Science.gov

Sample records for diabetic patient case

  1. Case series of rhinocerebral mucormycosis occurring in diabetic patients

    PubMed Central

    Mohammadi, Rasoul; Meidani, Mohsen; Mostafavizadeh, Kamyar; Iraj, Bijan; Hamedani, Pooria; Sayedain, Sayed Mohammad Amin; Mokhtari, Mojgan

    2015-01-01

    Background: Rhinocerebral mucormycosis is a fatal infection typically affecting diabetic or immunosuppressed patients. In most cases, infection is caused by inhalation of fungal spores. Mortality rate of patients is very high (40-85%). Case Presentation: In this study, three diabetic patients with rhinocerebral mucormycosis were presented. The etiologic agents of mucormycosis in two patients were isolated and identified by sequence analysis and data were registered in Gene bank database. Conclusion: In patients with mucoreosis, early detection, surgical excision and appropriate debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection. PMID:26644901

  2. A novel case of diabetic muscle necrosis in a patient with cystic fibrosis-related diabetes.

    PubMed

    Chalasani, Sreelatha; Bettadahalli, Shankar S; Bhupathi, Satya V; Aswani, Vijay H

    2013-09-01

    Cystic fibrosis is a recessive autosomal disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene. Cystic fibrosis-related diabetes (CFRD) is a common comorbidity of cystic fibrosis. Diabetic myonecrosis is a rare self-limited complication of poorly controlled diabetes mellitus that commonly presents with acute, intense pain and swelling of lower extremities and responds well to conservative management. We report the first case of diabetic myonecrosis in a patient with CFRD.

  3. Painful neuropathy in a diabetic patient resulting from lung cancer and not diabetes: A case report.

    PubMed

    Yao, He-Bin; Chen, Ya-Ning; Shang, Jian; Han, Qiao-Jun

    2015-12-01

    The current study reports the case of a 61-year-old man with diabetes who was suffering from generalized pain over the whole body and gradually progressive numbness. The patient was initially diagnosed with diabetic peripheral neuropathy and received treatment, however, the symptoms persisted. In October 2010, the patient was admitted to the Chinese People's Liberation Army Navy General Hospital (Beijing, China) for the treatment of diabetes, however, a full-body sharp pain was also described, which was relieved upon massaging the area. Causes, other than diabetes, were investigated for these symptoms. Chest computed tomography and positron emission tomography-computed tomography scans revealed a mass shadow in the right lower lobe of the lung, with multiple lymphatic metastases. Lung cancer was diagnosed with a tumor-node-metastasis stage of T1N3Mx. Following treatment of the cancer with chemotherapy and radiotherapy, the patient's symptoms were significantly improved. The present study reports a rare case of a paraneoplastic neurological syndrome (PNS) that presented as painful neuropathy resulting from lung cancer, which mimicked diabetic peripheral neuropathy.

  4. Pain in diabetic neuropathy case study: whole patient management.

    PubMed

    Marchettini, P; Teloni, L; Formaglio, F; Lacerenza, M

    2004-04-01

    Painful diabetic peripheral neuropathy (DPN) is described as a superficial burning pain associated with other positive and/or negative sensory systems affecting the feet and lower extremities. It is one of the most commonly encountered neuropathic pain syndromes in clinical practice. Presentation may be complicated by multiple symptoms, including allodynia, hyperalgesia, other less well characterized dysesthesias, and serious disruption of social functioning and mood. Peripheral nerve function may deteriorate, which can account for patient reports of diminution of pain after several years of follow-up. Although current understanding holds that the pathogenesis of DPN is multifactorial in nature, long-term studies have shown that rigorous glycemic control is the most relevant factor in clinical intervention and can delay the onset and slow the progression of neuropathy. In addition to glycemic control, other treatment approaches must be examined in order to restore quality of life for patients experiencing painful DPN. Differential diagnosis is required to isolate DPN from other unexplained chronic pain. Neurologic testing in painful DPN is an area of active research and is used to assess the neurologic pathways giving rise to the pain, the degree of neural damage and the degree of subclinical damage. Current treatment options for DPN include mainly antidepressants and anticonvulsants, with other agents such as tramadol, dextromethorphan and memantine being employed or studied. This review article includes a case study of a patient with painful DPN to demonstrate the current management strategies for this neuropathic pain syndrome.

  5. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

    PubMed Central

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-01-01

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients. PMID:27458594

  6. Case Reports That Illustrate the Efficacy of SGLT2 Inhibitors in the Type 1 Diabetic Patient.

    PubMed

    Bell, David S H

    2015-01-01

    SGLT2 inhibitors are only approved for use in adults with type 2 diabetes. However, because SGLT2 inhibitors have a mechanism of action that does not require the presence of endogenous insulin, these drugs should also be efficacious in type 1 diabetes where endogenous insulin production is greatly reduced or absent. Herein, I present five cases which illustrate the benefits of utilizing an SGLT2 inhibitor with type 1 diabetes. In these cases the use of SGLT2 inhibitors resulted not only in better glycemic control in most patients but also in some patients' less hypoglycemia, weight loss, and decreased doses of insulin. In type 1 diabetes Candida albicans vaginitis and balanitis may occur more frequently than in type 2 diabetes. These cases show that a large randomized clinical trial of SGLT2 inhibitors in type 1 diabetes needs to be performed.

  7. Successful Treatment of a Patient With Complicated Diabetic Foot Wound: A Case Report.

    PubMed

    Zheng, Yurong; Wang, Xingang; Zhang, Liping; You, Chuangang; Feng, Zhanzeng; Han, Chunmao

    2014-06-01

    Foot ulceration is one of the most serious complications of diabetes mellitus and may lead to amputation of the lower extremity. Timely prophylaxis and treatment of diabetic foot ulceration are important to maintain a good quality of life. This article reports a complicated diabetic patient with severe limb-threatening necrotizing infection. We successfully applied endovascular stent insertion, digit amputation, negative pressure wound therapy, and advanced dressings in different wound phases to achieve definitive wound healing after 12 months of treatment. Based on this case report, we would like to emphasize the importance of combined multiple therapies and patient compliance for severe diabetic foot ulcers.

  8. Evolution assessment of head and neck infections in diabetic patients--a case control study.

    PubMed

    Juncar, Mihai; Popa, Amorin R; Baciuţ, Mihaela F; Juncar, Raluca Iulia; Onisor-Gligor, Florin; Bran, Simion; Băciuţ, Grigore

    2014-07-01

    This research aimed to assess the occurrence and progression of head and neck infections in diabetic compared to non-diabetic patients. A retrospective study was carried out over a period of 10 years in 899 patients with head and neck infections. The patients who met the inclusion criteria were divided into cases and controls according to the presence/absence of diabetes. Seventy-three patients (8%, 95% CI [6.45%-10.12%]) were included in the case group and 826 (92%, 95% CI [89.87%-93.55%]) were assigned to the control group. The extension of the infection proved to be significantly (p < 0.001) higher in diabetic patients compared to non-diabetic patients. The difference between the two groups was statistically significant (Mann-Whitney U statistics = 18205.500, p < 1.56 · 10(-8)). A more than 10 year history of diabetes was statistically related to a wider extent of head and neck infections (p < 0.001). Diabetes proved to be associated with large necrotic areas and the spread of head and neck infections to more than two cavities.

  9. Dietary management of a patient with diabetes mellitus: a case report.

    PubMed

    Sidik, Sherina Mohd; Ahmad, Rozali

    2003-09-01

    The Ministry of Health has launched healthy lifestyle and diabetes campaigns. However, adopting healthy lifestyle practices is not easy as revealed in this case. Patients and their families need to be supervised personally and counseled regularly. Healthy lifestyle habits such as maintaining a balanced diet, ideal body weight and physical activities need to be cultivated and practised. Dietary counseling sessions need to be implemented, preferably by dietitians as this has been shown to be effective in motivating diabetic patients to achieve a better food choice, as well as better glycaemic, lipid and weight control, as shown in this case.

  10. A case report on escitalopram-induced hyperglycaemia in a diabetic patient.

    PubMed

    Zuccoli, M L; Milano, G; Leone, S; Fucile, C; Brasesco, P C; Martelli, A; Mattioli, F

    2013-01-01

    The incidence of depression in diabetic patients is quite high; moreover, it has been suggested that the presence of depression itself may increase the risk of diabetes mellitus. Hence, it follows that the simultaneous use of antidiabetic and antidepressant drugs is common. Some clinical evidence indicates that selective serotonin re-uptake inhibitors (SSRIs) could be very useful in treating overweight patients, both with and without diabetes. However, recent deregulation of glucidic metabolism was tested in diabetic subjects treated with antidepressants. Several cases of hyperglycaemia and hypoglycaemia associated with other SSRIs have been published, whereas only one case of escitalopram inducing hyperglycaemia has been noted. The exact mechanism of glucose control impairment in patients taking SSRIs--escitalopram in particular--still remains unclear. We describe a diabetic 83-year-old woman with good glycaemic control (as evinced by glycaemic and glycosylated haemoglobin assay--HbA1c--values) before escitalopram initiation in response to therapy with glibenclamide. Escitalopram resulted in a significantly increased glycaemia values 5 days following administration. Glycaemia values returned to normality only after suspension of escitalopram, despite antidiabetic dosage increase. We report this case to draw attention to escitalopram as a possible cause of glycaemic control loss.

  11. Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

    PubMed Central

    Babamahmoodi, Farhang; Shokohi, Tahereh; Ahangarkani, Fatemeh; Nabili, Mojtaba; Afzalian Ashkezari, Elham; Alinezhad, Sosan

    2015-01-01

    Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection. PMID:26064128

  12. Depression in Patients with Type II Diabetes: Case study at Diabetic Outpatient Clinic, in Samut Prakan

    PubMed Central

    Thongsai, Soontareeporn; Watanabenjasopa, Suntaree; Youjaiyen, Malinee

    2014-01-01

    This descriptive research studied the depression level of patients with diabetes type II at diabetic clinics in Samut Prakarn, and, identified the causes of severe depression in patients with type 2. There were 209 participants enrolled in the study. The samples were selected by opportunistic sampling technique. The data were collected from May 2013 to July 2013, using the CES-D questionnaire, with Cronbach’s coefficient alpha 0.82 and guidelines for interviews. Data were analyzed by descriptive statistics. Research Results: 1. 66 percent of participants had a depression score at a low level. 2. The CES-D showed that, 44 percent were unhappy and 38 percent did not feel that their life was enjoyable. 29 percent felt no hope for the future, 5.6 percent were easily upset and 8.3 percent suffered from insomnia and severe depression. 3. Half of the participants mentioned that troubled family relationships was a main cause of their depression, 42.9 percents felt worrying about their illness, 35.3 percent blamed over work and almost 15 percent identified loss of love as the cause of depression. PMID:24373272

  13. Myocutaneous Mucormycosis in a Diabetic Burnt Patient Led to Upper Extremity Amputation; A Case Report

    PubMed Central

    Ayaz, Mehdi; Moein, Reza

    2017-01-01

    Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, malignant and lethal course in patients with incompetent immunity. To enforce the importance of burn in patients with underlaying diseases such as diabetes, we are going to report a rare case of diabetic burnt patient complicated by right upper extremity myocutaneous mucormycosis. We selected this case to emphasis the importance of underlying disease (diabetes mellitus) with cutaneous burn, aggressive treatment of fungal infection in these patients and referring such case to burn center to prevent catastrophic results. A 50-year-old woman was introduced to us after several days of medical and surgical care of right upper extremity and trunk split-thickness burn. Due to gross muscle necrosis of right upper extremity and poor general condition of the patient, she was taken to the operating room that led to right upper extremity amputation and several times of aggressive debridement to save her life. Pathologic report was indicative of mucormycosis. We can conclude from this case that: 1) Burn, even partially thickness and with little body surface area, should be referred to burn center for better care 2) No response to usual medical treatment should make us more sensitive to consider the unusual causes of infection such as fungi 3) Suspected dead tissues should be excised aggressively especially if suspiciousness to wound sepsis and fungal infection is present especially in an immunocompromised patient. PMID:28246626

  14. Hemoptysis during general anesthesia in a diabetic patient with healed tuberculosis: a case report

    PubMed Central

    Chung, Mee Young; Jeong, Hyeon-Do; Kim, Seul-Gi

    2017-01-01

    Hemoptysis is a common complication of pulmonary tuberculosis. Most of the cases of hemoptysis originate from hypertrophied bronchial arteries. Also, diabetes induces pulmonary vascular abnormalities such as endothelial dysfunction, inflammatory infiltration and pulmonary vascular remodeling. A 27-year-old male, with diabetes and a history of tuberculosis, underwent the procedure of pars plana vitrectomy under general anesthesia. After an uneventful intra-operative period, he had hemoptysis prior to extubation. Emergency fiberoptic bronchscopy showed blood plugs and spotted fresh blood at the right upper lobar bronchus. After successful embolization of the bronchial artery, the patient made a recovery and was discharged without experiencing any complication. Predisposing factors of hemoptysis in this case are presumed to be tuberculosis and diabetes. The bleeding might had been caused by the rupture of a weakened artery within the cavity in the right upper lobe, through expansion of the lung during manual ventilation by positive pressure. PMID:28184273

  15. Diabetic myonecrosis in a patient with hepatic cirrhosis: a case report and review of the literature

    PubMed Central

    2009-01-01

    Introduction Diabetic myonecrosis was first reported by Angervall and Stener in 1965. In its classical clinical expression, it affects type 1 diabetes mellitus patients with long-standing poor metabolic control and advanced chronic microvascular complications. A sudden-onset of severe pain in the region of the involved muscle, usually the quadriceps, is the typical clinical manifestation. Magnetic resonance imaging (MRI) confirms the clinical diagnosis; in some cases of diagnostic uncertainty, a muscle biopsy may be required. Case Presentation We present the case of a 38 year-old Hispanic male from Mexico, with alcohol-induced hepatic cirrhosis (Child-Pugh C/MELD 45) and type 2 diabetes mellitus admitted to the emergency room due to hepatic encephalopathy with intense pain and an increase in volume of the left thigh. MRI showed edema and inflammatory changes of the quadriceps muscle with a hyperintense signal on T2-weighted images; in addition, there was a subacute hematoma. Conclusion To the best of our knowledge, this is the first case of diabetic myonecrosis associated with and complicated by advanced hepatic cirrhosis reported in the literature. PMID:20062734

  16. Prevalence of Gall Bladder Stones among Type 2 Diabetic Patients in Benghazi Libya: A Case-control Study

    PubMed Central

    Elmehdawi, RR; Elmajberi, SJ; Behieh, A; Elramli, A

    2009-01-01

    Background: Diabetes mellitus and gall bladder stones are both common and costly diseases. Increasing age, female gender, overweight, familial history of the disease and type 2 diabetes mellitus is all associated with an increased risk of gallstones. Several studies from around the world reported an increased prevalence of gall bladder stones in patients with diabetes mellitus. Aims and objectives: The aim of this study was to define the frequency of gall bladder stones among Libyan diabetics and to evaluate the possible associated risk factors in these patients. Patients and methods: A case-control study was performed during 2007 at Benghazi Diabetes and endocrinology Center. The study involved 161 randomly selected type-2 diabetic patients under regular follow up at the center, and 166 age and sex matched non-diabetic outpatients at the 7th of October teaching hospital. Real-time abdominal ultrasound was performed by two radiologists to examine the abdomen after an overnight fast. Results: About 40% of the diabetic cohort had gall bladder stones as compared to 17.5% of non-diabetic patients. Females were significantly more affected than males. Patients with gall bladder stones were significantly older and had a significantly higher body mass index than those without stones. Conclusion: The prevalence of gallstones in Libyan diabetic patients is higher than the rates reported in other parts of the world. Libyan diabetic patients with gallstones tend to be older and more obese than those without gallstones. Duration of diabetes mellitus and type of treatment does not seem to influence the frequency of gall bladder stones among Libyan diabetics. PMID:21483499

  17. Shoulder adhesive capsulitis prevalence among patients with type 2 diabetes mellitus in Damascus, Syrian Arab Republic: a case-control study.

    PubMed

    Sayed-Hassan, R; Alourfi, Z

    2014-01-09

    Diabetes mellitus is a known risk factor for shoulder adhesive capsulitis which causes disability and affects quality of life. This study determined the prevalence of shoulder adhesive capsulitis in 208 type 2 diabetes patients and 200 age- and sex-matched patients without diabetes, and with a case-control method investigated the clinical features of the diabetes patients with or without this complication. The sample was drawn from in- and outpatients at Al-Mouassat and Al-Assad university hospitals during November 2009-2010. The prevalence of shoulder adhesive capsulitis in diabetes patients was significantly higher than in those without diabetes (13.0% and 1.5% respectively, P < 0.01). Of the patients with the condition, those with diabetes were younger than those without diabetes. Shoulder adhesive capsulitis in the diabetes group was associated with diabetes duration and poor diabetes control (P < 0.05).

  18. Gestational diabetes insipidus. Case Report.

    PubMed

    Ejmocka-Ambroziak, Anna; Grzechocińska, Barbara; Jastrzebska, Helena; Kochman, Magdalena; Cyganek, Anna; Wielgoś, Mirosław; Zgliczyński, Wojciech

    2015-01-01

    Gestational diabetes insipidus is a very rare complication. However, undiagnosed and untreated may lead to serious complications in both mother and fetus. In this study, a case of 34-year-old female patient with diabetes insipidus associated with pregnancy was reported. We discussed process of diagnosis and treatment with particular emphasis on the monitoring of water-electrolyte imbalance during labor.

  19. Rhinocerebral mucormycosis in a patient with type 1 diabetes presenting as toothache: a case report from Himalayan region of India.

    PubMed

    Singh, Vikram; Singh, Mridu; Joshi, Chitra; Sangwan, Jyoti

    2013-10-30

    Mucormycosis is an angioinvasive infection caused by ubiquitous filamentous fungi of the order Mucorales. It is a rapidly progressive fatal infection mostly reported in susceptible individuals, such as those with poorly controlled diabetes or those with defects in phagocytic function. Rhinocerebral mucormycosis is the most common type of mucormycosis in diabetic patients. This case report describes a 17-year-old girl with type 1 diabetes mellitus presenting with rhinocerebral mucormycosis. The patient presented with a history of toothache and facial pain with oedema of left half of face, periorbital oedema and depressed conciousness. She had hyperglycaemia with diabetic ketoacidosis and rapidly developed hemiparesis progressing to quadriparesis and died within 3 days of admission. The current report emphasises the importance of having a high index of suspicion when dealing with patients with diabetes presenting with facial pain or cellulitis and prompt initiation of medical therapy along with surgical debridement for control of rhinocerebral mucormycosis.

  20. Rhinocerebral mucormycosis in a patient with type 1 diabetes presenting as toothache: a case report from Himalayan region of India

    PubMed Central

    Singh, Vikram; Singh, Mridu; Joshi, Chitra; Sangwan, Jyoti

    2013-01-01

    Mucormycosis is an angioinvasive infection caused by ubiquitous filamentous fungi of the order Mucorales. It is a rapidly progressive fatal infection mostly reported in susceptible individuals, such as those with poorly controlled diabetes or those with defects in phagocytic function. Rhinocerebral mucormycosis is the most common type of mucormycosis in diabetic patients. This case report describes a 17-year-old girl with type 1 diabetes mellitus presenting with rhinocerebral mucormycosis. The patient presented with a history of toothache and facial pain with oedema of left half of face, periorbital oedema and depressed conciousness. She had hyperglycaemia with diabetic ketoacidosis and rapidly developed hemiparesis progressing to quadriparesis and died within 3 days of admission. The current report emphasises the importance of having a high index of suspicion when dealing with patients with diabetes presenting with facial pain or cellulitis and prompt initiation of medical therapy along with surgical debridement for control of rhinocerebral mucormycosis. PMID:24172773

  1. Cyst decreased in size post maxillary sinus floor augmentation surgery in diabetic patient: A case report

    PubMed Central

    Zhang, Sijia; Song, Yingliang; Wei, Hongbo; Ren, Shuai

    2015-01-01

    Introduction Whether mucosal cyst of maxillary sinus is contraindication for sinus floor augmentation surgery has been a controversial hot spot for years. Presentation of case This case aims to present the surgical procedure of sinus floor augmentation surgery with cyst (18.72 mm × 24.61 mm) in diabetic patient. And 6 months later, the cyst decreased in size. The authors elevated the sinus floor and cyst simultaneously. The surgery was carried out successfully without sinus membrane perforation and the alveolar ridge gained about 8 mm height. Six months later, the cyst decreased in size and osseointegration was observed. Discussion Interdisciplinary cooperation is encouraged to diagnose benign mucosal cyst. The isolation between sinus lumen and the grafted sub-sinus space is important. Graft contamination or dispersion into the sinus lumen should be avoided. The integrity of the sinus membrane and use of antibiotics are very important to prevent the occurrence of postoperative sinus infection Conclusion The authors conclude that sinus augmentation surgery could be done with mucosal cyst in diabetic patient. PMID:26479781

  2. Diabetes mellitus increases the prevalence of anemia in patients with chronic kidney disease: A nested case-control study

    PubMed Central

    Loutradis, Charalampos; Skodra, Alexandra; Georgianos, Panagiotis; Tolika, Panagiota; Alexandrou, Dimitris; Avdelidou, Afroditi; Sarafidis, Pantelis A

    2016-01-01

    AIM: To compare anemia prevalence between matched chronic kidney disease (CKD) patients with and without diabetes mellitus (DM) and to assess factors associated with anemia development. METHODS: This is a nested case-control study of 184 type-2 diabetic and 184 non-diabetic CKD patients from a prospectively assembled database of a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate (eGFR). Prevalence of anemia (hemoglobin: Men: < 13 g/dL, women: < 12 g/dL and/or use of recombinant erythropoietin) was examined in comparison, in the total population and by CKD Stage. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with anemia. RESULTS: The total prevalence of anemia was higher in diabetics (47.8% vs 33.2%, P = 0.004). Accordingly, prevalence was higher in diabetics in CKD Stage 3 (53.5% vs 33.1%, P < 0.001) and particularly in Stage 3a (60.4% vs 26.4%, P < 0.001), whereas it was non-significantly higher in Stage 4 (61.3% vs 48.4%; P = 0.307). Serum ferritin was higher in diabetics in total and in CKD stages, while serum iron was similar between groups. In multivariate analyses, DM (OR = 2.206, 95%CI: 1.196-4.069), CKD Stages 3a, 3b, 4 (Stage 4: OR = 12.169, 95%CI: 3.783-39.147) and serum iron (OR = 0.976, 95%CI: 0.968-0.985 per mg/dL increase) were independently associated with anemia. CONCLUSION: Prevalence of anemia progressively increases with advancing stages of CKD and is higher in diabetic than matched non-diabetic CKD patients and diabetes is independently associated with anemia occurrence. Detection and treatment of anemia in diabetic CKD patients should be performed earlier than non-diabetic counterparts. PMID:27458564

  3. Seasonal variations of severe hypoglycemia in patients with type 1 diabetes mellitus, type 2 diabetes mellitus, and non-diabetes mellitus: clinical analysis of 578 hypoglycemia cases.

    PubMed

    Tsujimoto, Tetsuro; Yamamoto-Honda, Ritsuko; Kajio, Hiroshi; Kishimoto, Miyako; Noto, Hiroshi; Hachiya, Remi; Kimura, Akio; Kakei, Masafumi; Noda, Mitsuhiko

    2014-11-01

    Blood glucose control in patients with diabetes mellitus (DM) is reportedly influenced by the seasons, with hemoglobin A1c (HbA1c) levels decreasing in the summer or warm season and increasing in the winter or cold season. In addition, several studies have shown that sepsis is also associated with the seasons. Although both blood glucose control and sepsis can strongly affect the occurrence of severe hypoglycemia, few studies have examined the seasonal variation of severe hypoglycemia. The aim of the present study is to examine the association between severe hypoglycemia and the seasons in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and non-diabetes mellitus (non-DM). We retrospectively reviewed all the patients with severe hypoglycemia at a national center in Japan between April 1, 2006 and March 31, 2012. A total of 57,132 consecutive cases that had visited the emergency room by ambulance were screened, and 578 eligible cases of severe hypoglycemia were enrolled in this study. The primary outcome was to assess the seasonality of severe hypoglycemia. In the T1DM group (n  =  88), severe hypoglycemia occurred significantly more often in the summer than in the winter (35.2% in summer vs 18.2% in winter, P  =  0.01), and the HbA1c levels were highest in the winter and lowest in the summer (9.1% [7.6%-10.1%] in winter vs 7.7% [7.1%-8.3%] in summer, P  =  0.13). In the non-DM group (n  =  173), severe hypoglycemia occurred significantly more often in the winter than in the summer (30.6% in winter vs 19.6% in summer, P  =  0.01), and sepsis as a complication occurred significantly more often in winter than in summer (24.5% in winter vs 5.9% in summer, P  =  0.02). In the T2DM group (n  =  317), the occurrence of severe hypoglycemia and the HbA1c levels did not differ significantly among the seasons. The occurrence of severe hypoglycemia might be seasonal and might fluctuate with temperature changes

  4. Case Study: Weight loss in a patient with type 2 diabetes: Challenges of diabetes management.

    PubMed

    Lotfi, Katayoun; Palmer, Kenya; Apovian, Caroline M

    2015-04-01

    This patient with BMI 36 kg/m² and T2DM on insulin glargine and glyburide as well as atenolol for HTN was able to lose 10% of his initial body weight with a low-carbohydrate diet and exercise and adjustment of medications in approximately a 36-week time frame. Insulin glargine and glyburide were reduced gradually with blood glucose monitoring and replaced by an increase in metformin, start of liraglutide, and eventually phentermine/topiramate and canagliflozin (Figure). Therefore, medications that can exacerbate weight gain were discontinued in place of medications which promote weight loss.

  5. Diabetes insipidus due to herpes encephalitis in a patient with diffuse large cell lymphoma. A case report.

    PubMed

    Scheinpflug, K; Schalk, E; Reschke, K; Franke, A; Mohren, M

    2006-01-01

    The major causes of central diabetes insipidus are neoplastic or infiltrative lesions of the hypothalamus or pituitary, severe head injuries and pituitary or hypothalamic surgery. Central diabetes insipidus caused by viral infections has been rarely reported in immunosuppressed patients, such as those with acquired immunodeficiency syndrome or Cushing's syndrome. We report the case of a 48-year-old woman suffering from diffuse large cell lymphoma, who developed hypotonic polyuria, hypernatriaemia and somnolence after the first course of chemotherapy with CHOEP and rituximab. Diabetes insipidus was diagnosed by low urine osmolarity and an undetectable vasopressin concentration. MRI revealed no pituitary abnormalities but encephalitis, and lumbar punction confirmed herpes zoster infection. To the best of our knowledge this is the first description of central diabetes insipidus in a lymphoma patient caused by an opportunistic CNS-infection.

  6. Improved Clinical Outcomes of Patients With Type 2 Diabetes Mellitus Utilizing Integrative Medicine: A Case Report

    PubMed Central

    Grise, Diane E.; McAllister, Heath M.

    2015-01-01

    This case report demonstrates a successful approach to managing patients with type 2 diabetes mellitus (DM2). Botanical herbs (including Gymnema sylvestre) and nutrients (including alpha lipoic acid and chromium) were used alongside metformin to help improve insulin sensitization; however, the greatest emphasis of treatment for this patient centered on a low-carbohydrate, whole-foods diet and regular exercise that shifted the focus to the patient's role in controlling their disease. Research on DM2 often focuses on improving drug efficacy while diet and lifestyle are generally overlooked as both a preventive and curative tool. During the 7 months of treatment, the patient's hemoglobin A1c and fasting glucose significantly decreased to within normal ranges and both cholesterol and liver enzyme markers normalized. A significant body of evidence already exists advocating for disease management using various diets, including Mediterranean, low-carb, and low-fat vegan diets; however, no clear dietary standards have been established. This study supports the use of naturopathic medicine as well as dietary and lifestyle changes to develop the most efficacious approach for the treatment of DM2. PMID:25984419

  7. Improved clinical outcomes of patients with type 2 diabetes mellitus utilizing integrative medicine: a case report.

    PubMed

    Grise, Diane E; McAllister, Heath M; Langland, Jeffrey

    2015-05-01

    This case report demonstrates a successful approach to managing patients with type 2 diabetes mellitus (DM2). Botanical herbs (including Gymnema sylvestre) and nutrients (including alpha lipoic acid and chromium) were used alongside metformin to help improve insulin sensitization; however, the greatest emphasis of treatment for this patient centered on a low-carbohydrate, whole-foods diet and regular exercise that shifted the focus to the patient's role in controlling their disease. Research on DM2 often focuses on improving drug efficacy while diet and lifestyle are generally overlooked as both a preventive and curative tool. During the 7 months of treatment, the patient's hemoglobin A1c and fasting glucose significantly decreased to within normal ranges and both cholesterol and liver enzyme markers normalized. A significant body of evidence already exists advocating for disease management using various diets, including Mediterranean, low-carb, and low-fat vegan diets; however, no clear dietary standards have been established. This study supports the use of naturopathic medicine as well as dietary and lifestyle changes to develop the most efficacious approach for the treatment of DM2.

  8. Insulin antibodies in patients with type 2 diabetic receiving recombinant human insulin injection: A report of 12 cases.

    PubMed

    Hu, Xiaolei; Ma, Xiaowen; Wang, Xin; Zhao, Xiuli; Xu, Xuling; Gong, Hui; Chen, Fengling; Sun, Junjie

    2015-12-01

    We report 12 cases of patients with type 2 diabetic receiving recombinant human insulin injection, who had uncontrolled hyperglycemia or frequent episodes of hypoglycemia, high levels of serum insulin and positive insulin antibodies. The clinical characteristics and insulin antibodies pharmacokinetics parameters were analyzed. After administration of glucocorticoids, changing insulin formulations or discontinuing the insulin and switching to oral antidiabetic agents, the level of insulin antibodies decreased and the plasma glucose restored. Thus, we recommend to identify the presence of high insulin antibodies in patients with type 2 diabetes who experience unexplained high plasma glucose or frequent reoccurrence of hypoglycemia.

  9. Staphylococcus saprophyticus native valve endocarditis in a diabetic patient with neurogenic bladder: A case report.

    PubMed

    Magarifuchi, Hiroki; Kusaba, Koji; Yamakuchi, Hiroki; Hamada, Yohei; Urakami, Toshiharu; Aoki, Yosuke

    2015-09-01

    A 61-year-old man was admitted to our hospital with 2-day history of malaise and dyspnea. He had mitral prolapse and type II diabetes mellitus with neurogenic bladder, which was cared for by catheterization on his own. On arrival the patient was in septic condition with hypoxemia, and physical examination revealed systolic murmur at the apex. Transthoracic echocardiography revealed vegetation of the mitral and the aortic valve. The presence of continuous bacteremia was confirmed by multiple sets of blood culture, whereby gram-positive cocci was retrieved and identified as Staphylococcus saprophyticus (S. saprophyticus) both phenotypically and genetically. Because two major criteria of the Modified Duke Criteria were met, the patient was diagnosed with native valve endocarditis due to S. saprophyticus. The urine culture was also positive for gram-positive cocci, phenotypically identified as Staphylococcus warneri, which was subsequently identified as S. saprophyticus with the use of 16S rRNA gene sequence analysis and MALDI-TOF MS (matrix-assisted laser desorption ionization time of flight mass spectrometry), indicating strongly that the intermittent catheterization-associated urinary tract infection resulted in bacteremia that eventually lead to infective endocarditis. This patient was treated with vancomycin and clindamycin. Because of multiple cerebral infarctions, the patient underwent mitral and aortic valve replacement on hospital day 5. Blood culture turned negative at 6th hospital day. Antibiotic therapy was continued for six weeks after surgery. The patient's clinical course was uneventful thereafter, and was discharged home. This is the first case report of native valve endocarditis caused by S. saprophyticus of confirmed urinary origin.

  10. Patient credentialing as a population health management strategy: a diabetes case study.

    PubMed

    Watson, Lindsay L; Bluml, Benjamin M; Skoufalos, Alexandria

    2015-06-01

    When given the opportunity to become actively involved in the decision-making process, patients can positively impact their health outcomes. Understanding how to empower patients to become informed consumers of health care services is an important strategy for addressing disparities and variability in care. Patient credentialing identifies people who have a certain diagnosis and have achieved certain levels of competency in understanding and managing their disease. Patient credentialing was developed to meet 3 core purposes: (1) enhance patient engagement by increasing personal accountability for health outcomes, (2) create a mass customization strategy for providers to deliver high-quality, patient-centered collaborative care, and (3) provide payers with a foundation for properly aligning health benefit incentives. The Patient Self-Management Credential for Diabetes, a first-of-its-kind, psychometrically validated tool, has been deployed within 3 practice-based research initiatives as a component of innovative diabetes care. Results from these projects show improved clinical outcomes, reduced health care costs, and a relationship between credential achievement levels and clinical markers of diabetes. Implementing patient credentialing as part of collaborative care delivered within various settings across the health care system may be an effective way to reduce disparities, improve access to care and appropriate treatments, incentivize patient engagement in managing their health, and expend time and resources in a customized way to meet individual needs.

  11. Haemophilus influenzae Pyomyositis in a Patient with Diabetic Ketoacidosis: A Unique Case and Review of Literature

    PubMed Central

    George, Gemlyn; Climaco, Antoinette

    2017-01-01

    Haemophilus influenzae is a Gram-negative bacillus commonly known to cause upper respiratory tract infections. Skin and soft tissue infections are very uncommon. Of these, the majority were associated with necrotizing fasciitis requiring emergent debridement. We report a case of pyomyositis caused by Haemophilus influenzae in an adult with diabetes. PMID:28352482

  12. Lemierre's Syndrome Caused by Klebsiella pneumoniae in a Diabetic Patient: A Case Report and Review of the Literature

    PubMed Central

    Chuncharunee, Alan

    2015-01-01

    Lemierre's syndrome is characterized by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. This infection is usually caused by Fusobacterium spp. In this report, we present a rare case of Klebsiella pneumoniae-associated Lemierre's syndrome in a patient with poorly-controlled diabetes mellitus. The infection was complicated by septic emboli in many organs, which led to the patient's death, despite combined antibiotics, anticoagulant therapy, and surgical intervention. Therein, a literature review was performed for reported cases of Lemierre's syndrome caused by Klebsiella pneumoniae and the results are summarized here. PMID:26279962

  13. [A clinical case of development of lactic acid acidosis in a diabetic patient taking metformin].

    PubMed

    Cesur, Mustafa; Cekmen, Nedum; Cetinbas, Riza R; Badalov, Pavel; Erdemli, Ozcan

    2006-01-01

    Metformin is a biguanide. Due to its effects in suppressing the hepatic production of endogenous glucose and in increasing insulin sensitivity in adipose tissue and skeletal muscle, the agent is used particularly in type 2 diabetes mellitus and metabolic syndrome, in which insulin resistance is especially pronounced. Lactic acidosis is one of the most important side effects of metformin. A male patient, born in 1923, was admitted to the emergency unit of our hospital for sudden vertigo, weakness, dyspnea, cyanosis, and lethargy. His history data showed that the patient had been suffering from type 2 diabetes mellitus for 10 years and taking Glargin (insulin), 12 U/kg, once daily and Glucophage (metformin), 850 mg thrice daily. The patient's general condition was fair; stupor, time and spatial orientation were absent. Analysis of arterial blood gases showed the presence of metabolic acidosis, hypokalemia, hypoxemia, and hypercapnia. Thereafter the patient was transferred to the intensive care unit of the hospital; intubated and connected to a T-bird ventilation apparatus. On the following day, an analysis of arterial blood gases indicated the proximity of the results to their physiological parameters. Ventilation was stopped; and monitoring of the patient continued by following the T-shape type of ventilation discontinuation. There were no X-ray signs of pneumonia or pulmonary edema. On the same day, the patient was extubated and oxygen inhalation in a dose of L/min was continued through a mask. On day 4 since therapy was initiated, the patient's vital signs, serum sugar and lactate levels became normal. By determining a new treatment regimen, the patient was discharged from the intensive care unit. Dyspnea, acidosis, and hypoxia developed in the patient resulted from lactic acidosis caused by the use of metformin. It should be remembered that dyspnea, acidosis, and hypoxia, which suddenly developed in metformin-treated patients with type 2 diabetes mellitus, may be

  14. [A clinical case of lactic acidosis development in a diabetic patient taking metformin].

    PubMed

    Cezur, Mustafa; Celmen, Nedim; Cetinbas, Riza; Badalov, Pavel; Erdemli, Ozcan

    2009-01-01

    Metformin is a biguanide. Due to its effects in decreasing the hepatic production of glucose and in increasing insulin sensitivity in peripheral tissues, such as adipose tissue and skeletal muscle, the agent is used in metabolic syndrome and type 2 diabetes mellitus and, in which insulin resistance is especially pronounced. Eighty-one-year old male patient was admitted to the emergency unit with sudden vertigo, tiredness, dyspnea, cyanosis, and lethargy. He had had type 2 diabetes mellitus for 10 years and was taking glargin 12 U/kg once daily and metformin (glucophage) 850 mg thrice daily. The patient showed no cooperation and orientation. Metabolic acidosis, hypoxemia, and hypercapnea were detected in arterial blood gases (ABG). The patient was transferred to an intensive care unit of the hospital; endotracheal intubation was applied and mechanic ventilation was started. On the following day, his ABG got better; he was disconnected and weaning was applied. Lung X-ray study revealed no signs of pneumonia or pulmonary edema. On the same day, extubation was ended and O2 was given by mask at a rate of 4 L/min. After the patient's vital signs, blood sugar, and lactate levels were stabilized; his treatment regimen was arranged again and the patient was discharged on day 4 of his admission. Dyspnea, acidosis, and hypoxia seen in the patient were thought to be due to lactic acidosis which may rarely occur when metformin is used.

  15. Acupuncture for erectile dysfunction in a non-diabetic haemodialysis patient: a case report.

    PubMed

    Kim, Kun Hyung; Kim, Tae-Hun; Kang, Jung Won; Lee, Myeong Soo; Kim, Jong-In; Choi, Jun-Yong; Sul, Jae-Uk; Choi, Sun Mi

    2011-03-01

    Erectile dysfunction (ED) significantly affects the quality of life in male haemodialysis patients. This study reports the observed effects of acupuncture for ED in a non-diabetic haemodialysis patient. A 43-year-old man undergoing haemodialysis received 12 sessions of manual acupuncture over 6 weeks and was observed for 6 months after the end of treatment. Total International Index of Erectile Function Questionnaire scores of the patient were changed from 32 at baseline to 60 at post-treatment evaluation, which means there was a significant improvement of ED. All International Index of Erectile Function subscales also increased. This beneficial effect lasted up to 6 months after the end of treatment. No adverse events were observed. An interview revealed that the lowered self-esteem of the patient was restored with the improvement of ED following acupuncture. Further controlled studies are needed to determine whether acupuncture might be a feasible and useful treatment option for erectile dysfunction in haemodialysis patients.

  16. Complications associated with uni-portal endoscopic gastrocnemius recession in a diabetic patient population: an observational case series.

    PubMed

    Roukis, Thomas S; Schweinberger, Monica H

    2010-01-01

    The purpose of this article was to report the complications associated with uni-portal endoscopic gastrocnemius recession for surgical treatment of pathologic soft tissue ankle equinus contracture in diabetic patients. This is an observational case series involving a retrospective review of prospectively collected data of 23 uni-portal endoscopic gastrocnemius recessions used to treat pathologic soft tissue ankle equinus contracture in 18 consecutive diabetic patients between November 2006 and January 2009. Each patient underwent uni-portal endoscopic gastrocnemius recession under general or spinal anesthesia with thigh tourniquet control in combination with soft tissue and/or osseous reconstructive foot and/or ankle surgery. Patients were kept non-weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 9 male and 9 female patients with a mean age +/- SD of 69.0 +/- 7.4-years (range: 47.0 to 71.0 years). There were 11 right and 12 left lower limbs involved, with 5 procedures performed bilateral. Complications included 3 conversions to an open incision secondary to difficulty dissecting through excessive adipose tissue, delayed healing of 3 incision sites in patients with uncontrolled diabetes mellitus at the time of surgery, and 3 undercorrections in patients with spastic contractures. The remainder of the procedures were deemed successful with no saphenous nerve, sural nerve, or lesser saphenous vein related injuries occurring. When properly performed, uni-portal endoscopic gastrocnemius recession represents a safe, reliable, and minimally invasive technique useful for correcting pathologic soft tissue ankle equinus contracture in patients with diabetes. A percutaneous tendo-Achilles lengthening should be performed in patients who have marginal arterial inflow that precludes tourniquet use or have a spastic contracture. An open rather than endoscopic gastrocnemius recession should be performed in

  17. Treatment of Diabetic Ketoacidosis With Intravenous U-500 Insulin in a Patient With Rabson-Mendenhall Syndrome: A Case Report.

    PubMed

    Moore, Megan M; Bailey, Abby M; Flannery, Alexander H; Baum, Regan A

    2016-04-24

    Rabson-Mendenhall syndrome is a rare genetic disorder resulting from mutations in the insulin receptor and is associated with high degrees of insulin resistance. These patients are prone to complications secondary to their hyperglycemia including diabetic ketoacidosis (DKA). We report the case of a 19-year-old male with Rabson-Mendenhall syndrome presenting with DKA who required doses of up to 500 U/h (10.6 U/kg/h) of insulin. The patient's insulin infusion was originally compounded with U-100 regular insulin, although to minimize volume, the product was compounded with U-500 insulin. The DKA eventually resolved requiring infusion rates ranging from 400 to 500 U/h. Although numerous opportunities for medication errors exist with the use of U-500 insulin, this case outlines the safe use of concentrated intravenous insulin when clinically indicated for patients requiring extremely high doses of insulin to control blood glucose.

  18. Conservative treatment in a patient with diabetic osteomyelitis: antibiotic treatment is sufficient for complete bone regeneration in selected cases.

    PubMed

    Jeppesen, Sune Møller; Frøkjær, Johnny; Yderstræde, Knud

    2015-11-18

    Diabetic foot ulcers are commonly complicated by bone involvement and osteomyelitis. Diagnosing diabetic osteomyelitis can be problematic. However, positive findings at clinical examination and X-ray may set the diagnosis. Recent guidelines suggest that selected cases of diabetic osteomyelitis can be treated conservatively with antibiotics. We report on the successful treatment of a 52-year-old man with diabetes with osteomyelitis in the distal phalanx of a toe. On X-ray, the affected phalanx appeared completely eroded. However, regeneration of the bone tissue was observed following outpatient treatment with antibiotics. We therefore encourage doctors to provide conservative treatment for selected cases of diabetic osteomyelitis.

  19. Pulmonary fungus ball caused by Penicillium capsulatum in a patient with type 2 diabetes: a case report

    PubMed Central

    2013-01-01

    Background Following the recent transfer of all accepted species of Penicillium subgenus Biverticillium to Talaromyces (including Talaromyces marneffei, formerly Penicillium marneffei), Penicillium species are becoming increasingly rare causal agents of invasive infections. Herein, we present a report of a type 2 diabetes patient with a fungus ball in the respiratory tract caused by Penicillium capsulatum. Case presentation A 56-year-old Chinese female gardener with a 5-year history of type 2 diabetes presented at the Shanghai Changzheng Hospital with fever, a cough producing yellow-white sputum, and fatigue. The therapeutic effect of cefoxitin was poor. An HIV test was negative, but the β-D-glucan test was positive (459.3 pg/ml). Chest radiography revealed a cavitary lesion in the left upper lobe, and a CT scan showed globate cavities with a radiopaque, gravity-dependent ball. The histopathologic features of the tissue after haematoxylin-eosin staining showed septate hyphae. The fungus was isolated from the gravity-dependent ball and identified as Penicillium capsulatum based on the morphological analysis of microscopic and macroscopic features and on ribosomal internal transcribed spacer sequencing. After surgery, the patient was cured with a sequential treatment of fluconazole 400 mg per day for 90 days and caspofungin 70 mg per day for 14 days. Conclusions Although the prognosis is often satisfactory, clinicians, mycologists and epidemiologists should be aware of the possibility of infection by this uncommon fungal pathogen in diabetes patients, since it may cause severe invasive infections in immunocompromised hosts such as diabetes and AIDS patients. PMID:24152579

  20. [A Case of an Elderly Diabetic Patient Developing Wernicke Encephalopathy without Alcohol Abuse or an Unbalanced Diet].

    PubMed

    Kaneko, Yuji; Tsurutani, Yuya; Sagawa, Naoko; Kondo, Mai; Sata, Akira; Miyao, Mariko; Azuma, Reo; Orimo, Satoshi; Mizuno, Yuzo

    2015-01-01

    A 70-year-old man with a 28-year history of type 2 diabetes mellitus was admitted due to persistent vomiting and neurological abnormalities in Nov 2012. He had developed gait disturbance and diplopia for six months during antiplatelet therapy, which was initiated following the diagnosis of a cerebellar infarction in June 2012. He had nystagmus, truncal ataxia and an ocular motility disorder, and the MRI study showed increased FLAIR and DWI signals in the peri-third ventricle and periaqueductal region, in addition to the cerebellar vermis. Wernicke encephalopathy was suspected according to his symptoms, and thiamine administration dramatically improved his condition. He did not have a history of alcohol abuse or poor eating habits; however, various coexisting factors, including diabetes mellitus, pyloric stenosis and the use of antiulcer drugs and insulin, were considered to be responsible for Wernicke encephalopathy. This case demonstrates the importance of distinguishing Wernicke encephalopathy from cerebrovascular disease in elderly patients.

  1. Alternate-day dosing of linagliptin in type 2 diabetes patients controlled on once daily dose: A case series

    PubMed Central

    Baruah, Manash P.; Bhuyan, Sonali B.; Deka, Jumi; Bora, Jatin; Bora, Smritisikha; Barkakati, Murchana

    2016-01-01

    Linagliptin, a dipeptidyl peptidase 4 (DPP 4) inhibitor with a long terminal half life, significantly inhibits the DPP 4 enzyme at a steady state up to 48 h after the last dose. The present case series examined the hypothesis that linagliptin retains its efficacy during alternate day dosing in type 2 diabetes patients when switched over from once daily (OD) dosing. Eight type 2 diabetes patients maintaining stable glycosylated hemoglobin (HbA1c) with acceptable fasting plasma glucose and postprandial glucose levels and receiving linagliptin 5 mg OD for at least 6 weeks, with a stable dose of concomitant antidiabetic medications were given linagliptin 5 mg every alternate day. The median HbA1c while on the OD regimen was 6.1% (43 mmol/mol) (range: 5.8–6.9% [40–52 mmol/mol]) and median duration of diabetes was 7 years (range: 0.75–16 years). After a median follow-up period of 21weeks,the glycemic control was maintained in all patients similar to their baseline values (median HbA1c: 6.0% [42 mmol/mol], range: 5.1–7.1% [32–54 mmol/mol]). The body weight, fasting, and random glucose levels at baseline were also well maintained at the end of treatment. Optimal glycemic status maintained in our study population favors our hypothesis that linagliptin used alternate daily after switching from initial OD dose of the drug in patients on a stable background antidiabetic medications retains its efficacy. Paradoxically, alternate day dosing may affect compliance if the patient forgets when they took the last dose. Further studies including larger cohorts are needed to validate this finding and identify patients who can benefit from the alternate day regimen. PMID:27366728

  2. Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.

    PubMed

    Dahmardehei, Mostafa; Kazemikhoo, Nooshafarin; Vaghardoost, Reza; Mokmeli, Soheila; Momeni, Mahnoush; Nilforoushzadeh, Mohammad Ali; Ansari, Fereshteh; Amirkhani, Amir

    2016-04-01

    Significant populations in burn centers are diabetic burn patients. Healing process in these patients is more difficult due to diabetes complications. The gold standard treatment for patients with grade 3 burn ulcer is split-thickness skin grafting (STSG), but in the diabetic patients, the rate of graft failure and amputation is high due to impaired tissue perfusion. The technique of low level laser therapy (LLLT) improves tissue perfusion and fibroblast proliferation, increases collagen synthesis, and accelerates wound healing. The purpose of this case report is introducing a new therapeutic method for accelerating healing with better prognosis in these patients. The protocols and informed consent were reviewed according to the Medical Ethics, Board of Shahid Beheshti Medical Sciences (IR.SBMU.RAM.REC.13940.363). Diabetic type 2 patients with 13 grade 3 burn ulcers, candidate for amputation, were enrolled in the study. We used a 650-nm red laser light, 2 J/Cm for the bed of the ulcer and an 810-nm infrared laser light 6 J/Cm(2) for the margins along with intravenous laser therapy with a 660-nm red light, before and after STSG for treating grade 3 burn ulcers in 13 diabetic ulcers. The results of this study showed complete healing in the last 8 weeks for all patients who were candidates for amputation. In this case series, we present 13 cases of diabetic ulcer with type 3 burn wound, candidate for amputation, who healed completely using LLLT and STSG. This is the first time that these two techniques are combined for treatment of burn ulcer in diabetic patients. Using LLLT with STSG might be a promising treatment for burn victims especially diabetic patients.

  3. An assessment of patient education and self-management in diabetes disease management--two case studies.

    PubMed

    Fitzner, Karen; Greenwood, Deborah; Payne, Hildegarde; Thomson, John; Vukovljak, Lana; McCulloch, Amber; Specker, James E

    2008-12-01

    Diabetes affects 7.8% of Americans, nearly 24 million people, and costs $174 billion yearly. People with diabetes benefit from self-management; disease management (DM) programs are effective in managing populations with diabetes. Little has been published on the intersection of diabetes education and DM. Our hypothesis was that diabetes educators and their interventions integrate well with DM and effectively support providers' care delivery. A literature review was conducted for papers published within the past 3 years and identified using the search terms "diabetes educator" and "disease management." Those that primarily addressed community health workers or the primary care/community setting were excluded. Two case studies were conducted to augment the literature. Ten of 30 manuscripts identified in the literature review were applicable and indicate that techniques and interventions based on cognitive theories and behavioral change can be effective when coupled with diabetes DM. Better diabetes self-management through diabetes education encourages participation in DM programs and adherence to recommended care in programs offered by DM organizations or those that are provider based. Improved health outcomes and reduced cost can be achieved by blending diabetes education and DM. Diabetes educators are a critical part of the management team and, with their arsenal of goal setting and behavior change techniques, are an essential component for the success of diabetes DM programs. Additional research needs to be undertaken to identify effective ways to integrate diabetes educators and education into DM and to assess clinical, behavioral, and economic outcomes arising from such programs.

  4. The impact of built environment on diabetic patients: the case of Eastern Province, KIngdom of Saudi Arabia.

    PubMed

    Sidawi, Bhzad; Al-Hariri, Mohamed Taha Ali

    2012-06-13

    At present, Diabetes mellitus is considered as one of the main threats to the human health in the 21st century. It may lead to severe conditions such as blindness, end-stage of renal disease, limb amputation and a variety of debilitating neuropathies. Previous researches indicated that diabetes is caused by a complex interaction of patient's genetics, life-style and environmental factors. They also highlighted that providing quality and healthy built environment to citizens including diabetic patients would prevent poor and unhealthy condition. The Kingdom of Saudi Arabia (KSA) is one of top ten countries in the prevalence of diabetes. Little researches though were conducted in KSA in regards to the effect of environmental conditions of the built environment. In 2011, the present researchers have carried out a pilot survey on a number of diabetic patients to find out the possible impact of built environment settings on the patient's lifestyle. The research explored whether diabetic patients use smart tools in their daily life to overcome the daily life's difficulties and perform their life as normal as possible. The results showed a close link between a poor home and environmental settings, the patient's lifestyle, and the patient's health status. It also highlighted the absence of smart tools and systems use. The paper argues that certain changes to the built environment must be done and to provide a healthy and safe environment for diabetic patients. This would help these patients to abandon their bad habits and adopt healthier lifestyle.

  5. The “black evil” affecting patients with diabetes: a case of rhino orbito cerebral mucormycosis causing Garcin syndrome

    PubMed Central

    Narayanan, Santhosh; Panarkandy, Geetha; Subramaniam, Gomathy; Radhakrishnan, Chandni; Thulaseedharan, NK; Manikath, Neeraj; Ramaswamy, Sreejith; Radhakrishnan, Suma; Ekkalayil, Danish

    2017-01-01

    Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome. The hard palate had been eroded with formation of black eschar. Computed tomography of paranasal sinuses revealed right maxillary and ethmoid sinusitis, with spread of inflammation to infratemporal fossa and parapharynygeal neck spaces. Debridement of sinus mucosa was done, and culture of the same yielded growth of rhizopus species. Histopathological examination of the tissue showed angioinvasion and fungal hyphae suggestive of mucormycosis. She was treated with amphotericin B, posaconazole, and periodic nasal sinus debridement, but her general condition worsened after 8 weeks due to secondary sepsis and she succumbed to death.

  6. Simultaneous acute shoulder arthritis and multiple mononeuropathy in a newly diagnosed type 2 diabetes patient - First case report.

    PubMed

    Kotlęga, Dariusz; Gołąb-Janowska, Monika; Zaborowski, Grzegorz; Ciećwież, Sylwester; Nowacki, Przemysław

    Diabetes is a common disorder that leads to the musculoskeletal symptoms such as the shoulder arthritis. The involvement of peripheral nervous system is one of the troublesome for the patients as it provokes chronic sensory symptoms, lower motor neuron involvement and autonomic symptoms. In the course of the disease there has been several types of neuropathies described. A 41-year-old male patient was admitted to the internal medicine department because of the general weakness, malaise, polydypsia and polyuria since several days. The initial blood glucose level was 780mg/dl. During the first day the continuous insulin infusion was administered. On the next day when he woke up, the severe pain in the right shoulder with limited movement, right upper extremity weakness and burning pain in the radial aspect of this extremity appeared. On examination right shoulder joint movement limitation was found with the muscle weakness and sensory symptoms in the upper limbs. The clinical picture indicated on the right shoulder arthritis and the peripheral nervous system symptoms such as the right musculocutaneous, supraspinatus, right radial nerve and left radial nerve damage. We present a first case report of simultaneous, acute involvement of the shoulder joint and multiple neuropathy in a patient with newly diagnosed type 2 diabetes, presumably in the state of ketoacidosis.

  7. [Diabetes education in adult diabetic patients].

    PubMed

    Weitgasser, Raimund; Clodi, Martin; Cvach, Sarah; Grafinger, Peter; Lechleitner, Monika; Howorka, Kinga; Ludvik, Bernhard

    2016-04-01

    Diabetes education and self management has gained a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and treatment modification, as well as integration of diabetes in patients' daily life to achieve changes in lifestyle accordingly.Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes in everyday life and stress physical activity besides healthy eating as a main component of lifestyle therapy and use interactive methods in order to increase the acceptance of personal responsibility.

  8. Mucormycosis in a diabetic ketoacidosis patient.

    PubMed

    Vijayabala, G Sree; Annigeri, Rajeshwari G; Sudarshan, Ramachandran

    2013-10-01

    Oral cavity is considered to be a kaleidoscope for body's general health. Many systemic conditions do present with diverse oral manifestations. Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients. Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus. Hereby, we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis.

  9. Effectiveness and Safety of Sitagliptin in Patients with Beta-thalassaemia Major and Diabetes Mellitus: A Case Series

    PubMed Central

    Zonoozi, Shahrzad; Barnard, Maria; Prescott, Emma; Jones, Romilla; Shah, Farrukh T; Tzoulis, Ploutarchos

    2017-01-01

    Sitagliptin, a modern antidiabetic agent which is weight neutral and associated with low rate of hypoglycaemias, is being increasingly used in type 2 diabetes mellitus (DM). However, there is a paucity of data about its efficacy and safety in beta-thalassaemia major (β-TM). This retrospective case series of five patients (mean age of 45 years) is the first study evaluating the use of sitagliptin in patients with β-TM and DM. Four patients responded well to sitagliptin, as evidenced by a decrease in fructosamine by 77 and 96μmol/L (equivalent reduction in HbA1c of 1.5% and 1.9%) observed in two patients and reduction in the frequency of hypoglycaemia without worsening glycaemic control in two others. One patient did not respond to sitagliptin. No patients reported significant side effects. This study provides evidence that sitagliptin may be considered, with caution, for use in patients with β-TM and DM, under the close monitoring of a Diabetologist. PMID:28101310

  10. Metformin for Primary Colorectal Cancer Prevention in Diabetic Patients: A Case-Control Study in a US Population

    PubMed Central

    Sehdev, Amikar; Shih, Ya-Chen T.; Vekhter, Benjamin; Bissonnette, Marc; Olopade, Olufunmilayo I.; Polite, Blase

    2016-01-01

    Background Emerging evidence from observational studies suggests that metformin may be beneficial in the primary prevention of colorectal cancer (CRC). However, none of these were conducted in a US population. Since environmental factors, such as Western diet and obesity, are implicated in the causation of CRC, we conducted a large case control study to assess the effects of metformin on CRC incidence in a US population. Methods MarketScan® databases were used to identify diabetic patients with CRC. A case was defined as having an incident diagnosis of CRC. Up to two controls matched for age, sex and geographical region, were selected for each case. Metformin exposure was assessed by prescription tracking in the 12 months period prior to the index date. Conditional logistic regression was used to adjust for multiple potential confounders and to calculate adjusted odds ratios (AOR). Results The mean age of participants was 55 and 57 years in the control and case group, respectively (p=1.0). Sixty percent of the study participants were males and 40% were females in each group. In the multivariable model, any metformin use was associated with 15% reduced odds of CRC (AOR, 0.85, 95% confidence interval (CI), 0.76–0.95, p<0.007). After adjusting for health-care utilization the beneficial effect of metformin was reduced to 12% (AOR, 0.88, 95% CI, 0.77–1.00, p=0.05). The dose-response analyses showed no significant association with metformin dose, duration or total exposure. Conclusions Metformin use is associated with reduced risk of developing CRC among diabetic patients in the US population. PMID:25424411

  11. The additive value of transient left ventricular dilation using two-day dipyridamole 99mTc-MIBI SPET for screening coronary artery disease in patients with otherwise normal myocardial perfusion: a comparison between diabetic and non-diabetic cases.

    PubMed

    Fallahi, Babak; Beiki, Davood; Fard-Esfahani, Armaghan; Akbarpour, Saeed; Abolhassani, Arash; Kakhki, Vahid Reza Dabbagh; Eftekhari, Mohammad

    2010-01-01

    The prognostic value of transient ischemic dilation (TID) has been previously confirmed; however, its clinical significance for screening coronary artery disease (CAD) with balanced ischemia, as a cause of false negative myocardial perfusion imaging (MPI), is unclear. The goal of this study was to determine the additive diagnostic value of TID ratio for screening CAD in separate subgroups of diabetic and non-diabetics with normal perfusion. Eighty six patients with intermediate probability of CAD who had TID more than one in the presence of otherwise normal MPI using two-day technetium-99m methoxy isobutyl isonitrile ((99m)Tc-MIBI) single photon emission tomography (SPET) and dipyridamole stress (summed stress score<3 and left ventricular cavity<90 mL) were included in a prospective cohort study comprising two subgroups of diabetic and non- diabetic patients. An inclusive work-up with multiple noninvasive tests was performed for all patients from whom 38 cases subsequently underwent coronary angiography and 48 cases were categorized in the group with a very low likelihood (<5%) of CAD on the basis of clinical and paraclinical data over a minimum of 18 months follow up. The TID ratio was calculated using automated software. Gensini score (GS) as an indicator of severity/extent of stenosis and coronary artery index (CAI) as the number of arteries with more than 50% narrowing were calculated based on angiographic findings. Our results showed that only in diabetic patients with three-vessel disease, TID ratio (1.47 ± 0.23) differs significantly from the other groups of CAD. In diabetic patients subgroup, TID ratio correlated strongly with GS (r=0.957, P<0.0001) and CAI (r=0.659, P=0.001), while such correlations were not seen in the non-diabetic patients. On the basis of receiver operating characteristic curve analysis for screening CAD in diabetic patients with normal myocardial perfusion, 100% sensitivity and 77.8% normalcy rate were achieved when TID more than 1

  12. Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient.

    PubMed

    Yoshino, Hiroshi; Kawakami, Kyoko; Yoshino, Gen; Sawada, Katsuhiro

    2016-03-01

    A 64-year-old man was admitted to Shin-suma General Hospital, Kobe, Japan, complaining of a 3-day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5 °C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/μL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density of subcutaneous tissue and elevated air density. Thus, he was diagnosed with Fournier's gangrene. On the fourth hospital day, the patient underwent debridement of gangrenous tissue. Seton surgery was carried out for anal fistula on the 34th hospital day. He responded to the treatment very well. He was discharged on the 33rd postoperative day. Once Fournier's gangrene has been diagnosed, considering the association of anal fistula and perianal abscess is important.

  13. [Pathology of the oral mucosa in patients with type I diabetes mellitus: study of 44 cases].

    PubMed

    Bagan Sebastian, J V; Gisbert Selles, C; Milian Masanet, A

    1988-01-01

    We study the pathology of the oral mucosa in a group of type I diabetics. The most common disease was oral candidiasis (9.09%), whereas the other pathologies encountered showed no significant differences with the controls.

  14. Creating a healthy built environment for diabetic patients: the case study of the eastern province of the Kingdom of Saudi Arabia.

    PubMed

    Sidawi, Bhzad; Alhariri, Mohamed Taha; Albaker, Walid Ibrahim

    2014-04-14

    Many studies worldwide have demonstrated the negative impact of an unhealthy built environment on citizens. In the case of diabetes, studies have concentrated on the environmental impact and accessibility issues of a place i.e. the home and neighborhood, whereas few studies have addressed the comfort of the type and spatial arrangement of a household and linked it with the prevalence of diabetes. Also, little research has tackled the place's impact on diabetic patients and their views concerning their environments. This paper demonstrates the outcomes of survey that was carried out on diabetic individuals who usually visit the King Fahd teaching hospital of the University of Dammam, Al-Khober, the Kingdom of Saudi Arabia (KSA). The patients were surveyed and physically examined. The present researchers found significant links between patients' diabetes symptoms such as reported paresthesia and blurred vision, and medical investigations results such as lipid profile, blood glucose and blood pressure with the environmental conditions of their homes and neighborhoods. The paper shows that the prevalence of the disease is not only caused by an unhealthy lifestyle but also by an unhealthy built environment. Moreover, it illustrates that unhealthy built environment promotes unhealthy life styles. It makes recommendations on how to improve the built environment in the KSA to be healthier for all citizens including the diabetic patients.

  15. [Joint home follow-up of a patient with complicated diabetes mellitus by the case manager and the community nurse: II].

    PubMed

    López-Pisa, Rosa María; Prats-Guardiola, Marta

    2012-01-01

    This is a continuation of the article published in this journal (Enfermeria Clinica), entitled "Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home". We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources.Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team.

  16. Creating a Healthy Built Environment for Diabetic Patients: The Case Study of the Eastern Province of the Kingdom of Saudi Arabia

    PubMed Central

    Sidawi, Bhzad; Alhariri, Mohamed Taha; Albaker, Walid Ibrahim

    2014-01-01

    Many studies worldwide have demonstrated the negative impact of an unhealthy built environment on citizens. In the case of diabetes, studies have concentrated on the environmental impact and accessibility issues of a place i.e. the home and neighborhood, whereas few studies have addressed the comfort of the type and spatial arrangement of a household and linked it with the prevalence of diabetes. Also, little research has tackled the place’s impact on diabetic patients and their views concerning their environments. This paper demonstrates the outcomes of survey that was carried out on diabetic individuals who usually visit the King Fahd teaching hospital of the University of Dammam, Al-Khober, the Kingdom of Saudi Arabia (KSA). The patients were surveyed and physically examined. The present researchers found significant links between patients’ diabetes symptoms such as reported paresthesia and blurred vision, and medical investigations results such as lipid profile, blood glucose and blood pressure with the environmental conditions of their homes and neighborhoods. The paper shows that the prevalence of the disease is not only caused by an unhealthy lifestyle but also by an unhealthy built environment. Moreover, it illustrates that unhealthy built environment promotes unhealthy life styles. It makes recommendations on how to improve the built environment in the KSA to be healthier for all citizens including the diabetic patients. PMID:24999135

  17. Heart Health Tests for Diabetes Patients

    MedlinePlus

    ... Thromboembolism Aortic Aneurysm More Heart Health Tests for Diabetes Patients Updated:Dec 3,2015 If you have ... angiograms . This content was last reviewed August 2015. Diabetes • Home • About Diabetes • Why Diabetes Matters • Understand Your ...

