Co-occurrence Of Diabetes Research Articles

Genetic overlap between type 2 diabetes and depression in Swedish and Danish twin registries.

A bidirectional association between type 2 diabetes (T2DM) and depression has been consistently reported. Depression is associated with worse biomedical outcomes and increased mortality. The mechanisms underlying the association of T2DM with depression remain unclear. One possible question we can address is the extent to which the co-occurrence of diabetes and depression is due to correlated genetic and/or environmental risk factors. In this study, we performed structural equation model fitting to population-level data from the Swedish (n=68 606) and Danish (n=95 403) twin registries. The primary outcomes were clinical diagnosis of T2DM and depression using national hospital discharge registries. The phenotypic correlation between T2DM and depression is modest in both samples. In the Swedish sample, unique environmental effects explain a greater proportion of the covariance in males, whereas the association is primarily attributed to genetic effects in females. In the Danish sample, genetic effects account for the majority of the covariance in both males and females. Qualitative genetic sex differences are observed in both samples. We believe this is the first study to demonstrate significant genetic overlap between T2DM and depression.

Abstract C28: An exploratory study of co-occurrence of breast cancer and diabetes in medically underserved Latinas

Abstract Purpose: Cancer and diabetes are two severe chronic illnesses that often co-occur. The presence of diabetes in cancer patients is associated with increased risk for poor health outcomes and decreased overall survival. Lack of access to care and under-diagnosis of diabetes makes this co-occurrence particularly troubling among the Latino population. This preliminary study explored the association of diabetes with functioning and physical health outcomes among underserved Latina breast cancer survivors (BCS). Methods: In total, 137 low income Latina BCS were recruited from the California Cancer Registry, hospital cancer registries, and community agencies. Latina BCS completed a self-report questionnaire that assessed demographic and cancer-related medial characteristics, the co-occurrence of diabetes, and functional and physical outcomes. Results: Among Latina BCS, 98 (72%) were non-diabetic and 39 (28 %) were diabetic. Latina BCS with diabetes were more likely to report less than a high school education, being uninsured, and unemployed (p<0.01), and more likely to report later stage at diagnosis than BCS without diabetes. BCS with diabetes reported more lymphedema symptoms than BCS without diabetes (p<0.05). Although not statistically significant, BCS with diabetes had lower general health, experienced more pain, and reported greater social functioning and physical role limitations than BCS without diabetes. Conclusions: This preliminary investigation sheds new light on emerging evidence documenting the negative associations of comorbid chronic conditions such as diabetes on patients' outcomes. More attention to the co-occurrence of cancer and chronic disease is warranted for addressing cancer health disparities. Our descriptive analysis offers support for additional inquiry and attention to the co-occurrence of cancer and chronic disease as a target for action in improvements in quality, patient-centered care and in the reduction of persistent health disparities. Citation Format: Kimlin T. Ashing, Monica Rosales, Raynald Samoa, Lily Lai, Roberto Vargas, Courtney Vito, Arti Hurria, Mayra Serrano. An exploratory study of co-occurrence of breast cancer and diabetes in medically underserved Latinas. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C28. doi:10.1158/1538-7755.DISP13-C28

Management of diabetes in patients with cancer.

Diabetes is common amongst patients with cancer. The co-occurrence of diabetes and cancer may lead to poorer prognosis and complications in patients undergoing cancer therapy. There is no randomized trial evidence that treating hyperglycaemia in patients with cancer improves outcomes, and therefore a pragmatic approach to managing hyperglycaemic in such patients is required. We discuss the management of hyperglycaemia in relation to cancer chemotherapy, glucocorticoids and enteral feeding. We also discuss management of glucose in diabetic patients with cancer approaching end of life care.

