Degree Of Metabolic Control Research Articles

Smernice za perioperativno lečenje dece sa dijabetes melitusom

Diabetes mellitus is a chronic and insidious disease that can occur at all ages, including childhood. The disease, its diagnosis, treatment, and complications have certain specificities in children compared to adults with the same condition. Less frequently than in adults, diabetes mellitus can be a comorbidity in pediatric surgical patients. Less frequently than in adults, diabetes mellitus can be a comorbidity in pediatric surgical patients. Perioperative metabolic stress occurs as a result of changes in routine diabetes management, emotional stress and anxiety, the surgical condition, and the type of surgical procedure. The perioperative management of children with diabetes depends on preoperative therapeutic regimens (insulin vs oral hypoglycemics), the complexity of the surgical intervention, and the duration of preoperative and postoperative fasting. A thorough understanding of the disease from all aspects (type of diabetes, type of therapy, degree of metabolic control, chronic complications) is crucial for preoperative preparation or making decisions about postponing elective surgery or urgent treatment to prepare for emergency surgery. It has been proven that the use of evidence based protocols for the perioperative management of children with diabetes in various medical situations results in better treatment outcomes. However, acute perioperative complications such as ketoacidosis, hyperglycemic hyperosmolar states, and hypo/hyperglycemia can still occur. Therefore, increased caution is necessary when dealing with pediatric surgical patients with diabetes mellitus.

Prospective study of depressive symptoms and incident cardiovascular diseases in people with type 2 diabetes

BackgroundTo prospectively examine whether depressive symptoms were associated with higher risks of incident cardiovascular diseases (CVD) in individuals with type 2 diabetes. MethodsIncluded were 17,031 participants from UK Biobank with type 2 diabetes who were free of depression (identified by self-reported medical history, hospital record, and antidepressant use), and composite CVD, including atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Cox proportional hazards models were applied to examine the association between depressive symptoms measured by Patient Health Questionaire-2 (PHQ-2) and incident composite CVD and its subtypes, adjusting for potential confounders. ResultsDuring a median follow-up of 12.3 years, we documented 2875 incident composite CVD cases (including 1303 coronary artery disease, 531 ischemic stroke, 530 peripheral arterial disease, and 1142 HF cases). The presence of depressive symptoms had higher risks of composite CVD (adjusted HR, 1.34; 95 % CI, 1.17–1.54) among individuals with type 2 diabetes. Dose-response relationships were observed between depressive symptoms and the composite CVD, ASCVD, and three individual CVD outcomes (P-trend <0.05 for all). ConclusionsDepressive symptoms were associated with a higher risk of CVD events across all degrees of metabolic control and diabetes severity. Dose-response associations were also found between depressive symptoms score and all incident CVD outcomes, except for ischemic stroke, after adjustment for cardiovascular and diabetes-related risk factors. Therefore, simple screening questions regarding depressive symptoms might be applied to people with type 2 diabetes to predict CVD outcomes.

Bioleptin as a useful marker of metabolic status in children with diabetes mellitus type 1.

The purpose of our study was tomeasure the level of leptin and biologically active leptin (bioLEP) in children with type 1 diabetes, depending on the duration of diabetes and its degree of metabolic control. The study included 94 children (58 boys and 36 girls). In a group of children with diabetes, 40 patients were newly diagnosed with type 1 diabetes, 40 children who have diabetes for more than a year (20 with good metabolic control and 20 with poor metabolic control). The control group consisted of 14 healthy children. The serum level of leptin and bioLEP was measured using a sandwich enzyme-linked immunosorbent assay. To our knowledge, this is the first study to describe bioLEP levels among diabetic children with different forms of disease control. Lower levels of leptin were found in children with diabetes compared to healthy children. Furthermore, we found a statistically higher concentration of leptin in the group of children with newly diagnosed diabetes compared to children from the diabetic group with poor metabolic control and lower than healthy children (11.19 vs. 7.84 and 20.94 ng/mL). Moreover, children in the metabolically well-controlled group had statistically lower levels of this hormone (5.11 ng/mL) than healthy children. Leptin concentrations differed significantly between underweight, overweight, and obese children. In our study, the level of bioLEP differed significantly between children in the newly diagnosed diabetes group and children in the long-term, poorly controlled diabetes group and healthy controls. Despite many studies published in recent years, many aspects of leptin secretion, action, and mechanisms of its influence on carbohydrate and fat metabolism are still to be clarified. In our opinion, studies evaluating the status of bioLEP in diabetes can also contribute to a better understanding of the mechanisms regulating metabolism.

