Acta Diabetologica

Dupuytren’s disease (DD) was demonstrated in 169 of 959 diabetics (17.6%) and in 9 of 1,396 non-diabetic patients (0.64%). One hundred and seventy-nine of the 185 patients with DD had overt or latent diabetes mellitus (96.7%). The relative frequency of DD increased with age, the conditions was seldom found under the age of 40. DD should be regarded as a non-hyperglycemic manifestation of diabetes mellitus and its presence in a patient should prompt the investigation of glucose metabolism.

This report summarizes a 5-year phase 1/2 allogeneic islet transplantation clinical trial conducted at the University of Illinois at Chicago (UIC). Ten patients were enrolled in this single center, open label, and prospective trial in which patients received 1–3 transplants. The first four subjects underwent islet transplantation with the Edmonton immunosuppressive regimen and the remaining six subjects received the UIC immunosuppressive protocol (Edmonton plus etanercept and exenatide). All 10 patients achieved insulin independence after 1–3 transplants. At 5 years of follow-up, 6 of the initial 10 patients were free of exogenous insulin. During the follow-up period, 7 of the 10 patients maintained positive C-peptide levels and a composite hypoglycemic score of 0. Most patients maintained HbA1c levels <6.0 % (42.1 mmol/mol) and a significantly improved β-score. In conclusion, this study demonstrated long-term islet graft function without using T cell depleting induction, with an encouraging outcome that includes 60 % of patients remaining insulin independent after 5 years of initial transplantation.

Gestational diabetes (GDM) is a prevalent complication in pregnancy that requires effective self-management, which can be influenced by illness perceptions. Moreover, behavioral regulation can be affected by attachment styles. Thus, our study aimed to identify common GDM perception profiles and test their association with attachment styles. In this cross-sectional study, 446 women completed the Relationship Questionnaire (RQ), the Brief Illness Perception Questionnaire (BIPQ), and additional items about GDM diagnosis, information, competence, adherence, behavioral change. Latent profile analysis (LPA) was conducted to determine GDM perception profiles. Multinomial logistic regression followed to calculate the association between GDM perception profiles and attachment styles. Three distinct profiles emerged: coping (n = 172, 38.6%)—characterized by the most positive GDM perception, burdened (n = 222, 49.8%)—indicating the emotional burden of the disease, and resourceless (n = 52, 11.7%)—reporting lack of resources (i.e. information, competence). Women with insecure attachment styles were more likely to develop a burdened GDM perception profile. Specifically, the expression of a fearful (OR = 1.184 [95%CI: 1.03; 1.36], p = 0.016) and a preoccupied (OR = 1.154 [95%CI: 1.01; 1.32], p = 0.037) attachment style increased the likelihood for a burdened perception profile, while a secure attachment style (OR = 10.791 [95%CI: 0.65; 0.96], p = 0.017) decreased likelihood for developing resourceless GDM perception profile. Three GDM perception profiles were identified and the role of attachment styles in shaping these perceptions was confirmed. Further studies are needed to investigate whether a tailored treatment approach based on the predominant attachment style could lead to more positive GDM perceptions, improved glycemic control, and better perinatal outcomes.

In vascular atherosclerotic disease and in diabetes mellitus few studies have evaluated the polymorphonuclear leukocyte (PMN) adhesion molecule pattern. In this study we examined the PMN integrin expression at baseline and after activation in controls and type 2 diabetic subjects with macrovascular complications (MVC). We enrolled 21 subjects with type 2 diabetes mellitus and macrovascular complications, localized in peripheral, coronary and cerebral sites. The patients had peripheral occlusive arterial disease, chronic cerebrovascular disease or coronary heart disease. We evaluated the expression of some PMN integrins (CD11a, CD11b, CD11c, CD18), using flow cytofluorimetry, at baseline and after in vitro activation with 4-phorbol-12-myristate-13 acetate. Type 2 diabetic subjects with MVC showed, compared to normals, an increase of CD11a and CD18 and a decrease of CD11b and CD11c. After activation, in PMNs of normal subjects, we found an increase in the expression of all adhesion molecules, while in PMNS of type 2 diabetic subjects with MVC we observed an increase of CD11b and CD11c and a decrease of CD11a. In type 2 diabetic patients with MVC the basal upregulation of CD11a and CD18 may be related to the PMN spontaneous activation, while the behavior of CD11b may depend on its selfconsumption. After activation the CD11a modification may be due to its cleavage or to an altered integrin phosphorylation/dephosphorylation balance.