The nutritional status and factors contributing to malnutrition in children with chronic pancreatitis

Background/objectivesThe present study was undertaken to determine the prevalence of malnutrition among children with chronic pancreatitis (CP). Furthermore, we aimed to evaluate the relationship between etiological factors of CP, its clinical characteristics, and the severity of malnutrition. MethodsThe study included 208 children with CP (113 girls and 95 boys; mean age: 10.8 years, range: 1.6–18 years), hospitalized at our center between 1988 and 2012. The severity of malnutrition was graded on the basis of Cole's ratios, and its prevalence was analyzed according to the etiological factors of pancreatitis. Moreover, the analysis of discrimination was performed to identify the factors contributing to malnutrition among the following variables: age at CP onset, duration of CP, number of CP exacerbations, the number of ERCPs performed, the grade of pancreatic damage documented on imaging, co-occurrence of diabetes, and the results of 72-h fecal fat quantification. ResultsWe documented features of malnutrition in 52 (25%) children with CP, including 36 (17.3%) patients with moderate malnutrition, and 2 (0.96%) with severe malnutrition. There was no significant difference in the prevalence of malnutrition between groups of patients with various etiological factors of chronic pancreatitis. The age at CP onset showed the best discrimination ability of malnourished patients: the mean age at disease onset in a subgroup of malnourished children was significantly higher than in children with Cole's index >85%. ConclusionsA considerable percentage of children with CP can suffer from clinically significant malnutrition. Later age at CP onset predisposes to development of malnutrition.

Regulatory Networks and Complex Interactions between the Insulin and Angiotensin II Signalling Systems: Models and Implications for Hypertension and Diabetes

The cross-talk between insulin and angiotensin II signalling pathways plays a significant role in the co-occurrence of diabetes and hypertension. We developed a mathematical model of the system of interactions among the biomolecules that are involved in the cross-talk between the insulin and angiotensin II signalling pathways. We have identified several feedback structures that regulate the dynamic behavior of the individual signalling pathways and their interactions. Different scenarios are simulated and dominant steady-state, dynamic and stability characteristics are revealed. The proposed mechanistic model describes how angiotensin II inhibits the actions of insulin and impairs the insulin-mediated vasodilation. The model also predicts that poor glycaemic control induced by diabetes contributes to hypertension by activating the renin angiotensin aystem.

Oxidant Status and Lipid Composition of Erythrocyte Membranes in Patients with Type 2 Diabetes, Chronic Liver Damage, and a Combination of Both Pathologies

There is an important set of cirrhotic and diabetic patients that present both diseases. However, information about metabolic and cellular blood markers that are altered, in conjunction or distinctively, in the 3 pathological conditions is scarce. The aim of this project was to evaluate several indicators of prooxidant reactions and the membrane composition of blood samples (serum and red blood cells (RBCs)) from patients clinically classified as diabetic (n = 60), cirrhotic (n = 70), and diabetic with liver cirrhosis (n = 25) as compared to samples from a similar population of healthy individuals (n = 60). The results showed that levels of TBARS, nitrites, cysteine, and conjugated dienes in the RBC of cirrhotic patients were significantly increased. However, the coincidence of diabetes and cirrhosis partially reduced the alterations promoted by the cirrhotic condition. The amount of total phospholipids and cholesterol was greatly enhanced in the patients with both pathologies (between 60 and 200% according to the type of phospholipid) but not in the patients with only one disease. Overall, the data indicate that the cooccurrence of diabetes and cirrhosis elicits a physiopathological equilibrium that is different from the alterations typical of each individual malady.