Psychometric properties of a questionnaire to measure adherence to treatment in patients with type 1 diabetes mellitus.

AimTo validate the psychometric properties of a questionnaire to measure adherence to treatment among people with type 1 diabetes mellitus and to evaluate its relationship with metabolic control.DesignA cross‐sectional study of 167 adult people with type 1 diabetes mellitus recruited from the Endocrinology Service of University Hospital Doctor Peset (Spain).MethodsThe validity of the content, construct and reliability of the instrument were evaluated and the results correlated with levels of glycosylated haemoglobin.ResultsThe questionnaire was composed of 25 items and 5 dimensions, with a score of 25–150 points and an internal consistency of 0.92, according to Cronbach's coefficient α. The content of validity ratio and the construct (exploratory functional analysis, Kaiser–Meyer–Olkin index and Barlett's spherical test) were adequate. We observed a significant correlation between glycosylated haemoglobin levels and treatment adherence.ConclusionThe questionnaire to measure adherence to treatment in type 1 diabetes mellitus is consistent, reliable and valid, showing an excellent association with degree of metabolic control.

Specific model for the coordination of primary and hospital care for patients with diabetes mellitus. Evaluation of two-year results (2015–2017)

IntroductionDiabetes mellitus (DM) is one of the most prevalent chronicdiseases and has a significant health and social impact. Strict control of blood glucose levels and other risk factors for vascular disease (VD) reduces complications and mortality and is related to the quality of care received. Although care should be interdisciplinary, based on the coordination of primary care (PC) and hospital care (HC), little information is available on the effectiveness of the different existing intervention models. ObjectiveTo assess, in a population with DM from a healthcare area, the impact on health, quality of care, and effectiveness in the use of resources of a specific model of shared management of patients with DM (Instrument for Evaluation of Models of Chronic Care in Diabetes Mellitus; IEMAC-DM). Patients and methodsA quasi-experimental before-after intervention study in patients with DM in the Cádiz-San Fernando Healthcare Area (Andalusia, Spain) that allows for identifying the capacity of the program to improve the quality indicators both in the whole population with DM and in that referred to HC. For this, a working group consisting of healthcare professionals of different profiles and care levels was set up. An initial self-assessment was done using the IEMAC-DM tool and, after analysis of the preliminary results, improvement strategies were established and implemented. Finally, the clinical and resource management results were assessed before and two years after the implementation of the model. ResultsDuring the study period, no significant changes were seen in process indicators related to laboratory practices or examinations in the health area. The proportion of patients with acceptable metabolic control [glycosylated hemoglobin (HbA1c) level < 8%] was 49% in 2015 and 45% in 2017. The number of admissions related to acute myocardial infarction (AMI) and stroke remained constant, but there was an increase in the standardized ratio of major lower limb amputations (1.5 vs. 1.9). Of the 295 patients referred from PC to HC, the proportion of adequate referrals increased from 40% in 2015 to 76% in 2017 (P = .001). In the referred patients, a significant improvement was seen in the mean difference in glycosylated hemoglobin levels (HbA1c; 1.14 ± 1.73%; 95% CI: 0.73–1.55; P = .0001) and cholesterol (11.28 ± 40 mg/dL; 95% CI: 2.07–20.48; P = .012). ConclusionsThis study shows that an intervention based on a chronicity care model adapted to patients with DM improves certain aspects related to the quality of care and the degree of metabolic control. Improving health outcomes will require long-term evaluation and, probably, other additional interventions.