  18. The Impact of Built Environment on Diabetic Patients: The Case of Eastern Province, Kingdom of Saudi Arabia

    PubMed Central

    Sidawi, Bhzad; Al-Hariri, Mohamed Taha Ali

    2012-01-01

    At present, Diabetes mellitus is considered as one of the main threats to the human health in the 21st century. It may lead to severe conditions such as blindness, end-stage of renal disease, limb amputation and a variety of debilitating neuropathies. Previous researches indicated that diabetes is caused by a complex interaction of patient’s genetics, life-style and environmental factors. They also highlighted that providing quality and healthy built environment to citizens including diabetic patients would prevent poor and unhealthy condition. The Kingdom of Saudi Arabia (KSA) is one of top ten countries in the prevalence of diabetes. Little researches though were conducted in KSA in regards to the effect of environmental conditions of the built environment. In 2011, the present researchers have carried out a pilot survey on a number of diabetic patients to find out the possible impact of built environment settings on the patient’s lifestyle. The research explored whether diabetic patients use smart tools in their daily life to overcome the daily life’s difficulties and perform their life as normal as possible. The results showed a close link between a poor home and environmental settings, the patient’s lifestyle, and the patient’s health status. It also highlighted the absence of smart tools and systems use. The paper argues that certain changes to the built environment must be done and to provide a healthy and safe environment for diabetic patients. This would help these patients to abandon their bad habits and adopt healthier lifestyle. PMID:22980349

  19. Impact of Glucose-Lowering Agents on the Risk of Cancer in Type 2 Diabetic Patients. The Barcelona Case-Control Study

    PubMed Central

    Simó, Rafael; Plana-Ripoll, Oleguer; Puente, Diana; Morros, Rosa; Mundet, Xavier; Vilca, Luz M.; Hernández, Cristina; Fuentes, Inmaculada; Procupet, Adriana; Tabernero, Josep M.; Violán, Concepción

    2013-01-01

    Background The aim of the present study is to evaluate the impact of glucose-lowering agents in the risk of cancer in a large type 2 diabetic population. Methods A nested case-control study was conducted within a defined cohort (275,164 type 2 diabetic patients attending 16 Primary Health Care Centers of Barcelona). Cases (n = 1,040) comprised those subjects with any cancer diagnosed between 2008 and 2010, registered at the Cancer Registry of Hospital Vall d'Hebron (Barcelona). Three control subjects for each case (n = 3,120) were matched by age, sex, diabetes duration, and geographical area. The treatments analyzed (within 3 years prior to cancer diagnosis) were: insulin glargine, insulin detemir, human insulin, fast-acting insulin and analogues, metformin, sulfonylureas, repaglinide, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, and alpha glucosidase inhibitors. Conditional logistic regressions were used to calculate the risk of cancer associated with the use of each drug adjusted by age, BMI, dose and duration of treatment, alcohol use, smoking habit, and diabetes duration. Results No differences were observed between case and control subjects for the proportion, dose or duration of exposure to each treatment. None of the types of insulin and oral agents analyzed showed a significant increase in the risk of cancer. Moreover, no cancer risk was observed when glargine was used alone or in combination with metformin. Conclusions Our results suggest that diabetes treatment does not influence the risk of cancer associated with type 2 diabetes. Therefore, an eventual increase of cancer should not be a reason for biasing the selection of any glucose-lowering treatment in type 2 diabetic population. PMID:24278227

  20. Corneal Melting after Collagen Cross-Linking for Keratoconus in a Thin Cornea of a Diabetic Patient Treated with Topical Nepafenac: A Case Report with a Literature Review

    PubMed Central

    Mohamed-Noriega, Karim; Butrón-Valdez, Karla; Vazquez-Galvan, Jeronimo; Mohamed-Noriega, Jibran; Cavazos-Adame, Humberto; Mohamed-Hamsho, Jesús

    2016-01-01

    Purpose To report the case of a 50-year-old woman with diabetes that presented with corneal melting and perforation 6 weeks after collagen cross-linking (CxL) for keratoconus (KC) and postoperative use of nepafenac eye drops, a nonsteroidal anti-inflammatory drug (NSAID). Methods This is a case report of a patient with diabetes, KC and a thin cornea that had undergone left eye corneal CxL at a different hospital followed by postoperative use of nepafenac eye drops for 6 weeks. Results The patient presented for the first time to our clinic with left corneal melting, perforation and iris prolapse 6 weeks after corneal CxL and topical nepafenac use. She was treated with a left eye tectonic penetrating keratoplasty, extracapsular cataract extraction, intraocular lens implantation and pupilloplasty. Conclusions The corneal melting and perforation in this patient was associated with multiple risk factors: (1) nepafenac eye drop use, (2) CxL in a cornea thinner than 400 µm and (3) diabetes. The recommended corneal thickness limits should be respected. Topical NSAIDs should be used with caution if used as postoperative treatment after corneal CxL and in patients with diabetes, epithelial defect or delayed healing, because of the possible increased risk for corneal melting when multiple risk factors are observed. PMID:27293413

  1. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  2. Diabetes Insipidus and Polydipsia in a Patient with Asperger's Disorder and an Empty Sella: A Case Report.

    ERIC Educational Resources Information Center

    Raja, Michele; Azzoni, Antonella; Giammarco, Vincenzo

    1998-01-01

    Describes an Italian patient with Asperger disorders, Neurogenic Diabetes Insipidus, and Primary Empty Sella. His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. Implications of the observed concurrence of these rare disorders are discussed in relation to diagnosis and pathogenesis. (Author/CR)

  3. Gallbladder function in diabetic patients

    SciTech Connect

    Shreiner, D.P.; Sarva, R.P.; Van Thiel, D.; Yingvorapant, N.

    1986-03-01

    Gallbladder emptying and filling was studied in eight diabetic and six normal control patients. None of the patients had gallstones. Cholescintigraphy was performed using (/sup 99m/Tc)disofenin, and gallbladder emptying was studied using a 45-min i.v. infusion of the octapeptide of cholecystokinin (OP-CCK) 20 ng/kg X hr. The peak filling rate was greater in diabetic than in normal subjects; however, emptying of the gallbladder in response to OP-CCK was significantly less in the diabetic subjects (51.6 +/- 10.4% compared with 77.2 +/- 4.9%). When the diabetic group was subdivided into obese and nonobese diabetics, the obese diabetics had a much lower percentage of emptying than the nonobese diabetics (30.0 +/- 10.4% compared with 73.1 +/- 9.3%). These findings suggest that obese diabetics may have impaired emptying of the gallbladder even in the absence of gallstones. The more rapid rate of gallbladder filling in obesity may indicate hypotonicity of the gallbladder. The combination of these abnormalities may predispose the obese diabetic to the development of gallstones.

  4. Hallux ulceration in diabetic patients.

    PubMed

    ElMakki Ahmed, Mohamed; Tamimi, Abdulhakim O; Mahadi, Seif I; Widatalla, Abubakr H; Shawer, Mohamed A

    2010-01-01

    We undertook a prospective cohort study to assess risk factors associated with hallux ulceration, and to determine the incidence of healing or amputation, in consecutive patients with diabetes mellitus who were treated over the observation period extending from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum City, Sudan. There were 122 diabetic patients in the cohort (92 males and 30 females) with an overall mean age of 58 +/- 9 years. Fifty-three percent of patients had complete healing within 8 weeks and 43% healed within 20 weeks. The overall mean time to healing was 16 +/- 8 weeks. In 32 (26.2%) patients, osteomyelitic bone was removed, leaving a healed and boneless hallux. The hallux was amputated in 17 (13.9%) patients; in 2 (1.6%) patients it was followed by forefoot amputation and in 7 (5.7%) patients by below-the-knee amputation. In 90 (73.8%) patients the initial lesion was a blister. In conclusion, hallux ulceration is common in patients with diabetes mellitus and is usually preceded by a blister. Neuropathy, foot deformity, and wearing new shoes are common causative factors; and ischemia, osteomyelitis, any form of wound infection, and the size of the ulcer are main outcome determinants. Complete healing occurred in 103 (85%) of diabetic patients with a hallux ulcer. Vascular intervention is important relative to limb salvage when ischemia is the main cause of the ulcer.

  5. Personal models for diabetes in context and patients' health status.

    PubMed

    Lange, Lori J; Piette, John D

    2006-06-01

    In a diverse sample of 452 adult diabetes patients, we investigated: (1) personal model dimensions for diabetes and expanded upon the literature by indexing fatalism, (2) the relationship between contextual factors and patients' beliefs about the seriousness and controllability of diabetes, and (3) the unique contribution of illness representation combinations to clinical outcomes when controlling for baseline disease severity. Major categories of predictors included patients' sociocultural characteristics, illness history (e.g., co-morbidities, diabetes complications) and recent physical symptoms. Illness representations were measured using the Personal Models of Diabetes Interview and questions that index fatalistic beliefs. Clinical outcome measures included patients' glycemic control (HbA1c) and the patient's physical and mental functions as measured by the SF-12. Analyses corroborated the literature by identifying seriousness and treatment effectiveness cognitive model dimensions for diabetes. Physical symptoms and other disease-related factors were strong predictors of patients' seriousness beliefs for diabetes, whereas sociocultural factors (education, ethnicity) best explained representations related to the controllability of diabetes (i.e., treatment effectiveness, fatalism). Seriousness beliefs were good indicators of actual glucose control, except for cases in which patients were more fatalistic and believed diabetes to be less serious. Although patients had medically consistent views of their diabetes, variations in personal models of diabetes were related to specific contextual factors and independently explained diabetes control.

  6. Diabetes insipidus in a patient with diabetes mellitus.

    PubMed

    Paulose, K P; Padmakumar, N

    2002-09-01

    The association of Diabetes Mellitus (DM) and Diabetes Insipidus (DI) without any congenital defects is very rare and we report here a case of type 2 diabetes mellitus (NIDDM) whose blood sugar was controlled by insulin, developing central diabetes insipidus 2 years later, which could be successively controlled by synthetic vasopressin.

  7. Multimodal Surgical and Medical Treatment for Extensive Rhinocerebral Mucormycosis in an Elderly Diabetic Patient: A Case Report and Literature Review

    PubMed Central

    Pirrello, Roberto; Guadagnino, Giuliana; Richiusa, Pierina; Lo Casto, Antonio; Sarno, Caterina; Moschella, Francesco; Cabibi, Daniela

    2014-01-01

    Diabetes is a well-known risk factor for invasive mucormycosis with rhinocerebral involvement. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhino-orbital-cerebral mucormycosis. An aggressive surgical approach combined with antifungal therapy is usually necessary. In this report, we describe the successful, personalized medical and surgical management of extensive periorbital mucormycosis in an elderly diabetic, HIV-negative woman. Mono- or combination therapy with liposomal amphotericin B (L-AmB) and posaconazole (PSO) and withheld debridement is discussed. The role of aesthetic plastic surgery to preserve the patient's physical appearance is also reported. Any diabetic patient with sinonasal disease, regardless of their degree of metabolic control, is a candidate for prompt evaluation to rule out mucormycosis. Therapeutic and surgical strategies and adjunctive treatments are essential for successful disease management. These interventions may include combination therapy. Finally, a judicious multimodal treatment approach can improve appearance and optimize outcome in elderly patients. PMID:24982678

  8. Web-based Real-Time Case Finding for the Population Health Management of Patients With Diabetes Mellitus: A Prospective Validation of the Natural Language Processing–Based Algorithm With Statewide Electronic Medical Records

    PubMed Central

    Jin, Bo; Ngo, Anh D; Jackson-Browne, Medina S; Feller, Daniel J; Fu, Tianyun; Zhang, Karena; Zhou, Xin; Zhu, Chunqing; Dai, Dorothy; Yu, Yunxian; Zheng, Gang; Li, Yu-Ming; McElhinney, Doff B; Culver, Devore S; Alfreds, Shaun T; Stearns, Frank; Sylvester, Karl G; Widen, Eric

    2016-01-01

    Background Diabetes case finding based on structured medical records does not fully identify diabetic patients whose medical histories related to diabetes are available in the form of free text. Manual chart reviews have been used but involve high labor costs and long latency. Objective This study developed and tested a Web-based diabetes case finding algorithm using both structured and unstructured electronic medical records (EMRs). Methods This study was based on the health information exchange (HIE) EMR database that covers almost all health facilities in the state of Maine, United States. Using narrative clinical notes, a Web-based natural language processing (NLP) case finding algorithm was retrospectively (July 1, 2012, to June 30, 2013) developed with a random subset of HIE-associated facilities, which was then blind tested with the remaining facilities. The NLP-based algorithm was subsequently integrated into the HIE database and validated prospectively (July 1, 2013, to June 30, 2014). Results Of the 935,891 patients in the prospective cohort, 64,168 diabetes cases were identified using diagnosis codes alone. Our NLP-based case finding algorithm prospectively found an additional 5756 uncodified cases (5756/64,168, 8.97% increase) with a positive predictive value of .90. Of the 21,720 diabetic patients identified by both methods, 6616 patients (6616/21,720, 30.46%) were identified by the NLP-based algorithm before a diabetes diagnosis was noted in the structured EMR (mean time difference = 48 days). Conclusions The online NLP algorithm was effective in identifying uncodified diabetes cases in real time, leading to a significant improvement in diabetes case finding. The successful integration of the NLP-based case finding algorithm into the Maine HIE database indicates a strong potential for application of this novel method to achieve a more complete ascertainment of diagnoses of diabetes mellitus. PMID:27836816

  9. Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management

    PubMed Central

    Pinto, Sharrel L; Kumar, Jinender; Partha, Gautam; Bechtol, Robert A

    2013-01-01

    Background The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. Methods Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data. Results The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. Conclusion Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program. PMID:23610526

  10. Fatal Bacillus cereus bacteremia in a patient with diabetes.

    PubMed

    Orrett, F A

    2000-04-01

    This report describes a fatal case of Bacillus cereus septicemia in a patient with uncontrolled diabetes and re-emphasizes the potential seriousness of Bacillus infections in patients with compromised immune function.

  11. Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001-2010: Report of the Committee on Causes of Death in Diabetes Mellitus.

    PubMed

    Nakamura, Jiro; Kamiya, Hideki; Haneda, Masakazu; Inagaki, Nobuya; Tanizawa, Yukio; Araki, Eiichi; Ueki, Kohjiro; Nakayama, Takeo

    2017-03-27

    The principal causes of death among 45,708 patients with diabetes (29,801 men and 15,907 women) who died in 241 hospitals throughout Japan during 2001-2010 were determined based on a survey of the hospital records. Autopsy had been conducted in 978 of the 45,708 cases. The most frequent cause of death was malignant neoplasia (38.3%), followed by, in order of descending frequency: infections (17.0%); and then vascular diseases (14.9%), including renal failure (3.5%), ischemic heart diseases (4.8%) and cerebrovascular diseases (6.6%). Diabetic coma associated with hyperglycemia with or without ketoacidosis accounted for only 0.6% of the deaths. In regard to the relationship between the age and cause of death in patients with diabetes, the incidence of death due to vascular diseases was higher in patients over the age of 30 or 40 years, and the 97.0% of the total death due to vascular diseases was observed in patients over the age of 50 years. The incidence of death due to infectious diseases, especially pneumonia, increased in an age-dependent fashion, and the 80.7% of the total death due to pneumonia was observed in patients over the age of 70 years. 'Poorer' glycemic control was associated with the reduced lifespan of patients with diabetes, especially of those with nephropathy. The average age at death in the survey population was 72.6 years. The lifespan was 1.6 years shorter in patients with 'poorer' glycemic control than in those with 'better' glycemic control. In patients with diabetes of less than 10 years' duration, the incidence of death due to macroangiopathy was higher than that due to nephropathy. Of the 45,708 patients with diabetes, 33.9% were on oral medication, 41.9% received insulin therapy and 18.8% were treated by diet alone. Among the patients in whom the cause of death was diabetic nephropathy, a high percentage, 53.7%, was on insulin therapy. The average age at death of the 45,708 patients with diabetes was 71.4 years in men and 75.1

  12. The first case of bacteraemia due to non-O1/non-O139 Vibrio cholerae in a type 2 diabetes mellitus patient in mainland China.

    PubMed

    Lu, Binghuai; Zhou, Haijian; Li, Dong; Li, Fengjuan; Zhu, Fengxia; Cui, Yanchao; Huang, Lei; Wang, Duochun

    2014-08-01

    Bacteraemia due to non-O1/non-O139 Vibrio cholerae is rarely documented in mainland China. We report such a case in a 70-year-old male with type 2 diabetes mellitus. The clinical features, phenotypic analyses, and presence of a panel of known virulence genes in the isolated strain are described. To the best of our knowledge, this is the first reported case of bacteraemia due to this strain in a T2DM patient without other coexisting underlying diseases in mainland China.

  13. A case of Rathke's cleft cyst presenting with diabetes insipidus.

    PubMed

    Erşahin, Y; Ozdamar, N; Demirtaş, E; Mutluer, S

    1995-11-01

    Rathke's cleft cysts (RCCs) are considered to arise from the remnants of Rathke's pouch, an invagination of the stomodeum. They are classically described as benign epithelium lined intrasellar cysts containing mucoid material, and also found in 2-33% of routine autopsy series. The most common presenting symptoms are visual impairment, hypothalamic dysfunction, hypopituitarism and headache. Diabetes insipidus has been described in patients with RCC. Very few cases presented with only diabetes insipidus in adults. To our knowledge, our patient is the first case of RCC presenting with only diabetes insipidus in childhood. A 9-year-old girl presented with diabetes insipidus. The physical, neurological and endocrinological examinations were normal, except for diabetes insipidus. Magnetic resonance imaging scan revealed a hyperintense lesion with supra sellar extension in the posterior pituitary both on T1 and T2 weighted images. Subtotal excision of RCC was performed via transsphenoidal surgery. However, diabetes insipidus persisted after the surgery.

  14. [Proliferative diabetic retinopathy -- therapeutic approach (clinical case)].

    PubMed

    Burcea, M; Muşat, Ovidiu; Mahdi, Labib; Gheorghe, Andreea; Spulbar, F; Gobej, I

    2014-01-01

    We present the case of a 54 year old pacient diagnosed with neglected insulin dependent diabetes and proliferative diabetic retinopathy. Surgery was recommended and we practiced posterior vitrectomy, endolaser and heavy silicone oil endotamponade. Post-operative evolution was favorable.

  15. Preoperative Evaluation of Patients with Diabetes Mellitus.

    PubMed

    Miller, Joshua D; Richman, Deborah C

    2016-03-01

    There are more than 29 million people in the United States with diabetes; it is estimated that by 2050, one in 3 individuals will have the disease. At least 50% of patients with diabetes are expected to undergo surgery in their lifetime. Complications from uncontrolled diabetes can impact multiple organ systems and affect perioperative risk. In this review, the authors discuss principles in diabetes management that will assist the perioperative clinician in caring for patients with diabetes.

  16. A Case of Insulin-dependent Diabetes.

    PubMed

    Gonzalez, Nicholas

    2016-07-01

    Background • There is a paucity of information on alternative, nutrition-based treatments for insulin-dependent diabetes. Primary Study Objective • This case report provides detailed information on the nutrition-based treatment of a man with insulin-dependent diabetes. Methods/Design • This is a single case report taken from the author's private practice. Setting • The treatment was provided at a private office in New York, NY, USA. Participants • A single patient in the author's practice is reported. Intervention • The patient was treated with a combination of pancreatic enzymes, supplements and nutrients, and cleansing and detoxification procedures, plus amber lenses for severe insomnia. Primary Outcome Measures • The outcome measures were patient self-report of symptoms, overall well-being, and function at work and in leisure time; observation of the patient by the physician; and blood work. Results • The patient described dramatic, sustained improvement in terms of symptoms, function, well-being, and life satisfaction. Improvement in blood sugar control was documented by blood work. Conclusion • The complex, tailored nutritional protocol combined with detoxification procedures, resulted in marked improvement in a patient who had been treated by numerous different physicians without benefit prior to his consulting with the author.

  17. Infection, antibiotic therapy and risk of colorectal cancer: a nationwide nested case-control study in patients with Type 2 diabetes mellitus.

    PubMed

    Wang, Jiun-Ling; Chang, Chia-Hsuin; Lin, Jou-Wei; Wu, Li-Chiu; Chuang, Lee-Ming; Lai, Mei-Shu

    2014-08-15

    Patients with Type 2 diabetes mellitus are at a higher risk of colorectal cancer (CRC). The objective of our study was to examine the inter-relationship among infection sites, systemic antibiotic use and risk of CRC among patients with Type 2 diabetes mellitus. From a diabetic cohort from the Taiwan's National Health Insurance claims database, we identified 3,593 incident colon cancer cases, 1,979 rectal cancer cases and 22,288 controls and conducted a nested case-control study to examine the association between antibiotic use and CRC incidence. Logistic regression models were applied to estimate the odds ratio (OR) and the 95% confidence interval (95% CI) between infection sites, antibiotic use and CRC incidence. Patients with intra-abdominal infection were significantly associated with increased risk for colon cancer (OR = 2.01, 95% CI = 1.73-2.35) and rectal cancer (OR = 1.59, 95% CI = 1.26-2.00). Any antianaerobic antibiotic use was associated with a higher risk of colon cancer (OR = 2.31, 95% CI = 2.12-2.52) and rectal cancer (OR = 1.69, 95% CI = 1.50-1.90) but without an obvious dose-response relationship for cumulative use. Antianaerobic antibiotics also increased the risks for those with nonintra-abdominal infection. No association was found between antiaerobic agent use and the CRC risk. The results suggest intra-abdominal infections and antianaerobic antibiotic use may be a marker for precancerous lesions or early CRC, although the possibility of antianaerobic antibiotics playing an additional role cannot be excluded. Further research examining the relationship between intra-abdominal infection, antianaerobic antibiotics use and possible change of microbiota leading to colorectal carcinogenesis is warranted.

  18. Depression in diabetic patients attending University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia

    PubMed Central

    Birhanu, Anteneh Messele; Alemu, Fekadu Mazengia; Ashenafie, Tesfaye Demeke; Balcha, Shitaye Alemu; Dachew, Berihun Assefa

    2016-01-01

    Background Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%–75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. Results A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI): 11.7–19.2). Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1–6.0) and duration of diabetes (AOR =0.27 and 95% CI: 0.07–0.92) were the factors associated with depression among diabetic patients. Conclusion The prevalence of depression was low as compared to other similar studies elsewhere. Disease (diabetes) duration of 10 years and above and being a Muslim religion follower (as compared to Christian) were the factors significantly associated with depression. Early screening of depression and treating depression as a routine component of diabetes care are recommended. Further research with a large sample size, wider geographical coverage, and segregation of type of diabetes mellitus is recommended. PMID:27274296

  19. Outcomes of polytrauma patients with diabetes mellitus

    PubMed Central

    2014-01-01

    Background The impact of diabetes mellitus in patients with multiple system injuries remains obscure. This study was designed to increase knowledge of outcomes of polytrauma in patients who have diabetes mellitus. Methods Data from the Trauma Audit and Research Network was used to identify patients who had suffered polytrauma during 2003 to 2011. These patients were filtered to those with known outcomes, then separated into those with diabetes, those known to have other co-morbidities but not diabetes and those known not to have any co-morbidities or diabetes. The data were analyzed to establish if patients with diabetes had differing outcomes associated with their diabetes versus the other groups. Results In total, 222 patients had diabetes, 2,558 had no past medical co-morbidities (PMC), 2,709 had PMC but no diabetes. The diabetic group of patients was found to be older than the other groups (P <0.05). A higher mortality rate was found in the diabetic group compared to the non-PMC group (32.4% versus 12.9%), P <0.05). Rates of many complications including renal failure, myocardial infarction, acute respiratory distress syndrome, pulmonary embolism and deep vein thrombosis were all found to be higher in the diabetic group. Conclusions Close monitoring of diabetic patients may result in improved outcomes. Tighter glycemic control and earlier intervention for complications may reduce mortality and morbidity. PMID:25026864

  20. Primary Infrainguinal Subintimal Angioplasty in Diabetic Patients

    SciTech Connect

    Bargellini, Irene Petruzzi, Pasquale; Scatena, Alessia; Cioni, Roberto; Cicorelli, Antonio; Vignali, Claudio; Rizzo, Loredana; Piaggesi, Alberto; Bartolozzi, Carlo

    2008-07-15

    The aim of this study was to prospectively evaluate technical and clinical results of infrainguinal subintimal angioplasty in a series of diabetic patients with limb-threatening ischemia. From July 2003 to December 2007, 60 consecutive diabetic patients (M/F = 41/19; mean age, 69.4 {+-} 9.4 years) with Fontaine stage IV critical limb ischemia, not suitable for surgical recanalization, underwent primary infrainguinal subintimal angioplasty. The technical success, perioperative morbidity and mortality, and clinical success (defined by ulcer healing) were evaluated. Kaplan-Meier life-table analysis was obtained for cumulative clinical success, limb salvage, and survival rates. The procedure was technically successful in 55 of 60 (91.7%) patients; in 5 cases we were not able to achieve a reentry. Periprocedural mortality was 5% (3 patients); three patients (5%) required major amputation periprocedurally. Mean follow-up was 23 months (range, 0-48 months). On an intention-to-treat basis, the limb salvage rate was 93.3% (56/60 patients); ulcer healing was observed in 45 of 60 (75%) patients and it was significantly (p < 0.05) associated with serum creatinine and HbA1c levels, diabetes duration, and infrapopliteal recanalization. One- and three-year cumulative survival rates were 91.5% and 83.1%, respectively; serum creatinine levels, patient age, and clinical success were significant predictors of survival. In conclusion, infrainguinal primary subintimal angioplasty is a safe and effective treatment in diabetic patients with limb-threatening ischemia not suitable for surgical recanalization. This procedure is aimed to create a 'temporary bypass' that facilitates ulcer healing.

  1. Multiple fractures in a young diabetic patient.

    PubMed

    Varmarken, J E; Olsen, C A; Kristiansen, B

    1988-07-01

    Multiple fractures in a patient with juvenile diabetes mellitus are reported. The fractures could be spontaneous due to osteopenia caused by reduced bone mass found in diabetic patients. Bone and joint changes had a severe progression due to diabetic neuropathy. The importance of clinical and radiological examination is emphasized.

  2. Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet

    PubMed Central

    Hayami, Tomohide; Kato, Yoshiro; Kamiya, Hideki; Kondo, Masaki; Naito, Ena; Sugiura, Yukako; Kojima, Chika; Sato, Sami; Yamada, Yuichiro; Kasagi, Rina; Ando, Toshihito; Noda, Saeko; Nakai, Hiromi; Takada, Eriko; Asano, Emi; Motegi, Mikio; Watarai, Atsuko; Kato, Koichi; Nakamura, Jiro

    2015-01-01

    We present a case of a 32-year-old diabetic woman with Prader–Willi syndrome who developed severe ketoacidosis caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents, during a strict low-carbohydrate diet. At admission, a serum glucose level of 191 mg/dL was relatively low, though laboratory evaluations showed severe ketoacidosis. This is the first report of ketoacidosis caused by a SGLT2 inhibitor. It is necessary to not only pay attention when using a SGLT2 inhibitor in patients following a low-carbohydrate diet, but also to start a low-carbohydrate diet in patients treated with a SGLT2 inhibitor because of a high risk for developing ketoacidosis. PMID:26417418

  3. Non-diabetic renal disease in patients with type-2 diabetes mellitus.

    PubMed

    Yaqub, Sonia; Kashif, Waqar; Hussain, Syed Ather

    2012-09-01

    Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in diabetics worldwide, yet most patients with type-2 diabetes mellitus are not formally evaluated with a renal biopsy. The diagnosis is almost always based on clinical grounds. A wide spectrum of non-diabetic renal disease (NDRD) is reported to occur in patients with type-2 diabetes. It has been estimated that up to one-third of all diabetic patients who present with proteinuria are suffering from NDRD. The aim of this analysis was to evaluate the prevalence and etiology of NDRD in patients with type-2 diabetes. We retrospectively reviewed the medical records of patients with type-2 diabetes who underwent kidney biopsy on clinical suspicion of NDRD (absence of diabetic retinopathy and/or neuropathy; short duration of diabetes, i.e. less than five years) from January 2003 through December 2007 at the Aga Khan University Hospital, Karachi. Based on the biopsy findings, patients were grouped as Group-I, isolated NDRD; Group-II, NDRD with underlying DN; and Group-III, isolated DN. Of 68 patients studied, 75% were males and the mean age was 56 years. The mean duration of diabetes was nine years. Group-I included 34 patients (52%), Group-II included 11 patients (17%) and Group-III included 23 patients (31%). Among the Group-I patients, the mean age was 56 years (41-77 years). The most common NDRDs were acute interstitial nephritis (32%), diffuse proliferative glomerulonephritis (17%); membranous nephropathy (12%) and crescentic glomerulonephritis (12%). Among Group-II, the mean age was 60 years (46-71 years), and the most common lesion was interstitial nephritis superimposed on underlying DN (63% cases). Among Group-III, the mean age was 53 years (42- 80 years). The mean proteinuria was 5, 6.3 and 7.3 g/24 h of urine collection in Groups I, II and III, respectively (P = NS). The mean duration of diabetes was 7.3, 11.7 and 10.7 years in Groups I, II and III, respectively. The duration of diabetes

  4. Gestational Diabetes Insipidus Associated with HELLP Syndrome: A Case Report.

    PubMed

    Gambito, Renela; Chan, Michael; Sheta, Mohamed; Ramirez-Arao, Precious; Gurm, Harmeet; Tunkel, Allan; Nivera, Noel

    2012-01-01

    Gestational diabetes insipidus is a rare, but well recognized, complication of pregnancy. It is related to excess vasopressinase enzyme activity which is metabolized in the liver. A high index of suspicion of gestational diabetes insipidus is required in a correct clinical setting especially in the presence of other risk factors such as preeclampsia, HELLP syndrome, and twin pregnancies. We are presenting a case of gestational diabetes insipidus in a patient with HELLP syndrome. The newborn in this case also had hypernatremia thereby raising possibilities of vasopressinase crossing the placenta.

  5. Are Serum Levels of F2-Isoprostane and Oxidized-LDL Related to Vitamin D Status in Type 2 Diabetic Patients? A Case-Control Study

    PubMed Central

    Javanbakht, Mohammad Hassan; Mohammady, Hamed; Fooladsaz, Koorosh; Razzaghi, Maryam; Zarei, Mahnaz; Djalali, Mahmoud

    2016-01-01

    Background: Considerable evidence suggests that oxidative stress affects diabetes mellitus (DM) and contributes to its complications. Vitamin D has been shown to possess antioxidant properties. The aim of this study was to determine the association between serum levels of calcifediol (25-OH-D), an indicator of vitamin D status, and lipid profiles with oxidative stress in patients with type 2 diabetes mellitus (T2DM). Methods: In this case-control study, 57 T2DM patients with low vitamin D status (< 30 ng/mL) and 48 T2DM patients with normal vitamin D status (> 30 ng/mL) were enrolled. Fasting concentrations of 25-OH-D, calcium, phosphorus, parathyroid hormone (PTH), lipid profiles, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), F2-isoprostane, and oxidized-low-density lipoprotein (ox-LDL) were measured. Results: The mean fasting serum concentrations of 25-OH-D, calcium, and phosphorus in patients with low vitamin D status were significantly lower than in controls (p < 0.001). The mean concentrations of ox-LDL, F2-isoprostane, total cholesterol, and LDL were significantly higher in patients with low vitamin D status than in controls. There was a negative correlation between vitamin D levels and F2-isoprostane (r = 0.647and P = 0.0001), LDL (r = -0.218 and P = 0.030), and ox-LDL (r = -0.637 and P = 0.0001). Conclusion: The results of present study indicated that serum concentrations of 25-OH-D were inversely correlated with F2-isoprostane, LDL, and ox-LDL. Therefore, vitamin D may have a beneficial effect on the control of lipid profiles and oxidative stress in T2DM patients. PMID:28070531

  6. Wolfram Syndrome presenting with optic atrophy and diabetes mellitus: two case reports.

    PubMed

    Manaviat, Masoud Reza; Rashidi, Maryam; Mohammadi, Seyed Mohammad

    2009-12-19

    Wolfram syndrome is the constellation of juvenile onset diabetes mellitus and optic atrophy, known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness).Patients demonstrate diabetes mellitus followed by optic atrophy in the first decade, diabetes insipidus and sensorineural deafness in the second decade, dilated renal outflow tracts early in the third decade, and multiple neurological abnormalities early in the fourth decade.This study reports two siblings with late diagnosed wolfram syndrome with diabetes insipidus, diabetes mellitus, optic atrophy, deafness and severe urological abnormalities.In conclusion, cases having early onset insulin-dependent diabetes mellitus and optic atrophy together need to be evaluated with respect to Wolfram.

  7. Nutritional intervention for a patient with diabetic nephropathy.

    PubMed

    Kim, Hee Young

    2014-01-01

    In recent years, several studies have reported that the prevalence of diabetes mellitus is increasing every year, and also the acute and chronic complications accompanying this disease are increasing. Diabetic nephropathy is one of chronic complications of diabetes mellitus, and food intake which is burden to kidney function should be limited. At the same time, diet restriction could deteriorate quality of life of patient with diabetic nephropathy. According to the results of previous studies, the aggressive management is important for delaying of the progression to diabetic nephropathy. Also, the implementation of a personalized diet customized to individuals is an effective tool for preservation of kidney function. This is a case report of a patient with diabetic nephropathy who was introduced to a proper diet through nutrition education to prevent malnutrition, uremia and to maintain blood glucose levels.

  8. Nutritional Intervention for a Patient with Diabetic Nephropathy

    PubMed Central

    2014-01-01

    In recent years, several studies have reported that the prevalence of diabetes mellitus is increasing every year, and also the acute and chronic complications accompanying this disease are increasing. Diabetic nephropathy is one of chronic complications of diabetes mellitus, and food intake which is burden to kidney function should be limited. At the same time, diet restriction could deteriorate quality of life of patient with diabetic nephropathy. According to the results of previous studies, the aggressive management is important for delaying of the progression to diabetic nephropathy. Also, the implementation of a personalized diet customized to individuals is an effective tool for preservation of kidney function. This is a case report of a patient with diabetic nephropathy who was introduced to a proper diet through nutrition education to prevent malnutrition, uremia and to maintain blood glucose levels. PMID:24527422

  9. [Acyclovir-induced neurotoxicity and acute kidney injury in an elderly diabetic patient treated with valacyclovir: report of a case].

    PubMed

    Sagawa, Naoko; Tsurutani, Yuya; Nomura, Kazushi; Okuyama, Tomoko; Kondo, Mai; Sata, Akira; Miyao, Mariko; Mizuno, Yuzo

    2014-01-01

    An 83-year-old Japanese man had a 29-year history of well-controlled diabetes mellitus. His HbA1c level was approximately 6.0%, with no microalbuminuria and a serum creatinine level seven days before admission of 0.8 mg/dl (eGFR: 69.67 ml/min/1.73 m(2)). Five days before admission, he visited an ophthalmologist with inflammation of the right palpebra and conjunctiva and began taking valacyclovir at a dose of 3,000 mg for the treatment of herpes zoster. Two days before admission, he was prescribed loxoprofen at a dose of 180 mg for a headache. One day prior to admission, he developed dysarthria, wandering and loss of appetite. He was subsequently admitted to our hospital with progressive deterioration of consciousness (Japan Coma Scale: II-20). On admission, he exhibited renal dysfunction, with a serum creatinine level of 5.11 mg/dl (eGFR: 9.16 ml/min/1.73 m(2)). Based on his diverse symptoms and current treatment with valacyclovir, the patient was diagnosed with acyclovir-induced neurotoxicity and his symptoms rapidly improved after hemodialysis. The serum acyclovir level on admission was found to be 9.25 μg/ml. Although acyclovir-induced neurotoxicity is commonly seen in elderly patients with renal dysfunction, there are also reports of this condition in patients with a normal renal function. Valacyclovir is frequently prescribed to the elderly to treat diseases such as herpes zoster. As valacyclovir induces renal dysfunction, which raises the serum acyclovir level to the toxic range, special attention must be paid when administering this drug in elderly subjects.

  10. Rhinocerebral Mucormycosis Among Diabetic Patients: An Emerging Trend.

    PubMed

    Reddy, Sujatha S; Rakesh, N; Chauhan, Pallavi; Sharma, Shivani

    2015-12-01

    Mucormycosis is an acute necrotic fungal infection with a fulminant course. Earlier considered a rare entity, mucormycosis is being reported with increasing frequency in recent years, possibly due to the increase in immunocompromised population especially diabetic patients. We report three cases of rhinocerebral mucormycosis among poorly controlled diabetic patients. This article emphasizes the need for further awareness of this disease, early diagnosis, and treatment to counter this opportunistic infection.

  11. Health and diabetes self-efficacy: a study of diabetic and non-diabetic free clinic patients and family members.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Myers, Kyl; Nourian, Maziar M; Ashby, Jeanie; Greenwood, Jessica L J; Reel, Justine J

    2014-08-01

    Free clinics across the country provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. This study examined perceived health status among diabetic and non-diabetic free clinic patients and family members of the patients. Diabetes self-efficacy among diabetic free clinic patients was also investigated with the goal of developing appropriate diabetes health education programs to promote diabetes self-management. English or Spanish speaking patients and family members (N = 365) aged 18 years or older completed a self-administered survey. Physical and mental health and diabetes self-efficacy were measured using standardized instruments. Diabetic free clinic patients reported poorer physical and mental health and higher levels of dysfunction compared to non-diabetic free clinic patients and family members. Having a family history of diabetes and using emergency room or urgent care services were significant factors that affected health and dysfunction among diabetic and non-diabetes free clinic patients and family members. Diabetic free clinic patients need to receive services not only for diabetes, but also for overall health and dysfunction issues. Diabetes educational programs for free clinic patients should include a component to increase diabetes empowerment as well as the knowledge of treatment and management of diabetes. Non-diabetic patients and family members who have a family history of diabetes should also participate in diabetes education. Family members of free clinic patients need help to support a diabetic family member or with diabetes prevention.

  12. Erythroleukaemia, diabetes insipidus and hypophyseal damage: Two case reports.

    PubMed

    Piccin, A; Raimondi, R; Laspina, S; Marchi, M; Rodeghiero, F; Rovigatti, U

    2007-08-01

    We report on two cases of patients who developed diabetes insipidus (DI) before acute erythroleukaemia (EL). A brain MRI showed an empty sella turcica in one case and hypothalamo-hypophyseal peduncle damage in the second case. Reduced levels of TGF-beta1 and Vitamin D3, with associated EVI-1 over-expression and karyotypic abnormalities were documented. These two cases show specific chromosomal/molecular alterations in EL with DI. The hypothesis of pituitary involvement in erythroleukemogenesis is discussed.

  13. CUTANEOUS DISORDERS IN 500 DIABETIC PATIENTS ATTENDING DIABETIC CLINIC

    PubMed Central

    Ragunatha, Shivanna; Anitha, Bhaktavatsalam; Inamadar, Arun C; Palit, Aparna; Devarmani, Shashidhar S

    2011-01-01

    Background: The metabolic complications and pathologic changes that occur in diabetes mellitus (DM) influence the occurrence of various dermatoses. Aim: To study the impact of control of diabetes on the pattern of cutaneous disorders. Materials and Methods: A cross-sectional descriptive study of patients attending diabetic clinic in a tertiary care hospital. A total of 500 consecutive patients were studied. Detailed history, clinical examination and relevant investigations were done to diagnose diabetic complications and cutaneous disorders. Dermatoses with or without known pathogenesis were correlated with age, gender, fasting plasma glucose (FPG), duration of diabetes, and complications of DM. Statistical analysis was carried out using Student “t” test and Chi-square test with 5% confidence interval (P value 0.05). Results: Majority of patients had well-controlled (FPG<130 mg/ml, 60%) type 2 DM (98.8%). No statistically significant difference (P>0.05) between the patients with or without DM specific cutaneous disorders was noticed with reference to age and gender distribution, duration of DM and FPG. Signs of insulin resistance, acrochordon (26.2%), and acanthosis nigricans (5%) were common, followed by fungal (13.8%) and bacterial (6.8%) infections. Eruptive xanthoma (0.6%), diabetic foot (0.2%), diabetic bulla (0.4%), diabetic dermopathy (0.2%), generalized granuloma annulare (0.2%), and insulin reactions (6.2%) and lipodystrophy (14%) were also seen. Conclusion: Well-controlled diabetes decreases the prevalence of DM-specific cutaneous disorders associated with chronic hyperglycemia. It is necessary to have a dermatologist in the diabetic clinic for early detection of potentially grave or predisposing conditions. PMID:21716540

  14. Efficacy of Osteoporosis Therapies in Diabetic Patients.

    PubMed

    Schwartz, Ann V

    2017-02-01

    Diabetes is characterized by increased fracture risk and by reduced bone strength for a given density. Contributing factors may include lower bone turnover and accumulation of advanced glycation endproducts. There are concerns that the pharmacological therapies for osteoporosis, particularly anti-resorptive therapies that suppress bone turnover, may not be as effective in the setting of diabetes. This review considers clinical trials and observational studies that have assessed the efficacy of anti-resorptive and anabolic therapies in diabetic patients. Post hoc analyses of randomized trials indicate that raloxifene has similar efficacy for prevention of vertebral fractures in diabetic compared with non-diabetic patients. Evidence from randomized clinical trials is lacking for anti-fracture efficacy of other osteoporosis therapies in diabetes. However, observational studies suggest that bisphosphonates are effective in preventing fractures in diabetic patients. The great majority of diabetic patients in studies to date have been type 2, and efficacy of osteoporosis therapies in type 1 diabetic patients remains to be addressed. Further evaluation of the efficacy of osteoporosis therapies in the setting of diabetes is needed to provide optimal fracture prevention for this population.

  15. Coronary Artery Revascularization in Patients with Diabetes Mellitus

    MedlinePlus

    ... Patient Page Coronary Artery Revascularization in Patients With Diabetes Mellitus David H. Fitchett , Milan Gupta , Michael E. ... with exertion), heart attack, and possibly sudden death. Diabetes and Coronary Artery Disease Patients with diabetes mellitus ...

  16. A Rare Case of Congenital Diabetes Insipidus.

    PubMed

    Rege, Tanvi; Polsani, Srujana; Jim, Belinda

    2015-01-01

    Congenital nephrogenic diabetes insipidus (NDI) is a conformation disease resulting from protein misfolding. Ninety percent of mutations result from the inactivating mutations of the arginine vasopressin receptor 2 (AVPR2) gene transmitted in an X-linked fashion, blocking the response to vasopressin, resulting in the inability to concentrate urine. Clinical features include polyuria, polydispsia, dehydration, and hypernatremia. They are generally more severely in affected males but present variably in females due to skewed inactivation of the X chromosome. We describe a case of a 40-year-old woman with a history of Type 2 diabetes mellitus, hyperlipidemia, and obesity, who presents with debilitating polyuria since the age of 5 with no clear diagnosis. Interestingly, her son was diagnosed with NDI. Genetic testing revealed that she was heterozygous for the Val88Met mutation in the AVPR2 gene while her son was hemizygous for the same. The patient has since been successfully treated with diuretics and a low solute diet. We highlight that although X-linked NDI patients are mostly males, it should be considered in symptomatic females to prevent delays in the diagnosis. Conformational diseases such as NDI are presently the subject of research using pharmacological chaperones to restore proper receptor membrane localization and function.

  17. Cataracts in Diabetic Patients: A Review Article

    PubMed Central

    Javadi, Mohammad-Ali; Zarei-Ghanavati, Siamak

    2008-01-01

    The number of people with diabetes mellitus is increasing and cataracts are one of the most common causes of visual impairment in these subjects. Advances in cataract surgical techniques and instrumentation have generally improved the outcomes; however,surgery may not be safe and effective in certain individuals with pre-existing retinal pathology or limited visual potential. This review article aims to address different aspects surrounding cataracts in diabetic patients. In a computerized MEDLINE search,relevant studies were selected by two authors using the keywords “diabetes mellitus”, “cataract”, “diabetic retinopathy” and “diabetic maculopathy”. PMID:23479523

  18. Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study

    PubMed Central

    Pang, Junxiong; Hsu, Jung Pu; Yeo, Tsin Wen; Leo, Yee Sin; Lye, David C.

    2017-01-01

    Progression to severe organ involvement due to dengue infection has been associated with severe dengue disease, intensive care treatment, and mortality. However, there is a lack of understanding of the impact of pre-existing comorbidities and other risk factors of severe organ involvement among dengue adults. The aim of this retrospective case-control study is to characterize and identify risk factors that predispose dengue adults at risk of progression with severe organ involvement. This study involved 174 dengue patients who had progressed with severe organ involvement and 865 dengue patients without severe organ involvement, matched by the year of presentation of the cases, who were admitted to Tan Tock Seng Hospital between year 2005 and 2008. Age group of 60 years or older, diabetes, cardiac disorders, asthma, and having two or more pre-existing comorbidities were independent risk factors of severe organ involvement. Abdominal pain, clinical fluid accumulation, and hematocrit rise and rapid platelet count drop at presentation were significantly associated with severe organ involvement. These risk factors, when validated in a larger study, will be useful for triage by clinicians for prompt monitoring and clinical management at first presentation, to minimize the risk of severe organ involvement and hence, disease severity. PMID:28045096

  19. [Case report of introducing MMF and steroids as an immunosuppressive therapy after living-donor liver transplantation for a patient with the diabetic nephropathy].

    PubMed

    Kuramitsu, Shotaro; Iguchi, Tomohiro; Ninomiya, Mizuki; Yamashita, Yo-ichi; Harimoto, Norifumi; Ikegami, Toru; Uchiyama, Hideaki; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Kawanaka, Hirofumi; Ikeda, Tetsuo; Furuta, Toshiya; Tamada, Ryuichiro; Maehara, Yoshihiko

    2014-03-01

    Calcineurin inhibitor (CNI) combined with mycophenolate mofetil (MMF) and steroid is mainly used as immunosuppressive therapy after the living-donor liver transplantation (LDLT). However, the nephrotoxicity caused by CNI remains a critical problem for patients with chronic renal failure, especially on early postoperative period. A 62-year-old woman with decompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11 points) and chronic renal failure due to diabetic nephropathy (Cr 1.56 mg/dl, GFR 27 ml/min/1.73 m2) experienced LDLT. During the reconstruction of hepatic vein, the supra-and infra-hepatic vena cava was totally clamped. The estimated right lobe liver graft volume was 540 g, representing 51.3% of the standard liver volume of the recipient. Because of the perioperative renal dysfunction due to diabetic nephropathy and the total clamping the vena cava which induced the congestion kidney, MMF (1500 mg/day) and steroid (250 mg/day converted into predonisolone) were mainly introduced as an immunosuppressive therapy after LDLT. The low-dose CNI, tacrolimus also induced the nephrotoxicity and was given for only a short time. Finally, according to the postoperative renal function, the low-dose CNI, cyclosporin (50 mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500 mg/day), steroid (20 mg/day converted into predonisolone) and cyclosporin (75 mg/day) continued to be given as the immunosuppressive therapy and neither acute graft rejection nor drug-induced renal dysfunction was occurred. This is a case report of introducing with mainly MMF and steroid as an immunosuppressive therapy after LDLT for a patient with perioperative renal dysfunction.

  20. Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm

    PubMed Central

    Lucas Martín, Anna M.; Guanyabens, Elena; Zavala-Arauco, R.; Chamorro, Joaquín; Granada, Maria Luisa; Mauricio, Didac; Puig-Domingo, Manuel

    2015-01-01

    Type 2 diabetes (T2D) exists in 25–40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittance HbA1c was 7.7 ± 1.5%; 47% (189) had HbA1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA1c. Ninety-four of the 189 SCGC patients were evaluated 3–6 months later. Their HbA1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P < 0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia. PMID:26089883

  1. Comparisons of serum miRNA expression profiles in patients with diabetic retinopathy and type 2 diabetes mellitus

    PubMed Central

    Ma, Jianping; Wang, Jufang; Liu, Yanfen; Wang, Changyi; Duan, Donghui; Lu, Nanjia; Wang, Kaiyue; Zhang, Lu; Gu, Kaibo; Chen, Sihan; Zhang, Tao; You, Dingyun; Han, Liyuan

    2017-01-01

    OBJECTIVES: The aim of this study was to compare the expression levels of serum miRNAs in diabetic retinopathy and type 2 diabetes mellitus. METHODS: Serum miRNA expression profiles from diabetic retinopathy cases (type 2 diabetes mellitus patients with diabetic retinopathy) and type 2 diabetes mellitus controls (type 2 diabetes mellitus patients without diabetic retinopathy) were examined by miRNA-specific microarray analysis. Quantitative real-time polymerase chain reaction was used to validate the significantly differentially expressed serum miRNAs from the microarray analysis of 45 diabetic retinopathy cases and 45 age-, sex-, body mass index- and duration-of-diabetes-matched type 2 diabetes mellitus controls. The relative changes in serum miRNA expression levels were analyzed using the 2-ΔΔCt method. RESULTS: A total of 5 diabetic retinopathy cases and 5 type 2 diabetes mellitus controls were included in the miRNA-specific microarray analysis. The serum levels of miR-3939 and miR-1910-3p differed significantly between the two groups in the screening stage; however, quantitative real-time polymerase chain reaction did not reveal significant differences in miRNA expression for 45 diabetic retinopathy cases and their matched type 2 diabetes mellitus controls. CONCLUSION: Our findings indicate that miR-3939 and miR-1910-3p may not play important roles in the development of diabetic retinopathy; however, studies with a larger sample size are needed to confirm our findings. PMID:28273235

  2. The Case for Control in Diabetes Mellitus

    PubMed Central

    Davidson, Mayer B.

    1978-01-01

    In all diabetic animal models studied to date, microangiopathic complications develop which can be prevented by tight control and reversed by either islet cell transplantation or transplanting the diabetic kidney into a nondiabetic environment. In humans the prevalence of these complications in secondary diabetes mellitus is similar to the prevalence in genetic diabetes. Furthermore, mesangial basement membrane thickness is normal at the onset of the disease and increases shortly thereafter. These two facts strongly suggest that the microangiopathic complications are not an independent genetic component but rather are secondary to the metabolic derangements of uncontrolled diabetes. Normal kidneys transplanted into diabetic recipients developed the vascular lesions of diabetes. Conversely, two diabetic kidneys inadvertently transplanted into nondiabetic recipients showed clearing of the vascular lesions. Most retrospective studies support the conclusion that control is associated with lessened complications. The three prospective studies published to date also support this hypothesis. Because glucose concentrations cannot be brought to normal levels by present methods, the critical question is whether a major emphasis on restoring metabolism to as nearly normal as possible will help ameliorate the microangiopathic complications in our patients. The accumulated evidence would strongly favor an affirmative answer. Two daily injections of intermediate-acting insulin supplemented with small amounts of short-acting insulin as needed is one method to approach this goal. PMID:360622

  3. The effects of Low Level LASER Therapy (LLLT) on blood glucose levels in patients with Diabetes Mellitus type I : a case report

    NASA Astrophysics Data System (ADS)

    Longo, Leonardo; Postiglione, Marco; Buccioni, Tommaso; Longo, Diego

    2009-06-01

    Diabetes Mellitus (DM) is a widespread disease and a serious public health problem. Low Level LASER Therapy (LLLT) has been found to reduce glycaemia on DM type 1 patients, an observation requiring further research especially as regards characteristics of treatment protocol. The purpose of this work is to continue the line of research and propose a specific protocol for LLLT use. In spring 2008 a 48 year old man, DM type 1 insulin dependent patient has been submitted to 810 nm wavelength LLLT treatment in specific body areas daily for 3 weeks and then once a week for 4 weeks until normalization of glycaemia. Medical supervision was present before, during and after application. Insulin was reduced progressively and then stopped. A gradual reduction of glycaemia was noted during the course of treatment. In successive follow-ups a reduction in HbA1c was noted. Results confirm previous observations and need for further research on large cohorts. The indication that LASER may become a valuable addition to DM type 1 treatment is confirmed and the proposed protocol appears to be effective. The case presented merits review since it reports a therapeutic challenge, contributes to advance in medical science and spawns research.

  4. Platelet profile in patients with gestational diabetes: a retrospective study

    PubMed Central

    Sak, Muhammet Erdal; Soydinç, Hatice Ender; Özler, Ali; Evsen, Mehmet Sıddık; Turgut, Abdülkadir; Sak, Sibel; Gül, Talip

    2012-01-01

    Objective: To assess and compare alterations in the morphology and function of platelets occurring in gestational diabetes and healthy pregnancies. Material and Methods: A retrospective study was performed of 77 pregnant women: 42 cases with gestational diabetes and 35 healthy controls. The two groups were compared in terms of demographics and platelet parameters derived from complete blood counts. Results: The mean platelet volume (p=0.001) and HbA1c (p<0.001) were significantly increased in the patients with gestational diabetes. The mean platelet volume was well correlated with the platelet distribution width (rs=0.404, p<0.001) and the platelet count (rs=0.355, p=0.002) Conclusion: The mean platelet volume and other platelet parameters may significantly aid the identification of diabetic pregnants at risk for vascular complications. The role and possible clinical relevance of these changes during diabetic pregnancy need to be investigated in further studies. PMID:24592046

  5. Staphylococcus simulans osteitis in a diabetic patient.

    PubMed

    Désidéri-Vaillant, C; Nédelec, Y; Guichon, J-M; Le Louarn, S; Noyer, V; Sapin-Lory, J; Le Guen, P; Nicolas, X

    2011-12-01

    Staphylococcus simulans was identified as the aetiological agent of osteitis in a diabetic woman. Its identifying characteristics and antibiogram were confirmed. Diabetic foot frequently becomes infected and the spread of infection to bone is a major causal factor behind lower-limb amputation. Early diagnosis and appropriate treatment are essential in such cases.

  6. The large spectrum of renal disease in diabetic patients

    PubMed Central

    Bermejo, Sheila; Pascual, Julio

    2017-01-01

    Abstract The prevalence of diabetic nephropathy (DN) among diabetic patients seems to be overestimated. Recent studies with renal biopsies show that the incidence of non-diabetic nephropathy (NDN) among diabetic patients is higher than expected. Renal impairment of diabetic patients is frequently attributed to DN without meeting the KDOQI criteria or performing renal biopsy to exclude NDN. In this editorial, we update the spectrum of renal disease in diabetic patients and the impact on diagnosis, prognosis and therapy.

  7. Nocturnal convulsions and insulin-induced hypoglycaemia in diabetic patients.

    PubMed Central

    Fisher, B. M.; Frier, B. M.

    1987-01-01

    Convulsions may occur as a consequence of insulin-induced hypoglycaemia. We report three patients with insulin-dependent diabetes, who presented with generalized tonic-clonic seizures associated with nocturnal hypoglycaemia. None of the patients had experienced hypoglycaemia during waking hours and the convulsions were mistakenly diagnosed as idiopathic epilepsy. Recognition of the possible hypoglycaemia aetiology of these convulsions permitted appropriate alteration of the insulin regimens with no recurrence of convulsions. In one case, the seizure was associated with bilateral fractures of the neck of the humerus. Unrecognized hypoglycaemia should be considered as a possible cause of convulsions in insulin-dependent diabetic patients. Images Figure 1 PMID:3422871

  8. Knowledge of diabetes mellitus among diabetic and non-diabetic patients in Klinik Kesihatan Seremban.

    PubMed

    Ding, C H; Teng, C L; Koh, C N

    2006-10-01

    The Malaysian Ministry of Health has undertaken various campaigns on healthy lifestyle and health promotion over the years. The impact of these campaigns has been mixed and not well documented. This cross-sectional study evaluated the knowledge level of patients with and without diabetes in a large urban polyclinic using a 41-item questionnaire. One hundred and forty-nine adults (83 with diabetes, 66 without diabetes) participated in this study. Patients with diabetes had higher overall knowledge scores than those without diabetes (81.8% vs 64.0%, p < 0.001). While the overall knowledge of patients without diabetes appeared to be acceptable, several areas of knowledge deficiency were identified in this group--areas that should be filled by the on-going health promotion activities.

  9. Therapeutic potential of a low-cost device for wound healing: a study of three cases of healing after lower-extremity amputation in patients with diabetes.

    PubMed

    Vidal, Alejandra; Giacaman, Annesi; Oyarzun-Ampuero, Felipe A; Orellana, Sandra; Aburto, Isabel; Pavicic, María F; Sánchez, Alfonso; López, Claudia; Morales, Carlos; Caro, Marianela; Moreno-Villoslada, Ignacio; Concha, Miguel

    2013-01-01

    Diabetic foot ulcers constitute a tremendous challenge for patients, caregivers, and health care systems. The high incidence and high financial costs associated with their treatment have transformed them in a health and economic worldwide problem. The increase in population life expectancy and lifestyle changes have facilitated the spreading of diabetes, rising diabetic foot ulcer incidence. Only 60%-80% of the patients achieve healing of ulcers, and the incidence of a second ulcer, in the same or different site of the foot that has had a previous ulcer, is approximately 50% in 2-5 years. In addition, ulcers with duration longer than 4 weeks are commonly associated with bad results in healing and an increased risk of amputation. Three patients with type 2 diabetes mellitus have been subjected to treatment with NL.1.2, a low-cost, biocompatible solid device that presented pro-angiogenic properties. The selected patients had undergone amputation, and their wounds, classified as Wagner II, did not show a significant progress in healing after a period of 2-5 months before treatment with NL.1.2. Complete closure of their wounds was achieved in 42-60 days.

  10. [Diabetes in patients with malignant tumors].

    PubMed

    Lengyel, Zoltán; Boér, Katalin; Halászlaki, Csaba; Németh, Zsuzsanna

    2013-09-01

    Disturbances of the carbohydrate metabolism are fairly common is patients with malignancy. On the other hand, diabetes appears to have an effect on the development and progression of various tumors. Malignant diseases and the therapies used in their treatment often have an impact on carbohydrate metabolism, while diabetes may hinder specific oncotherapy or influence oncological therapeutic decisions. Several complications of malignant diseases and some of the medications used in their treatment, such as steroids or parenteral nutrition, may raise blood glucose levels. The various obstacles of oral nutrition frequently seen in patients with malignancy can lead to hypoglycaemia in patients with diabetes. Our article endeavours to review the pathophysiological and clinical connection between diabetes and malignant diseases and the use of insulin, oral antidiabetic drugs and diet in patients with malignant disease.

  11. Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy

    PubMed Central

    Yun, Jae-Seung; Cha, Seon-Ah; Lim, Tae-Seok; Lee, Eun-Young; Song, Ki-Ho; Ahn, Yu-Bae; Yoo, Ki-Dong; Kim, Joon-Sung; Park, Yong-Moon; Ko, Seung-Hyun

    2016-01-01

    Abstract We investigated the factors that might influence the development of diabetic foot ulcers (DFUs) in type 2 diabetes patients without diabetic polyneuropathy (DPN). From January 2000 to December 2005, a total of 595 patients who had type 2 diabetes without DPN between the ages of 25 and 75 years, and had no prior history of DFUs were consecutively enrolled in the study. A cardiovascular autonomic function test was performed to diagnose cardiovascular autonomic neuropathy (CAN) using heart rate variability parameters. The median follow-up time was 13.3 years. Among the 449 (75.4%) patients who completed the follow-up evaluation, 22 (4.9%) patients developed new ulcers, and 6 (1.3%) patients underwent the procedure for lower extremity amputations. The patients in the DFUs group had a longer duration of diabetes, higher baseline HbA1c levels, higher rates of nephropathy, and CAN. A Cox hazard regression analysis results revealed that the development of DFUs was significantly associated with the presence of CAN (normal vs definite CAN; HR, 4.45; 95% confidence interval, 1.29–15.33) after adjusting for possible confounding factors. The development of DFUs was independently associated with CAN in patients with type 2 diabetes without DPN. We suggested the importance of CAN as a predictor of DFUs even in the patients without DPN, and the need to pay attention to patients with definite CAN and type 2 diabetes. PMID:27015188

  12. Adipsia in a Diabetes Insipidus Patient.

    PubMed

    Pereira, Maria Conceição; Vieira, Margarida M; Pereira, Joana Simões; Salgado, Duarte

    2015-01-01

    Central diabetes insipidus is a very common disorder after brain surgery or/trauma or even in the presence of brain inflammatory diseases. Polyuria and polydipsia are the clinical markers, but sometimes clinical situations are presenting with no thirst. These are not frequent but are life-treating conditions. Diagnosis is not easy, and for this reason some cases are treated late. We describe here a very infrequent oncological case of dangerous adipsic diabetes insipidus in a young girl who survived.

  13. Somatotype in elderly type 2 diabetes patients.

    PubMed

    Buffa, Roberto; Floris, Giovanni; Putzu, Paolo F; Carboni, Luciano; Marini, Elisabetta

    2007-09-01

    Somatotyping is a practical technique for the description of physique. Individuals with Type 2 diabetes are characterized by physical peculiarities, such as overweight, obesity and a central pattern of body fat distribution. Somatotype applications to diabetes are limited. The objective of this study is to describe the somatotype of elderly type 2 diabetes patients. The sample consisted of 110 patients with type 2 diabetes (45 men, mean age 69.4 +/- 7.0 years; 65 women, mean age 72.9 +/- 7.1 years). The pathological subjects were compared with a control group consisting of 280 healthy individuals (134 men, mean age 74.2 +/- 7.3 years; 146 women, mean age 74.9 +/- 7.4 years). The Heath-Carter somatotype was applied. Diabetic men and women (mean somatotype, respectively: 6.8-5.6-0.6 and 8.6-6.4-0.2) presented significantly higher values of endomorphy than the controls (p = 0.043 in men, p = 0.003 in women); men also had a lower mesomorphic component (p = 0.000). The somatotype method revealed physical peculiarities in type 2 diabetes patients. The marked endomorphy in the pathological individuals can be related to general fatness, which is a well known disease risk factor. The somatotype appears to be a suitable technique for the assessment of physique in type 2 diabetes patients.

  14. Morphological changes in autonomic ganglionic cells of the heart in diabetic patients.

    PubMed

    Tsujimura, T; Nunotani, H; Fushimi, H; Inoue, T

    1986-06-01

    To clarify the histological changes of the cardiac autonomic nervous system in diabetes mellitus, ganglionic cells of the hearts of autopsy cases were examined light microscopically. In 7 severely diabetic patients, the ganglionic neurons showed cellular contraction, cytoplasmic condensation and poor staining of Nissl substance. As neuronal alterations were obvious neither in the mild diabetic patients nor in the non-diabetic patients, these alterations therefore seemed to correlate with diabetes mellitus. The neuronal changes did not seem to correlate with major coronary arterial atherosclerotic narrowing.

  15. Association between diabetes and tuberculosis: case-control study

    PubMed Central

    Pereira, Susan Martins; de Araújo, Gleide Santos; Santos, Carlos Antônio de Souza Teles; de Oliveira, Maeli Gomes; Barreto, Maurício Lima

    2016-01-01

    ABSTRACT OBJECTIVE To test the association between diabetes and tuberculosis. METHODS It is a case-control study, matched by age and sex. We included 323 new cases of tuberculosis with positive results for bacilloscopy. The controls were 323 respiratory symptomatic patients with negative bacilloscopy, from the same health services, such as: ambulatory cases from three referral hospitals and six basic health units responsible for the notifications of new cases of tuberculosis in Salvador, Bahia. Data collection occurred between 2008 and 2010. The instruments used were structured interview, including clinical data, capillary blood glucose (during fasting or postprandial), and the CAGE questionnaire for screening of abusive consumption of alcohol. Descriptive, exploratory, and multivariate analysis was performed using conditional logistic regression. RESULTS The average age of the cases was 38.5 (SD = 14.2) years and of the controls, 38.5 (SD = 14.3) years. Among cases and controls, most subjects (61%) were male. In univariate analysis we found association between the occurrence of diabetes and tuberculosis (OR = 2.37; 95%CI 1.04–5.42), which remained statistically significant after adjustment for potential confounders (OR = 3.12; 95%CI 1.12–7.94). CONCLUSIONS The association between diabetes and tuberculosis can hinder the control of tuberculosis, contributing to the maintainance of the disease burden. The situation demands increasing early detection of diabetes among people with tuberculosis, in an attempt to improve disease control strategies. PMID:28099656

  16. Euglycaemic diabetic ketoacidosis in a patient with type 2 diabetes started on empagliflozin.

    PubMed

    Rashid, Owais; Farooq, Saad; Kiran, Zareen; Islam, Najmul

    2016-05-13

    Diabetes ketoacidosis (DKA) is largely associated with type 1 diabetes and has hyperglycaemia as a cardinal feature. We discuss the case of a 42-year-old man, a patient with type 2 diabetes, who presented to the emergency room, with nausea, vomiting and abdominal pain. He had recently changed his diabetes medications and started on an SGLT2 inhibitor (empagliflozin) along with metformin, pioglitazone, liraglutide and self-adjusted exogenous insulin. DKA was suspected in the wake of clinical examination and lab findings but glucose levels were below the cut-off for DKA; therefore, he was diagnosed with euglycaemic DKA. He was successfully managed with intravenous hydration and insulin infusion. We discuss the link of SGLT2 inhibitors with DKA and the pathophysiology behind euglycaemic DKA.

  17. Kidney Transplantation in the Diabetic Patient

    PubMed Central

    Pérez-Sáez, María José; Pascual, Julio

    2015-01-01

    Diabetes mellitus is one of the most important causes of chronic kidney disease (CKD). In patients with advanced diabetic kidney disease, kidney transplantation (KT) with or without a pancreas transplant is the treatment of choice. We aimed to review current data regarding kidney and pancreas transplant options in patients with both type 1 and 2 diabetes and the outcomes of different treatment modalities. In general, pancreas transplantation is associated with long-term survival advantages despite an increased short-term morbidity and mortality risk. This applies to simultaneous pancreas kidney transplantation or pancreas after KT compared to KT alone (either living donor or deceased). Other factors as living donor availability, comorbidities, and expected waiting time have to be considered whens electing one transplant modality, rather than a clear benefit in survival of one strategy vs. others. In selected type 2 diabetic patients, data support cautious utilization of simultaneous pancreas kidney transplantation when a living kidney donor is not an option. Pancreas and kidney transplantation seems to be the treatment of choice for most type 1 diabetic and selected type 2 diabetic patients. PMID:26239558

  18. Diabetes mellitus in patients with cystic fibrosis.

    PubMed

    Alves, Crésio de Aragão Dantas; Aguiar, Renata Arruti; Alves, Ana Cláudia S; Santana, Maria Angélica

    2007-01-01

    Cystic fibrosis-related diabetes (CFRD) is the principal extra-pulmonary complication of cystic fibrosis, occurring in 15-30% of adult cystic fibrosis patients. The number of cystic fibrosis patients who develop diabetes is increasing in parallel with increases in life expectancy. The aim of this study was to review the physiopathology, clinical presentation, diagnosis and treatment of CFRD. A bibliographic search of the Medline and Latin American and Caribbean Health Sciences Literature databases was made. Articles were selected from among those published in the last twenty years. Insulin deficiency, caused by reduced beta-cell mass, is the main etiologic mechanism, although insulin resistance also plays a role. Presenting features of type 1 and type 2 diabetes, CFRD typically affects individuals of approximately 20 years of age. It can also be accompanied by fasting, non-fasting or intermittent hyperglycemia. Glucose intolerance is associated with worsening of nutritional status, increased morbidity, decreased survival and reduced pulmonary function. Microvascular complications are always present, although macrovascular complications are rarely seen. An oral glucose tolerance test is recommended annually for patients > or = 10 years of age and for any patients presenting unexplained weight loss or symptoms of diabetes. Patients hospitalized with severe diseases should also be screened. If fasting hyperglycemia persists for more than 48 h, insulin therapy is recommended. Insulin administration remains the treatment of choice for diabetes and fasting hyperglycemia. Calories should not be restricted, and patients with CFRD should be managed by a multidisciplinary team.

