Diabetes Mellitus Outpatients Research Articles

ECONOMIC IMPACT OF COUNSELING ON THE MANAGEMENT OF PATIENTS WITH TYPE 2 DIABETES MELLITUS ADMITTED TO A HOSPITAL

Objective: The objective of the study was to study the impact of counseling on costs and effectiveness of type 2 diabetes mellitus (T2DM) outpatients in An-Nisa Hospital, Tangerang, Indonesia, period July 2016 to November 2016.Methods: This 4-month prospective quasi-experimental study was undertaken to analyzed the impact of counseling on cost and effectiveness in the treatment of patients with T2DM (n=30). The cost analysis was conducted from the perspective of Badan Penyelenggara Jaminan Sosial abbreviated as BPJS (Social Security Management Agency abbreviated as SSMA). Characteristics of the patients were analyzed using the Chi-Square method. Cost-effectiveness was analyzed by calculating cost-effectiveness ratio (CER) and Incremental CER (ICER) in groups with and without counseling.Results: The study indicated that most (70%) of the patients were female with ages: >45, 83.3%; ≤45, 16.7%. It was found that CER in groups: Without counseling, Rp4,111,785; with counseling, Rp582,875. ICER was Rp67,416.Conclusion: This study proved that counseling improved the outcome on the treatment of patients with T2DM.

Higher Vegetable Intake Improved Blood Glucose Level in Vietnamese With Type 2 Diabetes Mellitus

Background: BMIs of Vietnamese type 2 diabetes mellitus (DM) are within the normal range. We felt that the crucial factor in DM is not obesity but rather low intake of vegetables and fiber (transition nutrition). Fiber has effect on controlling blood glucose. The main source of fiber in Vietnamese cuisine is vegetables but consumption is very low. In this study, we tried to increase vegetable and fiber intakes by using dressing and mayonnaise which are new foods in Vietnamand assessed their effects on blood glucose concentrations. Methods: We contacted 300 subjects from 2,000 DM outpatients at a hospital and selected 60 of them for the study. We made 30 pairs matched by sex, age, BMI and years of DM, and divided them randomly into intervention and control group. Both groups received basic nutrition education about vegetables. The intervention group was further instructed to use dressing and mayonnaise. At the baseline and final periods, anthropometric measurements, blood withdrawal and a 3-day weighing method nutrition survey were conducted. Results: From our daily contact, we think that vegetable intakes were 300g and 450g in the control and intervention group, respectively were maintained throughout the whole period. The fructosamine concentration in the intervention group had decreased significantly (P<0.05) but not in the control group (P>0.05). There was a negative correlation between vegetable intake and blood fructosamine levels. Conclusion: By using dressing and mayonnaise for 2 weeks, vegetable and fiber intakes were consumed about 450g and 12g a day respectively and fructosamine levels dropped.

Relationship of therapeutic outcome with quality of life on type 2 diabetes mellitus patients in Abdul Azis Singkawang hospital

Diabetes is one of the diseases that required long treatment. Therapeutic outcome is one of the important factors that affect the quality of life. The purpose of this research is to know the effect of therapeutic result on quality of life in Abdul Azis Singkawang hospital. This study used Cross-sectional design. The inclusion criteria for this study was patients with type 2 diabetes mellitus (T2DM) outpatients over 18 years with ICD code X E.11. This study used the EQ-5D to measure patient's quality of life. We recruited 86 T2DM patients who met the inclusion criteria and were dominated by female respondents around 57%. The average value of quality of life EQ-5D was the index value 0.75±0.22 and visual analog scale 74.02±11.80. The result of the analysis showed that there was significant relationship between income and quality of life (p=0.001) and there was significant correlation between 2-hour PG and quality of life (p=0.037). The conclusion of this study was the therapeutic outcome affect the quality of life in 2-h PG, where the higher 2-h PG showed the low quality of life.

