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Diabetology
Volume 4
Issue 1
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Diabetology, Volume 4, Issue 1 (March 2023) – 13 articles

Cover Story (view full-size image): Type 2 diabetes mellitus is a non-communicable epidemic. Many treatment options are available for patients with T2DM, yet less than half achieve their treatment goals. Current conventional clinical practices have proven largely unsuccessful in attaining adequate glycemic control and maintaining HbA1c under the recommended standard of 7.0%. Despite these shortcomings, evidence supports that multiple treatment options can result in T2DM remission when implemented promptly and correctly. In this manuscript, the authors review various treatments that have been able to induce T2DM remission and introduce the concept of a first-year plan that emphasizes the importance of early glycemic control and thoughtful selection of an aggressive, individualized treatment plan. View this paper
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9 pages, 1683 KiB  
Opinion
Lipodystrophies from Insulin Injection: An Update of the Italian Consensus Statement of AMD-OSDI Study Group on Injection Technique
by Sandro Gentile, Ersilia Satta, Giuseppina Guarino and Felice Strollo
Diabetology 2023, 4(1), 119-127; https://doi.org/10.3390/diabetology4010013 - 3 Mar 2023
Viewed by 2754
Abstract
The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how [...] Read more.
The causes and metabolic consequences of lipohypertrophy (LH) from incorrect insulin injection techniques have been well-known for a long time and are the subject of countless publications. However, only some researchers propose structured research modalities for LH and programs to teach patients how to prevent them and minimize their effects, thus contributing to complete rehabilitation. Experts and scientific societies have produced consensus documents and recommendations to spread the culture of LH and its complications among clinicians. However, they should go deeper into LH detection methods. This short article analyzes the recent literature on the best way to explore and find more or less evident LH lesions by using a structured and validated clinical methodology to benefit the many clinicians without access to technological equipment such as ultrasonography. This text also aims to bring awareness that since the last published recommendations on injection techniques, new needles for insulin injection, more technologically advanced and suitable for specific populations, have come to market but still need a thorough evaluation. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2022)
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11 pages, 552 KiB  
Article
Diabetes Management in Danish Primary School: A Survey of Experiences of Parents of Children with Type 1 Diabetes
by Mia K. Iken, Nuri C. Mateu, Lise B. Johansen, Kasper A. Pilgaard, Annette K. Mouritsen, Anders J. Schou, Line S. Høst, Anne Ø. Nannsen, Kurt Kristensen, Stine Hangaard, Mette Madsen and Dan Grabowski
Diabetology 2023, 4(1), 108-118; https://doi.org/10.3390/diabetology4010012 - 2 Mar 2023
Cited by 2 | Viewed by 2963
Abstract
Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This [...] Read more.
Supporting diabetes self-care in school is important for optimal glycemic control and mental health. The aim of this study was to investigate parental experiences of diabetes management in Danish schools, with an emphasis on the importance of school staff support in self-care. This cross-sectional study surveyed parents of schoolchildren with type 1 diabetes aged 6 to 16 years in Denmark. The parents were identified among members of the Danish Diabetes Association and were invited to complete an online questionnaire. A total of 252 parents of schoolchildren with type 1 diabetes answered the questionnaire. Only 28% of the children had a designated staff member responsible for support in diabetes self-care during school hours. Having a designated staff member responsible for support in self-care was positively associated with parental experiences of better school–parent cooperation (p < 0.001), better experience of diabetes management in school (p < 0.001), and larger proportions of children and parents feeling comfortable in school (p = 0.022 and p = 0.049, respectively). School staff support was positively associated with better parental experience of diabetes management and with some parameters of mental health in schoolchildren with type 1 diabetes and their parents in Denmark. Full article
(This article belongs to the Special Issue Lifestyle Behavior Intervention for Diabetes Prevention and Management)
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15 pages, 2069 KiB  
Review
Achieving Remission in the Era of Clinical Inertia: What Is Preventing Us from Treating Type 2 Diabetes?
by Austen Suits, Ridhi Gudoor and Jay H. Shubrook
Diabetology 2023, 4(1), 93-107; https://doi.org/10.3390/diabetology4010011 - 24 Feb 2023
Cited by 1 | Viewed by 6572
Abstract
Despite evolution in treatment options and improved understanding of pathophysiology, the treatment of type 2 diabetes remains unsatisfactory. Current management guidelines complicated by clinical inertia have resulted in over half of patients failing to meet glycemic targets. Expert consensus has defined a state [...] Read more.
