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  1. Diabetic Nephropathy: New Risk Factors and Improvements in Diagnosis.

    PubMed

    Tziomalos, Konstantinos; Athyros, Vasilios G

    2015-01-01

    Diabetic nephropathy is the leading cause of end-stage renal disease. Patients with diabetic nephropathy have a high cardiovascular risk, comparable to patients with coronary heart disease. Accordingly, identification and management of risk factors for diabetic nephropathy as well as timely diagnosis and prompt management of the condition are of paramount importance for effective treatment. A variety of risk factors promotes the development and progression of diabetic nephropathy, including elevated glucose levels, long duration of diabetes, high blood pressure, obesity, and dyslipidemia. Most of these risk factors are modifiable by antidiabetic, antihypertensive, or lipid-lowering treatment and lifestyle changes. Others such as genetic factors or advanced age cannot be modified. Therefore, the rigorous management of the modifiable risk factors is essential for preventing and delaying the decline in renal function. Early diagnosis of diabetic nephropathy is another essential component in the management of diabetes and its complications such as nephropathy. New markers may allow earlier diagnosis of this common and serious complication, but further studies are needed to clarify their additive predictive value, and to define their cost-benefit ratio. This article reviews the most important risk factors in the development and progression of diabetic nephropathy and summarizes recent developments in the diagnosis of this disease.

  2. Dietary Information Improves Model Performance and Predictive Ability of a Noninvasive Type 2 Diabetes Risk Model

    PubMed Central

    Han, Tianshu; Tian, Shuang; Wang, Li; Liang, Xi; Cui, Hongli; Du, Shanshan; Na, Guanqiong; Na, Lixin; Sun, Changhao

    2016-01-01

    There is no diabetes risk model that includes dietary predictors in Asia. We sought to develop a diet-containing noninvasive diabetes risk model in Northern China and to evaluate whether dietary predictors can improve model performance and predictive ability. Cross-sectional data for 9,734 adults aged 20–74 years old were used as the derivation data, and results obtained for a cohort of 4,515 adults with 4.2 years of follow-up were used as the validation data. We used a logistic regression model to develop a diet-containing noninvasive risk model. Akaike’s information criterion (AIC), area under curve (AUC), integrated discrimination improvements (IDI), net classification improvement (NRI) and calibration statistics were calculated to explicitly assess the effect of dietary predictors on a diabetes risk model. A diet-containing type 2 diabetes risk model was developed. The significant dietary predictors including the consumption of staple foods, livestock, eggs, potato, dairy products, fresh fruit and vegetables were included in the risk model. Dietary predictors improved the noninvasive diabetes risk model with a significant increase in the AUC (delta AUC = 0.03, P<0.001), an increase in relative IDI (24.6%, P-value for IDI <0.001), an increase in NRI (category-free NRI = 0.155, P<0.001), an increase in sensitivity of the model with 7.3% and a decrease in AIC (delta AIC = 199.5). The results of the validation data were similar to the derivation data. The calibration of the diet-containing diabetes risk model was better than that of the risk model without dietary predictors in the validation data. Dietary information improves model performance and predictive ability of noninvasive type 2 diabetes risk model based on classic risk factors. Dietary information may be useful for developing a noninvasive diabetes risk model. PMID:27851788

  3. Retinopathy Signs Improved Prediction and Reclassification of Cardiovascular Disease Risk in Diabetes: A prospective cohort study

    PubMed Central

    Ho, Henrietta; Cheung, Carol Y.; Sabanayagam, Charumathi; Yip, Wanfen; Ikram, Mohammad Kamran; Ong, Peng Guan; Mitchell, Paul; Chow, Khuan Yew; Cheng, Ching Yu; Tai, E. Shyong; Wong, Tien Yin

    2017-01-01

    CVD risk prediction in diabetics is imperfect, as risk models are derived mainly from the general population. We investigate whether the addition of retinopathy and retinal vascular caliber improve CVD prediction beyond established risk factors in persons with diabetes. We recruited participants from the Singapore Malay Eye Study (SiMES, 2004–2006) and Singapore Prospective Study Program (SP2, 2004–2007), diagnosed with diabetes but no known history of CVD at baseline. Retinopathy and retinal vascular (arteriolar and venular) caliber measurements were added to risk prediction models derived from Cox regression model that included established CVD risk factors and serum biomarkers in SiMES, and validated this internally and externally in SP2. We found that the addition of retinal parameters improved discrimination compared to the addition of biochemical markers of estimated glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hsCRP). This was even better when the retinal parameters and biomarkers were used in combination (C statistic 0.721 to 0.774, p = 0.013), showing improved discrimination, and overall reclassification (NRI = 17.0%, p = 0.004). External validation was consistent (C-statistics from 0.763 to 0.813, p = 0.045; NRI = 19.11%, p = 0.036). Our findings show that in persons with diabetes, retinopathy and retinal microvascular parameters add significant incremental value in reclassifying CVD risk, beyond established risk factors. PMID:28148953

  4. Improving Blood Pressure Control in Patients with Diabetes Mellitus and High Cardiovascular Risk

    PubMed Central

    Elliott, Henry L.; Lloyd, Suzanne M.; Ford, Ian; Meredith, Peter A.

    2010-01-01

    Patients with diabetes mellitus and symptomatic coronary artery disease are also likely to be hypertensive and, overall, are at very high cardiovascular (CV) risk. This paper reports the findings of a posthoc analysis of the 1113 patients with diabetes mellitus in the ACTION trial: ACTION itself showed that outcomes in patients with stable angina and hypertension were significantly improved when a long-acting calcium channel blocking drug (nifedipine GITS) was added to their treatment regimens. This further analysis of the ACTION database in those patients with diabetes has identified a number of practical therapeutic issues which are still relevant because of potential outcome benefits, particularly in relation to BP control. For example, despite background CV treatment and, specifically, despite the widespread use of ACE Inhibitor drugs, the addition of nifedipine GITS was associated with significant benefits: improvement in BP control by an average of 6/3 mmHg and significant improvements in outcome. In summary, this retrospective analysis has identified that the addition of nifedipine GITS resulted in improved BP control and significant outcome benefits in patients with diabetes who were at high CV risk. There is evidence to suggest that these findings are of direct relevance to current therapeutic practice. PMID:21274458

  5. Task oriented training improves the balance outcome & reducing fall risk in diabetic population

    PubMed Central

    Ghazal, Javeria; Malik, Arshad Nawaz; Amjad, Imran

    2016-01-01

    Objectives: The objective was to determine the balance impairments and to compare task oriented versus traditional balance training in fall reduction among diabetic patients. Methods: The randomized control trial with descriptive survey and 196 diabetic patients were recruited to assess balance impairments through purposive sampling technique. Eighteen patients were randomly allocated into two groups; task oriented balance training group TOB (n=8) and traditional balance training group TBT (n=10). The inclusion criteria were 30-50 years age bracket and diagnosed cases of Diabetes Mellitus with neuropathy. The demographics were taken through standardized & valid assessment tools include Berg Balance Scale and Functional Reach Test. The measurements were obtained at baseline, after 04 and 08 weeks of training. Results: The mean age of the participants was 49 ±6.79. The result shows that 165(84%) were at moderate risk of fall and 31(15%) were at mild risk of fall among total 196 diabetic patients. There was significant improvement (p <0.05) in task oriented balance training group for dynamic balance, anticipatory balance and reactive balance after 8 weeks of training as compare to traditional balance training. Conclusion: Task oriented balance training is effective in improving the dynamic, anticipator and reactive balance. The task oriented training reduces the risk of falling through enhancing balance outcome. PMID:27648053

  6. Can Time Efficient Exercise Improve Cardiometabolic Risk Factors in Type 2 Diabetes? A Pilot Study

    PubMed Central

    Revdal, Anders; Hollekim-Strand, Siri M.; Ingul, Charlotte B.

    2016-01-01

    Exercise is considered a cornerstone in the prevention and treatment of type 2 diabetes, but few individuals with type 2 diabetes exercise according to guidelines. We investigated the effect of two time efficient high intensity exercise interventions on exercise capacity, glycemic control and other cardiometabolic risk factors in patients with type 2 diabetes. Twenty-one individuals with type 2 diabetes were randomly assigned to low volume high intensity interval exercise (HIIE; 27 minutes/bout; 10x1-minute at 90 % of HRmax; n = 10) or extremely low volume sprint interval exercise (SIE; 10 minutes/bout; 2x20 seconds at maximum achievable intensity; n = 11) 3 days/week for 12 weeks. Aerobic exercise capacity (VO2peak), glycosylated hemoglobin (HbA1c), blood pressure and body composition were measured at baseline and post test. Both HIIE and SIE improved VO2peak (3.3 mL·min-1·kg-1, 10.4 %), p < 0.01, and 1.4 mL·min-1·kg-1 (4.6 %), p = 0.03, respectively). Only HIIE reduced body fat percentage (4.5 %, p = 0.04) and two minute heart rate recovery (11.0 bpm, p = 0.02). Neither HIIE nor SIE improved HbA1c. In conclusion, this study indicates that substantially lower exercise volumes than recommended in current guidelines can improve aerobic exercise capacity in individuals with type 2 diabetes. However, 12 weeks of time efficient high intensity exercise did not improve glycemic control, and interventions of longer duration should be investigated. Key points Low volume high-intensity interval exercise can improve peak oxygen uptake in previously sedentary individuals with type 2 diabetes The weekly exercise volumes in the two intervention groups of 81 and 30 minutes respectively, is substantially lower than recommended in current exercise guidelines and could reduce the time-barrier associated with exercise among patients with type 2 diabetes. However, 12 weeks of structured, supervised low-volume exercise did not improve glycemic control, indicating a need for

  7. Can Time Efficient Exercise Improve Cardiometabolic Risk Factors in Type 2 Diabetes? A Pilot Study.

    PubMed

    Revdal, Anders; Hollekim-Strand, Siri M; Ingul, Charlotte B

    2016-06-01

    Exercise is considered a cornerstone in the prevention and treatment of type 2 diabetes, but few individuals with type 2 diabetes exercise according to guidelines. We investigated the effect of two time efficient high intensity exercise interventions on exercise capacity, glycemic control and other cardiometabolic risk factors in patients with type 2 diabetes. Twenty-one individuals with type 2 diabetes were randomly assigned to low volume high intensity interval exercise (HIIE; 27 minutes/bout; 10x1-minute at 90 % of HRmax; n = 10) or extremely low volume sprint interval exercise (SIE; 10 minutes/bout; 2x20 seconds at maximum achievable intensity; n = 11) 3 days/week for 12 weeks. Aerobic exercise capacity (VO2peak), glycosylated hemoglobin (HbA1c), blood pressure and body composition were measured at baseline and post test. Both HIIE and SIE improved VO2peak (3.3 mL·min(-1)·kg(-1), 10.4 %), p < 0.01, and 1.4 mL·min(-1)·kg(-1) (4.6 %), p = 0.03, respectively). Only HIIE reduced body fat percentage (4.5 %, p = 0.04) and two minute heart rate recovery (11.0 bpm, p = 0.02). Neither HIIE nor SIE improved HbA1c. In conclusion, this study indicates that substantially lower exercise volumes than recommended in current guidelines can improve aerobic exercise capacity in individuals with type 2 diabetes. However, 12 weeks of time efficient high intensity exercise did not improve glycemic control, and interventions of longer duration should be investigated. Key pointsLow volume high-intensity interval exercise can improve peak oxygen uptake in previously sedentary individuals with type 2 diabetesThe weekly exercise volumes in the two intervention groups of 81 and 30 minutes respectively, is substantially lower than recommended in current exercise guidelines and could reduce the time-barrier associated with exercise among patients with type 2 diabetes.However, 12 weeks of structured, supervised low-volume exercise did not improve glycemic control, indicating a need for

  8. How can we improve the management of vascular risk in type 2 diabetes: insights from FIELD.

    PubMed

    Steiner, George

    2009-10-01

    Intensive multifactorial risk factor intervention, targeting blood glucose, blood pressure and low-density lipoprotein cholesterol, is central to therapeutic management of type 2 diabetes. This strategy reduces, but does not eliminate the risk for cardiovascular complications, and microvascular complications such as diabetic retinopathy and nephropathy still continue to develop or progress. Fibrates have been shown to be effective in managing mixed dyslipidemia characterized by elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C), typically associated with type 2 diabetes. Data were reviewed from the largest fibrate study to date, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study which evaluated the effect of fenofibrate treatment in 9,795 patients with type 2 diabetes (about 80% without prior cardiovascular disease or microvascular complications). Although FIELD did not show a significant benefit with fenofibrate for major coronary events (the primary outcome), there was significant reduction in total cardiovascular events (relative risk reduction [RRR] 11%, p = 0.035 vs. placebo). The clinical benefits of fenofibrate treatment were greater in patients with marked mixed dyslipidemia (elevated triglycerides >or=200 mg/dL and low plasma levels of HDL-C), features of the metabolic syndrome commonly observed in patients with type 2 diabetes, with a RRR of 27%, p = 0.005. These data are consistent with evidence from other fibrate trials showing increased treatment benefits in patients with metabolic syndrome or type 2 diabetes and mixed dyslipidemia. The FIELD study also provided promising data for microvascular benefits with fenofibrate, specifically on the need for laser treatment for diabetic retinopathy, progression of albuminuria, and prevention of diabetes-related lower-limb amputation. Adding fenofibrate to primary statin therapy might be a useful strategy to address residual macrovascular and microvascular risk in

  9. Diabetic nephropathy: new approaches for improving glycemic control and reducing risk.

    PubMed

    Schernthaner, Guntram; Schernthaner, Gerit Holger

    2013-01-01

    Nephropathy is a common consequence of diabetes, with a high prevalence in patients with type 1 (15%-25%) and type 2 diabetes mellitus (T2DM; 30%-40%). Nephropathy is associated with a poor prognosis and high economic burden. The risk of developing nephropathy increases with the duration of diabetes, and early diagnosis and treatment of risk factors for nephropathy (e.g., tight control of glycemia and hypertension) can reduce the development and progression of diabetic nephropathy. Advances in our understanding of the mechanisms of renal complications associated with diabetes and the etiology of nephropathy have identified additional risk factors for nephropathy, and novel therapeutic options are being explored. This review discusses the pathophysiology of diabetic nephropathy and common risk factors. Furthermore, we discuss emerging treatments for T2DM that could potentially slow or prevent the progression of diabetic nephropathy. The use of incretin-based therapies, such as the dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) analogs, is growing in patients with T2DM, due to their efficacy and tolerability profiles. As renal safety is a key factor when choosing treatment options to manage patients with T2DM, drugs that are suitable for use in patients with varying degrees of renal impairment without a requirement for dose adjustment, such as the DPP-4 inhibitor linagliptin, are of particular use. The ongoing advances in T2DM therapy may allow optimization of glycemic control in a wide range of patients, thereby helping to reduce the increasing morbidity and mortality associated with diabetic nephropathy.

  10. Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?

    PubMed

    Lo, H-Y; Yang, S-L; Lin, H-H; Bai, K-J; Lee, J-J; Lee, T-I; Chiang, C-Y

    2016-03-01

    The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients. Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.

  11. Improving Employee Health: Evaluation of a Worksite Lifestyle Change Program to Decrease Risk Factors for Diabetes and Cardiovascular Disease

    PubMed Central

    Kramer, M; Molenaar, D; Arena, V; Venditti, E; Meehan, R; Miller, R; Vanderwood, K; Eaglehouse, Y; Kriska, Andrea M

    2014-01-01

    Objective To determine if an evidence-based, behavioral lifestyle intervention program delivered at a worksite setting is effective in improving type 2 diabetes and CVD risk factors. Methods A randomized six-month delayed control design was utilized, with two-thirds of the participants assigned to begin intervention immediately and one-third beginning six months later. The year-long program (weekly for 3 months transitioning to monthly) focused on weight loss and increasing physical activity. Results The immediate intervention group had greater mean weight loss (−10.4 lbs., 5.1%, vs. −2.3 lbs., 1%, p=0.0001) than the delayed control group at 6 months and relatively greater improvements in activity, HbA1c and other risk factors. The delayed group experienced similar improvements after completing the intervention program. Conclusions A worksite behavioral lifestyle intervention is feasible and effective in significantly improving risk factors for diabetes and CVD. PMID:25742535

  12. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents.

    PubMed

    Inge, Thomas H; Miyano, Go; Bean, Judy; Helmrath, Michael; Courcoulas, Anita; Harmon, Carroll M; Chen, Mike K; Wilson, Kimberly; Daniels, Stephen R; Garcia, Victor F; Brandt, Mary L; Dolan, Lawrence M

    2009-01-01

    Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus. Eleven adolescents who underwent Roux-en-Y gastric bypass at 5 centers were included. Anthropometric, hemodynamic, and biochemical measures and surgical complications were analyzed. Similar measures from 67 adolescents with type 2 diabetes mellitus who were treated medically for 1 year were also analyzed. Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean BMI of 50 +/- 5.9 kg/m(2)) with numerous cardiovascular risk factors. After surgery there was evidence of remission of type 2 diabetes mellitus in all but 1 patient. Significant improvements in BMI (-34%), fasting blood glucose (-41%), fasting insulin concentrations (-81%), hemoglobin A1c levels (7.3%-5.6%), and insulin sensitivity were also seen. There were significant improvements in serum lipid levels and blood pressure. In comparison, adolescents with type 2 diabetes mellitus who were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 +/- 7.3 kg/m(2); 1-year BMI: 34.9 +/- 7.2 kg/m(2)) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% +/- 2.3%; 1 year: 7.1% +/- 2%). Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, beta-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux

  13. mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study

    PubMed Central

    Spring, Bonnie; Saligram, Nalini; Davé, Raj; Gowda, Arun; Blais, Linelle; Arora, Monika; Ranjani, Harish; Ganda, Om; Hedeker, Donald; Reddy, Sethu; Ramalingam, Sandhya

    2016-01-01

    Background In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults. Objective A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise. Methods Intervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015. Results 982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were

  14. Recommendations from the EGAPP Working Group: does genomic profiling to assess type 2 diabetes risk improve health outcomes?

    PubMed

    2013-08-01

    The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group (EWG) found insufficient evidence to recommend testing for predictive variants in 28 variants (listed in Table 1) to assess risk for type 2 diabetes in the general population, on the basis of studies in populations of northern European descent. The EWG found that the magnitude of net health benefit from the use of any of these tests alone or in combination is close to zero. The EWG discourages clinical use unless further evidence supports improved clinical outcomes.The EWG found insufficient evidence to recommend testing for the TCF7L2 gene to assess risk for type 2 diabetes in high-risk individuals. The EWG found that the magnitude of net health benefit from the use of this test is close to zero. The EWG discourages clinical use unless further evidence supports improved clinical outcomes.On the basis of the available evidence for both the scenarios, the overall certainty of net health benefit is deemed "low." It has been suggested that genomic profiling in the general population or in high-risk populations for type 2 diabetes might lead to management changes (e.g., earlier initiation or higher rates of medical interventions, or targeted recommendations for behavioral change) that improve type 2 diabetes outcomes or prevent type 2 diabetes. The EWG found no direct evidence to support this possibility; therefore, this review sought indirect evidence aimed at documenting the extent to which genomic profiling alters type 2 diabetes risk estimation, alone and in combination with traditional risk factors, and the extent to which risk classification improves health outcomes. Assay-related evidence on available genomic profiling tests was deemed inadequate. However, on the basis of existing technologies that have been or may be used, the analytic sensitivity and specificity of tests for individual gene variants might be at least satisfactory. Twenty-eight candidate markers were

  15. Improving diet, activity and wellness in adults at risk of diabetes: randomized controlled trial

    PubMed Central

    Block, G; Azar, K M J; Romanelli, R J; Block, T J; Palaniappan, L P; Dolginsky, M; Block, C H

    2016-01-01

    Objective: The purpose of this analysis is to examine the effect of an algorithm-driven online diabetes prevention program on changes in eating habits, physical activity and wellness/productivity factors. Methods: The intervention, Alive-PD, used small-step individually tailored goal setting and other features to promote changes in diet and physical activity. A 6-month randomized controlled trial was conducted among patients from a healthcare delivery system who had confirmed prediabetes (n =339). Change in weight and glycemic markers were measured in the clinic. Changes in physical activity, diet and wellness/productivity factors were self-reported. Mean age was 55 (s.d. 8.9) years, mean body mass index was 31 (s.d. 4.4) kg m−2, 68% were white and 69% were male. Results: The intervention group increased fruit/vegetable consumption by 3.71 (95% confidence interval (CI) 2.73, 4.70) times per week (effect size 0.62), and decreased refined carbohydrates by 3.77 (95% CI 3.10, 4.44) times per week both significantly (P<0.001) greater changes than in the control group. The intervention group also reported a significantly greater increase in physical activity than in the control group, effect size 0.49, P<0.001. In addition, the intervention group reported a significant increase in self-rated health, in confidence in ability to make dietary changes and in ability to accomplish tasks, and a decrease in fatigue, compared with the control group. These changes paralleled the significant treatment effects on glycemic markers and weight. Conclusions: In addition to promoting improvements in weight and glycemic markers, the Alive-PD program appears to improve eating habits and physical activity, behaviors important not just for diabetes prevention but for those with diagnosed diabetes or obesity. The improvements in wellness/productivity may derive from the diet and activity improvements, and from the satisfaction and self-efficacy of achieving goals. PMID:27643726

  16. Prevalence of self-reported diagnosis of diabetes mellitus and associated risk factors in a national survey in the US population: SHIELD (Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes)

    PubMed Central

    Bays, Harold E; Bazata, Debbra D; Clark, Nathaniel G; Gavin, James R; Green, Andrew J; Lewis, Sandra J; Reed, Michael L; Stewart, Walter; Chapman, Richard H; Fox, Kathleen M; Grandy, Susan

    2007-01-01

    Background Studies derived from continuous national surveys have shown that the prevalence of diagnosed diabetes mellitus in the US is increasing. This study estimated the prevalence in 2004 of self-reported diagnosis of diabetes and other conditions in a community-based population, using data from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Methods The initial screening questionnaire was mailed in 2004 to a stratified random sample of 200,000 households in the US, to identify individuals, age ≥ 18 years of age, with diabetes or risk factors associated with diabetes. Follow-up disease impact questionnaires were then mailed to a representative, stratified random sample of individuals (n = 22,001) in each subgroup of interest (those with diabetes or different numbers of risk factors for diabetes). Estimated national prevalence of diabetes and other conditions was calculated, and compared to prevalence estimates from the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Results Response rates were 63.7% for the screening, and 71.8% for the follow-up baseline survey. The SHIELD screening survey found overall prevalence of self-reported diagnosis of diabetes (either type 1 or type 2) was 8.2%, with increased prevalence with increasing age and decreasing income. In logistic regression modeling, individuals were more likely to be diagnosed with type 2 diabetes if they had abdominal obesity (odds ratio [OR] = 3.50; p < 0.0001), BMI ≥28 kg/m2 (OR = 4.04; p < 0.0001), or had been diagnosed with dyslipidemia (OR = 3.95; p < 0.0001), hypertension (OR = 4.82; p < 0.0001), or with cardiovascular disease (OR = 3.38; p < 0.0001). Conclusion The SHIELD design allowed for a very large, community-based sample with broad demographic representation of the population of interest. When comparing results from the SHIELD screening survey (self-report only) to those from NHANES 1999–2002 (self

  17. Assessment of serum 25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes.

    PubMed

    Heidari, Behnam; Nargesi, Arash Aghajani; Hafezi-Nejad, Nima; Sheikhbahaei, Sara; Pajouhi, Atieh; Nakhjavani, Manouchehr; Esteghamati, Alireza

    2015-09-01

    A growing body of evidence suggests an association between lower serum 25-hydroxy vitamin D (25(OH)VitD) levels and adverse cardiovascular events. Patients with type 2 diabetes mellitus (T2DM) are at increased risk for developing coronary heart disease (CHD). 25-Hydroxy vitamin D deficiency is highly prevalent, especially among patients with T2DM. This study aimed to evaluate the predictive value of serum 25(OH)VitD in improvement of CHD risk stratification in patients with T2DM. In an open cohort, community-dwelling T2DM patients were followed up for first CHD event. Patients were divided into 4 categories, based on 25(OH)VitD quartiles. Cox regression analysis was used to obtain hazard ratios. A total number of 2,607 T2DM patients were followed up for median time of 8.5 years. During follow-up, 299 patients experienced CHD events. Patients in the lowest quartile experienced more CHD events. Adjusted hazard ratios (95% CI) for developing CHD events were 0.77 (0.55-1.07) for second quartile, 0.52 (0.38-0.73) for third quartile, and 0.43 (0.31-0.60) for fourth quartile, compared with the first quartile. The incidence rate decreased as serum 25(OH)VitD increased, which remained significant after stepwise adjustments (P value for trend ≤.001). Addition of 25(OH)VitD to traditional risk factors in Framingham Risk Score successfully reclassified 29% of study population. Serum 25(OH)VitD is an independent predictor of future adverse CHD events in patients with T2DM. Addition of 25(OH)VitD status to Framingham Risk Score improves CHD risk prediction in patients with T2DM. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health.

    PubMed

    Tieu, Joanna; McPhee, Andrew J; Crowther, Caroline A; Middleton, Philippa; Shepherd, Emily

    2017-08-03

    Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so, the most appropriate setting for screening. This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014. To assess the effects of screening for gestational diabetes mellitus based on different risk profiles and settings on maternal and infant outcomes. We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (14 June 2017), and reference lists of retrieved studies. We included randomised and quasi-randomised trials evaluating the effects of different protocols, guidelines or programmes for screening for GDM based on different risk profiles and settings, compared with the absence of screening, or compared with other protocols, guidelines or programmes for screening. We planned to include trials published as abstracts only and cluster-randomised trials, but we did not identify any. Cross-over trials are not eligible for inclusion in this review. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included trials. We resolved disagreements through discussion or through consulting a third reviewer. We included two trials that randomised 4523 women and their infants. Both trials were conducted in Ireland. One trial (which quasi-randomised 3742 women, and analysed 3152 women) compared universal screening versus risk factor-based screening, and one trial (which randomised 781 women, and analysed 690 women) compared primary care screening versus

  19. Use of Net Reclassification Improvement (NRI) Method Confirms The Utility of Combined Genetic Risk Score to Predict Type 2 Diabetes

    PubMed Central

    Tam, Claudia H. T.; Ho, Janice S. K.; Wang, Ying; Lam, Vincent K. L.; Lee, Heung Man; Jiang, Guozhi; Lau, Eric S. H.; Kong, Alice P. S.; Fan, Xiaodan; Woo, Jean L. F.; Tsui, Stephen K. W.; Ng, Maggie C. Y.; So, Wing Yee; Chan, Juliana C. N.; Ma, Ronald C. W.

    2013-01-01

    Background Recent genome-wide association studies (GWAS) identified more than 70 novel loci for type 2 diabetes (T2D), some of which have been widely replicated in Asian populations. In this study, we investigated their individual and combined effects on T2D in a Chinese population. Methodology We selected 14 single nucleotide polymorphisms (SNPs) in T2D genes relating to beta-cell function validated in Asian populations and genotyped them in 5882 Chinese T2D patients and 2569 healthy controls. A combined genetic score (CGS) was calculated by summing up the number of risk alleles or weighted by the effect size for each SNP under an additive genetic model. We tested for associations by either logistic or linear regression analysis for T2D and quantitative traits, respectively. The contribution of the CGS for predicting T2D risk was evaluated by receiver operating characteristic (ROC) analysis and net reclassification improvement (NRI). Results We observed consistent and significant associations of IGF2BP2, WFS1, CDKAL1, SLC30A8, CDKN2A/B, HHEX, TCF7L2 and KCNQ1 (8.5×10−18risk, which yielded odds ratios ranging from 1.07 to 2.09. The 8 significant SNPs exhibited joint effect on increasing T2D risk, fasting plasma glucose and use of insulin therapy as well as reducing HOMA-β, BMI, waist circumference and younger age of diagnosis of T2D. The addition of CGS marginally increased AUC (2%) but significantly improved the predictive ability on T2D risk by 11.2% and 11.3% for unweighted and weighted CGS, respectively using the NRI approach (P<0.001). Conclusion In a Chinese population, the use of a CGS of 8 SNPs modestly but significantly improved its discriminative ability to predict T2D above and beyond that attributed to clinical risk factors (sex, age and BMI). PMID:24376643

  20. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS).

    PubMed

    Lindström, J; Peltonen, M; Eriksson, J G; Ilanne-Parikka, P; Aunola, S; Keinänen-Kiukaanniemi, S; Uusitupa, M; Tuomilehto, J

    2013-02-01

    This study aimed to determine whether lifestyle intervention lasting for 4 years affected diabetes incidence, body weight, glycaemia or lifestyle over 13 years among individuals at high risk of type 2 diabetes. Overweight, middle-aged men (n = 172) and women (n = 350) with impaired glucose tolerance were randomised in 1993-1998 to an intensive lifestyle intervention group (n = 265), aiming at weight reduction, dietary modification and increased physical activity, or to a control group (n = 257) that received general lifestyle information. The primary outcome was a diagnosis of diabetes based on annual OGTTs. Secondary outcomes included changes in body weight, glycaemia, physical activity and diet. After active intervention (median 4 years, range 1-6 years), participants still free of diabetes and willing to continue their participation (200 in the intervention group and 166 in the control group) were further followed until diabetes diagnosis, dropout or the end of 2009, with a median total follow-up of 9 years and a time span of 13 years from baseline. During the total follow-up the adjusted HR for diabetes (intervention group vs control group) was 0.614 (95% CI 0.478, 0.789; p < 0.001). The corresponding HR during the post-intervention follow-up was 0.672 (95% CI 0.477, 0.947; p = 0.023). The former intervention group participants sustained lower absolute levels of body weight, fasting and 2 h plasma glucose and a healthier diet. Adherence to lifestyle changes during the intervention period predicted greater risk reduction during the total follow-up. Lifestyle intervention in people at high risk of type 2 diabetes induces sustaining lifestyle change and results in long-term prevention of progression to type 2 diabetes.

  1. Improving diabetes care: Multi-component CArdiovascular Disease Risk Reduction Strategies for People with Diabetes in South Asia - The CARRS Multi-center Translation Trial

    PubMed Central

    Shah, Seema; Singh, Kavita; Ali, Mohammed K.; Mohan, V.; Kadir, Muhammad Masood; Unnikrishnan, A.G.; Sahay, Rakesh Kumar; Varthakavi, Premlata; Dharmalingam, Mala; Viswanathan, Vijay; Masood, Qamar; Bantwal, Ganapathi; Khadgawat, Rajesh; Desai, Ankush; Sethi, Bipin Kumar; Shivashankar, Roopa; Ajay, Vamadevan S; Reddy, K. Srinath; Narayan, K.M. Venkat; Prabhakaran, Dorairaj; Tandon, Nikhil

    2012-01-01

    Aims Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with diabetes in South Asia. The CARRS translation trial tests the effectiveness, cost-effectiveness, and sustainability of a clinic-based multi-component CVD risk reduction intervention among people with diabetes in India and Pakistan. Methods We randomly assigned 1,146 adults with diabetes recruited from 10 urban clinic sites, to receive usual care by physicians or to receive an integrated multi-component CVD risk reduction intervention. The intervention involves electronic health record management, decision-support prompts to the healthcare team, and the support of a care coordinator to actively facilitate patient and provider adherence to evidence-based guidelines. The primary outcome is a composite of multiple CVD risk factor control (blood glucose and either blood pressure or cholesterol, or all three). Other outcomes include control of the individual CVD risk factors, process and patient-centered measures, cost-effectiveness, and acceptability/feasibility. Conclusion The CARRS translation trial tests a low-cost diabetes care delivery model in urban South Asia to achieve comprehensive cardio-metabolic disease case-management of high-risk patients (clinicaltrials.gov number: NCT01212328). PMID:23084280

  2. Effect of Improved Fitness beyond Weight Loss on Cardiovascular Risk Factors in Individuals with Type 2 Diabetes in the Look AHEAD Study

    PubMed Central

    Gibbs, Bethany Barone; Brancati, Frederick L.; Chen, Haiying; Coday, Mace; Jakicic, John M.; Lewis, Cora; Stewart, Kerry J.; Clark, Jeanne M.

    2013-01-01

    Background Because lifestyle-induced improvements in cardiovascular risk factors vary substantially across individuals with type 2 diabetes, we investigated the extent to which increases in fitness explain cardiovascular risk factor improvements independent of weight loss in a lifestyle intervention. Methods We studied 1-year changes in Look AHEAD, a randomized trial comparing an intensive lifestyle intervention (ILI) to a diabetes support and education control group (DSE) in adults with type 2 diabetes. Assessments included weight, fitness, blood pressure (BP), glucose, HbA1c, and lipids. We evaluated the effects of changes in weight and fitness on changes in cardiovascular risk factors by study arm, using R2 from multiple linear regression. Results Analyses included participants with fitness data at baseline and 1-year (n=4,408; 41% male, 36% non-White, mean age 58.7± 6.8 years). Weight change alone improved R2 for explaining changes in risk factors up to 8.2% in ILI and 1.7% in DSE. Fitness change alone improved R2 up to 3.9% in ILI and 0.8% in DSE. After adjusting for weight change, fitness was independently associated (p<0.05) with improvements in R2 for glucose (+0.7%), HbA1c (+1.1 %), HDL cholesterol (+0.4%) and triglycerides (+0.2%) in ILI and DBP (+0.3%), glucose (+0.3%), HbA1c (+0.4%), and triglycerides (+0.1%) in DSE. Taken together, weight and fitness changes explained from 0.1–9.3% of the variability in cardiovascular risk factor changes. Conclusion Increased fitness explained statistically significant but small improvements in several cardiovascular risk factors beyond weight loss. Further research identifying other factors that explain cardiovascular risk factor change is needed. PMID:23012688

  3. Diabetes risk factors (image)

    MedlinePlus

    ... and type 2 diabetes typically begins in adulthood. Type 2 diabetes is becoming more common due to the growing number of older Americans and an increasing trend toward obesity and a sedentary lifestyle. Without proper ...

  4. Changes in Physical Fitness Predict Improvements in Modifiable Cardiovascular Risk Factors Independently of Body Weight Loss in Subjects With Type 2 Diabetes Participating in the Italian Diabetes and Exercise Study (IDES)

    PubMed Central

    Balducci, Stefano; Zanuso, Silvano; Cardelli, Patrizia; Salvi, Laura; Mazzitelli, Giulia; Bazuro, Alessandra; Iacobini, Carla; Nicolucci, Antonio; Pugliese, Giuseppe

    2012-01-01

    OBJECTIVE Physical fitness is inversely related to mortality in the general population and in subjects with type 2 diabetes. Here, we present data concerning the relationship between changes in physical fitness and modifiable cardiovascular risk factors in subjects with type 2 diabetes from the Italian Diabetes and Exercise Study. RESEARCH DESIGN AND METHODS Sedentary patients with type 2 diabetes (n = 606) were enrolled in 22 outpatient diabetes clinics and randomized to twice-a-week supervised aerobic and resistance training plus exercise counseling versus counseling alone for 12 months. Baseline to end-of-study changes in cardiorespiratory fitness, strength, and flexibility, as assessed by Vo2max estimation, a 5–8 maximal repetition test, and a hip/trunk flexibility test, respectively, were calculated in the whole cohort, and multiple regression analyses were applied to assess the relationship with cardiovascular risk factors. RESULTS Changes in Vo2max, upper and lower body strength, and flexibility were significantly associated with the variation in the volume of physical activity, HbA1c, BMI, waist circumference, high-sensitivity C-reactive protein (hs-CRP), coronary heart disease (CHD) risk score, and inversely, HDL cholesterol. Changes in fitness predicted improvements in HbA1c, waist circumference, HDL cholesterol, hs-CRP, and CHD risk score, independent of study arm, BMI, and in case of strength, also waist circumference. CONCLUSIONS Physical activity/exercise-induced increases in fitness, particularly muscular, predict improvements in cardiovascular risk factors in subjects with type 2 diabetes independently of weight loss, thus indicating the need for targeting fitness in these individuals, particularly in subjects who struggle to lose weight. PMID:22399699

  5. Canagliflozin improves risk factors of metabolic syndrome in patients with type 2 diabetes mellitus and metabolic syndrome.

    PubMed

    Davies, Michael J; Merton, Katherine W; Vijapurkar, Ujjwala; Balis, Dainius A; Desai, Mehul

    2017-01-01

    Metabolic syndrome refers to a collection of risk factors associated with the development of cardiovascular disease and type 2 diabetes mellitus (T2DM). Canagliflozin, a sodium glucose co-transporter 2 inhibitor, improves glycemic control and reduces body weight and blood pressure (BP) in a broad range of patients with T2DM. This post hoc analysis assessed the effects of canagliflozin on the components of metabolic syndrome in patients with T2DM and metabolic syndrome. This analysis was based on data from 2 head-to-head studies of canagliflozin in patients with T2DM on background metformin versus glimepiride (study 1) and background metformin plus sulfonylurea versus sitagliptin 100 mg (study 2). Changes from baseline in glycemic efficacy, anthropometric measures, BP, and lipids were evaluated with canagliflozin versus glimepiride and sitagliptin at week 52 in patients who met ≥2 of the criteria for metabolic syndrome (in addition to T2DM): triglycerides ≥1.7 mmol/L; high-density lipoprotein cholesterol (HDL-C) <1.0 mmol/L (men) or <1.3 mmol/L (women); waist circumference ≥102 cm (non-Asian men), ≥88 cm (non-Asian women), >90 cm (Asian men), or >80 cm (Asian women); diagnosis of hypertension or meeting BP-related criteria (systolic BP ≥130 mmHg or diastolic BP ≥85 mmHg). Safety was assessed based on adverse event reports. In study 1, canagliflozin 100 and 300 mg provided similar and greater HbA1c reductions versus glimepiride, respectively. In study 2, canagliflozin 300 mg provided greater HbA1c lowering versus sitagliptin 100 mg. Canagliflozin also reduced fasting plasma glucose, body weight, body mass index, waist circumference, BP, and triglycerides, and increased HDL-C and low-density lipoprotein cholesterol versus glimepiride and sitagliptin. Canagliflozin was generally well tolerated in each study. Canagliflozin was associated with improvements in all components of metabolic syndrome in patients with T2DM and metabolic syndrome, whereas

  6. Canagliflozin improves risk factors of metabolic syndrome in patients with type 2 diabetes mellitus and metabolic syndrome

    PubMed Central

    Davies, Michael J; Merton, Katherine W; Vijapurkar, Ujjwala; Balis, Dainius A; Desai, Mehul

    2017-01-01

    Objective Metabolic syndrome refers to a collection of risk factors associated with the development of cardiovascular disease and type 2 diabetes mellitus (T2DM). Canagliflozin, a sodium glucose co-transporter 2 inhibitor, improves glycemic control and reduces body weight and blood pressure (BP) in a broad range of patients with T2DM. This post hoc analysis assessed the effects of canagliflozin on the components of metabolic syndrome in patients with T2DM and metabolic syndrome. Methods This analysis was based on data from 2 head-to-head studies of canagliflozin in patients with T2DM on background metformin versus glimepiride (study 1) and background metformin plus sulfonylurea versus sitagliptin 100 mg (study 2). Changes from baseline in glycemic efficacy, anthropometric measures, BP, and lipids were evaluated with canagliflozin versus glimepiride and sitagliptin at week 52 in patients who met ≥2 of the criteria for metabolic syndrome (in addition to T2DM): triglycerides ≥1.7 mmol/L; high-density lipoprotein cholesterol (HDL-C) <1.0 mmol/L (men) or <1.3 mmol/L (women); waist circumference ≥102 cm (non-Asian men), ≥88 cm (non-Asian women), >90 cm (Asian men), or >80 cm (Asian women); diagnosis of hypertension or meeting BP-related criteria (systolic BP ≥130 mmHg or diastolic BP ≥85 mmHg). Safety was assessed based on adverse event reports. Results In study 1, canagliflozin 100 and 300 mg provided similar and greater HbA1c reductions versus glimepiride, respectively. In study 2, canagliflozin 300 mg provided greater HbA1c lowering versus sitagliptin 100 mg. Canagliflozin also reduced fasting plasma glucose, body weight, body mass index, waist circumference, BP, and triglycerides, and increased HDL-C and low-density lipoprotein cholesterol versus glimepiride and sitagliptin. Canagliflozin was generally well tolerated in each study. Conclusion Canagliflozin was associated with improvements in all components of metabolic syndrome in patients with T2DM and

  7. Chocolate intake and diabetes risk.

    PubMed

    Greenberg, James A

    2015-02-01

    In-vitro and rodent studies, and short-term human trials suggest that compounds in chocolate can enhance insulin sensitivity. Also, a recent prospective Japanese epidemiological analysis found that long-term chocolate consumption was inversely associated with diabetes risk. The objective of the present analysis was to test the epidemiological association between long-term chocolate consumption and diabetes risk in a U.S. cohort. Multivariable prospective Cox Regression analysis with time-dependent covariates was used to examine data from 7802 participants in the prospective Atherosclerosis Risk in Communities Cohort. The data included 861 new diabetes cases during 98,543 person-years of follow up (mean = 13.3 years). Compared to participants who ate 1 oz of chocolate less often than monthly, those who ate it 1-4 times/month, 2-6 times/week and ≥ 1 time/day had relative risks of being diagnosed with diabetes that were lower by 13% (95% confidence interval: -2%, 25%), 34% (18%, 47%) and 18% (-10%, 38%). These relative risks applied to participants without evidence of preexisting serious chronic disease that included diabetes, heart attacks, stroke or cancer. In conclusion, the risk of diabetes decreased as the frequency of chocolate intake increased, up to 2-6 servings (1 oz) per week. Consuming ≥ 1 serving per day did not yield significantly lower relative risk. These results suggest that consuming moderate amount of chocolate may reduce the risk of diabetes. Further research is required to confirm and explore these findings. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  8. Improved prognosis of diabetic nephropathy in type 1 diabetes.

    PubMed

    Andrésdóttir, Gudbjörg; Jensen, Majken L; Carstensen, Bendix; Parving, Hans-Henrik; Hovind, Peter; Hansen, Tine W; Rossing, Peter

    2015-02-01

    The natural history of diabetic nephropathy offered an average survival of only 5-7 years. During the past decades, multiple changes in therapy and lifestyle have occurred. The prognosis of diabetic nephropathy after implementing stricter control of blood pressure (including increased use of long-term renin-angiotensin system inhibition), lipids, and glycemia, along with less smoking and other lifestyle and treatment advancements, is inadequately analyzed. To clarify this, we studied 497 patients with type 1 diabetes and diabetic nephropathy at the Steno Diabetes Center and compared them with previous data, obtained using identical criteria at our hospital. The glomerular filtration rate, measured yearly by 51Cr-EDTA plasma clearance, was a mean of 71 ml/min per 1.73 m2 at baseline. The mean glomerular filtration rate decline was significantly reduced by 19% (95% confidence interval 5-34) from previously 4.0 to 3.3 ml/min per 1.73 m2/year. During a median follow-up of 9.1 years, 29% of participants doubled their plasma creatinine or developed end-stage renal disease. Mortality risk was similar to our prior study (hazard ratio 1.05 (0.76-1.43). However, after age adjustment, as both diabetes and nephropathy onset occurred later in life, mortality was reduced by 30%. Risk factors for decline in glomerular filtration rate, death, and other renal end points were generally in agreement with prior studies. Thus, with current treatment of nephropathy in type 1 diabetes, the prognosis and loss of renal function has improved along with better control of modifiable risk factors.

  9. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes.

    PubMed

    Barnard, Neal D; Cohen, Joshua; Jenkins, David J A; Turner-McGrievy, Gabrielle; Gloede, Lise; Jaster, Brent; Seidl, Kim; Green, Amber A; Talpers, Stanley

    2006-08-01

    We sought to investigate whether a low-fat vegan diet improves glycemic control and cardiovascular risk factors in individuals with type 2 diabetes. Individuals with type 2 diabetes (n = 99) were randomly assigned to a low-fat vegan diet (n = 49) or a diet following the American Diabetes Association (ADA) guidelines (n = 50). Participants were evaluated at baseline and 22 weeks. Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P = 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P = 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P < 0.001). Body weight change correlated with A1C change (r = 0.51, n = 57, P < 0.0001). Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P = 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24 h) than in the ADA group (10.9 mg/24 h) (P = 0.013). Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet.

  10. Improving diabetes care in developing countries: the example of Pakistan.

    PubMed

    Basit, Abdul; Riaz, Musarrat; Fawwad, Asher

    2015-02-01

    Pakistan is a developing country with limited recourses and diverse economic social patterns. Pakistan has high prevalence of diabetes and its complication, which is a huge challenge to the existing health care system. The major contributing risk factors are urbanization and change in lifestyle, maternal and fetal malnutrition and genetic factors. National action plans for control of diabetes have been made since 1995 but actions in this regard were not perfect. Training of primary care physicians and development of multidisciplinary diabetes care teams was initiated. Prioritization strategies were defined according to the International Diabetes Federation (IDF) guidance, mainly focusing on diabetic foot, diabetes education and children with diabetes. Researches for better understanding and management of diabetes in Pakistan were undertaken. Collaboration between various stakeholders was promoted at national and international level. In summary, public private relationships and development of multifaceted approaches is expected to improve the lives of millions of diabetics of Pakistan. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Diabetes mellitus: influences on cancer risk.

    PubMed

    Szablewski, Leszek

    2014-10-01

    Diabetes mellitus and cancer are common conditions, and their co-diagnosis in the same individual is not infrequent. The relative risks associated with type 2 diabetes are greater than twofold for hepatic, pancreatic, and endometrial cancers. The relative risk is somewhat lower, at 1.2-1.5-fold for colorectal, breast, and bladder cancers. In comparison, the relative risk of lung cancer is less than 1. The evidence for other malignancies (e.g. kidney, non-Hodgkin lymphoma) is inconclusive, whereas prostatic cancer occurs less frequently in male patients with diabetes. The potential biologic links between the two diseases are incompletely understood. Evidence from observational studies suggests that some medications used to treat hyperglycemia are associated with either increased or reduced risk of cancer. Whereas anti-diabetic drugs have a minor influence on cancer risk, drugs used to treat cancer may either cause diabetes or worsen pre-existing diabetes. If hyperinsulinemia acts as a critical link between the observed increased cancer risk and type 2 diabetes, one would predict that patients with type 1 diabetes would have a different cancer risk pattern than patients with type 2 diabetes because the former patients are exposed to lower levels of exogenous administered insulin. Obtained results showed that patients with type 1 diabetes had elevated risks of cancers of the stomach, cervix, and endometrium. Type 1 diabetes is associated with a modest excess cancer risk overall and risks of specific cancers that differ from those associated with type 2 diabetes.

  12. What do herbalists suggest to diabetic patients in order to improve glycemic control? Evaluation of scientific evidence and potential risks.

    PubMed

    Cicero, A F G; Derosa, G; Gaddi, A

    2004-09-01

    In the course of 12 continuing education seminars given in different regions of Italy in 2001, we distributed a questionnaire to all the attending herbalists asking information about the herbal remedy and dietary supplement they mainly recommended to subjects who required a "natural" treatment to control glycemia. We distributed 720 questionnaires and we received 685 completed ones. We have compiled a short review on the efficacy and safety of the 10 most frequently advised products for each category. The 10 more frequently suggested herbal remedies were gymnema, psyllium, fenugreek, bilberry, garlic, Chinese ginseng, dandelion, burdock, prickly pear cactus, and bitter melon. The 10 most frequently recommended dietary supplements were biotin, vanadium, chromium, vitamin B6, vitamin C, vitamin E, zinc, selenium, alpha-lipoic acid, and fructooligosaccharides. The majority of the products recommended by Italian herbalists may be efficacious in reducing glycemia. If a diabetic patient is already assuming products that even slightly reduce glycemia, we risk to underestimate the level of glucose intolerance, while if the patient stops the complementary treatment after initiating pharmaceutical therapy, in the subsequent visit we may underestimate the effect of our prescription. Therefore, if doctors are to have a role in gate-keeping or advising patients about complementary and alternative medicine, they need to be familiar with this type of medicine. If they choose otherwise, then the provision of complementary and alternative medicine will continue to be patchy and largely outside the conventional care framework, perhaps through a growing network of parallel care providers involving a large number of non-medically qualified practitioners, who patients will continue to access directly.

  13. Gestational Diabetes Mellitus: Post-partum Risk and Follow up.

    PubMed

    Poola-Kella, Silpa; Steinman, Rachel A; Mesmar, Bayan; Malek, Rana

    2017-09-11

    Women with gestational diabetes mellitus (GDM) are at an increased risk for developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. In this review, we will discuss postpartum cardiovascular and diabetes risk in women with a history of GDM and different ways to improve postpartum screening. This review involves a comprehensive literature review on gestational diabetes and post-partum risk for cardiovascular disease and diabetes mellitus as well as post-partum screening methods. Cardiovascular risk post-partum is potentiated by increased inflammatory markers leading to worsening atherosclerosis and cardiovascular events downstream. Decreased insulin sensitivity and β cell compensation, recurrent GDM, maternal factors such as pre and post-partum weight gain and lactation may contribute to T2DM risk. Postpartum glucose testing is essential in screening women as hyperglycemia in pregnancy has long term effects on both cardiovascular disease and diabetes risk on the mother. Long and short term improvement to post-partum glucose testing is essential to decreasing cardiometabolic and diabetes risk in women with gestational diabetes mellitus. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  14. Reducing the Health Risks of Diabetes: How Self-determination Theory May Help Improve Medication Adherence and Quality of Life

    PubMed Central

    Williams, Geoffrey C.; Patrick, Heather; Niemiec, Christopher P.; Williams, L. Keoki; Divine, George; Lafata, Jennifer Elston; Heisler, Michele; Tunceli, Kaan; Pladevall, Manel

    2010-01-01

    Purpose The purpose of this study was to apply the self-determination theory (SDT) model of health behavior to predict medication adherence, quality of life, and physiological outcomes among patients with diabetes. Methods Patients with diabetes (N = 2,973) receiving care from an integrated health-care delivery system in 2003 and 2004 were identified from automated databases and invited to participate in this study. In 2005, patients responded to a mixed telephone-and-mail survey assessing perceived autonomy-support from health-care providers, autonomous self-regulation for medication use, perceived competence for diabetes self-management, medication adherence, and quality of life. In 2006, we used pharmacy-claims data to indicate medication adherence and we assessed patients’ non-HDL cholesterol, HbA1c, and glucose levels. Results The SDT model of health behavior provided adequate fit to the data. As hypothesized, perceived autonomy-support from health-care providers related positively to autonomous self-regulation for medication use, which in turn related positively to perceived competence for diabetes self-management. Perceived competence then related positively to quality of life and medication adherence, and the latter construct related negatively to non-HDL cholesterol, HbA1c, and glucose levels. Conclusions Health-care providers’ support for patients’ autonomy and competence around medication use and diabetes self-management related positively to medication adherence, quality of life, and physiological outcomes among patients with diabetes. PMID:19325022

  15. A new fructose-free, resistant-starch type IV-enriched enteral formula improves glycaemic control and cardiovascular risk biomarkers when administered for six weeks to elderly diabetic patients.

    PubMed

    Mesa García, María Dolores; García-Rodríguez, Cruz Erika; Rico, María de la Cruz; Aguilera, Concepción María; Pérez-Rodríguez, Milagros; Pérez-de-la-Cruz, Antonio Jesús; Gil, Ángel

    2017-02-01

    Reducing the dietary glycaemic response has been proposed as a way to reduce the risk of diabetes complications. The aim of the present study was to evaluate the glycaemic control and cardiovascular risk biomarkers in fragile, elderly type 2 diabetes patients after the intake of a new fructose-free diabetes-specific formula enriched with resistant-starch type IV and high in monounsaturated fatty acids. Forty-one type 2 diabetes patients aged 78.9 ± 2.8 years were fed exclusively with an enteral diabetes-specific formula for 6 weeks. Data were collected at baseline and after 6 weeks of feeding. Carbohydrate and lipid metabolism and inflammatory and cardiovascular risk biomarkers were measured to evaluated the course of diabetes complications. Blood glycated haemoglobin significantly decreased after the intervention (6.1 ± 0.1 vs. 5.8 ± 0.1 %; p< 0,045), as well as monocyte chemotactic protein-1 and soluble E-selectin (p < 0.05), while soluble vascular cell adhesion molecule and plasminogen activator inhibitor-1 tended to decrease from baseline to 6 weeks (p = 0.084 and p = 0.05, respectively). The new product improves glycaemic control and cardiovascular risk without altering lipid metabolism, which is useful for the prevention of diabetic complications. Longer intervention studies are needed in order to validate these results in a larger population.

  16. Risk perception for diabetes in Appalachian women.

    PubMed

    Chopra, Ishveen; Chopra, Avijeet

    2016-04-11

    The social and economic burden of diabetes is large and growing. Diabetes is a significant public health issue in the Appalachian region; women constitute approximately 50% of those diagnosed with diabetes. This cross-sectional study examined the relationship among sociodemographic, anthropometric, lifestyle, and psychosocial factors (cognitive and affective representations) and perceived risk of diabetes in non-diabetic, non-elderly (21-50 years) Appalachian women residing in West Virginia (N = 202). Participants were recruited through social media, flyers, and a newsletter from the West Virginia University Extension. The final survey was conducted from March 2015 to June 2015. Bivariate analyses were used to examine unadjusted relations among sociodemographic, anthropometric, lifestyle, and psychosocial factors and comparative perceived risk of diabetes. In a multivariable logistic regression model, we found that younger age, higher body mass index, non-White race, greater diabetes knowledge, personal control, and moderate amounts of physical activity were significantly, positively associated with higher diabetes risk perception (p < .05). Our results indicated that diabetes knowledge, personal control, and physical activity were related to diabetes risk perception among Appalachian women. Understanding perceived diabetes-related risk may aid in the development of effective intervention strategies to reduce the burden of diabetes among Appalachian and other populations. These cross-sectional findings need further evaluation in longitudinal studies.

  17. Influence of diabetes mellitus on heart failure risk and outcome

    PubMed Central

    Bauters, Christophe; Lamblin, Nicolas; Mc Fadden, Eugène P; Van Belle, Eric; Millaire, Alain; de Groote, Pascal

    2003-01-01

    Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. The studies linking diabetes mellitus (DM) with heart failure (HF) The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. Treatment of heart failure in diabetic patients The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients. PMID:12556246

  18. [Risk perception and communication: from diabetes to cardiovascular diseases].

    PubMed

    Gianinazzi, F; Bodenmann, P; Izzo, F; Voeffray Favre, A C; Rossi, I; Ruiz, J

    2010-06-09

    Evidence-based medicine has enabled to approach disease in a more rational and scientific way. Clinical research has identified behaviours and risk factors that could cause disease often "silent" at the beginning, such as diabetes. Despite the clear impact of these evidences on public health, it seems that the individual risk perception level remains weak. To mention as well, the health professionals very often have a different views, which makes it difficult to communicate the risk with patients. In this article we describe the principles of risk perception, the diabetes related risk perception concerning cardiovascular complications, and suggest some practical strategies and tools which could improve risk communication in the everyday practice.

  19. Menopause and risk of diabetes in the Diabetes Prevention Program

    PubMed Central

    Kim, Catherine; Edelstein, Sharon L.; Crandall, Jill P.; Dabelea, Dana; Kitabchi, Abbas E.; Hamman, Richard F.; Montez, Maria G.; Perreault, Leigh; Foulkes, Mary A.; Barrett-Connor, Elizabeth

    2012-01-01

    Objective The study objective was to examine the association between menopause status and diabetes risk among women with glucose intolerance and to determine if menopausal status modifies response to diabetes prevention interventions. Methods The study population included women in premenopause (n=708), natural postmenopause (n=328), and bilateral oophorectomy (n=201) in the Diabetes Prevention Program (DPP), a randomized placebo-controlled trial of lifestyle intervention and metformin among glucose intolerant adults. Associations between menopause and diabetes risk were evaluated using Cox proportional hazard models that adjusted for demographic variables (age, race/ethnicity, family history of diabetes, history of gestational diabetes mellitus), waist circumference, insulin resistance and corrected insulin response. Similar models were constructed after stratification by menopause type and hormone therapy (HT) use. Results After adjustment for age, there was no association between natural menopause or bilateral oophorectomy and diabetes risk. Differences by study arm were observed in women who reported bilateral oophorectomy. In the lifestyle arm, women with bilateral oophorectomy had a lower adjusted hazard for diabetes (HR 0.19, 95% CI 0.04, 0.94), although observations were too few to determine if this was independent of HT use. No significant differences were seen in the metformin (HR 1.29, 95% CI 0.63, 2.64) or placebo arms (HR 1.37, 95% CI 0.74, 2.55). Conclusions Among women at high-risk for diabetes, natural menopause was not associated with diabetes risk and did not affect response to diabetes prevention interventions. In the lifestyle intervention, bilateral oophorectomy was associated with decreased diabetes risk. PMID:21709591

  20. Menopause and risk of diabetes in the Diabetes Prevention Program.

    PubMed

    Kim, Catherine; Edelstein, Sharon L; Crandall, Jill P; Dabelea, Dana; Kitabchi, Abbas E; Hamman, Richard F; Montez, Maria G; Perreault, Leigh; Foulkes, Mary A; Barrett-Connor, Elizabeth

    2011-08-01

    The study objectives were to examine the association between menopause status and diabetes risk among women with glucose intolerance and to determine if menopause status modifies response to diabetes prevention interventions. The study population included women in premenopause (n = 708), women in natural postmenopause (n = 328), and women with bilateral oophorectomy (n = 201) in the Diabetes Prevention Program, a randomized placebo-controlled trial of lifestyle intervention and metformin among glucose-intolerant adults. Associations between menopause and diabetes risk were evaluated using Cox proportional hazard models that adjusted for demographic variables (age, race/ethnicity, family history of diabetes, history of gestational diabetes mellitus), waist circumference, insulin resistance, and corrected insulin response. Similar models were constructed after stratification by menopause type and hormone therapy use. After adjustment for age, there was no association between natural menopause or bilateral oophorectomy and diabetes risk. Differences by study arm were observed in women who reported bilateral oophorectomy. In the lifestyle arm, women with bilateral oophorectomy had a lower adjusted hazard for diabetes (hazard ratio [HR], 0.19; 95% CI, 0.04-0.94), although observations were too few to determine if this was independent of hormone therapy use. No significant differences were seen in the metformin (HR, 1.29; 95% CI, 0.63-2.64) or placebo arms (HR, 1.37; 95% CI, 0.74-2.55). Among women at high risk for diabetes, natural menopause was not associated with diabetes risk and did not affect response to diabetes prevention interventions. In the lifestyle intervention, bilateral oophorectomy was associated with a decreased diabetes risk.

  1. A Combination of Prebiotic Inulin and Oligofructose Improve Some of Cardiovascular Disease Risk Factors in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial.

    PubMed

    Aliasgharzadeh, Akbar; Khalili, Mohammad; Mirtaheri, Elham; Pourghassem Gargari, Bahram; Tavakoli, Farnaz; Abbasalizad Farhangi, Mahdieh; Babaei, Hossein; Dehghan, Parvin

    2015-11-01

    This trial was conducted to evaluate the effects of oligofructose-enriched inulin on some of cardiovascular disease risk factors in women with type 2 diabetes. 52 females (25diabetes were randomly assigned to two groups. Participants received 10g/d oligofructose-enriched inulin (n=27) or 10g/d placebo (n=25) for 8 weeks. Fasting blood samples were taken to measure metabolic profiles, malondialdehyd and antioxidant enzymes at baseline and after the 8 weeks intervention. Paired, unpaired sample t-test and analysis of covariance were used to comparison of quantitative variables. After 8 weeks, in the oligofructose-enriched inulin group there was a significant increase in total antioxidant capacity (0.2 mmol/l, 20.0%) and a significant decrease in fasting plasma glucose (19.2 mg/dL, 9.4%) HbA1c (0.5%, 8.4%), total cholesterol (TC) (28.0 mg/dL, 14.1%), low-density lipoprotein cholesterol (LDL-c) (22.0 mg/dL, 21.7%), TC/HDL-c ratio (0.73, 20.7%), LDL-c/HDL-c ratio (0.55, 27.5%) and malondialdehyd (1.7 nmol/ml, 39.7%) compared to the placebo group. Changes in concentrations of triglycerides, high-density lipoprotein cholesterol (HDLc), superoxide dismutase, catalase and glutathione peroxidase were not significant in oligofructose-enriched inulin group compared to the placebo group. Oligofructose-enriched inulin may improve glycemic indices, lipid profile, antioxidant status and malondialdehyd in women with type 2 diabetes.

  2. A Combination of Prebiotic Inulin and Oligofructose Improve Some of Cardiovascular Disease Risk Factors in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial

    PubMed Central

    Aliasgharzadeh, Akbar; Khalili, Mohammad; Mirtaheri, Elham; Pourghassem Gargari, Bahram; Tavakoli, Farnaz; Abbasalizad Farhangi, Mahdieh; Babaei, Hossein; Dehghan, Parvin

    2015-01-01

    Purpose: This trial was conducted to evaluate the effects of oligofructose-enriched inulin on some of cardiovascular disease risk factors in women with type 2 diabetes. Methods: 52 females (25diabetes were randomly assigned to two groups. Participants received 10g/d oligofructose-enriched inulin (n=27) or 10g/d placebo (n=25) for 8 weeks. Fasting blood samples were taken to measure metabolic profiles, malondialdehyd and antioxidant enzymes at baseline and after the 8 weeks intervention. Paired, unpaired sample t-test and analysis of covariance were used to comparison of quantitative variables. Results: After 8 weeks, in the oligofructose-enriched inulin group there was a significant increase in total antioxidant capacity (0.2 mmol/l, 20.0%) and a significant decrease in fasting plasma glucose (19.2 mg/dL, 9.4%) HbA1c (0.5%, 8.4%), total cholesterol (TC) (28.0 mg/dL, 14.1%), low-density lipoprotein cholesterol (LDL-c) (22.0 mg/dL, 21.7%), TC/HDL-c ratio (0.73, 20.7%), LDL-c/HDL-c ratio (0.55, 27.5%) and malondialdehyd (1.7 nmol/ml, 39.7%) compared to the placebo group. Changes in concentrations of triglycerides, high-density lipoprotein cholesterol (HDLc), superoxide dismutase, catalase and glutathione peroxidase were not significant in oligofructose-enriched inulin group compared to the placebo group. Conclusion: Oligofructose-enriched inulin may improve glycemic indices, lipid profile, antioxidant status and malondialdehyd in women with type 2 diabetes. PMID:26819923

  3. Association of Weight Loss and Medication Adherence Among Adults With Type 2 Diabetes Mellitus: SHIELD (Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes).

    PubMed

    Grandy, Susan; Fox, Kathleen M; Hardy, Elise

    2013-12-01

    Adherence to prescribed diabetes medications is suboptimal, which can lead to poor glycemic control and diabetic complications. Treatment-related weight gain is a side effect of some oral antidiabetic agents and insulin, which may negatively affect adherence to therapy. This study investigated whether adults with type 2 diabetes mellitus (T2DM) who lost weight had better medication adherence than those who gained weight. Weight change over 1 year (2007 to 2008) was assessed among respondents in the US Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Weight loss of >1.0%, ≥3%, and ≥5% of weight was compared with weight gain of ≥1.0%. Medication adherence was assessed using the Morisky 4-item questionnaire for medication-taking behavior, with lower scores representing better adherence. There were 746 T2DM respondents who lost >1.0%, 483 who lost ≥3%, 310 who lost ≥5%, and 670 who gained ≥1.0% of weight. Each weight-loss group had significantly lower Morisky scores than the weight-gain group; mean scores of 0.389 versus 0.473 (P = 0.050) for the >1.0% weight-loss group, 0.365 versus 0.473 (P = 0.026) for the ≥3% weight-loss group, and 0.334 versus 0.473 (P = 0.014) for the ≥5% weight-loss group. Significantly fewer respondents who lost weight had received insulin, sulfonylurea, or thiazolidinedione therapy (57%) compared with respondents who gained weight (64%) (P = 0.002). Demographics, exercise habits, and dieting were similar between weight-loss and weight-gain groups. T2DM respondents with weight loss had significantly better medication adherence and were less likely to be on treatment regimens that increase weight than T2DM respondents with weight gain. These findings suggest that strategies that lead to weight loss, including use of diabetes medications associated with weight loss, may improve medication adherence.

