Management of diabetes mellitus type-2 in the geriatric population: Current perspectives

Glycemic Control Potential of Chemically Characterized Extract from Withania frutescens L. Roots in Severe Diabetes-Induced Mice

Diabetes mellitus is a metabolic syndrome that causes impairment, mortality, and many other complications. Insulin and several synthetic medications are currently used in the treatment of diabetes. However, these pharmaceutical drugs are costly, and therefore medicines place priority on alternatives to fight this lethal disease. This modest study aims to investigate the chemical composition, antidiabetic and antihyperglycemic potentials along with subacute toxicity (bodyweight change and biochemical parameters) of hydroethanol extract from Withania frutescens L. roots (WFRE). The chemical analysis was carried out using GC–MS after extract silylation. The chemical analysis identified many potentially active compounds that may determine the antidiabetic results of WFRE. The antidiabetic effect of WFRE was evaluated in mice with severe diabetes using oral administration of doses up to 400 mg/kg for 28 days. The results of the antidiabetic and antihyperglycemic tests indicate that WFRE possesses promising glucose-lowering effects and, as a result, it may serve as an antidiabetic alternative for long-term use. The 4-week treatments with different doses of plant extract did not alter the bodyweight appearance of the diabetic mice nor their biochemical parameters (AST and ALT). The findings obtained indicate that the studied plant extract controlled severe diabetes in mice. Therefore, Withania frutescens L. can serve society as it provides natural agents to control diabetes.

Current situation analysis of diabetic home care patients

OBJECTIVE

Diabetes is one of the primary diagnoses for admission to home health care units. Although there are many studies about elderly diabetic patients, there are not many studies on home care patients with diabetes. The present study aims to analyze the current status of diabetic home care patients with their biochemical data and medications.

METHODS

This was a retrospective study, including 256 diabetic patients who were following up by the Home Health Unit of Istanbul Provincial Health Directorate Public Hospitals Services-2. In this study, we analyzed the current biochemical data of the patients with their medications.

RESULTS

In this study, 185 female (72.3%) and 71 male (27.7%) patients were recruited with the mean HbA1c of 8.25±1.77. Among these patients, 65% of them were using oral antidiabetic (OAD), and 58% were using insulin. There were 21 (8.2%) patients who were not receiving any treatment. While patients who were using only oral antidiabetic have better A1c levels (A1c: 7.73±1.45), patients who were insülin using had HbA1c levels as high as the patients who were not using any medication. This may be due to the progression of diabetes, fear of hypoglycemia or insufficient insülin use. While metformin was the most commonly used OAD, with a 38% usage rate. When compared to HbA1c levels, there was no difference between the types of insulin used (p=0.167).

CONCLUSION

As a result, it is important to plan regular visits and personalized treatment by keeping in mind the benefits to risk ratios in home-care diabetic patients.

Effects of Whole-Body Vibration in Older Adult Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to determine the effects of whole-body vibration training on metabolic abnormalities, mobility, balance and aerobic capacity in older adult patients with type 2 diabetes mellitus.

METHODS

We searched PubMed, Cochrane Library, PEDro, LILACS and SciELO (from the earliest date available to March 2018) for controlled trials that evaluated the effects of whole-body vibration on the health-related outcomes of patients with type 2 diabetes. Two reviewers independently selected the studies and performed statistical analyses of the studies. Weighted mean differences, standard mean differences and 95% confidence intervals (CIs) were calculated.

RESULTS

In total, 7 studies, involving 279 patients who had type 2 diabetes, that compared whole-body vibration with other exercises and/or controls were included. Individual studies suggested that whole-body vibration was associated with improvements in pain levels, blood flow in the legs, glycated hemoglobin levels and fasting blood glucose levels. Whole-body vibration improved mobility weighted mean differences (-.24 seg; 95% CI -2.0, -0.5; n=96); balance standard mean differences (2.34; 95% CI 1.16, 3.5; n=57); and aerobic capacity standard mean differences (0.7; 95% CI 0.2, 1.3; n=59).

CONCLUSIONS

Whole-body vibration could be a useful strategy in the management of the symptoms and disabilities associated with type 2 diabetes; however, it is necessary to perform further studies to reinforce the reported findings.

Diabetes in the Elderly

The elderly are an important and distinct yet heterogeneous group of persons living with diabetes. The elderly have a unique biomedical, psychological, and social constitution. Their needs are different from those of younger adults. This implies that special care must be taken while evaluating and planning their nursing and management. Diabetes management in the elderly should focus on prevention and limitation of geriatric syndromes (medical conditions encountered in elderly persons), hypoglycemia (low blood glucose), and neurocognitive dysfunction (impairment in the functioning of the nervous system and brain). This review takes a practical approach to the assessment, nursing care, and medical treatment of diabetes in the elderly. It highlights major challenges and suggests solutions to these commonly encountered clinical problems.

Metformin use and the risk of colorectal adenoma: A systematic review and meta-analysis

BACKGROUND AND AIM

Although it is known that metformin can reduce risk of colorectal cancer, it is unclear whether it protects against colorectal adenoma.

METHODS

This study conducted a systematic literature search on MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "colorectal," "colon," "rectal," "rectum," "adenoma," "polyp," "neoplasia," "neoplasm," "metformin," and "diabetes." Studies were included if they evaluated the association between metformin use and colorectal adenoma and reported odds ratios (ORs) or provided data from which these could be estimated.

RESULTS

Ten studies and a total of 8726 patients were evaluated. Across all studies, a median of 32.1% (range: 15.2-53.0%) of patients taking metformin also had adenoma; a median of 43.5% (range: 20.5-59.6%) of those not taking metformin had adenoma. In our meta-analysis, metformin use reduced the risk of adenoma (pooled OR = 0.76, 95% confidence interval [CI] = 0.63-0.92, I²  = 60%). Upon subgroup analyses, metformin use tended to reduce risk of adenoma in a high-risk population consisting of patients with a history of colorectal neoplasia (CRN) (pooled OR = 0.61, 95% CI = 0.34-1.10, I²  = 79%). In addition, metformin reduced the risk of adenoma in a high-risk population consisting of patients with diabetes mellitus (pooled OR = 0.75, 95% CI = 0.62-0.91, I²  = 57%).

CONCLUSION

Metformin use seemed to be associated with a reduced risk of colorectal adenoma, especially in high-risk populations consisting of patients with diabetes mellitus or a history of CRN, although statistical power was not achieved in patients with a history of CRN.

Interdisciplinary position statement on management of hyperglycemia in peri-operative and intensive care

Hospitalized patients with diabetes pose numerous clinical challenges, including hyperglycemia, which may often be difficult to control. The therapeutic challenges are further accentuated by the difficulty in practical application of existing guidelines among Indian and South Asian patients. The present review highlights the various clinical challenges encountered during management of different diabetic hospitalized populations, and attempts to collate a set of practical, patient and physician friendly recommendations to manage hyperglycemia in such patients.