Diabetes-specific Complications Research Articles

Validating an electronic snacking questionnaire among New Zealand adolescents and young adults with type 1 diabetes – feasibility study

Type 1 diabetes (T1D) is a chronic autoimmune disease characterised by a deficiency in insulin production and consequent hyperglycaemia. A glycated haemoglobin (HbA1c) value < 53 mmol/mol (< 7%) is recommended to reduce the risk for diabetes-specific complications(1). However, most adolescents and young adults (AYAs) have an HbA1c above the target(2). Dietary behaviours, including a routine meal plan with snacks, play a significant role in self-management(3). Snacks without an insulin bolus, grazing or snacking to cope with stress contribute to out-of-target glucose levels. Although modifying AYAs’ snacking behaviours could be a low-cost, equitable, and effective approach to improving glycaemic control, there is a dearth of evidence to inform effective snacking interventions. Importantly, no brief, validated tool exists to assess snacking behaviour among individuals with T1D. This research explored the acceptability and feasibility of validating a snacking questionnaire adapted for AYAs with T1D; a crucial step before a larger validation study. Twenty-five AYAs (aged 13-20 years) with T1D and receiving diabetes care through Te Whatu Ora Southern were invited to participate in a feasibility study. Purposive sampling was used for maximum variability in participants’ demographic characteristics. All study procedures were completed remotely, with electronic questionnaires administered in the morning via a secure web platform. On days 1 and 8 of the 8-day study, participants completed a 30-item snacking questionnaire that assessed the timing and frequency of snacking and types of food or drinks consumed as a snack in the past seven days. The snacking questionnaire was adapted from questionnaires previously used in population-level surveys. An experienced diabetes dietitian ensured that items reflected foods commonly consumed by AYAs with T1D. Before recruitment, two diabetes dietitians and a young adult with T1D critically reviewed the adapted snacking questionnaire. On days 2-8, participants recalled their snacking behaviour (timing, frequency, food/drink consumed) over the previous day. The proportion of completed snacking questionnaires assessed feasibility, defined as a response rate ≥ 80%. The ease of completing the snacking questionnaires was self-reported on a Likert-type scale (1-completely agree, 5-completely disagree) to assess acceptability, defined as ≤ 20% of participants reporting the questionnaires were not easy to complete. Participants (n = 10) were aged 16.2 ± 1.69 years, 60% male, and 90% self-identified as New Zealand or Other European. All participants completed the proposed validation study. Most (95%) of the snacking questionnaires were completed. All (100%) daily snacking behaviour questionnaires were completed. All participants (100%) agreed that the questionnaires were easy to complete. The snacking behaviours questionnaire validation procedures are feasible and acceptable to New Zealand and Other European AYAs with T1D. Feasibility and acceptability must be explored among ethnically diverse AYAs before conducting a larger rigorous validation study.

Characterisation and clinical outcomes in children and adolescents with diabetes according to newly defined subgroups: a cohort study from the DPV registry