  19. Lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a diabetic patient.

    PubMed

    Vallianou, N; Gounari, P; Skourtis, A; Kougias, M; Sioula, E

    2013-10-01

    Pyomyositis is a rarely encountered infection among diabetics, which usually affects lower extremities. Herein, we present a case of lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a patient with poorly controlled diabetes mellitus.

  20. Hypernatremia in a non insulin dependent (type 2) diabetic patient with central diabetes insipidus.

    PubMed

    Kavelaars, J; Tamsma, J T; Meinders, A E

    2001-03-01

    We describe a patient with central diabetes insipidus who presented with hyperosmolar, non-ketotic hyperglycaemia. The role in this case of reduced thirst sensation with decreased water intake and abnormal AVP production illustrates the importance of these protective mechanisms in normal physiology regarding maintenance of normal plasma osmolality. Despite the complex pathophysiology in this patient, fluid resuscitation aimed at normalisation of the water deficit resulted in full recovery.

  1. Patient Self-Management of Diabetes Care in the Inpatient Setting

    PubMed Central

    Shah, Arti D.; Rushakoff, Robert J.

    2015-01-01

    Self-management of diabetes by inpatients can be problematic. People with type 1 diabetes often prefer to self-manage their diabetes in the inpatient setting. We report the case of a patient admitted to the surgical service who was self-administering his home insulin, often without telling his nurse or physician. He was aiming for tight glycemic control, which resulted in life-threatening hypoglycemia. While patients can often self-manage their diabetes in the outpatient setting, inpatient management of diabetes is very different. Patients may not be familiar with common scenarios requiring adjustments of insulin therapy. Therefore, we recommend against self-management of diabetes in the hospital. However, the patients should be involved in discussions about management of their diabetes in the hospital to allay their concerns about changes made to their insulin regimens. An example of successful cooperative management is with use of protocols that allow continued use of insulin pumps in the hospital. PMID:25990293

  2. Pulmonary tuberculosis and mucormycosis co-infection in a diabetic patient

    PubMed Central

    Aggarwal, Deepak; Chander, Jagdish; Janmeja, Ashok K.; Katyal, Rahul

    2015-01-01

    Uncontrolled diabetes mellitus is associated with a variety of infections which pose management difficulties. Herein, we report a case of diabetic patient who developed combined pulmonary tuberculosis and mucormycosis. The case illustrates management of this rare co-infection which despite being potentially fatal was treated successfully. PMID:25624598

  3. Pulmonary tuberculosis and mucormycosis co-infection in a diabetic patient.

    PubMed

    Aggarwal, Deepak; Chander, Jagdish; Janmeja, Ashok K; Katyal, Rahul

    2015-01-01

    Uncontrolled diabetes mellitus is associated with a variety of infections which pose management difficulties. Herein, we report a case of diabetic patient who developed combined pulmonary tuberculosis and mucormycosis. The case illustrates management of this rare co-infection which despite being potentially fatal was treated successfully.

  4. Invasive rhino-orbito-cerebral mucormycosis in a diabetic patient – the need for prompt treatment

    PubMed Central

    Chow, Vanessa; Khan, Sheema; Balogun, Adeola; Mitchell, David; Mühlschlegel, Fritz A.

    2014-01-01

    Mucormycosis is a rare life threatening fungal infection predominately seen in immunocompromised or diabetic patients. The following case is of a known type II diabetic patient who presented with sepsis and sudden unilateral loss of vision secondary to infective rhino-orbito-cerebral mucormycosis. Treatment of the condition required extensive surgical intervention and medical management for a life saving outcome. PMID:25750854

  5. Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre

    PubMed Central

    Fauzi, Aishah Ahmad; Chung, Tze Yang; Latif, Lydia Abdul

    2016-01-01

    INTRODUCTION This study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems. METHODS This was a case-control study involving diabetic patients attending the Diabetic Foot Care and Wound Management Clinic at University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June 2010 to June 2011. Data on sociodemographic profiles, foot factors and diabetes characteristics was collected and analysed. RESULTS A total of 48 diabetic patients with Charcot arthropathy of the foot were identified. Data from these 48 patients was compared with those of 52 diabetic patients without foot problems. Up to 83.3% of patients with diabetic Charcot arthropathy presented with unilateral Charcot foot, most commonly located at the midfoot (45.8%). Patients with a history of foot problems, including foot ulcer, amputation, surgery or a combination of problems, had the highest (26-time) likelihood of developing Charcot arthropathy (odds ratio 26.4; 95% confidence interval 6.4–109.6). Other significant risk factors included age below 60 years, more than ten years’ duration of diabetes mellitus and the presence of nephropathy. CONCLUSION A history of prior diabetic foot problems is the greatest risk factor for developing diabetic Charcot arthropathy, compared with other risk factors such as diabetes characteristics and sociodemographic profiles. Preventive management of diabetic foot problems in the primary care setting and multidisciplinary care are of paramount importance, especially among chronic diabetic patients. PMID:27075668

  6. Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus.

    PubMed

    Kadoi, Yuji

    2010-10-01

    Diabetes mellitus is an increasingly common disease that affects people of all ages, resulting in significant morbidity and mortality. Diabetic patients require perioperative care more frequently than their nondiabetic counterparts. The major risk factors for diabetics undergoing surgery are the associated end-organ diseases: cardiovascular disease, autonomic neuropathy, joint collagen tissue, and immune deficiency. Physicians need to pay extra attention to preoperative and preprocedure evaluation and treatment of these diseases to ensure optimal perioperative management.

  7. Management of critically ill patients with diabetes

    PubMed Central

    Silva-Perez, Livier Josefina; Benitez-Lopez, Mario Alberto; Varon, Joseph; Surani, Salim

    2017-01-01

    Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability. PMID:28344751

  8. Patients' health education and diabetes control in a developing country.

    PubMed

    Ezenwaka, C E; Offiah, N V

    2003-12-01

    We previously reported poor metabolic control in type 2 diabetic patients attending 2 primary care clinics in Trinidad. In an attempt to explain the poor metabolic control, we assessed primary care patients' theoretical knowledge of diabetes control and risk factors. Two hundred fifty-four diabetic out-patients recruited consecutively were asked by questionnaire: (i) if they were aware that family history of diabetes, obesity, physical inactivity and cigarette smoking were diabetes risk factors; (ii) if they knew the benefits of weight loss, exercise and healthy diet in diabetes management, and (iii) what where their common sources of diabetes health information. Although the majority of the patients (81.1%) were unaware that cigarette smoking is a diabetes risk factor, a majority were aware that obesity (66.3%), physical inactivity (73.5%) and being a relative of a diabetic patient (78.7%) constitute diabetes risk factors. Again, the majority of the patients were aware that healthy diet (94.9%), exercise (94.5%) and weight loss (87.4%) are beneficial in diabetes control. While media (48.6%) was the commonest source of diabetes information, doctors and nurses were consulted by 39.9% and 11.0% of patients, respectively. Type 2 diabetic patients in these clinics were well informed about diabetes risk factors and benefits of healthy lifestyle. Given our recent reports on poor metabolic control, application of this theoretical knowledge in controlling their diabetes remains doubtful.

  9. Scleredema Diabeticorum in a Patient with Type 2 Diabetes Mellitus

    PubMed Central

    Martín, C.; Requena, L.; Manrique, K.; Manzarbeitia, F. D.; Rovira, A.

    2011-01-01

    Background. Scleredema adultorum, a connective tissue disorder of unknown aetiology, is characterized by a thickening of the reticular dermis in the upper back of the body that may decrease the mobility of the affected tissues. It has been reported in diabetic patients with poor metabolic control. Therapeutic options are limited with generally poor results. Case Report. 53-year-old white male with type 2 diabetes mellitus was referred to our department for evaluation of incipient nephropathy and retinopathy. On examination, he presented erythematous, indurated, painless and ill-defined plaque on the skin of the upper back with limited movement of shoulders. A biopsy was done revealing scleredema. PUVA treatment and physiotherapy were started with the amelioration of mobility and acquiring some elasticity of the upper back. Discussion. The development of scleredema in diabetic patients has been related to prolonged exposure to chronic hyperglycaemia. Our patient has had diabetes for 20 years with an acceptable glucose control, however he developed the scleredema 10 years ago. Conclusions. Scleredema is a rare connective disorder that seems to appear most frequently in diabetic subjects. Good metabolic control seems not to preclude its development. PUVA treatment and physiotherapy are therapeutic options that seem to be of some help. PMID:22937286

  10. Improving Diabetes Care in the Military Primary Care Clinic: Case Study Review

    DTIC Science & Technology

    2016-03-23

    required application of innovative and creative strategies to improve self-management. The cases are representative of some common themes within the patient with type 2 diabetes in a military primary care clinic.

  11. Present Insights on Cardiomyopathy in Diabetic Patients

    PubMed Central

    Felício, João Soares; Koury, Camila Cavalcante; Carvalho, Carolina Tavares; Neto, João Felício 
Abrahão; Miléo, Karem Barbosa; Arbage, Thaís Pontes; Silva, Denisson Dias; Ferreira de Oliveira, Alana; Peixoto, Amanda Soares; Junior, Antônio Bentes Figueiredo; Ribeiro dos Santos, Ândrea Kely Campos; Yamada, Elizabeth Sumi; Zanella, Maria Teresa

    2016-01-01

    The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management. The novelty of this review is the role of CAN and reduction of blood pressure descent during sleep in the development of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium abnormalities. Considering that DCM could be asymptomatic for a long period and progress to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type 2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities in these tests in the attempt of reducing cardiovascular morbidity and mortality. PMID:26364799

  12. [Nasal mucosa in patients with diabetes mellitus].

    PubMed

    Müller, Maciej; Betlejewski, Stanisław

    2003-01-01

    Diabetes mellitus is the most common endocrinologic disease all over the world. 150 million people suffer from this disease, in Poland about 2 million. The disease on the basis of the onset and pathophysiology may be divided into type I and type II. Pathophysiologic changes include diabetic microangiopathy, macroangiopathy and neuropathy. The most common presentations in head and neck are otitis externa, hypoacusis, vertigo, disequilibrium, xerostomia, dysphagia, fungal and recurrent infections. The changes in nasal mucosa are not very well known. Only few papers concerned the problem. The main complaints of patients regarding the nose are xeromycteria, hyposmia and various degree of decreased patency of the nose. Chronic atrophic rhinitis, septal perforation, ulceration of nasal mucosa, alar necrosis, symptoms of staphylococcal or fungal infection can be found during otolaryngologic examination. The treatment in this group of patients should consist of systemic therapy of diabetes mellitus and on the other hand focal therapy with the use of a solution to moisten the nasal mucosa.

  13. Management of hospitalized type 2 diabetes mellitus patients

    PubMed Central

    Marín-Peñalver, Juan José; Martín-Timón, Iciar

    2016-01-01

    Abstract Both hyperglycemia and hypoglycemia in hospitalized patients are associated with adverse outcomes including increased rates of infection, longer hospital length of stay, and even death. Clinical trials in patients with type 2 diabetes mellitus proved that by improving glycemic control, we can reduce all of them. Insulin is the preferred treatment for glycemic control in most cases, but alternative treatment options that can normalize blood glucose levels without hypoglycemia are being sought. Moreover, hospitalized patients are particularly vulnerable to severe, prolonged hypoglycemia since they may be unable to sense or respond to the early warning signs and symptoms of low blood glucose. Finally, nutritional support, corticosteroid therapy, and surgery increase the risk of hyperglycemia that leads to an increased risk of morbidity and mortality. We review the management of type 2 diabetes mellitus patients who are admitted to the general medical wards of the hospital for a procedure of intercurrent illness. PMID:28191539

  14. Management of hospitalized type 2 diabetes mellitus patients.

    PubMed

    Marín-Peñalver, Juan José; Martín-Timón, Iciar; Del Cañizo-Gómez, Francisco Javier

    2016-12-01

    Both hyperglycemia and hypoglycemia in hospitalized patients are associated with adverse outcomes including increased rates of infection, longer hospital length of stay, and even death. Clinical trials in patients with type 2 diabetes mellitus proved that by improving glycemic control, we can reduce all of them. Insulin is the preferred treatment for glycemic control in most cases, but alternative treatment options that can normalize blood glucose levels without hypoglycemia are being sought. Moreover, hospitalized patients are particularly vulnerable to severe, prolonged hypoglycemia since they may be unable to sense or respond to the early warning signs and symptoms of low blood glucose. Finally, nutritional support, corticosteroid therapy, and surgery increase the risk of hyperglycemia that leads to an increased risk of morbidity and mortality. We review the management of type 2 diabetes mellitus patients who are admitted to the general medical wards of the hospital for a procedure of intercurrent illness.

  15. Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report

    PubMed Central

    Godoy-Santos, Alexandre L.; Amodio, Daniel T.; Pires, André; Lima, Ana L. M.; Wei, Teng H.; de Cesar-Netto, Cesar; Armstrong, David G.

    2017-01-01

    ABSTRACT The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team. PMID:28326158

  16. Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression

    PubMed Central

    Jeng, Chi-Juei; Hsieh, Yi-Ting; Yang, Chung-May; Yang, Chang-Hao; Lin, Cheng-Li

    2016-01-01

    The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68–5.37) and 9.7 (95% CI = 8.15–11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68–3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10–1.38 with NPDR; HR = 1.33, 95% CI = 1.02–1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72–2.41 in NPDR; HR = 2.95, 95% CI = 2.16–4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87–2.48) or progression (HR = 0.37, 95% CI = 0.11–1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation. PMID:27564383

  17. The Adult Diabetic Patient: An Education Challenge

    DTIC Science & Technology

    1993-05-01

    finding that he/she, too, must care for sicker patients. To better prepare these patients for life after discharge, patient education must be initiated as...admitted, patient education often begins at the physicians’ office. This paper explores diabetes mellitus in relation to concepts of self-care and adult...betting foj.L eduuation and iio.w, wore ofteni, patient education and follow-up sercvices- a:leL beiny p~rovided on ani outpatient bcdtsis" (p. 36) . Thet

  18. A Study of Vitiligo in Type 2 Diabetic Patients

    PubMed Central

    Raveendra, Leena; Hemavathi, Rekha N; Rajgopal, Sushma

    2017-01-01

    Context: Diabetes mellitus is associated with many skin manifestations including vitiligo. Vitiligo occurs more commonly in Type 1 diabetes mellitus. A few recent studies have shown its increased occurrence in Type 2 diabetes mellitus. Aims: This study aims to study the prevalence of vitiligo in Type 2 diabetic patients and to compare the prevalence of vitiligo in age- and sex-matched group of nondiabetic population. Settings and Design: The present study was a hospital-based cross-sectional study conducted in the Department of Dermatology in a tertiary care hospital. Subjects and Methods: Six hundred consecutive consenting patients of Type 2 diabetes were included in the study group and age- and sex-matched controls were healthy nondiabetic adult volunteers attending the Department of Dermatology. Fasting and postprandial blood sugar levels were done. A complete history, physical examination, and wood's lamp examination to detect vitiligo were conducted. In all those with vitiligo, the type of vitiligo was noted. Statistical Analysis Used: Data were analyzed using SPSS software version 20.0. Comparison between the presence of vitiligo in cases and controls was done using Chi-square test with P = 0.05 for significance. Results: Vitiligo was seen in 12% of cases and 6% of control group which was statistically significant (P < 0.01). There was no significant difference between cases and controls with respect to type of vitiligo. Conclusions: Vitiligo can occur in Type 2 diabetics as seen in our study and few other recent studies. The exact pathogenesis is not very clear and needs further consideration.

  19. Prediction of Outcome in Diabetic Acute Ischemic Stroke Patients: A Hospital-Based Pilot Study Report

    PubMed Central

    Nayak, Amit R.; Badar, Shweta R.; Lande, Neha; Kawle, Anuja P.; Kabra, Dinesh P.; Chandak, Nitin H.; Raje, Dhananjay V.; Singh, Lokendra R.; Daginawala, Hatim F.; Kashyap, Rajpal S.

    2016-01-01

    Background Demographic and clinical characteristics are known to influence the outcome in acute ischemic stroke (AIS) patients. Purpose This study is aimed at evaluating short- and long-term outcomes in diabetic AIS patients. In addition, the study also evaluates the impact of diabetes on the performance of indigenously reported biomarker, inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) and known biomarkers, neuron-specific enolase (NSE) and glial-derived S-100 beta beta protein (S-100ββ). Methods This study was performed on 29 diabetes and 75 non-diabetes AIS patients. Outcome of AIS patients was analyzed by using modified Rankin scale at discharge, then at 12 and 18 months after discharge. Based on the obtained scores, patients were classified as improved group (scales 1-3) and dependent/expired group (scales 3-6). Blood samples were collected during admission and at discharge/expired time. Levels of NSE, S100ββ, and ITIH4 were analyzed in all samples. Results On discharge, frequencies of dependent/expired outcome were 4/29 (14%) and 19/75 (17%) in diabetic and non-diabetic AIS patients. However, follow-up outcome at 12 and 18 months showed higher dependent/expired cases of 43 and 41% among diabetic AIS patients compared to 27 and 21% in non-diabetic patients. Multivariate analysis revealed that diabetes is an independent risk factor for dependent/expired outcome in AIS patients (OR 0.484 (at discharge); 1.307 (at 12 months) and 1.675 (at 18 months)). NSE, S100ββ, and ITIH4 showed a differential expression in both the outcome groups of AIS patients, irrespective of diabetes. Conclusion Diabetes increases the risk of dependent/expired outcome in AIS patients. Also, serum NSE, S100ββ, and ITIH4 are independent biomarkers for prognosis of outcome in AIS patients, irrespective of diabetes. PMID:27780987

  20. A case study of type 2 diabetes self-management

    PubMed Central

    Wu, Hsin-i

    2005-01-01

    Background It has been established that careful diabetes self-management is essential in avoiding chronic complications that compromise health. Disciplined diet control and regular exercise are the keys for the type 2 diabetes self-management. An ability to maintain one's blood glucose at a relatively flat level, not fluctuating wildly with meals and hypoglycemic medical intervention, would be the goal for self-management. Hemoglobin A1c (HbA1c or simply A1c) is a measure of a long-term blood plasma glucose average, a reliable index to reflect one's diabetic condition. A simple regimen that could reduce the elevated A1c levels without altering much of type 2 diabetic patients' daily routine denotes a successful self-management strategy. Methods A relatively simple model that relates the food impact on blood glucose excursions for type 2 diabetes was studied. Meal is treated as a bolus injection of glucose. Medical intervention of hypoglycaemic drug or injection, if any, is lumped with secreted insulin as a damping factor. Lunch was used for test meals. The recovery period of a blood glucose excursion returning to the pre-prandial level, the maximal reach, and the area under the excursion curve were used to characterize one's ability to regulate glucose metabolism. A case study is presented here to illustrate the possibility of devising an individual-based self-management regimen. Results Results of the lunch study for a type 2 diabetic subject indicate that the recovery time of the post-prandial blood glucose level can be adjusted to 4 hours, which is comparable to the typical time interval for non-diabetics: 3 to 4 hours. A moderate lifestyle adjustment of light supper coupled with morning swimming of 20 laps in a 25 m pool for 40 minutes enabled the subject to reduce his A1c level from 6.7 to 6.0 in six months and to maintain this level for the subsequent six months. Conclusions The preliminary result of this case study is encouraging. An individual life

  1. Vertebral hyperostosis and diabetes mellitus: a case-control study.

    PubMed Central

    Daragon, A; Mejjad, O; Czernichow, P; Louvel, J P; Vittecoq, O; Durr, A; Le Loët, X

    1995-01-01

    OBJECTIVE--To compare glucose metabolism in patients with vertebral hyperostosis (VH), with that in control patients. METHODS--We studied 50 patients aged 60 years or more who had VH according to Resnick's criteria, and 50 control patients without VH, matched for sex, age, weight and height. Plasma glucose was evaluated before and 120 minutes after ingestion of 75 g glucose. World Health Organisation criteria for diabetes mellitus (DM) were used. Radiographs of the pelvis and thoracic and lumbar spine were performed and read blind by two physicians. RESULTS--Statistical analysis showed no difference between cases and control patients for prevalence of DM, and plasma glucose at 0 and 120 minutes. CONCLUSION--These data suggest that glucoregulation in patients with VH does not differ from that in matched controls. PMID:7794043

  2. [Etiological diagnosis of central diabetes insipidus: about 41 cases].

    PubMed

    Chaker, Fatma; Chihaoui, Melika; Yazidi, Meriem; Slimane, Hedia

    2016-01-01

    The occurrence of polyuria-polydipsia syndrome with hypotonic urine requires careful diagnostic strategy. This study aims to evaluate diagnostic modalities for central diabetes insipidus. We conducted a retrospective study of 41 cases with central diabetes insipidus (CDI). Data were collected at the Department of Endocrinology, University Hospital La Rabta, Tunis, from 1990 to 2013. We identified the circumstances for detecting CDI, the abnormalities in anterior pituitary assessment and pituitary imaging. CDI occurred in the postoperative period in 20 patients. The average urine 24-hour volume was significantly higher in patients with CDI outside a surgical setting. Water deprivation test was successful in all patients who benefited from it. Outside of neurosurgery, infiltration causes were found in 6 patients and tumor causes were found in 6 patients. CDI was associated with empty sella turcica in 1 case and idiopathic sella turcica in 3 patients. Hypothalamic-pituitary magnetic resonance imaging and anterior pituitary balance sheet are systematic outside pituitary surgery setting and obvious primary polydipsia.

  3. [Hyperglycemic crisis in patients with diabetes mellitus].

    PubMed

    Schneider, S

    2012-09-01

    Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most acute life-threatening complications of diabetes mellitus and in most cases treatment should be administered in an intensive care unit. Clinically, DKA and HHS differ according to the presence of metabolic acidosis; however, the treatment of DKA and HHS is similar. The main principles are intravenous administration of insulin and correction of fluid and electrolyte abnormalities which are typically present. By the application of a standardized treatment algorithm a low mortality rate can be achieved.

  4. Treatment of Patients With Diabetic Gastroparesis

    PubMed Central

    Parkman, Henry P.; Fass, Ronnie; Foxx-Orenstein, Amy E.

    2010-01-01

    Gastroparesis, or chronic delayed gastric emptying without mechanical obstruction, affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes. Diabetic gastroparesis (DGP) typically causes nausea, vomiting, early satiety, bloating, and postprandial fullness. These symptoms can be extremely troubling and result in poor quality of life. The diagnosis of DGP is made by documenting the presence of chronic upper gastrointestinal (GI) symptoms, ruling out mechanical obstruction, and demonstrating delayed gastric emptying. The usual treatment for DGP includes dietary modifications, prokinetic agents, and antiemetic agents. Although the majority of patients have mild-to-moderate disease that can be managed using these measures, a substantial percentage of patients have severe DGP that is characterized by inadequate oral intake, malnutrition, weight loss, and frequent hospitalizations. Optimal management of these patients presents a difficult challenge for the clinician, although emerging treatment options, such as gastric neurostimulation, are encouraging. Patients with DGP often present with gastric comorbidities, including gastroesophageal reflux disease, intestinal dysmotility, and fungal and bacterial infections of the GI tract. This monograph will present an overview of the pathophysiology of DGP, review diagnostic testing with a discussion of emerging technology, and present the latest research in treatment options for DGP. In addition, management strategies for refractory DGP and gastric comorbidities will be described. PMID:20733935

  5. [Micronutrients and diabetes, the case of minerals].

    PubMed

    Granados-Silvestre, María de Los Ángeles; Ortiz-López, María Guadalupe; Montúfar-Robles, Isela; Menjívar-Iraheta, Marta

    2014-01-01

    Minerals are essential nutrients for the body, are of inorganic nature which gives them the characteristic of being resistant to heat, are involved in a lot of chemical reactions in metabolism, regulating electrolyte balance, in maintaining bone, in the process of blood clotting and the transmission of nerve impulses, particularly its role as enzyme cofactors confers a key role in various physiological processes. Glucose homeostasis involves a fine coordination of events where hormonal control by insulin plays a key role. However, the role of minerals like magnesium, zinc, chromium, iron and selenium in the diabetes is less obvious and in some cases may be controversial. This review shows the knowledge of these five elements and their correlation with diabetes.

  6. Ascending infection of foot tendons in diabetic patients.

    PubMed

    Mismar, Ayman; Yousef, Mohammad; Badran, Darwish; Younes, Nidal

    2013-12-01

    Bone and soft tissue infection in the foot of diabetic patients is a well-described issue in the literature. A sound anatomical knowledge of the foot anatomy and compartments is mandatory to understand the mechanisms of infection spread. We describe four cases of diabetic foot infection complicated by long ascending infection. All did not respond initially to antibiotic treatment and the usual surgical debridement and were cured only after excision of the infected tendons. We highlight a rare but serious complication of the diabetic foot disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition so that a prompt diagnosis is made and appropriate treatment started, thereby reducing the risk of major lower limb amputations.

  7. Diabetes mellitus in patients with cirrhosis: clinical implications and management.

    PubMed

    Elkrief, Laure; Rautou, Pierre-Emmanuel; Sarin, Shiv; Valla, Dominique; Paradis, Valérie; Moreau, Richard

    2016-07-01

    Disorders of glucose metabolism, namely glucose intolerance and diabetes, are frequent in patients with chronic liver diseases. In patients with cirrhosis, diabetes can be either a classical type 2 diabetes mellitus or the so-called hepatogenous diabetes, i.e. a consequence of liver insufficiency and portal hypertension. This review article provides an overview of the possible pathophysiological mechanisms explaining diabetes in patients with cirrhosis. Cirrhosis is associated with portosystemic shunts as well as reduced hepatic mass, which can both impair insulin clearance by the liver, contributing to peripheral insulin resistance through insulin receptors down-regulation. Moreover, cirrhosis is associated with increased levels of advanced-glycation-end products and hypoxia-inducible-factors, which may play a role in the development of diabetes. This review also focuses on the clinical implications of diabetes in patients with cirrhosis. First, diabetes is an independent factor for poor prognosis in patients with cirrhosis. Specifically, diabetes is associated with the occurrence of major complications of cirrhosis, including ascites and renal dysfunction, hepatic encephalopathy and bacterial infections. Diabetes is also associated with an increased risk of hepatocellular carcinoma in patients with chronic liver diseases. Last, the management of patients with concurrent diabetes and liver disease is also addressed. Recent findings suggest a beneficial impact of metformin in patients with chronic liver diseases. Insulin is often required in patients with advanced cirrhosis. However, the favourable impact of controlling diabetes in patients with cirrhosis has not been demonstrated yet.

  8. Plasma malondialdehyde in type 1 and type 2 diabetic patients.

    PubMed

    Gallou, G; Ruelland, A; Legras, B; Maugendre, D; Allannic, H; Cloarec, L

    1993-02-28

    Malondialdehyde, a marker of lipid peroxidation, was measured as thiobarbituric acid reactive substances (TBARS) in 117 diabetic patients and 53 controls. Patients were divided into groups and subgroups according to the type of diabetes (type 1 and type 2) and the existence or not of vascular complication (macro- or micro-angiopathy). Results showed that TBARS concentrations were significantly higher in type 1 (P < 0.0001) and type 2 (P < 0.001) diabetic patients than in the control group. The plasma TBARS concentrations in type 1 and type 2 diabetic patients did not differ significantly. Among the patients with vascular disease, type 2 diabetic patients with macroangiopathy had significantly higher TBARS concentrations than patients with no vascular complication (P < 0.05). Whichever the type of diabetes, there was no correlation between TBARS concentrations and glycaemic control: glycosylated haemoglobin, fasting blood glucose. This study confirmed the existence of lipid peroxidation disorders in diabetic patients.

  9. [Fatal pulmonary mycosis in a diabetic and cirrhotic patient].

    PubMed

    Ayadi-Kaddour, Aïda; Braham, Emna; Marghli, Adel; Ismail, Olfa; Helal, Imen; Mlika, Mona; Kilani, Tarak; El Mezni, Faouzi

    2015-04-01

    Pulmonary mucormycosis is a rare, devastating, opportunistic fungal infection, caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. This infection occurs principally in some particular conditions, specially in diabetic patients and immunocompromised host, and rarely in cirrhotic patients. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. We report a case of pulmonary mucormycosis in a 68-year-old woman with underlying liver cirrhosis and diabetes mellitus. Endoscopic and radiologic findings supported the diagnosis of hydatid cyst of the lung. The patient underwent surgical resection and was started on amphotericin B, after pathological examination. Unfortunately, she succumbed to the infection within one month of surgery.

  10. Lower Circulating Irisin Level in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis.

    PubMed

    Du, X-L; Jiang, W-X; Lv, Z-T

    2016-09-01

    Studies measuring circulating irisin levels in patients with insulin resistance conditions such as type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) have achieved controversial results. Our systematic review and meta-analysis aim to assess the circulating irisin levels in patients with diabetes mellitus. Pubmed, EMBASE, CENTRAL, ISI Web of Science, and CNKI were searched to identify observational studies of circulating irisin levels in patients with diabetes mellitus. Two reviewers independently searched the databases and screened studies according to the inclusion criteria. Data were extracted using a standardized collection form. Meta-analysis was performed. A total of 23 studies (17 cross-sectional and 6 case control) involving 1 745 diabetic patients and 1 337 non-diabetic controls were selected. Compared with non-diabetic controls, circulating irisin concentrations were significantly lower in patients with T2DM (SMD -1.72, 95%CI -2.49, -0.96; p<0.00001) and GDM (SMD -0.76, 95CI -1.31, -0.22; p=0.006), but 30 percent higher in patients with T1DM. Circulating irisin in Asian diabetic patients decreased more than European patients. The findings of our current review suggest that circulating irisin levels were decreased in patients with T2DM and GDM, but not in patients with T1DM.

  11. Psychosocial interventions for the diabetic patient.

    PubMed

    Harvey, John N

    2015-01-01

    Diabetes usually requires substantial life-long self-management by the patient. Psychological factors and the patient's health beliefs are important determinants of self-care behavior. Education has a modest influence on generating better self-care, but psychologically based interventions are clearly more effective. This review gives an overview of these interventions with some discussion of their basis in psychological theory. Some labels such as cognitive behavioral therapy and family therapy include a wide range of approaches. Randomized trials have generally produced improvement in measures of psychological well-being, but improved glycemic control has been more elusive. The influence on behavior can be very dependent on the individual therapist. Only a few trials have managed to sustain improvement in glycosylated hemoglobin beyond a year. Not all patients are prepared to engage and accept these forms of therapeutic intervention. We are still some way from moving psychological management from the trial situation into the diabetic clinic.

  12. [Erythermalgia and type 1 diabetes: diagnosis and management issues. A case report].

    PubMed

    Deghima, S; Chabane, W; Djorane, H; Azzouz, M; Hannachi, R; Boudiba, A

    2015-01-01

    Erythermalgia is a very rare acrosyndrome mainly characterized by lower limbs pain. It is either primitive or secondary. Concomittence of erythermalgia and diabetes is a coincidence and since the latter induces neuropathic and vascular lesions, erythermalgia is then considered as a consequence. We report the case of a young type 1 diabetic patient who presents with severe form of erythermalgia. Through this case report and a review of the literature, we shall explain the etiopathogenic mecanisms involved in erythermalgia in a diabetic patient and highlight the diagnosis and management challenges.

  13. Chronic ulcers: MATRIDERM® system in smoker, cardiopathic, and diabetic patients

    PubMed Central

    Gentile, Pietro; Agovino, Annarita; Migner, Alessia; Orlandi, Fabrizio; Delogu, Pamela; Cervelli, Valerio

    2013-01-01

    Diabetic ulcers and pressure ulcers represent a more frequent cause of chronic wounds in aging populations. It is estimated that approximately 15% of the diabetic population will develop diabetic ulcers during their life and over half of these patients develop an infection, often osteomyelitis, with 20% requiring amputation. The authors report a case of a 65-year-old woman affected by a post-traumatic loss of substance due to road accidents with soft tissue exposure (comprising muscle tendon) of the left knee combined with the fracture of the right fibula previously subjected to surgery and reconstruction of muscle tendon. The patient was affected by diabetes type II, hypertension, and ischemic heart disease. In 2008, she underwent a double bypass surgery and coronary angioplasty. Initially, the patient was treated with cycles of advanced dressings, with fibrinolytic ointments, hydrocolloid, and subsequently, when the bottom began granulated with fibrinolytic and idrocellulosa, Hydrofibra-Ag, and Ag-alginate, three times a week for 30 days. In the second step, the authors decided to treat the ulcer with the MATRIDERM system and auto skin graft. Following the first treatment, 7 days after the procedure, the authors found the reduction of the loss of substance until its complete closure. The wound’s infection was evaluated by a buffer negative confirmation performed every 2 weeks four times. We obtained decrease of limb edema and full functional rehabilitation. The skin appeared renovated, with volume restoration and an improvement of the texture. PMID:24020011

  14. Arterial Stiffness in Nonhypertensive Type 2 Diabetes Patients in Ghana

    PubMed Central

    Antwi, Daniel A.; Gyan, Ben

    2016-01-01

    Background. Increased arterial stiffness is an independent cardiovascular risk factor in diabetes patients and general population. However, the contribution of diabetes to arterial stiffness is often masked by coexistent obesity and hypertension. In this study, we assessed arterial stiffness in nonhypertensive, nonobese type 2 diabetes (T2DM) patients in Ghana. Methods. In case-control design, 166 nonhypertensive, nonobese participants, comprising 96 T2DM patients and 70 nondiabetes controls, were recruited. Peripheral and central blood pressure (BP) indices were measured, and arterial stiffness was assessed as aortic pulse wave velocity (PWVao), augmentation index (AIx), cardioankle vascular index (CAVI), and heart-ankle pulse wave velocity (haPWV). Results. With similar peripheral and central BP indices, T2DM patients had higher PWVao (8.3 ± 1 versus 7.8 ± 1.3, p = 0.044) and CAVI (7.9 ± 1.2 versus 6.9 ± 0.7, p = 0.021) than nondiabetic control. AIx and haPWV were similar between T2DM and nondiabetic controls. Multiple regression models showed that, in the entire study participants, the major determinants of PWVao were diabetes status, age, gender, systolic BP, and previous smoking status (β = 0.22, 0.36, 0.48, 0.21, and 0.25, resp.; all p < 0.05); the determinants of CAVI were diabetes status, age, BMI, heart rate, HbA1c, total cholesterol, HDL cholesterol, and previous smoking status (β = 0.21, 0.38, 0.2, 0.18, 0.24. 0.2, −0.19, and 0.2, resp.; all p < 0.05). Conclusion. Our findings suggest that nonhypertensive, nonobese T2DM patients have increased arterial stiffness without appreciable increase in peripheral and central pressure indices. PMID:27774104

  15. The value of urine specific gravity in detecting diabetes insipidus in a patient with uncontrolled diabetes mellitus: urine specific gravity in differential diagnosis.

    PubMed

    Akarsu, Ersin; Buyukhatipoglu, Hakan; Aktaran, Sebnem; Geyik, Ramazan

    2006-11-01

    When a patient with diabetes mellitus presents with worsening polyuria and polydipsia, what is a sensible, cost-effective approach? We report the unique coincidence of type 2 diabetes mellitus and diabetes insipidus. A 46-year-old woman with poorly controlled type 2 diabetes complained of polyuria with a daily output of 5 L. Although urinalysis demonstrated significant glucosuria, diabetes insipidus was suspected owing to a low urine specific gravity (1.008). The low specific gravity persisted during a water deprivation test. Ultimately, diabetes insipidus was confirmed when urine specific gravity and urine osmolality normalized following desmopressin administration. This case emphasizes the importance of accurately interpreting the urine specific gravity in patients with polyuria and diabetes mellitus to detect diabetes insipidus.

  16. Case study: use of vibration therapy in the treatment of diabetic peripheral small fiber neuropathy.

    PubMed

    Hong, Junggi; Barnes, Meredith; Kessler, Nathan

    2013-04-01

    The aim of the study was to describe a case of type II diabetic peripheral small fiber neuropathic pain treated with whole body vibration therapy after a failed trial of conventional drugs and interventional pain management. A 64-year-old male had chronic diabetic peripheral neuropathic pain in his both feet for about 2 years. The patient tried multiple pain medications and various interventional pain treatments without significant pain relief. After 4 weeks of vibration treatment, which targeted the feet the patient's pain level and gait patterns significantly improved. These findings illustrate the importance of considering whole body vibration as a complimentary treatment in patients with diabetic peripheral neuropathic pain.

  17. Diabetes mellitus with Laron syndrome: case report.

    PubMed

    Agladıoglu, Sebahat Yılmaz; Cetınkaya, Semra; Savas Erdeve, Senay; Onder, Asan; Kendırcı, Havva Nur Peltek; Bas, Veysel Nijat; Aycan, Zehra

    2013-01-01

    There are different opinions concerning changes in glucose metabolism in patients with Laron syndrome. In this paper we discuss the treatment results of our patient with Laron syndrome who developed diabetes during late adolescence. A 19-year-old boy with Laron syndrome was referred to our clinic for follow-up. He had been diagnosed with Laron syndrome (LS) at 4 years old and rIGF-1 therapy was initiated. After 4 months the treatment was discontinued. At the age of 17, rIGF-1 therapy was restarted. A height gain of 8.8 cm. was observed during the 2-year treatment period. He was admitted to our hospital at the age of 19 years following discontinuation of the therapy. At that time, his height was 142 cm, and weight for height was 136%. His blood glucose was 85 mg/dL (4.72 mmol/L), insulin was 26.39 pmol/L, and HbA1c was 5.4%. At the age of 20, when he has not been receiving IGF-1 therapy for 1 year, his weight for height was 143 cm. Laboratory evaluation revealed that fasting blood glucose was 176 mg/dL (9.77 mmol/L), fasting insulin was 29.86 pmol/L, and HbA1c was 7.5%. Primary insulin therapy was then initiated. His parents both had a diagnosis of type 2 diabetes. Insulin therapy was switched to oral antidiabetic (OAD) therapy at the end of the second year because of a normal C-peptide level of 0.8 nmol/L under insulin therapy. After 6 months of OAD, HbA1c was 5.7%. The treatment was then switched to IGF-1 therapy, but his blood glucose profile was impaired and OAD therapy was restarted. In conclusion, we observed that genetic susceptibility and abdominal obesity caused type 2 diabetes in this patient. We believe that oral antidiabetic agents and life-style changes may be the appropriate approach when diabetes is developed in LS patients.

  18. Care of Patients with Diabetic Foot Disease in Oman

    PubMed Central

    Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.

    2016-01-01

    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

  19. Psychosocial interventions for the diabetic patient

    PubMed Central

    Harvey, John N

    2015-01-01

    Diabetes usually requires substantial life-long self-management by the patient. Psychological factors and the patient’s health beliefs are important determinants of self-care behavior. Education has a modest influence on generating better self-care, but psychologically based interventions are clearly more effective. This review gives an overview of these interventions with some discussion of their basis in psychological theory. Some labels such as cognitive behavioral therapy and family therapy include a wide range of approaches. Randomized trials have generally produced improvement in measures of psychological well-being, but improved glycemic control has been more elusive. The influence on behavior can be very dependent on the individual therapist. Only a few trials have managed to sustain improvement in glycosylated hemoglobin beyond a year. Not all patients are prepared to engage and accept these forms of therapeutic intervention. We are still some way from moving psychological management from the trial situation into the diabetic clinic. PMID:25657590

  20. Barriers to diabetes management: patient and provider factors.

    PubMed

    Nam, Soohyun; Chesla, Catherine; Stotts, Nancy A; Kroon, Lisa; Janson, Susan L

    2011-07-01

    Despite significant advances in diagnosis and treatment, the persistence of inadequate metabolic control continues. Poor glycemic control may be reflected by both the failure of diabetes self-management by patients as well as inadequate intervention strategies by clinicians. The purpose of this systematic review is to summarize existing knowledge regarding various barriers of diabetes management from the perspectives of both patients and clinicians. A search of PubMed, CINAHL, ERIC, and PsycINFO identified 1454 articles in English published between 1990 and 2009, addressing type 2 diabetes, patient's barriers, clinician's barriers, and self-management. Patients' adherence, attitude, beliefs, and knowledge about diabetes may affect diabetes self-management. Culture and language capabilities influence the patient's health beliefs, attitudes, health literacy, thereby affecting diabetes self-management. Other influential factors include the patient's financial resources, co-morbidities, and social support. Clinician's attitude, beliefs and knowledge about diabetes also influence diabetes management. Clinicians may further influence the patient's perception through effective communication skills and by having a well-integrated health care system. Identifying barriers to diabetes management is necessary to improve the quality of diabetes care, including the improvement of metabolic control, and diabetes self-management. Further research that considers these barriers is necessary for developing interventions for individuals with type 2 diabetes.

  1. Clinical characteristics of eight patients with congenital nephrogenic diabetes insipidus.

    PubMed

    Mizuno, Haruo; Sugiyama, Yukari; Ohro, Yoichiro; Imamine, Hiroki; Kobayashi, Masanori; Sasaki, Sei; Uchida, Sinichi; Togari, Hajime

    2004-06-01

    Congenital nephrogenic diabetes insipidus (NDI) is characterized by the insensitivity of the distal nephron to arginine vasopressin. Clinical knowledge of this disease is based largely on case reports. For this study, we investigated the clinical findings of eight patients in terms of age at onset, age at diagnosis, main complaint, results of physical examination, the diagnosis, the effect of treatment, kidney function, and presence or absence of gene defects. The main complaints of all eight cases at initial examination were unknown fever, failure to thrive, and short stature. Polyuria and polydipsia are not always the chief complaints with congenital NDI. In one case, diabetes insipidus could be diagnosed based only on the results of a 5% hypertonic saline test. In six cases, we found abnormalities in the V2 receptor gene. Initially, trichlormethiazide therapy was shown to have a significant effect on polyuria; however, this effect decreased over time. In one patient with partial NDI, the addition of trichlormethiazide twice a day to 1-desamino-8-D-arginine vasopressin increased urine osmolality in the morning and caused nocturia to disappear. Results of 99mTc-diethylenetriamine pentaacetic acid kidney scintigraphy revealed a slight decrease in glomerular filtration rate in three patients. No patient experienced serious renal dysfunction.

  2. A cohort study of diabetic patients and diabetic foot ulceration patients in China.

    PubMed

    Jiang, Yufeng; Wang, Xuemei; Xia, Lei; Fu, Xiaobing; Xu, Zhangrong; Ran, Xingwu; Yan, Li; Li, Qiu; Mo, Zhaohui; Yan, Zhaoli; Ji, Qiuhe; Li, Qiang

    2015-01-01

    To determine the annual incidence and clinically relevant risk factors for foot ulceration in a large cohort study of diabetic foot ulcer (DFU) patients and diabetes mellitus (DM) patients in China. To investigate a cohort of 1,333 patients comprising 452 DFU patients and 881 DM patients, who underwent foot screening, physical examination, and laboratory tests in eight hospitals. The patients were assessed at baseline in terms of their demographic information, medical and social history, peripheral neuropathy disease (PND) screening, periphery artery disease (PAD) screening, assessment of nutritional status, and diabetic control. One year later, the patients were followed up to determine the incidence of new foot ulcers, amputation, and mortality. By univariate analysis, statistically significant differences were found in age, location, gender, living alone (yes/no), occupation, smoking, hypertension, PND, PAD, nephropathy, retinopathy, cataracts, duration of diabetes, Glycosylated hemoglobin A (HbA1c), fasting plasma glucose level, postprandial blood glucose level, insulin level, blood urea nitrogen, creatinine, cholesterol, triglyeride, high density lipoprotein (HDL), serum albumin, white blood cell, and body mass index. A binary logistic regression model was used to examine which of these risk factors were independent risk factors for foot ulceration. A total of 687 (51.5%) of the 1,333 patients were followed up for an average of 12 months; there were 458 DM patients and 229 DFU patients. A total of 46 patients died during the follow-up period; 13 were DM patients, and 33 were DFU patients. Of the 641 patients, 445 (69.4%) patients were DM patients, and 196 (30.6%) were DFU patients. At follow-up, 36/445 DM patients (8.1%), and 62/196 DFU patients (31.6%), developed new ulcers; 10/196 DFU patients underwent an amputation. The annual incidence of ulceration for DM patients and amputation for DFU patients were 8.1 and 5.1%, respectively. The annual mortality of

  3. Prevalence of thyroid dysfunction in patients with diabetes mellitus

    PubMed Central

    2013-01-01

    Background Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. The unrecognized TD may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective of this study was to investigate the prevalence of TD in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM). Methods This is an observational cross-sectional study. Three hundred eighty-six (386) patients with T1DM or T2DM that regularly attended the outpatient clinic of the Diabetes unit, Hospital Universitário Pedro Ernesto, participated in the study. All patients underwent a clinical and laboratory evaluation. Thyroid dysfunction was classified as clinical hypothyroidism (C-Hypo) if TSH > 4.20 μUI/mL and FT4 < 0.93 ng/dL; Subclinical hypothyroidism (SC-Hypo) if TSH > 4.20 μUI/ml and FT4 ranged from 0.93 to 1.7 ng/dL; Subclinical hyperthyroidism (SC-Hyper) if TSH < 0.27 μUI/ml and FT4 in the normal range (0.93 and 1.7 ng/dL) and Clinical hyperthyroidism (C-Hyper) if TSH < 0.27 μUI/ml and FT4 > 1.7 μUI/mL. Autoimmunity were diagnosed when anti-TPO levels were greater than 34 IU/mL. The positive autoimmunity was not considered as a criterion of thyroid dysfunction. Results The prevalence of TD in all diabetic patients was 14,7%. In patients who had not or denied prior TD the frequency of TD was 13%. The most frequently TD was subclinical hypothyroidism, in 13% of patients with T1DM and in 12% of patients with T2DM. The prevalence of anti-TPO antibodies was 10.8%. Forty-four (11.2%) new cases of TD were diagnosed during the clinical evaluation. The forty-nine patients with prior TD, 50% with T1DM and 76% with T2DM were with normal TSH levels. Conclusions We conclude that screening for thyroid disease among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the possible

  4. Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care.

    PubMed

    Jones, Shelley L

    2015-08-01

    The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions.

  5. Diabetic gangrene in multiple fingers and toes after a dog bite in an elderly patient with type 2 diabetes.

    PubMed

    Oya, Junko; Hanai, Ko; Miura, Junnosuke; Maruyama, Satoko; Ishii, Akiko; Syono, Kazu; Shinjo, Takamichi; Iwamoto, Yasuhiko

    2011-01-01

    A 78-year-old diabetic woman experienced multiple sites of gangrene not only in fingers that were directly bitten by a dog but also in fingers and toes that had not beenbitten. Her glycemic control was fair and microvascular complications were mild. There were no clinical findings related to angitis, collagenosis or severe infection. The fingers and toes with gangrene were amputated. The pathological diagnosis was diabetic gangrene. This report presents a case of multiple sites of gangrene of the fingers and toes after a dog bite in an elderly patient with type 2 diabetes.

  6. Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care

    ERIC Educational Resources Information Center

    Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.

    2009-01-01

    A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…

  7. Anemia in Patients with Type 2 Diabetes Mellitus.

    PubMed

    Barbieri, Jéssica; Fontela, Paula Caitano; Winkelmann, Eliane Roseli; Zimmermann, Carine Eloise Prestes; Sandri, Yana Picinin; Mallet, Emanelle Kerber Viera; Frizzo, Matias Nunes

    2015-01-01

    The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases.

  8. Dipstick urinalysis for diabetes screening in TB patients

    PubMed Central

    Restrepo, Blanca I.; Pino, Paula A.; Zarate, Izelda; Mora-Guzman, Francisco

    2013-01-01

    Introduction Diabetes knowledge among TB patients can contribute to improved TB treatment outcomes, but lack of diabetes diagnosis awareness is a limitation in developing countries. Given its low cost, the sensitivity of urine glucose dipsticks for diabetes screening in TB patients was assessed. Methods Glycosuria was assessed in 90 newly diagnosed TB patients (38 with diabetes) in south Texas, USA (n = 20) and northeast Mexico (n = 70) during January 2009–December 2010. Results Glycosuria was detected in 65% of the diabetic patients with chronic hyperglycemia (positive predictive value 91%, negative predictive value 84%). Conclusion We propose that TB clinics with limited budgets where portable glucometers may not be available conduct universal screening for diabetes with urine dipsticks. This could be followed by blood glucose or HbA1c testing in the subset of patients requiring confirmation or higher sensitivity assessment, to improve the comanagement of TB and diabetes. PMID:24030116

  9. Group B streptococcal necrotizing pneumonia in a diabetic adult patient.

    PubMed

    Pacha, Andrea; Luna Cian, Ramiro; Bonofiglio, Laura; Solari, Melisa; Strada, Virginia; Suárez, Mariana; Vigliarolo, Laura; Tersigni, Carina; Mollerach, Marta; Lopardo, Horacio

    2017-03-18

    The aim of this report is to describe a rare case of necrotizing pneumonia due to group B Streptococcus serotype III in a relatively young male adult (48 years old) suffering from diabetes. The organism was isolated from his pleural fluid and was only resistant to tetracycline. The patient first received ceftazidime (2g/8h i.v.)+clindamycin (300mg/8h) for 18 days and then he was discharged home and orally treated with amoxicillin clavulanic acid (1g/12h) for 23 days with an uneventful evolution. As in the cases of invasive infection by Streptococcus pyogenes, clindamycin could prevent streptococcal toxic shock syndrome.

  10. Diabetes Management via a Mobile Application: a Case Report

    PubMed Central

    2017-01-01

    Recently, mobile health care has been applied to manage diabetes requiring self-management. Health care by mobile applications (apps) has a great advantage when applied to patients with diabetes; the adherence to self-management activities for diabetes can be improved through mobile apps. The Food and Drug Administration (FDA) has cleared and approved the use of some mobile apps as medical devices for the management of diabetes since 2010. However, mobile apps may not be effective for all patients. We here report the effect of use of mobile-based diabetes care app (Healthy-note app) for 2 patients with diabetes, and discuss issues and strategies for effective mobile intervention. Further study is needed on improving patient's participation to increase the effect of management via a mobile app. PMID:28168183

  11. A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

    PubMed Central

    2013-01-01

    Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to

  12. [Diabetic patients in the Yom Kippur fast--who can fast and how to treat the fasting patients].

    PubMed

    Katz, Yisrael; Zangen, David; Leibowitz, Gil; Szalalt, Auryan

    2009-09-01

    Jews all over the world fast on Yom Kippur, a fast lasting 25 hours. For diabetic patients and their physicians the fast is a significant challenge. The Jewish law exempts patients from fasting if the fast endangers the patient's health. In order to know if they can fast safely, many diabetic patients consult their physicians. In this review, the authors summarize the potential risk for fasting in diabetic patients and propose treatment protocols for patients who intend to fast. The principle recommendations are based on data related to fasting diabetic patients during the Ramadan fast, which is shorter than Yom Kippur. Furthermore, practical suggestions are based on a recent Israeli study on type 1 diabetic patients fasting for 25 hours, taking into account the Jewish law. Every diabetic patient who intends to fast should consult his physician for assurance that fasting is safe. The physician should pay special attention to patients on intensive insulin treatment or on sulfonylureas. Some, but not all these patients, should avoid fasting. In case these patients decide to fast, intensive monitoring of blood glucose is required during the fast to prevent severe hypoglycemia.

  13. Anesthetic considerations in diabetic patients. Part II: intraoperative and postoperative management of patients with diabetes mellitus.

    PubMed

    Kadoi, Yuji

    2010-10-01

    Some studies have reported that tight glycemic control in diabetic patients undergoing major surgery improves perioperative morbidity and mortality rates. Recently, however, large randomized studies have shown such control increases the mortality rate, since aggressive glycemic control induces more frequent incidences of hypoglycemia. Diabetic patients have cerebral complications during the perioperative period more often than their nondiabetic counterparts. Further, anesthetic agents have some effects on cerebral circulation and cerebrovascular carbon dioxide reactivity. Hence, anesthesiologists should have adequate knowledge about anesthetic agents that maintain the integrity of the cerebral circulation. Patients with diabetes mellitus (DM) have an increased susceptibility to perioperative infections. Recent work confirmed that a combination of intravenous and subcutaneous insulin as a glucose management strategy had beneficial effects identical with intravenous insulin therapy alone on the reduction of infection rates during the postoperative period.

  14. Perforating necrobiosis lipoidica in a girl with type 1 diabetes mellitus: a new case reported.

    PubMed

    Hammami, Houda; Youssef, Soumaya; Jaber, Kahena; Dhaoui, Mohamed Raouf; Doss, Nejib

    2008-07-15

    Necrobiosis lipoidica is an idiopathic dermatological condition that is strongly associated with diabetes mellitus. It is more commonly seen in women than men. The average age of onset is 30-40 years. Necrobiosis Lipoidica diabeticorum is an extremely rare finding in childhood diabetes. We describe the case of a 13-year-old girl who has had type 1 diabetes mellitus since she was 8 years old. The patient presented with 2 well-defined, persistent plaques with a depressed central area and elevated purple peripheral ring, one on the right thigh and the other over the lateral left leg. Histopathologic evaluation of the patient's biopsy confirmed the diagnosis of necrobiosis lipoidica with transfollicular elimination. Our patient is the second pediatric case described with perforating necrobiosis lipoidica. We review the literature and discuss clinical features, several complications, and the most recent treatment options for necrobiosis lipoidica in diabetic children.

  15. Zinc Status in Type 2 Diabetic Patients: Relation to the Progression of Diabetic Nephropathy

    PubMed Central

    Sulieman, Dhia M; Hussen, Kajeen R.

    2014-01-01

    Background and Objectives: Zinc deficiency often occurs in patients with diabetes. Therefore, the relationship between zinc status and progression of nephropathy in diabetes has been explored. Materials and Methods: Total 300 diabetic patients and 100 non-diabetic healthy subjects (age matched) were selected followed by informed consent and divided into five groups as I: non-diabetic normotensive control; II: diabetic normotensive; III: diabetic hypertensive; IV: diabetic normotensive with microalbuminuria; V: diabetic hypertensive with microalbuminuria. The blood samples of all subjects were collected and analyzed for serum zinc, serum creatinine, and estimated-glomerular filtration rate (e-GFR). Urine zinc, creatinine and microalbuminuria concentrations were determined. Results: The serum zinc levels were low (p<0.01) in diabetic patients as compared to non-diabetic control subjects. The lower levels (p<0.001) of serum zinc were observed in Group IV and V as compared to group I-III. Significantly low levels of e-GFR (p<0.05) and high levels of microalbuminuria (p<0.001) were observed in diabetic patients with low serum zinc level as compared to normal serum zinc level. Serum zinc level in diabetic patients was inversely correlated with serum creatinine(r=-0.331, p<0.001), microalbuminuria (r=-0.587, p<0.001) and positively with e-GFR (r=0.194, p<0.01). Conclusion: It is evident from this study that advancing diabetic nephropathy represented by decreasing GFR and increasing microalbuminuria is associated with lower serum zinc levels. It thus indicates the need for determining serum zinc levels and the effectiveness of zinc supplementation in diabetic patients, particularly during the assessment of kidney damage. PMID:25584209

  16. Maxillary ulceration resulting from using a rapid maxillary expander in a diabetic patient.

    PubMed

    Maia, Luiz Guilherme Martins; Monini, André da Costa; Jacob, Helder Baldi; Gandini, Luiz Gonzaga

    2011-05-01

    One of the characteristics of diabetes mellitus is the exaggerated inflammatory response. The present report shows the reaction from the use of a rapid maxillary expander in a diabetic patient. A 9-year-old child presented an uncommon reaction to the treatment with a rapid maxillary expander, and on follow-up examination, it was discovered that the patient had diabetes mellitus. After controlling the disease, the proposed treatment was used without further incidents. The case calls attention to the presence of uncommon responses to treatment and the need for the orthodontist to suspect a patient's systemic compromise.

  17. Pulmonary Langerhans Cell Histiocytosis in an Adult Male Presenting with Central Diabetes Insipidus and Diabetes Mellitus: A Case Report.

    PubMed

    Choi, Yeun Seoung; Lim, Jung Soo; Kwon, Woocheol; Jung, Soon-Hee; Park, Il Hwan; Lee, Myoung Kyu; Lee, Won Yeon; Yong, Suk Joong; Lee, Seok Jeong; Jung, Ye-Ryung; Choi, Jiwon; Choi, Ji Sun; Jeong, Joon Taek; Yoo, Jin Sae; Kim, Sang-Ha

    2015-10-01

    Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.

  18. Pulmonary langerhans cell histiocytosis case with diabetes insipidus and tuberculosis.

    PubMed

    Ugurlu, E; Altinisik, G; Aydogmus, U; Bir, F

    2017-04-01

    A 19-year-old male patient was observed due to having central diabetes insipidus (DI) for five years. He had a history of smoking 5-10 cigarettes a day for two years, but stopped smoking from the last month. The computerized tomography revealed thin-walled cystic lesions in different sizes more dominantly in the upper lobes and consolidated areas in the left upper and lower lobes. The wedge resection from the right lower lobe revealed pulmonary langerhans cell histiocytosis. Follow-up acid-fast bacteria (AFB) examinations revealed (+++) and antituberculous treatment was started. On the 40th day of the anti-tuberculosis treatment, the patient applied once again due to fever and chest pain. Although infiltrations persisted in the left upper and middle zones in the postero-anterior lung rontgenogram, right-sided pneumothorax was detected. The case is considered tuberculosis and the patient continued to receive anti-TB treatment under the close supervision.

  19. Psychological Adjustment and Neuropsychological Performance in Diabetic Patients.

    ERIC Educational Resources Information Center

    Skenazy, Judy A.; Bigler, Erin D.

    1985-01-01

    Compared diabetic (N=39) with nondiabetic chronic illness patients (N=20) and healthy controls (N=24). The chronic illness and the diabetic groups had significant elevations on the Hypochondriasis, Depression, and Hysteria scales of the Feschingbauer Abbreviated MMPI. For diabetics, results demonstrated a negligible effect of poor adjustment on…

  20. Clinical Characteristics of Young Type 2 Diabetes Patients with Atherosclerosis

    PubMed Central

    Yang, Wenjia; Cai, Xiaoling; Han, Xueyao; Ji, Linong

    2016-01-01

    Objective The prevalence of type 2 diabetes is increasing rapidly in the young population. The clinical characteristics and risk factors for young type 2 diabetes patients with atherosclerosis are not fully explicated. The aim of the present study was to investigate various clinical and biochemical characteristics of young type 2 diabetic patients with atherosclerosis. Design and Methods This was a cross-sectional study. The study involved 2199 hospitalized patients with type 2 diabetes. The young patients were classified into the atherosclerotic group or the non-atherosclerotic group, and we also enrolled an older group with peripheral atherosclerosis disease and an age of at least 45 years. Comparisons were made between the different groups to investigate the cardiovascular and metabolic risk profiles of young type 2 diabetes patients with atherosclerosis. We also used logistic regression models to assess the atherosclerosis risk factors for young patients. Results Compared to older type 2 diabetes patients with atherosclerosis, young patients with atherosclerosis had more deleterious profiles of weight and hyperlipidemia. Only age and diabetes duration were found to be significant independent risk factors for atherosclerosis in young patients. The ratio of the presence of atherosclerosis in the lower extremity arteries alone was significantly higher in young patients than older patients (26.4% vs. 14.0%, P = 0.000). Conclusion Young type 2 diabetes patients with atherosclerosis have more adverse cardiovascular risk profiles and inadequate control of these risk factors. Lower extremity examination is of high importance in young patients. PMID:27391819

  1. Minimal Clinically Important Difference of Carpal Tunnel Release in Diabetic and Non-Diabetic Patients

    PubMed Central

    Ozer, Kagan; Malay, Sunitha; Toker, Serdar; Chung, Kevin C.

    2016-01-01

    Background Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is essential in outcomes research to evaluate patients’ perspective of treatment effectiveness. We aim to determine (MCID) after carpal tunnel release in diabetic and non-diabetic patients using the Boston Carpal Tunnel Questionnaire (BCTQ). Methods We prospectively evaluated 114 patients (87 non-diabetic, 27 diabetic) undergoing carpal tunnel release. In addition to standard history and physical examination, we obtained preoperative electrodiagnostic studies to confirm Carpal Tunnel Syndrome (CTS). The BCTQ was administered before and after the surgery at 3 and 6 months. Patients were asked about their level of satisfaction at the final follow-up period. We applied the receiver operating characteristic (ROC) curve approach to determine the MCID of symptom and function severity scales of the questionnaire. We used patient satisfaction as the reference standard to compare against the standardized change in scores after surgery for the 2 groups. Results For both diabetic and non-diabetic patients, symptom and function severity scales showed large effect size of >0.8 at 3 and 6 months after the surgery. At 6 months after surgery to be satisfied, diabetic patients required an MCID of 1.55 and 2.05 points for symptom and function scales, whereas non-diabetic patients required 1.45 and 1.6 points, respectively. Conclusion Diabetic patients needed a greater improvement in BCTQ score to be satisfied on functional and symptom severity scales than non-diabetic patients. Overall diabetic patients had less improvement in BCTQ final scores compared to non-diabetics. PMID:23416439

  2. Intentional hypoglycemia to control bingeing in a patient with type 1 diabetes and bulimia nervosa.

    PubMed

    Moosavi, Mandana; Kreisman, Stuart; Hall, Lacresha

    2015-02-01

    Most cases of eating disorders associated with type 1 diabetes mellitus are categorized as diabulimia, a disorder of withholding insulin treatment to lose weight through sustained hyperglycemia. In this paper, we report a unique case of a patient with both type 1 diabetes and bulimia nervosa who has an atypical way of controlling her bingeing by keeping her blood sugars low. This pattern of intentionally sustained hypoglycemia has not been previously described in the literature to the best of our knowledge. Knowing various presentations of eating disorders in patients with type 1 diabetes can provide healthcare workers with enhanced ability in recognizing and educating at-risk patients, in the hope of preventing serious hypoglycemia or complications. Furthermore, a patient's awareness of complications associated with suboptimal control of diabetes, whether by overdosing or underdosing their insulin regimen, might lead to avoidance of disordered eating behaviours.

  3. [Quality of life in patients with diabetes using the Diabetes 39 (D-39) instrument].

    PubMed

    Zulian, Luana Rosas; dos Santos, Manoel Antônio; Veras, Vívian Saraiva; Rodrigues, Flávia Fernanda Luchetti; Arrelias, Clarissa Cordeiro Alves; Zanetti, Maria Lucia

    2013-09-01

    The purpose of this study is to investigate the specific quality of life of patients with diabetes mellitus. It is a cross-sectional study, which was conducted from August 2-28, 2012 in two basic health units, in the interior of São Paulo. A convenience sample, made up of 75 patients, 18 years old or older, both sexes, in a group of self-monitoring of blood glucose, was used. The Diabetes 39 (D-39) Instrument Evaluation, containing five dimensions: energy and mobility (15 items), diabetes control (12), anxiety and worry (4) social overload (5) and sexual behavior (3), was used. Quality of life proved to be highly affected in the items related to the social overload dimension, embarrassment for having diabetes, being called diabetic and diabetes interfering with family life. The elucidation of the assessed factors contributes to the planning of educational programs, insofar as they may hinder the achievement of metabolic control in patients with diabetes.

  4. Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese Patients with Type 2 Diabetes

    PubMed Central

    Mottalib, Adham; Sakr, Mahmoud; Shehabeldin, Mohamed; Hamdy, Osama

    2015-01-01

    Partial or complete remission from type 2 diabetes was recently observed after bariatric surgeries. Limited data is available about the possibility of inducing diabetes remission through intensive weight reduction. We retrospectively evaluated diabetes remissions after one year of the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week intensive program for diabetes weight management in real-world clinical practice. Among 120 obese patients with type 2 diabetes who completed the program, 88 patients returned for follow-up at one year. Nineteen patients (21.6%) had major improvement in their glycemic control, defined as achieving an A1C <6.5% after one year. Four patients (4.5%) achieved either partial or complete diabetes remission defined as A1C <6.5% and <5.7%, respectively, on no antihyperglycemic medications for one year; 2 achieved partial remission (2.3%) and 2 achieved complete remission (2.3%). At the time of intervention, patients who achieved diabetes remission had shorter diabetes duration (<5 years) and lower A1C (<8%) and were treated with fewer than 2 oral medications. They achieved a weight reduction of >7% after 12 weeks. These results indicate that a subset of obese patients with type 2 diabetes is appropriate for intensive lifestyle intervention with the aim of inducing diabetes remission. PMID:26114120

  5. Learning Difficulties of Diabetic Patients: A Survey of Educators.

    ERIC Educational Resources Information Center

    Bonnet, Caroline; Gagnayre, Remi; d'Ivernois, Jean-Francois

    1998-01-01

    Surveys 85 health care professionals on the learning difficulties of diabetic patients. Results show that educators find it easy to teach techniques: patients master procedures well and make few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving.…

  6. Molecular genetic testing of patients with monogenic diabetes and hyperinsulinism.

    PubMed

    Bennett, James T; Vasta, Valeria; Zhang, Min; Narayanan, Jaya; Gerrits, Peter; Hahn, Si Houn

    2015-03-01

    Genetic sequencing has become a critical part of the diagnosis of certain forms of pancreatic beta cell dysfunction. Despite great advances in the speed and cost of DNA sequencing, determining the pathogenicity of variants remains a challenge, and requires sharing of sequence and phenotypic data between laboratories. We reviewed all diabetes and hyperinsulinism-associated molecular testing done at the Seattle Children's Molecular Genetics Laboratory from 2009 to 2013. 331 probands were referred to us for molecular genetic sequencing for Neonatal Diabetes (NDM), Maturity-Onset Diabetes of the Young (MODY), or Congenital Hyperinsulinism (CHI) during this period. Reportable variants were identified in 115 (35%) patients with 91 variants in one of 6 genes: HNF1A, GCK, HNF4A, ABCC8, KCNJ11, or INS. In addition to identifying 23 novel variants, we identified unusual mechanisms of inheritance, including mosaic and digenic MODY presentations. Re-analysis of all reported variants using more recently available databases led to a change in variant interpretation from the original report in 30% of cases. These results represent a resource for molecular testing of monogenic forms of diabetes and hyperinsulinism, providing a mutation spectrum for these disorders in a large North American cohort. In addition, they highlight the importance of periodic review of molecular testing results.

