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Sample records for diabetic patient case

  1. Mucormycosis in a Diabetic Ketoacidosis Patient: A Case Report.

    PubMed

    Biradar, Siddanagouda; Patil, Shivraj N; Kadeli, Deepak

    2016-05-01

    Mucormycosis is the name given to several different diseases caused by fungi of the order mucorales. It is commonly seen in patients with decreased immunity like patients with chronic renal failure, organ transplantation, neutropenia and most commonly in those with poorly controlled diabetes. We present a case of 55-year-old diabetic man who presented with headache and fever diagnosed with pulmonary and maxillary sinus mucormycosis presenting as diabetic ketoacidosis. PMID:27437278

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

    PubMed Central

    YAO, HE-BIN; CHEN, YA-NING; SHANG, JIAN; HAN, QIAO-JUN

    2015-01-01

    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. PMID:26788221

  3. Investigation of auditory thresholds in type 2 diabetic patients compared to non-diabetic cases

    PubMed Central

    Kiakojouri, Keivan; Monadi, Mohsen; Sheikhzadeh, Mahboobeh; Taghinejad Omran, Pouria; Bayani, Mohammad Ali; Khafri, Soraya

    2014-01-01

    Background: Hearing loss is one of the common complaints of diabetics. The aim of this study was to evaluate the hearing status of diabetic patients in Babol, North of Iran. Methods: The hearing status of 50 type 2 diabetic patients (case group) and 50 healthy individuals (control group) were evaluated from October 2011 to September 2012. Audiometry was done with the frequencies of 250, 500, 1000, 2000, 4000, 6000, 8000 HZ and speech tests like SRT (speech reception threshold), SDS (speech discrimination score) were performed. The data were collected and analyzed. Results: The mean age of case group was 50.1±3 and in control group was 49.9±3.2 years. Hearing thresholds were 10.55.6, 10.76.1, 15.27.1, 169.6, 21.213.5, 26.416.5, 28.32 db in the right ear of the case group and 11.25.3, 9.74.9, 127.1, 14.29.4, 20.913.3, 25.115.6, 27.620.2 db in control group with different frequencies (p<0.05). Similar results were obtained in the left ear of both groups. The mean SRT in the right ear of the case group was 15.77.7 and control group was 9.24.8 and 13.56.9 in case and 9.14 in the left ear of case group (P=0.0001). SDS was 94.33.7 and in 96.23.3 in the right ear for the case and control group, respectively (P=0.0001). For the left ear, these values were 94.44.4 and 95.93.2, respectively (P=0.023). Conclusion: The results show that hearing loss in different frequencies and speech reception threshold were higher in diabetic group but speech discrimination score was higher in normal individuals. Audiological monitoring is recommended in diabetic patients during therapy. PMID:24778785

  4. 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

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

    PubMed

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

    2016-07-16

    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. A case study of a patient with diabetic retinopathy.

    PubMed

    Ebrahimi, Mohammad Hossein; Gharibi, Hamed

    2016-01-01

    The patient, in this report, is a 52 years old male driver who had been diagnosed with type 2 diabetes mellitus (T2DM) five years ago without diabetic retinopathy at the baseline. The patient was being monitored for two intervals. It was at the second interval which he was diagnosed with proliferative retinopathy; in fact, the progression rate of retinopathy from its first sign, which occurred at the middle of the first and second interval, to the point at which the patient lost his vision from the left eye occurred within a year. In this work, we introduce a new factor ignored through all the previously conducted studies, namely, type of profession. This factor which contributes to occupational stress plays an important role in the progression of proliferative retinopathy. We speculate that this factor can accelerate the progression of this disease dramatically, even when the other risk factors are not present. PMID:26907970

  7. Diabetic foot risk factors in type 2 diabetes patients: a cross-sectional case control study

    PubMed Central

    2014-01-01

    Background Diabetic foot is a serious condition in patients with a long lasting diabetes mellitus. Diabetic foot treated improperly may lead not only to delayed ulceration healing, generalized inflammation, unnecessary surgical intervention, but also to the lower limb amputation. The aim of this study was to compare diabetic foot risk factors in population with type 2 diabetes and risk factors for diabetes in healthy subjects. Methods The study included 900 subjects: 145 with diabetic foot, 293 with type 2 diabetes without diabetic foot and 462 healthy controls matched in terms of mean age, gender structure and cardiovascular diseases absence. Study was conducted in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. In statistical analysis a logistic regression model, U Mann-Whitney’s and t-Student test were used. Results The binomial logit models analysis showed that the risk of diabetic foot in patients with type 2 diabetes was decreased by patient’s age (odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.92-0.96; p = 0.00001) and hyperlipidaemia (OR = 0.54; 95% CI: 0.36-0.81; p = 0.01). In contrast, male gender (OR = 2.83; 95% CI: 1.86-4.28; p = 0.00001) diabetes duration (OR = 1.04; 95% CI: 1.03-1.06; p = 0.0003), weight (OR = 1.04; 95% CI: 1.03-1.06; p = 0.00001), height (OR = 1.08; 95% CI: 1.05-1.11; p = 0.00001) and waist circumference (OR = 1.028; 95% CI: 1.007-1.050; p = 0.006) increase the risk of diabetic foot. The onset of type 2 diabetes in healthy subjects was increased by weight (OR = 1.035; 95% CI: 1.024-1.046; p = 0.00001), WC (OR = 1.075; 95% CI: 1.055-1.096; p = 00001), hip circumference (OR = 1.03; 95% CI: 1.01-1.05; p = 0.005), overweight defined with body mass index (BMI) above 24,9 kg/m2 (OR = 2.49; 95% CI: 1.77-3.51; p = 0.00001) and hyperlipidaemia (OR = 3.53; 95% CI: 2.57-4.84; p = 0.00001). Conclusions Risk factors for Type 2 diabetes and diabetic foot are only partially common. Study proved

  8. 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. PMID:22691734

  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. 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

  11. Isolated pulmonary candidiasis in a patient with diabetes mellitus: A rare case report.

    PubMed

    Hakamifard, Atousa; Khorvash, Farzin; Raisi, Arash

    2016-01-01

    Fungal infections are as a cause of morbidity and mortality in immunocompromise patients. Because the respiratory tract is colonized with Candida, the presence of this agent in respiratory specimens makes the diagnosis of Candida pneumonia problematic. Candida pneumonia is a rare infection, and the majority of cases are secondary to hematogenous dissemination. Furthermore isolated Candida pneumonia originating from endotracheal inoculation is an extremely rare entity. We describe a case of isolated pulmonary candidiasis in the form multiple nodular lesions in a patient with long-term history of diabetes mellitus without evidence of fungemia or systemic involvement who responded to antifungal therapy. PMID:27656615

  12. Isolated pulmonary candidiasis in a patient with diabetes mellitus: A rare case report

    PubMed Central

    Hakamifard, Atousa; Khorvash, Farzin; Raisi, Arash

    2016-01-01

    Fungal infections are as a cause of morbidity and mortality in immunocompromise patients. Because the respiratory tract is colonized with Candida, the presence of this agent in respiratory specimens makes the diagnosis of Candida pneumonia problematic. Candida pneumonia is a rare infection, and the majority of cases are secondary to hematogenous dissemination. Furthermore isolated Candida pneumonia originating from endotracheal inoculation is an extremely rare entity. We describe a case of isolated pulmonary candidiasis in the form multiple nodular lesions in a patient with long-term history of diabetes mellitus without evidence of fungemia or systemic involvement who responded to antifungal therapy.

  13. Isolated pulmonary candidiasis in a patient with diabetes mellitus: A rare case report

    PubMed Central

    Hakamifard, Atousa; Khorvash, Farzin; Raisi, Arash

    2016-01-01

    Fungal infections are as a cause of morbidity and mortality in immunocompromise patients. Because the respiratory tract is colonized with Candida, the presence of this agent in respiratory specimens makes the diagnosis of Candida pneumonia problematic. Candida pneumonia is a rare infection, and the majority of cases are secondary to hematogenous dissemination. Furthermore isolated Candida pneumonia originating from endotracheal inoculation is an extremely rare entity. We describe a case of isolated pulmonary candidiasis in the form multiple nodular lesions in a patient with long-term history of diabetes mellitus without evidence of fungemia or systemic involvement who responded to antifungal therapy. PMID:27656615

  14. Outcome of liver transplantation in patients with diabetes mellitus: a case-control study.

    PubMed

    John, P R; Thuluvath, P J

    2001-11-01

    The influence of preexisting diabetes mellitus (DM) on outcome after orthotopic liver transplantation (OLT) has not been well defined. The objective of our study was to compare the morbidity and mortality after OLT in 57 patients with preexisting DM (3 type I, 54 type II) with 114 age-, sex-, and race-matched patients without DM (case controls). The demographics were similar in both groups. Pretransplantation serum creatinine was significantly higher in the diabetic group compared with case controls. The incidence of the following complications was significantly higher in the diabetic group after OLT: cardiovascular (61.4% vs. 21.9%, P <.001), major (54.4% vs. 29.8%, P =.002) and minor infections (29.8% vs. 7.9%, P <.0001), renal (59.7% vs. 20.2%, P <.001), ophthalmologic (10.5% vs. 0.9%, P =.01), respiratory (24.6% vs. 7.0%, P =.001), neurologic (31.6% vs. 7.0%, P <.001), hematologic (19.3% vss 2.6%, P =.001), musculoskeletal (24.6% vs. 5.3%, P =.001), and malignancy (22.8% vs. 10.5%, P =.03). The duration of hospital stay, cost of hospitalization, retransplantation, and overall graft survival were similar. Acute rejection was seen in 50.9% of diabetics compared with 25.4% in controls (P =.0009). One-year (87% vs. 77%) and 2-year (81.6% vs. 70.1%) patient survival was similar, but 5-year survival was lower in the DM group (34.4% vs. 67.7%, P =.002). In conclusion, preexisting diabetes is associated with a significant post-OLT morbidity and mortality, and our observations suggest that patients with DM warrant more rigorous pre- and post-OLT evaluation. PMID:11679959

  15. Periodontal Regenerative Therapy in Patient with Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case Report.

    PubMed

    Seshima, Fumi; Nishina, Makiko; Namba, Takashi; Saito, Atsushi

    2016-01-01

    We report a case of generalized chronic periodontitis and type 2 diabetes mellitus requiring periodontal treatment including regenerative therapy. The patient was a 66-year-old man who presented with the chief complaint of gingival inflammation and mobile teeth in the molar region. He had been being treated for type 2 diabetes mellitus since 1999. His glycated hemoglobin (HbA1c) level was 7.8%. An initial examination revealed sites with a probing depth of ≥7 mm in the molar region, and radiography revealed angular bone defects in this area. Based on a clinical diagnosis of generalized chronic periodontitis, the patient underwent initial periodontal therapy. An improvement was observed in periodontal conditions on reevaluation, and his HbA1c level showed a reduction to 6.9%. Periodontal regenerative therapy with enamel matrix derivative was then performed on #16, 26, and 27. Following another reevaluation, a removable partial denture was fabricated for #47 and the patient placed on supportive periodontal therapy (SPT). To date, periodontal conditions have remained stable and the patient's HbA1c level has increased to 7.5% during SPT. The results show the importance of collaboration between dentist and physician in managing periodontal and diabetic conditions in such patients.

  16. [A case of an elderly diabetic patient with dementia effectively treated with weekly exenatide].

    PubMed

    Maruyama, Satoko; Tsurutani, Yuya; Kondo, Mai; Sagawa, Naoko; Sata, Akira; Miyao, Mariko; Mizuno, Yuzo

    2014-01-01

    A 74-year-old man with diabetes mellitus since 64 years of age had been treated with glimepiride, metformin and alogliptin; however, his glycemic control remained poor, i.e., a casual blood glucose level of 318 mg/dl, HbA1c level of 10.6% and glycated albumin level of 24.9%. Although his blood glucose level improved with intensive insulin therapy, he exhibited dementia with an MMSE score of 9/30 and was unable to continue insulin injections by himself, thus rejecting his family's help. The extended-release form of the GLP-1 agonist exenatide (Bydureon(®)) was recently introduced in Japan. This new anti-diabetic agent enables the administration of once-weekly type 2 diabetes treatment that delivers a continuous dose of exenatide in a single weekly injection. We employed weekly exenatide therapy in combination with oral hypoglycemic agents in this case. The patient visited our outpatient clinic for injections every week, showing a remarkable improvement in his HbA1c level, from 10.7% to 7.1% in five months. Subcutaneous induration was the only side effect of weekly exenatide injection. Weekly exenatide therapy can be easily managed by other caregivers and is expected to be a useful treatment approach in elderly diabetic patients with dementia. PMID:25327373

  17. 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.

  18. Miescher's granulomatosis (granulomatosis disciformis chronica et progressiva) in a non-diabetic patientcase report

    PubMed Central

    Bergler-Czop, Beata; Brzezińska-Wcisło, Ligia; Rogala-Poborska, Iwona

    2009-01-01

    Introduction Necrobiosis lipoidica diabeticorum is a rare disease of unclear etiology, that occurs in about 1% of diabetic patients. Case report We present case of granulomatosis disciformis chronica et progressiva Miescher with good response to systemic corticosteroids therapy. Patient 45 years old woman, with primary yellow-brown areas skin lesions, with foci well separated from surroundings on both lower legs, that occurred 5 years ago. In laboratory tests there was no abnormalities. Because of advance suggestion (after last admit in dermatological ward) of observation according to xantogranuloma necrobioticum tests for paraproteinemia were made. Immunoelectrophoresis, IgG, IgM, IgA levels, kappa light chain, lambda heavy chain; were correct, Bence-Johns protein-negative. During hospitalization in Clinic methylprednisolone in dose of 32 mg od, vascular drugs and local steroidotherapy was applied with good therapeutic response. Conclusion We described case of typical clinical and histological characters of necrobiosis lipoidica. without diabetes-granulomatosis disciformis chronica et progressiva Miescher that despite of suspicion of proper diagnosis for a long time was not treat effective. PMID:19715570

  19. Rheumatic manifestations in diabetic patients

    PubMed Central

    Serban, AL; Udrea, GF

    2012-01-01

    Diabetes mellitus (DM), a worldwide high prevalence disease, is associated with a large variety of rheumatic manifestations. For most of these affections, pathophysiologic correlations are not well established. Some of them, such as diabetic cheiroarthropathy, neuropathic arthritis, diabetic amyotrophy, diabetic muscle infraction, are considered intrinsic complications of DM. For others, like diffuse idiopathic skeletal hyperostosis or reflex sympathetic dystrophy, DM is considered a predisposing condition. In most cases, these affections cause pain and disability, affecting the quality of life of diabetic patients, but once correctly diagnosed, they often respond to the treatment, that generally requires a multidisciplinary team. This article reviews some epidemiological, clinical, diagnostic and therapeutic aspects of these conditions. PMID:23049626

  20. An interesting case of 'diabetic foot ulcer' in an HIV-positive patient.

    PubMed

    Sivaprakasam, Venkat; Chima-Okereke, Catherine

    2015-03-01

    Kaposi sarcoma is a highly vascularised tumour affecting the skin, lymph nodes and viscera. Kaposi sarcoma is most common in HIV-infected homosexual or bisexual men. We present here a 70-year-old white British male patient, who was under the care of the podiatric team for longstanding 'diabetic foot ulcers'. He was later referred to the Dermatology team who took a biopsy; this revealed features of Kaposi sarcoma which prompted an HIV test which was positive. This patient had previously presented to several healthcare professionals with symptoms suggestive of HIV infection. He was started on antiretroviral therapy and the HIV and human herpesvirus-8 viral loads became undetectable in the blood within weeks and he showed significant clinical improvement. This case report is a reminder to clinicians to have a high index of suspicion in patients presenting with symptoms and signs suggestive of HIV infection.

  1. 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

  2. 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

  3. Renal Biopsy in Type 2 Diabetic Patients

    PubMed Central

    Espinel, Eugenia; Agraz, Irene; Ibernon, Meritxell; Ramos, Natalia; Fort, Joan; Serón, Daniel

    2015-01-01

    The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients. PMID:26239461

  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. PMID:25900868

  5. 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. PMID:25984419

  6. 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.

  7. 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.

  8. 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. PMID:26184852

  9. 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.

  10. Type 1 Diabetes Mellitus and Pernicious Anemia in an Elderly Japanese Patient: A Case Report and Literature Review.

    PubMed

    Ohara, Nobumasa; Kaneko, Masanori; Yano, Toshio; Sato, Naoko; Usuda, Hiroyuki; Miyakoshi, Masashi; Furukawa, Tatsuo; Koike, Tadashi; Kaneko, Kenzo; Kamoi, Kyuzi

    2015-01-01

    We herein report the case of a 66-year-old Japanese man with acute-onset type 1 diabetes mellitus (T1D) accompanied by pernicious anemia. After 2 weeks of polyuria, the patient developed insulin-deficient hyperglycemia with diabetic ketoacidosis in the absence of verifiable islet-related autoantibodies and began insulin therapy in 2001. Eight years later, he developed gastric autoantibody-positive pernicious anemia and began methylcobalamin treatment. Previous studies have reported cases of slowly progressive autoimmune T1D concomitant with pernicious anemia. The present case suggests that potential associations with organ-specific autoimmune disorders should be considered during the long-term follow-up of T1D patients, even though verifiable islet-related autoantibodies are undetectable. PMID:26370862

  11. The Occurrence or Fibrillary Glomerulonephritis in Patients with Diabetes Mellitus May Not Be Coincidental: A Report of Four Cases

    PubMed Central

    González-Cabrera, Fayna; Henríquez-Palop, Fernando; Ramírez-Puga, Ana; Santana-Estupiñán, Raquel; Plaza-Toledano, Celia; Antón-Pérez, Gloria; Marrero-Robayna, Silvia; Ramírez-Medina, Davinia; Gallego-Samper, Roberto; Vega-Díaz, Nicanor; Camacho-Galan, Rafael; Rodríguez-Pérez, José C.

    2013-01-01

    Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45–50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed. PMID:23762079

  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. [Diabetes education in adult diabetic patients].

    PubMed

    Weitgasser, Raimund; Clodi, Martin; Kacerovsky-Bielesz, Gertrud; Grafinger, Peter; Lechleitner, Monika; Howorka, Kinga; Ludvik, Bernhard

    2012-12-01

    Diabetes education has gained a critical role in diabetes care. The empowerment of patients aims to actively influence the course of the disease by self-monitoring and treatment modification. 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.

  14. Movement disorders in patients with diabetes mellitus.

    PubMed

    Jagota, Priya; Bhidayasiri, Roongroj; Lang, Anthony E

    2012-03-15

    Movement disorders are not infrequent in patients with diabetes mellitus. These may occur on the basis of both central and peripheral nervous system dysfunction and can be secondary to severe hyperglycemia, complications of diabetes or its treatment and less often to diseases in which both diabetes and a movement disorder are primary manifestations of the same underlying disease. We present a typical case of a severe movement disorder complicating diabetes as a springboard to review the spectrum of disorders associated with this condition.

  15. 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

  16. Diabetic patients: Psychological aspects.

    PubMed

    Adili, Fatemeh; Larijani, Bagher; Haghighatpanah, Mohammadreza

    2006-11-01

    This study was undertaken to consider the psychological aspect of diabetes with regard to improving clinical outcomes. The review was limited to literature reports on the causes, solutions, and treatments of some common psychological problems known to complicate diabetes management. A literature search was undertaken using Pub-Med, CINAHL, Proquest, Elsevier, Blackwell Synergy, Ovid, Ebsco, Rose net, and Google websites, including studies published in English journals between 1995 and 2006. Therefore about 88 articles were selected based on the inclusion criteria. In earlier studies, relatively little empirical research was found to substantiate the effect of psychological counseling in complicated diabetes. The greatest deficits were seen in areas of mental health, self-esteem parent impact, and family cohesion. There were some different factors, which influence the psychological aspect of diabetic patients, such as age, gender, place of living, familial and social support, motivation, energy, life satisfaction, and lifestyle. There are various types of solutions for coping with the psychological problems in diabetic clients. The most essential solution lies in educating the patients and healthcare providers on the subject. Before initiating each educational intervention, a thorough assessment would be crucial. Treatment plans may benefit from cognitive behavior therapy (CBT), behavior family therapy, improving family communication, problem-solving skills, and providing motivation for diabetic patients. Moreover, it seems that the close collaboration between diabetologists and psychologists would be fruitful.

  17. Thymectomy Cures Diabetes Mellitus and Ameliorates Myasthenia Gravis in a Patient with Thymus Hyperplasia and Hyperthyroidism: Report of a Case.

    PubMed

    Feng, Shiyun; Zhang, Yao; Cui, Youbin; Chen, Yu

    2015-12-01

    Myasthenia gravis (MG) is a devastating autoimmune disease that involves the acetylcholine receptor (AchR) in the postsynaptic membrane of the neuromuscular junction. It is not uncommon for MG to accompany with other autoimmune diseases and complicate with multiple organ dysfunction. Here, we report on an 18-year-old female patient with a rare case of MG concomitant with thymus hyperplasia, diabetes mellitus, and hyperthyroidism. After full excision of the hyperplastic thymus gland, the patient's muscle weakness was greatly improved and her blood glucose level was restored to normal at the 6-month follow-up. PMID:26884666

  18. 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

  19. 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.

  20. [Nutrition for diabetic patients].

    PubMed

    Schindler, Karin; Brix, Johanna; Dämon, Sabine; Hoppichler, Friedrich; Kruschitz, Renate; Toplak, Hermann; Ludvik, Bernhard

    2016-04-01

    Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight. The main target of a diabetes therapy is aimed at achieving normal or nearly normal blood glucose levels. Reaching this goal may be facilitated by the following nutritional patterns: Using mainly carbohydrates from vegetables, whole grains, legumes and fruits, Restriction of mono- and disaccharides are often important factors in normalising body weight and blood glucose, Reduction of dietary fat could be indicated. However, the primary goal is the limitation of saturated fatty acids which to high percentage are consumed with animal products. There is not sufficient evidence to recommend a dietary protein consumption of more than 20% of energy intake. Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements. Natural food sources should be preferred. PMID:27052240

  1. 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.

  2. Cutaneous protothecosis in patient with diabetes mellitus and review of published case reports.

    PubMed

    Zhang, Qiang-Qiang; Li, Li; Zhu, Li-Ping; Zhao, Ying; Wang, Yun-Ru; Zhu, Jun-hao; Zhu, Min

    2012-03-01

    Protothecosis is an opportunistic infection caused by Prototheca, usually called as saprophytes, and is frequently found in natural and living surroundings with low virulence, but may cause chronic infection in immunocompromised individuals. We report a case of cutaneous protothecosis with zopfii var. portoricensis infection in a 66-year-old diabetic woman following hand surgery on middle right finger. Mycology study showed that smooth, creamy white, yeast-like colonies grown after necrotic tissue was cultured on Sabouraud dextrose agar at both 37 and 25°C. The organism was then identified as Prototheca zopfii var. portoricensis by molecular identification and also found from histopathology of the lesion. The lesion got improved with intravenous amphotericin B and itraconazole. PMID:21964624

  3. Evaluation of Salivary Glucose, IgA and Flow Rate in Diabetic Patients: A Case-Control Study

    PubMed Central

    Bakianian Vaziri, P.; Vahedi, M.; Mortazavi, H.; Abdollahzadeh, Sh.; Hajilooi, M.

    2010-01-01

    Objective: An association between diabetes mellitus and alterations in the oral cavity has been noted. In this study, we evaluated differences between salivary IgA, glucose and flow rate in diabetic patients compared with healthy controls. Materials and Methods: Forty patients with type 1 diabetes, 40 patients with type 2 diabetes and 40 healthy controls were selected. Whole unstimulated saliva samples were collected by the standard method and the salivary flow rate was determined. Nephelometric and Pars method were used to measure salivary IgA and salivary glucose concentrations, respectively. Statistical analysis was performed by Chi-square and t test. Results: There were no significant differences in salivary IgA and glucose concentrations between type 1 and type 2 diabetic patients and their matched control subjects (P>0.05). Salivary flow rate was significantly lower in diabetic patients (P<0.05). In addition, DMFT was higher in diabetic patients than the controls. Conclusion: Determination of salivary constituents may be useful in the description and management of oral findings in diabetic patients. PMID:21998770

  4. [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.

  5. 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

    2012-07-01

    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.

  6. Enterococcus gallinarum endocarditis in a diabetic patient.

    PubMed

    Ortu, Massimiliano; Gabrielli, Eugenia; Caramma, Ilaria; Rossotti, Roberto; Gambirasio, Maria; Gervasoni, Cristina

    2008-07-01

    Recent studies pointed out the increasing rate of infective endocarditis (IE) in diabetic patients. As diabetes mellitus (DM) prevalence is expected to increase in the coming years, infective endocarditis could be more frequently reported in these patients. We here describe a rare case of Enterococcus gallinarum endocarditis developing on normal native heart valve in an elderly diabetic woman. Therapeutic options were restricted due to resistance factors of the microorganism, limited guidance in the medical literature, and the patient's history and underlying condition. Despite these challenges, adequate antibiotic therapy led to the patient's recovery. PMID:18457897

  7. Current achievements with topical negative pressure to improve wound healing in dehiscent ischemic stumps of diabetic patients: a case series.

    PubMed

    Georgakarakos, Efstratios; Charalampidis, Dimitris; Kakagia, Despoina; Georgiadis, George S; Lazarides, Miltos K; Papanas, Nikolaos

    2013-06-01

    Negative pressure wound therapy has been increasingly used either as a primary or as an adjunctive therapeutic measure to treat a variety of recalcitrant wounds during the past years. It is thought to act by creating a local environment that promotes cell proliferation, angiogenesis, and granulation tissue formation, leading to accelerated wound healing to the point of spontaneous closure or reducing the wound size to facilitate significantly further surgical reconstruction. This case series presents our preliminary experience with the use of a Topical Negative Pressure system in the treatment of challenging ischemic wounds of diabetic patients. It aims to underscore its beneficial effects and explore its potential role in the management of ischemic amputated stumps to avoid ipsilateral re-amputation at a higher level. PMID:23667104

  8. 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

    2014-07-01

    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.

  9. 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

    2014-07-01

    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

  10. Heart Health Tests for Diabetes Patients

    MedlinePlus

    ... Tools & Resources Stroke 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 ...

  11. Perioperative management of the diabetic patient.

    PubMed

    Bergman, Stewart A

    2007-06-01

    Diabetes mellitus is a significant global public health problem and is a major source of morbidity and mortality in the world today. Type 2 diabetes mellitus is the predominant form of diabetes worldwide and represents approximately 90% of all cases. There is an epidemic of type 2 diabetes mellitus in the world today in both developed and developing countries. Globally, it is expected that the number of people with diabetes will increase from the current 150 million to 220 million by the year 2010 and to 300 million by the year 2025. In addition, there has been an alarming increase in the incidence of type 2 diabetes in children and adolescents. It is therefore increasingly likely that diabetic patients will appear for dental and oral maxillofacial surgical treatment in both the office and ambulatory surgery clinic setting. Surgical stress often produces hyperglycemia in the perioperative period. Hyperglycemia has been shown to cause a significant increase in perioperative morbidity and mortality. It is the general consensus that strict glycemic control is beneficial and should be achieved for diabetic patients in the perioperative period. Preoperative, intraoperative, and postoperative management protocols for improved perioperative glycemic control of both type 1 and type 2 diabetics are presented.

  12. 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

  13. 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

  14. Diabetic neuropathic cachexia: a case report

    PubMed Central

    2014-01-01

    Introduction We report a case of the rare entity of diabetic neuropathic cachexia, in order to remind clinicians that these cases still exist. Case presentation A 71-year-old Moslem Arab man with type 2 diabetes along with diabetic neuropathic cachexia complicated by a hyperfunctioning autonomous thyroid nodule, and undiagnosed acromegaly came under our care. We report the unique challenges as to what are the priorities to consider in the course of investigation and treatment. This case emphasizes the fast recovery from this remediable disorder, with antineuropathic medication and exogenous insulin to serve as an anabolic hormone on top of its hypoglycemic effect. Shared pathophysiologic aspects of diabetic neuropathic cachexia, cancerous etiologies and acute phase response are discussed. Conclusions Diabetic neuropathic cachexia is an integral differential diagnosis, whenever an intense neuropathic pain dominates patient complaints, accompanied with anorexia, weight loss as well as mood and sleep disturbances. This is an original case report of interest to internists, endocrinologists, diabetologists and pain clinic practitioners. Raising the suspicion of diabetic neuropathic cachexia early and concomitant to weight loss investigation, might curtail suffering and prompt early recovery from a severe illness that has a good prognosis. PMID:24428849

  15. [Vascular access in diabetic patients. Are these patients "difficult"?].

    PubMed

    Gołębiowski, Tomasz; Weyde, Wacław; Kusztal, Mariusz; Porażko, Tomasz; Augustyniak-Bartosik, Hanna; Madziarska, Katarzyna; Krajewska, Magdalena; Koniński, Przemysław; Sydor, Antoni; Letachowicz, Krzysztof; Klinger, Marian

    2015-01-01

    Diabetics with stage V chronic kidney disease (CKD) on hemodialysis (HD) are considered as "difficult patients", because of problems with creation of the vascular access. There is controversy regarding the results and recommendations for preparation of the vascular access in these patients. The aim of this retrospective study was to evaluate the results of creating different types of arteriovenous fistula (AVFs) in consecutive series of patients starting dialysis treatment. The analysis was performed in 741 patients (385 females and 356 males), average age 61.4±7 years, who started dialysis treatment in our department between January 2005 and December 2012. Native AVFs were created in all patients. No patients received an AVF requiring synthetic graft material. The number of patients with diabetic nephropathy was 166 (22.4%). Among them, 30 (18%) had type 1 diabetes and 136 (82%) type 2. In this group the occurrence of calcification in the forearm artery was estimated on the basis of physical examination, Allan's test, Doppler ultrasound and forearm X-ray. In a subgroup of patients with atherosclerotic changes in the arterial system the frequency of failed AVFs was analyzed. These results were compared with the group without diabetes. The number of procedures necessary for successfu AVF creation and type of access was counted in both groups. The assessment of the procedure frequency and AVF location in diabetic and in non-diabetic patients was made by χ² test with Yates correction. In the group of 166 patients with diabetes, in 100 cases (60%) atherosclerotic changes in forearm arteries were observed. In a subgroup of 30 patients with type 1 diabetes atherosclerosis was observed in 17 adults (57%). In this subgroup creation of a suitable forearm AVF in the first procedure in 9 patients was possible and in the other 8 cases the atherosclerotic changes necessitated repeated procedures and were an important obstacle to create the AVF. In the subgroup of 136

  16. 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

  17. 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

  18. 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

  19. 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.

  20. Candida Carriage Rate and Growth Characteristics of Saliva in Diabetes Mellitus Patients: A Case-Control Study.

    PubMed

    Balan, Preethi; B Gogineni, Subhas; Kumari N, Sucheta; Shetty, Veena; Lakshman Rangare, Anusha; L Castelino, Renita; Areekat K, Fazil

    2015-01-01

    Background and aims. The aim of this study was to establish a relationship between salivary glucose levels and Candida carriage rate in type 2 diabetes mellitus patients and assess the growth characteristics and acid production of Candida in glucose-supplemented saliva. Materials and methods . A total of 90 subjects, 30 with controlled type 2 diabetes, 30 with uncontrolled type 2 diabetes and 30 without diabetes (control subjects), aged 30‒60 years, participated in the study. Unstimulated saliva was collected and investigated for glucose levels (GOD-POD method), colony-forming units (CFU) of Candida and salivary pH, using Indikrom paper strips). Analysis of statistical significance of salivary glucose and PH levels was carried out using post hoc Tukey HSD test. Correlation of Candida carriage rate with salivary glucose and salivary PH in the study groups and control group was made using Pearson's correlation. Results. Candida CFUs were significantly higher in diabetic subjects, with a significant and positive correlation with salivary glucose levels. There was a negative correlation between salivary PH levels and Candida carriage rate. Conclusion. Increased salivary glucose was associated with increased prevalence of oral Candida in diabetic subjects. The growth of Candida in saliva was accompanied by a rapid decline in PH, which in turn favored their growth. PMID:26889366

  1. Candida Carriage Rate and Growth Characteristics of Saliva in Diabetes Mellitus Patients: A Case-Control Study

    PubMed Central

    Balan, Preethi; B Gogineni, Subhas; Kumari N, Sucheta; Shetty, Veena; Lakshman Rangare, Anusha; L Castelino, Renita; Areekat K, Fazil

    2015-01-01

    Background and aims. The aim of this study was to establish a relationship between salivary glucose levels and Candida carriage rate in type 2 diabetes mellitus patients and assess the growth characteristics and acid production of Candida in glucose-supplemented saliva. Materials and methods. A total of 90 subjects, 30 with controlled type 2 diabetes, 30 with uncontrolled type 2 diabetes and 30 without diabetes (control subjects), aged 30‒60 years, participated in the study. Unstimulated saliva was collected and investigated for glucose levels (GOD-POD method), colony-forming units (CFU) of Candida and salivary pH, using Indikrom paper strips). Analysis of statistical significance of salivary glucose and PH levels was carried out using post hoc Tukey HSD test. Correlation of Candida carriage rate with salivary glucose and salivary PH in the study groups and control group was made using Pearson’s correlation. Results.Candida CFUs were significantly higher in diabetic subjects, with a significant and positive correlation with salivary glucose levels. There was a negative correlation between salivary PH levels and Candida carriage rate. Conclusion. Increased salivary glucose was associated with increased prevalence of oral Candida in diabetic subjects. The growth of Candida in saliva was accompanied by a rapid decline in PH, which in turn favored their growth. PMID:26889366

  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. Telecare for diabetes mellitus: case managers' experiences.

    PubMed

    Chang, Chi-Ping; Lee, Ting-Ting; Chou, Chun-Chen; Mills, Mary Etta

    2013-10-01

    Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Changes in societal structure have fostered an increase in the incidence of diabetes and made the traditional hospital visit model less efficient for meeting the care needs of these patients. The care models that apply technology, such as telecare or so-called telehealth, may be useful in working with diabetes patients. The current study applied qualitative research methodology through interviews with nine diabetes case managers involved in telecare services. To identify the participants' acceptance and perceived effectiveness of telecare services, content analysis of the interview data was used. The following four major themes were identified in the study results: (1) improved case management, (2) setting appropriate expectations for care outcome, (3) acknowledging patients' sense of losing privacy, and (4) disease prevention and interdisciplinary cooperation. The study findings may serve as an indicator of the need for further promotion, appraisal, and validation of the telecare services model, to enhance the comprehensiveness of diabetes care.

  4. 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.

  5. [Perioperative management of diabetic patient].

    PubMed

    Carles, Michel; Raucoules-Aimé, Marc

    2011-06-01

    The prevalence of diabetes is rising and diabetics may soon represent more than 5% of the world population. The type 2 diabetes is a major independent risk factor for coronary artery disease. The screening for silent myocardial ischemia (IMS) must be systematic. The autonomic dysfunction and the cardiac microcirculatory disorders are at risk of hypotension and hypothermia during anesthesia. After 10 years of diabetes duration the incidence of perioperative complications and of difficult intubation are increased. The neurological deficits related to anesthesia are associated with general anesthesia in 85% of cases. Particular care will be provided during the surgical procedure to avoid skin, muscular and neurologic cuts. In most cases, the regional anesthesia will be preferred to general anesthesia. To avoid hypoglycemia, blood glucose concentration less than 11 mmol.L(-1)(2g.L(-1)) seems a reasonable target during and after surgery.

  6. 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

  7. Pancreas transplantation in diabetic patients.

    PubMed

    Pozza, G; Di Carlo, V

    1989-01-01

    After a brief historical background on pancreas transplantation in the treatment of diabetes mellitus, this review deals with the major surgical, pharmacological and functional aspects of this approach. In the Authors' opinion pancreas transplantation should be proposed only when the end-stage renal failure (ESRF), due to diabetic nephropathy, needs kidney transplantation. By using injection of polymers (mainly neoprene) into the pancreatic ducts, or urinary diversion of pancreatic juice and appropriate immunosuppressive therapy (cyclosporin, corticosteroids and azathioprine), dramatic advantages have been achieved in the last years, so that a satisfactory segmental or total pancreas graft survival on one hand, and the early graft rejection recognition on the other have been presently obtained. A prompt and good functional activity of pancreas graft has also been demonstrated by the Authors in successfully transplanted patients. As far as chronic diabetic complications are concerned, no conclusive results have been reported up to now; it is noteworthy, however, that pancreas transplantation may preserve the transplanted kidney from a relapse of diabetic nephropathy. The combined pancreas-kidney transplantation may actually be considered as a correct solution to the problem of diabetic patients with ESRF. Moreover, careful selection of patients, appropriate surgical technique and experienced immunosuppressive treatment are the major prerequisites to achieve a satisfactory improvement of diabetic status in addition to that of renal failure.