Personalised therapy has emerged as a possibly more efficient approach taking disease heterogeneity into account. The aim of this study was to determine whether recently described subgroups of childhood diabetes have prognostic association with diabetes-specific complications and, therefore, might be a basis for personalised therapies. We applied a previously developed subgroup classification to pediatric patients (diabetes onset <18 years) from the prospective Diabetes Patient Follow-up (DPV) registry with documented data between January 1, 2000 and March 31, 2022, from diabetes centers in Germany, Austria, Switzerland, and Luxembourg. The classification required information on islet autoantibody status, age, haemoglobin A1c (HbA1c), and body-mass index (BMI-SDS) at disease manifestation, as well as follow up data after 2 and after 4 years, which was available in 22,719 patients. Patients without documented data on these parameters were excluded from the analysis. The cumulative risk of severe hypoglycemia, diabetic ketoacidosis (DKA), retinopathy, and nephropathy were analysed by Kaplan-Meier analyses over a median follow-up of 6.8 years (IQR 4.8-9.6). Patients were classified into 10 subgroups (P1-P7 islet autoantibody-positive, n=19,811; N1-N3 islet autoantibody-negative, n=2908). The groups varied markedly with respect to specific acute and chronic complications. Severe hypoglycemia was a characteristic feature in young islet autoantibody-positive subgroups P1, P3, P4 (10-year risk 46, 46 and 47%) and the islet autoantibody-negative groups N1, N2 (43 and 46%). Nephropathy was identified in patient groups P2 and P5 (10-year risk 16%), which had features of moderate disease such as preserved C-peptide, low HbA1c, and very low frequency of DKA at diabetes onset. Group P7, which was defined by a high BMI, was associated with poor metabolic control, DKA, and retinopathy. In contrast, islet autoantibody-negative patients with high BMI (N3) had a low risk for all four complications. Subgrouping of childhood diabetes at diabetes onset provided prognostic value for the development of acute and chronic diabetes-specific complications. The DPV initiative is supported by The German Ministry of Education and Research (BMBF) within the German Center for Diabetes Research, the diabetes surveillance of the Robert Koch Institute, the German Diabetes Association (DDG) and INNODIA.

Diabetic complications and prospective immunotherapy.

The incidence of Diabetes Mellitus is increasing globally. Individuals who have been burdened with diabetes for many years often develop complications as a result of hyperglycemia. More and more research is being conducted highlighting inflammation as an important factor in disease progression. In all kinds of diabetes, hyperglycemia leads to activation of alternative glucose metabolic pathways, resulting in problematic by-products including reactive oxygen species and advanced glycation end products. This review takes a look into the pathogenesis of three specific diabetic complications; retinopathy, nephropathy and neuropathy as well as their current treatment options. By considering recent research papers investigating the effects of immunotherapy on relevant conditions in animal models, multiple strategies are suggested for future treatment and prevention of diabetic complications with an emphasis on molecular targets associated with the inflammation.

Prevalence of Anxiety and Associated Factors Among Inpatients with Type 2 Diabetes Mellitus in China: ACross-Sectional Study.

This study aimed to investigate the prevalence of anxiety and its associated factors among inpatients with type 2 diabetes mellitus (T2DM) in China. This study was a cross-sectional study. Inpatients with T2DM admitted to the Endocrinology Department of Xiangya Hospital, Central South University in Hunan Province of China from March 2021 to December 2021were consecutively included in this study. Participants were interviewed to obtain the data onsocio-demographic characteristics, lifestyle characteristics, T2DM-related information, and social support. Anxiety was measured using the Hospital Anxiety and Depression Scale-anxiety subscale by experienced physicians. Multivariable logistic regression analysis was used to estimate the independent contribution of each independent variable to anxiety. A total of 496 inpatients with T2DM were included in this study. The prevalence of anxiety was 21.8% (95% confidence interval [CI]: 18.1%-25.4%). The results of multivariable logistic regression analysis indicated that age of at least 60 (adjusted odd ratio[aOR] = 1.79, 95% CI: 1.04-3.08), and having diabetes specific complications (aOR = 4.78, 95% CI: 1.02-22.44) were risk factors for anxiety, and an educational level of high school or above (aOR = 0.55, 95% CI: 0.31-0.99), regular physical activity (aOR = 0.36, 95% CI: 0.22-0.58), and high social support (aOR = 0.30, 95% CI: 0.17-0.53) were protective factors for anxiety. A predictive model based on these five variables showed good performance (area under the curve = 0.80). Almost one in five inpatients with T2DM suffered from anxiety in China. Age, educational level, regular physical activity, diabetes specific complications, and social support were independently associated with anxiety.

