Diabetes & Metabolism Journal

Original Articles

The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes: Kang Hee Sim, Moon Sook Hwang, Sun Young Kim, Hye Mi Lee, Ji Yeun Chang, Moon Kyu Lee; Diabetes Metab J. 2014;38(2):120-133. Published online April 18, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.2.120

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Background

Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well.

Methods

First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression.

Results

The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI.

Conclusion

It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes.

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Comparison of EGF with VEGF Non-Viral Gene Therapy for Cutaneous Wound Healing of Streptozotocin Diabetic Mice: Junghae Ko, Haejung Jun, Hyesook Chung, Changshin Yoon, Taekyoon Kim, Minjeong Kwon, Soonhee Lee, Soojin Jung, Mikyung Kim, Jeong Hyun Park; Diabetes Metab J. 2011;35(3):226-235. Published online June 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.3.226

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Abstract PDF PubReader

Background

To accelerate the healing of diabetic wounds, various kinds of growth factors have been employed. It is the short half-life of administered growth factors in hostile wound beds that have limited wide-spread clinical usage. To overcome this limitation, growth factor gene therapy could be an attractive alternative rather than direct application of factors onto the wound beds. We administered two growth factor DNAs, epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) into a cutaneous wound on diabetic mice. We compared the different characteristics of the healing wounds.

Methods

Streptozotocin was injected intraperitoneally to induce diabetes into C57BL/6J mice. The ultrasound micro-bubble destruction method with SonoVue as a bubbling agent was used for non-viral gene delivery of EGF⁸²⁸ and VEGF¹⁶⁵ DNAs. Each gene was modified for increasing efficacy as FRM-EGF⁸²⁸ or minicircle VEGF¹⁶⁵. The degree of neoangiogenesis was assessed using qualitative laser Doppler flowmetry. We compared wound size and histological findings of the skin wounds in each group.

Results

In both groups, accelerated wound closure was observed in the mice receiving gene therapy compared with non treated diabetic control mice. Blood flow detected by laser doppler flowmetry was better in the VEGF group than in the EGF group. Wound healing rates and histological findings were more accelerated in the EGF gene therapy group than the VEGF group, but were not statistically significant.

Conclusion

Both non-viral EGF and VEGF gene therapy administrations could improve the speed and quality of skin wound healing. However, the detailed histological characteristics of the healing wounds were different.

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Joana Serra, Cláudia P. A. Alves, Joaquim M. S. Cabral, Gabriel A. Monteiro, Cláudia L. da Silva, Duarte Miguel F. Prazeres
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Dong Joo Yang, Sang Hyun Moh, Yun-Hee Choi, Ki Woo Kim
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Lyn M. Wise, Gabriella S. Stuart, Nicola C. Jones, Stephen B. Fleming, Andrew A. Mercer
Journal of Clinical Medicine.2020; 9(4): 1085. CrossRef
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Joana Serra, Cláudia P.A. Alves, Liliana Brito, Gabriel A. Monteiro, Joaquim M.S. Cabral, Duarte Miguel F. Prazeres, Cláudia L. da Silva
Human Gene Therapy.2019; 30(3): 316. CrossRef
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Advanced Drug Delivery Reviews.2018; 129: 262. CrossRef
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Mulugeta Gizaw, Jeffrey Thompson, Addison Faglie, Shih-Yu Lee, Pierre Neuenschwander, Shih-Feng Chou
Bioengineering.2018; 5(1): 9. CrossRef
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Marianna Foldvari, Ding Wen Chen, Nafiseh Nafissi, Daniella Calderon, Lokesh Narsineni, Amirreza Rafiee
Journal of Controlled Release.2016; 240: 165. CrossRef
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Journal of Materials Science: Materials in Medicine.2015;[Epub] CrossRef
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International Wound Journal.2015; 12(1): 10. CrossRef
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International Wound Journal.2015; 12(4): 387. CrossRef
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Diabetes mellitus.2014; 17(1): 63. CrossRef
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Molecular Medicine Reports.2014; 9(5): 1749. CrossRef
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International Journal of Molecular Sciences.2014; 15(5): 8407. CrossRef
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Review

Impaired Wound Healing in Diabetes Mellitus.: Min Jeong Kwon, Jeong Hyun Park; Korean Diabetes J. 2009;33(2):83-90. Published online April 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.2.83

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50 Download
3 Crossref

Abstract PDF

The normal healing of a cutaneous wound is achieved via well-orchestrated integration of complex biological and molecular events of cell migration, proliferation, extracellular matrix deposition and tissue remodeling. Chronic wounds fail to progress through the normal stages of healing, and enter a state of pathologic inflammation. Complicated diabetic patients show delayed wound healing caused by multiple factors including vascular insufficiency, abnormalities of the biochemical environment and hyperglycemia per se. Novel technologies including growth factor therapy, gene therapy, stem cell technologies, synthetic skins and hyperbaric oxygen treatment are under development. In the near future, these therapeutic strategies will be clinically available.

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