Influence of Patient Characteristics on The Type of Insulin Therapy Obtained by Diabetes Type 2 Outpatient in Denpasar Municipality

This study aims to investigate the influence of patient characteristics on the choice of insulin therapy in type 2 diabetes mellitus outpatients in Denpasar municipality. This is a descriptive analysis study using the patient's medical records as research material. Patients who meet inclusion and exclusion criteria are being recorded based on their medical records. Characteristics that are taken are age, gender, fasting blood glucose level (FBG), 2-hour postprandial blood glucose level (2-hours PPG) and HbA1c values of patients. Types of insulin therapy gained from patient medical records and drug use report in pharmacy. Characteristics data and type of insulin analyzed using correlation test to determine the effect of the patient characteristics on the selection of insulin therapy. 43 patients became the research subject. Males gendered patients (72.09%) and the patients aged less than 65 years (90.70%) are the dominant characteristics of the research subjects. The average value of FBG of patients is 212 mg / dL; 2-hours PPG 280 mg / dL and HbA1c 10.1%. There is a correlation between sex, age, HbA1c value and FBG with the type of insulin obtained by patients (p &lt;0.05). Based on the results of statistical tests, age and gender have a strong correlation on insulin choice, HbA1c and FBG level has a moderate influence and 2-hours PPG have a weak correlation. Patient characteristics had an influence on the type of insulin choice for diabetes mellitus type 2 outpatient in the Denpasar municipality.

Risk factors and complications in type 2 diabetes outpatients

Our study investigated type 2 diabetes mellitus (T2DM) outpatients attending a university hospital in Montes Claros, MG, to estimate the prevalence of risk factors and their association with diabetes complications. This was a quantitative, documental, retrospective and analytical study. Medical records of 95 outpatients with T2DM treated in this hospital from 2011 to 2015 were analyzed. Data were collected according to a structured questionnaire surveying sociodemographic, anthropometric and biochemical data and clinical and lifestyle aspects. Regression analysis was used to evaluate the association between risk factor variables and complications. With a mean age of 54 years, the study population showed irregular blood glucose control, despite the use of hypoglycemic medication, and did not have a healthy lifestyle. The main complication reported was high blood pressure (HBP), occurring in 70.9% of patients. The prevalence of complications was positively associated with patients receiving insulin treatment (p=0.042) and multidisciplinary monitoring (p=0.050). The associations identified reflect the condition of patients that were already treating diabetes and its complications, especially HBP. The characteristics of the study population indicate the need to improve clinical follow-up and increase motivation for healthy behaviors.

Translation, Revision, and Validation of the Diabetes Distress Scale for Indonesian Type 2 Diabetic Outpatients with Various Types of Complications

ObjectivesTo translate, revise, and validate the Diabetes Distress Scale (DDS) instrument for Indonesian type 2 diabetes mellitus (T2DM) outpatients with various complications. MethodsParticipants were recruited from four hospitals and two primary health care centers. The study was performed with forward and backward translations, an adaptation testing with a small subset of participants, and validation analysis. Factor analysis with maximum likelihood estimation and promax rotation was then used to investigate the instrument structure. Internal consistency among the items was estimated using Cronbach α for each domain of the DDS. ResultsIn total, 324 participants (246 from the hospitals and 78 from the primary health care centers) were involved in this study. To improve participant comprehension of the exact meaning of questions, examples of daily activities for patients with T2DM (e.g., diet, exercise, and adherence to therapy) were added to some questions after the translation and revision procedures. The factor analysis revealed a correlation among the four factors ranging from 0.40 to 0.67. The factor loadings of selected items from the four factors ranged from 0.41 to 0.98. The order of the four factors in the factor analysis was as follows: interpersonal distress, emotional burden, physician distress, and regimen distress. The internal consistency for the four domains ranged from 0.78 to 0.83. The instrument resulting from this study was labeled “DDS17 Bahasa Indonesia.” ConclusionsThe DDS17 Bahasa Indonesia provides an initial psychometric validation study, factor structure, and internal consistency for assessing the distress of Indonesian T2DM outpatients. Use of this instrument in future research and clinical trials is recommended for the Indonesian context.

Relationships between lifestyle patterns and cardio-renal-metabolic parameters in patients with type 2 diabetes mellitus: A cross-sectional study.