  4. Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk.

    PubMed

    Kirsh, Susan; Watts, Sharon; Pascuzzi, Kristina; O'Day, Mary Ellen; Davidson, David; Strauss, Gerald; Kern, Elizabeth O; Aron, David C

    2007-10-01

    The epidemic proportions and management complexity of diabetes have prompted efforts to improve clinic throughput and efficiency. One method of system redesign based on the chronic care model is the Shared Medical Appointment (SMA) in which groups of patients (8-20) are seen by a multi-disciplinary team in a 1-2 h appointment. Evaluation of the impact of SMAs on quality of care has been limited. The purpose of this quality improvement project was to improve intermediate outcome measures for diabetes (A1c, SBP, LDL-cholesterol) focusing on those patients at highest cardiovascular risk. Primary care clinic at a tertiary care academic medical center. Patients with diabetes with one or more of the following: A1c >9%, SBP blood pressure >160 mm Hg and LDL-c >130 mg/dl were targeted for potential participation; other patients were referred by their primary care providers. Patients participated in at least one SMA from 4/05 to 9/05. Quasi-experimental with concurrent, but non-randomised controls (patients who participated in SMAs from 5/06 through 8/06; a retrospective period of observation prior to their SMA participation was used). SMA system redesign. ANALYTICAL METHODS: Paired and independent t tests, chi(2) tests and Fisher Exact tests. Each group had up to 8 patients. Patients participated in 1-7 visits. At the initial visit, 83.3% had A1c levels >9%, 30.6% had LDL-cholesterol levels >130 mg/dl, and 34.1% had SBP >or=160 mm Hg. Levels of A1c, LDL-c and SBP all fell significantly postintervention with a mean (95% CI) decrease of A1c 1.4 (0.8, 2.1) (p<0.001), LDL-c 14.8 (2.3, 27.4) (p = 0.022) and SBP 16.0 (9.7, 22.3) (p<0.001). There were no significant differences at baseline between control and intervention groups in terms of age, baseline intermediate outcomes, or medication use. The reductions in A1c in % and SBP were greater in the intervention group relative to the control group: 1.44 vs -0.30 (p = 0.002) for A1c and 14.83 vs 2.54 mm Hg (p = 0.04) for SBP. LDL

  5. Genetic risk profiling for prediction of type 2 diabetes

    PubMed Central

    Mihaescu, Raluca; Meigs, James; Sijbrands, Eric; Janssens, A. Cecile

    2011-01-01

    Type 2 diabetes (T2D) is a common disease caused by a complex interplay between many genetic and environmental factors. Candidate gene studies and recent collaborative genome-wide association efforts revealed at least 38 common single nucleotide polymorphisms (SNPs) associated with increased risk of T2D. Genetic testing of multiple SNPs is considered a potentially useful tool for early detection of individuals at high diabetes risk leading to improved targeting of preventive interventions. PMID:21278902

  6. Type 2 Diabetes Risk Test

    MedlinePlus

    ... for signing up! engagement en -- Have Type 2 Diabetes? - 2017-03-lwt2d-en.html Have Type 2 Diabetes? ... 1-800-DIABETES (800-342-2383) Copyright 1995-2017. American Diabetes Association. All rights reserved. Use of this website ...

  7. Salsalate Improves Glycemia in Overweight Persons With Diabetes Risk Factors of Stable Statin-Treated Cardiovascular Disease: a 30-month Randomized Placebo-Controlled Trial.

    PubMed

    Salastekar, Ninad; Desai, Tanvi; Hauser, Thomas; Schaefer, Ernst J; Fowler, Kristen; Joseph, Stacey; Shoelson, Steven; Goldfine, Allison B

    2017-03-14

    Obesity related sub-acute chronic inflammation contributes to type 2 diabetes and atherosclerosis (1,2) . Multiple studies target inflammation to reduce dysglycemia and/or coronary heart disease (CHD) using diverse anti-inflammatory approaches. Several show salsalate, a pro-drug of salicylate, improves glycemia in type 2 diabetes, obesity, or impaired glucose tolerance. Durability of glycemic efficacy and safety of salsalate remains less well understood.

  8. Risk Factors For Diabetic Polyneuropathy

    PubMed Central

    KAPLAN, Yüksel; KURT, Semiha; KARAER ÜNALDI, Hatice; ERKORKMAZ, Ünal

    2014-01-01

    Introduction The aim of this study was to investigate the risk factors for distal symmetric sensory-motor polyneuropathy (DSP) in patients with type 2 diabetes mellitus (DM). Method Sixty seven patients with type 2 DM (33 males and 34 females) were included in the study. In addition to a detailed neurological examination, the Michigan Neuropathy Screening Instrument was administered to all patients and their total neuropathy scores were calculated. Nerve conduction examinations were performed for all patients. Results The mean age of the patients was 52.83±.87 years. The mean glycosylated hemoglobin (HbA1C) value was 8.56±2.07% (normal: 3–6.5%). The total neuropathy score significantly correlated with diabetes duration, hypertension, retinopathy, and HbA1C. Conclusion This study confirms the previous reports regarding the association of neuropathy with poor glycaemic control and duration of the disease. The association of neuropathy with retinopathy and hypertension is important.

  9. Periodontitis and risk of diabetes mellitus.

    PubMed

    Gurav, Abhijit; Jadhav, Varsha

    2011-03-01

    Diabetes mellitus (DM) is a complex disease with varying degrees of systemic and oral complications. The periodontium is also a target for diabetic damage. Diabetes is a pandemic in both developed and developing countries. In recent years, a link between periodontitis and diabetes mellitus has been postulated. The oral cavity serves as a continuous source of infectious agents that could further worsen the diabetic status of the patient and serve as an important risk factor deterioration of diabetes mellitus. The present review highlights the relationship between diabetes mellitus and periodontitis. The potential mechanisms involved in the deterioration of diabetic status and periodontal disease are also discussed. © 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

  10. Causal beliefs and perceptions of risk for diabetes and cardiovascular disease, The Netherlands, 2007.

    PubMed

    Claassen, Liesbeth; Henneman, Lidewij; Nijpels, Giel; Dekker, Jacqueline; Marteau, Theresa; Timmermans, Danielle

    2011-11-01

    Understanding people's perceptions of disease risk and how these perceptions compare with actual risk models may improve the effectiveness of risk communication. This study examined perceived disease risk and causal beliefs for type 2 diabetes and cardiovascular disease (CVD), the relationship between self-reported risk factors and perceived disease risk, and the influence of causal beliefs on perceived disease risk in people at increased risk. The sample (n = 255) consisted of people who were at increased risk for diabetes and CVD (aged 57-79 y). Participants completed a postal questionnaire assessing risk factors, perceived risk, and causal beliefs for diabetes and CVD. We used regression analyses to examine the relationship between risk factors and perceived disease risk and to explore how causal beliefs affect the relationship between risk factors and perceived disease risk. Associations between risk factors and perceived diabetes and CVD risks were weak. Perceived risk, causal beliefs, and explained variance of risk factors on perceived risk were lower for diabetes than for CVD. Stronger beliefs concerning 1) overweight as a cause of diabetes and 2) smoking as a cause of CVD strengthened the association between these risk factors and perceived disease risk. Although participants seemed to have some understanding of disease causation, they only partially translated their risk factors into accurate perceptions of risk. To improve understanding of risk information, health professionals may need to educate patients on how personal risk factors can contribute to the development of diabetes and CVD.

  11. Perceived risk of diabetes seriously underestimates actual diabetes risk: The KORA FF4 study

    PubMed Central

    Stang, Andreas; Bongaerts, Brenda; Kuss, Oliver; Herder, Christian; Roden, Michael; Quante, Anne; Holle, Rolf; Huth, Cornelia; Peters, Annette; Meisinger, Christa

    2017-01-01

    Objective Early detection of diabetes and prediabetic states is beneficial for patients, but may be delayed by patients´ being overly optimistic about their own health. Therefore, we assessed how persons without known diabetes perceive their risk of having or developing diabetes, and we identified factors associated with perception of diabetes risk. Research design and methods 1,953 participants without previously known diabetes from the population-based, German KORA FF4 Study (59.1 years, 47.8% men) had an oral glucose tolerance test. They estimated their probability of having undiagnosed diabetes mellitus (UDM) on a six category scale, and assessed whether they were at risk of developing diabetes in the future. We cross-tabulated glycemic status with risk perception, and fitted robust Poisson regression models to identify determinants of diabetes risk perception. Results 74% (95% CI: 65–82) of persons with UDM believed that their probability of having undetected diabetes was low or very low. 72% (95% CI: 69–75) of persons with prediabetes believed that they were not at risk of developing diabetes. In people with prediabetes, seeing oneself at risk of diabetes was associated with self-rated poor general health (prevalence ratio (PR) = 3.1 (95% CI: 1.4–6.8), parental diabetes (PR = 2.6, 1.9–3.4), high educational level (PR = 1.9 (1.4–2.5)), lower age (PR = 0.7, 0.6–0.8, per 1 standard deviation increase), female sex (PR = 1.2, 0.9–1.5) and obesity (PR = 1.5, 1.2–2.0). Conclusions People with undiagnosed diabetes or prediabetes considerably underestimate their probability of having or developing diabetes. Contrary to associations with actual diabetes risk, perceived diabetes risk was lower in men, lower educated and older persons. PMID:28141837

  12. A khorasan wheat-based replacement diet improves risk profile of patients with type 2 diabetes mellitus (T2DM): a randomized crossover trial.

    PubMed

    Whittaker, Anne; Dinu, Monica; Cesari, Francesca; Gori, Anna Maria; Fiorillo, Claudia; Becatti, Matteo; Casini, Alessandro; Marcucci, Rossella; Benedettelli, Stefano; Sofi, Francesco

    2017-04-01

    The aim of the present study was to examine whether a replacement diet with products made with organic ancient khorasan wheat could provide additive protective effects in reducing glucose, insulin, lipid and inflammatory risk factors, and in restoring blood redox balance in type 2 diabetes mellitus (T2DM) patients compared to diet with product made with modern organic wheat. We conducted a randomized, double-blinded crossover trial with two intervention phases on 21 T2DM patients (14 females, 7 males). The participants were assigned to consume products (bread, pasta, crackers and biscuits) made using semi-whole flour from organic wheat that was either from ancient khorasan wheat or modern control wheat for 8 weeks in a random order. An 8-week washout period was implemented between the interventions. Laboratory analyses were performed both at the beginning and at the end of each intervention phase. The metabolic risk profile improved only after the khorasan intervention period, as measured by a reduction in total and LDL cholesterol (mean reduction: -3.7 and -3.4 %, respectively), insulin (-16.3 %) and blood glucose (-9.1 %). Similarly, there was a significant reduction in circulating levels of reactive oxygen species (ROS), vascular endothelial growth factor (VEGF) and interleukin-1ra, and a significant increase of total antioxidant capacity (+6.3 %). No significant differences from baseline were noted after the modern control wheat intervention phase. The change (from pre- to post-intervention) between the two intervention arms was significantly different (p < 0.05) for total and LDL-c, insulin and HOMA index. A replacement diet with ancient khorasan wheat consumption provided additive protection in reducing total and LDL cholesterol, insulin, blood glucose, ROS production, and some inflammatory risk factors, which are all key factors warranting of control in secondary prevention of T2DM compared to a diet with products made with modern wheat.

  13. The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

    PubMed Central

    Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia

    2017-01-01

    Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies. PMID:28567711

  14. Predicting Risk of Type 2 Diabetes by Using Data on Easy-to-Measure Risk Factors

    PubMed Central

    Buchner, David M.; Grigsby-Toussaint, Diana S.

    2017-01-01

    Introduction Statistical models for assessing risk of type 2 diabetes are usually additive with linear terms that use non-nationally representative data. The objective of this study was to use nationally representative data on diabetes risk factors and spline regression models to determine the ability of models with nonlinear and interaction terms to assess the risk of type 2 diabetes. Methods We used 4 waves of data (2005–2006 to 2011–2012) on adults aged 20 or older from the National Health and Nutrition Examination Survey (n = 5,471) and multivariate adaptive regression splines (MARS) to build risk models in 2015. MARS allowed for interactions among 17 noninvasively measured risk factors for type 2 diabetes. Results A key risk factor for type 2 diabetes was increasing age, especially for those older than 69, followed by a family history of diabetes, with diminished risk among individuals younger than 45. Above age 69, other risk factors superseded age, including systolic and diastolic blood pressure. The additive MARS model with nonlinear terms had an area under curve (AUC) receiver operating characteristic of 0.847, whereas the 2-way interaction MARS model had an AUC of 0.851, a slight improvement. Both models had an 87% accuracy in classifying diabetes status. Conclusion Statistical models of type 2 diabetes risk should allow for nonlinear associations; incorporation of interaction terms into the MARS model improved its performance slightly. Robust statistical manipulation of risk factors commonly measured noninvasively in clinical settings might provide useful estimates of type 2 diabetes risk. PMID:28278129

  15. Role of Purified Anthocyanins in Improving Cardiometabolic Risk Factors in Chinese Men and Women with Prediabetes or Early Untreated Diabetes-A Randomized Controlled Trial.

    PubMed

    Yang, Liping; Ling, Wenhua; Yang, Yan; Chen, Yuming; Tian, Zezhong; Du, Zhicheng; Chen, Jianying; Xie, Yuanling; Liu, Zhaomin; Yang, Lili

    2017-10-10

    Objective: In vitro and animal studies suggest that purified anthocyanins have favorable effects on metabolic profiles, but clinical trials have reported inconsistent findings. Furthermore, no study has been specifically conducted among individuals with prediabetes. The aim of this study was to investigate whether purified anthocyanins could improve cardiometabolic risk factors in Chinese adults with early untreated hyperglycemia. Research Design and Methods: This was a 12-week randomized, double-blind, placebo-controlled trial. A total of 160 participants aged 40-75 years with prediabetes or early untreated diabetes were randomly allocated to receive either purified anthocyanins (320 mg/day, n = 80) or placebo (n = 80) of identical appearance. A three-hour oral glucose tolerance test (OGTT) was performed, and cardiometabolic biomarkers (glycated hemoglobin A1c (HbA1c), fasting and postprandial glucose, insulin, C-peptide, and lipids) were measured at baseline and at the end of the trial. Results: A total of 138 subjects completed the protocol. Compared with placebo, purified anthocyanins moderately reduced HbA1c (-0.14%, 95% CI: -0.23~-0.04%; p = 0.005), low-density lipoprotein-c (LDL-c) (-0.2 mmol/L, 95% CI: -0.38~-0.01, p = 0.04), apolipoprotein A-1 (apo A1) (0.09 g/L, 95% CI: 0.02~0.17; p = 0.02), and apolipoprotein B (apo B) (-0.07 g/L, 95% CI: -0.13~-0.01; p = 0.01) according to intention-to-treat analysis. Subgroup analyses suggested that purified anthocyanins were more effective at improving glycemic control, insulin sensitivity, and lipids among patients with elevated metabolic markers. Conclusions: The 12-week randomized controlled trials (RCT) in Chinese adults with prediabetes or early untreated diabetes indicated that purified anthocyanins favorably affected glycemic control and lipid profile. Future studies of a longer duration that explore the dose-response relationship among patients with cardiometabolic disorders are needed to confirm our findings.

  16. Predictors of success of a lifestyle intervention in relation to weight loss and improvement in glucose tolerance among individuals at high risk for type 2 diabetes: the FIN-D2D project.

    PubMed

    Rautio, Nina; Jokelainen, Jari; Saaristo, Timo; Oksa, Heikki; Keinänen-Kiukaanniemi, Sirkka; Peltonen, Markku; Vanhala, Mauno; Korpi-Hyövälti, Eeva; Moilanen, Leena; Saltevo, Juha; Niskanen, Leo; Tuomilehto, Jaakko; Uusitupa, Matti

    2013-01-01

    The authors assessed the predictors of success of a lifestyle intervention (weight loss ≥ 5% and improved glucose tolerance) in individuals at high risk for type 2 diabetes in a 1-year follow-up in a primary health care setting. High-risk individuals for type 2 diabetes were identified by opportunistic screening in the implementation of the Finnish National Diabetes Prevention Program (FIN-D2D). All together, 3880 individuals participated in the 1-year follow-up. Sociodemographic characteristics, health status and behavior, family history of diabetes, clinical factors, and health care provider were considered possible predictors of lifestyle intervention success. In sum, 19.3% of individuals lost at least 5% of weight, and 32.6% with abnormal glucose tolerance at baseline showed improvement in glucose tolerance. Abnormal glucose tolerance was the strongest predictor of weight loss and improvement in glucose tolerance. High attendance at lifestyle intervention visits, being outside of labor force, and high body mass index at baseline were also related to weight loss, and high education was related to improvement in glucose tolerance. In "real-life settings," glucose tolerance status, number of intervention visits, employment status, education, and body mass index explained the success of lifestyle intervention. These factors may help in targeting interventions, although they may not be generalized to other cultural settings.

  17. Type 2 diabetes mellitus and fracture risk.

    PubMed

    Dede, Anastasia D; Tournis, Symeon; Dontas, Ismene; Trovas, George

    2014-12-01

    Increased fracture risk, traditionally associated with type 1 diabetes, has lately been of great concern in patients with type 2 diabetes. A variable increase in fracture risk has been reported, ranging from 20% to 3-fold, depending on skeletal site, diabetes duration and study design. Longer disease duration, the presence of diabetic complications, inadequate glycemic control, insulin use and increased risk for falls are all reported to increase fracture risk. Patients with type 2 diabetes display a unique skeletal phenotype with either normal or more frequently increased, bone mineral density and impaired structural and geometric properties. Recently, alterations in bone material properties seem to be the predominant defect leading to increased bone fragility. Accumulation of advanced glycation end-products and changes in collagen cross-linking along with suppression of bone turnover seem to be significant factors impairing bone strength. FRAX score has been reported to underestimate fracture risk and lumbar spine BMD is inadequate in predicting vertebral fractures. Anti-diabetic medications, apart from thiazolidinediones, appear to be safe for the skeleton, although more data are needed. Optimal strategies to reduce skeletal fragility in type 2 diabetic patients are yet to be determined.

  18. Parental Longevity and Diabetes Risk in the Diabetes Prevention Program

    PubMed Central

    Crandall, Jill P.; Perreault, Leigh; Marcovina, Santica M.; Bray, George A.; Saudek, Christopher D.; Barrett-Connor, Elizabeth; Knowler, William C.

    2011-01-01

    Background. Longevity clusters in families, and parental longevity may be associated with lower risk of chronic diseases in their children. It is unknown if diabetes risk is associated with parental longevity. Methods. We evaluated participants in the Diabetes Prevention Program with a parental history questionnaire at study entry. We classified them into five groups: premature death (parental death at age < 50 years), parental longevity (living to at least 80 years), and three intermediate groups (alive by age 49 but dying at age 50–59, 60–69, or 70–79). Those with alive parents and younger than 80 years were excluded. We analyzed separately effects of paternal (n = 2,165) and maternal (n = 1,739) longevity on diabetes incidence and risk after an average follow-up of 3.2 years. Results. At baseline, more diabetes risk factors (parental history of diabetes, coronary heart disease, higher body mass index, homeostasis model assessment for insulin resistance, and corrected insulin response) were found in participants whose parents died prematurely. Diabetes incidence was 9.5 cases/100 person-years in the 229 whose fathers died prematurely. In the 618 with paternal longevity, the rate was 6.6 cases/100 person-years (hazard ratio [95% confidence interval] = 0.68 [0.49–0.94]). The rates were 10.7 cases/100 person-years (n = 156) and 7.3 cases/100 person-years (n = 699, hazard ratio = 0.67 [95% confidence interval 0.47–0.95]) for those with maternal premature death or longevity, respectively. Associations with demographic and diabetes risk factors had minimal influence on the reduced risk found in those with paternal (adjusted hazard ratio = 0.78, 95% confidence interval 0.52–1.16) and maternal (adjusted hazard ratio = 0.64, 95% confidence interval 0.41–1.01) longevity. Conclusion. Parental longevity is associated with lower diabetes incidence in adults at high risk of type 2 diabetes. PMID:21852284

  19. Markers of Cardiovascular Risk in Postmenopausal Women with Type 2 Diabetes Are Improved by the Daily Consumption of Almonds or Sunflower Kernels: A Feeding Study

    PubMed Central

    Richmond, Korina; Williams, Sheila; Mann, Jim; Brown, Rachel; Chisholm, Alexandra

    2013-01-01

    Dietary guidelines for the treatment of type 2 diabetes advocate the regular consumption of nuts and seeds. Key lipid abnormalities associated with diabetes include raised LDL-C, VLDL-C, and TAG concentrations and decreased concentrations of HDL-C. The fatty acid profiles of nuts and seeds differ and may potentially influence lipid outcomes in people with diabetes differently. To examine the effects of nut or seed consumption on lipid and lipoprotein markers of cardiovascular disease (CVD), we added almonds (AD) or sunflower kernels (SKD) to a recommended diet in a randomised crossover feeding study. Twenty-two postmenopausal women with type 2 diabetes consumed personalised diets, with the addition of 30 g/d of either almonds or sunflower kernels. All food was supplied for two periods of three weeks, separated by a four-week washout. There was a significant reduction in high-density lipoprotein cholesterol (HDL-C), triacylglycerol (TAG), and apolipoprotein (apo) A1 and B100 on the SKD compared to the AD. Total (TC) and low density lipoprotein cholesterol (LDL-C) decreased significantly on both diets from baseline, with no difference between diets. A diet with the addition of either almonds or sunflower kernels has clinically beneficial effects on lipid- and lipoprotein-mediated CVD risk. PMID:24959542

  20. Markers of cardiovascular risk in postmenopausal women with type 2 diabetes are improved by the daily consumption of almonds or sunflower kernels: a feeding study.

    PubMed

    Richmond, Korina; Williams, Sheila; Mann, Jim; Brown, Rachel; Chisholm, Alexandra

    2013-01-01

    Dietary guidelines for the treatment of type 2 diabetes advocate the regular consumption of nuts and seeds. Key lipid abnormalities associated with diabetes include raised LDL-C, VLDL-C, and TAG concentrations and decreased concentrations of HDL-C. The fatty acid profiles of nuts and seeds differ and may potentially influence lipid outcomes in people with diabetes differently. To examine the effects of nut or seed consumption on lipid and lipoprotein markers of cardiovascular disease (CVD), we added almonds (AD) or sunflower kernels (SKD) to a recommended diet in a randomised crossover feeding study. Twenty-two postmenopausal women with type 2 diabetes consumed personalised diets, with the addition of 30 g/d of either almonds or sunflower kernels. All food was supplied for two periods of three weeks, separated by a four-week washout. There was a significant reduction in high-density lipoprotein cholesterol (HDL-C), triacylglycerol (TAG), and apolipoprotein (apo) A1 and B100 on the SKD compared to the AD. Total (TC) and low density lipoprotein cholesterol (LDL-C) decreased significantly on both diets from baseline, with no difference between diets. A diet with the addition of either almonds or sunflower kernels has clinically beneficial effects on lipid- and lipoprotein-mediated CVD risk.

  1. Interventions to Improve Rate of Diabetes Testing Postpartum in Women With Gestational Diabetes Mellitus.

    PubMed

    Hamel, Maureen S; Werner, Erika F

    2017-02-01

    Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In the USA, four million women are screened annually for GDM in pregnancy in part to improve pregnancy outcomes but also because diagnosis predicts a high risk of future type 2 diabetes mellitus (T2DM). Therefore, among women with GDM, postpartum care should be focused on T2DM prevention. This review describes the current literature aimed to increase postpartum diabetes testing among women with GDM. Data suggest that proactive patient contact via a health educator, a phone call, or even postal mail is associated with higher rates of postpartum diabetes testing. There may also be utility to changing the timing of postpartum diabetes testing. Despite the widespread knowledge regarding the importance of postpartum testing for women with GDM, testing rates remain low. Alternative testing strategies and large randomized trials addressing postpartum testing are warranted.

  2. A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus.

    PubMed

    Mendham, Amy E; Duffield, Rob; Marino, Frank; Coutts, Aaron J

    2015-07-01

    This study assessed the effect of a 12-week sports-based exercise intervention on glucose regulation, anthropometry and inflammatory markers associated with the prevalence of type 2 diabetes mellitus (T2DM) in Indigenous Australian men. Twenty-six inactive Indigenous Australian men (48.6±6.6 years) were randomized into exercise (n=16) or control (n=10)conditions. Training included ∼2-3 days/week for 12 weeks of sports and gym exercises in a group environment, whilst control participants maintained normal activity and dietary patterns. Pre- and post-intervention testing included: anthropometry, peak aerobic capacity, fasting blood chemistry of inflammatory cytokines, adiponectin, leptin, cholesterol, glucose, insulin and C-peptide. An oral glucose tolerance test measured glucose, insulin and C-peptide 30, 60, 90 and 120min post 75g glucose ingestion. The exercise condition decreased insulin area under the curve (25±22%), increased estimated insulin sensitivity (35±62%) and decreased insulin resistance (9±35%; p<0.05), compared with control (p>0.05). The exercise condition decreased in body mass index, waist circumference and waist to hip ratio (p<0.05), compared to control (p>0.05). Leptin decreased in the exercise group, with no changes for adiponectin (p>0.05) or inflammatory markers (p>0.05) in either condition. Aerobic fitness variables showed significant increases in peak oxygen consumption for the exercise condition compared to no change in control (p>0.05). Findings indicate positive clinical outcomes in metabolic, anthropometric and aerobic fitness variables. This study provides evidence for sport and group-based activities leading to improved clinical risk factors associated with T2DM development in clinically obese Indigenous Australian men. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  3. Combination of chromium and biotin improves coronary risk factors in hypercholesterolemic type 2 diabetes mellitus: a placebo-controlled, double-blind randomized clinical trial.

    PubMed

    Albarracin, Cesar; Fuqua, Burcham; Geohas, Jeff; Juturu, Vijaya; Finch, Manley R; Komorowski, James R

    2007-01-01

    Dyslipidemia, often found in type 2 diabetes mellitus (T2DM) patients, plays an important role in the progression of cardiometabolic syndrome. Two essential nutrients, chromium and biotin, may maintain optimal glycemic control. The authors report here a randomized, double-blind placebo-controlled trial (N=348; chromium picolinate and biotin combination [CPB]: 226, placebo: 122; T2DM participants with hemoglobin A1c [HbA1c] >or=7%) evaluating the effects of CPB on lipid and lipoprotein levels. Participants were randomly assigned (2:1 ratio) to receive either CPB (600 microg chromium as chromium picolinate and 2 mg biotin) or a matching placebo once daily for 90 days. Statistical analyses were conducted in all eligible participants. Subsequent supplemental analyses were performed in T2DM participants with hypercholesterolemia (HC) and in those using stable doses of statins. In the primary analysis, CPB lowered HbA1c (P<.05) and glucose (P<.02) significantly compared with the placebo group. No significant changes were observed in other lipid levels. In participants with HC and T2DM, significant changes in total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels and atherogenic index were observed in the CPB group (P<.05). Significant decreases in LDL-C, total cholesterol, HbA1c , and very low-density cholesterol levels (P<.05) were observed in the CPB group taking statins. CPB treatment was well tolerated with no adverse effects, dissimilar from those associated with placebo. These data suggest that intervention with CPB improves cardiometabolic risk factors.

  4. Modifying Risk Factors: Strategies That Work Diabetes Mellitus.

    PubMed

    Stryker, Louis S

    2016-08-01

    An estimated 29.1 million Americans are currently diagnosed with diabetes, and this number is expected to increase to 48.3 million Americans by 2050. Correspondingly, the present burden of diabetes among patients undergoing total joint arthroplasty is significant and rising. Diabetes as a chronic condition is a well-established risk factor for complication after total joint arthroplasty. A growing body of evidence also indicates that hyperglycemia in the perioperative period, and not the diagnosis of diabetes alone, is similarly associated with increased complication risk. As a result, a coordinated approach to preoperative screening and optimization, combined with judicious perioperative glycemic control, may present an opportunity to improve outcomes, reduce complications, and avoid complication-related costs for patients undergoing total joint arthroplasty.

  5. Chronic Ingestion of Flavan-3-ols and Isoflavones Improves Insulin Sensitivity and Lipoprotein Status and Attenuates Estimated 10-Year CVD Risk in Medicated Postmenopausal Women With Type 2 Diabetes

    PubMed Central

    Curtis, Peter J.; Sampson, Mike; Potter, John; Dhatariya, Ketan; Kroon, Paul A.; Cassidy, Aedín

    2012-01-01

    OBJECTIVE To assess the effect of dietary flavonoids on cardiovascular disease (CVD) risk in postmenopausal women with type 2 diabetes on established statin and hypoglycemic therapy. RESEARCH DESIGN AND METHODS Despite being medicated, patients with type 2 diabetes have elevated CVD risk, particularly postmenopausal women. Although dietary flavonoids have been shown to reduce CVD risk factors in healthy participants, no long-term trials have examined the additional benefits of flavonoids to CVD risk in medicated postmenopausal women with type 2 diabetes. We conducted a parallel-design, placebo-controlled trial with type 2 diabetic patients randomized to consume 27 g/day (split dose) flavonoid-enriched chocolate (containing 850 mg flavan-3-ols [90 mg epicatechin] and 100 mg isoflavones [aglycone equivalents)]/day) or matched placebo for 1 year. RESULTS Ninety-three patients completed the trial, and adherence was high (flavonoid 91.3%; placebo 91.6%). Compared with the placebo group, the combined flavonoid intervention resulted in a significant reduction in estimated peripheral insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] −0.3 ± 0.2; P = 0.004) and improvement in insulin sensitivity (quantitative insulin sensitivity index [QUICKI] 0.003 ± 0.00; P = 0.04) as a result of a significant decrease in insulin levels (−0.8 ± 0.5 mU/L; P = 0.02). Significant reductions in total cholesterol:HDL-cholesterol (HDL-C) ratio (−0.2 ± 0.1; P = 0.01) and LDL-cholesterol (LDL-C) (−0.1 ± 0.1 mmol/L; P = 0.04) were also observed. Estimated 10-year total coronary heart disease risk (derived from UK Prospective Diabetes Study algorithm) was attenuated after flavonoid intervention (flavonoid +0.1 ± 0.3 vs. placebo 1.1 ± 0.3; P = 0.02). No effect on blood pressure, HbA1c, or glucose was observed. CONCLUSIONS One-year intervention with flavan-3-ols and isoflavones improved biomarkers of CVD risk, highlighting the additional benefit of

  6. Risk Assessment Tools for Identifying Individuals at Risk of Developing Type 2 Diabetes

    PubMed Central

    Buijsse, Brian; Simmons, Rebecca K.; Griffin, Simon J.; Schulze, Matthias B.

    2011-01-01

    Trials have demonstrated the preventability of type 2 diabetes through lifestyle modifications or drugs in people with impaired glucose tolerance. However, alternative ways of identifying people at risk of developing diabetes are required. Multivariate risk scores have been developed for this purpose. This article examines the evidence for performance of diabetes risk scores in adults by 1) systematically reviewing the literature on available scores and 2) their validation in external populations; and 3) exploring methodological issues surrounding the development, validation, and comparison of risk scores. Risk scores show overall good discriminatory ability in populations for whom they were developed. However, discriminatory performance is more heterogeneous and generally weaker in external populations, which suggests that risk scores may need to be validated within the population in which they are intended to be used. Whether risk scores enable accurate estimation of absolute risk remains unknown; thus, care is needed when using scores to communicate absolute diabetes risk to individuals. Several risk scores predict diabetes risk based on routine noninvasive measures or on data from questionnaires. Biochemical measures, in particular fasting plasma glucose, can improve prediction of such models. On the other hand, usefulness of genetic profiling currently appears limited. PMID:21622851

  7. Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus.

    PubMed

    Gibb, Roger D; McRorie, Johnson W; Russell, Darrell A; Hasselblad, Vic; D'Alessio, David A

    2015-12-01

    A number of health benefits are associated with intake of soluble, viscous, gel-forming fibers, including reduced serum cholesterol and the attenuation of postprandial glucose excursions. We assess the effects of psyllium, which is a soluble, gel-forming, nonfermented fiber supplement, on glycemic control in patients who were being treated for type 2 diabetes mellitus (T2DM) and in patients who were at risk of developing T2DM. A comprehensive search was performed of available published literature (Scopus scientific database) and clinical records stored by Procter & Gamble with the use of key search terms to identify clinical studies that assessed the glycemic effects of psyllium in nondiabetic, pre-T2DM, and T2DM patients. We identified 35 randomized, controlled, clinical studies that spanned 3 decades and 3 continents. These data were assessed in 8 meta-analyses. In patients with T2DM, multiweek studies (psyllium dosed before meals) showed significant improvement in both the fasting blood glucose (FBG) concentration (-37.0 mg/dL; P < 0.001) and glycated hemoglobin (HbA1c) [-0.97% (-10.6 mmol/mol); P = 0.048]. Glycemic effects were proportional to baseline FBG; no significant glucose lowering was observed in euglycemic subjects, a modest improvement was observed in subjects with pre-T2DM, and the greatest improvement was observed in subjects who were being treated for T2DM. These data indicate that psyllium would be an effective addition to a lifestyle-intervention program. The degree of psyllium's glycemic benefit was commensurate with the loss of glycemic control. Because the greatest effect was seen in patients who were being treated for T2DM, additional studies are needed to determine how best to incorporate psyllium into existing prevention and treatment algorithms with concomitant hypoglycemic medications. © 2015 American Society for Nutrition.

  8. Improving Diabetes Health Literacy by Animation.

    PubMed

    Calderón, José L; Shaheen, Magda; Hays, Ron D; Fleming, Erik S; Norris, Keith C; Baker, Richard S

    2014-05-01

    To produce a Spanish/English animated video about diabetes; to qualitatively assess cultural and linguistic appropriateness; and to test effectiveness at improving diabetes health literacy among Latino/Hispanics. Participatory research and animation production methods guided development of the video. Cultural appropriateness was assessed through focused discussion group methods. A prospective randomized controlled trial tested the effectiveness of the Spanish version at improving diabetes health literacy, compared to "easy to read" diabetes information from the National Institute of Diabetes and Digestive and Kidney Diseases. Functional health literacy was measured by the Short Test of Functional Health Literacy in Adults. Diabetes health literacy was measured by the Diabetes Health Literacy Survey (DHLS). No significant differences were recorded between experimental (n = 118) and control groups (n = 122) at baseline on demographic characteristics, Short Test of Functional Health Literacy in Adults score, or DHLS score. Fifty-eight percent of the study participants had inadequate functional health literacy. Mean DHLS score for all participants and those having adequate functional health literacy were 0.55 and 0.54, respectively (inadequate diabetes health literacy). When adjusting for baseline DHLS score, sex, age, and insurance status, DHLS scores improved significantly more in the experimental group than the control group (adjusted mean = 55% vs 53%, F = 4.7, df = 1, P = .03). Interaction between experimental group and health literacy level was significant (F = 6.37, df = 2, P = .002), but the experimental effect was significant only for participants with inadequate health literacy (P = .009). The positive effect on DHLS scores suggests that animation has great potential for improving diabetes health literacy among Latinos having limited functional health literacy. A study is needed that targets participants with inadequate health literacy and that uses the

  9. Coffee improves auditory neuropathy in diabetic mice.

    PubMed

    Hong, Bin Na; Yi, Tae Hoo; Park, Raekil; Kim, Sun Yeou; Kang, Tong Ho

    2008-08-29

    Coffee is a widely consumed beverage and has recently received considerable attention for its possible beneficial effects. Auditory neuropathy is a hearing disorder characterized by an abnormal auditory brainstem response. This study examined the auditory neuropathy induced by diabetes and investigated the action of coffee, trigonelline, and caffeine to determine whether they improved diabetic auditory neuropathy in mice. Auditory brainstem responses, auditory middle latency responses, and otoacoustic emissions were evaluated to assess auditory neuropathy. Coffee or trigonelline ameliorated the hearing threshold shift and delayed latency of the auditory evoked potential in diabetic neuropathy. These findings demonstrate that diabetes can produce a mouse model of auditory neuropathy and that coffee consumption potentially facilitates recovery from diabetes-induced auditory neuropathy. Furthermore, the active constituent in coffee may be trigonelline.

  10. Exercise improves cardiac autonomic function in obesity and diabetes.

    PubMed

    Voulgari, Christina; Pagoni, Stamatina; Vinik, Aaron; Poirier, Paul

    2013-05-01

    Physical activity is a key element in the prevention and management of obesity and diabetes. Regular physical activity efficiently supports diet-induced weight loss, improves glycemic control, and can prevent or delay type 2 diabetes diagnosis. Furthermore, physical activity positively affects lipid profile, blood pressure, reduces the rate of cardiovascular events and associated mortality, and restores the quality of life in type 2 diabetes. However, recent studies have documented that a high percentage of the cardiovascular benefits of exercise cannot be attributed solely to enhanced cardiovascular risk factor modulation. Obesity in concert with diabetes is characterized by sympathetic overactivity and the progressive loss of cardiac parasympathetic influx. These are manifested via different pathogenetic mechanisms, including hyperinsulinemia, visceral obesity, subclinical inflammation and increased thrombosis. Cardiac autonomic neuropathy is an underestimated risk factor for the increased cardiovascular morbidity and mortality associated with obesity and diabetes. The same is true for the role of physical exercise in the restoration of the heart cardioprotective autonomic modulation in these individuals. This review addresses the interplay of cardiac autonomic function in obesity and diabetes, and focuses on the importance of exercise in improving cardiac autonomic dysfunction. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Reducing Diabetes Risk in American Indian Women

    PubMed Central

    Thompson, Janice L.; Allen, Peg; Helitzer, Deborah L.; Qualls, Clifford; Whyte, Ayn N.; Wolfe, Venita K.; Herman, Carla J.

    2008-01-01

    Background American Indians experience high rates of type 2 diabetes. The impact of low-intensity interventions on diabetes risk among young American Indian women is unknown. Design Randomized controlled trial Setting/Participants Community-based; participants were 200 young urban American Indian women who were block-randomized on fasting blood glucose (FBG) into intervention and control groups. Inclusion criteria included self-reported identity, aged 18–40 years, not pregnant, willingness to stay in urban area for 2 years, and not having type 2 diabetes. Measures were taken at baseline, 6, 12, and 18 months. Data were gathered 2002–2006 and analyzed 2006–2007. Intervention Five discussion group sessions (one meeting per month for five months) were held focusing on healthful eating, physical activity, goal-setting, and social support.. Main Outcome Measures Primary outcomes included dietary fat and vegetable consumption and self-reported physical activity. Secondary outcomes included cardiorespiratory fitness, insulin sensitivity, blood pressure, lipid profiles, percent body fat, BMI, intake of fruit, total sugar and sweetened beverages, FBG, and television viewing. Results Mean vegetable and fruit intake increased significantly more in the intervention group than in the control group over time (group by visit interaction, p=0.02 and p=0.002, respectively). Both groups had significant increases in percent body fat and decreases in waist circumference, insulin sensitivity, blood cholesterol, LDL, television viewing, and total intakes of energy, saturated fat, sugar, and sweetened beverages. Conclusions A culturally influenced, low-intensity lifestyle intervention can improve self-reported intakes of vegetables and fruit over 18 months in young, urban American Indian women. PMID:18312806

  12. Improving the adverse cardiovascular prognosis of type 2 diabetes.

    PubMed

    O'Keefe, J H; Miles, J M; Harris, W H; Moe, R M; McCallister, B D

    1999-02-01

    Approximately 80% of all patients with diabetes die of cardiovascular disease. The traditional management of type 2 diabetes has been ineffective in altering this dismal prognosis. Insulin resistance is the fundamental defect of type 2 diabetes. Insulin resistance often leads to hyperinsulinemia, which is associated with hypertension, atherogenic dyslipidemia, left ventricular hypertrophy, impaired fibrinolysis, visceral obesity, and sedentary lifestyle. Although all these conditions are associated with atherosclerosis and adverse cardiovascular events, the therapeutic efforts in patients with diabetes have focused predominantly on normalizing glucose levels. Improved insulin sensitivity through lifestyle modifications or pharmacologic therapy (troglitazone and metformin) will lower both insulin and glucose levels as well as diminish dyslipidemia and hypertension. In contrast, sulfonylurea agents lower glucose by increasing insulin levels and may increase the risk of cardiovascular events. Therapy including aspirin, lipid agents (for example, statins), angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, postmenopausal estrogen replacement, and vitamin E should be considered for patients with type 2 diabetes. In most patients with diabetes who have multivessel coronary artery disease, coronary artery bypass grafting is superior to coronary angioplasty for improving long-term cardiovascular prognosis. This superiority is mediated in part by the use of a left internal mammary graft to the left anterior descending coronary artery. Urgent coronary angioplasty or thrombolytic therapy should be considered for all patients with diabetes who have acute myocardial infarction.

  13. Lifestyle Interventions to Reduce Risk of Diabetes among Women with Prior Gestational Diabetes Mellitus

    PubMed Central

    Chasan-Taber, Lisa

    2014-01-01

    While lifestyle interventions involving exercise and a healthy diet in high-risk adults have been found to reduce progression to type 2 diabetes by more than 50%, little attention has been given to the potential benefits of such strategies in women with a history of gestational diabetes mellitus (GDM). We conducted a literature search of PubMed for English-language studies of randomized controlled trials of lifestyle interventions among women with a history of GDM. In total, 9 studies were identified which fulfilled the eligibility criteria. The majority of randomized trials of lifestyle interventions in women with GDM have been limited to pilot or feasibility studies. However, preliminary findings suggest that such interventions can improve diabetes risk factors in women with a history of GDM. Larger, well-designed controlled randomized trials are needed to assess the effects of lifestyle interventions on preventing subsequent progression to type 2 diabetes among women with GDM. PMID:25220104

  14. Lifestyle interventions to reduce risk of diabetes among women with prior gestational diabetes mellitus.

    PubMed

    Chasan-Taber, Lisa

    2015-01-01

    While lifestyle interventions involving exercise and a healthy diet in high-risk adults have been found to reduce progression to type 2 diabetes by >50%, little attention has been given to the potential benefits of such strategies in women with a history of gestational diabetes mellitus (GDM). We conducted a literature search of PubMed for English language studies of randomized controlled trials of lifestyle interventions among women with a history of GDM. In total, nine studies were identified which fulfilled the eligibility criteria. The majority of randomized trials of lifestyle interventions in women with GDM have been limited to pilot or feasibility studies. However, preliminary findings suggest that such interventions can improve diabetes risk factors in women with a history of GDM. Larger, well-designed controlled randomized trials are needed to assess the effects of lifestyle interventions on preventing subsequent progression to type 2 diabetes among women with GDM. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Sleep Characteristics, Mental Health, and Diabetes Risk

    PubMed Central

    Boyko, Edward J.; Seelig, Amber D.; Jacobson, Isabel G.; Hooper, Tomoko I.; Smith, Besa; Smith, Tyler C.; Crum-Cianflone, Nancy F.

    2013-01-01

    OBJECTIVE Research has suggested that a higher risk of type 2 diabetes associated with sleep characteristics exists. However, studies have not thoroughly assessed the potential confounding effects of mental health conditions associated with alterations in sleep. RESEARCH DESIGN AND METHODS We prospectively assessed the association between sleep characteristics and self-reported incident diabetes among Millennium Cohort Study participants prospectively followed over a 6-year time period. Surveys are administered approximately every 3 years and collect self-reported data on demographics, height, weight, lifestyle, features of military service, sleep, clinician-diagnosed diabetes, and mental health conditions assessed by the PRIME-MD Patient Health Questionnaire and the PTSD Checklist–Civilian Version. Statistical methods for longitudinal data were used for data analysis. RESULTS We studied 47,093 participants (mean 34.9 years of age; mean BMI 26.0 kg/m2; 25.6% female). During 6 years of follow-up, 871 incident diabetes cases occurred (annual incidence 3.6/1,000 person-years). In univariate analyses, incident diabetes was significantly more likely among participants with self-reported trouble sleeping, sleep duration <6 h, and sleep apnea. Participants reporting incident diabetes were also significantly older, of nonwhite race, of higher BMI, less likely to have been deployed, and more likely to have reported baseline symptoms of panic, anxiety, posttraumatic stress disorder, and depression. After adjusting for covariates, trouble sleeping (odds ratio 1.21 [95% CI 1.03–1.42]) and sleep apnea (1.78 [1.39–2.28]) were significantly and independently related to incident diabetes. CONCLUSIONS Trouble sleeping and sleep apnea predict diabetes risk independent of mental health conditions and other diabetes risk factors. PMID:23835691

  16. Statin use and risk of diabetes mellitus

    PubMed Central

    Chogtu, Bharti; Magazine, Rahul; Bairy, KL

    2015-01-01

    The 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, statins, are widely used in the primary and secondary prevention of cardiovascular diseases to lower serum cholesterol levels. As type 2 diabetes mellitus is accompanied by dyslipidemia, statins have a major role in preventing the long term complications in diabetes and are recommended for diabetics with normal low density lipoprotein levels as well. In 2012, United States Food and Drug Administration released changes to statin safety label to include that statins have been found to increase glycosylated haemoglobin and fasting serum glucose levels. Many studies done on patients with cardiovascular risk factors have shown that statins have diabetogenic potential and the effect varies as per the dosage and type used. The various mechanisms for this effect have been proposed and one of them is downregulation of glucose transporters by the statins. The recommendations by the investigators are that though statins can have diabetogenic risk, they have more long term benefits which can outweigh the risk. In elderly patients and those with metabolic syndrome, as the risk of diabetes increase, the statins should be used cautiously. Other than a subset of population with risk for diabetes; statins still have long term survival benefits in most of the patients. PMID:25789118

  17. Pregnancy-Linked Diabetes Poses Risks for Mom, Baby

    MedlinePlus

    ... News) -- Diabetes that develops during pregnancy -- known as gestational diabetes -- carries health risks for both the mom-to- ... 2012. Compared to other pregnant women, those with gestational diabetes were 30 percent more likely to experience preterm ...

  18. Duration of Diabetes and Risk of Ischemic Stroke: The Northern Manhattan Study

    PubMed Central

    Banerjee, Chirantan; Moon, Yeseon P; Paik, Myunghee C; Rundek, Tatjana; Mora-McLaughlin, Consuelo; Vieira, Julio R; Sacco, Ralph L; Elkind, Mitchell SV

    2012-01-01

    Background and Purpose Diabetes increases stroke risk, but whether diabetes status immediately prior to stroke improves prediction, and whether duration is important, are less clear. We hypothesized that diabetes duration independently predicts ischemic stroke. Methods Among 3,298 stroke-free participants in the Northern Manhattan Study (NOMAS), baseline diabetes and age at diagnosis were determined. Incident diabetes was assessed annually (median=9 years). Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals (HR, 95% CI) for incident ischemic stroke using baseline diabetes, diabetes as a time-dependent covariate, and duration of diabetes as a time-varying covariate; models were adjusted for demographic and cardiovascular risk factors. Results Mean age was 69±10 years (52% Hispanic, 21% white, and 24% black); 22% were diabetic at baseline and 10% developed diabetes. There were 244 ischemic strokes, and both baseline diabetes (HR 2.5, 95% CI 1.9-3.3) and diabetes considered as a time-dependent covariate (HR 2.4, 95% CI 1.8-3.2) were similarly associated with stroke risk. Duration of diabetes was associated with ischemic stroke (adjusted HR=1.03 per year with diabetes, 95% CI=1.02-1.04). Compared to non-diabetic participants, those with diabetes for 0-5 years (adjusted HR=1.7, 95% CI=1.1-2.7), 5-10 years (adjusted HR=1.8, 95% CI=1.1-3.0), and ≥10 years (adjusted HR=3.2, 95% CI=2.4-4.5) were at increased risk. Conclusion Duration of diabetes is independently associated with ischemic stroke risk adjusting for risk factors. The risk increases 3% each year, and triples with diabetes ≥10 years. PMID:22382158

  19. Risk factors for diabetic foot ulcer.

    PubMed

    Ahmad, Wasim; Khan, Ishtiaq Ali; Ghaffar, Salma; Al-Swailmi, Farhan Khasham; Khan, Ihsanullah

    2013-01-01

    Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. Out of 196 patients 80.1% were male. One hundred and forty-six (74.48%) patients were in the range of 40-70) years. Right foot was more commonly involved (65.3%). 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients: staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease. grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. Neuropathy, peripheral arterial disease, duration of diseases and undlerlying osteomylitis are the major risk factors and

  20. Utilizing a Diabetes Risk Test and A1c Point-of-Care Instrument to Identify Increased Risk for Diabetes In an Educational Dental Hygiene Setting.

    PubMed

    Giblin, Lori J; Rainchuso, Lori; Rothman, Andrew

    2016-06-01

    The objective of this pilot study was to demonstrate the number of patients at increased risk for type 2 diabetes development using a validated survey; and to assess the rate of compliance for A1c screening in an educational dental hygiene setting. This was a descriptive study using a purposive sample of patients in an academic dental hygiene clinic, who were 18 years or older, not diagnosed with prediabetes or type 2 diabetes. Utilizing the American Diabetes Association adopted diabetes risk survey, patients determined to be at increased risk for type 2 diabetes were offered the opportunity for further assessment by having their A1c tested using a point of care instrument. Patients demonstrating an increased risk for prediabetes or type 2 diabetes, with either the survey or the point of care instrument, were referred to their primary physician for further evaluation. A total 179 of the 422 solicited patients agreed to participate in the American Diabetes Association adopted diabetes risk survey. According to the survey guidelines, 77 participants were considered increased risk for type 2 diabetes for an at-risk prevalence of 48% (95% Confidence Interval (CI): 40 to 56%). The at-risk participants were then asked to have an A1c test of which 45 agreed (compliance rate 58%, 95% CI: 47 to 70%). Using American Diabetes Association A1c parameters, 60.98% (n=25) indicated a prediabetes (5.7 to 6.4%) range, and 4.88% (n=2) indicated a diabetes (≥6.5%) range. Utilizing the American Diabetes Association adopted diabetes risk survey in any dental setting could provide patients with invaluable health information, and potentially improve overall health outcomes. Copyright © 2016 The American Dental Hygienists’ Association.

  1. Risk models and scores for type 2 diabetes: systematic review

    PubMed Central

    Mathur, Rohini; Dent, Tom; Meads, Catherine; Greenhalgh, Trisha

    2011-01-01

    Objective To evaluate current risk models and scores for type 2 diabetes and inform selection and implementation of these in practice. Design Systematic review using standard (quantitative) and realist (mainly qualitative) methodology. Inclusion criteria Papers in any language describing the development or external validation, or both, of models and scores to predict the risk of an adult developing type 2 diabetes. Data sources Medline, PreMedline, Embase, and Cochrane databases were searched. Included studies were citation tracked in Google Scholar to identify follow-on studies of usability or impact. Data extraction Data were extracted on statistical properties of models, details of internal or external validation, and use of risk scores beyond the studies that developed them. Quantitative data were tabulated to compare model components and statistical properties. Qualitative data were analysed thematically to identify mechanisms by which use of the risk model or score might improve patient outcomes. Results 8864 titles were scanned, 115 full text papers considered, and 43 papers included in the final sample. These described the prospective development or validation, or both, of 145 risk prediction models and scores, 94 of which were studied in detail here. They had been tested on 6.88 million participants followed for up to 28 years. Heterogeneity of primary studies precluded meta-analysis. Some but not all risk models or scores had robust statistical properties (for example, good discrimination and calibration) and had been externally validated on a different population. Genetic markers added nothing to models over clinical and sociodemographic factors. Most authors described their score as “simple” or “easily implemented,” although few were specific about the intended users and under what circumstances. Ten mechanisms were identified by which measuring diabetes risk might improve outcomes. Follow-on studies that applied a risk score as part of an

  2. Using Serum Advanced Glycation End Products-Peptides to Improve the Efficacy of World Health Organization Fasting Plasma Glucose Criterion in Screening for Diabetes in High-Risk Chinese Subjects.

    PubMed

    Sun, Zilin; He, Jiajia; Qiu, Shanhu; Lei, Chenghao; Zhou, Yi; Xie, Zuolin; Zhang, Lin; Wang, Yanping; Jin, Hui

    2015-01-01

    The efficacy of using fasting plasma glucose (FPG) alone as a preferred screening test for diabetes has been questioned. This study was aimed to evaluate whether the use of serum advanced glycation end products-peptides (sAGEP) would help to improve the efficacy of FPG in diabetes screening among high-risk Chinese subjects with FPG <7.0 mmol/L. FPG, 2-h plasma glucose (2h-PG), serum glycated haemoglobin A1c (HbA1c), and sAGEP were measured in 857 Chinese subjects with risk factors for diabetes. The areas under receiver operating characteristic (ROC) curves generated by logistic regression models were assessed and compared to find the best model for diabetes screening in subjects with FPG <7.0 mmol/L. The optimal critical line was determined by maximizing the sum of sensitivity and specificity. Among the enrolled subjects, 730 of them had FPG <7.0 mmol/L, and only 41.7% new diabetes cases were identified using the 1999 World Health Organization FPG criterion (FPG ≥7.0 mmol/L). The area under ROC curves generated by the model on FPG-sAGEP was the largest compared with that on FPG-HbA1c, sAGEP, HbA1c or FPG in subjects with FPG <7.0 mmol/L. By maximizing the sum of sensitivity and specificity, the optimal critical line was determined as 0.69×FPG + 0.14×sAGEP = 7.03, giving a critical sensitivity of 91.2% in detecting 2h-PG ≥11.1 mmol/L, which was significantly higher than that of FPG-HbA1c or HbA1c. The model on FPG-sAGEP improves the efficacy of using FPG alone in detecting diabetes among high-risk Chinese subjects with FPG <7.0 mmol/L, and is worth being promoted for future diabetes screening.

  3. Parental History of Diabetes, Positive Affect, and Diabetes Risk in Adults: Findings from MIDUS.

    PubMed

    Tsenkova, Vera K; Karlamangla, Arun S; Ryff, Carol D

    2016-12-01

    Family history of diabetes is one of the major risk factors for diabetes, but significant variability in this association remains unexplained, suggesting the presence of important effect modifiers. To our knowledge, no previous work has examined whether psychological factors moderate the degree to which family history of diabetes increases diabetes risk. We investigated the relationships among parental history of diabetes, affective states (positive affect, negative affect, and depressed affect), and diabetes in 978 adults from the MIDUS 2 national sample. As expected, parental history of diabetes was associated with an almost threefold increase in diabetes risk. We found a significant interaction between positive affect and parental history of diabetes on diabetes (p = .009): higher positive affect was associated with a statistically significant lower relative risk for diabetes in participants who reported having a parental history of diabetes (RR = .66 per unit increase in positive affect; 95 % CI = .47; .93), but it did not influence diabetes risk for participants who reported no parental history of diabetes (p = .34). This pattern persisted after adjusting for an extensive set of health and sociodemographic covariates and was independent of negative and depressed affect. These results suggest that psychological well-being may protect individuals at increased risk from developing diabetes. Understanding such interactions between non-modifiable risk factors and modifiable psychological resources is important for delineating biopsychosocial pathways to diabetes and informing theory-based, patient-centered interventions to prevent the development of diabetes.

  4. Statins and Risk of New-Onset Diabetes Mellitus

    MedlinePlus

    ... Patient Page Statins and Risk of New-Onset Diabetes Mellitus Ravi V. Shah , Allison B. Goldfine Download ... initiation in at-risk patients. Can Statins Cause Diabetes Mellitus? Careful review of findings from many trials ...

  5. Diabetes and Amoebiasis: a high risk encounter.

    PubMed

    Bredin, C; Margery, J; Bordier, L; Mayaudon, H; Dupuy, O; Vergeau, B; Bauduceau, B

    2004-02-01

    Amoebiasis is the second most common parasitic disease worldwIde. It occurs mainly in developing countries. A high percentage of people in countries where it is endemic are asymptomatic carriers. It results in severe disease that can be fatal in rare cases. Diabetics are at increased risk of exposure as travel to countries where it is endemic becomes more frequent, as indicated by the present case. This patient suffered from amoebiasis that produced an amoeboma which is most rare in cases of colonic amoebiasis. The clinical picture was that of an occluding gut tumor, but it was treated only with drugs. Retrospective studies show that diabetics are at increased risk of suffering severe complications after amoebic infection. The frequency and severity of this diabetes-amoeba association requires patients to take prophylactic measures, especially when travelling in developing countries.

  6. Diabetes and cancer II: role of diabetes medications and influence of shared risk factors.

    PubMed

    Onitilo, Adedayo A; Engel, Jessica M; Glurich, Ingrid; Stankowski, Rachel V; Williams, Gail M; Doi, Suhail A

    2012-07-01

    An association between type 2 diabetes mellitus (DM) and cancer has long been postulated, but the biological mechanism responsible for this association has not been defined. In part one of this review, we discussed the epidemiological evidence for increased risk of cancer, decreased cancer survival, and decreased rates of cancer screening in diabetic patients. Here we review the risk factors shared by cancer and DM and how DM medications play a role in altering cancer risk. Hyperinsulinemia stands out as a major factor contributing to the association between DM and cancer, and modulation of circulating insulin levels by DM medications appears to play an important role in altering cancer risk. Drugs that increase circulating insulin, including exogenous insulin, insulin analogs, and insulin secretagogues, are generally associated with an increased cancer risk. In contrast, drugs that regulate insulin signaling without increasing levels, especially metformin, appear to be associated with a decreased cancer risk. In addition to hyperinsulinemia, the effect of DM medications on other shared risk factors including hyperglycemia, obesity, and oxidative stress as well as demographic factors that may influence the use of certain DM drugs in different populations are described. Further elucidation of the mechanisms behind the association between DM, cancer, and the role of DM medications in modulating cancer risk may aid in the development of better prevention and treatment options for both DM and cancer. Additionally, incorporation of DM medication use into cancer prediction models may lead to the development of improved risk assessment tools for diabetic patients.

  7. Diabetes and cancer II: role of diabetes medications and influence of shared risk factors

    PubMed Central

    Engel, Jessica M.; Glurich, Ingrid; Stankowski, Rachel V.; Williams, Gail M.; Doi, Suhail A.

    2014-01-01

    An association between type 2 diabetes mellitus (DM) and cancer has long been postulated, but the biological mechanism responsible for this association has not been defined. In part one of this review, we discussed the epidemiological evidence for increased risk of cancer, decreased cancer survival, and decreased rates of cancer screening in diabetic patients. Here we review the risk factors shared by cancer and DM and how DM medications play a role in altering cancer risk. Hyperinsulinemia stands out as a major factor contributing to the association between DM and cancer, and modulation of circulating insulin levels by DM medications appears to play an important role in altering cancer risk. Drugs that increase circulating insulin, including exogenous insulin, insulin analogs, and insulin secretagogues, are generally associated with an increased cancer risk. In contrast, drugs that regulate insulin signaling without increasing levels, especially metformin, appear to be associated with a decreased cancer risk. In addition to hyperinsulinemia, the effect of DM medications on other shared risk factors including hyperglycemia, obesity, and oxidative stress as well as demographic factors that may influence the use of certain DM drugs in different populations are described. Further elucidation of the mechanisms behind the association between DM, cancer, and the role of DM medications in modulating cancer risk may aid in the development of better prevention and treatment options for both DM and cancer. Additionally, incorporation of DM medication use into cancer prediction models may lead to the development of improved risk assessment tools for diabetic patients. PMID:22527174

  8. Tryptophan Predicts the Risk for Future Type 2 Diabetes

    PubMed Central

    Chen, Tianlu; Zheng, Xiaojiao; Ma, Xiaojing; Bao, Yuqian; Ni, Yan; Hu, Cheng; Rajani, Cynthia; Huang, Fengjie; Zhao, Aihua; Jia, Weiping; Jia, Wei

    2016-01-01

    Recently, 5 amino acids were identified and verified as important metabolites highly associated with type 2 diabetes (T2D) development. This report aims to assess the association of tryptophan with the development of T2D and to evaluate its performance with existing amino acid markers. A total of 213 participants selected from a ten-year longitudinal Shanghai Diabetes Study (SHDS) were examined in two ways: 1) 51 subjects who developed diabetes and 162 individuals who remained metabolically healthy in 10 years; 2) the same 51 future diabetes and 23 strictly matched ones selected from the 162 healthy individuals. Baseline fasting serum tryptophan concentrations were quantitatively measured using ultra-performance liquid chromatography triple quadruple mass spectrometry. First, serum tryptophan level was found significantly higher in future T2D and was positively and independently associated with diabetes onset risk. Patients with higher tryptophan level tended to present higher degree of insulin resistance and secretion, triglyceride and blood pressure. Second, the prediction potential of tryptophan is non-inferior to the 5 existing amino acids. The predictive performance of the combined score improved after taking tryptophan into account. Our findings unveiled the potential of tryptophan as a new marker associated with diabetes risk in Chinese populations. The addition of tryptophan provided complementary value to the existing amino acid predictors. PMID:27598004

  9. Meat Consumption as a Risk Factor for Type 2 Diabetes

    PubMed Central

    Barnard, Neal; Levin, Susan; Trapp, Caroline

    2014-01-01

    Disease risk factors identified in epidemiological studies serve as important public health tools, helping clinicians identify individuals who may benefit from more aggressive screening or risk-modification procedures, allowing policymakers to prioritize intervention programs, and encouraging at-risk individuals to modify behavior and improve their health. These factors have been based primarily on evidence from cross-sectional and prospective studies, as most do not lend themselves to randomized trials. While some risk factors are not modifiable, eating habits are subject to change through both individual action and broader policy initiatives. Meat consumption has been frequently investigated as a variable associated with diabetes risk, but it has not yet been described as a diabetes risk factor. In this article, we evaluate the evidence supporting the use of meat consumption as a clinically useful risk factor for type 2 diabetes, based on studies evaluating the risks associated with meat consumption as a categorical dietary characteristic (i.e., meat consumption versus no meat consumption), as a scalar variable (i.e., gradations of meat consumption), or as part of a broader dietary pattern. PMID:24566443

  10. Health Behaviors Among Pregnant Latina Women at Risk for Gestational Diabetes Mellitus

    USDA-ARS?s Scientific Manuscript database

    Gestational diabetes mellitus (GDM), a common complication of pregnancy, increases the risk of subsequent diabetes and obesity. Latina women have over twice the risk for developing GDM as compared to non-Latina white women. Health-promoting practices during pregnancy may improve metabolic status an...

  11. Mechanisms of Type 2 Diabetes Risk Loci.

    PubMed

    Gaulton, Kyle J

    2017-09-01

    Deciphering the mechanisms of type 2 diabetes (T2DM) risk loci can greatly inform on disease pathology. This review discusses current knowledge of mechanisms through which genetic variants influence T2DM risk and considerations for future studies. Over 100 T2DM risk loci to date have been identified. Candidate causal variants at risk loci map predominantly to non-coding sequence. Physiological, epigenomic and gene expression data suggest that variants at many known T2DM risk loci affect pancreatic islet regulation, although variants at other loci also affect protein function and regulatory processes in adipose, pre-adipose, liver, skeletal muscle and brain. The effects of T2DM variants on regulatory activity in these tissues appear largely, but not exclusively, due to altered transcription factor binding. Putative target genes of T2DM variants have been defined at an increasing number of loci and some, such as FTO, may entail several genes and multiple tissues. Gene networks in islets and adipocytes have been implicated in T2DM risk, although the molecular pathways of risk genes remain largely undefined. Efforts to fully define the mechanisms of T2DM risk loci are just beginning. Continued identification of risk mechanisms will benefit from combining genetic fine-mapping with detailed phenotypic association data, high-throughput epigenomics data from diabetes-relevant tissue, functional screening of candidate genes and genome editing of cellular and animal models.