The Co-Occurrence of Diabetes and Depression: An Example of the Worldwide Epidemic of Comorbidity of Mental and Physical Illness

The Co-Occurrence of Diabetes and Depression: An Example of the Worldwide Epidemic of Comorbidity of Mental and Physical Illness

Co-occurrence of diabetes and depression: Conceptual considerations for an emerging global health challenge

Considering the relationships between diabetes and depression may enhance programs to reduce their individual and shared disease burden. This paper discusses relationships between diabetes and depression, the range of influences on each, conceptual issues central to their definition, and interventions including comprehensive, population approaches to their prevention and management. Foundational and exemplary literature was identified by the writing team according to their areas of expertise. Diabetes and depression influence each other while sharing a broad range of biological, psychological, socioeconomic and cultural determinants. They may be viewed as: (a) distinct but sometimes comorbid entities, (b) dimensions, (c) parts of broader categories, e.g., metabolic/cardiovascular abnormalities or negative emotions, or (d) integrated so that comprehensive treatment of diabetes includes depression or negative emotions, and that of depression routinely considers possible diabetes or other chronic diseases. The choice of literature relied primarily on the authors' knowledge of the issues addressed. Some important perspectives and research may have been overlooked. Collaboration among primary care and specialist clinicians as well as program and public health managers should reflect the commonalities among diabetes, depression, and other chronic mental and physical disorders. Interventions should include integrated clinical care and self-management programs along with population approaches to prevention and management. Self management and problem solving may provide a coherent framework for integrating the diverse tasks and objectives of those living with diabetes and depression or many other varieties of multi-morbidity.

Co-occurrence of diabetes, myocardial infarction, stroke, and cancer: quantifying age patterns in the Dutch population using health survey data

BackgroundThe high prevalence of chronic diseases in Western countries implies that the presence of multiple chronic diseases within one person is common. Especially at older ages, when the likelihood of having a chronic disease increases, the co-occurrence of distinct diseases will be encountered more frequently. The aim of this study was to estimate the age-specific prevalence of multimorbidity in the general population. In particular, we investigate to what extent specific pairs of diseases cluster within people and how this deviates from what is to be expected under the assumption of the independent occurrence of diseases (i.e., sheer coincidence).MethodsWe used data from a Dutch health survey to estimate the prevalence of pairs of chronic diseases specified by age. Diseases we focused on were diabetes, myocardial infarction, stroke, and cancer. Multinomial P-splines were fitted to the data to model the relation between age and disease status (single versus two diseases). To assess to what extent co-occurrence cannot be explained by independent occurrence, we estimated observed/expected co-occurrence ratios using predictions of the fitted regression models.ResultsPrevalence increased with age for all disease pairs. For all disease pairs, prevalence at most ages was much higher than is to be expected on the basis of coincidence. Observed/expected ratios of disease combinations decreased with age.ConclusionCommon chronic diseases co-occur in one individual more frequently than is due to chance. In monitoring the occurrence of diseases among the population at large, such multimorbidity is insufficiently taken into account.

Blood pressure control, hypertension, awareness, and treatment in adults with diabetes in the United States-Mexico border region

To determine prevalence of blood pressure control, hypertension, hypertension awareness, and antihypertensive treatment among adults (> 18 years old) with diabetes living in the border region between the United States of America and Mexico, and to explore variation in those variables between all adults on the Mexican side of the border ("Mexicans") and three groups on the U.S. side of the border ("all U.S. adults," "U.S.-born Hispanics," and "Mexican immigrants"). Using data from Phase I (February 2001-October 2002) of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, age-adjusted prevalence of hypertension-related variables was calculated for the sample (n = 682) and differences between the border groups were examined through logistic regression. Less than one-third of the sample had controlled blood pressure (< 130/80 mm Hg), almost half had hypertension (≥140/90 mm Hg), and hypertension awareness and treatment were inadequate. After adjusting for demographics, body mass index, and access to health care, there were no differences in blood pressure control, hypertension, hypertension awareness, or treatment between Mexicans and both U.S. adults and Mexican immigrants. However, compared to Mexicans and Mexican immigrants, U.S.-born Hispanics, particularly younger individuals, had the lowest rates of blood pressure control (17.3%) and the highest rates of coexisting hypertension (54.8%). Compared to Mexicans, U.S.-born Hispanics had lower odds of controlled blood pressure (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.09-0.95) and greater odds of hypertension (OR 3.75, 95% CI 1.51-9.29) and hypertension awareness (OR 6.19, 95% CI 1.46-26.15). Co-occurrence of diabetes and hypertension is a major public health problem among U.S.-Mexico border residents. The low rate of blood pressure control among various border groups, especially younger U.S.-born Hispanics, suggests that initiatives should aggressively target blood pressure control.

Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

We examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year adverse clinical events. The incidence of 3-year death/non-fatal myocardial infarction was 3.5% in patients with no risk factors (neither hopelessness nor diabetes), 8.2% in patients with diabetes, 11.2% in patients with high hopelessness, and 15.9% in patients with both factors (p = 0.001). Patients with hopelessness (HR: 3.28; 95% CI: 1.49-7.23) and co-occurring diabetes and hopelessness (HR: 4.89; 95% CI: 1.86-12.85) were at increased risk of 3-year adverse clinical events compared to patients with no risk factors, whereas patients with diabetes were at a clinically relevant but not statistically significant risk (HR: 2.40; 95% CI: 0.82-7.01). These results remained, adjusting for baseline characteristics and depressive symptoms. These findings testify to the importance of identifying patients with co-occurring risk factors, as they likely require special management in clinical practice in addition to standard medical treatment.

Editorial: Clustering of Schizophrenia With Other Comorbidities--What Can We Learn?

Despite great efforts to the contrary, the molecular basis underlying schizophrenia and many other psychiatric disorders remains elusive. Examination of the nonpsychiatric manifestations that sometimes accompany schizophrenia provides opportunities to more fully explore the scope of biochemical and metabolic abnormalities characterizing the disease spectrum. This issue of the Journal features a series of articles that focus on the systemic manifestations of schizophrenia. A more complete understanding of disease spectrum can provide important insights into disease etiology. For example, pathologic analyses of atherosclerotic vascular tissue revealed the presence of immune infiltrates, thereby helping to revamp our view of coronary artery disease as an inflammatory disease.1 In the psychiatric field, nonpsychiatric dimensions to schizophrenia have been well described, including a long-recognized association between diabetes and schizophrenia.2 While intriguing, the mechanisms that underlie this association are unclear. While there is little evidence that glucose intolerance itself may increase schizophrenia risk, one possibility is that the co-occurrence of diabetes and schizophrenia could be due to shared environmental/lifestyle factors that predispose subjects to both disorders. This possibility is supported by observations that newly diagnosed and/or drug-naive schizophrenia patients have higher than expected rates of glucose intolerance and/or diabetes.3,4 Alternatively, schizophrenia could increase risk of diabetes through reduced physical activity and concomitant obesity or via insulin desensitizing or weight gain promoting effects of antipsychotic medications. There is also a possibility that a shared genetic susceptibility characterizes both diabetes and schizophrenia, as has been suggested by a small number of family studies, with limited sample sizes, showing that first-degree relatives of schizophrenia patients have higher than expected prevalence of type 2 diabetes (eg, Fernandez-Egea et al,5 Ryan and Collins,6 and Spelman et al7). If there are genes that jointly influence schizophrenia and diabetes susceptibility, what are they and what might they do? Some recent data suggest a common pathway might involve regulation of mitochondrial oxidative energy metabolism.8 However, identifying the specific genes involved is likely to be difficult. Of the 20 or so bona fide diabetes susceptibility genes identified to date,9 none have been implicated in psychiatric disease etiology. Genetic linkage studies, however, have identified some chromosomal regions in common to both disorders, including chromosome 1q21–25.10,11 This region contains a large number of genes, some with potential joint effects on both metabolic and psychiatric outcomes, such as NOS1AP (carboxy-terminal PDZ ligand of neuronal nitric oxide synthase, also known as CAPON), for which polymorphisms have been associated with schizophrenia12 and cardiac repolarization,13,14 although not yet firmly with type 2 diabetes. Whether polymorphisms in NOS1AP or in any other gene will ultimately show joint and robust association to both diabetes and schizophrenia remains to be seen, but when found, such observations could provide valuable clues to unraveling the overlap between these disorders.

