHQ-9 score, GAD-7 score and SF-12 scores are closely related to NRS pain scores. In addition, there are still a considerable number of patients who have not used analgesics due to financial burdens and other reasons, suggesting that China still has insufficient pain management in DPN patients.
Collapse
Affiliation(s)
- Jingxuan Lian
- Department of Endocrinology, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Haijun Wang
- Department of Endocrinology, Yan’an People’s Hospital, Yan’an, China
| | - Rongrong Cui
- Department of Endocrinology, Shangluo Central Hospital, Shangluo, China
| | - Chaoxia Zhang
- Department of Endocrinology, Xi’an Daxing Hospital, Xi’an, China
| | - Jianfang Fu
- Department of Endocrinology, Xijing Hospital, The Air Force Medical University, Xi’an, China
- *Correspondence: Jianfang Fu,
| |
Collapse
|
6
|
Rayapu L, Chakraborty K, Valluru L. Marine Algae as a Potential Source for Anti-diabetic Compounds - A Brief Review. Curr Pharm Des 2021; 27:789-801. [PMID: 32912118 DOI: 10.2174/1381612826666200909124526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) is a major chronic metabolic disorder characterized by hyperglycemia that leads to several complications such as retinopathy, atherosclerosis, nephropathy, etc. In 2019, it was estimated that about 463 million people had diabetes, and it may increase up to 700 million in 2045. Marine macroalgae are the rich source of bioactive compounds for the treatment of diabetes mellitus. OBJECTIVE This review summarizes the recent epidemiology and possible use of marine macroalgae-derived bioactive compounds for the protection against chronic metabolic disease, diabetes mellitus and marine macroalgae as a nutraceutical supplement. CONCLUSION The present therapies available for diabetes treatment are oral medicines and insulin injections. But continuous use of synthetic medicines provides low therapeutic with many side effects. In continuing search of anti-diabetic drugs, marine macroalgae remain as a promising source with potent bioactivity. Among existing marine algae, red and brown algae are reported to show anti-diabetic activity. Hence, the present review focuses on the epidemiology, diabetes biomarkers and different secondary bioactive compounds present in marine macroalgae to treat diabetes mellitus.
Collapse
Affiliation(s)
- Lavanya Rayapu
- Department of Biotechnology, Dravidian University, Kuppam-517426, A.P, India
| | - Kajal Chakraborty
- Marine Biotechnology Division, Central Marine Fisheries Research Institute (CMFRI), Ernakulum, Cochin-682001, Kerala, India
| | - Lokanatha Valluru
- Department of Biotechnology, Dravidian University, Kuppam-517426, A.P, India
| |
Collapse
|
7
|
Racaru S, Sturt J, Celik A. The Effects of Psychological Interventions on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Pain Manag Nurs 2020; 22:302-311. [PMID: 33317935 DOI: 10.1016/j.pmn.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psychological interventions are effective at ameliorating the experience of pain in conditions such as rheumatoid arthritis and chronic back pain. However, their effect on diabetic peripheral neuropathy (DPN) pain has yet to be established AIM: To assess the effectiveness of psychological interventions on pain and related outcomes in adults with DPN. DESIGN Systematic review. SETTINGS Community, hospital in-patient and out-patient. PARTICIPANTS/SUBJECTS Adults with diabetic peripheral neuropathy. METHODS Medline, Embase, PsychInfo, and CINAHL databases together with grey literature and trial registers were searched. A meta-analysis and narrative synthesis of included studies were undertaken. RESULTS Nine studies were selected from 1610 citations. At short-term follow-up psychological therapies showed a large effect on pain severity (SMD = -0.94, 95%CI [-1.50, -0.37], p = .001), a small effect on pain interference (SMD = -0.39, 95%CI [-0.73, -0.05], p = .02), and a moderate effect on depressive symptoms (SMD = -0.58, 95%CI [-0.95, -0.21], p = .002). Quality of life significantly improved in experimental subjects, (MD = -2.35, 95%CI [-3.99, -0.71], p = .005). At medium-term follow-up there was a large effect on pain severity (SMD = -1.26, 95%CI [-1.76, -0.77], p < .00001) and on pain interference (SMD = -0.91, 95%CI [-1.61, -0.21], p = .01) and a moderate effect on depressive symptoms (SMD = -0.76, 95%CI [-1.48, -0.05], p = .04). At long-term follow-up, improvements in pain interference, mood, and self-care behaviors were reported. CONCLUSIONS These findings demonstrate that the relationship between pain and perceived control identified in other groups who experience chronic pain may also be replicated in the DPN population. This is an important outcome that can guide further research and associated service developments.