  8. Improving Depression Care in Patients with Diabetes and Multiple Complications

    PubMed Central

    Kinder, Leslie S; Katon, Wayne J; Ludman, Evette; Russo, Joan; Simon, Greg; Lin, Elizabeth HB; Ciechanowski, Paul; Von Korff, Michael; Young, Bessie

    2006-01-01

    BACKGROUND Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. PMID:16836628

  9. Gastric Inhibitory Polypeptide Receptor Methylation in Newly Diagnosed, Drug-Naïve Patients with Type 2 Diabetes: A Case-Control Study

    PubMed Central

    Canivell, Silvia; Ruano, Elena G.; Sisó-Almirall, Antoni; Kostov, Belchin; González-de Paz, Luis; Fernandez-Rebollo, Eduardo; Hanzu, Felicia; Párrizas, Marcelina; Novials, Anna; Gomis, Ramon

    2013-01-01

    GIP action in type 2 diabetic (T2D) patients is altered. We hypothesized that methylation changes could be present in GIP receptor of T2D patients. This study aimed to assess the differences in DNA methylation profile of GIPR promoter between T2D patients and age- and Body Mass Index (BMI)-matched controls. We included 93 T2D patients (cases) that were uniquely on diet (without any anti-diabetic pharmacological treatment). We matched one control (with oral glucose tolerance test negative, non diabetic), by age and BMI, for every case. Cytokines and hormones were determined by ELISA. DNA was extracted from whole blood and DNA methylation was assessed using the Sequenom EpiTYPER system. Our results showed that T2D patients were more insulin resistant and had a poorer β cell function than their controls. Fasting adiponectin was lower in T2D patients as compared to controls (7.0±3.8 µgr/mL vs. 10.0±4.2 µgr/mL). Levels of IL 12 in serum were almost double in T2D patients (52.8±58.3 pg/mL vs. 29.7±37.4 pg/mL). We found that GIPR promoter was hypomethylated in T2D patients as compared to controls. In addition, HOMA-IR and fasting glucose correlated negatively with mean methylation of GIPR promoter, especially in T2D patients. This case-control study confirms that newly diagnosed, drug-naïve T2D patients are more insulin resistant and have worse β cell function than age- and BMI-matched controls, which is partly related to changes in the insulin-sensitizing metabolites (adiponectin), in the proinflammatory profile (IL12) and we suggest in the methylation pattern of GIPR. Our study provides novel findings on GIPR promoter methylation profile which may improve our ability to understand type 2 diabetes pathogenesis. PMID:24086540

  10. [Intelligent footwear for diabetic patients].

    PubMed

    Pataky, Zoltan; Grivon, Daniel; Civet, Yoan; Perriard, Yves

    2016-01-20

    The incidence of diabetic foot ulcerations and lower extremity amputations remains very high and inacceptable. The high risk of ulceration and consequent amputation is strongly related to difficulties to obtain foot off-loading, particularly on long term. Due to the complexity of their utilization, the available foot off-loading devices are underused both by health care providers and patients with very low therapeutic adherence. This article summarizes the foot off-loading in diabetic patients and describes the concept of intelligent footwear we developed, based on continuous measurements and permanent and automatic adaptations of the shoe insole's rigidity.

  11. Minimally Invasive Treatment of a Complex Tibial Plateau Fracture with Diaphyseal Extension in a Patient with Uncontrolled Diabetes Mellitus: A Case Report and Review of Literature

    PubMed Central

    Rathod, Ashok K; Pawaskar, Aditya

    2016-01-01

    Fractures of the proximal tibia comprise a huge spectrum of injuries with different fracture configurations. The combination of tibia plateau fracture with diaphyseal extension is a rare injury with sparse literature being available on treatment of the same. Various treatment modalities can be adopted with the aim of achieving a well-aligned, congruous, stable joint, which allows early motion and function. We report a case of a 40-year-old male who sustained a Schatzker type VI fracture of left tibial plateau with diaphyseal extension. On further investigations, the patient was diagnosed to have diabetes mellitus with grossly deranged blood sugar levels. The depressed tibial condyle was manipulated to lift its articular surface using K-wire as a joystick and stabilized with an additional K-wire. Distal tibial skeletal traction was maintained for three weeks followed by an above knee cast. At eight months of follow-up, X-rays revealed a well-consolidated fracture site, and the patient had attained a reasonably good range of motion with only terminal restriction of squatting. Tibial plateau fractures with diaphyseal extension in a patient with uncontrolled diabetes mellitus is certainly a challenging entity. After an extended search of literature, we could not find any reports highlighting a similar method of treatment for complex tibial plateau injuries in a patient with uncontrolled diabetes mellitus. PMID:27335711

  12. Minimally Invasive Treatment of a Complex Tibial Plateau Fracture with Diaphyseal Extension in a Patient with Uncontrolled Diabetes Mellitus: A Case Report and Review of Literature.

    PubMed

    Rathod, Ashok K; Dhake, Rakesh P; Pawaskar, Aditya

    2016-01-01

    Fractures of the proximal tibia comprise a huge spectrum of injuries with different fracture configurations. The combination of tibia plateau fracture with diaphyseal extension is a rare injury with sparse literature being available on treatment of the same. Various treatment modalities can be adopted with the aim of achieving a well-aligned, congruous, stable joint, which allows early motion and function. We report a case of a 40-year-old male who sustained a Schatzker type VI fracture of left tibial plateau with diaphyseal extension. On further investigations, the patient was diagnosed to have diabetes mellitus with grossly deranged blood sugar levels. The depressed tibial condyle was manipulated to lift its articular surface using K-wire as a joystick and stabilized with an additional K-wire. Distal tibial skeletal traction was maintained for three weeks followed by an above knee cast. At eight months of follow-up, X-rays revealed a well-consolidated fracture site, and the patient had attained a reasonably good range of motion with only terminal restriction of squatting. Tibial plateau fractures with diaphyseal extension in a patient with uncontrolled diabetes mellitus is certainly a challenging entity. After an extended search of literature, we could not find any reports highlighting a similar method of treatment for complex tibial plateau injuries in a patient with uncontrolled diabetes mellitus. PMID:27335711

  13. [Treatment of diabetic macular oedema in a type 1 diabetes patient--mistakes in interdisciplinary collaboration].

    PubMed

    Veith, M

    2013-03-01

    Diabetic retinopathy (DR) is a significant microvascular complication of diabetes. High quality interdisciplinary collaboration is an important aspect ofa successful DR therapy. A case ofa 41-year-old diabetic is presented below, who has been in our care for almost four years. His Diabetes ID card only contains his current glycaemia values. Although the patient had been regularly given a report for his diabetologist with a request for additional information, we have only obtained one value of glycated haemoglobin through the course of the patient's dispensarisation. For this reason, and the non-stabilisation of DR, we have recommended that the patient starts to see a different diabetologist.

  14. [Caries status in diabetic patients].

    PubMed

    Albrecht, M; Bánóczy, J; Dinya, E; Tamás, G

    1991-09-01

    Clinical dental examination of 1600 diabetics (815 type 1 insulin dependent and 761 type 2 non-insulin dependent patients) has been performed according to the WHD criteria. According to examination results higher DMF mean value, less uncared of teeth with caries (D) and, in the age group of 19 years and above 30 years, more edentulousness has been found than with healthy individuals. The number of filled and crowded teeth (F) below the age of 35 years in diabetics (p 0.0001), above 45 years in the control group (p 0.0001) was higher. Concerning cared of teeth there was no deviation in the number of filled teeth between diabetic and healthy individuals whereas the number of crown covered teeth was higher with diabetics. (p 0.01). As to the distribution of individuals with healthy teeth and toothless ones it was found characteristic that while among diabetic individuals but 1%, in the control 1.4% possessed retained healthy teeth. The number of completely toothless individuals was higher (11.83%) with diabetics than with healthy individuals (2.25%).

  15. [Treatment of elderly diabetic patients].

    PubMed

    Rušavý, Zdeněk; Žourek, Michal

    2015-04-01

    Type 2 diabetes has become a pandemic disease over the past 50 years. Its incidence increases the most rapidly in the senior population, i.e. among people older than 65. In a number of countries 1/4 of the people with diabetes are now older than 65 years. Geriatrics now examines numerous differences regarding the senior patients, which often lead to somewhat different therapeutic procedures as compared to the treatment of other adult patients. This paper aims to show some different aspects of the treatment of an elderly patient with diabetes. The intensity of diabetes treatment in the elderly is mainly defined by the incidence of symptoms caused by diabetic decompensation which negatively affect quality of life and are likely to increase mortality. The treatment goals expressed by HbA1c, fasting and post-prandial glycemia, should be set individually based on age, initial HbA1c, present comorbidities and the level of frailty of an elderly patient. An effort to reduce weight regarding people at an older age is probably inappropriate and maybe even harmful, while physical activity reduces mortality and slows muscle catabolism at every age. Ideal is normal walking for 20-30 minutes a day. Except for "very fit elders" without renal insufficiency, the sulfonylurea treatment is unsuitable and perhaps even harmful. It significantly increases the incidence of different types of hypoglycemia and very likely overall mortality as well. The basis of diabetes treatment for the elderly is the effort to perform any regular exercise. In regard to medication treatment it is recommended to choose metformin or gliptin following the rule "start low, go slow", i.e. start with low medication doses and increase them at a slow pace. The main goal of the treatment is to maintain the good quality of life as long as possible, without symptoms associated with hyperglycemia with minimizing the risk of hypoglycemia development. PMID:25894262

  16. Management of diabetic foot ulcers: evaluation of case studies.

    PubMed

    Torkington-Stokes, Rachel; Metcalf, Daniel; Bowler, Philip

    2016-08-11

    This article explores local barriers to diabetic foot ulcer healing, and describes the use of a dressing designed to manage exudate, infection and biofilm (AQUACEL® Ag+ dressing (AQAg+)) on recalcitrant diabetic foot ulcers. The authors consider four case studies that demonstrate how managing local barriers to wound healing with antimicrobial and anti-biofilm dressings in protocols of care can improve outcomes for patients.

  17. [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.

  18. Re-amputation after minor foot amputation in diabetic patients: Risk factors leading to limb loss

    PubMed Central

    Nerone, Vincent S.; Springer, Kevin D.; Atway, Said

    2014-01-01

    Burn injury in diabetic patients has been a recent topic of interest in published studies. Previous studies have shown increased complications in diabetic patients compared with nondiabetic controls who have sustained these injuries. A paucity of research has been devoted to foot-specific diabetic burn injury. We present a case series evaluating the mechanisms and complications of diabetic foot burns. PMID:23419696

  19. Spontaneous calf hematoma in a patient with diabetic nephropathy receiving maintenance hemodialysis: A case report and review of the literature.

    PubMed

    Xiao, Li; Ling, Fengxia; Tan, Lihua; Li, Huabing; Hu, Chun; Luo, Ying; Tang, Dang; Liu, Fuyou; Kanwar, Yashpal S; Sun, Lin

    2015-10-01

    We report the outcome of a 52-year-old patient with diabetic nephropathy and receiving maintenance hemodialysis (HD) using low molecular weight heparin (LMWH) as an anticoagulant for 2 years. He presented right lower limb pain accompanied with difficulty in walking for 2 months, and had no history of bleeding tendency or trauma. Physical examination revealed marked swelling and tenderness on his right lower limb. By ultrasound and magnetic resonance imaging (MRI) diagnoses, the calf hematoma was diagnosed and identified with venous thrombosis. Following treatment with heparin-free HD, the swelling regressed and pain subsided, and a follow-up MRI showed complete dissolution of hematoma. However, similar symptoms recurred in the right upper limb after 2 months without any predisposition, he was just placed on HD with LMWH, and symptoms regressed following the aforementioned therapy. This suggests that HD patients, especially with diabetic nephropathy having extremity hematoma, should be watched for the development of spontaneous hemorrhage that can be differentially diagnosed by imaging tests, such as MRI, and can be effectively treated with heparin-free HD.

  20. 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

  1. 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.

  2. 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. PMID:27548490

  3. Outcome of renal replacement treatment in patients with diabetes mellitus.

    PubMed Central

    McMillan, M A; Briggs, J D; Junor, B J

    1990-01-01

    OBJECTIVE--To compare the outcome of renal replacement treatment in patients with diabetes mellitus and in non-diabetic patients with end stage renal failure. DESIGN--Retrospective comparison of cases and matched controls. SETTING--Renal unit, Western Infirmary, Glasgow, providing both dialysis and renal transplantation. PATIENTS--82 Diabetic patients starting renal replacement treatment between 1979 and 1988, compared with 82 matched non-diabetic controls with renal failure and 39 different matched controls undergoing renal transplantation. MAIN OUTCOME MEASURES--Patient characteristics, history of smoking, prevalence of left ventricular hypertrophy and myocardial ischaemia at start of renal replacement treatment; survival of patients with renal replacement treatment and of patients and allografts with renal transplantation. RESULTS--The overall survival of the diabetic patients during the treatment was 83%, 59%, and 50% at one, three, and five years. Survival was significantly poorer in the diabetic patients than the controls (p less than 0.001). Particularly adverse features for outcome at the start of treatment were increasing age (p less than 0.01) and current cigarette smoking (relative risk (95% confidence interval) 2.28 (0.93 to 4.84), p less than 0.05). Deaths were mainly from cardiac and vascular causes. The incidence of peritonitis in patients on continuous ambulatory peritoneal dialysis was the same in diabetic patients and controls (49% in each group remained free of peritonitis after one year), and the survival of renal allografts was not significantly worse in diabetic patients (p less than 0.5). CONCLUSIONS--Renal replacement treatment may give good results in diabetic patients, although the outlook remains less favourable than for non-diabetic patients because of coexistent, progressive vascular disease, which is more severe in older patients. PMID:2207427

  4. INTESTINAL PARASITES IN DIABETIC PATIENTS IN SOHAG UNIVERSITY HOSPITALS, EGYPT.

    PubMed

    Elnadi, Nada A; Hassanien, Hassan A; Ahmad, Amal M; Abd Ellah, Asmaa K

    2015-08-01

    Intestinal parasites usually create benign diseases, though they may induce complications with high morbidity and mortality to the immunocompromised, including diabetic patients. The study detected the prevalence of intestinal parasitic infections in diabetic patients, comparing to non-diabetic controls and other parameters. A total of 100 fecal samples were collected from diabetic patients at the outpatient clinic of Sohag University Hospitals and another 100 from cross matched controls. The samples were examined macroscopically and microscopically by direct smear and different concentration methods then stained by Modified Ziehl-Neelsen Acid fast stain. Glycated hemoglobin (Hb Alc) was measured to detect DM controlled patients. The data were organized, tabulated, and statistically analyzed. Intestinal parasites were found in 25 (25%) cases out of 100 patients in diabetic group and 7(7%) cases out of 100 controls with high significance (P<0.001)). In the diabetic group, Giardia lamblia was detected in 22 cases (22%) and 5 (5%) among controls, Entamoeba histolytica in 7 cases (7%) and 3 (3%) among controls, Hymenolypis nana in 5 cases (5%) and 3 (3%) among controls, Entamoeba coli in 8 patients (8%), Entamoeba hartmanni in 3 cases (3%), Dientamoeba fragilis in a case (1%), Cryptosporidium parvum in 5 cases (5%) and microsporidia in 3 cases (3%). But, E. coli, E. hartmanni, D. fragilis and C. parvum nor microsporidia were detected in controls. The rate of G. lamblia in DM patients compared to controls was high significant (P<0.001). Hymenolepis nana was 5% (5 cases) in diabetic patients compared to 3% (3 cases) in controls. Residence and sex differences were not significant, while age, >10 years showed the highest prevalence (P< 0.003), type I infection rate was significantly higher than type II (P<0.001). DM control was also significantly affected the infection rates (P<0.007 in type I and P< 0.01 in type II). PMID:26485865

  5. Diabetic striatopathy in a patient with hemiballism.

    PubMed

    Özgür, Anıl; Esen, Kaan; Kaleağası, Hakan; Yılmaz, Arda; Kara, Engin

    2015-06-01

    Diabetic striatopathy is a rare and life-threatening manifestation of diabetes mellitus. The disease commonly affects individuals of Asian descent, females, and the elderly. Patients usually present with hemiballism-hemichorea caused by nonketotic hyperglycemia. Hemiballism-hemichorea is defined as involuntary continuous random appearing movement involving one side of the body. This movement disorder may develop secondary to stroke, diabetic striatopathy, neoplasm, infection, Wilson's disease, and thyrotoxicosis. Despite being rare, prompt recognition of a hyperglycemia-induced hemiballism-hemichorea is essential because the symptoms are reversible with correction of hyperglycemia. Diagnosis is possible based on blood analysis and neuroimaging findings. Laboratory tests reveal raised blood glucose and hemoglobin A1C levels which indicate poorly controlled diabetes. Neuroimaging provides suggestive findings of diabetic striatopathy which are hyperattenuation on computed tomography and hyperintensity on T1-weighted magnetic resonance imaging in the basal ganglia. In this case report, our aim is to present neuroimaging findings in an adult man with sudden onset of hemiballism associated with nonketotic hyperglycemia.

  6. Prognostic significance of diabetes in patients with cirrhosis.

    PubMed

    Bianchi, G; Marchesini, G; Zoli, M; Bugianesi, E; Fabbri, A; Pisi, E

    1994-07-01

    Alterations in carbohydrate metabolism are frequently observed in cirrhosis, and approximately 15% to 30% of patients have overt diabetes. In a retrospective and prospective study in cirrhosis, we analyzed the prognostic significance of diabetes, which was defined as the presence of hyperglycemia and overt glycosuria that in most cases required dietary restrictions or active treatment. The clinical records of all patients with cirrhosis admitted to our department for the period 1980 to 1985 were reviewed in 1985 and 1986, and surviving patients were prospectively followed up until December 1991. Final status could be obtained in 354 (98 with diabetes) of 382 eligible patients; 110 were alive at the end of follow-up. Prognostic factors were identified by Kaplan-Meier analysis, followed by Cox's stepwise regression. The model identified, in sequence, albumin, ascites, age, encephalopathy, bilirubin, diabetes, and platelets as prognostic factors. The larger mortality rate in patients with diabetes was not due to complications of diabetes but to an increased risk of hepatocellular failure. Diabetes was no longer a risk factor as a covariate in a subgroup of 271 patients when varices were added but was again significant when patients who died of gastrointestinal bleeding were excluded. The presence of diabetes, clinically detectable and often requiring adequate treatment, is a risk factor for long-term survival in cirrhosis.

  7. Transient Tear Film Dysfunction after Cataract Surgery in Diabetic Patients

    PubMed Central

    Fu, Tongsheng; Mashaghi, Alireza; Liu, Qinghuai; Hong, Jiaxu

    2016-01-01

    Purpose Diabetes mellitus is an increasingly common systemic disease. Many diabetic patients seek cataract surgery for a better visual acuity. Unlike in the general population, the influence of cataract surgery on tear film function in diabetic patients remains elusive. The aim of this study was to evaluate the tear function in diabetic and nondiabetic patients following cataract surgery. Methods In this prospective, interventional case series, 174 diabetic patients without dry eye syndrome (DES) and 474 age-matched nondiabetic patients as control who underwent phacoemulsification were enrolled at two different eye centers between January 2011 and January 2013. Patients were followed up at baseline and at 7 days, 1 month, and 3 months postoperatively. Ocular symptom scores (Ocular Surface Disease Index, OSDI) and tear film function including tear film stability (tear film break-up time, TBUT), corneal epithelium integrity (corneal fluorescein staining, CFS), and tear secretion (Schirmer’s I test, SIT) were evaluated. Results In total, 83.9% of the diabetic patients (146 cases with 185 eyes) and 89.0% of the nondiabetic patients (422 cases with 463 eyes) completed all check-ups after the interventions (P = 0.095). The incidence of DES was 17.1% in the diabetic patients and 8.1% in the nondiabetic patients at 7 days after cataract surgery. In the diabetic patients, the incidence of DES remained 4.8% at 1 month postoperatively and decreased to zero at 3 months after surgery. No DES was diagnosed in nondiabetic patients at either the 1-month or 3-month follow-up. Compared with the baseline, the diabetic patients had worse symptom scores and lower TBUT values at 7 days and 1 month but not at 3 months postoperatively. In the nondiabetic patients, symptom scores and TBUT values had returned to preoperative levels at 1-month check-up. CFS scores and SIT values did not change significantly postoperatively in either group (P = 0.916 and P = 0.964, respectively

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

    PubMed

    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

    2015-09-01

    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

  9. 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

  10. Skin and nail mycoses in patients with diabetic foot.

    PubMed

    Papini, M; Cicoletti, M; Fabrizi, V; Landucci, P

    2013-12-01

    Diabetes mellitus affects all socioeconomic and age groups and its incidence is rapidly increasing worldwide. The diabetic foot complication represents one of the most complex and serious complications in these patients. Fungal infections can also contribute to the severity of the diabetic foot. The aim of the present study was to evaluate the prevalence of foot skin and toenail mycosis in a group of 75 patients with diabetic foot complication and in a matched control group. Diabetic patients showed onychomycosis in 53.3% and foot skin mycosis in 46.7% of the cases, with a prevalence of both fungal infections significantly higher than that observed in the control group. At least one type of these fungal infections was present in 69.3% of diabetic subjects with a highly significant difference compared to control group (P<0.001). Trichophyton rubrum and Trichophyton interdigitale were the most common species responsible of both nail and skin infections. Candida spp, Fusarium spp, Aspergillus spp and other moulds. were found in about 1/3 onychomycosis. Previous toe amputation was significantly associated with both skin and nail mycosis. The present study confirms that both tinea pedis and onychomycosis have a high prevalence in subjects suffering from diabetic foot complication, and that the problem of fungal infections of the foot in diabetic subjects is still highly underestimated. Consequently, there is an important clinical rationale for careful mycological examination of diabetic foot and an adequate treatment tailored for each individual patient according to the fungal species involved.

  11. 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.

  12. 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.

  13. Economic burden of hepatitis B infection among patients with diabetes

    PubMed Central

    Deshpande, Gaurav; Klink, Andrew J.; Shenolikar, Rahul; Singer, Joseph; Eisenberg Lawrence, Debra F.; Krishnarajah, Girishanthy

    2016-01-01

    ABSTRACT Despite ACIP recommendation and cost-effectiveness established in those 19–59 y old diabetes patients the uptake of Hepatitis B vaccine in diabetes patients is low. There is need to highlight the impact of Hepatitis B virus (HBV) infection in diabetes patients in terms of healthcare utilization and costs to recognize the burden of HBV in this population. This retrospective claims analysis included patients with diabetes and HBV (cases; n=1,236) and those with diabetes without HBV (controls; n=4,944), identified by ICD-9-CM diagnosis codes. Cases were matched with 4 controls using propensity score matching. Healthcare utilization and cost were compared; incremental effect of HBV infection was assessed using multivariate analysis. In the adjusted analyses, the mean number of hospitalizations (0.6 vs 0.4), outpatient service visits (34.2 vs. 20.4), and office visits (10.9 vs. 9.8) were 41%, 68%, and 11% higher, respectively, in cases vs. controls (all p<0.05). Gastroenterologist visits (0.8 vs. 0.2) and infectious disease visits (0.1 vs. 0.0) were 80% and 18% higher in subset of case and controls with these events. Cases ($39,435) incurred $16,397 incremental total costs compared with controls ($23,038). Medical ($30,968 vs. $17,765) and pharmacy costs ($8,029 vs. $5,114) were both significantly higher for cases (p < 0.0001). Healthcare utilization and costs were higher among patients with diabetes and HBV than in those with diabetes alone. These results provide evidence supporting the need for HBV vaccination among unvaccinated diabetes patients. PMID:27050021

  14. [Orthopaedic neurological diseases in patient with diabetes].

    PubMed

    Natsume, Tadahiro; Hirata, Hitoshi

    2014-02-01

    Individuals with diabetes are at a greater risk for microvascular complications, such as retinopathy, neuropathy, and nephropathy, than are individuals without diabetes. Diabetic neuropathies are complex heterogeneous disorders that include both focal neuropathies and diffuse polyneuropathy. Entrapment neuropathy is an example of a focal neuropathy, while distal symmetric polyneuropathy is the most common type of diffuse polyneuropathy. Entrapment neuropathies are highly prevalent in the diabetic population, but they develop insidiously and progressively, making it difficult to determine their true prevalence. Entrapment neuropathies are suspected to be a more common complication of diabetes than is polyneuropathy. For example, carpal tunnel syndrome (CTS)-one of the most common entrapment neuropathies encountered in patients with diabetes-results from median nerve compression, and has been shown to occur three times more frequently in a diabetic population than in a normal healthy population. Entrapment neuropathies should be actively screened for in patients showing the signs and symptoms of neuropathy, because such patients may require surgical treatment.

  15. Case 22:Type II diabetes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Diabetes mellitus is characterized by elevated blood glucose levels. It is composed of two types depending on the pathogenesis. Type I diabetes is characterized by insulin deficiency and usually has its onset during childhood or teenage years. This is also called ketosis-prone diabetes. Type II diab...

  16. Effects of aspartame on diabetic rats and diabetic patients.

    PubMed

    Shigeta, H; Yoshida, T; Nakai, M; Mori, H; Kano, Y; Nishioka, H; Kajiyama, S; Kitagawa, Y; Kanatsuna, T; Kondo, M

    1985-10-01

    The effects of aspartame (L-aspartyl-L-phenylalanine methyl ester) on plasma glucose and insulin levels were investigated in diabetic rats and patients with non-insulin-dependent diabetes mellitus. The oral administration of 0.45 mg aspartame per 100g body weight, which is equivalent to 150 mg of glucose in sweetness, to streptozotocin-induced diabetic rats had no effect on the plasma glucose or insulin levels. Also, 225 mg oral aspartame loading, which is equivalent to 75 g of glucose in sweetness, to patients with non-insulin-dependent diabetes mellitus did not increase plasma glucose or insulin levels, although 75 g of oral glucose loading increased plasma glucose and insulin levels in diabetic patients as expected. Aspartame ingestion for three days at a dose of 24-48 mg per day and the intake of snacks flavored with 240 mg of aspartame also did not increase fasting plasma glucose levels. These results suggest that acute administration of aspartame has no influence on plasma glucose or insulin levels in diabetic rats and patients with non-insulin-dependent diabetes mellitus.

  17. Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication.

    PubMed

    Abu-Abed Abdin, Asma; Hamza, Muhammad; Khan, Muhammad S; Ahmed, Awab

    2016-01-01

    Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as "euglycemic DKA." This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA.

  18. Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication.

    PubMed

    Abu-Abed Abdin, Asma; Hamza, Muhammad; Khan, Muhammad S; Ahmed, Awab

    2016-01-01

    Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as "euglycemic DKA." This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA. PMID:27579186

  19. Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy - A Case Series

    PubMed Central

    Piccoli, Giorgina B.; Tavassoli, Elisabetta; Melluzza, Carmela; Grassi, Giorgio; Monzeglio, Clara; Donvito, Valentina; Leone, Filomena; Attini, Rossella; Ghiotto, Sara; Clari, Roberta; Moro, Irene; Fassio, Federica; Parisi, Silvia; Pilloni, Eleonora; Vigotti, Federica N.; Giuffrida, Domenica; Rolfo, Alessandro; Todros, Tullia

    2013-01-01

    BACKGROUND: Diabetes and nephropathy are important challenges during pregnancy, increasingly encountered because of the advances in maternal-fetal care. AIM: To evaluate the maternal and fetal outcomes recorded in "severe" diabetic nephropathy in type 1 diabetic patients referred to nephrological healtcare. METHODS: The study was performed in an outpatient unit dedicated to kidney diseases in pregnancy (with joint nephrological and obstetric follow-up and strict cooperation with the diabetes unit). 383 pregnancies were referred to the outpatient unit in 2000-2012, 14 of which were complicated by type 1 diabetes. The report includes 12 deliveries, including 2 pregnancies in 1 patient; one twin pregnancy; 2 spontaneous abortions were not included. All cases had long-standing type 1 diabetes (median of 21 (15-31) years), relatively high median age (35 (29-40) years) and end-organ damage (all patients presented laser-treated retinopathy and half of them clinical neuropathy). Median glomerular filtration rate (GFR) at referral was 67 ml/min (48-122.6), proteinuria was 1.6 g/day (0.1-6.3 g/day). RESULTS: Proteinuria steeply increased in 11/12 patients, reaching the nephrotic range in nine (6 above 5 g/day). One patient increased by 2 chronic kidney disease (CKD) stages. Support therapy included blood pressure and diabetes control, bed rest, and moderate protein restriction. All children were preterm (7 early preterm); early spontaneous labor occurred in 4/12 patients. All singletons were appropriate for gestational age and developed normally after birth. The male twin child died 6 days after birth (after surgery for great vessel transposition). CONCLUSIONS: Diabetic patients with severe diabetic nephropathy are still present a considerable challenge. Therefore, further investigations are required, particularly on proteinuria management and the occurrence of spontaneous labor. PMID:24172700

  20. 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 ...

  1. Musculoskeletal manifestations in diabetic patients at a tertiary center

    PubMed Central

    Attar, Suzan M.

    2012-01-01

    Objectives Diabetes mellitus is a major public health problem worldwide. Most diabetic patients will develop functional disabilities due to multiple factors, including musculoskeletal (MSK) manifestations. The purpose of this study was to determine the frequency of MSK in diabetic patients and to examine the possible predictors for its development. Methods We performed a cross-sectional study from June 1, 2010, to June 30, 2011, to evaluate MSK manifestations in adult diabetic patients at an outpatient clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Baseline variables were examined to determine predictors for the development of MSK complications. Analyses were carried out using the Statistical Package for Social sciences. Results We included 252 diabetic patients; 45 (17.9%) had MSK manifestations. Of these 45 patients, 41 (91.1%) had type 2 diabetes. The most common manifestations were carpal tunnel syndrome (n=17, 6.7%), shoulder adhesive capsulitis (n=17, 6.7%), and diabetic amyotrophy (n=12, 4.8%). A significant association was found between the development of MSK manifestations and manual labor, overweight, and vascular complications. On logistic regression analysis, the presence of vascular complications in general (B-coefficient=1.27, odds ratio=3.57, P<0.05, 95% confidence interval=1.31–9.78), and retinopathy in particular (B-coefficient=1.17, odds ratio=3.21, P<0.05, 95% confidence interval=1.47–7.02) can predict the development of MSK manifestations in about 82% of the cases. Conclusion Musculoskeletal manifestations are under recognized in adult diabetic patients, occurring in 18% of the cases. Physicians should consider examining the periarticular region of the joints in the hands and shoulders whenever a diabetic patient presents with MSK symptoms. PMID:23115579

  2. Managing type 2 diabetes in Black patients.

    PubMed

    Akindana, Adeola; Ogunedo, Chioma

    2015-09-13

    Despite many novel treatments available for managing type 2 diabetes mellitus, Black patients continue to disproportionately suffer complications associated with poor glycemic control. This article describes a comprehensive approach to managing diabetes mellitus in these patients while addressing cultural nuances that may be barriers to positive outcomes. PMID:26259037

  3. The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

    PubMed Central

    McLintock, Kate; Russell, Amy M; Alderson, Sarah L; West, Robert; House, Allan; Westerman, Karen; Foy, Robbie

    2014-01-01

    Objective To evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions. Design Interrupted time series analysis. Setting General practices in Leeds, UK. Participants 65 (58%) of 112 general practices shared data on 37 229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101 008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma). Intervention Incentivised case finding for depression using two standard screening questions. Main outcome measures Clinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates. Results New diagnoses of depression increased from 21 to 94/100 000 per month in targeted patients between the periods 2002–2004 and 2007–2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100 000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=−4.14, p<0.01). Conclusions Incentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given

  4. 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.

  5. [Management of diabetes in elderly cardiac patients].

    PubMed

    Raccah, D

    2006-11-01

    In 1998, data from the Assurance Maladie (national health insurance) showed that 11.2% of people over 65 years old, and thus corresponding to the World Health Organisation's definition of being elderly, were diabetic. More recently the Entred trial, a national sample representative of diabetics, clarified the characteristics, the state of health and the medical management of diabetes in patients aged over 65 years. Among the randomly selected 10,000 adults in this study, 5350 subjects (54% of the Entred population) were over 65 years old. Other studies indicate that more than a million subjects aged over 65 years are diabetic and that 25% of diabetics are aged over 75 years. The growing proportion of elderly people in the French population, plus the improvement in the detection and the better management of diabetes are bound to contribute to a further increase in the prevalence of diabetes in elderly subjects.

  6. [Lifestyle of elderly patients with diabetes mellitus].

    PubMed

    Fukuoka, Yuki; Yamada, Yuichiro

    2013-11-01

    In elderly people, glucose tolerance is deteriorated and the incidence of diabetes mellitus is increased, due to decreased muscle mass and physical activity, declining pancreatic beta cell function, and other factors. Diabetes mellitus is an important risk factor for arteriosclerosis development in the elderly. Precise diagnosis and adequate treatment are necessary to prevent cerebrovascular and ischemic heart diseases. Elderly patients with diabetes mellitus are characteristically afflicted with more complications, impaired activities of daily living, cognitive function decline, and family environment problems, as compared with young and middle-aged diabetics. Therefore, tailor-made rather than uniform therapy becomes important. Lifestyle modification is the basis of diabetes treatment. Herein, we describe "prevention and management" of diabetes mellitus, focusing on the lifestyles of elderly diabetics.

  7. Morganella morganii-associated arthritis in a diabetic patient.

    PubMed

    Cetin, Meryem; Ocak, Sabahattin; Kuvandik, Guven; Aslan, Bahadir; Temiz, Muhyittin; Aslan, Ahmet

    2008-03-01

    This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

  8. Corneal hydrops induced by diabetic ketoacidosis: A case report

    PubMed Central

    Feng, Meiyan; Wang, Chao

    2016-01-01

    To the best of our knowledge, there have been no reports of corneal hydrops associated with diabetic ketoacidosis. The present study first reports a case of a 20-year-old male patient with diabetic ketoacidosis-induced corneal hydrops. The patient exhibited mild hydrops in their left eyelid, which was accompanied by mixed hyperemia, and hazy turbid in a white color was observed in the cornea. To alleviate the corneal hydrops, 5% glucose was administered dropwise to the left eye for 2 h to alleviate the inflammation. Finally, the patient was discharged from the hospital with a satisfactory outcome. PMID:27602094

  9. 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

  10. Bed occupancy by diabetic patients.

    PubMed

    Moffitt, P; Fowler, J; Eather, G

    1979-03-24

    The Royal Newcastle Hospital Diabetic Education and Stabilization Centre was instituted primarily to improve diabetics' understanding of their disease and its everyday management. Simultaneously with a five-day education course, stabilization if insulin-dependent diabetics was undertaken on an outpatient basis. In order to disseminate diabetic education as widely as possible, trained nurses from near and far were included in each course. It is believed that these nurses will be able to offer good advice to diabetics who have no other source of reliable information. By actively attempting to reduce hospital bed occupancy by diabetics there has been a reduction of 1400 bed days per year. It is recommended that similar centres be instituted throughout Australia.

  11. 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. PMID:17243515

  12. Vaccination of patients with diabetes mellitus--a retrospective study.

    PubMed

    Mad'ar, Rastislav; Benesová, Dagmar; Brandejská, Dana; Cermáková, Miriam; Dvorková, Alena; Gazárková, Olga; Jakubalová, Silvana; Kochová, Ilona; Lastovicková, Jana; Nebáznivá, Dagmar; Orolinová, Marta; Polomis, Karel; Rehka, Václav; Sattranová, Ludmila; Schejbalová, Miriam; Slámová, Alena; Skalleová, Deanna; Sevcíková, Hana; Tkadlecová, Hana; Tmejová, Marta; Trmal, Josef; Turková, Dagmar

    2011-06-01

    402 subjects with diabetes mellitus have been vaccinated of the total of 34,000 vaccinees immunized during the study period of 9 and half months. Altogether 229 diabetic patients (56.97%) have been vaccinated'against tick-borne encephalitis (TBE) and 74 (18.4%) against viral hepatitis (41 types A+B, 30 type A, 3 type B). The average age in four most commonly administered vaccines (FSME IMMUN 0.5 ML, Twinrix Adult, Typhim Vi, and Havrix 1440) was 65, 52, 56, and 54 years, respectively. Live attenuated vaccines have been given to 6 patients with diabetes (1.49%)--- 5 travellers to endemic countries received the yellow fever vaccine Stamaril (1 female, 4 male) and one male patient varicella vaccine Varilrix. Among the least common vaccines in diabetic patients were those against invasive pneumococcal and meningococcal infections. Not a single unexpected side effect has been observed following the vaccination procedure in any diabetic patient. Based on the results of this retrospective study we can conclude that vaccination in diabetic patients is free of any ri-k- provided that there are no other contraindications, e.g. allergy to vaccine components or severe acute febrile illness. In the case of unstable glycaemia and significantly impaired immune system due to diabetes mellitus, vaccination with live attenuated vaccines should be carefully considered and measured against the risks of exposure to each and every specific infectious agent. There is no reason to be afraid of vaccination in diabetic patients provided that general contraindications are respected. On the contrary, this risk group can benefit from vaccination more remarkably since it may have some life-saving potential.

