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Chronic Complications of Diabetes: Prevalence, Prevention and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (26 February 2024) | Viewed by 11297

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Dr. Ilias Migdalis

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Director of Diabetes Centre, Lefkos Stavros Hospital, 115 28 Athens, Greece
Interests: chronic complications of diabetes; prevention of diabetes
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Dear Colleagues,

The scale of the chronic complications of diabetes became clear in the late 1920s and 1930s, when detailed descriptions of the syndrome were first made. These include tissue complications, microvascular diseases (retinopathy, nephropathy, and neuropathy), and macrovascular diseases (atherosclerosis). There is strong evidence that microvascular disease is related to the duration and severity of hyperglycemia in both type 1 and type 2 diabetes. At present, there are specific treatments to slow the progression of established nephropathy, preserve vision in those with established retinopathy, and decrease the chance of neuropathy leading to foot damage. Macrovascular disease affects the coronary arteries, cerebral circulation, and peripheral vessels, and the risk of heart failure is considerably increased among patients with diabetes, in addition to being associated with substantial morbidity and mortality. In recent years, major advances have occurred in our understanding of the pathogenesis of diabetic complications. Major theories regarding the development of complications are based on metabolic and vascular changes.

Dr. Ilias Migdalis
Guest Editor

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Keywords

basic principles and clinical data of diabetic complications
pathogenesis of diabetic complications
the epidemiology of diabetic complications
cardiovascular disease in diabetes
hypertension in diabetes
diabetic nephropathy
diabetic eye disease
diabetes neuropathies
the diabetic foot
management of diabetic complications

Related Special Issue

Chronic Complications of Type 2 Diabetes: Prevalence, Prevention, and Management in Journal of Clinical Medicine

Published Papers (9 papers)

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Research

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10 pages, 452 KiB

Open AccessArticle

Use of Advanced Hybrid Closed-Loop System during Pregnancy: Strengths and Limitations of Achieving a Tight Glycemic Control

by Parthena Giannoulaki, Evangelia Kotzakioulafi, Alexandros Nakas, Zisis Kontoninas, Polykarpos Evripidou and Triantafyllos Didangelos

J. Clin. Med. 2024, 13(5), 1441; https://doi.org/10.3390/jcm13051441 - 1 Mar 2024

Viewed by 998

Abstract

Background: Pregnant women with type 1 diabetes mellitus (T1DM) face an elevated risk of complications for both themselves and their newborns. Experts recommend strict glycemic control. The advanced hybrid closed-loop (AHCL) system, though not officially approved for pregnant T1DM patients, is promising for optimal glycemic control. Methods: We collected CGM metrics, HbA1c levels, insulin pump settings, and doses from a 33-year-old pregnant woman with 23-year history of T1DM from the 6th week of gestation to birth. She was initially on continuous insulin pump therapy with CGM and switched to the AHCL system (MiniMed^TM 780G, Medtronic, Northridge, CA, USA) between weeks 13 and 14. Results: The AHCL system improved glycemic control from weeks 14 to 26, achieving international guidelines with TIR = 72%, TAR = 24%, TBR = 4%. At week 30, TIR was 66%, TAR 31%. By altering diet and adding ‘fake carbohydrates’, she maintained TIR ≥ 70%, TBR ≤ 4%, TAR ≤ 26% from week 34 to birth. A healthy 4 kg, 53 cm baby boy was born at week 38. Conclusions: The use of the AHCL system holds significant promise for improving glycemic control in pregnancy. Optimal glycemic control with MiniMed^TM 780G in pregnancy requires accurate carbohydrate counting, specific timing of insulin doses in relation to meal consumption and dietary choices that reduce the glycemic load of meals continue to be crucial factors in achieving optimal glycemic control during pregnancy using the MiniMedTM 780G system. Further research and clinical studies are needed to explore the full potential of these advanced systems in managing T1DM during pregnancy and optimizing maternal and neonatal outcomes. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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13 pages, 2221 KiB