Collapse
Affiliation(s)
- Simona Racaru
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK; St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Aycan Celik
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| |
Collapse
|
8
|
Deng H, Shu Y, Lv P, Zhao L, Cheng K, Zhang T, Song Y, Yang H, Tang H, Pei J, Shen X. Acupuncture for diabetic peripheral neuropathy: study protocol for a randomized, placebo-controlled trial. Trials 2020; 21:879. [PMID: 33106185 PMCID: PMC7586683 DOI: 10.1186/s13063-020-04811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common chronic complication of diabetes mellitus that has a considerable impact on quality of life, but there are few effective therapeutic strategies. The aim of this trial is to determine the efficacy and safety of manual acupuncture (MA) versus sham acupuncture (SA) for DPN. METHODS/DESIGN This is a study protocol for a randomized, placebo-controlled clinical trial. A total of 118 patients with DPN will be recruited and randomly assigned in a 1:1 ratio to either the MA group or SA group. All patients will receive 24 sessions over 12 weeks. Participants will complete the trial by visiting the research center at month 6 for a follow-up assessment. The primary outcome is peroneal motor nerve conduction velocity (peroneal MNCV) at week 12 compared with baseline. Secondary outcomes include peroneal motor nerve action potential amplitude (peroneal MNAP) and latent period (peroneal MNLP), sural sensory nerve conduction velocity (sural SNCV), action potential amplitude (sural SNAP) and latent period (sural SNLP), fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), glycated hemoglobin (HbAlc) at week 12 compared with baseline, Michigan Neuropathy Screening Instrument (MNSI) score and Diabetes Specific Quality of Life scale (DSQL) at week 12 and month 6 compared with baseline. Safety will be assessed during the whole trial. Masking effectiveness will be assessed by patients. DISCUSSION This trial may provide high-quality evidence for evaluating the efficacy and safety of MA treatment for DPN compared with SA treatment. Results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR1800020444. First registered on 29 December 2018, retrospectively registered, http://www.chictr.org.cn/showproj.aspx?Proj=31063 .
Collapse
Affiliation(s)
- Haiping Deng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China.,Shanghai Research Center of Acupuncture and Meridian, Pudong District, Shanghai, China
| | - Yu Shu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Peiran Lv
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Ling Zhao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Ke Cheng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China.,Shanghai Research Center of Acupuncture and Meridian, Pudong District, Shanghai, China
| | - Tingting Zhang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Yi Song
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China
| | - Hua Yang
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China
| | - Hong Tang
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China
| | - Jian Pei
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China.
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China.
| |
Collapse
|
9
|
Noronha JAF, Azevedo C, Moura CDC, Gusmão ECR, Cardoso ACLR, Chianca TCM. Altered touch perception and associated risk factors in individuals with diabetes mellitus. Rev Bras Enferm 2020; 73:e20190473. [DOI: 10.1590/0034-7167-2019-0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/17/2020] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the prevalence of altered touch perception in the feet of individuals with diabetes mellitus and the associated risk factors. Method: Cross-sectional study with 224 individuals with diabetes mellitus conducted in an endocrinology clinic at a public hospital in Campina Grande, Paraíba. The evaluation used touch sensitivity and perception, and a descriptive and multivariate analysis with Poisson regression was performed. Results: We found the prevalence of altered touch perception to be 53.1%. The risk factors that had a significant and joint impact on its occurrence were: female gender; previous ulcer; diabetes mellitus type 2; burning sensation, cracks, fissures, calluses, and Charcot foot. Conclusions: This study found a high prevalence of altered perception of touch, and this should support the planning of actions aimed at preventing the problem. The study showed the relevance of the phenomenon as a nursing diagnosis that could be included in NANDA-International.
Collapse
|
10
|
Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes 2019; 9:33. [PMID: 31685799 PMCID: PMC6828774 DOI: 10.1038/s41387-019-0101-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus is a worldwide epidemic affecting the health of millions of people. While type 1 diabetes (T1D) is caused by autoimmune destruction of the insulin-producing beta cells of the pancreas, type 2 diabetes (T2D) results from a combination of insulin resistance and beta cell insulin secretory defect. Clear definition and diagnosis of these two types of diabetes has been increasing more and more difficult, leading to the inclusion of a new category, namely double or hybrid diabetes (DD) that demonstrates symptoms of both T1D and T2D via the accelerator hypothesis. In this review, we discuss the worldwide prevalence of DD, its main physiological characteristics, including beta-cell autoimmunity, insulin resistance, and cardiovascular disease, the main risk factors of developing DD, mainly genetics, obesity and lifestyle choices, as well as potential treatments, such as insulin titration, metformin and behavioural modifications. Increasing awareness of DD among the general population and primary care practitioners is necessary for successfully treating this complex, hybrid disease in the future.
Collapse
Affiliation(s)
- Jomana Khawandanah
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom.
| |
Collapse
|