  13. 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.

  14. Vietnamese diabetic patients and their physicians

    PubMed Central

    Mull, Dorothy S; Nguyen, Nghia; Mull, J Dennis

    2001-01-01

    Objectives To describe the cultural context of type 2 diabetes mellitus among Vietnamese immigrants in the United States, including people's ideas about cause and proper treatment; and to suggest ways in which better control of the disease can be achieved in this population. Design The method was ethnographic. A native speaker used a structured interview guide to talk with 38 Vietnamese patients, and family members of 2 other patients, being treated for type 2 diabetes. In addition, 8 Vietnamese health providers—5 physicians, 2 nurses, and an herbalist—were interviewed. Setting A low-income area of southern California populated by a large number of Vietnamese. Participants Forty patients being treated for type 2 diabetes and 8 health practitioners. Results Three quarters of the patients had not achieved good control of their diabetes. Ideas about the cause and proper treatment of the disease were culturally shaped. Many patients used eastern (herbal) medicine and described a strong aversion to insulin injections. Patients stopped taking their oral medications when using eastern medicine, and a quarter lowered their dose whenever they felt “out of balance.” Almost two thirds had used traditional home remedies for diabetes. Two had received nonstandard medical care from neighborhood physicians trained in Viet Nam; 1 of these patients died during the study. Conclusion The Vietnamese community and physicians serving that community need culturally appropriate education about type 2 diabetes and modern therapy for the disease. PMID:11694472

  15. 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

  16. Adipsia in a Diabetes Insipidus Patient

    PubMed Central

    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. PMID:26500540

  17. 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.

  18. 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.

  19. [Cognitive functions impairment in diabetes mellitus patient].

    PubMed

    Prikryl, R

    2007-01-01

    An increased research interest in the relation between diabetes mellitus and dementia or deterioration of cognitive functions has been recently noticed. The relatively rich scientific literature in this topic shows that diabetes mellitus itself can cause an impairment of cognitive functions regardless patient's age or the fact whether he has type 1 or type 2 diabetes mellitus. Type 1 diabetes mellitus leads to a psychomotor retardation while type 2 diabetes mellitus tends to be associated with impaired storage of new information. The exact mechanism through which diabetes impairs cognition has not been explained sufficiently yet, but several hypothetical mechanisms which might explain the relation between diabetes and impaired cognition have been proposed. To explain the etiopathogenetic mechanisms underlying the relation between diabetes and dementia, further research, especially research focused on process clinical-imaging studies or clinical-pathological studies is necessary. As far as clinical practice is concerned, it is important to bear in mind that prevention, timely diagnosis and optimum treatment of diabetes may help to reduce incidence of dementia or cognitive functions' impairment.

  20. Managing coeliac disease in patients with diabetes.

    PubMed

    Leonard, M M; Cureton, P A; Fasano, A

    2015-01-01

    The association between coeliac disease and type 1 diabetes has long been established. The combination of genetic susceptibility along with a potential role for gluten in the pathogenesis of autoimmunity makes defining gluten's role in type 1 diabetes extremely important. Evidence supporting the role of a gluten-free diet to improve complications associated with type 1 diabetes is not robust. However there is evidence to support improved growth, bone density and potentially the prevention of additional autoimmune diseases in patients with coeliac disease and type 1 diabetes. The gluten free diet is expensive and challenging to adhere to in people already on a modified diet. Early identification of those who have coeliac disease and would benefit from a gluten-free diet is of utmost importance to prevent complications associated with type 1 diabetes and coeliac disease.

  1. Treating the elderly diabetic patient: special considerations

    PubMed Central

    Kezerle, Louise; Shalev, Leah; Barski, Leonid

    2014-01-01

    The prevalence of diabetes is rising in the >65 year-old group. The challenge of defining the goals of therapy arises from the heterogeneity of the aging process and the sparse clinical data in this patient population. In light of these challenges, the clinician should be aware of the pitfalls of caring for the older diabetic patient and prioritize an individualized treatment plan to ensure an optimal glycemic control, without placing the patient at unnecessary risk. We present a review of the current guidelines and literature that deal specifically with the treatment of the older diabetic patient in order to establish the principles of treatment in this age group and help the clinician make decisions regarding the care of these patients. PMID:25210468

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

    PubMed

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

    2016-01-01

    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. PMID:27177938

  3. 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. PMID:17724542

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

    PubMed

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

    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

  5. [Insulin treatment in elder patients with diabetes].

    PubMed

    Hamaguchi, Tomoya; Namba, Mitsuyoshi

    2006-01-01

    Diabetes is a highly expanding health problem in Japan, especially for older people. The prevalence of glucose intolerance and diabetes increases with age. A postprandial hyperglycemia is the primary clinical manifestation. In older diabetic patients, atherosclerotic complications (macroangiopathies), as well as microangiopathies, are significant problems, threatening their quality of life. Though insulin therapy requires some special considerations, insulin is indicated for any patients with a poor glycemic control with oral agents. Single or multiple dose (s) of insulin injection therapy is selected for each patient to prevent symptomatic hyperglycemia, or to achieve near-normal glycemic control. Also, to maintain the quality of life for these older patients, hypoglycemia, as well as hyperglycemia, should be avoided. Newly developed insulin analogue (s) may be more appropriate for preventing hypoglycemia. Another method of prevention and treatment of hypoglycemia are discussed in this article.

  6. Glycemic control and diabetes management in hospitalized patients in Brazil

    PubMed Central

    2013-01-01

    Background The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil. Methods A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient. Results Overall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively. Conclusions Inpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing

  7. 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.

  8. Reticulated platelets and antiplatelet therapy response in diabetic patients.

    PubMed

    Mijovic, Romana; Kovacevic, Nada; Zarkov, Marija; Stosic, Zoran; Cabarkapa, Velibor; Mitic, Gorana

    2015-08-01

    Increased platelet turnover and high level of reticulated platelets are associated with low response to antiplatelet therapy in diabetes mellitus type 2. This study evaluated association between percentage of reticulated platelets (%RP) and the response to antiplatelet therapy in patients with type 2 diabetes mellitus (T2DM). This prospective, pilot, case-control, clinical trial included 79 subjects stratified in three groups: group I included 30 patients with T2DM, group II included 34 non-diabetic patients and 15 healthy age and sex matched healthy volunteers were enrolled in control group. Platelet response to clopidogrel and aspirin was assessed by Multiplate(®) aggregometry analyzer. Individual response to dual antiplatelet therapy was estimated by the percentage of decrease in overall platelet aggregability (%DPA) obtained after antiplatelet therapy, calculated by presented formulas: %DPAadp = 100 × (1 - ADP/TRAP) and %DPAaspi = 100 × (1 - ASPI/TRAP). %RP was significantly higher in diabetics, than in non-diabetics, (3.17 ± 1.26 vs. 2.39 ± 1.56; p < 0.05). Significantly lower response to clopidogrel (31.55 ± 13.02 vs. 50.24 ± 11.38; p < 0.001) and aspirin (52.33 ± 22.67 vs. 64.31 ± 16.47; p < 0.05) therapy was observed in diabetics. %RP negatively correlated with response to clopidogrel therapy, but positively with metabolic profile indicators in diabetics (p < 0.05, all). Correlation of %RP with metabolic profile indicators and poor response to antiplatelet therapy suggest that altered metabolic profile can affect platelet turnover in T2DM leading to low responsiveness to antiplatelet therapy in these patients.

  9. Diabetic patient education: determinants of success.

    PubMed

    Day, J L

    2000-01-01

    Education/empowerment is critical if successful self-management is to be achieved. All professional patient interactions have a learning component. Clinical outcomes in diabetes are as dependent on psycho-social factors or learned behaviour as on metabolic state or therapeutic interventions. These factors include targets set, self-management skills, influence of living with diabetes, emotional factors, role of other people, perceived benefits and barriers, feelings of self-efficacy, weight concern and diet barrier. Training in learning processes and factors governing behaviour are essential for all those involved in delivery of patient care. Educational programmes should recognise the wide range of learning strategies used by different people.

  10. Navigating care for Bedouin patients with diabetes.

    PubMed

    Dunton, Shauna; Higgins, Alison; Amkraut, Jonathan; Abu-Rabia, Yones

    2016-01-01

    The Bedouin Arab population in the southern Negev region of Israel has faced health problems as a result of transitioning rapidly from a nomadic agricultural lifestyle to a more modern urban lifestyle. Like many populations around the world, the Bedouins have changed their diets and become more sedentary and this has led to a high rate of diabetes. In this case report, we examine how diabetes has affected the life of an influential man in the Bedouin community and the significance this case has in the greater context of a global rise in chronic disease. PMID:26944372

  11. Retrograde pedal access with a 20-gauge intravenous cannula after failed antegrade recanalization of a tibialis anterior artery in a diabetic patient: a case report.

    PubMed

    Colkesen, Yucel

    2015-01-01

    Retrograde tibiopedal approach is being used frequently in below-the-knee vascular interventions. In patients with diabetic foot pathology, complex anatomy often requires a retrograde technique when the distal vascular anatomy and puncture site is suitable. The dorsalis pedis and posterior tibial arteries can be punctured because of their relatively superficial position. We report a retrograde puncturing technique in patients with chronic total occlusions. After failed antegrade recanalization, puncturing and cannulation of a tiny dorsalis pedis artery with a narrow bore [20-gauge (0.8 mm)] intravenous cannula is described. PMID:26257023

  12. 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

  13. 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

  14. Euglycemic Diabetic Ketoacidosis in a Patient with Cocaine Intoxication

    PubMed Central

    Abu-Abed Abdin, Asma; Ahmed, Awab

    2016-01-01

    Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as “euglycemic DKA.” This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects. We describe an interesting case of euglycemic DKA in a middle-aged diabetic female presenting with elevated anion gap metabolic acidosis, with near-normal blood glucose, in the settings of noncompliance to insulin and cocaine abuse. We have postulated that cocaine abuse was implicated in the pathophysiology of euglycemic DKA in this case. This case highlights complex physiological interplay between type-1 diabetes, noncompliance to insulin, and cocaine abuse leading to DKA, with starvation physiology causing development of euglycemic DKA. PMID:27579186

  15. 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

  16. Diabetes insipidus in a quadriplegic patient.

    PubMed

    Farrell, C A; Staas, W E

    1986-02-01

    An incomplete quadriplegic patient underwent investigation for production of copious amounts of dilute urine. Serum osmolality, electrolytes, BUN, glucose, and serum antidiuretic hormone (ADH) were recorded, as well as urinary osmolality, electrolytes, glucose, and pH. In response to subcutaneous vasopressin during the dehydration test, the patient's urinary osmolality increased by 12%, from 620 mOsm/l to 695 mOsm/l. A definitive diagnosis of partial central diabetes insipidus was made. Physicians involved in the care of patients with spinal cord injuries should be aware of the method of evaluating polyuric conditions, particularly while the patient is undergoing catheterization. PMID:3954565

  17. 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.

  18. 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.

  19. Association Between Plasma Selenium and Glutathione Peroxidase Levels And Severity of Diabetic Nephropathy in Patients With Type Two Diabetes Mellitus

    PubMed Central

    Sedighi, Omid; Makhlough, Atieh; Shokrzadeh, Mohammad; Hoorshad, Shiva

    2014-01-01

    Background: Oxidative stress is thought to be involved in the pathogenesis of diabetic nephropathy. Selenium (Se), and antioxidant enzymes such as glutathione peroxidase (GPx) play an important protective role in diabetes complications. Objectives: This study aimed to evaluate the association between plasma Se and GPx levels with severity of diabetic nephropathy. Patients and Methods: In a case-control study, we measured plasma Se and GPx concentrations in patients with type two diabetes without microalbuminuria (group 1), with microalbuminuria (group 2), with macroalbuminuria (group 3), and healthy control subjects (group 4). We also assessed plasma glucose, urea, creatinine, and glycated hemoglobin levels in all study patients. Results: Plasma Se and GPx concentrations were significantly lower in diabetic patients with macroalbuminuria than other study groups (P < 0.001). Albuminuria (Alb/Cr in random urine sample) had a negative correlation with plasma Se (r = -0.40, P = 0.01), and GPx (r = -0.23, P = 0.03) concentrations. Conclusions: Plasma Se and GPx levels were lower in type two diabetic patients with macroalbuminuria and related to the stage of diabetic nephropathy. PMID:25695036

  20. EUGLYCEMIC DIABETIC KETOACIDOSIS AND SEVERE ACUTE KIDNEY INJURY SECONDARY TO OFF LABEL USE OF SODIUM GLUCOSE COTRANSPORTER-2 INHIBITOR IN A TYPE-1 DIABETIC PATIENT.

    PubMed

    Tahir, Hassan; Wani, Adil; Daruwalla, Vistasp; Daboul, Nour; Sagi, Jahnavi

    2015-01-01

    Sodium glucose Cotransporter-2 (SGLT2) inhibitors are a new class of drug approved for the treatment of type-2 diabetes; however they are also increasingly used off label in type-1 diabetic patients. SGLT2 Inhibitors work by increasing glucose excretion in urine. Euglycemic diabetic ketoacidosis (DKA) is potentially life threatening side effect as patients have normal glucose and minimal symptoms thus delaying diagnosis and treatment. Our case report highlights the risk of using SGLT2 inhibitors in type-1 diabetes and also supports the need for long term studies to define clear efficacy and complications of SGLT 2 inhibitors in both type-1 and type 2 diabetes mellitis. PMID:27004352

  1. [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.

  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. PMID:27642481

  3. 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

  4. Aquaporin 11 variant associates with kidney disease in type 2 diabetic patients.

    PubMed

    Choma, David P; Vanacore, Roberto; Naylor, Helen; Zimmerman, Ian A; Pavlichenko, Andrei; Pavlichenko, Artyom; Foye, Liberty; Carbone, David P; Harris, Raymond C; Dikov, Mikhail M; Tchekneva, Elena E

    2016-03-01

    Kidney disease, a common complication of diabetes, associates with poor prognosis. Our previous animal model studies linked aquaporin (AQP)11 to acute kidney injury, hyperglycemia-induced renal impairment, and kidney disease in diabetes. Here, we report the AQP11 rs2276415 variant as a genetic factor placing type 2 diabetic patients at greater risk for the development of kidney disease. We performed two independent retrospective case-control studies in 1,075 diabetic and 1,619 nondiabetic individuals who were identified in the Synthetic Derivative Database with DNA samples in the BioVU DNA repository at Vanderbilt University (Nashville, TN). A χ(2)-test and multivariable logistic regression analysis with adjustments for age, sex, baseline serum creatinine, and underlying comorbid disease covariates showed a significant association between rs2276415 and the prevalence of any event of acute kidney injury and chronic kidney disease (CKD) in diabetic patients but not in patients without diabetes. This result was replicated in the second independent study. Diabetic CKD patients over 55 yrs old with the minor AQP11 allele had a significantly faster progression of estimated glomerular filtration rate decline than patients with the wild-type genotype. Three-dimensional structural analysis suggested a functional impairment of AQP11 with rs2276415, which could place diabetic patients at a higher risk for kidney disease. These studies identified rs2276415 as a candidate genetic factor predisposing patients with type 2 diabetes to CKD. PMID:26719361

  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. PMID:25510799

  6. [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.

  7. 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.

  8. 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

  9. Care of Patients with Diabetic Foot Disease in Oman.

    PubMed

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

    2016-08-01

    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

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. Reduced risk of prostate cancer among patients with diabetes mellitus.

    PubMed

    Weiderpass, Elisabete; Ye, Weimin; Vainio, Harri; Kaaks, Rudolf; Adami, Hans-Olov

    2002-11-20

    Although diabetes mellitus is associated with an increased risk of several malignancies, a negative association with prostate cancer is biologically most plausible. The epidemiologic evidence is, however, inconsistent, limited and based mostly on small studies. We present results from a large, population-based cohort study in Sweden, where we assessed prostate cancer risk among patients hospitalized for diabetes mellitus. The cohort was composed of patients identified in the Swedish In-Patient Register as having a hospital discharge diagnosis of diabetes mellitus in 1965-1994. The follow-up was done by linkages with the national cancer register and other population-based registers. Standardized incidence ratios (SIRs), with 95% confidence interval (CI), were used as a measure of relative risk. After complete exclusion of the first year of follow-up (to avoid selection bias), 135,950 men remained in the cohort, contributing 827,099 years of follow-up to the study. A total of 2,455 incident cases of primary prostate cancer were identified during 1-31 years of follow-up, yielding an overall SIR of 0.91 (95% CI 0.87-0.94); this risk reduction was more pronounced among patients who have been hospitalized for diabetic complications (SIR = 0.82; 95% CI 0.74-0.91). We found no consistent trends in risk related to age at first hospitalization or to duration of follow-up. We did find a small, but significantly decreased risk of prostate cancer among men who had been hospitalized for diabetes mellitus.

  15. Creatine kinase activity in patients with diabetes mellitus type I and type II.

    PubMed

    Jevrić-Causević, Adlija; Malenica, Maja; Dujić, Tanja

    2006-08-01

    Diabetes mellitus can be looked upon as an array of diseases, all of which exhibit common symptoms. While pathogenesis of IDDM (insulin dependant diabetes mellitus) is well understood, the same is not true for diabetes mellitus type II. In the latter case, relative contribution of the two factors (insulin resistance or decreased insulin secretion) varies individually, being highly increased in peripheral tissues and strictly dependant on insulin for glucose uptake. Moreover, in patients with diabetes mellitus type II, disbalance at the level of regulation of glucose metabolism as well as lipid metabolism has been noted in skeletal muscles. It is normal to assume that in this type of diabetes, these changes are reflected at the level of total activity of enzyme creatine kinase. This experimental work was performed on a group of 80 regular patients of Sarajevo General Hospital. Forty of those patients were classified as patients with diabetes type I and forty as patients with diabetes type II. Each group of patients was carefully chosen and constituted of equal number of males and females. The same was applied for adequate controls. Concentration of glucose was determined for each patient with GOD method, while activity of creatine kinase was determined with CK-NAC activated kit. Statistical analysis of the results was performed with SPSS software for Windows. Obtained results point out highly expressed differences in enzyme activity between two populations examined. Changes in enzyme activity are more expressed in patients with diabetes type II. Positive correlation between concentration of glucose and serum activity of the enzyme is seen in both categories of diabetic patients which is not the case for the patients in control group. At the same time, correlation between age and type of diabetes does exist . This is not followed at the level of enzyme activity or concentration of glucose.

  16. 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…

  17. Use of collagenase ointment in conjunction with negative pressure wound therapy in the care of diabetic wounds: a case series of six patients

    PubMed Central

    Miller, John D.; Carter, Elizabeth; Hatch, David C.; Zhubrak, Michelle; Giovinco, Nicholas A.; Armstrong, David G.

    2015-01-01

    Background Diabetic wounds with additional comorbidities are costly, time intensive, and difficult to heal. Often, multiple modalities may be necessary to achieve wound resolution, relying on the synergistic advantage of each therapy to affect wound healing. The selectivity of Clostridium collagenase is physiologically effective at degrading non-viable collagen fibers while preserving living collagen tissue. Additionally, negative pressure wound therapy (NPWT) has long been used to aid wound healing while concurrently depreciating biological wound burden time. Methods Six patients were selected from those appearing to our university based limb salvage service. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base, in which NPWT was indicated, without exclusion criteria. Patients enrolled were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded. Results Tandem application of these therapies appeared to expedite wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Unfortunately, not all patients were able to reach full healing; with two patients experiencing ulcer recurrence, likely a result of their significant comorbid nature. Conclusion In our experience, we have noticed a specific subgroup of patients who benefit greatly when collagenase enzymatic debridement therapy is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds to the next step in healing despite the current paucity in literature discussing this specific pairing. PMID:25630362

  18. 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.

  19. The Influence of Smoking on Pulmonary Tuberculosis in Diabetic and Non-Diabetic Patients

    PubMed Central

    Bai, Kuan-Jen; Lee, Jen-Jyh; Chien, Shun-Tien; Suk, Chi-Won; Chiang, Chen-Yuan

    2016-01-01

    Background Both smoking and diabetes can increase the risk and influence the manifestations and outcomes of tuberculosis (TB). It is not clear whether the influence of smoking on pulmonary TB differs between non-diabetic and diabetic patients. Herein, we assessed the manifestations and outcomes of TB in relation to smoking in both diabetic and non-diabetic TB patients. Methodology/Principal Findings All diabetic culture-positive pulmonary TB patients notified from 2005–2010 at three teaching hospitals in Taiwan were enrolled. A culture-positive pulmonary TB patient without DM who was notified to the health authority immediately prior to each diabetic TB patient was selected for comparison. The 972 patients in this study cohort included 365 (37.6%) non-diabetic non-smokers, 149 (15.3%) non-diabetic smokers, 284 (29.2%) diabetic non-smokers, and 174 (17.9%) diabetic smokers. The adjusted relative risk of a pretreatment positive smear for a smoker compared with a non-smoker was 2.19 (95% CI 1.38–3.47) in non-diabetic patients and 2.23 (95% CI 1.29–3.87) in diabetic culture-positive pulmonary TB patients. The adjusted relative risk for a positive smear among diabetic smokers was 5.61 (95% CI 3.35–9.41) compared with non-diabetic non-smokers. Smoking was significantly associated with an increased frequency of bilateral lung parenchyma involvement (AdjOR 1.84, 95% CI 1.16–2.93), far-advanced pulmonary TB (AdjOR 1.91, 95% CI 1.04–3.50), cavitary lesions (AdjOR 2.03, 95% CI 1.29–3.20), and unfavorable outcomes of TB (AdjOR 2.35, 95% CI 1.02–5.41) in non-diabetic patients. However, smoking was not associated with cavitary lung parenchyma lesions regarding the location, number or size of the cavity in diabetic TB patients. Conclusions/Significance Smoking and diabetes have joint effects on a pretreatment positive smear. Diabetic smokers had more than a 5-fold increased risk of a pretreatment positive smear than did non-diabetic non-smokers, indicating

  20. Falciparum malaria-induced hypoglycaemia in a diabetic patient.

    PubMed Central

    Shalev, O.; Tsur, A.; Rahav, G.

    1992-01-01

    We report a patient with diabetes mellitus who suffered severe falciparum malaria complicated by profound and persistent hypoglycaemia. The hypoglycaemia evolved before therapy with quinine was begun and resolved with eradication of the parasitaemia. The patient reverted to her baseline hyperglycaemia despite continuation of quinine. This case illustrates the critical role of falciparum malaria in the pathogenesis of malaria-associated hypoglycaemia, rather than quinine-mediated mechanisms. Anticipation of hypoglycaemia in falciparum malaria and its vigorous treatment may improve the poor prognosis associated with this complication. PMID:1409194

  1. [Sick day management in elderly patients with diabetes mellitus].

    PubMed

    Suzuki, Susumu

    2013-11-01

    A bad cold, the flu or a serious illness can make blood glucose too high in elderly person with diabetes. Gastrointestinal illnesses may cause hypoglycemia for individuals treated with insulin, sulfonylureas or glitinides. When the persons with diabetes discontinue insulin or diabetes medications because of appetite loss and reduced food intake, they may fall into diabetic crises, such as ketoacidosis, or hyperosmolar hyperglycemic syndrome. The elderly patients need to take extra precautions on sick days to avoid diabetic crises or hypoglycemia. Key principles of sick day management are (1) maintaining hydration and carbohydrate intake, (2) monitoring blood glucose and ketone levels, (3) adjusting diabetes medications according to carbohydrate intake, blood glucose and ketone levels. In Japan, the numbers of frail elderly diabetic patients is markedly increased, effective and efficient sick day management for frail elderly diabetic patients is requested.

  2. 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

  3. 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

  4. 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…

  5. 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.

  6. 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.…

  7. [Changes in cognitive function in patients with diabetes mellitus].

    PubMed

    Szémán, Barbara; Nagy, Géza; Varga, Tímea; Veres-Székely, Anna; Sasvári, Mária; Fitala, Dávid; Szollosi, Adrienn; Katonai, Rózsa; Kotyuk, Eszter; Somogyi, Anikó

    2012-03-01

    Patients with diabetes are approximately 1.5 times more likely to experience cognitive decline than individuals without diabetes mellitus. Most of the data suggest that patients with diabetes have reduced performance in numerous domains of cognitive function. In patients with type 1 diabetes, specific and global deficits involving speed of psychomotor efficiency, information processing, mental flexibility, attention, and visual perception seem to be present, while in patients with type 2 diabetes an increase in memory deficits, a reduction in psychomotor speed, and reduced frontal lobe (executive) functions have been found. The complex pathophysiology of changes in the central nervous system in diabetes has not yet been fully elucidated. It is important to consider the patient's age at the onset of diabetes, the glycemic control status, and the presence of diabetic complications. Neurological consequences of diabetes appear parallel to those observed in the aging brain. Neuroimaging studies highlight several structural cerebral changes, cortical and subcortical atrophy, beside increased leukoaraiosis that occurs in association with diabetes. There is supporting evidence from many hypotheses to explain the pathophysiology of cognitive decline associated with diabetes. The main hypotheses pointing to the potential, implied mechanisms involve hyperglycemia, hypoglycemia, microvascular disease, insulin resistance, hyperinsulinism, hyperphosphorylation of tau protein, and amyloid-β deposition.

  8. 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

  9. A calculus within an anal fistula tract in a diabetic patient.

    PubMed

    Ahmed, M E; Shumo, A I

    2001-02-01

    A non-insulin dependent diabetic patient with a chronic anal fistula underwent fistulectomy. At operation a calculus was discovered. The patient had an uneventful recovery and healing of the wound in 4 weeks duration. The only case reported previously was in a nondiabetic patient and interestingly from this department. PMID:11299415

  10. Interleukin-10 polymorphisms in Spanish type 1 diabetes patients.

    PubMed

    Urcelay, E; Santiago, J L; de la Calle, H; Martínez, A; Figueredo, A; Fernández-Arquero, M; de la Concha, E G

    2004-06-01

    The MHC accounts for half of the genetic susceptibility to type 1 diabetes (T1D). Evidence suggests that an imbalance in Th1/Th2 responses may play a key role in the development of autoimmune diabetes. Since interleukin-10 (IL-10) modulates immune and inflammatory responses and has been implicated in many autoimmune diseases, it seemed interesting to examine whether IL-10 polymorphisms participate in diabetes predisposition. In fact, this is the first association study investigating the role of the IL- 10 polymorphisms in susceptibility to T1D in a Caucasian population. Three promoter polymorphisms (-1082G/A, -819C/T, -592C/A) and two CA-repeat microsatellites (IL-10R and IL-10G at -4 and -1.1 kb) were tested in a case-control study with 294 T1D patients and 574 healthy controls. Our results prove a minor role of IL-10 in the autoimmune diabetes risk, although we found the same association trend with IL-10G(*)12 allele as was previously observed for multiple sclerosis and rheumatoid arthritis. PMID:15057267

  11. 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

  12. Traumatic injuries in patients with diabetes mellitus.

    PubMed

    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

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

    PubMed Central

    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

    2015-01-01

    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. PMID:26508947

  14. 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.

  15. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

    PubMed Central

    2012-01-01

    Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004). Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743) in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434). After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected) to €463 (corrected) in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term. PMID:22361361

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

    PubMed

    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

  17. 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

  18. Depression and Quality of Life in Patients With Type 2 Diabetes

    PubMed Central

    Derakhshanpour, Firooze; Vakili, Mohammad Ali; Farsinia, Maryam; Mirkarimi, Kamal

    2015-01-01

    Background: Frequency of mood disorders in patients with chronic diseases, especially diabetes and its effects on life quality are dramatically increasing. Objectives: This study aimed to investigate the relation between depression and quality of life in patients with diabetes. Patients and Methods: This is a cross sectional survey. Subjects were selected from 330 eligible people referred to the only diabetes clinic in Gorgan City during 6 months, using systematic random sampling. Beak Depression questionnaire and the brief questioner with 26 questions recommended by the World Health Organization (WHOQOL-BREF) were used to measure depression and quality of life, respectively. Data were analyzed through descriptive methods, Chi-square, Independent t test and linear regression model using SPSS16; moreover, P value < 0.05 was considered as significant. Results: In total, 330 patients with diabetes (35.5 % male and 64.5% women) were studied. The mean and standard deviation of their age and years involved with diabetes were 50.6 ± 9.0 and 5.4 ± 4.5 years, respectively. Range of age was 25 - 75 years, as well. The prevalence of depression in all patients with diabetes was 58.2% (124 mild, 56 medium, and 12 with severe depression). Hypertension was 13.9% more in diabetic patients with depression (P value < 0.001) and physical activity in 24.7% of the cases was less with a meaningful difference (P value = 0.01). The mean and standard deviation of quality of life in diabetic patients with and without depression was 50.7 ± 14 and 60.5 ± 13.3, respectively that was significant in two groups (P < 0.0001). Conclusions: The prevalence of depression is high in patients with diabetes and has a considerable impact on the consequences of diabetes and quality of life too. PMID:26082854

  19. Dental implant survival in diabetic patients; review and recommendations

    PubMed Central

    Dubey, Rajendra Kumar; Gupta, Deepesh Kumar; Singh, Amit Kumar

    2013-01-01

    Rising population of diabetic individuals across the world has become a big concern to the society. The persistent hyperglycemia may affect each and every tissue and consequently results in morbidity and eventually mortality in diabetic patients. A direct negative response of diabetes has been observed on oral tissues with few contradictions however, little are known about effect of diabetes on dental implant treatment and the consequent results. Many studies concerned with osteointegration and prognosis of dental implant in diabetic patients have been conducted and published since 1994. These studies have been critically reviewed to understand the impact of diabetes on the success of dental implant and the factors to improve osseointegration and consequently survival of dental implant in diabetic patients. Theoretical literatures and studies in diabetic animals substantiate high failure rate of implants but most of clinical studies indicated statistically insignificant failure of dental implants even in moderately uncontrolled diabetic patients. Success of dental implant in well and fairly controlled diabetic patients with proper treatment planning, prophylactic remedies and adequate postsurgical maintenance appears as good as normal individuals. PMID:24665167

  20. [Superficial mycoses: comparative study between type 2 diabetic patients and a non-diabetic control group].

    PubMed

    García-Humbría, Leila; Richard-Yegres, Nicole; Pérez-Blanco, Maigualida; Yegres, Francisco; Mendoza, Mireya; Acosta, Arnaldo; Hernández, Rosaura; Zárraga, Eluz

    2005-03-01

    Superficial mycoses are considered to affect more frequently patients with type 2 diabetes mellitus (DM-2), specially onychomycosis and Tinea pedis. The purpose of this study was to compare the dermatophytoses, candidiasis and Pitiriasis versicolor frequency between 40 patients with DM-2 and 40 healthy persons of either sex, 40 years old or more. Clinical, metabolic, mycologic and inmunologic studies against Candida albicans, were carried out. Both diabetics 75% (30/40) and controls 65% (26/40) presented a high frequency of superficial mycoses (no significant difference p = 0.329). Pitiriasis versicolor was not detected in diabetic patients. They presented Tinea unguium, concomitant with Tinea pedis, with a higher frequency. The predominant dermatophyte was Trichophyton rubrum 18/23 (78%) in diabetics and 8/16 (50%) in non diabetics. Candida was isolated as commensal from oral mucous: 23/40 (58%) in diabetics and 21/40 (52%) in non diabetics (serotipo A was the more frequent), and from onychomycosis: 11/40 (28%) in diabetics and 12/40 (30%) in non diabetics. The immunological response was the same in both groups: celular 100%, humoral 20%. No statistical correlation among superficial mycoses, blood glucose level, glycosylated hemoglobin values or the time suffering the disease was observed. The high susceptibility to dermatophytes and Candida sp. infection showed to be associated with age and no with the diabetic type 2 condition in those patients.

  1. Macrovascular complication phenotypes in type 2 diabetic patients

    PubMed Central

    2013-01-01

    Background Macrovascular diseases (MVD) in type 2 diabetes mellitus (T2DM) are often considered all together, without discriminating the areas involved. The aim of our study was to analyse MVD prevalence in a large population of T2DM patients by dividing the cases into subgroups according to MVD sites (NMVD, no MVD; NSCS, non-significant carotid stenosis; CBVD, cerebrovascular disease; CAD, coronary artery disease; PAD, peripheral artery disease; PVD, polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group. Methods A diabetic outpatient cohort (n = 1199) was retrospectively studied. Demographic, clinical and laboratory parameters were included in analyses. A thorough cardiovascular history as documented by previous medical records (including medical and hospital records) and vascular laboratory studies (including standardised electrocardiogram, echocardiogram, provocative tests for cardiac ischaemia, ankle/brachial index, duplex ultrasonography of the carotid and lower limbs and, in selected cases, computed tomography angiography, carotid and peripheral arteriography and evaluation of transcutaneous oxygen pressure), was collected for all of the patients. Standardised procedures were used to assess microvascular complications as well as metabolic syndrome (Mets). Results The unadjusted MVD prevalence was 46.4% among the participants. The majority of patients with MVD were in the PVD group. In the multivariate analysis, age, male sex and diabetes duration were independent risk factors for PAD and PVD (P < 0.01). A low HDL-C value was an independent risk factor in the CAD and PVD groups (P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (94.9 and 95.7% respectively). The most MetS diagnostic criteria were recorded among members of the CAD group (all or all-1 criteria were present in 73% of patients). The average age in the CAD group (64.5 y) was comparable to that of the NMVD group

  2. Medication Oversupply in Patients with Diabetes

    PubMed Central

    Thorpe, Carolyn T.; Johnson, Heather; Dopp, Anna Legreid; Thorpe, Joshua M.; Ronk, Katie; Everett, Christine M.; Palta, Mari; Mott, David A.; Chewning, Betty; Schleiden, Loren; Smith, Maureen A.

    2014-01-01

    Background Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D. Objective The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan. Methods This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients’ quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression. Results The sample included 2,519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR=3.36, 95% CI=1.61-6.99), patients 65+ in Medicare (OR=2.51, 95% CI=1.37-4.60), patients <65 in Medicare/Medicaid (OR=4.55, 95% CI=2.33-8.92), and patients 65+ in Medicare/Medicaid (OR=5.73, 95% CI=2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control. Conclusions Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately

  3. Rare neonatal diabetes insipidus and associated late risks: Case report

    PubMed Central

    2012-01-01

    Background Most cases of neonatal central diabetes insipidus are caused by an injury, which often results in other handicaps in the patient. The infant’s prognosis will be determined by his or her own early age and disability as well as by the physician’s skill. However, the rarity of this condition prevents the acquisition of personal experience dealing with it. Case Presentation A neonatal hemorrhagic stroke, caused by an aortic coarctation, caused right lower limb paresis, swallowing disability, and central diabetes insipidus in a term infant. The scant oral intake, as a consequence of his disability, caused progressive undernutrition which closed a vicious circle, delaying his development and his ability to overcome the swallowing handicap. On the other hand, nasal desmopressin absorption was blocked by several common colds, resulting in brain bleeding because of severe dehydration. This even greater brain damage hampered the improvement of swallowing, closing a second harmful circle. Moreover, a devastating central myelinolysis with quadriplegia, caused by an uncontrolled intravenous infusion, consummated a pernicious sequence, possibly unreported. Conclusions The child’s overall development advanced rapidly when his nutrition was improved by gastrostomy: This was a key effect of nutrition on his highly sensitive neurodevelopment. Besides, this case shows potential risks related to intranasal desmopressin treatment in young children. PMID:22639945

  4. Markers of Antioxidant Defense in Patients with Type 2 Diabetes

    PubMed Central

    Gawlik, K.; Naskalski, J. W.; Fedak, D.; Pawlica-Gosiewska, D.; Grudzień, U.; Dumnicka, P.; Małecki, M. T.; Solnica, B.