Open AccessArticle

Vitamin D—A New Therapeutic Target in the Management of Type 2 Diabetes Patients

by Oana Albai, Adina Braha, Bogdan Timar, Ioana Golu and Romulus Timar

J. Clin. Med. 2024, 13(5), 1390; https://doi.org/10.3390/jcm13051390 - 28 Feb 2024

Cited by 2 | Viewed by 1091

Abstract

Background: Vitamin D is a fat-soluble vitamin that prevents cardiovascular diseases and diabetes mellitus (DM). The present research aimed to study the impact of 25-hydroxyvitamin D (25(OH)D) level on the health status of patients with type 2 DM (T2DM) hospitalized in the “Pius Brînzeu” Emergency Clinical County University Hospital in Timisoara, Romania. Methods: The study retrospectively included 160 patients with T2DM who were clinically and biologically evaluated during hospitalization. Results: 13.1% of patients had optimal, 23.1% insufficient, and 63.8% deficient 25(OH)D values. Patients with 25(OH)D deficiency presented poorer glycemic control and were older, with higher weight, but had altered renal function, anemia, and lower iron values. Also, patients with associated neoplasia, diabetic neuropathy, cardiovascular disease (CVD), dementia, and grade 3 arterial hypertension (HTN) had lower values of 25(OH)D. An age > 55 years (sensitivity 69.9, specificity 82.5, AUROC 0.786, p < 0.001) and an HbA1c > 7.7% (sensitivity 89.3, specificity 92.9, AUROC 0.938, p < 0.001) predict 25(OH)D deficiency in T2DM patients. Conclusions: Vitamin D influences almost every system and organ in the body, so it should be a routine test for all patients with DM to correct the deficiency and prevent other diseases and complications. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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11 pages, 927 KiB

Open AccessArticle

Factors Associated with Increased Intraocular Pressure in Type 2 Diabetes Patients

by Adina Braha, Amanda Simion, Romulus Timar and Bogdan Timar

J. Clin. Med. 2024, 13(3), 676; https://doi.org/10.3390/jcm13030676 - 24 Jan 2024

Viewed by 963

Abstract

Background: Over one-third of patients living with diabetes will develop ocular disease during their lifetime. The present study analyzes the association between metabolic and anthropometric markers, associated comorbidities, and intraocular pressure (IOP) in patients with type 2 diabetes mellitus (DM). Methods: The retrospective study included 87 adult patients with type 2 DM who underwent routine eye examinations and blood/urine tests. Results: 67.9% of the patients had an IOP > 14.5 mmHg and only 41.3% had an HbA1c < 7%. In a multivariate regression analysis, the mean IOP was associated with diabetes duration in subjects with a disease duration < 15 years and an HbA1c < 7% (adjusted R² = 0.29, p = 0.008). Also, patients with shorter diabetes duration and optimal glucose control had a lower mean IOP than patients with a higher HbA1c (mean IOP 15.1 mmHG vs. 18.9 mmHg, p = 0.04). The patient’s age, anthropometric or metabolic markers, associated comorbidities like hypertension (HTN) or retinal angiosclerosis, and diabetes therapies were not associated with IOP in this study. Conclusion: Diabetes progression is directly associated with increased IOP. Avoiding clinical inertia and optimizing glycemic control could prevent or delay the increase of IOP. Routine eye examination should include measuring IOP, not only diabetic retinopathy screening. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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14 pages, 1954 KiB

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Electrochemical Skin Conductance by Sudoscan in Non-Dialysis Chronic Kidney Disease Patients

by Liang-Te Chiu, Yu-Li Lin, Chih-Hsien Wang, Chii-Min Hwu, Hung-Hsiang Liou and Bang-Gee Hsu

J. Clin. Med. 2024, 13(1), 187; https://doi.org/10.3390/jcm13010187 - 28 Dec 2023

Cited by 1 | Viewed by 898

Abstract

Background. Peripheral neuropathy is prevalent among patients with chronic kidney disease (CKD). Sudoscan non-invasively detects polyneuropathy by measuring electrochemical skin conductance (ESC). We conducted a study on sudomotor function in CKD patients across various stages based on their estimated glomerular filtration rate (eGFR). Methods. In this cross-sectional study of 700 CKD patients, all underwent Sudoscan. Pathological ESC was defined as hands < 40 μS or feet < 50 μS. Clinical neuropathy scores including Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique en 4 questionnaire (DN4) were obtained. Results. Among participants, 344 had diabetes and 356 did not. Hands and feet ESC decreased with CKD progression (median (IQR) in stage 1–2, 3, 4–5: 54.0 (39.0–68.0), 45.5 (30.0–63.0), 41.8 (26.5–60.5), p trend < 0.001; 64.5 (53.5–74.0), 60.5 (43.0–72.5), 55.0 (39.0–69.8), p trend < 0.001). Pathological hands and feet ESC increased in later CKD stages (stage 1–2, 3, 4–5: 26.6%, 40.9%, 45.7%, p trend < 0.001; 21.7%, 34.0%, 40.6%, p trend < 0.001). Positive hands and feet ESC-eGFR correlation existed irrespective of diabetes. Diabetic patients had lower hands and feet ESC than non-diabetics as CKD progressed. However, multivariate regression found no significant ESC-eGFR association. Sudoscan correlated with clinical neuropathy scores. Conclusion. Pathological sudomotor function was common in non-dialysis CKD stages 4–5. Diabetic patients had worse function. Sudomotor dysfunction progressed with renal disease but eGFR was not an independent risk factor. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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17 pages, 914 KiB

