Treatment variation related to comorbidity and complications in type 2 diabetes: A real world analysis

The Pattern of Initial Presentation of Diabetes, Treatment Outcome and Its Predictors Among Diabetic Pediatrics Attended Service at Selected Public Hospitals of Southern Ethiopia: A Multi-Center Study

Background

Diabetes mellitus is the most common metabolic disorder in the pediatric population. Globally the incidence of diabetes increased from 11.3 million (95% UI 10.6-12.1) in 1990 to 22.9 million (21.1-25.4) in 2017, with a 102.9% increase and there was a 3% increase in diabetes mortality rates by age between 2000 and 2019.

Objective

This study aims to assess the pattern of initial presentation of pediatric diabetes mellitus, treatment outcome, and its predictors among pediatrics who attended service at selected public hospitals in southern Ethiopia from 2015 to 2019.

Methods

A cross-sectional study was conducted among 422 randomly selected pediatrics from October 1st, 2021 to December 30, 2021, and participants were selected randomly from 8 randomly selected public hospitals in southern Ethiopia after proportional to client flow allocation of samples. Data was extracted from clients' charts using a data extraction checklist. Statistical Package for Social Sciences (SPSS) version 24, and logistic regression analysis were applied to determine the presence of an association between dependent and independent variables, and significance was declared at p-value <0.05.

Results

In this study, most (74.6%) of the pediatrics initially presented with Diabetic ketoacidosis (DKA). This study found that Two-thirds (67.1%) of the respondents in the study had a good treatment outcome. In this study residence, presenting signs and symptoms; poly symptoms and weight loss, history of hospitalization, and comorbidity were predictors of treatment outcome of pediatric diabetes mellitus.

Conclusion

Diabetes mellitus with Diabetic ketoacidosis is the predominant pattern of initial presentation in the study. The magnitude of poor treatment outcomes of diabetes mellitus among pediatrics in this study is high and unacceptable Residence, signs, and symptoms at initial presentation, history of hospitalization, and comorbidity were found to be significant independent predictors of treatment outcome of pediatric diabetes mellitus.

The Value of White Cell Inflammatory Biomarkers as Potential Predictors for Diabetic Retinopathy in Type 2 Diabetes Mellitus (T2DM)

The pathogenesis of diabetic retinopathy is still challenging, with recent evidence proving the key role of inflammation in the damage of the retinal neurovascular unit. This study aims to investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) for diabetic retinopathy (DR) and its severity. We performed a retrospective study on 129 T2DM patients, divided into three groups: without retinopathy (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). NLR, MLR, and SII were significantly higher in the PDR group when compared to NDR and NPDR (3.2 ± 1.6 vs. 2.4 ± 0.9 and 2.4 ± 1.1; p = 0.005; 0.376 ± 0.216 vs. 0.269 ± 0.083 and 0.275 ± 0.111, p = 0.001; 754.4 ± 514.4 vs. 551.5 ± 215.1 and 560.3 ± 248.6, p = 0.013, respectively). PDR was correlated with serum creatinine (OR: 2.551), NLR (OR: 1.645), MPV (OR: 1.41), and duration of diabetes (OR: 1.301). Logistic regression analysis identified three predictive models with very good discrimination power for PDR (AUC ROC of 0.803, 0.809, and 0.830, respectively): combining duration of diabetes with NLR, MLR, and, respectively, PLR, MPV, and serum creatinine. NLR, MPV, SII, and LMR were associated with PDR and could be useful when integrated into comprehensive risk prediction models.

Risk assessment of amputation in patients with diabetic foot

The prevalence of diabetes has increased dramatically over the past decade, especially in developing countries, reaching pandemic proportions. Although has been the most important factor influencing the prevalence of type 2 diabetes, the prevalence of type 2 diabetes is on the increase among younger adults. The subsequent rate of increase with age is variable, which is more evident in societies where the general prevalence of the disease is higher. Based on clinical and statistical data obtained from the patients who were admitted to The First and Second Surgery Wards in the Sibiu County Emergency University Clinical Hospital (Sibiu, Romania) and the Proctoven Clinic (Sibiu, Romania) between January 2018 and December 2020, the present study attempted to devise a risk score that can be applied for the benefit of patients. The ultimate aim was that this risk score may be eventually applied by diabetologists and surgeons to assess the risk of amputation in patients with diabetic foot lesions. An important part in the therapeutic management of diabetic foot injuries is the assessment of risk factors. Using this risk score system devised, the risk factors that were found to exert influence in aggravating diabetic foot injuries are smoking, obesity, dyslipidaemia, unbalanced diabetes mellitus (glycated haemoglobin ≥7.5%), duration of diabetes >5 years, hepatic steatosis and the co-existence of various heart diseases. To conclude, all these risk factors aforementioned can decrease the effectiveness of treatment and can have a significant impact on the quality of life, if they are not well known.

Telerehabilitation intervention for type 2 diabetes

Diabetes has become an increasingly important health problem worldwide due to its prevalence. Although effective treatments for diabetes management have been developed, many patients have difficulty in achieving their therapeutic goals. Regular exercise training is suggested to prevent or delay the symptoms and complications of type 2 diabetes along with other medical treatments. It has become necessary to develop new rehabilitation models and practices in order to cope with the changing needs of the population. Treatment models using technology can be effective in disease management. Telerehabilitation may be effective as part of the rehabilitation program in the home environment, especially for patients who are unable to participate in conventional center-based rehabilitation due to transport difficulties or work resumption. Telerehabilitation is defined as the delivery of rehabilitation services via telecommunication technology, including phone, internet, and videoconference communications between the patient and health care provider. It is possible that telerehabilitation may benefit people with type 2 diabetes in similar ways with telemonitoring and interactive health communication systems. Although the applicability of telehealth methods has been proven in previous studies, telerehabi-litation studies in type 2 diabetes are inadequate in the literature. With larger, multi-centered randomized controlled studies, established clinical guidelines can be developed that will ultimately improve patient outcomes.