    2016-01-01

    Aims. Diabetes is considered a state of increased oxidative stress. This study evaluates blood concentrations of selected markers of antioxidant defense in patients with type 2 diabetes. Methods. The study included 80 type 2 diabetes patients and 79 apparently healthy controls. Measured markers included ferric reducing ability of plasma (FRAP), reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), γ-glutamyltransferase (GGT) and uric acid serum, and plasma and/or hemolysate levels. Results. FRAP, uric acid, CRP, and GGT levels were significantly higher in patients with diabetes. Plasma and hemolysate GR was significantly higher whereas GPx activity was significantly lower in patients with diabetes. There were no significant differences in antioxidant defense markers between patients with and without chronic diabetes complications. Fasting serum glucose correlated with plasma GPx, plasma and hemolysate GR, FRAP, and serum GGT, and HbA1c correlated with serum GGT. Only FRAP and serum uric acid were significantly higher in obese (BMI > 30 kg/m2) patients with diabetes than in nonobese patients. Conclusions. Some components of antioxidant defense such as GR, uric acid, and GGT are increased in patients with type 2 diabetes. However, the whole system cannot compensate for an enhanced production of ROS as reflected by the trend toward decreased erythrocytes GSH. PMID:26640613

  5. Stress echocardiography for risk assessment of diabetic patients

    PubMed Central

    Baur, L.H.B.; Graal, M.

    2004-01-01

    Coronary artery disease in patients suffering from diabetes mellitus will become an increasing problem in the future. Because diabetic patients benefit from treatment of symptomatic but also asymptomatic coronary artery disease, early diagnosis is warranted. The diagnostic techniques used to detect ischaemia, with a focus on stress echocardiography, are described. ImagesFigure 1 PMID:25696265

  6. 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,…

  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. 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

  9. [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.

  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. PMID:24523328

  11. Hyperglycaemia and ketosis in a non-diabetic patient--an unusual cause of delayed recovery.

    PubMed

    Pawar, Sundeep T; Nath, Soumya S; Ansari, Farrukh

    2014-01-01

    We report a case of hyperglycaemia and ketosis developing in a non-diabetic patient who underwent a neurosurgical procedure under general anaesthesia. A 52-year-old non-diabetic female patient underwent excision of acoustic neuroma under general anaesthesia. Pancreatic function was not disturbed and she received a single dose of dexamethasone (8 mg) and paracetamol (1 g). Delayed recovery from anaesthesia occurred. On investigation, she was found to have hyperglycaemia and ketosis. She was further managed on the line of diabetic ketoacidosis. After 24 hours, when blood glucose had normalised and ketosis abated, she could be weaned from mechanical ventilation and extubated. The patient did not receive any drugs known to cause such a condition. To the best of our knowledge, hyperglycaemia and ketosis developing in a non-diabetic patient causing delayed recovery and extubation is here reported for the first time.

  12. Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients

    MedlinePlus

    ... html Diabetes Drug Victoza Might Not Help Advanced Heart Failure Patients Study participants may have been too sick ... to improve heart function in patients with advanced heart failure, a new study finds. The theory for this ...

  13. E-prescribing: clinical implications for patients with diabetes.

    PubMed

    Smith, Marie; Dang, Devra; Lee, Jennifer

    2009-09-01

    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. 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

  15. Diabetes and insurance: a survey of patient experience.

    PubMed

    Frier, B M; Sullivan, F M; Stewart, E J

    1984-07-01

    A survey of 186 diabetic patients examined their collective experience of life and motor insurance. Some form of life insurance policy had been obtained by 150 patients, with a combined total of 204 policies, 107 of which had been agreed before the diagnosis of diabetes. Most patients had declared diabetes to the insurer but 12 patients had been refused acceptance. Only 15 patients sought alternative quotations. The premium had been loaded by 10-40% for 36 patients because of diabetes, and 48 required a medical report. Of 147 diabetic drivers, 95 (65%) had declared diabetes either to the Licensing authority, or to the motor insurer, but only 62 (42%) had informed both. Fourteen patients had been refused motor insurance cover by individual companies, and 36 patients were aware of having had their premium increased, but only 16 patients had sought alternative quotations. Major differences in attitude with regard to diabetes as a risk factor for insurance are evident, and patients should be advised to approach several companies when seeking insurance cover.

  16. Case Report of Two Cases of Patella Subacute Osteomyelitis in Diabetic Women A Rare Entity

    PubMed Central

    Kumar, R. Siva; K.Singhi, Prahalad; Chidambaram, M.; Kakkandki, Kiran

    2016-01-01

    Introduction: Patella osteomyelitis is a rare entity in adults. Most often it is seen in children of five to twelve years of age because of its unique ossification and vascularity. Immuno compromised states like HIV, tuberculosis, intravenous drug abuse and trauma have been predisposing factors for adult patellar osteomyelitis. We report two cases of patellar osteomyelitis in adult diabetic women with uncontrolled glycemic levels and having no previous history of any trauma or systemic infection. Case Report: A 43-year-old diabetic woman presented with complaints of left knee pain and swelling with no history of trauma. On examination, pointed tenderness was present over anterior aspect of patella with patellar grind test positive. Radiography and MRI revealed solitary well circumscribed patellar cyst. Lateral chondral blisters were noted while doing arthroscopy and secretions oozed out on puncturing. Curettage was carried out for the same. Culture and sensitivity revealed no growth and the patient was prescribed antibiotics for 6 weeks. Second case was a 46-year-old diabetic lady with similar presentation. MRI additionally showed abscess in intermuscular plains around knee joint. An aspirated fluid was negative for growth of organisms. Knee arthrotomy and curettage of patellar sinus tracts was done with evacuation of intramuscular abscess. Antibiotics were given for 6 weeks. Both patients had complete relief of symptoms. Conclusion: Patella osteomyelitis in adults is very rare. In patients with uncontrolled diabetes, vague anterior knee pain, elevated ESR and CRP, one should keep patellar subacute osteomyelitis as a differential diagnosis which can be further confirmed by X-ray, MRI or bone scan. An appropriate early treatment with antibiotics and surgical intervention can give a satisfactory result. PMID:27703930

  17. Transient gestational diabetes insipidus: report of two cases and review of pathophysiology and treatment.

    PubMed

    El-Hennawy, A S; Bassi, T; Koradia, N; Bocirnea, A

    2003-11-01

    Gestational diabetes insipidus is a rare disorder characterized by polyuria and polydipsia due to the inability of the kidneys to concentrate urine. We report two cases of transient gestational diabetes insipidus in which patients responded to intranasal DDAVP (1-deamino-8-D-arginine vasopressin) with greater than 50% increase in urine osmolality and marked reduction in urine output. Intranasal DDAVP was discontinued after their discharge and both patients maintained normal urine output and appropriate urine osmolality. In determining whether diabetes insipidus is present in a patient who is polyuric and hypernatremic, a urine osmolality below that of the plasma suggests the presence of diabetes insipidus. Understanding of the pathophysiology may soon lead to improved methods of prevention, diagnosis and treatment.

  18. 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

  19. Diabetic retinopathy and the associated risk factors in diabetes type 2 patients in Abha, Saudi Arabia

    PubMed Central

    Ahmed, Razia A.; Khalil, Shamsun N.; Al-Qahtani, Mohammad A. A.

    2016-01-01

    Objectives: To assess the proportion and grades of retinopathy and its risk factors in diabetes type 2 patients. Materials and Methods: This was a cross-sectional study of 401 type 2 diabetic patients. A questionnaire and checklist were used to collect the data. Retinopathy was diagnosed and graded by fundus photographs and slit lamp examination. The duration of diabetes, age of patients, age at onset of diabetes, body mass index, hemoglobin A1c level, blood pressure, and complications were noted. Results: The mean age of male and female patients was 54.93 and 54.25 years; 57.6% were males. The mean age of onset and mean duration of diabetes were 43.91 and 13.4 years, respectively. The proportion of retinopathy was 36.4%. Grades of retinopathy were: Mild 57.5%, moderate 19.9%, severe nonproliferative 11%, and proliferative retinopathy 11.6%; 7.2% of patients had maculopathy. Retinopathy was significantly associated with older age, younger age at onset, longer duration of disease, poorly controlled blood sugar, hypertension, insulin use; the presence of neuropathy and nephropathy appeared as a significant risk. Younger age at onset, longer duration, and insulin use appeared as the strongest predictors for diabetic retinopathy. Conclusions: More than a third (36.4%) of the diabetic patients attending a diabetic center had retinopathy. The control of the risk factors may reduce both prevalence and consequences of retinopathy. PMID:26929725

  20. Pulmonary function in patients with diabetes mellitus.

    PubMed

    Sreeja, C K; Samuel, Elizabeth; Kesavachandran, C; Shashidhar, Shankar

    2003-01-01

    The present study was carried out to assess the lung functions in oral medicated and insulin administered patients with normal controls. 20 subjects were selected as the study group for oral medication (Group I), 20 subjects were selected as the study group for insulin treatment (Group II) and 40 subjects were selected as normal controls. Age group of Group I and Group II were 51.25 +/- 6.28 and 50.8 +/- 6.56 respectively and controls were age and height matched. Seventeen patients of Group I were undergoing treatment for the last 10-20 years and 20 patients in Group II were undergoing treatment for the last 30 years. Only male subjects were selected for the study. Lung function test were carried out with Spirometer (Vitallograph Compact II). A significant reduction in forced expiratory volume/forced vital capacity (FEV1/FVC%) was observed in oral pills used subjects and insulin administered subjects as compared to controls. Significant decrease in forced expiratory flow rate (FEF25-75%) in group I subjects was also observed as compared to controls. Forced mid flow time (FMFT) showed a significant increase in group II in comparison to controls. These changes clearly show the expiratory flow rates are reduced both in orally medicated and insulin administered patients. Increase in FMFT in group I may be due to the reduced respiratory ability to carry out the FVC test along with the side effects of oral medication for diabetes mellitus. PMID:12708129

  1. 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

  2. A latent autoimmune diabetes in adults patient manifesting severe musculoskeletal complications.

    PubMed

    Yang, In-Ho; Lee, Sun Hee; Chin, Sang Ouk; Chon, Suk

    2014-11-01

    Patients with diabetes have many different kinds of complications involving multiple organs, but those involving the musculoskeletal system are relatively uncommon. Diabetic muscle infarction (DMI) is a rare, painful, and potentially serious condition in patients with poorly controlled diabetes mellitus. A 35-year-old man diagnosed with type 2 diabetes eight years ago, visited with severe muscle pain in the right anteromedial thigh without any event of trauma. He had been treated with metformin, but his glycemic control was very poor with a glycated hemoglobin of 14.5%. Evaluation of his painful thigh lesion did not reveal any evidence of infection or vasculitis, but the magnetic resonance imaging and bone scan showed findings of DMI at vastus medialis muscle and an insufficiency fracture at the right medial tibial condyle. He was diagnosed with retinopathy, neuropathy and microalbuminuria but not macrovascular complications. We also diagnosed his diabetes as latent autoimmune diabetes in adults (LADA) based on his low C-peptide level, positive anti-glutamic acid decarboxylase (GAD) antibody and early onset diabetes. Instead of antibiotics, bed rest, analgesics and strict blood glucose control with multiple daily insulin injections led to symptom improvement. This is an unusual case of a young man with LADA experiencing severe musculoskeletal complication of DMI and insufficiency fracture. If a poorly controlled diabetic patient appears to have unaccounted soft tissue pain, musculoskeletal complications such as DMI associated with hyperglycemia should be considered.

  3. Onset of type 1 diabetes mellitus in two patients with maturity onset diabetes of the young.

    PubMed

    Maltoni, Giulio; Zucchini, Stefano; Scipione, Mirella; Mantovani, Vilma; Salardi, Silvana; Cicognani, Alessandro

    2012-03-01

    The association between maturity onset diabetes of the young (MODY) and type 1 diabetes mellitus (T1DM) has been rarely described. We report two patients affected by MODY who developed T1DM. Case 1: a 4-yr-old girl referred for glycosuria presented hemoglobin A1c (HbA1c) of 6.6%. Islet cell antibodies (ICA) and anti-glutamic acid decarboxylase (GADA) were initially negative. As her father, uncle and grandmother showed mild hyperglycemia, they were screened for MODY 2. A novel mutation in glucokinase gene was found in the family. Few months later, her glycemic control worsened consistently and she required insulin treatment. A high titer of GADA and ICA was then detected. Six years afterwards insulin requirement is 0.8 U/kg and HbA1c 6.7%. Case 2: a 15-yr-old boy treated for growth hormone deficiency was found with a blood glucose level of 106 mg/dL. HbA1c was 7.2%, ICA and GADA were negative. Family history was positive for autoimmune diseases and type 2 diabetes mellitus. The patient was investigated for MODY 2 and MODY 3, and a mutation of hepatocyte nuclear factor-1 alpha gene was found. The same mutation was found in the mother who had never been referred for hyperglycemia. After 1 yr, due to an unjustified worsening of the metabolic control, autoimmunity was again investigated and a mild positivity was found. He then required insulin therapy and after 5 yr current HbA1c was 8.2%. The diagnosis of MODY does not exclude the risk of developing T1DM. Therefore autoimmunity should be investigated when ordinary treatments fail and metabolic control unexpectedly worsens.

  4. 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

  5. Medical Nutrition Therapy in Hospitalized Patients with Diabetes

    PubMed Central

    Gosmanov, Aidar R.

    2013-01-01

    Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed. In this article, we discuss general guidelines for the implementation of appropriate MNT in hospitalized patients with diabetes. PMID:21997598

  6. 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

  7. 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

  8. Left Ventricular Diastolic Dysfunction is More Common in Patients of Uncontrolled Diabetes Mellitus.

    PubMed

    Bhuiyan, A S; Bari, M A; Bari, M S; Aditya, G P; Islam, M Z; Pandit, H; Khan, J A

    2015-07-01

    There is a relationship between the left ventricular diastolic dysfunction with uncontrolled diabetes mellitus. A cross sectional study was designed to see the association of uncontrolled diabetes mellitus with diastolic dysfunction of the heart. The study was conducted from April 2012 to March 2013 in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh. Sixty cases were selected as study population; twenty one patients were in Group I with good glycaemic controlled of HbA1C <7% and 39 patients were in Group II with poorly controlled diabetes mellitus having HbA1C ≥ 7%. In the study population male were 43(71.70%) and female were 17(28.30%). Mean age in the two groups were 49.05 ± 6.34 years vs. 53.64 ± 5.38 years, which was not significant difference. Duration of diabetes was <10 years and ≥ 10 years in two groups. Glycaemic status (percentage of HbA1C) was 6.55 ± 0.29% vs. 8.72 ± 1.01% in controlled and uncontrolled diabetic patient groups respectively which was significant difference. Diastolic dysfunction was found more in uncontrolled diabetic patient (patients having HbA1C% ≥ 7%) than controlled diabetic patients (HbA1C <7%). Grade I diastolic dysfunction was in uncontrolled and controlled glycaemic status were 33(84.60%) and 04(19.00%). The difference was statistically significant. Diastolic dysfunction in type 2 diabetic subjects was significantly higher as compared to the well control group (p<0.001). And this study concluded as - Diastolic dysfunction is more common in patient with poorly controlled diabetes mellitus.

  9. A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature

    PubMed Central

    Draman, M S; Thabit, H; Kiernan, T J; O'Neill, J; Sreenan, S; McDermott, J H

    2013-01-01

    Summary Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes. Learning points Silent myocardial ischaemia (SMI) is an important clinical entity.SMI is common and occurs with increased frequency in patients with diabetes.SMI is an independent predictor of mortality.Recognition may lead to early intervention. PMID:24616778

  10. 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

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

    PubMed

    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.

  12. 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

  13. The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients.

    PubMed

    Halimi, J M

    2012-10-01

    The natural history of diabetic nephropathy was defined in the 1980s on the basis of longitudinal studies undertaken in patients with type 1 and type 2 diabetes. However, an increasing number of studies have indicated that certain diabetic patients do not present with the same evolution as was then defined: for example, some often have significant initial deterioration of glomerular filtration rate whereas, in others, microalbuminuria is reduced spontaneously. Chronic kidney disease (CKD) may be accompanied, rather than preceded, by macroalbuminuria, or it may develop in patients with microalbuminuria or even in those with albuminuria levels that revert to normal. CKD can also develop in patients whose albuminuria levels remain normal. Progression to macroalbuminuria is, in fact, less frequent than regression to normoalbuminuria or no change in microalbuminuria status in diabetic patients with microalbuminuria, especially in type 1 diabetes. Some experience progressive deterioration of renal function due to diabetes without developing significant proteinuria: this is seen fairly frequently and can affect 50% of patients with renal insufficiency. Such cases are more often older patients treated with renin-angiotensin system blockers who usually have a history of cardiovascular disease. Evolution to end-stage renal disease is slower in this subgroup of patients, although histological analyses may show surprisingly advanced glomerular lesions. The main parameters of surveillance remain regular monitoring of glycaemia, and control of blood pressure and the evolution of initial albuminuria levels. Nevertheless, why some patients exhibit conventional diabetic nephropathy while others have slower declines in renal function associated with normal albuminuria levels or microalbuminuria is unclear. It is hoped that the new pathological classification of diabetic nephropathy will help in our understanding of these discrepancies.

  14. 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

  15. Transitions in Care from the Hospital to Home for Patients With Diabetes

    PubMed Central

    Hirschman, Karen B.; Bixby, M. Brian

    2014-01-01

    In Brief Diabetes is a common coexisting chronic condition among older adults that can complicate a hospitalization and transition back to the community. The Transitional Care Model, which offers a set of time-limited, hospital-to-home services coordinated by a master's-prepared advanced practice nurse, is one option that could improve outcomes for patients with diabetes. A descriptive case study is presented. PMID:26246779

  16. Transitions in Care from the Hospital to Home for Patients With Diabetes.

    PubMed

    Hirschman, Karen B; Bixby, M Brian

    2014-08-01

    In Brief Diabetes is a common coexisting chronic condition among older adults that can complicate a hospitalization and transition back to the community. The Transitional Care Model, which offers a set of time-limited, hospital-to-home services coordinated by a master's-prepared advanced practice nurse, is one option that could improve outcomes for patients with diabetes. A descriptive case study is presented.

  17. [Comprehensive geriatric assessment in older patients with diabetes mellitus].

    PubMed

    Araki, Atsushi

    2013-11-01

    Because the prevalence of older old patients with diabetes is increasing in Japan, diabetic patients with physical or cognitive impairment are also becoming to be more prevalent in clinical practice. The comprehensive geriatric assessment (CGA) consists of 5 important domains: physical function (basic ADL, instrumental ADL, vision, etc.), psychological function, mental function, socio-economic conditions, and patient's preference. The functions in CGA can be used as predictors for prognosis, a tool for early diagnosis of dementia, assessment tool of patient's capacity for insulin self-injection, and outcomes of diabetes treatment. The CGA is also useful in performing a patient-centered approach to improve the physical, psychological, and mental functions as well as to individualize a treatment goal of HbA1c in elderly patients with diabetes mellitus.

  18. Contrasting patient and practitioner perspectives in type 2 diabetes management.

    PubMed

    Hunt, L M; Arar, N H; Larme, A C

    1998-12-01

    Studies of self-care behaviors in the management of type 2 diabetes often focus on patient knowledge and motivation, without considering the role of practitioner orientations. Using an exploratory descriptive design, we conducted open-ended interviews with 51 type 2 diabetes patients and 35 practitioners from clinics in San Antonio and Laredo, Texas. We found critical differences between patient and practitioner goals, evaluations, and strategies in diabetes management, especially regarding such key concepts as "control" and "taking care of self". Practitioners' perspectives are rooted in a clinical context, emphasizing technical considerations, whereas patients' perspectives exist within a life-world context and foreground practical and experiential considerations. These result in very different approaches to treatment. Practitioners, presuming failed treatment indicates uncooperativeness, try to inform and motivate patients. The patients we interviewed, however, understood and were committed to type 2 diabetes self-care, but lacked full access to behavioral options due to their poverty and limited social power. PMID:9842286

  19. [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. PMID:1755544

  20. Correlation between Microalbuminuria and Hypertension in Type 2 Diabetic Patients

    PubMed Central

    Ali, Alia; Taj, Azeem; Amin, Muhammad Joher; Iqbal, Farrukh; Iqbal, Zafar

    2014-01-01

    Background: Hypertension is commonly found in patients with Diabetic Kidney Disease (DKD). Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. Objectives: To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. Methods: One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Results: Patients were divided into two groups. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50). Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. Conclusion: The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients. PMID:24948969

  1. What the radiologist needs to know about the diabetic patient.

    PubMed

    Raptis, Athanasios E; Markakis, Konstantinos P; Mazioti, Maria C; Raptis, Sotirios A; Dimitriadis, George D

    2011-04-01

    Diabetes mellitus (DM) is recognised as a major health problem. Ninety-nine percent of diabetics suffer from type 2 DM and 10% from type 1 and other types of DM. The number of diabetic patients worldwide is expected to reach 380 millions over the next 15 years. The duration of diabetes is an important factor in the pathogenesis of complications, but other factors frequently coexisting with type 2 DM, such as hypertension, obesity and dyslipidaemia, also contribute to the development of diabetic angiopathy. Microvascular complications include retinopathy, nephropathy and neuropathy. Macroangiopathy mainly affects coronary arteries, carotid arteries and arteries of the lower extremities. Eighty percent of deaths in the diabetic population result from cardiovascular incidents. DM is considered an equivalent of coronary heart disease (CHD). Stroke and peripheral artery disease (PAD) are other main manifestations of diabetic macroangiopathy. Diabetic cardiomyopathy (DC) represents another chronic complication that occurs independently of CHD and hypertension. The greater susceptibility of diabetic patients to infections completes the spectrum of the main consequences of DM. The serious complications of DM make it essential for physicians to be aware of the screening guidelines, allowing for earlier patient diagnosis and treatment. PMID:22347947

  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. 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

  4. 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. PMID:24719247

  5. 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.

  6. Type 2 Diabetes Treatment in the Patient with Obesity.

    PubMed

    Malin, Steven K; Kashyap, Sangeeta R

    2016-09-01

    Lifestyle modification is the cornerstone treatment of type 2 diabetes in the obese patient, and is highly effective at promoting glucose regulation. However, many individuals struggle over time to maintain optimal glycemic control and/or body weight with lifestyle modification. Therefore, additional therapeutic approaches are needed. Pharmacologic interventions have shown promising results for obesity-related diabetes complications. Not surprisingly though lifestyle modification and pharmacology may become ineffective for treating diabetes over time. Bariatric surgery is considered by some, but not all, to be the most effective and durable treatment for combating obesity. In fact many patients with type 2 diabetes have normalized glucose concentrations within days postoperation. Taken together, treatment of obesity in the patient with type 2 diabetes requires a multi-faceted approach. PMID:27519130

  7. Candidate gene association study for diabetic retinopathy in Chinese patients with type 2 diabetes

    PubMed Central

    Yang, Xiufen; Deng, Yu; Gu, Hong; Ren, Xuetao; Li, Na; Lim, Apiradee; Snellingen, Torkel; Liu, Xipu; Wang, Ningli

    2014-01-01

    Purpose To investigate whether variants in a set of eight candidate genes are associated with diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). Methods Case-control study. Patients with T2DM were recruited from the Desheng community in urban Beijing and assigned into a DR group or diabetic without retinopathy (DWR) group, based on the duration of diabetes and grading of fundus images. Twenty-six single-nucleotide polymorphisms (SNPs) within eight candidate genes, including PPARγ, vascular endothelial growth factor (VEGF) and its receptor kinase insert domain receptor (KDR), erythropoietin, aldose reductase, protein kinase C-β, angiotensin-converting enzyme, and intercellular adhesion molecule 1, were analyzed using the MassARRAY genotyping system. Results A total of 500 patients with T2DM (216 with DR and 284 with DWR) were enrolled in the study. Significant associations of DR were noted with genotypes of four SNPs—rs699947 (p<0.001), rs833061 (p=0.001), rs13207351 (p<0.001), and rs2146323 (p=0.006)—in the VEGF gene and one variant, rs2071559, in the KDR gene (p=0.034). After adjustment for covariates, significant association of DR remained with the homozygous genotype of the minor allele for the SNPs rs699947 (odds ratio [OR] = 3.54, 95% confidence interval [CI]: 1.12–11.19), rs833061 (OR = 3.72, 95% CI: 1.17–11.85), rs13207351 (OR = 3.76, 95% CI: 1.21–11.71), and rs2146323 (OR = 2.8, 95% CI: 1.46–5.37) in the VEGF gene as well as the SNP rs2071559 (OR = 1.62, 95% CI: 1.08–2.41) in the KDR gene. However, only rs699947 and rs13207351 in the VEGF gene remained statistically significant after Bonferroni correction. No associations were found in other genes tested. Conclusions These data expanded previous observations on the association of DR with variants in the VEGF gene in Chinese patients with T2DM. Moreover, a possible association between DR and KDR polymorphisms is suggested. PMID:24623964

  8. Lymphocytic mastitis and diabetic mastopathy: a molecular, immunophenotypic, and clinicopathologic evaluation of 11 cases.

    PubMed

    Valdez, Riccardo; Thorson, John; Finn, William G; Schnitzer, Bertram; Kleer, Celina G

    2003-03-01

    Lymphocytic mastitis and diabetic mastopathy are uncommon fibroinflammatory breast diseases. The lesions seen in these entities are unique in that the associated lymphoid infiltrates are composed of predominantly B cells. In addition, B-cell lymphoepithelial lesions, a finding commonly associated with extranodal marginal zone B-cell/mucosa-associated lymphoid tissue (MALT) lymphomas, are also often present in lymphocytic mastitis and diabetic mastopathy. Although the clinical and immunomorphologic features are well characterized, the clonality of the B-cell infiltrate and the lymphomatous potential of lymphocytic mastitis and diabetic mastopathy have not been emphasized in the literature. We evaluated 11 cases of lymphocytic mastitis/diabetic mastopathy for immunoglobulin heavy chain gene rearrangement and correlated the findings with all available clinical data. A longstanding history of Type I diabetes mellitus was present in seven patients. One nondiabetic patient had Sjogren's syndrome, and two patients had no history of diabetes mellitus or other autoimmune disease. Clinical data were unavailable for one patient. B-cell-predominant lymphoid infiltrates were seen in all cases, and B-cell lymphoepithelial lesions were found in five. No evidence of a B-cell clone was found in any of the 11 cases by appropriately controlled immunoglobulin heavy chain gene rearrangement studies, and none of the patients developed lymphoma during follow-up intervals ranging from 2-126 months. These findings suggest that despite the presence of B-cell-predominant lymphoid infiltrates and lymphoepithelial lesions, lymphocytic mastitis and diabetic mastopathy do not appear to be associated with an increased risk for lymphoma. PMID:12640102

  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. 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

  12. Oral health related quality of life in diabetic patients.

    PubMed

    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

  13. Factors Related to Perceived Diabetes Control Are Not Related to Actual Glucose Control for Minority Patients With Diabetes

    PubMed Central

    McAndrew, Lisa M.; Horowitz, Carol R.; Lancaster, Kristie J.; Leventhal, Howard

    2010-01-01

    OBJECTIVE To examine variables associated with perceived diabetes control compared with an objective measure of glucose control (A1C). RESEARCH DESIGN AND METHODS Beliefs about diabetes were assessed among 334 individuals with diabetes living in a primarily low-income, minority, urban neighborhood. Regression analyses tested associations between disease beliefs and both participants' perceptions of control and actual control (A1C). RESULTS Poorer perceived diabetes control was associated with perceiving a greater impact of diabetes, greater depressive symptoms, not following a diabetic diet, A1C, and a trend toward less exercise. Variables associated with better actual control (A1C) included higher BMI, older age, and not using insulin. CONCLUSIONS Patients' perceptions of their diabetes control are informed by subjective diabetes cues (e.g., perceived impact of diabetes and adherence to a diabetic diet), which are not related to A1C. Clinicians should take into account what cues patients are using to assess their diabetes control. PMID:20067972

  14. 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

  15. Evidence for a Specific Diabetic Cardiomyopathy: An Observational Retrospective Echocardiographic Study in 656 Asymptomatic Type 2 Diabetic Patients.

    PubMed

    Pham, Isabelle; Cosson, Emmanuel; Nguyen, Minh Tuan; Banu, Isabela; Genevois, Isabelle; Poignard, Patricia; Valensi, Paul

    2015-01-01

    Aim. Our aim was to assess the prevalence of subclinical diabetic cardiomyopathy, occurring among diabetic patients without hypertension or coronary artery disease (CAD). Methods. 656 asymptomatic patients with type 2 diabetes for 14 ± 8 years (359 men, 59.7 ± 8.7 years old, HbA1c 8.7 ± 2.1%) and at least one cardiovascular risk factor had a cardiac echography at rest, a stress cardiac scintigraphy to screen for silent myocardial ischemia (SMI), and, in case of SMI, a coronary angiography to screen for silent CAD. Results. SMI was diagnosed in 206 patients, and 71 of them had CAD. In the 157 patients without hypertension or CAD, left ventricular hypertrophy (LVH: 24.1%) was the most frequent abnormality, followed by left ventricular dilation (8.6%), hypokinesia (5.3%), and systolic dysfunction (3.8%). SMI was independently associated with hypokinesia (odds ratio 14.7 [2.7-81.7], p < 0.01) and systolic dysfunction (OR 114.6 [1.7-7907], p < 0.01), while HbA1c (OR 1.9 [1.1-3.2], p < 0.05) and body mass index (OR 1.6 [1.1-2.4], p < 0.05) were associated with systolic dysfunction. LVH was more prevalent among hypertensive patients and hypokinesia in the patients with CAD. Conclusion. In asymptomatic type 2 diabetic patients, diabetic cardiomyopathy is highly prevalent and is predominantly characterized by LVH. SMI, obesity, and poor glycemic control contribute to structural and functional LV abnormalities. PMID:26074964

  16. Evidence for a Specific Diabetic Cardiomyopathy: An Observational Retrospective Echocardiographic Study in 656 Asymptomatic Type 2 Diabetic Patients.

    PubMed

    Pham, Isabelle; Cosson, Emmanuel; Nguyen, Minh Tuan; Banu, Isabela; Genevois, Isabelle; Poignard, Patricia; Valensi, Paul

    2015-01-01

    Aim. Our aim was to assess the prevalence of subclinical diabetic cardiomyopathy, occurring among diabetic patients without hypertension or coronary artery disease (CAD). Methods. 656 asymptomatic patients with type 2 diabetes for 14 ± 8 years (359 men, 59.7 ± 8.7 years old, HbA1c 8.7 ± 2.1%) and at least one cardiovascular risk factor had a cardiac echography at rest, a stress cardiac scintigraphy to screen for silent myocardial ischemia (SMI), and, in case of SMI, a coronary angiography to screen for silent CAD. Results. SMI was diagnosed in 206 patients, and 71 of them had CAD. In the 157 patients without hypertension or CAD, left ventricular hypertrophy (LVH: 24.1%) was the most frequent abnormality, followed by left ventricular dilation (8.6%), hypokinesia (5.3%), and systolic dysfunction (3.8%). SMI was independently associated with hypokinesia (odds ratio 14.7 [2.7-81.7], p < 0.01) and systolic dysfunction (OR 114.6 [1.7-7907], p < 0.01), while HbA1c (OR 1.9 [1.1-3.2], p < 0.05) and body mass index (OR 1.6 [1.1-2.4], p < 0.05) were associated with systolic dysfunction. LVH was more prevalent among hypertensive patients and hypokinesia in the patients with CAD. Conclusion. In asymptomatic type 2 diabetic patients, diabetic cardiomyopathy is highly prevalent and is predominantly characterized by LVH. SMI, obesity, and poor glycemic control contribute to structural and functional LV abnormalities.

  17. Evidence for a Specific Diabetic Cardiomyopathy: An Observational Retrospective Echocardiographic Study in 656 Asymptomatic Type 2 Diabetic Patients

    PubMed Central

    Pham, Isabelle; Cosson, Emmanuel; Nguyen, Minh Tuan; Banu, Isabela; Genevois, Isabelle; Poignard, Patricia; Valensi, Paul

    2015-01-01

    Aim. Our aim was to assess the prevalence of subclinical diabetic cardiomyopathy, occurring among diabetic patients without hypertension or coronary artery disease (CAD). Methods. 656 asymptomatic patients with type 2 diabetes for 14 ± 8 years (359 men, 59.7 ± 8.7 years old, HbA1c 8.7 ± 2.1%) and at least one cardiovascular risk factor had a cardiac echography at rest, a stress cardiac scintigraphy to screen for silent myocardial ischemia (SMI), and, in case of SMI, a coronary angiography to screen for silent CAD. Results. SMI was diagnosed in 206 patients, and 71 of them had CAD. In the 157 patients without hypertension or CAD, left ventricular hypertrophy (LVH: 24.1%) was the most frequent abnormality, followed by left ventricular dilation (8.6%), hypokinesia (5.3%), and systolic dysfunction (3.8%). SMI was independently associated with hypokinesia (odds ratio 14.7 [2.7–81.7], p < 0.01) and systolic dysfunction (OR 114.6 [1.7–7907], p < 0.01), while HbA1c (OR 1.9 [1.1–3.2], p < 0.05) and body mass index (OR 1.6 [1.1–2.4], p < 0.05) were associated with systolic dysfunction. LVH was more prevalent among hypertensive patients and hypokinesia in the patients with CAD. Conclusion. In asymptomatic type 2 diabetic patients, diabetic cardiomyopathy is highly prevalent and is predominantly characterized by LVH. SMI, obesity, and poor glycemic control contribute to structural and functional LV abnormalities. PMID:26074964

  18. Comparison of Manual Refraction Versus Autorefraction in 60 Diabetic Retinopathy Patients

    PubMed Central

    Shirzadi, Keyvan; Shahraki, Kourosh; Yahaghi, Emad; Makateb, Ali; Khosravifard, Keivan

    2016-01-01

    Aim: The purpose of the study was to evaluate the comparison of manual refraction versus autorefraction in diabetic retinopathy patients. Material and Methods: The study was conducted at the Be’sat Army Hospital from 2013-2015. In the present study differences between two common refractometry methods (manual refractometry and Auto refractometry) in diagnosis and follow up of retinopathy in patients affected with diabetes is investigated. Results: Our results showed that there is a significant difference in visual acuity score of patients between manual and auto refractometry. Despite this fact, spherical equivalent scores of two methods of refractometry did not show a significant statistical difference in the patients. Conclusion: Although use of manual refraction is comparable with autorefraction in evaluating spherical equivalent scores in diabetic patients affected with retinopathy, but in the case of visual acuity results from these two methods are not comparable. PMID:27703289

  19. Approach to the Patient with Gestational Diabetes after Delivery

    PubMed Central

    Page, Kathleen A.

