RESUMEN
BACKGROUND AND OBJECTIVES: The matrix metalloproteinase 7 (MMP-7) level gets heightened in the urine samples of diabetic individuals with impaired renal function. Renal biopsy is seldom offered because of its invasive nature. These concerns spurred the investigation of relationships between urine MMP-7 levels and the renal function of diabetic individuals. Studies exploring this aspect are scarce. We aimed to evaluate the glycemic and renal parameters of female and male individuals with or without type 2 diabetes mellitus (T2DM) or kidney disease. We also assessed the correlation of urine MMP-7 with various parameters. METHODS: This prospective, analytical, cross-sectional study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India, from February 2020 to January 2023. Female and male individuals 18-85 years of age diagnosed with either T2DM, hypertension, or kidney disease were assessed for their glycemic indices and renal parameters. Those with both renal disease and T2DM were placed in group A. The diabetic individuals without kidney disease constituted group B. People in group C had neither kidney disease nor T2DM. Patients in group D had kidney disease but were not diabetics. The parameters of the male and female participants in each of the four groups were assessed and compared, including: age, body mass index (BMI), fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), serum urea, serum creatinine, estimated glomerular filtration rate (eGFR), urine albumin, urine creatinine, urine albumin-creatinine ratio (ACR), serum sodium, serum potassium, and urine MMP-7 levels. Furthermore, we correlated urine MMP-7 with all these traits. We used R software (version 4.4.0, Vienna, Austria) for data analysis. RESULTS: Two hundred eighty-seven (87.5%) of the 328 individuals we screened were eligible. Of them, group A had the maximum number (94) of participants, followed by B (75), C (65), and D (53). Males comprised 60.3% (n = 173) of the study population. The median age of the participants was 52.0 (44.0-61.1) years. The intergroup variations were statistically significant (p < 0.001) owing to their glycemic status and renal function. The gender-basis comparison of FBS and HbA1c yielded non-significant differences. On the contrary, assessment of the renal parameters revealed significant differences (p < 0.001) between females and males. The study population had a median urine MMP-7 level of 19.9 (1.1-50.5) µg/L. Significant associations with urine MMP-7 were found with serum creatinine (r = 0.91, p < 0.001), urine ACR (r = 0.86, p < 0.001), and eGFR (r = -0.84, p < 0.001). CONCLUSION: Our study portrayed that male diabetics, in comparison to female diabetics, had greater levels of urine ACR, urine MMP-7, eGFR, and serum creatinine. Moreover, urine ACR, eGFR, and serum creatinine strongly correlated with the urine MMP-7 level.
RESUMEN
Assessing oxidative stress is vital in managing type 2 diabetes mellitus (T2DM) and its complications. This systematic review aims to identify the most important oxidative stress markers in T2DM patients and predict associated complications. A literature search was conducted from 2013 to 2023, focusing on case-control, cohort, cross-sectional, and randomized control trials. The included studies had open access and scientific methodologies for assessing oxidative stress markers, while the excluded studies were not published in English or lacked primary objectives related to oxidative stress markers and T2DM or its complications. The quality of eligible studies was evaluated using the Newcastle-Ottawa Scale (NOS) for case-control, cohort, and cross-sectional studies and the Jadad Scale for RCTs. Eighteen studies were selected for the review and 25 potential markers like malondialdehyde (MDA), 11 thiobarbituric acid reactive substances (TBARS), 8-hydroxydeoxyguanosine (8-OHdG), glutathione (GSH), superoxide dismutase (SOD), and isoprostanes were found to be the most commonly used markers to assess oxidative stress in T2DM. These markers help to assess oxidative stress levels in T2DM individuals as well as correlate with diabetic complications. Therefore, assessment and understanding of the role of oxidative stress in T2DM pathophysiology are crucial for improving patient care and mitigating complications.