1166-P: Identifying Knowledge Strengths and Deficits of Young Adults with Type 1 Diabetes (T1D)

Among challenges that young adults with T1D face in their care are expectations for independence with healthcare system navigation and diabetes knowledge competency. This is a particular concern given increased hemoglobin A1c (HbA1c) and complications among young adults. A 50-item diabetes-specific knowledge assessment (KA) was developed and utilized in a young adult diabetes program to identify the areas of strength and deficits to guide education and care. To identify the competency of diabetes knowledge, KA items were categorized to describe strengths, deficits, and variable responses. A retrospective chart review was performed in patients with T1D transferring from Texas Children's Hospital to a single adult endocrinology program. Inclusion criteria included T1D for &amp;gt;1 year and completion of KA by diabetes educator or provider. Each KA item was scored on a 1-4 scale (4 = high). Scores were grouped into 3 categories: strengths as &amp;gt;80% of the young adults scoring ≥3, deficits as &amp;gt;50% score &amp;lt;3, and Variable (V) not meeting criteria for strength nor deficit. Over 4.5 years, 142 patients had KAs (M age 20.5 ± 1.4 yrs, HbA1c = 8.8 ± 1.9%, T1D duration = 10.4 ± 4.7 yrs, 54% pump, 52% CGM). KA strengths (18) included questions addressing insurance card, safe sex practices, teaching treatment of mild hypoglycemia, and insulin pump management. KA deficits (11) included diabetes specific knowledge, alcohol use, tobacco, pregnancy, and acute and chronic complications of diabetes. Variable questions (21) included diabetes pathophysiology, identifying an adult PCP and hospital, and counting carbohydrates. Complications of diabetes, the effect of alcohol on blood glucose, glucagon administration, and pregnancy and diabetes should be re-educated upon transfer to adult healthcare. Questions related to insurance cards, safe sex, and insulin pump management may not need to be immediately prioritized at transfer. Further research with this KA will validate it for implementation in clinics and research. Disclosure E.A.Kubota-mishra: None. N.Miranda: None. M.E.Hilliard: None. S.Mckay: None.

Ultra-processed foods consumption, depression, and the risk of diabetes complications in the CARTaGENE project: a prospective cohort study in Quebec, Canada.

This study aimed to assess the association between depression, ultra-processed food consumption (UPFs), and the risk of developing diabetes-specific complications in adults with type 2 diabetes (T2D). Baseline data came from the CARTaGENE study, a health survey of adults (40-69 years) in Quebec, Canada. The incidence of T2D complications was examined in N= 683 participants with T2D without complications at baseline by linking survey data with administrative health data. Food and drink consumption was assessed using the Canadian Diet History Questionnaire and categorized by NOVA classification. Participants were categorized into tertiles of UPFs consumption. Depression was defined as having elevated depressive symptoms based on the Patient Health Questionnaire-9 or the use of antidepressant medications. Cox regression models were used to estimate the associations between UPFs, depression, and T2D complications. In total, 105 individuals developed diabetes-related complications over a 7-year period. Participants with high depressive symptoms and high UPFs consumption had the highest risk for diabetes complications (adjusted hazard ratio (aHR) 2.07, 95% CI: 0.91 - 4.70), compared to participants with low depressive symptoms and low UPFs consumption. Higher risks for diabetes complications were observed when high depressive symptoms and antidepressant use were combined with high UPFs consumption (aHR 2.59, 95% CI: 1.32 - 5.06). This study indicates that those with co-occurring depression and high UPFs consumption have a greater risk of diabetes complications. Early management and monitoring of both risk factors might be essential to prevent diabetes complications.

