There is an ongoing need for improvements in non-invasive, point-of-care tools for the diagnosis and prognosis of diabetes mellitus. Ideally, such technologies would allow for community screening.

Although the brain has long been considered an insulin-independent organ, recent research has shown that insulin has significant effects on the brain, where it plays a role in maintaining glucose and energy homeostasis. To avoid peripheral insulin resistance, the brain may act via hypoinsulinemic responses, maintaining glucose metabolism and insulin sensitivity within its own confines; however, brain insulin resistance may develop due to environmental factors. Insulin has two important functions in the brain: controlling food intake and regulating cognitive functions, particularly memory. Notably, defects in insulin signaling in the brain may contribute to neurodegenerative disorders. Insulin resistance may damage the cognitive system and lead to dementia states. Furthermore, inflammatory processes in the hypothalamus, where insulin receptors are expressed at high density, impair local signaling systems and cause glucose and energy metabolism disorders. Excessive caloric intake and high-fat diets initiate insulin and leptin resistance by inducing mitochondrial dysfunction and endoplasmic reticulum stress in the hypothalamus. This may lead to obesity and diabetes mellitus (DM). Exercise can enhance brain and hypothalamic insulin sensitivity, but it is the option least preferred and/or continuously practiced by the general population. Pharmacological treatments that increase brain and hypothalamic insulin sensitivity may provide new insights into the prevention of dementia disorders, obesity, and type 2 DM in the future.

Obesity, insulin resistance and hyperandrogenism, crucial parameters of Polycystic ovary syndrome (PCOS) play significant pathophysiological roles in lipidemic aberrations associated within the syndrome. Parts of the metabolic syndrome (low HDL and insulin resistance) appeared to facilitate the association between PCOS and coronary artery disease, independently of obesity. ABCA1 gene polymorphism may be altered this components in PCOS patients. In this study, we studied 98 PCOS patients and 93 healthy controls. All subjects underwent venous blood drawing for complete hormonal assays, lipid profile, glucose, insulin, malondialdehyde, nitric oxide, disulfide levels and ABCA genetic study. In PCOS group fasting glucose, DHEAS, 17-OHP, free testosterone, total-cholesterol, triglyceride, LDL-cholesterol and fibrinogen were significantly different compare to controls. The genotype ABCA G2706A distribution differed between the control group (GG 60.7%, GA 32.1%, AA 7.1%) and the PCOS patients (GG 8.7%, GA 8.7%, AA 76.8%). The frequency of the A allele (ABCAG2706A) was higher in PCOS patients than control group with 13,0% and 23,2%, respectively. In this study, the homocystein and insulin levels were significantly higher in PCOS patients with ABCA G1051A mutant genotype than those with heterozygote and wild genotypes. We found higher percentage of AA genotype and A allele of ABCA G2706A in PCOS patients compare to controls. The fasting insulin and homocystein levels were significantly higher in PCOS patients with ABCA G1051A mutant genotype than those with heterozygote and wild genotypes.

Clinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature. The patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features. A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 ± 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery. Invasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.

Amaç: Diyabetik ayak hastalarında yaşam kalitesi düzeylerinin ve etkileyen faktörlerin değerlendirilmesidir. Gereç ve Yöntem: Çalışmanın verileri Ocak – Mart 2020 tarihleri arasında üniversite hastanesinin diyabetik ayak konseyine başvuran 171 hastadan toplanmıştır. Verilerin toplanmasında birey tanıtım formu ve Diyabetik Ayak Ölçeği – Kısa Formu kullanılmıştır. Bu ölçekte alt boyutlar ve ölçek toplam puanı 0-100 aralığında değerler almakta olup yüksek puan ortalaması yüksek yaşam kalitesini, düşük puan ortalaması düşük yaşam kalitesini göstermektedir. Araştırmanın verileri IBM SPSS 25.0 paket programı ile analiz edilmiştir. Bulgular: Çalışmada yer alan hastaların %67,3’ünün erkek, %84,8’inin evli ve ortalama yaşı 61,57±10,03 yıl olarak saptanmıştır. Kadınların (p=0,009), insülin tedavisi alanların (p=0,004), sigara kullanmayan (p=0,027), alkol tüketimi olmayan (p=0,030) ve diyabete eşlik eden kronik hastalığı olmayan bireylerin (p=0,003) yaşam kalitesi puan ortalamalarının daha yüksek düzeyde olduğu saptanmıştır. Regresyon tahminlemesinde insülin tedavisi almanın (β=-0,23, p=0,024) ve eşlik eden kronik bir hastalığı olmamasının (β=-0,17, p=0,037) yaşam kalitesini olumlu yönde etkilediği saptanmıştır. Sonuç: Sonuç olarak diyabetik ayak hastalarında yaşam kalitesinin orta düzeyde olduğu cinsiyet, tedavi türü, sigara kullanımı, alkol kullanımı ve eşlik eden kronik hastalık varlığı bakımından gruplar arasında farklılık olduğu gözlemlenmiştir. Diyabetik ayak hastalarında tedavi türü ve eşlik eden kronik hastalık varlığının yaşam kalitesi üzerine anlamlı etkisi olduğu saptanmıştır.