RESUMEN
Introduction Myocardial infarction (MI) in young South Indians presents a shifting epidemiological landscape, challenging traditional perceptions of cardiovascular diseases. This study investigates the clinical and angiographic profiles of MI in this subgroup of the population in detail, emphasizing the interaction between lifestyle, environmental, and genetic factors that contribute to the incidence of MI in younger people. Methodology Utilizing a descriptive observational design, the study analyzed data from 70 young adults (aged 18-45 years) admitted to Frontier Lifeline Hospital, Chennai, with acute MI over six months. Patient demographics, clinical characteristics, and angiographic findings were collected and analyzed using standardized protocols. Statistical analysis employed chi-square tests and subgroup analyses to assess associations and differences between diabetic and non-diabetic patients. Results The study revealed a predominance of males (84.29%) among MI cases, with ST-elevation myocardial infarction (STEMI) being the most common presentation (52.86%). Anterior wall involvement was prevalent (50%), and left ventricular systolic dysfunction (LVSD) was observed in the majority (67%) of patients. Chest pain (87%) was the predominant symptom, and diabetes (47%) and hypertension (47%) were the risk variables that were most common. Angiographically, the left anterior descending artery (LAD) was often affected (51%), with single-vessel disease predominating (41.43%). Conclusion The findings underscore the significance of early detection and intervention strategies for MI in young South Indians. Gender-specific risk assessment, prompt diagnosis, and tailored treatment approaches are imperative. The high prevalence of LVSD highlights the burden of cardiac morbidity, particularly in diabetic individuals. Lifestyle modifications and weight management interventions are crucial for MI prevention. This study provides insights into the frequency and features of MI in young South Indians, emphasizing the importance of collaborative efforts for early identification and control of modifiable risk factors to mitigate the burden of coronary artery disease (CAD) in this population subset.
RESUMEN
Penile calciphylaxis is a rare presentation of calcific uremic arteriolopathy and can be a life-threatening condition usually seen in patients with end-stage renal failure with hemodialysis. The clear etiopathogenesis of calciphylaxis is not fully understood, but it is postulated to be characterized by the accumulation of calcium in the microvessels of adipose tissue and skin, which leads to ischemia and necrosis, causing painful ulcerations, and could potentially be complicated by sepsis and mortality. End-stage renal disease (ESRD) is one of the major risk factors for penile calciphylaxis. In this report, we describe a case of a 53-year-old Hispanic male patient with ESRD and diabetes on hemodialysis, who presented with a five-day history of acute, severe, burning, non-radiating pain to the head of his penis associated with black discoloration. He was diagnosed with penile calciphylaxis and received a combination of conservative and surgical interventions, resulting in a highly positive outcome marked by complete healing of the scar without any reported complications.
RESUMEN
In this case report, we discuss a 32-year-old diabetic male patient who presented with right foot pain three days following a spider bite. The foot progressively became swollen, preventing the patient from bearing weight on it. After admission to the emergency department, the examination showed discoloration of the dorsum of the proximal phalanx of the first toe with an open wound and pus. The patient received fluid resuscitation along with a course of metronidazole and levofloxacin. Subsequently, the patient was referred to an orthopedic and podiatric team where he underwent a complete foot fasciotomy. The procedure was successful, and the patient recovered well. This case showcases a rare manifestation of necrotizing fasciitis (NF) and highlights the importance of future research regarding NF and its association with diabetes mellitus.