Ophthalmologic disorders in adolescents with type 1 diabetes

Chronic complications of diabetes, including damage to the eye, are seen in patients with type 2 diabetes often soon after diagnosis. This type of diabetes is often diagnosed after a long period of unrecognized and untreated disease. Type 1 diabetes is one of the most common metabolic diseases diagnosed in children, and is associated with the risk of developing multiple chronic complications. Diabetic eye disease can be associated with abnormalities in various eye structures. It should be remembered that early changes in the organ of vision may not give clear clinical symptoms. Their detection requires the use of modern diagnostic methods, which also allow early detection of changes that threaten damage to the eye. The degree of metabolic control, the presence of dyslipidemia, as well as micro- and macroangiopathy affect the development of chronic complications, including changes in the eye. Damage to small blood vessels leads to changes in retinal perfusion and to macular edema. As a result of these changes, diabetic retinopathy develops. Early diagnosis of the above complications allows prevention of their development.

Assessment of pulmonary function by impulse oscillometry and spirometry in children with type 1 diabetes mellitus.

To assess the lung functions with impulse oscillometry (IOS) and spirometry in children with type 1 diabetes mellitus (T1DM). Fifty-one children with T1DM, and sex- and age-matched 53 healthy control (HC) subjects were included in this study. Demographic, clinical, and laboratory characteristics of the subjects were recorded and their pulmonary functions were analyzed by IOS and spirometry. In IOS, zR5, zR10, and zR20 levels were higher in children with T1DM compared with HCs (P = .019, P = .017, and P = .002, respectively). In spirometry, zFEF75 and zFEF25-75 were lower in children with T1DM compared with HCs (P = .025, P = .001, respectively). In IOS, zR5-20 (P = .008, P = .005, respectively) and zAX (P = .013, P = .009, respectively) were significantly lower in good-controlled group compared with moderate- and poor-controlled group. In spirometry, zFEF25-75 was significantly higher in good-controlled group compared with moderate- and poor-controlled group (P = .005, P = .009, respectively). HbA1c was positively correlated with zR5-20 value (r = .339; P = .017) in male children with T1DM. The duration of the disease was positively correlated with zR5-20 (r = .290; P = .043) and zFres (r = .358; P = .010). According to the receiver operating characteristic curve analysis to estimate optimal cut-offs to discriminate good control level of T1DM (HbA1c < 7%), a zR5-20 ≤ 2.28 demonstrated a 75.0% sensitivity and 82.9% specificity, with an area under the curve of 0.805 ([confidence interval, 0.615-0.995]; P = .007). This study showed subclinical impairment of lung functions which is associated with disease duration and the degree of metabolic control in children with T1DM.

Effect of Type 2 Diabetes Mellitus on the Hypoxia-Inducible Factor 1-Alpha Expression. Is There a Relationship with the Clock Genes?

Limited reports exist on the relationships between regulation of oxygen homeostasis and circadian clock genes in type 2 diabetes. We examined whether the expression of Hypoxia-Inducible Factor-1α (HIF-1α) and HIF-2α relates to changes in the expression of clock genes (Period homolog proteins (PER)1, PER2, PER3, Retinoid-related orphan receptor alpha (RORA), Aryl hydrocarbon receptor nuclear translocator-like protein 1 (ARNTL), Circadian locomotor output cycles kaput (CLOCK), and Cryptochrome proteins (CRY) 1 and CRY2) in patients with type 2 diabetes. A total of 129 subjects were evaluated in this cross-sectional study (48% with diabetes). The gene expression was measured by polymerase chain reaction. The lactate and pyruvate levels were used as surrogate of the hypoxia induced anaerobic glycolysis activity. Patients with diabetes showed an increased plasma concentration of both lactate (2102.1 ± 688.2 vs. 1730.4 ± 694.4 uM/L, p = 0.013) and pyruvate (61.9 ± 25.6 vs. 50.3 ± 23.1 uM/L, p = 0.026) in comparison to controls. However, this finding was accompanied by a blunted HIF-1α expression (1.1 (0.2 to 5.0) vs. 1.7 (0.4 to 9.2) arbitrary units (AU), p ≤ 0.001). Patients with diabetes also showed a significant reduction of all assessed clock genes’ expression. Univariate analysis showed that HIF-1α and almost all clock genes were significantly and negatively correlated with HbA1c concentration. In addition, positive correlations between HIF-1α and the clock genes were observed. The stepwise multivariate regression analysis showed that HbA1c and clock genes independently predicted the expression of HIF-1α. Type 2 diabetes modifies the expression of HIF-1α and clock genes, which correlates with the degree of metabolic control.