Diabetes-related distress and associated factors among adults with diabetes in Germany: Results of the nationwide study “Disease knowledge and information needs – Diabetes mellitus 2017”

BackgroundDiabetes-related distress (DRD) can affect diabetes management adversely. In lack of population-based data, the frequency and determinants of DRD among adults with diabetes in Germany remain controversial. MethodsThis study included 1367 adults with diabetes who participated in a nationwide health telephone survey conducted among German adults aged 18 years and older in 2017. The short form of the Problem Areas in Diabetes (PAID-5) scale was used to assess DRD. The associations of high DRD (PAID-5 sum score ≥ 8) with socio-demographics, diabetes-related risk factors, diabetes clinical characteristics as well as quality of self-care and chronic illness care assessed by patients were tested in multivariable logistic regression models. ResultsThe overall DRD prevalence was 15.1% (95% confidence intervals, 95% CIs, 12.5–18.0%) with no significant difference between men (14.7%, 95% CIs 11.2–19.1%) and women (15.4%, 11.9–19.8%). In multivariable analyses, DRD was significantly associated with younger age (odds ratio 0.96, 95% CIs 0.94–0.98, per year), immigration background (2.26, 1.16–4.42), current smoking (2.06, 1.14–3.70), insulin use (2.57, 1.45–4.56), and the presence of diabetes-specific complications (1.80, 1.10–2.94) or depressive symptoms (5.34, 3.24–8.81). Among those with depressive symptoms (18,4% of the study population), 38.3% also had DRD, which accounted for 7.0% (95% CIs 5.3–9.3%) of the study population. ConclusionDRD is a common health problem among adults with diabetes in Germany, and highly correlates with depressive symptoms, current smoking, immigration background, and insulin use. Addressing DRD needs to become an integrative part of ambulatory diabetes care.

KNOWLEDGE OF DIABETIC COMPLICATIONS AND PRACTICE OF ROUTINE MEDICAL CHECK-UP AMONG DIABETICS (&gt;10 YEARS) IN THE FIELD PRACTICE AREA OF GOVERNMENT MEDICAL COLLEGE, AMRITSAR

Context: Awareness about diabetic complications and regular medical check-up are essential for prevention, early detection and treatment of diabetic complications. Aims &amp; Objectives: 1. To assess the knowledge about diabetes complications among diabetic patients (&gt;10 years). 2. To evaluate the practices of routine medical check –up among Diabetics (&gt;10 years). Settings and Design: A community based cross-sectional study was conducted in rural and urban field practice areas of Government Medical College, Amritsar. Methods and Material: A total of 200 diabetic patients who had diabetes equal to or more than 10 years of duration were interviewed using pretested and predesigned questionnaire Statistical analysis used: Data such collected were analyzed and Chi-square/ Yates correction was used to know the level of significance at P &lt; 0.05. Results: Out of 200 respondents, 50% (100/200) were from urban area and 50% (100/200) were from the rural area. In both urban and rural areas, majority were literate and unemployed. The mean age of diabetic respondents was 61.08 years with a male to female ratio of 1.1:0.9. 44.5%(89) of the respondents were aware of diabetic complications(P&lt;0.05).92%(82), 89%(79), and 73%(65) of respondents had good knowledge about complications of Eye, Kidney and cardiac disease while respondents knowledge of Stroke and Nephropathy was inadequate i.e. 28%(25),47% (42) respectively. Only 25% (51) had followed definite routine for examination ,Out of which 61%(31) were doing health check up every 3 monthly and 27%(14) were doing every 6 monthly and 6(12%) were doing every yearly(P&lt;0.05). Conclusions: The practice of regular medical check-up was poor among diabetic patients, and this may be due to inadequate knowledge about specific diabetic complications.