Despite evolution in treatment options and improved understanding of pathophysiology, the treatment of type 2 diabetes remains unsatisfactory. Current management guidelines complicated by clinical inertia have resulted in over half of patients failing to meet glycemic targets. Expert consensus has defined a state of diabetes remission whereby treatment can induce sustained normalization of glucose levels. Evidence suggests that metabolic surgery, intensive lifestyle modification, and pharmacologic approaches are each viable options for achieving remission when implemented early in the disease course. The authors review each of these strategies and include practical considerations to aid in the pursuit of remission. Full article
(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)
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7 pages, 703 KiB  
Communication
Managing Hospitalized Patients Taking SGLT2 Inhibitors: Reducing the Risk of Euglycemic Diabetic Ketoacidosis
by Julia Selwyn and Ariana R. Pichardo-Lowden
Diabetology 2023, 4(1), 86-92; https://doi.org/10.3390/diabetology4010010 - 21 Feb 2023
Cited by 7 | Viewed by 12250
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are emerging as an important therapy not only for type 2 diabetes (T2DM), but also for heart disease and kidney disease. As these medicines gain acceptance, the number of hospitalized patients receiving them is likely to rise. During clinical [...] Read more.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are emerging as an important therapy not only for type 2 diabetes (T2DM), but also for heart disease and kidney disease. As these medicines gain acceptance, the number of hospitalized patients receiving them is likely to rise. During clinical trials, SGLT2 inhibitors were noted to have a potential risk for diabetic ketoacidosis (DKA), particularly DKA with relatively normal blood glucose levels, ‘euglycemic DKA’. Similar to DKA that is not associated with SGLT2 inhibitors, most of these events seem to be related to acute illnesses or other changes in a patient’s medications or self-management circumstances. This creates a need among hospital providers to create strategies to prevent DKA in their hospitalized patient and guidance on monitoring and treating euglycemic DKA. Our combined experience concerning this phenomenon has given a great deal of insight into this problem and the knowledge needed to improve patient care, by augmenting patient education, inpatient surveillance, and early treatment for euglycemic DKA. Full article
(This article belongs to the Special Issue Glycemic Care in Hospitalized Patients with Diabetes: Current Views and Future Perspectives)
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10 pages, 1664 KiB  
Brief Report
Knowledge of Diabetes among Adults at High Risk for Type 2 Diabetes in the Trivandrum District of Kerala, India
by Thirunavukkarasu Sathish, Kavumpurathu Raman Thankappan, Jeemon Panniyammakal and Brian Oldenburg
Diabetology 2023, 4(1), 76-85; https://doi.org/10.3390/diabetology4010009 - 16 Feb 2023
Viewed by 4144
Abstract
We aimed to study the knowledge of diabetes among individuals with a high risk for developing type 2 diabetes in the Trivandrum district of the Indian state of Kerala. The baseline data collected from 1007 participants of the Kerala Diabetes Prevention Program were [...] Read more.