  12. Hypogonadal obese men with and without diabetes mellitus type 2 lose weight and show improvement in cardiovascular risk factors when treated with testosterone: an observational study.

    PubMed

    Haider, Ahmad; Saad, Farid; Doros, Gheorghe; Gooren, Louis

    2014-01-01

    Treatment of obesity with diet and exercise may have short-term success but longer-term maintenance of weight loss is less successful. Obesity is associated with a reduction of serum testosterone, and, vice versa, a reduction in serum testosterone is associated with obesity and features of the metabolic syndrome. To investigate whether restoring serum testosterone to normal in hypo-gonadal obese men is beneficial with regard to weight loss and improvement of the metabolic syndrome. A prospective registry accumulated to 181 men over five years (mean serum testosterone 10.06±1.3 nmol/L (N>12.1), body mass index (BMI) ≥30 kg/m2. Of these men, 72 had diabetes mellitus type 2. All received parenteral testosterone undecanoate 1000 mg/12 weeks for up to five years. Waist circumference (cm) decreased from 111.2±7.54 to 100.46±7.1, weight (kg) from 114.71±11.59 to 93.2±8.49, BMI (kg/m2) from 36.72±3.72 to 30.2±2.59 (all variables statistically significant vs. baseline (p<0.0001) and each year compared to the previous year (p<0.0001)). In the 72 diabetic men, waist circumference (cm) decreased from 112.93±7.16 to 101.48±7.24, weight (kg) from 116.94±11.62 to 94.42±9.42, BMI (kg/m2) from 37.71±3.5 to 30.95±2.69 (all variables statistically significant vs. baseline (p<0.0001) and each year compared to the previous year (p<0.0001)). In all men serum glucose, HbA1c, lipid profiles and blood pressure improved significantly. Testosterone treatment as assessed by hemoglobin, hematocrit, serum prostate specific antigen (PSA) and occurrence of prostate cancer was acceptably safe. Normalizing serum testosterone in obese hypogonadal men, also in those with diabetes type 2, improved their metabolic state. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. All rights reserved.

  13. Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs

    PubMed Central

    Thomas, Melanie; Delgadillo-Duenas, Adriana T.; Leong, Karen; Najmabadi, Adriana; Harleman, Elizabeth; Rios, Christina; Quan, Judy; Soria, Catalina; Handley, Margaret A.

    2016-01-01

    Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18–39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420. PMID:27830157

  14. Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs.

    PubMed

    Athavale, Priyanka; Thomas, Melanie; Delgadillo-Duenas, Adriana T; Leong, Karen; Najmabadi, Adriana; Harleman, Elizabeth; Rios, Christina; Quan, Judy; Soria, Catalina; Handley, Margaret A

    2016-01-01

    Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18-39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.

  15. Obesity, diabetes, and risk of Parkinson's disease.

    PubMed

    Palacios, Natalia; Gao, Xiang; McCullough, Marjorie L; Jacobs, Eric J; Patel, Alpa V; Mayo, Tinisha; Schwarzschild, Michael A; Ascherio, Alberto

    2011-10-01

    The aim of this work was to investigate whether obesity and diabetes are related to risk of Parkinson's disease. We prospectively followed 147,096 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2005. Participants provided information on anthropometric variables and medical history at baseline and on waist circumference in 1997. Incident cases of Parkinson's disease (n = 656) were confirmed by treating neurologists and medical record review. Relative risks were estimated using proportional hazards models, adjusting for age, gender, smoking, and other risk factors. Neither body mass index nor waist circumference significantly predicted Parkinson's disease risk. Relative risk comparing individuals with a baseline body mass index of ≥ 30 to those with a body mass index <23 was 1.00 (95% confidence interval: 0.75, 1.34; P trend: 0.79), and that comparing individuals with a waist circumference in the top category (≥ 40.3 inches in men and ≥ 35 inches in women) to those in the bottom category (<34.5 inches in men and <28 inches in women) was 1.35 (95% confidence interval: 0.95, 1.93; P trend: 0.08). History of diabetes was not significantly associated with Parkinson's disease risk (combined relative risks = 0.88; 95% confidence interval: 0.62, 1.25; P heterogeneity = 0.96). In addition, neither body mass index at age 18 nor changes in weight between age 18 and baseline were significantly associated with Parkinson's disease risk. The results did not differ significantly by gender. Our results do not provide evidence for a relationship between body mass index, weight change, waist circumference, or baseline diabetes and risk of Parkinson's disease.

  16. Evaluation of risk for type 2 diabetes mellitus in medical students using Indian Diabetes Risk Score.

    PubMed

    Ashok, Pranita; Kharche, Jayshree S; Joshi, Aniruddha R

    2011-01-01

    According to World Health Organisation, type 2 diabetes mellitus [type 2 D. M] has recently escalated in all age groups and is now being identified in younger age groups. This underscores the need for mass awareness and screening programs to detect diabetes at an early stage. For this purpose we have used a simplified Indian Diabetes Risk Score (IDRS) for prediction of diabetes in undergraduate medical students. To screen and to identify 1st MBBS students at risk for developing type 2 D. M using IDRS. 261 undergraduates (1st MBBS students) were scored using IDRS which includes age, family history of diabetes, exercise status, and waist circumference. After scoring them, we assessed random capillary blood glucose (RCBG) in students with high IDRS score. Students with RCBG ≥ 113 mg/dl are followed for definitive tests for diagnosis of prediabetes and diabetes. We have assessed 261 students till now. It was observed that 5%, 55%, and 38% students in High, Moderate, and Low risk group, respectively, for developing type 2 D. M. The mean abdominal obesity in high risk students was 101.95 ± 5.76 as compared to 79.17 ± 11.08 in moderate and low risk students (P < 0.0001). 63% students were having sedentary lifestyle. Family history of diabetes in either or both parents was present in 25% students. Mean RCBG in students having score more than 50 was 97.33 ± 9.68 mg/dl. Also, two students were having RCBG > 113 mg/dl in which one student found to have prediabetic. This underscores the need for further investigations to detect diabetes at an early stage and to overcome the disease burden of diabetes in future. Prevention of obesity and promotion of physical activity have to be the future plan of action which can be suggested in the form of regular exercise and diet planning for the students as part of an integrated approach.

  17. Assessing diabetic foot ulcer development risk with hyperspectral tissue oximetry

    NASA Astrophysics Data System (ADS)

    Yudovsky, Dmitry; Nouvong, Aksone; Schomacker, Kevin; Pilon, Laurent

    2011-02-01

    Foot ulceration remains a serious health concern for diabetic patients and has a major impact on the cost of diabetes treatment. Early detection and preventive care, such as offloading or improved hygiene, can greatly reduce the risk of further complications. We aim to assess the use of hyperspectral tissue oximetry in predicting the risk of diabetic foot ulcer formation. Tissue oximetry measurements are performed during several visits with hyperspectral imaging of the feet in type 1 and 2 diabetes mellitus subjects that are at risk for foot ulceration. The data are retrospectively analyzed at 21 sites that ulcerated during the course of our study and an ulceration prediction index is developed. Then, an image processing algorithm based on this index is implemented. This algorithm is able to predict tissue at risk of ulceration with a sensitivity and specificity of 95 and 80%, respectively, for images taken, on average, 58 days before tissue damage is apparent to the naked eye. Receiver operating characteristic analysis is also performed to give a range of sensitivity/specificity values resulting in a Q-value of 89%.

  18. Obesity and Diabetes: The Increased Risk of Cancer and Cancer-Related Mortality

    PubMed Central

    LeRoith, Derek

    2015-01-01

    Obesity and type 2 diabetes are becoming increasingly prevalent worldwide, and both are associated with an increased incidence and mortality from many cancers. The metabolic abnormalities associated with type 2 diabetes develop many years before the onset of diabetes and, therefore, may be contributing to cancer risk before individuals are aware that they are at risk. Multiple factors potentially contribute to the progression of cancer in obesity and type 2 diabetes, including hyperinsulinemia and insulin-like growth factor I, hyperglycemia, dyslipidemia, adipokines and cytokines, and the gut microbiome. These metabolic changes may contribute directly or indirectly to cancer progression. Intentional weight loss may protect against cancer development, and therapies for diabetes may prove to be effective adjuvant agents in reducing cancer progression. In this review we discuss the current epidemiology, basic science, and clinical data that link obesity, diabetes, and cancer and how treating obesity and type 2 diabetes could also reduce cancer risk and improve outcomes. PMID:26084689

  19. Epigenetic Changes in Diabetes and Cardiovascular Risk

    PubMed Central

    Keating, Samuel T; Plutzky, Jorge; El-Osta, Assam

    2016-01-01

    Cardiovascular complications remain the leading causes of morbidity and premature mortality in patients with diabetes. Studies in humans and preclinical models demonstrate lasting gene expression changes in the vasculopathies initiated by previous exposure to high glucose concentrations and the associated overproduction of reactive oxygen species. The molecular signatures of chromatin architectures that sensitize the genome to these and other cardiometabolic risk factors of the diabetic milieu are increasingly implicated in the biologic memory underlying cardiovascular complications and now widely considered as promising therapeutic targets. Atherosclerosis is a complex heterocellular disease where the contributing cell types possess distinct epigenomes shaping diverse gene expression. While the extent that pathological chromatin changes can be manipulated in human cardiovascular disease remains to be established, the clinical applicability of epigenetic interventions will be greatly advanced by a deeper understanding of the cell type-specific roles played by writers, erasers, and readers of chromatin modifications in the diabetic vasculature. This review details a current perspective of epigenetic mechanisms of macrovascular disease in diabetes, and highlights recent key descriptions of chromatinized changes associated with persistent gene expression in endothelial, smooth muscle, and circulating immune cells relevant to atherosclerosis. Furthermore we discuss the challenges associated with pharmacological targeting of epigenetic networks to correct abnormal or deregulated gene expression as a strategy to alleviate the clinical burden of diabetic cardiovascular disease. PMID:27230637

  20. Evidence-based case report: acute diabetic complication risks of Ramadan fasting in type 2 diabetics.

    PubMed

    Iskandar, William J; Handjaja, C T; Salama, N; Anasy, N; Ardianto, M F; Kusumadewi, D

    2013-07-01

    to investigate causal relationship between Ramadan fasting and acute diabetic complications in adult controlled type 2 diabetics. a Pubmed's Clinical Queries and Embase search was conducted and resulted in 2 useful articles: 1 systematic review and 1 cohort study to be critically appraised. the incidence of acute diabetic complications is higher during Ramadan, with the relative risk for adult type 2 diabetics who fast during Ramadan is 1.36 and number needed to harm 50. Ramadan fasting was related with acute diabetic complications in adult controlled type 2 diabetics, but the risk was only slightly higher. It is acceptable for type 2 diabetics to fast during Ramadan.

  1. Dynamic aerobic exercise induces baroreflex improvement in diabetic rats.

    PubMed

    Jorge, Luciana; da Pureza, Demilto Y; da Silva Dias, Danielle; Conti, Filipe Fernandes; Irigoyen, Maria-Cláudia; De Angelis, Kátia

    2012-01-01

    The objective of the present study was to investigate the effects of an acute aerobic exercise on arterial pressure (AP), heart rate (HR), and baroreflex sensitivity (BRS) in STZ-induced diabetic rats. Male Wistar rats were divided into control (n = 8) and diabetic (n = 8) groups. AP, HR, and BRS, which were measured by tachycardic and bradycardic (BR) responses to AP changes, were evaluated at rest (R) and postexercise session (PE) on a treadmill. At rest, STZ diabetes induced AP and HR reductions, associated with BR impairment. Attenuation in resting diabetes-induced AP (R: 103 ± 2 versus PE: 111 ± 3 mmHg) and HR (R: 290 ± 7 versus PE: 328 ± 10 bpm) reductions and BR dysfunction (R: -0.70 ± 0.06 versus PE: -1.21 ± 0.09 bpm/mmHg) was observed in the postexercise period. In conclusion, the hemodynamic and arterial baro-mediated control of circulation improvement in the postexercise period reinforces the role of exercise in the management of cardiovascular risk in diabetes.

  2. Dynamic Aerobic Exercise Induces Baroreflex Improvement in Diabetic Rats

    PubMed Central

    Jorge, Luciana; da Pureza, Demilto Y.; Dias, Danielle da Silva; Conti, Filipe Fernandes; Irigoyen, Maria-Cláudia; De Angelis, Kátia

    2012-01-01

    The objective of the present study was to investigate the effects of an acute aerobic exercise on arterial pressure (AP), heart rate (HR), and baroreflex sensitivity (BRS) in STZ-induced diabetic rats. Male Wistar rats were divided into control (n = 8) and diabetic (n = 8) groups. AP, HR, and BRS, which were measured by tachycardic and bradycardic (BR) responses to AP changes, were evaluated at rest (R) and postexercise session (PE) on a treadmill. At rest, STZ diabetes induced AP and HR reductions, associated with BR impairment. Attenuation in resting diabetes-induced AP (R: 103 ± 2 versus PE: 111 ± 3 mmHg) and HR (R: 290 ± 7 versus PE: 328 ± 10 bpm) reductions and BR dysfunction (R: −0.70 ± 0.06 versus PE: −1.21 ± 0.09 bpm/mmHg) was observed in the postexercise period. In conclusion, the hemodynamic and arterial baro-mediated control of circulation improvement in the postexercise period reinforces the role of exercise in the management of cardiovascular risk in diabetes. PMID:22203833

  3. Early risk stratification in pediatric type 1 diabetes.

    PubMed

    Broe, Rebecca

    2015-03-01

    In the late 1980s all Danish children with type 1 diabetes were invited for a nationwide evaluation of glycemic control. Approximately 75% (n = 720) participated and have later been referred to as The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). The results were surprisingly poor glycemic control among these young patients which lead to a great emphasis on glycemic control in the Danish Pediatric Departments. In 1995 the participants were invited for yet another evaluation but this time with main focus on early signs of microvascular complications - 339 participated. The mean HbA1c had remained at high levels (9.6%) and 60% of the participants had some level of Diabetic Retinopathy (DR). However, as the patients with DR mostly had the very milder forms it was believed that stricter glycemic control would reverse or at least stop progression of the disease in accordance with results from the large intervention study DCCT. This was investigated further at follow-up in 2011. The first study in the present thesis aimed to describe the 16-year incidence, progression and regression of DR in 185 participants from the DCPD1987 cohort. The 16-year incidence of proliferative retinopathy (PDR), 2-step progression and regression of DR was 31.0, 64.4, and 0.0%, respectively. As expected, the participants with PDR at follow-up had significantly higher HbA1c-values at both baseline and follow-up than those without PDR. However; a significantly larger decrease in HbA1c was also observed in the group with PDR over the study period, which in accordance with DCCT should have prevented the development of PDR to some extent. A surprisingly high incidence of proliferative retinopathy amongst young patients with type 1 diabetes in Denmark was found despite improvements in HbA1c over time. The improvement in HbA1c was either too small or happened too late. This study highlights that sight-threatening diabetic retinopathy remain a major concern in type 1 diabetes and the importance

  4. Diabetes Risk May Be Higher for HIV-Positive Adults

    MedlinePlus

    ... people to live longer with HIV, which may increase their risk for other chronic health issues, such as diabetes. The study was published online Jan. 30 in BMJ Open Diabetes Research & Care . " ...

  5. Gestational Diabetes a Risk Factor for Postpartum Depression

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_163195.html Gestational Diabetes a Risk Factor for Postpartum Depression: Study It ... 23, 2017 MONDAY, Jan. 23, 2017 (HealthDay News) -- Gestational diabetes and a previous bout of depression can increase ...

  6. Metabolic factors and genetic risk mediate familial type 2 diabetes risk in the Framingham Heart Study

    PubMed Central

    Raghavan, Sridharan; Porneala, Bianca; McKeown, Nicola; Fox, Caroline S.; Dupuis, Josée; Meigs, James B.

    2015-01-01

    Aims/hypothesis Type 2 diabetes mellitus in parents is a strong determinant of diabetes risk in their offspring. We hypothesise that offspring diabetes risk associated with parental diabetes is mediated by metabolic risk factors. Methods We studied initially non-diabetic participants of the Framingham Offspring Study. Metabolic risk was estimated using beta cell corrected insulin response (CIR), HOMA-IR or a count of metabolic syndrome components (metabolic syndrome score [MSS]). Dietary risk and physical activity were estimated using questionnaire responses. Genetic risk score (GRS) was estimated as the count of 62 type 2 diabetes risk alleles. The outcome of incident diabetes in offspring was examined across levels of parental diabetes exposure, accounting for sibling correlation and adjusting for age, sex and putative mediators. The proportion mediated was estimated by comparing regression coefficients for parental diabetes with (βadj) and without (βunadj) adjustments for CIR, HOMA-IR, MSS and GRS (percentage mediated = 1 – βadj / βunadj). Results Metabolic factors mediated 11% of offspring diabetes risk associated with parental diabetes, corresponding to a reduction in OR per diabetic parent from 2.13 to 1.96. GRS mediated 9% of risk, corresponding to a reduction in OR per diabetic parent from 2.13 to 1.99. Conclusions/interpretation Metabolic risk factors partially mediated offspring type 2 diabetes risk conferred by parental diabetes to a similar magnitude as genetic risk. However, a substantial proportion of offspring diabetes risk associated with parental diabetes remains unexplained by metabolic factors, genetic risk, diet and physical activity, suggesting that important familial influences on diabetes risk remain undiscovered. PMID:25619168

  7. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient

    PubMed Central

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

    2017-01-01

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

  8. The impact of improved glycaemic control with GLP-1 receptor agonist therapy on diabetic retinopathy.

    PubMed

    Varadhan, Lakshminarayanan; Humphreys, Tracy; Walker, Adrian B; Varughese, George I

    2014-03-01

    Rapid improvement in glycaemic control with GLP-1 receptor agonist (RA) therapy has been reported to be associated with significant progression of diabetic retinopathy. This deterioration is transient, and continuing GLP-1 RA treatment is associated with reversal of this phenomenon. Pre-existent maculopathy, higher grade of retinopathy and longer duration of diabetes may be risk factors for persistent deterioration.

  9. Diabetes Care Program of Nova Scotia: Celebrating 25 Years of Improving Diabetes Care in Nova Scotia.

    PubMed

    Payne, Jennifer I; Dunbar, Margaret J; Talbot, Pamela; Tan, Meng H

    2017-08-16

    The Diabetes Care Program of Nova Scotia (DCPNS)'s mission is "to improve, through leadership and partnerships, the health of Nova Scotians living with, affected by, or at risk of developing diabetes." Working together with local, provincial and national partners, the DCPNS has improved and standardized diabetes care in Nova Scotia over the past 25 years by developing and deploying a resourceful and collaborative program model. This article describes the model and highlights its key achievements. With balanced representation from frontline providers through to senior decision makers in health care, the DCPNS works across the age continuum, supporting the implementation of national clinical practice guidelines and, when necessary, developing provincial guidelines to meet local needs. The development and implementation of standardized documentation and data collection tools in all diabetes centres created a robust opportunity for the development and expansion of the DCPNS registry. This registry provides useful clinical and statistical information to staff, providers within the circle of care, management and senior leadership. Data are used to support individual care, program planning, quality improvement and business planning at both the local and the provincial levels. The DCPNS supports the sharing of new knowledge and advances through continuous education for providers. The DCPNS's ability to engage diabetes educators and key physician champions has ensured balanced perspectives in the creation of tools and resources that can be effective in real-world practice. The DCPNS has evolved to become an illustrative example of the chronic care model in action. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

  10. [Primary care for diabetic patients: a quality improvement cycle].

    PubMed

    Navarro-Martínez, A; Suárez-Beke, M P; Sánchez-Nicolás, J A; Lázaro-Aragues, P; de Jesús Jiménez-Vázquez, E; Huertas-de Mora, O

    2014-01-01

    The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association. The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed. An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl in 2012. This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  11. Canagliflozin: Improving diabetes by making urine sweet.

    PubMed

    Vouyiouklis, Mary

    2013-11-01

    Canagliflozin is the first sodium-glucose cotransport 2 (SGLT2) inhibitor approved in the United States for treating type 2 diabetes mellitus. This drug blocks reabsorption of glucose in the proximal tubule, lowering the renal threshold for glucose and thereby increasing glucose excretion. Its novel mechanism of action is insulin-independent. Trials have demonstrated reductions in fasting glucose and hemoglobin A1c levels, with the added benefit of weight loss. The adverse effects most often reported include genital yeast infections and urinary tract infections. Ongoing trials will further elucidate possible long-term risks of this drug.

  12. Trends in the Risk for Cardiovascular Disease among Adults with Diabetes in Oman

    PubMed Central

    Al-Lawati, Jawad; Morsi, Magdi; Al-Riyami, Asya; Mabry, Ruth; El-Sayed, Medhat; El-Aty, Mahmoud Abd; Al-Lawati, Hawra

    2015-01-01

    Objectives: This study aimed to investigate trends in the estimated 10-year risk for developing cardiovascular disease (CVD) among adults with diagnosed diabetes in Oman. In addition, the effect of hypothetical risk reductions in this population was examined. Methods: Data from 1,077 Omani adults aged ≥40 years with diagnosed diabetes were collected and analysed from three national surveys conducted in 1991, 2000 and 2008 across all regions of Oman. The estimated 10-year CVD risk and hypothetical risk reductions were calculated using risk prediction algorithms from the Systematic COronary Risk Evaluation (SCORE), Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) and World Health Organization/International Society of Hypertension (WHO/ISH) risk tools. Results: Between 1991 and 2008, the estimated 10-year risk of CVD increased significantly in the total sample and among both genders, regardless of the risk prediction algorithm that was used. Hypothetical risk reduction models for three scenarios (eliminating smoking, controlling systolic blood pressure and reducing total cholesterol) identified that reducing systolic blood pressure to ≤130 mmHg would lead to the largest reduction in the 10-year risk of CVD in subjects with diabetes. Conclusion: The estimated 10-year risk for CVD among adults with diabetes increased significantly between 1991 and 2008 in Oman. Focused public health initiatives, involving recognised interventions to address behavioural and biological risks, should be a national priority. Improvements in the quality of care for diabetic patients, both at the individual and the healthcare system level, are required. PMID:25685383

  13. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

    PubMed

    Martín-Timón, Iciar; Sevillano-Collantes, Cristina; Segura-Galindo, Amparo; Del Cañizo-Gómez, Francisco Javier

    2014-08-15

    Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from "common soil". The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients.

  14. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

    PubMed Central

    Martín-Timón, Iciar; Sevillano-Collantes, Cristina; Segura-Galindo, Amparo; del Cañizo-Gómez, Francisco Javier

    2014-01-01

    Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from “common soil”. The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients. PMID:25126392

  15. Importance of risk factor management in diabetic patients and reduction in Stage B heart failure.

    PubMed

    Murtagh, G; O Connell, J; O Connell, E; Tallon, E; Watson, C; Gallagher, J; Baugh, J; Patle, A; O Connell, L; Griffin, J; O'Hanlon, R; Voon, V; Ledwidge, M; O Shea, D; McDonald, K

    2015-04-01

    A number of studies have demonstrated the presence of a diabetic cardiomyopathy, increasing the risk of heart failure development in this population. Improvements in present-day risk factor control may have modified the risk of diabetes-associated cardiomyopathy. We sought to determine the contemporary impact of diabetes mellitus (DM) on the prevalence of cardiomyopathy in at-risk patients with and without adjustment for risk factor control. A cross-sectional study in a population at risk for heart failure. Those with diabetes were compared to those with other cardiovascular risk factors, unmatched, matched for age and gender and then matched for age, gender, body mass index, systolic blood pressure and low density lipoprotein cholesterol. In total, 1399 patients enrolled in the St Vincent's Screening to Prevent Heart Failure (STOP-HF) cohort were included. About 543 participants had an established history of DM. In the whole sample, Stage B heart failure (asymptomatic cardiomyopathy) was not found more frequently among the diabetic cohort compared to those without diabetes [113 (20.8%) vs. 154 (18.0%), P = 0.22], even when matched for age and gender. When controlling for these risk factors and risk factor control Stage B was found to be more prevalent in those with diabetes [88 (22.2%)] compared to those without diabetes [65 (16.4%), P = 0.048]. In this cohort of patients with established risk factors for Stage B heart failure superior risk factor management among the diabetic population appears to dilute the independent diabetic insult to left ventricular structure and function, underlining the importance and benefit of effective risk factor control in this population on cardiovascular outcomes. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. One Egg per Day Improves Inflammation when Compared to an Oatmeal-Based Breakfast without Increasing Other Cardiometabolic Risk Factors in Diabetic Patients

    PubMed Central

    Ballesteros, Martha Nydia; Valenzuela, Fabrizio; Robles, Alma E.; Artalejo, Elizabeth; Aguilar, David; Andersen, Catherine J.; Valdez, Herlindo; Fernandez, Maria Luz

    2015-01-01

    There is concern that egg intake may increase blood glucose in patients with type 2 diabetes mellitus (T2DM). However, we have previously shown that eggs reduce inflammation in patients at risk for T2DM, including obese subjects and those with metabolic syndrome. Thus, we hypothesized that egg intake would not alter plasma glucose in T2DM patients when compared to oatmeal intake. Our primary endpoints for this clinical intervention were plasma glucose and the inflammatory markers tumor necrosis factor (TNF)-α and interleukin 6 (IL-6). As secondary endpoints, we evaluated additional parameters of glucose metabolism, dyslipidemias, oxidative stress and inflammation. Twenty-nine subjects, 35–65 years with glycosylated hemoglobin (HbA1c) values <9% were recruited and randomly allocated to consume isocaloric breakfasts containing either one egg/day or 40 g of oatmeal with 472 mL of lactose-free milk/day for five weeks. Following a three-week washout period, subjects were assigned to the alternate breakfast. At the end of each period, we measured all primary and secondary endpoints. Subjects completed four-day dietary recalls and one exercise questionnaire for each breakfast period. There were no significant differences in plasma glucose, our primary endpoint, plasma lipids, lipoprotein size or subfraction concentrations, insulin, HbA1c, apolipoprotein B, oxidized LDL or C-reactive protein. However, after adjusting for gender, age and body mass index, aspartate amino-transferase (AST) (p < 0.05) and tumor necrosis factor (TNF)-α (p < 0.01), one of our primary endpoints were significantly reduced during the egg period. These results suggest that compared to an oatmeal-based breakfast, eggs do not have any detrimental effects on lipoprotein or glucose metabolism in T2DM. In contrast, eggs reduce AST and TNF-α in this population characterized by chronic low-grade inflammation. PMID:25970149

  17. One Egg per Day Improves Inflammation when Compared to an Oatmeal-Based Breakfast without Increasing Other Cardiometabolic Risk Factors in Diabetic Patients.

    PubMed

    Ballesteros, Martha Nydia; Valenzuela, Fabrizio; Robles, Alma E; Artalejo, Elizabeth; Aguilar, David; Andersen, Catherine J; Valdez, Herlindo; Fernandez, Maria Luz

    2015-05-11

    There is concern that egg intake may increase blood glucose in patients with type 2 diabetes mellitus (T2DM). However, we have previously shown that eggs reduce inflammation in patients at risk for T2DM, including obese subjects and those with metabolic syndrome. Thus, we hypothesized that egg intake would not alter plasma glucose in T2DM patients when compared to oatmeal intake. Our primary endpoints for this clinical intervention were plasma glucose and the inflammatory markers tumor necrosis factor (TNF)-α and interleukin 6 (IL-6). As secondary endpoints, we evaluated additional parameters of glucose metabolism, dyslipidemias, oxidative stress and inflammation. Twenty-nine subjects, 35-65 years with glycosylated hemoglobin (HbA1c) values <9% were recruited and randomly allocated to consume isocaloric breakfasts containing either one egg/day or 40 g of oatmeal with 472 mL of lactose-free milk/day for five weeks. Following a three-week washout period, subjects were assigned to the alternate breakfast. At the end of each period, we measured all primary and secondary endpoints. Subjects completed four-day dietary recalls and one exercise questionnaire for each breakfast period. There were no significant differences in plasma glucose, our primary endpoint, plasma lipids, lipoprotein size or subfraction concentrations, insulin, HbA1c, apolipoprotein B, oxidized LDL or C-reactive protein. However, after adjusting for gender, age and body mass index, aspartate amino-transferase (AST) (p < 0.05) and tumor necrosis factor (TNF)-α (p < 0.01), one of our primary endpoints were significantly reduced during the egg period. These results suggest that compared to an oatmeal-based breakfast, eggs do not have any detrimental effects on lipoprotein or glucose metabolism in T2DM. In contrast, eggs reduce AST and TNF-α in this population characterized by chronic low-grade inflammation.

  18. Lipid profiling identifies a triacylglycerol signature of insulin resistance and improves diabetes prediction in humans

    PubMed Central

    Rhee, Eugene P.; Cheng, Susan; Larson, Martin G.; Walford, Geoffrey A.; Lewis, Gregory D.; McCabe, Elizabeth; Yang, Elaine; Farrell, Laurie; Fox, Caroline S.; O’Donnell, Christopher J.; Carr, Steven A.; Vasan, Ramachandran S.; Florez, Jose C.; Clish, Clary B.; Wang, Thomas J.; Gerszten, Robert E.

    2011-01-01

    Dyslipidemia is an independent risk factor for type 2 diabetes, although exactly which of the many plasma lipids contribute to this remains unclear. We therefore investigated whether lipid profiling can inform diabetes prediction by performing liquid chromatography/mass spectrometry–based lipid profiling in 189 individuals who developed type 2 diabetes and 189 matched disease-free individuals, with over 12 years of follow up in the Framingham Heart Study. We found that lipids of lower carbon number and double bond content were associated with an increased risk of diabetes, whereas lipids of higher carbon number and double bond content were associated with decreased risk. This pattern was strongest for triacylglycerols (TAGs) and persisted after multivariable adjustment for age, sex, BMI, fasting glucose, fasting insulin, total triglycerides, and HDL cholesterol. A combination of 2 TAGs further improved diabetes prediction. To explore potential mechanisms that modulate the distribution of plasma lipids, we performed lipid profiling during oral glucose tolerance testing, pharmacologic interventions, and acute exercise testing. Levels of TAGs associated with increased risk for diabetes decreased in response to insulin action and were elevated in the setting of insulin resistance. Conversely, levels of TAGs associated with decreased diabetes risk rose in response to insulin and were poorly correlated with insulin resistance. These studies identify a relationship between lipid acyl chain content and diabetes risk and demonstrate how lipid profiling could aid in clinical risk assessment. PMID:21403394

  19. Childhood type 2 diabetes: Risks and complications

    PubMed Central

    Xue, Ying; Gao, Min; Gao, Yiqing

    2016-01-01

    The universal endocrine pathological state affecting young individuals and adults is type 2 diabetes mellitus, which has seen a significant increase in the last 30 years, particularly in children. Genetic and evnironmental factors are the causative agents for this pathological state in children. This rapid and wide spread of the disease can be controlled by enforcing amendments in environmental factors such as diet, physical activities and obesity. In young infants breastfeeding may be a key modulator of the disease. Associated disorders co-observed in the patients of type 2 diabetes mellitus include renal failure, heart problems and circulatory dysfunctionalities, such as cardiac failure and vision disability. These associated disorders become more pronounced in young patients when they reach puberty. To overcome the lethal outcomes of the disease, early screening of the disease is crucial. The present review focused on the latest updates in the field, as well as plausible risks and complications of this pathological state. PMID:27703500

  20. Early nutrition and later diabetes risk.

    PubMed

    Knip, Mikael; Akerblom, Hans K

    2005-01-01

    Early feeding may modify the risk of both type 1 (T1D) and type 2 diabetes (T2D) later in life. The information generated so far is, however, controversial. When evaluating studies on the impact of early feeding on risk of later diabetes, the data have to be assessed critically and possible confounding factors have to be considered. The study design may induce biases and there are considerable differences in early feeding practices across various countries and cultures. Accordingly it may not be possible to generalise observations based on one population. Long breastfeeding, exclusive breastfeeding in particular, and supplementation with vitamin D in infancy have been reported to confer partial protection against beta-cell autoimmunity and TID. In contrast, early exposure to cow's milk proteins and cereals and heavy weight in infancy have been implicated as risk factors for T1D. Long breastfeeding has also been observed to protect against T2D in aboriginal populations. Poor fetal nutrition resulting in low birth weight has been identified as a factor contributing to later insulin resistance and T2D. Recent data indicate that current overweight and obesity are stronger determinants of insulin resistance than birth weight among preschool children. High-nutrient diet and rapid growth in early infancy have been reported to adversely programme the principal components of the metabolic syndrome including insulin resistance and T2D. It is an important scientific and public-health objective to define protective and predisposing effects of early nutrition on the development of diabetes, since early feeding can potentially be modified to minimise the risk of later chronic diseases.

  1. Area under the curve during OGTT in first degree relatives of diabetic patients as an efficient indicator of future risk of type 2 diabetes and pre-diabetes.

    PubMed

    Feizi, Awat; Meamar, Rokhsareh; Eslamian, Mohammad; Amini, Massoud; Nasri, Maryam; Iraj, Bijan

    2017-08-09

    To establish whether the area under the curve of an OGTT has a predictive role in identifying pre-diabetic and diabetic subjects amongst first-degree relatives (FDR) of patients with diabetes mellitus type 2 (DM). In a population-based cohort study, 766 FDR of diabetic patients with a normal glucose tolerance test (NGT) completed a 2-h OGTT. They were followed up for 7 years and classified according to the American Diabetes Association criteria into: NGT, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and DM. Relative risk (RR) and 95% confidence intervals (95%CI) were calculated based on logistic regression. Receiver-Operator Characteristic (ROC) analysis along with AUC at different intervals and at time points during the OGTT was used to evaluate the risk of pre-diabetes and diabetes. Twenty-three subjects (3%) developed type 2 DM, 118 (29.3%) IFG, 81 (11.5%) IGT and 544 (71%) subjects remained NGT. AUC and mean difference of glucose in all high-risk groups demonstrated significant differences both in intervals and time points when compared with the NGT group. The cutoff values during OGTT to predict pre-diabetes and diabetes was determined as blood glucose more than 7.2 and 7.8mmol/l at 30 and 60 minutes, respectively. The time point 60 has the highest predictive role for the development of diabetes, alone, and improved the performance of a prediction model containing multiple important clinical risk factors. The data suggests that the glycaemic response to an OGTT may predict the risk of development of diabetes in first-degree relatives of DM patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  2. Call to action: A new path for improving diabetes care for Indigenous peoples, a global review.

    PubMed

    Harris, Stewart B; Tompkins, Jordan W; TeHiwi, Braden

    2017-01-01

    Diabetes has reached epidemic proportions in Indigenous populations around the globe, and there is an urgent need to improve the health and health equity of Indigenous peoples with diabetes through timely and appropriate diabetes prevention and management strategies. This review describes the evolution of the diabetes epidemic in Indigenous populations and associated risk factors, highlighting gestational diabetes and intergenerational risk, lifestyle risk factors and social determinants as having particular importance and impact on Indigenous peoples. This review further describes the impact of chronic disease and diabetes on Indigenous peoples and communities, specifically diabetes-related comorbidities and complications. This review provides continued evidence that dramatic changes are necessary to reduce diabetes-related inequities in Indigenous populations, with a call to action to support programmatic primary healthcare transformation capable of empowering Indigenous peoples and communities and improving chronic disease prevention and management. Promising strategies for transforming health services and care for Indigenous peoples include quality improvement initiatives, facilitating diabetes and chronic disease registry and surveillance systems to identify care gaps, and prioritizing evaluation to build the evidence-base necessary to guide future health policy and planning locally and on a global scale. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Risk factor control is key in diabetic nephropathy.

    PubMed

    Lewis, Gareth; Maxwell, Alexander P

    2014-02-01

    Prolonged duration of diabetes, poor glycaemic control and hypertension are major risk factors for both diabetic nephropathy and cardiovascular disease. Optimising blood sugar control together with excellent control of blood pressure can reduce the risk of developing diabetic nephropathy. Diabetic nephropathy should be considered in any patient with diabetes when persistent albuminuria develops. Microalbuminuria is the earliest clinically detectable indicator of diabetic nephropathy risk. The majority of patients with diabetic nephropathy are appropriately diagnosed based on elevated urinary albumin excretion and/or reduced 0032-6518 renal function. Patients with type 2 diabetes should have annual urinary ACR measurements from the time of diabetes diagnosis while those with type 1 diabetes should commence five years after diagnosis. Blood pressure lowering to 130/80mmHg and reduction of proteinuria to <1 g/day retards progression of diabetic nephropathy and reduces the number of cardiovascular events. Drugs that block the renin-angiotensin-aldosterone system (RAAS) are effective in reducing proteinuria, managing hypertension and reducing cardiovascular risk. Unless there are clear contraindications or intolerance all patients with diabetic nephropathy should be prescribed an ACEI or ARB. Stopping an ACEI or ARB during intercurrent illness or times of volume depletion is critically important. Patients with diabetic nephropathy should have at least yearly measurements of blood pressure, renal function and urinary ACR.

  4. Natural Products for the Prevention and Alleviation of Risk Factors for Diabetes: Chromium and Cinnamon

    USDA-ARS?s Scientific Manuscript database

    Natural products are widespread for the alleviation and prevention of the risk factors of the metabolic syndrome and diabetes. We have shown that glucose, insulin, cholesterol, and hemoglobin A1c levels are all improved in people with type 2 diabetes following chromium supplementation in a double-b...

  5. Novel metabolic markers for the risk of diabetes development in American Indians.

    PubMed

    Zhao, Jinying; Zhu, Yun; Hyun, Noorie; Zeng, Donglin; Uppal, Karan; Tran, ViLinh T; Yu, Tianwei; Jones, Dean; He, Jiang; Lee, Elisa T; Howard, Barbara V

    2015-02-01

    To identify novel metabolic markers for diabetes development in American Indians. Using an untargeted high-resolution liquid chromatography-mass spectrometry, we conducted metabolomics analysis of study participants who developed incident diabetes (n = 133) and those who did not (n = 298) from 2,117 normoglycemic American Indians followed for an average of 5.5 years in the Strong Heart Family Study. Relative abundances of metabolites were quantified in baseline fasting plasma of all 431 participants. Prospective association of each metabolite with risk of developing type 2 diabetes (T2D) was examined using logistic regression adjusting for established diabetes risk factors. Seven metabolites (five known and two unknown) significantly predict the risk of T2D. Notably, one metabolite matching 2-hydroxybiphenyl was significantly associated with an increased risk of diabetes, whereas four metabolites matching PC (22:6/20:4), (3S)-7-hydroxy-2',3',4',5',8-pentamethoxyisoflavan, or tetrapeptides were significantly associated with decreased risk of diabetes. A multimarker score comprising all seven metabolites significantly improved risk prediction beyond established diabetes risk factors including BMI, fasting glucose, and insulin resistance. The findings suggest that these newly detected metabolites may represent novel prognostic markers of T2D in American Indians, a group suffering from a disproportionately high rate of T2D. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  6. Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease

    PubMed Central

    Diaz, Lars J.; Leirgul, Elisabeth; Boyd, Heather A.; Priest, James; Mathiesen, Elisabeth R.; Quertermous, Thomas; Wohlfahrt, Jan; Melbye, Mads

    2016-01-01

    Background— Maternal diabetes mellitus is associated with an increased risk of offspring congenital heart defects (CHD); however, the causal mechanism is poorly understood. We further investigated this association in a Danish nationwide cohort. Methods and Results— In a national cohort study, we identified 2 025 727 persons born from 1978 to 2011; among them were 7296 (0.36%) persons exposed to maternal pregestational diabetes mellitus. Pregestational diabetes mellitus was identified by using the National Patient Register and individual-level information on all prescriptions filled in Danish pharmacies. Persons with CHD (n=16 325) were assigned to embryologically related cardiac phenotypes. The CHD prevalence in the offspring of mothers with pregestational diabetes mellitus was 318 per 10 000 live births (n=232) in comparison with a baseline risk of 80 per 10 000; the adjusted relative risk for CHD was 4.00 (95% confidence interval, 3.51–4.53). The association was not modified by year of birth, maternal age at diabetes onset, or diabetes duration, and CHD risks associated with type 1 (insulin-dependent) and type 2 (insulin-independent) diabetes mellitus did not differ significantly. Persons born to women with previous acute diabetes complications had a higher CHD risk than those exposed to maternal diabetes mellitus without complications (relative risk, 7.62; 95% confidence interval, 5.23–10.6, and relative risk, 3.49; 95% confidence interval, 2.91–4.13, respectively; P=0.0004). All specific CHD phenotypes were associated with maternal pregestational diabetes mellitus (relative risk range, 2.74–13.8). Conclusions— The profoundly increased CHD risk conferred by maternal pregestational diabetes mellitus neither changed over time nor differed by diabetes subtype. The association with acute pregestational diabetes complications was particularly strong, suggesting a role for glucose in the causal pathway. PMID:27166384

  7. Improving risk literacy in surgeons.

    PubMed

    Garcia-Retamero, Rocio; Cokely, Edward T; Wicki, Barbara; Joeris, Alexander

    2016-07-01

    To effectively practice evidence-based medicine, surgeons need to understand and be able to communicate health-relevant numerical information. We present the first study examining risk literacy in surgeons by assessing numeracy and surgical risk comprehension. Our study also investigated whether visual aids improve risk comprehension in surgeons with limited numeracy. Participants were 292 surgeons from 60 countries who completed an instrument measuring numeracy and evaluated the results of a randomized controlled trial including post-surgical side-effects. Half of the surgeons received this information in numbers. The other half received the information represented visually. Accuracy of risk estimation, reading latency, and estimate latency (i.e., deliberation) were assessed. Some surgeons have low numeracy and could not correctly interpret surgical risks without additional support. Visual aids made risks transparent and eliminated differences in risk understanding between more and less numerate surgeons, increasing the amount of time that less numerate surgeons spent deliberating about risks. Visual aids can be an efficient and inexpensive means of improving risk comprehension and clinical judgement in surgeons with low numerical and statistical skills. Programs designed to help professionals represent and communicate health-relevant numerical information in simple transparent graphs may unobtrusively promote informed decision making. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Pre-Diabetes Non-Modifiable Risk Factors

    MedlinePlus

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Pre-diabetes Non-modifiable Risk Factors Updated:Nov 9,2015 ... This content was last reviewed August 2015. Pre-diabetes • Introduction • About Pre-diabetes • What's the Problem? Intro ...

  9. Prevalence of Risk for Type 2 Diabetes in School Children

    ERIC Educational Resources Information Center

    Urrutia-Rojas, Ximena; Menchaca, John

    2006-01-01

    According to the Centers for Disease Control and Prevention, 1 in 3 children born in 2000 in the United States will become diabetic. The odds are higher for African American and Hispanic children as nearly 50% of them will develop diabetes. Random screening is not effective in identifying children at risk for type 2 diabetes mellitus (T2DM);…

  10. Prevalence of Risk for Type 2 Diabetes in School Children

    ERIC Educational Resources Information Center

    Urrutia-Rojas, Ximena; Menchaca, John

    2006-01-01

    According to the Centers for Disease Control and Prevention, 1 in 3 children born in 2000 in the United States will become diabetic. The odds are higher for African American and Hispanic children as nearly 50% of them will develop diabetes. Random screening is not effective in identifying children at risk for type 2 diabetes mellitus (T2DM);…

  11. The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

    PubMed Central

    Gow, Megan L.; Garnett, Sarah P.; Baur, Louise A.; Lister, Natalie B.

    2016-01-01

    Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet. PMID:27517953

  12. The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth.

    PubMed

    Gow, Megan L; Garnett, Sarah P; Baur, Louise A; Lister, Natalie B

    2016-08-09

    Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet.

  13. Updated risk factors should be used to predict development of diabetes.

    PubMed

    Bethel, Mary Angelyn; Hyland, Kristen A; Chacra, Antonio R; Deedwania, Prakash; Fulcher, Gregory R; Holman, Rury R; Jenssen, Trond; Levitt, Naomi S; McMurray, John J V; Boutati, Eleni; Thomas, Laine; Sun, Jie-Lena; Haffner, Steven M

    2017-05-01

    Predicting incident diabetes could inform treatment strategies for diabetes prevention, but the incremental benefit of recalculating risk using updated risk factors is unknown. We used baseline and 1-year data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) Trial to compare diabetes risk prediction using historical or updated clinical information. Among non-diabetic participants reaching 1year of follow-up in NAVIGATOR, we compared the performance of the published baseline diabetes risk model with a "landmark" model incorporating risk factors updated at the 1-year time point. The C-statistic was used to compare model discrimination and reclassification analyses to demonstrate the relative accuracy of diabetes prediction. A total of 7527 participants remained non-diabetic at 1year, and 2375 developed diabetes during a median of 4years of follow-up. The C-statistic for the landmark model was higher (0.73 [95% CI 0.72-0.74]) than for the baseline model (0.67 [95% CI 0.66-0.68]). The landmark model improved classification to modest (<20%), moderate (20%-40%), and high (>40%) 4-year risk, with a net reclassification index of 0.14 (95% CI 0.10-0.16) and an integrated discrimination index of 0.01 (95% CI 0.003-0.013). Using historical clinical values to calculate diabetes risk reduces the accuracy of prediction. Diabetes risk calculations should be routinely updated to inform discussions about diabetes prevention at both the patient and population health levels. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Improvement of Recalcitrant Diabetic Macular Edema After Peritoneal Dialysis.

    PubMed

    Ong, Sally S; Thomas, Akshay S; Fekrat, Sharon

    2017-10-01

    Nephropathy may be an independent and contributory risk factor for diabetic macular edema (DME). A 69-year-old man who had previously been treated with panretinal laser photocoagulation for proliferative diabetic retinopathy as well as with steroid and anti-vascular endothelial growth factor injections for DME declined additional treatment for the DME, which was worse in the right eye. The DME was observed without further treatment for the next 36 months. Despite well-controlled blood sugar, blood pressure, and lipid levels, the DME remained unchanged. Peritoneal dialysis was started due to end-stage renal disease. Three months after commencing dialysis, the DME improved significantly. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:834-837.]. Copyright 2017, SLACK Incorporated.

  15. Diabetes awareness and diabetes risk reduction behaviors among attendance of primary healthcare centers.

    PubMed

    Al-Khawaldeh, Omar A; Al-Jaradeen, Najah

    2013-01-01

    The aims of this study were to assess level of awareness about diabetes and the level of adoption of diabetes risk behaviors among adult attending primary healthcare centers. A cross-sectional descriptive study was conducted using a self-administrated questionnaire. In addition to demographic information, the questionnaire contained questions on diabetes awareness related to diabetes definition, symptoms, risk factors, complications and management of diabetes as well as questions on diabetes risk reduction behaviors and sources of information on diabetes. The data was analyzed with independent t-test, Pearson's correlation coefficient, and ANOVA test. A total of 541 participants aged ≥ 18 years were recruited. The mean score of diabetes awareness was 27.5/40 [SD=5.7]. The participants performed best in symptoms section with a mean score of 6.3/8 [SD=1.6], and worst in the risk factors section with a mean score of 3.6/6 (SD=1.4). With respect to diabetes risk reduction behaviors the results showed that the highest mean score was for fat reduction 2.0/4 [SD=0.8]; and the lowest mean score was for weight control or losing 1.7/4 [SD=0.8]. The current study demonstrated that substantial numbers of adult Jordanian lack the sufficient awareness about diabetes to prevent and cope with the increasing prevalence of diabetes in Jordan. Also, it demonstrated that adoption of diabetes risk reduction behaviors was suboptimal. Raising public awareness of diabetes and diabetes risk reduction behaviors through population-based programs and mass media should be planned and implemented. Copyright © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  16. Occupational chemical exposure and diabetes mellitus risk.

    PubMed

    Leso, Veruscka; Capitanelli, Ilaria; Lops, Erika Alessandra; Ricciardi, Walter; Iavicoli, Ivo

    2017-03-01

    Diabetes mellitus (DM) is a group of metabolic diseases that may originate from an interaction between genetic and lifestyle risk factors. However, the possible role of occupational chemical exposures in the disease development and progression remains unclear. Therefore, this review aimed to provide a comprehensive evaluation of the relationship between occupational exposure to specific chemical substances or industrial activities and DM morbidity and mortality outcomes. Although some positive findings may support the diabetogenic role of certain pesticides and dioxins in different workplaces, the variable conditions of exposure, the lack of quantitative environmental or biological monitoring data and the different outcomes evaluated do not allow defining a specific exposure-disease causality. Therefore, further epidemiological studies will be necessary to adequately assess modes of action for different substances, dose-response relationships as well as individual susceptibility factors potentially affecting the exposure-disease continuum. Overall, this appears important to adequately assess, communicate and manage risks in occupational chemical exposure settings with the aim to protect workers and build healthier job conditions for diabetic employees.

  17. Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality

    PubMed Central

    Magee, M. J.; Foote, M.; Ray, S. M.; Gandhi, N. R.; Kempker, R. R.

    2017-01-01

    Summary Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ≥16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27.8%) had any EPTB including 258 (19.5%) with only EPTB and 111 (8.4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11.9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1.04, 95% confidence interval (CI) 0.70–1.56]. The risk of death was 23.8% in patients with EPTB and diabetes vs. 9.8% in those with no diabetes (P < 0.01); after adjusting for covariates the difference was not significant (aRR 1.19, 95% CI 0.54–2.63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management. PMID:26926092

  18. Improving pandemic influenza risk assessment.

    PubMed

    Russell, Colin A; Kasson, Peter M; Donis, Ruben O; Riley, Steven; Dunbar, John; Rambaut, Andrew; Asher, Jason; Burke, Stephen; Davis, C Todd; Garten, Rebecca J; Gnanakaran, Sandrasegaram; Hay, Simon I; Herfst, Sander; Lewis, Nicola S; Lloyd-Smith, James O; Macken, Catherine A; Maurer-Stroh, Sebastian; Neuhaus, Elizabeth; Parrish, Colin R; Pepin, Kim M; Shepard, Samuel S; Smith, David L; Suarez, David L; Trock, Susan C; Widdowson, Marc-Alain; George, Dylan B; Lipsitch, Marc; Bloom, Jesse D

    2014-10-16

    Assessing the pandemic risk posed by specific non-human influenza A viruses is an important goal in public health research. As influenza virus genome sequencing becomes cheaper, faster, and more readily available, the ability to predict pandemic potential from sequence data could transform pandemic influenza risk assessment capabilities. However, the complexities of the relationships between virus genotype and phenotype make such predictions extremely difficult. The integration of experimental work, computational tool development, and analysis of evolutionary pathways, together with refinements to influenza surveillance, has the potential to transform our ability to assess the risks posed to humans by non-human influenza viruses and lead to improved pandemic preparedness and response.

  19. Air Pollution May Raise Risk of Type 2 Diabetes

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_163536.html Air Pollution May Raise Risk of Type 2 Diabetes Study ... Feb. 10, 2017 (HealthDay News) -- High levels of air pollution may increase some Hispanic children's risk of type ...

  20. Novel Metabolic Markers for the Risk of Diabetes Development in American Indians

    PubMed Central

    Zhu, Yun; Hyun, Noorie; Zeng, Donglin; Uppal, Karan; Tran, ViLinh T.; Yu, Tianwei; Jones, Dean; He, Jiang; Lee, Elisa T.; Howard, Barbara V.

    2015-01-01

    OBJECTIVE To identify novel metabolic markers for diabetes development in American Indians. RESEARCH DESIGN AND METHODS Using an untargeted high-resolution liquid chromatography–mass spectrometry, we conducted metabolomics analysis of study participants who developed incident diabetes (n = 133) and those who did not (n = 298) from 2,117 normoglycemic American Indians followed for an average of 5.5 years in the Strong Heart Family Study. Relative abundances of metabolites were quantified in baseline fasting plasma of all 431 participants. Prospective association of each metabolite with risk of developing type 2 diabetes (T2D) was examined using logistic regression adjusting for established diabetes risk factors. RESULTS Seven metabolites (five known and two unknown) significantly predict the risk of T2D. Notably, one metabolite matching 2-hydroxybiphenyl was significantly associated with an increased risk of diabetes, whereas four metabolites matching PC (22:6/20:4), (3S)-7-hydroxy-2′,3′,4′,5′,8-pentamethoxyisoflavan, or tetrapeptides were significantly associated with decreased risk of diabetes. A multimarker score comprising all seven metabolites significantly improved risk prediction beyond established diabetes risk factors including BMI, fasting glucose, and insulin resistance. CONCLUSIONS The findings suggest that these newly detected metabolites may represent novel prognostic markers of T2D in American Indians, a group suffering from a disproportionately high rate of T2D. PMID:25468946

  1. A school-based intervention for diabetes risk reduction

    USDA-ARS?s Scientific Manuscript database

    We examined the effects of a multicomponent, school-based program, addressing risk factors for diabetes among children whose race, or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. Using a cluster design, we randomly assigned 42 schools to either a mu...

  2. Improving adherence and outcomes in diabetic patients

    PubMed Central

    Joshi, Renu; Joshi, Disha; Cheriyath, Pramil

    2017-01-01

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

  3. Effects of Exenatide on Diabetes, Obesity, Cardiovascular Risk Factors, and Hepatic Biomarkers in Patients with Type 2 Diabetes

    PubMed Central

    Nielsen, Loretta L.; Okerson, Ted; Holcombe, John; Hoogwerf, Byron

    2008-01-01

    Obesity increases the risk of diabetes up to 90-fold and worsens hyperglycemia, hyperinsulinemia, insulin resistance, dyslipidemia, and nonalcoholic fatty liver disease. For patients with type 2 diabetes, weight loss can trigger improvements in all these conditions and decrease the need for glucose-lowering agents. The incretin mimetic exenatide shares many glucoregulatory properties with native glucagon-like peptide-1, including enhancement of glucose-dependent insulin secretion, glucose-dependent suppression of inappropriately high glucagon secretion, slowing of gastric emptying, and reduction of food intake in patients with type 2 diabetes. Exenatide treatment was associated with progressive weight loss in the majority of patients in clinical trials. In addition, patients with elevated markers of liver injury at baseline showed improvements. Therefore, exenatide represents a unique option for adjunctive therapy for patients with type 2 diabetes not achieving adequate glycemic control on oral antidiabetic agents, especially in patients for whom weight gain would be an additional contraindication. PMID:19885351

  4. Incentivizing behavior change to improve diabetes care

    PubMed Central

    Petry, Nancy M.; Cengiz, Eda; Wagner, Julie A.; Hood, Korey K.; Carria, Lori; Tamborlane, William V.

    2013-01-01

    Behavioral economics refers to the study of psychological and cognitive factors that relate to decision-making processes. This field is being applied increasingly to health care settings, in which patients receive tangible reinforcers or incentives for meeting objective behavioral criteria consistent with healthy lifestyles. This paper reviews the background and efficacy of reinforcement interventions in general, and then as applied to behaviors related to diabetes prevention and management. Specifically, reinforcement interventions have been applied with some notable success toward promoting greater attendance at medical appointments, enhancing weight loss efforts, augmenting exercising regimes, improving medication adherence, and increasing blood glucose monitoring. Suggestions for promising areas of future research are provided, keeping in mind the controversial nature of these interventions. PMID:23574494

  5. Increased cardiovascular risk associated with diabetes in Dallas County.

    PubMed

    Das, Sandeep R; Vaeth, Patrice A C; Stanek, Harold G; de Lemos, James A; Dobbins, Robert L; McGuire, Darren K

    2006-05-01

    Diabetes mellitus is a major public health problem in the United States. We assess the prevalence of diabetes in Dallas County, quantify the association between diabetes and subclinical cardiovascular disease, and assess the use of evidence-based cardiovascular disease risk-modifying therapies. This study uses data from 3392 participants aged 30 to 65 years from the Dallas Heart Study, a probability-based, multiethnic sample of residents living in Dallas County, Texas. Three primary outcomes were examined: (1) diabetes prevalence, (2) adjusted odds ratios for detectable coronary calcium stratified by diabetes diagnosis status, and (3) rates of use of evidence-based cardiovascular disease risk-modifying therapies among subjects with diabetes stratified by diabetes diagnosis status. The estimated prevalence of diabetes in Dallas County was 7.8%, with >40% of diabetic patients undiagnosed before participation in the Dallas Heart Study. Both previously diagnosed and previously undiagnosed diabetes were independently associated with the presence of coronary artery calcium (diagnosed: OR 3.55, 95% CI 1.56-8.05) (undiagnosed: OR 2.98, 95% CI 1.39-6.39). The rates of use of aspirin, angiotensin-converting enzyme inhibitors, and statins were suboptimal, and blood pressure and low-density lipoprotein cholesterol targets were rarely met, especially among subjects with previously undiagnosed diabetes. Diabetes is prevalent and is associated with subclinical cardiovascular disease; this association is present even at the time of diagnosis. Despite the cardiovascular risk associated with diabetes, evidence-based risk-modifying therapies continue to be underused, and therapeutic targets remain unmet, especially among people unaware of their diabetes diagnosis.

  6. Know your diabetes risk project: Student pharmacists educating adults about diabetes risk in a community pharmacy setting.

    PubMed

    Letassy, Nancy; Dennis, Vincent; Lyons, Timothy J; Harrison, Don; Burton, Michael; Kirkpatrick, Alice

    To determine the feasibility of educating adults about their risk of prediabetes/diabetes in a community pharmacy, to determine the common risk factors for prediabetes/diabetes in adults visiting a community pharmacy, and to assess any association between risk factors and age. Cross sectional. Oklahoma community pharmacies between April 1 and December 31, 2008. 1,852 patients aged 18 to 80 years. Student pharmacists invited adults to complete a survey to assess their risk for diabetes/prediabetes. Students reviewed participants' risk and educated them on lifestyle changes to lower diabetes risk. Patient risk factors, pharmacy identifier, and pharmacy type (independent, chain, or clinic pharmacy) and location (rural, suburban, or city). Diabetes risk assessment and education of 1,852 adults was performed by 110 student pharmacists in 52 community pharmacies located in 27 cities across 13 (of 77) Oklahoma counties. Obesity/overweight was the most common risk factor (57%), with positive family history, hypertension, elevated cholesterol, member of high-risk ethnic group, and sedentary lifestyle being reported by at least 20% of participants. The number of risk factors increased with age, with a significant increase occurring in participants older than 40 years of age. This project demonstrated that it is feasible to perform diabetes risk assessment and to provide education on lowering that risk through community pharmacies.

  7. Interactive Multimedia Tailored to Improve Diabetes Self-Management.

    PubMed

    Wood, Felecia G; Alley, Elizabeth; Baer, Spencer; Johnson, Rebecca

    2015-09-01

    A pilot program was initiated to improve self-management of type 2 diabetes by rural adults. Using an iOS-based, individually tailored pre-/postintervention to improve diabetes self-management, undergraduate students developed a native mobile application to help participants effectively manage their diabetes. Brief quizzes assessed diabetes knowledge. A diabetes dictionary and physical activity assessment provided additional support to users of the app. On completion of the pilot, data analysis indicated increased diabetes knowledge and self-efficacy, and ease of use of the technology. Native app technology permits ready access to important information for those living with type 2 diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update

    PubMed Central

    Burlina, S.; Dalfrà, M. G.

    2016-01-01

    The prevalence of gestational diabetes mellitus is increasing in parallel with the rising prevalence of type 2 diabetes and obesity around the world. Current evidence strongly suggests that women who have had gestational diabetes mellitus are at greater risk of cardiovascular disease later in life. Given the growing prevalence of gestational diabetes mellitus, it is important to identify appropriate reliable markers of cardiovascular disease and specific treatment strategies capable of containing obesity, diabetes, and metabolic syndrome in order to reduce the burden of cardiovascular disease in the women affected. PMID:27956897

  9. Performance of Comorbidity, Risk Adjustment, and Functional Status Measures in Expenditure Prediction for Patients With Diabetes

    PubMed Central

    Maciejewski, Matthew L.; Liu, Chuan-Fen; Fihn, Stephan D.

    2009-01-01

    OBJECTIVE—To compare the ability of generic comorbidity and risk adjustment measures, a diabetes-specific measure, and a self-reported functional status measure to explain variation in health care expenditures for individuals with diabetes. RESEARCH DESIGN AND METHODS—This study included a retrospective cohort of 3,092 diabetic veterans participating in a multisite trial. Two comorbidity measures, four risk adjusters, a functional status measure, a diabetes complication count, and baseline expenditures were constructed from administrative and survey data. Outpatient, inpatient, and total expenditure models were estimated using ordinary least squares regression. Adjusted R2 statistics and predictive ratios were compared across measures to assess overall explanatory power and explanatory power of low- and high-cost subgroups. RESULTS—Administrative data–based risk adjusters performed better than the comorbidity, functional status, and diabetes-specific measures in all expenditure models. The diagnostic cost groups (DCGs) measure had the greatest predictive power overall and for the low- and high-cost subgroups, while the diabetes-specific measure had the lowest predictive power. A model with DCGs and the diabetes-specific measure modestly improved predictive power. CONCLUSIONS—Existing generic measures can be useful for diabetes-specific research and policy applications, but more predictive diabetes-specific measures are needed. PMID:18945927

  10. Performance of comorbidity, risk adjustment, and functional status measures in expenditure prediction for patients with diabetes.

    PubMed

    Maciejewski, Matthew L; Liu, Chuan-Fen; Fihn, Stephan D

    2009-01-01

    To compare the ability of generic comorbidity and risk adjustment measures, a diabetes-specific measure, and a self-reported functional status measure to explain variation in health care expenditures for individuals with diabetes. This study included a retrospective cohort of 3,092 diabetic veterans participating in a multisite trial. Two comorbidity measures, four risk adjusters, a functional status measure, a diabetes complication count, and baseline expenditures were constructed from administrative and survey data. Outpatient, inpatient, and total expenditure models were estimated using ordinary least squares regression. Adjusted R(2) statistics and predictive ratios were compared across measures to assess overall explanatory power and explanatory power of low- and high-cost subgroups. Administrative data-based risk adjusters performed better than the comorbidity, functional status, and diabetes-specific measures in all expenditure models. The diagnostic cost groups (DCGs) measure had the greatest predictive power overall and for the low- and high-cost subgroups, while the diabetes-specific measure had the lowest predictive power. A model with DCGs and the diabetes-specific measure modestly improved predictive power. Existing generic measures can be useful for diabetes-specific research and policy applications, but more predictive diabetes-specific measures are needed.

  11. [Self care and risk factors of diabetic foot in patients with type II diabetes mellitus].

    PubMed

    Moreno Hernández, M I; Trilla Soler, M; Espluga Capdevila, A; Mengual Miralles, N; Bundó Vidiella, M; Juanola Costa, J; Aubà Llambrich, J

    1997-09-15

    To find the amount of self-care (SC), health education (HE) received and the prevalence of risk factors for diabetic foot (RFDF) in patients with type II Diabetes Mellitus (DM) attended in Primary Care. A descriptive crossover study. Primary Care Centre. 100 DM patients attending over 2 months (May and June 1995) to see the doctor or collect prescriptions. Questionnaire on HE, SC habits and social and demographic data, inspection of the feet and physical investigation of lower extremities. 36% had deficient or very deficient hygiene; 73% did not go regularly to the chiropodist, 76% used scissors, 75% did not check the inside of the shoe. 38% had signs of neuropathy and 17%, of peripheric vasculopathy. 25% were at high risk of diabetic foot. Women had more RFDF. The amount of self-care is very low, especially in hygiene, which did not improve over time. HE on foot care is extremely poor despite its being a priority. Educational interventions are required to motivate healthworkers and patients, especially those with most RFDF, in the area of SC.

