Khouloud Boujelbene

This article delves into the intricate relationships between Type 1 Diabetes Mellitus (T1DM), thyroid function, and hepatic metabolism, shedding light on the complex interplay that influences insulin sensitivity, glucose homeostasis, and liver health. The study, conducted at Al-Qadisiyah Teaching Hospital in Iraq from January 2021 to July 2021, involved 60 T1DM patients and 40 healthy controls aged 1 to 16 years. Results from the investigation revealed significant elevations in thyroid-stimulating hormone (TSH) levels among individuals with diabetes, emphasizing the intricate interplay between T1DM and thyroid function. Moreover, T1DM patients exhibited marked increases in liver enzymes and bilirubin levels, underscoring the potential hepatocellular implications associated with metabolic dysregulation. Our findings highlight the augmented production of TSH in individuals with diabetes as a potential defensive mechanism to mitigate the consequences of elevated blood glucose. The crucial role of triiodothyronine (T3) in enhancing insulin sensitivity and reducing serum blood glucose levels is emphasized, reinforcing its position as a key player in glucose metabolism. On hepatic level, the presence of advanced glycation end-products (AGEs) in diabetes amplifies oxidative stress, potentially leading to inflammation and tissue damage in the liver. The study illustrates a model of interaction between hepatic metabolism and T1DM, highlighting the impact of diabetes on liver apoptosis, bilirubin metabolism, and the intricate interplay between high blood sugar levels, AGEs, and red blood cell (RBC) membranes. Our findings provide comprehensive insights into the interconnected dynamics of T1DM, thyroid function, and hepatic metabolism, contributing to a deeper understanding of the complex physiological interactions within the context of diabetes mellitus.

Amidst the myriad challenges faced by individuals managing diabetes, medication non-adherence emerges as a critical barrier to achieving optimal health outcomes. Against this backdrop, the aim of this study is twofold. First, we seek to evaluate therapeutic compliance in elderly diabetics. Second, we delve into the intricate web of factors associated with poor compliance. We conducted a descriptive cross-sectional study at the endocrinology department of Hedi Chaker University Hospital in Sfax from January to March 2023. The study included patients aged 65 years and older who had been diagnosed with either type 1 or type 2 diabetes and had been receiving treatment with oral antidiabetic medications and/or insulin for at least three months. This study included a sample of 137 elderly patients, with a mean age of 71.49 years (±6.2), ranging from 65 to 90 years old. A female predominance (51.8%) was observed. Regarding therapeutic adherence, 77 patients were found to have poor medication adherence, representing a prevalence of 56.2%. In contrast, moderate adherence was observed in 38 patients (27.7%), while 22 patients (16.1%) exhibited good adherence.. Individuals who do not adhere to prescribed treatments, as instructed by their healthcare provider, are more prone to non-adherence [OR = 4.644; 95% CI (1.457-14.804), p = 0.009] compared to those who follow their prescriptions. Thus, the absence of self-monitoring of blood glucose [OR = 2.987; 95% CI (1.295-6.889), p = 0.01] and irregular medical visits [OR = 5.383; 95% CI (1.353-21.419), p = 0.017] was associated with a higher likelihood of non-adherence compared to those who actively monitored their diabetes and had regular medical visits, respectively. Moreover, individuals with diabetes who have high HbA1C levels (>7%) had a higher propensity for non-adherence [OR = 3.008; 95% CI (1.194-7,580), p = 0.02] than their counterparts. People diagnosed with diabetic retinopathy were also more likely to be non-adherent [OR = 2.987; 95% CI (1.327-6.725), p = 0.008] than those without this condition.