Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.

Coronavirus disease 2019 (COVID-19) is a highly heterogeneous disease regarding severity, vulnerability to infection due to comorbidities, and treatment approaches. The hypothalamic–pituitary–adrenal (HPA) axis has been identified as one of the most critical endocrine targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that might significantly impact outcomes after infection. Herein we review the rationale for glucocorticoid use in the setting of COVID-19 and emphasize the need to have a low index of suspicion for glucocorticoid-induced adrenal insufficiency, adjusting for the glucocorticoid formulation used, dose, treatment duration, and underlying health problems. We also address several additional mechanisms that may cause HPA axis dysfunction, including critical illness-related corticosteroid insufficiency, the direct cytopathic impacts of SARS-CoV-2 infection on the adrenals, pituitary, and hypothalamus, immune-mediated inflammations, small vessel vasculitis, microthrombotic events, the resistance of cortisol receptors, and impaired post-receptor signaling, as well as the dissociation of ACTH and cortisol regulation. We also discuss the increased risk of infection and more severe illness in COVID-19 patients with pre-existing disorders of the HPA axis, from insufficiency to excess. These insights into the complex regulation of the HPA axis reveal how well the body performs in its adaptive survival mechanism during a severe infection, such as SARS-CoV-2, and how many parameters might disbalance the outcomes of this adaptation.

The past two decades have witnessed telemedicine becoming a crucial part of health care as a method to facilitate doctor-patient interaction. Due to technological developments and the incremental acquisition of experience in its use, telemedicine’s advantages and cost-effectiveness has led to it being recognised as specifically relevant to diabetology. However, the pandemic created new challenges for healthcare systems and the rate of development of digital services started to grow exponentially. It was soon discovered that COVID-19-infected patients with diabetes had an increased risk of both mortality and debilitating sequelae. In addition, it was observed that this higher risk could be attenuated primarily by maintaining optimal control of the patient’s glucose metabolism. As opportunities for actual physical doctor-patient visits became restricted, telemedicine provided the most convenient opportunity to communicate with patients and maintain delivery of care. The wide range of experiences of health care provision during the pandemic has led to the development of several excellent strategies regarding the applicability of telemedicine across the whole spectrum of diabetes care. The continuation of these strategies is likely to benefit clinical practice even after the pandemic crisis is over.

The therapeutic effectiveness of a benfotiamine (CAS 22457-89-2)-vitamin B combination (Milgamma-N®), administered in high (4 × 2 capsules/day, = 320 mg benfotiamine/day) and medium doses (3 × 1 capsules/day), was compared to a monotherapy with benfotiamine (Benfogamma®) (3 × 1 tablets/day, = 150 mg benfotiamine/day) in diabetic patients suffering from painful peripheral diabetic neuropathy (DNP). In a 6-week open clinical trial, 36 patients (aged 40 to 70 yrs) having acceptable metabolic control (HbA_1c, < 8.0%) were randomly assigned to three groups, each of them comprising 12 participants. Neuropathy was assessed by five parameters: the pain sensation (evaluated by a modified analogue visual scale), the vibration sensation (measured with a tuning fork using the Riedel-Seyfert method) and the current perception threshold (CPT) on the peroneal nerve at 3 frequencies: 5, 250 and 2000 Hz). Parameters were registered at the beginning of the study and at the end of the 3rd and 6th week of therapy. An overall beneficial therapeutic effect on the neuropathy status was observed in all three groups during the study, and a significant improvement in most of the parameters studied appeared already at the 3rd week of therapy (p < 0.01). The greatest change occurred in the group of patients receiving the high dose of benfotiamine (p < 0.01 and 0.05, resp., compared to the other groups). Metabolic control did not change over the study. It is concluded that benfotiamine is most effective in large doses, although even in smaller daily dosages, either in combination or in monotherapy, it is effective. Wirksamkeit verschiedener Benfotiamin-Dosierungsschemata bei der Behandlung schmerzhafter diabetischer Neuropathie Die therapeutische Wirksamkeit einer Benfotiamin (CAS 22457-89-2)-Vitamin B-Kombination (Milgamma-N®), verabreicht an Diabetespatienten mit schmerzhafter peripherer diabetischer Neuropathie (DNP), in hohen (4 × 2 Kapseln/Tag = 320 mg Benfotiamin/Tag) und mittleren Dosierungen (3 × 1 Kapsel/Tag), wurde mit einer Monotherapie mit Benfotiamin (Benfogamma®) (3 × 1 Tablette/Tag = 150 mg Benfotiamin/Tag) verglichen. Im Rahmen einer offenen klinischen Studie, die sich über sechs Wochen erstreckte, wurden 36 Patienten im Alter von 40 bis 70 Jahren, die einen akzeptablen Stoffwechselzustand aufwiesen (HbA₁₀ < 8,0%), nach dem Zufallsprinzip drei Gruppen zugeordnet, die aus jeweils 12 Teilnehmern bestanden. Die Neuropathie wurde nach fünf Parametern beurteilt: dem Schmerzempfinden (bewertet anhand einer modifizierten analogen visuellen Skala), dem Vibrationsempfinden (gemessen nach der Riedel-Seyfert-Methode mit Hilfe einer Stimmgabel) und der aktuellen Wahrnehmungsschwelle (CPT = current perception threshold) am N. peronaeus bei drei Frequenzen: 5, 250 und 2000 Hz. Diese Parameter wurden zu Beginn der Studie sowie am Ende der 3. und 6. Behandlungswoche aufgezeichnet. Während der Studie war in allen drei Gruppen eine günstige therapeutische Gesamtwirkung auf den Status der Neuropathie zu verzeichnen, und bereits in der dritten Behandlungswoche wurde eine signifikante Verbesserung bei den meisten untersuchten Parametern deutlich (p < 0,01.). Die stärkste Veränderung zeigte sich in der Patientengruppe, der eine hohe Dosis Benfotiamin verabreicht wurde (p < 0,01 bzw. 0,05, im Vergleich zu den anderen Gruppen). Der Stoffwechselzustand veränderte sich während der Studie nicht. Dieses läßt die Schlußfolgerung zu, daß Benfotiamin in hohen Dosierungen die größte Wirkung zeigt, obwohl es sich auch in geringeren Tagesdosen, sowohl in Kombination als auch als Monotherapie, als wirksam erweist.