SERUM MAGNESIUM LEVEL IN TYPE2 DIABETES MELLITUS WITH SPECIAL REFERENCE TO DIABETIC RETINOPATHY

Background: Diabetes mellitus (DM) is a worldwide, growing epidemic, with an estimated 415 million adults globally. Patients with diabetes are at increased risk of death and a triad of serious diabetes-specific complications (neuropathy, nephropathy, and retinopathy) and other associated complications. Magnesium is an intracellular cation and co-enzyme for various reactions of glycolytic pathway. Hence, we evaluated serum magnesium level in type 2 DM with and without diabetic retinopathy. Materials and methods: The study is carried out on 40 patients of type 2 DM with retinopathy and 40 patients of type 2 DM without retinopathy. All patients are subjected to the detailed history taking, ocular examination, and investigations like serum magnesium, FBS, PPBS, glycated hemoglobin. Results: The study revealed that there is a significant decrease in serum magnesium level in diabetic patients with retinopathy than without retinopathy (t= -6.297, df= 58 p= &lt;0.001).Similarly Fasting Blood sugar, post prandial blood sugar and duration of diabetes also show significant difference. Conclusion: As magnesium level decreases in patients with type 2 DM, the prevalence of retinopathy increases. Timely monitoring of serum magnesium levels and glycated hemoglobin as well as appropriate interventions would be beneficial in early detection and treatment of diabetic retinopathy.

The effect of Galega officinalis L. extract on the content of the advanced glycation end products and their receptors in rat leukocytes under experimental diabetes mellitus

Background. Diabetes mellitus intensifies non-enzymatic glycosylation (glycation) of biomolecules under conditions of chronic hyperglycemia and facilitates accumulation of advanced glycation end products. Disorders of the cells of various tissues are caused by binding of advanced glycation end products to the corresponding receptors, the level of receptors for advanced glycation end products increases under conditions of hyperglycemia. The interaction between receptors for advanced glycation end products and advanced glycation end products leads to the formation of excessive reactive oxygen species, changes in intracellular signaling, gene expression, increased secretion of pro-inflammatory cytokines and contributes to the development of diabetic complications. The search for factors of natural origin that will slow down the development of specific complications of diabetes, determines the feasibility of studies of the corrective ability of biologically active substances isolated from medicinal plants for the process of glycation of proteins in diabetes. Materials and methods. Experimental diabetes mellitus was induced by intraperitoneal administration of streptozotocin. Separation of blood leukocytes was performed in Ficoll density gradient. To determine the extent of advanced glycation end products and receptor for advanced glycation end products in leukocyte immunoperoxidase labeling was performed. Results. A decrease in the content of advanced glycation end products in leukocy­tes under conditions of experimental diabetes mellitus was found. The obtained data indicate a possible contravention of glucose uptake by leukocytes in the studied pathology. At the same time, an increase in exposure to the receptor for advanced glycation end products leukocyte membranes in response to chronic hyperglycemia has been demonstrated. The ability of alkaloid free fraction of Galega officinalis extract to reduce the content of receptors for end products of glycation on the membranes of immunocompetent cells in diabetic animals has been confirmed, which may be due to the presence of biologically active substances with hypoglycemic action in its composition. Conclusion. Corrective effect of alkaloid free fraction of Galega officinalis L. extract on the content of receptor for advanced glycation end products in diabetes mellitus is mediated by its normalizing effect on carbohydrate metabolism.

Effects of Community-Based Interventions on Medication Adherence and Hospitalization for Elderly Patients with Type 2 Diabetes at Primary Care Clinics in South Korea.

Korean Disease Control and Prevention Agency launched Control and Prevention Community-based Registration and Management for Hypertension and Diabetes mellitus Project (CRMHDP) in Gwangmyeong city, 2009. This project has provided incentives on both patient and physician and has made private clinics and Public Health Center (PHC) in a community collaborate for effective chronic disease management among elderly people. This study aimed to evaluate the effects of CRMHDP on medication compliance and hospitalization due to diabetes-specific complications. The retrospective cohort study design was based on data of Korean National Health Insurance (KNHI) with 2 control areas (A & B) with usual primary care service similar to Gwangmyeong city regarding community health resources. The data on the study subjects were examined for the following 5 years since the baseline point. Medication adherence rates of CRMHDP-enrollees after the project was significantly higher than two control groups. For the hospitalization due to any complications, adjusted hazard ratio in the intervention group, compared to the control group A and B, were 0.76 (95% Confidence Interval: 0.65–0.78) and 0.52 (95% Confidence Interval 0.41–0.78), respectively. CRMHDP could successful in improving the management of type 2 diabetes mellitus among elderly people in South Korean primary care settings.