IntroductionWhile individuals tend to show accumulation of certain lifestyle patterns, the effect of such patterns in real daily life on cardio-renal—metabolic parameters remains largely unknown. This study aimed to assess clustering of lifestyle patterns and investigate the relationships between such patterns and cardio-renal-metabolic parameters.Participants and methodsThe study participants were 726 Japanese type 2 diabetes mellitus (T2DM) outpatients free of history of cardiovascular diseases. The relationship between lifestyle patterns and cardio-renal-metabolic parameters was investigated by linear and logistic regression analyses.ResultsFactor analysis identified three lifestyle patterns. Subjects characterized by evening type, poor sleep quality and depressive status (type 1 pattern) had high levels of HbA1c, alanine aminotransferase and albuminuria. Subjects characterized by high consumption of food, alcohol and cigarettes (type 2 pattern) had high levels of γ-glutamyl transpeptidase, triglycerides, HDL-cholesterol, blood pressure, and brachial-ankle pulse wave velocity. Subjects characterized by high physical activity (type 3 pattern) had low uric acid and mild elevation of alanine aminotransferase and aspartate aminotransferase. In multivariate regression analysis adjusted by age, gender and BMI, type 1 pattern was associated with higher HbA1c levels, systolic BP and brachial-ankle pulse wave velocity. Type 2 pattern was associated with higher HDL-cholesterol levels, triglycerides, aspartate aminotransferase, ɤ- glutamyl transpeptidase levels, and diastolic BP.ConclusionsThe study identified three lifestyle patterns that were associated with distinct cardio-metabolic-renal parameters in T2DM patients.Trial registrationUMIN000010932

THE INFLUENCE OF EDUCATION OF DRUG INFORMATION BY PHARMACIST ON THE IMPROVEMENT OF KNOWLEDGE AND THERAPEUTIC TARGET TO TYPE 2 DIABETES MELLITUS OUTPATIENTS IN HOSPITAL

Objective: The study aims to determine the influence of education of drug information by the pharmacist on the improvement of knowledge and therapeutic target to type 2 diabetes mellitus outpatients in Dr. Moewardi Surakarta Hospital.Methods: The research used the quasi-experimental method, repeated measure experiment design, pre-posttest design with the prospective patient data retrieval. 90 patients with type 2 diabetes mellitus were used as the subjects of the research divided into three groups (two test groups and one control group). In the test1 group, patients were educated about the drug information through leaflets and through oral explanation, the test 2 group through leaflets, and a control group through leaflets once at the beginning of the study. The study lasted for three months in which in every month fasting blood glucose levels (FBG) and blood glucose levels were analyzed within two hours after a meal (BG2PP) and given questionnaires knowledge to see the socio-demographic profile, knowledge, and blood glucose level of the patient. The data analysis used the statistical package for social sciences (SPSS) version 16 in the form of analysis Kolmogorov-Smirnov test and one-way anova test.Results: The results showed that the education of the drug information by a pharmacist using leaflets and oral explanation in the test1 group was able to improve knowledge of type 2 diabetes mellitus outpatients in Dr. Moewardi Surakarta Hospital, in comparison to the leaflets giving information only to the test 2 group and control group. The education of drug information on the test 1 group was able to improve the patients' knowledge reaching 100%. Type 2 diabetes outpatients in the test 1 group could achieve a reduction in blood sugar levels, to the FBG level (136.47±36.08) mg/dl and BG2PP levels (193.43±58.21) mg/dl.Conclusion: The education of drug information from the pharmacist had the influence to improves the knowledge and therapeutic target of type 2 diabetes mellitus outpatients in Dr. Moewardi Surakarta Hospital.

Diabetes Mellitus, Leprosy: Intensive Education Protocol in Foot at Risk, Santa Marcelina Hospital, Amazon, Brazil

Objective: To apply an intensive and multidisciplinary education protocol in order to decrease, improve, delay or cancel the beginning of neuropathy and the manifestation of lesions in diabetic patients. Methodology: This is a cross-sectional descriptive study carried out at the Diabetes Mellitus Outpatient Clinic and Ward of Santa Marcelina Hospital in Porto Velho. This research was based on cases of patients with Diabetes and Diabetics with Leprosy. The criteria used to include the patients were: being treated with insulin therapy, not to be amputated, being on high medication of the leprosy at the moment of the evaluation and to present nutritional risk classification by the screening. The population was divided into two groups of fifteen patients: eight diabetic patients, four male and four female. Seven diabetics associated with leprosy were 4 males and 3 females. The monofilament test (Semmes-Weinstein 10 g) was used as the classification basis. Results and Discussion: Group A, called the intensive care group, began diabetes education work with medical, nutritional and rehabilitation guidelines by a multidisciplinary team for an average period of 15 days in the ward and after discharged with biweekly monitoring. Group B, called conventional care, received the same guidelines in outpatient care and the monitoring followed the quarterly protocol. Both groups were evaluated and reassessed for a period of 180 days in the outpatient clinic. Group A consisted of 8 (100%) patients, 4 (50%) diabetics and 4 (50%) diabetics and leprosy patients. Conclusion: Intensive education in diabetes showed an improvement in the sensitivity, healing and nutritional status of the patients, leading to an improvement in quality of life and disability level, reducing or delaying the beginning of neurological complications. The protocol intensive method demonstrated a 100% improvement in patients in group A.