Self-Reported Comorbid Conditions and Medication Usage in Breast Cancer Survivors With and Without Lymphedema

To compare the self-reported comorbid conditions and medication usage between breast cancer survivors with and without breast cancer treatment-related lymphedema. Descriptive, cross-sectional. A community-based study conducted in a major metropolitan area and surrounding rural counties in the southeastern United States. A convenience sample of 64 breast cancer survivors with lymphedema and 64 breast cancer survivors without lymphedema who were age matched within three years and recruited for a parent study. Twenty-one additional non-age-matched breast cancer survivors with or without lymphedema also were included. Self-reported survey instruments and height and weight measurement. Lymphedema, demographic information, self-reported comorbid diseases or medical issues, and medication usage. Breast cancer survivors with lymphedema experienced more comorbid conditions. Statistically significant group differences were found in body mass index, orthopedic issues, cardiac medications, hormone blockers, and osteoporosis medication or calcium supplement usage. Co-occurrence of diabetes and carpal tunnel syndrome approached statistical significance. Breast cancer survivors with lymphedema were older and had lower incomes. Comorbid conditions may influence the development of breast cancer treatment-related lymphedema. Further research, particularly a longitudinal study, is indicated. Healthcare professionals who care for breast cancer survivors need to routinely assess them for the presence of comorbid conditions and the development of lymphedema. Obese breast cancer survivors may benefit from weight reduction interventions to possibly decrease their risk of developing lymphedema and improve their overall health status. Patients with arthritis and orthopedic and cardiac issues such as hypertension may warrant careful monitoring.

Well Balanced: 8 Steps to Wellness for Adults with Mental Illness and Diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.

Diabetes and Depression: Pharmacologic Considerations

QUESTION: During the last year a large number of patients with type II diabetes have been referred from primary care providers for evaluation and treatment of major depression. I know research findings are inconsistent concerning the co-occurrence of diabetes and depression, but what are the clinical implications for treating patients with diabetes and major depression? DEBORAH ANTAI-OTONG RESPONDS: The precise relationship between diabetes and depression continues to be debated. However, most research implicates a positive correlation between depression and type II diabetes ( Anderson, Freedland, Clouse, & Lustman, 2001 ; Nichols & Brown, 2003 ). Controversy about this relationship and necessity to screen patients presenting with diabetes exists as well ( Brown, Sumit, Majumdar, & Johnson, 2006 ). Depression is widespread in patients with diabetes, but it often goes unrecognized and undertreated in primary care settings. Left untreated, depression can result in negative clinical outcomes, increased healthcare and economic burden, and a threat to overall health integrity and quality of life. Psychiatric nurses must be prepared to collaborate with primary care and other healthcare providers to screen patients with diabetes who are at risk for depression. Accurate diagnosis ensures the initiation of pharmacologic and nonpharmacologic treatments that reduce complications of both chronic diseases.

Improving Compliance With Diabetes Management in Young Adolescents With Attention-Deficit/Hyperactivity Disorder Using Behavior Therapy

Medical adherence to complex diabetes regimens can be challenging, particularly for adolescents, and therefore represents the most common reason for referral to behavioral psychologists among this population. Attention-deficit/hyperactivity disorder (ADHD), when present in children and adolescents with diabetes, presents unique barriers to compliance with diabetes management. Existing research on the co-occurrence of diabetes and ADHD is reviewed, and a framework is presented in which evidence-based behavioral treatments for ADHD may be applied to target diabetes management for this population. Case illustrations of two young adolescents with co-occurring diabetes and ADHD are offered, in which evidence-based ADHD treatments were successful in increasing medical compliance. Recommendations for larger clinical trials with this population are made.