Evaluation of serum magnesium level in patients with type 2 diabetes mellitus with and without diabetic retinopathy

Background Diabetes mellitus (DM) is a worldwide, growing epidemic, with an estimated 415 million adults globally. Patients with diabetes are at increased risk of death and a triad of serious diabetes-specific complications (neuropathy, nephropathy, and retinopathy) and other associated complications. So, it becomes important to prioritize research on prevention and primary care of diabetic complications. Poor glycemic control has been associated with retinopathy. Hence, we evaluated serum magnesium level in type 2 DM with and without retinopathy. Magnesium is an intracellular cation and coenzyme for various reactions of glycolytic pathway, so hypomagnesemia has been shown to precipitate hyperglycemia. Objectives To assess serum magnesium level in type 2 diabetic patients and its correlation with retinopathy. Patients and methods This is a cross-sectional study that was carried out on 25 patients of type 2 diabetes with retinopathy and 25 patients of type 2 diabetes without retinopathy attending ophthalmology clinic of Al-Zahraa University Hospital. All patients were subjected to the following: detailed history taking, full ophthalmological examination, and investigations like fundus fluorescein angiography and serum magnesium. Results The results of the study revealed that there was a significant more decrease in serum magnesium level in diabetic patients with retinopathy than diabetic patients without retinopathy (P=0.028). Conclusion As magnesium level decreases in patients with type 2 DM, the prevalence of retinopathy increases. Hypomagnesemia correlated significantly with glycated hemoglobin. Timely monitoring of serum magnesium levels and glycated hemoglobin as well as appropriate interventions would be beneficial in early detection and treatment of diabetic retinopathy.

The impact of periodontal treatment on healthcare costs in newly diagnosed diabetes patients: Evidence from a German claims database

AimsThere is sufficient scientific evidence for the bidirectional association between periodontal diseases and diabetes. In this context, we hypothesized that periodontal treatment leads to lower healthcare costs in newly diagnosed diabetes patients by promoting a milder disease course. MethodsA total of 23,771 persons were investigated who were continuously insured by German health insurances between 2011 and 2016, 18 years or older, and newly diagnosed with diabetes in 2013. The study population was divided into a periodontal treatment and control group (no periodontal treatment). The average treatment effect of a periodontal treatment on various types of healthcare costs (inpatient, outpatient, drug costs) was analyzed by a doubly robust method. ResultsFinally, 5.3% of the study population could be assigned to the treatment group. In newly diagnosed diabetes patients with periodontal treatment, a reduction in total healthcare costs (0.96, 95%CI 0.89; 1.04), inpatient costs (0.87, 95%CI 0.69; 1.08), diabetes-related drug costs (0.93, 95%CI 0.84; 1.03) and other drug costs (0.97, 95%CI 0.89; 1.05) could be shown compared to the control group. ConclusionsThis study provides evidence that periodontal treatment for diabetes patients reduces healthcare costs. Fewer diabetes-specific complications and hospitalizations are expected.

When ESKD complicates the management of diabetes mellitus

Given the increased incidence and prevalence of ESKD (end-stage kidney disease) attributed to diabetes mellitus, it is important to consider the physiological and global sociodemographic factors that give rise to unique challenges in providing excellent care to this population. The individual with diabetes and ESKD faces alterations of glucose homeostasis that require close therapeutic attention, as well as the consideration of safe and effective means of maintaining glycemic control. Implementation of routine monitoring of blood glucose and thoughtful alteration of the individual's hypoglycemic drug regimen must be employed to reduce the risk of neurological, cardiovascular, and diabetes-specific complications that may arise as a result of ESKD. Titration of insulin therapy may become quite challenging, as kidney replacement therapy often significantly impacts insulin requirements. New medications have significantly improved the ability of the clinician to provide effective therapies for the management of diabetes, but have also raised an equal amount of uncertainty with respect to their safety and efficacy in the ESKD population. Additionally, the clinician must consider the challenges related to the delivery of kidney replacement therapy, and how inter-modality differences may impact glycemic control, diabetes, and ESKD-related complications, and issues surrounding dialysis vascular access creation.