Sociodemographic Characteristic and Health Related Quality of Life in Outpatients of Type 2 Diabetes Mellitus under JKN

Penelitian dilakukan untuk mengetahui perbedaan Health Related Quality of Life (HRQoL) terhadap karakteristik sosiodemografi antara pasien diabetes mellitus tipe 2 pada salah satu rumah sakit pemerintah di Jakarta. Penelitian dilaksanakan secara cross-sectional dari Februari sampai April 2015. Total sampel 83 pasien. Laki-laki 31(37,4%) dan perempuan 52 (62,6%). Terdapat perbedaan yang signifikan (P&lt;0,05) nilai HRQoL terhadap tingkat pendidikan. Berdasarkan nilai domain HRQoL, perempuan memiliki nilai lebih tinggi (69.82 ± 3.14) dibandingkan dengan laki-laki (67.32 ± 4.50) pada domain frekuensi gejala (P&lt;0,05). Pasien dengan usia yang lebih lanjut memiliki nilai tertinggi pada domain kepuasan (P&lt;0,05). Sebaliknya, pasien dengan usia lebih lanjut memiliki nilai terendah (64,14 ± 4,03) pada domain frekuensi gejala (P&lt;0,05). Pasien dengan tingkat pendikan SMA memiliki nilai lebih rendah (60,17 ± 24,65) pada domain kepuasan pengobatan dibandingkan dengan pasien dengan pendidikan diploma/sarjana (78,78 ± 21,98). Nilai domain frekuensi gejala lebih tinggi pada pasien bekerja dibandingkan dengan tidak bekerja (P&lt;0,05). Jumlah pendapatan tidak mempengaruhi secara signifikan terhadap nilai semua domain (P&gt;0,05) HRQoL. Selanjutnya, lama menderita diabetes mempengaruhi nilai domain kepuasan (P=0,05) dan frekuensi gejala (P=0,00). Sehingga dapat disimpulkan, karakteristik sosiodemografi meliputi tingkat pendidikan memiliki perbedaan secara signifikan terhadap kualitas hidup antara pasien rawat jalan diabetes mellitus tipe 2.

The relationship between fried food consumption and physical activity with diabetes mellitus in Yogyakarta, Indonesia

Background: Diabetes mellitus (DM) is one of degenerative disease and the prevalence is increasing each year. WHO predicted that in 2025 the number of diabetes mellitus outpatients in the world can reach up to 300 milions people. Early detection is needed to prevent higher prevalence in type 2 DM. Moreover, nowadays people are tend to have sedentary lifestyle and bad food pattern. The Objective of this research aims to determine risk factors which related the evidence of type 2 DM.Methods:It was an observational study with cross sectional design. Subjects were 179 people of the study were staffs of Gadjah Mada University who did general check-up at Gadjah Mada Medical Center (GMC) health cencer on March and April 2014. Research variable included diabetic family history, ethnic, physical activity, habit of smoking history, obese, eating pattern, fried foods consumption and diabetes. Data of eating pattern and fried foods consumption are obtained by semi quantitative food frequency questionnaire (SQFFQ). Data about diabetic family history, ethnic, habit of smoking are obtained by interview. Data about physical activity is obtained by IPAQ questionnaire and data about obese an fasting blood glucose value are obtained by secondary data from GMC health center. Data were analyzed using chi square.Results: There was significant association between diabetic family history, fried food’s consumption frequency and the incidence of type 2 diabetes mellitus (p&lt;0.05). There was no significant association between ethnic, physical activity, habit of smoking, obese, eating pattern, fried food consumption (fried foods mass, fried foods energy and fried foods fat) (p&gt;0.05).Conclusions:Risk factors related with type 2 DM evidence are diabetic family history and fried food’s consumption frequency.