    2011-01-01

    The diagnosis of gestational diabetes mellitus (GDM) identifies patients with a pancreatic β-cell defect. In some patients, the defect is transient or stable, but in most it is progressive, imparting a high risk of diabetes for at least a decade after the index pregnancy. The β-cell defects in GDM can result from many causes, including genetic variants typical of monogenic forms of diabetes and autoimmunity typical of evolving type 1 diabetes. No specific disease-modifying therapies are available for those patients. The majority of women with GDM have clinical characteristics indicating a risk for type 2 diabetes (T2D). Available evidence indicates that T2D can be prevented or delayed by intensive lifestyle modification and by medications, particularly those that ameliorate insulin resistance. Clinical management should include assessment of glucose tolerance in the postpartum period to detect diabetes or assess diabetes risk. Women who don't have diabetes should be advised about their risk and participate in family planning to prevent subsequent pregnancies with undiagnosed hyperglycemia. All patients should be monitored for rising glycemia indicative of progressive β-cell deterioration. We suggest a combination of fasting glucose and glycosylated hemoglobin measurements for this purpose. Monitoring should be initiated at least annually and should be intensified if glycemia is rising and/or impaired. Lifestyle modification is advised to reduce the risk for T2D. Like monitoring, lifestyle modification should be intensified for rising glycemia and/or development of impaired glucose levels. At present, there is insufficient evidence to recommend medications to prevent T2D. Close follow-up and monitoring will allow initiation of pharmacological treatment as soon as diabetes develops. Children of women with GDM are at increased risk for obesity and diabetes. They should receive education, monitoring, and lifestyle advice to minimize obesity and diabetes risk. PMID

  20. Pioglitazone for the treatment of type 2 diabetes in patients inadequately controlled on insulin

    PubMed Central

    Schwartz, Stanley S

    2010-01-01

    Insulin resistance and impaired beta-cell function are primary defects that occur early in the course of development of type 2 diabetes. Insulin resistance leads to hyperinsulinemia in order to maintain normal glucose tolerance. In most cases of type 2 diabetes, beta-cell dysfunction develops subsequent to the development of insulin resistance, and it is not until such beta-cell dysfunction develops that any abnormality in glucose tolerance is seen. Insulin resistance is a primary defect in type 2 diabetes. The risk of coronary heart disease is significantly increased in patients with type 2 diabetes. Cardiovascular disease causes 80% of all diabetic mortality, and in 75% of those cases, it is a result of coronary atherosclerosis. These points provide a rationale for early and aggressive management of cardiovascular risk in patients with diabetes. Thiazolidinediones represent an effective tool for targeting some features of this increased risk as they decrease insulin resistance and can prevent and/or delay diabetes progression. PMID:21437092

  1. Are antiresorptive drugs effective against fractures in patients with diabetes?

    PubMed

    Vestergaard, Peter; Rejnmark, Lars; Mosekilde, Leif

    2011-03-01

    We studied whether the reduction in bone turnover by use of antiresorptive drugs is detrimental in patients with diabetes who already have low bone turnover due to hyperglycemia in a nationwide cohort study from Denmark. All users of antiresorptive drugs against osteoporosis between 1996 and 2006 (n = 103,562) were the exposed group, with three age- and gender-matched controls from the general population (n = 310,683). Patients on bisphosphonates and raloxifene had a higher risk of hip, spine, and forearm fractures. However, no difference was observed in the antifracture efficacy between patients with diabetes and nondiabetic controls or between patients with type 1 and type 2 diabetes. Too few were users of strontium to allow analysis for this compound. The excess risk of fractures among patients treated with bisphosphonates or raloxifene compared to nonexposed controls was due to the higher a priori risk of fractures among patients treated for osteoporosis. Diabetes does not seem to affect the fracture-preventive potential of bisphosphonates or raloxifene. The low-turnover state of diabetes thus does not seem to be a hindrance to the effect of these drugs against osteoporosis. Therefore, patients with diabetes should receive treatment for osteoporosis in the same way as nondiabetic patients. PMID:21161194

  2. Successful Management of Tardive Dyskinesia with Quetiapine and Clonazepam in a Patient of Schizophrenia with Type 2 Diabetes Mellitus.

    PubMed

    Mohapatra, Satyakam

    2016-05-31

    Tardive dyskinesia is one of the most significant side effects of antipsychotic medications. Antipsychotic treated schizophrenia patients with diabetes mellitus are more likely to develop tardive dyskinesia than those without diabetes. Clozapine is probably best supported for management of tardive dyskinesia. But clozapine has been strongly linked to hyperglycaemia and impaired glucose tolerance, so it is not preferred in patients with diabetes mellitus. We present a case of 35-year-old male with a diagnosis of schizophrenia and type 2 diabetes mellitus with tardive dyskinesia, who was successfully treated with quetiapine and clonazepam. PMID:27121435

  3. Successful Management of Tardive Dyskinesia with Quetiapine and Clonazepam in a Patient of Schizophrenia with Type 2 Diabetes Mellitus

    PubMed Central

    Mohapatra, Satyakam

    2016-01-01

    Tardive dyskinesia is one of the most significant side effects of antipsychotic medications. Antipsychotic treated schizophrenia patients with diabetes mellitus are more likely to develop tardive dyskinesia than those without diabetes. Clozapine is probably best supported for management of tardive dyskinesia. But clozapine has been strongly linked to hyperglycaemia and impaired glucose tolerance, so it is not preferred in patients with diabetes mellitus. We present a case of 35-year-old male with a diagnosis of schizophrenia and type 2 diabetes mellitus with tardive dyskinesia, who was successfully treated with quetiapine and clonazepam. PMID:27121435

  4. [Efficiency of cerebrolysin in the diabetic polyneuropathy in patients with insulin-dependency diabetes mellitus].

    PubMed

    Bogdanov, E I; Sakovets, T G

    2011-01-01

    78 patients with clinical features of diabetic polyneuropathy have been examined. 39 patients, who took cerebrolysin, compose the basic group, 39 patients, who made up control one, took milgamma. The dynamics of clinical signs of the diabetic polyneuropathy was evaluated by difference of points in the first and the second examination with the use of scales: NSC (Neuropathy Symptoms and Change) and NDS (Neuropathy Dysfunction Score); the visual analog scale (VAS) and changes of the signs of orthostatic test. For the detection of the effectiveness of treatment was estimated dynamics of neuropathic disorders represented in patient with diabetes mellitus types I and II (with secondary insulin-dependency), witch allowed to reveal the considerable therapeutic effectiveness of cerebrolysin in treatment of diabetic polyneuropathic disorders.

  5. Supporting patients with type 1 diabetes.

    PubMed

    Phillips, Anne

    Type 1 diabetes is an autoimmune condition that is mediated by genetic, immunologic and environmental factors. Its prevalence is further complicated by increasing obesity levels, and this can make diagnosis complicated. Health professionals play a key role in enablement and optimising person-centred care approaches to educate and augment the essential skills required for successful self-management of this lifelong condition. This article reflects on the physiology and aetiology of type 1 diabetes and prevalence and considers recent guidance from the National Institute for Health and Care Excellence for adults with type 1 diabetes (NG17) and for children and young people with type 1 and type 2 diabetes (NG18).

  6. 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

  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. PMID:26640706

  8. 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. PMID:24380085

  9. Ocular surface changes in type II diabetic patients with proliferative diabetic retinopathy

    PubMed Central

    Gao, Yan; Zhang, Yan; Ru, Yu-Sha; Wang, Xiao-Wu; Yang, Ji-Zhong; Li, Chun-Hui; Wang, Hong-Xing; Li, Xiao-Rong; Li, Bing

    2015-01-01

    AIM To detect and analyze the changes on ocular surface and tear function in type II diabetic patients with proliferative diabetic retinopathy (PDR), an advanced stage of diabetic retinopathy (DR), using conventional ophthalmic tests and the high-resolution laser scanning confocal microscopy. METHODS Fifty-eight patients with type II diabetes were selected. Based on the diagnostic criteria and stage classification of DR, the patients were divided into the non-DR (NDR) group and the PDR group. Thirty-six patients with cataract but no other ocular and systemic disease were included as non-diabetic controls. All the patients were subjected to the conventional clinical tests of corneal sensitivity, Schirmer I Test, and corneal fluorescein staining. The non-invasive tear film break-up time (NIBUT) and tear interferometry were conducted by a Tearscope Plus. The morphology of corneal epithelia and nerve fibers was examined using the high-resolution confocal microscopy. RESULTS The NDR group exhibited significantly declined corneal sensitivity and Schirmer I test value, as compared to the non-diabetic controls (P< 0.001). The PDR group showed significantly reduced corneal sensitivity, Schirmer I test value, and NIBUT in comparison to the non-diabetic controls (P < 0.001). Corneal fluorescein staining revealed the progressively injured corneal epithelia in the PDR patients. Moreover, significant decrease in the corneal epithelial density and morphological abnormalities in the corneal epithelia and nerve fibers were also observed in the PDR patients. CONCLUSION Ocular surface changes, including blunted corneal sensitivity, reduced tear secretion, tear film dysfunction, progressive loss of corneal epithelia and degeneration of nerve fibers, are common in type II diabetic patients, particularly in the diabetic patients with PDR. The corneal sensitivity, fluorescein staining scores, and the density of corneal epithelial cells and nerve fibers in the diabetic patients correlate

  10. Glycemic management in diabetes and the associated cardiovascular risk: are we helping or hurting our patients?

    PubMed

    Koshizaka, Masaya; Green, Jennifer B; Alexander, John H

    2012-01-01

    Diabetes, which is a metabolic disorder with multiple comorbidities, increases the risk of cardiovascular disease. Although it was once assumed that controlling plasma glucose levels would reduce diabetes-related morbidity and mortality, recent trials have demonstrated that this is not consistently the case. Data from large, well-designed trials suggest that intensive glycemic therapy may be useful in preventing cardiovascular events if initiated early in the disease course, but may be harmful or not useful if applied to high-risk patients with a longer history of diabetes. Furthermore, the cardiovascular safety of existing individual antihyperglycemic agents remains largely unknown. We review the relationship between glycemic control targets and cardiovascular outcomes, as well as the current understanding of the cardiovascular effects of existing glucose-lowering therapies. This information has affected recommendations for diabetes care in Japan and the United States differently, and supports a more comprehensive and prospective approach to cardiovascular safety assessments of diabetes therapies in the future. Results from ongoing cardiovascular outcomes trials of diabetes medications may help to define optimal glucose-lowering strategies for patients at high risk of cardiovascular complications. Until then, glycemic control targets and the medications used to achieve them should be individualized according to each patient's age, duration of diabetes, risk of hypoglycemia, risk of cardiovascular complications, and life expectancy.

  11. Immune dysfunction in patients with diabetes mellitus (DM).

    PubMed

    Geerlings, S E; Hoepelman, A I

    1999-12-01

    Patients with diabetes mellitus (DM) have infections more often than those without DM. The course of the infections is also more complicated in this patient group. One of the possible causes of this increased prevalence of infections is defects in immunity. Besides some decreased cellular responses in vitro, no disturbances in adaptive immunity in diabetic patients have been described. Different disturbances (low complement factor 4, decreased cytokine response after stimulation) in humoral innate immunity have been described in diabetic patients. However, the clinical relevance of these findings is not clear. Concerning cellular innate immunity most studies show decreased functions (chemotaxis, phagocytosis, killing) of diabetic polymorphonuclear cells and diabetic monocytes/macrophages compared to cells of controls. In general, a better regulation of the DM leads to an improvement of these cellular functions. Furthermore, some microorganisms become more virulent in a high glucose environment. Another mechanism which can lead to the increased prevalence of infections in diabetic patients is an increased adherence of microorganisms to diabetic compared to nondiabetic cells. This has been described for Candida albicans. Possibly the carbohydrate composition of the receptor plays a role in this phenomenon.

  12. Approach to diabetes management in patients with CVD.

    PubMed

    Lathief, Sanam; Inzucchi, Silvio E

    2016-02-01

    Epidemiologic analyses have established a clear association between diabetes and macrovascular disease. Vascular dysfunction caused by metabolic abnormalities in patients with diabetes is associated with accelerated atherosclerosis and increased risk of myocardial infarction (MI), stroke, and peripheral arterial disease. Patients with diabetes are at two to four fold higher CV risk as compared to non-diabetic individuals, and CVD remains the leading cause of mortality in patients with this condition. One strategy to reduce CVD burden in patients with diabetes has been to focus on controlling the major metabolic abnormality in this condition, namely hyperglycemia. However, this has not been unequivocally demonstrated to reduced CV events, in contrast to controlling other CVD risk factors linked to hyperglycemia, such as blood pressure, dyslipidemia, and platelet dysfunction. However, In contradistinction, accrued data from a number of large, randomized clinical trials in both type 1 (T1DM) and type 2 diabetes (T2DM) over the past 3 decades have proven that more intensive glycemic control retards the onset and progression of microvascular disease. In this review, we will summarize the key glucose-lowering CV outcomes trials in diabetes, provide an overview of the different drugs and their impact on the CV system, and describe our approach to management of the frequently encountered patient with T2DM and coronary artery disease (CAD) and/or heart failure (HF).

  13. 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

  14. Diabetes Is a Risk Factor for Pulmonary Tuberculosis: A Case-Control Study from Mwanza, Tanzania

    PubMed Central

    Faurholt-Jepsen, Daniel; Range, Nyagosya; PrayGod, George; Jeremiah, Kidola; Faurholt-Jepsen, Maria; Aabye, Martine Grosos; Changalucha, John; Christensen, Dirk Lund; Pipper, Christian Bressen; Krarup, Henrik; Witte, Daniel Rinse; Andersen, Aase Bengaard; Friis, Henrik

    2011-01-01

    Background Diabetes and TB are associated, and diabetes is increasingly common in low-income countries where tuberculosis (TB) is highly endemic. However, the role of diabetes for TB has not been assessed in populations where HIV is prevalent. Methods A case-control study was conducted in an urban population in Tanzania among culture-confirmed pulmonary TB patients and non-TB neighbourhood controls. Participants were tested for diabetes according to WHO guidelines and serum concentrations of acute phase reactants were measured. The association between diabetes and TB, and the role of HIV as an effect modifier, were examined using logistic regression. Since blood glucose levels increase during the acute phase response, we adjusted for elevated serum acute phase reactants. Results Among 803 cases and 350 controls the mean (SD) age was 34.8 (11.9) and 33.8 (12.0) years, and the prevalence of diabetes was 16.7% (95% CI: 14.2; 19.4) and 9.4% (6.6; 13.0), respectively. Diabetes was associated with TB (OR 2.2, 95% CI: 1.5; 3.4, p<0.001). However, the association depended on HIV status (interaction, p = 0.01) due to a stronger association among HIV uninfected (OR 4.2, 95% CI: 1.5; 11.6, p = 0.01) compared to HIV infected (OR 0.1, 95% CI: 0.01; 1.8, p = 0.13) after adjusting for age, sex, demographic factors and elevated serum acute phase reactants. Conclusion Diabetes is a risk factor for TB in HIV uninfected, whereas the association in HIV infected patients needs further study. The increasing diabetes prevalence may be a threat to TB control. PMID:21912626

  15. 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

  16. 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.

  17. 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

  18. Retinopathy and microalbuminuria in type II diabetic patients

    PubMed Central

    Manaviat, Masoud R; Afkhami, Mohammad; Shoja, Mohammad R

    2004-01-01

    Background The aim of this study was to identify risk factors for the development of retinopathy and microalbuminuria and their correlation in type II diabetic patients. Methods In this cross-sectional study 590 patients suffering from diabetis type II were examined. Fundoscopy was performed by practising ophthalmologist. The ratio of urinary albumin to creatinine was assessed by clinitek 100 (Bayer corporation–USA). HbA1C, height and weight also were measured. Results The overall prevalence of retinopathy was 39.3% (232 patients), 5.4% of which showed to be prolifrative diabetic retinopathy (PDR). The diabetic retinopathy had significant inverse correlation with body mass index (BMI) (P = 0.02). HbA1C was higher in patients with PDR (mean = 10.5%) than in patients with no signs of retinopathy (mean = 9.5%) and this difference was statistically significant (P = 0.001). The prevalence of microalbuminuria was 25.9% while 14.5% of the patients revealed to have macroalbuminuria. As expected, diabetic retinopathy and renal involvement were highly positively correlated. (P = 0.001). Conclusion Microalbuminuria is associated with diabetic retinopathy in type II diabetic patients and is a reliable marker of retinopathy. PMID:15228626

  19. Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure.

    PubMed

    Grande Villoria, J; Macias Nunez, J F; Miralles, J M; De Castro del Pozo, S; Tabernero Romo, J M

    1988-01-01

    Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

  20. Gestational diabetes insipidus, HELLP syndrome and eclampsia in a twin pregnancy: a case report.

    PubMed

    Woelk, J L; Dombroski, R A; Brezina, P R

    2010-02-01

    We report a case of eclampsia in a twin pregnancy complicated by HELLP syndrome and diabetes insipidus. This confluence of disease processes suggests that a modification of common magnesium sulfate treatment protocols may be appropriate in a certain subset of patients.

  1. Urinary biomarkers for early diabetic nephropathy in type 2 diabetic patients.

    PubMed

    Fiseha, Temesgen

    2015-01-01

    Diabetic nephropathy (DN) is a serious complication of diabetes associated with increased risk of mortality, and cardiovascular and renal outcomes. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. Urinary biomarkers may be elevated in diabetic patients even before the appearance of microalbuminuria, and can be used as useful marker for detecting nephropathy in patients with normoalbuminuria (early DN). We reviewed some new and important urinary biomarkers, such as: Neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase (NAG), Cystatin C, alpha 1-microglobulin, immunoglobulin G or M, type IV collagen, nephrin, angiotensinogen and liver-type fatty acid-binding protein (L-FABP) associated with early DN in type 2 diabetic patients. Our search identified a total of 42 studies that have been published to date. Urinary levels of these biomarkers were elevated in type 2 diabetic patients compared with non-diabetic controls, including in patients who had no signs indicating nephropathy (without microalbuminuria), and showed positive correlation with albuminuria. Despite the promise of these new urinary biomarkers, further large, multicenter prospective studies are still needed to confirm their clinical utility as a screening tool for early type 2 DN in every day practice. PMID:26146561

  2. Diabetes self-care behaviours and clinical outcomes among Taiwanese patients with type 2 diabetes.

    PubMed

    Ouyang, Chung-Mei; Dwyer, Johanna T; Jacques, Paul F; Chuang, Lee-Ming; Haas, Catherine F; Weinger, Katie

    2015-01-01

    We examined the influences of patients' background characteristics on the frequency of performing five diabetes self-care behaviours that 185 Taiwanese outpatients reported. All patients had type 2 diabetes diagnosed for more than a year and attended an outpatient clinic at a large university hospital where they had received at least one dietitian-led individual nutrition education session and one nurse-led diabetes education session during the course of their care. Seventy nine percent of the patients regularly (defined as responses often or always on the questionnaire) took their medications and over half followed recommended meal plans and exercised, but fewer performed foot care (38%) or checked their blood glucose levels (20%) regularly. The associations between patients' demographics and disease-related characteristics and their performance of self-care behaviours were assessed with logistic regression. Although checking blood glucose levels and performing diabetes foot care were unrelated to any clinical outcome examined, patients who took their diabetes medications had lower hemoglobin A1c levels and fewer chronic complications than those who did not. Furthermore, patients who followed a diabetes meal plan also had lower hemoglobin A1c levels, and those who exercised regularly had healthier body mass indices (BMI) than those who did not. PMID:26420184

  3. 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.

  4. 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. PMID:21136122

  5. 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.

  6. [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.

  7. [Intracranial hypertension in severe diabetic ketoacidosis with coma. Two cases].

    PubMed

    Blanc, P L; Bedock, B; Jay, S; Martin, A; Marc, J M

    1994-11-19

    We observed two cases of severe diabetic ketoacidosis with coma and shock. In one case, coma was present at admission and in the second occurred within 15 hours. In both cases, intracranial hypertension was confirmed with an extradural captor. These findings are in agreement with observations of brain oedema in diabetic ketoacidosis with coma. Clinical data suggest that brain oedema may occur after a latency period but that clinical expression is much more rare, perhaps favoured by treatment (excessive rehydratation, alkalinization, too sharp drop in blood glucose level). In our cases, despite major fluid infusion, shock persisted requiring norepinephrine. This shock could have been the expression of the severe ketoacidosis or have resulted from an underlying infection. In case of sudden onset coma, a regularly encountered manifestation of brain oedema, respiratory assistance and mannitol infusion must be instituted rapidly. With this type of management, it should be possible to improve the severe prognosis of brain oedema in diabetic ketoacidosis. PMID:7899292

  8. Imaging Features of Pulmonary CT in Type 2 Diabetic Patients with Multidrug-Resistant Tuberculosis

    PubMed Central

    Jiang, Hongbo; Ren, Yanwei; Lu, Xiwei

    2016-01-01

    Background Until now, radiographic manifestations of multidrug-resistant pulmonary tuberculosis (MDR- TB) in patients with diabetes mellitus (DM) have not been reported. We conducted a study to investigate the imaging features of pulmonary computed tomography (CT) for type 2 diabetic (T2DM) patients with MDR-TB. Methods The clinical data and pulmonary CT findings of 39 type 2 diabetic patients with MDR-TB, 46 type 2 diabetic patients with drug-susceptible tuberculosis (DS-TB), and 72 pure drug-susceptible TB cases (without T2DM and MDR) treated at Dalian Tuberculosis Hospital from 2012 to 2015 were collected, and the clinical features and imaging differences of the three groups were compared. Results The clinical characteristics of the three groups of patients were not significantly different except with respect to age and previous treatment history. However, on imaging, the patients with MDR-TB showed consolidation in and above the pulmonary segments was significantly more extensive than that seen in the DS-TB group with or without T2DM. Conclusion Consolidation in or above multiple pulmonary segments with multiple mouth-eaten cavities and bronchial damage on pulmonary CT images in type 2 diabetic patients with tuberculosis suggests the possibility of multi-drug resistance. PMID:27022735

  9. Antibodies to new beta cell antigen ICA12 in Latvian diabetes patients.

    PubMed

    Shtauvere-Brameus, A; Hagopian, W; Rumba, I; Sanjeevi, C B

    2002-04-01

    In Latvia diabetes mellitus is diagnosed using the WHO's clinical criteria, and assays for the detection of autoantibodies are not available. In consequence, slowly progressive autoimmune diabetes or LADA is likely to be missed. Antibodies to GAD65 and IA-2 are the major immunological markers in autoimmune diabetes. Recently, a new beta cell antigen, called ICA12, has been identified, which has a homology to the SOX family of transcription factors. The aim of the study was to analyze the prevalence of ICA12 antibodies in diabetes mellitus patients and controls from Latvia and to see whether this antigen is important in revealing autoimmunity when antibodies against major antigens are not present. We studied 88 IDDM patients and 100 NIDDM patients as well as controls for the prevalence of GAD65, IA-2, and ICA12 antibodies by radioligand binding assay (RIA) using (35)S-labeled islet antigens. We found ICA12Abs in 26 of 88 IDDM patients (30%) vs. 4% in healthy controls (4/100) and in 9 of 100 NIDDM patients (9%) vs. 2% controls (2/100). ICA12Abs alone are present in only 3% (3/88) of the patients with IDDM and 1% (1/100) of the NIDDM patients. We conclude that ICA12 represents the minor antigens in autoimmune diabetes and that, as a minor antigen, ICA12 alone does not contribute significantly in revealing new cases of autoimmunity.

  10. 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.

  11. 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

  12. Study of the lipidemic profile of diabetic patients. Negative correlation of cholesterol levels of diabetes type I patients with serum amylase concentration.

    PubMed

    Eleftheriou, Phaedra; Tseka, Eros; Varaga, Evagelia; Nasiou, Margarita; Sampanis, Christos; Zografou, Ioanna; Oulorgia, Jensila; Damontsidou, Katerina; Zaimi, Terpsithea; Markou, Helen-Irene; Varsamidis, Kostantinos; Petrou, Christos; Limberaki, Eugenia; Ganou, Christina-Joulia

    2014-01-01

    Diabetes Mellitus type I (DM1) and II (DM2) share the common characteristic of high blood glucose concentration and the health complications resulting from uncontrolled hyperglycemia such as hyperlipidemia, cardiovascular problems, stroke, ketoacidosis, kidney failure and blindness but have different etiology. DM1 is practically an autoimmune disease. Genetic susceptibility together with environmental factors leads to disease development. The main characteristics of Diabetes type II (DM2) is insulin resistance in muscle and liver cells accompanied by loss of β-cell function. However, adipose tissue, gastro-intestinal tract, pancreatic a-cell activity, may be involved in disease development. In parallel to the impairment of endocrine pancreatic function, a reduction in exocrine function has also been observed in all types of Diabetes Mellitus. A decrease in amylase and lipase activity has been mentioned by many authors, although cases with elevated amylase have been referred. Most recently a trend for positive correlation between HDL cholesterol and amylase in Diabetes type II patients was shown. In the present study we evaluated the lipidemic profile and related factors such as cortisol, total serum antioxidant capacity (TAC) and amylase in patients suffering from diabetes type I and II. The relationship between different parameters was examined. Blood serum from 20 DM1 patients and 45 DM2 patients was used. Serum from 50 healthy individuals was used as control. Total cholesterol and triglycerides were measured using an enzymatic colorimetric method. Serum cortisol, auto-antibodies and anti-Neu5Gc antibodies were measured using immunoenzyme assays and TAC measurement was made using the ABTS method. Mean total cholesterol was 245.5mg/dL in Diabetes I patients and was significantly elevated compared to healthy individuals as well as Diabetes II patients (168.71±76.0mg/dL). The observed difference was statistically significant (P=0.0004). On the contrary

  13. 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…

  14. Psychiatric and cardiovascular comorbidities in patients with diabetes mellitus starting antiobesity drugs.

    PubMed

    Willemen, Marjolein J; Mantel-Teeuwisse, Aukje K; Straus, Sabine M; Leufkens, Hubert G; Egberts, Antoine C

    2008-10-01

    The aim of the study was to assess whether the baseline risk of psychiatric and cardiovascular disease in patients with diabetes mellitus differs between those starting to use antiobesity drugs and those not starting to use these drugs. A retrospective nested case-control study within the General Practice Research Database (1987-2002) was done. The cohort included all patients with diabetes mellitus (n = 141,164). Information on patient characteristics (general, cardiovascular, and psychiatric characteristics) was extracted from the medical records. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A total of 511 patients starting to use antiobesity drugs (cases) and 3,065 controls were included in the study cohort. Starters were younger and more frequently female. Of the starters, 91.8% did not receive any dietary advice before starting treatment. Depression (in the year before index date) was associated with the use of antiobesity drugs (OR 2.2; 95% CI 1.7-2.8), as was anxiety (OR 1.6; 95% CI 1.1-2.4). Of the cases, 25.2% had multiple cardiovascular risk factors (>4) compared to 19.0% of the controls. The baseline risk for psychiatric disorders and cardiovascular disease was found to be higher in patients with diabetes mellitus starting to use antiobesity drugs compared to patients with diabetes mellitus not starting such treatment.

  15. [IMSS in Numbers: the Census of Diabetic Patients, 2004].

    PubMed

    2006-01-01

    The census of diabetic patients at the Instituto Mexicano del Seguro Social describes the state and level of control of biologic markers, such as glucose, BMI and blood pressure of all diabetic patients attending the family medicine units during 2004. The main results show that 2,334,340 diabetic patients visited the health units of the Instituto Mexicano del Seguro Social with an average of 3.7 visits per year. Around 75% of the patients had their weight and height registered; 73%, their blood pressure, and only 28.8%, their glycemia level. One third of the patients (35.7%) had an unspecified diagnosis of diabetes mellitus and 91.3% had no complications reported. Of those with glycemia reported, 56.9% had a poor blood glucose control. Half of the diabetic patients were also diagnosed as hypertensive though 74% had good blood pressure control. The BMI reported that 40.4% were obese and 39.6% were overweight. All these data are important to measure the impact of different health interventions that point to a better control of diabetes at the IMSS.

  16. Updates on the Management of Diabetes in Dialysis Patients

    PubMed Central

    Rhee, Connie M.; Leung, Angela M.; Kovesdy, Csaba P.; Lynch, Katherine E.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar

    2014-01-01

    Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U.S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. The treatment of diabetes in ESRD patients is challenging, given changes in glucose homeostasis, the unclear accuracy of glycemic control metrics, and the altered pharmacokinetics of glucose-lowering drugs by kidney dysfunction, the uremic milieu, and dialysis therapy. Up to one-third of diabetic dialysis patients may experience spontaneous resolution of hyperglycemia with hemoglobin A1c (HbA1c) levels <6%, a phenomenon known as “Burnt-Out Diabetes,” which remains with unclear biologic plausibility and undetermined clinical implications. Conventional methods of glycemic control assessment are confounded by the laboratory abnormalities and comorbidities associated with ESRD. Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7 to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients. PMID:24588802

  17. Gene polymorphism of transforming growth factor-β1 in Egyptian patients with type 2 diabetes and diabetic nephropathy.

    PubMed

    El-Sherbini, Sherif M; Shahen, Samar M; Mosaad, Youssef M; Abdelgawad, Mohamed S; Talaat, Roba M

    2013-04-01

    Role of the transforming growth factor-β1 (TGF-β1) gene polymorphisms located at codons 10 and 25 in the genetic predisposition to type 2 diabetes (T2D) and in diabetic nephropathy (DN) in Egyptian patients was investigated. A case control study was done for 99 unrelated Egyptian patients with T2D (50 DN(-) and 49 DN(+)) and 98 age- and sex-matched healthy controls. TGF-β1 T869C (codon 10) and G915C (codon 25) polymorphism detection was done by amplification refractory mutation system method. DN(+) patients were younger, with higher body mass index, serum triglycerides, serum creatinine, and lower serum albumin than those in DN(-) patients. Moderate and bad grades of diabetic control were associated with DN (P < 0.001). The TGF-β1 (T869C) C allele, TC and TC + CC genotypes were significantly higher in patients; the T allele and TT genotype were significantly higher in controls (Pc < 0.001). The TGF-β1 TC genotype was associated with DN (Pc < 0.05). Non-significant differences were detected between T2D patients and controls in the frequencies of TGF-β1 (G915C) alleles and genotypes. In conclusion, these preliminary data showed that the TGF-β1 codon 10 C allele, and C allele-containing genotypes may be susceptible, and T allele/TT genotype may be protective factors for T2D and DN(+) complications.

  18. Teriparatide in patients with osteoporosis and type 2 diabetes.

    PubMed

    Schwartz, Ann V; Pavo, Imre; Alam, Jahangir; Disch, Damon P; Schuster, Dara; Harris, Jennifer M; Krege, John H

    2016-10-01

    Despite evidence for higher fracture risk, clinical effects of osteoporosis treatments in type 2 diabetes (T2D) are largely unknown. Post hoc analyses of the DANCE observational study compared T2D patients and patients without diabetes to assess the effect of teriparatide, an osteoanabolic therapy on skeletal outcomes and safety. Patients included ambulatory men and women with osteoporosis receiving teriparatide 20μg/day SQ up to 24months followed by observation up to 24months. Main outcome measures included nonvertebral fracture incidence comparing 0-6months with 6+ months of teriparatide, change from baseline in BMD and back pain severity, and serious adverse events. Analyses included 4042 patients; 291 with T2D, 3751 without diabetes. Treatment exposure did not differ by group. For T2D patients, fracture incidence was 3.5 per 100 patient-years during 0-6months treatment, and 1.6 during 6months to treatment end (47% of baseline, 95% CI 12-187%); during similar periods, for patients without diabetes, fracture incidence was 3.2 and 1.8 (57% of baseline, 95% CI 39-83%). As determinants of fracture outcome during teriparatide treatment, diabetes was not a significant factor (P=0.858), treatment duration was significant (P=0.003), and the effect of duration was not significantly different between the groups (interaction P=0.792). Increases in spine and total hip BMD did not differ between groups; increase in femoral neck BMD was greater in T2D patients than in patients without diabetes (+0.34 and +0.004g/cm(2), respectively; P=0.014). Back pain severity decreased in both groups. Teriparatide was well tolerated without new safety findings. In conclusion, during teriparatide treatment, reduction in nonvertebral fracture incidence, increase in BMD, and decrease in back pain were similar in T2D and non-diabetic patients. PMID:27374026

  19. [Renal histological lesions in patients with type II diabetes mellitus].

    PubMed

    Castellano, I; Covarsí, A; Novillo, R; Gómez-Martino, J R; Ferrando, L

    2002-01-01

    Diabetic glomerulosclerosis is the most frequent cause of renal disease in patients with type II diabetes mellitus (DM), sometimes accompanied by vascular lesions. However, other glomerular pathologies are important in these patients. The aim of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) in selected patients with type II DM, and to identify clinical markers that may predict its presence in this population. We reviewed 20 renal biopsies performed on twenty patients with type II DM. Nine of them showed diabetic nephropathy (DN) (45%), whereas eleven showed NDN (55%): 1 IgA nephropathy, 3 vasculitis and 7 membranous nephropathy. We found no differences between the two groups with regard to sex, duration of DM, insulin therapy, glycosylated haemoglobin, proteinuria, presence of nephrotic syndrome, hypertension, serum IgA level or renal size. The NDN group had haematuria in 63.6%, whereas the patients with NDN had it in 44.4% (NS). Body mass index was higher in NDN patients (30 +/- 6.7 vs 22 +/- 2.9; p < 0.01), The same was true for creatinine clearance (82.2 +/- 51.4 ml/m vs 40.4 +/- 19.6 ml/m; p < 0.05). The age at the moment of diagnosis was higher in ND patients (67 +/- 11.2 vs 54.3 +/- 4.6; p < 0.05). The 3 patients who had diabetic retinopathy were found to have DN on renal biopsy (diagnostic specificity = 100%), although 66.7% of the patients with diabetic glomerulopathy had no retinopathy. We conclude that patients with type II DM with renal findings suggesting non-diabetic renal disease frequently it have NDN, and a renal biopsy must be performed. The presence of retinopathy has a predictive value of 100% in predicting DN, therefore its existence may make this diagnostic procedure unneccesary.

  20. [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.

  1. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors.

    PubMed

    Nakamura, Yuya; Hasegawa, Hitomi; Tsuji, Mayumi; Udaka, Yuko; Mihara, Masatomo; Shimizu, Tatsuo; Inoue, Michiyasu; Goto, Yoshikazu; Gotoh, Hiromichi; Inagaki, Masahiro; Oguchi, Katsuji

    2015-06-25

    Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The following 7 DPP-4 inhibitors are available worldwide: sitagliptin, vildagliptin, alogliptin, linagliptin, teneligliptin, anagliptin, and saxagliptin. All of these are administered once daily with dose adjustments in HD patients. Four types of oral antidiabetic drugs can be administered for combination oral therapy with DPP-4 inhibitors, including sulfonylureas, meglitinide, thiazolidinediones, and alpha-glucosidase inhibitor. Nine studies examined the antidiabetic effects in HD patients. Treatments decreased hemoglobin A1c and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. The efficacy of DPP-4 inhibitor treatment is high among HD patients, and no patients exhibited significant severe adverse effects such as hypoglycemia and liver dysfunction. DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and with limited choices for diabetes treatment.

  2. Age, race, diabetes, blood pressure, and mortality among hemodialysis patients.

    PubMed

    Myers, Orrin B; Adams, Christopher; Rohrscheib, Mark R; Servilla, Karen S; Miskulin, Dana; Bedrick, Edward J; Zager, Philip G

    2010-11-01

    Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality. Overall, low SBP associated with increased mortality, and the association was more pronounced among older patients and those with diabetes. Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status. We observed a survival advantage for black patients primarily among older patients. Diabetes associated with increased mortality mainly among older patients with low BP. In conclusion, the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration.

  3. Bone and wound healing in the diabetic patient.

    PubMed

    Mehta, Siddhant K; Breitbart, Eric A; Berberian, Wayne S; Liporace, Frank A; Lin, Sheldon S

    2010-09-01

    Impaired soft tissue regeneration and delayed osseous healing are known complications associated with diabetes mellitus with regard to orthopedic surgery, making the management and treatment of diabetic patients undergoing foot and ankle surgery more complex and difficult. At the moment several options are available to address the known issues that complicate the clinical outcomes in these high-risk patients. Using a multifaceted approach, with close attention to intraoperative and perioperative considerations including modification of surgical technique to supplement fixation, local application of orthobiologics, tight glycemic control, administration of supplementary oxygen, and biophysical stimulation via low-intensity pulsed ultrasound and electrical bone stimulation, the impediments associated with diabetic healing can potentially be overcome, to yield improved clinical results for diabetic patients after acute or elective foot and ankle surgery.

  4. Pre and post-operative needs of patients with diabetes.

    PubMed

    Holt, Paula

    The incidence of diabetes is rising rapidly and individuals with the condition often have complex comorbidities, which may increase the need for surgical procedures such as amputation and cardiac, renal and eye surgery. Patients with diabetes undergoing surgery may have specific needs, particularly in relation to blood glucose control, and healthcare professionals need to be able to assess and manage these individuals to ensure optimum surgical outcomes. This article considers the potential effects of anaesthesia and surgery on blood glucose control. Diabetes-related complications, particularly signs and symptoms, and effects of these complications on patient safety during surgery are discussed. Specific pre and post-operative care of patients with type land type 2 diabetes is described, with reference to nil-by-mouth practices, blood glucose control, and post-operative infection and pain.