  12. Effects of Physical Activity on Diabetes Management and Lowering Risk for Type 2 Diabetes

    ERIC Educational Resources Information Center

    Tompkins, Connie L.; Soros, Arlette; Sothern, Melinda S.; Vargas, Alfonso

    2009-01-01

    Physical activity is a proven form of diabetes management and is considered a cornerstone in the prevention of diabetes. In children with diabetes, physical activity may improve insulin sensitivity and glucose uptake in skeletal muscle. Aerobic-based physical activity lasting 40-60 minutes daily for a minimum of four months is shown to enhance…

  13. Pumpers, skypers, surfers and texters: technology to improve the management of diabetes in teenagers.

    PubMed

    Harris, M A; Hood, K K; Mulvaney, S A

    2012-11-01

    A variety of innovative technologies are available to assist with the management of diabetes in teenagers. Technologies include devices that assist with the direct day-to-day management of diabetes including insulin pumps and continuous glucose monitors. These devices are being used more and more with teenagers as a means of improving treatment adherence and glycaemic control. In addition, telehealth is being used to deliver care and support around diabetes management issues for teens with diabetes. Telehealth used in diabetes care for teens includes cell phones and video-conferencing. The goal of this telehealth technology is to support health behaviours and implement behavioural change strategies in a way that is more integrated into the everyday lives of patients and even in the context in which the behaviours occur in 'real time'. Finally, information and support via the Internet are gaining acceptance and use among teens with diabetes as an effective means of strategies for improved diabetes self-care. All three of these broad uses of technology in diabetes in teens represent flexible, innovative, and accessible approaches to improving both diabetes management and glycaemic control in this 'at risk' population. © 2012 Blackwell Publishing Ltd.

  14. Association between diabetes, diabetes treatment and risk of developing endometrial cancer.

    PubMed

    Luo, J; Beresford, S; Chen, C; Chlebowski, R; Garcia, L; Kuller, L; Regier, M; Wactawski-Wende, J; Margolis, K L

    2014-09-23

    A growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women's Health Initiative (WHI). A total of 88 107 postmenopausal women aged 50-79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer. Over a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95% CI: 1.13-1.85 for diabetes, HR=1.57, 95% CI: 1.19-2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95% CI: 1.08-1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer

  15. The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

    PubMed

    Udenze, I C; Azinge, E C; Ebuehi, O A T; Awolola, N A; Adekola, O O; Menkiti, I; Irurhe, N K

    2012-01-01

    In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

  16. Risky Business: Risk Behaviors in Adolescents With Type 1 Diabetes

    PubMed Central

    Jaser, Sarah S.; Yates, Heather; Dumser, Susan; Whittemore, Robin

    2012-01-01

    Purpose The purpose of this article is to review risk behaviors and their health consequences in adolescents with type 1 diabetes. The existing literature on common risk behaviors in adolescents is examined, with a focus on illicit drug use, alcohol use, smoking, unprotected sexual activity, and disordered eating behaviors. Conclusions A review of the literature highlights the lack of studies of risk behaviors in this population. Much of what is known comes from studies with adolescents in the general population or from studies of adults with type 1 diabetes. Known risk and protective factors for risk behaviors and health outcomes are noted. Based on these findings, suggestions are provided for diabetes educators and health care providers to assess for and prevent risk behaviors in adolescents with type 1 diabetes. Directions for future research in this population are indicated, including the need to develop and test standardized prevention programs. PMID:22002971

  17. Prediction of type 1 diabetes using a genetic risk model in the Diabetes Autoimmunity Study in the Young.

    PubMed

    Frohnert, Brigitte I; Laimighofer, Michael; Krumsiek, Jan; Theis, Fabian J; Winkler, Christiane; Norris, Jill M; Ziegler, Anette-Gabriele; Rewers, Marian J; Steck, Andrea K

    2017-07-11

    Genetic predisposition for type 1 diabetes (T1D) is largely determined by human leukocyte antigen (HLA) genes; however, over 50 other genetic regions confer susceptibility. We evaluated a previously reported 10-factor weighted model derived from the Type 1 Diabetes Genetics Consortium to predict the development of diabetes in the Diabetes Autoimmunity Study in the Young (DAISY) prospective cohort. Performance of the model, derived from individuals with first-degree relatives (FDR) with T1D, was evaluated in DAISY general population (GP) participants as well as FDR subjects. The 10-factor weighted risk model (HLA, PTPN22 , INS , IL2RA , ERBB3 , ORMDL3 , BACH2 , IL27 , GLIS3 , RNLS ), 3-factor model (HLA, PTPN22, INS ), and HLA alone were compared for the prediction of diabetes in children with complete SNP data (n = 1941). Stratification by risk score significantly predicted progression to diabetes by Kaplan-Meier analysis (GP: P = .00006; FDR: P = .0022). The 10-factor model performed better in discriminating diabetes outcome than HLA alone (GP, P = .03; FDR, P = .01). In GP, the restricted 3-factor model was superior to HLA (P = .03), but not different from the 10-factor model (P = .22). In contrast, for FDR the 3-factor model did not show improvement over HLA (P = .12) and performed worse than the 10-factor model (P = .02) CONCLUSIONS: We have shown a 10-factor risk model predicts development of diabetes in both GP and FDR children. While this model was superior to a minimal model in FDR, it did not confer improvement in GP. Differences in model performance in FDR vs GP children may lead to important insights into screening strategies specific to these groups. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Diabetes and Cardiovascular Risk Factors in Native Hawaiians

    PubMed Central

    Aluli, N. Emmett; Jones, Kristina L.; Reyes, Phillip W.; Brady, S. Kalani; Tsark, JoAnn U.; Howard, Barbara V.

    2015-01-01

    Objective Diabetes is an increasing health problem among Native Hawaiians. Diabetes is a risk factor for cardiovascular disease (CVD), the leading cause of death among Native Hawaiians. In this article, the prevalence of diabetes is reported and associations with CVD risk factors are examined. Design and Methods Cross-section of 862 Native Hawaiians, ages 19–88. Physical exam included anthropometric measures, blood pressure, glucose and lipid measures, and personal interview. Results Age-adjusted prevalences of diabetes (25.1% in men vs. 22.6% in women) and impaired fasting glucose (IFG) (47.8% vs. 39.3%) increased with age and were higher in men. Fasting glucose was higher in diabetic men than women (209 mg/dL vs. 179, p = .0117). BMI, waist circumference, systolic blood pressure, triglycerides, and low-density lipoprotein cholesterol were higher in diabetic participants (all p < .01), and high-density lipoprotein cholesterol was lower (p < .005). Conclusions Diabetes prevalence in Native Hawaiians is high. The high proportion with IFG and the increase in CVD risk factors with diabetes suggest that community-based programs are needed to focus on diabetes and diabetes-related CVD. PMID:19653416

  19. The New Zealand Diabetes Passport Study: a randomized controlled trial of the impact of a diabetes passport on risk factors for diabetes-related complications.

    PubMed

    Simmons, D; Gamble, G D; Foote, S; Cole, D R; Coster, G

    2004-03-01

    To assess the efficacy (change in HbA1c) of a patient-held communication, self-empowerment and educational device for people with diabetes (the New Zealand Diabetes Passport) in patients with poor glycaemic control. A 12-month, multicentre, general practice-based randomized controlled trial in urban, provincial and rural New Zealand involving 398 people with poorly controlled Type 1 or Type 2 diabetes. The intervention included a specifically designed and piloted New Zealand Diabetes Passport including information relating to diabetes knowledge, self-assessments, and guidance concerning how to engage with diabetes health professionals. The primary end point was change in HbA1c. Assessments were made at 0, 6 and 12 months. Two hundred and twenty-two patients received the Passport, 176 the control booklet, coming from 69 and 66 general practitioners, respectively. Use of the Passport was associated with a relative reduction in HbA1c of 0.4% (P = 0.017) and a relative increase in weight of 1.0 kg/m2 (P = 0.028), but no changes in diabetes knowledge, attitudes to diabetes or risk factors for diabetic tissue damage. The dissemination of the New Zealand Diabetes Passport, in isolation, was not associated with improvements in either diabetes knowledge or self-empowerment. While a small improvement in glycaemic control occurred, this was probably due to changes in insulin therapy in the intervention group. It is possible that linking the use of the Passport with other behavioural and educational interventions may make the Passport more useful. Further study is required to confirm the effect of such multifaceted interventions.

  20. Major Risk Factors for Heart Disease: Diabetes

    MedlinePlus

    ... is more common among American Indians, Hispanic Americans, African Americans, Asian Americans, and Pacific Islanders. Women who have had diabetes during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds are also more ...

  1. Diabetes and Risk of Hospitalized Fall Injury Among Older Adults

    PubMed Central

    Yau, Rebecca K.; Strotmeyer, Elsa S.; Resnick, Helaine E.; Sellmeyer, Deborah E.; Feingold, Kenneth R.; Cauley, Jane A.; Vittinghoff, Eric; De Rekeneire, Nathalie; Harris, Tamara B.; Nevitt, Michael C.; Cummings, Steven R.; Shorr, Ronald I.; Schwartz, Ann V.

    2013-01-01

    OBJECTIVE To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization. RESEARCH DESIGN AND METHODS The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70–79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models. RESULTS At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12–1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78–5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05–1.88]) and insulin-treated diabetes (2.24 [1.24–4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization. CONCLUSIONS Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall. PMID:24130352

  2. Racial Differences in the Performance of Existing Risk Prediction Models for Incident Type 2 Diabetes: The CARDIA Study

    PubMed Central

    Wellenius, Gregory A.; Carnethon, Mercedes R.; Loucks, Eric B.; Carson, April P.; Luo, Xi; Kiefe, Catarina I.; Gjelsvik, Annie; Gunderson, Erica P.; Eaton, Charles B.; Wu, Wen-Chih

    2016-01-01

    OBJECTIVE In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for diagnosing type 2 diabetes. However, existing models for predicting diabetes risk were developed prior to the widespread adoption of A1C. Thus, it remains unknown how well existing diabetes risk prediction models predict incident diabetes defined according to the ADA 2010 guidelines. Accordingly, we examined the performance of an existing diabetes prediction model applied to a cohort of African American (AA) and white adults from the Coronary Artery Risk Development Study in Young Adults (CARDIA). RESEARCH DESIGN AND METHODS We evaluated the performance of the Atherosclerosis Risk in Communities (ARIC) diabetes risk prediction model among 2,456 participants in CARDIA free of diabetes at the 2005–2006 exam and followed for 5 years. We evaluated model discrimination, calibration, and integrated discrimination improvement with incident diabetes defined by ADA 2010 guidelines before and after adding baseline A1C to the prediction model. RESULTS In the overall cohort, re-estimating the ARIC model in the CARDIA cohort resulted in good discrimination for the prediction of 5-year diabetes risk (area under the curve [AUC] 0.841). Adding baseline A1C as a predictor improved discrimination (AUC 0.841 vs. 0.863, P = 0.03). In race-stratified analyses, model discrimination was significantly higher in whites than AA (AUC AA 0.816 vs. whites 0.902; P = 0.008). CONCLUSIONS Addition of A1C to the ARIC diabetes risk prediction model improved performance overall and in racial subgroups. However, for all models examined, discrimination was better in whites than AA. Additional studies are needed to further improve diabetes risk prediction among AA. PMID:26628420

  3. Improving pandemic influenza risk assessment

    PubMed Central

    Russell, Colin A; Kasson, Peter M; Donis, Ruben O; Riley, Steven; Dunbar, John; Rambaut, Andrew; Asher, Jason; Burke, Stephen; Davis, C Todd; Garten, Rebecca J; Gnanakaran, Sandrasegaram; Hay, Simon I; Herfst, Sander; Lewis, Nicola S; Lloyd-Smith, James O; Macken, Catherine A; Maurer-Stroh, Sebastian; Neuhaus, Elizabeth; Parrish, Colin R; Pepin, Kim M; Shepard, Samuel S; Smith, David L; Suarez, David L; Trock, Susan C; Widdowson, Marc-Alain; George, Dylan B; Lipsitch, Marc; Bloom, Jesse D

    2014-01-01

    Assessing the pandemic risk posed by specific non-human influenza A viruses is an important goal in public health research. As influenza virus genome sequencing becomes cheaper, faster, and more readily available, the ability to predict pandemic potential from sequence data could transform pandemic influenza risk assessment capabilities. However, the complexities of the relationships between virus genotype and phenotype make such predictions extremely difficult. The integration of experimental work, computational tool development, and analysis of evolutionary pathways, together with refinements to influenza surveillance, has the potential to transform our ability to assess the risks posed to humans by non-human influenza viruses and lead to improved pandemic preparedness and response. DOI: http://dx.doi.org/10.7554/eLife.03883.001 PMID:25321142

  4. Sedentary behavior, gestational diabetes mellitus, and type 2 diabetes risk: where do we stand?

    PubMed

    Johnson, Steven T; Lynch, Brigid; Vallance, Jeff; Davenport, Margie H; Gardiner, Paul A; Butalia, Sonia

    2016-04-01

    A substantial number of pregnancies are complicated by gestational diabetes mellitus (GDM) and up to 70 % of women with GDM go on to develop type 2 diabetes. Given the extensive body of research suggesting physical activity reduces the risk of type 2 diabetes, facilitating physical activity, and reducing sedentary time may be effective approaches to promote the health of women with a previous GDM diagnosis. Here, we discuss physical activity, exercise, and sedentary behavior, in the context of GDM and the potential for type 2 diabetes risk reduction.

  5. Metabolite Profiles and the Risk of Developing Diabetes

    PubMed Central

    Wang, Thomas J.; Larson, Martin G.; Vasan, Ramachandran S.; Cheng, Susan; Rhee, Eugene P.; McCabe, Elizabeth; Lewis, Gregory D.; Fox, Caroline S.; Jacques, Paul F.; Fernandez, Céline; O’Donnell, Christopher J.; Carr, Stephen A.; Mootha, Vamsi K.; Florez, Jose C.; Souza, Amanda; Melander, Olle; Clish, Clary B.; Gerszten, Robert E.

    2011-01-01

    Emerging technologies allow the high-throughput profiling of metabolic status from a blood specimen (metabolomics). We investigated whether metabolite profiles could predict the development of diabetes. Among 2,422 normoglycemic individuals followed for 12 years, 201 developed diabetes. Amino acids, amines, and other polar metabolites were profiled in baseline specimens using liquid chromatography-tandem mass spectrometry. Cases and controls were matched for age, body mass index and fasting glucose. Five branched-chain and aromatic amino acids had highly-significant associations with future diabetes: isoleucine, leucine, valine, tyrosine, and phenylalanine. A combination of three amino acids predicted future diabetes (>5-fold higher risk for individuals in top quartile). The results were replicated in an independent, prospective cohort. These findings underscore the potential importance of amino acid metabolism early in the pathogenesis of diabetes, and suggest that amino acid profiles could aid in diabetes risk assessment. PMID:21423183

  6. A Risk Assessment Model for Type 2 Diabetes in Chinese

    PubMed Central

    Luo, Senlin; Han, Longfei; Zeng, Ping; Chen, Feng; Pan, Limin; Wang, Shu; Zhang, Tiemei

    2014-01-01

    Aims To develop a risk assessment model for persons at risk from type 2 diabetes in Chinese. Materials and Methods The model was generated from the cross-sectional data of 16246 persons aged from 20 years old and over. C4.5 algorithm and multivariate logistic regression were used for variable selection. Relative risk value combined with expert decision constructed a comprehensive risk assessment for evaluating the individual risk category. The validity of the model was tested by cross validation and a survey performed six years later with some participants. Results Nine variables were selected as risk variables. A mathematical model was established to calculate the average probability of diabetes in each cluster's group divided by sex and age. A series of criteria combined with relative RR value (2.2) and level of risk variables stratified individuals into four risk groups (non, low, medium and high risk). The overall accuracy reached 90.99% evaluated by cross-validation inside the model population. The incidence of diabetes for each risk group increased from 1.5 (non-risk group) to 28.2(high-risk group) per one thousand persons per year with six years follow-up. Discussion The model could determine the individual risk for type 2 diabetes by four risk degrees. This model could be used as a technique tool not only to support screening persons at different risk, but also to evaluate the result of the intervention. PMID:25101994

  7. A Multifaceted School-based Intervention to Reduce Risk for Type 2 Diabetes in At-Risk Youth

    PubMed Central

    Grey, Margaret; Jaser, Sarah S.; Holl, Marita G.; Jefferson, Vanessa; Dziura, James; Northrup, Veronika

    2009-01-01

    Objective To evaluate the impact of a multifaceted, school-based intervention on inner city youth at high risk for type 2 diabetes mellitus (T2DM) and to determine whether the addition of coping skills training (CST) and health coaching improves outcomes. Method 198 students in New Haven, CT at risk for T2DM (BMI > 85th percentile and family history of diabetes) were randomized by school to an educational intervention with or without the addition of CST and health coaching. Students were enrolled from 2004–2007 and followed for 12 months. Results Students in both groups showed some improvement in anthropometric measures, lipids, and depressive symptoms over 12 months. BMI was not improved by the intervention. Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only. Conclusion A multifaceted, school-based intervention may hold promise for reducing metabolic risk in urban, minority youth. PMID:19643125

  8. Biomarkers of cardiovascular disease: contributions to risk prediction in individuals with diabetes.

    PubMed

    Bachmann, Katherine N; Wang, Thomas J

    2017-09-28

    Cardiovascular disease is a leading cause of death, especially in individuals with diabetes mellitus, whose risk of morbidity and mortality due to cardiovascular disease is markedly increased compared with the general population. There has been growing interest in the identification of biomarkers of cardiovascular disease in people with diabetes. The present review focuses on the current and potential contributions of these biomarkers to predicting cardiovascular risk in individuals with diabetes. At present, certain biomarkers and biomarker combinations can lead to modest improvements in the prediction of cardiovascular disease in diabetes beyond traditional cardiovascular risk factors. Emerging technologies may enable the discovery of novel biomarkers and generate new information about known biomarkers (such as new combinations of biomarkers), which could lead to significant improvements in cardiovascular disease risk prediction. A critical question, however, is whether improvements in risk prediction will affect processes of care and decision making in clinical practice, as this will be required to achieve the ultimate goal of improving clinical outcomes in diabetes.

  9. Risk factors for retinopathy in diabetes mellitus in Kelantan, Malaysia.

    PubMed

    Shriwas, S R; Rahman Isa, A B; Reddy, S C; Mohammad, M; Mohammad, W B; Mazlan, M

    1996-12-01

    Few attempts have been made to determine the risk factors for diabetic retinopathy which is a major cause of visual impairment and blindness. One hundred and forty patients of diabetes mellitus were studied to determine the prevalence and types of retinopathy, and its relation to various risk factors. Nearly half (48.6%) of the patients suffered from retinopathy. The significant associated risk factors were long duration of diabetes, proteinuria and elevated serum creatinine level. However, there was no significant association between the prevalence of retinopathy and high levels of serum cholesterol, C-peptide levels, associated hypertension, and glycaemic control of diabetes mellitus. An effective screening programme for detection of retinopathy in the patients of diabetes as a regular practice is encouraged.

  10. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials.

    PubMed

    Cavanaugh, Kerri; Wallston, Kenneth A; Gebretsadik, Tebeb; Shintani, Ayumi; Huizinga, Mary Margaret; Davis, Dianne; Gregory, Rebecca Pratt; Malone, Robb; Pignone, Michael; DeWalt, Darren; Elasy, Tom A; Rothman, Russell L

    2009-12-01

    Diabetic patients with lower literacy or numeracy skills are at greater risk for poor diabetes outcomes. This study evaluated the impact of providing literacy- and numeracy-sensitive diabetes care within an enhanced diabetes care program on A1C and other diabetes outcomes. In two randomized controlled trials, we enrolled 198 adult diabetic patients with most recent A1C >or=7.0%, referred for participation in an enhanced diabetes care program. For 3 months, control patients received care from existing enhanced diabetes care programs, whereas intervention patients received enhanced programs that also addressed literacy and numeracy at each institution. Intervention providers received health communication training and used the interactive Diabetes Literacy and Numeracy Education Toolkit with patients. A1C was measured at 3 and 6 months follow-up. Secondary outcomes included self-efficacy, self-management behaviors, and treatment satisfaction. At 3 months, both intervention and control patients had significant improvements in A1C from baseline (intervention -1.50 [95% CI -1.80 to -1.02]; control -0.80 [-1.10 to -0.30]). In adjusted analysis, there was greater improvement in A1C in the intervention group than in the control group (P = 0.03). At 6 months, there were no differences in A1C between intervention and control groups. Self-efficacy improved from baseline for both groups. No significant differences were found for self-management behaviors or satisfaction. A literacy- and numeracy-focused diabetes care program modestly improved self-efficacy and glycemic control compared with standard enhanced diabetes care, but the difference attenuated after conclusion of the intervention.

  11. Using web-based familial risk information for diabetes prevention: a randomized controlled trial

    PubMed Central

    2013-01-01

    Background It has been suggested that family history information may be effective in motivating people to adopt health promoting behaviour. The aim was to determine if diabetic familial risk information by using a web-based tool leads to improved self-reported risk-reducing behaviour among individuals with a diabetic family history, without causing false reassurance among those without a family history. Methods An online sample of 1,174 healthy adults aged 35–65 years with a BMI ≥ 25 was randomized into two groups receiving an online diabetes risk assessment. Both arms received general tailored diabetes prevention information, whilst the intervention arm also received familial risk information after completing a detailed family history questionnaire. Separate analysis was performed for four groups (family history group: 286 control versus 288 intervention group; no family history: 269 control versus 266 intervention group). Primary outcomes were self-reported behavioural outcomes: fat intake, physical activity, and attitudes towards diabetes testing. Secondary outcomes were illness and risk perceptions. Results For individuals at familial risk there was no overall intervention effect on risk-reducing behaviour after three months, except for a decrease in self-reported saturated fat intake among low-educated individuals (Beta (b) -1.01, 95% CI −2.01 to 0.00). Familial risk information resulted in a decrease of diabetes risk worries (b −0.21, -0.40 to −0.03). For individuals without family history no effect was found on risk-reducing behaviour and perceived risk. A detailed family history assessment resulted in a greater percentage of individuals reporting a familial risk for diabetes compared to a simple enquiry. Conclusions Web-based familial risk information reduced worry related to diabetes risk and decreased saturated fat intake of those at greatest need of preventative care. However, the intervention was not effective for the total study population on

  12. Using web-based familial risk information for diabetes prevention: a randomized controlled trial.

    PubMed

    Wijdenes, Miranda; Henneman, Lidewij; Qureshi, Nadeem; Kostense, Piet J; Cornel, Martina C; Timmermans, Danielle R M

    2013-05-17

    It has been suggested that family history information may be effective in motivating people to adopt health promoting behaviour. The aim was to determine if diabetic familial risk information by using a web-based tool leads to improved self-reported risk-reducing behaviour among individuals with a diabetic family history, without causing false reassurance among those without a family history. An online sample of 1,174 healthy adults aged 35-65 years with a BMI ≥ 25 was randomized into two groups receiving an online diabetes risk assessment. Both arms received general tailored diabetes prevention information, whilst the intervention arm also received familial risk information after completing a detailed family history questionnaire. Separate analysis was performed for four groups (family history group: 286 control versus 288 intervention group; no family history: 269 control versus 266 intervention group). Primary outcomes were self-reported behavioural outcomes: fat intake, physical activity, and attitudes towards diabetes testing. Secondary outcomes were illness and risk perceptions. For individuals at familial risk there was no overall intervention effect on risk-reducing behaviour after three months, except for a decrease in self-reported saturated fat intake among low-educated individuals (Beta (b) -1.01, 95% CI -2.01 to 0.00). Familial risk information resulted in a decrease of diabetes risk worries (b -0.21, -0.40 to -0.03). For individuals without family history no effect was found on risk-reducing behaviour and perceived risk. A detailed family history assessment resulted in a greater percentage of individuals reporting a familial risk for diabetes compared to a simple enquiry. Web-based familial risk information reduced worry related to diabetes risk and decreased saturated fat intake of those at greatest need of preventative care. However, the intervention was not effective for the total study population on improving risk-reducing behaviour. The

  13. The role of exercise in reducing the risks of gestational diabetes mellitus in obese women.

    PubMed

    Artal, Raul

    2015-01-01

    The global obesity epidemic continues unabated, now rapidly expanding to developing countries. Multiple comorbidities and premature mortality are associated with obesity, most frequently diabetes. The associated financial and economical burden is escalating as well. The sedentary lifestyle adopted by many pregnant women because of traditional practices and the current recommendation for gestational weight gain are contributing factors to the obesity and diabetes epidemic. Physical inactivity is recognized as an independent risk factor for obesity insulin resistance and type 2 diabetes; the physiological and hormonal changes associated with pregnancy magnify this risk. Conversely, evidence and accumulated experience indicate that antenatal lifestyle interventions that include physical activity and judicious dieting could improve the pregnancy outcome and reduce the risk of gestational diabetes and is effective as an adjunctive therapy for diabetes in pregnancy. All major professional organizations, among them American Congress of Obstetricians and Gynecologists (ACOG), American Diabetes Association (ADA), Royal College of Obstetricians and Gynaecologists (RCOG), and Society of Obstetricians and Gynaecologists of Canada (SOGC), recommend lifestyle interventions that include diet and exercise to prevent or manage gestational diabetes or diabetes mellitus. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Improving diabetes management with mobile health technology.

    PubMed

    Sieverdes, John C; Treiber, Frank; Jenkins, Carolyn

    2013-04-01

    Diabetes affects 25.8 million persons in the United States, and these persons make more than 35 million ambulatory care visits annually. Yet, less than half of persons with diabetes meet the recommended levels of A1C, blood pressure and lipid control. One innovative approach is to use mobile health technologies to help patients better manage their diabetes and related conditions, and 85% to 90% of patients have access to mobile health technology. A brief review of the guidelines for diabetes care and mobile health technology that can support the guidelines are reported related to (1) glycemic control and self-monitoring of blood glucose, (2) pharmacological approaches and medication management, (3) medical nutrition therapy, (4) physical activity and resistance training, (5) weight loss, (6) diabetes self-management education and (7) blood pressure control and hypertension. The patient and provider are encouraged to explore possibilities for mobile health technologies that can support behavior change.

  15. Diabetes and Risk of Renal Cell Carcinoma

    PubMed Central

    Habib, Samy L; Prihoda, Thomas J; Luna, Maria; Werner, Sherry A

    2012-01-01

    Background and objectives: There is evidence that the incidence of solid tumors is markedly increased in patients with diabetes mellitus. In the current study, we investigate the association between diabetes and renal cancer. Patients and Methods: A single-center retrospective analysis of 473 patients who underwent nephrectomy for renal cell carcinoma (RCC) was performed. Diabetic RCC patients were screened for age, gender, ethnicity, HgA1C, glucose levels and renal function. Results: Of the 473 cases with RCC, we identified 120 patients (25.4%) with a history of diabetes. The incidence of diabetes in RCC patients was higher in female than male subjects and in Hispanic compared to White and Other ethnic backgrounds. At diagnosis, the majority of diabetic RCC patients were 50-59 years of age. In diabetic RCC cases, clear cell type histology (92.0%), nuclear grade 2 (56.1%) and tumor size range from 1-5 cm (65.7%) were the most common in each category. Conclusion: Our findings indicate that diabetic RCC patients have a predominance of localized, small clear cell RCC. In addition, females with a history of RCC have a higher frequency of diabetes compared to males. This is the first report of clinical and histopathological features of RCC associated with diabetes. PMID:22232697

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

    PubMed

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

    2016-12-01

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

  17. Tips for Kids: Lower Your Risk for Type 2 Diabetes

    ERIC Educational Resources Information Center

    US Department of Health and Human Services, 2005

    2005-01-01

    Today, more kids have type 2 diabetes than ever before. This colorful, easy-to-read tip sheet encourages young people to take steps to lower their risk for type 2 diabetes. A list of warning signs and a healthy eating guide is offered, along with a list of websites to learn more. [This brochure was prepared by the Department of Health and Human…

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

    PubMed Central

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

    2017-01-01

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

  19. Risk assessment in diabetes management: how do general practitioners estimate risks due to diabetes?

    PubMed Central

    Häussler, Bertram; Fischer, Gisela C; Meyer, Sibylle; Sturm, Diethard

    2007-01-01

    Objectives To evaluate the ability of general practitioners (GPs) in Germany to estimate the risk of patients with diabetes developing complications. Methods An interview study using a structured questionnaire to estimate risks of four case vignettes having diabetes‐specific complications within the next 10 years, risk reduction and life expectancy potential. A representative random sample of 584 GPs has been drawn, of which 150 could be interviewed. We compared GPs' estimates among each other (intraclass correlation coefficient (ICC) and Cohen's (multirater‐) κ) and with risks for long‐term complications generated by the multifactor disease model “Mellibase”, which is a knowledge‐based support system for medical decision management. Results The risk estimates by GPs varied widely (ICC 0.21 95% CI (0.13 to 0.36)). The average level of potential risk reduction was between 47% and 70%. Compared with Mellibase values, on average, the GPs overestimated the risk threefold. Mean estimates of potential prolongation of life expectancy were close to 10 years for each patient, whereas the Mellibase calculations ranged from 3 to 10 years. Conclusions Overestimation could lead to unnecessary care and waste of resources. PMID:17545348

  20. Sex Differences in the Excess Risk of Cardiovascular Diseases Associated with Type 2 Diabetes: Potential Explanations and Clinical Implications.

    PubMed

    Peters, Sanne A E; Huxley, Rachel R; Sattar, Naveed; Woodward, Mark

    Strong evidence suggests that type 2 diabetes confers a stronger excess risk of cardiovascular diseases in women than in men; with women having a 27 % higher relative risk of stroke and a 44 % higher relative risk of coronary heart disease compared with men. The mechanisms that underpin these sex differences in the associations between diabetes and cardiovascular disease risk are not fully understood. Some of the excess risk may be the result of a sex disparity in the management and treatment of diabetes, to the detriment of women. However, accruing evidence suggests that real biological differences between men and women underpin the excess risk of diabetes-related cardiovascular risk in women such that there is a greater decline in risk factor status in women than in men in the transition from normoglycemia to overt diabetes. This greater risk factor decline appears to be associated with women having to put on more weight than men, and thus attain a higher body mass index, to develop diabetes. Further studies addressing the mechanisms responsible for sex differences in the excess risk of cardiovascular diseases associated with diabetes are needed to improve the prevention and management of diabetes in clinical practise.

  1. Global prevalence and major risk factors of diabetic retinopathy.

    PubMed

    Yau, Joanne W Y; Rogers, Sophie L; Kawasaki, Ryo; Lamoureux, Ecosse L; Kowalski, Jonathan W; Bek, Toke; Chen, Shih-Jen; Dekker, Jacqueline M; Fletcher, Astrid; Grauslund, Jakob; Haffner, Steven; Hamman, Richard F; Ikram, M Kamran; Kayama, Takamasa; Klein, Barbara E K; Klein, Ronald; Krishnaiah, Sannapaneni; Mayurasakorn, Korapat; O'Hare, Joseph P; Orchard, Trevor J; Porta, Massimo; Rema, Mohan; Roy, Monique S; Sharma, Tarun; Shaw, Jonathan; Taylor, Hugh; Tielsch, James M; Varma, Rohit; Wang, Jie Jin; Wang, Ningli; West, Sheila; Xu, Liang; Yasuda, Miho; Zhang, Xinzhi; Mitchell, Paul; Wong, Tien Y

    2012-03-01

    To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A(1c), and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

  2. Dietary intake of carotenoids and risk of type 2 diabetes.

    PubMed

    Sluijs, I; Cadier, E; Beulens, J W J; van der A, D L; Spijkerman, A M W; van der Schouw, Y T

    2015-04-01

    Carotenoids may reduce diabetes risk, due to their antioxidant properties. However, the association between dietary carotenoids intake and type 2 diabetes risk is still unclear. Therefore, the objective of this study was to examine whether higher dietary carotenoid intakes associate with reduced type 2 diabetes risk. Data from 37,846 participants of the European Prospective Investigation into Cancer and Nutrition- Netherlands study were analyzed. Dietary intakes of β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein & zeaxanthin and the sum of these carotenoids were assessed using a validated food frequency questionnaire. Incident type 2 diabetes was mainly self-reported, and verified against general practitioner information. Mean ±SD total carotenoid intake was 10 ± 4 mg/day. During a mean ±SD follow-up of 10 ± 2 years, 915 incident cases of type 2 diabetes were ascertained. After adjustment for age, sex, diabetes risk factors, dietary intake, waist circumference and BMI, higher β-carotene intakes associated inversely with diabetes risk [Hazard Ratio quartile 4 versus quartile 1 (HR(Q4)): 0.78 (95%CI:0.64,0.95), P-linear trend 0.01]. For α-carotene, a borderline significant reduced risk was observed, with a HR(Q4) of 0.85 (95%CI:0.70,1.03), and P-linear trend 0.05. β-cryptoxanthin, lycopene, lutein & zeaxanthin, and the sum of all carotenoids did not associate with diabetes risk. This study shows that diets high in β-carotene and α-carotene are associated with reduced type 2 diabetes in generally healthy men and women. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Coronary risk prediction for those with and without diabetes.

    PubMed

    2006-02-01

    Coronary risk prediction 'engines' are now in common use, and their worth is well proven. There remains the question of how to deal with a prior diagnosis of diabetes. An individual participant meta-analysis of 33 cohort studies involving 364 566 subjects. Fatal coronary hazard ratios for age, smoking, systolic blood pressure and cholesterol, were computed from Cox models, comparing those with and without diabetes. Three risk prediction equations were compared: a 'stepped model', which included the risk factors and diabetes status; an 'interaction model', which included interactions between diabetes and the risk factors; and a 'fixed model', which fixed the 10-year rate of coronary death amongst those with diabetes to be 7%. These were compared through the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow statistics. The hazard ratio for age was greater for those without diabetes than those with, for men (P=0.005) and women (P=0.02); for men only, systolic blood pressure showed a similar differential (P=0.011). Nevertheless, AUCs were only 0.001 different for the stepped and interaction models for each sex. The AUC for the fixed model was lower and, unlike the other two, showed significant lack of fit for both sexes (P<0.001). There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk. Diabetes status might, instead, be used as a risk variable in an overall population equation.

  4. Improving Diabetes Management With a Patient Portal: Qualitative Study of a Diabetes Self-Management Portal

    PubMed Central

    Dupak, Kourtney; Kuehner, Zachary; Leonard, Kevin; Lovrics, Emily; Picton, Peter; Seto, Emily; Cafazzo, Joe

    2012-01-01

    Background Effective management and care of diabetes is crucial to reducing associated risks such as heart disease and kidney failure. With increasing access and use of the Internet, online chronic disease management is being explored as a means of providing patients with support and the necessary tools to monitor and manage their disease. Objective The objective of our study was to evaluate the experience of patients and providers using an online diabetes management portal for patients. Methods Participants were recruited from a large sample population of 887 for a follow-up questionnaire to be completed after 6 months of using the patient portal. Participants were presented with the option to participate in an additional interview and, if the participant agreed, a time and date was scheduled for the interview. A 5-item, open-ended questionnaire was used to capture providers' opinions of the patient portal. Providers included general practitioners (GPs), nurses, nurse practitioners (NPs), dieticians, diabetes educators (DECs), and other clinical staff. Results A total of 854 patients were consented for the questionnaire. Seventeen (8 male, 9 female) patients agreed to participate in a telephone interview. Sixty-four health care providers completed the five open-ended questions; however, an average of 48.2 responses were recorded per question. Four major themes were identified and will be discussed in this paper. These themes have been classified as: facilitators of disease management, barriers to portal use, patient-provider communication and relationship, and recommendations for portal improvements. Conclusions This qualitative study shows that online chronic disease management portals increase patient access to information and engagement in their health care, but improvements in the portal itself may improve usability and reduce attrition. Furthermore, this study identifies a grey area that exists in the roles that GPs and AHPs should play in the facilitation of

  5. A comparative approach to using the diabetes prevention program to reduce diabetes risk in a worksite setting.

    PubMed

    Dallam, George M; Foust, Carol P

    2013-03-01

    The rapidly increasing rate of non-insulin-dependent diabetes (NIDDM) among both market economy and developing countries is a worldwide health phenomenon. The number of diabetics worldwide has been projected to increase from 135 million in 1995 to 300 million in 2025. The purpose of this study was to examine the relative effectiveness of three different approaches to the implementation of the Diabetes Prevention Program, a standardized diabetes prevention curriculum, in various worksite organizations within a single community. The methods of implementation selected included an intensive one-on-one counseling approach, a support group meeting approach, and a passive transfer of information approach. The intervention was successful in creating significant mean improvements overall in the participants who completed the 26-week program as follows: (a) reduction in overall mean body weight and mean body mass index, (b) reduction in overall average mean arterial blood pressure, (c) reduction in overall mean diabetes risk score, and (d) increase in overall mean physical activity level. Although the largest proportion of these changes occurred in the one-on-one intervention group, significant changes in some factors were found in all groups. This illustrates the utility of an on-site and incentive-driven approach to diabetes risk factor modification in the workplace.

  6. Longitudinal Study of Hypertensive Subjects With Type 2 Diabetes Mellitus: Overall and Cardiovascular Risk.

    PubMed

    Safar, Michel E; Gnakaméné, Jean-Barthélémy; Bahous, Sola Aoun; Yannoutsos, Alexandra; Thomas, Frédérique

    2017-04-10

    Despite adequate glycemic and blood pressure control, treated type 2 diabetic hypertensive subjects have a significantly elevated overall/cardiovascular risk. We studied 244 816 normotensive and 99 720 hypertensive subjects (including 7480 type 2 diabetics) attending medical checkups between 1992 and 2011. We sought to identify significant differences in overall/cardiovascular risk between hypertension with and without diabetes mellitus. Mean follow-up was 12.7 years; 14 050 all-cause deaths were reported. From normotensive to hypertensive populations, a significant progression in overall/cardiovascular mortality was observed. Mortality was significantly greater among diabetic than nondiabetic hypertensive subjects (all-cause mortality, 14.05% versus 7.43%; and cardiovascular mortality, 1.28% versus 0.7%). No interaction was observed between hemodynamic measurements and overall/cardiovascular risk, suggesting that blood pressure factors, even during drug therapy, could not explain the differences in mortality rates between diabetic and nondiabetic hypertensive patients. Using cross-sectional regression models, a significant association was observed between higher education levels, lower levels of anxiety and depression, and reduced overall mortality in diabetic hypertensive subjects, while impaired renal function, a history of stroke and myocardial infarction, and increased alcohol and tobacco consumption were significantly associated with increased mortality. Blood pressure and glycemic control alone cannot reverse overall/cardiovascular risk in diabetics with hypertension. Together with cardiovascular measures, overall prevention should include recommendations to reduce alcohol and tobacco consumption and improve stress, education levels, and physical activity.

  7. Quantification of diabetes comorbidity risks across life using nation-wide big claims data.

    PubMed

    Klimek, Peter; Kautzky-Willer, Alexandra; Chmiel, Anna; Schiller-Frühwirth, Irmgard; Thurner, Stefan

    2015-04-01

    Despite substantial progress in the study of diabetes, important questions remain about its comorbidities and clinical heterogeneity. To explore these issues, we develop a framework allowing for the first time to quantify nation-wide risks and their age- and sex-dependence for each diabetic comorbidity, and whether the association may be consequential or causal, in a sample of almost two million patients. This study is equivalent to nearly 40,000 single clinical measurements. We confirm the highly controversial relation of increased risk for Parkinson's disease in diabetics, using a 10 times larger cohort than previous studies on this relation. Detection of type 1 diabetes leads detection of depressions, whereas there is a strong comorbidity relation between type 2 diabetes and schizophrenia, suggesting similar pathogenic or medication-related mechanisms. We find significant sex differences in the progression of, for instance, sleep disorders and congestive heart failure in diabetic patients. Hypertension is a highly sex-sensitive comorbidity with females being at lower risk during fertile age, but at higher risk otherwise. These results may be useful to improve screening practices in the general population. Clinical management of diabetes must address age- and sex-dependence of multiple comorbid conditions.

  8. Obesity and type 2 diabetes: which patients are at risk?

    PubMed

    Garber, A J

    2012-05-01

    An estimated 72.5 million American adults are obese, and the growing US obesity epidemic is responsible for substantial increase in morbidity and mortality, as well as increased health care costs. Obesity results from a combination of personal and societal factors, but is often viewed as a character flaw rather than a medical condition. This leads to stigma and discrimination towards obese individuals and decreases the likelihood of effective intervention. Conditions related to obesity are increasingly common, such as metabolic syndrome, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), all of which indicate high risk for type 2 diabetes (T2DM). This paper reviews the progression from obesity to diabetes, identifying physiological changes that occur along this path as well as opportunities for patient identification and disease prevention. Patients with prediabetes (defined as having IFG, IGT or both) and/or metabolic syndrome require interventions designed to preserve insulin sensitivity and β-cell function, both of which start to deteriorate prior to T2DM diagnosis. Lifestyle modification, including both healthy eating choices and increased physical activity, is essential for weight management and diabetes prevention. Although sustained weight loss is often considered by patients and physicians as being impossible to achieve, effective interventions do exist. Specifically, the Diabetes Prevention Program (DPP) and programs modelled along its parameters have shown repeated successes, even with long-term maintenance. Recent setbacks in the development of medications for weight loss further stress the importance of lifestyle management. By viewing obesity as a metabolic disorder rather than a personal weakness, we can work with patients to address this increasingly prevalent condition and improve long-term health outcomes. © 2011 Blackwell Publishing Ltd.

  9. Gestational diabetes mellitus: risks and management during and after pregnancy.

    PubMed

    Buchanan, Thomas A; Xiang, Anny H; Page, Kathleen A

    2012-11-01

    Gestational diabetes mellitus (GDM) carries a small but potentially important risk of adverse perinatal outcomes and a long-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of developing diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements complement maternal glucose monitoring in the identification of pregnancies that require such intensification. Glucose testing shortly after delivery can stratify the short-term diabetes risk in mothers. Thereafter, annual glucose and HbA(1c) testing can detect deteriorating glycaemic control, a harbinger of future diabetes mellitus, usually type 2 diabetes mellitus. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning enables optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity.

  10. Sulodexide improves endothelial dysfunction in streptozotocin-induced diabetes in rats.

    PubMed

    Kristová, V; Lísková, S; Sotníková, R; Vojtko, R; Kurtanský, A

    2008-01-01

    Diabetes mellitus is associated with many complications including retinopathy, nephropathy, neuropathy and angiopathy. Increased cardiovascular risk is accompanied with diabetes-induced endothelial dysfunction. Pharmacological agents with endothelium-protective effects may decrease cardiovascular complications. In present study sulodexide (glycosaminoglycans composed from heparin-like and dermatan fractions) was chosen to evaluate its protective properties on endothelial dysfunction in diabetes. Effect of sulodexide treatment (SLX, 100 UI/kg/day, i.p.) in 5 and 10 weeks lasting streptozotocin-induced diabetes (30 mg/kg/day, i.p. administered for three consecutive days) was investigated. Animals were divided into four groups: control (injected with saline solution), control-treated with sulodexide (SLX), diabetic (DM) and diabetic-treated with sulodexide (DM+SLX). The pre-prandial and postprandial plasma glucose levels, number of circulating endothelial cells (EC) and acetylcholine-induced relaxation of isolated aorta and mesenteric artery were evaluated. Streptozotocin elicited hyperglycemia irrespective of SLX treatment. Streptozotocin-induced diabetes enhanced the number of circulating endothelial cells compared to controls. SLX treatment decreased the number of EC in 10-week diabetes. Acetylcholine-induced relaxation of mesenteric arteries was significantly impaired in 5 and 10-week diabetes. SLX administration improved relaxation to acetylcholine in 5 and 10-week diabetes. Diabetes impaired acetylcholine-induced relaxation of rat aorta irrespective of SLX treatment. Our results demonstrate that SLX treatment lowers the number of circulating endothelial cells and improves endothelium-dependent relaxation in small arteries. These findings suggest endothelium-protective effect of sulodexide in streptozotocin-induced diabetes.

  11. MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis.

    PubMed

    Wang, Bin; An, Xiaofei; Shi, Xiaohong; Zhang, Jin-An

    2017-10-01

    Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed. © 2017 European Society of Endocrinology.

  12. Too Much Screen Time May Raise Kids' Diabetes Risk

    MedlinePlus

    ... reducing type 2 diabetes risk factors, in both boys and girls and in different ethnic groups from an early ... Excessive screen time was far more common among boys than girls. Children of African or Caribbean descent were also ...

  13. Development and validation of a Diabetes Risk Score for screening undiagnosed diabetes in Sri Lanka (SLDRISK).

    PubMed

    Katulanda, P; Hill, N R; Stratton, I; Sheriff, R; De Silva, S D N; Matthews, D R

    2016-07-25

    Screening for undiagnosed diabetes is not widely undertaken due to the high costs and invasiveness of blood sampling. Simple non-invasive tools to identify high risk individuals can facilitate screening. The main objectives of this study are to develop and validate a risk score for screening undiagnosed diabetes among Sri Lankan adults and to compare its performance with the Cambridge Risk Score (CRS), the Indian Diabetes Risk Score (IDRS) and three other Asian risk scores. Data were available from a representative sample of 4276 adults without diagnosed diabetes. In a jack-knife approach two thirds of the sample was used for the development of the risk score and the remainder for the validation. Age, waist circumference, BMI, hypertension, balanitis or vulvitis, family history of diabetes, gestational diabetes, physical activity and osmotic symptoms were significantly associated with undiagnosed diabetes (age most to osmotic symptoms least). Individual scores were generated for these factors using the beta coefficient values obtained in multiple logistic regression. A cut-off value of sum = 31 was determined by ROC curve analysis. The area under the ROC curve of the risk score for prevalent diabetes was 0.78 (CI 0.73-0.82). In the sample 36.3 % were above the cut-off of 31. A risk score above 31 gave a sensitivity, specificity, positive predictive value and negative predictive value of 77.9, 65.6, 9.4 and 98.3 % respectively. For Sri Lankans the AUC for the CRS and IDRS were 0.72 and 0.66 repectively. This simple non-invasive screening tool can identify 80 % of undiagnosed diabetes by selecting 40 % of Sri Lankan adults for confirmatory blood investigations.

  14. Cognitive function and the risk for diabetes among young men.

    PubMed

    Twig, Gilad; Gluzman, Israel; Tirosh, Amir; Gerstein, Hertzel C; Yaniv, Gal; Afek, Arnon; Derazne, Estela; Tzur, Dorit; Karasik, Avraham; Gordon, Barak; Fruchter, Eyal; Lubin, Gadi; Rudich, Assaf; Cukierman-Yaffe, Tali

    2014-11-01

    Diabetes is a risk factor for an accelerated rate of cognitive decline and dementia. However, the relationship between cognitive function and the subsequent development of diabetes is unclear. We conducted a historical-prospective cohort study merging data collected at premilitary recruitment assessment with information collected at the Staff Periodic Examination Center of the Israeli Army Medical Corps. Included were men aged 25 years or older without a history of diabetes at the beginning of follow-up with available data regarding their general intelligence score (GIS), a comprehensive measure of cognitive function, at age 17 years. Among 35,500 men followed for a median of 5.5 years, 770 new cases of diabetes were diagnosed. After adjustment for age, participants in the lowest GIS category had a 2.6-fold greater risk for developing diabetes compared with those in the highest GIS category. In multivariable analysis adjusted for age, BMI, fasting plasma glucose, sociogenetic variables, and lifestyle risk factors, those in the lowest GIS category had a twofold greater risk for incident diabetes when compared with the highest GIS category (hazard ratio 2.1 [95% CI 1.5-3.1]; P < 0.001). Additionally, participants in the lowest GIS category developed diabetes at a mean age of 39.5 ± 4.7 years and those in the highest GIS group at a mean age of 41.5 ± 5.1 years (P for comparison 0.042). This study demonstrates that in addition to a potential causal link between diabetes and enhanced cognitive decline, lower cognitive function at late adolescence is independently associated with an elevated risk for future diabetes. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  15. A new DAWN: Improving the psychosocial management of diabetes

    PubMed Central

    Holt, Richard I. G.; Kalra, Sanjay

    2013-01-01

    Aims: The second Diabetes Attitudes, Wishes and Needs (DAWN-2) study assessed psychosocial issues and health-care provision of people with diabetes, their family members and health-care professionals. Materials and Methods: Participants completed an online, telephone or in-person survey designed to assess health-related quality-of-life, self-management, attitudes/beliefs, social support and priorities for improving diabetes care as well as health-care provision and the impact of diabetes on family life. Results: A total of 8596 adults with diabetes, 2057 family members of people with diabetes and 4785 health-care professionals across 17 countries completed the survey. There were significant between country differences, but no one country's outcomes were consistently better or worse than others. A high proportion of people with diabetes reported likely depression (13.8%) and poor quality-of-life (12.2%). Diabetes had a negative impact on many aspects of life, including relationships with family/friends and physical health. A third of family members did not know how to help the person with diabetes, but wanted to be more involved in their care. Many health-care professionals indicated that major improvements were needed across a range of areas including health-care organization, resources for diabetes prevention, earlier diagnosis and treatment and psychological support. Conclusions: DAWN-2 is a multinational, multidisciplinary systematic study that compared unmet needs of people with diabetes and those who care for them in 17 countries across four continents. Its findings should facilitate innovative efforts to improve self-management and psychosocial support in diabetes, with the aim of reducing the burden of disease. The implications for India are discussed. PMID:24251231

  16. The Genetic Risk of Kidney Disease in Type 2 Diabetes

    PubMed Central

    Pezzolesi, Marcus G.; Krolewski, Andrzej S.

    2012-01-01

    Evidence of familial aggregation of diabetic nephropathy (DN) in type 2 diabetes and the heritability of its related traits provide compelling evidence that genetic factors contribute to their susceptibility. Segregation analyses suggest the existence of at least one major DN susceptibility gene as well as multiple other genetic factors with small to moderate effects on its risk. For more than 20 years, these studies have motivated investigators working to identify the causal genes responsible for the development of DN. During this period, advances in genomics and evolving technology have improved our understanding of the genetic basis of DN and revolutionized our ability to identify genes that underlie this disease. In this review, we discuss the major approaches being used to identify DN susceptibility genes in T2D and highlight the salient findings from studies where these approaches have been implemented. The recent advent of next-generation sequencing technology is beginning to impact DN gene mapping strategies. As the field moves forward, family-based approaches should greatly facilitate efforts to identify variants in genes that have a major affect on the risk of DN in T2D. To be successful, the ascertainment and comprehensive study of families with multiple affected members is critical. PMID:23290732

  17. Intermittent Vagal Nerve Block for Improvements in Obesity, Cardiovascular Risk Factors, and Glycemic Control in Patients with Type 2 Diabetes Mellitus: 2-Year Results of the VBLOC DM2 Study.

    PubMed

    Shikora, Scott A; Toouli, James; Herrera, Miguel F; Kulseng, Bård; Brancatisano, Roy; Kow, Lilian; Pantoja, Juan P; Johnsen, Gjermund; Brancatisano, Anthony; Tweden, Katherine S; Knudson, Mark B; Billington, Charles J; Billingto, Charles J

    2016-05-01

    One-year results of the VBLOC DM2 study found that intermittent vagal blocking (VBLOC therapy) was safe among subjects with obesity and type 2 diabetes mellitus (T2DM) and led to significant weight loss and improvements in glycemic parameters and cardiovascular risk factors. Longer-term data are needed to determine whether the results are sustained. VBLOC DM2 is a prospective, observational study of 28 subjects with T2DM and body mass index (BMI) between 30 and 40 kg/m(2) to assess mid-term safety and weight loss and improvements in glycemic parameters, and other cardiovascular risk factors with VBLOC therapy. Continuous outcome variables are reported using mixed models. At 24 months, the mean percentage of excess weight loss was 22% (95% CI, 15 to 28, p < 0.0001) or 7.0% total body weight loss (95% CI, 5.0 to 9.0, p < 0.0001). Hemoglobin A1c decreased by 0.6 percentage points (95% CI, 0.2 to 1.0, p = 0.0026) on average from 7.8% at baseline. Fasting plasma glucose declined by 15 mg/dL (95% CI, 0 to 29, p = 0.0564) on average from 151 mg/dL at baseline. Among subjects who were hypertensive at baseline, systolic blood pressure declined 10 mmHg (95% CI, 2 to 19, p = 0.02), diastolic blood pressure declined by 6 mmHg (95% CI, 0 to 12, p = 0.0423), and mean arterial pressure declined 7 mmHg (95% CI, 2 to 13, p = 0.014). Waist circumference was significantly reduced by 7 cm (95% CI, 4 to 10, p < 0.0001) from a baseline of 120 cm. The most common adverse events were mild or moderate heartburn, implant site pain, and constipation. Improvements in obesity and glycemic control were largely sustained after 2 years of treatment with VBLOC therapy with a well-tolerated risk profile.

  18. Quality improvement in diabetes--successful in achieving better care with hopes for prevention.

    PubMed

    Haw, J Sonya; Narayan, K M Venkat; Ali, Mohammed K

    2015-09-01

    Diabetes affects 29 million Americans and is associated with billions of dollars in health expenditures and lost productivity. Robust evidence has shown that lifestyle interventions in people at high risk for diabetes and comprehensive management of cardiometabolic risk factors like glucose, blood pressure, and lipids can delay the onset of diabetes and its complications, respectively. However, realizing the "triple aim" of better health, better care, and lower cost in diabetes has been hampered by low adoption of lifestyle interventions to prevent diabetes and poor achievement of care goals for those with diabetes. To achieve better care, a number of quality improvement (QI) strategies targeting the health system, healthcare providers, and/or patients have been evaluated in both controlled trials and real-world programs, and have shown some successes, though barriers still impede wider adoption, effectiveness, real-world feasibility, and scalability. Here, we summarize the effectiveness and cost-effectiveness data regarding QI strategies in diabetes care and discuss the potential role of quality monitoring and QI in trying to implement primary prevention of diabetes more widely and effectively. Over time, achieving better care and better health will likely help bend the ever-growing cost curve.

  19. Diet and risk of coronary heart disease and type 2 diabetes.

    PubMed

    Mann, J I

    2002-09-07

    A high intake of saturated fat is an important risk factor for coronary heart disease (CHD) and type 2 diabetes. However the declining rates of CHD in many affluent societies and the steady increase in type 2 diabetes worldwide suggest that these important causes of serious morbidity and premature mortality have differing risk or protective factors worldwide. Changed macronutrient composition, reduced cigarette smoking, and improved treatment of risk factors and acute cardiac events might explain the reduction in risk of CHD, whereas the increasing rates of obesity are probably the most important explanation for the increase in diabetes. Coronary risk factors associated with diabetes could outweigh improvements in conventional cardiovascular risk factors such that the decline in CHD could be stopped or reversed unless rates of obesity can be reduced. Reduced intake of saturated fatty acids and other lifestyle interventions aimed at lowering rates of obesity are the changes most likely to reduce the epidemic numbers of people with type 2 diabetes and CHD.

  20. Risk Prediction for Early CKD in Type 2 Diabetes

    PubMed Central

    Gao, Peggy; Lee, Shun Fu; Heinze, Georg; Clase, Catherine M.; Tobe, Sheldon; Teo, Koon K.; Gerstein, Hertzel; Mann, Johannes F.E.

    2015-01-01

    Background and objectives Quantitative data for prediction of incidence and progression of early CKD are scarce in individuals with type 2 diabetes. Therefore, two risk prediction models were developed for incidence and progression of CKD after 5.5 years and the relative effect of predictors were ascertained. Design, setting, participants, & measurements Baseline and prospective follow-up data of two randomized clinical trials, ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Outcome Reduction with Initial Glargine Intervention (ORIGIN), were used as development and independent validation cohorts, respectively. Individuals aged ≥55 years with type 2 diabetes and normo- or microalbuminuria at baseline were included. Incidence or progression of CKD after 5.5 years was defined as new micro- or macroalbuminuria, doubling of creatinine, or ESRD. The competing risk of death was considered as an additional outcome state in the multinomial logistic models. Results Of the 6766 ONTARGET participants with diabetes, 1079 (15.9%) experienced incidence or progression of CKD, and 1032 (15.3%) died. The well calibrated, parsimonious laboratory prediction model incorporating only baseline albuminuria, eGFR, sex, and age exhibited an externally validated c-statistic of 0.68 and an R2 value of 10.6%. Albuminuria, modeled to depict the difference between baseline urinary albumin/creatinine ratio and the threshold for micro- or macroalbuminuria, was mostly responsible for the predictive performance. Inclusion of clinical predictors, such as glucose control, diabetes duration, number of prescribed antihypertensive drugs, previous vascular events, or vascular comorbidities, increased the externally validated c-statistic and R2 value only to 0.69 and 12.1%, respectively. Explained variation was largely driven by renal and not clinical predictors. Conclusions Albuminuria and eGFR were the most important factors to predict onset and

  1. Metabolite Traits and Genetic Risk Provide Complementary Information for the Prediction of Future Type 2 Diabetes

    PubMed Central

    Porneala, Bianca C.; Dauriz, Marco; Vassy, Jason L.; Cheng, Susan; Rhee, Eugene P.; Wang, Thomas J.; Meigs, James B.; Gerszten, Robert E.

    2014-01-01

    OBJECTIVE A genetic risk score (GRS) comprised of single nucleotide polymorphisms (SNPs) and metabolite biomarkers have each been shown, separately, to predict incident type 2 diabetes. We tested whether genetic and metabolite markers provide complementary information for type 2 diabetes prediction and, together, improve the accuracy of prediction models containing clinical traits. RESEARCH DESIGN AND METHODS Diabetes risk was modeled with a 62-SNP GRS, nine metabolites, and clinical traits. We fit age- and sex-adjusted logistic regression models to test the association of these sources of information, separately and jointly, with incident type 2 diabetes among 1,622 initially nondiabetic participants from the Framingham Offspring Study. The predictive capacity of each model was assessed by area under the curve (AUC). RESULTS Two hundred and six new diabetes cases were observed during 13.5 years of follow-up. The AUC was greater for the model containing the GRS and metabolite measurements together versus GRS or metabolites alone (0.820 vs. 0.641, P < 0.0001, or 0.820 vs. 0.803, P = 0.01, respectively). Odds ratios for association of GRS or metabolites with type 2 diabetes were not attenuated in the combined model. The AUC was greater for the model containing the GRS, metabolites, and clinical traits versus clinical traits only (0.880 vs. 0.856, P = 0.002). CONCLUSIONS Metabolite and genetic traits provide complementary information to each other for the prediction of future type 2 diabetes. These novel markers of diabetes risk modestly improve the predictive accuracy of incident type 2 diabetes based only on traditional clinical risk factors. PMID:24947790

  2. Assessing the risk of gestational diabetes in twin gestation.

    PubMed Central

    Henderson, C. E.; Scarpelli, S.; LaRosa, D.; Divon, M. Y.

    1995-01-01

    This study examines the hypothesis that twin gestation is a risk factor for gestational diabetes. In a retrospective analysis, the incidence of gestational diabetes in twin and singleton pregnancies was determined in groups matched for maternal age, weight, and parity. One-hour oral glucose challenge tests (50 g) were used to screen 9185 pregnant women. Gestational diabetes was diagnosed when abnormal screens (> or = 130 mg/dL) were followed by two or more abnormal values on a 3-hour (100 g) glucose tolerance test using National Diabetes Data Group (NDDG) criteria. A twin gestation was identified in 1.5% (138/9185) of the pregnancies. Gestational diabetes was diagnosed in 5.8% (8/138) and 5.4% (439/9047) of the twin and singleton pregnancies, respectively. The incidence of gestational diabetes is similar for singleton and twin gestations. PMID:7473851

  3. Diabetes Mellitus, Arterial Wall, and Cardiovascular Risk Assessment

    PubMed Central

    Kozakova, Michaela; Palombo, Carlo

    2016-01-01

    Diabetes mellitus is an independent risk factor for atherothrombotic cardiovascular disease. Adults with diabetes are two to four times more likely to develop heart disease or stroke than adults without diabetes. The two major features of diabetes, i.e., hyperglycemia and insulin-resistance, trigger arterial stiffening and increase the susceptibility of the arterial wall to atherosclerosis at any given age. These pathological changes in the arterial wall may provide a functional and structural background for cardiovascular events. The present paper provides a critical overview of the clinical evidence linking diabetes-related metabolic abnormalities to cardiovascular risk, debates the pathophysiologic mechanisms through which insulin resistance and hyperglycemia may affect the arterial wall, and discusses the associations between vascular biomarkers, metabolic abnormalities and cardiovascular events. PMID:26861377

  4. Population-Level Prediction of Type 2 Diabetes From Claims Data and Analysis of Risk Factors.

    PubMed

    Razavian, Narges; Blecker, Saul; Schmidt, Ann Marie; Smith-McLallen, Aaron; Nigam, Somesh; Sontag, David

    2015-12-01

    We present a new approach to population health, in which data-driven predictive models are learned for outcomes such as type 2 diabetes. Our approach enables risk assessment from readily available electronic claims data on large populations, without additional screening cost. Proposed model uncovers early and late-stage risk factors. Using administrative claims, pharmacy records, healthcare utilization, and laboratory results of 4.1 million individuals between 2005 and 2009, an initial set of 42,000 variables were derived that together describe the full health status and history of every individual. Machine learning was then used to methodically enhance predictive variable set and fit models predicting onset of type 2 diabetes in 2009-2011, 2010-2012, and 2011-2013. We compared the enhanced model with a parsimonious model consisting of known diabetes risk factors in a real-world environment, where missing values are common and prevalent. Furthermore, we analyzed novel and known risk factors emerging from the model at different age groups at different stages before the onset. Parsimonious model using 21 classic diabetes risk factors resulted in area under ROC curve (AUC) of 0.75 for diabetes prediction within a 2-year window following the baseline. The enhanced model increased the AUC to 0.80, with about 900 variables selected as predictive (p < 0.0001 for differences between AUCs). Similar improvements were observed for models predicting diabetes onset 1-3 years and 2-4 years after baseline. The enhanced model improved positive predictive value by at least 50% and identified novel surrogate risk factors for type 2 diabetes, such as chronic liver disease (odds ratio [OR] 3.71), high alanine aminotransferase (OR 2.26), esophageal reflux (OR 1.85), and history of acute bronchitis (OR 1.45). Liver risk factors emerge later in the process of diabetes development compared with obesity-related factors such as hypertension and high hemoglobin A1c. In conclusion

  5. Integrating smartphone technology, social support and the outdoor physical environment to improve fitness among adults at risk of, or diagnosed with, Type 2 Diabetes: Findings from the 'eCoFit' randomized controlled trial.

    PubMed

    Plotnikoff, Ronald C; Wilczynska, Magdalena; Cohen, Kristen E; Smith, Jordan J; Lubans, David R

    2017-09-05

    The risk and prevalence of Type 2 Diabetes (T2D) has dramatically increased over the past decade. The aim of this study was to develop, implement and evaluate a physical activity intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. A 20-week, assessor blinded, parallel-group randomized controlled trial (RCT) was conducted at the University of Newcastle (June-December 2015). Adults were randomized to the intervention (n=42) or wait-list control group (n=42). The theory-based intervention included: Phase 1 (weeks 1-10) integrated group sessions (outdoor physical activity and cognitive mentoring), and the eCoFit smartphone application (app). Phase 2 (weeks 11-20) only included the eCoFit app. Participants were assessed at baseline, 10weeks and 20weeks. Linear mixed models (intention-to-treat) were used to determine group-by-time interactions at 10weeks (primary time-point) and 20weeks for the primary outcomes. Several secondary outcomes were also assessed. After 10weeks, significant group-by-time effects were observed for aerobic fitness (4.5mL/kg/min; 95% CI [1.3, 7.7], d=0.68) and muscular fitness (lower body) (3.4 reps, 95% CI [2.7, 4.2], d=1.45). Intervention effects for secondary outcomes included significant increased physical activity (1330steps/week), improved upper body muscular fitness (5 reps; arm-curl test), improved functionality (-1.8s; timed-up and go test) reduced waist circumference (2.8cm) and systolic blood pressure (-10.4mmHg). After 20weeks, significant effects were observed for lower body muscular fitness and health outcomes. eCoFit is an innovative lifestyle intervention which integrates smartphone technology, social support, and the outdoor environment to improve aerobic and muscular fitness. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Am I at Risk for Gestational Diabetes?