  7. Association between subclinical hypothyroidism and diabetic nephropathy in patients with type 2 diabetes mellitus.

    PubMed

    Furukawa, Shinya; Yamamoto, Shin; Todo, Yasuhiko; Maruyama, Kotatsu; Miyake, Teruki; Ueda, Teruhisa; Niiya, Tetsuji; Senba, Takatoshi; Torisu, Masamoto; Kumagi, Teru; Miyauchi, Syozo; Sakai, Takenori; Minami, Hisaka; Miyaoka, Hiroaki; Matsuura, Bunzo; Hiasa, Yoichi; Onji, Morikazu; Tanigawa, Takeshi

    2014-01-01

    Subclinical hypothyroidism (SCH) has been associated with type 2 diabetes mellitus. However, it is unknown whether common complications of type 2 diabetes, such as diabetic nephropathy, are also present with SCH. Here, we investigated the association between SCH and diabetic nephropathy among Japanese patients with type 2 diabetes mellitus. In this multicenter cross-sectional study, we recruited 414 such patients who had no previous history of thyroid disease. Serum thyroid hormone levels and the urinary albumin:creatinine ratio were measured. SCH was defined as an elevated thyroid-stimulating hormone (TSH) level (>4.0 mIU/L), and diabetic nephropathy was defined as urinary albumin/creatinine ratio ≥300 mg/g. The prevalence of SCH was 8.7% (n = 36) among patients with type 2 diabetes mellitus. The SCH group had a higher prevalence of dyslipidemia (p = 0.008) and diabetic nephropathy (p = 0.014) than the euthyroid group. Multivariate analysis identified significant positive associations between diabetic nephropathy and SCH (odds ratio [OR], 3.51; 95% confidence interval [CI], 1.10-10.0; p = 0.034), hypertension (OR, 4.56; 95% CI, 1.69-14.7; p = 0.001), and smoking (OR, 3.02; 95% CI, 1.14-7.91; p = 0.026). SCH may be independently associated with diabetic nephropathy in Japanese patients with type 2 diabetes mellitus.

  8. Urinary tract infection in patients with diabetes mellitus.

    PubMed

    Fünfstück, Reinhard; Nicolle, Lindsay E; Hanefeld, Markolf; Naber, Kurt G

    2012-01-01

    Urinary tract infection occurs with increased frequency and severity in patients with diabetes mellitus. General host factors enhancing risk for urinary tract infection in diabetics include age, metabolic control, and long term complications, primarily diabetic nephropathy and cystopathy. Alterations in the innate immune system have been described and may also contribute. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated. Early diagnosis and prompt intervention is recommended to limit morbidity of symptomatic infection. Clinical studies comparing management of urinary tract infection in persons with diabetes compared to those without as well as diabetic patients with good or poor glucose control will be necessary to improve care of urinary infection in persons with diabetes mellitus.

  9. Exploring salivary proteomes in edentulous patients with type 2 diabetes.

    PubMed

    Border, Michael B; Schwartz, Sarah; Carlson, Jim; Dibble, Christopher F; Kohltfarber, Heidi; Offenbacher, Steven; Buse, John B; Bencharit, Sompop

    2012-04-01

    Type 2 diabetes and tooth loss are linked both epidemiologically and pathophysiologically. We applied label-free differential protein expression analysis using multidimensional liquid chromatography/tandem mass spectrometry (2D-LC-MS/MS) to explore the proteomic profile of saliva samples collected from selected type 2 diabetic edentulous patients and non-diabetic controls. Ninety-six peptides corresponding to 52 proteins were differentially expressed between the diabetic edentulous patients and controls (p < 0.05). Some diabetes-related inflammatory biomarkers including glyceraldehyde-3-phosphate dehydrogenase and serum amyloid A were detected with levels increased in diabetic samples. Other biomarkers including amylase, palate, lung and nasal epithelium associated protein (PLUNC), and serotransferrin levels were decreased in diabetic samples. In contrast with previous findings, salivary carbonic anhydrase 6 and alpha-2 macroglobulin levels, however, were decreased in this diabetic patient population. Cluster analysis and principle component analysis demonstrated a differential pattern of protein biomarker expression between diabetic and control subjects. Western blot analysis was completed to confirm the relatively lower expression level of two biomarkers, including PLUNC and amylase in the diabetic group compared to control subjects. The presence of salivary biomarkers specific for diabetes in edentulous subjects mimics those in serum, especially those related to inflammatory/lipid metabolism. While this exploratory study requires further validation with a larger population, it provides proof-of-principle for salivary proteomics for edentulous subjects with diabetes.

  10. Traumatic injuries in patients with diabetes mellitus

    PubMed Central

    El-Menyar, Ayman; Mekkodathil, Ahammed; Al-Thani, Hassan

    2016-01-01

    Diabetes mellitus (DM) is associated with increased in-hospital morbidity and mortality in patients sustained traumatic injuries. Identification of risk factors of traumatic injuries that lead to hospital admissions and death in DM patients is crucial to set effective preventive strategies. We aimed to conduct a traditional narrative literature review to describe the role of hypoglycemia as a risk factor of driving and fall-related traumatic injuries. DM poses significant burden as a risk factor and predictor of worse outcomes in traumatic injuries. Although there is no consensus on the impact and clear hazards of hyperglycemia in comparison to the hypoglycemia, both extremes of DM need to be carefully addressed and taken into consideration for proper management. Moreover, physicians, patients, and concerned authorities should be aware of all these potential hazards to share and establish the right management plans. PMID:27162438

  11. [Preoperative assessment of patients with diabetes mellitus].

    PubMed

    Takeda, Kiyoshi

    2010-07-01

    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  12. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient

    PubMed Central

    Budoff, Matthew J.; Raggi, Paolo; Beller, George A.; Berman, Daniel S.; Druz, Regina S.; Malik, Shaista; Rigolin, Vera H.; Weigold, Wm. Guy; Soman, Prem

    2017-01-01

    Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a “coronary risk equivalent,” implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data. PMID:26846937

  13. Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection.

    PubMed

    Rana, S V; Malik, Aastha; Bhadada, Sanjay K; Sachdeva, Naresh; Morya, Rajesh Kumar; Sharma, Gaurav

    2017-03-01

    Type 2 diabetes mellitus consists of dysfunctions characterized by hyperglycemia and resulting from combination of resistance to insulin action and inadequate insulin secretion. Most of diabetic patients report significant gastrointestinal symptoms. Entire GI tract can be affected by diabetes from oral cavity to large bowel and anorectal region. Proteins, carbohydrates, fats, and most fluids are absorbed in small intestine. Malabsorption may occurs when proper absorption of nutrients does not take place due to bacterial overgrowth or altered gut motility. The present study was planned to measure various malabsorption parameters in type 2 diabetic patients. 175 patients and 175 age and sex matched healthy controls attending Endocrinology Clinic in PGI, Chandigarh were enrolled. Lactose intolerance was measured by using non-invasive lactose hydrogen breath test. Urinary d-xylose and fecal fat were estimated using standard methods. Orocecal transit time and small intestinal bacterial overgrowth were measured using non-invasive lactulose and glucose breath test respectively. Out of 175 diabetic patients enrolled, 87 were males while among 175 healthy subjects 88 were males. SIBO was observed in 14.8 % type 2 diabetic patients and in 2.8 % of controls. There was statistically significant increase (p < 0.002) in OCTT in type 2 diabetic patients compared with controls. OCTT was observed to be more delayed (p < 0.003) in patients who were found to have SIBO than in patients without SIBO. Lactose intolerance was observed in 60 % diabetic patients and 39.4 % in controls. Urinary d-xylose levels were also lower in case of diabetic patients but no significant difference was found in 72 h fecal fat excretion among diabetic patients and controls. Urinary d-xylose and lactose intolerance in SIBO positive type 2 diabetic patients was more severe as compared to SIBO negative diabetic patients. From this study we can conclude that delayed OCTT may have led to SIBO which may

  14. Prognostic Value of Admission Blood Glucose in Diabetic and Non-diabetic Patients with Intracerebral Hemorrhage

    PubMed Central

    Sun, Shichao; Pan, Yuesong; Zhao, Xingquan; Liu, Liping; Li, Hao; He, Yan; Wang, Yilong; Wang, Yongjun; Guo, Li

    2016-01-01

    We aimed to validate prognostic value of elevated admission blood glucose (ABG) for clinical outcomes in diabetic and non-diabetic patients with intracerebral hemorrhage (ICH) in a representative large cohort. Data of ICH patients with onset time ≤24 h were derived from the China National Stroke Registry. Clinical outcomes included 3-month poor outcome (death or dependency) and death. Logistic regression was performed for the association between ABG and clinical outcomes, both in the entire cohort and in patients with and without diabetes mellitus. 2951 ICH patients were enrolled, including 267 (9.0%) diabetics. In the entire cohort, there was a trend to increased risk of poor outcome with increasing ABG levels (adjusted OR 1.09; 95% CI, 1.04–1.15; P < 0.001). The risk of poor outcome was significantly greatest for the highest quartile (≥7.53 mmol/L) of ABG (adjusted OR 1.54; 95% CI, 1.17–2.03; p = 0.002, P for trend 0.004). We got similar association in non-diabetics but not in diabetics. Elevated ABG confers a higher risk of poor outcome in non-diabetics than diabetics with similar glucose level. Elevated ABG is an independent predictor of 3-month poor outcome in ICH patients, the prognostic value of which is greater in non-diabetics than diabetics with similar glucose level. PMID:27562114

  15. Diabetic neuropathic cachexia: report of a recurrent case

    PubMed Central

    Jackson, C.; Barohn, R.

    1998-01-01

    Diabetic neuropathic cachexia is an uncommon peripheral neuropathy associated with diabetes mellitus and characterised by profound weight loss and painful dysaesthesias over the limbs and trunk. The pathophysiological basis of this disorder remains unknown and there have been no published cases of recurrent episodes. A hispanic man who experienced two episodes of diabetic neuropathic cachexia over a seven year period is described.

 PMID:9647310

  16. Improving adherence and outcomes in diabetic patients

    PubMed Central

    Joshi, Renu; Joshi, Disha; Cheriyath, Pramil

    2017-01-01

    Objective Nonadherence in diabetes is a problem leading to wasted resources and preventable deaths each year. Remedies for diminishing nonadherence are many but marginally effective, and outcomes remain suboptimal. Aim The aim of this study was to test a new iOS “app”, PatientPartner. Derived from complexity theory, this novel technology has been extensively used in other fields; this is the first trial in a patient population. Methods Physicians referred patients who were “severely non-adherent” with HbA1c levels >8. After consent and random assignment (n=107), subjects in the intervention group were immersed in the 12-min PatientPartner game, which assesses and trains subjects on parameters of thinking that are critical for good decision making in health care: information management, stress coping, and health strategies. The control group did not play PatientPartner. All subjects were called each week for 3 weeks and self-reported on their medication adherence, diet, and exercise. Baseline and 3-month post-intervention HbA1c levels were recorded for the intervention group. Results Although the control group showed no difference on any measures at 3 weeks, the intervention group reported significant mean percentage improvements on all measures: medication adherence (57%, standard deviation [SD] 18%–96%, SD 9), diet (50%, SD 33%–75%, SD 28), and exercise (29%, SD 31%–43%, SD 33). At 3 months, the mean HbA1c levels in the intervention group were significantly lower (9.6) than baseline (10.7). Conclusion Many programs to improve adherence have been proved to be expensive and marginally effective. Therefore, improvements from the single use of a 12-min-long “app” are noteworthy. This is the first ever randomized, controlled trial to demonstrate that an “app” can impact the gold standard biological marker, HbA1c, in diabetes. PMID:28243070

  17. Screening for diabetic retinopathy and nephropathy in patients with diabetes: a nationwide survey in Korea.

    PubMed

    Byun, Sang-Ho; Ma, Seung Hyun; Jun, Jae Kwan; Jung, Kyu-Won; Park, Boyoung

    2013-01-01

    This study was performed to identify factors associated with screening for diabetic retinopathy and nephropathy. Data from the Korean National Health and Nutrition Examination Survey between 2007 and 2009 were analyzed. Of 24,871 participants, 1,288 patients diagnosed with diabetes at ≥30 years of age were included. 36.3% received screening for diabetic retinopathy, and 40.5% received screening for diabetic nephropathy during the previous year. Patients living in rural areas, those with less education, those who had not received education about diabetes care, and those who did not receive medical care for diabetes were screened less often for retinopathy or nephropathy. Patients with poorer self-reported health status were screened more often. Occupation, smoking status, and diabetes duration were associated with retinopathy screening. Lower family income was associated with decreased nephropathy screening. Receiving education about diabetes care and receiving medical care for diabetes were significant factors in patients with a shorter duration of diabetes (the significant odds ratio [OR] of not receiving education varied between 0.27 and 0.51, and that of not receiving medical care varied between 0.34 and 0.42). Sociodemographic factors and health-related factors as well as education and medical care influenced screening for diabetic complications among those with a longer duration of diabetes (for retinopathy and nephropathy, the significant OR of living in a rural area varied between 0.56 and 0.61; for retinopathy, the significant OR of current smokers was 0.55, and the p-trend of subjective health status was <0.001; for nephropathy, the significant OR of a monthly household income of <3000 dollars was 0.61 and the p-trends of education and subjective health status were 0.030 and 0.007, respectively). Efforts to decrease sociodemographic disparities should be combined with education about diabetes care to increase the screening, especially for those with a

  18. Factitious disorder as repeated diabetic ketoacidosis: a case report.

    PubMed

    Alinejad, Nima A; Oettel, David J

    2011-02-01

    Factitious disorder is a challenging entity, both in diagnosis and treatment. The clinical presentation is variable in feigned symptoms and spans virtually all organ systems. The diagnostic criteria are simple, yet making the diagnosis is often complicated and can be delayed by focusing on the urgent or readily observable diagnosis. In this article, the authors present a case of factitious diabetic ketoacidosis resulting from the deliberate withholding of exogenous insulin. This particular case is dissected in order to portray the underlying psychopathology. In doing so, the authors illustrate how a patient with factitious disorder might fulfill unmet, presumably unrealized needs. The authors also discuss the diagnostic criteria and treatment strategies of factitious disorder, both of which are of considerable debate within the psychiatric community.

  19. Inhaled insulin for controlling blood glucose in patients with diabetes

    PubMed Central

    Silverman, Bernard L; Barnes, Christopher J; Campaigne, Barbara N; Muchmore, Douglas B

    2007-01-01

    Diabetes mellitus is a significant worldwide health problem, with the incidence of type 2 diabetes increasing at alarming rates. Insulin resistance and dysregulated blood glucose control are established risk factors for microvascular complications and cardiovascular disease. Despite the recognition of diabetes as a major health issue and the availability of a growing number of medications designed to counteract its detrimental effects, real and perceived barriers remain that prevent patients from achieving optimal blood glucose control. The development and utilization of inhaled insulin as a novel insulin delivery system may positively influence patient treatment adherence and optimal glycemic control, potentially leading to a reduction in cardiovascular complications in patients with diabetes. PMID:18200813

  20. Diabetes and Reduced Risk for Thoracic Aortic Aneurysms and Dissections: A Nationwide Case-Control Study

    PubMed Central

    Prakash, Siddharth K.; Pedroza, Claudia; Khalil, Yameen A.; Milewicz, Dianna M.

    2012-01-01

    Background Vascular diseases are the principal causes of death and disability in people with diabetes. At the same time, studies suggest a protective role of diabetes in the development of abdominal aortic aneurysms. We sought to determine whether diabetes is associated with decreased hospitalization due to thoracic aortic aneurysms and dissections (TAAD). Methods and Results We used the 2006 and 2007 Nationwide Inpatient Sample (NIS) to determine TAAD discharge rates. Control subjects were randomly selected to achieve three controls per case. Predictor variables in multilevel logistic regression included age, race, median income, diabetes, and hypertension. We estimated that the average rate of hospital discharge for TAAD among individuals diagnosed with diabetes was 9.7 per 10 000, compared to 15.6 per 10 000 among all discharges. The prevalence of diabetes was substantially lower in TAAD (13%) than in control (22%) records. After adjustment for demographic characteristics, the negative association between diabetes and TAAD remained highly significant in both NIS datasets. Compared to discharges without diabetes, those with chronic complications of diabetes were least likely to be diagnosed with TAAD (OR [odds ratio] 0.17, 95% CI, 0.12–0.23). A significant association remained between uncomplicated diabetes and TAAD. We replicated these findings in an independent group of patients who were hospitalized with acute thoracic aortic dissections. Conclusions The principal implication of our findings is that diabetes is independently associated with a decreased rate of hospitalization due to TAAD in proportion to the severity of diabetic complications. Future studies should consider diabetes in predictive models of aneurysm expansion or dissection. (J Am Heart Assoc. 2012;1:jah3-e000323 doi: 10.1161/JAHA.111.000323.) PMID:23130125

  1. Severe diabetic papillopathy mimicking non-arteritic anterior ischemic optic neuropathy (NAION) in a young patient.

    PubMed

    Mallika, P S; Aziz, S; Asok, T; Chong, M S; Tan, A K; Chua, C N

    2012-04-01

    With the pathophysiology not clearly understood and fewer than 130 cases having been reported in the literature, diabetic papillopathy presents a special challenge to the ophthalmologist. We report a case of a young patient with more than 12 years of type 1 diabetes mellitus (T1DM) on insulin with poor compliance to treatment who presented with sudden bilateral loss of vision. Ocular examination, fluorescence angiography (FA) and systemic signs were conclusive of diabetic papillopathy. His fasting blood sugar level was high and serum glycosylated haemoglobin (HbA1c) indicated a long term fluctuating blood glucose control. His vision initially improved with treatment, but later deteriorated with tight glycemic control.

  2. Diabetes Screening, Diagnosis, and Therapy in Pediatric Patients With Type 2 Diabetes

    PubMed Central

    Rodbard, Helena W.

    2008-01-01

    Abstract and Introduction Abstract The dramatic rise in the incidence and prevalence of type 2 diabetes mellitus in the pediatric and adolescent populations has been associated with the ongoing epidemic of overweight, obesity, insulin resistance, and metabolic syndrome seen in these age groups. Although the majority of pediatric patients diagnosed with diabetes are still classified as having type 1 diabetes, almost 50% of patients with diabetes in the pediatric age range (under 18 years) may have type 2 diabetes. Screening of high-risk patients for diabetes and prediabetes is important. Prompt diagnosis and accurate diabetes classification facilitate appropriate and timely treatment and may reduce the risk for complications. This is especially important in children because lifestyle interventions may be successful and the lifelong risk for complications is greatest. Treatment usually begins with dietary modification, weight loss, and a structured program of physical exercise. Oral antidiabetic agents are added when lifestyle intervention alone fails to maintain glycemic control. Given the natural history of type 2 diabetes, most if not all patients will eventually require insulin therapy. In those requiring insulin, improved glycemic control and reduced frequency of hypoglycemia can be achieved with insulin analogs. It is common to add insulin therapy to existing oral therapy only when oral agents no longer provide adequate glycemic control. Introduction The incidence of type 2 diabetes in children and adolescents has reached epidemic proportions in the United States.[1] Recent reports indicate that as many as 45% of pediatric patients diagnosed with diabetes in the United States have type 2 diabetes.[1] Furthermore, the prevalence of type 2 diabetes may be underestimated due to misclassification of the disease.[2] Prior to the late 1990s, only 1% to 2% of children diagnosed with diabetes mellitus in the United States had type 2 diabetes. Since then, owing to a

  3. [Spontaneous gas gangrene in a diabetic patient with Clostridium septicum].

    PubMed

    Mischke, A; Besier, S; Walcher, F; Waibel, H; Brade, V; Brandt, C

    2005-10-01

    Atraumatic infections due to Clostridium septicum are known to be associated with immunosuppression or even malignancy. In this case report, we present a patient with severe Clostridium septicum infection related to advanced colon cancer that had not previously been diagnosed. The case demonstrates the strong association between Clostridium septicum infections and malignancy, particularly in the presence of other predisposing diseases such as diabetes mellitus. It strongly suggests excluding malignant neoplasms, especially of the gastrointestinal tract, when severe Clostridium septicum infections occur. Moreover, if patients with known colorectal or other malignancy develop septicaemia or spontaneous gas gangrene, clinicians should be aware of Clostridium septicum as one of the main causative agents, as early diagnosis and aggressive treatment are important to improve prognosis.

  4. Changes in the tear proteins of diabetic patients

    PubMed Central

    Grus, F H; Sabuncuo, P; Dick, H B; Augustin, A J; Pfeiffer, N

    2002-01-01

    Background Previous studies have shown a significant increase in tear protein peaks in the tears of diabetic patients suffering from dry eye. The aim of this study was to analyze the tear protein patterns from patients with diabetes mellitus who do not suffer from ocular surface diseases (DIA). Methods A total of 515 patients were examined in this study (255 healthy subjects (controls) and 260 patients suffering from diabetes mellitus). Tear proteins were separated by sodium-dodecyl-sulfate polyacrylamide gel electrophoresis. After digital image analysis densitometric data files were created and subsequently used for multivariate statistical procedures. Results A significant increase in the number of peaks was detected in diabetic patients compared to controls (P < 0.0003). The analysis of discriminance revealed a highly significant discrimination between diabetic patients and controls (Wilks lambda: 0.27; P < 0.000001). Furthermore, a significant difference in the protein pattern of diabetic patients could be detected between those suffering from dry eye or not (P < 0.002). The changes in protein patterns of diabetic patients increased with the duration of the diabetic disease. In diabetic patients with a disease duration longer than 10 years the changes were significantly more expressed than in patients with a shorter diabetic history (P < 0.003) and in healthy subjects (P < 0.0001). Conclusions The tear protein patterns of diabetic patients are very different in the number and intensity of spots from those of healthy subjects. Furthermore, it could be demonstrated that the differences found in the tear patterns of diabetic patients are not equal to those found in previous studies in patients suffering from dry-eye disease. The alterations in the diabetic tears were correlated with the duration of the diabetic disease. With longer disease, history changes in the tear protein patterns increased. With the course of the disease some protein peaks appeared that are

  5. Thyroid gland diseases in adult patients with diabetes mellitus.

    PubMed

    Vondra, K; Vrbikova, J; Dvorakova, K

    2005-12-01

    This review concerns the relation between most frequent thyroid gland diseases and diabetes mellitus in adult patients. Special attention is paid to autoimmune thyroiditis, Graves' disease, thyroid autoimmunity in pregnant diabetic women, and iodine metabolism. We focused on mechanisms leading to coexistence of both endocrine disorders, and on distinctions in the prevalence, diagnosis, clinical course and treatment of thyroid diseases in diabetic patients. The prevalence of thyroid diseases in diabetic patients is 2-3 times higher than in nondiabetic subjects; it raises with age, and is strongly influenced by female gender and autoimmune diabetes. Clinical relevance of thyroid diseases, especially in diabetic patients, significantly increases if it is associated with deteriorated function, which always cause a number problems with metabolic compensation of diabetes. Most serious consequences are increased frequency of hypoglycaemia in hypothyroidism and development of potentially life-threatening ketoacidosis in thyrotoxicosis. In spite of that, little attention is paid to the diagnosis of thyroid diseases in diabetics, as they are diagnosed in only about half of the patients. At the end, we provide recommendations for the thyroid disease screening and diagnosis in patients with diabetes mellitus based on our experience.

  6. When "diabetic nephropathy" is not always of diabetic origin: a case report.

    PubMed

    Wróblewski, Krzysztof; Sodolska, Małgorzata; Wągrowska-Danilewicz, Małgorzata; Danilewicz, Marian; Moczulski, Dariusz

    2012-06-01

    The etiology and pathogenesis of fibrillary glomerulonephritis (FGN) remains unknown. The presented case shows an extremely rare FGN in association with commonly diagnosed diabetes. A 74-year-old, non-smoking, obese and diabetic woman was hospitalized due to a progressive and accelerated decrease in the renal function. The primary cause of chronic kidney disease was believed to be of diabetic origin. In the renal biopsy, light microscopy showed glomerular changes resembling diabetic nephropathy, however electron microscopy evaluation revealed linear, randomly arranged fibrils present in the glomerular mesangium and in peripheral capillary loops. The biopsy confirmed fibrillary glomerulopathy.

  7. Diabetic Foot Syndrome as a Possible Cardiovascular Marker in Diabetic Patients

    PubMed Central

    Tuttolomondo, Antonino; Maida, Carlo; Pinto, Antonio

    2015-01-01

    Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality; in fact, some authors showed a higher prevalence of major, previous and new-onset, cardiovascular, and cerebrovascular events in diabetic patients with foot ulcers than in those without these complications. This is consistent with the fact that in diabetes there is a complex interplay of several variables with inflammatory metabolic disorders and their effect on the cardiovascular system that could explain previous reports of high morbidity and mortality rates in diabetic patients with amputations. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects confirmed the pathogenetic issue of the “adipovascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. In patients with diabetic foot, this “adipovascular axis” expression in lower plasma levels of adiponectin and higher plasma levels of IL-6 could be linked to foot ulcers pathogenesis by microvascular and inflammatory mechanisms. The purpose of this review is to focus on the immune inflammatory features of DFS and its possible role as a marker of cardiovascular risk in diabetes patients. PMID:25883983

  8. Polymorphism of catalase gene promoter in Romanian patients with diabetic kidney disease and type 1 diabetes.

    PubMed

    Panduru, N M; Moţa, E; Moţa, Maria; Cimponeriu, D; Serafinceanu, C; Cheţa, D M

    2010-01-01

    Hyperglycaemia leads to ROS (Reactive oxygen species) generation, affecting the cells that cannot decrease glucose uptake such as: glomerular epithelial cells, mesangial cells and proximal tubule cells. ROS excess seems to activate important pathogenic pathways of development of diabetic nephropathy. The decrease of CAT activity, one of the most important antioxidant enzymes, following to some genetic defects, may be a risk factor for diabetic nephropathy. The purpose of this study is to investigate the association of 21A/T (rs7943316) polymorphism of CAT gene with advanced diabetic nephropathy in patients with type 1 diabetes in Romania. There have been studied 238 patients with T1D (type 1 diabetes), divided into the group with diabetic nephropathy (DN) (106 patients) and the group without renal affectation (132 patients). The genotyping has been made by using PCR-RFLP technique. The analysis of association has been made by using DeFinetti programme. The value considered significant has been p < 0.05. There has been a deviation from Hardy-Weinberg equilibrium in the group with diabetic nephropathy (p = 0.019), the equilibrium being preserved by the control group (p = 0.771). T allele does not confer a risk for advanced diabetic nephropathy (ORT = 0.757, 95% C.I. = 0.405-1.414; P = 0.381), the result being statistically insignificant even taking into consideration the risk allele A (ORA = 0.793, 95% C.I. = 0.465-1.350; P = 0.392). The results remain concordant too after applying the Cochran -Armitage test. Our data do not suggest an effect of 21A/T (rs7943316) polymorphism in the susceptibility for diabetic nephropathy in Romanian patients with type 1 diabetes. Further studies are necessary in order to demonstrate or exclude the role of CAT gene in diabetic nephropathy in patients with type 1 diabetes.

  9. Difficulties of Diabetic Patients in Learning about Their Illness.

    ERIC Educational Resources Information Center

    Bonnet, Caroline; Gagnayre, Remi; d'Ivernois, Jean Francois

    2001-01-01

    Examines the difficulties experienced by diabetic patients in learning about their illness. Diabetic people (N=138) were questioned by means of a closed answer questionnaire. Results reveal that patients easily acquired manual skills, yet numerous learning difficulties were associated with the skills required to solve problems and make decisions,…

  10. [Correction of dyslipidemia in patients with chronic hepatitis C, combined with diabetes type 2].

    PubMed

    Derbak, M; Boldizhar, P

    2014-01-01

    The article shows the results of treatment of 118 patients with chronic hepatitis C (CHC) which is associated with type 2 diabetes mellitus (DM). When planning therapeutic interventions in chronic hepatitis C in patients with diabetes, it is considered the presence of visceral obesit , dyslipidemia, and hepatic steatosis. The efficacy of different treatment regimens was studied. Found that the usage of ursodeoxycholic acid and ademetionin in HCV patients with diabetes type 2 receiving standard antiviral therapy (SAVT), significantly make a positive effect on the level of dyslipidemia. The normalization of lipid profile allows for a full course of SAVT, which reduces the frequency of relapse. It is also noted that the simultaneous use of ademetionin and ursodeoxycholic acid in treatment of chronic hepatitis C leads to a reduction of side effects of SAVT. Metabolic therapy may be recommended for patients with chronic hepatitis C in combination with type 2 diabetes in case of SAVT, and at its contraindications or intolerance.

  11. A rare case of abdominal infection: Emphysematous pyelonephritis without diabetes

    PubMed Central

    Ünlüer, Erden Erol; Şahı̇n, Yusuf; Oyar, Orhan; Tan, Gözde Canan; Karagöz, Arı̇f; Turan, Celaleddı̇n

    2016-01-01

    Emphysematous pyelonephritis (EP) is a rare form of necrotizing pyelonephritis. It is a life-threatening condition that usually affects patients with diabetes, and a small percentage may be due to urinary tract obstruction. Here, we present the case of an EP caused by urinary tract obstruction without diabetes. A 45-year-old woman presented to the emergency department with fever, chills, and abdominal pain. There was no significant past history. Physical examination depicted bilateral lower abdominal and right flank knocking tenderness. Laboratory exams revealed leukocytosis, neutrophilia, a high C-reactive protein level, and pyuria. Abdominal computerized tomography (CT) showed diffuse gas in the right renal collecting system and dilatation of the right renal pelvis compared to the right side, in addition to multiple millimetric stones located in the right kidney and right ureter. After emergent placement of a percutaneous nephrostomy, she was admitted. Control abdominal CT without contrast revealed the absence of gas, hydronephrosis of the right renal pelvis, and the presence of nephrolithiasis. The patient was discharged 10 days of post-procedure with instructions for follow-up. Emergency physicians need to remain alert about this life-threatening disease and the typical CT findings of this disease to make a timely diagnosis and navigate management. PMID:28250980

  12. Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy

    PubMed Central

    Kwon, Jin-woo; Jee, Donghyun; La, Tae Yoon

    2017-01-01

    Abstract To evaluate the prevalence and risk factors of neovascular glaucoma (NVG) after vitrectomy in patients with vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR). This retrospective, noncomparative, observational study included 127 eyes of 127 patients with PDR who received vitrectomy with a follow-up period of at least 6 months. The prevalence of NVG and associated risk factors were assessed including sex, age, previous panretinal photocoagulation, baseline intraocular pressure, combined phacovitrectomy, and pretreatment with intravitreal bevacizumab (IVB) before vitrectomy for the treatment of vitreous hemorrhage. NVG developed in 15 (11.8%) of 127 patients. Of the 15 eyes with NVG, 11 cases (73.3%) postoperatively developed NVG within 6 months. Postoperative NVG was associated with preoperative IVB treatment (odds ratio, 4.43; P = 0.019). The prevalence of NVG after vitrectomy was 11.8%, and an associated risk factor for NVG was preoperative IVB for the treatment of vitreous hemorrhage. PMID:28272234

  13. E-Prescribing: Clinical Implications for Patients with Diabetes

    PubMed Central

    Smith, Marie; Dang, Devra; Lee, Jennifer

    2009-01-01

    With the recent Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many clinicians are expected to adopt or enhance their use of e-prescribing systems. E-prescribing has nearly eradicated medication errors resulting from prescriber handwriting interpretations, yet several other patient-care and workflow benefits still remain a promise. As prescribers select or update their e-prescribing systems (whether stand-alone or integrated with electronic health records), close attention is needed to the e-prescribing application features and level of clinical decision support to avoid clinical blind spots, including incomplete or inaccurate patient medication lists, poor drop-down menu or screen design, and lack of clinically relevant and actionable drug interaction and drug allergy alerts. This article presents three case studies that highlight common e-prescribing problems involving diabetes patients. PMID:20144439

  14. Metformin in Patients With Type 2 Diabetes and Kidney Disease

    PubMed Central

    Inzucchi, Silvio E.; Lipska, Kasia J.; Mayo, Helen; Bailey, Clifford J.; McGuire, Darren K.

    2015-01-01

    IMPORTANCE Metformin is widely viewed as the best initial pharmacological option to lower glucose concentrations in patients with type 2 diabetes mellitus. However, the drug is contraindicated in many individuals with impaired kidney function because of concerns of lactic acidosis. OBJECTIVE To assess the risk of lactic acidosis associated with metformin use in individuals with impaired kidney function. EVIDENCE ACQUISITION In July 2014, we searched the MEDLINE and Cochrane databases for English-language articles pertaining to metformin, kidney disease, and lactic acidosis in humans between 1950 and June 2014. We excluded reviews, letters, editorials, case reports, small case series, and manuscripts that did not directly pertain to the topic area or that met other exclusion criteria. Of an original 818 articles, 65 were included in this review, including pharmacokinetic/metabolic studies, large case series, retrospective studies, meta-analyses, and a clinical trial. RESULTS Although metformin is renally cleared, drug levels generally remain within the therapeutic range and lactate concentrations are not substantially increased when used in patients with mild to moderate chronic kidney disease (estimated glomerular filtration rates, 30-60 mL/min per 1.73 m2). The overall incidence of lactic acidosis in metformin users varies across studies from approximately 3 per 100 000 person-years to 10 per 100 000 person-years and is generally indistinguishable from the background rate in the overall population with diabetes. Data suggesting an increased risk of lactic acidosis in metformin-treated patients with chronic kidney disease are limited, and no randomized controlled trials have been conducted to test the safety of metformin in patients with significantly impaired kidney function. Population-based studies demonstrate that metformin may be prescribed counter to prevailing guidelines suggesting a renal risk in up to 1 in 4 patients with type 2 diabetes mellitus

  15. Association Between Overactive Bladder and Polyneuropathy in Diabetic Patients

    PubMed Central

    2016-01-01

    Purpose Diabetes mellitus (DM) is a chronic metabolic disorder that often leads to complications. We aimed to correlate two complications of DM, polyneuropathy and hyperactive bladder syndrome, using noninvasive measures, such as screening tests. Methods We included 80 female and 40 male type 2 diabetic patients in this prospective study. Diabetic polyneuropathy evaluations were conducted using the Douleur Neuropathique 4 Questions (DN4), and overactive bladder (OAB) evaluations were performed using the Overactive Bladder Questionnaire (OAB-V8). The patients were also evaluated for retinopathy and nephropathy. The diabetic male and female patients with or without OAB were chosen and compared for microvascular complications (polyneuropathy, retinopathy, and nephropathy). Results There were no significant correlations between OAB and retinopathy as well as between OAB and nephropathy among diabetic patients (female patients, P>0.05; male patients, P>0.05). However, the patients with OAB were significantly more likely to develop polyneuropathy (female patients, P<0.05; male patients, P<0.05). Conclusions In diabetic patients, OAB and diabetic peripheral neuropathy are significantly correlated. These correlations were demonstrated using short, understandable, valid, and reliable disease-specific tests without invasive measures. Using these screening tests, both neurologists and urologists can easily diagnose these complications. PMID:27706007

  16. Diabetes Causation Beliefs Among Spanish-Speaking Patients

    PubMed Central

    Concha, Jeannie Belinda; Mayer, Sallie D.; Mezuk, Briana R.; Avula, Danielle

    2016-01-01

    Purpose The purpose of this study was to explore how the inquiry of cultural diabetes causation beliefs can improve Hispanic/Latino patient self-management. Methods Two semistructured focus groups were conducted with 13 Hispanic/Latinos adults diagnosed with type 2 diabetes mellitus. Prior to taking part in the group discussion, participants completed a demographic survey and the Illness Perception Questionnaire–Revised. Results The top 5 diabetes causation items endorsed by participants per the questionnaire included stress or worry, behavior, hereditary, diet/eating habits, and family problems/worries. The qualitative analysis revealed stress as a recurring theme for a cause of diabetes. Work stress was specifically identified as a contributor to unhealthy eating and diabetes. Most participants were aware of and believed in susto and referred to it as coraje (anger). Participants believed that asking patients about their diabetes causation beliefs and emotional status can help health professionals (1) better understand the patient and (2) identify and prioritize diabetes treatments. Participants also indicated that the role of doctors is important and the encouragement that they give to patients is clinically and spiritually valued. Conclusions Stress was identified as a cause of diabetes in addition to unhealthy diets and heredity. Asking patients about diabetes causation beliefs and emotional status may help prioritize treatment and management goals. PMID:26568376

  17. [Screening and management of coronary artery disease in diabetic patients].

    PubMed

    Kraiem, Sondos; Abassi, Chedly; Annabi, Nizar; Smaali, Ibtissem; Issaa, Inès; Wali, Mouin; Malou, Monia; Hannachi, Sofiane; Longo, Selma; Battikh, Kaies; Slimane, Mohamed Lotfi

    2006-10-01

    Diabetes represents as independent risk factor for coronary artery disease (CAD) and the prognosis in term of survival rates is worse for diabetic patients who have CAD with report to those with CAD but no diabetes. The coronary artery disease in diabetes has specificities and, in particular, more extensive atherosclerosis. Diabetic patients are also more frequently asymptomatic. Due to the extreme complexity of ischemic vascular disease in patients with diabetes, an optimal therapeutic strategy is based on the correction of elevated blood glucose and lipid levels, of blood pressure, of platelet and coagulation abnormalities. Diabetic patients benefit from secondary prevention by drug therapy(aspirin, lipid lowering with statines, beta blocker and ACE inhibitors) to the same extent as, or more than, non-diabetic patients. Both percutaneous and surgical myocardial revascularization have been proved equally effective for CAD treatment in diabetes. A recent randomized trial has shown a significantly improved outcome after surgical revascularization. But, the effects of drug-eluting stents, which dramatically decrease the incidence of re-stenosis, seem promising.

  18. Ocular Disease, Knowledge, and Technology Applications in Patients with Diabetes

    PubMed Central

    Threatt, Jennifer; Williamson, Jennifer Faye; Huynh, Kyle; Davis, Richard M.

    2013-01-01

    An estimated 25.8 million children and adults in the United States, approximately 8.3% of the population, have diabetes. Diabetes prevalence varies by race and ethnicity. African Americans have the highest prevalence (12.6%), followed closely by Hispanics (11.8%), Asian Americans (8.4%), and Whites (7.1%). The purpose of this article is to discuss the ocular complications of diabetes, the cultural and racial differences in diabetes knowledge, and the role of telemedicine as a means to reach the undeserved who are at risk of complications. Information on the pathophysiology of ocular disease in patients with diabetes and the role of telemedicine in diabetes care was derived from a literature review. National Institutes of Health (NIH) on-line resources were queried to present data on the racial and cultural understandings of diabetes and diabetes-related complications. The microvascular ocular complications of diabetes are discussed for retinopathy, cataracts, glaucoma and ocular surface disease. Racial and cultural differences in knowledge of recommended self-care practices are presented. These differences in part, may explain health disparities and the increased risk of diabetes and its complications in rural minority communities. Finally, advances in telemedicine technology are discussed that show improvements in metabolic control and cardiovascular risk in adults with type 2 diabetes. Improving provider and patient understanding of diabetes complications may improve management and self care practices that are important for diabetes control. Telemedicine may improve access to diabetes specialists and may improve self-management education and diabetes control particularly in rural and underserved communities. PMID:23531956

  19. Changes in retinal microvascular diameter in patients with diabetes

    PubMed Central

    da Silva, Andréa Vasconcellos Batista; Gouvea, Sonia Alves; da Silva, Aurélio Paulo Batista; Bortolon, Saulo; Rodrigues, Anabel Nunes; Abreu, Glaucia Rodrigues; Herkenhoff, Fernando Luiz

    2015-01-01

    Background and objectives Diabetic retinopathy is the main microvascular complication in diabetes mellitus and needs to be diagnosed early to prevent severe sight-threatening retinopathy. The purpose of this study was to quantify the retinal microvasculature pattern and analyze the influence of blood glucose level and the duration of diabetes mellitus on the retinal microvasculature. Methods Two groups were analyzed: patients with diabetes (N=26) and patients without diabetes, ie, controls (N=26). A quantitative semiautomated method analyzed retinal microvasculature. The diameters of arterioles and venules were measured. The total numbers of arterioles and venules were counted. The ratio of arteriole diameter to venule diameter was calculated. The retinal microvasculature pattern was related to clinical and biochemical parameters. Results Patients with diabetes exhibited larger venule diameters in the upper temporal quadrant of the retina compared to the lower temporal quadrant (124.85±38.03 µm vs 102.92±15.69 µm; P<0.01). Patients with diabetes for 5 or more years had larger venule diameters in the upper temporal quadrant than patients without diabetes (141.62±44.44 vs 112.58±32.11 µm; P<0.05). The degree of venodilation in the upper temporal quadrant was positively correlated with blood glucose level and the estimated duration of diabetes mellitus. Interpretation and conclusion The employed quantitative method demonstrated that patients with diabetes exhibited venule dilation in the upper temporal quadrant, and the duration of diabetes mellitus was positively correlated with blood glucose level. Therefore, the early assessment of retinal microvascular changes is possible prior to the onset of diabetic retinopathy. PMID:26345217

  20. [Screening of early color vision loss in diabetic patients].

    PubMed

    Peduzzi, M; Longanesi, L; Ascari, A; Cascione, S; Galletti, M; Roncaia, R; Pacchioni, C; Maione, M

    1989-01-01

    Colour vision defects have been claimed to appear in diabetes before any retinopathy is visible. In the present study diabetic patients and non diabetic control subjects were screened with two different colour vision tests which include both red-green and blue-yellow parts, and are suitable for quantitative analysis of scores. The Lanthony 40 Hue test and the Tokyo Medical College--T.M.C. tables were used to assess colour vision in 106 diabetic (50 insulin dependent and 56 non insulin dependent) patients and in 99 non diabetic control subjects. Diabetic patients without visible retinopathy, familiar colour vision defects and/or lens changes, had significantly higher scores than control subjects in both eyes. The differences were more evident in non insulin dependent patients. Statistical analysis showed that early loss of colour vision was correlated with age and duration of diabetes for older patients, while correlation with glycosylated hemoglobin was moderately positive only for younger patients. Both tests (especially the Lanthony 40 Hue) resulted to be highly specific and could be used for the clinical study of colour vision losses in diabetic patients.

  1. Insulin amyloid at injection sites of patients with diabetes.

    PubMed

    Nilsson, Melanie R

    2016-09-01

    The formation of insulin amyloid can dramatically impact glycemic control in patients with diabetes, making it an important therapeutic consideration. In addition, the cost associated with the excess insulin required by patients with amyloid is estimated to be $3K per patient per year, which adds to the growing financial burden of this disease. Insulin amyloid has been observed with every mode of therapeutic insulin administration (infusion, injection and inhalation), and the number of reported cases has increased significantly since 2002. The new cases represent a much broader demographic, and include many patients who have used exclusively human insulin and human insulin analogs. The reason for the increase in case reports is unknown, but this review explores the possibility that changes in patient care, improved differential diagnosis and/or changes in insulin type and insulin delivery systems may be important factors. The goal of this review is to raise key questions that will inspire proactive measures to prevent, identify and treat insulin amyloid. Furthermore, this comprehensive examination of insulin amyloid can provide insight into important considerations for other injectable drugs that are prone to form amyloid deposits.

  2. Disordered eating behaviors in type 1 diabetic patients

    PubMed Central

    Larrañaga, Alejandra; Docet, María F; García-Mayor, Ricardo V

    2011-01-01

    Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population. PMID:22087355

  3. Disordered eating behaviors in type 1 diabetic patients.

    PubMed

    Larrañaga, Alejandra; Docet, María F; García-Mayor, Ricardo V

    2011-11-15

    Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.

  4. Platelet volume indices as predictive biomarkers for diabetic complications in Type 2 diabetic patients

    PubMed Central

    Buch, Archana; Kaur, Supreet; Nair, Rahul; Jain, Ambuj

    2017-01-01

    BACKGROUND: Platelet volume indices (PVI) such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) are the indicators of increased platelet activity and can be considered as potential biomarkers for diabetic complications. PURPOSE: To study PVI in Type 2 diabetics with and without complications in comparison to nondiabetic patients. MATERIALS AND METHODS: A case–control study was conducted on 300 Type 2 diabetics and 200 nondiabetics. Detailed clinical history regarding duration, hypertension, and complications was taken. PVI was obtained using automated cell counter. Fasting blood glucose, hemoglobin A1c, lipid profile, creatinine were also obtained. Diabetics were further categorized into patients with complications and without complications. Statistical analysis was performed by Statistical Package for the Social Sciences Version 17 (Chicago, IL) Student's t-test and ANOVA test. RESULTS: Platelet count was significantly decreased in diabetics (P = 0.005). MPV was significantly increased in diabetic patients with complications as compared to diabetics without complications and nondiabetic group (P < 0.0001). PDW showed statistically significant difference between diabetics with and without complications and nondiabetics (P < 0.0001). However, no statistically significant difference was observed in platelet-large cell ratio (P-LCR) among all the three study groups. We found statistically significant correlation of MPV with diabetic retinopathy (P = 0.000), nephropathy (P = 0.005), and diabetic foot (P = 0.048). PDW was significantly increased in diabetic retinopathy (P = 0.035) and nephropathy (P = 0.007). P-LCR had no statistically significant correlation with diabetic complications. CONCLUSION: MPV and PDW are predictive biomarkers of diabetic vascular complications. They are more significant in microvascular complications than macrovascular complications. PMID:28367021

  5. Effect of hope therapy on the hope of diabetic patients

    PubMed Central

    Ghazavi, Zahra; Khaledi-Sardashti, Firouz; Kajbaf, Mohamad Bagher; Esmaielzadeh, Mojtaba

    2015-01-01

    Background: Hope is the most important factor in diabetic patients’ life. The level of hope may be changing among these individuals as a result of chronic nature of diabetes and its complications. When the level of hope increases among these patients, they can resist against physical and psychological complications of diabetes more, accept the treatment better, enjoy life more, and adapt with their situations more efficiently. This study aimed to define the efficacy of hope therapy on hope among diabetic patients. Materials and Methods: This was a quasi-experimental study conducted on 38 diabetic patients referring to Sedigheh Tahereh Research and Treatment Center affiliated to Isfahan University of Medical Sciences in Iran in 2012. The subjects were selected based on the goals and inclusion criteria of the study and then were randomly assigned to study and control groups. Herth Hope Index (HHI) was completed by both groups before, after, and 1 month after intervention. In the study group, 120-min sessions of hope therapy were held twice a week for 4 weeks. Descriptive and inferential statistical tests were adopted to analyze the data through SPSS version 12. Results: Comparison of the results showed that hope therapy significantly increased hope in diabetic patients after intervention in the study group compared to control (P < 0.001). Conclusions: The results showed that hope therapy increased hope among diabetic patients. This method is suggested to be conducted for diabetic patients. PMID:25709694

  6. Associations with fracture in patients with diabetes: a nested case–control study

    PubMed Central

    Starup-Linde, Jakob; Gregersen, Søren; Vestergaard, Peter

    2016-01-01

    Objectives Diabetes mellitus is associated with an increased risk of fractures, which is not fully explained by bone mineral density and common risk factors. The aim of this study is to investigate the association of medication and biochemical markers on the risk of fracture in a diabetes population. Design and setting A nested case–control study was conducted based on Danish diabetes patients from The Danish National Hospital Discharge Registry. Participants The cases of the study were diabetes patients with a fracture (n=24 349), and controls were diabetes patients with no fracture (n=132 349). A total of 2627 diabetes patients were available for an analysis of patient characteristics, comorbidities, biochemical parameters and drug usage. Results Age (OR=1.02, 95% CI 1.01 to 1.04), diabetes duration (OR=1.06, 95% CI 1.02 to 1.09), a diagnosis of previous fracture (OR=2.20, 95% CI 1.55 to 3.11), an alcohol-related diagnosis (OR=2.94, 95% CI 1.76 to 4.91), total cholesterol level (OR=2.50, 95% CI 1.20 to 5.21) and the usage of antiepileptics (OR=2.12, 95% CI 1.39 to 3.59) all increased the odds of fracture. Low-density lipoprotein cholesterol levels decreased the odds of fracture (OR =0.34, 95% CI 0.16 to 0.74), where the level of 3.04–5.96 mmol/L was optimal with regard to fracture risk. Conclusions Low-density lipoprotein cholesterol may improve our understanding of fractures in diabetes patients, and it may be added to current fracture risk models in diabetes patients. PMID:26873048

  7. Prevalence of microalbuminuria in relation to glycemic control in type-2 diabetic patients in Mymensingh.

    PubMed

    Hasan, M J; Muqueet, A; Sharmeen, A; Hoque, M R

    2015-01-01

    Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of diabetes mellitus like myocardial infarction, stroke and nephropathy. Poor glycemic control increases the risk of microalbuminuria. This study was conducted to determine the frequency of microalbuminuria in type 2 diabetes and compare the frequency of microalbuminuria in poor and good glycemic control in type 2 diabetes. One Hundred and twenty two type 2 diabetic patients were included in the study. Data on age, gender, duration of diabetes, microalbuminuria and HbA1c were recorded. Urine and blood samples were collected and analyzed for microalbuminuria, blood glucose and HbA1c. All patients of both genders with type 2 diabetes for over 2 years were selected in this study. Patients with other causes of proteinuria were excluded. Out of 120 cases 93(77.5%) were male and 27(22.5%) were female. Mean age of patients was 57.8±14.7 years and average duration of diabetes was 9.2 years. Microalbuminuria was found 76.9% of male and 23.1% of female. Patients with poor glycemic control and good glycemic control have frequency of microalbuminuria of 55% and 54% respectively. Uncontrolled diabetes is strongly associated with prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in newly and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.

  8. Anorexia nervosa complicated by diabetes mellitus: the case for permissive hyperglycemia.

    PubMed

    Brown, Carrie; Mehler, Philip S

    2014-09-01

    The coexistence of Type 1 Diabetes Mellitus and anorexia nervosa results in an increased incidence of known diabetic complications such as retinopathy and nephropathy, presumably because blood glucose is difficult to control within the throes of comorbid anorexia nervosa. In addition, even when a diabetic patient with anorexia nervosa has committed to resolving his or her eating disorder, glucose control is again difficult and fraught with complexity and peril as will be highlighted in the following case report. Prudence dictates that strict glucose control is not indicated for the relatively short period of time that constitutes the early stage of refeeding in a patient with severe anorexia nervosa. Rather, "permissive hyperglycemia" may be the more optimal course to pursue, as a clinical strategy which is considerate of both the criticality of the refeeding treatment plan and of the long-term nature of the diabetic illness.

  9. The DKA that wasn't: a case of euglycemic diabetic ketoacidosis due to empagliflozin

    PubMed Central

    Candelario, Nellowe; Wykretowicz, Jedrzej

    2016-01-01

    Sodium glucose co-transporter (SGLT-2) inhibitor is a relatively new medication used to treat diabetes. At present, the Food and Drug Administration (FDA) has only approved three medications (canagliflozin, dapagliflozin and empagliflozin) in this drug class for the management of Type 2 diabetes. In May 2015, the FDA issued a warning of ketoacidosis with use of this drug class. Risk factors for the development of ketoacidosis among patients who take SGLT-2 inhibitors include decrease carbohydrate intake/starvation, acute illness and decrease in insulin dose. When identified, immediate cessation of the medication and administration of glucose must be done, and in some instances, starting an insulin drip might be necessary. We present a case of a patient with diabetes mellitus being on empagliflozin (SGLT-2 antagonist) who was admitted for acute cholecystitis. The hospital course was complicated by euglycemic diabetic ketoacidosis after being kept nothing per orem before a contemplated cholecystectomy. PMID:27471597

  10. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes

    PubMed Central

    Nyenwe, Ebenezer A.; Jerkins, Terri W.; Umpierrez, Guillermo E.; Kitabchi, Abbas E.

    2013-01-01

    The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes. Although the pathogenesis and long-term complications of type 2 diabetes are fairly well known, its treatment has remained challenging, with only half of the patients achieving the recommended hemoglobin A1c target. This narrative review explores the pathogenetic rationale for the treatment of type 2 diabetes, with the view of fostering better understanding of the evolving treatment modalities. The diagnostic criteria including the role of hemoglobin A1c in the diagnosis of diabetes are discussed. Due attention is given to the different therapeutic maneuvers and their utility in the management of the diabetic patient. The evidence supporting the role of exercise, medical nutrition therapy, glucose monitoring, and antiobesity measures including pharmacotherapy and bariatric surgery is discussed. The controversial subject of optimum glycemic control in hospitalized and ambulatory patients is discussed in detail. An update of the available pharmacologic options for the management of type 2 diabetes is provided with particular emphasis on newer and emerging modalities. Special attention has been given to the initiation of insulin therapy in patients with type 2 diabetes, with explanation of the pathophysiologic basis for insulin therapy in the ambulatory diabetic patient. A review of the evidence supporting the efficacy of the different preventive measures is also provided. PMID:21134520

  11. Left ventricular systolic function in selected type 1 diabetic patients with or without diabetic retinopathy and microalbuminuria.

    PubMed

    Bućan, Kajo; Bojić, Lovro; Fabijanić, Damir; Galetović, Davor; Čapkun, Vesna; Utrobičić, Dobrila Karlica; Bućan, Ivona

    2014-12-01

    Vascular endothelial dysfunction is a basic etiologic factor for the development of late clinical complications in patients with diabetes mellitus type 1, such as diabetic retinopathy, diabetic nephropathy (which is characterized at the very beginning by microalbuminuria), and left ventricular cardiac dysfunction. The aims of this study were to determine the prevalence of asymptomatic left ventricular systolic dysfunction in patients with diabetes mellitus type 1 and with or without diabetic retinopathy and microalbuminuria, and to correlate the duration of diabetes with the dynamics of diabetic retinopathy, microalbuminuria and asymptomatic left ventricular dysfunction development in these patients. One-hundred and twenty selected patients with diabetes mellitus type 1 were examined by ophthalmologist and cardiologist. All patients underwent ergometric testing and two-dimensional (2-D) echocardiography with pulsed Doppler. Patients were divided into three groups according to their fundus findings and microalbuminuria: (1) patients without diabetic retinopathy and without microalbuminuria (n = 40); (2) patients with diabetic retinopathy without microalbuminuria (n = 40); and (3) patients with diabetic retinopathy and microalbuminuria (n = 40). All three groups of patients with diabetes mellitus type 1 (with low cardiovascular risk, regulated blood sugar, and without diabetic neuropathy) had echocardiographic values in the normal range. We found no statistically significant correlation between the duration of diabetes mellitus type 1 and echocardiographic values.

  12. Nrf2 and Redox Status in Prediabetic and Diabetic Patients

    PubMed Central

    Jiménez-Osorio, Angélica S.; Picazo, Alejandra; González-Reyes, Susana; Barrera-Oviedo, Diana; Rodríguez-Arellano, Martha E.; Pedraza-Chaverri, José

    2014-01-01

    The redox status associated with nuclear factor erythroid 2-related factor-2 (Nrf2) was evaluated in prediabetic and diabetic subjects. Total antioxidant status (TAS) in plasma and erythrocytes, glutathione (GSH) and malondialdehyde (MDA) content and activity of antioxidant enzymes were measured as redox status markers in 259 controls, 111 prediabetics and 186 diabetic type 2 subjects. Nrf2 was measured in nuclear extract fractions from peripheral blood mononuclear cells (PBMC). Nrf2 levels were lower in prediabetic and diabetic patients. TAS, GSH and activity of glutamate cysteine ligase were lower in diabetic subjects. An increase of MDA and superoxide dismutase activity was found in diabetic subjects. These results suggest that low levels of Nrf2 are involved in the development of oxidative stress and redox status disbalance in diabetic patients. PMID:25383674

  13. Oral Disease Burden in Northern Manhattan Patients With Diabetes Mellitus

    PubMed Central

    Lalla, Evanthia; Park, David B.; Papapanou, Panos N.; Lamster, Ira B.

    2004-01-01

    Objectives. We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population. Methods. Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. Results. There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. Conclusions. Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes PMID:15117696

  14. Oral Disease Burden in Northern Manhattan Patients With Diabetes Mellitus

    PubMed Central

    Lalla, Evanthia; Park, David B.; Papapanou, Panos N.; Lamster, Ira B.

    2008-01-01

    Objectives. We explored the association between diabetes mellitus and oral disease in a low-socioeconomic-status urban population. Methods. Dental records of 150 adults with diabetes and 150 nondiabetic controls from the dental clinic at Columbia University in Northern Manhattan matched by age and gender were studied. Results. There was a 50% increase in alveolar bone loss in diabetic patients compared with nondiabetic controls. Diabetes, increasing age, male gender, and use of tobacco products had a statistically significant effect on bone loss. Conclusions. Our findings provide evidence that diabetes is an added risk for oral disease in this low-income, underserved population of Northern Manhattan. Oral disease prevention and treatment programs may need to be part of the standards of continuing care for patients with diabetes PMID:18687631

  15. Normoglycemic Diabetic Ketoacidosis in a Pregnant Patient with Type II Diabetes Mellitus Presenting for Emergent Cesarean Delivery.

    PubMed

    Cardonell, Bradford L; Marks, Barry A; Entrup, Michael H

    2016-04-15

    The development of acute abdominal pain in a laboring parturient after a previous cesarean delivery is of concern and may be the result of a potentially life-threatening condition such as uterine rupture. We present a case of a parturient with type II diabetes mellitus, who had undergone 2 previous cesarean deliveries and now presented in labor with increasing abdominal pain. An emergency cesarean delivery was performed for probable uterine rupture. Intraoperatively, the patient was noted to be severely hypocarbic with significant metabolic acidosis, and the diagnosis of diabetic ketoacidosis was established.

  16. Infratemporal Space Infection Following Maxillary Third Molar Extraction in an Uncontrolled Diabetic Patient

    PubMed Central

    Mesgarzadeh, Ali Hossein; Ghavimi, Mohammad Ali; Gok, Gulşen; Zarghami, Afsaneh

    2012-01-01

    Infratemporal space infection is a rare but serious sequel of odontogenic infection. The diagnosis is difficult due to non spe-cific signs and symptoms. Diabetes mellitus as a definitive risk factor for odontogenic infections needs more consideration during clinical procedures. We report a case of an undiagnosed diabetic patient with isolated infratemporal space infection after tooth extraction with presentation of similar signs and symptoms of temporomandibular joint and muscle problem. PMID:22991649

  17. Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

    PubMed Central

    Devrajani, Bikha Ram; Shah, Syed Zulfiquar Ali; Soomro, Aftab Ahmed; Devrajani, Tarachand

    2010-01-01

    Objective: To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups. Study Design: Case control. Place and Duration: Department of Medicine, Liaquat University Hospital from October 2007 to March 2008. Materials and Methods: This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of ≥ 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis. Results: Majority of the patients were male with mean age ± SD, 52.86 ± 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication. Conclusion: Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection. PMID:20431802

  18. Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics

    PubMed Central

    Agarwal, Aniruddha; Soliman, Mohamed K; Sepah, Yasir J; Do, Diana V; Nguyen, Quan Dong

    2014-01-01

    Diabetes and its microvascular complications in patients poses a significant challenge and constitutes a major health problem. When it comes to manifestations in the eye, each case of diabetic retinopathy (DR) is unique, in terms of the phenotype, genotype, and, more importantly, the therapeutic response. It is therefore important to identify factors that distinguish one patient from another. Personalized therapy in DR is a new trend aimed at achieving maximum therapeutic response in patients by identifying genotypic and phenotypic factors that may result in less than optimal response to conventional therapy, and consequently, lead to poorer outcome. With advances in the identification of these genetic markers, such as gene polymorphisms and human leucocyte antigen associations, as well as development of drugs that can target their effects, the future of personalized medicine in DR is promising. In this comprehensive review, data from various studies have been analyzed to present what has been achieved in the field of pharmacogenomics thus far. An insight into future research is also provided. PMID:25548526

  19. Assessment of Diabetic Polyneuropathy and Plantar Pressure in Patients with Diabetes Mellitus in Prevention of Diabetic Foot

    PubMed Central

    Skopljak, Amira; Sukalo, Aziz; Batic-Mujanovic, Olivera; Muftic, Mirsad; Tiric-Campara, Merita; Zunic, Lejla

    2014-01-01

    Introduction: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. Material and methods: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. Results: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That’s a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). Conclusion: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes. PMID:25650237

  20. [Diabetes insipidus in infancy. II. Study of eleven cases (author's transl)].

    PubMed

    de Yturriaga, R; Barrio, R; Nieto, J A; Rabadán, B; Lledó, G; Gracia, R

    1977-01-01

    Eleven cases of diabetes insipidus are revised and distributed in the following four groups: I. Idiopathic diabetes insipidus, three. II. Secondary diabetes insipidus, four. III. Nephrogenic diabetes insipidus, two. IV. Psychogenic diabetes insipidus, two. In all these cases, clinical parameters, general analysis, hydric metabolism (static and dinamic), are studied. The precocious beginning of psychogenic diabetes insipidus, and some conclusions, on a difficult case of hard diagnosis are emphasized.

  1. Diabetes as an increasingly common comorbidity among patient hospitalizations for tuberculosis in the USA

    PubMed Central

    Zahr, Roula S; Peterson, Ryan A; Polgreen, Linnea A; Cavanaugh, Joseph E; Hornick, Douglas B; Winthrop, Kevin L; Polgreen, Philip M

    2016-01-01

    Objective Diabetes is a risk factor for active tuberculosis (TB). The purpose of this paper was to estimate the risk of hospitalization for TB with and without a secondary diagnosis of diabetes in groups with different ethnic backgrounds. Research design and methods We used the Nationwide Inpatient Sample from 1998 to 2011, identifying all patients with a primary diagnosis of TB and/or a secondary diagnosis of diabetes (type 1 or type 2) or HIV. Next, we performed logistic regression to investigate the association of diabetes status, HIV status, and race (and the interaction of diabetes and race) with the risk of hospitalization with a primary diagnosis of TB. We also included a time covariate, to determine whether potential risk factors changed during the study period. Results Controlling for HIV status, diabetes did not increase the odds of TB in white and black patients. However, in Hispanic and Asian/Pacific Islander patients, diabetes increased the odds of TB by a factor of 1.7 (95% CI 1.51 to 1.83). Asian/Pacific Islanders who had diabetes but not HIV experienced 26.4 (95% CI 23.1 to 30.1) times the odds of TB relative to the white males without diabetes or HIV. In addition, the percent of TB cases that belong to these high-risk groups (Asian/Pacific Islander/Hispanic diabetics) has more than doubled from 4.6% in 1998 to 9.6% in 2011. Conclusions In specific demographic groups, diabetes was a strong risk factor for hospital admissions for TB. PMID:27843553

  2. Predictors of direct cost of diabetes care in pediatric patients with type 1 diabetes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study examines factors that predict elevated direct costs of pediatric patients with type 1 diabetes. Methods: A cohort of 784 children with type 1 diabetes at least 6 months postdiagnosis and managed by pediatric endocrinologists at Texas Children's Hospital were included in this study. Actual...

  3. Prevalence of peripheral neuropathy in type 2 diabetic patients attending a diabetes center in Turkey.

    PubMed

    Börü, Ulkü Türk; Alp, Recep; Sargin, Haluk; Koçer, Abdulkadir; Sargin, Mehmet; Lüleci, Arda; Yayla, Ali

    2004-12-01

    The aim of this study was to determine the prevalence and risk factors for neuropathy in type 2 diabetic patients attending a major Turkish diabetes center. Eight hundred and sixty-six consecutive type 2 diabetic patients were included in the study. A single observer performed biothesiometry studies on these patients. The presence of diabetic neuropathy was investigated using neurological symptom scale (NSS) and neurological disability score (NDS) performed. Neuropathy was determined with standardized neurological examinations and defined as the presence of abnormal NSS and NDS together with abnormal sensory or motor signs and symptoms as well as decreased great toe vibration perception. Overall, 60% (n = 520) of the patients were diagnosed as having neuropathy. The prevalence of neuropathy increased with age (p < 0.001) and duration of diabetes (p < 0.001). Multiple logistic regression analysis revealed the duration of diabetes (p < 0.001) and HbA1c levels (p < 0.001) as the risk factors for neuropathy. The overall prevalence of neuropathy in Turkish type 2 diabetic population was 60%. Age, duration of diabetes, and poor glycemic control were considered to be the risk factors for neuropathy.

  4. Predictors of Glycated Hemoglobin among Jordanian Diabetic Patients

    PubMed Central

    HAMMAD, Sawsan; DARAWAD, Muhammad; HOURANI, Eman; DEMEH, Waddah

    2015-01-01

    Background: We explored the level of Jordanian patients' knowledge, diabetes related distress, self-management activities and these effects on the A1C level. Methodology: This descriptive cross-sectional correlational design (conducted in 2013) was utilized to recruit 289 diabetic patients from outpatient diabetes clinics, using self-reported questionnaires (Diabetes Knowledge Test, Diabetes Distress Scale, and Diabetes Self-Management Questionnaire) in addition to chart review for selected variables. Results: Participants' had mean glycated hemoglobin of 7.88%. Good glycemic control was significantly associated with higher self-management activities (r= −.147), high income (r= −.171), older age (r= −.252), shorter duration of illness (r= .153), and low levels of distress. Despite these relationships only age, duration of illness and income significantly predicted A1C (F (5, 284) = 11.57, P<.001, R2 = .17). Further, diabetes knowledge, diabetes-related distress, and self-management could not predict A1C level. Conclusion: Only diabetes-related distress and self-management correlated with patients' A1C, with no predictive power. Thus, further research is required to shed the light on the large unexplained components of the A1C variance. PMID:26744705

  5. [Antibiotic treatment in patients amputated for ischemic diabetic foot].

    PubMed

    Fernández Montequín, J I; McCook Martínez, J; Lima Santana, B; Velasco Armas, N; Montalvo Diago, J; Mahía Vilas, M

    1991-01-01

    Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment.

  6. Iloprost infusion in diabetic patients with peripheral arterial occlusive disease and foot ulcers.

    PubMed

    Mirenda, Francesco; La Spada, Michele; Baccellieri, Domenico; Stilo, Francesco; Benedetto, Filippo; Spinelli, Francesco

    2005-01-01

    The aim of the study was to evaluate iloprost infusion as an alternative to open surgical revascularisation in diabetic patients with foot ulcers, also as a support measure in conjunction with endovascular procedures. We studied 244 patients with critical ischaemia of the lower limbs, 146 of whom (59.8%) affected by diabetes. A femoro-distal bypass was performed in 175 patients. In the 69 nonsurgical diabetic patients (47.3% of the diabetics) an iloprost infusion was started. These diabetics presented foot ulcers, a palpable or slightly hypo-sphygmic popliteal pulse and high distal arterial flow at the ankle. In 55 of these patients (79.7% of those not operated on and 37.6% of the diabetics) who were non-responders to medical therapy, an endovascular procedure was also performed. The results of the iloprost infusion (69 pts.) were evaluated after one week. In 14 responders treated only with iloprost infusion, complete healing of the lesions occurred during the 3 weeks following the end of the 4-week course of therapy. No severe ischaemia recurrences were reported in the follow-up of these 69 patients. In the 47.3% of subjects with diabetic arteriopathy presenting foot ulcers and high distal flow, it proved possible to avoid an open surgical revascularisation procedure and to resort to medical therapy with iloprost, completed in 79.7% of cases with endovascular procedures. Iloprost infusion improves limb perfusion and, in selected cases may be an important therapeutic tool for the care of ulcerative lesions of the diabetic foot, also as a support measure in conjunction with endovascular procedures.

  7. Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil

    PubMed Central

    2011-01-01

    Diabetic foot wounds represent a class of chronic non-healing wounds that can lead to the development of soft tissue infections and osteomyelitis. We reviewed the case of a 44-year-old female with a diabetic foot wound who developed gas gangrene while treating her wound with tea tree oil, a naturally derived antibiotic agent. This case report includes images that represent clinical examination and x-ray findings of a patient who required broad-spectrum antibiotics and emergent surgical consultation. Emergency Department (ED) detection of these complications may prevent loss of life or limb in these patients. PMID:21559069

  8. Evaluation of patients with intracranial tumors and central diabetes insipidus.

    PubMed

    Varan, Ali; Atas, Erman; Aydın, Burça; Yalçın, Bilgehan; Akyüz, Canan; Kutluk, Tezer; Büyükpamukçu, Münevver

    2013-10-01

    The aim of the study is to evaluate the etiologic and clinical characteristics, treatment regimens, and outcome of the patients with intracranial tumors presenting with central diabetes insipidus (DI). Sixty-nine patients with intracranial tumors presenting with central DI between 1972 and 2012 were retrospectively evaluated. Fifty-three out of 69 patients were included in the analysis. Male/female ratio was 1.52, median age was 7.6 years. Of 53 patients, 37 patients (69.8%) were diagnosed with Langerhans cell histiocytosis, 14 patients (26.4%) with germinoma, 1 (1.9%) with astrocytoma, and 1 (1.9%) with optic glioma. 10-year overall survival (OS) rate and disease-free survival rate for all patients were 91.7% and 52%. 10-year OS rate according to diagnostic criteria was 91% for Langerhans cell histiocytosis (LCH) cases, 79% for intracranial germinoma, which was statistically significant (P = .0001). Central DI may be very important clinical presentation of serious underlying disease in children. Intracranial tumors are the most frequent cause of DI. Most frequent diagnosis were LCH and germ cell tumors in our series.

  9. 3D DCE-MRA of pedal arteries in patients with diabetes mellitus

    NASA Astrophysics Data System (ADS)

    Zamyshevskaya, M.; Zavadovskaya, V.; Zorkaltsev, M.; Udodov, V.; Grigorev, E.

    2016-02-01

    Purpose was identification and evaluation of pedal vascularization in diabetic patients of using contrast MR-angiography (3D DCE-MRA). 23 diabetic feet of 23 patients (15 male, 8 female; mean age 56 ± 14.6) underwent 3D DCE-MRA (Gadobutrol 15ml) at 1.5 T. Imaging analysis included blood-flow's speed, vascular architectonic's condition and character of contrast's accumulation. Osteomyelitis was verified by surgery in 15 cases. All patients were divided in 3 groups: neuropathic, neuroischemic, ischemic forms of diabetic foot. First- pass MRA detected significant delay of contrast's arrival in ischemic group. There were no significant differences between the values of neuropathic and neuroischemic forms of diabetic foot. Pedal vessels in patients were absent. Contrast MRA revealed three types of contrast distribution in soft tissues: uniform, local increase and local absence. Osteomyelitis was associated with diffuse enhanced contrast accumulation in all cases. In summary, MRI blood vessel imaging is a promising and valuable method for examining peripheral arterial changes in diabetic foot and might be useful for treatment planning in different forms of diabetic foot.

  10. Comparison and correlation of candidal colonization in diabetic patients and normal individuals

    PubMed Central

    2014-01-01

    Background Diabetes mellitus is a common universal endocrine disorder with decreased host immunity towards infections. In these people the most common opportunistic infection is oral candidiasis. Oral candidiasis is most commonly caused by yeast like fungus Candida albicans. In healthy individuals these microorganisms are believed to be commensals but in diabetic patients, it forms severe colonization, even in the absence of any clinically evident oral candidiasis. This type of subclinical colonization can make them more prone to develop deeper mucosal colonization with further dissemination via blood. The aim of this study is to compare the frequency and severity of oral candidal colonization in diabetic patients with normal individuals through cytological method. Methods 30 cases of diabetic patients and 30 cases of normal healthy individuals were examined to determine the oral candidal colonization through oral exfoliative cytological methods. Statistical analysis was done using the Chi - square test. Results A statistically significant increase in the candidal colonization was observed in diabetic patients as compared to normal individuals. Conclusions Oral exfoliative cytological method is an easy and effective chair side technique to assess the oral candidal colonization in the diabetic group. PMID:24991533

  11. Infections in patients with diabetes mellitus: A review of pathogenesis

    PubMed Central

    Casqueiro, Juliana; Casqueiro, Janine; Alves, Cresio

    2012-01-01

    In general, infectious diseases are more frequent and/or serious in patients with diabetes mellitus, which potentially increases their morbimortality. The greater frequency of infections in diabetic patients is caused by the hyperglycemic environment that favors immune dysfunction (e.g., damage to the neutrophil function, depression of the antioxidant system, and humoral immunity), micro- and macro-angiopathies, neuropathy, decrease in the antibacterial activity of urine, gastrointestinal and urinary dysmotility, and greater number of medical interventions in these patients. The infections affect all organs and systems. Some of these problems are seen mostly in diabetic people, such as foot infections, malignant external otitis, rhinocerebral mucormycosis, and gangrenous cholecystitis. In addition to the increased morbidity, infectious processes may be the first manifestation of diabetes mellitus or the precipitating factors for complications inherent to the disease, such as diabetic ketoacidosis and hypoglycemia. Immunization with anti-pneumococcal and influenza vaccines is recommended to reduce hospitalizations, deaths, and medical expenses. PMID:22701840

  12. Bendamustine-Induced Nephrogenic Diabetes Insipidus in a Patient With AL Amyloidosis.

    PubMed

    Uwumugambi, Nsabimana A; Sanchorawala, Vaishali; Shelton, Anthony C; Stern, Lauren; Gordon, Craig E

    2017-02-01

    Nephrogenic diabetes insipidus is a condition characterized by polyuria with dilute urine due to the inability of the principal cells of the renal collecting ducts to respond to antidiuretic hormone and concentrate urine. Nephrogenic diabetes insipidus can be drug induced, and several chemotherapeutic agents have been reported to cause it. Bendamustine is a traditional chemotherapeutic agent being studied for treatment for relapsed systemic AL amyloidosis. We report a case of a 59-year-old man with AL amyloidosis who developed partial nephrogenic diabetes insipidus after receiving bendamustine for treatment of AL amyloidosis. The nephrogenic diabetes insipidus responded well to sodium restriction, hydrochlorothiazide, and desmopressin treatment, allowing the patient to receive subsequent bendamustine cycles without polyuria. Nephrogenic diabetes insipidus resolved shortly after completion of bendamustine therapy.

  13. [Dental local anesthesia in patients with diabetes mellitus].

    PubMed

    Klammt, J; Krüger, H U; Thoma, C

    1978-09-01

    In 51 tooth extractions in medicinally controlled diabetics, adrenaline and noradrenaline (used as vasoconstricting additives to the local anaesthetic) did not differ in their effects on the blood-sugar level. A clinically important or lasting disturbance of the carbohydrate metabolism was observed in no case. The general preference given to noradrenaline as a vasoconstrictor in diabetics is not supported by the present study.

  14. Height at diagnosis of insulin dependent diabetes in patients and their non-diabetic family members.

    PubMed Central

    Songer, T J; LaPorte, R E; Tajima, N; Orchard, T J; Rabin, B S; Eberhardt, M S; Dorman, J S; Cruickshanks, K J; Cavender, D E; Becker, D J

    1986-01-01

    Height at the onset of insulin dependent diabetes mellitus was evaluated in 200 newly diagnosed children, 187 non-diabetic siblings, and 169 parents. Diabetic children 5-9 years of age at diagnosis were consistently taller than the national average. Non-diabetic siblings of the same age were also tall. Diabetic children aged 14 or over at diagnosis were short, while their siblings and parents were of normal height. Diabetic children positive for islet cell antibodies were taller than those without islet cell antibodies. No association between height and HLA antigens was found. Non-diabetic siblings at high risk for the disease were closer in height to the diabetic children than were the lower risk, non-diabetic siblings. Siblings, particularly those under 10, were also significantly more obese than the general population. Deviations in growth in patients with insulin dependent diabetes mellitus appear to be related to age at diagnosis and a factor(s) not related to parental height. PMID:3087454

  15. Presence and Risk Factors for Glaucoma in Patients with Diabetes

    PubMed Central

    Song, Brian J.; Aiello, Lloyd Paul; Pasquale, Louis R.

    2017-01-01

    Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure – the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better-defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients. PMID:27766584

  16. Benefit of Blood Pressure Control in Diabetic Patients.

    PubMed

    Kintscher, Ulrich

    2015-07-01

    The coexistence of arterial hypertension and diabetes represents a devastating partnership for cardiovascular health. Thus, blood pressure and blood glucose control are essential therapeutic goals to reduce cardiovascular risk and other diabetes-related endpoints in these patients. The major benefit of blood pressure lowering in diabetes comes from a marked reduction of cardiovascular and renal endpoints. New target blood pressure values to achieve maximum cardiovascular and renal protection will be discussed. In addition to the reduction of macrovascular endpoints, blood pressure lowering therapy in diabetic patients has also been discussed to improve microvascular diseases during diabetes, in particular microalbuminuria or diabetic retinopathy. However, current clinical trial evidence is less robust than for macrovascular disease. Clinical studies showed controversial results, and will be discussed. Finally, new data from the ADVANCE-ON study about the long-term, sustained benefit of blood pressure lowering in hypertensive, diabetic patients has been recently published, and will be evaluated in the context of previous evidence. In summary, the present article will discuss selected new topics in the field of hypertension and diabetes focusing on the benefits achieved by blood pressure lowering in these patients.

  17. Oral Health Related Quality of Life in Diabetic Patients

    PubMed Central

    Sadeghi, Rokhsareh; Taleghani, Ferial; Farhadi, Sareh

    2014-01-01

    Background and aims. Diabetic patients display an increased risk of oral disorders, and oral health related quality of life (OHRQL) might affect their management and treatment modalities. The aim of the present study was to determine OHRQL and associated parameters in patients with diabetes. Materials and methods. In this study two hundred patients were recruited from the diabetes clinic in Mustafa Khomeini Hospital in Tehran, Iran. OHRQL was assessed using Oral Health Impact Profile Questionnaire (OHIP-20). Also, another questionnaire was designed which contained questions regarding participants’ knowledge about oral complications of diabetes and oral health behavior. OHRQL was categorized as low and good. Data were analyzed using logistic regression at P = 0.05. Results. Of the diabetic patients assessed, 77.5% were in good and 22.5% were in low categories of OHRQL. This quality was significantly associated with age (OR = 4.03, 95% CI = 1.63-11.29), knowledge about diabetes oral complications (OR = 18.17 95% CI = 4.42-158.6), educational level (OR = 26.31 95% CI = 4.2-1080.3), referred for dental visit by physician (OR = 3.16 95% CI = 1.48-6.69), frequency of brushing (OR = 10.29 95% CI = 3.96-31.2) and length of time diagnosed with diabetes (OR = 6.21 95% CI = 2.86-13.63). Conclusion. Oral health related quality of life was not negatively affected by diabetes mellitus in the assessed sample. PMID:25587385

  18. Association Between Diabetic Macular Edema and Cardiovascular Events in Type 2 Diabetes Patients

    PubMed Central

    Leveziel, Nicolas; Ragot, Stéphanie; Gand, Elise; Lichtwitz, Olivier; Halimi, Jean Michel; Gozlan, Julien; Gourdy, Pierre; Robert, Marie-Françoise; Dardari, Dured; Boissonnot, Michèle; Roussel, Ronan; Piguel, Xavier; Dupuy, Olivier; Torremocha, Florence; Saulnier, Pierre-Jean; Maréchaud, Richard; Hadjadj, Samy

    2015-01-01

    Abstract Diabetic macular edema (DME) is the main cause of visual loss associated with diabetes but any association between DME and cardiovascular events is unclear. This study aims to describe the possible association between DME and cardiovascular events in a multicenter cross-sectional study of patients with type 2 diabetes. Two thousand eight hundred seven patients with type 2 diabetes were recruited from diabetes and nephrology clinical institutional centers participating in the DIAB 2 NEPHROGENE study focusing on diabetic complications. DME (presence/absence) and diabetic retinopathy (DR) classification were based on ophthalmological report and/or on 30° color retinal photographs. DR was defined as absent, nonproliferative (background, moderate, or severe) or proliferative. Cardiovascular events were stroke, myocardial infarction, and lower limb amputation. Details regarding associations between DME and cardiovascular events were evaluated. The study included 2807 patients with type 2 diabetes, of whom 355 (12.6%) had DME. DME was significantly and independently associated with patient age, known duration of diabetes, HbA1c, systolic blood pressure, and DR stage. Only the prior history of lower limb amputation was strongly associated with DME in univariate and multivariate analyses, whereas no association was found with regard to myocardial infarction or stroke. Moreover, both major (n = 32) and minor lower limb (n = 96) amputations were similarly associated with DME, with respective odds ratio of 3.7 (95% confidence interval [CI], 1.77–7.74; P = 0.0012) and of 4.29 (95% CI, 2.79–6.61; P < 0.001). DME is strongly and independently associated with lower limb amputation in type 2 diabetic patients. PMID:26287408

  19. Abdominal pain in an adult with Type 2 diabetes: A case report

    PubMed Central

    Panagoulias, George; Tentolouris, Nicholas; Ladas, Spiros S

    2008-01-01

    Introduction Chronic abdominal pain (CAP) may be a manifestation of diseases involving many intra-abdominal organs. Beside diseases affecting subjects without diabetes mellitus, diabetic patients may have CAP due to diabetes-related complications like neuritis, motor diseases of the gastrointestinal tract and autonomic dysfunction. Atherosclerosis is 2–4 times more common in patients with diabetes and affects mainly carotid, coronary, iliac and lower limb arteries as well as aorta. Another less common complication is chronic mesenteric ischemia (CMI, intestinal angina), caused by atherosclerotic obstruction of the celiac artery and its branches and results in episodic or constant intestinal hypoperfusion. Case presentation We present a case of a diabetic patient with CMI in whom the diagnosis was delayed by almost 5 years. The dominant symptoms were crampy abdominal postprandial pain, anorexia, changes in bowel habits and cachexia. Conventional angiography revealed significant stenosis of the celiac artery and complete obstruction of the inferior mesenteric artery. Noteworthy, no significant stenoses in carotids or limbs' arteries were found. Revascularization resulted in clinical improvement 1 week post-intervention. Conclusion CAP in patients with diabetes may be due to CMI. The typical presentation is crampy postprandial abdominal pain in a heavy smoker male patient with long-standing diabetes, accompanied by anorexia, changes in bowel habits and mild to moderate weight loss. At least two of the three main splanchnic arteries must be significantly occluded in order CMI to be symptomatic. The diagnostic procedure of choice is conventional angiography and revascularization of the occluded arteries is the radical treatment. PMID:18798976

  20. Clinical Characteristics of Diabetic Patients Transferred to Korean Referral Hospitals

    PubMed Central

    Oh, Min Young; Kim, Sang Soo; Lee, In Kyu; Baek, Hong Sun; Lee, Hyoung Woo; Chung, Min Young

    2014-01-01

    Background We evaluated the disease profile and clinical management, including the status of both glycemic control and complications, in patients with diabetes who were transferred to referral hospitals in Korea. Methods Patients referred to 20 referral hospitals in Gyeongsangnam/Gyeongsangbuk-do and Jeollanam/Jeollabuk-do with at least a 1-year history of diabetes between January and June 2011 were retrospectively reviewed using medical records, laboratory tests, and questionnaires. Results A total of 654 patients were enrolled in the study. In total, 437 patients (67%) were transferred from clinics and 197 (30%) patients were transferred from hospitals. A total of 279 patients (43%) visited higher medical institutions without a written medical request. The main reason for the referral was glycemic control in 433 patients (66%). Seventy-three patients (11%) had received more than one session of diabetic education. Only 177 patients (27%) had been routinely self-monitoring blood glucose, and 146 patients (22%) were monitoring hemoglobin A1c. In addition, proper evaluations for diabetic complications were performed for 74 patients (11%). The most common complication was neuropathy (32%) followed by nephropathy (31%). In total, 538 patients (82%) had been taking oral hypoglycemic agents. A relatively large number of patients (44%) had been taking antihypertensive medications. Conclusion We investigated the clinical characteristics of diabetic patients and identified specific problems in diabetic management prior to the transfer. We also found several problems in the medical system, which were divided into three medical institutions having different roles in Korea. Our findings suggested that the relationships among medical institutions have to be improved, particularly for diabetes. PMID:25349826

  1. [Monogenic form of diabetes mellitus due to HNF4α mutation (MODY-1) - the first case in Hungary].

    PubMed

    Jermendy, György; Balogh, István; Gaál, Zsolt

    2016-03-20

    The classification of diabetes mellitus in adolescents and young adults is often difficult. The diagnosis of the monogenic form of diabetes may have substantial influence on quality of life, prognosis and the choice of the appropriate treatment of affected patients. Among MODY (maturity-onset of diabetes in the young) MODY-1 is rarely detected, only 13 families were described in 2000, and 103 different mutations in 173 families were known in 2013 worldwide. The authors present the first Hungarian case of a monogenic form of diabetes due to HNF4α mutation (MODY-1). The diabetes of the index patient No. 1 (42-year-old woman with insulin treated diabetes) was diagnosed as gestational diabetes at age of 20 when she was treated with diet only. Later, insulin treatment has been initiated when marked hyperglycaemia was detected during an episode of acute pneumonia at age of 26. The diabetes of the index patient No. 2 (20-year-old daughter of the index patient No. 1, treated also with insulin) was diagnosed as type 2 diabetes at age of 13 and the patient was treated with diet only. Later the classification was modified to type 1 and insulin therapy was initiated at age of 14. The manifestation of diabetes, the familial occurrence and the low dose insulin requirement were suggestive for monogenic diabetes. Using molecular genetic method a mutation (c.869G>A, p.R290H) of HNF4α gene was found and MODY-1 was diagnosed in both cases. Insulin therapy was switched to treatment with low dose sulfanylurea and an excellent glycaemic control was achieved and sustained at follow-up of 1-year. No further positive cases were found during screening of other family members.

  2. Chronic maxillary sinusitis and diabetes related maxillary osteonecrosis: a case report

    PubMed Central

    2015-01-01

    Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment. PMID:26734561

  3. Indium-111-oxine labeled platelet kinetics in patients with diabetes mellitus

    SciTech Connect

    Forstrom, L.A.; Luikens, B.; Johnson, T.

    1984-01-01

    The possible role of abnormal platelet function in the pathogenesis of vascular disease in patients with diabetes mellitus remains controversial. In vitro studies have shown variable alterations in platelet function in such patients. Studies of in vivo platelet kinetics in diabetic patients have been inconclusive, although decreased platelet survival has been observed in some cases. Earlier studies were carried out using chromium-51 or selenium-75 for platelet labeling. The authors have performed Indium-111-oxine labeled platelet kinetic and biodistribution studies in 4 patients with diabetes mellitus (ages 49-61 years), and in 4 control subjects (ages 46-60 years). All subjects were male. All diabetic patients were poorly controlled at the time of study, with blood glucose > 140 mg% and hemoglobin A-1c > 10%. Autologous platelets were labeled with Indium-111-oxine in ACD:plasma by previously reported methods, and reinjected in a dose of approximately 50 ..mu..Ci (range 42-67..mu..Ci). Average recovery of the injected platelets was 67% (range 41-85%). Computer analyzed images at 24 hours showed no significant difference in liver uptake between diabetic and control subjects. Mildly increased splenic uptake in diabetic patients was of borderline significance (p=.07). Platelet survival was slightly decreased in diabetic subjects by 3 of 4 models utilized (linear, exponential, multiple hit and weighted mean), although the difference achieved significance only for the weighted man model (p=.05). These data support observations by earlier methods which suggest that platelet survival may be decreased in patients with diabetes mellitus.

  4. [Anti-TPO antibodies and screening of thyroid dysfunction in type 1 diabetic patients].

    PubMed

    Maugendre, D; Guilhem, I; Karacatsanis, C; Poirier, J Y; Leguerrier, A M; Lorcy, Y; Derrien, C; Sonnet, E; Massart, C

    2000-12-01

    The diagnosis of thyroid dysfunction is often late in type 1 diabetic population. So, the aims of this study were 1) to evaluate the prevalences of thyroperoxydase (TPO) and thyroglobulin (Tg) autoantibodies detected by highly sensitive radioimmunological method in a cohort of 258 adult type 1 diabetic patients without evidence of clinical thyroid disease; 2) to determine whether or not measurement of TPO and/or Tg antibodies can identify subjects at risk of clinical or infraclinical thyroid dysfunction by measuring TSH in the entire group. TPO antibodies were found in 45 of the 258 diabetic patients (17%). The prevalence of TPO antibodies was not influenced by the following factors: gender, duration of disease, age at screening and at diabetes diagnosis, positivity of familial history. Tg antibodies were found in 19 patients (7%), including 13 cases with TPO antibodies. All patients without TPO antibody (n=213), including Tg-positive patients displayed TSH values in normal range. Among the 45 TPO-positive patients, 11 patients displayed infraclinical thyroid dysfunction. At the end of the 5-year follow-up, only 2/45 patients became anti-TPO negative. Thirteen of the 45 patients developed subclinical or clinical thyroid diseases (4 Graves'disease and 9 thyroiditis with hypothyroidism). By contrast, none of 45 TPO negative patients, sex and age matched with the TPO-positive patients, developed during follow-up anti-TPO positivity and/or infraclinical thyroid dysfunction. In conclusion, the determination of TPO antibodies by a highly sensitive method allows identifying diabetic patients with thyroid autoimmunity and at risk of subsequent impaired thyroid function, whatever age at diagnosis and diabetes duration. By contrast, anti-Tg determination did not give further information about subsequent thyroid dysfunction. In TPO antibody positive patients repeated thyroid clinical examination and TSH determination could be recommended to detect infraclinical thyroid

  5. Anemia in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Barbieri, Jéssica; Fontela, Paula Caitano; Winkelmann, Eliane Roseli; Zimmermann, Carine Eloise Prestes; Sandri, Yana Picinin; Mallet, Emanelle Kerber Viera; Frizzo, Matias Nunes

    2015-01-01

    The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases. PMID:26640706

  6. Dyslipidemia, kidney disease, and cardiovascular disease in diabetic patients.

    PubMed

    Chen, Szu-chi; Tseng, Chin-Hsiao

    2013-01-01

    This article reviews the relationship between dyslipidemia, chronic kidney disease, and cardiovascular diseases in patients with diabetes. Diabetes mellitus is associated with complications in the cardiovascular and renal system, and is increasing in prevalence worldwide. Modification of the multifactorial risk factors, in particular dyslipidemia, has been suggested to reduce the rates of diabetes-related complications. Dyslipidemia in diabetes is a condition that includes hypertriglyceridemia, low high-density lipoprotein levels, and increased small and dense low-density lipoprotein particles. This condition is associated with higher cardiovascular risk and mortality in diabetic patients. Current treatment guidelines focus on lowering the low-density lipoprotein cholesterol level; multiple trials have confirmed the cardiovascular benefits of treatment with statins. Chronic kidney disease also contributes to dyslipidemia, and dyslipidemia in turn is related to the occurrence and progression of diabetic nephropathy. Different patterns of dyslipidemia are associated with different stages of diabetic nephropathy. Some trials have shown that treatment with statins not only decreased the risk of cardiovascular events, but also delayed the progression of diabetic nephropathy. However, studies using statins as the sole treatment of hyperlipidemia in patients on dialysis have not shown benefits with respect to cardiovascular risk. Diabetic patients with nephropathy have a higher risk of cardiovascular events than those without nephropathy. The degree of albuminuria and the reduction in estimated glomerular filtration rate are also correlated with the risk of cardiovascular events. Treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to reduce albuminuria in diabetic patients has been shown to decrease the risk of cardiovascular morbidity and mortality.

  7. Plasma proteome analysis of patients with type 1 diabetes with diabetic nephropathy

    PubMed Central

    2010-01-01

    Background As part of a clinical proteomics program focused on diabetes and its complications we are looking for new and better protein biomarkers for diabetic nephropathy. The search for new and better biomarkers for diabetic nephropathy has, with a few exceptions, previously focused on either hypothesis-driven studies or urinary based investigations. To date only two studies have investigated the proteome of blood in search for new biomarkers, and these studies were conducted in sera from patients with type 2 diabetes. This is the first reported in depth proteomic study where plasma from type 1 diabetic patients was investigated with the goal of finding improved candidate biomarkers to predict diabetic nephropathy. In order to reach lower concentration proteins in plasma a pre-fractionation step, either hexapeptide bead-based libraries or anion exchange chromatography, was performed prior to surface enhanced laser desorption/ionization time-of-flight mass spectrometry analysis. Results Proteomic analysis of plasma from a cross-sectional cohort of 123 type 1 diabetic patients previously diagnosed as normoalbuminuric, microalbuminuric or macroalbuminuric, gave rise to 290 peaks clusters of which 16 were selected as the most promising biomarker candidates based on statistical performance, including independent component analysis. Four of the peaks that were discovered have been identified as transthyretin, apolipoprotein A1, apolipoprotein C1 and cystatin C. Several yet unidentified proteins discovered by this novel approach appear to have more potential as biomarkers for diabetic nephropathy. Conclusion These results demonstrate the capacity of proteomic analysis of plasma, by confirming the presence of known biomarkers as well as revealing new biomarkers for diabetic nephropathy in plasma in type 1 diabetic patients. PMID:20205888

  8. Comparison of Age of Onset and Frequency of Diabetic Complications in the Very Elderly Patients with Type 2 Diabetes

    PubMed Central

    2016-01-01

    Background The prevalence of type 2 diabetes in elderly people has increased dramatically in the last few decades. This study was designed to clarify the clinical characteristics of type 2 diabetes in patients aged ≥80 years according to age of onset. Methods We reviewed the medical records of 289 patients aged ≥80 years with type 2 diabetes at the outpatient diabetes clinics of Kangwon National University Hospital from September 2010 to June 2014. We divided the patients into middle-age-onset diabetes (onset before 65 years of age) and elderly-onset diabetes (onset at 65+ years of age). Results There were 141 male and 148 female patients. The patients had a mean age of 83.2±2.9 years and the mean duration of diabetes was 14.3±10.4 years. One hundred and ninety-nine patients had elderly-onset diabetes. The patients with elderly-onset diabetes had a significantly lower frequency of diabetic retinopathy and nephropathy, lower serum creatinine levels, lower glycated hemoglobin (HbA1c) levels, and similar coronary revascularization and cerebral infarction rates compared to those with middle-age-onset diabetes. There was no frequency difference in coronary revascularization and cerebral infarction and HbA1c levels between three subgroups (<5, 5 to 15, and ≥15 years) of diabetes duration in elderly onset diabetes. However, both in the elderly onset diabetes and middle-age-onset diabetes, the cumulative incidence of retinopathy was increasing rapidly according to the duration of diabetes. Conclusion We report that individuals with elderly-onset diabetes have a lower frequency of diabetic retinopathy and nephropathy and similar cardiovascular complications compared to those with middle-age-onset diabetes. PMID:27586451

  9. Comparison of oral Lactobacillus and Streptococcus mutans between diabetic dialysis patients with non-diabetic dialysis patients and healthy people

    PubMed Central

    Rezazadeh, Fahimeh; Bazargani, Abdollah; Roozbeh-Shahroodi, Jamshid; Pooladi, Ali; Arasteh, Peyman; Zamani, Khosro

    2016-01-01

    Introduction: Diabetes is associated with higher rates of caries, on the other hand some studies have shown that renal failure can be protective against dental caries. Objectives: In this study we compared oral Lactobacillus and Streptococcus mutans between diabetic dialysis and non-diabetic dialysis patients and the normal population. Patients and Methods: During November 2014 to January 2014, 85 people that referred to our medical care center entered the study. The sample included 30 diabetic dialysis, 28 non-diabetic dialysis patients and 27 healthy people. Oral saliva samples were obtained from their tongue and oral floor for microbiological examination. Patients’ data were compared before and after dialysis. Results: The amount of Lactobacillus and S. mutans did not show a significant difference between the three groups (P=0.092 and P=0.966 for S. mutans and lactobacillus, respectively). A positive and meaningful correlation was seen between fasting blood sugar (FBS) levels and the amount of S. mutans in the diabetic dialysis group (P=0.023; r=0.413). A meaningful and positive correlation was also seen between the amount of blood urea nitrogen (BUN) after dialysis and the amount of oral S. mutans in the non-diabetic dialysis group (P=0.03; r=0.403). Conclusion: Despite the differences in the prevalence of caries that have been reported between renal failure patients and diabetic patients, we did not find any significant difference between diabetic dialysis, non-diabetic dialysis patients and the healthy population, regarding their amount of oral cariogenic bacteria. PMID:27689112

  10. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region.

    PubMed

    Jambart, S; Ammache, Z; Haddad, F; Younes, A; Hassoun, A; Abdalla, K; Selwan, C Abou; Sunna, N; Wajsbrot, D; Youseif, E

    2011-01-01

    The prevalence of painful diabetic peripheral neuropathy (DPN) was evaluated in type 1 or type 2 diabetes mellitus patients (n = 4097) attending outpatient clinics across the Middle East. Overall, 53.7% of 3989 patients with DN4 data met the criteria for painful DPN (Douleur Neuropathique-4 [DN4] scores ≥ 4). Significant predictors of painful DPN included long history (≥ 10 years) of diabetes (odds ratio [OR] 2.43), age ≥ 65 years (OR 2.13), age 50 - 64 years (OR 1.75), presence of type 1 versus type 2 diabetes (OR 1.59), body mass index > 30 kg/m(2) (OR 1.35) and female gender (OR 1.27). Living in one of the Gulf States was associated with the lowest odds of having painful DPN (OR 0.44). The odds of painful DPN were highest among patients with peripheral vascular disease (OR 4.98), diabetic retinopathy (OR 3.90) and diabetic nephropathy (OR 3.23). Because of the high prevalence and associated suffering, disability and economic burden of painful DPN, it is important that diabetic patients are periodically screened, using a simple instrument such as the DN4, and receive appropriate treatment if symptoms develop.

  11. [Diabetes following kidney transplantation. Report of 35 cases].

    PubMed

    Kaaroud, Hayet; Khiari, Karima; Beji, Soumaya; Cherif, Lotfi; Ben Abdallah, Nejib; Ben Moussa, Fatma; Ayed, Khaled; Ben Abdallah, Taieb; Ben Maïz, Hedi

    2004-02-01

    Post-transplant diabetes mellitus (PTDM) is a frequent complication of renal transplantation. It has a prevalence rate ranging from 3 to 46%. We undertook a retrospective study of 175 nondiabetic renal transplant recipients to determine the prevalence rate, clinical characteristics, and risk factors of PTDM in kidney transplant recipients in our region. Thirty five patients (20%) developed PTDM, 50% were diagnosed by 3 months post transplantation. Eight patients (22.8%) were insulin recurrent. PTDM was independent of kidney source, family history of diabetes, age, sex, incidence of acute rejection, body weight gain, steroid or cyclosporine dose, use of beta-blockers and cytomegalovirus infection. Acturial 5 years survival was 79.4% in the diabetic compared to 80.5% in the control group. Patient survival was similar in the two groups. We conclude that PTDM is frequent in our patients. No significant risk factors of PTDM were identified in this study.

  12. Improper sharp disposal practices among diabetes patients in home care settings: Need for concern?

    PubMed

    Majumdar, Anindo; Sahoo, Jayaprakash; Roy, Gautam; Kamalanathan, Sadishkumar

    2015-01-01

    In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the health of the population and a marked economic loss. This article discusses the sharp disposal practices prevalent among diabetes patients, the importance of proper sharp disposal, barriers to safe disposal of sharps, and the options available for doing the same. For adopting an environmentally safe wholesome approach, disposal of plastics generated as a result of diabetes self-care at home is important as well. The article also looks at the possible long-term solutions to these issues that are sustainable in an Indian context.

  13. Assessing of oxidative stress related parameters in diabetes mellitus type 2: cause excessive damaging to DNA and enhanced homocysteine in diabetic patients.

    PubMed

    Bukhari, Shazia Anwer; Naqvi, Syed Ali Raza; Nagra, Saeed Ahmad; Anjum, Fauzia; Javed, Sadia; Farooq, Muhammad

    2015-03-01

    Oxidative stress and reactive oxygen species (ROS) have been documented subsist to the pathogenesis of many diseases including diabetes mellitus. The strength of both parameters could be estimated by measuring oxidative stress marker thiobarbituric acid reactive substances (TBARS), its related parameters and the antioxidants glutathione peroxidase and superoxide dismutase (SOD) in plasma of DM patients. Lipid peroxidation was measured as TBARS and presented as malondialdehyde, total cholesterol (TC), low-density lipoprotein (LDL), triglyceride (Tg), the antioxidants (vitamin A (β-carotene), vitamin E, vitamin C, glutathione peroxidase (GPx) and superoxide dismutase) levels. The results showed that these parameters, commonly, were declined appreciably in diabetic individuals as compared to the healthy individuals. In most cases, age and gender were appeared to involve in having greater values of diabetes marker. Further, increased level of lipid peroxidation and random behaviour of antioxidant potential also associated with Diabetes. For that reason these biomarkers might be of great important to diagnosis DNA damages of diabetic patients.

  14. Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis.

    PubMed

    Isidro, María L; Jorge, Segundo

    2013-04-01

    To evaluate the association between recreational drug use and diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in our area. Retrospective examination of records from a 1,450 bed urban teaching hospital in Spain. All adult admissions for DK or DKA from January 1, 2005, to December 31, 2009 in our hospital were included. Demographic, exploratory (blood pressure, heart rate, respiratory rate), and analytical data (glucose, urea, creatinine, corrected Na(+), K(+), pH, HCO3(-) and HbA1c) at admittance were recorded. In 152 patients, 253 episodes of DK or DKA occurred. Screening for drug use was performed in 40.3% of the events; 20.6% of the episodes (n = 52) were shown to be substance abuse. Cocaine, followed by cannabis and alcohol, was the most frequently involved drug. Poly-substance abuse occurred in 67.3% of them. Comorbidities were present in 11.5 and 39.8% of the cases shown and not shown to be related to drug use (P = 0.00). Seventy percent of the patients who were at least once shown to have consumed drugs, and 15.9% of those who were never shown to have done so, were admitted more than once (P = 0.00). The frequency of recent drug misuse in patients presenting with DK or DKA was high. Substance abuse screening was frequently neglected. Adverse profile, most significantly in readmission to hospital, was found in the patients with positive drug findings. History taking in this context should routinely include questions on substance abuse, and toxicology screening may be worthwhile, particularly in those with the history of frequent readmissions.

  15. [Sacubitril / Valsartan in patients with diabetes and heart failure].

    PubMed

    Brandenburg, Vincent Matthias; Rocca, Hans-Peter Brunner-La; Marx, Nikolaus

    2016-10-01

    Sacubitril / Valsartan proofed to be an effective treatment compared to enalapril in reducing heart failure hospitalisations and mortality in patients with severe "Heart failure with reduced ejection fraction" (HFREF). Recent European cardiology guidelines attributed a class IB recommendation for Sacubitril / Valsartan in HFREF patients who remain symptomatic despite optimal treatment with ACE-I, a beta-blocker, and a mineralocorticoid receptor antagonist. There is a significant overlap between diabetic and HFREF patients and thus, efficacy assessment of Sacubitril / Valsartan is a clinically meaningful issue in the large subgroup of HFREF patients with diabetes. We discuss the present evidence why local authorities speculated about a potential interaction between the two diseases decreasing the efficacy of sacubitril/valsartan in terms of reducing relevant end-points in this cohort. Overall, Sacubitril / Valsartan is obviously a treatment option in diabetics with HFREF. However, diabetic cardiomyopathy needs to be recognised as a specific disease condition.

  16. Depression among patients with type-II diabetes mellitus.

    PubMed

    Khan, Mohammad Akmal; Sultan, Sayed Mohammad; Nazli, Rubina; Akhtar, Tasleem; Khan, Mudasar Ahmad; Sher, Nabila; Aslam, Hina

    2014-10-01

    This study aimed to determine the frequency of depression among patients with type-II diabetes mellitus in Peshawar at Khyber Teaching Hospital, Peshawar, from March to September 2010. Depression was assessed by using Beck Depressive Inventory-II (BDI-II). Out of 140 patients with type-II diabetes, 85 (61%) were women and 55 (39%) were men. Mean age was 45±7.45 years. Eighty four (60%) patients presented with severe depression. Depression was higher in females than males and widows. Depression was high in diabetic patients, especially in females and widows. It is of essence that psychiatric attention may be necessary to be incorporated in diabetes care both for prevention and treatment.

  17. New-onset diabetic ketoacidosis in a 13-months old african toddler: a case report

    PubMed Central

    Katte, Jean-Claude; Djoumessi, Romance; Njindam, Gisele; Fetse, Gerard Tama; Dehayem, Mesmin; Kengne, Andre-Pascal

    2015-01-01

    Type 1 diabetes mellitus is very rare in infants and toddlers and is usually associated with high mortality when complicated with diabetic ketoacidosis (DKA). Toddlers in DKA are often missed in our typical African setting where there is low index of suspicion. Usually, the classical symptoms are not usually at the forefront and many infants and toddlers who develop DKA are mistreated for infections. The case of a 13-months old toddler with new-onset type 1 diabetes mellitus, complicated with DKA at diagnosis is reported in view of its rarity and elevated mortality even when diagnosed in our African setting. She was subsequently treated with intravenous insulin and was passed over to subcutaneous insulin after the eradication of ketones in urine. She continues follow-up at the out-patient children diabetes clinic at the Bafoussam Regional Hospital. PMID:26966489

  18. Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients with Diabetes, Combined with Patient and Provider Perspectives

    PubMed Central

    Fisher, Maxine D.; Rajput, Yamina; Gu, Tao; Singer, Joseph R.; Marshall, Amanda R.; Ryu, Seonyoung; Barron, John; MacLean, Catherine

    2016-01-01

    Background Diabetes mellitus remains the leading cause of new cases of blindness among US adults. Routine dilated eye examinations can facilitate early detection and intervention for diabetes-related eye disease, providing an opportunity to reduce the risk for diabetes-related blindness in working-aged Americans. The Healthcare Effectiveness Data and Information Set (HEDIS) established criteria for performing dilated eye examination in patients with diabetes. Objectives To obtain information about adherence and nonadherence to diabetic eye examinations among insured patients to understand the barriers to routine dilated eye examinations, and to identify ways to improve the quality of care for these patients. Methods This retrospective claims analysis is based on administrative claims from the HealthCore Integrated Research Database, a broad database representing claims from a large commercially insured population. Patients with diabetes and who had ≥1 dilated eye examinations between August 1, 2011, and July 31, 2013, were defined as adherent to the HEDIS recommendations. The analysis was augmented with findings from focus groups. The patient focus groups included adherent and nonadherent patients. The provider focus group participants were general practice or internal medicine physicians and ophthalmologists who provided medical care for the study population. For the administrative claims analysis, comparisons between the adherent and nonadherent patients were performed using t-tests for continuous data and chi-square tests for categorical data. Results Of 339,646 patients with diabetes identified in a claims data set, 43% were adherent and 57% were nonadherent to the HEDIS eye examination performance measure. The common barriers to routine eye examination cited by 29 patients across 4 focus groups included a lack of understanding of insurance benefits (N = 15), a lack of awareness of the importance of dilated eye examinations (N = 12), and time constraints (N

  19. Economic analysis of a diabetes-specific nutritional meal replacement for patients with type 2 diabetes.

    PubMed

    Randolph, Stephen; Mustad, Vikkie A; Lee, James; Sun, Jianqin

    2010-01-01

    This study extends nutritional intervention results reported by short-term clinical trials of a diabetes-specific nutritional meal replacement by assessing the ten-year impact of the interventions on patient outcomes and costs compared to usual care. We developed and validated a computer simulation of type 2 diabetes based on published data from major clinical trials. The model tracks patients through microvascular and macrovascular health states and reports cumulative costs and quality adjusted life years. We modeled different scenarios that include a diabetes-specific nutritional meal replacement as part of a structured lifestyle intervention, and also as the only difference between the intervention and usual care treatment groups, and compared them to usual care with diet and physical activity recommendations. We used sensitivity analysis to explore the robustness of results. When a diabetes-specific nutritional meal replacement is the only treatment difference and is considered an equal cost meal replacement, the diabetes-specific nutritional meal replacement interventions are less costly and more effective than usual care. As an added cost meal replacement, the diabetes-specific nutritional meal replacement has an incremental cost-effectiveness ratio between $50,414 and $55,036 depending on improvement in percent glycated hemoglobin. A hypothetical lifestyle intervention using a diabetes-specific nutritional meal replacement has an incremental cost-effectiveness ratio of $47,917. The diabetes-specific nutritional meal replacement was found to be cost-effective under the various conditions simulated.

  20. Factors influencing the quality of life perception in patients with type 2 diabetes mellitus

    PubMed Central

    Timar, Romulus; Velea, Iulian; Timar, Bogdan; Lungeanu, Diana; Oancea, Cristian; Roman, Deiana; Mazilu, Octavian

    2016-01-01

    Purpose To evaluate the impact of several factors on the patient’s perception on quality of life in a group of patients with type 2 diabetes mellitus (T2DM). Patients and methods In this cross-sectional study, 198 patients with T2DM were enrolled according to a consecutive-case population-based study design. In all participants, the perception on the quality of life was measured using the quality of life index – diabetes version III proposed by Ferrans and Powers. We evaluated the impact of several anthropometric and diabetes-related (ie, diabetes history and quality of glycemic control) factors on the patient’s perception on the quality of life. Results The presence of diabetes complications was associated with a decreased quality of life: retinopathy (1 vs 5 points; P<0.001), chronic kidney disease (−1 vs 5 points; P<0.001), and neuropathy (−1 vs 5 points; P<0.001). A significant reverse correlation was found between the patient’s quality of life and depression’s severity (Spearman’s r=−0.345; P<0.001) and body mass index (Spearman’s r=−0.158; P=0.026). A positive association between the quality of life and the quality of diabetes-related self-care activities was found (Spearman’s r=0.338; P<0.001). No significant association was found between the patient’s quality of life and the quality of glycemic control, diabetes duration, age, gender, or smoking status. Conclusion To improve the patient’s quality of life, special care should be given to the modifiable diabetes-related factors: the prevention and treatment of diabetes complications, treatment of depression, and weight loss in obese and overweight patients. PMID:28003741

  1. Educating Resident Physicians Using Virtual Case-Based Simulation Improves Diabetes Management: A Randomized Controlled Trial

    PubMed Central

    Sperl-Hillen, JoAnn; O’Connor, Patrick J.; Ekstrom, Heidi L.; Rush, William A.; Asche, Stephen E.; Fernandes, Omar D.; Apana, Deepika; Amundson, Gerald H.; Johnson, Paul E.; Curran, Debra M.

    2014-01-01

    Purpose To test a virtual case-based Simulated Diabetes Education (SimDE) intervention developed to teach primary care residents how to manage diabetes. Method Nineteen primary care residency programs, with 341 volunteer residents in all post-graduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models. Eighteen distinct learning cases (L-cases) were assigned to SimDE residents over 6 months from 2010–2011. Impact was assessed using performance on 4 virtual assessment cases (A-cases), an objective knowledge test, and pre-post changes in self-assessed diabetes knowledge and confidence. Group comparisons were analyzed using generalized linear mixed models, controlling for clustering of residents within residency programs and differences in baseline knowledge. Results The percentage of residents appropriately achieving A-case composite clinical goals for glucose, blood pressure, and lipids was: A-Case 1, SimDE = 21.2%, CG = 1.8%, P = .002; A-Case 2, SimDE = 15.7%, CG = 4.7%, P = .02; A-Case 3, SimDE = 48.0%, CG = 10.4%, P < .001; A-Case 4, SimDE = 42.1%, CG = 18.7%, P = .004. The mean knowledge score and pre-post changes in self-assessed knowledge and confidence were significantly better for SimDE group than CG participants. Conclusions A virtual case-based simulated diabetes education intervention improved diabetes management skills, knowledge, and confidence for primary care residents. PMID:25006707

  2. High L-carnitine concentrations do not prevent late diabetic complications in type 1 and 2 diabetic patients.

    PubMed

    Liepinsh, Edgars; Skapare, Elina; Vavers, Edijs; Konrade, Ilze; Strele, Ieva; Grinberga, Solveiga; Pugovics, Osvalds; Dambrova, Maija

    2012-05-01

    Increased intake of L-carnitine, a cofactor in cellular energy metabolism, is recommended for diabetic patients with late complications. However, its clinical benefits remain controversial. We hypothesized that patients with low L-carnitine levels would have an increased rate of diabetic complications. To test this hypothesis, we evaluated the relationship of L-carnitine concentrations in blood with the prevalence and severity of late diabetic complications in type 1 and 2 diabetic patients. Human blood samples were collected from 93 and 87 patients diagnosed as having type 1 or type 2 diabetes, respectively, and 122 nondiabetic individuals. The determination of free L-carnitine concentrations in whole blood lysates was performed using ultra-performance liquid chromatography with tandem mass spectrometry. In diabetic patients, diabetic complications such as neuropathy, retinopathy, nephropathy, or hypertension were recorded. The average L-carnitine concentration in the blood of control subjects was 33 ± 8 nmol/mL, which was not significantly different from subgroups of patients with type 1 (32 ± 10 nmol/mL) or type 2 diabetes (36 ± 11 nmol/mL). Patients with low (<20 nmol/mL) l-carnitine levels did not have increased occurrences of late diabetic complications. In addition, patient subgroups with higher L-carnitine concentrations did not have decreased prevalence of late diabetic complications. Our results provide evidence that higher L-carnitine concentrations do not prevent late diabetic complications in type 1 and 2 diabetic patients.

  3. Comparison of the Hospital Arrival Time and Differences in Pain Quality between Diabetic and Non-Diabetic STEMI Patients

    PubMed Central

    Gradišer, Marina; Dilber, Dario; Cmrečnjak, Jasna; Ostrički, Branko; Bilić-Ćurčić, Ines

    2015-01-01

    The aim of our study was to determine whether diabetic ST segment elevation myocardial infarction (STEMI) patients arrive in the emergency room (ER) later than non-diabetics, compare the differences in pain quality and quantity between those groups, and measure differences in the outcome after an index hospitalization. A total of 266 patients with first presentation of STEMI were included in our study during a period of two years, 62 with diabetes and 204 without diabetes type 2. Pain intensity and quality at admission were measured using a McGill short form questionnaire. Diabetic patients did not arrive significantly later than non-diabetic (χ2; p = 0.105). Most diabetic patients described their pain as “slight” or “none” (χ2; p < 0.01), while most non-diabetic patients graded their pain as “moderate” or “severe” (χ2; p < 0.01). The quality of pain tended to be more distinct in non-diabetic patients, while diabetic patients reported mainly shortness of breath (χ2; p < 0.01). Diabetic patients were more likely to suffer a multi-vessel disease (χ2; p < 0.01), especially in the late arrival group. Therefore, cautious evaluation of diabetic patients and adequate education of target population could improve overall survival while well-organized care like a primary PCI Network program could significantly reduce CV mortality. PMID:25633029

  4. The Relationship between Serum Carbonic Anhydrase I-II Autoantibody Levels and Diabetic Retinopathy in Type 1 Diabetes Patients

    PubMed Central

    Türk, Adem; Mollamehmetoğlu, Süleyman; Alver, Ahmet; Menteşe, Ahmet; Nuhoğlu, İrfan; Erem, Cihangir; İmamoğlu, Halil İbrahim

    2017-01-01

    Objectives: To investigate the relationship between serum carbonic anhydrase I-II (CA-I and II) autoantibody levels and diabetic retinopathy (DRP) in cases with type 1 diabetes. Materials and Methods: A total of 37 type-1 diabetic patients, 17 with DRP (group 1) and 20 without (group 2), and 38 healthy control subjects (group 3) were included. CA-I and CA-II autoantibody levels were measured in serum samples obtained from each of the three groups and compared statistically. Additionally, the correlation between CA-I and CA-II autoantibody levels and the presence of diabetic macular edema was examined. Results: Mean measured CA-I autoantibody levels were 0.145±0.072, 0.117±0.047, and 0.138±0.061 ABSU in group 1, group 2, and group 3, respectively (p=0.327). The average CA-II autoantibody levels achieved in the same groups were 0.253±0.174, 0.155±0.137, and 0.131±0.085 ABSU, respectively (p=0.005). No significant difference was obtained between the subgroups of group 1, with macular edema (n=8) and without (n=9), in terms of both CA-I and CA-II autoantibody levels (p=0.501, p=0.178, respectively). Conclusion: A significant correlation was observed between the development of DRP and serum CA-II autoantibody levels in type 1 diabetic cases. However, there was no correlation between the autoantibody levels and the presence of diabetic macular edema in cases with DRP.

  5. An Analysis, Using Concept Mapping, of Diabetic Patients' Knowledge, before and after Patient Education.

    ERIC Educational Resources Information Center

    Marchand, C.; d'Ivernois, J. F.; Assal, J. P.; Slama, G.; Hivon, R.

    2002-01-01

    Assesses whether concept maps used with diabetic patients could describe their cognitive structure, before and after having followed an educational program. Involves 10 diabetic patients and shows that concept maps can be a suitable technique to explore the type and organization of the patients' prior knowledge and to visualize what they have…

  6. Diabetes - tests and checkups

    MedlinePlus

    ... High blood pressure Microalbuminuria test Type 1 diabetes Type 2 diabetes Patient Instructions ACE inhibitors Diabetes and exercise Diabetes - eye care Diabetes - foot ulcers Diabetes - keeping ...

  7. Pattern Visual Evoked Potential Changes in Diabetic Patients without Retinopathy

    PubMed Central

    Sungur, Gulten; Yakin, Mehmet; Unlu, Nurten; Balta, Oyku Bezen; Ornek, Firdevs

    2017-01-01

    Purpose. To assess the different check sizes of pattern visual evoked potential (PVEP) in diabetic patients without retinopathy according to HbA1c levels and diabetes duration. Methods. Fifty-eight eligible patients with type 2 diabetes mellitus and 26 age- and sex-matched healthy controls were included in the study. Only the right eye of each patient was analyzed. All of the patients underwent a comprehensive ophthalmic examination, and the PVEPs were recorded. Results. There was a statistically significant difference in P100 latency in 1-degree check size and in N135 latency in 2-degree check size between controls and patient groups which have different HbA1c levels. There were statistically significant, positive, and weak correlations with diabetes duration and P100 latency in 7-minute and 15-minute check sizes and N135 latency in 15-minute check size. Conclusions. It was showed that there were prolongations in P100 latency only in 1-degree check size and in N135 only in 2-degree check size in diabetic patients without retinopathy. There was statistically significant correlation between diabetes duration and P100 and N135 latencies in different check sizes. PMID:28392940

  8. Evaluating older patients with diabetes for insulin pump therapy.

    PubMed

    Stephens, Elizabeth A; Heffner, John

    2010-06-01

    The increasing prevalence of diabetes among elderly patients underscores the importance of matching the most effective therapy for diabetes self-management with patients' cognitive and motor skills, as these diminish with advancing age. Although many geriatric patients state interest in insulin pump therapy for tight glycemic control, few studies have examined the effectiveness, safety, and feasibility of insulin pumps compared to traditional injected insulin therapy in older age groups. It is important, therefore, for physicians to recognize the indications and the age-related barriers to insulin pump therapy in geriatric patients. Indications include glucose variability, hypoglycemia, and poor glycemic control with traditional insulin regimens. Common barriers include poor vision, dexterity, and cognitive status. Successful implementation of insulin pump therapy for older patients requires an experienced diabetes management team that can assess patient needs and tailor therapy in the context of age-related disabilities.

  9. Male gonadal axis function in patients with type 2 diabetes.

    PubMed

    Costanzo, Pablo R; Knoblovits, Pablo

    2016-05-01

    Patients with type 2 diabetes have lower serum testosterone levels and a higher prevalence of hypogonadism than non-diabetic patients, independently of the metabolic control of disease. The mechanisms underlying a decrease in testosterone might be related to age, obesity and insulin resistance, often present in patients with type 2 diabetes. The increase in estrogens due to higher aromatase enzyme activity in increased adipose tissue might exert negative-feedback inhibition centrally. Insulin stimulates gonadal axis activity at all three levels and therefore insulin resistance might account for the lower testosterone production. Leptin exerts a central stimulatory effect but inhibits testicular testosterone secretion. Thus, resistance to leptin in obese subjects with type 2 diabetes determines lower central effects of leptin with lower gonadotropin-releasing hormone (GnRH) secretion and, on the other hand, hyperleptinemia secondary to leptin resistance inhibits testosterone secretion at the testicular level. However, lower testosterone levels in patients with diabetes are observed independently of age, weight and body mass index, which leads to the assumption that hyperglycemia per se might play a role in the decrease in testosterone. Several studies have shown that an overload of glucose results in decreased serum testosterone levels. The aim of this review is to assess changes in the male gonadal axis that occur in patients with type 2 diabetes.

  10. Lipoprotein(a) and cardiovascular disease in diabetic patients

    PubMed Central

    Qi, Qibin; Qi, Lu

    2012-01-01

    Lipoprotein(a) (Lp[a]) is a LDL-like particle consisting of an ApoA moiety linked to one molecule of ApoB100. Recent data from large-scale prospective studies and genetic association studies provide highly suggestive evidence for a potentially causal role of Lp(a) in affecting risk of cardiovascular disease (CVD) in general populations. Patients with Type 2 diabetes display clustered metabolic abnormalities and elevated risk of CVD. Lower plasma Lp(a) levels were observed in diabetic patients in several recent studies. Epidemiology studies of Lp(a) and CVD risk in diabetic patients generated inconsistent results. We recently found that Lp(a)-related genetic markers did not predict CVD in two diabetic cohorts. The current data suggest that Lp(a) may differentially affect cardiovascular risk in diabetic patients and in the general population. More prospective studies, Mendelian randomization analysis and functional studies are needed to clarify the causal relationship of Lp(a) and CVD in diabetic patients. PMID:23136583

  11. A comprehensive review of urologic complications in patients with diabetes.

    PubMed

    Arrellano-Valdez, Fernando; Urrutia-Osorio, Marta; Arroyo, Carlos; Soto-Vega, Elena

    2014-01-01

    Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections. Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39-61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract. Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18-42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population.

  12. Blood pressure control in type 2 diabetic patients.

    PubMed

    Grossman, Alon; Grossman, Ehud

    2017-01-06

    Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature. In recent years, new medications were introduced for the treatment of DM, some of which also affect BP and the clinician treating hypertensive and diabetic patients should be familiar with these medications and their effect on BP. In this manuscript, we discuss the evidence supporting different BP targets in diabetics and review the various guidelines on this topic. In addition, we discuss the various options available for the treatment of hypertension in diabetics and the recommendations for a specific treatment over the other. Finally we briefly discuss the new diabetic drug classes and their influence on BP.

  13. Uncommon fungi isolated from diabetic patients toenails with or without visible onychomycoses.

    PubMed

    González-Avila, Marisela; Gómez-Gómez, Juan Vicente; Texis, Alejandra Paula Espinosa; Imbert-Palafox, José Luis; Becerril-Flores, Marco Antonio; Blasco, José Luis

    2011-09-01

    Kodamaea ohmeri and Prototheca wickerhamii are rare pathogens for humans, and even more rare as cause of onychomycosis. This work reports the second case of onychomycosis by K. ohmeri and the fourth of onycoprotothecosis; it was made in public health institutions in the Hidalgo State, Mexico, studying 261 diabetic patients during 2005 and 2006. Kodamaea ohmeri was isolated from toenails of a 51-year-old female patient, and P. wickerhamii from three female patients of 48, 49, and 61 years old, respectively, all of them with type 2 diabetes mellitus (DM 2). Identifications were done by standard microbiological methods and a commercial system. Only one patient infected with P. wickerhamii showed mixed infection with dermatophytes. Out of the total studied DM 2 patients, 1.15% presented onycoprotothecosis and 0.38% onychomycosis by K. ohmeri, high percentages if it is considered that few cases have been reported of K. ohmeri and P. wickerhamii as onychomycosis causal agents.

  14. Estimation of Salivary Amylase in Diabetic Patients and Saliva as a Diagnostic Tool in Early Diabetic Patients

    PubMed Central

    Malathi, L.; Masthan, K.M.K.; Balachander, N.; Babu, N. Aravindha; Rajesh, E.

    2013-01-01

    Aim: The aim of this study was to estimate the salivary amylase levels in non-insulin dependent diabetes mellitus patients and to correlate these findings with those in normal individuals, in order to provide salivary amylase level as a bio-chemical indicator for diagnosing and monitoring the glucose levels. Material and Methods: The study samples consisted of 60 individuals. Both males and females participated in the study. Thirty non-insulin dependent diabetes mellitus patients of age group of 30 to 60 years and healthy individuals of same number and age group were included in this study. The data obtained in this study were statistically analyzed by using Student’s t–test. Results: In estimation of salivary amylase levels, the comparison of mean and standard deviation showed the highest mean score (2739.48 +1525.20) among the diabetic patients and lowest mean score (1740.38 + 638.51) among the non-diabetic patients. The p-value obtained was less than 0.01. Hence, a highly significant difference in the mean scores regarding salivary amylase (u/l) was found among the two groups. Conclusion: The mean scores of age, fasting blood sugar, post prandial blood sugar, HbA1c and salivary amylase levels were greater in diabetic patients than in non-diabetic patients. PMID:24392426

  15. Chronic optic disc swelling overlooked in a diabetic patient with a devastating outcome

    PubMed Central

    Braithwaite, Tasanee; Plant, Gordon T

    2010-01-01

    We present a case of asymmetrical but bilateral, progressive, painless visual deterioration over 5 years to no perception of light, in a 61-year-old male diabetic patient referred for a second opinion. The patient had a chronic history of bilateral diabetic maculopathy and unexplained swelling of the optic discs. He was diagnosed with optic atrophy secondary to pseudotumour cerebri (termed idiopathic intracranial hypertension when underlying causes have been excluded), which was associated with obstructive sleep apnoea. The case highlights the critical importance of identifying and investigating chronic papilloedema for reversible causes; the sometimes subtle presentation of pseudotumour cerebri; and the vital role of visual field testing and diagnostic lumbar puncture for timely diagnosis. It also reminds us that chronic bilateral optic disc swelling is not a normal feature of diabetic eye disease, and that alarm bells should sound if reduced visual acuity seems disproportionate to the degree of maculopathy. PMID:22442651

  16. [The origin of papillary neovascularization in patients with proliferative diabetic retinopathy].

    PubMed

    Sdobnikova, S V; Mazurina, N K

    2004-01-01

    The case study covers examinations of 63 patients with diabetes mellitus (DM), type 1, and with proliferative diabetic retinopathy (PDR). According to the results of fluorescence angiography, the patients were shared between 3 groups: Group 1--early contrasting of papillary vascular neoplasms; Group 2--late contrasting; and Group 3--mixed contrasting. We explained the available differences by that the vascular neoplasms of the optic nerve disk (OND) originate from 2 main blood supply basins, i.e. choroidal and retinal ones. They reflect, with respect to the above stated, the hemodynamic properties of the choroidal mycocirculation, which is characterized by a higher hemodynamic load and a higher intravascular pressure, or the retinal hemomicrocirculation. The pathological signs of diabetic retinopathy in the choroidal system may fail to correlate with changes in the retinal vascular system itself. Therefore, the findings of fluorescence angiography do not always represent the genuine scope of pathological manifestations occurring in the hemomicrocirculation system in case of PDR.

  17. Diabetes

    MedlinePlus

    ... version of this page please turn Javascript on. Diabetes What is Diabetes? Too Much Glucose in the Blood Diabetes means ... high, causing pre-diabetes or diabetes. Types of Diabetes There are three main kinds of diabetes: type ...

  18. Thyroid Cancer Risk Is Not Increased in Diabetic Patients

    PubMed Central

    Tseng, Chin-Hsiao

    2012-01-01

    Objective This study evaluated thyroid cancer risk with regards to diabetes status and diabetes duration, and with the use of anti-diabetic drugs including sulfonylurea, metformin, insulin, acarbose, pioglitazone and rosiglitazone, by using a population-based reimbursement database in Taiwan. Methods A random sample of 1,000,000 subjects covered by the National Health Insurance was recruited. After excluding patients with type 1 diabetes, 999730 subjects (495673 men and 504057 women) were recruited into the analyses. Logistic regression estimated the odds ratios (OR) and their 95% confidence intervals (CI) for independent variables including age, sex, diabetes status/duration, anti-diabetic drugs, other medications, comorbidities, living regions, occupation and examinations that might potentially lead to the diagnosis of thyroid cancer in various models. Results The diabetic patients had a significantly higher probability of receiving potential detection examinations (6.38% vs. 5.83%, P<0.0001). After multivariable-adjustment, the OR (95% CI) for diabetes status was 0.816 (0.652–1.021); and for diabetes duration <1 year, 1–3 years, 3–5 years and ≥5 years vs. non-diabetes was 0.071 (0.010–0.507), 0.450 (0.250–0.813), 0.374 (0.203–0.689) and 1.159 (0.914–1.470), respectively. Among the anti-diabetic agents, only sulfonylurea was significantly associated with thyroid cancer, OR (95% CI): 1.882 (1.202–2.947). The OR (95% CI) for insulin, metformin, acarbose, pioglitazone and rosiglitazone was 1.701 (0.860–3.364), 0.696 (0.419–1.155), 0.581 (0.202–1.674), 0.522 (0.069–3.926) and 0.669 (0.230–1.948), respectively. Furthermore, patients with benign thyroid disease or other cancer, living in Kao-Ping/Eastern regions, or receiving potential detection examinations might have a significantly higher risk; and male sex, hypertension, dyslipidemia, chronic obstructive pulmonary disease, vascular complications or use of statin, aspirin or non

  19. Cytokine genotype distribution in patients with periodontal disease and rheumatoid arthritis or diabetes mellitus.

    PubMed

    Crincoli, V; Ballini, A; Fatone, L; Di Bisceglie, M B; Nardi, G M; Grassi, F R

    2016-01-01

    The association between oral and systemic health has highlighted the importance of periodontal health and treatment, with the consequence that dental assessment and attention to oral hygiene have assumed an increasingly important part in the clinical management of patients with diabetes mellitus and rheumatoid arthritis. The aim of this work was to assess genotype frequencies in polymorphisms of genes of IL-1α-889 and IL-1β-511 in a case-controlled study population of patients affected by periodontal disease and rheumatoid arthritis or diabetes mellitus.

  20. Hypopituitarism possibly due to lymphocytic hypophysitis in a patient with type 1 diabetes.

    PubMed

    Matoba, Keiichiro; Mitsuishi, Sumie; Hayashida, Satoshi; Yamazaki, Hiroyuki

    2014-01-01

    Hypopituitarism often develops insidiously, and undiagnosed hypopituitarism can influence the glycemic profile of patients with type 1 diabetes. We herein report the case of a 49-year-old man with type 1 diabetes and Hashimoto's thyroiditis who experienced an unexplained improvement in his glycemic level and recurrent severe hypoglycemia, despite a reduction in the dose of insulin. Based on the patient's endocrinological findings, he was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis, as supported by positive results for human leukocyte antigen A24 and Cw3. Following the administration of hydrocortisone replacement therapy, his insulin requirement increased to a premorbid level, and the severe hypoglycemia resolved.

  1. Use of social media to support patients with diabetes mellitus.

    PubMed

    Lee, Rebecca; Whitley, Heather P

    2014-01-01

    The prevalence of diabetes is increasing, especially in the elderly population. Unfortunately, many seniors have limited access to ongoing health care, which may hinder improvements in these chronic disease states. Use of social media continues to increase among all populations. Thus, use of this venue to reach patients, including those with diabetes, is a reasonable undertaking. Countryside Diabetes is a Facebook page created and administered by Auburn University Harrison School of Pharmacy faculty and students to reach this growing and often underserved demographic. The aim is to provide ongoing education and support for people affected by diabetes. Information posted on the Web site began addressing usual diabetes-related topics such as nutrition, exercise, and selfcare. Each week the site focused on an individual topic, and specialists collaborated on these efforts, fortifying the site content through a multidisciplinary approach. Membership in the senior population continues to grow and garner participation.

  2. Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?

    PubMed Central

    Piccoli, Giorgina B.; Ventrella, Federica; Capizzi, Irene; Vigotti, Federica N.; Mongilardi, Elena; Grassi, Giorgio; Loi, Valentina; Cabiddu, Gianfranca; Avagnina, Paolo; Versino, Elisabetta

    2016-01-01

    Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan–Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity. PMID:27775639

  3. Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?

    PubMed

    Piccoli, Giorgina B; Ventrella, Federica; Capizzi, Irene; Vigotti, Federica N; Mongilardi, Elena; Grassi, Giorgio; Loi, Valentina; Cabiddu, Gianfranca; Avagnina, Paolo; Versino, Elisabetta

    2016-10-21

    Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan-Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity.

  4. Case study in treatment of diabetic foot ulcer with alimentary gelatin.

    PubMed

    Teles Pinto, Nuno Manuel

    The patient with diabetic foot ulceration is undoubtedly one of the major challenges faced by nurses and physicians working in the field of wound treatment. About 15% of diabetic patients experience foot ulceration in the course of their disease. This article reports the adoption of an unconventional treatment, based on gelatin, in a case of a stagnant diabetic foot ulcer, resulting in the successful healing of the wound and the limb being saved. Gelatin is fundamentally denatured collagen; its presence is paramount in the natural healing process, and this may be one of the reasons that the treatment obtained a good result. The fact that the gelatin used is of animal origin does not appear to compromise the outcome of treatment.

  5. Risk factors for major amputation in hospitalised diabetic foot patients.

    PubMed

    Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung

    2016-03-01

    Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.

  6. Novel and emerging diabetes mellitus drug therapies for the type 2 diabetes patient

    PubMed Central

    Rochester, Charmaine D; Akiyode, Oluwaranti

    2014-01-01

    Type 2 diabetes mellitus is a metabolic disorder of deranged fat, protein and carbohydrate metabolism resulting in hyperglycemia as a result of insulin resistance and inadequate insulin secretion. Although a wide variety of diabetes therapies is available, yet limited efficacy, adverse effects, cost, contraindications, renal dosage adjustments, inflexible dosing schedules and weight gain significantly limit their use. In addition, many patients in the United States fail to meet the therapeutic HbA1c goal of < 7% set by the American Diabetes Association. As such new and emerging diabetes therapies with different mechanisms of action hope to address some of these drawbacks to improve the patient with type 2 diabetes. This article reviews new and emerging classes, including the sodium-glucose cotransporter-2 inhibitors, 11β-Hydroxysteroid dehydrogenase type 1 inhibitors, glycogen phosphorylase inhibitors; protein tyrosine phosphatase 1B inhibitors, G Protein-Coupled receptor agonists and glucokinase activators. These emerging diabetes agents hold the promise of providing benefit of glucose lowering, weight reduction, low hypoglycemia risk, improve insulin sensitivity, pancreatic β cell preservation, and oral formulation availability. However, further studies are needed to evaluate their safety profile, cardiovascular effects, and efficacy durability in order to determine their role in type 2 diabetes management. PMID:24936252

  7. Prognostic relations between inflammatory markers and mortality in diabetic patients with non-ST elevation acute coronary syndrome

    PubMed Central

    Sanchez, P L; Morinigo, J L; Pabon, P; Martin, F; Piedra, I; Palacios, I F; Martin-Luengo, C

    2004-01-01

    Objective: To determine the differences in the inflammatory status between diabetic and non-diabetic patients and to evaluate the usefulness of C reactive protein, fibrinogen, and leucocyte count as predictors of death in diabetic patients with unstable coronary disease. Design: Nested case-control comparisons of the inflammatory status between diabetic and non-diabetic patients. Prospective cohort analysis of C reactive protein concentration, fibrinogen concentration, and leucocyte count as predictors of cardiovascular death in diabetic patients. Setting: Coronary care unit in Spain. Participants: 83 diabetic patients with non-ST elevation acute coronary syndrome and 83 sex and aged matched patients selected from 361 non-diabetic patients with non-ST elevation acute coronary syndrome. Main outcome measures: Plasma concentrations of C reactive protein and fibrinogen, and leucocyte count. Investigators contacted patients to assess clinical events. Results: Concentrations of C reactive protein and fibrinogen, and leucocyte count on admission were higher in diabetic than in non-diabetic patients (7 mg/l v 5 mg/l, p  =  0.020; 3.34 g/l v 2.90 g/l, p  =  0.013; and 8.8 × 109/l v 7.8 × 109/l, p  =  0.040). Among diabetic patients, these values were also higher in those who died during the 22 month follow up (13 mg/l v 6 mg/l, p  =  0.001; 3.95 g/l v 3.05 g/l, p < 0.001; and 11.4 × 109/l v 8.4 × 109/l, p  =  0.005). After adjustment for confounding factors, diabetic patients in the highest tertile of C reactive protein had a hazard ratio for cardiovascular death of 4.51 (95% confidence interval (CI) 1.62 to 12.55). Similar hazard ratios were for fibrinogen 3.74 (95% CI 1.32 to 10.62) and for leucocyte count 3.64 (95% CI 1.37 to 9.68). Conclusions: Inflammation appears more evident in diabetic than in non-diabetic patients with acute coronary syndrome. C reactive protein concentration, fibrinogen concentration, and leucocyte count constitute

  8. Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

    PubMed Central

    Fawzy, Olfat A; Arafa, Asmaa I; El Wakeel, Mervat A; Abdul Kareem, Shaimaa H

    2014-01-01

    BACKGROUND Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. SUBJECTS AND METHODS A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. RESULTS PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) (P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups (P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group (P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN

  9. [The hemodynamic characterization of the diabetic patient with arterial calcifications].

    PubMed

    Vega Gómez, M E; Ley Pozo, J; Aldama Figueroa, A; Lima Santana, B; Montalvo Diago, J; Bustillo, C; Fernández Boloña, A; Gutiérrez Jiménez, O; Ramirez Muñoz, O; Martínez Hernández, R

    1993-01-01

    This study was designed to describe the presence of calcifications according to the clinical features of the diabetic patient and the hemodynamics of the calcified arteries. With this purpose, 197 lower limbs from diabetic patients (type I and II) and carbon-hydrate intolerant patients, were studied. In all of the patients, the pressure ratio leg/arm was measured. On the same way, the arterial flow velocity was recorded using the Doppler ultrasonography on the pedia and postero-tibial arteries. The arterial calcifications, evident on the radiography of the foot, were more frequent between the type I patients and the neuro-infections diabetic foot. According to the hemodynamics point of view, we found a trend of association of more pathologic arterial flow velocity curves with the presence of calcifications (specially on the intima layer). It was also remarkable that an arterial incomprensibility was always associated with arterial calcifications.

  10. A case of esomeprazole-induced transient diabetes and hepatitis: the role of liver inflammation in the pathogenesis of insulin resistance.

    PubMed

    Zaccardi, Francesco; Pitocco, Dario; Martini, Francesca; Caputo, Salvatore; Miele, Luca; Grieco, Antonio; Ghirlanda, Giovanni

    2014-02-01

    We describe a case report of a patient who developed transient type 2 diabetes after a drug-induced (esomeprazole) sub-acute hepatitis. This case evidences the pathophysiological relevance, also in humans, of liver inflammation in the pathogenesis of type 2 diabetes.

  11. Brain changes in diabetes mellitus patients with gastrointestinal symptoms

    PubMed Central

    Drewes, Anne M; Søfteland, Eirik; Dimcevski, Georg; Farmer, Adam D; Brock, Christina; Frøkjær, Jens B; Krogh, Klaus; Drewes, Asbjørn M

    2016-01-01

    Diabetes mellitus is a common disease and its prevalence is increasing worldwide. In various studies up to 30%-70% of patients present dysfunction and complications related to the gut. To date several clinical studies have demonstrated that autonomic nervous system neuropathy and generalized neuropathy of the central nervous system (CNS) may play a major role. This systematic review provides an overview of the neurodegenerative changes that occur as a consequence of diabetes with a focus on the CNS changes and gastrointestinal (GI) dysfunction. Animal models where diabetes was induced experimentally support that the disease induces changes in CNS. Recent investigations with electroencephalography and functional brain imaging in patients with diabetes confirm these structural and functional brain changes. Encephalographic studies demonstrated that altered insular processing of sensory stimuli seems to be a key player in symptom generation. In fact one study indicated that the more GI symptoms the patients experienced, the deeper the insular electrical source was located. The electroencephalography was often used in combination with quantitative sensory testing mainly showing hyposensitivity to stimulation of GI organs. Imaging studies on patients with diabetes and GI symptoms mainly showed microstructural changes, especially in brain areas involved in visceral sensory processing. As the electrophysiological and imaging changes were associated with GI and autonomic symptoms they may represent a future therapeutic target for treating diabetics either pharmacologically or with neuromodulation. PMID:26839652

  12. Periodontal disease in diabetic patients - clinical and histopathological aspects.

    PubMed

    Corlan Puşcu, Dorina; Ciuluvică, Radu Constantin; Anghel, Andreea; Mălăescu, Gheorghe Dan; Ciursaş, Adina Nicoleta; Popa, Gabriel Valeriu; Agop Forna, Doriana; Busuioc, Cristina Jana; Siloşi, Izabela

    2016-01-01

    Periodontal disease is one of the most frequent diseases affecting people all over the world. The relation between periodontal disease and diabetes mellitus raised the interest both of dentists and doctors treating metabolic diseases, as the two conditions influence one another. In our study, we analyzed a number of 75 patients with diabetes mellitus and periodontal disease that presented to the medical consultory for conditions of the dental maxillary system. The clinical study showed that periodontal disease and diabetes may affect young adults as well, still this pathological association more frequently appears after the age of 50. The disease was identified especially in the women living in urban area. The clinical examination of the dental maxillary system identified the presence of gingival ulcerations, dental calculus, gingival bleeding, radicular leftovers with anfractuous margins, fixed prostheses with an inappropriate cervical adjustment. Of the systemic diseases associated to periodontal disease and diabetes mellitus, there was observed that 66.66% of the patients also suffered from cardiovascular diseases (high blood pressure, ischemic cardiopathy, heart failure), and 37.33% suffered from obesity. The histopathological and immunohistochemical tests highlighted the presence of an inflammatory chronic, intense reaction, mainly formed of lymphocytes, plasmocytes, macrophages and granulocytes, heterogeneously disseminated and alteration of the structure of marginal and superficial periodontium. The inflammatory reaction in the patients with periodontal disease and diabetes was more intense than in the patients with periodontal disease without diabetes.

  13. Trandolapril/verapamil combination in hypertensive diabetic patients

    PubMed Central

    García Donaire, José A; Ruilope, Luis M

    2007-01-01

    Cardiovascular diseases are directly affected by arterial hypertension. When associated with diabetes mellitus, the potential deleterious effects are well amplified. Both conditions play a central role in the pathogenesis of coronary artery disease, heart failure, stroke, and renal insufficiency. Prevalence of hypertension is much higher among diabetic than non-diabetic patients, and the hypertensive patient is more likely to develop type 2 diabetes. Current international guidelines recommend aggressive reductions in blood pressure (BP) in hypertensive patients with additional risk factors, including cardiovascular risk factors, and emphasize the relevance of intensive reduction in patients with diabetes mellitus; a goal of 130/80 mm Hg is required. To achieve BP target a combination of antihypertensives will be needed, and the use of long-acting drugs that are able to provide 24-hour efficacy with a once-daily dosing confers the noteworthy advantages of compliance improvement and BP variation lessening. Lower dosages of the individual treatments of the combination therapy can be administered for the same antihypertensive efficiency as that attained with high dosages of monotherapy. Angiotensin-converting enzyme inhibitors and calcium-channel blockers as a combination have theoretically compelling advantages for vessel homeostasis. Trandolapril/verapamil sustained release combination has showed beneficial effects on cardiac and renal systems as well as its antihypertensive efficacy, with no metabolic disturbances. This combination can be considered as an effective therapy for the diabetic hypertensive population. PMID:17583177

  14. The association of patient trust and self-care among patients with diabetes mellitus

    PubMed Central

    Bonds, Denise E; Camacho, Fabian; Bell, Ronny A; Duren-Winfield, Vanessa T; Anderson, Roger T; Goff, David C

    2004-01-01

    Background Diabetes requires significant alterations to lifestyle and completion of self management tasks to obtain good control of disease. The objective of this study was to determine if patient trust is associated with reduced difficulty and hassles in altering lifestyle and completing self care tasks. Methods A cross-sectional telephone survey and medical record review was performed to measure patient trust and difficulty in completing diabetes tasks among 320 medically underserved patients attending diabetes programs in rural North Carolina, USA. Diabetes tasks were measured three ways: perceived hassles of diabetic care activities, difficulty in completing diabetes-related care activities, and a global assessment of overall ability to complete diabetes care activities. The association of patient trust with self-management was examined after controlling for patient demographics, physical functioning, mental health and co-morbidities. Results Level of patient trust was high (median 22, possible max 25). Higher trust levels were associated with lower levels of hassles (p = 0.006) and lower difficulty in completing care activities (p = 0.001). Patients with higher trust had better global assessments of overall ability to complete diabetes care activities (p < 0.0001). Conclusion Higher patient trust in physicians is associated with reduced difficulty in completing disease specific tasks by patients. Further studies are needed to determine the causal relationship of this association, the effect of trust on other outcomes, and the potential modifiability of trust PMID:15546482

  15. Lipoprotein alterations in hemodialysis: differences between diabetic and nondiabetic patients.

    PubMed

    González, Ana Inés; Schreier, Laura; Elbert, Alicia; Berg, Gabriela; Beresan, Hugo; López, Graciela; Wikinski, Regina

    2003-01-01

    Both renal failure and type 2 diabetes may contribute synergistically to the dyslipemia of diabetic renal failure with the development of atherosclerosis as the possible consequence. It has not yet been conclusively evaluated whether diabetic patients with end-stage renal failure under maintenance hemodialysis (HD) show accentuated alterations in plasma lipids and lipoproteins in comparison to nondiabetics under HD. These abnormalities would involve hepatic lipase activity and the regulation of triglyceride-rich lipoprotein metabolism. The purpose of the present study was to evaluate whether type 2 diabetic patients undergoing HD exhibited a lipid-lipoprotein profile different from that of nondiabetic hemodialyzed patients. We compared plasma lipids, apoprotein (apo) A-I and B, and lipoprotein parameters among 3 groups: 25 type 2 diabetics, 25 nondiabetics, both undergoing HD, and 20 healthy control subjects. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) were isolated by sequential ultracentrifugation. Hepatic lipase activity was measured in postheparin plasma. Both groups of HD patients showed higher triglyceride and IDL cholesterol (P <.001), and lower high-density lipoprotein (HDL) cholesterol (P <.01) and apo A-I (P <.001) levels compared to the control group, even after adjustment for age and body mass index (BMI). However, no differences were found in lipid, lipoprotein, and apoprotein concentrations between diabetic and nondiabetic HD patients, except for high LDL triglyceride content of diabetic HD patients (P <.01). Nondiabetics undergoing HD also presented higher LDL triglyceride levels than controls (P <.05). LDL triglyceride correlated with plasma triglycerides (r = 0.51, P <.001). A lower LDL cholesterol/apo B ratio was found in each group of HD patients in comparison to controls (P <.02). Comparing the diabetic and nondiabetic patients, hepatic lipase activity remained unchanged, but significantly lower than control subjects

  16. Are diabetic patients being screened for sleep related breathing disorder?

    PubMed Central

    Surani, Salim

    2013-01-01

    Prevalence of both diabetes mellitus and obstructive sleep apnea (OSA) is high among general population. Both of these conditions are associated with significant morbidity. OSA affects approximately 25% of men and 9% of women, and its prevalence is even higher among obese, Hispanics, African American and diabetic patients. Diabetes on the other hand besides having high prevalence in general population has even higher prevalence among ethnic populations as Hispanics and African American. Despite the availability of several simple screening tools for OSA, as Berlin questionnaire, STOP-BANG questionnaire, NAMES Criteria, the utility for screening of OSA among the diabetic population remains marginal. This in turn can lead to significant morbidity and complications related to OSA as well as worsening of diabetes mellitus and increase in diabetic complications due to untreated sleep related breathing disorder. It is therefore imperative for the primary care giver to screen for OSA among the diabetic population as a part of their routine evaluation to prevent worsening of diabetes, and its cardiovascular, renal, ophthalmologic and neurological complications. PMID:24147199

  17. Subclinical neuropathy in diabetic patients: a risk factor for bilateral lower limb neurological deficit following spinal anesthesia?

    PubMed

    Angadi, Darshan S; Garde, Ajit

    2012-02-01

    Total knee arthroplasty performed under spinal or general anesthesia is a common successful orthopedic procedure. Nonetheless, in patients with diabetes mellitus this procedure can present unique challenges to orthopedic surgeon and anesthesiologist alike. We describe a case of an elderly male diabetic patient who developed bilaterally symmetrical lower limb neurological deficit following an uneventful total knee arthroplasty performed under spinal anesthesia. Postoperative nerve conduction study with electromyography confirmed symmetrical extensive denervation of lower limb muscles, including low-voltage fibrillation potentials and positive sharp waves. These findings were consistent with a preexisting neuropathy, thereby suggesting a subclinical neuropathy as a potential risk factor for this neurological complication. Our case highlights the fact that patients with longstanding comorbidities, namely peripheral vascular disease and diabetes mellitus, may be at an increased risk of neurological injury following regional anesthesia. Hence, we believe that preoperative evaluation of diabetic patients should include neurophysiological studies to identify subclinical neuropathy and minimize the risk of neurological injury.

  18. Improvements in Care and Reduced Self-Management Barriers Among Rural Patients With Diabetes

    ERIC Educational Resources Information Center

    Dettori, Nancy; Flook, Benjamin N.; Pessl, Erich; Quesenberry, Kim; Loh, Johnson; Harris, Colleen; McDowall, Janet M.; Butcher, Marcene K.; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

    2005-01-01

    Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. In 2000, the Park County Diabetes Project and the Montana Diabetes Control…

  19. [COMBINED HONDROPROTECTION IN REHABILITATION OF PATIENTS WITH DIABETES MELLITUS WITH DIABETIC ARTHROPATHY].

    PubMed

    Orlenko, V L

    2015-01-01

    The efficacy and tolerability of combined chondroprotectors Teraflex® in patients with diabetes mellitus type 1 and 2, complicated by arthropathy were investigated. It was established, that Tera- flex® therapy positively influences on the development of diabetic arthropathy (reducing intensity of pain, increasing the range of movements and reduced volume of the affected joints, increasing the functionality of the patient). In addition, an analysis of the impact of chondroprotectors on the level of sugar among patients.It was found, that it is necessary to control blood sugar while taking chondroprotectors and if needed, increasing the dose of hypoglycohaemic drugs during this period.

  20. Serum magnesium, iron and ferritin levels in patients with diabetic retinopathy attending Makkah Eye Complex, Khartoum, Sudan.

    PubMed

    Hamdan, Hamdan Z; Nasser, Nasser M; Adam, Ammar M; Saleem, Mahgoub A; Elamin, Maha I

    2015-05-01

    Diabetic retinopathy is the most common complications of diabetes mellitus that, in most occasions, lead to blindness. Multiple evidences linked the serum magnesium, iron and ferritin disturbance with diabetes and its complications. A case-control study was conducted at Makkah Eye Complex, Khartoum, Sudan, to compare the levels of serum magnesium, iron and ferritin in patients with diabetic retinopathy with diabetic patients without diabetic retinopathy (controls). Findings indicate that all patients had type 2 diabetes. The two groups (50 in each arm) were well matched in their basic characteristics. Median (25th-75th interquartile) of serum magnesium in patients with diabetic retinopathy were significantly lower than patients without diabetic retinopathy [1.48 (0.75-1.64) vs. 1.92 (1.4-2.3)mg/dl, P = 0.022]. The median of serum iron and ferritin were lower in cases than control group but did not reach a statistical significance [20.5 (17.2-48.0) vs. 27.0 (16.0-54.0) μg/dl, P = 0.568; 98.0 (45.0-134.75) vs. 101.0 (47.0-161.0) μg/l, P = 0.818]. The duration of diabetes [16.5 (9.3) vs. 11.2 (6.6) years; P = 0.014] and haemoglobin level [13.7 (0.9) vs. 12.5 (2.0) g/dl; P = 0.039] were significantly higher in cases group than control group. A significant inverse correlation was observed between serum magnesium and iron levels. Twenty (40 %) patients had severe non-proliferative diabetic retinopathy with mild macular edema, which is the most prevalent type among the cases group. Hypomagnesaemia among diabetic patients was associated with diabetic retinopathy, while serum iron and ferritin have no significant effect in this setting. Severe non-proliferative diabetic retinopathy with mild macular edema is the prevalent type in this study.

  1. Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases.

    PubMed

    Zhang, Yunqian; Li, Jintao; Wang, Tingjuan; Wang, Jianlin

    2014-07-15

    Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.

  2. Insulin resistant diabetes mellitus without the presence of insulin antibodies. A case report.

    PubMed

    Páv, J; Srámková, J; Matys, Z

    1976-07-01

    A case of a 26-year old woman suffering from an insulin resistant diabetes mellitus for 14 years is described. Acanthosis nigricans was diagnosed in the patient's second year and the syndrome of Stein-Leventhal at the age of 15. Diabetes could not be properly controlled either with the daily dosis of insulin as high as 1140 U or with peroral tolbutamide. Fasting serum IRI concentrations were elevated, the secretoric response to the stimulation by glucose or tolbutamide was substantial and protracted. The hypoglycemic response to the i.v. application of commercial insulin was insignificant. Serum growth hormone levels were normal. No presence of insulin antibodies in the serum was detected.

  3. Tendinopathy in diabetes mellitus patients-Epidemiology, pathogenesis, and management.

    PubMed

    Lui, Pauline Po Yee

    2017-01-20

    Chronic tendinopathy is a frequent and disabling musculo-skeletal problem affecting the athletic and general populations. The affected tendon is presented with local tenderness, swelling, and pain which restrict the activity of the individual. Tendon degeneration reduces the mechanical strength and predisposes it to rupture. The pathogenic mechanisms of chronic tendinopathy are not fully understood and several major non-mutually exclusive hypotheses including activation of the hypoxia-apoptosis-pro-inflammatory cytokines cascade, neurovascular ingrowth, increased production of neuromediators, and erroneous stem cell differentiation have been proposed. Many intrinsic and extrinsic risk/causative factors can predispose to the development of tendinopathy. Among them, diabetes mellitus is an important risk/causative factor. This review aims to appraise the current literature on the epidemiology and pathology of tendinopathy in diabetic patients. Systematic reviews were done to summarize the literature on (a) the association between diabetes mellitus and tendinopathy/tendon tears, (b) the pathological changes in tendon under diabetic or hyperglycemic conditions, and (c) the effects of diabetes mellitus or hyperglycemia on the outcomes of tendon healing. The potential mechanisms of diabetes mellitus in causing and exacerbating tendinopathy with reference to the major non-mutually exclusive hypotheses of the pathogenic mechanisms of chronic tendinopathy as reported in the literature are also discussed. Potential strategies for the management of tendinopathy in diabetic patients are presented.

  4. Immunoregulatory molecules in patients with gestational diabetes mellitus.

    PubMed

    Pendeloski, Karen Priscilla Tezotto; Mattar, Rosiane; Torloni, Maria Regina; Gomes, Caio Perez; Alexandre, Sandra Maria; Daher, Silvia

    2015-09-01

    Induction of maternal-fetal immune tolerance is essential for the development of normal pregnancy. Impaired expression of costimulatory molecules may lead to intense inflammatory reaction, a mechanism involved in the pathophysiology of gestational diabetes mellitus (GDM). The aim of this study was to investigate whether immunoregulatory molecules are involved in the physiopathology of GDM. This case-control study included 30 healthy pregnant women and 20 GDM patients. Flow cytometry was used to assess peripheral blood T subpopulations (CD4(+) and CD8(+)), the expression of immunoregulatory molecules (CD28, ICOS, CTLA-4, and PD-1) and activation markers (CD69 and HLA-DR). Compared to healthy women, GDM patients had a significantly higher frequency of CD4(+)CD69(+) and CD8(+)CD69(+) T cells; only patients with insulin-treated GDM had increased numbers of CD4(+)HLA-DR(+) T cells. We also observed significantly higher percentages of CD4(+)CD28(+)HLA-DR(+), CD3(+)CD4(+)ICOS(+), CD3(+)CD4(+)PD-1(+), CD8(+)CD28(+)CD69(+), CD8(+)CD28(+)HLA-DR(+), CD8(+)CTLA-4(+)HLA-DR(+), and CD3(+)CD8(+)ICOS(+) T cells and lower frequency of CD3(+)CD4(+)CTLA-4(+), CD3(+)CD8(+)CTLA-4(+), and CD8(+)ICOS(+)HLA-DR(+) T cells in GDM patients compared to healthy pregnant women. This first study assessing costimulatory molecules in GDM patients shows that these patients have exacerbated markers of T cell activation along with CTLA-4 deficiency, findings that indicate that the maternal-fetal tolerance is compromised in these patients.

  5. Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention

    PubMed Central

    O’Brien, Matthew J.; Moran, Margaret R.; Tang, Joyce W.; Vargas, Maria C.; Talen, Mary; Zimmermann, Laura J.; Ackermanna, Ronald T.; Kandula, Namratha R.

    2016-01-01

    Purpose The purpose of this study was to explore how adults with prediabetes perceive their risk of developing diabetes and examine their preferences for evidence-based treatment options to prevent diabetes. Methods A qualitative study was conducted in 2 large Midwest primary care practices, involving in-depth semistructured interviews with 35 adult patients with prediabetes. Results This ethnically diverse (77% nonwhite) sample of middle-aged primary care patients exhibited multiple diabetes risk factors. Knowledge gaps about prediabetes and its medical management were pervasive. Most patients overestimated the risk of developing diabetes and were not familiar with evidence-based treatment options for prediabetes. They suggested that receiving brief, yet specific information about these topics during the study interview motivated them to act. The majority of participants considered both intensive lifestyle intervention and metformin acceptable treatment options. Many preferred initial treatment with intensive lifestyle intervention but would take metformin if their efforts at lifestyle change failed and their primary care physician recommended it. Some participants expressed wanting to combine both treatments. Conclusions This qualitative study highlights potential opportunities to promote patient-centered dialogue about prediabetes in primary care settings. Providing patients specific information about the risk of developing diabetes and evidence-based treatment options to prevent or delay its onset may encourage action. Physicians’ prediabetes counseling efforts should be informed by the finding that most patients consider both intensive lifestyle intervention and metformin acceptable treatment options. PMID:27621093

  6. Quantitative estimation of antioxidant therapy efficiency in diabetes mellitus patients

    NASA Astrophysics Data System (ADS)

    Gurfinkel, Youri I.; Ishunina, Angela M.; Ovsyannickov, Konstantin V.; Strokov, Igor A.

    2000-11-01

    The aim of this work was to find out to which degree Tanakan affects the microcirculation parameters and the malonic dialdehyde level as a parameter of intense lipid peroxidation in insulin-independent diabetes patients with different disease durations. We used computerized capillaroscope GY-0.04 designed by the Centre for Analysis of Substances, Russia for the non-invasive measurement of capillary blood velocity as well as the size of the perivascular zone and density of blood aggregates and lipid inclusions. The microcirculation parameters were studied in two groups of insulin-independent diabetes patients. The basic group included 58 patients (61+/-9,0 years, disease duration 14,7+/-7,8 years). The patients had late diabetic complications as retinopathy and nephrophathy, neuropathy, confirmed by clinical and tool investigation. In this group we also studied the level of serum malonic dialdehyde, as a parameter of intense lipid peroxidation. The reference group included 31 patients (57+/-1,3 years, disease duration 3,6+/-0,6 years) with minimum diabetic complication. We show that Tanakan in daily dosage 120 mg for 2 months reduces the malonic dialdehyde level in the blood serum and the erythrocyte membranes of type II diabetes patients and improves the microcirculation parameters. There are correspondences between the density of lipid inclusions as determined with computerized capillaroscopy and the lipid exchange parameters as determined using a routing blood test. Thus, noninvasive blood lipid quantification is feasible and reliable.

  7. Elevated soluble CD40 ligand in diabetic patients with painless myocardial infarction.

    PubMed

    Huang, Yu; Qiu, Jianping; Zhang, Denghai; Qiu, Geng

    2011-01-01

    Because a useful biomarker for painless myocardial infarction (MI) has yet to be identified, the aim of this study was to identify a biomarker for diabetic patients with painless MI. A case-control design was used to compare inflammatory cytokine levels among 111 patients with diabetes mellitus, including 31 patients with stable coronary heart disease (CHD), 30 patients with painful MI, 20 patients with painless MI, and 30 age- and sex-matched patients without CHD (control group). In addition to baseline parameters, cytokine levels, including plasma high sensitivity C-reactive protein (HsCRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and soluble CD40 ligand (sCD40L) levels, were analyzed using enzyme-linked immunosorbent assays (ELISAs). No differences in baseline characteristics were observed for patients with painless MI as compared to the other patient groups. Significantly higher sCD40L, HsCRP, IL-6, and TNF-α levels were detected in patients with MI, and markedly elevated sCD40L and IL-6 levels were observed in patients with painless MI as compared to those with painful MI. sCD40L may be a useful biomarker for painless MI in diabetic patients, which could reduce misdiagnosis and expedite treatment. Further studies are required to validate the diagnostic utility of this putative biomarker as well as investigate the mechanism by which sCD40L is elevated in these patients.

  8. The relationship between diabetes attitudes and treatment among free clinic patients and volunteers.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Nourian, Maziar M; Myers, Kyl; Saunders, AnnMarie; Solis, Silvia P; Ashby, Jeanie; Greenwood, Jessica L J; Reel, Justine J

    2014-12-01

    Free clinics provide free primary care to the under or uninsured and have been playing an important role in serving the socio-economically disadvantaged. Free clinic patients represent a group of people who experience significant barriers to receiving diabetes prevention and intervention. This study examined diabetes attitudes among free clinic patients and volunteers. English or Spanish speaking patients and volunteers (N = 384), aged 18 years or older completed a self-administered survey. Diabetic patients and volunteers shared similar levels of diabetes attitudes compared to non-diabetic patients. Among patients, ethnicity, education level, diabetes education, and family history affected diabetes attitudes. Among volunteers, diabetes education was an important factor associated with positive diabetes attitudes. Whether the volunteer is a healthcare professional or student was related only to one aspect of diabetes attitudes, seriousness of type 2 diabetes. The results, indicating free clinic diabetic patients and volunteers shared similar levels of diabetes attitudes, were positive for maintaining and developing diabetes education programs at a free clinic. Unfortunately, the average length of volunteering at this free clinic was short and student volunteers likely leave the clinic upon graduation. Future research should examine issues of volunteer retention in free clinics. Diabetes education for patients may need to be diversified according to ethnicity, family history of diabetes, and educational level. Finally, non-healthcare professional volunteers could potentially be involved in diabetes education at a free clinic.

  9. Diabetic Cardiovascular Autonomic Neuropathy Predicts Recurrent Cardiovascular Diseases in Patients with Type 2 Diabetes

    PubMed Central

    Cha, Seon-Ah; Yun, Jae-Seung; Lim, Tae-Seok; Min, Kyoungil; Song, Ki-Ho; Yoo, Ki-Dong; Park, Yong-Moon; Ahn, Yu-Bae

    2016-01-01

    Cardiovascular autonomic neuropathy (CAN) is a risk factor for cardiovascular disease (CVD) and mortality in patients with type 2 diabetes. This study evaluated the relationship between CAN and recurrent CVD in type 2 diabetes. A total of 206 patients with type 2 diabetes who had a history of CVD within 3 years of enrollment were consecutively recruited from January 2001 to December 2009 and followed-up until December 2015. Cardiovascular autonomic function tests were performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. We estimated the recurrence of CVD events during the follow-up period. A total of 159 (77.2%) of the 206 patients enrolled completed the follow up, and 78 (49.1%) patients had recurrent episodes of CVD, with an incidence rate of 75.6 per 1,000 patient-years. The mean age and diabetes duration were 62.5 ± 8.7 and 9.2 ± 6.9 years, respectively. Patients who developed recurrent CVD also exhibited hypertension (P = 0.004), diabetic nephropathy (P = 0.012), higher mean systolic blood pressure (P = 0.006), urinary albumin excretion (P = 0.015), and mean triglyceride level (P = 0.035) than did patients without recurrent CVD. Multivariable Cox hazard regression analysis revealed that definite CAN was significantly associated with an increased risk of recurrent CVD (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.39−6.60; P = 0.005). Definite CAN was an independent predictor for recurrent CVD in patients with type 2 diabetes who had a known prior CVD event. PMID:27741306

  10. Plasma 25-Hydroxyvitamin D and Progression to Diabetes in Patients at Risk for Diabetes

    PubMed Central

    Pittas, Anastassios G.; Nelson, Jason; Mitri, Joanna; Hillmann, William; Garganta, Cheryl; Nathan, David M.; Hu, Frank B.; Dawson-Hughes, Bess

    2012-01-01

    OBJECTIVE To investigate the association between vitamin D status, assessed by plasma 25-hydroxyvitamin D, and risk of incident diabetes. RESEARCH DESIGN AND METHODS Prospective observational study with a mean follow-up of 2.7 years in the Diabetes Prevention Program (DPP), a multicenter trial comparing different strategies for prevention of diabetes in patients with prediabetes. We assessed the association between plasma 25-hydroxyvitamin D, measured repeatedly during follow-up, and incident diabetes in the combined placebo (n = 1,022) and intensive lifestyle (n = 1,017) randomized arms of the DPP. Variables measured at multiple study time points (25-hydroxyvitamin D, BMI, and physical activity) entered the analyses as time-varying “lagged” covariates, as the mean of the previous and current visits at which diabetes status was assessed. RESULTS After multivariate adjustment, including for the DPP intervention, participants in the highest tertile of 25-hydroxyvitamin D (median concentration, 30.1 ng/mL) had a hazard ratio of 0.72 (95% CI 0.56–0.90) for developing diabetes compared with participants in the lowest tertile (median concentration, 12.8 ng/mL). The association was in the same direction in placebo (0.70; 0.52–0.94) versus lifestyle arm (0.80; 0.54–1.17). CONCLUSIONS Higher plasma 25-hydroxyvitamin D, assessed repeatedly, was associated with lower risk of incident diabetes in high-risk patients, after adjusting for lifestyle interventions (dietary changes, increased physical activity, and weight loss) known to decrease diabetes risk. Because of the observational nature of the study, the potential association between vitamin D and diabetes needs to be confirmed in intervention studies. PMID:22323410

  11. Fulminant type I diabetes mellitus associated with nivolumab in a patient with relapsed classical Hodgkin lymphoma.

    PubMed

    Munakata, Wataru; Ohashi, Ken; Yamauchi, Nobuhiko; Tobinai, Kensei

    2017-03-01

    We report the case of a patient with relapsed classical Hodgkin lymphoma who developed fulminant type I diabetes mellitus as a severe adverse event of treatment with the anti-programmed cell death-1 (PD-1) antibody, nivolumab. On the first day of the sixth cycle, the blood glucose level was markedly elevated (375 mg/dL). Although neither ketoacidosis nor ketonuria was detected, the markedly acute onset of the hyperglycemia was consistent with the typical clinical course of fulminant type I diabetes mellitus, and this diagnosis was supported by clinical data. All autoantibodies associated with type I diabetes mellitus were negative. The endogenous insulin secretion ceased completely within 2 weeks. After the blood glucose level was brought under control, nivolumab was resumed and continued without other major adverse events. Human leukocyte antigen (HLA) analysis revealed that the patient carried the HLA-B*4002 haplotype, a susceptibility allele for this type of diabetes mellitus. This case suggests that fulminant type I diabetes mellitus may be triggered by nivolumab in patients with a genetic background associated with the condition, warranting careful future consideration of this particular adverse event.

  12. Diabetes and glucose disturbances in patients with psychosis in Sweden

    PubMed Central

    Olsson, Eric; Westman, Jeanette; Sudic Hukic, Dzana; Eriksson, Sven V; Edman, Gunnar; Bodén, Robert; Jedenius, Erik; Reutfors, Johan; Berntsson, Anders; Hilding, Agneta; Schalling, Martin; Östenson, Claes-Göran; Ösby, Urban

    2015-01-01

    Objective The objectives of this study were to (1) analyze the prevalence of diabetes, prediabetes, and antidiabetic medication in patients with psychosis compared with control subjects and (2) determine what factors in patients with psychosis were associated with antidiabetic medication. Method We studied 977 patients with psychosis recruited from outpatient clinics in Stockholm County, Sweden, and they were compared with 3908 non-psychotic control subjects for fasting plasma glucose levels; prevalence of diabetes, prediabetes, antidiabetic treatment, and tobacco use; and blood pressure, weight, height, and waist circumference. Group differences were evaluated with analysis of variance and χ2 test, and factors associated with antidiabetic treatment were evaluated with logistic regression. Results Diabetes was observed in 94 (10%) patients with psychosis, 2.7 times the prevalence observed in control subjects. Among patients with psychosis, 87 (10%) had prediabetes (fasting glucose, 6.1–6.9 mmol/L) compared with 149 (3.8%) control subjects. Most patients with psychosis (77%) who had prediabetes fulfilled criteria for metabolic syndrome. In patients with psychosis, both lipid-lowering medication and fasting glucose were significantly associated with antidiabetic treatment. There was no significant relation between antidiabetic treatment and lifestyle factors such as smoking or degree of psychiatric illness. Conclusions The high prevalence of impaired fasting glucose and metabolic syndrome in patients with psychosis warrants further clinical research in preventing or delaying the onset of diabetes in these patients by pharmacotherapy and/or lifestyle intervention. PMID:26468398

  13. Patient involvement in diabetes care: experiences in nine diabetes care groups

    PubMed Central

    de Bruin, Simone R.; Struijs, Jeroen N.; Rijken, Mieke; Nijpels, Giel; Baan, Caroline A.

    2015-01-01

    Introduction Despite the expected beneficial effects on quality of care, patient involvement in diabetes care groups, which deliver a bundled paid integrated care programme for diabetes type 2, seems to be limited. The aim of this study was to gain insight into levels and methods of patient involvement, into facilitators and barriers, and into the future preferences of care groups and patient representatives. Theory and methods Semi-structured interviews were held with 10 representatives of care groups and 11 representatives of patient advocacy groups. An adapted version of Arnstein's ladder of citizen participation was used to define five levels of patient involvement. Results Patient involvement in care groups was mostly limited to informing and consulting patients. Higher levels, i.e., advising, co-producing and decision-making, were less frequently observed. Care groups and patient representatives perceived largely the same barriers and facilitators and had similar preferences regarding future themes and design of patient involvement. Conclusion Constructive collaboration between diabetes care groups and patient representatives to enhance patient involvement in the future seems viable. Several issues such as the lack of evidence for effectiveness of patient involvement, differences in viewpoints on the role and responsibilities of care groups and perceived barriers need to be addressed. PMID:27118961

  14. Urinary 6-sulfatoxymelatonin level in diabetic retinopathy patients with type 2 diabetes.

    PubMed

    Chen, Wei; Cao, Hui; Lu, Qian-Yi; Wang, Na; Zhao, Shu-Zhi; Xu, Xun; Zheng, Zhi

    2014-01-01

    Melatonin is a powerful antioxidant. Decreased melatonin excretion has been reported to be associated with several oxidative stress-related diseases. The urinary metabolite of melatonin, 6-sulfatoxymelatonin (aMT6s), has proved to be a very reliable index of melatonin production. The present study aims to evaluate the level of urinary aMT6s in patients with type 2 diabetes mellitus and diabetic retinopathy. Urine samples were collected from 10 patients with diabetes and no diabetic retinopathy (NDR), 19 patients with nonproliferative diabetic retinopathy (NPDR), 38 patients with proliferative diabetic retinopathy (PDR), and 16 subjects without diabetes mellitus, who served as controls. The level of aMT6s in specimens was assayed by a commercial aMT6s ELISA kit, creatinine levels were also measured for each sample to get urinary aMT6s/creatinine ratio. Creatinine-adjusted urinary aMT6s values were compared among four groups. The urinary aMT6s (mean ± SD) levels were 9.95 ± 2.42, 9.90 ± 2.28, 8.40 ± 1.84 and 5.58 ± 1.33 ng/mg creatinine in the controls and in patients with NDR, NPDR, or PDR, respectively. The urinary aMT6s level of the PDR group was significantly lower than that of the control, NDR and DR groups. No significant difference was found among the control, NDR and DR groups. After adjustment for various factors (age, smoking, cancer, and coronary heart disease) that may influence the aMT6s level, the odds-ratio of urinary aMT6s comparing PDR patients to controls was 0.246 (95% confidence interval = 0.108-0.558, P = 0.001). Therefore, the urinary aMT6s level is significantly decreased in diabetic patients with PDR but not in diabetic patients without PDR, which indicates that decreased urinary aMT6s level may be associated with the pathogenesis of PDR.

  15. Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist

    PubMed Central

    Stepan, Jeffrey G.; London, Daniel A.; Boyer, Martin I.; Calfee, Ryan P.

    2014-01-01

    Purpose To quantify diabetic patients’ change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels. Methods Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2 receiving a corticosteroid injection recorded their morning fasting blood glucose levels for 14 days after their injection. Fasting glucose levels on days 1–7 after injection qualified as “case” data with levels on days 10–14 providing control data. A mixed model with a priori contrasts were used to compare post-injection blood glucose levels to baseline levels. A linear regression model was used to determine patient predictors of a post-injection rise in blood glucose levels. Results Forty of 67 patients (60%) recruited for the study returned completed blood glucose logs. There was a significant increase in fasting blood glucose levels following injection limited to post-injection days 1 and 2. Among patient risk factors in our linear regression model, type 1 diabetes and use of insulin each predicted a post-injection increase in blood glucose levels from baseline while higher HbA1c levels did not predict increases. Discussion Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels. Level of Evidence Therapeutic Level III PMID:24679910

  16. [Characteristics of aphakic eye in patients with diabetes].

    PubMed

    Kartasheva, E A; Abramov, M V; Evdokimova, M I

    1998-01-01

    Ninety patients with aphakia and diabetes were examined. Intraocular pressure was normal in 30 patients, in 30 aphakia was concomitant with primary glaucoma, and 30 presented with aphakic glaucoma. Fundus oculi was examined with a slit lamp and +60 D lens, gonioscopy and cycloscopy were carried out using a contact prism proposed by the authors. Aphakic glaucoma developed as a result of changes in the anterior chamber corner: coarse postoperative cicatrices and vitreo-corneal adhesions. Diabetic retinopathy was equally incident in all three groups of patients. Changes in the ciliary vessels can anticipate diabetic retinopathy. New vessels on ciliary body processes is an unfavorable prognostic sign as regards visual functions in patients with aphakia and increased intraocular pressure.

  17. Ultrasonic Measurement of Common Carotid Intima-Media Thickness in Type 2 Diabetic and Non-Diabetic Patients

    PubMed Central

    Alizadeh, Ahmad; Roudbari, Ali; Heidarzadeh, Abtin; Babaei Jandaghi, Ali; Bani Jamali, Maryam

    2012-01-01

    Background Diabetes mellitus is a widespread disease. Its vascular complications can be characterized by arteriosclerosis formation in carotid arteries. Due to its delayed diagnosis resulting in more complications in Iran, it seems that screening diabetic patients is mandatory. Objectives The aim of this study was to compare the intima-media thickness (IMT) of carotid artery in diabetic and non-diabetic patients. Patients and Methods This is a cross-sectional study, which included 80 participants (40 diabetics and 40 non-diabetics). By using ultrasound, bilateral IMTs of the distal carotid were measured and the data were analyzed using ANOVA and multivariate regression tests in SPSS 14. Results The mean IMT was 0.97 in diabetic patients and 0.63 in non-diabetics (P < 0.001). Age and gender had significant positive effects on the increase of IMT (P < 0.05 and P < 0.005, respectively for age and gender). Past medical history of coronary heart disease (CHD) and cerebrovascular accident (CVA) in diabetes is associated significantly with an increase in IMT (P =0.019 and 0.027 respectively). Other confounding variables such as smoking, history of hypertension (HTN) and hyperlipoproteinemia (HLP) in diabetic patients showed no significant relationship with the increase of IMT. Conclusions Although measuring the IMT of the carotid artery by sonography is a useful tool for screening diabetic patients, more studies are needed for determining how to use these measurements in promoting the patients outcomes. PMID:23329968

  18. Patient Selection in Vitamin E Treatment in Diabetes Mellitus

    PubMed Central

    Goldenstein, Hagit; Levy, Nina S.; Lipener, Yisrael T.; Levy, Andrew P.

    2013-01-01

    In diabetes there is an increase in oxidative stress due to elevated glucose levels in the plasma. High glucose promotes glycosylation of both plasma and cellular proteins which particularly affects the endothelial cell lining of the blood vessel wall and interferes with its normal function. Thus diabetes mellitus patients suffer from a higher incidence of cardiovascular complications such as atherosclerosis as compared to the non-diabetic population. Haptoglobin (Hp) is a plasma protein which binds free hemoglobin and prevents heme-iron mediated oxidation. There are three different types of Hp which differ in their antioxidant ability. Several clinical studies have shown that the Hp 2-2 genotype is associated with higher incidence of cardiovascular diseases among diabetics. Vitamin E, a low cost, easy to use antioxidant, was found to decrease the risk of developing cardiovascular diseases in Hp 2-2 diabetic patients. This review summarizes several studies which show the importance of vitamin E supplementation in a specific sub-group of patients consisting of diabetic individuals carrying the Hp 2-2 genotype. PMID:23469912

  19. Therapeutic efficacy of ozone in patients with diabetic foot.

    PubMed

    Martínez-Sánchez, Gregorio; Al-Dalain, Saied M; Menéndez, Silvia; Re, Lamberto; Giuliani, Attilia; Candelario-Jalil, Eduardo; Alvarez, Hector; Fernández-Montequín, José Ignacio; León, Olga Sonia

    2005-10-31

    Oxidative stress is suggested to have an important role in the development of complications in diabetes. Because ozone therapy can activate the antioxidant system, influencing the level of glycemia and some markers of endothelial cell damage, the aim of this study was to investigate the therapeutic efficacy of ozone in the treatment of patients with type 2 diabetes and diabetic feet and to compare ozone with antibiotic therapy. A randomized controlled clinical trial was performed with 101 patients divided into two groups: one (n = 52) treated with ozone (local and rectal insufflation of the gas) and the other (n = 49) treated with topical and systemic antibiotics. The efficacy of the treatments was evaluated by comparing the glycemic index, the area and perimeter of the lesions and biochemical markers of oxidative stress and endothelial damage in both groups after 20 days of treatment. Ozone treatment improved glycemic control, prevented oxidative stress, normalized levels of organic peroxides, and activated superoxide dismutase. The pharmacodynamic effect of ozone in the treatment of patients with neuroinfectious diabetic foot can be ascribed to the possibility of it being a superoxide scavenger. Superoxide is considered a link between the four metabolic routes associated with diabetes pathology and its complications. Furthermore, the healing of the lesions improved, resulting in fewer amputations than in control group. There were no side effects. These results show that medical ozone treatment could be an alternative therapy in the treatment of diabetes and its complications.

  20. Retinal Capillary Rarefaction in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Jumar, Agnes; Harazny, Joanna M.; Ott, Christian; Friedrich, Stefanie; Kistner, Iris; Striepe, Kristina

    2016-01-01

    Purpose In diabetes mellitus type 2, capillary rarefaction plays a pivotal role in the pathogenesis of end-organ damage. We investigated retinal capillary density in patients with early disease. Methods This cross-sectional study compares retinal capillary rarefaction determined by intercapillary distance (ICD) and capillary area (CapA), measured non-invasively and in vivo by scanning laser Doppler flowmetry, in 73 patients with type 2 diabetes, 55 healthy controls and 134 individuals with hypertension stage 1 or 2. Results In diabetic patients, ICD was greater (23.2±5.5 vs 20.2±4.2, p = 0.013) and CapA smaller (1592±595 vs 1821±652, p = 0.019) than in healthy controls after adjustment for differences in cardiovascular risk factors between the groups. Compared to hypertensive patients, diabetic individuals showed no difference in ICD (23.1±5.8, p = 0.781) and CapA (1556±649, p = 0.768). Conclusion In the early stage of diabetes type 2, patients showed capillary rarefaction compared to healthy individuals. PMID:27935938

  1. Dietary Treatment Options for Depression among Diabetic Patient, Focusing on Macronutrients

    PubMed Central

    Azadbakht, Leila

    2013-01-01

    There is a bidirectional adverse association between diabetes and depression. The odds for experiencing depressive symptoms in diabetic patients are two times more than nondiabetic persons, and depression is an independent predictor for the onset of diabetes. However, depression has been approximately unrecognized and untreated in two-thirds of diabetic patients, which may lead to worsened diabetes complications. A cornerstone strategy for managing depression among diabetic patients is the use of diet to improve both health problems. Because of similar pathophysiology for chronic diseases and depression, it seems that similar dietary recommendations could be useful. However, few studies have been conducted among diabetic patients. Regarding the complications of diabetes such as renal diseases and coronary heart diseases, the proper range of various macronutrients should be clarified in depressed diabetic patients as well as the proper type of each macronutrient. In this paper, we reviewed the available data on the treatment of depression in diabetic patients. PMID:24199205

  2. Updated management of chronic kidney disease in patients with diabetes.

    PubMed

    Hass, Virginia McCoy

    2014-06-01

    Chronic diseases, including chronic kidney disease (CKD), are the primary threat to global public health in the 21st century. Recently updated guidelines from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative provide patient care benchmarks that physician assistants can use when caring for patients with diabetes and CKD and developing clinical performance improvement plans.

  3. Understanding diabetes in patients with HIV/AIDS

    PubMed Central

    2011-01-01

    This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy. PMID:21232158

  4. Potential Effect of Opium Consumption on Controlling Diabetes and Some Cardiovascular Risk Factors in Diabetic Patients

    PubMed Central

    Rahimi, Najmeh; Gozashti, Mohamad Hossain; Najafipour, Hamid; Shokoohi, Mostafa; Marefati, Hamid

    2014-01-01

    Background Due to this belief that opium may have beneficial effects on diabetes or cardiovascular risk factors, the present study aimed to assess the potential and possible effects of opium consumption on diabetes control and some cardiovascular risk factors in diabetic patients. Methods This study enrolled 374 diabetic subjects from diabetes care centers in Kerman, Iran, including opium user group (n = 179) and a non-opium user group (n = 195). The data were collected through a questionnaire completed by interviewing, physical examination and laboratory assessment. Findings Opium did not show any statistically significant effect on blood glucose, glycated hemoglobin (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL) and diastolic blood pressure. However, systolic blood pressure (SBP) and prevalence of high SBP were significantly higher in opium user group (P < 0.050). In addition, lower serum high-density lipoprotein (HDL) and frequency of lower HDL was significantly higher in opium user group (P < 0.001). Conclusion According to this study, opium does not seem to have beneficial effects on diabetes control or cardiovascular risk factors. Therefore, it would not be advisable to consume opium as an anti-diabetes or cardioprotective agent. PMID:25140211

  5. The use of medicinal herbs by diabetic Jordanian patients.

    PubMed

    Otoom, S A; Al-Safi, S A; Kerem, Z K; Alkofahi, A

    2006-01-01

    Diabetes mellitus is the most common metabolic disorder worldwide. To date, there have been no reports on the frequency of use of herb medicines in the managements of diabetes mellitus in Jordan. This cross-sectional study was conducted by interviewing 310 diabetic patients visiting two medical centers in Jordan: Jordan University of Science & Technology Medical Center and Sarih Medical Center between December 2003 and August 2004. It is found that 31% of interviewed patients have used herbal products (96 patients). The results revealed that the most commonly used herbs by diabetic patients in Jordan were Trigonella foenumgraecum (22.9%), Lupinus albus (14.6%), Allium sativum (11.5%), Allium cepa (5.2%), Nigella sativa (7.3%), Zea mays L. (6.3%), Urtica dioica L. (8.3%), Eucalyptus globules LA (9.4%), Olea europea L. (3.1%), Cumminum cyminum (9.4%), Coriandrum sativum (10.4%), Salvia officinalis L. (3.1%), and Tilia cordata (1%). Furthermore, it is found that 47.9% of the patients used herbs according to advice from their friends on a daily basis. The side effects were reported by 36.5% of the patients and include headache, nausea, dizziness, itching, palpitation, and sweating. Among the patients, 72.9% used the herbs as adjunctive therapy along with their anti-diabetic drugs and 80.2% of the patients informed their physicians about their use. A 79.2% of the sample confirmed their intention to re-use these herbs as 86.5% of them were satisfied with their diabetes control. There was a significant relationship between the use of herbs, the patient's place of residence and his/her level of education. The main conclusion of this survey is that the use of medicinal herbs among diabetic patient in Jordan is common. Therefore, it is essential to increase the level of awareness among diabetic patients and health care providers regarding the efficacy and toxicity of these medicinal herbs.

  6. Fluorescence lifetime imaging ophthalmoscopy in type 2 diabetic patients who have no signs of diabetic retinopathy

    NASA Astrophysics Data System (ADS)

    Schweitzer, Dietrich; Deutsch, Lydia; Klemm, Matthias; Jentsch, Susanne; Hammer, Martin; Peters, Sven; Haueisen, Jens; Müller, Ulrich A.; Dawczynski, Jens

    2015-06-01

    The time-resolved autofluorescence of the eye is used for the detection of metabolic alteration in diabetic patients who have no signs of diabetic retinopathy. One eye from 37 phakic and 11 pseudophakic patients with type 2 diabetes, and one eye from 25 phakic and 23 pseudophakic healthy subjects were included in the study. After a three-exponential fit of the decay of autofluorescence, histograms of lifetimes τi, amplitudes αi, and relative contributions Qi were statistically compared between corresponding groups in two spectral channels (490diabetic patients and age-matched controls (p<0.000004). The lack of pixels with a τ2 of ˜360 ps, the increased number of pixels with τ2>450 ps, and the shift of τ3 from ˜3000 to 3700 ps in ch1 of diabetic patients when compared with healthy subjects indicate an increased production of free flavin adenine dinucleotide, accumulation of advanced glycation end products (AGE), and, probably, a change from free to protein-bound reduced nicotinamide adenine dinucleotide at the fundus. AGE also accumulated in the crystalline lens.

  7. Impact of intensive nutritional education with carbohydrate counting on diabetes control in type 2 diabetic patients

    PubMed Central

    Zipp, Christopher; Roehr, Jessica Terrone; Weiss, Lucia Beck; Filipetto, Frank

    2011-01-01

    This pilot study assessed the impact of an intensive carbohydrate counting educational intervention on diabetes control in type 2 diabetic patients. An experimental, prospective study design was used to assess the effect of nutritional education on diabetes control. The impact and efficacy of the education were measured over a 1-year period through changes in diabetes clinical markers, including hemoglobin A1c, lipid profiles, glucose levels, patients’ energy levels, and sense of well-being. Six patients were initially enrolled in the pilot study, with only three patients completing the intervention phase and the 3-month follow-up. Two patients were followed-up at the 1-year mark for their diabetes, although neither continued participation in the study beyond the 3-month mark. Marginal improvements in clinical markers at 3 months were found. However, due to the small sample size, changes in the clinical profiles may have occurred because of variables unrelated to the nutritional intervention. Further research is indicated for the control of these variables. PMID:21311697

  8. The use of complementary medicine in patients with diabetes

    PubMed Central

    Ilhan, Muzaffer; Demir, Büşra; Yüksel, Sena; Çataklı, Serra Aydın; Yıldız, Rabia Sevda; Karaman, Ozcan; Taşan, Ertuğrul

    2016-01-01

    OBJECTIVE: Diabetes mellitus (DM) is a growing health problem with serious complications. The chronic and progressive nature of the disease often leads patients to use complementary and integrative medicine. The present study aimed to investigate the frequency of use of alternative medicine by patients with DM and the products used. METHODS: Between September 2014 and May 2015, 301 patients with DM were selected from Bezmialem Foundation University Hospital Diabetes Clinic to participate in the study. RESULTS: The results of the study indicate that 81 (26.9%) patients had tried alternative medicine, and 50 (16.6%) patients continued to use some form of alternative medicine product. A total of 43 (14.3%) patients used such products every day and 24 (8%) patients had used alternative medicine products for up to 6 months. Glycated hemoglobin (HbA1c) levels were significantly decreased in patients using alternative medicine products compared to the remainder of patients in the study (p=0.017). No other significant difference was found between the two groups. It was observed that among patients using alternative medicine products, only 10 (12%) had informed their physicians. CONCLUSION: This study indicated that patients with diabetes are very likely to use alternative medicine products. Additional studies are needed to further determine the efficacy of these products. Patients as well as health providers must be educated about complementary medicine and alternative products. PMID:28058383

  9. Identification of Microbial Pathogens in Periodontal disease and Diabetic patients of South Indian Population

    PubMed Central

    Chiranjeevi, Tikka; Prasad, Osuru Hari; Prasad, Uppu Venkateswara; Kumar, Avula Kishor; Chakravarthi, Veeraraghavulu Praveen; Rao, Paramala Balaji; Sarma, Potuguchi Venkata Gurunadha Krishna; Reddy, Nagi reddy Raveendra; Bhaskar, Matcha

    2014-01-01

    Periodontitis have been referred to as the sixth complication of diabetes found in high prevalence among diabetic patients than among healthy controls. The aim of the present study was to examine the periodontal disease status among collected dental plaque samples. Chromosomal DNA was isolated and amplified by universal primers. The DNA was sequenced for bacterial confirmation and phylogenetic analysis performed for the evolutionary relationship with other known pathogens. No amplification products were observed in groups labeled non periodontal and non Diabetes (NP&ND) and non Periodontal and Diabetes (NP&D). But in the case of Periodontal and non Diabetes (P&ND) groups 22 amplified products were observed. In case of Periodontal and Diabetes (P&D), 32 amplified products were positive for microbes. Among the four microbial groups, Treponemadenticola, and Tannerella forsythia were found to be prevalent in P&D. The phylogenetic analysis of 16s rRNA of Treponemadenticola showed the relationship with other Treponema oral pathogen species and with the Spirochaetazuelaera. Tannerella forsythia shows its evolutionary relationship only with four oral pathogens (Macellibacteroidesfermentans, Porphyromadaceae bacterium, Parabacteroidesmeredae and Bacillus fosythus). Prevotellaintermedia also showed its evolutionary relationship only with Prevotella Spcs while Fusobacterium revealed close evolutionary relationship only with Porpiromonasgingivalis. PMID:24966528

  10. Health care services provided to type 1 and type 2 diabetic patients in Saudi Arabia

    PubMed Central

    Al-Rubeaan, Khalid A.; Al-Manaa, Hamad A.; Khoja, Tawfik A.; Al-Sharqawi, Ahmad H.; Aburisheh, Khaled H.; Youssef, Amira M.; Alotaibi, Metib S.; Al-Gamdi, Ali A.

    2015-01-01

    Objectives: To assess health care services provided to type 1 and type 2 diabetic patients and diabetes health care expenditure in the Kingdom of Saudi Arabia (KSA). Methods: This study was part of a nationwide, household, population based cross-sectional survey conducted at the University Diabetes Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between January 2007 and December 2009 covering 13 administrative regions of the Kingdom. Using patients’ interview questionnaires, health care services data were collected by trained staff. Results: A total of 5,983 diabetic patients were chosen to assess health care services and expenditure. Approximately 92.2% of health services were governmental and the remaining 7.8% were in private services. The mean annual number of visits to physicians was 6.5±3.9 and laboratories was 5.1±3.9. Diabetic patients required one admission every 3 years with a mean admission duration of 13.3±28.3 days. General practitioners managed 85.9% of diabetic cases alone, or shared with internists and/or endocrinologists. Health care expenditure was governmental in 90% of cases, while it was personal in 7.7% or based on insurance payment in 2.3%. Conclusion: Health services and its expenditure provided to diabetic citizens in Saudi Arabia are mainly governmental. Empowerment of the role of both the private sector and health insurance system is badly needed, aside from implementing proper management guidelines to deliver good services at different levels. PMID:26446334

  11. Mobile application to induce lifestyle modifications in type 2 diabetic patients: prototype based on international guidelines

    NASA Astrophysics Data System (ADS)

    García-Jaramillo, M.; Delgado, J. S.; León-Vargas, F.

    2015-12-01

    This paper describes a prototype app to induce lifestyle modifications in newly diagnosed type 2 diabetic patients. The app design is based on International Diabetes Federation guidelines and recommendations from clinical studies related to diabetes health-care. Two main approaches, lifestyle modification and self-management education are used owing to significant benefits reported. The method used is based on setting goals under medical support related to physical activity, nutritional habits and weight loss, in addition to educational messages. This is specially implemented to address the main challenges that have limited the success of similar mobile applications already validated on diabetic patients. A traffic light is used to show the overall state of the goals compliance. This state could be understood as excellent (green), there are aspects to improve (yellow), or some individual goals are not carrying out (red). An example of how works this method is presented in results. Furthermore, the app provides recommendations to the user in case the overall state was in yellow or red. The recommendations pretend to induce the user to make changes in their eating habits and physical activity. According to international guidelines and clinical studies, a prototype of mobile application to induce a lifestyle modification in order to prevent adverse risk factors related to diabetes was presented. The resulting application is apparently consistent with clinical judgments, but a formal clinical validation is required. The effectiveness of this app is currently under consideration for the Colombian population with type 2 diabetes.

  12. Addressing the needs of Latinos with type 2 diabetes through online patient education.

    PubMed

    Fitzgerald, Sharon A; Gutierrez Ocampo, Alejandro; Blanco, Kenia Yazmin Reyna; Lewis, Virginia; Cupertino, A Paula; Ellerbeck, Edward F

    2014-09-01

    Patients with Type 2 diabetes are increasingly turning to the Web for information about diabetes and self-management. These sites, however, fail to address the cultural and linguistic needs of the growing community of Latinos with diabetes. The Juntos Controlamos la Diabetes Web site was designed as a low-cost patient education tool to be used by patients, caregivers, and healthcare providers to provide ongoing information about diabetes self-management tailored to the needs of the regional Latino community.

  13. Homocysteine Serum Levels in Diabetic Patients with Non Proliferative, Proliferative and without Retinopathy

    PubMed Central

    Gagliano, Caterina; Giordano, Maria; Vacante, Marco; Caraci, Filippo; Drago, Filippo; Avitabile, Teresio; Motta, Massimo

    2014-01-01

    Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients. PMID:24877066

  14. Homocysteine serum levels in diabetic patients with non proliferative, proliferative and without retinopathy.

    PubMed

    Malaguarnera, Giulia; Gagliano, Caterina; Giordano, Maria; Salomone, Salvatore; Vacante, Marco; Bucolo, Claudio; Caraci, Filippo; Reibaldi, Michele; Drago, Filippo; Avitabile, Teresio; Motta, Massimo

    2014-01-01

    Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients.

  15. Clinical Heterogeneity in Patients With FOXP3 Mutations Presenting With Permanent Neonatal Diabetes

    PubMed Central

    Rubio-Cabezas, Oscar; Minton, Jayne A.L.; Caswell, Richard; Shield, Julian P.; Deiss, Dorothee; Sumnik, Zdenek; Cayssials, Amely; Herr, Mathias; Loew, Anja; Lewis, Vaughan; Ellard, Sian; Hattersley, Andrew T.

    2009-01-01

    OBJECTIVE—Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is caused by FOXP3 mutations. We aimed to determine the prevalence, genetics, and clinical phenotype of FOXP3 mutations in a large cohort with permanent neonatal diabetes (PNDM). RESEARCH DESIGN AND METHODS—The 11 coding exons and the polyadenylation region of FOXP3 were sequenced in 26 male subjects with diabetes diagnosed before 6 months of age in whom common genetic causes of PNDM had been excluded. Ten subjects had at least one additional immune-related disorder, and the remaining 16 had isolated diabetes. RESULTS—We identified four hemizygous FOXP3 mutations in 6 of 10 patients with associated immune-related disorders and in 0 of 16 patients with isolated diabetes (P = 0.002). Three patients with two novel mutations (R337Q and P339A) and the previously reported L76QfsX53 developed classic IPEX syndrome and died within the first 13 months. The novel mutation V408M was found in three patients from two unrelated families and had a mild phenotype with hypothyroidism and autoimmune enteropathy (n = 2) or nephrotic syndrome (n = 1) and survival to 12–15 years. CONCLUSIONS—FOXP3 mutations result in ∼4% of cases of male patients with permanent diabetes diagnosed before 6 months. Patients not only have classic IPEX syndrome but, unexpectedly, may have a more benign phenotype. FOXP3 sequencing should be performed in any male patient with the diagnosis of diabetes in the first 6 months who develops other possible autoimmune-associated conditions, even in the absence of full IPEX syndrome. PMID:18931102

  16. Relationship of cytokines and AGE products in diabetic and non-diabetic patients with cataract

    PubMed Central

    Hamid, Sadaf; Gul, Anjuman; Hamid, Qamar

    2016-01-01

    Objectives Cytokines are important mediators of inflammatory and immune responses. The aim of this study was to investigate the changes in cytokines concentration (IL-6, IL-8 and TNF-α) and serum advanced glycation end products (sAGEs) in senile diabetics with or without cataract and non-diabetic patients with cataract. Methodology The study included 124 subjects (sixty or over sixty years age), distributed as four groups thirty senile diabetic patients with cataract (Group I) (16 female and 14 male), thirty senile non-diabetic patients with cataract (Group II) (15 female and 15 male), thirty three senile diabetic patients without any complication (Group III) (16 female and 17 male), thirty one apparently normal healthy individuals (Group IV) (16 female and 15 male), age, sex and weight matched with senile control subjects were investigated. Patients were selected on clinical grounds from Eye Ward Jinnah Postgraduate Medical Centre. Results Interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) levels were significantly increased (P < 0.001) in Group I and III as compared to Group II and IV. Fasting blood glucose, glycosylated hemoglobin, serum fructosamine, malondialdehyde (MDA), sAGEs, IL-6, IL-8 and TNF-α levels were significantly increased (P < 0.001) in Group I as compared to Group II and the levels were almost same in Group II and IV. There was a significant decrease in serum vitamin E and total antioxidant status (p< 0.001) in Group I and Group III as compared to Group II and Group IV. Conclusion The results of the present study thus demonstrated that levels increased in both condition but are more severe in diabetic patients with cataract that may be a predictor for cataractogenesis and the levels were almost same in Group II and IV. PMID:27833515

  17. Case Study: Hidden Complexity of Medicines Use: Information Provided by a Person with Intellectual Disability and Diabetes to a Pharmacist

    ERIC Educational Resources Information Center

    Flood, Bernadette; Henman, Martin C.