  5. Bone and wound healing in the diabetic patient.

    PubMed

    Mehta, Siddhant K; Breitbart, Eric A; Berberian, Wayne S; Liporace, Frank A; Lin, Sheldon S

    2010-09-01

    Impaired soft tissue regeneration and delayed osseous healing are known complications associated with diabetes mellitus with regard to orthopedic surgery, making the management and treatment of diabetic patients undergoing foot and ankle surgery more complex and difficult. At the moment several options are available to address the known issues that complicate the clinical outcomes in these high-risk patients. Using a multifaceted approach, with close attention to intraoperative and perioperative considerations including modification of surgical technique to supplement fixation, local application of orthobiologics, tight glycemic control, administration of supplementary oxygen, and biophysical stimulation via low-intensity pulsed ultrasound and electrical bone stimulation, the impediments associated with diabetic healing can potentially be overcome, to yield improved clinical results for diabetic patients after acute or elective foot and ankle surgery. PMID:20682414

  6. Corneal oedema after phacoemulsification in the early postoperative period: A qualitative comparative case-control study between diabetics and non-diabetics

    PubMed Central

    Tsaousis, Konstantinos T.; Panagiotou, Dimitrios Z.; Kostopoulou, Eirini; Vlatsios, Vasileios; Stampouli, Despoina

    2015-01-01

    Background The occurrence and severity of corneal oedema after phacoemulsification is dependent on the integrity of corneal endothelial cells. The function of these cells is affected by diabetes mellitus and consequently the behaviour of the cornea in diabetic patients is of special interest. Aim To compare the frequency of corneal oedema in two age-matched groups of diabetics and non diabetic patients that underwent cataract surgery in the Ophthalmology Department of Xanthi General Hospital in Greece. Methods A retrospective case control study was conducted in a retrospective fashion. Patients in the control and study groups were assessed regarding the severity of corneal oedema at three postoperative visits: days 1, 3–7, 10–14 after the operation. Ultrasound energy consumed during phacoemulsification was also a parameter of interest and possible correlations with the pre-existent cataract severity and the subsequent incidence of corneal oedema were investigated. Results The difference in the incidence of severe corneal oedema between the study and control group was statistically significant: (4.5% non diabetics vs 14.3% diabetics). The consumed ultrasound energy did not define final clinical outcome. Conclusions The existence of diabetes mellitus type 2 appears to be a significant risk factor for the development of persistent corneal oedema. The results of our study led to the modification of the algorithm for postoperative follow-up of patients of this remote area of Greece. PMID:26865977

  7. 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

  8. SESAM-DIABETE, an expert system for insulin-requiring diabetic patient education.

    PubMed

    Levy, M; Ferrand, P; Chirat, V

    1989-10-01

    SESAM-DIABETE is an interactive educational expert system that provides personalized advice and therapeutic recommendations for insulin-requiring diabetic patients. Because of its sophisticated explanation facilities, this system is intended to complete the more traditional educational tools for diabetic patients. It has been developed using an original essential expert system, namely SESAM, itself implemented in an upper-layer of Lisp, MBX. Its control structure uses a top-down strategy to solve a problem; i.e., it decomposes the current problem into subproblems easier to solve, this method being recursively applied to each subproblem. All information about patients is kept in a Patient Medical Record, which allows their follow-up. This system is currently available from their home for selected patients through the French telematic network TELETEL and is under clinical evaluation.

  9. SESAM-DIABETE, an expert system for insulin-requiring diabetic patient education.

    PubMed

    Levy, M; Ferrand, P; Chirat, V

    1989-10-01

    SESAM-DIABETE is an interactive educational expert system that provides personalized advice and therapeutic recommendations for insulin-requiring diabetic patients. Because of its sophisticated explanation facilities, this system is intended to complete the more traditional educational tools for diabetic patients. It has been developed using an original essential expert system, namely SESAM, itself implemented in an upper-layer of Lisp, MBX. Its control structure uses a top-down strategy to solve a problem; i.e., it decomposes the current problem into subproblems easier to solve, this method being recursively applied to each subproblem. All information about patients is kept in a Patient Medical Record, which allows their follow-up. This system is currently available from their home for selected patients through the French telematic network TELETEL and is under clinical evaluation. PMID:2776447

  10. Review of gastroesophageal reflux disease (GERD) in the diabetic patient.

    PubMed

    Punjabi, Paawan; Hira, Angela; Prasad, Shanti; Wang, Xiangbing; Chokhavatia, Sita

    2015-09-01

    This article reviews the known pathophysiological mechanisms of comorbid gastroesophageal reflux disease (GERD) in the diabetic patient, discusses therapeutic options in care, and provides an approach to its evaluation and management. We searched for review articles published in the past 10 years through a PubMed search using the filters diabetes mellitus, GERD, pathophysiology, and management. The search only yielded a handful of articles, so we independently included relevant studies from these review articles along with related citations as suggested by PubMed. We found diabetic patients are more prone to developing GERD and may present with atypical manifestations. A number of mechanisms have been proposed to elucidate the connection between these two diseases. Studies involving treatment options for comorbid disease suggest conflicting drug-drug interactions. Currently, there are no published guidelines specifically for the evaluation and management of GERD in the diabetic patient. Although there are several proposed mechanisms for the higher prevalence of GERD in the diabetic patient, this complex interrelationship requires further research. Understanding the pathophysiology will help direct diagnostic evaluation. In our review, we propose a management algorithm for GERD in the diabetic patient.

  11. [Association of idiopathic thrombocytopenic purpura and type 1 diabetes mellitus--a case report].

    PubMed

    Prusek, Katarzyna; Deja, Grażyna; Jarosz-Chobot, Przemysława

    2010-01-01

    The relation between type 1 diabetes mellitus and autoimmune thyroid diseases is well known. In the pathogenesis of both diseases, chronic autoimmunization plays an essential role. Specific autoantibodies are also responsible for the onset of idiopathic thrombocytopenic purpura. In the paper we present a case of an 11-year-old girl with insulin dependent diabetes in whom the idiopathic thrombocytopenic purpura without bleeding diathesis has been newly diagnosed. The patient had positive titres of thyroid autoantibodies, whilst she did not suffer from thyroid dysfunction. Due to inefficiency of intravenous gammaglobulins the patient was treated with a steroid therapy, which elevated the platelet counts to safe levels. However, the episodes of hyperglycemia have appeared as a side effect. The insulin therapy was modified and the girl was released in a good condition. In this case report, consideration should be given to the wide range of autoimmune diseases that can accompany type one diabetes mellitus--not only can we observe immune diabetic markers, but also thyroid autoantibodies and anti-platelet antibodies. Particular therapeutic dilemmas resulting in a difficult decision on steroid therapy while treating a diabetic patient with idiopathic thrombocytopenic purpura are also presented. PMID:21092704

  12. 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.

  13. Hospitalized cardiovascular events in patients with diabetic macular edema

    PubMed Central

    2012-01-01

    Background Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI) and cerebrovascular accidents (CVA) in patients with diabetic macular edema (DME) compared with diabetic patients without retinal diseases. Methods This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519) and diabetes controls without retinal disease (n = 10557) were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated. Results The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p < 0.001) for DME versus diabetes controls. Predictors of MI events were heart disease, history of acute MI, and prior use of antiplatelet or anticoagulant drugs. The adjusted rate ratio for CVA was 1.98 (95% CI: 1.39-2.83, p < 0.001) for DME versus diabetes controls. Predictors of CVA events were cardiac arrhythmia, Charlson comorbidity scores, history of CVA, hyperlipidemia, and other cerebrovascular diseases. Conclusion Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes. PMID:22646811

  14. Towards Automatic Diabetes Case Detection and ABCS Protocol Compliance Assessment

    PubMed Central

    Mishra, Ninad K.; Son, Roderick Y.; Arnzen, James J.

    2012-01-01

    Objective According to the American Diabetes Association, the implementation of the standards of care for diabetes has been suboptimal in most clinical settings. Diabetes is a disease that had a total estimated cost of $174 billion in 2007 for an estimated diabetes-affected population of 17.5 million in the United States. With the advent of electronic medical records (EMR), tools to analyze data residing in the EMR for healthcare surveillance can help reduce the burdens experienced today. This study was primarily designed to evaluate the efficacy of employing clinical natural language processing to analyze discharge summaries for evidence indicating a presence of diabetes, as well as to assess diabetes protocol compliance and high risk factors. Methods Three sets of algorithms were developed to analyze discharge summaries for: (1) identification of diabetes, (2) protocol compliance, and (3) identification of high risk factors. The algorithms utilize a common natural language processing framework that extracts relevant discourse evidence from the medical text. Evidence utilized in one or more of the algorithms include assertion of the disease and associated findings in medical text, as well as numerical clinical measurements and prescribed medications. Results The diabetes classifier was successful at classifying reports for the presence and absence of diabetes. Evaluated against 444 discharge summaries, the classifier’s performance included macro and micro F-scores of 0.9698 and 0.9865, respectively. Furthermore, the protocol compliance and high risk factor classifiers showed promising results, with most F-measures exceeding 0.9. Conclusions The presented approach accurately identified diabetes in medical discharge summaries and showed promise with regards to assessment of protocol compliance and high risk factors. Utilizing free-text analytic techniques on medical text can complement clinical-public health decision support by identifying cases and high risk

  15. An ontological case base engineering methodology for diabetes management.

    PubMed

    El-Sappagh, Shaker H; El-Masri, Samir; Elmogy, Mohammed; Riad, A M; Saddik, Basema

    2014-08-01

    Ontology engineering covers issues related to ontology development and use. In Case Based Reasoning (CBR) system, ontology plays two main roles; the first as case base and the second as domain ontology. However, the ontology engineering literature does not provide adequate guidance on how to build, evaluate, and maintain ontologies. This paper proposes an ontology engineering methodology to generate case bases in the medical domain. It mainly focuses on the research of case representation in the form of ontology to support the case semantic retrieval and enhance all knowledge intensive CBR processes. A case study on diabetes diagnosis case base will be provided to evaluate the proposed methodology.

  16. An audit of cushioned diabetic footwear: relation to patient compliance.

    PubMed

    Chantelau, E; Haage, P

    1994-01-01

    The recurrence rate of neuropathic foot ulcers is reported in 51 diabetic patients regularly attending a diabetic foot clinic. All of the patients were provided with protective footwear reducing peak plantar pressure at the forefoot area by 50% (versus normal shoes), and were followed up for up to 4 years. Compliance with this footwear was recorded by assessing the daily time of wearing protective or normal shoes, and compliance with foot care was recorded from the entries in the patients charts. The results of this observational study demonstrate that wearing protective shoes for > 60% of the daytime significantly (p = 0.0002) reduced the ulcer relapse rate by > 50% in comparison with shorter wearing times for these shoes. In addition, patients without ulcer relapses had foot care significantly more frequently than patients with relapse (p < 0.05). It is concluded that cushioned protective footwear in association with frequent foot care is essential in the prevention of neuropathic diabetic foot ulcer recurrence.

  17. 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

  18. Patient Characteristics Associated with Measurement of Routine Diabetes Care: An Observational Study

    PubMed Central

    Van Doorn-Klomberg, Arna L.; Braspenning, Jozé C. C.; Atsma, Femke; Jansen, Birgit; Bouma, Margriet; Wolters, René J.; Wensing, Michel

    2015-01-01

    Background Non-modifiable patient characteristics, including age, gender, ethnicity as well as the occurrence of multi-morbidities, are associated with processes and outcomes of diabetes care. Information on these factors can be used in case mix adjustment of performance measures. However, the practical relevance of such adjustment is not clear. The aim of this study was to assess the strength of associations between patient factors and diabetes care processes and outcomes. Methods We performed an observational study based on routinely collected data of 12,498 diabetes patients in 59 Dutch primary care practices. Data were collected on patient age, gender, whether the patient lived in a deprived area, body mass index and the co-occurrence of cardiovascular disease, chronic obstructive pulmonary disease, depression or anxiety. Outcomes included 6 dichotomous measures (3 process and 3 outcome related) regarding glycosylated hemoglobin, systolic blood pressure and low density lipoprotein-cholesterol. We performed separate hierarchical logistic mixed model regression models for each of the outcome measures. Results Each of the process measure models showed moderate effect sizes, with pooled areas under the curve that varied between 0.66 and 0.76. The frequency of diabetes related consultations as a measure of patient compliance to treatment showed the strongest association with all process measures (odds ratios between 5.6 and 14.5). The effect sizes of the outcome measure models were considerably smaller than the process measure models, with pooled areas under the curve varying from 0.57 to 0.61. Conclusions Several non-modifiable patient factors could be associated with processes and outcomes of diabetes care. However, associations were small. These results suggest that case-mix correction or stratification in assessing diabetes care has limited practical relevance. PMID:25822978

  19. 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

  20. 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 ...

  1. Attenuated Purinergic Receptor Function in Patients With Type 2 Diabetes

    PubMed Central

    Thaning, Pia; Bune, Laurids T.; Hellsten, Ylva; Pilegaard, Henriette; Saltin, Bengt; Rosenmeier, Jaya B.

    2010-01-01

    OBJECTIVE Extracellular nucleotides and nucleosides are involved in regulation of skeletal muscle blood flow. Diabetes induces cardiovascular dysregulation, but the extent to which the vasodilatatory capacity of nucleotides and nucleosides is affected in type 2 diabetes is unknown. The present study investigated 1) the vasodilatatory effect of ATP, uridine-triphosphate (UTP), and adenosine (ADO) and 2) the expression and distribution of P2Y2 and P2X1 receptors in skeletal muscles of diabetic subjects. RESEARCH DESIGN AND METHODS In 10 diabetic patients and 10 age-matched control subjects, leg blood flow (LBF) was measured during intrafemoral artery infusion of ATP, UTP, and ADO, eliciting a blood flow equal to knee-extensor exercise at 12 W (∼2.6 l/min). RESULTS The vasodilatatory effect of the purinergic system was 50% lower in the diabetic group as exemplified by an LBF increase of 274 ± 37 vs. 143 ± 26 ml/μmol ATP × kg, 494 ± 80 vs. 234 ± 39 ml/μmol UTP × kg, and 14.9 ± 2.7 vs. 7.5 ± 0.6 ml/μmol ADO × kg in control and diabetic subjects, respectively, thus making the vasodilator potency as follows: UTP control subjects (100) > ATP control subjects (55) > UTP diabetic subjects (47) > ATP diabetic subjects (29) > ADO control subjects (3) > ADO diabetic subjects (1.5). The distribution and mRNA expression of receptors were similar in the two groups. CONCLUSIONS The vasodilatatory effect of the purinergic system is severely reduced in type 2 diabetic patients. The potency of nucleotides varies with the following rank order: UTP > ATP > ADO. This is not due to alterations in receptor distribution and mRNA expression, but may be due to differences in receptor sensitivity. PMID:19808895

  2. Brain changes in diabetes mellitus patients with gastrointestinal symptoms.

    PubMed

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

    2016-01-25

    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.

  3. 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

  4. Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model.

    PubMed

    Javitt, J C; Canner, J K; Frank, R G; Steinwachs, D M; Sommer, A

    1990-04-01

    Diabetic retinopathy is the major cause of new cases of blindness among working-age Americans. The authors analyzed the medical and economic implications of alternative screening strategies for detecting retinopathy in a diabetic population. The approaches compared included dilated fundus examination at 6-, 12-, and 24-month intervals with and without fundus photography. Potential savings from screening and treatment are based on amounts paid by the federal government for blindness-related disability. Screening for and treating retinopathy in patients with type I diabetes mellitus was cost-effective using all screening strategies. Between 71,474 and 85,315 person years of sight and 76,886 and 94,705 person years of reading vision can be saved for each annual cohort of patients with type I diabetes mellitus when proper laser photocoagulation is administered. This results in a cost savings of $62.1 to $108.6 million. Annual examination of all diabetic patients and semi-annual examination of those with retinopathy was more effective than annual examination with fundus photography. This screening strategy is consistent with the Preferred Practice Pattern for Diabetic Retinopathy of the American Academy of Ophthalmology. PMID:2109299

  5. Comparing the Levels of Trace Elements in Patients With Diabetic Nephropathy and Healthy Individuals

    PubMed Central

    Makhlough, Atieh; Makhlough, Marjan; Shokrzadeh, Mohammad; Mohammadian, Mozhdeh; Sedighi, Omid; Faghihan, Mansooreh

    2015-01-01

    Background: Diabetic nephropathy is the most common cause of end stage renal disease (ESRD) in developed countries. Several trace elements were reported to be changed in diabetic nephropathy. Objectives: The aim of this study was to investigate changes in serum levels of zinc, copper and chromium and their association with the incidence of ESRD in patients with diabetes. Patients and Methods: This study was performed on 70 patients with type 2 diabetic nephropathy (macro and micro-albuminuria) and 70 healthy individuals. Samples were collected to survey metals by atomic absorption spectrophotometer. Data was analyzed by SPSS18 using descriptive and inferential analysis methods. Results: Mean ± SD levels of Zn, Cu and Cr were significantly decreased in blood samples of patients compared to healthy subjects (P < 0.01). Also the mean concentrations of Cu, Zn and Cr in drinking water of Sari were lower than the accepted limit. Only in one case, Cu was higher than the accepted limit, which was the possibility of contamination by water supply pipes. Conclusions: Cu, Zn and Cr play a specific role in the pathophysiology of diabetic nephropathy. Meanwhile in these patients, low serum levels of Cu, Zn and Cr were not associated with factors such as drinking water. Possible causes should be sought in other factors like urine, intervention factors in absorption and utilization and individual conditions. PMID:26539418

  6. [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.

  7. [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. PMID:26118037

  8. 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.

  9. 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…

  10. 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

  11. 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.

  12. 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. PMID:24756836

  13. [Actions of physicians, nurses, parents and friends in relationship with young diabetic patients].

    PubMed

    Hentinen, M; Kyngäs, H

    1993-01-01

    The purpose of this study was to use young diabetics descriptions of their illness, treatment and care to explain the actions of physicians, nurses, parents and friends relationship with diabetics'. The empirical data were collected by interviewing 51 diabetics of age 13-17-years. The data were processed by the method of continuous comparative analysis. The young diabetics described the actions of physicians as motivating, authoritarian, negligent and routine. By motivating they meant that, the doctors and young diabetics acted together, discussing the treatment and care and planning it together, whereas the routine and authoritarian aspects of their action referred to things that the doctors didn't discuss with the patient, and care that wasn't individual. The nurses' were described as taking notice of the young diabetics as individuals, but their actions were or intended to comply with the doctors' instructions. The individual aspect consisted of planning the care together and trying to combine it with the young persons's life. The actions of the parents were described as motivating, involving acceptance and disciplined control. Their motivating action consisted of support and a natural interest in young diabetics's life and not only in the disease. The parents who accepted the young diabetics didn't try to influence them. They accepted that the people would not necessarily care for themselves. Their disciplined control consisted of a lot of questions about care and attempts to oblige the young diabetics to care for themselves better than they do. The young diabetics described their interaction with friends, in terms of their silent support, their friends dominating their lives or their friends having no meaning for their self care. When their friends dominated their lives, the young diabetics lived according to their friends' habit, in which case the care didn't fit in with the young diabetics' life style. The silent support of the friends was typical in that

  14. The feet in diabetes. Roentgenologic observation in 1501 cases.

    PubMed

    Geoffroy, J; Hoeffel, J C; Pointel, J P; Drouin, P; Debry, G; Martin, R

    1979-01-01

    The manifestations of diabetic osteoarthropathy are described. Computerized analysis of the films of the feet of 1501 diabetic patients showed one or more lesions in 55% of patients. Exostosis (36%), vascular calcifications (25%) and osteoporosis (12.2%) are by far the most frequent symptoms. Geodes (3.7%), destructive lesions (3.9%), sclerosis (4%) and articular lesions (5.1%) are second in frequency. Osteolytic lesions and reconstruction showed a high female predominance, whereas sclerosis is predominant in males (61.6--38.4%).

  15. 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

  16. 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

  17. [Is scuba diving allowed in diabetic patients treated with insulin?].

    PubMed

    Dufaitre, L; Vialettes, B

    2000-11-01

    Scuba diving is usually prohibited in diabetic patients at risk of hypoglycemic attacks (i.e. IDDM and NIDDM treated with sulfonylureas) due to the particular severity of these episodes in a hostile environment. In fact, diabetic subjects can perform this popular leisure activity without extra-risk, provided strict requisites in aptitude, practice and environment are enforced. These limitations lead to the establishment of practical guidelines, as proposed in this paper.

  18. Kidney Transplantation in Patients with Type 1 Diabetes Mellitus: Long-Term Prognosis for Patients and Grafts

    PubMed Central

    Kim, Hyang; Cheigh, Jhoong S.

    2001-01-01

    Kidney transplantation is the best therapeutic choice to improve survival and quality of life in patients with end-stage diabetic nephropathy. Long-term prognosis in diabetic patients who received kidney transplants, however, has not been delineated. We, therefore, studied patient and graft survival, graft function and cause of graft failure in 78 Type I diabetic kidney transplant recipients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who had functioning grafts for more than one year. The results were compared with 78 non-diabetic patients who had functioning grafts for more than one year and were matched for age, gender, donor source, time of transplantation and immunosuppressive therapy protocol. Cumulative patient survival rates for diabetic patients were significantly lower than those of non-diabetic patients (86% vs. 97% at 5 years and 74% vs. 95% at 10 years, respectively: p<0.05). The most common cause of death was cardiovascular disease. Graft survival rates for diabetic patients were also lower than that of non-diabetic patients (71% vs. 80% at 5 years and 58% vs. 72% at 10 years, respectively), but the differences did not reach statistical significance. Among the 22 failed grafts in diabetic patients, 7 (32%) were due to patient death rather than primary graft failure. If the patients who died with a functioning graft were censored, graft survival rates of diabetic patients approached those of non-diabetic patients (80% vs. 81% at 5 years and 65% vs. 73% at 10 years, respectively). Creatinine clearances in diabetic patients were lower than that in non-diabetic patients through the follow-up period, but the differences were significant only for the first few years. At no time was there a higher creatinine clearance for diabetic patients. Among the 16 patients who had transplant kidney biopsies two to seven years post-transplant, 6 showed morphological changes consistent with diabetic nephropathy. One patient lost graft function

  19. Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers

    PubMed Central

    Vedhara, Kavita; Dawe, Karen; Miles, Jeremy N. V.; Wetherell, Mark A.; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona; Reps, Jenna; Soria, Daniele

    2016-01-01

    Background Patients’ illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions. Objective We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration. Methods Patients (n = 169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1st November 2011. Number of days survived reflected the number of days from date of recruitment to 1st November 2011. Results Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death. Conclusions Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival. PMID:27096609

  20. Spousal undermining of older diabetic patients' disease management.

    PubMed

    Henry, Shayna L; Rook, Karen S; Stephens, Mary A P; Franks, Melissa M

    2013-12-01

    Marriage can enhance health for individuals with a chronic disease, yet spouses may also undermine disease management. The current study investigated spousal undermining of dietary regimen in 129 patients with type 2 diabetes mellitus. A total of 40 patients reported that their spouses tempted them with forbidden foods, and 15 reported that their spouses conveyed disregard for their diabetic diet. Spousal tempting was associated with worse dietary adherence, and spousal disregard with worse nondietary adherence. Spousal undermining is relatively rare but is associated with patients' disease management and warrants further investigation to better understand how spouses influence partners' day-to-day management of chronic diseases.

  1. 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

  2. The role of met-enkephalin in silent myocardial ischemia in diabetic patients.

    PubMed

    Parlapiano, C; Borgia, M C; Tonnarini, G; Campana, E; Giancaspro, G; Pantone, P; Giovanniello, T; Cardarelli, G; Vincentelli, G M; Alegiani, F; Negri, M

    2001-01-01

    Met-enkephalin plasma levels were evaluated in 20 cardioischemic diabetic patients. All the patients had ECG ischemic signs. Ten patients with diabetic autonomic neuropathy, experienced no pain during myocarial ischemia. Met-enkephalin levels in the diabetic patients with silent myiocardial ischemia were significantly lower compared to those in the symptomatic patients. This demonstrates that the absence of myocardial ischemic pain in neuropathic diabetic patients is not accounted for by met-enkephalin action. PMID:11958273

  3. 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

  4. Managing diabetes in hospitalized patients with chronic kidney disease.

    PubMed

    Iyer, Shridhar N; Tanenberg, Robert J

    2016-04-01

    Because few randomized trials have been done, little is known about appropriate glycemic control in hospitalized patients with chronic kidney disease (CKD) and diabetes mellitus. These patients are at high risk of hypoglycemia. It is prudent to monitor glucose closely, set less-stringent blood sugar goals, avoid oral antidiabetic agents, and possibly reduce insulin dosage. PMID:27055204

  5. 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.

  6. 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.

  7. A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

    PubMed Central

    Satoh-Asahara, Noriko; Ito, Hiroto; Akashi, Tomoyuki; Yamakage, Hajime; Kotani, Kazuhiko; Nagata, Daisuke; Nakagome, Kazuyuki; Noda, Mitsuhiko

    2016-01-01

    PURPOSE Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. CONCLUSION A new PHR may be suitable for comorbid patients with diabetes and depression. PMID:27478395

  8. Association between osteoprotegerin gene polymorphisms and cardiovascular disease in type 2 diabetic patients

    PubMed Central

    Guo, Changlei; Hu, Fudong; Zhang, Shaoli; Wang, Yakun; Liu, Hengdao

    2013-01-01

    Osteoprotegerin (OPG) gene polymorphisms (T245G, T950C and G1181C) have been associated with osteoporosis and early predictors of cardiovascular disease. The aim of this study was to evaluate whether these polymorphisms contribute to cardiovascular disease (CVD) in type 2 diabetic patients. We performed a case-control study with 178 CVD subjects with diabetes and 312 diabetic patients without CVD to assess the impact of variants of the OPG gene on the risk of CVD. The OPG gene polymorphisms were analyzed by using the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). There was no significant association between the T245G and G1181C polymorphisms and CVD in the additive genetic model (OR = 0.96, 95% CI 0.64–1.45, p = 0.79; OR = 1.06, 95% CI 0.81–1.39, p = 0.65, respectively). However, the C allele of the T950C polymorphism was independently associated with a risk of CVD in type 2 diabetic patients in this genetic model (OR = 1.38, 95% CI 1.07–1.80, p = 0.01). This study provides evidence that the C allele of the T950C polymorphism is associated with increased risk of CVD in diabetic patients. However, well-designed prospective studies with a larger sample size are needed to validate these results. PMID:23885198

  9. Chlorpropamide-alcohol flushing is not useful for individual genetic counseling of diabetic patients.

    PubMed

    Dreyer, M; Kühnau, J; Rüdiger, H W

    1980-09-01

    The presence or absence of chlorpropamide-alcohol flushing (CPAF) was not correlated with the classification of diabetes. Five out of twelve patients with juvenile-onset diabetes (JOD) flushed and three out of four patients with maturity-onset diabetes in young people (MODY) did not flush. Consequently, CPAF cannot be used for individual genetic counseling in diabetes mellitus. PMID:7438499

  10. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  11. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  12. 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

  13. 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. PMID:24877066

  14. 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

  15. Glycemic control in non-diabetic critically ill patients

    PubMed Central

    Farrokhi, Farnoosh; Smiley, Dawn; Umpierrez, Guillermo E.

    2013-01-01

    Hyperglycemia is a common and costly health care problem in hospitalized patients. In hospital hyperglycemia is defined as any glucose value >7.8 mmol/l (140 mg/dl). Hyperglycemia is present in 40% of critically ill patients and in up to 80% of patients after cardiac surgery, with ~ 80% of ICU patients with hyperglycemia having no history of diabetes prior to admission. The risk of hospital complications relates to the severity of hyperglycemia, with a higher risk observed in patients without a history of diabetes compared to those with known diabetes. Improvement in glycemic control reduces hospital complications and mortality; however, the ideal glycemic target has not been determined. A target glucose level between 7.8 and 10.0 mmol/l (140 and 180 mg/dl) is recommended for the majority of ICU patients. This review aims to present updated recommendations for the inpatient management of hyperglycemia in critically ill patients with and without a history of diabetes. PMID:21925080

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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

  1. Guidelines for Perioperative Management of the Diabetic Patient

    PubMed Central

    Surani, Salim R.

    2015-01-01

    Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

  2. Health coaching in diabetes: empowering patients to self-manage.

    PubMed

    Wong-Rieger, Durhane; Rieger, Francis P

    2013-02-01

    To effectively manage diabetes mellitus, patients must adhere to treatment recommendations and healthy lifestyle behaviors, but research shows many patients do not do this. Education is effective when combined with self-management support but peer-support programs do not lead to lasting changes. Health coaching, or professional support, can be highly effective if it focuses on developing self-efficacy and skills such as goal-setting, problem-solving and managing cognitive and emotional barriers. This overview discusses the benefits of patient self-management for chronic conditions such as diabetes, core competencies for health coaching, theoretical bases and principles of health coaching interventions, delivery methods and the evidence that health coaching works for diabetes self-management.

  3. 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

  4. 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.

  5. 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. PMID:18399745

  6. 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

  7. The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

    PubMed

    Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

    2007-10-01

    Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

  8. Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems

    PubMed Central

    Yusof, Nazri Mohd; Rahman, Jamalludin Ab; Zulkifly, Ahmad Hafiz; Che-Ahmad, Aminudin; Khalid, Kamarul Ariffin; Sulong, Ahmad Fadzli; Vijayasingham, Naveen

    2015-01-01

    INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems. PMID:26668408

  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. 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.

  11. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient.

    PubMed

    Goetti, Patrick; 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

  12. Frequency of latent autoimmune diabetes in adults in Asian patients diagnosed as type 2 diabetes in Birmingham, United Kingdom.

    PubMed

    Tica, Valeria; Hanif, M Wasim; Andersson, Annika; Valsamakis, G; Barnett, A H; Kumar, Sudesh; Sanjeevi, C B

    2003-11-01

    The aims of our study were to measure autoantibodies to glutamic acid decarboxylase and autoantibodies to protein tyrosine phosphatase in patients with type 2 diabetes mellitus, patients with impaired glucose tolerance, and healthy controls of Asian origin from Birmingham, United Kingdom. According to our findings, 27% (9/33) of patients initially diagnosed with type 2 diabetes mellitus carry autoantibodies to GAD65.

  13. Tedium among patients with insulin-dependent diabetes mellitus.

    PubMed

    Lundman, B; Asplund, K; Norberg, A

    1988-01-01

    Tedium assessment and factor analysis of psychosocial variables were performed in 158 insulin-dependent diabetic patients. High tedium scores correlated significantly (P less than 0.05) with high education, lack of self-monitoring, many reported problems concerning insulin injections, diet, strict planning of the activities of everyday life and anxiety concerning complications. There was also a significant relationship between low tedium scores and reported positive effects of the diabetes. There was a higher proportion (ns) of high tedium scores among patients in poor or good metabolic control than in those with intermediate metabolic control. PMID:3372882

  14. 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

  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. [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.

  17. Predicting Mortality in Patients with Diabetes Starting Dialysis

    PubMed Central

    Dekkers, Olaf M.; Rotmans, Joris I.; Krediet, Raymond T.; Boeschoten, Elisabeth W.; Dekker, Friedo W.

    2014-01-01

    Background While some prediction models have been developed for diabetic populations, prediction rules for mortality in diabetic dialysis patients are still lacking. Therefore, the objective of this study was to identify predictors for 1-year mortality in diabetic dialysis patients and use these results to develop a prediction model. Methods Data were used from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a multicenter, prospective cohort study in which incident patients with end stage renal disease (ESRD) were monitored until transplantation or death. For the present analysis, patients with DM at baseline were included. A prediction algorithm for 1-year all-cause mortality was developed through multivariate logistic regression. Candidate predictors were selected based on literature and clinical expertise. The final model was constructed through backward selection. The model's predictive performance, measured by calibration and discrimination, was assessed and internally validated through bootstrapping. Results A total of 394 patients were available for statistical analysis; 82 (21%) patients died within one year after baseline (3 months after starting dialysis therapy). The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. Predictive performance was good, as shown by the c-statistic of 0.810. Internal validation showed a slightly lower, but still adequate performance. Sensitivity analyses showed stability of results. Conclusions A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary. PMID:24594735

  18. Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus

    PubMed Central

    Yan, Zhi-Peng; Ma, Jing-Xue

    2016-01-01

    AIM To investigate the prevalence and risk factors of diabetic retinopathy (DR) in northern Chinese patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective cross-sectional study was performed between May 2011 and April 2012. A total of 1100 patients (male/female, 483/617) were included in this study. DR was defined following the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. All included patients accepted a comprehensive ophthalmic examination including retinal photographs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for age and gender. RESULTS Retinopathy was present in 307 patients with a prevalence of 27.9%. In univariate logistic analysis, presence of DR was associated with longer duration of diabetes (OR, 5.70; 95%CI, 2.91-12.56), higher concentration of fasting blood glucose (OR, 12.94; 95%CI, 2.40-67.71), higher level of glycosylated hemoglobin HbA1c (OR, 5.50; 95%CI, 3.78-11.97) and insulin treatment (OR, 6.99; 95%CI, 1.39-35.12). The lifestyle of patients with T2DM including smoking, alcohol consumption and regular exercise seemed not associated with the development of DR. CONCLUSION Our study suggests that fasting serum glucose concentration, HbA1c level, duration of diabetes and insulin treatment are potential risk factors for DR in northern Chinese patients with T2DM, while the lifestyle of included patients seems not associated with DR. PMID:27588275

  19. 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…

  20. Diabetes care quality is highly correlated with patient panel characteristics

    PubMed Central

    Bailey, Steffani; O’Malley, Jean P.; Gold, Rachel; Heintzman, John; Likumahuwa, Sonja; DeVoe, Jennifer E.

    2014-01-01

    Introduction Health care reimbursement is increasingly based on quality. Little is known about how clinic-level patient characteristics affect quality performance, particularly in community health centers (CHCs). Methods Using electronic health record data for 4,019 diabetic patients from 23 CHC primary care clinics in the OCHIN practice-based research network, we calculated correlations between a clinic’s patient panel characteristics and delivery rates of diabetes preventive services in 2007. Using regression models, we estimated the proportion of clinic variability in clinics’ preventive services rates associated with the variability in the clinics’ patient panel characteristics. We also explored whether clinics’ performance rates were affected by how patient panel denominators were defined. Results Clinic rates of glycosylated hemoglobin testing, influenza immunizations, and lipid screening were positively associated with the percentage of patients with continuous health insurance coverage, and negatively associated with the percentage uninsured. Microalbumin screening rates were positively associated with the percentage of racial minorities in a clinic’s panel. Associations remained consistent with different panel denominators. Conclusions Clinic variability in delivery rates of preventive services correlates with differences in clinics’ patient panel characteristics, particularly the percentage of patients with continuous insurance coverage. Quality scores that do not account for these differences could create disincentives to diabetes care for vulnerable patients. PMID:24204063

  1. Missed opportunities for Hepatitis B vaccination among diabetic patients

    PubMed Central

    Ozisik, Lale; Tanriover, Mine Durusu; Calik Basaran, Nursel; Oz, S Gul; Unal, Serhat

    2015-01-01

    Many infectious diseases in adults can be prevented by a ‘life-long vaccination strategy’. Hepatitis B disease burden was shown to be higher in diabetic patients. American Advisory Committee on Immunization Practices recommends to vaccinate diabetic patients against hepatitis B since 2011. In this study, we aimed to determine hepatitis B virus serology status to determine the rates of diabetic patients who have indications for hepatitis B vaccination. The electronic database of the hospital was searched to identify adult patients aged above 18 years and with hemoglobin A1C levels of 6.5% or above, who have been seen at General Medicine Outpatient Clinics of a university hospital during a 3-year period. A total of 5187 patients were included in the study. After exclusion of patients with an incomplete serological panel, 1358 patients were included for further analyses. Twenty-nine percent of the patients had indication for hepatitis B vaccination, whereas only 8% were vaccinated. This study showed that nearly one third of patients who had hepatitis B serological data had an indication for hepatitis B vaccination and this is a clear reflection of the need to keep a lifelong vaccination log and inquire vaccination data. PMID:26366628

  2. Patient selection and vitamin E treatment in diabetes mellitus.

    PubMed

    Goldenstein, Hagit; Levy, Nina S; Lipener, Yisrael T; Levy, Andrew P

    2013-03-01

    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 with the nondiabetic population. Haptoglobin (Hp) is a plasma protein that 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 that show the importance of vitamin E supplementation in a specific subgroup of patients, diabetic individuals carrying the Hp 2-2 genotype. PMID:23469912

  3. Oral magnesium supplementation in type II diabetic patients

    PubMed Central

    Solati, Mehrdad; Ouspid, Elham; Hosseini, Saeedeh; Soltani, Nepton; Keshavarz, Mansoor; Dehghani, Mohsen

    2014-01-01

    Background: Magnesium is the second most abundant intracellular cation. It plays an important role in insulin homeostasis and glucose metabolism through multiple enzymatic reactions. With increasing data on magnesium deficiency in diabetic patients and epidemiological studies demonstrating magnesium deficiency as a risk factor for diabetes, it is logical to search for its possible beneficial effects on diabetes control and prevention. We aimed to determine whether oral magnesium supplementation improves metabolic control, lipid profile and blood pressure in patients with type II diabetes. Methods: Fifty four patients with type II diabetes were included in a randomized double blind placebocontrolled clinical trial.Patients received either placebo or 300 mg elemental magnesium (as magnesium sulfate -MgSo4-) daily, for 3 months. Metabolic control, lipid profile, blood pressure, magnesium status, hepatic enzymes, hemoglobin concentration, and anthropometric indices were determined in the beginning and at the end of the study. Results: Daily administration of 300 mg elemental magnesium for 3 months, significantly improved fasting blood glucose (183.9±15.43 to 125.8±6.52 vs. 196.5±28.12 to 136.5±7.94, p< 0.0001), 2-hour post prandial glucose (239.1±74.75 to 189.1±60mg/dl vs. 246.4±97.37 to 247.8±86.74mg/dl, p< 0.01), lipid profile, blood pressure and hepatic enzymes. Conclusion: Oral magnesium supplementation with proper dosage has beneficial effects on blood glucose, lipid profile, and blood pressure in patients with type II diabetes. PMID:25405132

  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. Atypical onset of diabetes in a teenage girl: a case report

    PubMed Central

    Mihai, Cristina Maria; Catrinoiu, Doina; Stoicescu, Ramona Mihaela

    2008-01-01

    Background Chorea, hemichorea-hemiballismus and severe partial seizures may be the presenting feature of nonketotic hyperglycemia in older adults with type 2 diabetes, but cases in children with type 1 diabetes are rare, since the most easily recognized symptoms of type 1 diabetes in children are secondary to hyperglycemia, glycosuria, and ketoacidosis. Case presentation A previously healthy 15-year-old girl presents with sudden onset of right-sided chorea. Brain CT did not detect any abnormal density areas. A T1-weighted image of brain MRI was normal. Investigations revealed hyperglycemia with absent ketones and normal serum osmolality. Achievement of normoglycemia with insulin therapy determined the involuntary movements to regress completely within a day. The direct effect of hyperglycemia could be the pathogenesis of the chorea in our patient. Severe hyperglycemia without ketosis at the clinical onset of insulin-dependent diabetes mellitus (type 1) has been reported in children and adolescents, but nonketotic hyperglycemia is an unusual cause of chorea-ballismus in children, and chorea-ballismus is also a rare manifestation of primary diabetes mellitus. Conclusion The importance of clinical evaluation, laboratory testing and neuroimaging for the differential diagnostics of chorea is emphasized. PMID:19116001

  6. 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

  7. 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

  8. 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.