    MedlinePlus

    ... level is: High 1 Average 0 Low Your health care provider: Will test you as soon as you know you are ... their lifetime. If you had gestational diabetes, your health care provider will test you for diabetes 6 weeks after you give ...

  7. Role of coffee in modulation of diabetes risk.

    PubMed

    Natella, Fausta; Scaccini, Cristina

    2012-04-01

    Coffee consumption has been associated with a lower risk of type 2 diabetes. This association does not depend on race, gender, geographic distribution of the study populations, or the type of coffee consumed (i.e., caffeinated or decaffeinated). This review discusses the strength of this relationship, examines the possibility that the pattern of coffee consumption could influence the association, and evaluates the possible relationship between coffee consumption and other risk factors associated with diabetes. Particular attention is paid to the identification, on the basis of the scientific evidence, of the possible mechanisms by which coffee components might affect diabetes development, especially in light of the paradoxical effect of caffeine on glucose metabolism. In addition to the role of coffee in reducing the risk of developing type 2 diabetes, the possible role of coffee in the course of the illness is explored. Finally, the possibility that coffee can also affect the risk of other forms of diabetes (e.g., type 1 diabetes and gestational diabetes) is examined.

  8. Modifiable Lifestyle Risk Factors and Incident Diabetes in African Americans.

    PubMed

    Joseph, Joshua J; Echouffo-Tcheugui, Justin B; Talegawkar, Sameera A; Effoe, Valery S; Okhomina, Victoria; Carnethon, Mercedes R; Hsueh, Willa A; Golden, Sherita H

    2017-08-14

    The associations of modifiable lifestyle risk factors with incident diabetes are not well investigated in African Americans (AAs). This study investigated the association of modifiable lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden) with incident diabetes among AAs. Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson Heart Study who were free of diabetes at baseline (2000-2004) using baseline questionnaires and combined into risk factor categories: poor (0-3 points), average (4-7 points), and optimal (8-11 points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI. Outcomes were collected 2005-2012 and data analyzed in 2016. Over 7.6 years, there were 560 incident diabetes cases (mean age=53.3 years, 64% female). An average or optimal compared to poor risk factor categorization was associated with a 21% (IRR=0.79, 95% CI=0.62, 0.99) and 31% (IRR=0.69, 95% CI=0.48, 1.01) lower risk of diabetes. Among participants with BMI <30, IRRs for average or optimal compared to poor categorization were 0.60 (95% CI=0.40, 0.91) and 0.53 (95% CI=0.29, 0.97) versus 0.90 (95% CI=0.67, 1.21) and 0.83 (95% CI=0.51, 1.34) among participants with BMI ≥30. A combination of modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, particularly among those without obesity. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Diabetic retinopathy, duration of diabetes and risk factors of atherosclerotic cardiovascular disease.

    PubMed

    Job, D; Eschwège, E; Tchobroutsky, G; Guyot-Argenton, C; Aubry, J P; Dérot, N

    1975-01-01

    The present study, concerning 145 insulin-dependent diabetics showed positive relationships between the severity of retinal disease on the one hand, and body weight, blood pressure, and serum cholesterol level on the other. These relationships remain significant when the duration of the clinical diabetes and the age of the patient are taken into account. Two interpretations are suggested. They are not incompatible. In diabetic subjects, either the increase in blood pressure and serum cholesterol level causes an aggravation of diabetic retinopathy or there exists a common factor at the origin of retinal lesions and of an increase in risk of cardiovascular disease through atherosclerosis.

  10. Diabetes, glucose tolerance, and the risk of sudden cardiac death.

    PubMed

    Eranti, Antti; Kerola, Tuomas; Aro, Aapo L; Tikkanen, Jani T; Rissanen, Harri A; Anttonen, Olli; Junttila, M Juhani; Knekt, Paul; Huikuri, Heikki V

    2016-02-24

    Diabetes predisposes to sudden cardiac death (SCD). However, it is uncertain whether greater proportion of cardiac deaths are sudden among diabetes patients than other subjects. It is also unclear whether the risk of SCD is pronounced already early in the course of the disease. The relationship of impaired glucose tolerance (IGT) and SCD is scarcely documented. A general population cohort of 10594 middle-aged subjects (mean age 44 years, 52.6 % male, follow-up duration 35-41 years) was divided into diabetes patients (n = 82), subjects with IGT (n = 3806, plasma glucose ≥9.58 mmol/l in one-hour glucose tolerance test), and controls (n = 6706). Diabetes patients had an increased risk of SCD after adjustment confounders (hazard ratio 2.62, 95 % confidence interval 1.46-4.70, p = 0.001) but risk for non-sudden cardiac death was similarly increased and the proportion of SCD of cardiac deaths was not increased. The SCD risk persisted after exclusion of subjects with baseline cardiac disease or non-fatal cardiac events during the follow-up. Subjects with IGT were at increased risk for SCD (univariate hazard ratio 1.51; 95 % confidence interval 1.31-1.74; p < 0.001) and also for non-sudden cardiac deaths and non-fatal cardiac events but adjustments for other risk factors attenuated these effects. Diabetes was associated with increased risk of SCD but also the risk of non-sudden cardiac death was similarly increased. The proportion of cardiac deaths being sudden in subjects with diabetes was not increased. The higher SCD risk in diabetes patients was independent of known cardiac disease at baseline or occurrence of non-fatal cardiac event during the follow-up.

  11. The impact of diabetes and associated cardiometabolic risk factors on members: strategies for optimizing outcomes.

    PubMed

    Hoerger, Thomas J; Ahmann, Andrew J

    2008-02-01

    In the past decade, the prevalence of obesity, diabetes, and metabolic syndrome has increased exponentially. Estimated national spending on direct costs related to these conditions exceeds $90 billion for overweight and obesity, $90 billion for diabetes, and $250 billion for cardiovascular disease (CVD). Spending on prescription drugs that are used to modify cardiometabolic risk (CMR) is both a major component of all spending on prescription drugs and a leading cause of the increase in such spending. Also, spending on antihyperglycemic agents is projected to become the largest single component of all spending on prescription drugs in the near future. As the use of antihyperglycemic agents continues to increase, there is a growing need to evaluate the relative and comparative cost-effectiveness of these products. As new antihyperglycemic agents appear, physicians and health plans may begin differentiating products in this category not only on the basis of their use in achieving glycemic control, but also in the context of their effect on global CMR factor modification. To describe the effect of overall CMR on clinical outcomes and costs in patients with diabetes. Metabolic syndrome is defined as a clustering of risk factors that identify those at increased risk of CVD and diabetes. Although the exact definition and clinical use of the term "metabolic syndrome" are debated, the clinical community is united in identifying its individual risk factors as important contributors to the development of cardiometabolic disease. Two of the most important points of consensus are that diabetes significantly increases the risk of CVD and that the CVD risk associated with metabolic syndrome is greater than the sum of its measured risk factors. Therefore, it is increasingly recognized that the risk of CVD is greater in patients with diabetes and other CMR factors than in those with diabetes alone. Diabetes treatment goals extend beyond glycemic control to include other risk factor

  12. Diabetes mellitus increases the risk of ruptured abdominal aortic aneurysms.

    PubMed

    Wierzba, Waldemar; Sliwczynski, Andrzej; Pinkas, Jaroslaw; Jawien, Arkadiusz; Karnafel, Waldemar

    2017-09-01

    The publication is a polemical response to reports that present data that diabetes reduces the risk of rupture of abdominal aortic aneurysm (AAA). The study analyzed all cases of developing AAA in patients with and without diabetes in 2012 in Poland. Data for the analysis were obtained with a unique and complete resources of the National Health Fund (NFZ) and population data from the Central Statistical Office (GUS). In Poland during 2012 2,227,453 patients with diabetes were treated, 975,364 males and 1,252,089 females. The incidence of AAA without rupture in patients without diabetes calculated per 100,000 of the non-diabetes general population was 25.0 +/- 9.0 in males and 5.6 +/- 2.3 in females. The incidence of ruptured AAA in the general population without diabetes was 3.6 +/- 0.9 in males, and 0.6 +/- 0.3 in females calculated per 100,000 of inhabitants without diabetes. The incidence of AAA without rupture in patients with diabetes was 184.897 +/- 70.653 in males and 35.364 +/- 24.925 in females calculated per 100,000 of patients diagnosed with diabetes. The incidence of ruptured AAA in patients with diabetes was 21.090 +/- 6.050 in males and 5.170 +/- 3.053 in females calculated per 100,000 of patients diagnosed with diabetes. The incidence rate for ruptured AAA in 2012 in Poland is statistically higher both in females and males in the population with diabetes. The incidence rate for AAA without rupture in 2012 in Poland is statistically higher in patients diagnosed with diabetes.

  13. Diabetes Risk Factors, Diabetes Risk Algorithms, and the Prediction of Future Frailty: The Whitehall II Prospective Cohort Study

    PubMed Central

    Bouillon, Kim; Kivimäki, Mika; Hamer, Mark; Shipley, Martin J.; Akbaraly, Tasnime N.; Tabak, Adam; Singh-Manoux, Archana; Batty, G. David

    2013-01-01

    Objective To examine whether established diabetes risk factors and diabetes risk algorithms are associated with future frailty. Design Prospective cohort study. Risk algorithms at baseline (1997–1999) were the Framingham Offspring, Cambridge, and Finnish diabetes risk scores. Setting Civil service departments in London, United Kingdom. Participants There were 2707 participants (72% men) aged 45 to 69 years at baseline assessment and free of diabetes. Measurements Risk factors (age, sex, family history of diabetes, body mass index, waist circumference, systolic and diastolic blood pressure, antihypertensive and corticosteroid treatments, history of high blood glucose, smoking status, physical activity, consumption of fruits and vegetables, fasting glucose, HDL-cholesterol, and triglycerides) were used to construct the risk algorithms. Frailty, assessed during a resurvey in 2007–2009, was denoted by the presence of 3 or more of the following indicators: self-reported exhaustion, low physical activity, slow walking speed, low grip strength, and weight loss; “prefrailty” was defined as having 2 or fewer of these indicators. Results After a mean follow-up of 10.5 years, 2.8% of the sample was classified as frail and 37.5% as prefrail. Increased age, being female, stopping smoking, low physical activity, and not having a daily consumption of fruits and vegetables were each associated with frailty or prefrailty. The Cambridge and Finnish diabetes risk scores were associated with frailty/prefrailty with odds ratios per 1 SD increase (disadvantage) in score of 1.18 (95% confidence interval: 1.09–1.27) and 1.27 (1.17–1.37), respectively. Conclusion Selected diabetes risk factors and risk scores are associated with subsequent frailty. Risk scores may have utility for frailty prediction in clinical practice. PMID:24103860

  14. Modified lipoproteins as biomarkers of cardiovascular risk in diabetes mellitus.

    PubMed

    Sánchez-Quesada, José Luis; Pérez, Antonio

    2013-11-01

    Prevention of high incidence of cardiovascular disease in diabetes is one of the challenges of endocrinology. Validation of new biomarkers that may contribute to a better assessment of cardiovascular risk and help implement treatment strategies is one of the promising approaches in research on prevention and reduction of cardiovascular risk. Modification of low density lipoprotein (LDL) is a key element in development of atherosclerotic lesions. Several pathophysiological characteristics of diabetes are crucial for the LDL of these patients to have higher modification rates as compared to the healthy population. Diabetic dyslipidemia, hyperglycemia, and oxidative stress synergistically promote the occurrence of lipoperoxidation, glycosylation and glycoxidation processes, which will generate modified lipoproteins that stimulate development of atherosclerosis. This article reviews the role of different types of modified LDL in development of atherosclerosis in diabetes, as well as the possibility of using its quantification in cardiovascular risk prediction. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  15. Different type 2 diabetes risk assessments predict dissimilar numbers at 'high risk': a retrospective analysis of diabetes risk-assessment tools.

    PubMed

    Gray, Benjamin J; Bracken, Richard M; Turner, Daniel; Morgan, Kerry; Thomas, Michael; Williams, Sally P; Williams, Meurig; Rice, Sam; Stephens, Jeffrey W

    2015-12-01

    Use of a validated risk-assessment tool to identify individuals at high risk of developing type 2 diabetes is currently recommended. It is under-reported, however, whether a different risk tool alters the predicted risk of an individual. This study explored any differences between commonly used validated risk-assessment tools for type 2 diabetes. Cross-sectional analysis of individuals who participated in a workplace-based risk assessment in Carmarthenshire, South Wales. Retrospective analysis of 676 individuals (389 females and 287 males) who participated in a workplace-based diabetes risk-assessment initiative. Ten-year risk of type 2 diabetes was predicted using the validated QDiabetes(®), Leicester Risk Assessment (LRA), FINDRISC, and Cambridge Risk Score (CRS) algorithms. Differences between the risk-assessment tools were apparent following retrospective analysis of individuals. CRS categorised the highest proportion (13.6%) of individuals at 'high risk' followed by FINDRISC (6.6%), QDiabetes (6.1%), and, finally, the LRA was the most conservative risk tool (3.1%). Following further analysis by sex, over one-quarter of males were categorised at high risk using CRS (25.4%), whereas a greater percentage of females were categorised as high risk using FINDRISC (7.8%). The adoption of a different valid risk-assessment tool can alter the predicted risk of an individual and caution should be used to identify those individuals who really are at high risk of type 2 diabetes. © British Journal of General Practice 2015.

  16. Antidepressant medicine use and risk of developing diabetes during the diabetes prevention program and diabetes prevention program outcomes study.

    PubMed

    Rubin, Richard R; Ma, Yong; Peyrot, Mark; Marrero, David G; Price, David W; Barrett-Connor, Elizabeth; Knowler, William C

    2010-12-01

    To assess the association between antidepressant medicine use and risk of developing diabetes during the Diabetes Prevention Program (DPP) and Diabetes Prevention Program Outcomes Study (DPPOS). DPP/DPPOS participants were assessed for diabetes every 6 months and for antidepressant use every 3 months in DPP and every 6 months in DPPOS for a median 10.0-year follow-up. Controlled for factors associated with diabetes risk, continuous antidepressant use compared with no use was associated with diabetes risk in the placebo (adjusted hazard ratio 2.34 [95% CI 1.32-4.15]) and lifestyle (2.48 [1.45-4.22]) arms, but not in the metformin arm (0.55 [0.25-1.19]). Continuous antidepressant use was significantly associated with diabetes risk in the placebo and lifestyle arms. Measured confounders and mediators did not account for this association, which could represent a drug effect or reflect differences not assessed in this study between antidepressant users and nonusers.

  17. Obesity and Diabetes: The Increased Risk of Cancer and Cancer-Related Mortality.

    PubMed

    Gallagher, Emily Jane; LeRoith, Derek

    2015-07-01

    Obesity and type 2 diabetes are becoming increasingly prevalent worldwide, and both are associated with an increased incidence and mortality from many cancers. The metabolic abnormalities associated with type 2 diabetes develop many years before the onset of diabetes and, therefore, may be contributing to cancer risk before individuals are aware that they are at risk. Multiple factors potentially contribute to the progression of cancer in obesity and type 2 diabetes, including hyperinsulinemia and insulin-like growth factor I, hyperglycemia, dyslipidemia, adipokines and cytokines, and the gut microbiome. These metabolic changes may contribute directly or indirectly to cancer progression. Intentional weight loss may protect against cancer development, and therapies for diabetes may prove to be effective adjuvant agents in reducing cancer progression. In this review we discuss the current epidemiology, basic science, and clinical data that link obesity, diabetes, and cancer and how treating obesity and type 2 diabetes could also reduce cancer risk and improve outcomes. Copyright © 2015 the American Physiological Society.

  18. Prediabetes: a high-risk state for diabetes development.

    PubMed

    Tabák, Adam G; Herder, Christian; Rathmann, Wolfgang; Brunner, Eric J; Kivimäki, Mika

    2012-06-16

    Prediabetes (intermediate hyperglycaemia) is a high-risk state for diabetes that is defined by glycaemic variables that are higher than normal, but lower than diabetes thresholds. 5-10% of people per year with prediabetes will progress to diabetes, with the same proportion converting back to normoglycaemia. Prevalence of prediabetes is increasing worldwide and experts have projected that more than 470 million people will have prediabetes by 2030. Prediabetes is associated with the simultaneous presence of insulin resistance and β-cell dysfunction-abnormalities that start before glucose changes are detectable. Observational evidence shows associations between prediabetes and early forms of nephropathy, chronic kidney disease, small fibre neuropathy, diabetic retinopathy, and increased risk of macrovascular disease. Multifactorial risk scores using non-invasive measures and blood-based metabolic traits, in addition to glycaemic values, could optimise estimation of diabetes risk. For prediabetic individuals, lifestyle modification is the cornerstone of diabetes prevention, with evidence of a 40-70% relative-risk reduction. Accumulating data also show potential benefits from pharmacotherapy. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Gestational Diabetes Mellitus: Risks and Management during and after Pregnancy

    PubMed Central

    Buchanan, Thomas A.; Xiang, Anny H.; Page, Kathleen A.

    2015-01-01

    Gestational diabetes mellitus (GDM) represents glucose levels in the high end of the population distribution during pregnancy. GDM carries a small but potentially important risk of adverse perinatal outcomes and a longer-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements compliment maternal glucose measurements in identifying pregnancies that need such intensification. Glucose testing shortly after pregnancy can stratify the near-term diabetes risk in mothers, Thereafter, annual glucose and HbA1C testing can detect deteriorating glycaemic control, a harbinger of future diabetes, usually type 2. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning allows optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity. PMID:22751341

  20. Environmental risk factors for type 1 diabetes

    PubMed Central

    Rewers, Marian; Ludvigsson, Johnny

    2017-01-01

    The incidence of type 1 diabetes has risen considerably in the past 30 years due to changes in the environment that have been only partially identified. In this Series paper, we critically discuss candidate triggers of islet autoimmunity and factors thought to promote progression from autoimmunity to overt type 1 diabetes. We revisit previously proposed hypotheses to explain the growth in the incidence of type 1 diabetes in light of current data. Finally, we suggest a unified model in which immune tolerance to β cells can be broken by several environmental exposures that induce generation of hybrid peptides acting as neoautoantigens. PMID:27302273

  1. Thyroid Cancer Risk Is Not Increased in Diabetic Patients

    PubMed Central

    Tseng, Chin-Hsiao

    2012-01-01

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

  2. Diabetes mellitus and cancer risk: review of the epidemiological evidence.

    PubMed

    Shikata, Kentaro; Ninomiya, Toshiharu; Kiyohara, Yutaka

    2013-01-01

    Diabetes mellitus and cancer are diseases of epidemic proportions across the globe. These diseases are influenced by many factors, both genetic and environmental. A possible association between diabetes and cancer risk has long been speculated. Increased incidence of several cancers has been observed in diabetes patients, notably pancreatic, hepatic, colorectal, breast, urinary tract, and endometrial cancers. In contrast, a decreased incidence of prostate cancer is observed in diabetes patients, implying a protective effect. Precise knowledge of the complex associations and interactions between these two conditions is of great importance for their prevention and treatment. Multiple potential mechanisms have been proposed, but they have tended to be site-specific. Possible common mechanisms for a biological link between diabetes and cancer include hyperinsulinemia, hyperglycemia, and inflammation. Today, 366 million people live with diabetes globally, and this figure is expected to increase. Thus, if diabetes is associated with even a small increase in cancer risk, this may have important consequences at the population level. The aim of this review is to summarize recent epidemiological evidence of an association between diabetes and total cancer and specific sites of cancer, and to consider causal associations between these diseases. © 2012 Japanese Cancer Association.

  3. Diabetes and coronary heart disease risk in Mexican Americans.

    PubMed

    Mitchell, B D; Haffner, S M; Hazuda, H P; Patterson, J K; Stern, M P

    1992-01-01

    Mexican Americans have a high prevalence of diabetes relative to non-Hispanic whites, but paradoxically experience a lower prevalence of myocardial infarction and lower cardiovascular mortality (at least in men). To determine whether Mexican Americans might be more resistant to the atherogenic effects of diabetes than non-Hispanic whites, we examined the associations between diabetes and myocardial infarction and selected coronary heart disease (CHD) risk factors in these two ethnic groups. The study population consisted of 5149 Mexican Americans and non-Hispanic whites who were 25 to 64 years old and recruited from the San Antonio Heart Study, a population-based study of cardiovascular risk factors and diabetes conducted between 1979 and 1988. Diabetic men were more than twice as likely to have an electrocardiography (ECG)-documented myocardial infarction than were nondiabetic men, while diabetic women were more than three times as likely to have a myocardial infarction than were nondiabetic women. In both sexes the association between myocardial infarction and diabetes was nearly identical between the two ethnic groups. In both ethnic groups diabetes was also more strongly associated with conventional CHD risk factors (e.g., triglycerides, systolic blood pressure, and high-density-lipoprotein cholesterol) in women than in men. Furthermore, these associations were at least as strong, if not stronger, in Mexican Americans as in non-Hispanic whites. Thus, these data provide no evidence to suggest that Mexican Americans are resistant to the lipid-altering effects of diabetes. We conclude that the protective effect against CHD conferred by Mexican American ethnicity may be obscured in part by the high prevalence of diabetes in this ethnic group.

  4. Family interventions to improve diabetes outcomes for adults

    PubMed Central

    Baig, Arshiya A.; Benitez, Amanda; Quinn, Michael T.; Burnet, Deborah L.

    2015-01-01

    Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient’s disease management, involving them in self-care interventions may positively influence patients’ diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients’ diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients’ self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients’ clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement. PMID:26250784

  5. [Relevance of diabetes in high cardiovascular risk hypertensive patients].

    PubMed

    Segura, Julián; de la Sierra, Alejandro; Fernández, Sandra; Ruilope, Luis M

    2013-10-05

    The aim of this cross-sectional study was to compare the prevalence of target organ damage (TOD) and established cardiovascular disease (CVD) in a cohort of nondiabetic hypertensive patients with 3 or more cardiovascular risk factors (CVRF) against a group of hypertensives with type 2 diabetes. We included 4,725 hypertensive patients, 62% male, mean age 64 (SD 12) years, with type 2 diabetes mellitus, independently of the number of associated CVRF (N=2,608), or non-diabetics, in which case we required the presence of 3 CVRF (N=2,117). The prevalence of established CVD (clinical interview) and TOD (left ventricular hypertrophy by electrocardiogram, microalbuminuria and estimated glomerular filtration rate) were estimated. Hypertensive patients with type 2 diabetes had an older age and more marked obesity. Furthermore, these patients showed a higher prevalence of micro- and macroalbuminuria, renal failure, left ventricular hypertrophy, atherosclerotic plaques in carotid arteries and CVD compared with nondiabetic hypertensive patients with 3 or more CVRF. Multivariate analysis showed that the risk of TOD or established CVD were associated independently with the presence of diabetes. Hypertensive patients with type 2 diabetes have a higher prevalence of LOD and CVD compared to nondiabetic hypertensive patients with 3 or more CVRF. Although both situations are included in the high cardiovascular risk stratum, it would be expected an increased incidence of cardiovascular complications in hypertensive diabetic patients. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  6. Environmental Risk Factors for Diabetes Mellitus in Cats.

    PubMed

    Öhlund, M; Egenvall, A; Fall, T; Hansson-Hamlin, H; Röcklinsberg, H; Holst, B S

    2017-01-01

    Diabetes in cats resembles type 2 diabetes in people. The etiology is not fully understood, but both genetic and environmental factors are believed to contribute. To assess the associations of environmental risk factors with diabetes in cats. Cats with a diagnosis of diabetes (n = 396) insured by a Swedish insurance company during years 2009-2013, and a control group (n = 1,670) matched on birth year. A web-based questionnaire was used in a case-control study. An invitation to participate was sent to owners of 1,369 diabetic cats and 5,363 control cats. The survey contained questions related to the cat's breed, age, sex, neutering status, body condition, housing, access to the outdoors, activity level, diet, eating behavior, feeding routine, general health, stressful events, other pets in the household, medications, and vaccination status. Data were analyzed by multiple logistic regression. Response rate was 35% for the diabetic group and 32% for the control group. Indoor confinement, being a greedy eater, and being overweight were associated with an increased risk of diabetes. In cats assessed by owners as being normal weight, there was an association between eating predominantly dry food and an increased risk of diabetes (Odds ratio 3.8; 95% confidence intervals 1.3-11.2). Dry food is commonly fed to cats worldwide. The association found between dry food and an increased risk of diabetes in cats assessed as normal weight by owners warrants further attention. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  7. The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

    PubMed Central

    Sibbald, R. Gary; Martin, Carlos

    2015-01-01

    Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P < 0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years. PMID:26089901

  8. Italian risk factor-based screening for gestational diabetes.

    PubMed

    Corrado, F; Pintaudi, B; Di Vieste, G; Interdonato, M L; Magliarditi, M; Santamaria, A; D'Anna, R; Di Benedetto, A

    2014-09-01

    There is a debate about whether universal or risk factors-based screening is most appropriate for gestational diabetes diagnosis. The aim of our retrospective study was to compare in our population the universal screening test recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) panel and the American Diabetes Association (ADA) versus the selective screening proposed by the United Kingdom National Institute for Health and Clinical Excellence guidelines (NICE) but modified by the Italian National Institute of Health. From May 2010 to October 2011 all consecutive pregnant women were screened for gestational diabetes according to the IADPSG's panel criteria, while all the risk factors for each patient were registered. Of the 1015 pregnant women included in the study, 113 (11%) were diagnosed with gestational diabetes and 26 (23%) of them would not have been identified by the selective screening proposed by the Italian National Institute of Health. However, all the risk factors considered by the selective screening revealed a good predictive role except for maternal age ≥ 35 years (OR: 0.98). In the group without the risk factors considered, it was reported the predictive role for gestational diabetes of prepregnancy BMI and nulliparity. The selective risk factors-based screening proposed by the Italian National Institute of Health has detected 77% of gestational diabetes cases in our population, sparing the oral glucose tolerance test for more than 40% of pregnant women at the same time. More information on the clinical impact of this choice could be obtained by a strict analysis of treatment, perinatal outcome and follow-up of an adequate sample size of "missed" gestational diabetes.

  9. Diabetes risk in women with gestational diabetes mellitus and a history of polycystic ovary syndrome: a retrospective cohort study.

    PubMed

    Bond, R; Pace, R; Rahme, E; Dasgupta, K

    2017-08-07

    To investigate whether polycystic ovary syndrome further increases postpartum diabetes risk in women with gestational diabetes mellitus and to explore relationships between polycystic ovary syndrome and incident diabetes in women who do not develop gestational diabetes. This retrospective cohort study (Quebec Physician Services Claims; Hospitalization Discharge Databases; Birth and Death registries) included 34 686 women with gestational diabetes during pregnancy (live birth), matched 1:1 to women without gestational diabetes by age group, year of delivery and health region. Diagnostic codes were used to define polycystic ovary syndrome and incident diabetes. Cox regression models were used to examine associations between polycystic ovary syndrome and incident diabetes. Polycystic ovary syndrome was present in 1.5% of women with gestational diabetes and 1.2% of women without gestational diabetes. There were more younger mothers and mothers who were not of white European ancestry among those with polycystic ovary syndrome. Those with polycystic ovary syndrome more often had a comorbidity and a lower proportion had a previous pregnancy. Polycystic ovary syndrome was associated with incident diabetes (hazard ratio 1.52; 95% CI 1.27, 1.82) among women with gestational diabetes. No conclusive associations between polycystic ovary syndrome and diabetes were identified (hazard ratio 0.94; 95% CI 0.39, 2.27) in women without gestational diabetes. In women with gestational diabetes, polycystic ovary syndrome confers additional risk for incident diabetes postpartum. In women without gestational diabetes, an association between PCOS and incident diabetes was not observed. Given the already elevated risk of diabetes in women with a history of gestational diabetes, a history of both polycystic ovary syndrome and gestational diabetes signal a critical need for diabetes surveillance and prevention. © 2017 Diabetes UK.

  10. Improving Information Security Risk Management

    ERIC Educational Resources Information Center

    Singh, Anand

    2009-01-01

    manaOptimizing risk to information to protect the enterprise as well as to satisfy government and industry mandates is a core function of most information security departments. Risk management is the discipline that is focused on assessing, mitigating, monitoring and optimizing risks to information. Risk assessments and analyses are critical…

  11. Improving Information Security Risk Management

    ERIC Educational Resources Information Center

    Singh, Anand

    2009-01-01

    manaOptimizing risk to information to protect the enterprise as well as to satisfy government and industry mandates is a core function of most information security departments. Risk management is the discipline that is focused on assessing, mitigating, monitoring and optimizing risks to information. Risk assessments and analyses are critical…

  12. Identifying risk and preventing progression to Type 2 diabetes in vulnerable and disadvantaged adults: a pragmatic review.

    PubMed

    Taylor, J; Cottrell, C; Chatterton, H; Hill, J; Hughes, R; Wohlgemuth, C; Holt, R I G

    2013-01-01

    To identify effective approaches to recognize diabetes risk and prevent progression to Type 2 diabetes in vulnerable groups, whose diabetes risk may be difficult to identify or manage. UK-based interventions that assess diabetes risk and/or target known risk factors were identified through four main sources: submissions to two calls for evidence by the National Institute for Health and Clinical Excellence; local practice examples collected via a targeted email questionnaire; selected electronic databases; and a focused search of relevant websites. No restriction was placed on the study type or evaluation methods used. Key themes and sub-themes on outcomes, as well as facilitators and barriers to successful delivery, are reported. Twenty-four interventions met all inclusion criteria: 15 included a risk identification element and 14 included preventative activities. A range of risk identification tools were used to improve diagnosis of unmet diabetes-related health needs and raise awareness of diabetes risk factors. All preventative interventions focused on lifestyle change. No interventions monitored blood glucose as an outcome and only one reported improvements in baseline risk scores. Facilitators included tailored and flexible programme design, outreach delivery in familiar locations and effective inter-agency working. Barriers included literacy and language difficulties, transient participant populations, low prioritization of diabetes prevention and cost. It is possible to engage successfully with high-risk adults in vulnerable groups to achieve positive health outcomes relevant to the prevention of diabetes. However, more robust evidence on longer-term outcomes is required to ensure that programmes are targeted and delivered appropriately. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  13. Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: The SEARCH for Diabetes in Youth Study.

    PubMed

    Barnes, T L; Crandell, J L; Bell, R A; Mayer-Davis, E J; Dabelea, D; Liese, A D

    2013-10-14

    Youth with diabetes are at an increased risk of cardiovascular disease (CVD). Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to improve CVD risk. In this study, we evaluated whether changes in diet quality as characterized by DASH are associated with changes in CVD risk factors in youth with diabetes over time. Longitudinal mixed models were applied to data from 797 participants in the SEARCH for Diabetes in Youth Study representing three time points: baseline, 12- and 60-month follow-up. Data were restricted to youth whose diabetes was first diagnosed in 2002-2005. DASH-related adherence was poor and changed very little over time. However, an increase in DASH diet score was significantly associated with a decrease in HbA1c levels in youth with type 1 diabetes (β=-0.20, P-value=0.0063) and a decrease in systolic blood pressure among youth with type 2 diabetes (β=-2.02, P-value=0.0406). Improvements in dietary quality may be beneficial in youth with type 1 or type 2 diabetes. However, further work in larger groups of youth with type 1 and 2 diabetes is desirable.

  14. Special Diabetes Program for Indians: Retention in Cardiovascular Risk Reduction

    ERIC Educational Resources Information Center

    Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette

    2011-01-01

    Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American…

  15. Diabetes Drug Gets FDA Warning Due to Amputation Risk

    MedlinePlus

    ... html Diabetes Drug Gets FDA Warning Due to Amputation Risk Canagliflozin tied to a doubling of amputations of legs, feet, agency says To use the ... to increase the risk of leg and foot amputations, the U.S. Food and Drug Administration says. The ...

  16. Special Diabetes Program for Indians: Retention in Cardiovascular Risk Reduction

    ERIC Educational Resources Information Center

    Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette

    2011-01-01

    Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American…

  17. Minocycline improves peripheral and autonomic neuropathy in type 2 diabetes: MIND study.

    PubMed

    Syngle, Ashit; Verma, Inderjeet; Krishan, Pawan; Garg, Nidhi; Syngle, Vijaita

    2014-07-01

    Diabetic peripheral neuropathy and diabetic autonomic neuropathy are serious and common complications of diabetes associated with increased risk of mortality and cardiovascular disease. We sought to evaluate the safety and efficacy of minocycline in type 2 diabetic patients with diabetic peripheral and autonomic neuropathy. In a randomized placebo controlled study, 50 outpatients were randomly assigned to receive 100 mg minocycline or placebo. Outcome measures included the vibration perception threshold (VPT), Leeds assessment of neuropathic symptoms and signs (LANSS), Pain Disability Index (PDI), Visual Analog Scale (VAS), beck depression inventory (BDI), health assessment questionnaire (HAQ) and autonomic neuropathy, assessed by cardiovascular reflex tests according to Ewing and peripheral sympathetic autonomic function was assessed by FDA approved Sudoscan. At baseline there were no significant differences between demographic variables and the neuropathy variables in the minocycline and placebo groups. After treatment, VPT significantly improved in the minocycline group as compared to the placebo group. Mean posttreatment scores on the LANSS, PDI and HAQ were significantly lower in the minocycline group compared with the placebo group. However, BDI and VAS significantly (p = 0.01) improved in both minocycline and placebo groups (Table 2). After treatment with minocycline, heart rate (HR) response to standing significantly improved, while there was a borderline significance toward a reduction in HR response to deep breath. These finding indicate that 6-week oral treatment with minocycline is safe, well tolerated and significantly improves peripheral and autonomic neuropathy in type 2 diabetic patients.

  18. Potential Effect of Opium Consumption on Controlling Diabetes and Some Cardiovascular Risk Factors in Diabetic Patients

    PubMed Central

    Rahimi, Najmeh; Gozashti, Mohamad Hossain; Najafipour, Hamid; Shokoohi, Mostafa; Marefati, Hamid

    2014-01-01

    Background Due to this belief that opium may have beneficial effects on diabetes or cardiovascular risk factors, the present study aimed to assess the potential and possible effects of opium consumption on diabetes control and some cardiovascular risk factors in diabetic patients. Methods This study enrolled 374 diabetic subjects from diabetes care centers in Kerman, Iran, including opium user group (n = 179) and a non-opium user group (n = 195). The data were collected through a questionnaire completed by interviewing, physical examination and laboratory assessment. Findings Opium did not show any statistically significant effect on blood glucose, glycated hemoglobin (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL) and diastolic blood pressure. However, systolic blood pressure (SBP) and prevalence of high SBP were significantly higher in opium user group (P < 0.050). In addition, lower serum high-density lipoprotein (HDL) and frequency of lower HDL was significantly higher in opium user group (P < 0.001). Conclusion According to this study, opium does not seem to have beneficial effects on diabetes control or cardiovascular risk factors. Therefore, it would not be advisable to consume opium as an anti-diabetes or cardioprotective agent. PMID:25140211

  19. Insulin glargine improves glycemic control and health-related quality of life in type 1 diabetes.

    PubMed

    Manini, Rita; Forlani, Gabriele; Moscatiello, Simona; Zannoni, Chiara; Marzocchi, Rebecca; Marchesini, Giulio

    2007-09-01

    Glargine improves glucose control and reduces the risk of nocturnal hypoglycemia compared with neutral protamine Hagedorn (NPH) insulin. To date, only one study has measured the effects of glargine on health-related quality of life (HRQL); the aim of this study was therefore to confirm the beneficial effects of glargine on disease-specific HRQL in type 1 diabetes. Forty-seven patients (mean age, 46 range, 25-74; males, 54%) with diabetes of at least 1-year duration, and with suboptimal glucose control under intensive insulin treatment (IIT), were switched from NPH to glargine. Forty patients maintained on IIT were used as controls. Diabetes-related HRQL was assessed using the Well-being Enquiry for Diabetics (WED), before and after a 6- to 8-month switch to glargine. An 11-item questionnaire based upon diabetes-specific issues was used to assess treatment satisfaction and perceived changes after switching. On glargine, the mean glycosylated hemoglobin decreased by 0.7% (treatment vs. baseline, P<0.0001) and several WED scores improved (discomfort, P=0.020; impact, P=0.0002; total score, P=0.0005). WED changes were associated with a lower perceived risk of hypoglycemia and less problems in daily life on glargine. The results of this study show that the beneficial effect of glargine is not limited to better metabolic control; the burden of type 1 diabetes mellitus on everyday life is also reduced.

  20. 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

  1. 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…

  2. 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…

  3. [Diabetes and amoebiasis: a high-risk combination].

    PubMed

    Bredin, C; Margery, J; Bordier, L; Mayaudon, H; Dupuis, O; Vergeau, B; Bauduceau, B

    2004-01-01

    Amoebiasis is the second most common parasitic disease in the world. It occurs mainly in developing countries. Many people in endemic countries are asymptomatic carriers. It results in severe disease that can be fatal in rare cases. The case described in this report illustrates the growing risk of exposure to amoebiasis for diabetic patients as travel to endemic countries becomes more and more frequent. In the patient described here amoebiasis led to amoeboma, a rare complication of the colonic presentation. Despite a clinical disease syndrome mimicking that of an occluding gut tumor, the patient was treated medically with drugs alone. Retrospective studies show that diabetics are at higher risk for severe complications after amoebic infection. Because of the high incidence and severity of concurrent diabetes and amoeba, prophylactic measures are necessary for diabetic patients traveling in developing countries.

  4. Survival Association Rule Mining Towards Type 2 Diabetes Risk Assessment

    PubMed Central

    Simon, Gyorgy J.; Schrom, John; Castro, M. Regina; Li, Peter W.; Caraballo, Pedro J.

    2013-01-01

    Type-2 Diabetes Mellitus is a growing epidemic that often leads to severe complications. Effective preventive measures exist and identifying patients at high risk of diabetes is a major health-care need. The use of association rule mining (ARM) is advantageous, as it was specifically developed to identify associations between risk factors in an interpretable form. Unfortunately, traditional ARM is not directly applicable to survival outcomes and it lacks the ability to compensate for confounders and to incorporate dosage effects. In this work, we propose Survival Association Rule (SAR) Mining, which addresses these shortcomings. We demonstrate on a real diabetes data set that SARs are naturally more interpretable than the traditional association rules, and predictive models built on top of these rules are very competitive relative to state of the art survival models and substantially outperform the most widely used diabetes index, the Framingham score. PMID:24551408

  5. HDL cholesterol and risk of diabetic nephropathy in patient with type 1 diabetes: A meta-analysis of cohort studies.

    PubMed

    Chen, Ying; Zhi, Yunqing; Li, Chengqian; Liu, Ying; Zhang, Lifang; Wang, Yangang; Che, Kui

    2016-12-01

    A meta-analysis was conducted to assess the impact of HDL on risk of diabetic nephropathy in T1DM patients. Ten papers containing (7698) participants were included in this meta-analysis. Our meta-analysis suggest that the risk of diabetic nephropathy was decreased with HDL in type 1 diabetes.

  6. Decreased Cardiovascular Risk after Roux-en-Y Gastric Bypass Surgery in Chinese Diabetic Patients with Obesity

    PubMed Central

    Duan, Wenyan; Sun, Chenglin; Li, Zhuo; Xiao, Xianchao; Wang, Gang

    2017-01-01

    Background The influence of bariatric surgery on cardiovascular risks in Chinese diabetic patients remains unclear. Here, we aimed to explore the impact of Roux-en-Y gastric bypass surgery (RYGB) on cardiovascular risks in Chinese diabetic patients with obesity. Methods Twenty Chinese patients with T2DM and obesity undergoing RYGB surgery were included in this study. Cardiovascular risk factors were measured before and 18 months after surgery. A 10-year cardiovascular risk was calculated by the UKPDS risk engine. Linear regression analysis was performed on CHD risk, stroke risk, and baseline metabolic parameters. Results The complete remission rate of diabetes was 90% after RYGB surgery, with significant improvements in blood pressure, BMI, glucose, and lipid metabolism (P < 0.05). The 10-year cardiovascular risk of coronary heart disease reduced from 13.05% to 3.81% (P = 0.001) and the 10-year risk of stroke reduced from 19.66% to 14.22% (P = 0.002). In subgroup analysis, Chinese diabetic patients who were women, <45 years old, with BMI < 35 kg/m2, and DM duration > 5 years, using noninsulin therapy presented more obvious improvements in the 10-year cardiovascular risk after RYGB surgery. WHR, age, LDL-C, and HbA1c were the most important factors influencing CHD or stroke risk after RYGB surgery (P < 0.01). Conclusion RYGB surgery is an effective treatment to reduce cardiovascular risk in Chinese diabetic patients with obesity. PMID:28744472

  7. Prevalence and risk factors for diabetes and diabetic retinopathy: results from the Nigeria national blindness and visual impairment survey.

    PubMed

    Kyari, Fatima; Tafida, Abubakar; Sivasubramaniam, Selvaraj; Murthy, Gudlavalleti V S; Peto, Tunde; Gilbert, Clare E

    2014-12-18

    In Nigeria, urbanisation and increasing life expectancy are likely to increase the incidence of non-communicable diseases. As the epidemic of diabetes matures, visual loss from diabetic retinopathy (DR) will increase unless mechanisms for early detection and treatment improve, and health systems respond to the growing burden of non-communicable diseases. A nationally-representative population-based sample of 13,591 participants aged ≥40 years selected by multistage-stratified-cluster-random-sampling with probability-proportional-to-size procedures were examined in 305 clusters in Nigeria between January 2005 to June 2007. All were asked about history of diabetes and underwent basic eye examination. Visual acuity (VA) was measured using logMAR E-chart. Participants with VA<6/12 and/or DR detected underwent detailed eye examination including dilated retinal examination and retinal photography. Systematic sampling of 1-in-7 gave a subsample (n=1759) examined in detail regardless of VA; and had random blood glucose (RBG) testing. Images were graded by Moorfields Eye Hospital Reading Centre. Participants were defined as having diabetes if they were previously diagnosed or RBG>11.1mmol/l or had DR. Data in the subsample were used to estimate the prevalence and to analyse risk factors for diabetes and DR using multivariable logistic regression. Additional information on the types of DR was obtained from participants not in the subsample. In the subsample, 164 participants were excluded due to missing data; and 1,595 analysed. 52/1,595 had diabetes, a prevalence of 3.3% (95%CI 2.5-4.3%); and 25/52(48%) did not know. Media opacity in 8/52 precluded retinal examination. 9/44(20.5%) had DR. Higher prevalence of diabetes was associated with urban residence (Odds ratio [OR]1.87) and overweight/obesity (OR3.02/4.43 respectively). Although not statistically significant, DR was associated with hypertension (OR3.49) and RBG>15.0mmol/L (OR8.10). Persons with diabetes had 3 times

  8. A2B Adenosine Receptor Agonist Improves Erectile Function in Diabetic Rats.

    PubMed

    Wen, Jiaming; Wang, Bohan; Du, Chuanjun; Xu, Gang; Zhang, Zhewei; Li, Yi; Zhang, Nan

    2015-10-01

    Diabetes is an important risk factor for erectile dysfunction (ED). Recent studies have indicated that A2B adenosine receptor (ADORA2B) signaling is essential for penile erection. Thus, we hypothesize that diabetic ED may be attributed to impaired A2B adenosine signaling. To test this hypothesis, we generated diabetic rats by injecting streptozocin as animal model. After 12 weeks, immunohistochemistry staining was used to localize the expression of ADORA2B. Western Blot and quantitative PCR were employed to determine ADORA2B expression level. Intracavernosal pressure (ICP) measurement was used to evaluate erectile function. Diabetic rats received a single intravenous injection of BAY 60-6583, an ADORA2B agonist, or vehicle solution, at 60 min before the ICP measurement. The results showed that ADORA2B expressed in the nerve bundle, smooth muscle, and endothelium in penile tissue of control mice. Western Blot and quantitative PCR results indicated that the expression levels of ADORA2B protein and mRNA were significantly reduced in penile tissues of diabetic rats. Functional studies showed that the erectile response induced by electrical stimulation was remarkably decreased in diabetic rats, compared with age-matched control rats. However, at 60 min after BAY 60-6583 treatment, the erectile function was improved in diabetic rats, suggesting that enhancement of ADORA2B signaling may improve erectile function in diabetic ED. This preclinical study has revealed a previously unrecognized therapeutic possibility of BAY 60-6583 as an effective and mechanism-based drug to treat diabetic ED. In conclusion, we propose that impaired A2B adenosine signaling is one of the pathological mechanisms of diabetic ED.

  9. Prediabetes: A high-risk state for developing diabetes

    PubMed Central

    Tabák, Adam G.; Herder, Christian; Rathmann, Wolfgang; Brunner, Eric J.; Kivimäki, Mika

    2013-01-01

    Summary Prediabetes (or “intermediate hyperglycaemia”), based on glycaemic parameters above normal but below diabetes thresholds is a high risk state for diabetes with an annualized conversion rate of 5%–10%; with similar proportion converting back to normoglycaemia. The prevalence of prediabetes is increasing worldwide and it is projected that >470 million people will have prediabetes in 2030. Prediabetes is associated with the simultaneous presence of insulin resistance and β-cell dysfunction, abnormalities that start before glucose changes are detectable. Observational evidence shows associations of prediabetes with early forms of nephropathy, chronic kidney disease, small fibre neuropathy, diabetic retinopathy, and increased risk of macrovascular disease. Multifactorial risk scores could optimize the estimation of diabetes risk using non-invasive parameters and blood-based metabolic traits in addition to glycaemic values. For prediabetic individuals, lifestyle modification is the cornerstone of diabetes prevention with evidence of a 40%–70% relative risk reduction. Accumulating data also suggests potential benefits from pharmacotherapy. PMID:22683128

  10. Berberine chloride improved synaptic plasticity in STZ induced diabetic rats.

    PubMed

    Moghaddam, Hamid Kalalian; Baluchnejadmojarad, Tourandokht; Roghani, Mehrdad; Goshadrou, Fatemeh; Ronaghi, Abdolaziz

    2013-09-01

    Previous studies indicated that diabetes affects synaptic transmission in the hippocampus, leading to impairments of synaptic plasticity and defects in learning and memory. Although berberine treatment ameliorates memory impairment and improves synaptic plasticity in streptozotocin (STZ) induced diabetic rats, it is not clear if the effects are pre- or post-synaptic or both. The aim of this study was to evaluate the effects of berberine chloride on short-term plasticity in inhibitory interneurons in the dentate gyrus of STZ-induced diabetic rats. Experimental groups included: The control, control berberine treated (100 mg/kg), diabetic and diabetic berberine treated (50,100 mg/kg/day for 12 weeks) groups. The paired pulse paradigm was used to stimulate the perforant pathway and field excitatory post-synaptic potentials (fEPSP) were recorded in dentate gyrus (DG). In comparison with control, paired pulse facilitation in the diabetic group was significantly increased (P < 0.01) and this effect prevented by chronic berberine treatment (50,100 mg/kg). However, there were no differences between responses of the control berberine 100 mg/kg treated and diabetes berberine treated (50 and 100 mg/kg) groups as compared to the control group. The present results suggest that the pre-synaptic component of synaptic plasticity in the dentate gyrus is affected under diabetic conditions and that berberine prevents this effect.

  11. The Impact of Personalized Risk Feedback on Mexican Americans' Perceived Risk for Heart Disease and Diabetes

    ERIC Educational Resources Information Center

    Hovick, Shelly R.; Wilkinson, Anna V.; Ashida, Sato; de Heer, Hendrik D.; Koehly, Laura M.

    2014-01-01

    Little is known about the effect of personalized risk information on risk perceptions over time, particularly among ethnically diverse subpopulations. The present study examines Mexican American's (MAs) risk perceptions for heart disease and diabetes at baseline and following receipt of risk feedback based on family health history. Participants…

  12. The Impact of Personalized Risk Feedback on Mexican Americans' Perceived Risk for Heart Disease and Diabetes

    ERIC Educational Resources Information Center

    Hovick, Shelly R.; Wilkinson, Anna V.; Ashida, Sato; de Heer, Hendrik D.; Koehly, Laura M.

    2014-01-01

    Little is known about the effect of personalized risk information on risk perceptions over time, particularly among ethnically diverse subpopulations. The present study examines Mexican American's (MAs) risk perceptions for heart disease and diabetes at baseline and following receipt of risk feedback based on family health history. Participants…

  13. Improved diabetes control in the elderly delays global cognitive decline.

    PubMed

    Luchsinger, J A; Palmas, W; Teresi, J A; Silver, S; Kong, J; Eimicke, J P; Weinstock, R S; Shea, S

    2011-06-01

    To examine whether improved diabetes control is related to better cognitive outcomes. Randomized control trial. A randomized trial of telemedicine vs. usual care in elderly persons with type 2 diabetes. Participants were 2169 persons 55 years and older with type 2 diabetes from New York City and Upstate New York. The diabetes case management intervention was implemented by a diabetes nurse, via a telemedicine unit in the participant's home, and in coordination with the primary care physician. Hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low density lipoprotein cholesterol (LDL), were measured at a baseline visit and at up to 5 annual follow-up visits. Global cognition was measured at those visits with the Comprehensive Assessment and Referral Evaluation (CARE). In mixed models the intervention was related to slower global cognitive decline in the intervention group (p = 0.01). Improvements in HbA1c (p = 0.03), but not SBP or LDL, mediated the effect of the intervention on cognitive decline. Improved diabetes control in the elderly following existing guidelines through a telemedicine intervention was associated with less global cognitive decline. The main mediator of this effect seemed to be improvements in HbA1c.

  14. Healthy Pre-Pregnancy Diet and Exercise May Reduce Risk of Gestational Diabetes

    MedlinePlus

    ... Pregnancy Diet and Exercise May Reduce Risk of Gestational Diabetes Skip sharing on social media links Share this: ... they become pregnant are less likely to develop gestational diabetes mellitus, a type of diabetes that occurs only ...

  15. The Relationship between Native American Ancestry, Body Mass Index and Diabetes Risk among Mexican-Americans.

    PubMed

    Hu, Hao; Huff, Chad D; Yamamura, Yuko; Wu, Xifeng; Strom, Sara S

    2015-01-01

    Higher body mass index (BMI) is a well-established risk factor for type 2 diabetes, and rates of obesity and type 2 diabetes are substantially higher among Mexican-Americans relative to non-Hispanic European Americans. Mexican-Americans are genetically diverse, with a highly variable distribution of Native American, European, and African ancestries. Here, we evaluate the role of Native American ancestry on BMI and diabetes risk in a well-defined Mexican-American population. Participants were randomly selected among individuals residing in the Houston area who are enrolled in the Mexican-American Cohort study. Using a custom Illumina GoldenGate Panel, we genotyped DNA from 4,662 cohort participants for 87 Ancestry-Informative Markers. On average, the participants were of 50.2% Native American ancestry, 42.7% European ancestry and 7.1% African ancestry. Using multivariate linear regression, we found BMI and Native American ancestry were inversely correlated; individuals with <20% Native American ancestry were 2.5 times more likely to be severely obese compared to those with >80% Native American ancestry. Furthermore, we demonstrated an interaction between BMI and Native American ancestry in diabetes risk among women; Native American ancestry was a strong risk factor for diabetes only among overweight and obese women (OR = 1.190 for each 10% increase in Native American ancestry). This study offers new insight into the complex relationship between obesity, genetic ancestry, and their respective effects on diabetes risk. Findings from this study may improve the diabetes risk prediction among Mexican-American individuals thereby facilitating targeted prevention strategies.

  16. The Relationship between Native American Ancestry, Body Mass Index and Diabetes Risk among Mexican-Americans

    PubMed Central

    Hu, Hao; Huff, Chad D.; Yamamura, Yuko; Wu, Xifeng; Strom, Sara S.

    2015-01-01

    Higher body mass index (BMI) is a well-established risk factor for type 2 diabetes, and rates of obesity and type 2 diabetes are substantially higher among Mexican-Americans relative to non-Hispanic European Americans. Mexican-Americans are genetically diverse, with a highly variable distribution of Native American, European, and African ancestries. Here, we evaluate the role of Native American ancestry on BMI and diabetes risk in a well-defined Mexican-American population. Participants were randomly selected among individuals residing in the Houston area who are enrolled in the Mexican-American Cohort study. Using a custom Illumina GoldenGate Panel, we genotyped DNA from 4,662 cohort participants for 87 Ancestry-Informative Markers. On average, the participants were of 50.2% Native American ancestry, 42.7% European ancestry and 7.1% African ancestry. Using multivariate linear regression, we found BMI and Native American ancestry were inversely correlated; individuals with <20% Native American ancestry were 2.5 times more likely to be severely obese compared to those with >80% Native American ancestry. Furthermore, we demonstrated an interaction between BMI and Native American ancestry in diabetes risk among women; Native American ancestry was a strong risk factor for diabetes only among overweight and obese women (OR = 1.190 for each 10% increase in Native American ancestry). This study offers new insight into the complex relationship between obesity, genetic ancestry, and their respective effects on diabetes risk. Findings from this study may improve the diabetes risk prediction among Mexican-American individuals thereby facilitating targeted prevention strategies. PMID:26501420

  17. Prevalence of risk factors for diabetic foot complications

    PubMed Central

    Al-Maskari, Fatma; El-Sadig, Mohammed

    2007-01-01

    Background Foot complications are common in diabetic patients and are considered one of the most expensive diabetes (DM) complications to treat. The aim of this study was to determine the prevalence and risk factors for foot complications among diabetic patients in Al-Ain district, United Arab Emirates (UAE). Methods The study was part of a general cross-sectional survey carried out to assess the prevalence of DM complications in Al-Ain district, UAE. A sample of 513 diabetic patients with a mean age of 53 years (SD: ± 13) were randomly selected during 2003/2004. All completed an interviewer-administered questionnaire and underwent medical assessment including foot examination and assessment of presence of peripheral neuropathy (PN) and peripheral vascular disease (PVD). Results Forty nine percent of the study populations were diagnosed to have DM without presenting with symptoms of diabetes and 35% had hypertension. The majority (86%) had type 2 DM. Of the total sample, 39% (95% CI: 35.1-43.7%) had PN and 12% (95% CI: 8.8–14.4%) had PVD. There were no cases of amputation and only one case had previous history of lower extremity ulceration. Significant risk factors for PN and PVD were: male gender, poor level of education, UAE nationality, increased duration of diabetes, type 2 DM, presence of hypertension and microalbuminuria (MA). Conclusion Despite the low prevalence of foot ulceration and amputation among the study population, nevertheless, a substantial proportion had potential risk factors for foot complications. PMID:17927826

  18. Considerable disturbances of cardiovascular risk factors in women with diabetes and myocardial infarction.

    PubMed

    Dotevall, Annika; Wilhelmsen, Lars; Lappas, Georg; Rosengren, Annika

    2005-01-01

    To investigate to which extent differences in cardiovascular risk factors explain the increased risk of myocardial infarction (MI) and complication rate in women with diabetes mellitus (DM). Case-control study. We compared women with diabetes and previous MI (n=29), diabetes but no MI (n=46), prior MI but no diabetes (n=64), and healthy controls (n=125). Smoking habits, physical activity, blood pressure (BP), body mass index (BMI), waist/hip ratio (WHR), serum lipids, plasma fibrinogen, and serum sex hormones. Despite the fact that diabetic women had similar BMI, those with a past MI, compared to diabetic women without MI, had significantly higher WHR (mean, 95% CI) [0.89 (0.87, 0.92) vs. 0.84 (0.81, 0.86) mmol/l, P=.001] and very high S-triglycerides [3.03 (2.23, 3.83) vs. 1.69, (1.39, 1.99) mmol/l, P=.001] and low HDL-cholesterol [1.09 (0.94, 1.24) vs. 1.56 (1.41, 1.71) mmol/l, P<.001], indicating pronounced metabolic disturbances. Women with MI but no diabetes had intermediate values for WHR, triglycerides, and HDL-cholesterol. Furthermore, women with diabetes and MI had significantly higher p-fibrinogen, were smokers, and lived a more sedentary life than the other women. Over half of all women with prior MI were on lipid-lowering therapy and tended to have nonsignificantly lower S-cholesterol than women without MI. Women with diabetes who have manifested an MI carry a very substantial cardiovascular risk factor burden, which probably explain their increased morbidity and mortality. In order to improve prognosis, studies targeted at investigating treatment modalities for these abnormalities are needed.

  19. Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes.

    PubMed

    Loskutova, Natalia Y; Tsai, Adam G; Fisher, Edwin B; LaCruz, Debby M; Cherrington, Andrea L; Harrington, T Michael; Turner, Tamela J; Pace, Wilson D

    2016-01-01

    Despite the recognized importance of lifestyle modification in reducing risk of developing type 2 diabetes and in diabetes management, the use of available community resources by both patients and their primary care providers (PCPs) remains low. The patient navigator model, widely used in cancer care, may have the potential to link PCPs and community resources for reduction of risk and control of type 2 diabetes. In this study we tested the feasibility and acceptability of telephone-based nonprofessional patient navigation to promote linkages between the PCP office and community programs for patients with or at risk for diabetes. This was a mixed-methods interventional prospective cohort study conducted between November 2012 and August 2013. We included adult patients with and at risk for type 2 diabetes from six primary care practices. Patient-level measures of glycemic control, diabetes care, and self-efficacy from medical records, and qualitative interview data on acceptability and feasibility, were used. A total of 179 patients participated in the study. Two patient navigators provided services over the phone, using motivational interviewing techniques. Patient navigators provided regular feedback to PCPs and followed up with the patients through phone calls. The patient navigators made 1028 calls, with an average of 6 calls per patient. At follow-up, reduction in HbA1c (7.8 ± 1.9% vs 7.2 ± 1.3%; P = .001) and improvement in patient self-efficacy (3.1 ± 0.8 vs 3.6 ± 0.7; P < .001) were observed. Qualitative analysis revealed uniformly positive feedback from providers and patients. The patient navigator model is a promising and acceptable strategy to link patient, PCP, and community resources for promoting lifestyle modification in people living with or at risk for type 2 diabetes. © Copyright 2016 by the American Board of Family Medicine.

  20. Risk factors of hypertensive pregnancies in women with diabetes and the influence on their future life.

    PubMed

    Gordin, Daniel; Forsblom, Carol; Groop, Per-Henrik; Teramo, Kari; Kaaja, Risto

    2014-11-01

    Diabetic women carry a 2-4 times increased risk of a hypertensive pregnancy compared to non-diabetic people. This risk is related to presence of diabetic nephropathy, but also poor glycaemic control. Efforts to improve glycaemic control have decreased perinatal morbidity and mortality related to diabetic nephropathy. Despite good glycaemic control, overt nephropathy is associated with a variety of pregnancy complications, such as fetal growth restriction and pre-eclampsia. General population studies show that women with a history of pre-eclampsia are more prone to develop cardiovascular disease later in life than women with a history of normotensive pregnancy. Furthermore, recent data regarding the long-term effects of hypertensive pregnancies on late diabetic complications indicate that these women should be followed and treatment should be started early. In this review we summarize data on risk factors and long-term effects of hypertensive pregnancies on late diabetic complications that may be of clinical relevance in the prevention of these complications.

  1. Impact of body mass index on the predictive ability of body fat distribution for type 2 diabetes risk in Koreans.

    PubMed

    Kim, C-H; Kim, H-K; Kim, E-H; Bae, S-J; Park, J-Y

    2012-11-01

    The optimal anthropometric measure of obesity or body fat distribution that best predicts the risk of Type 2 diabetes in Asians is unclear. Moreover, it has not been determined whether BMI modifies the effect of body fat distribution on diabetes risk in Asians. We analysed the anthropometric and laboratory data of 7658 non-diabetic Korean adults (5061 men and 2597 women, aged 20-79 years) who underwent routine medical check-ups at 5-year intervals. BMI, waist circumference, waist-to-height ratio, and bioelectrical impedance (to calculate fat mass and per cent body fat) were measured at baseline. Of the 7658 participants, 278 subjects (3.6%) developed diabetes over 5 years. Each of the anthropometric measures of general obesity (BMI, fat mass, per cent body fat) and central body fat distribution (waist circumference and waist-to-height ratio) was a good predictor of Type 2 diabetes. However, when the areas under the receiver-operating characteristic curves were compared, BMI (0.697; 95% CI, 0.669-0.725), waist circumference (0.709, 0.682-0.736) and waist-to-height ratio (0.718, 0.692-0.743) were better predictors of diabetes risk than fat mass (0.672, 0.643-0.700) or per cent body fat (0.657, 0.628-0.686). In the low- (< 23 kg/m(2)) and mid- (23-27 kg/m(2)) BMI groups, the addition of waist-to-height ratio or waist circumference to BMI could improve the prediction of diabetes risk. BMI, waist circumference and waist-to-height ratio were good predictors of Type 2 diabetes risk in Koreans. In non-obese or less obese subjects, measures of central body fat distribution can help improve the prediction of Type 2 diabetes risk when added to measures of general obesity. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  2. A novel botanical formula prevents diabetes by improving insulin resistance.

    PubMed

    Kan, Juntao; Velliquette, Rodney A; Grann, Kerry; Burns, Charlie R; Scholten, Jeff; Tian, Feng; Zhang, Qi; Gui, Min

    2017-07-05

    Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease, and the prevalence has increased significantly in recent decades to epidemic proportions in China. Individually, fenugreek (Trigonella foenum graecum) seed, mulberry (Morus alba L.) leaf and American ginseng (Panax quinquefolius) root can improve glycemia in various animal models and humans with impaired glucose metabolism and T2DM. The aim of this study was to design an optimized botanical formula containing these herbal extracts as a nutritional strategy for the prevention of insulin resistance and T2DM. Cell-free α-amylase and α-glucosidase enzyme assays were used to determine inhibitory potential of extracts. Glucose uptake was examined in differentiated human adipocytes using radiolabeled 2-deoxyglucose. Male Sprague Dawley rats were divided and glycemia balanced into 5 groups: two controls (naïve and model) and three doses of the botanical test formula containing standardized fenugreek seed, mulberry leaf and American ginseng extracts (42.33, 84.66 and 169.33 mg/kg BW). Insulin resistance and T2DM was induced by feeding animals a high fat diet and with an alloxan injection. Glucose tolerance was examined by measuring serum glucose levels following an oral glucose load. Fenugreek seed and mulberry leaf dose dependently inhibited α-amylase (IC50 = 73.2 μg/mL) and α-glucosidase (IC50 = 111.8 ng/mL), respectively. All three botanical extracts improved insulin sensitivity and glucose uptake in human adipocytes, which lead to the design of an optimized botanical test formula. In a rat model of insulin resistance and T2DM, the optimized botanical test formula improved fasting serum glucose levels, fasting insulin resistance and the development of impaired glucose tolerance. The reduction in epididymal adipose tissue GLUT4 and PDK1 expression induced by high fat diet and alloxan was blunted by the botanical test formula. A novel botanical formula containing standardized

  3. Advances in the management of cardiovascular risk for patients with type 2 diabetes: perspectives from the Academy for Cardiovascular Risk, Outcomes and Safety Studies in Type 2 Diabetes

    PubMed Central

    Schernthaner, Guntram; Jarvis, Sarah; Lotan, Chaim; Prázný, Martin; Wanner, Christoph; Wascher, Thomas C

    2017-01-01

    Diabetes is a global health emergency projected to affect 642 million people by 2040. Type 2 diabetes (T2D) represents 90% of diabetes cases and is associated with a range of cardiovascular (CV) risk factors that are more than double the incidence of CV disease and significantly increase mortality rates. Diabetes treatments have typically focused on improving glycemic control but their effect on CV outcomes has remained uncertain. In 2008, the US Food and Drug Administration (FDA) looked to address this knowledge gap and mandated CV outcome trials (CVOTs) for all new antidiabetic therapies. In 2015, EMPA-REG OUTCOME® became the first CVOT to present results for a sodium/glucose cotransporter 2 (SGLT2; also known as SLC5A2) inhibitor, empagliflozin. Subsequently, a regional meeting of the Academy for Cardiovascular Risk, Outcomes and Safety Studies in Type 2 Diabetes (ACROSS T2D) brought together a respected faculty of international experts and 150 physicians from 14 countries to discuss the current unmet medical needs of patients with T2D, the results from the EMPA-REG OUTCOME study and the implications of these results for clinical practice. This article summarizes the current scientific evidence and the discussions that took place at the ACROSS T2D regional meeting, which was held in Vienna, Austria, on May 30, 2016. PMID:28144148

  4. Stress Perfusion Cardiovascular Magnetic Resonance Imaging Effectively Risk Stratifies Diabetic Patients With Suspected Myocardial Ischemia

    PubMed Central

    Heydari, Bobak; Juan, Yu-Hsiang; Liu, Hui; Abbasi, Siddique; Shah, Ravi; Blankstein, Ron; Steigner, Michael; Jerosch-Herold, Michael; Kwong, Raymond Y.