    2015-01-01

    People with intellectual disabilities may be "invisible" to pharmacists. They are a complex group of patients many of whom have diabetes. Pharmacists may have little experience of the challenges faced by this high risk group of patients who may be prescribed high risk medications. This case report details information supplied by Pat, a…

  18. Prevalence of Urinary Tract Infection and Antimicrobial Susceptibility among Diabetic Patients with Controlled and Uncontrolled Glycemia in Kuwait

    PubMed Central

    Sewify, May; Nair, Shinu; Warsame, Samia; Murad, Mohamed; Alhubail, Asma; Behbehani, Kazem; Al-Refaei, Faisal; Tiss, Ali

    2016-01-01

    Diabetic patients have higher risk of urinary tract infection (UTI). In the present study, we investigated the impact of glycemic control in diabetic patients on UTI prevalence, type of strains, and their antimicrobial drugs susceptibility. This study was conducted on urine samples from 722 adult diabetic patients from which 252 (35%) samples were positive for uropathogens. Most UTI cases occurred in the uncontrolled glycemic group (197 patients) versus 55 patients with controlled glycemia. Higher glycemic levels were measured in uncontrolled glycemia group (HbA1c = 8.3 ± 1.5 and 5.4 ± 0.4, resp., P < 0.0001). Females showed much higher prevalence of UTI than males in both glycemic groups (88.5% and 11.5%, resp., P < 0.0001). In the uncontrolled glycemia group 90.9% of the UTI cases happened at ages above 40 years and a clear correlation was obtained between patient age ranges and number of UTI cases (r = 0.94; P = 0.017), whereas in the group with controlled glycemia no trend was observed. Escherichia coli was the predominant uropathogen followed by Klebsiella pneumoniae and they were together involved in 76.2% of UTI cases. Those species were similarly present in both diabetic groups and displayed comparable antibiotic resistance pattern. These results highlight the importance of controlling glycemia in diabetic patients to reduce the UTI regardless of age and gender. PMID:26844231

  19. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy

    SciTech Connect

    Nesto, R.W.; Phillips, R.T.; Kett, K.G.; Hill, T.; Perper, E.; Young, E.; Leland, O.S. Jr.

    1988-02-01

    Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 7 patients with diabetes compared with 17 patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted.

  20. HDL cholesterol and risk of diabetic nephropathy in patient with type 1 diabetes: A meta-analysis of cohort studies.

    PubMed

    Chen, Ying; Zhi, Yunqing; Li, Chengqian; Liu, Ying; Zhang, Lifang; Wang, Yangang; Che, Kui

    2016-12-01

    A meta-analysis was conducted to assess the impact of HDL on risk of diabetic nephropathy in T1DM patients. Ten papers containing (7698) participants were included in this meta-analysis. Our meta-analysis suggest that the risk of diabetic nephropathy was decreased with HDL in type 1 diabetes.

  1. Proximal gastric motility in critically ill patients with type 2 diabetes mellitus

    PubMed Central

    Nguyen, Nam Q; Fraser, Robert J; Bryant, Laura K; Chapman, Marianne; Holloway, Richard H

    2007-01-01

    AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long-standing type 2 diabetes mellitus. METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure® (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years). RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/min infusion was initially reduced in diabetic patients (p < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients. CONCLUSION: In patients with diabetes mellitus, proximal gastric motility is less disturbed than non-diabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying. PMID:17226907

  2. Diabetes.

    PubMed

    Lomberk, Gwen

    2009-01-01

    Pancreatologists have often divided research of the pancreas based upon the origin of the function or disease, namely the endocrine or exocrine pancreas. In fact, as a result, many of our meetings and conferences have followed separate paths. Interestingly, among patients with chronic pancreatitis and pancreatic cancer, both disorders of the exocrine pancreas, diabetes is common. However, the clinical features of the diabetes associated with these two differ. Peripheral insulin resistance and hyperinsulinemia are the predominant diabetic traits in pancreatic cancer, while reduced islet cell mass and impaired insulin secretion are observed more often in chronic pancreatitis. The causal relationship between diabetes and pancreatic cancer remains an intriguing but unanswered question. Since diabetes often precedes pancreatic cancer, it is regarded as a potential risk factor for malignancy. On the other hand, there remains the possibility that pancreatic cancer secretes diabetogenic factors. Regardless of how the science ultimately illuminates this issue, there is increasing interest in utilizing screening for diabetes to aid early detection of pancreatic tumor lesions. Therefore, in this issue of Pancreatology and the Web, we explore the topic of diabetes to keep us alert to this very important association, even if we study diseases of the exocrine pancreas.

  3. Managing special populations among patients with type 2 diabetes mellitus.

    PubMed

    Marquess, Jonathan G

    2011-12-01

    Glycemic goals and the therapies used to achieve them must be individualized for each patient based on several factors, one of the more important being coexisting conditions such as renal disease, liver disease, and cardiovascular disease. The potential to lower hemoglobin A(1c) and the possible long-term benefits of diabetes treatments must be balanced with safety issues, adverse effects, tolerability, ease of use, long-term adherence, and expense. The American Association of Clinical Endocrinologists and the American Diabetes Association have addressed these concerns by developing treatment guidelines to maximize efficacy and safety in the majority of patients with type 2 diabetes. Other organizations, including the American Medical Directors Association and the American Geriatric Society, have also published guidelines for diabetes management for patients in long-term care facilities. This review discusses the safety profiles of antidiabetic drugs, and the special treatment needs with respect to these drugs for patients with diabetes and comorbidities such as renal disease, liver disease, and cardiovascular disease.

  4. Combined 'en bloc' liver and pancreas transplantation in patients with liver disease and type 1 diabetes mellitus.

    PubMed

    Pirenne, Jacques; Deloose, Koen; Coosemans, Willy; Aerts, Raymond; Van Gelder, Frank; Kuypers, Dirk; Maes, Bart; Verslype, Chris; Yap, Paul; Van Steenbergen, Werner; Roskams, Tania; Mathieu, Chantal; Fevery, Johan; Nevens, Frederik

    2004-11-01

    Liver disease alters the glucose metabolism and may cause diabetes, but this condition is potentially reversible with liver transplantation (LTx). Type 1 diabetes mellitus may be coincidentally present in a LTx candidate and immunosuppressive drugs will aggravate diabetes and make its management more difficult for posttransplant. In addition, diabetes negatively influences outcome after LTx. Therefore, the question arises as to why not transplanting the pancreas in addition to the liver in selected patients suffering from both liver disease and Type 1 diabetes. We report two cases of en bloc combined liver and pancreatic transplantation, a technique originally described a decade ago in the treatment of upper abdominal malignancies but rarely used for the treatment of combined liver disease and Type 1 diabetes. Both recipients are currently liver disease-free and insulin-free more than 2 and 4 years posttransplant, respectively. Surgical, medical and immunological aspects of combined liver-pancreas transplantation are discussed in the light of the existing relevant literature.

  5. Mechanisms of hypoglycemia unawareness and implications in diabetic patients

    PubMed Central

    Martín-Timón, Iciar; del Cañizo-Gómez, Francisco Javier

    2015-01-01

    Hypoglycemia unawareness (HU) is defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms. It is a major limitation to achieving tight diabetes and reduced quality of life. HU occurs in approximately 40% of people with type 1 diabetes mellitus (T1DM) and with less frequency in T2DM. Though the aetiology of HU is multifactorial, possible mechanisms include chronic exposure to low blood glucose, antecedent hypoglycaemia, recurrent severe hypoglycaemia and the failure of counter-regulatory hormones. Clinically it manifests as the inability to recognise impeding hypoglycaemia by symptoms, but the mechanisms and mediators remain largely unknown. Prevention and management of HU is complex, and can only be achieved by a multifactorial intervention of clinical care and structured patient education by the diabetes team. Less know regarding the impact of medications on the development or recognition of this condition in patients with diabetes. Several medications are thought to worsen or promote HU, whereas others may have an attenuating effect on the problem. This article reviews recent advances in how the brain senses and responds to hypoglycaemia, novel mechanisms by which people with insulin-treated diabetes develop HU and impaired counter-regulatory responses. The consequences that HU has on the person with diabetes and their family are also described. Finally, it examines the evidence for prevention and treatment of HU, and summarizes the effects of medications that may influence it. PMID:26185599

  6. Dysregulation and containment in the psychoanalytic psychotherapy of a poorly controlled diabetic patient.

    PubMed

    Ginieri-Coccossis, Maria; Vaslamatzis, Grigoris

    2008-01-01

    Dysregulation, as a phenomenon of disruption in the psychotherapeutic setting, may be evidenced in the psychoanalytic psychotherapy of diabetic patients presenting poor metabolic and treatment control. In the case of a female patient, violations of the setting via acting out behaviors provided an opportunity for working through and understanding in depth the patient's unconscious attempts to activate traumatic childhood experiences and introduce loss and confusion into the relationship with the psychotherapist. Dysregulation was considered in connection with the patient's pathological containment function, in conflicting part self and object representations, and in relation to traumatic experiences of maternal desertion. Improvement of the patient was identified in her relationships with the psychotherapist, significant others, and the medical health providers, as well as in the overall management of her diabetic treatment.

  7. Vitamin D deficiency is associated with inflammatory cytokine concentrations in patients with diabetic foot infection.

    PubMed

    Tiwari, Shalbha; Pratyush, Daliparthy Devi; Gupta, Sanjeev Kumar; Singh, Surya Kumar

    2014-12-28

    Vitamin D has been recognised as a potent immunomodulator and its deficiency is common in different population groups including patients with diabetic foot infection. Diabetic foot infection reflects the altered immune status of the host. As cytokine regulation plays a significant role in infection and wound-healing processes, the present study aimed to evaluate the association between vitamin D status and inflammatory cytokine profiles in patients with diabetic foot infection. The serum concentrations of vitamin D (25-hydroxyvitamin D), IL-1β, IL-6, TNF-α and interferon-γ (IFN-γ) were measured in 112 diabetic foot infection cases and 109 diabetic controls. Severe vitamin D deficiency (25-hydroxyvitamin D concentration < 25 nmol/l) was more common in cases than in controls (48.2 v. 20.5%). Although age, duration of diabetes, HbA1C (glycosylated Hb) concentration and BMI were similar, cases had significantly higher concentrations of IL-6 (P≤ 0.001), IL-1β (P≤ 0.02) and TNF-α (P≤ 0.006) than controls. A significant negative correlation was also observed between 25-hydroxyvitamin D concentration and circulating concentrations of IL-1β (r -0.323; P≤ 0.001) as well as IL-6 (r -0.154; P≤ 0.04), but not between 25-hydroxyvitamin D and TNF-α and IFN-γ concentrations. Furthermore, a significant difference in IL-1β (P≤ 0.007) and IL-6 (P≤ 0.02) concentrations was observed in patients with severe 25-hydroxyvitamin D deficiency compared with patients with 25-hydroxyvitamin D concentration ≥ 25 nmol/l, and this difference was remarkable for TNF-α. In conclusion, severe vitamin D deficiency is associated with elevated inflammatory cytokine concentrations in diabetic patients, particularly in those with foot infection. A 25-hydroxyvitamin D concentration value < 25 nmol/l is suggested as the 'cut-off' for such immunological alterations in patients with diabetes mellitus.

  8. Bringing patient centricity to diabetes medication access in Canada

    PubMed Central

    Glennie, Judith L; Kovacs Burns, Katharina; Oh, Paul

    2016-01-01

    Canada must become proactive in addressing type 2 diabetes. With the second highest rate of diabetes prevalence in the developed world, the number of Canadians living with diabetes will soon reach epidemic levels. Against international comparisons, Canada also performs poorly with respect to diabetes-related hospitalizations, mortality rates, and access to medications. Diabetes and its comorbidities pose a significant burden on people with diabetes (PWD) and their families, through out-of-pocket expenses for medications, devices, supplies, and the support needed to manage their illness. Rising direct and indirect costs of diabetes will become a drain on Canada’s economy and undermine the financial stability of our health care system. Canada’s approach to diabetes medication assessment and funding has created a patchwork of medication access across provinces. Access to treatments for those who rely on public programs is highly restricted compared to Canadians with private drug plans, as well in contrast with public payers in other countries. Each person living with diabetes has different needs, so a “patient-centric” approach ensures treatment focused on individual circumstances. Such tailoring is difficult to achieve, with the linear approach required by public payers. We may be undermining optimal care for PWD because of access policies that are not aligned with individualized approaches – and increasing overall health care costs in the process. The scope of Canada’s diabetes challenge demands holistic and proactive solutions. Canada needs to get out from “behind the eight ball” and get “ahead of the curve” when it comes to diabetes care. Improving access to medications is one of the tools for getting there. Canada’s “call to action” for diabetes starts with effective implementation of existing best practices. A personalized approach to medication access, to meet individual needs and optimize outcomes, is also a key enabler. PWD and

  9. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient

    PubMed Central

    Gallusser, Nicolas; Borens, Olivier

    2016-01-01

    Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease's low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients. PMID:27668112

  10. Conservative Surgery of Diabetic Forefoot Osteomyelitis: How Can I Operate on This Patient Without Amputation?

    PubMed

    Aragón-Sánchez, Javier; Lázaro-Martínez, Jose L; Alvaro-Afonso, Francisco Javier; Molinés-Barroso, Raúl

    2015-06-01

    Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection. Several issues should be taken into account when considering surgery for treating diabetic foot osteomyelitis. It is necessary to have a surgeon available with diabetic foot expertise. Regarding location of diabetic foot osteomyelitis, it is important to consider whether isolated bone or a joint is involved. In cases in which osteomyelitis is associated with a bone deformity, surgery should be able to correct this. The surgeon should always reflect about whether extensive/radical surgery could destabilize the foot. The forefoot is the most frequent location of diabetic foot osteomyelitis and is associated with better prognosis than midfoot and hindfoot osteomyelitis. Many surgical procedures can be performed in patients with diabetes and forefoot ulcers complicated by osteomyelitis while avoiding amputations. Performing conservative surgeries without amputations of any part of the foot is not always feasible in cases in which the infection has destroyed the soft tissue envelope. Attempting conservative surgery in such cases risks infected tissues remaining in the wound bed leading to failure. The election of different surgical options depends on the expertise of the surgeons selected for the multidisciplinary teams. It is the aim of this article to provide a sample of surgical techniques in order to remove the bone infection from the forefoot while avoiding amputations.

  11. Anaemia and type 2 diabetes: implications from a retrospectively studied primary care case series.

    PubMed

    Chen, C Xr; Li, Y C; Chan, S L; Chan, K H

    2013-06-01

    OBJECTIVES. To identify the prevalence of anaemia in Chinese type 2 diabetic patients managed in a primary care setting and to explore its associations with cardiovascular complications and kidney disease. DESIGN. Retrospective case series study. SETTING. General Out-patient Clinic of Hospital Authority, Hong Kong. PATIENTS. Chinese type 2 diabetic patients who had annual assessments between 1 January 2010 and 31 December 2011 were recruited. Their complete blood picture, serum creatinine, estimated glomerular filtration rate (calculated by Modification of Diet in Renal Disease method), haemoglobin A1c, and urine albumin-creatinine ratio were retrieved. Anaemia was defined as a haemoglobin level of <130 g/L in men and <120 g/L in women (World Health Organization criteria). Student's t test and analysis of variance were used to analyse continuous variables and the Chi squared test for categorical data. Pearson's correlation coefficient and multivariate logistic regression were used to examine associations between haemoglobin level and different variables including age, gender, serum creatinine level, estimated glomerular filtration rate, and urine albumin-creatinine ratio. All statistical tests were two-sided, and a P value of <0.05 was considered significant. RESULTS. Among 6325 Chinese type 2 diabetic patients fulfilling the inclusion criteria, 1441 were found to have anaemia with a period prevalence of 22.8%. The prevalence of anaemia increased significantly with deterioration of renal function. Compared with diabetic patients with normal haemoglobin levels, anaemic diabetic patients had a higher co-morbidity rate for stroke, ischaemic heart disease, hypertension, and chronic kidney disease (P<0.001). Independent predictors for haemoglobin level among diabetic patients were age, gender, serum creatinine level, estimated glomerular filtration rate, haemoglobin A1c, and urine albumin-creatinine ratio (P<0.001). Multivariate analysis showed that male gender, old age

  12. Bone mineral density evaluation of patients with type 2 diabetes mellitus.

    PubMed

    Adil, Camli; Aydın, Teoman; Taşpınar, Özgür; Kızıltan, Huriye; Eriş, Ali Hikmet; Hocaoglu, Ilknur Turk; Poşul, Sevde; Kepekci, Muge; Denizli, Ebru; Güler, Mustafa

    2015-01-01

    [Purpose] Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. A consequence of this is chronic hyperglycemia with disturbances in carbohydrate, fat and protein metabolism. We investigated whether there is any difference among DM patients and a control group in terms of lumbar and femur BMD (bone mineral density), and standard deviation scores (Z score and T score). [Subjects and Methods] This randomized, prospective, controlled, single-blind study was conducted in the Physical Medicine and Rehabilitation Department Faculty of Medicine, Bezm-i Alem Vakıf University. Patients with type 2 diabetes mellitus were included in the patient groups. Healthy individuals were included in the control group. [Results] A total of 126 patients completed the study (63 in the study group, 63 in the control group). There was no significant difference in the results of the laboratory examinations of the cases. The bone mineral densities of the cases were found to be significantly low in terms of the lumbar (L1-4) T scores in the type 2 diabetes group. [Conclusion] Although osteoporosis is one of the potential complications of type 1 diabetes, its effect on bone mineral density in type 2 DM is controversial. In different studies, the bone mineral density values have increased, decreased or remained normal. With the exception of the lumbar (L1-4) T score, similar results were obtained in this study.

  13. [Eosinophilic fasciitis (Shulman syndrome) associated with insulin-dependent diabete. 1 case (author's transl)].

    PubMed

    Gourvil, J; Wechsler, J; Revuz, J; Touraine, R

    1979-12-24

    A patient with eosinophilic fasciitis and insulin-dependent diabete mellitus is recorded. Diabete and blood hypereosinophilia occurred four months before acute onset of severe proximal sclerodermic features. The deep seated level of fibrosis, mainly localized in subcutaneous fat and fascia was documented by histologic examination. Prednisone therapy (0,75 mg/kg/day) resulted in cutaneous improvement and disparition of eosinophilia. Survey of pertinent literature lead us to consider Shulman's syndrome as a distinct entity amid the broad scleroderma spectrum. Features of esosinophilic fasciitis are very close to, and sometimes undistinguable from generalized morphea. Simultaneous occurence of diabete mellitus in this case is not fortuitous. The same association has already been recoreded with various sclerodermic syndromes.

  14. A case of primary aldosteronism combined with acquired nephrogenic diabetes insipidus.

    PubMed

    Kim, Kitae; Lee, Jae Hyoung; Kim, Sun Chul; Cha, Dae Ryong; Kang, Young Sun

    2014-12-01

    Aldosterone-producing adrenal adenoma can induce various clinical manifestations as a result of chronic exposure to aldosterone. We report a rare case of a 37-year-old man who complained of general weakness and polyuria. He was diagnosed with aldosterone-producing adrenal adenoma and nephrogenic diabetes insipidus. Aldosterone enhances the secretion of potassium in the collecting duct, which can lead to hypokalemia. By contrast, nephrogenic diabetes insipidus, which manifests as polyuria and polydipsia, can occur in several clinical conditions such as acquired tubular disease and those attributed to toxins and congenital causes. Among them, hypokalemia can also damage tubular structures in response to vasopressin. The patient's urine output was >3 L/d and was diluted. Owing to the ineffectiveness of vasopressin, we eventually made a diagnosis of nephrogenic diabetes insipidus. Laparoscopic adrenalectomy and intraoperative kidney biopsy were subsequently performed. The pathologic finding of kidney biopsy revealed a decrease in aquaporin-2 on immunohistochemical stain.

  15. Possible genetic defects in regulation of glycosaminoglycans in patients with diabetic nephropathy

    SciTech Connect

    Deckert, T.; Horowitz, I.M.; Kofoed-Enevoldsen, A.; Kjellen, L.; Deckert, M.; Lykkelund, C.; Burcharth, F. )

    1991-06-01

    The hypothesis of genetic defects in glycosaminoglycan (GAG) regulation among patients with insulin-dependent diabetes mellitus (IDDM) and nephropathy was assessed by studies in tissue cultures of fibroblasts obtained from 7 patients with normal urinary albumin excretion, 11 patients with diabetic nephropathy, and 6 nondiabetic control subjects. The incorporation of (2H) glucosamine and (35S) sulfate into hyaluronic acid (HA), chondroitin sulfate and dermatan sulfate (CS + DS), and heparan sulfate (HS) was measured in cells, matrix, and medium and related to micrograms of tissue protein. Large interindividual variations were seen in all three groups, and the incorporation of (3H) glucosamine into HA, CS + DS, and HS and (35S) sulfate into CS + DS and HS were not significantly different between the three groups. However, the fractional incorporation of (3H)glucosamine into HS was significantly reduced in diabetic patients with nephropathy compared with control subjects. This was the case not only when related to the total amount of GAGs (P = 0.014) but also when related to HA (P = 0.014). No significant difference was seen between control subjects and normoalbuminuric diabetic patients. The degree of N-sulfation of HS was not significantly different between the experimental groups. The results suggest that patients with diabetic nephropathy may suffer from deficiencies of coordinate regulation in the biosynthesis of GAG in fibroblasts, which may lead to a reduced density of HS in the extracellular matrix. If these changes reflect alterations in the biosynthesis of GAG from endothelial, myomedial, and mesangial cells, this observation may be relevant for the pathogenesis of severe diabetic complications.

  16. [Neutrophils expression of adhesion molecules in diabetic nephropaty patients].

    PubMed

    Shcherban', T D

    2013-01-01

    CD11b and CD54 expression on neutrophils in patients with diabetic nephropathy (DN), arterial hypertension patients and healthy donors were examined. Development of DN associates with an increase of the number of CD11b and CD54 positive cells and violation of cellular co-operation. In the conditions of diabetic microenvironment expression of adhesion molecules rises substantially, what may characterized the mechanism of connection between hyperglycemia and vascular and tissues injury at DN. Authentication of morphological and biochemical markers of intercellular co-operation must in a prospect assist the deeper understanding of pathogenic mechanisms of DN.

  17. [Clinical and pathophysiological features of Japanese patients with type 2 diabetes mellitus and their risk factors for diabetic complication].

    PubMed

    Sone, Hirohito

    2015-12-01

    The pathophysiological backgrounds as well as clinical phenotypes of Japanese or East Asian patients with type 2 diabetes are quite different from those in Western countries. According to results of East Asian large-scale studies such as the Japan Diabetes Complications Study (JDCS), which is a representative cohort of Japanese patients with type 2 diabetes, Japanese patients had a much lower body mass index and lower incidence of coronary heart disease compared with Caucasian diabetic patients. Other differences between Japanese and Caucasian patients with type 2 diabetes could be found in risk factors such as fruit intake on retinopathy and significance of triglycerides, or the effects of moderate alcohol drinking on cardiovascular disease. These results demonstrated a necessity of ethnic group-specific risk evaluations and care of type 2 diabetes and its complications.

  18. A Rare Case of Tolosa-Hunt-Like Syndrome in a Poorly Controlled Diabetes Mellitus

    PubMed Central

    Lasam, Glenmore; Kapur, Sakshi

    2016-01-01

    We report a case of a 50-year-old female with diabetes mellitus who presented with progressive second, third, fifth, sixth, and eighth cranial nerve palsy. Diagnostic investigation revealed hyperglycemic state, and brain imaging showed a right cavernous sinus enhancement suggestive of and consistent with Tolosa-Hunt syndrome. The patient was started on steroids with tight glycemic control for eight weeks; subsequently, the cranial nerve palsies resolved as well as documented resolution of the right cavernous sinus enhancement. PMID:27087813

  19. Who Treats Patients with Diabetes and Compensated Cirrhosis

    PubMed Central

    Barritt IV, A. Sidney; Weinberger, Morris; Paul, John E.; Fried, Bruce; Trogdon, Justin G.

    2016-01-01

    Background Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. Objective We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. Design Retrospective cross-sectional study using 2000–2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases. Patients We identified 22,516 adults (≥ 18 years) dually-diagnosed with diabetes and compensated cirrhosis. Patients with decompensated cirrhosis, HIV/AIDS, or liver transplantation prior to dual diagnosis were excluded. Main Measures Physician mix categories: patients were assigned to one of four physician mix categories: primary care physicians (PCP) with no gastroenterologists (GI) or endocrinologists (ENDO); GI/ENDO with no PCP; PCP and GI/ENDO; and neither PCP nor GI/ENDO. Health care utilization: annual physician visits and health care expenditures were assessed by four physician mix categories. Key Results Throughout the 14 years of study, 92% of patients visited PCPs (54% with GI/ENDO and 39% with no GI/ENDO). The percentage who visited PCPs without GI/ENDO decreased 22% (from 63% to 49%), while patients who also visited GI/ENDO increased 71% (from 25% to 42%). Conclusions This is the first large nationally representative study to document the types of physicians seen by patients dually-diagnosed with diabetes and cirrhosis. A large proportion of these complex patients only visited PCPs, but there was a trend toward greater specialty care. The trend toward co-management by both PCPs and GI/ENDOs suggests that PCMH initiatives will be important for these complex patients. Documenting patterns of primary and specialty care is the first step toward improved care coordination. PMID:27783702

  20. [Stress, anxiety, depression and erectile dysfunction in patients with diabetes mellitus].

    PubMed

    Mekhtiev, T V

    2013-01-01

    It was studied the erectile dysfunction (ED), the severity of depression and stress in patients with diabetes mellitus (DM) in the stage of compensation and decompensation, also investigated the relationship between the duration of the disease and the clinical manifestation of the various forms of ED. On a material of 293 male patients aged 17-60 years. The duration of diabetes ranged from 6 months to 30 years (at avarage - 17,4±17,5 years). Performed routine and special methods of investigation (pharmacodopplerography), also fixed psychogenic, organic and mixed forms of erectile dysfunction in correlation with the clinical form of the current CD according International index of Erectile function (EF) and the tables of Juneman et al. Found that in patients with type I and II diabetes anxiety and depression were found in 32.1 % of cases, and were accompanied by ED. In the state of decompensation of diabetes mellitus manifestation of anxiety, depression and erectile dysfunction were observed more often than in a state of long-term compensation. Between the increase in the period of limitation of the DM and the incidence of organic and mixed forms of ED there is a direct correlation, and between the increase of diabetes duration and the frequency of occurrence of psychogenic form of erectile dysfunction - inversly relationship.

  1. Primary Paranasal Tuberculosis in a Diabetic Mimicking Odontogenic Infection: A Rare Case; A Unique Presentation

    PubMed Central

    Mehendirratta, Monica; Sareen, Chanchal; Aggarwal, Anju

    2016-01-01

    The incidence of Tuberculosis (TB) is high especially in developing countries but primary para-nasal TB is still a rarity. The latter often remains quiescent until it reaches an advanced stage and offers a diagnostic challenge. In the present case report maxillary sinus TB mimicked a destructive periodontitis induced space infection, thus causing a delay in treatment. The present case report describes clinical presentation, diagnosis, management and outcome of a 50-year-old diabetic/HIV seronegative patient with histopathologically confirmed case of maxillary sinus TB. PMID:27135017

  2. Hypodermic needles in the neuropathic foot of a patient with diabetes

    PubMed Central

    Woolfrey, P G; Kirby, R L

    1998-01-01

    A 54-year-old woman with insulin-dependent diabetes mellitus, diabetic neuropathy, neuropathic arthropathy of the feet and a plantar ulcer underwent plain radiography, which showed 2 clipped-off hypodermic needles, of which she had been unaware, in the soft tissue of one foot. This previously unreported complication is clinically instructive in that it demonstrates the importance of counselling patients about the protection of insensitive extremities. This case also has public health implications, suggesting as it does that the still-common practice of breaking hypodermic needles before disposal should be strongly discouraged. PMID:9538856

  3. The use of an extract of Hypericum perforatum and Azadirachta indica in a neuropathic patient with advanced diabetic foot.

    PubMed

    Iabichella, Maria Letizia; Caruso, Claudio; Lugli, Marzia

    2014-11-06

    The successful use of an extract of Hypericum flowers (Hypericum perforatum) and nimh oil (Azadirachta indica; Hyperoil) in foot wounds with exposed bone in a patient with bilateral advanced diabetic ulcers, has been reported previously. It was hypothesised that this amelioration was linked with the improved glycaemic control and peripheral microvascular circulation. In this case report, the surprisingly successful outcome of another patient using Hyperoil for infection damaged diabetic foot, without prior use of surgical procedure, is described. The patient had no macrovascular pattern impairment. Diabetic foot healing paralleled with controlled local infection and enhanced glycaemic control. The outcome of this patient suggests that the effectiveness of this inexpensive therapy using Hyperoil for diabetic foot is not only linked with the presence of severe microvascular disorder, but also with the appropriate local treatment for ulcer being a must for its recovery.

  4. Markers for Risk of Type 1 Diabetes in Relatives of Alsacian Patients With Type 1 Diabetes

    PubMed Central

    Sapin, Remi; Pinget, Michel; Belcourt, Alain

    2002-01-01

    Background: The cytotoxic T lymphocyteassociated antigen 4 gene (CTLA-4) encode the T cell receptor involved in the control of T cell proliferation and mediates T cell apoptosis. The receptor protein is a specific T lymphocyte surface antigen that is detected on cells only after antigen presentation. Thus, CTLA-4 is directly involved in both immune and autoimmune responses and may be involved in the pathogenesis of multiple T cell-mediated autoimmune disorders. There is polymorphism at position 49 in exon 1 of the CTLA-4 gene, providing an A-G exchange. Moreover, we assessed the CTLA-4 49 (Thr/Ala) polymorphism in diabetic patients and first-degree relatives as compared to control subjects. Research design and methods: Three loci (HLA-DQB1, DQA1 and CTLA-4) were analysed in 62 type 1 diabetic patients, 72 firstdegree relatives and 84 nondiabetic control subjects by means of PCR-RFLP. Results: A significant enrichment in DQB1 alleles encoding for an amino acid different from Asp in position 57 (NA) and DQA1 alleles encoding for Arg in position 52 was observed in diabetic subjects and first-degree relatives as compared to controls. The genotype and allele frequencies of these polymorphisms in type 1 diabetic patients and firstdegree relatives differed significantly from those of controls (p< 0.001 and 0.05 respectively). CTLA-49 Ala alleles frequencies were 75.8% in type 1 diabetic patients and 68.1% in first-degree relatives in comparison to 35.7% in control subjects. The Ala/Ala genotype conferred a relative risk of 18.8 (p < 0.001). Conclusion: The CTLA-4 49 Ala allele confers an increased risk of type 1 diabetes, independent of age and HLA-DQ genetic markers. PMID:11900275

  5. Case study: a patient's survival.

    PubMed

    Nauer, K A; Kramer, L; Lockard, K L

    2000-05-01

    Presentation of a case study involving a female patient, in her 20s, undergoing routine surgery for removal of atrial myxoma leading to a heart transplant. This case study will show the progression from postcardiotomy failure, the emergent use of the extracorporeal membrane oxygenator device, the insertion of the HeartMate device, and the final return to the operating room for a heart transplant. The case study will examine the physiologic demands on the patient, as well as the psychological effects from the various life-saving devices.

  6. Prevalence of Diabetes Mellitus in Patients with Chronic Kidney Disease

    PubMed Central

    Stojceva-Taneva, Olivera; Otovic, Natasa Eftimovska; Taneva, Borjanka

    2016-01-01

    BACKGROUND: Chronic kidney disease (CKD) became a new epidemic of the twentieth and twenty-first centuries. Diabetic nephropathy is one of the leading causes of end-stage renal failure as a result of the diabetes epidemic worldwide. AIM: The aim of our study was to assess the prevalence of CKD in the Republic of Macedonia and its association with diabetes mellitus. MATERIALS AND METHODS: The study was a part of a study conducted in 2006 in terms of screening for early detection of kidney disease. It was a cross-sectional study based on a random sample of patients aged > 20, consecutively consulting their primary physician for any cause. Fifty physicians throughout the country were included in the study. A total of 2637 patients have been analyzed based on integrity data. GFR was estimated using corrected values of serum creatinine and calculating kidney function by the Cockroft & Gault formula, adjusted for body surface using the Gehan & George formula. Patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min were considered as having CKD. Blood pressure, body weight, height, serum creatinine, glucose, hemoglobin, hematocrit, urinalysis and medical history for presence of cardiovascular diseases or diabetes were also assessed. RESULTS: The mean age of the subjects was 45.97 ± 16.55 SD and 17.97% were older than 60. Regarding gender, 44.14% were males. The prevalence of diabetes mellitus was 13.9%. Subjects with CKD (eGFR less than 60 ml/min) were 7.53% of the total. Subjects aged 60 or above, had 20 times higher risk of having CKD (eGFR less than 60 ml/min/1.73 m2). Out of the total group of subjects, 13.9% had diabetes mellitus and they had 3.13 times higher risk of having CKD stage 3-5 (eGFR less than 60 ml/min/1.73 m2) when compared to non-diabetics. The results showed that diabetes was significantly more associated with lower eGFR (less than 60 ml/min/1.73 m2) in younger subjects (age less than 60) compared to older ones (odds ratio 3

  7. Meanings of Health for Iranian Diabetic Patients: A qualitative study

    PubMed Central

    Moridi, Golrokh; Valiee, Sina; Nasrabadi, Alireza Nikbakht; Nasab, Golnaz Esmaeil; Khaledi, Shahnaz

    2016-01-01

    Introduction Health is an exclusive and subjective phenomenon, and one of the most important situations with regard to perception of health, arises when patients suffer from a chronic disease. This study was conducted within the qualitative research framework and aimed to explore the meanings of health as perceived by a group of Iranian diabetic patients. Methods A descriptive qualitative analysis design was used. Data were collected through semi-structured interviews with 20 participants among diabetic patients, who were admitted to the diabetes care centre of Tohid Hospital of the Kurdistan University of Medical Sciences, Sanandaj, Iran during a ten-month period in 2014. Interviews were transcribed and analysed through conventional content analysis. Results Based on the findings of the study, three major health-related themes emerged: 1) the syndrome of the healthy body and the happy heart (physical well-being vivacity, satisfaction, and calmness of the mind), 2) life without compulsory limitations (lack of dietary limitations, No activity limitations, lack of social limitations), and 3) exalted spirituality (satisfying self and others, trusting God, remembering God). Conclusion Health care providers should consider the meaning of health in special groups, chiefly in patients with chronic diseases. It facilitates the development of appropriate programmes to improve desirable health levels among diabetic patients. PMID:27790342

  8. Glycemic control in diabetic patients served by community health centers.

    PubMed

    Maizlish, Neil A; Shaw, Beryl; Hendry, Khati

    2004-01-01

    The Community Health Center Network measured the prevalence of glycemic control in diabetic patients at 7 community health centers as part of its clinical quality improvement program. A cross-sectional survey was carried out in a random sample of 1817 diabetic patients having 1 or more encounters from October 1, 2000 to September 30, 2001. Computerized laboratory results for hemoglobin A1c (HbA1c) tests were available for half the sample. Manual review of medical charts was carried out for the rest. The proportion of diabetic patients with 1 or more HbA1c tests in the measurement year was 91% (CI95%: 90-93%) and poor glycemic control (HbA1c > 9%) occurred in 27% (CIM%: 25-30%). The mean of the most recent test was 7.8%. The frequency of testing varied significantly by clinic from 79% to 94% and increased with the number of encounters. Poor glycemic control also varied significantly by clinic (17-48%) and was significantly better in females and older patients. Measures of glycemic control were not associated with ethnicity or insurance status in multivariate analyses. A high proportion of diabetic patients received appropriate care, and this care was not associated with ethnicity or insurance status. The data warehouse was an essential tool for the clinical quality improvement program.

  9. Secondary prevention of stroke with antiplatelet agents in patients with diabetes mellitus.

    PubMed

    Piechowski-Jozwiak, Bartlomiej; Maulaz, Alexander; Bogousslavsky, Julien

    2005-01-01

    The prevalence of diabetes mellitus (DM) varies from 1.2 to 13.3% in the general population. The most frequent is type 2 (non-insulin-dependent) DM, which constitutes 90-95% of all cases. DM increases the risk of cardiac disease, stroke, retinopathy, nephropathy, neuropathy and gangrene, and the disease is associated with an increased prevalence of other cardiovascular risk factors such as hypertension, hypercholesterolaemia, asymptomatic carotid artery disease, and obesity. The risk of stroke may be directly and indirectly increased by the presence of DM. Epidemiological data show that DM independently amplifies the risk of ischaemic stroke from 1.8- up to 6-fold, so that prevention of cardiovascular risk in diabetics is of utmost importance. The main goal is to control glycaemia, although it has never been shown to be beneficial in stroke patients. Other preventive strategies include antiplatelet treatment. The open-label Primary Prevention Project trial tested the efficacy of low-dose acetylsalicylic acid (ASA) in prevention of ischaemic events in high-risk patients, but failed to demonstrate a significant benefit of ASA in diabetic patients. However, in the CAPRIE trial, the benefit of clopidogrel was amplified in patients with DM versus those without DM in preventing ischaemic events. This difference was even more striking when comparing patients treated with insulin versus non-diabetics. Another trial -- MATCH -- tested the benefit of adding ASA to clopidogrel versus clopidogrel alone in the prevention of ischaemic events in high-risk cerebrovascular patients, two-thirds of whom had DM. Further research is needed to clarify the effects of different antiplatelet regimens in stroke prevention in diabetic patients, who should be considered as high vascular-risk patients.

  10. Screening tuberculosis patients for diabetes mellitus in Fiji: notes from the field.

    PubMed

    Gounder, S; Harries, A D

    2012-12-21

    Diabetes (DM) is a problem in Fiji and threatens tuberculosis (TB) control efforts. A review was conducted of all TB patients registered in Fiji in 2011 to assess routine practices of screening for DM. Of 221 TB patients, 138 (62%) had their DM status recorded in their case folders; 18 (13%) had a known history of DM. Random blood glucose (RBG) was performed in 91 (76%) of the remaining 120 patients: 47(52%) had RBG ≥ 6.1 mmol/l, but only three were further investigated, of whom one was diagnosed with DM. There are deficiencies in screening TB patients for DM in Fiji, and improvements are needed.

  11. Recurrence of diabetic kidney disease in a type 1 diabetic patient after kidney transplantation.

    PubMed

    Nyumura, Izumi; Honda, Kazuho; Babazono, Tetsuya; Horita, Shigeru; Murakami, Toru; Fuchinoue, Shohei; Uchigata, Yasuko

    2015-07-01

    Post-transplant hyperglycaemia of diabetic patients may cause recurrent diabetic kidney disease (DKD) in kidney allografts. We report a patient with slowly progressive DKD with calcineurin inhibitor toxicity (CNI) toxicity after the kidney transplantation. A 28-year-old female with type 1 diabetes mellitus underwent successful kidney transplantation from her mother in April 2003, and the kidney graft survived for more than 10 years. She was treated with combined immunosuppressive therapy consisting of cyclosporine and mycophenolate mofetil. After transplantation, she continued to take insulin injection four times per day, but her glycosylated haemoglobin (HbA1c) was above 10%. Protocol allograft kidney biopsies performed 5 and 10 years after transplantation revealed the recurrence of slowly progressive diabetic kidney disease. In addition, arteriolar hyalinosis partly associated with calcineurin inhibitor toxicity (CNI) was detected with progression. Post-transplant hyperglycaemia causes recurrent diabetic kidney disease (DKD) in kidney allografts, but its progression is usually slow. For long-term management, it is important to prevent the progression of the calcineurin inhibitor arteriolopathy, as well as maintain favourable glycaemic control.

  12. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients

    PubMed Central

    2016-01-01

    Diabetes mellitus is a public health concern in Malaysia. Treatment of diabetes is costly and can lead to complications if disease is poorly controlled. Diabetes self-management (DSM) is found to be essential for optimal glycemic control. This cross-sectional study was conducted among samples from four randomly selected diabetes clinics in Sarawak, Malaysia. The aim was to determine the predictors for DSM. Face-to-face interview using questionnaire was used to collect data. Four hundred respondents with type 2 diabetes mellitus (T2DM) were recruited. Majority of the respondents were Sarawak Bumiputra (Iban and Bidayuh, 48.6%) and female (68.6%). The mean age was 58.77 years (SD = 11.46) and approximately half of the respondents (50.6%) had T2DM for six years (SD = 4.46). The mean fasting blood glucose (FBG) was 8.06 mmol/L (SD = 2.94), with majority (76.1%) having the level higher than 6.1 mmol/L. Multiple logistic regression tests showed significant linear relationship between DSM and belief in treatment effectiveness (p = 0.001), family support (p = 0.007), and self-efficacy (p = 0.027). Health care personnel must convince patients with T2DM of the effectiveness of the treatment, empower and enhance their self-efficacy, and enlist the family support so as to ensure patients sustain their DSM efforts. PMID:27563681

  13. Fractal analysis of circulating platelets in type 2 diabetic patients.

    PubMed

    Bianciardi, G; Tanganelli, I

    2015-01-01

    This paper investigates the use of computerized fractal analysis for objective characterization by means of transmission electron microscopy of the complexity of circulating platelets collected from healthy individuals and from type 2 diabetic patients, a pathologic condition in which platelet hyperreactivity has been described. Platelet boundaries were extracted by means of automatically image analysis. Local fractal dimension by box counting (measure of geometric complexity) was automatically calculated. The results showed that the platelet boundary observed by electron microscopy is fractal and that the shape of the circulating platelets is significantly more complex in the diabetic patients in comparison to healthy subjects (p <  0.01), with 100% correct classification. In vitro activated platelets from healthy subjects show an analogous increase of geometric complexity. Computerized fractal analysis of platelet shape by transmission electron microscopy can provide accurate, quantitative, data to study platelet activation in diabetes mellitus.

  14. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional – observational study

    PubMed Central

    Akkus, Gamze; Evran, Mehtap; Gungor, Dilek; Karakas, Mehmet; Sert, Murat; Tetiker, Tamer

    2016-01-01

    Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer. Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection. Results: Native positivity between toes was higher in men compared to women (p<0.05). We obtained significant relation between HbA1c elevation and native positivity between toes (p<0.05). Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (p<0.05). Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings (p<0.05). Conclusion: Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers. PMID:27648034

  15. Effect of a polyherbal formulation cream on diabetic neuropathic pain among patients with type 2 diabetes – A pilot study

    PubMed Central

    Viswanathan, Vijay; Rajsekar, Seena; Selvaraj, Bamila; Kumpatla, Satyavani

    2016-01-01

    Background & objectives: Painful diabetic neuropathy is a common complication of diabetes and can severely limit patients’ daily functions. The aim of this pilot study was to evaluate the safety and effect of using a polyherbal formulation in reducing the symptoms of diabetic neuropathic pain in comparison with placebo among patients with type 2 diabetes. Methods: A total of 50 (M:F = 33:17) consecutive type 2 diabetes patients with painful diabetic neuropathy were enrolled in this study. All these patients had either two or more symptoms of diabetic neuropathy such as pain, burning and pricking sensations and numbness in their feet. They were randomly assigned to two groups: group 1 (n = 26) patients were treated with polyherbal formulation cream and group 2 (n = 24) patients were administered placebo. The patients were followed up for six months. Changes in the symptoms of painful diabetic neuropathy of each patient were recorded at baseline, third and sixth month using the Diabetic Neuropathic Score. Results: The mean age of the patients, duration of diabetes and glycated haemoglobin (HbA1c) were similar in both groups at baseline. During follow up visits, there was a decrease in the HbA1c levels in the study and control groups. The symptoms of painful diabetic neuropathy were also similar in both groups at baseline. A significant decrease in symptoms of neuropathic pain was observed among the group of patients treated with polyherbal formulation cream (76.9 per cent) compared to the placebo-treated group (12.5 per cent) (P<0.001), at the end of the final follow up. Interpretation & conclusions: In this pilot study polyherbal formulation cream was found to be effective as well as safe to treat painful diabetic neuropathy. However, its long term use needs to be evaluated for any further effectiveness and side effects. PMID:27934800

  16. Balneotherapy and platelet glutathione metabolism in type II diabetic patients

    NASA Astrophysics Data System (ADS)

    Ohtsuka, Yoshinori; Yabunaka, Noriyuki; Watanabe, Ichiro; Noro, Hiroshi; Agishi, Yuko

    1996-09-01

    Effects of balneotherapy on platelet glutathione metabolism were investigated in 12 type II (non-insulin-dependent) diabetic patients. Levels of the reduced form of glutathione (GSH) on admission were well correlated with those of fasting plasma glucose (FPG; r=0.692, P<0.02). After 4 weeks of balneotherapy, the mean level of GSH showed no changes; however, in well-controlled patients (FPG <150 mg/dl), the level increased ( P<0.01) and in poorly controlled patients (FPG >150 mg/dl), the value decreased ( P<0.05). There was a negative correlation between glutathione peroxidase (GPX) activities and the levels of FPG ( r=-0.430, P<0.05). After balneotherapy, the activity increased in 5 patients, decreased in 3 patients and showed no changes (alteration within ±3%) in all the other patients. From these findings in diabetic patients we concluded: (1) platelet GSH synthesis appeared to be induced in response to oxidative stress; (2) lowered GPX activities indicated that the antioxidative defense system was impaired; and (3) platelet glutathione metabolism was partially improved by 4 weeks balneotherapy, an effect thought to be dependent on the control status of plasma glucose levels. It is suggested that balneotherapy is beneficial for patients whose platelet antioxidative defense system is damaged, such as those with diabetes mellitus and coronary heart disease.

  17. Camel milk: a possible boon for type 1 diabetic patients.

    PubMed

    Agrawal, R P; Tantia, P; Jain, S; Agrawal, R; Agrawal, V

    2013-11-03

    Poor nutrition in utero and in early life combined with over nutrition in later life may also play a role in epidemic of diabetes. The efficacy of camel milk consumption as an adjunct to routine diabetic management in type 1 diabetes is a approach showing new rays of hope to cope with this disorder by adding a food supplement with medicinal values. Research on the beneficial aspects of camel milk has been taking place in different corners of globe since last three decades. Continuous efforts to disclose the role of camel milk in diabetes has rendered it title of 'white gold'. Biochemical studies has revealed the components e.g. insulin like protein, lactoferrin, immunoglobulins are responsible for imparting camel milk the scientific weightage. In parallel, epidemiological surveys stating low prevalence of diabetes in communities consuming camel milk clearly indicate towards its hopeful role in maintaining hyperglycemia. This article shades light on camel milk production, composition, characteristics as well as it expresses positive effect of camel milk on blood glucose level, insulin dose, beta cell function. This review also compiles various epidemiological studies carried out to bring forth utility of camel milk suggesting it as a useful food supplement or alternative therapy for type 1 diabetic patients.

  18. Permanent neonatal diabetes mellitus - a case report of a rare cause of diabetes mellitus in East Africa.

    PubMed

    Nyangabyaki-Twesigye, Catherine; Muhame, Michael Rugambwa; Bahendeka, Silver

    2015-12-01

    Diabetes mellitus is a metabolic disease characterised by chronically high glucose levels. Genetic factors have been implicated in the aetiology following mutations in a single gene. An extremely rare form of diabetes mellitus is monogenic diabetes, a subset of which is permanent neonatal diabetes, and is usually suspected if a child is diagnosed with diabetes at less than 6 months of age. We present the first case reported from East Africa of a child diagnosed with permanent neonatal diabetes resulting from a mutation in the KCNJ11 gene encoding the Kir6.2 subunit. Despite the rarity of permanent neonatal diabetes, this diagnosis should be considered in infants with persistent hyperglycaemia requiring insulin therapy. Children with an ATP-sensitive potassium channel defect in the pancreatic beta cell have an overall good prognosis when treated with oral sulphonylurea therapy.

  19. Malnutrition prevalence in hospitalized elderly diabetic patients.

    PubMed

    Sanz París, Alejandro; García, José M; Gómez-Candela, Carmen; Burgos, Rosa; Martín, Ángela; Matía, Pilar

    2013-01-01

    Introducción: La prevalencia de desnutrición es desconocida entre los ancianos con diabetes mellitus. Objetivos: Determinar la prevalencia de desnutrición en ancianos hospitalizados con diabetes mellitus, y describir su impacto en el pronóstico clínico. Material y métodos: Se llevó a cabo un estudio multicéntrico en 35 hospitales españoles. La desnutrición fue valorada mediante la herramienta Mini Nutritional Assessment (MNA). Los pacientes fueron seguidos hasta el alta. Resultados: Fueron incluidos 1.090 sujetos (78 ± 7,1 años; 50% hombres). 39,1% mostraron riesgo de desnutrición y 21,2% desnutrición establecida. El 15,5% de los sujetos desnutridos y 31,9 % de aquellos en riesgo tenían un IMC ≥30 kg/m(2). En el análisis multivariante, el sexo femenino (OR = 1,38; IC 95%: 1,19-1,11), la edad (OR = 1,04; IC 95%: 1,02-1,06) y la presencia de complicaciones por diabetes (OR = 1,97; IC 95%: 1,52-2,56) se asociaron al diagnóstico de desnutrición. La estancia media fue mayor en sujetos en riesgo y con desnutrición que en los pacientes bien nutridos (12,7 ± 9,9 y 15,7 ± 12.8 días vs 10,7 ± 9,9 días; p < 0,0001). Tras ajustar por edad y sexo, la puntuación del MNA (OR = 0,895; IC 95% 0,814-0,985) y el valor de albúmina (OR = 0,441; IC 95% 0,212-0,915) se asociaron de forma independiente con la mortalidad. La puntuación del MNA se asoció con la probabilidad de alta a domicilio (OR = 1,150; IC 95% 1,084-1,219). Conclusiones: Se observó una elevada prevalencia de desnutrición entre los ancianos hospitalizados con diabetes, independientemente del IMC. El diagnóstico de desnutrición, el valor de albúmina y la puntuación del MNA se asociaron con la estancia media, mortalidad y destino al alta.

  20. Clinical Features, Etiology, and Outcomes of Community-Acquired Pneumonia in Patients With Diabetes Mellitus

    PubMed Central

    Di Yacovo, Silvana; Garcia-Vidal, Carolina; Viasus, Diego; Adamuz, Jordi; Oriol, Isabel; Gili, Francesca; Vilarrasa, Núria; García-Somoza, M. Dolors; Dorca, Jordi; Carratalà, Jordi

    2013-01-01

    Abstract We performed an observational analysis of a prospective cohort of immunocompetent hospitalized adults with community-acquired pneumonia (CAP) to determine the epidemiology, clinical features, and outcomes of pneumonia in patients with diabetes mellitus (DM). We also analyzed the risk factors for mortality and the impact of statins and other cardiovascular drugs on outcomes. Of 2407 CAP episodes, 516 (21.4%) occurred in patients with DM; 483 (97%) had type 2 diabetes, 197 (40%) were on insulin treatment, and 119 (23.9%) had end-organ damage related to DM. Patients with DM had different clinical features compared to the other patients. They were less likely to have acute onset, cough, purulent sputum, and pleural chest pain. No differences in etiology were found between study groups. Patients with DM had more inhospital acute metabolic complications, although the case-fatality rate was similar between the groups. Independent risk factors for mortality in patients with DM were advanced age, bacteremia, septic shock, and gram-negative pneumonia. Patients with end-organ damage related to DM had more inhospital cardiac events and a higher early case-fatality rate than did the overall population. The use of statins and other cardiovascular drugs was not associated with better CAP outcomes in patients with DM. In conclusion, CAP in patients with DM presents different clinical features compared to the features of patients without DM. PMID:23263718

  1. Diabetes as a case study of chronic disease management with a personalized approach: the role of a structured feedback loop.

    PubMed

    Ceriello, Antonio; Barkai, László; Christiansen, Jens Sandahl; Czupryniak, Leszek; Gomis, Ramon; Harno, Kari; Kulzer, Bernhard; Ludvigsson, Johnny; Némethyová, Zuzana; Owens, David; Schnell, Oliver; Tankova, Tsvetalina; Taskinen, Marja-Riitta; Vergès, Bruno; Weitgasser, Raimund; Wens, Johan

    2012-10-01

    As non-communicable or chronic diseases are a growing threat to human health and economic growth, political stakeholders are aiming to identify options for improved response to the challenges of prevention and management of non-communicable diseases. This paper is intended to contribute ideas on personalized chronic disease management which are based on experience with one major chronic disease, namely diabetes mellitus. Diabetes provides a pertinent case of chronic disease management with a particular focus on patient self-management. Despite advances in diabetes therapy, many people with diabetes still fail to achieve treatment targets thus remaining at risk of complications. Personalizing the management of diabetes according to the patient's individual profile can help in improving therapy adherence and treatment outcomes. This paper suggests using a six-step cycle for personalized diabetes (self-)management and collaborative use of structured blood glucose data. E-health solutions can be used to improve process efficiencies and allow remote access. Decision support tools and algorithms can help doctors in making therapeutic decisions based on individual patient profiles. Available evidence about the effectiveness of the cycle's constituting elements justifies expectations that the diabetes management cycle as a whole can generate medical and economic benefit.

  2. Euglycemic Diabetic Ketoacidosis in a 27 year-old female patient with type-1-Diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitor Canagliflozin

    PubMed Central

    Bader, Nimrah; Mirza, Lubna

    2016-01-01

    We are reporting a timely case of atypical euglycemic diabetic ketoacidosis in a type 1 diabetic patient treated with sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin. The clinical history, physical examination findings and laboratory values are described. Other causes of acidosis such as salicylate toxicity or alcohol intoxication were excluded. Ketoacidosis resolved after increasing dextrose and insulin doses supporting the hypothesis that SGLT-2 inhibitors may lead to hypoinsulinemia. Euglycemic ketoacidosis did not recur in our patient after discontinuing canagliflozin. We recommend reserving SGLT2 inhibitor therapy to type 2 diabetics, discontinuing medication and treating patients presenting with ketoacidosis due to SGLT-2 inhibitors with higher concentrations of dextrose with appropriate doses of insulin to help resolve acidosis. PMID:27375734

  3. Euglycemic Diabetic Ketoacidosis in a 27 year-old female patient with type-1-Diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitor Canagliflozin.

    PubMed

    Bader, Nimrah; Mirza, Lubna

    2016-01-01

    We are reporting a timely case of atypical euglycemic diabetic ketoacidosis in a type 1 diabetic patient treated with sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin. The clinical history, physical examination findings and laboratory values are described. Other causes of acidosis such as salicylate toxicity or alcohol intoxication were excluded. Ketoacidosis resolved after increasing dextrose and insulin doses supporting the hypothesis that SGLT-2 inhibitors may lead to hypoinsulinemia. Euglycemic ketoacidosis did not recur in our patient after discontinuing canagliflozin. We recommend reserving SGLT2 inhibitor therapy to type 2 diabetics, discontinuing medication and treating patients presenting with ketoacidosis due to SGLT-2 inhibitors with higher concentrations of dextrose with appropriate doses of insulin to help resolve acidosis.

  4. Biophoton emission from blood serum of diabetic patients

    NASA Astrophysics Data System (ADS)

    Van Wijk, R.; Wiegant, F. A. C.; Popp, Fritz A.; Storms, G. E. M. G.

    1994-12-01

    The concept that free radicals mediate vascular abnormalities in diabetes has been debated. This study examines the relationship between serum free radical activity and glycaemic regulation. A cross-sectional assessment is presented of the chemiluminescence of blood serum, long term glycaemic control (HbAlc, fructosamine) and blood glucose concentrations in patients with type-1 (n equals 114) and patients with type-2 (n equals 112) diabetes. The average value of serum chemiluminescence of type-1 patients is higher than that of type-2 patients (p equals 0.014). Spectral analysis suggests that different sources of free radical activity are responsible in different ratios for chemiluminescence in type-1 and type-2 sera. Serum chemiluminescence values of type-1 patients strongly correspond with blood glucose levels (p < 0.001). Chemiluminescence values were higher, although not significant (p equals 0.082) in the 'poorly' controlled group characterized by high values of HbAlc and/or fructosamine in comparision with the group of 'good' glycaemic control with lower values of HbAlc and/or fructosamine. Serum chemeluminescence values of type-2 patients neither correspond to their long tern glycaemic status nor to their blood glucose levels. It is concluded that changes in glucose metabolism and changes in chemiluminescence are coordinated for type-1 but not for type-2 patients. This strongly indicates the relevance of ther free radical connection to diabetes type-1 complications.

  5. Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass

    SciTech Connect

    Croughwell, N.; Lyth, M.; Quill, T.J.; Newman, M.; Greeley, W.J.; Smith, L.R.; Reves, J.G. )

    1990-11-01

    We tested the hypothesis that insulin-dependent diabetic patients with coronary artery bypass graft surgery experience altered coupling of cerebral blood flow and oxygen consumption. In a study of 23 patients (11 diabetics and 12 age-matched controls), cerebral blood flow was measured using 133Xe clearance during nonpulsatile, alpha-stat blood gas managed cardiopulmonary bypass at the conditions of hypothermia and normothermia. In diabetic patients, the cerebral blood flow at 26.6 +/- 2.42 degrees C was 25.3 +/- 14.34 ml/100 g/min and at 36.9 +/- 0.58 degrees C it was 27.3 +/- 7.40 ml/100 g/min (p = NS). The control patients increased cerebral blood flow from 20.7 +/- 6.78 ml/100 g/min at 28.4 +/- 2.81 degrees C to 37.6 +/- 8.81 ml/100 g/min at 36.5 +/- 0.45 degrees C (p less than or equal to 0.005). The oxygen consumption was calculated from jugular bulb effluent and increased from hypothermic values of 0.52 +/- 0.20 ml/100 g/min in diabetics to 1.26 +/- 0.28 ml/100 g/min (p = 0.001) at normothermia and rose from 0.60 +/- 0.27 to 1.49 +/- 0.35 ml/100 g/min (p = 0.0005) in the controls. Thus, despite temperature-mediated changes in oxygen consumption, diabetic patients did not increase cerebral blood flow as metabolism increased. Arteriovenous oxygen saturation gradients and oxygen extraction across the brain were calculated from arterial and jugular bulb blood samples. The increase in arteriovenous oxygen difference between temperature conditions in diabetic patients and controls was significantly different (p = 0.01). These data reveal that diabetic patients lose cerebral autoregulation during cardiopulmonary bypass and compensate for an imbalance in adequate oxygen delivery by increasing oxygen extraction.

  6. IA-2 autoantibodies in incident type I diabetes patients are associated with a polyadenylation signal polymorphism in GIMAP5.

    PubMed

    Shin, J-H; Janer, M; McNeney, B; Blay, S; Deutsch, K; Sanjeevi, C B; Kockum, I; Lernmark, A; Graham, J; Arnqvist, Hans; Björck, Elizabeth; Eriksson, Jan; Nyström, Lennarth; Ohlson, Lars Olof; Scherstén, Bengt; Ostman, Jan; Aili, M; Bååth, L E; Carlsson, E; Edenwall, H; Forsander, G; Granström, B W; Gustavsson, I; Hanås, R; Hellenberg, L; Hellgren, H; Holmberg, E; Hörnell, H; Ivarsson, Sten-A; Johansson, C; Jonsell, G; Kockum, K; Lindblad, B; Lindh, A; Ludvigsson, J; Myrdal, U; Neiderud, J; Segnestam, K; Sjöblad, S; Skogsberg, L; Strömberg, L; Ståhle, U; Thalme, B; Tullus, K; Tuvemo, T; Wallensteen, M; Westphal, O; Aman, J

    2007-09-01

    In a large case-control study of Swedish incident type I diabetes patients and controls, 0-34 years of age, we tested the hypothesis that the GIMAP5 gene, a key genetic factor for lymphopenia in spontaneous BioBreeding rat diabetes, is associated with type I diabetes; with islet autoantibodies in incident type I diabetes patients or with age at clinical onset in incident type I diabetes patients. Initial scans of allelic association were followed by more detailed logistic regression modeling that adjusted for known type I diabetes risk factors and potential confounding variables. The single nucleotide polymorphism (SNP) rs6598, located in a polyadenylation signal of GIMAP5, was associated with the presence of significant levels of IA-2 autoantibodies in the type I diabetes patients. Patients with the minor allele A of rs6598 had an increased prevalence of IA-2 autoantibody levels compared to patients without the minor allele (OR=2.2; Bonferroni-corrected P=0.003), after adjusting for age at clinical onset (P=8.0 x 10(-13)) and the numbers of HLA-DQ A1*0501-B1*0201 haplotypes (P=2.4 x 10(-5)) and DQ A1*0301-B1*0302 haplotypes (P=0.002). GIMAP5 polymorphism was not associated with type I diabetes or with GAD65 or insulin autoantibodies, ICA, or age at clinical onset in patients. These data suggest that the GIMAP5 gene is associated with islet autoimmunity in type I diabetes and add to recent findings implicating the same SNP in another autoimmune disease.

  7. Prevalence of diabetes mellitus and hypertension among Indian glaucoma patients and evaluation of systemic therapy.

    PubMed

    Dave, Abhishek; Bali, Shveta Jindal; Sharma, Reetika; Khurana, Aruj K; Gupta, Raghav; Dada, Tanuj

    2013-10-01

    To study the prevalence and systemic control and evaluate the adequacy of therapy of diabetes mellitus (DM) and hypertension (HT) in glaucoma patients visiting a tertiary care eye facility at a university hospital. Consecutive cases with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG) attending the outpatient services were evaluated for the presence of DM and HT and any systemic/ocular medications being taken were recorded. Of 615 glaucoma cases evaluated, 281 (45.7 %) were POAG and 334 (54.3 %) were PACG. The mean age was 58.19 ± 10.8 years with males comprising 60.5 % of the study group. Two hundred and ninety-two (47.5 %) glaucoma patients had HT and 181 (29.4 %) had DM, including 97 (15.8 %) patients who had both. One hundred and thirty-three (47.3 %) patients with POAG and 159 (47.6 %) patients with PACG had HT. Ninety-seven (34.5 %) POAG patients and 84 (25.1 %) PACG patients were diabetics. One hundred and sixty-one (55.1 %) HT patients had blood pressure above control levels and 88 (48.6 %) diabetics had uncontrolled blood sugars. Twenty-eight (9.6 %) patients with HT were found to be taking combined systemic and topical β-blocker therapy. A large majority of adult glaucoma patients had concurrent systemic disease, which was not adequately controlled. Patients were using systemic medications with known interactions with ocular hypotensive medications. This study highlights the unmet need for better coordination between ophthalmologists and physicians to improve the overall health of glaucoma patients.

  8. Family clustering of secondary chronic kidney disease with hypertension or diabetes mellitus. A case-control study.

    PubMed

    de Almeida, Fernando Antonio; Ciambelli, Giuliano Serafino; Bertoco, André Luz; Jurado, Marcelo Mai; Siqueira, Guilherme Vasconcelos; Bernardo, Eder Augusto; Pavan, Maria Valeria; Gianini, Reinaldo José

    2015-02-01

    In Brazil hypertension and type 2 diabetes mellitus are responsible for 60% of cases of end-stage renal disease in renal replacement therapy. In the United States studies have identified family clustering of chronic kidney disease, predominantly in African-Americans. A single Brazilian study observed family clustering among patients with chronic kidney disease when compared with hospitalized patients with normal renal function. This article aims to assess whether there is family clustering of chronic kidney disease in relatives of individuals in renal replacement therapy caused by hypertension and/or diabetes mellitus. A case-control study with 336 patients in renal replacement therapy with diabetes mellitus or hypertension for at least 5 years (cases) and a control matched sample group of individuals with hypertension or diabetes mellitus and normal renal function (n = 389). Individuals in renal replacement therapy (cases) had a ratio of 2.35 (95% CI 1.42-3.89, p < 0.001) versus the control group in having relatives with chronic renal disease, irrespective of race or causative illness. There is family clustering of chronic kidney disease in the sample studied, and this predisposition is irrespective of race and underlying disease (hypertension or diabetes mellitus).