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Achievement of Treatment Goals and Mortality in Individuals with Diabetes: The ELSA-Brasil Study

by Bruna Cristine Chwal, Rodrigo Citton P. dos Reis, Maria Inês Schmidt, Sandhi Maria Barreto, Rosane Harter Griep and Bruce B. Duncan

J. Clin. Med. 2023, 12(24), 7663; https://doi.org/10.3390/jcm12247663 - 13 Dec 2023

Viewed by 822

Abstract

Background: To prevent diabetes complications, the American Diabetes Association (ADA) has recommended the treatment of blood glucose, blood pressure, and LDL-cholesterol (LDL-c) to target levels. Our aim is to characterize the risk of death according to the achievement of these goals in subjects with diabetes participating in the ELSA-Brasil study. Methods: ELSA-Brasil is an occupational cohort study of middle-aged and elderly adults followed from a 2008–2010 baseline to 2019 by two additional clinic visits and annual telephone interviews. We ascertained known diabetes by self-reported diagnosis or anti-diabetic medication use. We used treatment targets based on the 2022 ADA guidelines. We ascertained deaths from any cause based on the annual surveillance confirmed by death certificates. Results: After 11 (1.8) years of follow-up, 261 subjects had died among 2423 with known diabetes. Within-target HbA1c was associated with the greatest protection (HR = 0.66; 95%CI 0.50–0.88) against all-cause mortality. Achieving both glycemic and blood pressure targets conferred substantial protection (HR = 0.54; 95%CI 0.37–0.78). Within-target LDL-c, however, was associated with increased mortality (HR = 1.44; 95%CI 1.11–1.88). Conclusions: Glucose and blood pressure control, especially when concomitant, reduced mortality. The increased mortality associated with achieving the LDL-c target merits further investigation. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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12 pages, 271 KiB

Open AccessArticle

Better Detection of Peripheral Arterial Disease with Toe-Brachial Index Compared to Ankle-Brachial Index among Taiwanese Patients with Diabetic Kidney Disease

by Chia-Wei Chang, Ya-Wen Sung, Yu-Ting Huang, Yong-Chuan Chung and Mei-Yueh Lee

J. Clin. Med. 2023, 12(23), 7393; https://doi.org/10.3390/jcm12237393 - 29 Nov 2023

Cited by 1 | Viewed by 923

Abstract

Background: Ankle-brachial index (ABI) is a simple method for diagnosing peripheral artery disease (PAD) but has limited reliability in patients with diabetes mellitus (DM) because of medial artery calcification. Our study aims to investigate whether the toe brachial index (TBI) or the cardio-ankle vascular index (CAVI) has a better detection over the ABI for diagnosing PAD in diabetic kidney disease (DKD). Materials and Methods: A cohort of 368 patients (mean age 68.59 ± 13.14 years, 190 males and 178 females) with type 2 DM underwent ABI, TBI, and CAVI measurements at our outpatient clinic. Results: Of all enrolled patients, the TBI is significant in evaluating PAD, especially in patients whose chronic kidney disease (CKD) stage 3a with adjusted odds ratio (AOR) = 6.50, 95% confidence interval (CI) 1.63–25.97, p = 0.0080, stage 3b AOR = 7.47, 95% CI 1.52–36.81, p = 0.0135, and stage 4–5 AOR = 20.13, 95% CI 1.34–94.24, p = 0.0116. CAVI is also significant in CKD stage 1 with AOR = 0.16, 95% CI 0.03–0.77, p = 0.0223, stage 2 with AOR = 0.18, 95% CI 0.04–0.74, p = 0.0180, and stage 3a AOR = 0.31, 95% CI 0.10–0.93, p = 0.0375. Conclusion: TBI has a better yield of detection of PAD compared to ABI among Taiwanese patients with DKD. CAVI may play a role in the early stage of DKD. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