RESUMEN
Background and purpose Cerebral haemodynamics and cognitive performance may be adversely affected in type 2 diabetes mellitus (T2DM). Previous studies reported reduced cerebral blood flow (CBF) and altered cerebrovascular reactivity (CVR) in T2DM. Yoga, an ancient holistic health approach, is known to be beneficial for T2DM. We hypothesized that yoga practice may alter CBF and the flow resistance in the middle cerebral artery (MCA) and improve cognition in T2DM. Our secondary objective was to explore the relationship between changes in cerebral haemodynamics and cognition in T2DM. Materials and methods Participants were randomly allotted into the yoga and control groups based on the eligibility criteria. One hour of yoga intervention specific to type 2 diabetes was provided to the yoga group for three months, while conventional treatment was provided to the control group. A transcranial Doppler was used to evaluate longitudinal changes in cerebral haemodynamics in MCA. A Corsi block tapping test was used to assess visio-spatial working memory. Results There were 75 participants recruited, of whom 38 participated in yoga and 37 participated in a control group. Both intention to treat and per protocol analysis showed significant results. At day 90, intention-to-treat analysis showed significant changes in CBF velocities (mean difference -10.85%, 95% CI (-13.26, -6.15), p<0.001), cerebral vasodilatory reserve (mean difference -0.23%, 95% CI (-0.43, -0.03), p=0.02) and cognition (mean difference -12.13%, 95% CI (-17.48, -6.78), p≤0.001). There was no between-group effect. Also, the correlation between the CBF and cognition did not show any significant results. Conclusion The three-month yoga intervention was associated with an improvement in cerebral hemodynamics. The study also revealed an improvement in visio-spatial working memory among patients with T2DM. The study did not show any correlation between the improvement in cerebral haemodynamics and working memory. We recommend larger and longer studies on yoga intervention for T2DM patients to evaluate whether such benefits are sustained and improve their quality of life.
RESUMEN
INTRODUCTION: Periodontal disease and type 2 diabetes are interrelated, with inflammation playing a significant role in the progression of both conditions. Previous research has demonstrated the potential of various treatments, such as diet, exercise, and periodontal therapies, to improve glycemic control in diabetic patients. METHOD: This study proposed a novel surgical approach, the Renew Procedure, as a potential solution to enhance glycemic control in type 2 diabetic patients with periodontal issues. The procedure involves the removal of all teeth, the elimination of oral and maxillofacial infections, the placement of dental implants, and the provision of implant-supported and implant-retained removable dentures. RESULTS: Preliminary findings indicated a significant reduction in HbA1c levels post-surgery, suggesting that this approach may improve overall oral health, reduce inflammation, and consequently lower HbA1c levels. CONCLUSION: Further research is necessary to confirm the efficacy of the proposed solution, but these initial results highlight the importance of addressing oral health through comprehensive strategies for diabetic and periodontitis patients.
RESUMEN
Euglycemic diabetic ketoacidosis (DKA) is a rare, but clinically important, presentation that can lead to significant morbidity and mortality in patients with diabetes mellitus. It has been associated with multiple etiologies, including sodium-glucose cotransport-2 (SGLT2) inhibitor use. This case report details the presentation of a 28-year-old male patient who was recently diagnosed with non-ST elevated myocardial infarction (NSTEMI) status post-percutaneous coronary intervention (PCI) to left anterior descending (LAD) and type 2 diabetes mellitus (T2DM) and discharged on a new medical regiment that included an SGLT2 inhibitor. The patient presented five days later with dyspnea, nausea, and vomiting. On initial evaluation, he had tachycardia and hypertension. Lab work revealed hyperkalemia, metabolic anion gap acidosis, and the presence of ketones and glucose in the urine, which led to the diagnosis of euglycemic DKA. The patient was started on intravenous (IV) insulin, bicarbonate, and D5 ½ normal saline (NS) and required five days of continuous treatment for the anion gap to close. Considering studies have shown that SGLT2 inhibitors are associated with euglycemic DKA, it is proposed that the use of an SGLT2 inhibitor in this newly diagnosed, post-PCI patient led to the development of euglycemic DKA. DKA most commonly resolves within 24 hours of treatment; however, our patient did not recover until after 120 hours of treatment. Recent studies have suggested that SGLT2-inhibitor euglycemic DKA may be associated with longer recovery time; however, there is still a need to further research the consistency of these findings and quantify the estimated duration of treatment across populations. There is also a need for investigation into how co-morbid factors, such as a recent NSTEMI and PCI, may affect recovery times or predispose patients who are taking SGLT2-inhibitors to develop euglycemic DKA as SGLT2 inhibitors are being more widely prescribed. This case report highlights the importance of creating more detailed and evidence-based guidelines for prescribing SGLT2 inhibitors for patients with diabetes and encourages more research into the expected duration of treatment for patients with SGLT2-induced euglycemic DKA and factors that may affect it.