    2016-01-01

    Background Diabetics remain at high risk of cardiovascular disease and mortality despite advancements in medical therapy. Noninvasive cardiac risk profiling is often more difficult in diabetics owing to the prevalence of silent ischemia with unrecognized myocardial infarction (MI), reduced exercise capacity, non-diagnostic electrocardiographic changes, and balanced ischemia from diffuse epicardial coronary atherosclerosis and microvascular dysfunction. Methods and Results A consecutive cohort of 173 diabetic patients (mean age 61.7±11.9, 37% female) with suspected myocardial ischemia underwent stress perfusion CMR. Patients were evaluated for adverse cardiac events following CMR with mean follow-up time of 2.9 ± 2.5 years. Mean HbA1C for the population was 7.9±1.8%. Primary endpoint was a composite of cardiac death and nonfatal MI. Diabetics with no inducible ischemia (n=94) experienced an annualized event rate of 1.4% compared to 8.2% (P=0.0003) in those with inducible ischemia (n=79). Diabetics without late gadolinium enhancement or inducible ischemia had a very low annual cardiac event rate (0.5%/year). Presence of inducible ischemia was the strongest unadjusted predictor (HR 4.86, P<0.01) for cardiac death and nonfatal MI. This association remained robust in adjusted stepwise multivariable Cox regression analysis (HR 4.28, P=0.02). In addition, categorical net reclassification index (NRI) using 5-year risk cutoffs of 5% and 10% resulted in reclassification of 43.4% of the diabetic cohort with NRI of 0.38 (95% CI 0.20–0.56, P<0.0001). Conclusions Stress perfusion CMR provided independent prognostic utility and effectively reclassified risk in diabetic patients referred for ischemic assessment. Further evaluation is required to determine if a noninvasive imaging strategy with CMR can favorably impact downstream outcomes and improve cost-effectiveness of care in diabetics. PMID:27059504

  5. Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes.

    PubMed

    Schouten, Loes M T; Niessen, Louis W; van de Pas, Jeroen W A M; Grol, Richard P T M; Hulscher, Marlies E J L

    2010-10-01

    To investigate the lifelong health effects, costs, and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting. Economic evaluation from a healthcare perspective with lifetime horizon alongside a nonrandomized, controlled, before-after study in the Netherlands. Analyses were based on 1861 diabetes patients in 6 intervention and 9 control regions, representing 37 general practices and 13 out-patient clinics. Change in the United Kingdom Prospective Diabetes Study score, remaining lifetime, and costs per quality-adjusted life year gained were calculated. Probabilistic life tables were constructed using the United Kingdom Prospective Diabetes Study risk engine, a validated diabetes model, and nonparametric bootstrapping of individual patient data. Annual United Kingdom Prospective Diabetes Study risk scores reduced for cardiovascular events (hazard ratio: 0.83 and 0.98) and cardiovascular mortality (hazard ratio: 0.78 and 0.88) for men and women, respectively. Life expectancy improved by 0.97 and 0.76 years for men and women, and quality-adjusted life years by 0.44 and 0.37, respectively. Higher life expectancy in the intervention group increased lifelong costs by &OV0556;860 for men and &OV0556;645 for women. Initial program costs were about &OV0556;22 per patient. The incremental costs per quality-adjusted life year were &OV0556;1937 for men and &OV0556;1751 for women compared with usual care costs. There is a probability >95% that the collaborative is cost-effective, using a threshold of &OV0556;20,000 per quality-adjusted life year. Optimizing integrated and patient-centered diabetes care through a quality-improvement collaborative is cost-effective compared with usual care.

  6. Improvements in the Life Expectancy of Type 1 Diabetes

    PubMed Central

    Miller, Rachel G.; Secrest, Aaron M.; Sharma, Ravi K.; Songer, Thomas J.; Orchard, Trevor J.

    2012-01-01

    Survival in type 1 diabetes has improved, but the impact on life expectancy in the U.S. type 1 diabetes population is not well established. Our objective was to estimate the life expectancy of the Pittsburgh Epidemiology of Diabetes Complications (EDC) study cohort and quantify improvements by comparing two subcohorts based on year of diabetes diagnosis (1950–1964 [n = 390] vs. 1965–1980 [n = 543]). The EDC study is a prospective cohort study of 933 participants with childhood-onset (aged <17 years) type 1 diabetes diagnosed at Children’s Hospital of Pittsburgh from 1950 to 1980. Mortality ascertainment was censored 31 December 2009. Abridged cohort life tables were constructed to calculate life expectancy. Death occurred in 237 (60.8%) of the 1950–1964 subcohort compared with 88 (16.2%) of the 1965–1980 subcohort. The life expectancy at birth for those diagnosed 1965–1980 was ∼15 years greater than participants diagnosed 1950–1964 (68.8 [95% CI 64.7–72.8] vs. 53.4 [50.8–56.0] years, respectively) (P < 0.0001); this difference persisted regardless of sex or pubertal status at diagnosis. This improvement in life expectancy emphasizes the need for insurance companies to update analysis of the life expectancy of those with childhood-onset type 1 diabetes because weighting of insurance premiums is based on outdated estimates. PMID:22851572

  7. Type 2 Diabetes Mellitus, Oral Diabetic Medications, Insulin Therapy, and Overall Breast Cancer Risk

    PubMed Central

    Ahmadieh, Hala; Azar, Sami T.

    2013-01-01

    Breast cancer is among the most common cancers worldwide. Diabetes is an important chronic health problem associated with insulin resistance, increased insulin level, changes in growth hormones and factors, and activation of mitogen-activating protein kinase (MAPK) pathways, leading to an increased breast cancer risk. This paper looked at the epidemiologic studies of the association between type 2 diabetes and risk of breast cancer and its effect on overall cancer-specific survival. The combined evidence overall supported a modest association between type 2 diabetes and the risk of breast cancer, which was found to be more prevalent among postmenopausal women. Effect of oral diabetics and insulin therapy on breast cancer risk was also evaluated. It was found that metformin and thiazolidinones tended to have a protective role. Metformin therapy trials for its use as an adjuvant for breast cancer treatment are still ongoing. Sulfonylurea and insulin therapy were found to be mildly associated with increased overall cancers. No evidence or studies evaluated the association of DPPIV inhibitors and GLP 1 agonists with breast cancer risk because of their recent introduction into the management of diabetes. PMID:23401790

  8. Survey of diabetes risk assessment tools: concepts, structure and performance.

    PubMed

    Thoopputra, Thitaporn; Newby, David; Schneider, Jennifer; Li, Shu Chuen

    2012-09-01

    The objective of this study is to review the effectiveness and limitations of existing diabetes risk screening tools to assess the need for further developing of such tools. An electronic search of the EMBASE, MEDLINE, and Cochrane library supplemented by a manual search was performed from 1995-2010. The search retrieved a total of 2168 articles reporting diabetes risk assessment tools which, after culling, produced 41 tools developed in 22 countries, with the majority (n = 26) developed in North America and Europe. All are short questionnaires of 2-16 questions incorporating common variables including age, gender, waist circumference, BMI, family history of diabetes, history of hypertension or antihypertensive medications. While scoring format and cut-offs point are diverse between questionnaires, overall accuracy value range of 40-97%, 24-86% and 62-87% were reported for sensitivity, specificity and receiver operating characteristic curve respectively. In summary, there is a trend of increasing availability of diabetes prediction tools with the existing risk assessment tools being generally a short questionnaire aiming for ease of use in clinical practice. The overall performance of existing tools showed moderate to high accuracy in their predictive performance. However, further detailed comparison of existing questionnaires is needed to evaluate whether they can serve adequately as diabetes risk assessment tool in clinical practice. Copyright © 2012 John Wiley & Sons, Ltd.

  9. Alcohol consumption and diabetes risk in the Diabetes Prevention Program1234

    PubMed Central

    Polsky, Sarit; Howard, Andrea A; Perreault, Leigh; Bray, George A; Barrett-Connor, Elizabeth; Brown-Friday, Janet; Whittington, Tracy; Foo, Sandra; Ma, Yong; Edelstein, Sharon L

    2009-01-01

    Background: Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes in the general population, but little is known about the effects in individuals at high risk of diabetes. Objectives: The objectives were to determine associations between alcohol consumption and diabetes risk factors and whether alcohol consumption was a predictor of incident diabetes in individuals enrolled in the Diabetes Prevention Program (DPP). Design: DPP participants (n = 3175) had impaired glucose tolerance (2-h glucose: 7.8–11.1 mmol/L), elevated fasting glucose (5.3–7.0 mmol/L), and a body mass index (in kg/m2) ≥24. Participants were randomly assigned to placebo, metformin, or lifestyle modification and were followed for a mean of 3.2 y. Alcohol intake was assessed at baseline and year 1 by using a semiquantitative food-frequency questionnaire. Diabetes was diagnosed by annual oral-glucose-tolerance testing and semiannual fasting plasma glucose measurement. Results: Participants who reported higher alcohol consumption tended to be male, older, white, and less obese and to have a higher calorie intake and a higher HDL-cholesterol concentration. Higher alcohol consumption was associated with lower insulin secretion at any level of insulin sensitivity. We found lower incidence rates of diabetes with higher alcohol consumption in the metformin (P < 0.01 for trend) and lifestyle modification (P = 0.02 for trend) groups, which remained significant after adjustment for multiple baseline covariates. No similar association was observed in the placebo group. Conclusions: Despite overall low rates of alcohol consumption, there was a reduced risk of incident diabetes in those who reported modest daily alcohol intake and were assigned to metformin or lifestyle modification. Moderate daily alcohol intake is associated with lower insulin secretion—an effect that warrants further investigation. This trial was registered at clinicaltrials.gov as NCT00038727. PMID

  10. Strategies for Improving Participation in Diabetes Education. A Qualitative Study

    PubMed Central

    Schäfer, Ingmar; Pawels, Marc; Küver, Claudia; Pohontsch, Nadine Janis; Scherer, Martin; van den Bussche, Hendrik; Kaduszkiewicz, Hanna

    2014-01-01

    increased blood sugar values only and no risk for harmful consequences or if they already have sufficient knowledge on diabetes. PMID:24733428

  11. The role of ethnicity in predicting diabetes risk at the population level

    PubMed Central

    Rosella, Laura C.; Mustard, Cameron A.; Stukel, Therese A.; Corey, Paul; Hux, Jan; Roos, Les; Manuel, Douglas G.

    2012-01-01

    Background. The current form of the Diabetes Population Risk Tool (DPoRT) includes a non-specific category of ethnicity in concordance with publicly data available. Given the importance of ethnicity in influencing diabetes risk and its significance in a multi-ethnic population, it is prudent to determine its influence on a population-based risk prediction tool. Objective. To apply and compare the DPoRT with a modified version that includes detailed ethnic information in Canada's largest and most ethnically diverse province. Methods. Two additional diabetes prediction models were created: a model that contained predictors specific to the following ethnic groups – White, Black, Asian, south Asian, and First Nation; and a reference model which did not include a term for ethnicity. In addition to discrimination and calibration, 10-year diabetes incidence was compared. The algorithms were developed in Ontario using the 1996–1997 National Population Health Survey (N = 19,861) and validated in the 2000/2001 Canadian Community Health Survey (N = 26,465). Results. All non-white ethnicities were associated with higher risk for developing diabetes with south Asians having the highest risk. Discrimination was similar (0.75–0.77) and sufficient calibration was maintained for all models except the detailed ethnicity models for males. DPoRT produced the lowest overall ratio between observed and predicted diabetes risk. DPoRT identified more high risk cases than the other algorithms in males, whereas in females both DPoRT and the full ethnicity model identified more high risk cases. Overall DPoRT and full ethnicity algorithms were very similar in terms of predictive accuracy and population risk. Conclusion. Although from the individual risk perspective, incorporating information on ethnicity is important, when predicting new cases of diabetes at the population level and accounting for other risk factors, detailed ethnic information did not improve the discrimination and

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

    PubMed

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

    2016-03-01

    Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  13. Changes in Overall Diet Quality and Subsequent Type 2 Diabetes Risk: Three U.S. Prospective Cohorts.

    PubMed

    Ley, Sylvia H; Pan, An; Li, Yanping; Manson, JoAnn E; Willett, Walter C; Sun, Qi; Hu, Frank B

    2016-11-01

    Recent public health recommendations emphasize adopting a healthful dietary pattern, but evidence is scarce on whether incremental diet quality changes have an impact on long-term diabetes prevention. We aim to evaluate diet quality changes during a 4-year period and subsequent 4-year type 2 diabetes incidence. Participants of prospective cohorts, the Nurses' Health Study (NHS), NHS II, and the Health Professionals Follow-up Study, who were free of diabetes at baseline (n = 124,607), were observed for ≥20 years. Diet quality, reflected by the Alternate Healthy Eating Index (AHEI) score, was assessed every 4 years to calculate changes. We documented 9,361 cases of type 2 diabetes during 2,093,416 person-years of follow-up. A >10% decrease in AHEI score over 4 years was associated with a higher subsequent diabetes risk (pooled hazard ratio 1.34 [95% CI 1.23-1.46]) with multiple adjustment, whereas a >10% increase in AHEI score was associated with a lower risk (0.84 [0.78-0.90]). Greater improvement in diet quality was associated with lower diabetes risk across baseline diet quality status (P for trend ≤ 0.001 for low, medium, or high initial diet quality) and baseline BMI (P for trend ≤ 0.01 for BMI <25, 25-29, or 30 kg/m(2)). Changes in body weight explained 32% (95% CI 24-41) of the association between AHEI changes (per 10% increase) and diabetes risk. Improvement in overall diet quality is associated with a lower risk of type 2 diabetes, whereas deterioration in diet quality is associated with a higher risk. The association between diet quality changes and diabetes risk is only partly explained by body weight changes. © 2016 by the American Diabetes Association.

  14. Maternal overweight and obesity and risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes.

    PubMed

    Persson, Martina; Cnattingius, Sven; Wikström, Anna-Karin; Johansson, Stefan

    2016-10-01

    Women with type 1 or type 2 diabetes are at increased risk of pre-eclampsia. Overweight and obesity are associated with an increased risk of pre-eclampsia in women without diabetes. The aim of the study was to investigate the impact of maternal overweight and obesity on the risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes. In a population-based cohort study including singleton births in Sweden, we estimated the risk of pre-eclampsia among women with type 1 diabetes (n = 7062) and type 2 diabetes (n = 886), and investigated whether maternal overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI ≥30.0 kg/m(2)) modified the risk. Logistic regression analyses were used to estimate crude and adjusted ORs with 95% CIs, using women without diabetes as the reference group (n = 1,509,525). Compared with women without diabetes, the adjusted ORs for pre-eclampsia in women with type 1 and type 2 diabetes were 5.74 (95% CI 5.31, 6.20) and 2.11 (95% CI 1.65, 2.70), respectively. The corresponding risks of pre-eclampsia combined with preterm birth were even higher. Risks of pre-eclampsia increased with maternal overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI ≥30.0 kg/m(2)), foremost in women without diabetes, to a lesser extent in women with type 1 diabetes but not in women with type 2 diabetes. Maternal overweight and obesity increased risks of pre-eclampsia in women with type 1 diabetes but not in women with type 2 diabetes. Even so, considering associations between maternal BMI and overall maternal and offspring risk, all women (with and without diabetes) should aim for a normal weight before pregnancy.

  15. Risk factors in patients with type 2 diabetes mellitus.

    PubMed

    Carolino, Idalina Diair Regla; Molena-Fernandes, Carlos Alexandre; Tasca, Raquel Soares; Marcon, Sonia Silva; Cuman, Roberto Kenji Nakamura

    2008-01-01

    This study was carried out to evaluate the risk factors of type 2 diabetic patients through sociodemographic data, habits of health, anthropometric and biochemist profiles, assisted at a basic public health care unit in Maringá, Paraná. Sixty-six patients, 56 women aged over than 50 years-old were interviewed. High prevalence factors for cardiovascular risk were observed, such as: overweight and obesity, hypertension, dyslipidemia, sedentariness and inadequate diet. Data suggested the need for multidisciplinary intervention programs in health care units associated to educative programs, adjusted diet intake and regular physical activity for these diabetic patients.

  16. The impact of web-based diabetes risk calculators on information processing and risk perceptions.

    PubMed

    Harle, Christopher; Padman, Rema; Downs, Julie

    2008-11-06

    As consumer demand for online health information grows, many organizations are providing personalized and interactive health risk communication tools. In response, there is a need to better understand how effective these features are in influencing user attention, information processing and risk perceptions. This study randomly assigned 100 middle-aged and elderly adult users to one of three versions of an experimental type 2 diabetes "risk calculator" in order to determine if personalized risk estimates and interactive risk feedback impact usage behavior and beliefs about future diabetes onset. Results suggest that personalization and interactive features did not lead to increases in user attention or systematic information processing. The experiment provided only modest evidence that personalization was related to increased accuracy in absolute diabetes risk perceptions. Future studies are warranted to more precisely explain the descriptive and normative implications when laypersons use web-based risk communication tools.

  17. Can a Chronic Care Model Collaborative Reduce Heart Disease Risk in Patients with Diabetes?

    PubMed Central

    Mangione, Carol M.; Asch, Steven; Keesey, Joan; Rosen, Mayde; Schonlau, Matthias; Keeler, Emmett B.

    2007-01-01

    Background There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes. Objective We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes. Design Controlled pre- and postintervention study. Patients/Participants Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites. Measurements and Main Results Ten-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI −3.7%, −0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention. Conclusions Over a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization’s settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction. PMID:17356989

  18. Can a chronic care model collaborative reduce heart disease risk in patients with diabetes?

    PubMed

    Vargas, Roberto B; Mangione, Carol M; Asch, Steven; Keesey, Joan; Rosen, Mayde; Schonlau, Matthias; Keeler, Emmett B

    2007-02-01

    There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes. We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes. Controlled pre- and postintervention study. Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites. Ten-year risk of cardiovascular disease; determined using a modified United Kingdom Prospective Diabetes Study risk engine score. A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria. The baseline mean 10-year risk of cardiovascular disease was 31% for both the intervention group and the control group. Participants in both groups had improved blood pressure, lipid levels, and HbA1c levels during the observation period. Random intercept hierarchical regression models showed that the intervention group had a 2.1% (95% CI -3.7%, -0.5%) greater reduction in predicted risk for future cardiovascular events when compared to the control group. This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention. Over a 1-year interval, this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization's settings. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction.

  19. Improving pandemic influenza risk assessment

    USDA-ARS?s Scientific Manuscript database

    Assessing the pandemic risk posed by specific non-human influenza A viruses remains a complex challenge. As influenza virus genome sequencing becomes cheaper, faster and more readily available, the ability to predict pandemic potential from sequence data could transform pandemic influenza risk asses...

  20. Risk perception and unrecognized type 2 diabetes in women with previous gestational diabetes mellitus.

    PubMed

    Malcolm, Janine; Lawson, Margaret L; Gaboury, Isabelle; Keely, Erin

    2009-09-01

    Women with a history of gestational diabetes mellitus (GDM) have a high chance of developing type 2 diabetes mellitus (T2DM) following the index pregnancy, however, little is known of women's perception of this risk. The objectives were to (1) determine women's perception of risk of future development of T2DM following a GDM pregnancy and (2) describe the prevalence of undetected dysglycaemia in a Canadian population. The study was designed as a 9-11 year follow-up study of women previously enrolled in a randomized controlled trial of tight versus minimal intervention for GDM. Women's perception of future risk of diabetes was determined by questionnaire. Fasting lipid profile, height and weight were performed on all participants. Oral glucose tolerance tests were performed on all women without prior history of diabetes mellitus type 2 (DM2). The study was conducted at Ottawa Hospital General Campus and Children's Hospital of Eastern Ontario, in Ottawa, Canada. Eighty-nine of 299 (30%) of the original cohort were recruited. Eighty-eight women completed the questionnaire and 77 women without known diabetes underwent two hour glucose tolerance testing. Twenty-three (30%) felt their risk was no different than other women or did not know, 27 (35%) felt risk was increased a little and 27 (35%) felt risk was increased a lot. Only 52% (40/77) had normal glucose tolerance. Of all, 25/88 (28%) patients had diabetes (11 previously diagnosed and 14 diagnosed within the study). Of those newly diagnosed with DM2, four (29%) were diagnosed by fasting glucose, six (42%) by two hour glucose tolerance test (GTT) alone and four (29%) by both. Twenty-four of the women (27%) had impaired glucose tolerance (IGT). Of those with IGT, 12 (57%) had a fasting food glucose < 5.6 mmol/L. In the high-risk perception group with newly diagnosed diabetes, two were overweight, seven were obese, four had a family history of DM2, and all had a waist circumference >88 cm. In conclusion the perception

  1. Dietary magnesium intake and the risk of diabetes in the Japanese community: results from the Takayama study.

    PubMed

    Konishi, Kie; Wada, Keiko; Tamura, Takashi; Tsuji, Michiko; Kawachi, Toshiaki; Nagata, Chisato

    2017-03-01

    Several experimental studies showed that magnesium intake improved insulin resistance and glucose uptake in diabetes patients. However, epidemiological studies on the association between magnesium intake and diabetes risk have yielded inconsistent results. We investigated whether magnesium intake is related to the risk of developing diabetes in a population-based cohort study in Japan. Study subjects were participants in the Takayama study. A total of 13,525 residents in Takayama City, Japan, responded to a self-administered questionnaire in 1992 and to a follow-up questionnaire seeking information about diabetes in 2002. Magnesium and other nutrient intakes were estimated from a validated food frequency questionnaire administered at the baseline. During a follow-up of 10 years, 438 subjects reported diabetes newly diagnosed by physician. Compared with women in the low quartile of magnesium intake, women in the high quartile were at a significantly reduced risk of diabetes (HR 0.50; 95 % CI 0.30-0.84; P-trend 0.005) after adjustments for covariates. In men, there was no association between magnesium intake and the risk of diabetes. These results suggest that diets with a high intake of magnesium may decrease the risk of diabetes in women.

  2. Treatment and risk factor analysis of hypoglycemia in diabetic rhesus monkeys.

    PubMed

    He, Sirong; Chen, Younan; Wei, Lingling; Jin, Xi; Zeng, Li; Ren, Yan; Zhang, Jie; Wang, Li; Li, Hongxia; Lu, Yanrong; Cheng, Jingqiu

    2011-02-01

    In order to anticipate and promptly treat hypoglycemia in diabetic monkeys treated with insulin or other glucose-lowering drugs, the relationships between the incidence and symptoms of hypoglycemia in these animals, and many factors involved in model development and sustainment were analyzed. Different procedures were performed on 22 monkeys for the induction of diabetes. The monkey models were evaluated by blood glucose, insulin, C-peptide levels and intravenous glucose tolerance tests. A glucose treatment program for the diabetic monkeys was administered and laboratory tests were regularly performed. A standard procedure of hypoglycemia treatment was established and the risk factors of hypoglycemia were analyzed by a logistic regression model. Furthermore, the relationships between the four methods of diabetes induction, renal function, glycemic control and hypoglycemia were studied using one-way analysis of variance and t-test. We found that the hypoglycemic conditions of diabetic monkeys were improved rapidly by our treatment. The statistical analysis suggested that the modeling methods, renal function and glycemic control were related to the incidence of hypoglycemia. In detail, the progress of diabetes, effects of glycemic control and, particularly, the severity of the hypoglycemia differed according to the induction strategy used. The models induced by partial pancreatectomy with low-dose streptozotocin were not prone to hypoglycemia and their glycemic controls were stable. However, the models induced by total pancreatectomy were more vulnerable to severe hypoglycemia and their glycemic controls were the most unstable. Moreover, the levels of blood creatinine and triglyceride increased after the development of diabetes, which was related to the occurrence of hypoglycemia. In conclusion, we suggested that total pancreatectomy and renal impairment are two important risk factors for hypoglycemia in diabetic monkeys. More attention should be paid to daily care

  3. Osteoarthritis-related difficulty walking and risk for diabetes complications.

    PubMed

    Hawker, G A; Croxford, R; Bierman, A S; Harvey, P; Ravi, B; Kendzerska, T; Stanaitis, I; King, L K; Lipscombe, L

    2017-01-01

    To examine the effect of Osteoarthritis (OA)-related difficulty walking on risk for diabetes complications in persons with diabetes and OA. A population cohort aged 55+ years with symptomatic hip and knee OA was recruited 1996-98 and followed through provincial administrative data to 2015 (n = 2,225). In those with confirmed OA (examination and radiographs) and self-reported diabetes at baseline (n = 359), multivariate Cox regression modeling was used to examine the relationship between baseline difficulty walking (Health Assessment Questionnaire (HAQ) difficulty walking score; use of walking aid) and time to first diabetes-specific complication (hospitalization for hypo- or hyperglycemia, infection, amputation, retinopathy, or initiation of chronic renal dialysis) and cardiovascular (CV) events. Participants' mean baseline age was 71.4 years; 66.9% were female, 77.7% had hypertension, 54.0% had pre-existing CV disease, 42.9% were obese and 15.3% were smokers. Median HAQ difficulty walking score was 2/3 indicating moderate to severe walking disability; 54.9% used a walking aid. Over a median 6.1 years, 184 (51.3%) experienced one or more diabetes-specific complications; 191 (53.2%) experienced a CV event over a median 5.7 years. Greater baseline difficulty walking was associated with shorter time to the first diabetes-specific complication (adjusted HR per unit increase in HAQ walking 1.24, 95% CI 1.04-1.47, P = 0.02) and CV event (adjusted HR for those using a walking aid 1.35, 95% CI 1.00-1.83, P = 0.04). In a population cohort with OA and diabetes, OA-related difficulty walking was a significant - and potentially modifiable - risk factor for diabetes complications. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  4. The PRIDE (Partnership to Improve Diabetes Education) Toolkit

    PubMed Central

    Wolff, Kathleen; Chambers, Laura; Bumol, Stefan; White, Richard O.; Gregory, Becky Pratt; Davis, Dianne; Rothman, Russell L.

    2016-01-01

    Purpose Patients with low literacy, low numeracy, and/or linguistic needs can experience challenges understanding diabetes information and applying concepts to their self-management. The authors designed a toolkit of education materials that are sensitive to patients' literacy and numeracy levels, language preferences, and cultural norms and that encourage shared goal setting to improve diabetes self-management and health outcomes. The Partnership to Improve Diabetes Education (PRIDE) toolkit was developed to facilitate diabetes self-management education and support. Methods The PRIDE toolkit includes a comprehensive set of 30 interactive education modules in English and Spanish to support diabetes self-management activities. The toolkit builds upon the authors' previously validated Diabetes Literacy and Numeracy Education Toolkit (DLNET) by adding a focus on shared goal setting, addressing the needs of Spanish-speaking patients, and including a broader range of diabetes management topics. Each PRIDE module was evaluated using the Suitability Assessment of Materials (SAM) instrument to determine the material's cultural appropriateness and its sensitivity to the needs of patients with low literacy and low numeracy. Reading grade level was also assessed using the Automated Readability Index (ARI), Coleman-Liau, Flesch-Kincaid, Fry, and SMOG formulas. Conclusions The average reading grade level of the materials was 5.3 (SD 1.0), with a mean SAM of 91.2 (SD 5.4). All of the 30 modules received a “superior” score (SAM >70%) when evaluated by 2 independent raters. The PRIDE toolkit modules can be used by all members of a multidisciplinary team to assist patients with low literacy and low numeracy in managing their diabetes. PMID:26647414

  5. Strength training and risk of type 2 diabetes in a Japanese working population: A cohort study.

    PubMed

    Kuwahara, Keisuke; Honda, Toru; Nakagawa, Tohru; Yamamoto, Shuichiro; Nanri, Akiko; Kurotani, Kayo; Hayashi, Takeshi; Mizoue, Tetsuya

    2015-11-01

    Muscle strength training has been suggested to improve glucose metabolism; however, epidemiological evidence regarding strength training's effects on diabetes risk is scarce. We prospectively examined the association between strength training and the risk of type 2 diabetes in Japanese men and women. The sample included health checkups on 26,630 Japanese male and female workers aged 30-64 years without diabetes at baseline. Weekly time spent on strength training was elicited using a self-reported questionnaire. Type 2 diabetes was diagnosed based on hemoglobin A1c, fasting glucose, random plasma glucose and self-report in an annual health checkup. Hazard ratio (HR) and its 95% confidence interval (CI) for incident diabetes was estimated using a Cox proportional hazards model. During a mean follow up of 5.2 years with 139,748 person-years, 1,770 individuals developed diabetes. Age- and sex-adjusted HR for diabetes was 0.58 (95% CI 0.42-0.79) in those who engaged in strength training compared with those who engaged in no strength training. After further adjusting for potential confounders, the corresponding HR was 0.66 (95% CI 0.48-0.90). Additional adjustment for body mass index did not materially change the result; the HR was 0.70 (95% CI 0.51-0.96). The association was more pronounced in individuals aged 50 years or older than those aged <50 years, although the difference in the association by age was not significant. These results suggest that engagement in strength training could help to reduce the risk of type 2 diabetes in a Japanese working population.

  6. Strength training and risk of type 2 diabetes in a Japanese working population: A cohort study

    PubMed Central

    Kuwahara, Keisuke; Honda, Toru; Nakagawa, Tohru; Yamamoto, Shuichiro; Nanri, Akiko; Kurotani, Kayo; Hayashi, Takeshi; Mizoue, Tetsuya

    2015-01-01

    Aims/Introduction Muscle strength training has been suggested to improve glucose metabolism; however, epidemiological evidence regarding strength training's effects on diabetes risk is scarce. We prospectively examined the association between strength training and the risk of type 2 diabetes in Japanese men and women. Materials and Methods The sample included health checkups on 26,630 Japanese male and female workers aged 30–64 years without diabetes at baseline. Weekly time spent on strength training was elicited using a self-reported questionnaire. Type 2 diabetes was diagnosed based on hemoglobin A1c, fasting glucose, random plasma glucose and self-report in an annual health checkup. Hazard ratio (HR) and its 95% confidence interval (CI) for incident diabetes was estimated using a Cox proportional hazards model. Results During a mean follow up of 5.2 years with 139,748 person-years, 1,770 individuals developed diabetes. Age- and sex-adjusted HR for diabetes was 0.58 (95% CI 0.42–0.79) in those who engaged in strength training compared with those who engaged in no strength training. After further adjusting for potential confounders, the corresponding HR was 0.66 (95% CI 0.48–0.90). Additional adjustment for body mass index did not materially change the result; the HR was 0.70 (95% CI 0.51–0.96). The association was more pronounced in individuals aged 50 years or older than those aged <50 years, although the difference in the association by age was not significant. Conclusions These results suggest that engagement in strength training could help to reduce the risk of type 2 diabetes in a Japanese working population. PMID:26543539

  7. [Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit].

    PubMed

    Márquez-Godínez, S A; Zonana-Nacach, A; Anzaldo-Campos, M C; Muñoz-Martínez, J A

    2014-01-01

    To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income <236 euros (OR 2.0; 95%CI: 1.1-3.8), and a glycosylated hemoglobin ≥ 7.0% (OR 2.8; 95%CI: 1.5-5.0). It is necessary that all DM patients seen in a family medicine clinic have a yearly screening for the early detection of diabetic neuropathy, since they have a high risk of diabetic foot. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  8. Age at Menarche and Type 2 Diabetes Risk

    PubMed Central

    Elks, Cathy E.; Ong, Ken K.; Scott, Robert A.; van der Schouw, Yvonne T.; Brand, Judith S.; Wark, Petra A.; Amiano, Pilar; Balkau, Beverley; Barricarte, Aurelio; Boeing, Heiner; Fonseca-Nunes, Ana; Franks, Paul W.; Grioni, Sara; Halkjaer, Jytte; Kaaks, Rudolf; Key, Timothy J.; Khaw, Kay Tee; Mattiello, Amalia; Nilsson, Peter M.; Overvad, Kim; Palli, Domenico; Quirós, J. Ramón; Rinaldi, Sabina; Rolandsson, Olov; Romieu, Isabelle; Sacerdote, Carlotta; Sánchez, María-José; Spijkerman, Annemieke M.W.; Tjonneland, Anne; Tormo, Maria-Jose; Tumino, Rosario; van der A, Daphne L.; Forouhi, Nita G.; Sharp, Stephen J.; Langenberg, Claudia; Riboli, Elio; Wareham, Nicholas J.

    2013-01-01

    OBJECTIVE Younger age at menarche, a marker of pubertal timing in girls, is associated with higher risk of later type 2 diabetes. We aimed to confirm this association and to examine whether it is explained by adiposity. RESEARCH DESIGN AND METHODS The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from 26 research centers across eight European countries. We tested the association between age at menarche and incident type 2 diabetes using Prentice-weighted Cox regression in 15,168 women (n = 5,995 cases). Models were adjusted in a sequential manner for potential confounding and mediating factors, including adult BMI. RESULTS Mean menarcheal age ranged from 12.6 to 13.6 years across InterAct countries. Each year later menarche was associated with 0.32 kg/m2 lower adult BMI. Women in the earliest menarche quintile (8–11 years, n = 2,418) had 70% higher incidence of type 2 diabetes compared with those in the middle quintile (13 years, n = 3,634), adjusting for age at recruitment, research center, and a range of lifestyle and reproductive factors (hazard ratio [HR], 1.70; 95% CI, 1.49–1.94; P < 0.001). Adjustment for BMI partially attenuated this association (HR, 1.42; 95% CI, 1.18–1.71; P < 0.001). Later menarche beyond the median age was not protective against type 2 diabetes. CONCLUSIONS Women with history of early menarche have higher risk of type 2 diabetes in adulthood. Less than half of this association appears to be mediated by higher adult BMI, suggesting that early pubertal development also may directly increase type 2 diabetes risk. PMID:24159179

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

    PubMed Central

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

    2014-01-01

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

  10. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    PubMed Central

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  11. Diabetes among Ethiopian Immigrants to Israel: Exploring the Effects of Migration and Ethnicity on Diabetes Risk.

    PubMed

    Jaffe, Anat; Giveon, Shmuel; Wulffhart, Liat; Oberman, Bernice; Freedman, Laurence; Ziv, Arnona; Kalter-Leibovici, Ofra

    2016-01-01

    Diabetes prevalence among ethnic minorities and immigrants often differs from the majority indigenous population. We compared diabetes prevalence, incidence and risk among Ethiopian and non-Ethiopian Jews. Within these main groups, we controlled for the effect of migration on diabetes risk by comparing the subgroups of Ethiopian and former Soviet Union (FSU) immigrants, and compared both with Israeli-born non-Ethiopian Jews. The study cohort included adult Ethiopian (n = 8,398) and age-matched non-Ethiopian Jews (n = 15,977) and subgroups: Ethiopian immigrants (n = 7,994), FSU immigrants (n = 1,541) and Israeli-born non-Ethiopian Jews (n = 10,828). Diabetes prevalence, annual incidence, and hazard ratios (HRs) adjusted for sex and metabolic syndrome (MetS)-components, were determined in three age groups (<50yrs, 50-59yrs, and ≥60yrs). Comparisons of body mass index (BMI) at diabetes incidence were made. Younger (<50yrs) Ethiopians had higher prevalence rates, 3.6% (95%CI: 3.1-4.1) and annual incidence, 0.9% (95%CI: 0.8-1.0) than non-Ethiopians, 2.7% (95%CI: 2.3-3.0) and 0.5% (95%CI: 0.4-0.6), respectively. These differences were particularly pronounced among Ethiopian women. Diabetes risk among Ethiopians was higher and adjustment for MetS-components was important only for BMI, which further increased hazard ratio (HR) estimates associated with Ethiopian ethnicity from 1.81 (95% CI:1.50-2.17) to 2.31 (95% CI:1.91-2.79). The same differences were seen when comparing Ethiopian to FSU immigrants. BMI before incident diabetes was lower among younger Ethiopian immigrants than younger FSU immigrants and Israeli-born. Ethiopian ethnicity is associated with increased diabetes risk, which is age and BMI dependent. Young Ethiopians<50yrs, particularly women, had the greatest increase in risk. Lower BMI cut-offs should be defined to reflect diabetes risk among Ethiopians.

  12. Cost-effectiveness of the diabetes care protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk.

    PubMed

    Cleveringa, Frits G W; Welsing, Paco M J; van den Donk, Maureen; Gorter, Kees J; Niessen, Louis W; Rutten, Guy E H M; Redekop, William K

    2010-02-01

    The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model, computing individual lifetime health-related costs, and health effects. Incremental costs and effectiveness (quality-adjusted life-years [QALYs]) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+ or CVD- patients, respectively). Excluding stroke, DCP patients lived longer (0.14 life-years, P = NS), experienced more QALYs (0.037, P = NS), and incurred higher total costs (euro 1,415, P = NS), resulting in an ICER of euro 38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of euro 20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER = euro 14,814) than for CVD- patients (ICER = euro 121,285). Coronary heart disease costs were reduced (euro-587, P < 0.05). DCP reduces cardiovascular risk, resulting in only a slight improvement in QALYs, lower CVD costs, but higher total costs, with a high cost-effectiveness ratio. Cost-effective care can be achieved by focusing on cardiovascular risk factors in type 2 diabetic patients with a history of CVD.

  13. Bienestar: a diabetes risk-factor prevention program.

    PubMed

    Trevino, R P; Pugh, J A; Hernandez, A E; Menchaca, V D; Ramirez, R R; Mendoza, M

    1998-02-01

    The Bienester Health Program, a diabetes risk-factor prevention pilot program, targeted fourth grade Mexican American children. The primary goals are to decrease the two established risk factors for diabetes--overweight and dietary fats. Since the health program is based on Social Cognitive Theory, on social systems structure, and on culturally relevant material, it considers the child's social systems on both its health program and process evaluation. Learning activities were developed for four social systems that potentially influence children's health behaviors (parent, classroom, school cafeteria, and after-school care). Preliminary results show that the Bienestar Health Program significantly decreased dietary fat, increased fruit and vegetable servings, and increased diabetes health knowledge.

  14. A requirements engineering approach for improving the quality of diabetes education websites.

    PubMed

    Shabestari, Omid; Roudsari, Abdul

    2011-01-01

    Diabetes Mellitus is a major chronic disease with multi-organ involvement and high-cost complications. Although it has been proved that structured education can control the risk of developing these complications, there is big room for improvement in the educational services for these patients. e-learning can be a good solution to fill this gap. Most of the current e-learning solutions for diabetes were designed by computer experts and healthcare professionals but the patients, as end-users of these systems, haven't been deeply involved in the design process. Considering the expectations of the patients, this article investigates a requirement engineering process comparing the level of importance given to different attributes of the e-learning by patients and healthcare professionals. The results of this comparison can be used for improving the currently developed online diabetes education systems.

  15. Mobile Applications for Type 2 Diabetes Risk Estimation: a Systematic Review.

    PubMed

    Fijacko, Nino; Brzan, Petra Povalej; Stiglic, Gregor

    2015-10-01

    Screening for chronical diseases like type 2 diabetes can be done using different methods and various risk tests. This study present a review of type 2 diabetes risk estimation mobile applications focusing on their functionality and availability of information on the underlying risk calculators. Only 9 out of 31 reviewed mobile applications, featured in three major mobile application stores, disclosed the name of risk calculator used for assessing the risk of type 2 diabetes. Even more concerning, none of the reviewed applications mentioned that they are collecting the data from users to improve the performance of their risk estimation calculators or offer users the descriptive statistics of the results from users that already used the application. For that purpose the questionnaires used for calculation of risk should be upgraded by including the information on the most recent blood sugar level measurements from users. Although mobile applications represent a great future potential for health applications, developers still do not put enough emphasis on informing the user of the underlying methods used to estimate the risk for a specific clinical condition.

  16. Nontraditional cardiovascular risk factors in pediatric type 1 diabetes.

    PubMed

    Hoffman, Robert P

    2016-12-01

    If we are to gain a full and complete understanding of mechanisms of cardiovascular risk factors in adolescent type 1 diabetes mechanistic risk markers must be developed that predict risk accurately and which can be used as endpoints for short or intermediate term intervention studies aimed at reducing risk. A variety of biochemical and vascular markers have potential to meet these requirements. Biochemical markers include markers of inflammation, oxidation, and endothelial damage. Vascular markers include static and dynamic measures of arterial function. Adolescents with type 1 diabetes demonstrate alterations in many of these markers. For many of the biochemical markers precise cut-off points with high sensitivity and specificity are not available and many of the vascular measures require specific equipment and are operator dependent.

  17. Diabetes mellitus is a coronary heart disease risk equivalent for peripheral vascular disease.

    PubMed

    Newman, Jonathan D; Rockman, Caron B; Kosiborod, Mikhail; Guo, Yu; Zhong, Hua; Weintraub, Howard S; Schwartzbard, Arthur Z; Adelman, Mark A; Berger, Jeffrey S

    2017-02-01

    Diabetes mellitus (diabetes) is associated with significantly increased risk of peripheral vascular disease. Diabetes is classified as a coronary heart disease (CHD) risk equivalent, but it is unknown whether diabetes is a CHD risk equivalent for peripheral vascular disease. The objective was to evaluate the odds of peripheral arterial disease (PAD) or carotid artery stenosis (CAS) among participants with diabetes, CHD, or both, compared with participants without diabetes or CHD, in a nationwide vascular screening database. We hypothesized that diabetes and CHD would confer similar odds of PAD and CAS.

  18. The Impact of Hepatitis B Vaccination Status on the Risk of Diabetes, Implicating Diabetes Risk Reduction by Successful Vaccination

    PubMed Central

    Karnchanasorn, Rudruidee; Feng, Wei; Samoa, Raynald; Chuang, Lee-Ming; Chiu, Ken C.

    2015-01-01

    Background The liver plays a key role in fuel metabolism. It is well established that liver disease is associated with an increased risk for diabetes mellitus. Hepatitis C virus infection has been known to increase the risk of diabetes. However, much less is known about the role of hepatitis B virus (HBV) infection in diabetes. We examined the association of diabetes based on the vaccination status for HBV. Methods In this cross-sectional study, we included adult subjects (≥20 y/o) with HBV serology available from the National Health and Nutrition Examination Survey 2005–2010. Diabetes was defined as established diabetes or fasting plasma glucose concentration ≥7.0 mmol/L, 2-hour plasma glucose concentration ≥11.1 mmol/L, or HbA1c ≥ 47.5 mmol/mol (6.5%). Vaccination was based on the reported history and immunization was determined by HBV serology. The odds ratio (OR) with 95% confidence intervals (95% CI) were calculated with consideration of the following covariates: age, gender, BMI, ethnic/racial group, current smoker, current alcohol consumption, family history of diabetes, poverty index, and education. Results This study included 15,316 subjects. Among them, 2,320 subjects was immunized based the HBV serology. Among 4,063 subjects who received HBV vaccination, successful vaccination was only noted in 39% of subjects. The HBV vaccination was not associated with diabetes (OR: 1.08, 95%CI: 0.96–1.23). Serology evidence of HBV immunization was associated with a reduced OR of diabetes (0.75, 95%CI: 0.62–0.90). Successful HBV vaccination was also associated with a reduced OR of diabetes (0.67, 95%CI: 0.52–0.84). Conclusions Although our study shows the association of HBV vaccination with the reduced odds of diabetes by 33%, a prospective study is warranted to confirm and examine the impact of HBV vaccination in prevention of diabetes. PMID:26509504

  19. Expanding role of the Madras Diabetes Research Foundation - Indian Diabetes Risk Score in clinical practice.

    PubMed

    Mohan, Viswanathan; Anbalagan, Viknesh Prabu

    2013-01-01

    The Indian Diabetes Risk Score was initially developed by the Madras Diabetes Research Foundation (MDRF-IDRS) to help detect undiagnosed Type 2 diabetes (T2DM) in the community. Soon it was found that the MDRF-IDRS could also help to predict incident diabetes, metabolic syndrome, coronary artery disease (CAD), non-alcoholic fatty liver disease as well as sleep disorders in the community. It helps to differentiate T2DM from non-T2DM. Finally, it also helps to identify those with CAD, peripheral vascular disease and neuropathy among those with T2DM. Thus, the MDRF-IDRS is a simple, virtually 'no cost' tool which is useful in several clinical and epidemiological settings.

  20. Comparison of frequency of obesity in high risk non diabetic young individuals with low risk non diabetic young individuals.

    PubMed

    Shaikh, Mumtaz Ali; Kumar, Raj; Ghori, Raft Ahmed; Shaikh, Dur-e-Yakta

    2011-06-01

    To assess the body mass index and waist circumferences of high risk non diabetic young individuals and compare them with low risk non diabetic young individuals. A cross sectional, case control comparative study was conducted in the department of medicine, LUMHS from January 2008 to March 2009. Five hundred individuals 20-40 years of age were selected and divided into two groups i.e. Group A: high risk (250 individuals) and Group B: low risk (250 individuals) on the basis of same age and gender. Group A included those who had positive family history of type 2 DM in 1st degree relatives while group B had no family history of type 2 DM in 1st degree relatives. The blood pressure, BMI and Waist Circumference was measured and Fasting Blood Sugar was estimated in each individual. In each group 125 (50%) were males and 125 (50%) were females. In group A 58% and in group B 28.8% individuals represented raised BMI whereas 42% in group A and 36% in group B individuals showed an increased waist circumference. Mean fasting blood glucose was significantly higher in Group A than in Group B (P = 0.001). Impaired Fasting Glucose is strongly associated with family history of type 2 diabetes mellitus. Presence of obesity specially in high risk non-diabetic young individuals emphasize the need for routine health screening for early institution of preventive measures.

  1. Bienestar: A Diabetes Risk-Factor Prevention Program.

    ERIC Educational Resources Information Center

    Trevino, Robert P.; Pugh, Jacqueline A.; Hernandez, Arthur E.; Menchaca, Velma D.; Ramirez, Robert R.; Mendoza, Monica

    1998-01-01

    The Bienestar Health Program is a diabetes risk-factor prevention program targeting Mexican American fourth graders. Program goals are to decrease overweight and dietary fats. The program is based on social cognitive theory and uses culturally relevant material. Preliminary evaluation indicates the program significantly decreases dietary fat,…

  2. Bienestar: A Diabetes Risk-Factor Prevention Program.

    ERIC Educational Resources Information Center

    Trevino, Robert P.; Pugh, Jacqueline A.; Hernandez, Arthur E.; Menchaca, Velma D.; Ramirez, Robert R.; Mendoza, Monica

    1998-01-01

    The Bienestar Health Program is a diabetes risk-factor prevention program targeting Mexican American fourth graders. Program goals are to decrease overweight and dietary fats. The program is based on social cognitive theory and uses culturally relevant material. Preliminary evaluation indicates the program significantly decreases dietary fat,…

  3. Risk Stratification for 25-Year Cardiovascular Disease Incidence in Type 1 Diabetes: Tree-Structured Survival Analysis of the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study

    PubMed Central

    Miller, Rachel G.; Anderson, Stewart J.; Costacou, Tina; Sekikawa, Akira; Orchard, Trevor J.

    2017-01-01

    Background The formal identification of subgroups with varying levels of risk is uncommon in observational studies of cardiovascular disease (CVD), although such insight might be useful for clinical management. Methods Tree-structured survival analysis (TSSA) was utilized to determine whether there are meaningful subgroups at varying levels of CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, a prospective cohort study of childhood-onset (<17 years old) type 1 diabetes. Results Of the 561 participants free of CVD (coronary artery disease, stroke, or lower extremity arterial disease) at baseline, 263 (46.9%) had an incident CVD event over the 25-year follow-up. TSSA revealed a range of risk groups, from 24 to 85%, which demonstrate that those with short diabetes duration and elevated non-HDL cholesterol have similar CVD risk to those with long diabetes duration and that renal disease is a better discriminator of risk in men than in women. Conclusions Our findings suggest that subgroups with major CVD risk differences exist in this type 1 diabetes cohort. Using TSSA may help to identify these groups and the interrelationships between their associated risk factors. This approach may improve our understanding of various clinical pathways to CVD and help target intervention strategies. PMID:27190081

  4. Gender aspects in type 2 diabetes mellitus and cardiometabolic risk.

    PubMed

    Sattar, Naveed

    2013-08-01

    Men are well known to have a higher risk than women for cardiovascular disease. In recent years, however, studies show adult men also have higher risk for type 2 diabetes, an observation which has important clinical implications, particularly in the public health arena. This chapter explores the relevant data underlying this observation, examines potential mechanisms including life course changes in insulin resistance and role of adiposity, and discusses relevant clinical implications and solutions. Copyright © 2013. Published by Elsevier Ltd.

  5. Risk of tuberculosis in patients with diabetes: population based cohort study using the UK Clinical Practice Research Datalink.

    PubMed

    Pealing, Louise; Wing, Kevin; Mathur, Rohini; Prieto-Merino, David; Smeeth, Liam; Moore, David A J

    2015-06-05

    Previous cohort studies demonstrate diabetes as a risk factor for tuberculosis (TB) disease. Public Health England has identified improved TB control as a priority area and has proposed a primary care-based screening program for latent TB. We investigated the association between diabetes and risk of tuberculosis in a UK General Practice cohort in order to identify potential high-risk groups appropriate for latent TB screening. Using data from the UK Clinical Practice Research Datalink we constructed a cohort of patients with incident diabetes. We included 222,731 patients with diabetes diagnosed from 1990-2013 and 1,218,616 controls without diabetes at index date who were matched for age, sex and general practice. The effect of diabetes was explored using a Poisson analysis adjusted for age, ethnicity, body mass index, socioeconomic status, alcohol intake and smoking. We explored the effects of age, diabetes duration and severity. The effects of diabetes on risk of incident TB were explored across strata of chronic disease care defined by cholesterol and blood pressure measurement and influenza vaccination rates. During just under 7 million person-years of follow-up, 969 cases of TB were identified. The incidence of TB was higher amongst patients with diabetes compared with the unexposed group: 16.2 and 13.5 cases per 100,000 person-years, respectively. After adjustment for potential confounders the association between diabetes and TB remained (adjusted RR 1.30, 95 % CI 1.01 to 1.67, P = 0.04). There was no evidence that age, time since diagnosis and severity of diabetes affected the association between diabetes and TB. Diabetes patients with the lowest and highest rates of chronic disease management had a higher risk of TB (P <0.001 for all comparisons). Diabetes as an independent risk factor is associated with only a modest overall increased risk of TB in our UK General Practice cohort and is unlikely to be sufficient cause to screen for latent TB. Across

  6. Therapies for type 2 diabetes: lowering HbA1c and associated cardiovascular risk factors

    PubMed Central

    2010-01-01

    Objectives To summarize data supporting the effects of antidiabetes agents on glucose control and cardiovascular risk factors in patients with type 2 diabetes. Methods Studies reporting on the effects of antidiabetes agents on glycemic control, body weight, lipid levels, and blood pressure parameters are reviewed and summarized for the purpose of selecting optimal therapeutic regimens for patients with type 2 diabetes. Results National guidelines recommend the aggressive management of cardiovascular risk factors in patients with type 2 diabetes, including weight loss and achieving lipid and blood pressure treatment goals. All antidiabetes pharmacotherapies lower glucose; however, effects on cardiovascular risk factors vary greatly among agents. While thiazolidinediones, sulfonylureas, and insulin are associated with weight gain, dipeptidyl peptidase-4 inhibitors are considered weight neutral and metformin can be weight neutral or associated with a small weight loss. Glucagon-like peptide-1 receptor agonists and amylinomimetics (e.g. pramlintide) result in weight loss. Additionally, metformin, thiazolidinediones, insulin, and glucagon-like peptide-1 receptor agonists have demonstrated beneficial effects on lipid and blood pressure parameters. Conclusion Management of the cardiovascular risk factors experienced by patients with type 2 diabetes requires a multidisciplinary approach with implementation of treatment strategies to achieve not only glycemic goals but to improve and/or correct the underlying cardiovascular risk factors. PMID:20804556

  7. Improvement in diabetes care of underinsured patients enrolled in project dulce: a community-based, culturally appropriate, nurse case management and peer education diabetes care model.

    PubMed

    Philis-Tsimikas, Athena; Walker, Chris; Rivard, Lisa; Talavera, Gregory; Reimann, Joachim O F; Salmon, Michelle; Araujo, Rachel

    2004-01-01

    To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes. A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA(1c), lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce. After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA(1c) (12.0-8.3%, P < 0.0001), total cholesterol (5.82-4.86 mmol/l, P < 0.0001), LDL cholesterol (3.39-2.79 mmol/l, P < 0.0001), and diastolic blood pressure (80-76 mmHg, P < 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P = 0.024), treatment satisfaction (P = 0.001), and culture-based beliefs (P = 0.001) were also improved. A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations.

  8. Gestational diabetes: risks, management, and treatment options

    PubMed Central

    Kim, Catherine

    2010-01-01

    Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insulin analogs in lieu of human insulin. Postpartum glucose screening and initiation of healthy lifestyle behaviors, including exercise, adequate fruit and vegetable intake, breastfeeding, and contraception, are encouraged to decrease rates of future glucose intolerance in mothers and offspring. PMID:21151681

  9. Vitamin C improves basal metabolic rate and lipid profile in alloxan-induced diabetes mellitus in rats.

    PubMed

    Owu, D U; Antai, A B; Udofia, K H; Obembe, A O; Obasi, K O; Eteng, M U

    2006-12-01

    Diabetes mellitus (DM)is a multi-factorial disease which is characterized by hyperglycaemia, lipoprotein abnormalities and oxidative stress. This study evaluated effect of oral vitamin C administration on basal metabolic rate and lipid profile of alloxan-induced diabetic rats. Vitamin C was administered at 200 mg/kg body wt. by gavage for four weeks to diabetic rats after which the resting metabolic rate and plasma lipid profile was determined. The results showed that vitamin C administration significantly (p less than 0.01) reduced the resting metabolic rate in diabetic rats; and also lowered plasma triglyceride, total cholesterol and low-density lipoprotein cholesterol. These results suggest that the administration of vitamin C in this model of established diabetes mellitus might be beneficial for the restoration of basal metabolic rate and improvement of lipid profile. This may at least in part reduce the risk of cardiovascular events seen in diabetes mellitus.

  10. Diabetes mellitus as a novel risk factor for gastrointestinal malignancies.

    PubMed

    Herrigel, Dana J; Moss, Rebecca A

    2014-10-01

    Evidence of an emerging etiologic link between diabetes mellitus and several gastrointestinal malignancies is presented. Although a correlation between pancreatic cancer and diabetes mellitus has long been suspected, the potential role diabetes mellitus plays in the pathogenicity of both hepatocellular carcinoma and colon cancer is becoming increasingly well defined. Further supporting the prospect of etiologic linkage, the association of diabetes mellitus with colon cancer is consistently demonstrated to be independent of obesity. An increasing incidence of diabetes and obesity in the United States has led to a recent surge in incidence of hepatocellular cancer on the background of nonalcoholic fatty liver disease, and this disease is expected to commensurately grow in incidence. Widespread recognition of this emerging risk factor may lead to a change in screening practices. Although the mechanisms underlying the correlation are still under investigation, the role of insulin, the insulin-like growth factor-I, and related binding and signaling pathways as regulators of cell growth and cell proliferation are implicated in carcinogenesis and tumor growth. The potential role of metformin and other medications for diabetes mellitus in the chemoprevention, carcinogenesis, and treatment of gastrointestinal malignancies is also presented.

  11. Results of a diabetic retinopathy screening. Risk markers analysis.

    PubMed

    Ancochea, G; Martín Sánchez, M D

    2016-01-01

    To identify risk markers for retinopathy in patients from our geographic area, and to compare them with those published in other studies. To design a screening interval strategy, taking into account these results, and compare it with intervals suggested in published studies. Cross-sectional observational study on 383 diabetic patients with no previous retinopathy diagnosis, who were screened for diabetic retinopathy. An analysis was made on the possible association between patient factors and presence of retinopathy. A greater probability for finding retinopathy in diabetic patients was associated to insulin treatment in our study, with a statistical significance level of 95%. In patients with less than 10year onset of their diabetes, only mild retinopathy without macular oedema was found. Insulin treatment and time of onset of diabetes should be taken into account when designing efficient screening strategies for diabetic retinopathy. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Retinopathy and risk factors in diabetic patients from Al-Madinah Al-Munawarah in the Kingdom of Saudi Arabia.

    PubMed

    El-Bab, Mohamed F; Shawky, Nashaat; Al-Sisi, Ali; Akhtar, Mohamed

    2012-01-01

    Diabetes mellitus is accompanied by chronic and dangerous microvascular changes affecting most body systems, especially the eye, leading to diabetic retinopathy. Diabetic retinopathy without appropriate management is emerging as one of the leading causes of blindness. Therefore, it is necessary to improve the early diagnosis of diabetic retinopathy, reduce the risk of blindness, and identify relevant risk factors. This descriptive study was designed to estimate the prevalence of retinopathy and its staging in diabetic patients attending the diabetes clinic at King Fahd Hospital in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia, from 2008 to 2010. Patients completed a questionnaire, underwent a full medical assessment carried out by the treating clinicians, and were examined for evidence of diabetic retinopathy using standard ophthalmic outpatient instruments. In total, 690 randomly selected diabetic patients of mean age 46.10 ± 11.85 (range 16-88) years were included, comprising 395 men (57.2%) of mean age 46.50 ± 11.31 years and 295 women (42.8%) of mean age 45.55 ± 12.53 years. The mean duration of diabetes mellitus was 11.91 ± 7.92 years in the women and 14.42 ± 8.20 years in the men, and the mean total duration of known diabetes mellitus was 13.35 ± 8.17 years. Glycated hemoglobin was higher in men (8.53% ± 1.81%) than in women (7.73% ± 1.84%), and this difference was statistically significant (P ≤ 0.0001). Of the 690 diabetic patients, 249 (36.1%) had retinopathy. Mild nonproliferative diabetic retinopathy was present in 13.6% of patients, being of moderate grade in 8% and of severe grade in 8.1%. A further 6.4% had proliferative diabetic retinopathy. Regular screening to detect diabetic retinopathy is strongly recommended because early detection has the best chance of preventing retinal complications.

  13. Risk of Bladder Cancer Among Diabetic Patients Treated With Pioglitazone

    PubMed Central

    Lewis, James D.; Ferrara, Assiamira; Peng, Tiffany; Hedderson, Monique; Bilker, Warren B.; Quesenberry, Charles P.; Vaughn, David J.; Nessel, Lisa; Selby, Joseph; Strom, Brian L.

    2011-01-01

    OBJECTIVE Some preclinical in vivo studies and limited human data suggest a possible increased risk of bladder cancer with pioglitazone therapy. This is an interim report of an ongoing cohort study examining the association between pioglitazone therapy and the risk of bladder cancer in patients with diabetes. RESEARCH DESIGN AND METHODS This study includes 193,099 patients in the Kaiser Permanente Northern California diabetes registry who were ≥40 years of age between 1997 and 2002. Those with prior bladder cancer were excluded. Ever use of each diabetes medication (defined as two or more prescriptions within 6 months) was treated as a time-dependent variable. Cox regression–generated hazard ratios (HRs) compared pioglitazone use with nonpioglitazone use adjusted for age, sex, race/ethnicity, diabetes medications, A1C, heart failure, household income, renal function, other bladder conditions, and smoking. RESULTS The group treated with pioglitazone comprised 30,173 patients. There were 90 cases of bladder cancer among pioglitazone users and 791 cases of bladder cancer among nonpioglitazone users. Overall, ever use of pioglitazone was not associated with risk of bladder cancer (HR 1.2 [95% CI 0.9–1.5]), with similar results in men and women (test for interaction P = 0.8). However, in the a priori category of >24 months of therapy, there was an increased risk (1.4 [1.03–2.0]). Ninety-five percent of cancers diagnosed among pioglitazone users were detected at early stage. CONCLUSIONS In this cohort of patients with diabetes, short-term use of pioglitazone was not associated with an increased incidence of bladder cancer, but use for more than 2 years was weakly associated with increased risk. PMID:21447663

  14. Sex of the baby and future maternal risk of Type 2 diabetes in women who had gestational diabetes.

    PubMed

    Retnakaran, R; Shah, B R

    2016-07-01

    Women who develop gestational diabetes mellitus have a chronic defect in the secretion of insulin by the pancreatic β cells that underlies both their diagnostic hyperglycaemia in pregnancy and their elevated lifetime risk of developing Type 2 diabetes in the future. It has recently emerged that carrying a male fetus is associated with poorer maternal β-cell function and an increased risk of gestational diabetes, whereas the development of gestational diabetes when carrying a girl (as compared with a boy) predicts a comparatively higher risk of early progression to Type 2 diabetes before any subsequent pregnancy. In this context, we sought to determine the impact of fetal sex on the long-term risk of Type 2 diabetes in women with gestational diabetes. Using population-based administrative databases, we identified all women in Ontario, Canada, with a singleton live-birth first pregnancy complicated by gestational diabetes between April 2000 and March 2010 (n = 23 363). We compared the risk of subsequent Type 2 diabetes after pregnancy in those who carried a girl (n = 11 229) vs. those who carried a boy (n = 12 134). Over median 5.5 years follow-up, 5483 women (23.5%) were diagnosed with diabetes. Compared with those who carried a boy, women who had a girl had an elevated risk of subsequently developing diabetes (adjusted hazard ratio = 1.06, 95% CI 1.01-1.12). Among women with gestational diabetes, those who are carrying a girl have a slightly higher overall future risk of Type 2 diabetes. © 2015 Diabetes UK.

  15. Effect of intensive nursing education on the prevention of diabetic foot ulceration among patients with high-risk diabetic foot: a follow-up analysis.

    PubMed

    Ren, Meng; Yang, Chuan; Lin, Diao Zhu; Xiao, Hui Sheng; Mai, Li Fang; Guo, Yi Chen; Yan, Li

    2014-09-01

    The aim of the study was to discuss the effect of intensive nursing education on the prevention of diabetic foot ulceration among patients at high risk for diabetic foot. One hundred eighty-five diabetes patients at high risk for foot diseases were enrolled in this study and provided with intensive nursing education, including individualized education about diabetes mellitus and diabetic foot diseases, instruction in podiatric care (the right way of washing the foot, the care of foot skin, appropriate choice of shoes and socks, intense examinations and records of feet by patients themselves every day, and the assistant management of calluses). Study subjects were followed up for 2 years. Once the foot ulceration developed, the inducing factors of foot ulceration were inquired about, the ulcers were evaluated, and the incidence of foot ulceration was analyzed before and after the intensive nursing education according to self-paired data. Results showed there were highly statistically significant improvements in the intensive treatment group compared with the control group in plasma glucose, blood pressure, and high-density lipoprotein cholesterol levels. More important is that intensive nursing education helps to prevent diabetic foot ulceration and to decrease the rate of amputation among patients at high risk for diabetic foot.