23 pages, 603 KiB

Open AccessArticle

by Mohammad Dweib and Nuha El Sharif

J. Clin. Med. 2023, 12(21), 6719; https://doi.org/10.3390/jcm12216719 - 24 Oct 2023

Cited by 1 | Viewed by 1454

Abstract

Background: Worldwide, retinopathy, nephropathy, and neuropathy are the major diabetes-related microvascular complications. In Palestine, a low-middle-income country, diabetes is the fourth reason for death. However, a few studies examined diabetes microvascular consequences and its management. Therefore, we carried out a national study that aims to investigate the factors associated with diabetes-related microvascular complications among individuals seeking care in primary healthcare settings of the West Bank of Palestine. Method: Using a cluster systematic sampling technique, 882 participants with diabetes patients were chosen for a cross-sectional study from primary healthcare facilities operated by the Ministry of Health (PMoH), the United Nations Relief and Works Agency (UNRWA), and the Palestinian Medical Relief Society (PMRS). Data about patients related to diabetes-related complications, medication use, and other diseases were extracted from patients’ medical records. In addition, an interview face-to-face questionnaire was used to collect information about patients’ sociodemographic variables, medical history, smoking habits, duration of the disease, presence of concurrent conditions previous referrals, and hospital admissions, as well as their level of knowledge regarding diabetes, complications, and treatments. Results: Approximately 34.4% of persons with diabetes patients in Palestine encounter at least one microvascular complication associated with diabetes. The most prevalent diabetes-related microvascular complication was retinopathy (17.3%), 23.4% of participants had more than one microvascular complication, and 29% of male patients had erectile dysfunction. A higher probability of having any microvascular complications was associated with older age (over 60 years). Participants with diabetes patients with fundoscopy or ophthalmology reports, according to diabetes follow-up guidelines, were less likely to develop retinopathy. Also, those who performed regular kidney function testing were less likely to have nephropathy, and those who performed a regular foot exam were less likely to develop diabetic foot. Conclusions: Diabetes-related microvascular complications were associated with patient age, low education level, residency location, and adherence to diabetes follow-up guidelines of diabetes management; i.e., having been tested for HbA1c, consulting with specialists, regular kidney function, and foot examination. These factors can be utilized in setting up proper management protocols to prevent or delay microvascular complications in many patients. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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17 pages, 1650 KiB

Open AccessArticle

Association between the Prognostic Nutritional Index and Chronic Microvascular Complications in Patients with Type 2 Diabetes Mellitus

by Gulali Aktas

J. Clin. Med. 2023, 12(18), 5952; https://doi.org/10.3390/jcm12185952 - 13 Sep 2023

Cited by 16 | Viewed by 1129

Abstract

The prognostic nutritional index (PNI) is associated with inflammatory conditions. Since type 2 diabetes mellitus (T2DM) and its microvascular complications produce a significant inflammatory burden, we aimed to compare the PNI levels of the subjects with T2DM to those of healthy individuals. Furthermore, we aimed to compare the PNI levels of the diabetic subjects, with and without microvascular complications. The study cohort consisted of T2DM patients and healthy volunteers. The general characteristics, laboratory data, and PNI of the T2DM and control groups were compared. We further compared the PNI levels of the diabetic patients, with and without diabetic microvascular complications. The PNI levels of the T2DM patients and the control group were 51.6 (30.1–73.8)% and 64.8 (49.4–76)%, respectively (p < 0.001). Subgroup analyses revealed that the PNI was lower in the diabetic subjects with diabetic microvascular complications than in the diabetic patients without microvascular complications (p < 0.001), in patients with diabetic nephropathy compared to those without nephropathy (p < 0.001), in patients with diabetic retinopathy compared to those without retinopathy (p < 0.001), and in patients with diabetic neuropathy compared to those without neuropathy (p < 0.001). In conclusion, we assert that assessing the PNI may yield additional diagnostic value in regards to the timely determination of diabetic microvascular complications. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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Review

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18 pages, 1898 KiB

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Depiction of Branched-Chain Amino Acids (BCAAs) in Diabetes with a Focus on Diabetic Microvascular Complications

by Daniela Maria Tanase, Evelina Maria Gosav, Tina Botoc, Mariana Floria, Claudia Cristina Tarniceriu, Minela Aida Maranduca, Anca Haisan, Andrei Ionut Cucu, Ciprian Rezus and Claudia Florida Costea

J. Clin. Med. 2023, 12(18), 6053; https://doi.org/10.3390/jcm12186053 - 19 Sep 2023

Cited by 2 | Viewed by 2559

Abstract

Type 2 diabetes mellitus (T2DM) still holds the title as one of the most debilitating chronic diseases with rising prevalence and incidence, including its complications such as retinal, renal, and peripheral nerve disease. In order to develop novel molecules for diagnosis and treatment, a deep understanding of the complex molecular pathways is imperative. Currently, the existing agents for T2DM treatment target only blood glucose levels. Over the past decades, specific building blocks of proteins—branched-chain amino acids (BCAAs) including leucine, isoleucine, and valine—have gained attention because they are linked with insulin resistance, pre-diabetes, and diabetes development. In this review, we discuss the hypothetical link between BCAA metabolism, insulin resistance, T2DM, and its microvascular complications including diabetic retinopathy and diabetic nephropathy. Further research on these amino acids and their derivates may eventually pave the way to novel biomarkers or therapeutic concepts for the treatment of diabetes and its accompanied complications. Full article

(This article belongs to the Special Issue Chronic Complications of Diabetes: Prevalence, Prevention and Management)

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