To summarize the effects of centralization of diabetic fundus photograph interpretation into a virtual reading center. In 2016 Kaiser Permanente Northern California, a large, membership-based health plan with an ethnically and racially diverse population, centralized diabetic retinopathy screening into a virtual reading center. Retina screens were based on single field, 45-degree fundus photographs. We compared the accuracy of photography interpretation the year before centralization to the year after using masked reads performed by retina specialists of 1000 randomly selected screens from each time period. In all, 1902 patient screens with adequate quality images were included in the primary analysis. Images from pre-centralization screens were largely read by ophthalmologists (76.2%), while screens post-centralization were mainly read by optometrists (84.6%). Despite being interpreted by readers with lower levels of professional training, the sensitivity of screening increased from 43.9% (95% CI 38.0–49.8%) to 66.0% (95% CI 60.5–71.4%). A move to a centralized virtual reading center was associated with improved accuracy of diabetic retinopathy screening.

In this analysis, we sought to examine the prospective association of the disposition index (DIo) derived from oral glucose tolerance test with incident diabetes in Asian Indian men with impaired glucose tolerance (IGT). These post hoc analyses used data from a 2-year prospective study in primary prevention of diabetes using lifestyle intervention among 517 men with IGT. All the participants received standard lifestyle advice at baseline. The surrogate insulin sensitivity and insulin secretion measures were tested for their hyperbolic relationship. Predictive associations of various surrogate measures with incident diabetes were determined using receiver operating characteristic curves. The combination of total area under the curve of insulin-to-glucose ratio (AUCinsulin/glucose) and Matsuda’s insulin sensitivity index was the best equation to depict DIo [β: −0.954 (95 % CI −1.015 to −0.893)] compared to other measures tested in this cohort. There was an inverse association between change in DIo at the final follow-up and development of incident diabetes. Among the surrogate insulin measures studied, DIo [AUC (0.717 (95 % CI 0.675–0.756))] as a composite measure was superior than other surrogate indices. Among the surrogate indices studied, DIo was the best measure associated with incident diabetes.

Lifestyle changes to healthy diet (HD) and habitual physical activity (HPA) are recommended in type 2 diabetes mellitus (T2DM). Yet, for most people with diabetes, it may be difficult to start changing. We investigated the stage of change toward healthier lifestyles according to Prochaska’s model, and the associated psychological factors in T2DM patients, as a prerequisite to improve strategies to implement behavior changes in the population. A total of 1,353 consecutive outpatients with T2DM attending 14 tertiary centers for diabetes treatment completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments to define the stage of change for HD and HPA, respectively. Logistic regression was used to determine the factors associated with stages that may hinder behavioral changes. A stage of change favoring progress to healthier behaviors was more common in the area of HD than in HPA, with higher scores in action and maintenance. Differences were observed in relation to gender, age and duration of disease. After adjustment for confounders, resistance to change toward HD was associated with higher body mass index (BMI) (odds ratio (OR) 1.05; 95 % confidence interval (CI) 1.02–1.08). Resistance to improve HPA also increased with BMI (OR 1.06; 95 % CI 1.03–1.10) and decreased with education level (OR 0.74; 95 % CI 0.64–0.92). Changing lifestyle, particularly in the area of HPA, is not perceived as an essential part of treatment by many subjects with T2DM. This evidence must be considered when planning behavioral programs, and specific interventions are needed to promote adherence to HPA.