  9. Predictors of Diabetes Self-Management among Type 2 Diabetes Patients.

    PubMed

    Gunggu, Azylina; Thon, Chang Ching; Whye Lian, Cheah

    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

  10. 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

  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. 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.

  13. 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

  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.

  15. Renal histological heterogeneity and functional progress in normoalbuminuric and microalbuminuric Japanese patients with type 2 diabetes

    PubMed Central

    Moriya, Tatsumi; Suzuki, Yoshiki; Inomata, Shigeki; Iwano, Masayuki; Kanauchi, Masao; Haneda, Masakazu

    2014-01-01

    Background and objectives Renal histological injury patterns in type 2 diabetes are heterogeneous. We compared renal histological injury patterns using renal biopsy findings with renal function and followed up renal functional changes in normoalbuminuric and microalbuminuric patients with type 2 diabetes to determine whether renal function progresses according to injury patterns. Design, setting, participants, and measurements We examined 111 patients with type 2 diabetes with percutaneous renal biopsy (78 men, 52±11 years old, 59 normoalbuminuria, 52 microalbuminuria) and followed up 37 cases for 11 years. Light microscopy of tissues revealed renal injury patterns as: category I (CI), normal or near-normal structure; category II (CII), typical diabetic glomerulopathy; category III (CIII), atypical (disproportionately severe tubulointerstitial/vascular damage with no/mild glomerulopathy). Results There were 29 CI, 62 CII, and 20 CIII patients. CII patients had a higher frequency of chronic kidney disease (CKD) G3-4, while the injury pattern distribution was not different among the albuminuria stages. The mean glomerular volume and volume fraction of cortical interstitium were larger than those of controls. The arteriolar hyalinosis index was larger in CII and CIII, while the percent global glomerular sclerosis was larger in CKD G3-4 compared with CKD G1-2. Renal function at follow-up was decreased in CII and CIII compared with the baseline estimated glomerular filtration rate (eGFR), while the GFR decline rate was faster in CII. Conclusions In normoalbuminuric and microalbuminuric patients with type 2 diabetes, loss of GFR could indicate typical diabetic glomerulosclerosis and a high frequency of global glomerular sclerosis. Urinary biomarkers identifying histological patterns of renal injury are necessary because GFR decline rates differed according to histological injury patterns. PMID:25452869

  16. Impact of the conversation map tools in patients with type 2 diabetes mellitus

    PubMed Central

    Yang, Qing; Fang, Ping

    2016-01-01

    Abstract Background: Diabetes is one of the leading causes of morbidity and mortality worldwide, and type 2 diabetes is the most common type accounting for 90% of all diabetes cases. Health education is considered as the first choice to control blood glucose levels. We conducted a meta-analysis to assess the effect of health education tool “Conversation Map” in diabetes patients to control blood glucose. Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, China Knowledge Resource Integrated Database, and China Science Periodical Database up to December, 2015. We assessed the results using the inverse variance method to pool diabetes relative indicators, and assessed the heterogeneity of the results using I-square. Results: We collected 22 trials in our meta-analysis, which included 3360 patients. The results showed that the fasting blood-glucose level was significantly reduced in the type 2 diabetes group patients educated with “Conversation Map” when compared to their respective control groups (weighted mean difference [WMD]: −2.23, 95% confidence interval [CI]: −2.70 to −1.76, P < 0.001). Also a significant reduction of 2-hour postprandial blood glucose (WMD: −1.59, 95% CI: −2.27 to −0.92, P < 0.001) and Hemoglobin A1C levels (WMD: −0.63, 95% CI: −1.08 to −0.17, P < 0.001) was also observed when compared to the control groups. Conclusion: Conversation Map is an effective health education tool for type 2 diabetes, and significantly reduced patients’ blood glucose related index. PMID:27749529

  17. 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

  18. [Celiac disease: association with rheumatoid arthritis and diabetes mellitus. Apropos of a clinical case].

    PubMed

    Mingrone, G; Negrini, A P; Principi, E; De Cunto, F; Vecchio, F M; Altomonte, L; Magarò, M

    1980-08-25

    A case of coeliac disease accompanied by serum-negative rheumatoid arthritis and (subsequently) by diabetes mellitus is described. The appearance of a similar clinical and sympatomatological enteric and articular picture in one of the patient's brothers is seen as evidence that the link between the components of the three-fold syndrome is to be found in common genetic factors, with an onset in the form of a cellular and biohumoral immunological disorder. PMID:7432643

  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. Does the Diabetic Foot Have a Significant Impact on Selected Psychological or Social Characteristics of Patients with Diabetes Mellitus?

    PubMed Central

    Fejfarová, Vladimíra; Jirkovská, Alexandra; Dragomirecká, Eva; Game, Frances; Bém, Robert; Dubský, Michal; Wosková, Veronika; Křížová, Marta; Skibová, Jelena; Wu, Stephanie

    2014-01-01

    The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls). Methods. 104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics. Results. Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P < 0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P < 0.01) that negatively correlated with diabetes duration (r = −0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P < 0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P < 0.01), more patients with disability pensions (P < 0.01), and low self-support (P < 0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P < 0.01), employment status, and stress readaptation (P < 0.01) in contrast to the main study groups. Conclusions. Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences. PMID:24791012

  1. Primary Paranasal Tuberculosis in a Diabetic Mimicking Odontogenic Infection: A Rare Case; A Unique Presentation.

    PubMed

    Gupta, Amit; Mehendirratta, Monica; Sareen, Chanchal; Aggarwal, Anju

    2016-03-01

    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. 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

  3. 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.

  4. Study on Glycaemic Status and Lipid Profile in Type 2 Diabetic Patients Attending Mymensingh Medical College Hospital, Mymensingh.

    PubMed

    Tabazzum, R; Mia, A R; Haq, R U; Epsi, E Z

    2016-07-01

    Recent increases in the incidence of diabetes in developing countries have been associated with complications resulting in mortality and morbidity. A case control study of 120 subjects attending out patient department of Mymensingh Medical College, Mymensingh was done with an aim to evaluate alteration of serum lipid profile and HbA1c in type 2 diabetic patients and compare with age matched healthy control. Of the total cases, 60 were Type 2 diabetic patients and 60 were apparently healthy persons recruited for the study. These patients and control subjects were classified as male (50%) and female (50%). Fasting lipid profile and HbA1c% were measured by following the standard laboratory methods. The study subjects had relatively poor glycemic control. The mean HbA1c was 9.21±1.19% in diabetes patient and 4.71±0.60% was in control. The mean fasting blood glucose level was 10.18±1.56mmol/L in diabetes patient and 4.51±0.48mmol/L in control. The mean total cholesterol, triacylglycerols, HDL-C & LDL-C were 211.93±11.83mg/dl, 156.90±7.96mg/dl, 35.20±3.17mg/dl & 133.20±3.99mg/dl in diabetes patient accordingly and the mean total cholesterol, triacylglycerols, HDL-C & LDL-C were 159.72±4.89mg/dl, 117.45±12.97mg/dl, 44.23±2.75mg/dl & 92.15±5.67mg/dl in control group accordingly. The study revealed that the most common abnormality seen was decreased serum HDL-Cholesterol levels (91.67%). Hypertriglyceridaemia present in 81.67% patients, 78.34% had high LDL-Cholesterol and 73.34% had hypercholesteromia. Diabetic males had significantly higher levels of total cholesterol and LDL-Cholesterol compared to diabetic females and diabetic females had significantly lower levels of HDL-Cholesterol compared to diabetic males. It was concluded from the results of this study that, diabetic patients are more prone to develop dyslipidaemia. Thus early diagnosis of dyslipidemia and good glycaemic control can be used as a preventive measure for the development of cardiovascular

  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. 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. PMID:27375734

  7. Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus.

    PubMed

    Hashimoto, Kunihiko; Koga, Masafumi

    2015-07-25

    Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternal-infant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus (GDM) have been changed. Therefore, in patients with GDM and pregnant women with diabetes mellitus, even stricter glycemic control than before is required to reduce the incidence of perinatal maternal-infant complications. Strict glycemic control cannot be attained without an indicator of glycemic control; this review proposes a reliable indicator. The gold standard indicator of glycemic control in patients with diabetes mellitus is hemoglobin A1c (HbA1c); however, we have demonstrated that HbA1c does not reflect glycemic control accurately during pregnancy because of iron deficiency. It has also become clear that glycated albumin, another indicator of glycemic control, is not influenced by iron deficiency and therefore might be a better indicator of glycemic control in patients with GDM and pregnant women with diabetes mellitus. However, large-population epidemiological studies are necessary in order to confirm our proposal. Here, we outline the most recent findings about the indicators of glycemic control during pregnancy including fructosamine and 1,5-anhydroglucitol.

  8. 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

  9. [The cure of type 2 diabetes and patient education].

    PubMed

    Lagger, G; Chambouleyron, M; Correia, J C; Sittarame, F; Miganne, G; Lasserre Moutet, A; Golay, A

    2015-03-25

    Type 2 diabetes is a potentially reversible disease. Patient education encompasses a deep investment of the health care providers, who with the aid of pedagogic tools, help the pa tient commit to this path. This facilitates the learning of uncommon knowledge and skills required. Whether or not it leads to a complete remission of the disease may not be the main purpose. The main goal lies in the patient's motivation to learn and change on a long term basis.

  10. A Clinical Study of Meibomian Gland Dysfunction in Patients with Diabetes

    PubMed Central

    Shamsheer, R. P.; Arunachalam, Cynthia

    2015-01-01

    Aims of the Study: To study the frequency of meibomian gland dysfunction (MGD) in patients of diabetes mellitus with dry eye. Materials and Methods: A case-control cross sectional study. Sampling: Purposive random sampling. Totally, 200 eyes of 100 patients of diabetes mellitus and an equal number of eyes of normal subjects as control, who were gender and age matched and all of whom were symptomatic for dry eye were assessed for MGD by noting the symptoms and determining the meibomian gland expression scale for volume and viscosity, and ocular surface staining with Lissamine green, and Fluorescein sodium. All the subjects were graded for the severity of MGD. The results were compared in both the groups to ascertain whether the frequency of MGD in diabetics is significantly more as compared to nondiabetics. Statistical Analysis: The data were analyzed by Chi-square test for significance. P < 0.05 was considered as statistically significant. Results: There was a significant increase in the frequency of MGD in diabetics as compared to the nondiabetics. Conclusion: Diabetes mellitus is associated with MGD. PMID:26692718

  11. Lipid peroxidation and antioxidant enzymes activity in controlled and uncontrolled Type 2 diabetic patients

    PubMed Central

    Zarei, Mahnaz; Farahnak, Zahra; Hosseinzadeh-Attar, Mohammad Javad; Javanbakht, Mohammad Hassan; Hosseinzadeh, Payam; Derakhshanian, Hoda; Farahbakhsh-Farsi, Payam; Djalali, Mahmoud

    2016-01-01

    BACKGROUND This study was designed to compare lipid peroxidation and antioxidant enzymes activity in Type 2 diabetes patients with good or weak glycemic control. METHODS In this case-control study, 62 Type 2 diabetic patients with glycated hemoglobin (HbA1c) between 6 and 8 were enrolled as the controlled group and 55 patients with HbA1c > 8 were selected as an uncontrolled group. Patients were all referred to Iranian Diabetes Association in Tehran, Iran, from 2010 onward. Groups were chosen by convenience sampling and were matched based on age, sex and duration of disease. Demographic questionnaire, two 24-hour food recall, HbA1c, insulin, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase were measured in blood samples. Data were analyzed by Food Processor II and SPSS software. RESULTS A mean daily consumption of energy, carbohydrate, protein, and fat was not significantly different between two groups. MDA in the uncontrolled group was significantly higher than controlled group (2.03 ± 0.88 vs. 1.65 ± 1.01 nmol/ml; P = 0.030). A mean SOD was slightly higher in the uncontrolled group comparing to the control group (843.3 ± 101.9 vs. 828.0 ± 127.3 U/g Hb; P = 0.400). CONCLUSION These data suggest that MDA as a lipid peroxidation indicator is higher in uncontrolled diabetes probably due to chronic high blood sugar followed by higher oxidative stress. PMID:27752268

  12. Panel: Big Data & Social Media for Empowering Patients with Diabetes.

    PubMed

    Fernandez-Luque, Luis; Mejova, Yelena; Mayer, Miguel-Angel; Hasvold, Per Erlend; Joshi, Surabhi

    2016-01-01

    Millions of people living with diabetes are using mobile phones, Internet and social media to socialize with other patients, share experience or search information relevant for their self-management. This phenomena is leading towards a new paradigm of hyper-connected diabetes digital self-management. This is also leading towards an explosion on data, a large amount of data is collected on populations around the world. This panel will address the opportunities this data presents, discuss the latest research that uses it, and the limitations and other concerns. PMID:27332274

  13. Sphingomonas paucimobilis bacteraemia and septic arthritis in a diabetic patient presenting with septic pulmonary emboli.

    PubMed

    Kuo, I-Ching; Lu, Po-Liang; Lin, Wei-Ru; Lin, Chun-Yu; Chang, Yu-Wei; Chen, Tun-Chieh; Chen, Yen-Hsu

    2009-09-01

    Sphingomonas paucimobilis, a yellow-pigmented, aerobic, glucose non-fermenting, Gram-negative bacillus, is a rare cause of human infection normally associated with immunocompromised hosts. We report a case of bacteraemia and septic arthritis in a 47-year-old diabetic man who presented with septic pulmonary emboli due to S. paucimobilis. The patient had an initial presentation of fever, right knee pain, coughing, dyspnoea and chest pain. The infection was treated successfully by surgical debridement combined with meropenem plus ciprofloxacin, based on the patient's antibiotic susceptibility profile. To our knowledge, this is the first case report for septic pulmonary emboli having arisen from an S. paucimobilis infection.

  14. Circadian rhythm of autonomic activity in non diabetic offsprings of type 2 diabetic patients

    PubMed Central

    Fiorentini, A; Perciaccante, A; Paris, A; Serra, P; Tubani, L

    2005-01-01

    The aim of the present study was to evaluate, by heart rate variability (HRV) with 24-hours ECG Holter (HRV), the circadian autonomic activity in offspring of type 2 diabetic subjects and the relation with insulin-resistance. METHODS: 50 Caucasian offsprings of type 2 diabetic subjects were divided in two groups: insulin-resistant offsprings (IR) and non insulin-resistant offsprings (NIR). Autonomic nervous activity was studied by HRV. Time domain and spectral analysis (low frequency, LF, and high frequency, HF, provide markers of sympathetic and parasympathetic modulation when assessed in normalized units) were evaluated. RESULTS. Time domain showed a reduction of total SDNN in IR (p < 0.001) and NIR (p 0.047) versus controls. Spectral analysis showed a total and night LF higher in IR and NIR than in control group (all p < 0.001). CONCLUSION. In frequency domain, the analysis of sympathetic (LF) and parasympathetic (HF) component evidenced an association between the offspring of type 2 diabetic subjects and a sympathetic overactivity. A global reduction and alteration of circadian rhythm of autonomic activity are present in offspring of type 2 diabetic patients with and without insulin resistance. The data of our study suggested that an autonomic impairment is associated with the familiarity for type 2 diabetes independently to insulin resistance and that an impairment of autonomic system activity could precede the insulin resistance. PMID:16197556

  15. [Sodium-glucose cotransporter 2 (SGLT-2) inhibitors for patients with Type 2 diabetes].

    PubMed

    Røder, Michael Einar; Storgaard, Heidi; Rungby, Jørgen; Knop, Filip Krag; Vilsbøll, Tina

    2016-09-19

    The sodium-glucose cotransporter 2 inhibitor (SGLT-2i)-class is efficacious as monotherapy and as add-on therapy with an expected lowering of the glycated haemoglobin (HbA1c) concentration of approximately 7 mmol/mol. Side effects relate to the mode of action, genital infections are the main problem. Extremely rare cases of ketoacidosis are reported, mostly in patients with Type 1 diabetes. One SGLT-2i, empagliflozin, has been shown to reduce cardiovascular mortality and progression of kidney disease in patients with Type 2 diabetes and cardiovascular disease. Outcome trials for other SGLT-2i are pending. SGLT-2i are now in guidelines as a possible second-line therapy or in case of metformin intolerance. PMID:27649712

  16. The evaluation of diabetic patients' use of a telehealth program.

    PubMed

    Lee, Ting-Ting; Huang, Tzu-Yi; Chang, Chi-Ping; Lin, Kuan-Chia; Tu, Hsiu-Mei; Fan, Ching-Jih; Mills, Mary Etta

    2014-12-01

    Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Care models that apply technology, such as telehealth, may be useful in working with diabetes patients. The development and application of wireless communication telehealth have significantly affected healthcare in recent years. Thus, the purpose of this study was to evaluate diabetic patients' use of a telehealth program by using questionnaire survey and laboratory data results. A quantitative study, 1-group pretest-posttest design, was conducted. This study recruited 20 diabetic patients who received telehealth service to measure their glucose, heart rate, and blood pressure, with data uploaded back to the hospital daily. A questionnaire survey was conducted in May 2012 and between August and January 2013 with 20 participants. The test values (blood pressure, heart rate, and blood glucose) of subjects were obtained from the hospital telecare platform and the outpatient monthly reporting system. Study findings showed an overall satisfaction rating of 91% by telehealth participants. Nonparametric statistical analysis demonstrated a significant difference (P < .01) in participants' glycosylated hemoglobin and resultant effective control. These findings indicated that participants accepted this care model, and telehealth could improve participants' glucose control.

  17. 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

  18. Influencing factors for dietary behaviors of patients with diabetic nephropathy.

    PubMed

    Sumiyoshi, Kazuko; Kawata, Chieko; Shikata, Kenichi; Makino, Hirofumi

    2010-02-01

    The aim of this study was to clarify the factors influencing the dietary behavior of patients with diabetic nephropathy. One hundred twenty-two patients with type 2 diabetes were recruited from the outpatients of Okayama University Hospital in Okayama, Japan. We performed a cross-sectional study using a questionnaire including 206 items among 18 categories as follows: background factors, coping behavior (coping scale), degree of uncertainty in illness (uncertainty scale), and dietary behavior. The data were analyzed by correlation analysis, t-test, one-way analysis of variance, Pearson correlation analysis, and multiple regression analysis. We found that those patients with microalbuminuria alone tended to recognize more mild about their kidney status than those with macroalbuminuria and chronic renal failure. We also found that common factors influencing the dietary behavior of diabetic patients with and without nephropathy are as follows: 1. coping with the problem (beta = 0.342, p < 0.01); 2. anxiety about prognosis (beta = -0.344, p < 0.01); 3. sex (beta = -0.234, p < 0.05); 4. uncertainty regarding treatment (beta = 0.377, p < 0.01); 5. negative coping (beta = -0.354, p< 0.01); and 6. employment status (beta = 0.367, p < 0.01). Coping and uncertainty in illness had a significant relation to positive support and lack of support. To maintain appropriate dietary behavior in diabetic patients, medical staff need to determine what the social supports are important for the patient, and also to ensure good communication among healthcare personnel as well as positive support for patients and families.

  19. 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. PMID:27190996

  20. 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

  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. 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.

  3. [Serological tests for celiac disease in Moroccan patients with type 1 diabetes].

    PubMed

    Bourhanbour, Asmaa Drissi; Ouadghiri, Sanae; Benseffaj, Nadia; Essakalli, Malika

    2016-01-01

    Celiac disease (CD) is an autoimmune disease frequently associated with type 1 diabetes (T1D). The prevalence of CD in patients with T1D varies from 3 to 6%. The clinical manifestation of CD in patients with T1D is classified as asymptomatic in about half of cases. Our study aims to determine the frequency of anti-tissue transglutaminase autoantibodies (IgA-tTG) and anti-gliadin antibodies (AGA) in patients with type 1 diabetes in order to early recommend jejunal biopsy and establish a gluten-free diet before the onset of clinical signs and complications of celiac disease. Subjects included in this study were patients with T1D and untreated CD who showed no signs of this disease. The detection of IgG tTG, IgG IgA and IgG AAG was performed using Luminex technology. We enrolled 31 patients. The study involved 16 men and 15 women. IgA AAG were positive in 4(13%) patients and IgG were positive in 7(22,5%) patients. IgA tTG were positive in 3(10%) patients and IgG was positive in one (3%) patient. In our study the association of diabetes type 1 with biomarkers of CD is not uncommon hence the importance of systematic screening for type 1 diabetes. The diagnosis of this atypical and silent CD form is important given the risk of serious complications such as malabsorption and gastrointestinal cancers. PMID:27642442

  4. Improvement of Diabetic Patients Nursing Care by the Development of Educational Programs

    PubMed Central

    Vissarion, Bakalis; Malliarou, Maria; Theofilou, Paraskevi; Zyga, Sofia

    2014-01-01

    Diabetes is a major health problem with many social and economic consequences in general population. The importance of education in the diabetic patient and his family, led to the development of diabetes clinical nurse specialist. The role of diabetes clinical nurse specialist is essential and crucial to the hospitals and the community, in order to form a relationship with the diabetic patient and his/her family. In this way health is promoted to the maximum extent possible. In conclusion educational programs help patients with diabetes to obtain information about their condition and improve their self-care skills. PMID:26973922

  5. 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.

  6. Use of Antibiotics and Risk of Type 2 Diabetes: A Population-Based Case-Control Study

    PubMed Central

    Knop, Filip Krag; Frost, Morten; Hallas, Jesper; Pottegård, Anton

    2015-01-01

    Context and objective: Evidence that bacteria in the human gut may influence nutrient metabolism is accumulating. We investigated whether use of antibiotics influences the risk of developing type 2 diabetes and whether the effect can be attributed to specific types of antibiotics. Methods: We conducted a population-based case-control study of incident type 2 diabetes cases in Denmark (population 5.6 million) between January 1, 2000, and December 31, 2012. Data from the Danish National Registry of Patients, the Danish National Prescription Registry, and the Danish Person Registry were combined. Results: The odds ratio (OR) associating type 2 diabetes with exposure to antibiotics of any type was 1.53 (95% confidence interval 1.50–1.55) with redemption of more than or equal to 5 versus 0–1 prescriptions. Although no individual group of antibiotics was specifically associated with type 2 diabetes risk, slightly higher ORs for type 2 diabetes were seen with narrow-spectrum and bactericidal antibiotics (OR 1.55 and 1.48) compared to broad-spectrum and bacteriostatic types of antibiotics (OR 1.31 and 1.39), respectively. A clear dose-response effect was seen with increasing cumulative load of antibiotics. The increased use of antibiotics in patients with type 2 diabetes was found up to 15 years before diagnosis of type 2 diabetes as well as after the diagnosis. Conclusions: Our results could support the possibility that antibiotics exposure increases type 2 diabetes risk. However, the findings may also represent an increased demand for antibiotics from increased risk of infections in patients with yet-undiagnosed diabetes. PMID:26312581

  7. Prevalence of metabolic syndrome in type 2 diabetes mellitus patients

    PubMed Central

    Nsiah, Kwabena; Shang, V Owusua; Boateng, K Agyenim; Mensah, FO

    2015-01-01

    Background: The diabetic condition is influenced by several factors, some of which can accelerate the disease's progression to various complications that aggravate the morbidity. Aims: This study aimed at determining the prevalence of metabolic syndrome (MetS) and its individual components and the most critical predictive risk factors of MetS in type 2 diabetic patients. Materials and Methods: This cross-sectional study involved 150 type 2 diabetes mellitus patients and was conducted at the Diabetes Centre of the Komfo Anokye Teaching Hospital in Kumasi, the Ashanti Region of Ghana, from February, 2013 to April, 2013. The study involved the use of a questionnaire to obtain some information on the diabetics, undertaking anthropometric measurements, as well as collecting blood samples for the measurement of some biochemical parameters; fasting blood glucose and lipid profile. MetS was defined according to the National Cholesterol Education Program/Adult Treatment Panel III criteria. Results: The prevalence of MetS was 58% in the studied Ghanaian population. Hypertension was the commonest risk factor (60%), followed by central obesity (48.67%) and dyslipidemia (37%). Female type 2 diabetics had a higher prevalence of MetS, and carried more components than their male counterparts. Regression analysis showed three factors; femininity, high body mass index and low educational status were the most critical predictive risk factors of MetS, according to this study. Conclusion: With hypertension being the commonest component, future cardiovascular disease prevention strategies should focus attention on its management and prevention, through education. PMID:26097823

  8. Total Antioxidant Status in Type 2 Diabetic Patients in Palestine.

    PubMed

    Kharroubi, Akram T; Darwish, Hisham M; Akkawi, Mutaz A; Ashareef, Abdelkareem A; Almasri, Zaher A; Bader, Khaldoun A; Khammash, Umaiyeh M

    2015-01-01

    The objective of this study was to compare the level of total antioxidant status (TAS) in type 2 diabetic and normal Palestinian subjects as well as the major factors influencing TAS levels. A sample of convenience composed of 212 type 2 diabetic and 208 normal subjects above the age of 40 were recruited. Only 9.8% of the subjects had normal body mass index (BMI) levels (<25), 29% were overweight (≥25 to <30), and 61.2% were obese (≥30). The mean levels of TAS were significantly higher in diabetic compared to control subjects (2.18 versus 1.84 mM Trolox, P = 0.001) and in hypertensive subjects compared to subjects with normal blood pressure (BP). Mean TAS levels were higher in obese compared to nonobese subjects (2.12 versus 1.85 mM Trolox, P = 0.001). Mean TAS levels were similarly higher in subjects with high fasting plasma glucose (FPG) compared to normal FPG (2.19 versus 1.90 mM Trolox) and high HbA1c (≥6.5%) compared to HbA1c < 6.5% (2.14 versus 1.91 mM Trolox). Multivariate analysis revealed that only diabetic status (P = 0.032) and the level of education (P = 0.036) were significantly associated with TAS. In conclusion diabetic patients had 18.5% increase in TAS levels compared to control subjects. PMID:26090472

  9. Lipids and lipoproteins in patients with type 2 diabetes.

    PubMed

    Krauss, Ronald M

    2004-06-01

    Insulin resistance and type 2 diabetes are associated with a clustering of interrelated plasma lipid and lipoprotein abnormalities, which include reduced HDL cholesterol, a predominance of small dense LDL particles, and elevated triglyceride levels. Each of these dyslipidemic features is associated with an increased risk of cardiovascular disease. Increased hepatic secretion of large triglyceride-rich VLDL and impaired clearance of VLDL appears to be of central importance in the pathophysiology of this dyslipidemia. Small dense LDL particles arise from the intravascular processing of specific larger VLDL precursors. Typically, reduced plasma HDL levels in type 2 diabetes are manifest as reductions in the HDL(2b) subspecies and relative or absolute increases in smaller denser HDL(3b) and HDL(3c). Although behavioral interventions such as diet and exercise can improve diabetic dyslipidemia, for most patients, pharmacological therapy is needed to reach treatment goals. There are several classes of medications that can be used to treat lipid and lipoprotein abnormalities associated with insulin resistance and type 2 diabetes, including statins, fibrates, niacin, and thiazolidinediones. Clinical trials have shown significant improvement in coronary artery disease after diabetic dyslipidemia treatment.

  10. Canagliflozin Treatment in Patients with Type 2 Diabetes Mellitus.

    PubMed

    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.

  11. 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

  12. 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.

  13. 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.

  14. Bilateral basal ganglia lesions in patients with end-stage diabetic nephropathy.

    PubMed

    Li, Jordan Y Z; Yong, Tuck Y; Sebben, Ruben; Khoo, Eewin; Disney, Alex P S

    2008-02-01

    Acute movement disorder associated with reversible bilateral basal ganglia lesions is an increasingly recognized syndrome in patients with end-stage renal disease, especially in the setting of concurrent diabetes mellitus. We report an elderly man with end-stage diabetic nephropathy treated by daily automated peritoneal dialysis who developed subacute symptoms of gait disturbance, dysarthria, dysphagia and lethargy. Computed tomography and magnetic resonance imaging of the head revealed bilateral symmetrical basal ganglia lesions. Repeat imaging 3 weeks later showed that these lesions had regressed spontaneously. However, his neurological symptoms improved slowly. These findings were similar to 23 other cases in the literature. Review of these cases shows that clinical features were predominantly bradykinesia, gait disturbance and concurrent metabolic acidosis (observed in 90% of cases). The pathogenesis of this condition has not been clearly defined, but uraemia may be an aggravating factor in predisposed patients, particularly in the presence of diabetic microvascular disease. There is no specific treatment for this condition; supportive measures are the mainstay of management. In the majority of patients, neurological improvement lags behind regression of basal ganglia lesions seen with neuroimaging, and the long-term outcome is variable.

  15. 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

  16. 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

  17. Prevalence of lipohypertrophy in insulin-treated diabetic patients and predisposing factors.

    PubMed

    Hauner, H; Stockamp, B; Haastert, B

    1996-01-01

    In a cross-sectional study the frequency of insulin-induced lipohypertrophy at injection sites was assessed in 223 type 1 and 56 type 2 diabetic patients. 64 (28.7%) of the subjects with type 1 diabetes, but only 2 (3.6%) of those with type 2 diabetes presented clinical evidence of lipohypertrophy. In every second affected type 1 diabetic patient lipohypertrophy developed within 2 years after starting insulin therapy. The occurrence of lipohypertrophy was independent of the insulin source and mode of therapy. In a multivariate logistic regression analysis young age, low body mass index, abdominal injection site and, particularly, missing rotation of injection site were significant independent risk factors for the presence of insulin-induced lipohypertrophy. Avoidance of such areas led to a partial or full remission of tissue swellings in 6 of 11 cases under observation for one year. In conclusion, lipohypertrophy is still a frequent complication of insulin therapy. To prevent such local skin reactions insulin-treated patients should be more intensively trained to regularly change injection sites.

  18. 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

  19. Curious case of missing (A) in coeliac disease with type 1 diabetes mellitus

    PubMed Central

    Joshi, Ameya S; Varthakavi, Premlata K; Bhagwat, Nikhil M; Dalwadi, Pradip

    2013-01-01

    Coeliac screening in type 1 diabetes mellitus (T1DM) is universally recommended, but not all authorities recommend serum IgA estimation before using an IgA-based test. We report a case of T1DM with poor glycaemic control and recurrent episodes of hypoglycaemias and diabetic ketoacidosis (DKA). Recurrent oromucosal and respiratory infections further complicated the course of illness, resulting in the increasing proneness to DKA. The patient was screened for coeliac disease but the IgA-based screening test was negative (IgA tissue transglutaminase) due to the low IgA level, whereas the IgG antigliadin was positive. The patient benefited from initiation of a gluten-free diet. PMID:24214150

  20. 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.

  1. [Bone and visceral manifestations of lipoatrophic diabetes. Apropos of a case].

    PubMed

    de Wazieres, B; Wendling, D; Fest, T; Morin, G; Dupond, J L

    1992-11-30

    Lipoatrophic diabetes, known by pediatricians as Lawrence-Seip disease or Berardinelli lipodystrophy syndrome, is an infrequent condition of which approximately one hundred cases have been published to date. A case in a 24-year-old female with a fifteen-year follow-up is reported. Manifestations included acanthosis nigricans, generalized lipoatrophy, hirsutism, muscle hypertrophy, and intellectual impairment. Biologic tests revealed insulin-resistant diabetes mellitus with major diet-dependent type V hypertriglyceridemia. The patient had nephrotic syndrome (focal and segmental endocapillary proliferative glomerulonephritis without dense deposits). Phosphorus and calcium determinations were normal, as were the endocrinologic tests. Roentgenograms of the bones disclosed increased density of axial bones and large epiphyseal defects with increased bone density as determined by osteodensitometric studies. The bone manifestations of this syndrome have been documented but are often overshadowed by the severe metabolic alterations. PMID:1306598

  2. [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.

  3. Diabetic Ketoacidosis in a Patient with Type 2 Diabetes After Initiation of Sodium-Glucose Cotransporter 2 Inhibitor Treatment.

    PubMed

    Storgaard, Heidi; Bagger, Jonatan I; Knop, Filip K; Vilsbøll, Tina; Rungby, Jørgen

    2016-02-01

    Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were recently introduced for the treatment of type 2 diabetes (T2D). SGLT2i lower plasma glucose by inhibiting the renal reuptake of glucose leading to glucosuria. Generally, these drugs are considered safe to use. However, recently, SGLT2i have been suggested to predispose to ketoacidosis. Here, we present a case of diabetic ketoacidosis (DKA) developed in an obese, poorly controlled male patient with T2D treated with the SGLT2i dapagliflozin. He was admitted with DKA 5 days after the initiation of treatment with the SGLT2i dapagliflozin. On admission, the primary symptoms were nausea and dizziness, and he was hypertensive (170/103) and tachycardic (119 bpm) and had mild hyperglycaemia (15.3 mmol/l), severe ketonuria and severe metabolic acidosis (pH 7.08). He responded well to infusions of insulin, glucose and saline and was discharged after 72 hr with insulin as the only glucose-lowering therapy. After 1 month, dapagliflozin was reintroduced as add-on to insulin with no recurrent signs of ketoacidosis. During acute illness or other conditions with increased insulin demands in diabetes, SGLT2i may predispose to the formation of ketone bodies and ensuing acidosis.

  4. Evidence-based dietary recommendations for patients with type 2 diabetes mellitus.

    PubMed

    Neff, Lisa M

    2003-01-01

    We review the scientific evidence behind current dietary recommendations for patients with type 2 diabetes and examine the effects of various dietary interventions on glycemic control, serum lipids, and inflammation in individuals with diabetes. Attention is focused on dietary fiber, glycemic index, dietary protein, omega-3 fatty acids, chromium, magnesium, and vitamin E. Practical dietary recommendations for patients with type 2 diabetes are highlighted.

  5. Adherence to therapies in patients with type 2 diabetes.

    PubMed

    García-Pérez, Luis-Emilio; Alvarez, María; Dilla, Tatiana; Gil-Guillén, Vicente; Orozco-Beltrán, Domingo

    2013-12-01

    Adherence to therapy is defined as the extent to which a person's behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider. Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral hypoglycemic agents and later may include an injectable treatment. To prevent the complications associated with type 2 diabetes, therapy frequently also includes medications for control of blood pressure, dyslipidemia and other disorders, since patients often have more than three or four chronic conditions. Despite the benefits of therapy, studies have indicated that recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies. As a result, hyperglycemia and long-term complications increase morbidity and premature mortality, and lead to increased costs to health services. Reasons for nonadherence are multifactorial and difficult to identify. They include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost. Various measures to increase patient satisfaction and increase adherence in type 2 diabetes have been investigated. These include reducing the complexity of therapy by fixed-dose combination pills and less frequent dosing regimens, using medications that are associated with fewer adverse events (hypoglycemia or weight gain), educational initiatives with improved patient-healthcare provider communication, reminder systems and social support to help reduce costs. In the current narrative review, factors that influence adherence to different therapies for type 2 diabetes are discussed, along with outcomes of poor adherence, the economic impact of nonadherence, and strategies aimed at improving

  6. [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.