  16. Increased plasma N-glycome complexity is associated with higher risk of type 2 diabetes.

    PubMed

    Keser, Toma; Gornik, Ivan; Vučković, Frano; Selak, Najda; Pavić, Tamara; Lukić, Edita; Gudelj, Ivan; Gašparović, Hrvoje; Biočina, Bojan; Tilin, Therese; Wennerström, Annika; Männistö, Satu; Salomaa, Veikko; Havulinna, Aki; Wang, Wei; Wilson, James F; Charutvedi, Nishi; Perola, Markus; Campbell, Harry; Lauc, Gordan; Gornik, Olga

    2017-09-13

    Better understanding of type 2 diabetes and its prevention is a pressing need. Changes in human plasma N-glycome are associated with many diseases and represent promising diagnostic and prognostic biomarkers. Variations in glucose metabolism directly affect glycosylation through the hexosamine pathway but studies of plasma glycome in type 2 diabetes are scarce. The aim of this study was to determine whether plasma protein N-glycome is changed in individuals who are at greater risk of developing type 2 diabetes. Using a chromatographic approach, we analysed N-linked glycans from plasma proteins in two populations comprising individuals with registered hyperglycaemia during critical illness (increased risk for development of type 2 diabetes) and individuals who stayed normoglycaemic during the same condition: AcuteInflammation (59 cases vs 49 controls) and AcuteInflammation Replication (52 cases vs 14 controls) populations. N-glycome was also studied in individuals from FinRisk (37 incident cases of type 2 diabetes collected at baseline vs 37 controls), Orkney Complex Disease Study (ORCADES; 94 individuals with HbA1c > 6.5% [47.5 mmol/mol] vs 658 controls) and Southall and Brent Revisited (SABRE) cohort studies (307 individuals with HbA1c > 6.5% [47.5 mmol/mol] vs 307 controls). Individuals with increased risk for diabetes type 2 development (AcuteInflammation and AcuteInflammation Replication populations), incident cases of type 2 diabetes collected at baseline (FinRisk population) and individuals with elevated HbA1c (ORCADES and SABRE populations) all presented with increased branching, galactosylation and sialylation of plasma protein N-glycans and these changes were of similar magnitude. Increased complexity of plasma N-glycan structures is associated with higher risk of developing type 2 diabetes and poorer regulation of blood glucose levels. Although further research is needed, this finding could offer a potential new approach for improvement in prevention

  17. Type 2 diabetes mellitus, glycemic control, and cancer risk.

    PubMed

    Onitilo, Adedayo A; Stankowski, Rachel V; Berg, Richard L; Engel, Jessica M; Glurich, Ingrid; Williams, Gail M; Doi, Suhail A

    2014-03-01

    Type 2 diabetes mellitus is characterized by prolonged hyperinsulinemia, insulin resistance, and progressive hyperglycemia. Disease management relies on glycemic control through diet, exercise, and pharmacological intervention. The goal of the present study was to examine the effects of glycemic control and the use of glucose-lowering medication on the risk of breast, prostate, and colon cancer. Patients diagnosed with type 2 diabetes mellitus (N=9486) between 1 January 1995 and 31 December 2009 were identified and data on glycemic control (hemoglobin A1c, glucose), glucose-lowering medication use (insulin, metformin, sulfonylurea), age, BMI, date of diabetes diagnosis, insurance status, comorbidities, smoking history, location of residence, and cancer diagnoses were electronically abstracted. Cox proportional hazards regression modeling was used to examine the relationship between glycemic control, including medication use, and cancer risk. The results varied by cancer type and medication exposure. There was no association between glycemic control and breast or colon cancer; however, prostate cancer risk was significantly higher with better glycemic control (hemoglobin A1c ≤ 7.0%). Insulin use was associated with increased colon cancer incidence in women, but not with colon cancer in men or breast or prostate cancer risk. Metformin exposure was associated with reduced breast and prostate cancer incidence, but had no association with colon cancer risk. Sulfonylurea exposure was not associated with risk of any type of cancer. The data reported here support hyperinsulinemia, rather than hyperglycemia, as a major diabetes-related factor associated with increased risk of breast and colon cancer. In contrast, hyperglycemia appears to be protective in the case of prostate cancer.

  18. Cardiovascular disease risk in young people with type 1 diabetes.

    PubMed

    Snell-Bergeon, Janet K; Nadeau, Kristen

    2012-08-01

    Cardiovascular disease (CVD) is the most frequent cause of death in people with type 1 diabetes (T1D), despite modern advances in glycemic control and CVD risk factor modification. CVD risk identification is essential in this high-risk population, yet remains poorly understood. This review discusses the risk factors for CVD in young people with T1D, including hyperglycemia, traditional CVD risk factors (dyslipidemia, smoking, physical activity, hypertension), as well as novel risk factors such as insulin resistance, inflammation, and hypoglycemia. We present evidence that adverse changes in cardiovascular function, arterial compliance, and atherosclerosis are present even during adolescence in people with T1D, highlighting the need for earlier intervention. The methods for investigating cardiovascular risk are discussed and reviewed. Finally, we discuss the observational studies and clinical trials which have thus far attempted to elucidate the best targets for early intervention in order to reduce the burden of CVD in people with T1D.

  19. Can computerized clinical decision support systems improve diabetes management? A systematic review and meta-analysis.

    PubMed

    Jeffery, R; Iserman, E; Haynes, R B

    2013-06-01

    To systematically review randomized trials that assessed the effects of computerized clinical decision support systems in ambulatory diabetes management compared with a non-computerized clinical decision support system control. We included all diabetes trials from a comprehensive computerized clinical decision support system overview completed in January 2010, and searched EMBASE, MEDLINE, INSPEC/COMPENDEX and Evidence-Based Medicine Reviews (EBMR) from January 2010 to April 2012. Reference lists of related reviews, included articles and Clinicaltrials.gov were also searched. Randomized controlled trials of patients with diabetes in ambulatory care settings comparing a computerized clinical decision support system intervention with a non-computerized clinical decision support system control, measuring either a process of care or a patient outcome, were included. Screening of studies, data extraction, risk of bias and quality of evidence assessments were carried out independently by two reviewers, and discrepancies were resolved through consensus or third-party arbitration. Authors were contacted for any missing data. Fifteen trials were included (13 from the previous review and two from the current search). Only one study was at low risk of bias, while the others were of moderate to high risk of bias because of methodological limitations. HbA1c (3 months' follow-up), quality of life and hospitalization (12 months' follow-up) were pooled and all favoured the computerized clinical decision support systems over the control, although none were statistically significant. Triglycerides and practitioner performance tended to favour computerized clinical decision support systems although results were too heterogeneous to pool. Computerized clinical decision support systems in diabetes management may marginally improve clinical outcomes, but confidence in the evidence is low because of risk of bias, inconsistency and imprecision. © 2012 The Authors. Diabetic Medicine

  20. A pragmatic comparison of two diabetes education programs in improving type 2 diabetes mellitus outcomes.

    PubMed

    Dorland, Katherine; Liddy, Clare

    2014-03-28

    Although it is clear that education programs constitute key elements of improved diabetes management, uncertainty exists regarding the optimal method of delivering that education. In addition to the lack of consensus regarding the most appropriate delivery methods for these programs, there is a paucity of research which evaluates these methods in terms of specific clinical outcomes. This pragmatic study compares the effectiveness of two distinct diabetes education programs in improving clinical outcomes in patients with type 2 diabetes mellitus in a primary care setting. The two diabetes education classes (n = 80 enrolled) retrospectively evaluated were 'the ABC's of Diabetes' (one 2-hour didactic teaching session) and 'Conversation Maps' (3 highly interactive weekly classes, 6 hours in total). Eligible participants (n = 32) had their charts reviewed and outcome measures (i.e., glycosylated hemoglobin levels (HbA1c), low density lipoprotein (LDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight) recorded 1 year prior to and 6 months following the class. Pre- and post-class outcome measures were compared. A trend towards lower HbA1c was observed after completion of both classes, with an average reduction of 0.2%, and 0.6% after 6 months in the 'ABC's of Diabetes' class and 'Conversation Maps' class respectively. A significant decrease in weight was observed 6 months after the 'ABC's of Diabetes' class (p = 0.028), and in LDL after the 'Conversation Maps' class (p = 0.049). Patients with HbA1c ≥ 8% showed a drop of 1.1% in HbA1c 3 months after either class (p = 0.004). No significant difference in outcomes was found between the two diabetes education classes assessed. There was a trend towards improved glycemic control after both classes, and patients with high HbA1c levels demonstrated statistically significant improvements. This indicates that shorter sessions using didactic teaching methods may be equally

  1. New Advanced Technology to Improve Prediction and Prevention of Type 1 Diabetes

    DTIC Science & Technology

    2006-11-01

    32 Genetic Screening in Diabetes : Candidate Gene Analysis for Diabetic Nephropathy University of Hawaii... treatment and prevention of life threatening disease. The overall goal of the research project is to provide a means to genetically test diabetic ...patients for their inherited risk for developing the 3 principal complications of diabetes , i.e., nephropathy , neuropathy, and retinopathy. The

  2. Persistent organic pollutants as risk factors for type 2 diabetes.

    PubMed

    Ngwa, Elvis Ndonwi; Kengne, Andre-Pascal; Tiedeu-Atogho, Barbara; Mofo-Mato, Edith-Pascale; Sobngwi, Eugene

    2015-01-01

    Type 2 diabetes mellitus (T2DM) is a major and fast growing public health problem. Although obesity is considered to be the main driver of the pandemic of T2DM, a possible contribution of some environmental contaminants, of which persistent organic pollutants (POPs) form a particular class, has been suggested. POPs are organic compounds that are resistant to environmental degradation through chemical, biological, and photolytic processes which enable them to persist in the environment, to be capable of long-range transport, bio accumulate in human and animal tissue, bio accumulate in food chains, and to have potential significant impacts on human health and the environment. Several epidemiological studies have reported an association between persistent organic pollutants and diabetes risk. These findings have been replicated in experimental studies both in human (in-vitro) and animals (in-vivo and in-vitro), and patho-physiological derangements through which these pollutants exercise their harmful effect on diabetes risk postulated. This review summarizes available studies, emphasises on limitations so as to enable subsequent studies to be centralized on possible pathways and bring out clearly the role of POPs on diabetes risk.

  3. Identifying Common Genetic Risk Factors of Diabetic Neuropathies

    PubMed Central

    Witzel, Ini-Isabée; Jelinek, Herbert F.; Khalaf, Kinda; Lee, Sungmun; Khandoker, Ahsan H.; Alsafar, Habiba

    2015-01-01

    Type 2 diabetes mellitus (T2DM) is a global public health problem of epidemic proportions, with 60–70% of affected individuals suffering from associated neurovascular complications that act on multiple organ systems. The most common and clinically significant neuropathies of T2DM include uremic neuropathy, peripheral neuropathy, and cardiac autonomic neuropathy. These conditions seriously impact an individual’s quality of life and significantly increase the risk of morbidity and mortality. Although advances in gene sequencing technologies have identified several genetic variants that may regulate the development and progression of T2DM, little is known about whether or not the variants are involved in disease progression and how these genetic variants are associated with diabetic neuropathy specifically. Significant missing heritability data and complex disease etiologies remain to be explained. This article is the first to provide a review of the genetic risk variants implicated in the diabetic neuropathies and to highlight potential commonalities. We thereby aim to contribute to the creation of a genetic-metabolic model that will help to elucidate the cause of diabetic neuropathies, evaluate a patient’s risk profile, and ultimately facilitate preventative and targeted treatment for the individual. PMID:26074879

  4. Exploring lifestyle and risk in preventing type 2 diabetes-a nested qualitative study of older participants in a lifestyle intervention program (VEND-RISK).

    PubMed

    Følling, Ingrid S; Solbjør, Marit; Midthjell, Kristian; Kulseng, Bård; Helvik, Anne-S

    2016-08-25

    Lifestyle intervention may reduce the development of type 2 diabetes among high-risk individuals. The aim of this study was to explore how older adults perceived their own lifestyle and being at increased risk for type 2 diabetes while they participated in a lifestyle intervention programme. A nested qualitative study was performed with 26 participants (mean age 68 years) in the VEND-RISK Study. Participants had previously participated in the HUNT3 Study and the HUNT DE-PLAN Study, where their risk for developing type 2 diabetes (FIND-RISC ≥ 15) had been identified. The data were analysed using systematic text condensation. Two main themes were identified. The first theme was having resources available for an active lifestyle, which included having a family and being part of a social network, having a positive attitude toward life, and maintaining established habits from childhood to the present. The second theme was being at increased risk for type 2 diabetes, which included varied reactions to the information on increased risk, how lifestyle intervention raised awareness about risk behaviour, and health-related worries and ambitions as type 2 diabetes prevention. Assessing a participant's resources could improve the outcomes of lifestyle intervention programmes. Both family history and risk perception could be used in preventive strategies to enhance changes in lifestyle. The VEND-RISK Study was registered in ClinicalTrials.gov on April 26, 2010, with the registration number NCT01135901 .

  5. [Incidence and clinical risk factors for the development of diabetes mellitus in women with previous gestational diabetes].

    PubMed

    Domínguez-Vigo, P; Álvarez-Silvares, E; Alves-Pérez M T; Domínguez-Sánchez, J; González-González, A

    2016-04-01

    Gestational diabetes is considered a variant of diabetes mellitus as they share a common pathophysiological basis: insulin resistance in target and insufficient secretion of it by pancreatic p-cell bodies. Pregnancy is a unique physiological situation provides an opportunity to identify future risk of diabetes mellitus. To determine the long-term incidence of diabetes mellitus in women who have previously been diagnosed with gestational diabetes and identifying clinical risk factors for developing the same. nested case-control cohort study. 671 patients between 1996 and 2009 were diagnosed with gestational diabetes were selected. The incidence of diabetes mellitus was estimated and 2 subgroups were formed: Group A or cases: women who develop diabetes mellitus after diagnosis of gestational diabetes. Group B or control: random sample of 71 women with a history of gestational diabetes in the follow-up period remained normoglycemic. Both groups were studied up to 18 years postpartum. By studying Kaplan Meier survival of the influence of different gestational variables it was obtained in the later development of diabetes mellitus with time parameter and COX models for categorical variables were applied. Significant variables were studied by multivariate Cox analysis. In all analyzes the Hazard ratio was calculated with confidence intervals at 95%. The incidence of diabetes mellitus was 10.3% in patients with a history of gestational diabetes. They were identified as risk factors in the index pregnancy to later development of diabetes mellitus: greater than 35 and younger than 27 years maternal age, BMI greater than 30 kg/m2, hypertensive disorders of pregnancy, insulin therapy, poor metabolic control and more than a complicated pregnancy with gestational diabetes. Clinical factors have been identified in the pregnancy complicated by gestational diabetes that determine a higher probability of progression to diabetes mellitus in the medium and long term.

  6. Osteoporosis and risk of fracture in patients with diabetes: an update.

    PubMed

    Montagnani, Andrea; Gonnelli, Stefano; Alessandri, Massimo; Nuti, Ranuccio

    2011-04-01

    Diabetes mellitus (DM) and osteoporotic fractures are two of the most important causes of mortality and morbidity in older subjects. Recent data report a close association between fragility fracture risk and DM of both type 1 (DM1) and type 2 (DM2). However, DM1 is associated with reduced bone mineral density (BMD), whereas patients with DM2 generally have normal or increased BMD. This apparent paradox may be explained by the fact that, at a given level of BMD, diabetic patients present lower bone quality with respect to non-diabetics, as shown by several studies reporting that diabetes may affect bone tissue by means of various mechanisms, including hyperinsulinemia, deposition of advanced glycosylation endproducts (AGEs) in collagen, reduced serum levels of IGF-1, hypercalciuria, renal failure, microangiopathy and inflammation. In addition, the propensity to fall and several comorbidities may further explain the higher fracture incidence in DM patients with respect to the general population. It is reasonable to expect that close metabolic control of diabetes may improve bone status, although its effect on reduction of fracture risk has not yet been demonstrated. However, metformin has a direct effect on bone tissue by reducing AGE accumulation, whereas insulin acts directly on osteoclast activity, and thiazolidinediones (TZD) may have a negative effect by switching mesenchymal progenitor cells to adipose rather than bone tissue. New prospects include the incretins, a class of antidiabetic drugs which may play a role linking nutrition and bone metabolism. Better knowledge on how diabetes and its treatments influence bone tissue may lie at the basis of effective prevention of bone fracture in diabetic patients. Thus, close glycemic control, adequate intake of calcium and vitamin D, screening for low BMD, and prevention and treatment of diabetic complications are key elements in the management of osteoporosis in both DM1 and DM2. Attention should be paid to treating

  7. Prevalence and risk factors of gestational diabetes mellitus in Yemen

    PubMed Central

    Ali, Abdullatif D; Mehrass, Amat Al-Khaleq O; Al-Adhroey, Abdulelah H; Al-Shammakh, Abdulqawi A; Amran, Adel A

    2016-01-01

    Purpose Gestational diabetes mellitus (GDM) continues to be a significant health disorder triggering harmful complications in pregnant women and fetuses. Our knowledge of GDM epidemiology in Yemen is largely based on very limited data. The aim of this study was, therefore, to determine the prevalence and risk factors of GDM among pregnant women in Dhamar governorate, Yemen. Patients and methods A total of 311 subjects were randomly selected for this cross sectional survey. Health history data and blood samples were collected using a pretested questionnaire. To determine the prevalence of GDM, the fasting and random blood glucose techniques were applied according to the recommendations of the American Diabetes Association, using alternative methods that are more convenient to the targeted population. Poisson’s regression model incorporating robust sandwich variance was utilized to assess the association of potential risk factors in developing GDM. Results The prevalence of GDM was found to be 5.1% among the study population. Multivariate analysis confirmed age ≥30 years, previous GDM, family history of diabetes, and history of polycystic ovary syndrome as independent risk factors for GDM prevalence. However, body mass index ≥30 kg/m2 and previous macrosomic baby were found to be dependent risk factors. Conclusion This study reports new epidemiological information about the prevalence and risk factors of GDM in Yemen. Introduction of proper maternal and neonatal medical care and health education are important in order to save the mother and the baby. PMID:26869814

  8. Utilizing health ambassadors to improve type 2 diabetes and cardiovascular disease outcomes in Gadsden County, Florida.

    PubMed

    Suther, Sandra; Battle, Arrie M; Battle-Jones, Felecia; Seaborn, Cynthia

    2016-04-01

    Minority racial and ethnic groups are at higher risk for developing type 2 diabetes. These groups also experience more severe complications from diabetes and have higher mortality rates as a result of the disease, such as cardiovascular disease, amputation and kidney failure. Underserved rural ethnically disparate populations benefit from health education outreach efforts that are conveyed and translated by specially-trained community health ambassadors. Project H.I.G.H. (Helping Individuals Get Healthy) was developed to target the priority areas of type 2 diabetes and cardiovascular disease. Utilizing trained community health ambassadors, CDC's The Road to Health Toolkit as well as New Beginnings: A Discussion Guide for Living Well with Diabetes was used as a model for a community-based educational program. The overall goal of Project H.I.G.H was to implement and evaluate: (1) a coordinated, behavior-focused, family-centered, community-based educational program and; (2) a client service coordination effort resulting in improved health outcomes (BMI, Glucose Levels, BP) for individuals with type 2 diabetes and cardiovascular disease in Gadsden County, Florida. Overall, Project H.I.G.H. was very successful in its first year at motivating participants to delay or prevent diabetes and/or cardiovascular disease or at the very least to start taking better care of their health.

  9. Antidepressant Medication as a Risk Factor for Type 2 Diabetes and Impaired Glucose Regulation

    PubMed Central

    Barnard, Katharine; Peveler, Robert C.; Holt, Richard I.G.

    2013-01-01

    OBJECTIVE Antidepressant use has risen sharply over recent years. Recent concerns that antidepressants may adversely affect glucose metabolism require investigation. Our aim was to assess the risk of type 2 diabetes associated with antidepressants through a systematic review. RESEARCH DESIGN AND METHODS Data sources were MEDLINE, Embase, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of the European Association for the Study of Diabetes, American Diabetes Association, and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, U.K. Clinical Research Network, scrutiny of bibliographies of retrieved articles, and contact with relevant experts. Relevant studies of antidepressant effects were included. Key outcomes were diabetes incidence and change in blood glucose (fasting and random). RESULTS Three systemic reviews and 22 studies met the inclusion criteria. Research designs included 1 case series and 21 observational studies comprising 4 cross-sectional, 5 case-control, and 12 cohort studies. There was evidence that antidepressant use is associated with type 2 diabetes. Causality is not established, but rather, the picture is confused, with some antidepressants linked to worsening glucose control, particularly with higher doses and longer duration, others linked with improved control, and yet more with mixed results. The more recent, larger studies, however, suggest a modest effect. Study quality was variable. CONCLUSIONS Although evidence exists that antidepressant use may be an independent risk factor for type 2 diabetes, long-term prospective studies of the effects of individual antidepressants rather than class effects are required. Heightened alertness to potential risks is necessary until these are complete. PMID:24065841

  10. Cancer risks from diabetes therapies: evaluating the evidence.

    PubMed

    Li, Chen; Kong, Deling

    2014-10-01

    Epidemiological studies have identified positive associations between diabetes, obesity and cancer. Insulin, metformin and thiazolidinediones (TDZs) are among the major diabetes therapies that improve glycaemic control by acting via molecular targets including the insulin receptor and insulin-like growth factor pathways, adenosine monophosphate-activated kinase and peroxisome proliferator-activated receptor γ. It is well-established that clinical application of insulin and TDZs is associated with weight gain, but the potential of these therapies to promote tumourigenesis is less well-studied. In addition, although anti-tumour properties of metformin have been proposed, recently published data do not support a protective effect of metformin against cancer in diabetic patients. Given that diabetes and cancer each account for 8% and 13% of global deaths and there is a substantial financial burden incurred by both disorders, developing diabetes therapies that are safe, efficacious and cost-effective has never been more desirable. This timely review examines recent progress in delineating the molecular mechanisms responsible for the anti-diabetic actions of insulin, metformin and TZDs and considers evidence implicating these therapies in cell transformation and tumourigenesis. In addition, since the endocannabinoid signalling system (ECS) is now considered a therapeutic target and biomarker candidate for hyperglycaemia, obesity and cell growth, a brief section covering recent scientific advances regarding the ECS, particularly its functions in regulating glucose metabolism and cell survival, is also included in this review. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Diabetes.

    PubMed

    2014-09-23

    Essential facts Type 1 and type 2 diabetes affect 3.2 million people in the UK. Diabetes is associated with serious complications, including heart disease and stroke, which can lead to disability and premature death. It is the leading cause of preventable sight loss in people of working age in the UK. A quarter of people with diabetes will have kidney disease at some point in their lives, and the condition increases the risk of amputation. Good diabetes management has been shown to reduce the incidence of these serious complications.

  12. Nut and peanut butter consumption and risk of type 2 diabetes in women.

    PubMed

    Jiang, Rui; Manson, JoAnn E; Stampfer, Meir J; Liu, Simin; Willett, Walter C; Hu, Frank B

    2002-11-27

    Nuts are high in unsaturated (polyunsaturated and monounsaturated) fat and other nutrients that may improve glucose and insulin homeostasis. To examine prospectively the relationship between nut consumption and risk of type 2 diabetes. Prospective cohort study of 83 818 women from 11 states in the Nurses' Health Study. The women were aged 34 to 59 years, had no history of diabetes, cardiovascular disease, or cancer, completed a validated dietary questionnaire at baseline in 1980, and were followed up for 16 years. Incident cases of type 2 diabetes. We documented 3206 new cases of type 2 diabetes. Nut consumption was inversely associated with risk of type 2 diabetes after adjustment for age, body mass index (BMI), family history of diabetes, physical activity, smoking, alcohol use, and total energy intake. The multivariate relative risks (RRs) across categories of nut consumption (never/almost never, or =5 times/week) for a 28-g (1 oz) serving size were 1.0, 0.92 (95% confidence interval [CI], 0.85-1.00), 0.84 (0.95% CI, 0.76-0.93), and 0.73 (95% CI, 0.60-0.89) (P for trend <.001). Further adjustment for intakes of dietary fats, cereal fiber, and other dietary factors did not appreciably change the results. The inverse association persisted within strata defined by levels of BMI, smoking, alcohol use, and other diabetes risk factors. Consumption of peanut butter was also inversely associated with type 2 diabetes. The multivariate RR was 0.79 (95% CI, 0.68-0.91; P for trend <.001) in women consuming peanut butter 5 times or more a week (equivalent to > or =140 g [5 oz] of peanuts/week) compared with those who never/almost never ate peanut butter. Our findings suggest potential benefits of higher nut and peanut butter consumption in lowering risk of type 2 diabetes in women. To avoid increasing caloric intake, regular nut consumption can be recommended as a replacement for consumption of refined grain products or red or processed

  13. Testosterone and modifiable risk factors associated with diabetes in men.

    PubMed

    Atlantis, Evan; Lange, Kylie; Martin, Sean; Haren, Matthew T; Taylor, Anne; O'Loughlin, Peter D; Marshall, Villis; Wittert, Gary A

    2011-03-01

    The role of endogenous testosterone in the pathogenesis of type 2 diabetes mellitus remains vague. We investigated whether associations between endogenous testosterone and diabetes prevalence in men could be partially explained by modifiable risk factors. A random population-based cross-sectional study of 1195 men aged 35-80 years living in the north-west regions of Adelaide, Australia. Data collections occurred between 2002 and 2005, and response rate was 45.1%. Diabetes (non-specific) was classified by either: (1) self-report for doctor diagnosis of diabetes; (2) prescription medication for diabetes; (3) fasting plasma glucose ≥ 7 mmol/L; or (4) glycosylated haemoglobin ≥ 6.2%. Logistic regressions were used to estimate odds ratios (OR [with 95% confidence intervals]) for diabetes, with stepwise adjustments for demographic, lifestyle, and clinical factors. Diabetes prevalence was positively associated with age groups 45-54 years (2.8 [1.4, 5.8]), 55-64 years (3.9 [1.9, 8.3]) and ≥ 65 years (4.0 [1.8, 8.9]), lowest income group (1.8 [1.0, 3.4]), ex-smoker (1.8 [1.2, 2.9]), lowest (3.2 [1.9, 5.5]) and middle (1.9 [1.1, 3.4]) alcohol tertiles, cardiovascular disease (1.9 [1.2, 2.8]), metabolic syndrome (4.0 [2.6, 6.1]), and lowest plasma total testosterone tertile (1.8 [1.1, 3.0]), but negatively associated with middle (0.5 [0.3, 0.8]) and highest (0.4 [0.3, 0.7]) sugar intake tertiles, arthritis (0.6 [0.3, 1.0]), and elevated LDL cholesterol (0.5 [0.3, 0.8]); ORs showed an inverted 'U' shape for middle and highest voiding lower urinary tract symptoms tertiles. Body composition, muscle strength, and cardio-metabolic factors partially explained the association between low plasma total testosterone and diabetes. Plasma total testosterone was inversely and independently associated with diabetes prevalence, that might have been partially explained by several modifiable risk factors. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Insulin-treated diabetes mellitus: An important, actionable risk marker after coronary stenting.

    PubMed

    Hillegass, William B

    2016-01-01

    Insulin treatment for diabetes is a simple but important risk marker for doubled adjusted death and myocardial infarction rates and tripled stent thrombosis risk after coronary stenting. Insulin treatment does not predict meaningfully increased major bleeding or additional revascularization procedures after drug eluting coronary stent implantation. Third generation P2 Y12 receptor antagonists substantially lower risk of events in diabetics after stenting with insulin treated diabetics having twice the magnitude of benefit of diabetics not needing insulin.

  15. Developing an Objective Evaluation Method to Estimate Diabetes Risk in Community-Based Settings

    PubMed Central

    He, Qing; Fullilove, Robert; Kotler, Donald P.

    2011-01-01

    Abstract Background Exercise interventions often aim to affect abdominal obesity and glucose tolerance, two significant risk factors for type 2 diabetes. Because of limited financial and clinical resources in community and university-based environments, intervention effects are often measured with interviews or questionnaires and correlated with weight loss or body fat indicated by body bioimpedence analysis (BIA). However, self-reported assessments are subject to high levels of bias and low levels of reliability. Because obesity and body fat are correlated with diabetes at different levels in various ethnic groups, data reflecting changes in weight or fat do not necessarily indicate changes in diabetes risk. To determine how exercise interventions affect diabetes risk in community and university-based settings, improved evaluation methods are warranted. Methods We compared a noninvasive, objective measurement technique—regional BIA—with whole-body BIA for its ability to assess abdominal obesity and predict glucose tolerance in 39 women. To determine regional BIA's utility in predicting glucose, we tested the association between the regional BIA method and blood glucose levels. Results Regional BIA estimates of abdominal fat area were significantly correlated (r = 0.554, P < 0.003) with fasting glucose. When waist circumference and family history of diabetes were added to abdominal fat in multiple regression models, the association with glucose increased further (r = 0.701, P < 0.001). Conclusions Regional BIA estimates of abdominal fat may predict fasting glucose better than whole-body BIA as well as provide an objective assessment of changes in diabetes risk achieved through physical activity interventions in community settings. PMID:21406009

  16. Tipping the balance: Haemoglobinopathies and the risk of diabetes

    PubMed Central

    Baldwin, Henry J; Green, Aislinn E; Spellar, Kayleigh M; Arthur, Philip J; Phillips, Hannah G; Patel, Jeetesh V

    2016-01-01

    AIM: To establish a link between the risk of diabetes with haemoglobinopathies by examining available evidence of the effects of iron and blood glucose homeostasis from molecular to epidemiological perspectives. METHODS: A systematic literature search was performed using electronic literature databases using various search terms. The International Diabetes Federation World Atlas was used to generate a list of populations with high rates of diabetes. PubMed, Scopus and Google Scholar were used to identify which of these populations also had a reported prevalence of haemoglobin abnormalities. RESULTS: Abnormalities in iron homeostasis leads to increases in reactive oxygen species in the blood. This promotes oxidative stress which contributes to peripheral resistance to insulin in two ways: (1) reduced insulin/insulin receptor interaction; and (2) β-cell dysfunction. Hepcidin is crucial in terms of maintaining appropriate amounts of iron in the body and is in turn affected by haemoglobinopathies. Hepcidin also has other metabolic effects in places such as the liver but so far the extent of these is not well understood. It does however directly control the levels of serum ferritin. High serum ferritin is found in obese patients and those with diabetes and a meta-analysis of the various studies shows that high serum ferritin does indeed increase diabetes risk. CONCLUSION: From an epidemiological standpoint, it is plausible that the well-documented protective effects of haemoglobinopathies with regard to malaria may have also offered other evolutionary advantages. By contributing to peripheral insulin resistance, haemoglobinopathies may have helped to sculpt the so-called “thrifty genotype”, which hypothetically is advantageous in times of famine. The prevalence data however is not extensive enough to provide concrete associations between diabetes and haemoglobinopathies - more precise studies are required. PMID:26788262

  17. Common familial risk factors for schizophrenia and diabetes mellitus.

    PubMed

    Foley, Debra L; Mackinnon, Andrew; Morgan, Vera A; Watts, Gerald F; Castle, David J; Waterreus, Anna; Galletly, Cherrie A

    2016-05-01

    The co-occurrence of type 2 diabetes and psychosis is an important form of medical comorbidity within individuals, but no large-scale study has evaluated comorbidity within families. The aim of this study was to determine whether there is evidence for familial comorbidity between type 2 diabetes and psychosis. Data were analysed from an observational study of a nationally representative sample of 1642 people with psychosis who were in contact with psychiatric services at the time of survey (The 2010 Australian National Survey of Psychosis). Participants were aged 18-64 years and met World Health Organization's International Classification of Diseases, 10th Revision diagnostic criteria for a psychotic disorder (857 with schizophrenia, 319 with bipolar disorder with psychotic features, 293 with schizoaffective disorder, 81 with depressive psychosis and 92 with delusional disorder or other non-organic psychoses). Logistic regression was used to estimate the association between a family history of diabetes and a family history of schizophrenia. A positive family history of diabetes was associated with a positive family history of schizophrenia in those with a psychotic disorder (odds ratio = 1.35, p = 0.01, adjusted for age and gender). The association was different in those with an affective versus non-affective psychosis (odds ratio = 0.613, p = 0.019, adjusted for age and gender) and was significant only in those with a non-affective psychosis, specifically schizophrenia (odds ratio = 1.58, p = 0.005, adjusted for age and sex). Adjustment for demographic factors in those with schizophrenia slightly strengthened the association (odds ratio = 1.74, p = 0.001, adjusted for age, gender, diagnosis, ethnicity, education, employment, income and marital status). Elevated risk for type 2 diabetes in people with schizophrenia is not simply a consequence of antipsychotic medication; type 2 diabetes and schizophrenia share familial risk factors. © The Royal Australian and New

  18. High diabetes risk among asylum seekers in The Netherlands.

    PubMed

    Goosen, S; Middelkoop, B; Stronks, K; Agyemang, C; Kunst, A E

    2014-12-01

    To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardized prevalence ratios were found for asylum seekers from Somalia, Sudan and Sri Lanka. The standardized prevalence ratio was higher in asylum seekers aged ≥ 30 years. Incidence rates were higher compared with the reference population for all length-of-stay intervals. Asylum seekers from the majority of countries of origin were at higher risk of diabetes compared with the general population in the Netherlands. Asylum seekers from Somalia were particularly at risk. This emerging public health issue requires attention from policy-makers and care providers. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  19. Diabetes mellitus after renal transplantation: characteristics, outcome, and risk factors.

    PubMed

    Vesco, L; Busson, M; Bedrossian, J; Bitker, M O; Hiesse, C; Lang, P

    1996-05-27

    The incidence and risk factors of posttransplant diabetes mellitus were evaluated in 1325 consecutive renal transplant recipients. Thirty-three (2.5%) patients developed diabetes mellitus requiring insulin therapy. Onset occurred a mean of 5.7 +/- 1.5 months following transplantation. The patients were compared with 33 paired-control kidney recipients. The patients were significantly older than the controls (46.8 +/- 1.9 vs. 40.6 +/- 2.1 years) (P<0.05), and chronic renal failure was more often related to interstitial nephritis (P<0.05). A family history of diabetes mellitus, the body mass index, ethnic origin, HLA phenotype, and the total doses of steroids and cyclosporine were similar in the two groups. The number of patients with at least one rejection episode was significantly higher among the diabetic patients (21 versus 9) but the number of episodes was similar. Diabetes occurred a mean of 1.1 +/- 0.3 months following rejection treatment. Intravenous pulsed prednisolone was always used for anti-rejection therapy. Insulin was withdrawn in 16 cases after a mean of 4 +/- 1 months, independently of steroid dosage reductions. Actuarial patient and graft survival rates were not significantly different, although 6-year outcome tended to be better in the controls (86% versus 93% for patient survival and 67% versus 93% for graft survival). This study suggests that pulsed steroid therapy might be the critical factor in the onset of posttransplant diabetes and that the risk is increased in older patients with chronic interstitial nephrititis.

  20. Metformin Improves Overall Survival of Colorectal Cancer Patients with Diabetes: A Meta-Analysis

    PubMed Central

    Meng, Fanqiang

    2017-01-01

    Introduction. Diabetic population has a higher risk of colorectal cancer (CRC) incidence and mortality than nondiabetics. The role of metformin in CRC prognosis is still controversial. The meta-analysis aims to investigate whether metformin improves the survival of diabetic CRC patients. Methods. PubMed, EMBASE, and Cochrane Library were searched till July 1, 2016. Cohort studies were included. All articles were evaluated by Newcastle-Ottawa Scale. Hazard Ratios (HRs) with 95% confidence intervals (CIs) for each study were calculated and pooled HRs with corresponding 95% CIs were generated using the random-effects model. Heterogeneity and publication bias were assessed. Results. We included seven cohort studies with a medium heterogeneity (I2 = 56.1% and p = 0.033) in our meta-analysis. An improved overall survival (OS) for metformin users over nonusers among colorectal cancers with diabetes was noted (HR 0.75; 95% CI 0.65 to 0.87). However, metformin reveals no benefits for cancer-specific survival (HR 0.79, 95%, CI 0.58 to 1.08). Conclusions. Metformin prolongs the OS of diabetic CRC patients, but it does not affect the CRC-specific survival. Metformin may be a good choice in treating CRC patients with diabetes mellitus in clinical settings.

  1. The impact of an intervention to improve diabetes management in primary healthcare professionals' practices in Brazil.

    PubMed

    da Silva Marinho, Michelly Georgia; Fontbonne, Annick; Vasconcelos Barbosa, Jessyka Mary; de Melo Rodrigues, Heloisa; Freese de Carvalho, Eduardo; Vieira de Souza, Wayner; Pessoa Cesse, Eduarda Angela

    2017-06-26

    To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management. The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests. The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p<0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p<0.01). The only differences favoring the intervention group were the higher proportion of nurses (p<0.05) and community health workers (p<0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p<0.01). These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  2. Clinical decision support software for diabetic foot risk stratification: development and formative evaluation.

    PubMed

    Schoen, Deborah E; Glance, David G; Thompson, Sandra C

    2015-01-01

    Identifying people at risk of developing diabetic foot complications is a vital step in prevention programs in primary healthcare settings. Diabetic foot risk stratification systems predict foot ulceration. The aim of this study was to explore the views and experiences of potential end users during development and formative evaluations of an electronic diabetic foot risk stratification tool based on evidence-based guidelines and determine the accuracy of the tool. Formative evaluation of the risk tool occurred in five stages over an eight-month period and employed a mixed methods research design consisting of semi-structured interviews, focus group and participant observation, online survey, expert review, comparison to the Australian Guidelines and clinical testing. A total of 43 healthcare practitioners trialled the computerised clinical decision support system during development, with multiple software changes made as a result of feedback. Individual and focus group participants exposed critical design flaws. Live testing revealed risk stratification errors and functional limitations providing the basis for practical improvements. In the final product, all risk calculations and recommendations made by the clinical decision support system reflect current Australian Guidelines. Development of the computerised clinical decision support system using evidence-based guidelines can be optimised by a multidisciplinary iterative process of feedback, testing and software adaptation by experts in modern development technologies.

  3. Immunoglobulin E and Mast Cell Proteases Are Potential Risk Factors of Human Pre-Diabetes and Diabetes Mellitus

    PubMed Central

    Wang, Zhen; Zhang, Hong; Shen, Xu-Hui; Jin, Kui-Li; Ye, Guo-fen; Qian, Li; Li, Bo; Zhang, Yong-Hong; Shi, Guo-Ping

    2011-01-01

    Background Recent studies have suggested that mast-cell activation and inflammation are important in obesity and diabetes. Plasma levels of mast cell proteases and the mast cell activator immunoglobulin E (IgE) may serve as novel inflammatory markers that associate with the risk of pre-diabetes and diabetes mellitus. Methods and Results A total of 340 subjects 55 to 75 years of age were grouped according to the American Diabetes Association 2003 criteria of normal glucose tolerance, pre-diabetes, and diabetes mellitus. The Kruskal-Wallis test demonstrated significant differences in plasma IgE levels (P = 0.008) among groups with different glucose tolerance status. Linear regression analysis revealed significant correlations between plasma levels of chymase (P = 0.030) or IgE (P = 0.022) and diabetes mellitus. Ordinal logistic regression analysis showed that IgE was a significant risk factor of pre-diabetes and diabetes mellitus (odds ratio [OR]: 1.674, P = 0.034). After adjustment for common diabetes risk factors, including age, sex, hypertension, body-mass index, cholesterol, homeostatic model assessment (HOMA) index, high-sensitivity C-reactive protein (hs-CRP), and mast cell chymase and tryptase, IgE remained a significant risk factor (OR: 1.866, P = 0.015). Two-variable ordinal logistic analysis indicated that interactions between hs-CRP and IgE, or between IgE and chymase, increased further the risks of developing pre-diabetes and diabetes mellitus before (OR: 2.204, P = 0.044; OR: 2.479, P = 0.033) and after (OR: 2.251, P = 0.040; OR: 2.594, P = 0.026) adjustment for common diabetes risk factors. Conclusions Both IgE and chymase associate with diabetes status. While IgE and hs-CRP are individual risk factors of pre-diabetes and diabetes mellitus, interactions of IgE with hs-CRP or with chymase further increased the risk of pre-diabetes and diabetes mellitus. PMID:22194960

  4. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches

    PubMed Central

    Kalofoutis, Christos; Piperi, Christina; Kalofoutis, Anastasios; Harris, Fred; Phoenix, David; Singh, Jaipaul

    2007-01-01

    Worldwide, approximately 200 million people currently have type II diabetes mellitus (DM), a prevalence that has been predicted to increase to 366 million by 2030. Rates of cardiovascular disease (CVD) mortality and morbidity are particularly high in this population, representing a significant cost for health care systems. Type II DM patients generally carry a number of risk factors for CVD, including hyperglycemia, abnormal lipid profiles, alterations in inflammatory mediators and coagulation/thrombolytic parameters, as well as other ‘nontraditional’ risk factors, many of which may be closely associated with insulin resistance. Therefore, successful management of CVD associated with diabetes represents a major challenge to the clinicians. An effective way of tackling this problem is to detect the associated risk factors and to target treatment toward their improvement. Targeting hyperglycemia alone does not reduce the excess risk in diabetes, highlighting the need for aggressive treatment of other risk factors. Although the current use of statin therapy is effective at reducing low-density lipoprotein cholesterol, residual risk remains for other independent lipid and nonlipid factors. The peroxisome proliferator-activated receptor-γ appears to be closely involved in regulating risk markers at multiple levels. A relatively new class of therapeutic agents that activate peroxisome proliferator-activated receptor-γ, the thiazolidinedione insulin-sensitizing agents, is currently used to manage type II DM. These agents display a number of potential antiatherogenic properties, including effects on high-density lipoprotein cholesterol and triglycerides, as well as other beneficial nonlipid effects, such as regulating levels of mediators involved in inflammation and endothelial dysfunction. Research data suggest that simple strategies combining thiazolidinediones and statins could have complementary effects on CVD risk-factor profiles in diabetes, alongside the

  5. ANGPTL2 is associated with an increased risk of cardiovascular events and death in diabetic patients.

    PubMed

    Gellen, Barnabas; Thorin-Trescases, Nathalie; Sosner, Philippe; Gand, Elise; Saulnier, Pierre-Jean; Ragot, Stéphanie; Fraty, Mathilde; Laugier, Stéphanie; Ducrocq, Grégory; Montaigne, David; Llaty, Pierre; Rigalleau, Vincent; Zaoui, Philippe; Halimi, Jean-Michel; Roussel, Ronan; Thorin, Eric; Hadjadj, Samy

    2016-11-01

    A high serum angiopoietin-like 2 (ANGPTL2) concentration is an independent risk factor for developing diabetes and is associated with insulin resistance and atherosclerosis. In this work, we have examined the impact of serum ANGPTL2 on improving cardiovascular (CV) risk stratification in patients with type 2 diabetes. A prospective, monocentric cohort of consecutive type 2 diabetes patients (the SURDIAGENE cohort; total of 1353 type 2 diabetes patients; 58% men, mean ± SD age 64 ± 11 years) was followed for a median of 6.0 years for death as primary endpoint and major adverse CV events (MACE; i.e. CV death, myocardial infarction or stroke) as a secondary endpoint. Patients with end-stage renal disease, defined as a requirement for dialysis or a history of kidney transplantation, were excluded. Patients were grouped into quartiles according to ANGPTL2 concentrations at inclusion: <11.2 (Q1), 11.2-14.7 (Q2), 14.8-19.5 (Q3) or >19.5 (Q4) ng/ml. During follow up, 367 patients (representing 4.5% of the total person-years) died and 290 patients (representing 3.7% of the total person-years) presented with MACE. Both the survival and MACE-free survival rates were significantly different between ANGPTL2 quartiles (logrank 82.12, p < 0.0001 for death; and logrank 65.14, p < 0.0001 for MACE). Patients with ANGPTL2 concentrations higher than 19.5 ng/ml (Q4) had a significantly higher risk of death and MACE than those with ANGPTL2 levels of 19.5 ng/ml or less (Q1-3) (HR for death 2.44 [95% CI 1.98, 3.00], p < 0.0001; HR for MACE 2.43 [95% CI 1.92, 3.06], p < 0.0001) after adjustment for sex, age and established CV risk factors. Using ANGPTL2 concentrations, prediction of the risk of mortality, as assessed by integrated discrimination improvement (IDI), was significantly improved (IDI 0.006 ± 0.002, p = 0.0002). In patients with type 2 diabetes, serum ANGPTL2 concentrations were independently associated with death and MACE. Therefore

  6. Association of GSTs polymorphisms with risk of gestational diabetes mellitus.

    PubMed

    Li, Yan; Li, Shaoru; Zhai, Qianqian; Hai, Jie; Wang, Di; Cao, Meng; Zhang, Qinggui

    2015-01-01

    We conducted a case-control study to investigate the association between GSTM1, GSTT1 and GSTP1 IIe105Val polymorphisms and development of gestational diabetes mellitus in a Chinese population. A total of 320 patients with gestational diabetes mellitus and 358 pregnancy subjects were consecutively collected between January 2013 and December 2014. Genotyping for detection of GSTM1, GSTT1 and GSTP1 IIe105Val was conducted by using PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphisms) method. By Fisher's exact test, we found that the genotype distributions of GSTP1 IIe105Val were in line with the Hardy-Weinberg equilibrium in control subjects (P=0.57). By Chi-square test, we found significant differences in the genotype distributions of GSTM1 (χ(2)=11.49, P=0.001) and GSTT1 (χ(2)=18.50, P<0.001). Using unconditional logistic analysis, individuals carrying the null genotypes of GSTM1 and GSTT1 were associated with an increased risk of gestational diabetes mellitus when compared with the present genotype, and the adjusted Ors (95% CI) were 1.71 (1.24-2.36) and 2.00 (1.44-2.79), respectively. However, the GSTP1 IIe105Val polymorphism was not associated with an elevated risk of gestational diabetes mellitus. In conclusion, we suggest that the GSTM1 null genotype and GSTT1 null genotype are correlated with an increased risk of gestational diabetes mellitus in a Chinese population.

  7. Association of GSTs polymorphisms with risk of gestational diabetes mellitus

    PubMed Central

    Li, Yan; Li, Shaoru; Zhai, Qianqian; Hai, Jie; Wang, Di; Cao, Meng; Zhang, Qinggui

    2015-01-01

    We conducted a case-control study to investigate the association between GSTM1, GSTT1 and GSTP1 IIe105Val polymorphisms and development of gestational diabetes mellitus in a Chinese population. A total of 320 patients with gestational diabetes mellitus and 358 pregnancy subjects were consecutively collected between January 2013 and December 2014. Genotyping for detection of GSTM1, GSTT1 and GSTP1 IIe105Val was conducted by using PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphisms) method. By Fisher’s exact test, we found that the genotype distributions of GSTP1 IIe105Val were in line with the Hardy-Weinberg equilibrium in control subjects (P=0.57). By Chi-square test, we found significant differences in the genotype distributions of GSTM1 (χ2=11.49, P=0.001) and GSTT1 (χ2=18.50, P<0.001). Using unconditional logistic analysis, individuals carrying the null genotypes of GSTM1 and GSTT1 were associated with an increased risk of gestational diabetes mellitus when compared with the present genotype, and the adjusted Ors (95% CI) were 1.71 (1.24-2.36) and 2.00 (1.44-2.79), respectively. However, the GSTP1 IIe105Val polymorphism was not associated with an elevated risk of gestational diabetes mellitus. In conclusion, we suggest that the GSTM1 null genotype and GSTT1 null genotype are correlated with an increased risk of gestational diabetes mellitus in a Chinese population. PMID:26823865

  8. Motivational interviewing for modifying diabetes risk: a randomised controlled trial

    PubMed Central

    Greaves, Colin J; Middlebrooke, Andrew; O'Loughlin, Lucy; Holland, Sandra; Piper, Jane; Steele, Anna; Gale, Tracy; Hammerton, Fenella; Daly, Mark

    2008-01-01

    Background Around 10–15% of adults aged over 40 years have pre-diabetes, which carries a high risk of progression to type 2 diabetes. Intensive lifestyle intervention reduces progression by as much as 58%. However, the cost and personnel requirements of these interventions are major obstacles to delivery in NHS primary care. Aim To assess the effectiveness of a low-cost intervention, delivered in primary care by non-NHS staff, to reduce the risk of diabetes through weight loss and physical activity. Design of study Pragmatic single-blind randomised controlled trial with researchers and statistician blinded to group allocation. Setting UK primary care. Method One-hundred and forty-one participants with a body mass index of 28 kg/m2 or more, but without diabetes or heart disease, received either information leaflets or individual behavioural counselling using motivational interviewing techniques. The intervention was delivered by five counsellors recruited from the local community. The primary outcomes were the proportions of participants meeting predefined targets for weight loss (5%) and moderate physical activity (150 minutes/week) after 6 months. Results Using intention-to-treat analysis, more people in the intervention group achieved the weight-loss target (24% versus 7% for controls; odds ratio [OR] = 3.96; 95% confidence interval [Cl] = 1.4 to 11.4; number needed to treat [NNT] = 6.1 (95% Cl = 4 to 21). The proportion achieving the physical activity target did not increase significantly (38% versus 28% for controls; OR = 1.6; 95% Cl = 0.7 to 3.8). Conclusion Short-term weight loss, at a level which, if sustained, is clinically meaningful for reducing diabetes risk, is achievable in primary care, without excessive use of NHS monetary or personnel resources. PMID:18682011

  9. Implications of Type 2 Diabetes on Adolescent Reproductive Health Risk

    PubMed Central

    Downs, Julie S.; Arslanian, Silva; de Bruin, Wändi Bruine; Copeland, Valire Carr; Doswell, Willa; Herman, William; Lain, Kristine; Mansfield, Joan; Murray, Pamela J.; White, Neil; Charron-Prochownik, Denise

    2012-01-01

    Purpose The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D). Methods Using a mental model approach, a panel of experts—representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health—was convened to discuss reproductive health issues for female adolescents with T2D. Results Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one’s lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management. Conclusions Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D. PMID:20944055

  10. Novel Risk Factors for Type 2 Diabetes in African-Americans.

    PubMed

    Chatterjee, Ranee; Maruthur, Nisa M; Edelman, David

    2015-12-01

    In the USA, compared to whites, African-Americans are disproportionately impacted by the diabetes epidemic. Traditional diabetes risk factors, such as obesity, are more common among African-Americans, but these traditional risk factors do not explain all of the disparity in diabetes risk. Recent research has identified novel environmental, lifestyle, physiologic, and genetic risk factors for diabetes, some of which appear to impact African-Americans more than whites. This manuscript reviews the recent literature to highlight some of these novel risk factors that may be contributing to the racial disparity in diabetes risk. Further study is needed of the modifiable risk factors for development of interventions to reduce the risk of diabetes in African-Americans, as well as other high-risk populations.

  11. Minimization of the Risk of Diabetic Microangiopathy in Rats by Nigella sativa.

    PubMed

    Somboonwong, Juraiporn; Yusuksawad, Mariem; Keelawat, Somboon; Thongruay, Sirima; Poumsuk, Ubon

    2016-05-01

    treatment of diabetic rats enlarged the capillary lumens and tended to attenuate dermal capillary basement membrane thickeningN. sativa treatment of diabetic rats reduced the mean glycosylated hemoglobin concentration by 1.4%, which exceeds the necessary reduction previously described to decrease the risk of diabetic microangiopathy, without affecting the lipid profile or tumor necrosis factor-alpha levelN. sativa improves rat diabetic microangiopathy, potentially due in part to its glycemic control activity. Abbreviations used: H and E: Hematoxylin and eosin, HbA1c: Glycosylated hemoglobin, HDL-C: High-density lipoprotein cholesterol, LDL-C: Low-density lipoprotein cholesterol, PAS: Periodic acid-Schiff, STZ: Streptozotocin.

  12. Minimization of the Risk of Diabetic Microangiopathy in Rats by Nigella sativa

    PubMed Central

    Somboonwong, Juraiporn; Yusuksawad, Mariem; Keelawat, Somboon; Thongruay, Sirima; Poumsuk, Ubon

    2016-01-01

    membrane thickening and a decreased capillary luminal diameterNigella sativa treatment of diabetic rats enlarged the capillary lumens and tended to attenuate dermal capillary basement membrane thickeningN. sativa treatment of diabetic rats reduced the mean glycosylated hemoglobin concentration by 1.4%, which exceeds the necessary reduction previously described to decrease the risk of diabetic microangiopathy, without affecting the lipid profile or tumor necrosis factor-alpha levelN. sativa improves rat diabetic microangiopathy, potentially due in part to its glycemic control activity. Abbreviations used: H and E: Hematoxylin and eosin, HbA1c: Glycosylated hemoglobin, HDL-C: High-density lipoprotein cholesterol, LDL-C: Low-density lipoprotein cholesterol, PAS: Periodic acid-Schiff, STZ: Streptozotocin, PMID:27279704

  13. Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS).

    PubMed

    Dominguez, Ligia J; Bes-Rastrollo, Maira; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Martínez-González, Miguel A

    2015-01-01

    Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN ("Seguimiento Universidad de Navarra") longitudinal study. We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM. We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25-39 points) vs. low (11-24) category 0.43 [95% confidence interval (CI) 0.21, 0.89]; and for high (40-60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019). The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM and

  14. Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS)

    PubMed Central

    Dominguez, Ligia J.; Bes-Rastrollo, Maira; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Martínez-González, Miguel A.

    2015-01-01

    Background Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN (“Seguimiento Universidad de Navarra”) longitudinal study. Methods We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM. Results We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25–39 points) vs. low (11–24) category 0.43 [95% confidence interval (CI) 0.21, 0.89]; and for high (40–60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019). Conclusions The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve

  15. Lifestyle Change Plus Dental Care (LCDC) program improves knowledge, attitude, and practice (KAP) toward oral health and diabetes mellitus among the elderly with type 2 diabetes.

    PubMed

    Saengtipbovorn, Saruta; Taneepanichskul, Surasak

    2015-03-01

    Currently, there is an increased prevalence of diabetes mellitus among the elderly. Chronic inflammation from diabetes mellitus effects glycemic control and increases risk of diabetes complications. To assess the effectiveness of a Lifestyle Change plus Dental Care (LCDC) program by improved knowledge, attitude, and practice (KAP) toward oral health and diabetes mellitus among the elderly with type 2 diabetes. A quasi-experimental study was conducted in two Health Centers (HC 54 intervention and HC 59 control) between October 2013 and April 2014. Sixty-six diabetic patients per health center were recruited. At baseline, the intervention group attended a 20-minute lifestyle and oral health education program, individual lifestyle counseling using motivational interviewing, application of self-regulation manual, and individual oral hygiene instruction. At 3-month follow-up, the intervention group received individual lifestyle counseling and oral hygiene instruction. The intervention group received booster education every visit by viewing a 15-minute educational video. The control group received the routine program. Participants were assessed at baseline, 3-month, and 6-month follow-up for knowledge, attitude, and practice (KAP) toward oral health and diabetes mellitus. Data was analyzed by using descriptive statistic, Chi-square test, Fisher's exact test, and repeated measure ANOVA. After the 6-month follow-up, repeated measure ANOVA analysis showed that participants in the intervention group had significantly higher knowledge and attitude toward oral health and diabetes mellitus. The participants in the intervention group were more likely to exercise, modify diet, have foot examinations, always wear covered shoes, participate in self-feet screening, use dental floss, and use inter-proximal brush than the control group with statistically significant differences. The combination of lifestyle change and dental care in one program improved knowledge, attitude

  16. Walking vs running for hypertension, cholesterol, & diabetes risk reduction

    PubMed Central

    Thompson, Paul D.

    2013-01-01

    Background To test whether equivalent energy expenditure by moderate-intensity (e.g., walking) and vigorous-intensity exercise (e.g., running) provides equivalent health benefits. Methods and Results We used the National Runners’ (n=33,060) and Walkers’ (n=15,945) Health Study cohorts to examine the effect of differences in exercise mode and thereby exercise intensity on coronary heart disease (CHD) risk factors. Baseline expenditure (METhr/d) was compared to self-reported, physician-diagnosed incident hypertension, hypercholesterolemia, diabetes and CHD during 6.2 years follow-up. Running significantly decreased the risks for incident hypertension by 4.2% (P<10-7), hypercholesterolemia by 4.3% (P<10-14), diabetes by 12.1% (P<10-5), and CHD by 4.5% per METh/d run (P=0.05). The corresponding reductions for walking were 7.2% (P<10-6), 7.0% (P<10-8), 12.3% (P<10-4), and 9.3% (P=0.01). Relative to <1.8 METh/d, the risk reductions for 1.8 to 3.6, 3.6 to 5.4, 5.4 to 7.2, and ≥ 7.2 METh/d were: 1) 10.1%, 17.7%, 25.1% and 34.9% from running and 14.0%, 23.8%, 21.8% and 38.3% from walking for hypercholesterolemia; 2) 19.7%, 19.4%, 26.8% and 39.8% from running and 14.7%, 19.1%, 23.6% and 13.3% from walking for hypertension; 3) 43.5%, 44.1%, 47.7% and 68.2% from running and 34.1%, 44.2%, and 23.6% from walking for diabetes (too few cases for diabetes for walking >5.4 METh/d). The risk reductions were not significantly greater for running than walking for diabetes (P=0.94) or CHD (P=0.26), and only marginally greater for walking than running for hypertension (P=0.06) and hypercholesterolemia (P=0.04). Conclusion Equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes, and CHD, but there is limited statistical power to evaluate CHD conclusively. PMID:23559628

  17. Environmental Risk Factors for Type 1 Diabetes Mellitus Development.

    PubMed

    Antonela, Boljat; Ivana, Gunjača; Ivan, Konstantinović; Nikolina, Vidan; Vesna, Boraska Perica; Marina, Pehlić; Veselin, Škrabić; Tatijana, Zemunik

    2017-09-01

    Background Although environmental factors induce development of type 1 diabetes mellitus (T1DM) in genetically susceptible individuals, many of those factors have been uncovered. Therefore, the aim of the present study was to analyze associations of T1DM with a wide range of environmental factors. Material and Methods A case-control study was conducted on 249 diabetic and 255 healthy individuals from the Dalmatian region of South Croatia. Data regarding risk factors during pregnancy and early life period of the child were evaluated. Results History of antihypertensive intake (p=0.04) and frequency of stressful life events during pregnancy (p=0.01) were associated with higher risk of T1DM, while hypertension was associated with lower risk of T1DM (p=0.01). Maternal age<25 years at delivery was associated with a higher risk of T1DM (p=0.01).Diabetic patients had a positive family history of T1DM or T2DM (p=0.002) more frequently than controls, while history of infectious diseases was inversely associated with the risk of T1DM (p=0.03). A higher risk of T1DM was significantly associated with earlier introduction of cow's milk (p=0.001), higher number of meals consumed per day (p=0.02), higher frequency of carbohydrate (p=0.001) and meat (p=0.01) consumption and stressful life events during childhood (p=0.02) while earlier introduction of fruit was associated with a lower risk of T1DM (p=0.03) Conclusion This case-control study confirmed associations of a large number of environmental factors with development of T1DM with emphasis on the association of mother's antihypertensive intake during pregnancy, which extends our knowledge about environmental factors related with development of T1DM. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Berberine improves kidney function in diabetic mice via AMPK activation.

    PubMed

    Zhao, Long; Sun, Li-Na; Nie, Hui-Bin; Wang, Xue-Ling; Guan, Guang-Ju

    2014-01-01

    Diabetic nephropathy is a major cause of morbidity and mortality in diabetic patients. Effective therapies to prevent the development of this disease are required. Berberine (BBR) has several preventive effects on diabetes and its complications. However, the molecular mechanism of BBR on kidney function in diabetes is not well defined. Here, we reported that activation of AMP-activated protein kinase (AMPK) is required for BBR-induced improvement of kidney function in vivo. AMPK phosphorylation and activity, productions of reactive oxygen species (ROS), kidney function including serum blood urea nitrogen (BUN), creatinine clearance (Ccr), and urinary protein excretion, morphology of glomerulus were determined in vitro or in vivo. Exposure of cultured human glomerulus mesangial cells (HGMCs) to BBR time- or dose-dependently activates AMPK by increasing the thr172 phosphorylation and its activities. Inhibition of LKB1 by siRNA or mutant abolished BBR-induced AMPK activation. Incubation of cells with high glucose (HG, 30 mM) markedly induced the oxidative stress of HGMCs, which were abolished by 5-aminoimidazole-4-carboxamide ribonucleoside, AMPK gene overexpression or BBR. Importantly, the effects induced by BBR were bypassed by AMPK siRNA transfection in HG-treated HGMCs. In animal studies, streptozotocin-induced hyperglycemia dramatically promoted glomerulosclerosis and impaired kidney function by increasing serum BUN, urinary protein excretion, and decreasing Ccr, as well as increased oxidative stress. Administration of BBR remarkably improved kidney function in wildtype mice but not in AMPKα2-deficient mice. We conclude that AMPK activation is required for BBR to improve kidney function in diabetic mice.

  19. Risk Profiling May Improve Lung Cancer Screening

    Cancer.gov

    A new modeling study suggests that individualized, risk-based selection of ever-smokers for lung cancer screening may prevent more lung cancer deaths and improve the effectiveness and efficiency of screening compared with current screening recommendations

  20. Air Pollution as a Risk Factor for Type 2 Diabetes

    PubMed Central

    Rao, Xiaoquan; Patel, Priti; Puett, Robin; Rajagopalan, Sanjay

    2015-01-01

    Recent studies in both humans and animals suggest that air pollution is an important risk factor for type 2 diabetes mellitus (T2DM). However, the mechanism by which air pollution mediates propensity to diabetes is not fully understood. While a number of epidemiologic studies have shown a positive association between ambient air pollution exposure and risk for T2DM, some studies have not found such a relationship. Experimental studies in susceptible disease models do support this association and suggest the involvement of tissues involved in the pathogenesis of T2DM such as the immune system, adipose, liver, and central nervous system. This review summarizes the epidemiologic and experimental evidence between ambient outdoor air pollution and T2DM. PMID:25628401

  1. Diabetes in Utah among adults: interaction between diabetes and other risk factors for microvascular and macrovascular complications.

    PubMed Central

    Schumacher, M C; Smith, K R

    1988-01-01

    From a telephone survey of the health status of a random sample of the general population of Utah, we identified 255 people with adult onset diabetes. We compared them to 622 non-diabetic controls, matched for age, sex, and urban/rural country of residence. We examined diabetes as a risk factor for heart diseases, stroke, and blindness and its interaction with other known risk factors. Diabetes interacted with smoking history so as to increase the risk of stroke, heart disease, and blindness. Diabetes also interacted with hypertension in their effect on the prevalence of blindness and, to a small extent, heart disease. Among the diabetics, duration of diabetes was associated with macrovascular and microvascular complications developing after the diagnosis of diabetes. Those with longer duration of disease showed an increase in risk for microvascular (kidney disease, blindness) and macrovascular (heart disease, stroke, amputations) complications. Although the estimates were imprecise, the effect of duration on macrovascular complications was greater among diabetics with a history of hypertension; the effect on microvascular complications was greater among smokers. The findings are compared to previous studies and the utility of diabetes prevalence data is discussed. PMID:3407819

  2. [Influence of diabetes on mechanics efficiency of pregnant women's feet end risk of diabetic foot].

    PubMed

    Głebocka, Anna Katarzyna; Zarzycki, Wiesław; Knaś, Małgorzata

    2014-05-01

    A foot is a complicated osteoarticular system. The complex structure and variability predispose it to the formation of foot deformity. The cause deformities of the feet are weakened muscle tissue and ligaments, systemic diseases: obesity, musculoskeletal defects, neurological diseases, rheumatism, diabetes, pregnancy, improper shoes or socks. They interfere with the function of the foot and are reflected in the distribution of support points. The aim of this study was to assess the impact of diabetes on pregnancy and the mechanics of the foot and the risk of developing diabetic foot. The study took part in healthy and diseased women with type 1 diabetes in pregnancy. Evaluation of static foot was performed using podoscope, made up of mirrors, lights and camera. The camera described the distribution of the pressure on the glass plate, which the person being investigated was standing on. It recorded the reflection of feet and transmit them to a computer. Description the results consisted of defining relevant indicators. The evaluation was performed using the dynamic pressure Parotec system, the measuring cylinder placed inside the patient's shoe provided with sensors recording the foot pressure distribution on the ground while standing and walking. The data were stored on a memory card loaded into the computer, where the analysis took place. It has been calculated the average values of pressures exerted on the various zones of the foot. It was found that the increase in body weight resulting from the advancement of women pregnancy increases the load exerted on the foot. Forces are growing in subsequent trimesters of pregnancy reaching a maximum at the end of the third trimester. The longitudinal and transverse arches of the foot are reducing. After the birth, the pressure exerted on each area of the foot decreases, arches of the foot are getting back to starting position. Number of foot deformities is higher in women with type 1 diabetes. It grow the risk of

  3. 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

  4. The Risk of Type 2 Diabetes in Men Is Synergistically Affected by Parental History of Diabetes and Overweight

    PubMed Central

    Wikner, Cecilia; Gigante, Bruna; Hellénius, Mai-Lis; de Faire, Ulf; Leander, Karin

    2013-01-01

    Interactions between genetic- and lifestyle factors may be of specific importance for the development of type 2 diabetes. Only a few earlier studies have evaluated interaction effects for the combination of family history of diabetes and presence of risk factors related to lifestyle. We explored whether 60-year-old men and women from Stockholm with a parental history of diabetes are more susceptible than their counterparts without a parental history of diabetes to the negative influence from physical inactivity, overweight or smoking regarding risk of developing type 2 diabetes. The study comprised 4232 participants of which 205 men and 113 women had diabetes (the vast majority type 2 diabetes considering the age of study participants) and 224 men and 115 women had prediabetes (fasting glucose 6.1–6.9 mmol/l). Prevalence odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using logistic regression. Biologic interaction was analyzed using a Synergy index (S) score. The crude OR for type 2 diabetes associated with a parental history of diabetes was 2.4 (95% CI 1.7–3.5) in men and 1.4 (95% CI 0.9–2.3) in women. Adjustments for overweight, physical inactivity and current smoking had minimal effects on the association observed in men whereas in women it attenuated results. In men, but not in women, a significant interaction effect that synergistically increases the risk of developing type 2 diabetes was observed for the combination of BMI>30 and a parental history of diabetes, S 2.4 (95% CI 1.1–5.1). No signs of interactions were noted for a parental history of diabetes combined with physical inactivity and smoking, respectively. In conclusion, obesity in combination with presence of a parental history of diabetes may be particularly hazardous in men as these two factors were observed to synergistically increase the risk of developing type 2 diabetes in men. PMID:23630613

  5. The risk of type 2 diabetes in men is synergistically affected by parental history of diabetes and overweight.

    PubMed

    Wikner, Cecilia; Gigante, Bruna; Hellénius, Mai-Lis; de Faire, Ulf; Leander, Karin

    2013-01-01

    Interactions between genetic- and lifestyle factors may be of specific importance for the development of type 2 diabetes. Only a few earlier studies have evaluated interaction effects for the combination of family history of diabetes and presence of risk factors related to lifestyle. We explored whether 60-year-old men and women from Stockholm with a parental history of diabetes are more susceptible than their counterparts without a parental history of diabetes to the negative influence from physical inactivity, overweight or smoking regarding risk of developing type 2 diabetes. The study comprised 4232 participants of which 205 men and 113 women had diabetes (the vast majority type 2 diabetes considering the age of study participants) and 224 men and 115 women had prediabetes (fasting glucose 6.1-6.9 mmol/l). Prevalence odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using logistic regression. Biologic interaction was analyzed using a Synergy index (S) score. The crude OR for type 2 diabetes associated with a parental history of diabetes was 2.4 (95% CI 1.7-3.5) in men and 1.4 (95% CI 0.9-2.3) in women. Adjustments for overweight, physical inactivity and current smoking had minimal effects on the association observed in men whereas in women it attenuated results. In men, but not in women, a significant interaction effect that synergistically increases the risk of developing type 2 diabetes was observed for the combination of BMI>30 and a parental history of diabetes, S 2.4 (95% CI 1.1-5.1). No signs of interactions were noted for a parental history of diabetes combined with physical inactivity and smoking, respectively. In conclusion, obesity in combination with presence of a parental history of diabetes may be particularly hazardous in men as these two factors were observed to synergistically increase the risk of developing type 2 diabetes in men.

  6. Missing risks in opportunistic screening for type 2 diabetes - CroDiabGP study.

    PubMed

    Vrca Botica, Marija; Carcaxhiu, Linda; Kern, Josipa; Kuehlein, Thomas; Botica, Iva; Gavran, Larisa; Zelić, Ines; Iliev, Darko; Haralović, Dijana; Vrca, Anđelko

    2017-02-01

    Aim To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record(EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients' data using Wonca International Classification Committee(WICC). Missing data were detected in each list. Methods A prospective study included a group of 1883 patients(aged 45-70) identified with risks. Risks were assessed based on EMR for continuity variables and FM's assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D. Results Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p<.001). Conclusion Two methods of extraction could not detect data for episodes of the disease. In the list of personal information, FMs could not assess overweight for one in six patients and family history for every other patient. The study can stimulate improving coded and structured data in EMR.

  7. All about Your Risk for Prediabetes, Type 2 Diabetes, and Heart Disease

    MedlinePlus

    Toolkit No. 1 All About Your Risk for Prediabetes, Type 2 Diabetes, and Heart Disease What does prediabetes have to do with type ... Diabetes Association, Inc. 1/15 Toolkit No. 1: All About Your Risk for Prediabetes, Type 2 Diabetes, ...

  8. Pruritus induced self injury behavior: an overlooked risk factor for amputation in diabetic neuropathy?

    PubMed

    Dorfman, David; George, Mary Catherine; Tamler, Ronald; Lushing, Julia; Nmashie, Alexandra; Simpson, David M

    2014-03-01

    Pruritus is a risk factor for self-injury behavior (SIB) in sensory polyneuropathies. Although diabetes patients have elevated risk for pruritus, there are no reports of SIB in diabetic neuropathy. We present the case of a diabetes patient with neuropathy, whose pruritus induced SIB, resulted in partial amputation of a toe.

  9. PGE2, Kidney Disease, and Cardiovascular Risk: Beyond Hypertension and Diabetes

    PubMed Central

    Nasrallah, Rania; Hassouneh, Ramzi

    2016-01-01

    An important measure of cardiovascular health is obtained by evaluating the global cardiovascular risk, which comprises a number of factors, including hypertension and type 2 diabetes, the leading causes of illness and death in the world, as well as the metabolic syndrome. Altered immunity, inflammation, and oxidative stress underlie many of the changes associated with cardiovascular disease, diabetes, and the metabolic syndrome, and recent efforts have begun to elucidate the contribution of PGE2 in these events. This review summarizes the role of PGE2 in kidney disease outcomes that accelerate cardiovascular disease, highlights the role of cyclooxygenase-2/microsomal PGE synthase 1/PGE2 signaling in hypertension and diabetes, and outlines the contribution of PGE2 to other aspects of the metabolic syndrome, particularly abdominal adiposity, dyslipidemia, and atherogenesis. A clearer understanding of the role of PGE2 could lead to new avenues to improve therapeutic options and disease management strategies. PMID:26319242

  10. H. pylori seroprevalence and risk of diabetes: An ancillary case-control study nested in the diabetes prevention program.

    PubMed

    Alzahrani, Saud; Nelson, Jason; Moss, Steven F; Paulus, Jessica K; Knowler, William C; Pittas, Anastassios G

    2017-10-01

    To determine the association between H. pylori infection and risk of incident diabetes in adults at high risk for diabetes who participated in the Diabetes Prevention Program (DPP) study. In a nested case-control study conducted among 421 adults with newly diagnosed diabetes and 421 matched controls, we examined the association between serological status of H. pylori at baseline and risk of incident diabetes over a mean follow-up period of 2.6years. Using data from the baseline visit of the DPP, we also examined the cross-sectional association between presence of H. pylori antibodies and insulin sensitivity, insulin secretion and the disposition index-like measure after a 75-g oral glucose tolerance test (OGTT). At baseline, H. pylori antibodies were present in 40% of participants who developed diabetes and 39% of controls. After adjusting for matching factors, there was no association between exposure to H. pylori and incident diabetes (odds ratio [OR] of 1.04 (95% CI, 0.77 to 1.40). In cross-sectional analyses, H. pylori status was not significantly associated with insulin sensitivity and disposition index-like measure from OGTT. In adults at high risk for diabetes, H. pylori seropositivity was not associated with risk of developing diabetes. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Diabetes risks and health literacy in southern African American and Latino women.

    PubMed

    Ivanov, L Louise; Wallace, Debra C; Hernández, Christina; Hyde, Yolanda

    2015-01-01

    Minority women experience health disparities, especially related to diabetes. The purpose of this article is to examine diabetes risk in minority women. A survey design was used to recruit 52 African Americans (AA) and 48 Latina women. Participants described their health, health behaviors, and health literacy. Blood pressure and body mass index were measured. AA women had more diabetes risks than Latinas, and older women had more risks than younger women. All of the women had low health literacy. Women with higher numbers of diabetes risks had lower health literacy. Findings can be used to develop diabetes prevention and education programs.

  12. Diabetes Risks and Health Literacy in Southern African American and Latino Women

    PubMed Central

    Ivanov, L. Louise; Wallace, Debra C.; Hernández, Christina; Hyde, Yolanda

    2015-01-01

    Minority women experience health disparities, especially related to diabetes. The purpose of the paper is to examine diabetes risk in minority women. A survey design was used to recruit 52 African Americans (AA) and 48 Latina women. Participants described their health, health behaviors, and health literacy. Blood pressure and BMI were measured. AA women had more diabetes risks than Latinas, and older women had more risks than younger women. All of the women had low health literacy. Women with higher numbers of diabetes risks had lower health literacy. Findings can be used to develop diabetes prevention and education programs. PMID:25674971

  13. [A brief of gestational diabetes mellitus, risk factors and current criteria of diagnosis].

    PubMed

    Al-Aissa, Zahra; Hadarits, Orsolya; Rosta, Klára; Zóka, András; Rigó, János; Firneisz, Gábor; Somogyi, Anikó

    2017-02-01

    Diabetes is one of the most common metabolic disorders that may cause pathological pregnancy. Treating diabetes recognized during pregnancy results in lowering maternal and fetal complications. These patients present higher risk for excessive weight gain, preeclampsia, delivery with cesarean sections, high risk of developing type 2 diabetes and cardiovascular disease in the future. Fetuses of mothers with gestational diabetes are at higher risk for macrosomia and birth trauma, after delivery they present higher risk of developing neonatal hypoglycemia, hyperbilirubinemia, and respiratory distress syndrome. There is still no consensus in the recommendations for the diagnosis of gestational diabetes mellitus by expert committees. Orv. Hetil., 2017, 158(8), 283-290.

  14. Body Size and Shape Changes and the Risk of Diabetes in the Diabetes Prevention Program

    PubMed Central

    Fujimoto, Wilfred Y.; Jablonski, Kathleen A.; Bray, George A.; Kriska, Andrea; Barrett-Connor, Elizabeth; Haffner, Steven; Hanson, Robert; Hill, James O.; Hubbard, Van; Stamm, E.; Pi-Sunyer, F. Xavier

    2008-01-01

    The researchers conducted this study to test the hypothesis that risk of type 2 diabetes is less following reductions in body size and central adiposity. The Diabetes Prevention Program (DPP) recruited and randomized individuals with impaired glucose tolerance to treatment with placebo, metformin, or lifestyle modification. Height, weight, waist circumference, and subcutaneous and visceral fat at L2-L3 and L4-L5 by computed tomography were measured at baseline and at 1 year. Cox proportional hazards models assessed by sex the effect of change in these variables over the 1st year of intervention upon development of diabetes over subsequent follow-up in a subset of 758 participants. Lifestyle reduced visceral fat at L2-L3 (men −24.3%, women −18.2%) and at L4-L5 (men −22.4%, women −17.8%), subcutaneous fat at L2-L3 (men −15.7%, women −11.4%) and at L4-L5 (men −16.7%, women −11.9%), weight (men −8.2%, women −7.8%), BMI (men −8.2%, women −7.8%), and waist circumference (men −7.5%, women −6.1%). Metformin reduced weight (−2.9%) and BMI (−2.9%) in men and subcutaneous fat (−3.6% at L2-L3 and −4.7% at L4-L5), weight (−3.3%), BMI (−3.3%), and waist circumference (−2.8%) in women. Decreased diabetes risk by lifestyle intervention was associated with reductions of body weight, BMI, and central body fat distribution after adjustment for age and self-reported ethnicity. Reduced diabetes risk with lifestyle intervention may have been through effects upon both overall body fat and central body fat but with metformin appeared to be independent of body fat. PMID:17363740

  15. HLA Risk Haplotype: Insulin Deficiency in Pediatric Type 1 Diabetes.

    PubMed

    Gómez-Díaz, Rita A; Nishimura-Meguro, Elisa; Garrido-Magaña, Eulalia; Lizárraga-Paulin, Lorena; Aguilar-Herrera, Blanca E; Bekker-Méndez, Carolina; Medina-Santillán, Roberto; Barquera, Rodrigo; Mondragón-González, Rafael; Wacher, Niels H

    2016-01-01

    Certain HLA class II haplotypes have long been related with the risk of developing type 1 diabetes. The presence of the HLA haplotype DRB1*04/DQA1*03/DQB1*03:02, together with specific β-cell autoantibodies, contributes to the development and/or severity of insulin deficiency in type 1 diabetes. To evaluate the association of HLA risk haplotype HLA-DRB1/-DQA1/-DQB1 with β-cell function and antibody markers in recent-onset type 1 diabetes patients, their siblings, and controls. We studied recently diagnosed type 1 diabetes pediatric patients, their siblings, and healthy controls, analyzing autoantibodies (anti-glutamic acid decarboxylase, anti-IA-2, and anti-insulin), HLA risk and protector haplotypes, and β-cell function (plasma proinsulin, insulin and C-peptide). X2, ANOVA or Kruskal-Wallis and multiple logistic regression were used to analyze data. We included 46 patients, 72 siblings, and 160 controls. Prevalence of anti-tyrosine phosphatase-related islet antigen 2 and anti-glutamic acid decarboxylase antibodies was higher in patients than siblings and controls. We found risk haplotype DRB1*04/DQA1*03/DQB1*03:02 in 95.7% of patients vs. 51.87% of controls; DRB1*03:01/DQA1*05/DQB1*02 in 47.8% of patients vs. 8.12% of controls; and DRB1*14/DQA1*05/DQB1*03:01 in 2.2% of patients vs. 20.0% of controls. With DRB1*04/DQA1*03/DQB1*03:02, the prevalence of antibodies was significantly higher in patients, although not within any single group. In regression model based on insulin secretion, only anti-tyrosine phosphatase-related islet antigen 2 antibodies and age were associated with the risk haplotype. The DRB1*04/DQA1*03/DQB1*03:02 haplotype increased the risk for lower insulin, proinsulin, and C-peptide concentrations, suggesting an association with the severity of insulin deficiency in type 1 diabetes patients. This haplotype, added to antibody positivity, is a predictor of deficient insulin secretion in a Mexican pediatric population.

  16. Identifying older diabetic patients at risk of poor glycemic control

    PubMed Central

    Incalzi, Raffaele Antonelli; Corsonello, Andrea; Pedone, Claudio; Corica, Francesco; Carosella, Luciana; Mazzei, Bruno; Perticone, Francesco; Carbonin, PierUgo

    2002-01-01

    Background Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. Methods A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia ≥ 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia ≥ 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population. Results Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143–218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia ≥ 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia ≥ 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population. Conclusion A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control. PMID:12194701

  17. Community based diabetes risk assessment in Ogun state, Nigeria (World Diabetes Foundation project 08-321)

    PubMed Central

    Alebiosu, Olutayo C.; Familoni, Oluranti B.; Ogunsemi, Olawale O.; Raimi, T. H.; Balogun, Williams O.; Odusan, O.; Oguntona, Segun A.; Olunuga, Taiwo; Kolawole, Babatope A.; Ikem, Rosemary T.; Adeleye, Jokotade O.; Adesina, Olubiyi F.; Adewuyi, Peter A.

    2013-01-01

    Objective: The study assessed the risk of developing type 2 diabetes Mellitus in Ogun State, Nigeria. Materials and Methods: Finnish Medical Association diabetes risk score was administered across 25 communities facilitated by non-communicable disease clinics established under a World Diabetes Foundation project. Subjects in the high risk group had blood glucose estimated. Results: 58,567 respondents included 34,990 (59.6%) females and 23,667 (40.3%) males. Majority (61.2%) were between 25 years and 54 years. Considering waist circumference, 34,990 (38.1%) females and 23,667 (5.3%) males had values above 88 cm and 102 cm respectively. Overall, 11,266 (19.2%) were obese and 28.9% overweight using body mass index (BMI). More females had elevated BMI than males. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were 129.54 mm Hg ± 23.5 mm Hg and 76.21 mm Hg ± 15.5 mm Hg respectively. Prevalence of hypertension (Joint National Committee VII classification) was 27.7%. More subjects had normal DBP than SBP (68.2% vs. 42.5% P < 0.05). Mean fasting blood glucose (FBG) of all subjects was 5.5 mmol/L ± 0.67 mmol/L. Using a casual blood glucose >11.1 mmol/L and/or FBG >7 mmol/L, the total yield of subjects adjudged as having diabetes was 2,956 (5.05%). Mean total risk score was 5.60 ± 3.90; this was significantly higher in females (6.34 ± 4.16 vs. 4.24 ± 3.71, P < 0.05). A total of 2,956 (5.05%) had high risk of developing DM within 10 years. Conclusion: The risk of developing DM is high in the community studied with females having a higher risk score. There is urgent need to implement diabetes prevention strategies. PMID:23961481

  18. Management of patients with diabetes and CKD: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference.

    PubMed

    Perkovic, Vlado; Agarwal, Rajiv; Fioretto, Paola; Hemmelgarn, Brenda R; Levin, Adeera; Thomas, Merlin C; Wanner, Christoph; Kasiske, Bertram L; Wheeler, David C; Groop, Per-Henrik

    2016-12-01

    The prevalence of diabetes around the world has reached epidemic proportions and is projected to increase to 642 million people by 2040. Diabetes is already the leading cause of end-stage kidney disease (ESKD) in most developed countries, and the growth in the number of people with ESKD around the world parallels the increase in diabetes. The presence of kidney disease is associated with a markedly elevated risk of cardiovascular disease and death in people with diabetes. Several new therapies and novel investigational agents targeting chronic kidney disease patients with diabetes are now under development. This conference was convened to assess our current state of knowledge regarding optimal glycemic control, current antidiabetic agents and their safety, and new therapies being developed to improve kidney function and cardiovascular outcomes for this vulnerable population.

  19. Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life.

    PubMed

    Cadore, Eduardo Lusa; Izquierdo, Mikel

    2015-06-01

    In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

  20. Obesity and Hyperlipidemia are Risk Factors for Early Diabetic Neuropathy

    PubMed Central

    Smith, A. Gordon; Singleton, J. Robinson

    2013-01-01

    The Utah Diabetic Neuropathy Study (UDNS) examined 218 type 2 diabetic subjects without neuropathy symptoms, or with symptoms of < 5 years, in order to evaluate risk factors for neuropathy development. Each subject completed symptom questionnaires, the Utah Early Neuropathy Scale (UENS), nerve conduction studies (NCS), quantitative sensory testing (QST) for vibration and cold detection, quantitative sudomotor axon reflex testing (QSART), and skin biopsy with measurement of intraepidermal nerve fiber density (IENFD). Those with abnormalities of ≥ 3 were classified as having probable, and those with 1–2 as possible neuropathy. The relationship between glycemic control, lipid parameters (high density lipoprotein and triglyceride levels), blood pressure, and obesity, and neuropathy risk was examined. There was a significant relationship between the number of abnormalities among these features and neuropathy status (p<0.01). Hypertriglyceridemia, obesity and 3 or more abnormalities increased neuropathy risk (risk ratios 2.1 p<0.03, 2.9 p>0.02 and 3.0 p<0.004 respectively). Multivariate analysis found obesity and triglycerides were related to loss of small unmyelinated axons based on IENFD whereas elevated hemoglobin A1c was related to large myelinated fiber loss (motor conduction velocity). These findings indicate obesity and hypertriglyceridemia significantly increase risk for peripheral neuropathy, independent of glucose control. Obesity/hypertriglyceridemia and hyperglycemia may have differential effects on small versus large fibers. PMID:23731827

  1. Obesity and hyperlipidemia are risk factors for early diabetic neuropathy.

    PubMed

    Smith, A Gordon; Singleton, J Robinson

    2013-01-01

    The Utah Diabetic Neuropathy Study (UDNS) examined 218 type 2 diabetic subjects without neuropathy symptoms, or with symptoms of<5 years, in order to evaluate risk factors for neuropathy development. Each subject completed symptom questionnaires, the Utah Early Neuropathy Scale (UENS), nerve conduction studies (NCS), quantitative sensory testing (QST) for vibration and cold detection, quantitative sudomotor axon reflex testing (QSART), and skin biopsy with measurement of intraepidermal nerve fiber density (IENFD). Those with abnormalities of≥3 were classified as having probable, and those with 1-2 as possible neuropathy. The relationship between glycemic control, lipid parameters (high density lipoprotein and triglyceride levels), blood pressure, and obesity, and neuropathy risk was examined. There was a significant relationship between the number of abnormalities among these features and neuropathy status (p<0.01). Hypertriglyceridemia, obesity and 3 or more abnormalities increased neuropathy risk (risk ratios 2.1 p<0.03, 2.9 p>0.02 and 3.0 p<0.004 respectively). Multivariate analysis found obesity and triglycerides were related to loss of small unmyelinated axons based on IENFD whereas elevated hemoglobin A1c was related to large myelinated fiber loss (motor conduction velocity). These findings indicate obesity and hypertriglyceridemia significantly increase risk for peripheral neuropathy, independent of glucose control. Obesity/hypertriglyceridemia and hyperglycemia may have differential effects on small versus large fibers.

  2. Peer Support For Self-Management Of Diabetes Improved Outcomes In International Settings

    PubMed Central

    Fisher, Edwin B.; Boothroyd, Renée I.; Coufal, Maggy Muchieh; Baumann, Linda; Mbanya, Jean Claude; Rotheram-Borus, Mary Jane; Sanguanprasit, Boosaba; Tanasugarn, Chanuantong

    2014-01-01

    Self-management of diabetes is essential to reducing the risks of associated disabilities. But effective self-management is often short-lived. Peers can provide the kind of ongoing support that is needed for sustained self-management of diabetes. In this context, peers are nonprofessionals who have diabetes or close familiarity with its management. Key functions of effective peer support include assistance in daily management, social and emotional support, linkage to clinical care, and ongoing availability of support. Using these four functions as a template of peer support, project teams in Cameroon, South Africa, Thailand, and Uganda developed and then evaluated peer support interventions for adults with diabetes. Our initial assessment found improvements in symptom management, diet, blood pressure, body mass index, and blood sugar levels for many of those taking part in the programs. For policy makers, the broader message is that by emphasizing the four key peer support functions, diabetes management programs can be successfully introduced across varied cultural settings and within diverse health systems. PMID:22232103

  3. Peer support for self-management of diabetes improved outcomes in international settings.

    PubMed

    Fisher, Edwin B; Boothroyd, Renée I; Coufal, Muchieh Maggy; Baumann, Linda C; Mbanya, Jean Claude; Rotheram-Borus, Mary Jane; Sanguanprasit, Boosaba; Tanasugarn, Chanuantong

    2012-01-01

    Self-management of diabetes is essential to reducing the risks of associated disabilities. But effective self-management is often short-lived. Peers can provide the kind of ongoing support that is needed for sustained self-management of diabetes. In this context, peers are nonprofessionals who have diabetes or close familiarity with its management. Key functions of effective peer support include assistance in daily management, social and emotional support, linkage to clinical care, and ongoing availability of support. Using these four functions as a template of peer support, project teams in Cameroon, South Africa, Thailand, and Uganda developed and then evaluated peer support interventions for adults with diabetes. Our initial assessment found improvements in symptom management, diet, blood pressure, body mass index, and blood sugar levels for many of those taking part in the programs. For policy makers, the broader message is that by emphasizing the four key peer support functions, diabetes management programs can be successfully introduced across varied cultural settings and within diverse health systems.

  4. Improving the Transition from Pediatric to Adult Diabetes Healthcare: A Literature Review.

    PubMed

    Wafa, Sarah; Nakhla, Meranda

    2015-12-01

    Effective transition to adult care is a significant component of an emerging adult's diabetes care. Poor transition places them at risk for disengagement with the health care system and for poor diabetes-related outcomes. The purpose of this paper was to review the literature to date on existing methods of transition care delivery for emerging adults with diabetes. We conducted a literature review using MEDLINE via OvidSP and searching the grey literature. Papers published in English between January 1, 2000 and March 25, 2015 that evaluated transition care programs for emerging adults with diabetes were included. 16 original studies, 1 study protocol and 1 technical brief describing transition programs were reviewed. Common components of care included transition care coordination, young adult clinics, transition preparation, familiarity with adult health care providers and support groups. Overall, when emerging adults are supported during the transition period, clinic attendance and glycemic control can be maintained or improved, and diabetes-related complications reduced. Despite widespread support in the literature for the need for structured transition care delivery, methodologically strong research evaluating transition care services remains limited. The literature to date encompasses a variety of care models that lack consistency in outcome measurements as well as lacking frameworks describing the interventions, which impedes comparison across studies. Further research, using a consistent framework for transition care program design, delivery and evaluation as well as reporting of outcomes, is needed to inform how best to deliver transition care services to this vulnerable population.

  5. Community-based primary care: improving and assessing diabetes management.

    PubMed

    Gannon, Meghan; Qaseem, Amir; Snow, Vincenza

    2010-01-01

    Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module.The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abstraction. This module contained chapters on clinical education, practice tools, and self-assessment. The results showed a sustained improvement in most clinical outcomes and demonstrated the effectiveness of using Web-based mediums to reinforce clinical guidelines and change physician behavior.

  6. Petalonia improves glucose homeostasis in streptozotocin-induced diabetic mice

    SciTech Connect

    Kang, Seong-Il; Jin, Young-Jun; Ko, Hee-Chul; Choi, Soo-Youn; Hwang, Joon-Ho; Whang, Ilson; Kim, Moo-Han; Shin, Hye-Sun; Jeong, Hyung-Bok; Kim, Se-Jae

    2008-08-22

    The anti-diabetic potential of Petalonia binghamiae extract (PBE) was evaluated in vivo. Dietary administration of PBE to streptozotocin (STZ)-induced diabetic mice significantly lowered blood glucose levels and improved glucose tolerance. The mode of action by which PBE attenuated diabetes was investigated in vitro using 3T3-L1 cells. PBE treatment stimulated 3T3-L1 adipocyte differentiation as evidenced by increased triglyceride accumulation. At the molecular level, peroxisome proliferator-activated receptor {gamma} (PPAR{gamma}) and terminal marker protein aP2, as well as the mRNA of GLUT4 were up-regulated by PBE. In mature adipocytes, PBE significantly stimulated the uptake of glucose and the expression of insulin receptor substrate-1 (IRS-1). Furthermore, PBE increased PPAR{gamma} luciferase reporter gene activity in COS-1 cells. Taken together, these results suggest that the in vivo anti-diabetic effect of PBE is mediated by both insulin-like and insulin-sensitizing actions in adipocytes.

  7. Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA).

    PubMed

    Rasouli, B; Andersson, T; Carlsson, P-O; Grill, V; Groop, L; Martinell, M; Midthjell, K; Storm, P; Tuomi, T; Carlsson, S

    2017-04-01

    It has been suggested that moist snuff (snus), a smokeless tobacco product that is high in nicotine and widespread in Scandinavia, increases the risk of Type 2 diabetes. Previous studies are however few, contradictory and, with regard to autoimmune diabetes, lacking. Our aim was to study the association between snus use and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA). Analyses were based on incident cases (Type 2 diabetes, n = 724; LADA, n = 200) and population-based controls (n = 699) from a Swedish case-control study. Additional analyses were performed on cross-sectional data from the Norwegian HUNT study (n = 21 473) with 829 prevalent cases of Type 2 diabetes. Odds ratios (OR) were estimated adjusted for age, BMI family history of diabetes and smoking. Only men were included. No association between snus use and Type 2 diabetes or LADA was seen in the Swedish data. For Type 2 diabetes, the OR for > 10 box-years was 1.00 [95% confidence interval (CI), 0.47 to 2.11] and for LADA 1.01 (95% CI, 0.45 to 2.29). Similarly, in HUNT, the OR for Type 2 diabetes in ever-users was estimated at 0.91 (95% CI, 0.75 to 1.10) and in heavy users at 0.92 (95% CI, 0.46 to 1.83). The risk of Type 2 diabetes and LADA is unrelated to the use of snus, despite its high nicotine content. This opens the possibility of the increased risk of Type 2 diabetes seen in smokers may not be attributed to nicotine, but to other substances in tobacco smoke. © 2016 Diabetes UK.

  8. A critical dialogue: communicating with type 2 diabetes patients about cardiovascular risk.

    PubMed

    Roach, Paris; Marrero, David

    2005-01-01

    Patients with type 2 diabetes mellitus (DM) are at increased risk for cardiovascular disease (CVD), and many patients are inadequately treated for risk factors such as hyperglycemia, hyperlipidemia, hypertension, and smoking. Providing individualized risk information in a clear and engaging manner may serve to encourage both patients and their physicians to intensify risk-reducing behaviors and therapies. This review outlines simple and effective methods for making CVD risk information understandable to persons of all levels of literacy and mathematical ability. To allow the patient to understand what might happen and how, personal risk factors should be clearly communicated and the potential consequences of a CVD event should be presented in a graphic but factual manner. Risk calculation software can provide CVD risk estimates, and the resulting information can be made understandable by assigning risk severity (eg, "high") by comparing clinical parameters with accepted treatment targets and by comparing the individual's risk with that of the "average" person. Patients must also be informed about how they might reduce their CVD risk and be supported in these efforts. Thoughtful risk communication using these techniques can improve access to health information for individuals of low literacy, especially when interactive computer technology is employed. Research is needed to find the best methods for communicating risk in daily clinical practice.

  9. Diabetes Onset at 31–45 Years of Age is Associated with an Increased Risk of Diabetic Retinopathy in Type 2 Diabetes

    PubMed Central

    Zou, Wenjun; Ni, Lisha; Lu, Qianyi; Zou, Chen; Zhao, Minjie; Xu, Xun; Chen, Haibing; Zheng, Zhi

    2016-01-01

    This hospital-based, cross-sectional study investigated the effect of age of diabetes onset on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. A total of 5,214 patients with type 2 DM who were referred to the Department of Ophthalmology at the Shanghai First People’s Hospital from 2009 to 2013 was eligible for inclusion. Diabetic retinopathy status was classified using the grading system of the Early Treatment Diabetic Retinopathy Study (ETDRS). Logistic and hierarchical regression analyses were used to identify independent variables affecting the development of DR. Upon multiple logistic regression analysis, patient age at the time of diabetes onset was significantly associated with development of DR. Further, when the risk of retinopathy was stratified by patient age at the onset of diabetes, the risk was highest in patients in whom diabetes developed at an age of 31–45 years (odds ratio [OR] 1.815 [1.139–2.892]; p = 0.012). Furthermore, when patients were divided into four groups based on the duration of diabetes, DR development was maximal at a diabetes onset age of 31–45 years within each group. A diabetes onset age of 31–45 years is an independent risk factor for DR development in Chinese type 2 DM patients. PMID:27897261

  10. A school-based intervention for diabetes risk reduction.

    PubMed

    Foster, Gary D; Linder, Barbara; Baranowski, Tom; Cooper, Dan M; Goldberg, Linn; Harrell, Joanne S; Kaufman, Francine; Marcus, Marsha D; Treviño, Roberto P; Hirst, Kathryn

    2010-07-29

    We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.)

  11. Risk factors for Type II diabetes and diabetic retinopathy in a mexican-american population: Proyecto VER.

    PubMed

    West, Sheila K; Munoz, Beatriz; Klein, Ronald; Broman, Aimee T; Sanchez, Rosario; Rodriguez, Jorge; Snyder, Robert

    2002-09-01

    Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans. Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older. Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A(1c) value of > or = 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables. 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than $20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31-11.80). Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.

  12. [Increased risk of type II diabetes mellitus and cardiovascular disease after gestational diabetes mellitus: a systematic review].

    PubMed

    Hopmans, Tara-Eileen J P; van Houten, Chantal B; Kasius, Annemieke; Kouznetsova, Ouliana I; Nguyen, Ly A; Rooijmans, Sanne V; Voormolen, Daphne N; van Vliet, Elvira O G; Franx, Arie; Koster, M P H Wendy

    2015-01-01

    To determine the long-term risk of developing type II diabetes (T2D) and cardiovascular disease (CVD) for women with a history of gestational diabetes mellitus. Systematic review and meta-analysis. Two search strategies were used in PubMed and Embase to determine the long-term risks of developing T2D and CVD after a pregnancy complicated by gestational diabetes mellitus. After critical appraisal of the papers found, 11 papers were included, involving a total of 328,423 patients. Absolute and relative risks (RRs) were calculated. Eight studies (n=276,829) reported on the long-term risk of T2D and 4 (n=141,048) on the long-term risk of CVD. Follow-up ranged from 3.5 to 11.5 years for T2D and from 1.2 to 74.0 years for CVD. Women with gestational diabetes had a risk of T2D varying between 9.5% and 37.0% and a risk of CVD of between 0.28% and 15.5%. Women with gestational diabetes were at increased risk of T2D (weighted RR: 13.2; 95% CI: 8.5-20.7) and CVD (weighted RR: 2.0; 95% CI: 1.1-3.7) compared to women without gestational diabetes. Women with prior gestational diabetes mellitus have a significantly increased risk of developing T2D and CVD. It is very important that gestational diabetes is recognised as a cardiovascular risk factor in daily practice. It would be desirable to screen this group of women for the presence of hyperglycaemia and other cardiovascular risk factors. Further research is required to be able to specify the long-term risk of T2D and CVD and to demonstrate whether such screening is cost-effective.

  13. Autoantibody-defined risk for Type 1 diabetes mellitus in a general population of schoolchildren: results of the Karlsburg Type 1 Diabetes Risk Study after 18 years.

    PubMed

    Till, A-M; Kenk, H; Rjasanowski, I; Wassmuth, R; Walschus, U; Kerner, W; Schlosser, M

    2015-08-01

    To investigate the occurrence of diabetes-associated autoantibodies and cumulative Type 1 diabetes risk over 18 years in a general population of schoolchildren. In the Karlsburg Type 1 Diabetes Risk Study, 11 986 schoolchildren from north-eastern Germany without a family history of diabetes were screened for glutamic acid decarboxylase antibodies, insulinoma-associated antigen-2 antibodies and insulin autoantibodies by radioligand binding assay. Those children found to be autoantibody-positive were invited to follow-up examinations and HLA-DQB1 genotyping, and were followed for progression to Type 1 diabetes. At first follow-up, 119 children had single and 36 children had multiple autoantibodies. Of the multiple autoantibody-positive children, 33 had at least one diabetes-associated HLA-DQB1 allele (*02 and/or *0302). A total of 26 children progressed to Type 1 diabetes, of whom 22 had multiple autoantibodies. The male-to-female ratio of those who progressed to Type 1 diabetes was 1.6. The positive predictive value of multiple autoantibodies was 61.1% compared with only 23.7% for diabetes-associated HLA-DQB1 genotypes among all those who were autoantibody-positive. The cumulative risk was 59.7% after 10 years and 75.1% after 18 years for children with multiple autoantibodies compared with 1.2 and 22.6%, respectively, for children with single autoantibodies (P<0.001). Among the three examined autoantibodies, insulinoma-associated antigen-2 antibodies conferred the highest risk. The diabetes risk in schoolchildren with multiple autoantibodies was similar to the risk reported in other studies for genetically preselected probands; thus, a combined autoantibody-based screening could effectively identify at-risk individuals from the general population for future intervention trials. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  14. Vascular risk factors in the obliterative peripheral arteriopathy of diabetic patients.

    PubMed

    Fekete, T; Mösler, R; Panduru, V

    1985-01-01

    To estimate the role of some vascular risk factors in the obliterative arteriopathy of diabetic patients, 71 subjects have been investigated: diabetics without arteriopathy, diabetics with arteriopathy and non-diabetics with arteriopathy. Age, sex, body weight, smoking habits, blood pressure, sedentary life style, diabetes therapy, plasma glucose, cholesterol, triglycerides, total lipids, HDL-cholesterol, uric acid, and fibrinogen have been assessed, the parameters investigated. The results show that the risk factors studied maintain their role even in the obliterative peripheral arteriopathy of diabetic patients; however, there are differences in the relative importance of some of them.

  15. Stress Perfusion Cardiac Magnetic Resonance Imaging Effectively Risk Stratifies Diabetic Patients With Suspected Myocardial Ischemia.

    PubMed

    Heydari, Bobak; Juan, Yu-Hsiang; Liu, Hui; Abbasi, Siddique; Shah, Ravi; Blankstein, Ron; Steigner, Michael; Jerosch-Herold, Michael; Kwong, Raymond Y

    2016-04-01

    Diabetics remain at high risk of cardiovascular disease and mortality despite advancements in medical therapy. Noninvasive cardiac risk profiling is often more difficult in diabetics owing to the prevalence of silent ischemia with unrecognized myocardial infarction, reduced exercise capacity, nondiagnostic electrocardiographic changes, and balanced ischemia from diffuse epicardial coronary atherosclerosis and microvascular dysfunction. A consecutive cohort of 173 patients with diabetes mellitus (mean age, 61.7±11.9 years; 37% women) with suspected myocardial ischemia underwent stress perfusion cardiac magnetic resonance imaging. Patients were evaluated for adverse cardiac events after cardiac magnetic resonance imaging with mean follow-up time of 2.9±2.5 years. Mean hemoglobin A1c for the population was 7.9±1.8%. Primary end point was a composite of cardiac death and nonfatal myocardial infarction. Diabetics with no inducible ischemia (n=94) experienced an annualized event rate of 1.4% compared with 8.2% (P=0.0003) in those with inducible ischemia (n=79). Diabetics without late gadolinium enhancement or inducible ischemia had a low annual cardiac event rate (0.5% per year). The presence of inducible ischemia was the strongest unadjusted predictor (hazard ratio, 4.86; P<0.01) for cardiac death and nonfatal myocardial infarction. This association remained robust in adjusted stepwise multivariable Cox regression analysis (hazard ratio, 4.28; P=0.02). In addition, categorical net reclassification index using 5-year risk cutoffs of 5% and 10% resulted in reclassification of 43.4% of the diabetic cohort with net reclassification index of 0.38 (95% confidence interval, 0.20-0.56; P<0.0001). Stress perfusion cardiac magnetic resonance imaging provided independent prognostic utility and effectively reclassified risk in patients with diabetes mellitus referred for ischemic assessment. Further evaluation is required to determine whether a noninvasive imaging strategy with

  16. Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk.

    PubMed

    Chow, Elaine; Bernjak, Alan; Williams, Scott; Fawdry, Robert A; Hibbert, Steve; Freeman, Jenny; Sheridan, Paul J; Heller, Simon R

    2014-05-01

    Recent trials of intensive glycemic control suggest a possible link between hypoglycemia and excess cardiovascular mortality in patients with type 2 diabetes. Hypoglycemia might cause arrhythmias through effects on cardiac repolarization and changes in cardiac autonomic activity. Our aim was to study the risk of arrhythmias during spontaneous hypoglycemia in type 2 diabetic patients with cardiovascular risk. Twenty-five insulin-treated patients with type 2 diabetes and a history of cardiovascular disease or two or more risk factors underwent simultaneous continuous interstitial glucose and ambulatory electrocardiogram monitoring. Frequency of arrhythmias, heart rate variability, and markers of cardiac repolarization were compared between hypoglycemia and euglycemia and between hyperglycemia and euglycemia matched for time of day. There were 134 h of recording at hypoglycemia, 65 h at hyperglycemia, and 1,258 h at euglycemia. Bradycardia and atrial and ventricular ectopic counts were significantly higher during nocturnal hypoglycemia compared with euglycemia. Arrhythmias were more frequent during nocturnal versus daytime hypoglycemia. Excessive compensatory vagal activation after the counterregulatory phase may account for bradycardia and associated arrhythmias. QT intervals, corrected for heart rate, >500 ms and abnormal T-wave morphology were observed during hypoglycemia in some participants. Hypoglycemia, frequently asymptomatic and prolonged, may increase the risk of arrhythmias in patients with type 2 diabetes and high cardiovascular risk. This is a plausible mechanism that could contribute to increased cardiovascular mortality during intensive glycemic therapy.

  17. Dietary Patterns in Adults with Type 2 Diabetes Predict Cardiometabolic Risk Factors.

    PubMed

    Mathe, Nonsikelelo; Pisa, Pedro T; Johnson, Jeffrey A; Johnson, Steven T

    2016-08-01

    Examining the diets of people living with type 2 diabetes may improve understanding of how diet affects disease progression. We derived dietary patterns in adults living with type 2 diabetes and explored associations among patterns, sociodemographic variables and cardiometabolic risk factors. Dietary patterns were derived from food frequency questionnaires (FFQs) in 196 adults with type 2 diabetes using principal components analysis (PCA). Multilinear regression models were fitted for the differing dietary pattern scores so as to estimate the marginal contribution of each variable explaining variations in diet. Differences in clinical variables across dietary patterns, adjusting for sex, smoking and total energy intake, were assessed. Three principal components (PCs), or patterns, were identified, explaining 56.5% of the total variance in diet: (PC1) fried foods, cakes and ice cream; (PC2) fish and vegetables; and (PC3) pasta, potatoes and breads. Female sex, current smoker and total energy were significant associated with patterns. Total energy accounted for the greatest amount of variance in each pattern (11.2% for fried foods, cakes and ice cream, 3.89% for fish and vegetables and 9.21% for pasta, potatoes and breads). After adjustment for sex, smoking and total energy, the pasta, potatoes and breads pattern was inversely associated with systolic blood pressure and low-density lipoprotein-cholesterol. Of the 3 distinct diet patterns characterized, the carbohydrate-based pattern was most closely associated with cardiometabolic risk factors. To better understand and improve self-management by people living with type 2 diabetes through dietary modifications, further improvements in measuring and assessing diet using comparable instruments and comparisons with apparently healthy populations is required. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  18. Risk perception is not associated with attendance at a preventive intervention for type 2 diabetes mellitus among South Asians at risk of diabetes.

    PubMed

    Vlaar, Everlina M A; Nierkens, Vera; Nicolaou, Mary; Middelkoop, Barend J C; Stronks, Karien; van Valkengoed, Irene G M

    2015-04-01

    To evaluate the association between risk perception and attendance in a diabetes prevention programme among South Asians with a high risk for diabetes. An observational study. We measured risk perception during the baseline interview with causal beliefs, perceived susceptibility and perceived controllability. We used logistic regression to examine the relationship between risk perception and attendance. We adjusted for relevant sociodemographic factors, screening results and psychosocial factors. The Hague, the Netherlands. Five hundred and thirty-five Hindustani Surinamese (South Asians) aged 18-60 years from a lifestyle-versus-control intervention for the prevention of diabetes. In total, 68·2% attended the lifestyle or control intervention. Participants perceived lifestyle and heredity to increase the risk of diabetes and perceived increasing physical activity to decrease it. Only 44·2% of the participants perceived themselves as susceptible to diabetes and only those who perceived a family history of diabetes as a cause of diabetes appeared to be more inclined to attend. However, after adjustment for confounding, the association was not statistically significant. Risk perception was not significantly associated with attendance. The results suggest that increasing the risk perception alone in this South Asian population is unlikely to increase the attendance at a diabetes prevention programme.

  19. Children under the age of seven with diabetes are increasing their cardiovascular risk by their food choices.

    PubMed

    Sundberg, F; Augustsson, M; Forsander, G; Cederholm, U; Axelsen, M

    2014-04-01

    Early-onset diabetes increases the risk of cardiovascular disease. This study examined the eating habits of children under 7 years of age with diabetes to see whether their diet increased that risk even further. A total of 24 children with type 1 diabetes (mean age 4.5 years) and 27 healthy controls (mean age 4.6 years) participated in this cross-sectional study. Food intake was assessed by two 4-day food records. Children with type 1 diabetes had a higher energy intake from protein (18 vs 15%, p < 0.05) and fat (35 vs 31%, p < 0.05) but lower intake from carbohydrates (47 vs 54%, p < 0.05), than the healthy control group. Intake of saturated fat was higher than recommended in both groups, and consumption of fruit and vegetables was lower than recommended, but similar, in both the diabetes and control groups (191 vs 207 g per day). Total intake of fat was negatively correlated with intake of fruit and vegetables (r = -0.74 p < 0.05) in children with type 1 diabetes. Children under 7 years of age with type 1 diabetes eat too much saturated fat and not enough fruit and vegetables. Their diet should be improved to reduce their cardiovascular risk. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  20. Metabolic Syndrome as a Risk Factor for Cardiovascular Disease, Mortality, and Progression of Diabetic Nephropathy in Type 1 Diabetes

    PubMed Central

    Thorn, Lena M.; Forsblom, Carol; Wadén, Johan; Saraheimo, Markku; Tolonen, Nina; Hietala, Kustaa; Groop, Per-Henrik

    2009-01-01

    OBJECTIVE To assess the predictive value of the metabolic syndrome in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS Patients were from the prospective Finnish Diabetic Nephropathy (FinnDiane) Study (n = 3,783): mean age 37 ± 12 years and diabetes duration 23 ± 12 years. Metabolic syndrome was defined according to World Health Organization (WHO), National Cholesterol Education Program (NCEP), and International Diabetes Federation (IDF) definitions. Follow-up time was median 5.5 years (interquartile range 3.7–6.7). Mortality data were complete, whereas morbidity data were available in 69% of the patients. RESULTS The WHO definition was associated with a 2.1-fold increased risk of cardiovascular events and a 2.5-fold increased risk of cardiovascular- and diabetes-related mortality, after adjustment for traditional risk factors and diabetic nephropathy. The NCEP definition did not predict outcomes when adjusted for nephropathy but markedly added to the risk associated with elevated albuminuria alone (P < 0.001). The IDF definition did not predict outcomes. CONCLUSIONS The metabolic syndrome is a risk factor, beyond albuminuria, for cardiovascular morbidity and diabetes-related mortality in type 1 diabetes. PMID:19196885

  1. [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.

  2. Contribution of the Nurses' Health Studies to Uncovering Risk Factors for Type 2 Diabetes: Diet, Lifestyle, Biomarkers, and Genetics.

    PubMed

    Ley, Sylvia H; Ardisson Korat, Andres V; Sun, Qi; Tobias, Deirdre K; Zhang, Cuilin; Qi, Lu; Willett, Walter C; Manson, JoAnn E; Hu, Frank B

    2016-09-01

    To review the contribution of the Nurses' Health Study (NHS) and the NHS II to addressing hypotheses regarding risk factors for type 2 diabetes. We carried out a narrative review of 1976 to 2016 NHS and NHS II publications. The NHS and NHS II have uncovered important roles in type 2 diabetes for individual nutrients, foods, dietary patterns, and physical activity independent of excess body weight. Up to 90% of type 2 diabetes cases are potentially preventable if individuals follow a healthy diet and lifestyle. The NHS investigations have also identified novel biomarkers for diabetes, including adipokines, inflammatory cytokines, nutrition metabolites, and environmental pollutants, offering new insights into the pathophysiology of the disease. Global collaborative efforts have uncovered many common genetic variants associated with type 2 diabetes and improved our understanding of gene-environment interactions. Continued efforts to identify epigenetic, metagenomic, and metabolomic risk factors for type 2 diabetes have the potential to reveal new pathways and improve prediction and prevention. Over the past several decades, the NHS and NHS II have made major contributions to public health recommendations and strategies designed to reduce the global burden of diabetes.

  3. Contribution of the Nurses’ Health Studies to Uncovering Risk Factors for Type 2 Diabetes: Diet, Lifestyle, Biomarkers, and Genetics

    PubMed Central

    Ley, Sylvia H.; Ardisson Korat, Andres V.; Sun, Qi; Tobias, Deirdre K.; Zhang, Cuilin; Qi, Lu; Willett, Walter C.; Manson, JoAnn E.

    2016-01-01

    Objectives. To review the contribution of the Nurses’ Health Study (NHS) and the NHS II to addressing hypotheses regarding risk factors for type 2 diabetes. Methods. We carried out a narrative review of 1976 to 2016 NHS and NHS II publications. Results. The NHS and NHS II have uncovered important roles in type 2 diabetes for individual nutrients, foods, dietary patterns, and physical activity independent of excess body weight. Up to 90% of type 2 diabetes cases are potentially preventable if individuals follow a healthy diet and lifestyle. The NHS investigations have also identified novel biomarkers for diabetes, including adipokines, inflammatory cytokines, nutrition metabolites, and environmental pollutants, offering new insights into the pathophysiology of the disease. Global collaborative efforts have uncovered many common genetic variants associated with type 2 diabetes and improved our understanding of gene–environment interactions. Continued efforts to identify epigenetic, metagenomic, and metabolomic risk factors for type 2 diabetes have the potential to reveal new pathways and improve prediction and prevention. Conclusions. Over the past several decades, the NHS and NHS II have made major contributions to public health recommendations and strategies designed to reduce the global burden of diabetes. PMID:27459454

  4. Quality improvement and cost reduction realized by a purchaser through diabetes disease management.

    PubMed

    Snyder, James W; Malaskovitz, Joyce; Griego, Janet; Persson, Jeffrey; Flatt, Kristy

    2003-01-01

    This report documents the clinical improvements and costs experienced by a purchaser after introduction of a diabetes disease management program. A purchaser contracted with American Healthways, a disease management organization, to initiate a diabetes disease management program called Diabetes Decisions. Started in 1998, the program grew to include 662 participants. The results reported are based on the continuously participating population (12 months of participation in the program for the reporting year). Participants were entered into American Healthways' clinical information system and risk-stratified, and an individualized treatment plan was devised. Outbound telephone calls by specially trained nurses were a key intervention. Data were collected on key process measures, financial parameters, and participant satisfaction. By year 3, there were 422 continuously participating participants. From baseline to the third year of the program, significant increases in frequency of A1C testing (21.3% to 82.2%), dilated retinal exams (17.2% to 70.7%), and performance of foot exams (2.0% to 75.6%) were noted. For 166 participants with five A1C determinations, A1C values dropped from 8.89% to 7.88%. Participants experienced a 36% drop in inpatient costs. Without adjustment for medical inflation, total medical costs decreased by 26.8% from the baseline period, dropping to $268.63 per diabetes participant per month (PDPPM) by year 3, a gross savings of $98.49 PDPPM. After subtracting the fees paid to Diabetes Decisions, a net savings of $986,538 was realized. This yielded a return on investment of 3.37. By investing in a diabetes disease management program, a purchaser was able to realize significant improvements in clinical care, substantial cost savings, and a favorable return on investment.

  5. [Foot ulceration risk factors in type 2 diabetes mellitus].

    PubMed

    Bustos-Saldaña, Rafael; Prieto-Miranda, Sergio

    2009-01-01

    To identify risk factor prevalence for development of foot ulcers in patients with type 2 diabetes (DM2). A cross sectional study, of 2067 patients with DM2 from seven primary care units was conducted. A questionnaire exploring age, sex, occupation, time from diabetes mellitus diagnosis (DMD), and data concerning neuropathy, vascular changes, and presence of infections, anthropometry, and gait was applied. We found mean age, 59.96 +/- 11.47 years and time from DMD, 10.2 +/- 8.09 years. From 1360 women, 65.8 % presented the following risk factors: age, 34.7 %; schooling, 49.5 %; time from DMD, 38.8 %; occupation, 20 %; smoking, 24.3 %; alcoholism, 4.6 %; fasting glucose disturbance, 78 %; ulcer history, 10 %. In relation to associated diseases, 67.5 % of patients had one or more antecedent. The presence of risk factors in the sample was 9.716 +/- 2.52, of which 6.259 +/- 1.59 were modifiable. Patients studied presented high risk factor prevalence for development of foot ulcer. The majority of RF is potentially modifiable by adjusting patients' customs and habits.

  6. Developing a Conceptually Equivalent Type 2 Diabetes Risk Score for Indian Gujaratis in the UK

    PubMed Central

    Patel, Naina; Stone, Margaret; Barber, Shaun; Gray, Laura; Davies, Melanie; Khunti, Kamlesh

    2016-01-01

    Aims. To apply and assess the suitability of a model consisting of commonly used cross-cultural translation methods to achieve a conceptually equivalent Gujarati language version of the Leicester self-assessment type 2 diabetes risk score. Methods. Implementation of the model involved multiple stages, including pretesting of the translated risk score by conducting semistructured interviews with a purposive sample of volunteers. Interviews were conducted on an iterative basis to enable findings to inform translation revisions and to elicit volunteers' ability to self-complete and understand the risk score. Results. The pretest stage was an essential component involving recruitment of a diverse sample of 18 Gujarati volunteers, many of whom gave detailed suggestions for improving the instructions for the calculation of the risk score and BMI table. Volunteers found the standard and level of Gujarati accessible and helpful in understanding the concept of risk, although many of the volunteers struggled to calculate their BMI. Conclusions. This is the first time that a multicomponent translation model has been applied to the translation of a type 2 diabetes risk score into another language. This project provides an invaluable opportunity to share learning about the transferability of this model for translation of self-completed risk scores in other health conditions. PMID:27703985

  7. Developing a Conceptually Equivalent Type 2 Diabetes Risk Score for Indian Gujaratis in the UK.

    PubMed

    Patel, Naina; Willis, Andrew; Stone, Margaret; Barber, Shaun; Gray, Laura; Davies, Melanie; Khunti, Kamlesh

    2016-01-01

    Aims. To apply and assess the suitability of a model consisting of commonly used cross-cultural translation methods to achieve a conceptually equivalent Gujarati language version of the Leicester self-assessment type 2 diabetes risk score. Methods. Implementation of the model involved multiple stages, including pretesting of the translated risk score by conducting semistructured interviews with a purposive sample of volunteers. Interviews were conducted on an iterative basis to enable findings to inform translation revisions and to elicit volunteers' ability to self-complete and understand the risk score. Results. The pretest stage was an essential component involving recruitment of a diverse sample of 18 Gujarati volunteers, many of whom gave detailed suggestions for improving the instructions for the calculation of the risk score and BMI table. Volunteers found the standard and level of Gujarati accessible and helpful in understanding the concept of risk, although many of the volunteers struggled to calculate their BMI. Conclusions. This is the first time that a multicomponent translation model has been applied to the translation of a type 2 diabetes risk score into another language. This project provides an invaluable opportunity to share learning about the transferability of this model for translation of self-completed risk scores in other health conditions.

  8. Spa adjuvant therapy improves diabetic lower extremity arterial disease.

    PubMed

    Qiu, Yongbin; Zhu, Yi; Jia, Wei; Chen, Songhua; Meng, Qingzhou

    2014-08-01

    To investigate the effect of spa adjuvant therapy on diabetic lower extremity arterial disease (LEAD). 128 patients with type II diabetes were separated into three groups according to the degree of lower extremity vascular stenosis. Patients within each group were then randomly divided to receive no treatment (control) or spa adjuvant therapy (treatment). Clinical symptoms, blood pressure and hemodynamic analyses were compared between control and treatment groups by Chi square or t-test. After adjuvant therapy with spa, patients' pain, numbness, and cold sensation were significantly improved compared with control groups (P<0.05). Spa adjuvant therapy also significantly increased the dorsalis pedis pulse and systolic peak velocity ratio of patients with mild lower extremity vascular stenosis compared with control groups (P<0.05), while there were no significant differences between the two groups for patients with moderate and severe stenosis (P>0.05). Both in the spa and control groups, there were no significant differences before and after medication for fasting, 2-h postprandial blood glucose and glycosylated hemoglobin (HbA1C) analyses (P>0.05). Spa adjuvant therapy can significantly alleviate lower extremity pain, numbness, and cold sensory symptoms in diabetic LEAD patients with stenosis. Moreover, in LEAD patients with mild stenosis, spa adjuvant therapy also improves the dorsalis pedis pulse and systolic peak velocity ratio, suggesting a potential role for spa therapy as an early intervention strategy to treat the initial stages of disease. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Key considerations around the risks and consequences of hypoglycaemia in people with type 2 diabetes.

    PubMed

    Barnett, A H; Cradock, S; Fisher, M; Hall, G; Hughes, E; Middleton, A

    2010-07-01

    Hypoglycaemia and its consequences represent a significant risk for many people who have type 2 diabetes, and hypoglycaemia is currently under-recognised and commonly avoidable. Current clinical guidelines recommend the targeting of tight glycaemic control and this strategy may also be associated with an increased risk of hypoglycaemia. Hypoglycaemia impacts on morbidity, mortality and quality of life of people with type 2 diabetes, and improved recognition of the symptoms of hypoglycaemia will allow effective treatment and reduce the risk of progression to more severe episodes. A common cause of hypoglycaemia in people with type 2 diabetes is glucose-lowering medication, in particular, those which raise insulin independently of ambient glucose concentration such as sulphonylureas and exogenous insulin. The recently published National Institute for Health and Clinical Excellence guideline recommends the use of Dipeptidyl peptidase-4 inhibitors or thiazolidinediones (glitazones) as alternative second-line therapy instead of a sulphonylurea in those patients who are at significant risk of hypoglycaemia and its consequences.

  10. Academic Skills in Children with Early-Onset Type 1 Diabetes: The Effects of Diabetes-Related Risk Factors

    ERIC Educational Resources Information Center

    Hannonen, Riitta; Komulainen, Jorma; Riikonen, Raili; Ahonen, Timo; Eklund, Kenneth; Tolvanen, Asko; Keskinen, Paivi; Nuuja, Anja

    2012-01-01

    Aim: The study aimed to assess the effects of diabetes-related risk factors, especially severe hypoglycaemia, on the academic skills of children with early-onset type 1 diabetes mellitus (T1DM). Method: The study comprised 63 children with T1DM (31 females, 32 males; mean age 9y 11mo, SD 4mo) and 92 comparison children without diabetes (40…

  11. Academic Skills in Children with Early-Onset Type 1 Diabetes: The Effects of Diabetes-Related Risk Factors

    ERIC Educational Resources Information Center

    Hannonen, Riitta; Komulainen, Jorma; Riikonen, Raili; Ahonen, Timo; Eklund, Kenneth; Tolvanen, Asko; Keskinen, Paivi; Nuuja, Anja

    2012-01-01

    Aim: The study aimed to assess the effects of diabetes-related risk factors, especially severe hypoglycaemia, on the academic skills of children with early-onset type 1 diabetes mellitus (T1DM). Method: The study comprised 63 children with T1DM (31 females, 32 males; mean age 9y 11mo, SD 4mo) and 92 comparison children without diabetes (40…

  12. Obesity, Diabetes, the Cardiorenal Syndrome, and Risk for Cancer

    PubMed Central

    Forte, Victoria; Pandey, Abhishek; Abdelmessih, Rita; Forte, Giovanna; Whaley-Connell, Adam; Sowers, James R.; McFarlane, Samy I.

    2012-01-01

    Numerous epidemiological studies confirm that the prevalence of obesity and the cardiorenal metabolic syndrome (CRS) is extraordinarily high and that the rates have increased dramatically in the last three decades. In addition, epidemiological data demonstrate that obesity, the CRS, and diabetes are inextricably linked and are all associated with an increased incidence of a number of solid tissue cancers. The mechanisms for this association have been examined, including, but not limited to, higher levels of insulin and free levels of insulin-like growth factor and insulin resistance in obesity and the CRS. Mortality, morbidity, and the associated health care costs which are the link between obesity, the CRS, and diabetes are just beginning to be examined. In addition, we review the advantages of implementing lifestyle and surgical changes to modify obesity, lessening the development of the CRS, diabetes, and associated cancers. Epidemiological data regarding the general mechanisms of the pathogenesis of cancers associated with obesity, the CRS, and diabetes (specifically colon, pancreas, esophageal, liver, breast, prostate, thyroid, and renal carcinomas) are reviewed. The mechanisms by which obesity and other components of the CRS contribute to the pathogenesis of these cancers, such as hormone alterations and insulin- and insulin-like growth factor-dependent pathways of tumor pathogenesis, include the attending roles of inflammation and oxidative stress. Emphasis has been placed on obesity as a modifiable risk factor which, when addressed, provides a reduction in the rate of cancer deaths. In a second part to be published in the next issue of this journal, the relationship between diabetes and cancer will be reviewed in detail. PMID:22851963

  13. Insulin therapy, glycemic control, and cardiovascular risk factors in young Latin Americans with type 2 diabetes mellitus.

    PubMed

    Avilés-Santa, Larissa; Salinas, Karin; Adams-Huet, Beverley; Raskin, Philip

    2006-01-01

    . Despite a significant decrease in percent hemoglobin A1c (22.2%; p = < .0001), lipid and lipoprotein profiles, highly sensitive CRP, leukocyte adhesion molecules, and other nontraditional CV risk factors did not change significantly. In young, obese, Latino type 2 diabetic patients, improvement in glycemic control with insulin monotherapy was not associated with a parallel improvement in markers of vascular inflammation. Premenopausal Latino women with uncontrolled type 2 diabetes have CV risks comparable to Latino diabetic men of the same age. Obesity and underlying insulin resistance may counteract the potential CV benefits associated with insulin therapy in lean diabetic patients. Weight loss could be a potential therapeutic modality to improve CV risk in Latino type 2 diabetic patients, especially women.

  14. [Risk factors for fetal macrosomia in patients without gestational diabetes mellitus].

    PubMed

    García-De la Torre, J I; Rodríguez-Valdez, A; Delgado-Rosas, A

    2016-03-01

    Fetal macrosomia is birth weight of 4,000 grams or more, regardless of gestational age, in Mexico representing about 5.4%. Associated with multiple demographic, physiological, metabolic and genetic factors of each population. Determine the risk factors associated with the development of fetal macrosomia in patients without gestational diabetes mellitus. Retrospective, descriptive and comparative study of patients who came to delivery from January 2012 to June 2014, 88 patients, 23 patients with diagnosis of macrosomia, and 65 patients without macrosomia without gestational diabetes mellitus were included. An incidence of fetal macrosomia of 18.6%. Risk factors such as parity, history of fetal macrosomia, maternal age, maternal height more to 1.70 meters showed no difference, the percentage of overweight 105% showed 69% vs 52% on the control group and gestational diabetes screening altered that present 30.4 vs 20%. Increased incidence of macrosomia was demonstrated in patients with meta