We aimed to study the knowledge of diabetes among individuals with a high risk for developing type 2 diabetes in the Trivandrum district of the Indian state of Kerala. The baseline data collected from 1007 participants of the Kerala Diabetes Prevention Program were analyzed. Diabetes knowledge was assessed using a scale adapted from a large nationwide study conducted in India. The composite score of the scale ranged from 0 to 8. The mean age of the participants was 46.0 (SD: 7.5) years, and 47.2% were women. The mean diabetes knowledge score was 6.9 (SD: 2.1), with 59.5% having the maximum possible score of 8. Of the 1007 participants, 968 (96.1%) had heard the term diabetes, and of them, 87.2% knew that the prevalence of diabetes is increasing, 92.9% knew at least one risk factor for diabetes, 79.6% knew that diabetes can cause complications in organs, and 75.9% knew that diabetes can be prevented. While the overall level of knowledge of diabetes about its risk factors, complications, and prevention was generally high, an alarmingly low proportion of participants knew that diabetes can affect key organs such as the eyes (24.0%), heart (20.1%), feet (10.2%), and nerves (2.9%), and nearly a quarter (24.1%) were not aware that diabetes can be prevented. It is essential to educate high-risk individuals about diabetes complications and the importance of and strategies for diabetes prevention in the Trivandrum district of Kerala. Full article
(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members in Diabetology)
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12 pages, 419 KiB  
Review
The Lipids and Volume in Satiation and Satiety (LIVES) Hypothesis: A Proposed Alternative Model for the Pathogenesis of Obesity
by Andrew Warrilow, Kate Pumpa, Shawn Somerset and Nenad Naumovski
Diabetology 2023, 4(1), 64-75; https://doi.org/10.3390/diabetology4010008 - 14 Feb 2023
Cited by 2 | Viewed by 3353
Abstract
Obesity is one of the most important factors responsible for the marked increase in both the incidence and prevalence of type 2 diabetes mellitus (T2DM) in recent decades. Addressing the lifestyle factors associated with the progression to T2DM would present a potential rational [...] Read more.
Obesity is one of the most important factors responsible for the marked increase in both the incidence and prevalence of type 2 diabetes mellitus (T2DM) in recent decades. Addressing the lifestyle factors associated with the progression to T2DM would present a potential rational early prevention strategy. The current evidence suggests that excessive energy intake is mediated via dietary fat. Biochemical signals released in response to the ingestion of food require supportive signalling from the presence of food in the stomach. The degree of supportive volume signalling emanating from the stomach influences both the satiation and satiety phases. The Lipids and Volume in Satiation and Satiety (LIVES) Hypothesis proposes that the biological feedback from fat intake appears to be influenced by the other macronutrients with which it is consumed. By identifying the various possible macronutrient combinations with fat, it is possible to construct a matrix of food composition/volume scenarios, which may help elucidate dysfunction in the human food energy regulation system within the context of the modern food environment. Full article
(This article belongs to the Special Issue Lifestyle Behavior Intervention for Diabetes Prevention and Management)
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2 pages, 162 KiB  
Editorial
Editorial to “Gender Differences in Diabetes”
by Giancarlo Tonolo
Diabetology 2023, 4(1), 62-63; https://doi.org/10.3390/diabetology4010007 - 3 Feb 2023
Viewed by 1383
Abstract
Welcome to this Special Issue of Diabetology entitled “Gender Difference in Diabetes” [...] Full article
(This article belongs to the Special Issue Gender Difference in Diabetes)
16 pages, 648 KiB  
Article
Transitioning to Telehealth during COVID-19: Experiences and Insights from Diabetes Prevention and Management Program Providers in Los Angeles County
by Sally L. Bullock, Telma Menendez, Liz Schwarte, Lisa Craypo, Jennifer T. Mosst, Gabrielle Green, Noel C. Barragan and Tony Kuo
Diabetology 2023, 4(1), 46-61; https://doi.org/10.3390/diabetology4010006 - 31 Jan 2023
Cited by 6 | Viewed by 3238
Abstract
The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via [...] Read more.