RESUMEN
INTRODUCTION: Oral semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) class of antidiabetic medication. High costs and GI side effects are the major limitations of its widespread use. Some patients who were on a 14 mg dose of oral semaglutide self-prescribed an alternate-day schedule to mitigate GI side effects and to reduce the cost. METHODS: This retrospective observational cohort study evaluates the ambulatory glucose profile (AGP) data, extrapolated glycosylated hemoglobin (HbA1C), and BMI of 11 types of 2 diabetes mellitus (T2DM) while they were on an alternate-day 14 mg dose of oral semaglutide compared to their record while on a daily 7 mg dose. The AGP metrics (time-in-range (TIR), time-below-range (TBR), and time-above-range (TAR)) along with extrapolated HbA1C and BMI were analyzed. Statistical analysis was done using SPSS Statistics version 21.0. RESULTS: No statistically significant difference in the AGP metrics between the AGP profile of a daily 7 mg dose and the AGP profile of an alternate-day 14 mg dose of oral semaglutide was observed. Interestingly, a statistically significant progressive decline in BMI value was observed even on the alternate-day 14 mg dose when compared to the daily 7 mg dose. CONCLUSION: In this small cohort of patients, the metrics of short-term glycemic control and the extrapolated HbA1C values were similar for the daily 7 mg dose versus the alternate-day 14 mg dose of oral semaglutide. BMI showed progressive reduction which was statistically significant even with the alternate-day 14 mg dose of oral semaglutide.
RESUMEN
We present the case of a 43-year-old male with a history of poorly controlled type II diabetes who presented with altered mental status, urinary incontinence, and diabetic ketoacidosis (DKA). Initial brain imaging studies were negative for acute intracranial pathology; however, the next day, the patient was found to have left-sided paralysis. Repeat imaging studies revealed a right middle cerebral artery infarct with hemorrhagic conversion. Given that the rate of reported strokes in the setting of DKA in adults is limited, this case report affirms to discuss the importance of prompt recognition, evaluation, and adequate treatment of DKA to prevent neurological complications, as well as the pathophysiology behind the etiology of DKA-induced stroke. This case also underscores the importance of early recognition and missed strokes in the emergency department (ED) and emphasizes the need for stroke evaluation in patients with altered mental status even though an alternative diagnosis is apparent to avoid anchor bias.
RESUMEN
Introduction Brightness mode ultrasound (B-mode US) and FibroScan (Echosens, Paris, France) are the two ultrasound methods often recommended for screening non-alcoholic fatty liver disease (NAFLD) in persons with type 2 diabetes mellitus (T2DM). This study assessed the diagnostic performance of B-mode US using FibroScan as the reference standard. Methods Persons with a known history of T2DM were invited to screen for NAFLD using B-mode US and FibroScan on separate days within a one-month period. Assessors of B-mode US and FibroScan were blinded to each other's findings. Both B-mode US and FibroScan independently assessed and graded each participant for the presence of NAFLD. Using the diagnostic test findings of FibroScan as a reference standard, the sensitivity and specificity of B-mode US were analyzed. The area under the receiver operating characteristic curve (AUROC) was analyzed using Jamovi (version 2.3.21). A multinomial logistic regression of the B-mode US and FibroScan in predicting NAFLD grade was also analyzed. Results A total of 171 participants were assessed. B-mode US detected NAFLD in T2DM patients with 63.6% sensitivity, 65.6% specificity, and 0.646 AUROC. Sensitivity and specificity in overweight and obese participants were 36-43% and 76-85%, respectively. Multinomial logistic regression demonstrated an insignificant statistical relationship between FibroScan and B-mode US in predicting grade 1 steatosis (p-value = 0.397), which was significantly affected by a higher BMI (p-value = 0.034) rather than a higher liver fibrosis level (p-value = 0.941). The logistic regression further showed a significant relationship between B-mode US and FibroScan in predicting steatosis grade 2 (p-value = 0.045) and grade 3 (p-value < 0.001), which was not significantly affected by BMI (p-value = 0.091). Conclusion B-mode US can replace FibroScan for severe steatosis; however, it cannot be used to screen for NAFLD in T2DM patients due to lower sensitivity for early detection in the overweight.