Modelo específico de coordinación entre atención primaria y hospitalaria para la atención a pacientes con diabetes mellitus. Evaluación de resultados a dos años (2015-2017)

IntroductionDiabetes mellitus (DM) is one of the most prevalent chronic diseases and has a significant health and social impact. Strict control of blood glucose levels and other risk factors for vascular disease reduces complications and mortality and is related to the quality of care received. Although care should be interdisciplinary, based on the coordination of primary care (PC) and hospital care (HC), little information is available on the effectiveness of the different existing intervention models. ObjectiveTo assess, in a population with DM from a healthcare area, the impact on health, quality of care, and effectiveness in the use of resources of a specific model of shared management of patients with DM (Instrument for Evaluation of Models of Chronic Care in Diabetes Mellitus; IEMAC-DM). Patients and methodsA quasi-experimental before-after intervention study in patients with DM in the Cádiz-San Fernando Healthcare Area (Andalusia, Spain) that allows for identifying the capacity of the program to improve the quality indicators both in the whole population with DM and in that referred to HC. For this, a working group consisting of healthcare professionals of different profiles and care levels was set up. An initial self-assessment was done using the IEMAC-DM tool and, after analysis of the preliminary results, improvement strategies were established and implemented. Finally, the clinical and resource management results were assessed before and two years after the implementation of the model. ResultsDuring the study period, no significant changes were seen in process indicators related to laboratory practices or examinations in the health area. The proportion of patients with acceptable metabolic control [glycosylated hemoglobin (HbA1c) level<8%] was 49% in 2015 and 45% in 2017. The number of admissions related to acute myocardial infarction and stroke remained constant, but there was an increase in the standardized ratio of major lower limb amputations (1.5 vs. 1.9). Of the 295 patients referred from PC to HC, the proportion of adequate referrals increased from 40% in 2015 to 76% in 2017 (p=0.001). In the referred patients, a significant improvement was seen in the mean difference in glycosylated hemoglobin levels (HbA1c; 1.14±1.73%; 95% CI: 0.73-1.55; p=0.0001) and cholesterol (11.28±40mg/dL; 95% CI: 2.07-20.48; p=0.012). ConclusionsThis study shows that an intervention based on a chronicity care model adapted to patients with DM improves certain aspects related to the quality of care and the degree of metabolic control. Improving health outcomes will require long-term evaluation and, probably, other additional interventions.

Body Fat Percentage Rather than Body Mass Index Related to the High Occurrence of Type 2 Diabetes

Diabetes prevalence estimation and reduction of its risk factors remain the major goals of health services. While obesity is the major risk factor for diabetes, body fat distribution may be a better predictor. To estimate the prevalence of diabetes in an adult working population in Mexico City, and to evaluate the strength of association with different risk factors. A cross-sectional survey was conducted in two city halls of Mexico City. Anthropometrics, blood pressure, physical activity, diet, and biochemical parameters were assessed. Diabetes was defined as a fasting plasma glucose level ≥7.0mmol/l or referred diabetes. The bioelectrical impedance analysis of body components was performed and weight, soft lean mass, body fat percentage and abdominal fat were obtained. Prevalence with 95% confidence intervals was estimated, as well as odds ratios derived from a logistic regression model. The prevalence of type 2 diabetes was 11.0% (95% CI 9.6-12.4%). The proportion of individuals with diabetes who were unaware of having the disease was higher in women (42.5 vs. 36.9%), and the degree of metabolic control was better in women (39.1 vs. 25.0%). Age, blood pressure, triglycerides and the percentage of body fat, were major risk factors related to the occurrence of type 2 diabetes. No relation was observed with physical activity and diet. The prevalence of type 2 diabetes in Mexico continues to be high and obesity measured by body fat percentage seems to be a better predictor of its occurrence than body mass index.

Diabetes Knowledge and its relationship with metabolic control and comorbidities in type 2 diabetes patients

Background: Education in diabetes patients is key in the intervention to avoid complications and develop new and better habits. It is necessary to know the relationship between the current diabetes knowledge of these patients with their metabolic control and the presence of comorbidities. Objective: To evaluate the diabetes knowledge and its probable association with their metabolic control and comorbidities in type 2 diabetes patients. Methods: A validated questionnaire (Diabetes Knowledge Questionnaire, DKQ) was applied to 134 patients who attended a nutrition consultation at the UMF7-IMSS. Their sociodemographic data, metabolic parameters and presence of comorbidities were determined. Results: 89 patients were women (66.4%). The mean age was 53 years; body weight 75.5 kg (95% CI: 72.8-78.3); glucose 201.2 mg/dL (95% CI: 187-215); cholesterol 205 mg/dL (95% CI: 190.8-219.1); triglycerides 260.7 mg/dL (95% CI: 240.3-281.1). The level of diabetes knowledge is low, a negative relationship was found between age and the number of right answers in the DKQ. High level of general metabolic alterations was found in most of the subjects studied; an increase in the number of comorbidities was observed as glucose levels increased. In the present study, no correlation was found between the level of knowledge in diabetes and the degree of metabolic control. Conclusion: Although patients know the consequences of their disease status, they have difficulty identifying key aspects to prevent complications and promote adequate metabolic control. This work identifies the need to develop studies on effective educational strategies to minimize knowledge gaps about this condition.

Micro-RNAs 518d-3p and 618 Are Upregulated in Individuals With Type 1 Diabetes With Multiple Microvascular Complications.

Objective: To compare the serum micro-RNAs (miRNAs) profile of individuals with type 1 diabetes without microvascular complications vs. those with multiple severe microvascular complications, in order to identify epigenetically modulated pathways in these two groups of individuals.Research Design and Methods: A total of 10 subjects were selected among individuals followed in the Diabetes Outpatient Clinic and sorted according to the absence or presence of all microvascular complications. Samples from these participants were used for evaluation of serum miRNA expression profile employing a qRT-PCR assay with hydrolysis probes based on the Taqman Low Density Arrays (TLDA) system. The top six most differentially expressed miRNAs between the aforementioned groups were validated by qRT-PCR in additional 47 type 1 diabetes individuals sorted according to the absence or presence of all microvascular complications and matched for age, sex, degree of metabolic control, diabetes duration, and age at diagnosis.Results: Twenty one out of three hundred and seventy seven miRNAs were upregulated in the group of individuals with all microvascular complications vs. the group without complications. The following miRs were validated: 518-3p, 34a-5p, 126-5p, 425-5p, 618, and 139-5p and logistic regression analyses showed that miRNA-518-3p and miRNA-618 were positively associated with multiple microvascular complications after adjustment for age, sex, diabetes duration, HbA1c and use of statin, angiotensin-converting enzyme inhibitors and amlodipine.Conclusions: In this cohort of type 1 diabetes individuals, serum miR-518d-3p and miR-618 were upregulated in those with diabetes kidney disease, diabetes retinopathy, peripheral neuropathy, and cardiovascular autonomic neuropathy in comparison to individuals with no microvascular complications.

376-P: Type 2 Diabetes Individuals Are at High Risk of Continuous Glucose Monitoring Detected Hypoglycemia Regardless of Degree of Metabolic Control

Type 2 diabetes patients, especially those with poor metabolic control or treated with oral hypoglycemic agents (OHA) only are often regarded as being at lower risk of hypoglycemia than type 1 diabetes subjects. We used continuous glucose monitoring system (CGMS) in 69 type 2 diabetes individuals (mean [±SD] age 63±9 years, duration of diabetes 12±7 years, BMI 31.8±5.2 kg/m2, HbA1c 8.4±0.7%, 74% treated with insulin ± OHA, 26% - treated with OHA only, including sulfonylureas) to assess the hypoglycemia prevalence. Each patient underwent blinded CGMS (iPro2, Medtronic) for 5.8±0.8 days, duration of the time spent at blood glucose (BG) &amp;lt;70 mg/dl was determined and expressed as a percentage of total CGMS use time (T hypo). Clinically statistical hypoglycemia (CSH) episodes defined as BG &amp;lt;54 mg/dl lasting &amp;gt;15 minutes were also recorded. Overall, hypoglycemia was detected in 28 (40.6%) patients, including five treated with OHA only. T hypo ranged from 1 to 15% (6.1±4.7%), and was twice as long in insulin treated individuals than in those on OHA only (8.8±5.1 vs. 4.2±3.6; p&amp;lt;0.05). 57% of all patients experiencing hypoglycemia (including two treated with OHA only) had at least one episode of nocturnal CSH, with BG as low as 40 mg/dl, and none was symptomatic. To assess the relationship between hypoglycemia risk and degree of metabolic control the study subjects were divided into two subgroups: with good (n=29; HbA1c 7.2±0.6, range 6-8%) and poor (n=40; HbA1c 9.6±0.8, range 9-12%) metabolic control. Hypoglycemia was recorded in 37.9 and 42.5%, nocturnal hypoglycemia - in 54.5 and 58.8% of subjects from each group, and T hypo was 6.7±4.9 and 5.7±4.6%, respectively (p&amp;gt;0.05). In conclusion, 40% of type 2 diabetes individuals experience hypoglycemia when assessed with CGMS for 5-6 days, with majority having asymptomatic nighttime events. Importantly, the high prevalence of CGMS detected hypoglycemia was not related to the degree of metabolic control of diabetes. Disclosure E. Szymanska-Garbacz: None. A. Borkowska: None. L. Czupryniak: None.

The correlation of peripheral neuropathy in children suffering from Type 1 diabetes Mellitus (IDDM) with duration of disease and degree of metabolic control by means of electrophysiological methods

The correlation of peripheral neuropathy in children suffering from Type 1 diabetes Mellitus (IDDM) with duration of disease and degree of metabolic control by means of electrophysiological methods

Variability of glycemia and cognitive impairment in patients with diabetes mellitus type 1.

Diabetes mellitus type 1 is associated with impaired cognitive function. Based on the results of systematic reviews and meta-analyzes, the most likely modifiable risk factor is the degree of metabolic control, in particular the variability of glycemia. Aims: to determine the influence of the variability of glycemia on cognitive functions in patients with type 1 diabetes mellitus. Material and methods. Design-observational, one-stage, cross-sectional research. We examined 30 patients with type 1 diabetes mellitus who were divided into 2 groups: 1 group (main) with cognitive impairment, and 2 (control) with normal cognitive functions. All patients were screened for cognitive functions using the Montreal scale (MoCa test). For the diagnosis of fluctuations in glucose level, continuous monitoring of glycemia was carried out using the iPro-2 device (Medtronic, USA): mean glycemic mean (MEAN), standard deviation (SD), mean amplitude of glycemic fluctuation (MAGE), long-term glycemic index (CONGA) Glycemia lability index (LI), hypoglycemia risk index (LBGI), hyperglycemia risk index (HBGI), mean hourly rate of glycemic change (MAG). Results. The study revealed that in patients with type 1 diabetes mellitus, cognitive impairment was dominated by a violation of constructive praxis, memory and attention. Recorded a significant difference in MEAN, SD, CONGA, Gindex, LBGI, HBGI, MAGE, Mvalue and MAG. Correlation analysis revealed the relationship of cognitive impairments with the level of HbA1c, as well as the variability parameters MEAN, SD, CONGA, Gindex, LBGI, HBGI, MAGE, Mvalue, MAG. Conclusions. The relationship between the variability of glycemia and cognitive impairment was registered in patients with type 1 diabetes mellitus

Predictors of renal complications in pediatric patients with type 1 diabetes mellitus: A prospective cohort study

AimsDiabetic Nephropathy (DN) is rarely encountered in childhood, otherwise early subclinical abnormalities are detectable few years after diabetes diagnosis. Our aim was to evaluate the incidence rate of microalbuminuria in childhood onset type 1 diabetes (DM1) patients. Secondary aim was to examine which variables could influence the development of DN. MethodsWe longitudinally evaluated 137 young patients with DM1 from diagnosis (1994–2004) for a median of 11.8 years (1st–3rd q: 9.7–15.0). Overnight albumin excretion rate, degree of metabolic control, presence of microangiopathic complications and autoimmune co-morbidities were retrospectively collected. ResultsDN was observed in 16/137 cases (11.7%), with an incidence rate of 10.0 per 1000 person-years. Young T1D patients with persistent micro/macro-albuminuria were more likely to have higher HbA1c concentrations over the last four years (P = 0.04), and were more likely to have retinopathy (P = 0.011) and subclinical peripheral neuropathy (P = 0.003). ConclusionsDN predictors were age at DM1 diagnosis and mean HbA1c levels. Even if DN incidence is lower than reported, periodical screening is mandatory. Moreover, borderline microalbuminuria as additional risk factor deserves attention.

Evaluation of Coagulation Profile in Children with Type 1 Diabetes Mellitus Using Rotational Thromboelastometry.

The prothrombotic state in type 1 diabetes mellitus (T1DM) has been reported as a plausible cause of vascular complications. Rotational thromboelastometry (ROTEM) assay enables the global assessment of coagulation status. This study aimed to assess hypercoagulability in children with T1DM using ROTEM. A total of 43 T1DM children (20 females and 23 males) aged 2-18years and age- and sex-matched 30 healthy control subjects were enrolled in the study group. ROTEM assays [intrinsic TEM (INTEM) and extrinsic TEM (EXTEM)] were used to measure and analyze coagulation time (CT), clot formation time, maximum clot firmness (MCF). Glycated hemoglobin levels (HbA1c), diabetic complications, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and dimerized plasmin fragment D (D-dimer) were determined in the study group. The mean duration of T1DM diagnosis was 3.15±2.49years, and the mean HbA1c level was 8.94±1.88% (74.29±20.59mmol/mol). None of the patients had macrovascular complications. Nephropathy was present in five patients. In the T1DM group, EXTEM-CT [80.00 (66.75-108.50)] was significantly lower, and EXTEM-MCF [65.00 (64.00-70.00)] and INTEM-MCF [65.00 (62.00-68.00)] were significantly higher than in the controls (p<0.001, p=0.026, and p=0.004, respectively). However, the duration of T1DM and the degree of metabolic control had no influence on these parameters. Platelet count, PT, aPTT, fibrinogen and D-dimer levels were comparable between the diabetic patients and the control group. There were statistically significant correlations between fibrinogen level and INTEM-MCF and EXTEM-MCF (p<0.001, p=0.002 and r=0.545, r=0.454, respectively) This study shows that decreased levels of CT and increased levels of MCF suggest hypercoagulability in patients with T1DM. Further studies are needed to confirm our findings on a larger number of diabetic patients.

Neurocognitive consequences of diabetes.

Mild cognitive dysfunction is a well-established complication of diabetes and its management, although large numbers of psychologists and health professionals may be unaware of its existence, clinical implications, and etiology. Drawing on results from key studies, systematic reviews, and meta-analyses, this article delineates the neurocognitive phenotypes characteristic of Type 1 diabetes (T1D) and Type 2 diabetes (T2D), and identifies the most plausible risk factors, both those that may be modifiable, like degree of metabolic control, and those that cannot be changed, like the age when a child or adult is diagnosed. Most children and adults with T1D typically manifest lower scores on measures of intelligence and academic achievement, attention, psychomotor speed, and executive functions. These effects are especially pronounced in those who develop diabetes early in life, before the age of 6 or 7 years. Chronically elevated blood glucose values increase the risk of both cognitive dysfunction and microstructural changes in white matter tracts. Adults with T2D manifest cognitive dysfunction characterized by poorer performance on tasks requiring attention, psychomotor speed, planning and executive functions, and learning and memory. They are also at increased risk of developing dementia. Poorer metabolic control accelerates the rate of cognitive decline over time, and research suggests that improving metabolic control may slow the rate of decline. Psychologists and behavioral scientists can play a key role in preventing the onset of cognitive complications or in ameliorating their severity by implementing behavioral strategies known to increase adherence to medical regimens and improve metabolic control. (PsycINFO Database Record

Assessment of Nerve Conduction Study and Electroencephalogram Abnormalities in Type 2 Diabetes Mellitus

Abstract Background and aims: This study aims to evaluate the electroencephalographic and nerve conduction changes in type 2 diabetes mellitus (T2DM) patients with and without peripheral neuropathy (DPN) and to investigate the relationship with other variables such as age, gender, duration of the diabetes and the degree of metabolic control. Materials and methods: This was a cross-sectional study, including 100 patients with T2DM and 100 control subjects, aged 34 to 77 years. All patients enrolled in the study were subjected to full assessment, including: history, biochemical and electrophysiological tests. Results: The study found that patients with diabetic peripheral neuropathy (DPN) in comparison to patients without DPN and control subjects were older, had longer duration of diabetes and poorer glycemic control reflected by fasting blood glucose and glycated hemoglobin. The electrophysiological findings showed that patients with DPN have significant differences in nerve conduction study (NCS) parameters when compared to patients without DPN and control subjects in the form of axonal degeneration and demyelination. They also had abnormalities of the electroencephalogram (EEG) which are correlated with nerve conduction study severity. Conclusion: Routine NCS is an important method for evaluating DPN. Investigating sensory nerves of lower limbs is helpful in discovering the early stages of DPN when other tested nerves are normal. The F-wave can be used as a sensitive indicator for the early diagnosis of DPN and it can help to detect the subclinical lesions. EEG examination in diabetic patients with severe DPN is important in showing the defect in the central nervous system.

Differences in dental caries experience between diabetic adolescents and healthy controls

Introduction: While the influence of type 1 diabetes mellitus (T1DM) on periodontal health is well established, results of previous studies regarding the association of this metabolic disease and caries experience are rather inconsistent. The aim of this study was to assess the differences between caries status of healthy and adolescents with T1DM, as well as to determine the differences in caries experience among diabetic patients in relation to their metabolic control.Methods: Assessment of caries status was performed using the DMFT index (decayed, missing, and filled teeth). The study group (Diabetic) included 60 patients diagnosed with T1DM, aged 12-18 years, from Sarajevo Canton. This group was divided into two sub-groups: a sub-group Diabetic-W consisted of 30 patients with well-controlled glycaemia, while a subgroup Diabetic-P comprised of 30 patients with poorer glycemic control. The control group consisted of 30 age-matched metabolically healthy individuals.Results: The T1DM adolescents had a significantly higher (p &lt; 0.01) mean DMFT score than the healthy subjects, 11.49 and 6.19 respectively. Statistically, the diabetic group had also significantly higher values of the D and M components. Concerning the metabolic control, mean DMFT score in the Diabetic-W subgroup was lower (10.57) than in the Diabetic-P subgroup (12.39), however the difference was not statistically significant.Conclusions: The results demonstrate that the T1DM patients have a higher caries experience, regardless of the degree of metabolic control. The level of untreated dental decay and missing teeth components among the diabetic adolescents indicates irregular dental attendance.