Diabetic Retinopathy-An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes.

Diabetes mellitus is a world-wide epidemic and diabetic retinopathy, a devastating, vision-threatening condition, is one of the most common diabetes-specific complications. Diabetic retinopathy is now recognized to be an inflammatory, neuro-vascular complication with neuronal injury/dysfunction preceding clinical microvascular damage. Importantly, the same pathophysiologic mechanisms that damage the pancreatic β-cell (e.g., inflammation, epigenetic changes, insulin resistance, fuel excess, and abnormal metabolic environment), also lead to cell and tissue damage causing organ dysfunction, elevating the risk of all complications, including diabetic retinopathy. Viewing diabetic retinopathy within the context whereby diabetes and all its complications arise from common pathophysiologic factors allows for the consideration of a wider array of potential ocular as well as systemic treatments for this common and devastating complication. Moreover, it also raises the importance of the need for methods that will provide more timely detection and prediction of the course in order to address early damage to the neurovascular unit prior to the clinical observation of microangiopathy. Currently, treatment success is limited as it is often initiated far too late and after significant neurodegeneration has occurred. This forward-thinking approach of earlier detection and treatment with a wider array of possible therapies broadens the physician's armamentarium and increases the opportunity for prevention and early treatment of diabetic retinopathy with preservation of good vision, as well the prevention of similar destructive processes occurring among other organs.

An Update on Corneal Biomechanics and Architecture in Diabetes.

In the last decade, we have witnessed substantial progress in our understanding of corneal biomechanics and architecture. It is well known that diabetes is a systemic metabolic disease that causes chronic progressive damage in the main organs of the human body, including the eyeball. Although the main and most widely recognized ocular effect of diabetes is on the retina, the structure of the cornea (the outermost and transparent tissue of the eye) can also be affected by the poor glycemic control characterizing diabetes. The different corneal structures (epithelium, stroma, and endothelium) are affected by specific complications of diabetes. The development of new noninvasive diagnostic technologies has provided a better understanding of corneal tissue modifications. The objective of this review is to describe the advances in the knowledge of the corneal alterations that diabetes can induce.

Assessment of prevalence of dry eyes in diabetic patients

Background: Diabetes Mellitus (DM) has topped the leading health related catastrophes the world ever witnessed. Various corneal components like the epithelium, endothelium, nerves and immune cells signify specific systemic complications of diabetes. Hence; the present study was undertaken for assessing the prevalence dry eyes in diabetic patients. Materials & methods: A total of 50 type 2 diabetic patients were included in the present study. Complete demographic details of all the patients were obtained. Prevalence of dry eye syndrome was recorded. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. Results: The overall prevalence of dry eyes among type 2 diabetic patients was 32 percent (16 patients). Conclusion: Significant proportion of diabetic patients is affected by dry eyes during the course of the disease.

Knowledge about Complications of Diabetes in Diabetic Patients Attending in General Health Checkup, Tribhuvan University Teaching Hospital Nepal