RESUMEN
The rising prevalence of diabetes mellitus brings with it a rise in the occurrence of several complications of the disease such as chronic non-healing wounds. Diabetics are more prone to developing chronic wounds due to complications like peripheral neuropathy, poor foot care, hyperglycaemia and peripheral vascular diseases. The aim of this review is to discuss the various imbalances in the cytokine environment of diabetic wounds and to explore the developments in their management with an emphasis on agents that may be used topically to aid the healing process of chronic wounds. A systematic search was conducted on Scopus, PubMed and Google Scholar and relevant articles were shortlisted. We conclude that increased blood sugar impairs most phases of wound healing in several ways. Supplementary therapy with either topical or systemic cytokines is shown to promote wound healing in a diabetic wound.
RESUMEN
Emphysematous pyelonephritis (EPN) is a rare life-threatening infection that is usually encountered in diabetic patients. Herein, we are reporting a 41-year-old male patient with a past medical history of stage 3B chronic kidney disease (CKD), neurogenic bladder, and poorly controlled diabetes who presented with left-sided pyelonephritis and septic shock. E. coli was detected in urine and blood. Lack of adequate clinical response to appropriate antibiotic coverage prompted computed tomography (CT) scan of the abdomen that revealed EPN. Despite aggressive conservative management along with nephrostomy, the patient had multiple risk factors to fail conservative management and require nephrectomy. This left the patient on life-long dependence on hemodialysis. This case report is not only interesting as EPN is a rare clinical pathology, but it also helps to remind clinicians to remain vigilant on when to consider early imaging in pyelonephritis. In the appropriate clinical scenario of acute pyelonephritis in a diabetic patient with urinary obstruction, it is important to rule out EPN as an early diagnosis and conservative management including relief of urinary obstruction can lead to a better outcome, help preserve renal function, and spare nephrectomy.
RESUMEN
Introduction The impact of the coronavirus disease (COVID-19) COVID-19 pandemic on the care of pregnant patients with gestational diabetes (GDM) is largely unreported. The objective of this study was to compare the completion of postpartum oral glucose tolerance testing (GTT) prior to and during the COVID-19 pandemic among patients with GDM. Methods This was a retrospective review of patients diagnosed with GDM between April 2019 and March 2021. Medical records of patients diagnosed with GDM prior to and during the pandemic were compared. The primary outcome was the difference in the completion of postpartum GTT prior to and during the COVID-19 pandemic. Completion was defined as testing between four weeks to six months postpartum. Secondary objectives were: 1) to compare maternal and neonatal outcomes prior to and during the pandemic among patients with GDM, and 2) to compare pregnancy characteristics and outcomes by compliance with postpartum GTT. Results There were 185 patients included in the study, of whom 83 (44.9%) delivered prior to the pandemic and 102 (55.1%) delivered during the pandemic. There was no difference in completion of postpartum diabetes testing prior, compared to during the pandemic (27.7% vs 33.3%, p=0.47). Postpartum diagnosis of pre-diabetes and type two diabetes mellitus (T2DM) did not differ between groups (p=0.36 and p=1.00, respectively). Patients who completed postpartum testing were less likely to have preeclampsia with severe features compared to patients who did not (OR 0.08, 95% CI 0.01-0.96, p=0.02). Conclusion Completion of postpartum testing for T2DM remained poor prior to and during the COVID-19 pandemic. These findings underscore the need for the adoption of more accessible methods of postpartum testing for T2DM among patients with GDM.
