The impact of diabetes on the pathogenesis of sepsis

Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones

Respiratory Burst Process in Diabetic Children

Background Increased rate of infections in diabetes mellitus (DM) is an accepted fact. Pathophysiologically, several tasks of the immune system could be involved including polymorphonuclear (PMN) functions. Objectives The aim of this research was to evaluate the respiratory burst process of PMNs that is an essential part of phagocytosis, in children with DM. Patients and Methods Fifty two children with insulin dependent diabetes and 29 non-diabetic children were enrolled in this cross sectional study from 2010 to 2011. Nitroblue tetrazolium (NBT) test was done on PMNs taken from their heparinized blood. The resultant data was analyzed by SPSS version 16. P values were considered significant when it was under 0.05. Results Mean NBTs were 72.1 ± 15.84 and 94.68 ± 5.31 in diabetics and non-diabetics, respectively (P < 0.001). Using Pearson correlation, there was no significant correlation between the NBT level and age, gender, duration of diabetes, daily insulin usage and blood HbA1C level. Conclusions Compared to non-diabetics, respiratory burst process of polymorphonuclears is obviously decreased in diabetic children. This can explain one of the mechanisms involved in the increased rate of infections in DM

Impaired endothelial function in female adolescents with type 1 diabetes measured by peripheral artery tonometry

Abstract: The reactive hyperemia peripheral artery tonometry (RH-PAT) is a newly developed method for non-invasive endothelial function assessment. The goal of this study is to determine whether a significant difference in RH-PAT score is present between adolescents with type 1 diabetes (T1D) in comparison with controls. Thirty-four adolescents with T1D and 25 control subjects (age 12-20 years) underwent RH-PAT endothelial function testing after an overnight fast. Height, weight, body mass index (BMI), blood pressure (BP), fasting lipid profile, Tanner stage, and glucose level were determined in each child. Adolescents with T1D had significantly lower RH-PAT scores compared to healthy controls, and this difference remained significant when overweight cases were not considered (p < 0.05). This difference was also observed in the female subgroup (p = 0.005). The interindividual variability in RH-PAT observations in T1D cases was not explained by BMI standard deviation score (SDS), BP SDS, age, duration of T1D, hemoglobin A1c, triglycerides, and pubertal stage, respectively. The RH-PAT technique is used as a non-invasive test to assess for early vascular changes in high-risk patient groups. Endothelial dysfunction, measured by RH-PAT, was present in diabetic adolescent, especially in the female subgroup. Although additional longitudinal studies are required, early detection of this reversible process may have therapeutic and prognostic implications