  7. 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

  8. Two Cases of Allergy to Insulin in Gestational Diabetes

    PubMed Central

    Kim, Gi Jun; Kim, Shin Bum; Jo, Seong Il; Shin, Jin Kyeong; Kwon, Hee Sun; Jeong, Heekyung; Son, Jang Won; Lee, Seong Su; Kim, Sung Rae; Kim, Byung Kee

    2015-01-01

    Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity. PMID:26435137

  9. Two Cases of Allergy to Insulin in Gestational Diabetes.

    PubMed

    Kim, Gi Jun; Kim, Shin Bum; Jo, Seong Il; Shin, Jin Kyeong; Kwon, Hee Sun; Jeong, Heekyung; Son, Jang Won; Lee, Seong Su; Kim, Sung Rae; Kim, Byung Kee; Yoo, Soon Jib

    2015-09-01

    Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity. PMID:26435137

  10. 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.

  11. Fifteen-Year Trends in the Prevalence of Diabetes among Hospitalized HIV-Infected Patients in Spain (1997-2012)

    PubMed Central

    Alvaro-Meca, Alejandro; Jimenez-Trujillo, Isabel; Hernandez-Barrera, Valentin; de Miguel-Diez, Javier

    2016-01-01

    Objective To describe trends in the prevalence of diabetes among hospitalized HIV-infected patients between 1997 and 2012 in Spain and compare them with those of age- and sex-matched non–HIV-infected patients. Methods The study was based on Spanish national hospital discharge data. We performed a retrospective study for the period 1997–2012. HIV infection (HIV-infected versus non–HIV-infected [control group])and calendar period in relation to widespread use of combination antiretroviral therapy (cART) (1997–1999; 2000–2003; 2004–2007 and 2008–2012), were the exposure variables The outcome variables were diagnosis of diabetes and in-hospital mortality (IHM). Results From 1997 to 2012, we identified 91,752 cases of diabetes: 15,398 in the HIV-infected group (403,277 hospital admissions) and 76,354 in the non–HIV-infected group (1,503,467 hospital admissions). Overall, HIV-infected patients had lower prevalence values for diabetes than non–HIV-infected patients throughout the follow-up (3.8% vs. 5.1%; p<0.001). The prevalence of diabetes increased 1.56-fold among non–HIV-infected patients and 4.2-fold among HIV-infected patients. The prevalence of diabetes in females was almost twice as high in HIV-infected patients as in non–HIV-infected patients during the last study period (4.72% vs. 2.88%; p<0.001). Diabetes showed a protective effect against IHM throughout the study period (aOR = 0.70; 95%CI, 0.65–0.75). Conclusions During the cART era, the prevalence of diabetes has increased sharply among HIV-infected hospitalized patients compared with matched non–HIV-infected subjects. The prevalence of diabetes is rising very fast among HIV-infected women. Diabetes has a protective effect on IHM among HIV-infected patients. Nevertheless, our study has several limitations. No information is available in the database used on important sociodemographic characteristics and relevant clinical variables including duration of the HIV infection, treatments

  12. Impact of a diabetes disease management program on diabetes control and patient quality of life.

    PubMed

    Rasekaba, Tshepo Mokuedi; Graco, Marnie; Risteski, Chrissie; Jasper, Andrea; Berlowitz, David J; Hawthorne, Graeme; Hutchinson, Anastasia

    2012-02-01

    The worldwide burden of diabetes is projected to be 5.4% of the adult population by the year 2025. Diabetes is associated with multiple medical complications that both decrease health-related quality of life (HR-QOL) and contribute to earlier mortality. There is growing evidence for the effectiveness of multidisciplinary disease management programs that incorporate self-management principles in improving patients' long-term outcomes. The aim of this project was to evaluate the effectiveness of this approach in improving: (1) glycemic control measured by HbA1c, and (2) HR-QOL measured by the Assessment of Quality of Life (AQOL), at enrollment and at 12-months follow-up. Between 2004 and 2008, a total of 967 patients were enrolled in the program; 545 (56%) of these patients had HbA1c data available at baseline and at 12 months. Mean HbA1c at enrollment was 8.6% (SD 1.9) versus 7.3% (SD 1.2) at 12 months (P<0.001). Overall, 68% of patients experienced improvements in HbA1c. At enrollment, patients reported "fair" HR-QOL, which was significantly lower than age-adjusted population norms who reported "good" HR-QOL. At 12 months, 251 (64%) patients had improved HR-QOL, 27 (7%) had no change, and 114 (29%) deteriorated. Mean utility scores improved by 0.11 (P<0.001), which is almost twice the minimum clinically important difference for the AQOL. This study confirms that a multidisciplinary disease management program for patients with poorly controlled type 2 diabetes can improve both glycemic control and HR-QOL.

  13. [Lower extremity amputation rates in diabetic patients].

    PubMed

    Cisneros-González, Nelly; Ascencio-Montiel, Iván Jesús; Libreros-Bango, Vita Norma; Rodríguez-Vázquez, Héctor; Campos-Hernández, Ángel; Dávila-Torres, Javier; Kumate-Rodríguez, Jesús; Borja-Aburto, Víctor Hugo

    2016-01-01

    Introducción: las amputaciones de extremidades inferiores disminuyen la calidad de vida de los pacientes con diabetes mellitus (DM). El objetivo de este estudio fue describir el índice de amputaciones de extremidades inferiores (mayores y menores) en sujetos con DM adscritos al Instituto Mexicano del Seguro Social (IMSS), comparando los años 2004 y 2013. Métodos: estudio observacional transversal comparativo. Se evaluaron los registros hospitalarios de amputaciones obtenidos del Sistema de Estadísticas Médicas (DataMart) y del Censo de pacientes con DM obtenido del Sistema de Atención Integral a la Salud. Se calcularon los índices de amputaciones mayores y menores x 100,000 sujetos con DM adscritos a Medicina Familiar. Resultados: durante 2004 y 2013 se observaron 2 334 340 y 3 416 643 pacientes con DM adscritos a Medicina Familiar respectivamente. Los promedios de edad al momento de la amputación fueron similares en el año 2004 y 2013 (61.7 años para las amputaciones menores y 65.6 años para las amputaciones mayores). Los índices de amputaciones mayores fueron de 100.9 y de 111.1 x 100 000 sujetos con DM en 2004 y 2013; mientras que el índice de amputaciones menores de extremidades inferiores fue de 168.8 y de 162.5 x 100 000 sujetos con DM en el durante 2004 y 2013 respectivamente. Conclusiones: el índice de amputaciones de extremidades inferiores en el IMSS es muy alto comparado con lo reportado en países desarrollados. El índice de amputaciones mayores se incrementó para el año 2013, comparado con 2004.

  14. The Management of Diabetic Neuropathy in CKD and Dialysis Patients

    PubMed Central

    Pop-Busui, Rodica; Roberts, Laurel; Pennathur, Subramaniam; Kretzler, Mathias; Brosius, Frank C.; Feldman, Eva L.

    2014-01-01

    Case Presentation A 64-year-old male with a 15-year history of poorly controlled type 2 diabetes and a 10-year history of hypertension and hyperlipidemia had developed multiple diabetes-related complications within the last 5 years. He first developed albuminuria 5 years ago, and over the next several years experienced fairly rapid decline in kidney function, with eGFR of 55 mL/min/1.73m2 noted 2 years ago. He was diagnosed with proliferative retinopathy 5 years ago and underwent laser photocoagulation. Four years ago, he noted symptoms of peripheral neuropathy manifested as shooting pain and numbness with loss of light touch, thermal and vibratory sensation in a stocking distribution. Last year he developed a non-healing ulcer on the plantar aspect of his left foot which was complicated with gangrene and resulted in a below-the-knee amputation of the left leg one year ago. He now reports a new onset of weakness, lightheadedness and dizziness on standing that affects his daily activities. He reports lancinating pain in his right lower extremity, worse in the evening. Medications include: neutral protamine Hagedorn insulin twice daily and regular insulin on a sliding scale, metoprolol 50 mg/d, lisinopril 40 mg/d, atorvastatin 80 mg/d, furosemide 40 mg/d and aspirin 81 mg/d. Blood pressure is 127/69 mm Hg with a pulse rate of 96 bpm while supine and 94/50 mmHg with a pulse rate of 102 bpm while standing. Strength is normal but with a complete loss of all sensory modalities to the knee in his remaining limb and up to the wrists in both upper extremities, and he is areflexic. Today's laboratory evaluations show a serum creatinine of 2.8 mg/dl, an estimated GFR (eGFR) of 24 ml/min/1.73m2, a hemoglobin A1c (HbA1c) of 7.9 % and 2.1 g of urine protein per gram of creatinine. What would be the most appropriate management for this patient? PMID:20042258

  15. Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis.

    PubMed

    Allen, Latricia L; Kalmar, Garrett; Driver, Vickie R

    2016-06-01

    We report a case of calcaneal osteomyelitis that was surgically resected from a patient with diabetes and peripheral vascular disease. A 91-year-old male with history of type 2 diabetes, peripheral vascular disease, balloon angioplasty, and recent (2 months ago) stent of the superficial femoral artery presented to the emergency department with a left heel wound infection probed to bone. The patient reported having been on intravenous Zosyn for several months via an outside infectious disease provider for clinical suspicion of osteomyelitis, but noted no improvement. This report includes information regarding the clinical examination and imaging findings, which were used to assess this high-risk patient. Our patient underwent a partial calcanectomy and completed a 6-week course of intravenous antibiotics. The purpose of this case report is to illustrate limb preservation in a high-risk patient with compromised vascular supply who underwent a partial calcanectomy for treatment of calcaneal osteomyelitis. The patient underwent surgical resection of the calcaneus without complications and healed unremarkably with the ability to ambulate while wearing an ankle foot orthosis with a custom shoe. This report was authorized for publication as an educational report to contribute to generalizable knowledge and does not include any patient health information. PMID:27423990

  16. 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

  17. Spinal cord infarction in diabetic pregnancy: a case report.

    PubMed

    Sugihara, Takeru; Kido, Koichiro; Sasamori, Yukifumi; Shiba, Masahiro; Ayabe, Takuya

    2013-10-01

    Spinal cord infarction (SCI) is uncommon as compared to cerebral stroke. Moreover, SCI during pregnancy is rare. Here, we report a case of SCI in diabetic pregnancy, properly diagnosed, promptly treated, and a good prognosis achieved. A 38-year-old, pregnant woman, para 1, with type 1 diabetes mellitus on insulin since 14 years of age, was admitted to our hospital for paresthesia and numbness in the lower left side of the body, with movement disturbances. On the basis of the temporal profile of the onset and the multiple resonance imaging scans, SCI was diagnosed. Steroid pulse therapy and low-dose aspirin administration was initiated. Her symptoms were improved and discharged. A repeat cesarean section was performed at 37 weeks of gestation and her postoperative course was uneventful. Her daily activities were not hindered severely, though she experienced defecation discomfort.

  18. Anakinra treatment in patients with gout and type 2 diabetes.

    PubMed

    Vitale, Antonio; Cantarini, Luca; Rigante, Donato; Bardelli, Marco; Galeazzi, Mauro

    2015-05-01

    We report three Caucasian patients affected by gout and type 2 diabetes, who were treated with the recombinant nonglycosylated human interleukin-1 receptor antagonist anakinra (100 mg/day subcutaneously) after an unsatisfactory or incomplete response to urate-lowering therapy, colchicine, nonsteroidal anti-inflammatory drugs, and prednisone. The remarkable clinical improvement in joint symptoms within 24 h and in glycemic control during a 6-month period gives anakinra a potential therapeutic role in the management of gout and type 2 diabetes. When anakinra was discontinued, a gout attack occurred within 3-25 days in all three patients. The contribution of anakinra in the treatment of such syndromes is encouraging, but requires further studies to establish its long-term efficacy.

  19. One year remission of type 1 diabetes mellitus in a patient treated with sitagliptin

    PubMed Central

    Guerra-Alcalá, Ernesto; Contreras, Miguel; Nastasi, José; Noble, Janelle A; Polychronakos, Constantin

    2014-01-01

    Summary Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by the autoimmune destruction of pancreatic β-cells. This paper describes the case of a 19-year-old male patient who presented with glutamic acid decarboxylase (GAD) antibody positive and diabetic ketoacidosis, which mandated intensive insulin treatment. Once the ketoacidosis was controlled, an oral dose of 100 mg of sitagliptin was administered once a day. Ketoacidosis was managed by insulin and insulin daily requirement began to dwindle after one month, until its complete withdrawal at 8 weeks, when partial remission was reached. The patient has now remained on sitagliptin treatment alone for a year, without requiring insulin. The benefit observed with this medication is possibly associated with its immunological effects. Inhibition of dipeptidyl peptidase 4 in animal models deregulates the Th1 immune response, increases secretion of Th2 cytokines, activates CD4+CD25+FoxP3+ regulatory T-cells, and prevents IL17 production. Learning points The use of insulin-dose-adjusted HbA1c constitutes the best way to define partial remission in T1DM patients.The use of sitagliptin in T1DM patients could help to decrease daily requirement of insulin by delaying β-cell loss and improving endogenous insulin production.The determination of antibodies against insulin, islet cells, and GAD permits differentiation of T1DM patients from those with atypical or ketosis-prone diabetes. PMID:25332771

  20. Psychological aspects of diabetes care: Effecting behavioral change in patients.

    PubMed

    Chew, Boon-How; Shariff-Ghazali, Sazlina; Fernandez, Aaron

    2014-12-15

    Patients with diabetes mellitus (DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient's adherence to the effective therapies, there would be persistent sub-optimal control of diseases, increase diabetes-related complications, causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient's psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation, self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors, coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relation to DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

  1. Effect of polymorphisms of the MTHFR and APOE genes on susceptibility to diabetes and severity of diabetic retinopathy in Brazilian patients.

    PubMed

    Errera, F I V; Silva, M E R; Yeh, E; Maranduba, C M C; Folco, B; Takahashi, W; Pereira, A C; Krieger, J E; Passos-Bueno, M R

    2006-07-01

    Diabetes mellitus (DM) is a highly prevalent complex genetic disorder. There has been a worldwide effort in the identification of susceptibility genes for DM and its complications, and the 5-10-methylenetetrahydrofolate reductase (MTHFR) and apolipoprotein-E (APOE) genes have been considered good candidate susceptibility genes to this condition. The objectives of the present study were to determine if the 677T MTHFR and epsilon2/epsilon3/epsilon4 APOE alleles are risk factors for DM and for severity of diabetic retinopathy (DR). A total of 248 individuals were studied: 107 healthy individuals and 141 diabetic patients (46 with type 1 diabetes and 95 with type 2 diabetes), who also had DR (81 with non-proliferative DR and 60 with proliferative DR). The polymorphisms were analyzed by PCR followed by digestion with restriction enzyme or the single-nucleotide primer extension method. No evidence of association between the 677TT genotype of MTHFR gene and DM [cases: TT = 10/95 (10.6%); controls: TT = 14/107 (13%)] or with severity of DR was observed [cases: TT = 5/60 (8.5%); controls: TT = 9/81 (11.1%); P > 0.05]. We also did not find evidence of an association between APOE alleles and proliferative DR (epsilon2, epsilon3 and epsilon4 in cases: 9, 76, and 15%, and in controls: 5, 88, and 12%, respectively) but the carriers of epsilon2 allele were more frequent among patients with type 2 DM and DR than in controls [cases: 15/95 (15.8%); controls: 7/107 (6.5%); P < 0.05]. Therefore, our results suggest that the epsilon2 allele/APOE might be a risk factor for diabetes in the Brazilian population.

  2. Salmonella newport causing osteomyelitis in a patient with diabetes.

    PubMed

    Weston, Natasha; Moran, Ed

    2015-11-24

    Salmonella is a foodborne pathogen that commonly causes intestinal symptoms. Bacteraemia and extraintestinal infections have been documented within the literature, and are more frequently associated with immunodeficiency and general debilitation. We discuss the case of a previously well 36-year-old man who presented with a septic knee and new-onset diabetes. Imaging confirmed osteomyelitis and a Brodie's abscess, with blood and tissue cultures revealing the isolate Salmonella enterica newport. He denied any previous gastrointestinal symptoms, recent travel, change in usual dietary habit or symptoms of diabetes. So far there have only been three reported cases of S. newport causing osteomyelitis. We discuss the incidence of Salmonella infections, including extraintestinal symptoms, its relation to immunodeficiency and the disease burden of S. newport.

  3. [Visual materials for the education of patients with diabetes].

    PubMed

    Morineau, Claudie

    2015-12-01

    Some people living with diabetes are not included in any educational approach due to their cultural or linguistic particularities, their level of elementary education or their metacognitive deficiencies. It is essential for the caregiver to reflect on how to provide adapted and relevant therapeutic education to these patients. In this context, visual materials have been designed in order to be able to offer personalised support.

  4. [Visual materials for the education of patients with diabetes].

    PubMed

    Morineau, Claudie

    2015-12-01

    Some people living with diabetes are not included in any educational approach due to their cultural or linguistic particularities, their level of elementary education or their metacognitive deficiencies. It is essential for the caregiver to reflect on how to provide adapted and relevant therapeutic education to these patients. In this context, visual materials have been designed in order to be able to offer personalised support. PMID:26675098

  5. Patient innovation: an analysis of patients' designs of digital technology support for everyday living with diabetes.

    PubMed

    Kanstrup, Anne Marie; Bertelsen, Pernille; Nohr, Christian

    2015-01-01

    The aim of this paper is to identify characteristics of patients' contributions to innovation in health information technology (HIT). The paper outlines a theoretical definition of patient innovation and presents an analysis of four digital prototypes and 22 low-fidelity mock-ups designed by people affected by the chronic illness diabetes mellitus. Seventeen families (a total of 60 people) with one or more diabetic family members participated in design activities in a four-year research project focused on the design of digital support for everyday living with diabetes. Our analysis documented the originality of the analysed patient designs and identified three characteristics of patients' designs: socio-technical networks, objects with associated personal meanings and technology supporting the expression of identity. The paper concludes that patient innovation is defined by what is perceived as new by patients and/or others within the social system of adaptation. The analysed patient designs are original (as distinct from replications of or improvements on known products), and their characteristics are innovative contributions to the social system of everyday living with diabetes (i.e. they are perceived as new to the patients in the research study). The results of the analysis contribute to the credentials of patients as key actors in HIT innovation and call for participatory approaches in health informatics.

  6. Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist.

    PubMed

    Tsui, Irena; Drexler, Andrew; Stanton, Annette L; Kageyama, Jennie; Ngo, Elaine; Straatsma, Bradley R

    2014-07-01

    In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors.

  7. Pilot Study Using Mobile Health to Coordinate the Diabetic Patient, Diabetologist, and Ophthalmologist

    PubMed Central

    Drexler, Andrew; Stanton, Annette L.; Kageyama, Jennie; Ngo, Elaine; Straatsma, Bradley R.

    2014-01-01

    Background: In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Methods: Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Results: Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. Conclusions: This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors. PMID:24876413

  8. Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist.

    PubMed

    Tsui, Irena; Drexler, Andrew; Stanton, Annette L; Kageyama, Jennie; Ngo, Elaine; Straatsma, Bradley R

    2014-07-01

    In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors. PMID:24876413

  9. Salivary gland dysfunction markers in type 2 diabetes mellitus patients

    PubMed Central

    Aitken-Saavedra, Juan; Rojas-Alcayaga, Gonzalo; Maturana-Ramírez, Andrea; Escobar-Álvarez, Alejandro; Cortes-Coloma, Andrea; Reyes-Rojas, Montserrat; Viera -Sapiain, Valentina; Villablanca-Martínez, Claudia

    2015-01-01

    Background Diabetes mellitus (DM) is a chronic disease of the carbohydrate metabolism that, when not rigorously controlled, compromises systemic and organ integrity, thereby causing renal diseases, blindness, neuropathy, arteriosclerosis, infections, and glandular dysfunction, including the salivary glands. The aim of this study was to determine the relationship between the qualitative and quantitative parameters of salivary alteration, which are indicators of salivary gland dysfunction, and the level of metabolic control of type 2 diabetes patients. Material and Methods A convenience sample of 74 voluntary patients with type 2 DM was selected, each of whom donated a sample of unstimulated saliva. Salivary parameters such as salivary flow rate, protein concentration, pH, and xerostomia were studied. Results There is a positive relationship between the level of metabolic control measured with HbA1 and the protein concentration in saliva (Spearman rho = 0.329 and p = 0.004). The same assay showed an inverse correlation between HbA1 and pH (Spearman rho = -0.225 and p = 0.05). Conclusions The protein concentration in saliva and, to a lesser extent, the pH may be useful as glandular dysfunction indicators in DM2 patients. Key words:Saliva, type 2 diabetes mellitus, pH, protein concentration, xerostomia. PMID:26535097

  10. Target Blood Pressure in Patients with Diabetes: Asian Perspective.

    PubMed

    Park, Sungha; Kario, Kazuomi; Park, Chang Gyu; Huang, Qi Fang; Cheng, Hao Min; Hoshide, Satoshi; Wang, Ji Guang; Chen, Chen Huan

    2016-11-01

    Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despite the significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjects enrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associated with a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130-140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated

  11. Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes

    PubMed Central

    Rodríguez-Poncelas, Antonio; Mundet-Tudurí, Xavier; Miravet-Jiménez, Sonia; Casellas, Aina; Barrot-De la Puente, Joan F.; Franch-Nadal, Josep; Coll-de Tuero, Gabriel

    2016-01-01

    Purpose To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). Methods This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73m2 and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy. Results CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4–1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6–2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73m2 [OR], 95% confidence interval [CI], 1.3 (1.1–1.6). Conclusions These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population. PMID:26886129

  12. Attainment of Canadian Diabetes Association recommended targets in patients with type 2 diabetes

    PubMed Central

    McCrate, Farah; Godwin, Marshall; Murphy, Laura

    2010-01-01

    OBJECTIVE To examine the degree to which targets for diabetes (blood pressure [BP], glycated hemoglobin [HbA1c], and low-density lipoprotein cholesterol [LDL-C]) are achieved in family practices and how these results compare with family physicians’ perceptions of how well targets are being achieved. DESIGN Chart audit and physician survey. SETTING Newfoundland and Labrador. PARTICIPANTS Patients with type 2 diabetes and their family physicians. INTERVENTIONS The charts of 20 patients with type 2 diabetes were randomly chosen from each of 8 family physician practices in St John’s, Nfld, and data were abstracted. All family physicians in the province were surveyed using a modified Dillman method. MAIN OUTCOME MEASURES The most recent HbA1c, LDL-C, and BP measurements listed in each audited chart; surveyed family physicians’ knowledge of the recommended targets for HbA1c, LDL-C, and BP and their estimates of what percentage of their patients were at those recommended targets. RESULTS The chart audit revealed that 20.6% of patients were at the recommended target for BP, 48.1% were at the recommended target for HbA1c, and 17.5% were at the recommended target for LDL-C. When targets were examined collectively, only 2.5% of patients were achieving targets in all 3 areas. The survey found that most family physicians were aware of the recommended targets for BP, LDL-C, and HbA1c. However, their estimates of the percentages of patients in their practices achieving these targets appeared high (59.3% for BP, 58.2% for HbA1c, and 48.4% for LDL-C) compared with the results of the chart audit. CONCLUSION The findings of the chart audit are consistent with other published reports, which have illustrated that a large majority of patients with diabetes fall short of reaching recommended targets for BP, blood glucose, and lipid levels. Although family physicians are knowledgeable about recommended targets, there is a gap between knowledge and clinical outcomes. The reasons for

  13. Diabetes screening: a pending issue in hypertense/obese patients

    PubMed Central

    Sepehri, Armina; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

    2015-01-01

    The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003–2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted. PMID:25922799

  14. Frequency of ABO/Rhesus Blood Groups in Patients with Diabetes Mellitus.

    PubMed

    Oner, Can; Dogan, Burcu; Telatar, Berrin; Celik Yagan, Canan Fidan; Oguz, Aytekin

    2016-01-01

    The correlation between ABO/Rh blood groups and diabetes mellitus is still controversial. The aim of this study was to determine the relationship between ABO/Rhesus blood groups and diabetes in Turkish population. This cross-sectional study was conducted in Istanbul Medeniyet University Göztepe Education and Training Hospital's Diabetes Units. The study group was composed of 421 patients with type-1 diabetes, 484 patients with type-2 diabetes and 432 controls. Blood samples were collected and tested for ABO/Rhesus blood groups. Data was analyzed by SPSS version 17.0. A significant association was found between blood groups and diabetes mellitus. The frequency of AB blood group was significantly higher in type-1 diabetics; and A blood group was significantly higher in type-2 diabetics. Furthermore, Rh negativity were significantly more frequent in type-2 diabetics.

  15. Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator.

    PubMed

    Rodriguez, Kellie M

    2013-02-01

    Patients with diabetes are responsible for the vast majority of management requirements of their condition. However, their ability and motivation to engage in required self-management behaviors may be mitigated by multiple intrinsic and extrinsic factors. Intrinsic barriers include attitudes and health beliefs, limited diabetes knowledge and technical skill, reduced functional health literacy, and inadequate self-efficacy to promote positive behavior change. Extrinsic barriers include financial considerations, inadequate family and community support systems, ineffective clinical relationships, and limited access to effective diabetes health care delivery. Diabetes providers have opportunities for enhancing patient engagement with clinical recommendations and diabetes self-management through effective communication, including efforts to contextually assess patients' perceptions of diabetes and how the condition fits within the context of their changing lives. This article provides a conceptual framework for establishing and building an effective clinical alliance with patients with the goal of empowering them to take more control of their diabetes and reduce their risks for poor diabetes outcomes. PMID:23411000

  16. Amputation and ambulation in diabetic patients: function is the goal.

    PubMed

    Attinger, Christopher E; Brown, Benjamin J

    2012-02-01

    The role of amputation in limb salvage is often poorly defined because the surgeon and the patient often attempt to save all limbs at all costs. The difficulty lies in selecting limb salvage versus early amputation. For the sedentary patient, a poorly functional salvaged limb can provide him/her with a higher quality of life than he/she would have with an amputation. For the active patient, early major amputation may offer the best functional outcome. Our experience with diabetic limb salvage over the last 20 years was retrospectively reviewed and compared with the existing literature in an attempt to better understand the role of amputation versus limb salvage in patients with diabetes. In the process, surgical techniques that we believe optimize foot and leg amputations were reviewed. Utilizing a team approach, limb salvage can yield a 64% ambulation rate and an 80% 2-year survival rate. Below-knee amputation led to a similar ambulatory rate, but the 2-year survival in these patients was 52%. With more severe rear-foot ulcers and osteomyelitis, the ambulatory rate declined with each comorbidity. However, those whose foot was saved had a higher chance of walking than those who underwent amputation. Function and quality of life are the outcomes of interest and may be maximized through either limb salvage or amputation. Our job as physicians is to match the correct solution to the patients' lifestyle and their medical, physical and psychological conditions so they can achieve their desired level of activity as quickly as possible.

  17. Hemichorea with unilateral MRI striatal hyperintensity in a Saudi patient with diabetes.

    PubMed

    Al-Quliti, Khalid W; Assaedi, Ekhlas S

    2016-01-01

    Hemichorea is a disorder characterized by abnormal, continuous, nonrhythmic, jerky, and distal movement involving one side of the body. It may result from cerebrovascular insult to basal ganglia, or from other causes including neoplasm, infection, and non-ketotic hyperglycemia. We report the clinical, laboratory, and neuroimaging data with treatment response of a Saudi woman who has diabetes with left side hemichorea, involving the face, and upper and lower extremities, with unilateral right striatal hyperintense signal changes in T1 weighted MRI, and a hyperglycemic state of longstanding uncontrolled diabetes. Literature review suggested a syndrome with a triad of symptoms: non-ketotic hyperglycemia, hemichorea, and T1 MRI striatal hyperintensities. As the number of internationally reported cases is still modest, reporting more patients will highlight aspects pertaining to the diagnosis and treatment of this condition. We present a patient who had a sustained therapeutic result from haloperidol and clonazepam. PMID:26818169

  18. Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Ha, Jun Ouk; Lee, Tae Hee; Park, Ja Young; Choi, Seong Ho; Park, Hee Seung; Lee, Jae Seung; Lee, Seung Heon; Seo, Eun Hee; Kim, Young Hwan; Kang, Young Woo

    2016-01-01

    Background Gastrointestinal symptoms are common in patients with type 2 diabetes mellitus (T2DM). The prevalence of gastroesophageal reflux disease (GERD) in Korea appears to be increasing. Some studies have shown that T2DM is a risk factor for symptomatic GERD. However, this possibility is still debated, and the pathogenesis of GERD in T2DM is not yet fully understood. The aim of this study was to analyze the prevalence and risk factors (including autonomic neuropathy) of GERD in patients with T2DM. Methods This cross-sectional case-control study enrolled T2DM patients (n=258) and healthy controls (n=184). All participants underwent physical examinations and laboratory tests. We evaluated medical records and long-term diabetes complications, including peripheral and autonomic neuropathy in patients with T2DM. Esophagogastroduodenoscopy was performed in all patients. The Los Angeles (LA) classification was used to grade GERD. GERD was defined as LA grade A (or higher) or minimal change with GERD symptoms. GERD symptoms were examined using a frequency scale. Data were expressed as mean±standard error. Independent t-tests or chi-square tests were used to make comparisons between groups. Results The prevalence of GERD (32.6% vs. 35.9%, P=0.266) and GERD symptoms (58.8% vs. 59.2%, P=0.503) was not significantly different between T2DM patients and controls. We found no significant differences between T2DM patients with GERD and T2DM patients without GERD with respect to diabetic complications, including autonomic neuropathy, peripheral neuropathy, duration of DM, and glucose control. Conclusion The prevalence of GERD in patients with T2DM showed no difference from that of controls. GERD was also not associated with peripheral and cardiovascular autonomic neuropathy, age, or duration of DM in patients with T2DM. PMID:27352149

  19. Cental Macular Thickness in Patients with Type 2 Diabetes Mellitus without Clinical Retinopathy.

    PubMed

    Demir, Mehmet; Dirim, Burcu; Acar, Zeynep; Yılmaz, Murat; Sendul, Yekta

    2013-01-01

    Objective. To compare central macular thickness (CMT) of diabetic patients with type 2 diabetes without clinical retinopathy and healthy subjects. Materials and Methods. Optical coherence tomography (OCT) measurements were performed in 124 eyes of 62 subjects with diabetes mellitus without clinical retinopathy (study group: 39 females, 23 males; mean age: 55.06 ± 9.77 years) and in 120 eyes of 60 healthy subjects (control group: 35 females, 25 males; mean age: 55.78 ± 10.34 years). Blood biochemistry parameters were analyzed in all cases. The data for central macular thickness (at 1 mm), the levels of fasting plasma glucose, and glycosylated hemoglobin (HbA1c) were compared in both groups. Results. The mean central macular thickness was 232.12 ± 24.41 µm in the study group and 227.19 ± 29.94 µm in the control group. The mean HbA1c level was 8.92 ± 2.58% in the study group and 5.07 ± 0.70% in the control group (P = 0.001). No statistically significant relationship was found between CMT, HbA1c, and fasting plasma glucose level in either group (P > 0.05). Conclusions. Central macular thickness was not significantly thicker in patients with type 2 diabetes without clinical retinopathy than in healthy subjects. PMID:23691279

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

    PubMed Central

    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. PMID:25932402

  1. Pneumococcal and seasonal influenza vaccination among elderly patients with diabetes.

    PubMed

    Gorska-Ciebiada, Małgorzata; Saryusz-Wolska, Małgorzata; Ciebiada, Maciej; Loba, Jerzy

    2015-10-28

    Both seasonal influenza vaccination and pneumococcal vaccination are recommended for elderly diabetics. The aim of the study was to determine the rate of seasonal influenza vaccination over the previous twelve months, pneumococcal vaccination over a lifetime, and to identify predictors which affect likelihood of vaccination. 219 diabetics elders were detailed questioned 3 months after the end of 2012/2013 influenza season. 26.48% of patients have been vaccinated against influenza in the last year and only 9.13% of patients reported pneumococcal vaccination in the past. The logistic regression analysis revealed that variables which increased the likelihood of having been vaccinated against influenza were: higher number of anti-hyperglycemic medications, increased number of co-morbidities, higher patients' income, recommendation of vaccination from General Practitioners (GPs) and specialist. Significant predictors of pneumococcal vaccine uptake included increased number of co-morbidities and recommendation of vaccination received from GPs and specialist. The commonest reasons given by those unvaccinated were lack of information about immunization and low perceived benefits of vaccination. Of patients who were not treated with influenza vaccine 86.7% had never received recommendation from specialist and 71.4% had never been advised by GPs. Influenza vaccination was too expensive to 24.85% of patients. The vaccination rate among elderly diabetics in Poland is low. Lack of knowledge and patients' income are the main barriers. Increased awareness of healthcare professionals to educate and encourage vaccination and propagation of free vaccinations to all people at risk may increase the rate of vaccination against influenza and pneumococcal disease.

  2. Pneumococcal and seasonal influenza vaccination among elderly patients with diabetes.

    PubMed

    Gorska-Ciebiada, Małgorzata; Saryusz-Wolska, Małgorzata; Ciebiada, Maciej; Loba, Jerzy

    2015-01-01

    Both seasonal influenza vaccination and pneumococcal vaccination are recommended for elderly diabetics. The aim of the study was to determine the rate of seasonal influenza vaccination over the previous twelve months, pneumococcal vaccination over a lifetime, and to identify predictors which affect likelihood of vaccination. 219 diabetics elders were detailed questioned 3 months after the end of 2012/2013 influenza season. 26.48% of patients have been vaccinated against influenza in the last year and only 9.13% of patients reported pneumococcal vaccination in the past. The logistic regression analysis revealed that variables which increased the likelihood of having been vaccinated against influenza were: higher number of anti-hyperglycemic medications, increased number of co-morbidities, higher patients' income, recommendation of vaccination from General Practitioners (GPs) and specialist. Significant predictors of pneumococcal vaccine uptake included increased number of co-morbidities and recommendation of vaccination received from GPs and specialist. The commonest reasons given by those unvaccinated were lack of information about immunization and low perceived benefits of vaccination. Of patients who were not treated with influenza vaccine 86.7% had never received recommendation from specialist and 71.4% had never been advised by GPs. Influenza vaccination was too expensive to 24.85% of patients. The vaccination rate among elderly diabetics in Poland is low. Lack of knowledge and patients' income are the main barriers. Increased awareness of healthcare professionals to educate and encourage vaccination and propagation of free vaccinations to all people at risk may increase the rate of vaccination against influenza and pneumococcal disease. PMID:26561844

  3. Thiazolidinediones and Cardiovascular Events In High-Risk Patients with Type-2 Diabetes Mellitus

    PubMed Central

    Shaya, Fadia T.; Lu, Zhiqiang; Sohn, Kyongsei; Weir, Matthew R.

    2009-01-01

    Context. The use of thiazolidinediones (TZDs) in patients with type-2 diabetes mellitus appears to be associated with an increased risk of myocardial infarction (MI) compared with placebo or other oral antidiabetic drug regimens. Objective. We conducted a study to investigate whether there was a difference in the risk of acute MI and hemorrhagic and non-hemorrhagic stroke between specific TZDs, namely rosiglitazone maleate (Avandia) and pioglitazone (Actos), and other oral antidiabetic agents in a high-risk, largely underrepresented and largely minority Medicaid population. Study Design, Setting, and Patients. We analyzed patient encounter data using propensity-scoring methods and logistic regression to compare the risk of cardiovascular (CV) events in patients with type-2 diabetes in a high-risk population. Main Outcome Measures. Outcomes were identified through International Classification of Disease (ICD-9) codes 410–411 for acute MI; 430–438 for stroke; and revenue (emergency department) codes 450–459 in the case of MI. Results. Using retrospective medical encounter and prescription data analyses, we found that rosiglitazone, compared with other oral antidiabetic agents, was associated with an increased rate of CV events by 20% in a high-risk cohort of diabetic patients. Neither pioglitazone nor the TZD drug class as a whole was associated with an increased CV risk. Conclusion. Rosiglitazone was associated with a significant increase in CV events (MI and stroke) among high-risk patients with type-2 diabetes, whereas pioglitazone was not. We recommend further research to capture risk factors that were not observed in our encounter data. PMID:20140111