RESUMEN
Background Age- and gender-based differences in diabetes demographic characteristics have been studied in many types of research. These differences extend further to diabetes-related comorbidities. Dyslipidemia is a common complication associated with diabetes and causes a substantial increase in cardiovascular morbidity. The study aims to compare the pattern of dyslipidemia between males and females among different age categories in newly diagnosed type 2 diabetes mellitus (T2DM). Methodology A retrospective database study was conducted at Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), Basrah, Southern Iraq. We included adult patients with newly diagnosed and drug naïve T2DM between January 2018 and October 2022. Patients' data in the form of body mass index (BMI), hemoglobin A1c (HbA1c), fasting blood glucose (FBG), random blood glucose (RBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were used for comparisons. Results Below the age of 35, males exhibited significantly higher levels of HbA1c, FBG, and TG compared to females, along with a significantly lower level of HDL-C. However, there were no significant differences in BMI, RBG, TC, and LDL-C. Between the ages of 35 and 44, females in this study demonstrated significantly higher BMI and HDL-C levels, while males exhibited higher levels of HbA1c, FBG, RBG, and TG. However, there were no significant differences observed in TC and LDL-C levels. Similar results were found among the age group 45 to 55, with the only exception being FBG, which became nonsignificant. In patients between 55 and 64 years old, BMI, HDL-C, and TC were significantly higher in females (P < 0.05). In patients aged above 65 years, BMI and HDL-C remained significantly higher in females, while RBG was significantly higher in males. No significant differences were observed among other parameters (HbA1c, TG, TC, and LDL-C). Conclusions In patients aged 54 years and younger, males were significantly more likely to have severe hyperglycemia, higher TG, and lower HDL-C compared to females at the time of T2DM diagnosis. In older patients, this pattern is lost, with only a significantly lower HDL-C observed.
RESUMEN
Background and objective Diabetes mellitus (DM) is a chronic, metabolic disease characterized by elevated blood glucose levels that eventually lead to several acute and chronic complications. Type 2 DM (T2DM) is a major healthcare problem globally as well as in the Kingdom of Saudi Arabia (KSA). Predicting and identifying people at high risk for developing T2DM will help implement preventive measures for these individuals. In light of this, the present study was designed to estimate the 10-year risk of developing T2DM among the Saudi general population. Methodology A descriptive, cross-sectional survey involving 15,509 Saudi individuals was undertaken. The participants were selected from all 13 provinces of KSA based on stratified random sampling. The Finnish Diabetes Risk Score (FINDRISC), a validated tool for T2DM risk assessment, was employed. Descriptive and chi-square analyses were used. Results The mean age of the participants was 28.33 years. Subjects with a moderate, high, and very high risk of developing T2DM within the next 10 years comprised approximately 18% of the sample. The mean FINDRISC was 7.53 [standard deviation (SD): 4.28], which is considered a level associated with a slightly elevated risk of developing T2DM. Of note, 938 participants (6.05%) among the sample population had a high risk of developing T2DM as predicted by FINDRISC. Education, daily physical activity, high blood glucose, and family history of DM were significantly higher in females compared to males (p<0.001). On the other hand, smoking rates and use of antihypertensive medications were substantially higher among males (p<0.001). Conclusion Based on our findings, approximately 18% of the Saudi general population has a moderate to high risk of developing T2DM. T2DM risk assessment should be widely and regularly practiced by general practitioners and internists as part of national programs for diabetes prevention.
RESUMEN
Diabetes mellitus (DM) is a chronic metabolic disease characterized by inappropriately elevated blood glucose levels. If not treated at the early stage, it can lead to complications like diabetic retinopathy (DR) and diabetic nephropathy (DN) which are often associated with severe morbidity and mortality. This study was designed to identify the prevalence of retinopathy and nephropathy in diabetic patients and also to determine the correlation between DR and DN. In this cross-sectional study, a total of 84 diabetic patients (Male: Female- 53:31) were included. The mean age at presentation was 54.06 ± 9.85 years. Among them, 28% of patients had a duration of diabetes of < 5 years. Nearly 42% and 30% of patients had diabetes between 5-10 years, and more than 10 years respectively. At the time of presentation to us, a total of 42.8% of patients had a combination of nephropathy and retinopathy, 40.4% of patients had only retinopathy, and 16.6% of patients with only nephropathy. Among patients with nephropathy and microalbuminuria, only 5.9% had DR ranging from mild to a moderate degree and none had severe DR. In patients with macroalbuminuria, 26.2% had moderate to severe DR. Microvascular complications are more prevalent in diabetics with disease progression. Microalbuminuria is a marker for retinopathy and these patients require ophthalmic evaluation at the earliest. Early recognition and management of these, can reduce the occurrence of complications as well as disease progression, thus reducing the related mortality.