  9. Gender Differences in Periodontal Status and Oral Hygiene of Non-Diabetic and Type 2 Diabetic Patients

    PubMed Central

    Schulze, Antina; Busse, Martin

    2016-01-01

    Background: This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects. Methods: 517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were “periodontitis” and “oral hygiene behaviour”, each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The “low performance index“ (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0). Results: Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6). Conclusions: The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women. PMID:27347232

  10. Prevalence and factors associated with diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia: Cross sectional study

    PubMed Central

    Chisha, Yilma; Terefe, Wondwossen; Assefa, Huruy; Lakew, Serawit

    2017-01-01

    Background Currently 93 million people are estimated as living with diabetic retinopathy worldwide. The prevalence and risk factors of diabetic retinopathy in developed countries have been well documented; but in Ethiopia, data on prevalence and associated factors of diabetic retinopathy is lacking. Objective To determine prevalence and factors associated with development of diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia. Method Cross-sectional study design with record review of 400 diabetic patients was conducted at Arbaminch General Hospital from November to January 2015. Among 400 diabetic patients, 270 patients with baseline information and without history of hypertension at baseline were included in this study. But patients with gestational diabetes and with retinopathy at baseline were excluded from the study. Consecutive sampling technique was applied to select study participants. Data of cohorts was extracted from medical record using pre tested structured extraction check list. Data cleaning, coding, categorizing, merging and analysis carried out by STATA version 12. Descriptive statistics was done and presented accordingly. Bivariate binary logistic regression analysis was done to select potential candidates for the full model at P-value cutoff point ≤ 0.25 and multivariable binary logistic regression analysis was made to estimate the independent effect of predictors on the occurrence of diabetic retinopathy. Model diagnostic tests were done, final model fitness was checked using Hosmer and Lemeshow chi square test. Finally, statistical significance was tested at P-value <0.05. Result Prevalence of diabetic retinopathy among diabetic patients at Arbaminch General Hospital was 13%. Adjusted analysis showed that the odds of diabetic retinopathy were statistically and significantly associated with baseline age (AOR = 6.06: 95%CI; 2.42, 15.21), baseline systolic blood pressure level (AOR = 4.38: 95%CI; 1.64, 11

  11. Rapid onset of syndrome of inappropriate antidiuretic hormone secretion induced by duloxetine in an elderly type 2 diabetic patient with painful diabetic neuropathy.

    PubMed

    Kamei, Shinji; Kaneto, Hideaki; Tanabe, Akihito; Irie, Shintaro; Hirata, Yurie; Shimoda, Masashi; Kohara, Kenji; Mune, Tomoatsu; Kaku, Kohei

    2015-05-01

    Diabetic neuropathy is the most common diabetic complication. Duloxetine, a serotonin noradrenaline reuptake inhibitor (SNRI), is widely used for the treatment of diabetic painful neuropathy (DPN) because of the efficacy and safety profile. Syndrome of inappropriate antidiuretic hormone secretion, which is strongly associated duloxetine, is a rare but occasionally life-threatening adverse effect. Here, we report a case of syndrome of inappropriate antidiuretic hormone secretion that rapidly developed after starting duloxetine in an elderly Japanese female type 2 diabetes mellitus patient. Furthermore, we discuss the possible relationship between the onset of syndrome of inappropriate antidiuretic hormone secretion and the gene polymorphism of cytochrome P450 isoform 1A2 and 2D6, both of which are responsible for duloxetine metabolism.

  12. Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient

    PubMed Central

    Kurasawa, Miwa; Nishikido, Takashi; Koike, Junko; Tominaga, Shin-ichi; Tamemoto, Hiroyuki

    2014-01-01

    We experienced a case of liver abscess due to Clostridium perfringens (CP) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important. PMID:24748935

  13. Efficacy and Safety of Sitagliptin in Japanese Patients With Type 2 Diabetes

    PubMed Central

    Ohmura, Hirotoshi; Mita, Tomoya; Taneda, Yoshinobu; Sugawara, Masahiro; Funayama, Hideaki; Matsuoka, Joe; Watada, Hirotaka; Daida, Hiroyuki

    2015-01-01

    Background The aim of this study was to investigate the clinical efficacy and safety of sitagliptin in Japanese patients with type 2 diabetes. Methods A total of 3,247 subjects treated with sitagliptin were retrospectively recruited. Glucose parameters were collected at baseline, and 1, 3 and 6 months after initiation of sitagliptin. In addition, we explored factors that can be used to predict sitagliptin-induced reduction in HbA1c using linear mixed effect model. Factors associated with hypoglycemic events were examined by logistic analyses. Results We analyzed the available data of 3,201 subjects (1,287 females). Treatment of sitagliptin significantly reduced HbA1c level from 7.44±1.20% at baseline to 6.73±0.99% at 6 months (P < 0.0001). Linear mixed effect model analyses demonstrated that reduction of HbA1c was associated with higher baseline HbA1c level, younger age, lower BMI and sitagliptin monotherapy. During this study, 82 cases of hypoglycemia were recorded. Logistic analyses indicated that hypoglycemic events were more frequent in female patients, and patients with low BMI, long history of type 2 diabetes, high HbA1c and on combination therapy experienced. Other adverse events were rare and mild. Conclusions Sitagliptin is effective for diabetic management and generally well tolerated in Japanese patients with type 2 diabetes. This trial was registered with UMIN (no. 000004121). PMID:25699116

  14. Comparison of the nerve fiber layer of type 2 diabetic patients without glaucoma with normal subjects of the same age and sex

    PubMed Central

    Takis, Alexandros; Alonistiotis, Dimitrios; Panagiotidis, Dimitrios; Ioannou, Nikolaos; Papaconstantinou, Dimitris; Theodossiadis, Panagiotis

    2014-01-01

    Background The retinal nerve fiber layer (RNFL) thickness in patients with diabetes mellitus type 2 was compared to normal subjects of similar age and sex, having first excluded any risk factors for glaucoma. The correlation between the RNFL thickness and the severity of diabetic retinopathy was investigated at its primary stages and with other ocular and diabetic parameters. Methods A prospective, case series study was carried out. Twenty-seven diabetic patients without diabetic retinopathy, 24 diabetic patients with mild retinopathy, and 25 normal, age-matched subjects underwent a complete ophthalmological examination and imaging with scanning laser polarimetry for the evaluation of the RNFL. Multivariate analysis was applied in order to investigate the correlation between RNFL and diabetic parameters, such as age, duration of diabetes, insulin therapy, levels of glycosylated hemoglobin; and ocular parameters, such as cup to disc ratio, levels of normal intraocular pressure, and central corneal thickness. Results The mean inferior average of RNFL and the temporal-superior-nasal-inferior-temporal standard deviation were statistically significantly lower in both diabetic groups, and the nerve fiber index was higher (P=0.04) compared to the normal group. There was no statistically significant difference between the diabetic groups. The factor analysis showed no significant correlation between the RNFL and the previously mentioned diabetic and ocular parameters. Conclusion The existence of diabetes should be seriously considered in evaluating the results of scanning laser polarimetry. Multivariate analysis for RNFL was used for the first time. PMID:24596452

  15. Infrared dermal thermography on diabetic feet soles to predict ulcerations: a case study

    NASA Astrophysics Data System (ADS)

    Liu, Chanjuan; van der Heijden, Ferdi; Klein, Marvin E.; van Baal, Jeff G.; Bus, Sicco A.; van Netten, Jaap J.

    2013-03-01

    Diabetic foot ulceration is a major complication for patients with diabetes mellitus. If not adequately treated, these ulcers may lead to foot infection, and ultimately to lower extremity amputation, which imposes a major burden to society and great loss in health-related quality of life for patients. Early identification and subsequent preventive treatment have proven useful to limit the incidence of foot ulcers and lower extremity amputation. Thus, the development of new diagnosis tools has become an attractive option. The ultimate objective of our project is to develop an intelligent telemedicine monitoring system for frequent examination on patients' feet, to timely detect pre-signs of ulceration. Inflammation in diabetic feet can be an early and predictive warning sign for ulceration, and temperature has been proven to be a vicarious marker for inflammation. Studies have indicated that infrared dermal thermography of foot soles can be one of the important parameters for assessing the risk of diabetic foot ulceration. This paper covers the feasibility study of using an infrared camera, FLIR SC305, in our setup, to acquire the spatial thermal distribution on the feet soles. With the obtained thermal images, automated detection through image analysis was performed to identify the abnormal increased/decreased temperature and assess the risk for ulceration. The thermography for feet soles of patients with diagnosed diabetic foot complications were acquired before the ordinary foot examinations. Assessment from clinicians and thermography were compared and follow-up measurements were performed to investigate the prediction. A preliminary case study will be presented, indicating that dermal thermography in our proposed setup can be a screening modality to timely detect pre-signs of ulceration.

  16. Identifying older diabetic patients at risk of poor glycemic control

    PubMed Central

    Incalzi, Raffaele Antonelli; Corsonello, Andrea; Pedone, Claudio; Corica, Francesco; Carosella, Luciana; Mazzei, Bruno; Perticone, Francesco; Carbonin, PierUgo

    2002-01-01

    Background Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. Methods A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia ≥ 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia ≥ 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population. Results Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143–218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia ≥ 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia ≥ 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population. Conclusion A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control. PMID:12194701

  17. Hypoglycaemia due to interaction of glimepiride with isoniazid in a patient with type 2 diabetes mellitus.

    PubMed

    Boglou, Panagiotis; Steiropoulos, Paschalis; Papanas, Nikolaos; Bouros, Demosthenes

    2013-04-16

    Hypoglycaemia is a well-recognised untoward effect of sulfonylureas. We report a case of severe hypoglycaemia after isoniazid initiation in a type 2 diabetic patient. An oral glucose tolerance test revealed high serum insulin and C peptide, suggesting hyperinsulinaemia, and it was used to ascertain the relationship between insulin, glucose and C peptide levels. Insulin and C peptide elevation was attributed to the interaction between the two drugs. As a cytochrome inhibitor, isoniazid increased serum glimepiride concentration, resulting in hyperinsulinaemia. The diagnosis of occult insulinoma or nesidioblastosis was ruled out by CT and MRI, as we could not perform more sensitive, still invasive, diagnostic procedures. After isoniazid withdrawal, hypoglycaemia regressed and glimepiride was reinitiated. In conclusion, this case illustrates the need of caution when prescribing isoniazid in patients with type 2 diabetes mellitus receiving glimepiride to avoid hypoglycaemia.

  18. The functional Q84R polymorphism of TRIB3 gene is associated with diabetic nephropathy in Chinese type 2 diabetic patients.

    PubMed

    Zhang, Weiwei; Yang, Zhen; Li, Xiaoyong; Wen, Jie; Zhang, Hongmei; Wang, Suijun; Wang, Xuanchun; Zhou, Houguang; Fang, Wenjun; Qin, Li; Su, Qing

    2015-01-25

    Increased oxidative stress and circulating free fatty acids (FFA) has been suggested to involve in the pathogenesis of diabetic nephropathy. TRIB3 can inhibit FFA and reactive oxygen species (ROS) stimulated podocyte production of MCP-1. Smoking increases the production of reactive oxygen species, which accelerates oxidative stress under hyperglycemia. To determine whether the Q84R polymorphism (rs2295490), alone or in combination with smoking, contributes to the development of diabetic nephropathy, a case-control study was performed in 812 Chinese patients with type 2 diabetes. Among patients, 214 had diabetic nephropathy with microalbuminuria (n=156) or overt albuminuria (n=58), and 598 did not show either of these symptoms but had diabetes for ≥10 years and were not undergoing antihypertension treatment. After adjustment for confounders, TRIB3 single-nucleotide polymorphism rs2295490 was associated with DN (OR 1.318, 95% CI 1.075, 1.653, p=0.017); smoking was also an independent risk factor for diabetic nephropathy (1.42 [1.25-2.04], p<0.001). In addition, we identified possible synergistic effects; i.e., the high-risk group (smokers with the AG+GG genotype) showed 2.13 times higher risk (1.51-3.96, p<0.001) of diabetic nephropathy than the low-risk group (nonsmokers with the AA genotype) in a multiple logistic regression analysis controlled for the confounders, but no departure from additivity was found. Our results indicate that smoking and the TRIB3 G-allele is associated with an increased risk of diabetic nephropathy, which supports the hypothesis that oxidative stress contributes to the development of diabetic nephropathy.

  19. Diabetic kidney disease and vascular comorbidities in patients with type 2 diabetes mellitus in a developing country.

    PubMed

    Bentata, Yassamine; Chemlal, A; Karimi, I; El Alaoui, F; Haddiya, I; Abouqal, Redouane

    2015-09-01

    Type 2 diabetes mellitus (T2DM) is associated with an increased risk of progression toward end-stage renal disease and cardiovascular (CV) risk mortality. To investigate this association, we studied 637 patients with T2DM in the Eastern area of Morocco. The mean follow-up period was 42 ± 11 months. At the baseline visit, 22.8%, 59.1% and 18.1% of the patients had normo-albuminuria, micro-albuminuria and macro-albuminuria, respectively. Of all patients, 51.6% had a history of hypertension and 37.4% had hypertension on admission. At the end of follow-up, rapid progression (estimated glomerular filtration rate >5 mL/min/1.73 m² /year) was observed in 24.1% of the cases and the frequency of occurrence of CV events was 5%, 18.5% and 32.5% in the normo-, micro- and macro-albuminuria groups, respectively (P <0.001). In multivariate analysis, arterial hypertension was identified as an independent risk factor related to diabetic kidney disease (DKD, P = 0.04) and occurrence of CV events (P = 0.02), while albuminuria was not identified as an independent risk factor, either for DKD or for the occurrence of CV events. Our study found that hypertension was an independent risk factor for the DKD and the occurrence of the CV events in T2DM patients.

  20. Use of wireless microcurrent stimulation for the treatment of diabetes-related wounds: 2 case reports.

    PubMed

    Ramadhinara, Adisaputra; Poulas, Konstantinos

    2013-01-01

    Wireless microcurrent stimulation (WMCS) is a new method in wound healing that may have advantages compared with conventional electrical stimulation (ES) devices. Although ES has been widely known as an effective method to promote the wound-healing process in patients with type 2 diabetes mellitus, to the authors' knowledge, there are still no data about the ability of WMCS to match the desired effect. In this article, the authors report the results of 2 cases of diabetes-related wounds (1 acute and 1 chronic) that have been treated successfully using WMCS. Neither patient reported discomfort during treatment, and the risk of infection was minimized because there was no direct contact from the device during the treatment course.

  1. Prevalance and risk factors for yeast colonization in adult diabetic patients.

    PubMed

    Sahin, Idris; Oksuz, Sukru; Sencan, Irfan; Gulcan, Aynur; Karabay, Oguz; Gulcan, Erim; Yildiz, Ozcan

    2005-04-01

    The aim of this study is to describe the associations between various host characteristics and yeast colonization; biofilm and phospholipase production in diabetic patients. The study was conducted between January 2003 and June 2003 in Abant Izzet Baysal University, Duzce, Turkey. One hundred and fourty five diabetic patients were included to the study. All oral and faecal specimens were placed on Sabourand dextrose agar with chloramphenicol and gentamicin. All isolates were identified with classic methods and carbohydrate assimilation patterns using API 20 CAUX. C. dubliniensis isolates were identified by CHROM agar Candida and chlamydospore formation according to the referral to the literature. Biofilm and phospholipase production was assessed by using previously described methods. The most common colonized species were C. albicans in oral and faecal cultures. C. dubliniensis was isolated in four oral cultures of the patients. Dental prosthesis, tooth brushing, older age, antibiotic use in the previous two weeks were found to be the significant factors for the oral yeast colonization. Younger age, smoking, shorter duration of diabetes, hospitalization in the last year and antibiotic use in the previous two weeks were found to be the significant factors for the faecal yeast colonization. Biofilm production was found to be positive in nine cases of oral and seven of faecal isolates. Phospholipase production was determined to be positive in 18 cases oral and 14 of faecal isolates. In conclusion, glycaemia control and other diabetic factors are not effective for yeast colonlizing. There was not any significant correlation between biofilm and phospholipase production and host characteristics in yeast colonization. Oral hygiene may be an effetive for decreasing the oral colonization in diabetic patients.

  2. Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain

    PubMed Central

    Dòria, Montserrat; Rosado, Verónica; Pacheco, Linda Roxana; Betriu, Àngels; Valls, Joan; Mauricio, Dídac

    2016-01-01

    Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care. PMID:27190996

  3. Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain.

    PubMed

    Dòria, Montserrat; Rosado, Verónica; Pacheco, Linda Roxana; Hernández, Marta; Betriu, Àngels; Valls, Joan; Franch-Nadal, Josep; Fernández, Elvira; Mauricio, Dídac

    2016-01-01

    Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.

  4. Course of acute pancreatitis in diabetic patients.

    PubMed

    Koziel, Dorota; Gluszek, Stanislaw; Osuch, Martyna Gluszek

    2016-01-01

    Negli anni recenti in molti paesi europei si è dimostrata una crescente incidenza della pancreatite acuta (AP), ed alcuni studi indicano un aumento di rischio di AP nei pazienti diabetici. Questo studio è pertanto finalizzato a valutare il decorso clinico della AP nei pazienti diabetici. Sono stati studiati tutti i pazienti curati in reparto chirurgico per una diagnosi di AP identificando come pazienti diabetici quelli che all’anamnesi hanno confermato essere affetti da diabete di tipo 1 o di tipo 2 prima di essere ricoverati per AP. I pazienti ricoverati per AP, ed arruolati nello studio sono stati 963, e tra essi vi erano 87 (9%) diabetici. Tra questi ultimi erano più numerosi quelli portatori di calcolosi biliare quale causa della pancreatite (46% vs 32%). Nella maggioranza dei casi il decorso della AP è stato di gravità moderata, ma comunque nel 10,3% dei pazienti con diabete il decorso della malattia è stato moderatamente grave, e nel 12,7% decisamente grave. Non sono state osservate differenze nella mortalità da AP in entrambi i gruppi. Insufficienza sistemica è stata osservata più frequentemente nel gruppo dei diabetici di tipo 2 (5,4%) e 23,1% in quelli di tipo 2, a fronte del 5,1% dei pazienti non diabetici, con differenze statisticamente non significative. In conclusione l’incidenza della AP nei pazienti diabetici aumenta con l’età, ed è più spesso correlata con la calcolosi biliare. In questo gruppo di pazienti in decorso clinico è èiù frequentemente grave, con insufficienza sistemica nei diabetici di tipo 1.

  5. Latent Autoimmune Diabetes in Adults: a case report.

    PubMed

    Bermúdez, Valmore; Aparicio, Daniel; Colmenares, Carlos; Peñaranda, Lianny; Luti, Yettana; Gotera, Daniela; Rojas, Joselyn; Cabrera, Mayela; Reyna, Nadia; Velasco, Manuel; Israili, Zafar H

    2010-01-01

    Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune endocrine disorder in which despite the presence of antipancreatic islets antibodies in the moment of diagnostics, the progression to beta-cell secretory insufficiency is slow. It is often confused with others types of diabetes and therefore the management is frequently inadequate. We report a clinical case of a 23-year-old man with diagnosis of type 2 diabetes since 6 months ago, poorly controlled with a sulfonylurea, who initially presented 2 months ago from polyuria, polydipsia, and asthenia and 6 kg weight loss. History of past illness was negative, however, his mother relates exclusive breastfeeding during the first 15 days of life and later (until the 6 months) he was fed with infant formula (S-26). Family history revealed a first-degree relative (father) with diabetes mellitus secondary to steroid administration due to diagnosis of bone marrow hypoplasia. Also presents second-degree family history (uncle and grandfather) of type 2 diabetes mellitus. There were no pathologic findings at the physical examination. Anthropometry and laboratory tests were as follows: body mass index (BMI) = 19.66 kg/m, basal and postprandial glycemia = 108, and 276 mg/dL respectively, glycated haemoglobin = 8.9%, basal and postprandial C-peptide (2 hours) = 1.9, and 3.2 ng/mL, homeostasis model assessment of beta cell function: 87.5%, homeostasis model assessment of insulin resistance: 1.6. LADA presumptive diagnosis was confirmed with presence of autoantibodies anti-tyrosin-phosphatase and GAD65. At the time of diagnosis, individuals with LADA present an onset age <50, BMI <25 kg/m2, low magnitude postprandial and basal hyperglycemia, normal or close to normal C-peptide values, and thus not occur with acute hyperglycemic crises. Insulin therapy preserves pancreatic b-cell function, at the point that eventually prescribed insulin doses need to be reduced.

  6. How health information is received by diabetic patients?

    PubMed Central

    Zare-Farashbandi, Firoozeh; Lalazaryan, Anasik; Rahimi, Alireza; Zadeh, Akbar Hassan

    2015-01-01

    Background: Knowledge of correct information-seeking behavior by the patients can provide health specialists and health information specialists with valuable information in improving health care. This study aimed to investigate the passive receipt and active seeking of health information by diabetic patients. Materials and Methods: A survey method was used in this research on 6426 diabetic patients of whom 362 patients were selected by a no percentage stratified random sampling. The Longo information-seeking behavior questionnaire was used to collect data and they were analyzed by SPSS 20 software. Results: The most common information source by diabetic patients was practitioners (3.12). The minimum usage among the information sources were from charity organizations and emergency phone lines with a usage of close to zero. The amount of health information gained passively from each source has the lowest average of 4.18 and usage of this information in making health decision has the highest average score of 5.83. Analysis of the data related to active seeking of information showed that knowledge of available medical information from each source has the lowest average score of 3.95 and ability in using the acquired information for making medical decisions has the highest average score of 5.28. The paired t-test showed that differences between passive information receipt (41.68) and active information seeking (39.20) considered as statistically significant (P < 0.001). Conclusion: Because diabetic patients are more passive information receivers than active information seekers, the health information must be distributed by passive means to these patients. In addition, information-seeking behavior during different time periods should be investigated; to identify more effective distribution of health information. PMID:26261828

  7. [Non-diabetic renal disease in type II diabetes mellitus patients in Mohammed V Military Hospital, Rabat, Morocco].

    PubMed

    Y, Zajjari; Benyahia, M; Ibrahim, D Montasser; Kassouati, J; Maoujoud, O; El Guendouz, F; Oualim, Z

    2012-06-01

    The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients (37.5%); IgA nephropathy was the most frequent non-diabetic renal disease (half of non-diabetic renal diseases). Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group (16.7% versus 80.0%, P = 0024), duration of diabetes was a shorter (4.5 versus 15.5 years, P = 0.022) and diabetic retinopathy was absent (100% versus 40%, P = 0.026). There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephrotic syndrome and microscopic haematuria.

  8. Diet and physical activity in patients with type 1 diabetes.

    PubMed

    Iafusco, Dario

    2006-01-01

    Patients with type 1 diabetes require adequate amounts of macronutrients to support their training and sustain performance during regular exercise and during competitions. A frequent goal in competitive sports is to improve performance, and athletes may resort to a number of practices that can adversely affect blood glucose control and health in general in an attempt to gain a competitive advantage. These may include unsafe dietary patterns, and the use of nutritional supplements, other ergogenic aids and illegal substances. In this paper we review data on the relationship between insulin therapy and needs of single macronutrients before, during and after regular and competitive exercise in young subjects and athletes with type 1 diabetes. We also list nutrition integrators, available in the gymnasium or as over-the-counter drugs, which are increasingly being used by athletes, and describe their interactions with diabetes.

  9. [Current developments in renal failure in diabetic patients].

    PubMed

    Lindenmeyer, Maja

    2015-02-11

    Diabetic kidney disease (DKD) has become the leading cause of end-stage renal disease. Recent studies demonstrate that in a significant part of diabetic patients the renal insufficiency is frequently caused by non-diabetic kidney diseases, so that an effective clarification of untypical clinical courses is mandatory. Important cornerstones of DKD therapy are an optimized glycaemic management as well as a good blood pressure control. Although the prognosis of DKD has been improved in the last years, it is, even with novel therapy approaches, not possible to prevent the development of DKD. It remains to hope that with extended knowledge, intensified preclinical studies and well-defined clinical trials novel nephroprotective therapies become available in the next years.

  10. Clinical course and visual outcome in patients with diabetes mellitus and uveitis

    PubMed Central

    2013-01-01

    Purpose We report the clinical course and visual outcome of patients with diabetes mellitus (DM) who subsequently developed uveitis from any cause. Methods Longitudinal, retrospective case note review. Results A total of 36 patients (M/F: 18/18, 58 eyes) were included, Of the 36 patients, 35 had Type 2 DM and one had Type 1 DM. Mean age of onset of DM was 49 years and uveitis 55 years. The uveitis was bilateral in 22 (61%) patients. There were 19 patients with anterior uveitis, 12 with panuveitis and 5 with intermediate uveitis. Mean follow up was 4.4 years (range 1-18). Mean number of uveitis recurrences was 3 (range 1-7). Causes of vision of 6/18 or worse appeared related to the uveitis in 9 eyes and diabetes in 4 eyes. Cataract occurred in 22 eyes, glaucoma in 17 eyes, and cystoid macular oedema in 10 eyes. Diabetic retinopathy was detected in 38 (65.5%) eyes (29 non-proliferative including 6 with clinically significant macular oedema, and 9 proliferative). Progression of diabetic retinopathy to proliferative stage occurred in 7 eyes of 4 patients over a mean duration of 4.4 years. In 10 patients with active uveitis the mean HbA1c was 80 mmol/mol [9.5%], (range 49-137 [6.6-14.7]), and 67 mmol/mol [8.3%] (range 46-105 [6.4-11.8]) when the uveitis was quiescent, p = 0.01. Better glycaemic control was required in 10 patients during episodes of uveitis. Conclusions Patients with DM who develop uveitis may have a high complication rate, reduced vision and poor glycaemic control. Checking blood glucose during episodes of uveitis is important. PMID:23628425

  11. Six-month Outcomes of Mobile Phone Application-based Self-management in a Patient with Type 2 Diabetes.

    PubMed

    Hong, Mi Kyeong; Cho, Young Yun; Rha, Mi Yong; Kim, Jae Hyeon; Lee, Moon-Kyu

    2015-07-01

    We report the case in order to examine the effect of a mobile application program ("Diabetes & Nutrition") developed in 2011-2012 for self-management in patients with type 2 diabetes and to recommend important considerations when the mobile application program is developed. A 46-year-old man was newly diagnosed with type 2 diabetes in 2013 and had no complications. The height of the patient was 168 cm and the body weight was 75.6 kg. Nutrition education was conducted according to a medical prescription, and follow-up nutrition education was conducted after 3 and 6 months. After nutrition education, the patient was engaged in self-management using "Diabetes & Nutrition" program during 3 months. At 3 months, the body weight had decreased by 4.4 kg (from 75.6 to 71.2 kg), waist circumference by 5 cm (from 88 to 83 cm) and HbA1c level from 7.9% to 6.1%. Also at 3 months, the medication was reduced from from the dose of 850 mg to the dose of 500 mg metformin per twice a day. Since then, the patient did not continue to use the "Diabetes & Nutrition" because the level of blood glucose had stabilized, and the patient felt inconvenient and annoying to use the program. At 6 months, no significant change in the body weight and body composition was observed in comparison with those at 3 months. The present case demonstrates that the early use of "Diabetes & Nutrition" could be helpful for self-management of glycemic control in patients with type 2 diabetes. Developing self-management mobile application programs in the future will require strategies of how to promote continuous use of application program and self-management of type 2 diabetes.

  12. Role of surgical revascularization in diabetic patients with coronary artery disease.

    PubMed

    Góngora, Enrique; Sundt, Thoralf M

    2005-03-01

    Diabetes is a well-known risk factor for morbidity and mortality associated with coronary artery disease. Currently, diabetics represent approximately a quarter of patients requiring coronary revascularization in the USA. The purpose of this article is to review and analyze the available data in surgical revascularization of diabetic patients with coronary artery disease. The review will also examine new developments in myocardial revascularization and assess their probable impact on the long-term outcome of diabetic patients.

  13. Effective Nurse Communication With Type 2 Diabetes Patients: A Review.

    PubMed

    Mulder, Bob C; Lokhorst, Anne Marike; Rutten, Guy E H M; van Woerkum, Cees M J

    2015-08-01

    Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse-patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.

  14. Effects of Apolipoprotein E Isoforms in Diabetic Nephropathy of Chinese Type 2 Diabetic Patients

    PubMed Central

    Ma, Liang; Han, ChengWu; Liu, Qian; Cong, Xiao; Xu, YaPing; Zhao, TingTing

    2017-01-01

    Diabetic nephropathy (DN) is one of the major chronic complications of diabetes. Genetic polymorphism of Apolipoprotein E (ApoE) has been proposed to participating in DN. The purpose of the study was to evaluate the relationship between ApoE genetic polymorphism and the presence of DN in Chinese type 2 diabetic patients. We studied 845 diabetic patients who were divided into DN group (n = 429) and control group (n = 416). ApoE genotype was determined by ApoE genotyping chip and the plasmatic biochemical characterization was performed on all subjects. There were differences (P < 0.001) in HbA1c, creatinine, and urinary albumin between the two groups. The ApoE ε2 allelic frequency was 7.69% in DN group versus 3.49% in control group (OR = 2.22, 95% CI = 1.41–3.47, and P < 0.05), as expected, ApoE E2/E2 and E2/E3 genotype frequency were higher in DN group (13.75% versus 6.49%, P < 0.05). The ApoE ε4 allelic frequency was 7.93% in DN group versus 11.54% in control group (OR = 0.70, 95% CI = 0.50–0.97, and P < 0.05), and DN group presented a lower frequency of ApoE E3/E4 and E4/E4 genotype frequency (14.91% versus 19.96%, P < 0.05). These results suggest ApoE ε2 allele may be a risk factor; however ApoE ε4 allele may play a protective role of DN in Chinese type 2 diabetic patients. PMID:28326331

  15. Canagliflozin Treatment in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Triplitt, Curtis; Cornell, Susan

    2015-01-01

    Current guidelines for treatment of type 2 diabetes mellitus (T2DM) indicate a patient-centered approach that should go beyond glycemic control. Of the many antihyperglycemic agents available for treatment of T2DM, sodium-glucose cotransporter 2 (SGLT2) inhibitors offer the advantages of reduced glycated hemoglobin (A1C), body weight (BW), and systolic blood pressure (SBP) and are associated with a low risk of hypoglycemia when used either as monotherapy or with other agents not typically associated with increased risk of hypoglycemia. Collaborative, multidisciplinary teams are best suited to provide care to patients with diabetes, and clinical pharmacists can enhance the care provided by these teams. This review aims to provide insight into the mode of action, pharmacology, potential drug–drug interactions, clinical benefits, and safety considerations associated with use of the SGLT2 inhibitor canagliflozin in patients with T2DM and to provide information to enhance clinical pharmacists’ understanding of canagliflozin. PMID:26523120

  16. Mortality and diabetes mellitus in amputations of the lower limbs for gas gangrene: a case report.

    PubMed

    Pereira de Godoy, José Maria; Vasconcelos Ribeiro, Janalice; Caracanhas, Lívia Andrioli

    2008-12-01

    The aim of this study was to examine any association between the presence of diabetes in patients with gas gangrene of the legs and mortality following major lower limb amputation. In a retrospective study, patients submitted to amputation of lower limbs for anaerobic infections were evaluated in the period from January 2005 to January 2007 in the University Hospital de Base in Sao Jose do Rio Preto. All the patients were hospitalized for the treatment of ulcerated lesions of the leg. The study sample consisted of 30 men and 10 women aged between 46 and 87 years (mean 69 years) suffering from anaerobic infections. During treatment, the presence of crepitation in the skin was observed as was gas by radiological examination. Amputation was performed within 2 to 6 hours after diagnosis. Diabetes was identified in 33 patients and death occurred within the perioperative period in 12 cases. Diabetes is associated with the necessity of amputation for gas gangrene resulting in a high mortality rate.

  17. [Quality of care in diabetic patients receiving pharmacologic treatment].

    PubMed

    Lombraña, María A; Capetta, María E; Ugarte, Alejandro; Correa, Viviana; Giganti, Jorge; Saubidet, Cristian Lopez; Stryjewski, Martin E

    2007-01-01

    Diabetes mellitus is a chronic disease with an increasing prevalence. Appropriate treatment of the disease and prevention of chronic complications reduce morbidity and mortality in a cost-effective manner. These actions should be measured through the use of validated indicators for quality of care. The goal of this study was to assess the quality of care in diabetic patients under pharmacologic treatment in a private university hospital. A retrospective study was conducted in adult patients who bought insulin or oral hypoglycemic agents during a 3 month period; demographic and clinical data were obtained for 12 consecutive months following the buying period. The study included 305 adult patients; most were males (60%), with type 2 diabetes (95%), and using oral hipoglycemic agents (86%). Control of blood pressure was registered in 80%, foot exam in 5%, eye exam in 27%, HbA1C blood level in 85%, complete lipid profile in 82%, microalbuminuria in 27% and creatinine clearance in 22% of patients, respectively. Mean values were HbA1C 7.1(+/- 1.6)%, and < or = 7% in 66%, LDL 113 (+/- 33.6) mg/dl and <100 mg/dl in 30%, BP 136-79 mm Hg and < 130-80 mm Hg in 46% of patients, respectively. This study emphasizes the need for quality of care assessment through validated indicators and points out the aspects that should be improved within a health care system.

  18. [Intensified smoking cessation for diabetic patients--preliminary results].

    PubMed

    Brath, H; Lasar, D; Buchhäusl, I; Kästenbauer, T; Binter, E

    1999-01-01

    Cigarette smoking is the most prominent yet avoidable cause of illness in the general population as well as in patients with diabetes. The danger of developing late complications is much higher for smoking than for non-smoking diabetic patients. The aim of this study was to determine whether an intensified smoking cessation program for patients with diabetes, including an initial 3 week-period of inpatient cessation, is effective and more successful than a mere outpatient program. The outpatient program consisted of at least 7 consultations within 2 years, and included nicotine replacement therapy, steps for modifying the smokers' behavioural patterns, advice in dietary and exercise as well as measurements of amounts of exhaled carbonmonoxide and lung function. In the inpatient program the patients passed the first 3 cessation weeks in a specialised clinic providing a similar, but intensified program, aside from daily life and professional routine. The following consultations corresponded to those of the outpatient program. Altogether we analysed 89 patients (64 in the outpatient and 25 in the inpatient program).

  19. Diabetic kidney disease patients on hemodialysis: a retrospective survival analysis across different socioeconomic groups

    PubMed Central

    Vijayan, Madhusudan; Radhakrishnan, Saranya; Mathew, Milly; Sampathkumar, Krishnaswamy; Mancha, Nevin Philip

    2016-01-01

    Background Diabetic kidney disease is the leading cause of stage 5 chronic kidney disease (CKD) in India. Renal replacement therapy (RRT) is accessible to very few patients because of socioeconomic deprivation. We studied the effect of diabetes and socioeconomic status on the outcome of patients on maintenance hemodialysis (MHD). Methods We retrospectively analyzed the outcome of 897 patients (629 males/268 females; mean age ± standard deviation 48.69 ± 14.27 years) initiated on MHD from 2003 to 2009 at five dialysis centers in south India. There were 335 type 2 diabetic patients and 562 non-diabetic patients. Group 1 comprised the self-paying patients (518 patients) and Group 2 included the TANKER Foundation charity dialysis patients (379 patients). We compared the 5-year survival rates of Group 1 versus Group 2 and also those of diabetic versus non-diabetic patients, using the Kaplan–Meier survival estimator. Results Of the 897 patients, 166 patients survived, 350 died, 234 were lost to follow-up, 137 had renal transplantation and 10 patients were transferred to peritoneal dialysis. The 5-year survival rates after censoring were 20.7 and 38.2% for diabetic and non-diabetic patients, respectively (P < 0.001). The survival rate of diabetic patients was significantly lower, compared with non-diabetic patients, in Group 2 (P < 0.001), but not significantly lower in Group 1 (P = 0.226). Conclusions Diabetic patients have poor survival rates on MHD, especially those from poor socioeconomic groups. Due to scarce RRT facilities and poor survival rates of diabetic patients, prevention, early detection and management of diabetic CKD patients should be the way to go forward. PMID:27994864

  20. The Relationship between Body Mass Index and Periodontitis in Arab Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Awad, Manal; Rahman, Betul; Hasan, Haidar; Ali, Houssam

    2015-01-01

    Objective Our study sought to evaluate the association between periodontitis and body mass index (BMI) among patients with type 2 diabetes mellitus.  Methods In this cross-sectional case control study analysis of 186 diabetic patients, 112 patients had a body mass index ≥30kg/m2 and 74 control patients had BMI <30kg/m2. All participants underwent oral examinations including a full mouth recording of clinical attachment level (CAL). Information regarding HbA1c levels and high-sensitivity C-reactive protein (hs-CRP) were also gathered.  Results Over half (61%) of patients had a BMI ≥30. Of these 52% had CAL less than 2mm. Multivariate logistic regression analysis showed that there was no association between BMI and CAL. In addition, hs-CRP levels were significantly and positively associated with CAL (OR:1.06, 95% CI: 1.01, 1.12; p=0.007).  Conclusion Among patients with type 2 diabetes mellitus, there was no association between periodontitis and BMI. More studies are needed to further explore this relationship taking into consideration additional lifestyle factors. PMID:25829999

  1. Exercise thallium imaging in patients with diabetes mellitus. Prognostic implications

    SciTech Connect

    Felsher, J.; Meissner, M.D.; Hakki, A.H.; Heo, J.; Kane-Marsch, S.; Iskandrian, A.S.

    1987-02-01

    We used exercise thallium 201 imaging in 123 patients with diabetes mellitus (77 men and 46 women, aged 56 +/- 8 years), 75% of whom had angina pectoris (typical or atypical). During exercise testing, 18 patients (15%) had angina pectoris, 28 (23%) had ischemic ST changes, and 69 (56%) had abnormal thallium images. During follow-up (up to 36 months), there were 12 cardiac events; four patients died of cardiac causes and eight had nonfatal acute myocardial infarction. Univariate and multivariate survival analysis identified two independent predictors of cardiac events: the event rate was significantly less in patients with normal images and exercise heart rate over 120 beats per minute than in patients with abnormal images and exercise heart rate of 120 beats per minute or less (0% vs 22%). The patients with abnormal images or exercise heart rate of 120 beats per minute or less had an intermediate event rate (11.5%). Furthermore, two of the 54 patients with normal images and ten of 69 patients with abnormal images had subsequent cardiac events. Thus, exercise thallium imaging is useful in risk stratification in patients with diabetes mellitus.

  2. Intralesional epidermal growth factor for diabetic foot wounds: the first cases in Turkey

    PubMed Central

    Ertugrul, Bulent M.; Buke, Cagri; Ersoy, Ozlem Saylak; Ay, Bengisu; Demirez, Dilek Senen; Savk, Oner

    2015-01-01

    Background Intralesional recombinant epidermal growth factor (EGF) was produced in the Centre for Genetic Engineering and Biotechnology (CIGB), Cuba, in 1988 and licensed in 2006. Because it may accelerate wound healing, it is a potential new treatment option in patients with a diabetic foot wound (whether infected or not) as an adjunct to standard treatment (i.e. debridement, antibiotics). We conducted the initial evaluation of EGF for diabetic foot wounds in Turkey. Methods We enrolled 17 patients who were hospitalized in various medical centers for a foot ulcer and/or infection and for whom below the knee amputation was suggested to all except one. All patients received 75 μg intralesional EGF three times per week on alternate days. Results The appearance of new granulation tissue on the wound site (≥75%) was observed in 13 patients (76%), and complete wound closure was observed in 3 patients (18%), yielding a ‘complete recovery’ rate of 94%. The most common side effects were tremor (n=10, 59%) and nausea (n=6, 35%). In only one case,a serious side effect requiring cessation of EGF treatment was noted. That patient experienced severe hypotension at the 16th application session, and treatment was discontinued. At baseline, a total of 21 causative bacteria were isolated from 15 patients, whereascultures were sterile in two patients. The most frequently isolated species was Pseudomonas aeruginosa. Conclusion Thus, this preliminary study suggests that EGF seems to be a potential adjunctive treatment option in patients with limb-threatening diabetic foot wounds. PMID:26268583

  3. Hyperglycemic crisis precipitated by Lassa fever in a patient with previously undiagnosed type 2 diabetes mellitus.

    PubMed

    Edo, A E; Okaka, E; Ezeani, I U

    2014-01-01

    Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly precipitated by infections and non-compliance with therapy. Viral precipitant of HC is uncommon. To report a rare case of HC unmasked by Lassa fever in a patient previously not known to have diabetes mellitus. A 54 year old lady presented with complaints of generalized body weakness, inability to pass stool, and fever. There was no abdominal pain, vomiting and nausea. There were no features of DM. She is not a known case of diabetes mellitus or hypertension. Patient does not drink alcoholic beverages. There was no history of bleeding from any orifices. She was acutely ill-looking, afebrile, not pale, anicteric, nil pedal oedema. Pulse rate was 110 beats per minute, regular, normal volume. Blood pressure was 110/80 mmHg. Respiratory rate was 26 cycles/minute, breath sound was vesicular. Abdomen was full and moved with respiration. There were no areas of tenderness, no organomegaly, no ascites, and bowel sounds were normoactive. Neurologic examination revealed a conscious patient who was restless. Casual blood glucose was 600mg/dl. Urinalysis: Glycosuria (+++), HbA1c was 12.4%. Lassa PCR done was positive. Patient was managed for hyperglycemic crisis with intravenous normal saline and soluble insulin. She was also commenced on Ribavirin but died of complications of lassa fever. Lassa fever should be included as a precipitant of hyperglycemic crisis in endemic countries.

  4. Isolated oculomotor nerve palsy after lumbar epidural steroid injection in a diabetic patient

    PubMed Central

    Gozal, Yair M.; Atchley, Kristine; Curt, Bradford A.

    2016-01-01

    Background: In patients with diabetes mellitus, epidural steroid injections (ESI) have been noted to cause significant elevation of blood glucose levels, typically lasting 1–3 days. Here, we describe a previously unreported complication of a diabetic third nerve palsy associated with an ESI. Case Description: A 66-year-old man with a history of coronary artery disease, hypertension, and insulin-dependent diabetes mellitus presented with low back pain and left lower extremity radiculopathy. The lumbar magnetic resonance imaging (MRI) revealed mild spondylosis, most severe at the L4-5 level, accompanied by a broad based disc protrusion resulting in mild central and moderate biforaminal stenosis. The patient underwent a left-sided L4-L5 transforaminal ESI resulting in transient elevation of his blood glucose levels. On post-procedure day 2, he developed a frontal headache and a complete right third nerve palsy with partial pupillary involvement. The MRI and MR angiography (MRA) of the brain revealed no compressive lesions or oculomotor abnormalities. Ophthalmoplegia and pupillary dysfunction resolved spontaneously over 4 months. Conclusions: Although rare, a history of a recent ESI should be considered as the etiology of an isolated oculomotor palsy in diabetic patients. PMID:28144494

  5. Acute pulmonary edema due to rosiglitazone use in a patient with diabetes mellitus.

    PubMed

    Cekmen, Nedim; Cesur, Mustafa; Cetinbas, Riza; Bedel, Pasa; Erdemli, Ozcan

    2006-01-01

    Rosiglitazone is a peroxisome proliferator active receptor. gamma agonist, which increases insulin sensitivity in adipose tissue, muscle, and liver. Rosiglitazone is a member of the thiazolidinedione group, and because of its significantly positive effect on glycemic control, it is especially preferred in type 2 diabetic patients with a high cardiovascular disease risk. This drug, because of its decreasing effect on insulin resistance, is used alone or combined with type 2 diabetic drugs. A 73-year-old female patient was admitted to the emergency department with dyspnea, pink frothing phlegm, cyanosis, and tiredness. She was lethargic, uncooperative, and had no orientation. In arterial blood gases, hypoxemia and hypercapnia were found. She was taken to the general intensive care unit, and oxygen was applied via mask. The patient had a history of 10 years of diabetes mellitus, hypertension, and atherosclerotic cardiac disease, and she was using rosiglitazone for the past 6 weeks. Her chest x-ray was taken, and acute pulmonary edema was diagnosed. In her last echocardiography, which was performed 1 year before, no signs indicating cardiac failure and pleural effusion could be found. Therefore, it was concluded that pulmonary edema occurred as a complication of rosiglitazone use. After stabilizing the patient's vital signs, blood glucose levels, and lactate levels, medical treatment of diabetes mellitus was rearranged, and she was discharged on the seventh day after her admittance. In a patient with diabetes mellitus who has been admitted to the intensive care unit because of acute pulmonary edema, for differential diagnosis, use of rosiglitazone should be kept in mind during the determination of treatment. Therefore, the authors aim to discuss the effect of rosiglitazone on creating acute pulmonary edema with a case report presentation.

  6. High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

    PubMed

    Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

    2015-01-01

    Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.

  7. Physician Notification of Their Diabetes Patients' Limited Health Literacy

    PubMed Central

    Seligman, Hilary K; Wang, Frances F; Palacios, Jorge L; Wilson, Clifford C; Daher, Carolyn; Piette, John D; Schillinger, Dean

    2005-01-01

    BACKGROUND Many patients with chronic disease have limited health literacy (HL). Because physicians have difficulty identifying these patients, some experts recommend instituting screening programs in clinical settings. It is unclear if notifying physicians of patients' limited HL improves care processes or outcomes. OBJECTIVE To determine whether notifying physicians of their patients' limited HL affects physician behavior, physician satisfaction, or patient self-efficacy. DESIGN We screened all patients for limited HL and randomized physicians to be notified if their patients had limited HL skills. PARTICIPANTS Sixty-three primary care physicians affiliated with a public hospital and 182 diabetic patients with limited HL. MEASUREMENTS After their visit, physicians reported their management strategies, satisfaction, perceived effectiveness, and attitudes toward HL screening. We also assessed patients' self-efficacy, feelings regarding HL screening's usefulness, and glycemic control. RESULTS Intervention physicians were more likely than control physicians to use management strategies recommended for patients with limited HL (OR 3.2, P=.04). However, intervention physicians felt less satisfied with their visits (81% vs 93%, P=.01) and marginally less effective (38% vs 53%, P=.10). Intervention and control patients' post-visit self-efficacy scores were similar (12.6 vs 12.9, P=.6). Sixty-four percent of intervention physicians and 96% of patients felt HL screening was useful. CONCLUSIONS Physicians are responsive to receiving notification of their patients' limited HL, and patients support the potential utility of HL screening. However, instituting screening programs without specific training and/or system-wide support for physicians and patients is unlikely to be a powerful tool in improving diabetes outcomes. PMID:16307624

  8. Oral Candida spp carriers: its prevalence in patients with type 2 Diabetes Mellitus*

    PubMed Central

    Martinez, Ramon Felipe Fernandez; Jaimes-Aveldañez, Alejandra; Hernández-Pérez, Francisco; Arenas, Roberto; Miguel, Guadalupe Fabián-San

    2013-01-01

    BACKGROUND: Prevalence of oral candidiasis in diabetic patients is 13.7-64%. Candida albicans was the most frequently isolated species (75-86.5%). OBJECTIVE: To obtain the prevalence of Candida carriers among patients with type 2 diabetes mellitus to identify the species of the yeast. Study design: It is an open, observational, descriptive, cross-sectional, and prospective study. METHODS: We included voluntary patients from the National Diabetes Marathon and performed a blood glucose measurement, sialometry test, Gram-stained exfoliative cytology, and culture on Sabouraud dextrose agar and CHROMagar Candida TM. Results were analyzed using descriptive statistics. RESULTS: We examined 141 patients (mean age 57 years): 103 women (73%) and 38 men (26.9%). Exfoliative cytology was positive in 32 cases (23 with oral lesions); 78 had oral lesions but no Candida (93.9%). Candida was isolated in 58 patients (41.1%), 21 (45.6 %) had blood glucose greater than 126 mg/dl, and 37 (38.9%) had less than 126 mg/dl. The most frequent species was C. albicans (82.7%). Forty-two Candida carriers had salivary flow greater than 20 mm (72.4%), and 16 (27.5%) had hyposalivation. Candida was isolated in 25 of 79 patients with dental prosthesis (31.6%), 9 of 15 were smokers (60%), and 22 of 71 had symptoms (30.9%). CONCLUSIONS: Prevalence of oral Candida carriers in patients with type 2 diabetes mellitus in Mexico was similar to that found in other countries; exfoliative cytology was effective in finding Candida; salivary flow rate, use of prosthesis, and presence of oral lesions and symptoms were similar in oral Candida carriers and negative patients. Most smokers were Candida carriers. PMID:23739717

  9. Spontaneous and transient predinner hyperglycemia in some patients with diabetes

    PubMed Central

    Li, Wei; Du, Si-na; Shi, Min-jia; Sun, Zhan-zhan

    2016-01-01

    Abstract Blood glucose fluctuations have higher risk than absolute blood glucose level in diabetic chronic complications. At present, “dawn phenomenon” is well known by clinicians, but “dusk phenomenon” has not been recognized. This study explored the objective existence of “dusk phenomenon” (spontaneous and transient predinner hyperglycemia) and its clinical significance. The data of 54 patients with diabetes, who received routine insulin pump therapy between December 2010 and October 2012 in our hospital, were retrospectively analyzed. These patients included 4 patients with type 1 diabetes mellitus (DM) (T1DM) and 50 patients with type 2 DM (T2DM). According to the difference between predinner and postlunch blood glucose levels, the 50 patients with T2DM were divided into dusk phenomenon group (4 patients, all the differences ≥0 mmol/L during insulin pump therapy), nondusk phenomenon group (12 patients, all the differences <0 mmol/L during insulin pump therapy), and suspicious group (34 patients, the differences were uncertain during insulin pump therapy). In the 4 patients with T1DM of this study, the differences all were more than 0 mmol/L during insulin pump therapy. The changes in blood glucose levels were observed, and the correlations of blood glucose level with other factors were analyzed in T1DM and T2DM patients, respectively. In T1DM patients, blood glucose level was significantly higher in predinner than in prebreakfast and prelunch (all P < 0.01), and in postdinner 2 hour than in postlunch 2 hour (P = 0.021). The predinner blood level had no significant correlations with the blood glucose level at other time points and insulin dosages (all P > 0.05). In T2DM patients, the predinner blood glucose level was significantly higher in dusk phenomenon group than in suspicious group and nondusk phenomenon group (all P < 0.05). In dusk phenomenon group, the blood glucose level remained rising from predinner to prebed, and

  10. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes.

    PubMed

    Marso, Steven P; Bain, Stephen C; Consoli, Agostino; Eliaschewitz, Freddy G; Jódar, Esteban; Leiter, Lawrence A; Lingvay, Ildiko; Rosenstock, Julio; Seufert, Jochen; Warren, Mark L; Woo, Vincent; Hansen, Oluf; Holst, Anders G; Pettersson, Jonas; Vilsbøll, Tina

    2016-11-10

    Background Regulatory guidance specifies the need to establish cardiovascular safety of new diabetes therapies in patients with type 2 diabetes in order to rule out excess cardiovascular risk. The cardiovascular effects of semaglutide, a glucagon-like peptide 1 analogue with an extended half-life of approximately 1 week, in type 2 diabetes are unknown. Methods We randomly assigned 3297 patients with type 2 diabetes who were on a standard-care regimen to receive once-weekly semaglutide (0.5 mg or 1.0 mg) or placebo for 104 weeks. The primary composite outcome was the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. We hypothesized that semaglutide would be noninferior to placebo for the primary outcome. The noninferiority margin was 1.8 for the upper boundary of the 95% confidence interval of the hazard ratio. Results At baseline, 2735 of the patients (83.0%) had established cardiovascular disease, chronic kidney disease, or both. The primary outcome occurred in 108 of 1648 patients (6.6%) in the semaglutide group and in 146 of 1649 patients (8.9%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.58 to 0.95; P<0.001 for noninferiority). Nonfatal myocardial infarction occurred in 2.9% of the patients receiving semaglutide and in 3.9% of those receiving placebo (hazard ratio, 0.74; 95% CI, 0.51 to 1.08; P=0.12); nonfatal stroke occurred in 1.6% and 2.7%, respectively (hazard ratio, 0.61; 95% CI, 0.38 to 0.99; P=0.04). Rates of death from cardiovascular causes were similar in the two groups. Rates of new or worsening nephropathy were lower in the semaglutide group, but rates of retinopathy complications (vitreous hemorrhage, blindness, or conditions requiring treatment with an intravitreal agent or photocoagulation) were significantly higher (hazard ratio, 1.76; 95% CI, 1.11 to 2.78; P=0.02). Fewer serious adverse events occurred in the semaglutide group, although more patients discontinued treatment

  11. Cardiac autonomic neuropathy in patients with diabetes mellitus

    PubMed Central

    Dimitropoulos, Gerasimos; Tahrani, Abd A; Stevens, Martin J

    2014-01-01

    Cardiac autonomic neuropathy (CAN) is an often overlooked and common complication of diabetes mellitus. CAN is associated with increased cardiovascular morbidity and mortality. The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death. In addition, autoimmune and genetic factors are involved in the development of CAN. CAN might be subclinical for several years until the patient develops resting tachycardia, exercise intolerance, postural hypotension, cardiac dysfunction and diabetic cardiomyopathy. During its sub-clinical phase, heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic. Newer imaging techniques (such as scintigraphy) have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system. One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN; however, the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN, and also proposed screening for CAN in patients with diabetes mellitus. A major challenge, however, is the lack of specific treatment to slow the progression or prevent the development of CAN. Lifestyle changes, improved metabolic control might prevent or slow the progression of CAN. Reversal will require combination of these treatments with new targeted therapeutic approaches. The aim of this article is to review the latest evidence regarding the epidemiology, pathogenesis, manifestations, diagnosis and treatment for CAN. PMID:24567799

  12. Cardiac autonomic neuropathy in patients with diabetes mellitus.

    PubMed

    Dimitropoulos, Gerasimos; Tahrani, Abd A; Stevens, Martin J

    2014-02-15

    Cardiac autonomic neuropathy (CAN) is an often overlooked and common complication of diabetes mellitus. CAN is associated with increased cardiovascular morbidity and mortality. The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death. In addition, autoimmune and genetic factors are involved in the development of CAN. CAN might be subclinical for several years until the patient develops resting tachycardia, exercise intolerance, postural hypotension, cardiac dysfunction and diabetic cardiomyopathy. During its sub-clinical phase, heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic. Newer imaging techniques (such as scintigraphy) have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system. One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN; however, the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN, and also proposed screening for CAN in patients with diabetes mellitus. A major challenge, however, is the lack of specific treatment to slow the progression or prevent the development of CAN. Lifestyle changes, improved metabolic control might prevent or slow the progression of CAN. Reversal will require combination of these treatments with new targeted therapeutic approaches. The aim of this article is to review the latest evidence regarding the epidemiology, pathogenesis, manifestations, diagnosis and treatment for CAN.

  13. Quality of life and characteristics of diabetic patients.

    PubMed

    Corrêa, Karina; Gouvêa, Giovana Renata; Silva, Marco Antonio Viera da; Possobon, Rosana de Fátima; Barbosa, Luis Fernando de Lima Nunes; Pereira, Antonio Carlos; Miranda, Luciane Guerra; Cortellazzi, Karine Laura

    2017-03-01

    This study aimed to assess the association between quality of life and clinical and sociodemographic variables in type 2 diabetes patients, after they had started treatment in Primary and Specialized Health Care. This is an analytical cross-sectional study with a sampling of diabetic patients from Primary (n = 385) and Specialized (n = 385) Health Care. The dependent variable, quality of life, was evaluated by the Diabetes Quality of Life Measure - Brazil. Clinical and sociodemographic data were collected. Bivariate analysis by chi square test tested the association between the dependent variable with the independent ones. Next, we performed an analysis of multiple logistic regression. In Specialized Health Care, individuals who practice physical activity had less chance of having worse quality of life and those with less time of diagnosis presented higher chance of worse quality of life. In Primary Health Care, those who performed diets and presented glycated hemoglobin ≤ 7% had less chance of having worse quality of life. Women presented higher chances of worse quality of life than men. We concluded that with exception to the time of diagnosis and sex, other variables that influenced quality of life of diabetics were modifiable factors (glycated hemoglobin, alimentary diet and physical activity).

  14. Management of the hospitalized patient with type 1 diabetes mellitus.

    PubMed

    Mendez, Carlos E; Umpierrez, Guillermo

    2013-08-01

    Patients with type 1 diabetes mellitus (T1DM) have minimal to absent pancreatic β-cell function and rely on the exogenous delivery of insulin to obtain adequate and life-sustaining glucose homeostasis. Maintaining glycemic control is challenging in hospitalized patients with T1DM, as insulin requirements are influenced by the presence of acute medical or surgical conditions, as well as altered nutritional intake. The risks of hyperglycemia, ketoacidosis, hypoglycemia, and glycemic variability are increased in hospitalized patients with T1DM. Diabetic ketoacidosis and severe hypoglycemia are the 2 most common emergency conditions that account for the majority of hospital admissions in patients with T1DM. The association between hyperglycemia and increased risk of complications and mortality in patients with type 2 diabetes (T2DM) is well established; however, the impact of glycemic control on clinical outcomes has not been determined in patients with T1DM who present without ketoacidosis. To decrease complications associated with insulin therapy, health care professionals must be well versed in the use of insulin because it is a common source of medication error. For non-critically ill, hospitalized patients, subcutaneous insulin given to cover basal and prandial needs instead of sliding scale is the preferred method of insulin dosing. Protocols are available for initiating and titrating insulin doses, as well as for transitioning from an insulin infusion to a subcutaneous regimen. In our review, we identify and discuss special considerations related to inpatient glycemic control of non-ketotic patients with T1DM. Additionally, point differences and similarities associated with the management of patients with T2DM are discussed.

  15. [Neurological effects of hypoglycemia in diabetic patients].

    PubMed

    Caballero-Corchuelo, J

    2016-09-16

    Introduccion. El tratamiento farmacologico de la diabetes se asocia a un aumento en el riesgo de hipoglucemia. Los episodios de hipoglucemia afectan a la calidad de vida del paciente y a actividades diarias comunes, ademas de la morbimortalidad que pueden producir en casos con sintomatologia neurologica. Objetivo. Revisar las principales complicaciones neurologicas de la hipoglucemia en pacientes diabeticos, con especial interes en las consecuencias a largo plazo. Desarrollo. Tras revisar la fisiopatologia de la hipoglucemia en el paciente diabetico, se describe el papel de la hipoglucemia en tres situaciones: las alteraciones en los mecanismos neuroendocrinos de regulacion de la glucemia, los efectos de la hipoglucemia en los niños y la relacion con el deterioro cognitivo en los adultos. Conclusiones. Aparte de los daños neurologicos agudos que pueden suceder en casos de hipoglucemia grave, los episodios de hipoglucemia repetidos se asocian a otros efectos neurologicos a largo plazo: afectan a los mecanismos de contrarregulacion ante episodios de hipoglucemia subsiguientes, aumentando el riesgo de hipoglucemias graves, y pueden producir alteraciones cognitivas en poblaciones vulnerables, como los niños pequeños o ancianos.

  16. Prevalence and predictors of depression and anxiety in patients of diabetes mellitus in a tertiary care center

    PubMed Central

    Rajput, Rajesh; Gehlawat, Pratibha; Gehlan, Deepak; Gupta, Rajiv; Rajput, Meena

    2016-01-01

    Background: Diabetes is one of the most common chronic diseases and affects virtually every organ of the human system. Depression and anxiety is common among patients with diabetes and associated with worse diabetes outcomes. Aims and Objective: To study the prevalence and predictors of depression and anxiety in patients of Type 2 diabetes mellitus (T2DM) in Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India, a tertiary care center in Northern India. Materials and Methods: Four hundred ten consecutive patients having T2DM and 410 healthy controls matched for age and sex attending the endocrine out-patient department of a tertiary care center of Northern India were included in the study. Sociodemographic and relevant clinical variables were collected. They were evaluated for depression and anxiety using Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale respectively. Results: It was found that a significantly larger proportion of diabetic patients had depression (26.3% vs. 11.2%, P = 0.001), anxiety (27.6% vs. 12.7%, P = 0.001) and comorbid depression and anxiety (21.0% vs. 7.3%, P = 0.001) as compared to healthy controls. Diabetic women had higher depression (17.1% vs. 9.3%) and anxiety (17.6% vs. 10.0%) than men. The major predictors for a severe form of depression and anxiety among T2DM cases were age, female sex, insulin therapy, retinopathy, nephropathy, and ischemic heart disease. Conclusion: The present findings reveal that diabetic cases had significantly higher depression and anxiety as compared to healthy controls. The risk factors for depression and anxiety were age, female sex, insulin therapy, and diabetic complications. PMID:27867873

  17. Diabetes-related distress and its associated factors among patients with type 2 diabetes mellitus in China.

    PubMed

    Zhou, Huanhuan; Zhu, Junya; Liu, Lin; Li, Fan; Fish, Anne F; Chen, Tao; Lou, Qingqing

    2017-02-24

    Diabetes-related distress is one of the psychological disorders affecting patients with diabetes, yet there are few studies about diabetes-related distress in Chinese patients. To assess the level of psychological distress and examine its associated factors, we conducted a cross-sectional analysis of patients with type 2 diabetes mellitus from a Chinese tertiary hospital. The Diabetes Distress Scale (DDS) and the General Self-Efficacy Scale (GSES) were administered. There were 210 (57.85%) patients with little or no diabetes-related distress, 84 (23.14%) with moderate diabetes-related distress and 69 (19.01%) with high diabetes-related distress. Stepwise multiple linear regression showed that sleep time was significantly related to the DDS total score and the subscale scores of emotional burden (EB) (β=-0.190, -0.379), respectively. GSES was associated with the DDS total score (β=-0.128) and the EB score (β=-0.153). Oral medication plus insulin was significantly related to regimen-related distress (RD) (β=0.137), physician-related distress (PD) (β=0.152) and interpersonal distress (ID) (β=0.103). Physical activity (β=-0.185) and making meal plan with health care professionals(HCP) (β=-0.169) were associated with RD. The prevalence of diabetes-related distress among patients with type 2 diabetes mellitus was high in China. DDS and EB were associated with poorer sleep time and lower self-efficacy. Interventions to improve sleep are needed. Qualitative and longitudinal studies are required to understand why type 2 diabetic patients are not getting enough sleep.

  18. Persistent corneal epithelial defect responding to rebamipide ophthalmic solution in a patient with diabetes

    PubMed Central

    Hayashi, Yusuke; Toshida, Hiroshi; Matsuzaki, Yusuke; Matsui, Asaki; Ohta, Toshihiko

    2016-01-01

    Objective Rebamipide ophthalmic suspension was developed for the treatment of dry eyes and for other corneal diseases, promoting the secretion of both mucin in tear fluid and membrane-associated mucin, increasing the number of goblet cells, and restoring the barrier function of the corneal epithelium. We report a case of a persistent corneal epithelial defect in a patient with diabetes treated with topical application of rebamipide ophthalmic suspension. Case presentation A 73-year-old woman had a history of type 2 diabetes for 35 years and nonproliferative diabetic retinopathy for 23 years. She presented to our department with discharge and ophthalmalgia in the left eye. A corneal ulcer was detected, and culture of corneal scrapings was performed, with Staphylococcus aureus and Streptococcus canis being isolated. The infection was treated with levofloxacin eye drops and ofloxacin ophthalmic ointment based on the sensitivity profile of the isolate. However, a corneal epithelial defect persisted for approximately 2 months despite continuing treatment with 0.1% hyaluronic acid ophthalmic suspension and 0.3% ofloxacin eye ointment. Her hemoglobin A1c was 7.3%. The persistent corneal epithelial defect showed improvement at 2 weeks after treatment with rebamipide unit dose 2% ophthalmic suspension, and it did not recur even when vitrectomy was subsequently performed for vitreous hemorrhage due to progression of diabetic retinopathy. Conclusion This is the first report about efficacy of rebamipide unit dose 2% ophthalmic suspension for presenting persistent corneal epithelial defect in a patient with diabetes. In the present case, the suggested mechanisms are the following: improving the corneal barrier function, stabilization of mucin on the keratoconjunctival epithelium, and improving the wettability and stability of the tear film, which resulted in the promotion of healing of the corneal epithelial defect in a short time period. PMID:27257394

  19. [Change in the incidence of diabetes mellitus in oral cancer patients based on a long-term comparative study].

    PubMed

    Végh, Dániel; Bányai, Dorottya; Ujpál, Márta

    2015-03-01

    Our research is focused on the incidence of diabetes mellitus and glucose metabolic disorders among oral cancer patients and the frequency of different oral localizations of cancer. Diabetes mellitus affects 7% of the Hungarian population. This study uses data spanning 14 years, with 2 datasets of 1998-1999 and 2012-2013, collected first hand by the authors. These datasets have led us to examine the blood glucose level in 267 patients with histologically confirmed malignant tumours in the oral cavity. Diabetes mellitus was found in 59 of them (22.1%), The blood glucose was elevated in 32 cases (12%). The most frequent tumor locations among the diabetic patients: labial, lingual and gingival tumors gingivae. Comparative epidemiological study demonstrates that in 2012-2013 dataset there was an increased observed percentage of people with diabetes mellitus [17.6% to 22.1%]. The percentage of patients with IFG (impaired fasting glucose) also increased from 9.8% to 12%. Overall the number of patients with glucose metabolic disorders climbed from 27.4% to 34.1%, (p > 0.05). Our intention of this introductory analysis is to emphasize the close connection of these two very important disease groups, and the wider spread of diabetes mellitus.

  20. A novel ALMS1 splice mutation in a non-obese juvenile-onset insulin-dependent syndromic diabetic patient.

    PubMed

    Sanyoura, May; Woudstra, Cédric; Halaby, George; Baz, Patrick; Senée, Valérie; Guillausseau, Pierre-Jean; Zalloua, Pierre; Julier, Cécile

    2014-01-01

    Insulin-dependent juvenile-onset diabetes may occur in the context of rare syndromic presentations suggesting monogenic inheritance rather than common multifactorial autoimmune type 1 diabetes. Here, we report the case of a Lebanese patient diagnosed with juvenile-onset insulin-dependent diabetes presenting ketoacidosis, early-onset retinopathy with optic atrophy, hearing loss, diabetes insipidus, epilepsy, and normal weight and stature, who later developed insulin resistance. Despite similarities with Wolfram syndrome, we excluded the WFS1 gene as responsible for this disease. Using combined linkage and candidate gene study, we selected ALMS1, responsible for Alström syndrome, as a candidate gene. We identified a novel splice mutation in intron 18 located 3 bp before the intron-exon junction (IVS18-3T>G), resulting in exon 19 skipping and consequent frameshift generating a truncated protein (V3958fs3964X). The clinical presentation of the patient significantly differed from typical Alström syndrome by the absence of truncal obesity and short stature, and by the presence of ketoacidotic insulin-dependent diabetes, optic atrophy and diabetes insipidus. Our observation broadens the clinical spectrum of Alström syndrome and suggests that ALMS1 mutations may be considered in patients who initially present with an acute onset of insulin-dependent diabetes.