PDB36 - Translation, Adaptation And Validation Of The Diabetes Distress Scale For Indonesian Diabetic Outpatients With Various Types Of Complications

To translate, adapt and validate the Diabetes Distress Scale (DDS) instrument for Indonesian type 2 diabetes mellitus (T2DM) outpatients with various types of complications. Participants were recruited from four hospitals and two primary healthcare facilities. The procedure of the study included forward and backward translations, an adaptation testing with a small subset of participants, and a validation test. Factor analysis with maximum likelihood estimation and promax rotation was used to investigate the instrument structure. Internal consistency among the items was estimated using Cronbach’s alpha for each of the four domains of the DDS. The instrument form resulting from this study was labeled DDS17 Bahasa Indonesia. 324 participants (246 from hospitals and 78 from primary healthcare facilities) were involved in this study. Understanding of the exact meaning of questions by study participants was improved by adding T2DM daily activity examples (e.g. diet, exercise and adherence to therapy) to several questions after the translations and adaptation procedure. The factor analysis showed correlation among the four factors ranging from 0.40 to 0.67. The order in the factor analysis was first interpersonal distress, followed by emotional burden, physician distress, and regimen distress. The internal consistency for the four domains ranged from 0.78 to 0.83. The DDS17 Bahasa Indonesia provides a valid and reliable scale for assessing distress of Indonesian T2DM outpatients. The use of this instrument in future research and clinical trials is recommended for the Indonesian context.

Perbedaan perubahan berat badan, aktivitas fisik, dan kontrol glukosa darah antara anggota organisasi penyandang diabetes melitus dan non anggota

Background: Diabetes Mellitus (DM) is a metabolic disease that can not be cured, but the blood glucose levels can be controlled with diabetes management. There is organization in Indonesia for people with diabetes mellitus called Persadia (Persatuan Diabetes Indonesia). Patients who join diabetes peer group is expected to have a better lifestyle. Objective: To determine differences in weight changes, physical activity, and blood glucose control between Persadia members and non members.Method: Cross sectional study, with 42 subjects. The subjects were type 2 DM outpatients in Pantiwilasa Citarum Hospital, choosen by consecutive sampling and devided into 2 groups, Persadia members and non members. Weight changes was the difference of current weight with weight from 3 months ago. Physical activity was exercise habits and measured by questionnaire. Blood glucose control was glucose concentrations and measured by HbA1C examination. Statistical analysis used was Chi Square, Kolmogorov-Smirnov, and Fisher.Result: Persadia group members had more frequent physical activity (52.4%) than non-member groups (9.6%). Based on statistical analysis there is a difference of physical activity between Persadia group members and non members (p = 0,042). While on weight change (p = 0,537) and blood glucose control (p = 0,663) there was no difference between Persadia member and non member.Conclusion: There is a difference between Persadia members and non-members on physical activity. However, there was no difference in weight change and blood glucose control between Persadia and non-member members.

Family Support and Self-Motivation Influence Dietary Compliance and Glycaemic Control among Type 2 Diabetes Mellitus Outpatients

Diabetes Mellitus is a disease due to reduced insulin sensitivity and secretion in the body which associated with obesity and hypertension. This study aimed to determine the influence of family support and self-motivation towards dietary compliance and glycaemic control among Type 2 Diabetes Mellitus (T2DM) outpatients. This cross-sectional study involved 35 subjects selected from Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Cheras and Ampangan Health Clinic in Seremban. Anthropometric measurements and fasting blood glucose have been obtained. Face-to-face interview session was done to obtain socio-demographic and diet intake. Further, dietary compliance, social support and self-motivation were assessed using Summary Diabetes Self Care Activities (SDSCA), Diabetes Social Support Questionnaire Family version (DSSQ-Fa) and Treatment Self-Regulation Questionnaire (TSRQ), respectively. Only 8.6% of subjects complied with dietary counselling. Fasting blood glucose for both men (7.93 ± 1.99 mmol/L) and women (8.77 ± 3.08 mmol/L) were higher than normal range. Self-motivation (r = 0.358, p < 0.05) and family support (r = 0.460, p < 0.01) significantly correlated with dietary compliance. Self-motivation and family support are important factors which can increase compliance towards dietary counseling. Further investigation should be carried out to determine factors that may influence dietary compliance and family support towards achieving desirable glycaemic control among T2DM patients. DOI : http://dx.doi.org./10.17576/JSKM-2016-1402-05

Urinary Cyclophilin A as a New Marker for Diabetic Nephropathy: A Cross-Sectional Analysis of Diabetes Mellitus.