Introduction: The prevalence of diabetes mellitus has risen exponentially over the last three decades, with resultant increase in morbidity and mortality mainly due to its complications. The study aimed to assess the knowledge about the complications of diabetes in diabetic patients. Methods: A cross-sectional observational study was conducted among 100 diabetic patients who attended general health check-up clinic of Tribhuvan University Teaching Hospital. Results: Majority of the female patients (78.8%) had the knowledge of diabetes mellitus. Among them, over half had knowledge that diabetes can cause the problem of cardiovascular, kidney failure and retinopathy .Similarly, four-fifths (80%) of the patients above 40 years of age and majority (92.3%) of the patients with more than 5 years duration of diabetes had knowledge about diabetic complications. Conclusion: Female diabetic patients had slightly more knowledge of complication of diabetes in comparison to their male counterparts. The knowledge of diabetic complication was generally high among the patients above 40 years of age and the patients with more than 5 years duration of diabetes. Even then, sex and age was not associated with the knowledge of the need for annual eye checkup and specific diabetic complications such as, kidney and cardiovascular problem, hypoglycemia, neuropathy, foot problem, retinopathy, diabetic ketoacidosis and stroke. However, duration of patient’s diabetics was associated with their knowledge regarding cardiovascular problem, eye check-up annual and retinopathy but was not associated with kidney problem, hypoglycemia, neuropathy, foot problem, diabetic ketoacidosis and stroke. In order to make patient along with their family knowledgeable about the diabetes and its complications, there is need to incorporate diabetes counseling and education activities in General Health Check Up Clinic.

Self-Care Practices of Preparatory School Students with Type 1 Diabetes Mellitus in ELBehira Governorate

Background: Type 1 diabetes (T1D) is more prevailing disease in adolescence. Intervening in self-care is crucial for disease management and to reduce the risk of diabetes-specific complications. The aim of the study was to assess self-care practices of preparatory school students with type 1 Diabetes Mellitus in EL Behira Governorate. Egypt. Subjects: A total number of 300 students constituted the subjects of the study. Research design: A descriptive research design was used. Setting: Data was gained from governmental preparatory schools in El-Behira governorate. Sampling students were chosen by multistage sampling technique. Tools: one tool was used for data collection, a structured interview schedule composed of three parts to collect data about socio-demographic characteristics, students’ knowledge about TID, and assessment of students’ self-care practices. Results: 53.3% of the studied diabetic preparatory school students have fair total self-care practices score while 29.7% of them have poor self-care practices. A significant difference was revealed between the studied diabetic students’ total score of knowledge and self-care practices. 76.7% of the studied diabetic preparatory school students have poor total knowledge score. A significant difference was revealed between the studied diabetic students’ total score of knowledge and self-care practices In addition, diabetic students' age, previous hospitalization due to hypo/hyperglycemic coma, duration of disease discovery and socioeconomic status were significantly varied among them in relation to their total knowledge and self-care practices scores. Moreover, diabetic students' gender, father's education, mothers' education, mother's working condition were significantly varied among them in relation to their total self-care practices score. Conclusion and recommendations: The results of the present study concluded that the highest percentage of the studied diabetic preparatory school students have either fair or poor self-care practices and poor total knowledge score, so it is recommended to develop hotlines, mass media campaigns for dissemination of accurate information about juvenile diabetes and establishing an accurate surveillance and documentation system of diabetic students for easy accessibility and provision of accurate information.

Global trends in diabetes complications: a review of current evidence.

In recent decades, large increases in diabetes prevalence have been demonstrated in virtually all regions of the world. The increase in the number of people with diabetes or with a longer duration of diabetes is likely to alter the disease profile in many populations around the globe, particularly due to a higher incidence of diabetes-specific complications, such as kidney failure and peripheral arterial disease. The epidemiology of other conditions frequently associated with diabetes, including infections and cardiovascular disease, may also change, with direct effects on quality of life, demands on health services and economic costs. The current understanding of the international burden of and variation in diabetes-related complications is poor. The available data suggest that rates of myocardial infarction, stroke and amputation are decreasing among people with diabetes, in parallel with declining mortality. However, these data predominantly come from studies in only a few high-income countries. Trends in other complications of diabetes, such as end-stage renal disease, retinopathy and cancer, are less well explored. In this review, we synthesise data from population-based studies on trends in diabetes complications, with the objectives of: (1) characterising recent and long-term trends in diabetes-related complications; (2) describing regional variation in the excess risk of complications, where possible; and (3) identifying and prioritising gaps for future surveillance and study.