Major Research Findings

Diabetes complications can be related to the long duration of the disease or chronic hyperglycemia. 2 Following up with diabetic patients is based on managing chronic hyperglycemia. However, rapid correction of hyperglycemia in people with severe chronic hyperglycemia can paradoxically worsen the disease or even induce complications.

A systematic review of literature describing the impact of rapid and intense treatment of hyperglycemia on diabetic complications showed that worsening complications occurred significantly in diabetic microangiopathy with the onset of specific neuropathy induced by the correction of diabetes. 2 The results for macroangiopathy were somewhat mixed, with intensive and rapid correction of chronic hyperglycemia having a neutral impact on stroke and myocardial infarction, but a significant increase in cardiovascular mortality.

The management of diabetes has now entered a new era with new therapeutic molecules, such as gliflozin for patients living with type 2 diabetes, or hybrid insulin delivery systems for patients with insulin-treated diabetes. 2 This manuscript provides evidence in support of these personalized and progressive algorithms for the control of chronic hyperglycemia.

The results of treatment of patients with diabetic foot syndrome (DFS) remain unsatisfactory, 34% of patients have another wound defect in the foot within 1 year, and the recurrence rate within 5 years is 70%. 3

Diabetes mellitus (DM) is a metabolic disease, now prevalent worldwide, which is characterized by a relative or absolute lack of insulin secretion leading to chronically increased blood glucose levels. 4 Diabetic patients are often accompanied by multiple macrovascular complications, such as coronary heart disease, hypertension, macrovascular arteriosclerosis, and microvascular complications. Microvascular complications include diabetic kidney injury, diabetic encephalopathy, and diabetic foot, which reduce the quality of life and survival status of patients. Mesenchymal stem cell exosomes (MSC-Exos) possess repair functions similar to MSCs, low immunogenicity, and ease of storage and transport. MSC-Exos have been proven to possess excellent repair effects in repairing various organ damages. This study reviews the application of MSC-Exos in the treatment of DM and its common complications. MSC-Exos may be used as an effective treatment for DM and its complications.

Diabetes is a complex metabolic disorder resulting either from insulin resistance or an impaired insulin secretion. 5 Prolonged elevated blood glucose concentration, the key clinical sign of diabetes, initiates an enhancement of reactive oxygen species derived from glucose autoxidation and glycosylation of proteins. Consequently, chronic oxidative stress overwhelms cellular endogenous antioxidant defenses and leads to the acute and long-standing structural and functional changes of macromolecules resulting in impaired cellular functioning, cell death and organ dysfunction. The oxidative stress provoked chain of pathological events over time cause diabetic complications such as nephropathy, peripheral neuropathy, cardiomyopathy, retinopathy, hypertension, and liver disease.

treatmentまとめ

The treatment of diabetes has entered a new era with new therapeutic molecules, such as gliflozin for patients living with type 2 diabetes, or hybrid insulin delivery systems for patients with insulin-treated diabetes. 2 This manuscript provides evidence in support of these personalized and progressive algorithms for the control of chronic hyperglycemia.

Mesenchymal stem cell exosomes (MSC-Exos) are a promising new treatment for DM and its complications. 4 MSC-Exos possess repair functions similar to MSCs, low immunogenicity, and ease of storage and transport.

Plant extracts and phytoconstituents can influence antioxidant enzyme activity and gene expression, potentially helping to prevent and treat diabetes complications. 5

Benefits and Risks

Benefit Summary

The benefits of managing diabetes include improved glycemic control, blood pressure management, and lipid management, which can delay or prevent the onset of diabetic complications. 14 Early treatment of risk factors, including hypertension, hyperglycemia, and dyslipidemia can delay or prevent diabetic nephropathy. 12 Metformin appears to reduce mortality in patients with type 2 diabetes. 1

Risk Summary

The risks associated with diabetes treatment include hypoglycemia and side effects from medications. Rapid correction of hyperglycemia can paradoxically worsen the disease or even induce complications. 2 It is important to follow your doctor's instructions and get regular checkups.

Comparison of Studies

Similarities between studies

Many studies indicate that risk factors such as high blood sugar, high blood pressure, and abnormal lipid levels contribute to the development of diabetes complications. 14 12 There is a common understanding that managing blood sugar, blood pressure, and lipids is important in the treatment of diabetes. 12 1

Differences between studies

Studies show different treatment effects and risks for diabetes complications. For example, some studies have shown that rapid correction of hyperglycemia can worsen complications. 2 Metformin has been shown to reduce mortality in patients with type 2 diabetes, but other hypoglycemic drugs have not shown the same effect. 1 These differences are likely due to the different patient populations and treatment methods used in the studies.

Consistency and Contradictions in Results

Many studies demonstrate that managing blood sugar, blood pressure, and lipids is crucial for preventing and treating diabetes complications. However, some studies have shown that rapid improvement in blood sugar levels may worsen complications. 2 These contradictions are likely due to variations in the patient populations and treatment methods used in the studies.

Considerations for Applying Results to Real Life

It is important to follow your doctor's instructions and get regular checkups. You should also have a good understanding of the risk of hypoglycemia and the side effects of medications. Making changes to your lifestyle, such as diet and exercise, can also help prevent diabetes complications. Early diagnosis and treatment are important for preventing diabetes complications. Regular checkups can help detect complications early and receive appropriate treatment.

Limitations of Current Research

Many studies are small-scale, involving relatively few patients, and require validation through larger studies. Comparisons of research findings can be difficult due to variations in patient populations and treatment methods. Additionally, many factors are believed to contribute to the development of diabetes complications, including genetic and environmental factors. Research that considers all these factors is still limited.

Future Research Directions

To develop effective prevention and treatment methods for diabetes complications, large-scale studies and multi-center collaborative research are needed. Research that considers various factors, such as genetic and environmental factors, is also needed. In addition, the development of new drugs and treatment methods and clinical trials should be actively promoted.

Conclusion

Diabetes complications are a major cause of death and disability in people with diabetes. By providing appropriate treatment, such as blood sugar control, blood pressure management, and lipid management, the onset of diabetic complications can be delayed or prevented. It is important to follow your doctor's instructions and get regular checkups.

Treatment List

• Glycemic Control
• Blood Pressure Management
• Lipid Management
• Gliflozin
• Hybrid Insulin Delivery Systems
• Mesenchymal Stem Cell Exosomes (MSC-Exos)
• Plant Extracts
• Phytoconstituents
• Aldose Reductase (AR) Inhibitors