The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models. Full article
(This article belongs to the Special Issue Diabetology: Feature Papers 2022)
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16 pages, 1646 KiB  
Review
Are Dietary Sugars Potent Adipose Tissue and Immune Cell Modulators?
by Pedro Barbosa and Eugenia Carvalho
Diabetology 2023, 4(1), 30-45; https://doi.org/10.3390/diabetology4010005 - 19 Jan 2023
Cited by 2 | Viewed by 3150
Abstract
Glucose, fructose, and galactose are widely used in the food industry as sweeteners and food additives. The over-consumption of these carbohydrates has been identified as a possible trigger of non-communicable diseases. These include insulin resistance, obesity, and type 2 diabetes. These sugars induce [...] Read more.
Glucose, fructose, and galactose are widely used in the food industry as sweeteners and food additives. The over-consumption of these carbohydrates has been identified as a possible trigger of non-communicable diseases. These include insulin resistance, obesity, and type 2 diabetes. These sugars induce an energy overload with consequent adipose tissue (AT) expansion, contributing to the development of obesity. Furthermore, a common feature of these non-communicable diseases is the detrimental, chronic, low-grade inflammation contributing to their onset. In the present review, we identify the most widely used dietary free sugars and their direct impacts on AT metabolism and inflammation, as well as their involvement in systemic inflammation and effects on the immune cell phenotype and function. Additionally, we discuss the capacity of the free sugars to induce immune modulation, enhancing inflammation, an underlying hallmark of insulin resistance, obesity, and T2DM. Dietary sugars have an important and deleterious metabolic impact on AT and also on immune cells. More research is needed to effectively understand the impact of chronic exposure to high levels of individual or combined sugars on metabolism, with the impact on immunomodulation being especially important. Full article
(This article belongs to the Special Issue Nutritional Modulation of Dietary Sugars as a Strategy to Improve Insulin Resistance and Energy Balance in Diabetes)
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2 pages, 143 KiB  
Editorial
Acknowledgment to the Reviewers of Diabetology in 2022
by Diabetology Editorial Office
Diabetology 2023, 4(1), 28-29; https://doi.org/10.3390/diabetology4010004 - 19 Jan 2023
Viewed by 1111
Abstract
High-quality academic publishing is built on rigorous peer review [...] Full article
9 pages, 520 KiB  
Brief Report
Glycemia and New-Onset Diabetes among COVID-19 Patients with Prediabetes: A Follow-Study of Case Series in India
by Nirmala Devi Chandrasekaran and Thirunavukkarasu Sathish
Diabetology 2023, 4(1), 19-27; https://doi.org/10.3390/diabetology4010003 - 6 Jan 2023
Viewed by 2412
Abstract
Studies have shown that COVID-19 patients with prediabetes frequently present with high plasma glucose levels on hospital admission. However, whether the glycemic abnormalities are temporary or persist after recovery from the illness is unclear. We conducted a follow-up study of the case series [...] Read more.
Studies have shown that COVID-19 patients with prediabetes frequently present with high plasma glucose levels on hospital admission. However, whether the glycemic abnormalities are temporary or persist after recovery from the illness is unclear. We conducted a follow-up study of the case series of 69 COVID-19 patients with prediabetes (HbA1c 5.7–6.4%) who were admitted to a tertiary care hospital in Chennai, India, from May to October 2020 and were discharged alive. Over a mean follow-up of 146.6 (SD: 72.5) days, the mean fasting plasma glucose rose significantly by 16.8 mg/dL (from 119.3–136.1 mg/dL), 2-hr post-prandial glucose by 61.0 mg/dL (from 176.2–237.2 mg/dL), and HbA1c by 0.6% (5.9–6.5%). Of the 49 (84.5%) patients who were discharged with glucose-lowering medications, 40 (81.6%) continued taking them at the first follow-up visit (mean of 50.1 days from admission), and 39 (79.6%) continued taking them at the second follow-up visit (mean of 114.3 days from the first follow-up visit). In addition, 12.1% of patients developed new-onset diabetes after recovery from the illness. These findings underscore the importance of regular monitoring of glycemic parameters in COVID-19 patients with prediabetes after recovery. Full article
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8 pages, 273 KiB  
Systematic Review
The Impact of Moderate-to-High-Intensity Exercise Protocols on Glycated Hemoglobin Levels in Type 2 Diabetes Patients
by Ana Pedrosa, Guilherme Furtado, Marcelo Paes de Barros, André Luís Lacerda Bachi, José Pedro Ferreira, Vilma A. Sardão, Luís Rama and Ana Teixeira
Diabetology 2023, 4(1), 11-18; https://doi.org/10.3390/diabetology4010002 - 28 Dec 2022
Cited by 3 | Viewed by 4056
Abstract
Type 2 diabetes mellitus (T2DM) is a growing global health issue that is closely linked to the epidemic of obesity. In addition to genetic factors, environmental and health-risk behaviours (i.e., high-carbohydrate diet and physical inactivity) contribute to a variety of pathophysiological disorders. Advanced [...] Read more.