Type 2 diabetes mellitus (DM) is the most common single cause of end-stage renal disease. Albuminuria is the most commonly used marker to predict onset of diabetic nephropathy (DN) without enough sensitivity and specificity to detect early DN. This is the first study to identify urinary cyclophilin A (CypA) as a new biomarker for early DN.We recruited DM outpatients and healthy control subjects from January 2014 to December 2014. In this cross-sectional study, patients’ urine samples were collected to determine the expression of urinary CypA. We also treated mesangial (MES-13) and tubular (HK-2) cells with glucose or free radicals to observe the expression of secreted CypA in Western blot analysis.A total of 100 DN patients and 20 healthy control subjects were enrolled. All variables were matched. In univariate analysis, the concentration of urinary CypA correlated well with the progression of renal function. A significant increase in urinary CypA was noted in stage 2 DN and persisted in later stages. We could diagnose stage 2 DN using urinary CypA with a sensitivity of 90.0% and specificity of 72.7%. The area under curve was up to 0.85, indicating a good discriminatory power. In cellular models, MES-13 and HK-2 cells can both release CypA.Urinary CypA is a good biomarker for early DN detection in humans and it can be released from either mesangial or tubular cells. The underlying molecular mechanisms still need further clarification in cellular and animal studies.

Prevalence and Predictors of Depression among Type 2 Diabetes Mellitus Outpatients in Eastern Province , Saudi Arabia

Diabetes Mellitus is frequently accompanied by serious complications. Less known is the increased risk for depression. Undiagnosed depression prevents initiation of treatment, thereby contributing to poor clinical outcomes. Study aimed to determine prevalence and predictors of depression among type 2 diabetes mellitus patients. Study was cross-sectional. It was conducted in the outpatient clinics of diabetes mellitus in a governmental hospital in Eastern Province, Saudi Arabia in 2013. Patients with type 2 diabetes mellitus (260 participants) were selected using systematic random sampling technique. One interview questionnaire was designed to collect demographic and health factors. Two self- administered instruments were used to assess perceived social support and depression. Assessment of the relationship between depression and its predictors was done using Univariate analysis. Multivariable analysis was used to evaluate the combined effect of several factors associated with depression among type 2 diabetes mellitus patients after adjusting for confounding variables. Almost fifty percent of diabetics were depressed (49.6%). Patients with poor diabetes mellitus control (OR 3.221, P.000) and unmarried (OR 3.206, P .025) were more risky for developing depression and difference was significant. Prevalence of depression among Type 2 diabetes mellitus patients was almost fifty percent. So, diabetics should be regularly examined for signs and symptoms of depression.

A possible relationship between renal impairment and complications development in type 2 diabetes mellitus: a prospective, observational study in Italy

BackgroundWe investigated the relationship between complications development and estimated glomerular filtration rate (eGFR), in a cohort of type 2 diabetes mellitus (T2DM) outpatients. MethodsThis observational study considered 1284 T2DM outpatients, who had been followed-up for 4.5±1.6years. eGFR was estimated using Chronic Kidney Disease Epidemiology Collaboration equation. The independent relationship between development of complications and clinical data was evaluated, and hazard ratio (HR) by Cox regression analysis calculated. ResultsMean age of the population was 66.8±10.4years; mean serum creatinine and eGFR were 1.05±0.36mg/dl and 71.6±21.6ml/min/1.73m2, respectively. Complications including death (14.2% of the whole population) were recorded in 504 subjects (39.3%). Patients with complications were older and more frequently male with history of hypertension, coronary heart disease, congestive heart disease, retinopathy, nephropathy and had higher levels of glycated hemoglobin. At Cox regression analysis, eGFR was the major risk factor for development of complications, and the HR increased according with lower eGFR (HR 1.53 and 1.86, for eGFR<45 and<30ml/min/1.73m2, respectively). ConclusionsIn our cohort of T2DM outpatients, a reduced eGFR was associated with an increased risk of complications development.

Marker of lipid peroxidation related to diabetic nephropathy in Indonesian type 2 diabetes mellitus patients