RESUMEN
Diabetes mellitus (DM) is a highly prevalent disease in the modern society. It can be defined as a group of metabolic diseases marked by chronic hyperglycemia arising from defects in insulin secretion or resistance to insulin action, or both. Its predecessor, prediabetes, is also an important entity, and its management is essential to prevent its progression to DM. Together, these entities burden global health and the world economy, and therefore, prevention and management are key to improving global health and reducing the financial burden on the world economy. Comprehensive lifestyle modification has been proven to be a safe and effective method for preventing the progression of prediabetes and treatment of type 2 diabetes mellitus. Lifestyle modifications such as weight loss, exercise, and diets such as low-carbohydrate one, Mediterranean, and very low calorie diets are traditionally recommended. These particular diets aim to attain calorie deficits and thus induce weight loss. Intermittent fasting (IF) is one such diet that focuses more on the timing of calorie consumption. However, there are several methods of achieving this, which are highlighted in this review. IF has been shown to promote weight loss, reduce insulin resistance, improve glycemic control and lower the risk of cardiometabolic diseases. However, little literature is available regarding the use of IF in managing DM. This review intends to elucidate the role of intermittent fasting in preventing and treating DM, including its benefits and limitations. From the various studies reviewed in this article, it can be deduced that intermittent fasting can achieve suitable glycemic targets and weight control.
RESUMEN
Fournier's gangrene is a severe polymicrobial infection that results in necrosis of the perineal and genital fasciae with rapid progression. This case report describes a 55-year-old male with a past medical history of HIV, type 2 diabetes, and hypertension who was diagnosed with Fournier's gangrene after the administration of empagliflozin (Jardiance). The patient presented with a worsening ulcer of the right groin and was diagnosed with Fournier's gangrene based on clinical and radiographic findings. He underwent surgical debridement of the wound. The patient was treated with empiric vancomycin, piperacillin-tazobactam, and clindamycin. Wound cultures grew Streptococcus anginosus and Staphylococcus epidermidis. His antibiotic regimen was simplified to ampicillin-sulbactam. The patient required reconstructive surgery for wound closure after debridement.â¯He received an additional 18 days of augmentin therapy with the resolution of the infectious process. At the time of Fournier's gangrene onset, the patient's last HbA1C level was 8.2%, despite treatment with glipizide and empagliflozin. This case suggests an association between empagliflozin and Fournier's gangrene in the setting of active HIV infection.
RESUMEN
Pneumonia is the most frequent cause of hospitalization, resulting in a high risk of mortality. Diabetic patients are at high risk of aquatinting pneumococcal infections with their consequent complications. Despite the fact that glycemic control of the patients reduces the risk of diabetic complications and enhances their immunity, pneumococcal vaccination should still be given irrespective of the patients' glycemic control. The purpose of this review is to address the present situation of pneumococcal disease prevention in diabetic patients in the Kingdom of Saudi Arabia (KSA) and to gather professional recommendations to overcome the vaccination-related barriers. Onsite insights of scientific leaders in family medicine, endocrinology, and internal medicine in Riyadh and Jeddah were gathered and linked with the available literature to tackle the current practice of pneumococcal disease prevention in diabetic patients in the Kingdom of Saudi Arabia. Pneumococcal vaccination importance is still not well recognized among endocrinologists across the Kingdom of Saudi Arabia, despite the availability of established local recommendations and the National Immunization Program. The prevention of serious and fatal pneumococcal diseases should be one of the treatment pillars for diabetic patients, and it is not less important than controlling other risk factors.