Type 2 diabetes mellitus (T2DM) is a growing global health issue that is closely linked to the epidemic of obesity. In addition to genetic factors, environmental and health-risk behaviours (i.e., high-carbohydrate diet and physical inactivity) contribute to a variety of pathophysiological disorders. Advanced exercise protocols, such as Moderate-to-intensity (MIT) and High Intensity Interval Training (HIIT), revealed a strategy for mitigating and/or attenuating the DTMII’s harmful effects by controlling glycated haemoglobin (HbA1c) levels. The goals of this review were to summarize the most recent evidence on the impact of HIIT on HbA1c levels. A mini-review protocol was performed through the PubMed/Medline database. The search comprised experimental and randomized controlled trial studies published in English between 2016 and 2021. The terms HbA1c, T2DM, MIT and HIIT, and their analogues were used. A total of seven studies were finally included. Our findings showed that the HIIT protocol is an effective strategy to induce HbA1c balance and improve glycaemic control than moderate training. The HIIT conducted in the laboratory and involving aerobic exercise on a cycle ergometer appears to be more efficient that MIT. Additional findings include improved beta-cell function, decreased low-grade inflammation, and the induction of cardiovascular benefits. More research is required to investigate the feasibility and safety of HIIT protocols in T2DM patients. Full article
(This article belongs to the Special Issue Nutritional Modulation of Dietary Sugars as a Strategy to Improve Insulin Resistance and Energy Balance in Diabetes)
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10 pages, 5533 KiB  
Review
Impact of Sugars on Hypothalamic Satiety Pathways and Its Contribution to Dysmetabolic States
by Adriana M. Capucho and Silvia V. Conde
Diabetology 2023, 4(1), 1-10; https://doi.org/10.3390/diabetology4010001 - 24 Dec 2022
Cited by 1 | Viewed by 4859
Abstract
Food behaviour is a complex and multifaceted cooperation between physiologic, psychological, social, and genetic factors, influencing meal timing, amount of food intake, food preferences, and food selections. Deregulation of the neurobiological mechanisms controlling food behaviour underlies the development of obesity and type 2 [...] Read more.
Food behaviour is a complex and multifaceted cooperation between physiologic, psychological, social, and genetic factors, influencing meal timing, amount of food intake, food preferences, and food selections. Deregulation of the neurobiological mechanisms controlling food behaviour underlies the development of obesity and type 2 diabetes, two epidemics of the present century. Several brain nuclei are involved in the regulation of the different components of food behaviours; the hypothalamus is the key in controlling appetite and energy homeostasis. In this review, we will explain the role of the hypothalamus in the control of food intake and its interplay with other brain nuclei important in food behaviour. We will also highlight the deregulation of satiety pathways in type 2 diabetes and obesity and the mechanisms behind this deregulation. Finally, knowing that there are different categories of sugars and that they differently impact food behaviours, we will review in a concise manner the studies referring to the effects of sugars in satiety and reward pathways and their impacts on metabolic diseases. Full article
(This article belongs to the Special Issue Nutritional Modulation of Dietary Sugars as a Strategy to Improve Insulin Resistance and Energy Balance in Diabetes)
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