ObjectiveEven though diabetes patients exhibit an increased oxidative stress, its correlation with diabetic nephropathy is not fully understood. The purpose of this study was to determine whether lipid peroxidation marker correlates well with eGFR and UACR in type 2 diabetes mellitus patients. MethodsWe collected urine and serum samples of Indonesian type 2 diabetes mellitus outpatients with normo- and microalbuminuria at a Local Government Clinic (from ages: 39–74 years). Urinary 8-iso-PGF2α was measured by ELISA, the serum malondialdehyde by TBARS assay, and urinary albumin by BCG albumin assay. eGFR was calculated using the corrected-Cockcroft–Gault (CG), MDRD, and CKD-EPI equation. Other necessary data were obtained through questionnaires. ResultsThe results showed that the increasing level of malondialdehyde was mildly correlated with the decline in eGFR (MDRD). In contrary, there was a significant positive correlation between 8-iso-PGF2α concentration and eGFR based on the corrected-CG, MDRD study, and CKD-EPI equation (r=0.457, p<0.001; r=0.424, p<0.001; r=0.443, p<0.001). This relationship still persisted in the normoalbuminuric subjects (n=43) (r=0.491, p=0.001; r=0.461, p=0.002; r=0.455, p=0.002). The multivariate analysis showed that 8-iso-PGF2α together with fasting plasma glucose was the most predictive factor for the high 2-quantile eGFR (adjusted OR 1.001, (95% CI, 1.000–1.001)). However, there was no significant correlation between UACR with malondialdehyde (r=0.268, p=0.050) and 8-iso-PGF2α(r=−0.030, p=0.808). UACR itself was inversely correlated with eGFR based on the corrected-CG, the MDRD, and CKD-EPI (r=−0.232, p<0.05; r=−0.228, p<0.05; r=−0.232, p<0.05). ConclusionsIncreased 8-iso-PGF2α and malondialdehyde in type 2 diabetes mellitus patients may play a role in the pathophysiologic significance of diabetic nephropathy, even while considering the effect of potential confounders.

Health literacy skills in type 2 diabetes mellitus outpatients from an university-affiliated hospital in Rio de Janeiro, Brazil.

BackgroundType 2 diabetes mellitus is the most common metabolic disorder and has considerable impact on quality of life. Treatment of DM2 is complex and adherence to treatment requires sophisticated cognition which includes literacy skills.MethodsHealth literacy skills of a cross-sectional nonrandom sample of 164 DM2 outpatients at the Diabetes Unit of the Hospital Universitário Pedro Ernesto at the State University of Rio de Janeiro were evaluated by the short version of the Test of Functional Health Literacy in Adults (s-TOFHLA). Procedures available in the SPSS package were used in data analysis.ResultsFourteen out of 164 patients (8.5%) were completely illiterate and therefore were not further assessed. The remaining 150 patients (75 men and 75 women) were the participants of this study. Data showed that 110 (73.3%) participants had adequate health literacy skills, 17 (11.3%) had marginal skills and 23 (15.3%) had inadequate skills. Moreover, older participants performed worse than younger patients. In addition, Caucasian and multiethnic participants performed better than Afro-Brazilians. Furthermore, participants with higher educational and occupational levels outperformed those with lower levels. However, only age and education, but not ethnic group and occupation, contributed significantly and independently to health literacy.ConclusionThis study showed that almost a quarter of the participants are illiterate or have inadequate health literacy skills. Therefore, our results indicate the need for the development of health care instructions properly calibrated to the health literacy skills of DM2 patients.

Relationship between the brain natriuretic peptide (BNP) level and remission of diabetic nephropathy with microalbuminuria: a 3-year follow-up study.

The aim of the study was to examine the relationship between the brain natriuretic peptide (BNP) level and progression or remission of diabetic nephropathy with microalbuminuria for 3 years. The subjects were 100 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between metabolic parameters at baseline [HbA1c, systolic blood pressure (SBP), urine albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and BNP] and the progression or remission of diabetic nephropathy were examined for 3 years. A total of 83 patients were examined at the end of the 3-year period, including 17 with remission to normoalbuminuria, 47 with continuing microalbuminuria, and 19 with progression to macroalbuminuria. HbA1c, ACR, and BNP differed significantly among the 3 groups (p=0.024, p<0.001, p=0.002, respectively). Among baseline factors, HbA1c and BNP were significant predictors of the percentage increase in ACR for 3 years in multiple linear regression analysis (β=0.259, p=0.02; β=0.299, p=0.007, respectively). In multivariate logistic regression analysis, HbA1c and ACR were independently associated with progression of diabetic nephropathy (p=0.008, p=0.023, respectively), and ACR and BNP were independently associated with remission of diabetic nephropathy (p=0.029, p=0.012, respectively). ROC curve analysis gave a cutoff value for BNP of 14.9 pg/ml for prediction of remission of diabetic nephropathy (p=0.016). The BNP level has a relationship with diabetic nephropathy and a low BNP level predicts remission of diabetic nephropathy. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy.