Known Duration Of Diabetes Research Articles

Associations of age-adjusted coefficient of variation of R-R intervals with autonomic and peripheral nerve function in non-elderly persons with diabetes.

Early diagnosis of diabetes-associated cardiac autonomic neuropathy using the coefficient of variation of R-R intervals (CVRR) may improve outcomes for individuals with diabetes. The present study examined the associations of decreased CVRR at rest and during deep breathing (DB) with other autonomic nerve function parameters. The electronic records of 141 inpatients with diabetes (22-65 years) admitted to our hospital between March 2015 and March 2019 were analyzed retrospectively. After assessment by exclusion criteria, 51 inpatients were included. All inpatients were assessed for peripheral and autonomic nerve function, clinical characteristics, and physical abilities. Inpatients with decreased CVRR at rest (n = 9 (17.6%)) and during DB (n = 12 (23.5%)) had a longer duration of known diabetes, a higher prevalence of diabetic retinopathy, lower body mass index (BMI), skeletal mass index (SMI), and knee extension strength, and a higher proportion of impaired standing balance. Decreased CVRR at rest was associated with a greater fall in diastolic BP from supine to standing, higher resting HR, longer QTc, longer time of voiding, and sensory symptoms. Decreased CVRR at rest and during deep breathing was associated with lower BMI, SMI, and knee strength and a higher proportion of impaired standing balance among non-elderly inpatients with diabetes. Decreased CVRR at rest appeared more strongly associated with a greater orthostatic BP decline, higher resting heart rate, longer QTc, lower urinary tract dysfunction, and sensory symptoms than a decreased CVRR during deep breathing.

Clinical Outcomes of 27-Gauge Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment Repair.

Purpose: To analyze the clinical outcomes of 27-gauge pars plana vitrectomy (PPV) repair of diabetic tractional retinal detachment (TRD) of various severities. Methods: This retrospective case series examined the outcomes of 27-gauge PPV to repair diabetic TRD from 2016 to 2020. The effect of medical and ophthalmologic history parameters and baseline detachment characteristics on visual acuity (VA) and retinal reattachment was analyzed. A grading system was established to stage the severity of the baseline vitreoretinal traction or detachment and compare the visual and anatomic outcomes between stages. Results: The study comprised 79 eyes (79 patients). The overall redetachment rate was 10.1% (8/79). The proportion of eyes with severe visual impairment (worse than 20/200) decreased from 81.0% (64/79) preoperatively to 56.9% (37/65) 6 months postoperatively (P < .001). Worse preoperative logMAR VA was associated with greater odds of redetachment (P = .017) and worse postoperative VA (P < .001). Insulin dependence was associated with better VA at 6 months (P = .017). A shorter known duration of diabetes (P = .026) and evidence of neovascularization of the iris (NVI) or angle (P = .004) were associated with worse visual outcomes. Eyes with detachment involving the posterior pole extending beyond the equator had worse VA at 6 months (P = .048). Conclusions: The primary reattachment rate after 27-gauge PPV was 89.9%. There was significant VA improvement, with a roughly 40% reduction in the number of eyes with severe visual impairment by the final follow-up. Insulin dependence, duration of diabetes, presence of NVI before surgery, and baseline posterior pole detachment extending beyond the equator were predictors of visual outcomes.

Prevalence of diabetic retinopathy and reduced vision among indigenous Australians in the nurse-led integrated Diabetes Education and Eye Screening study in a regional primary care clinic.

Nationally, Indigenous Australians are more likely to have diabetes and diabetic retinopathy (DR) than non-Indigenous Australians. However, the prevalence of DR and impaired vision in regional primary care settings is unclear. To describe the prevalence and severity of DR and presenting vision level among Indigenous Australian adults with diabetes attending an indigenous primary care clinic in regional Australia. Participants underwent nurse-led retinal imaging and DR screening with offsite retinal grading in the integrated Diabetes Education and Eye Screening (iDEES) project implemented at a regional indigenous primary healthcare setting between January 2018 and March 2020. Of 172 eligible adults, 135 (79%) were recruited and screened for DR and vision level. The median age was 56 (46-67) years, 130 (96%) had type 2 diabetes of median (interquartile range) duration 6 (2-12) years and 48 (36%) were male. Images from 132 (97.8%) participants were gradable. DR was present in 38 (29%) participants: mild non-proliferative in 33 (25%); moderate-severe in three (2.5%); and sight-threatening two (1.5%). Subnormal presenting vision was present in 33%. A nurse-led model of care integrating diabetes eye screening and education at a single visit was successful at recruiting Indigenous Australian adults with diabetes, screening their vision and acquiring a high rate of gradable images. Even for a short duration of known diabetes, DR was present in three out of 10 patients screened.

High Glycated Hemoglobin Instead of High Body Mass Index Might Increase the Urine N-Acetyl-β-D-glucosaminidase Con-Centration in Children and Adolescents with Diabetes Mellitus.

Children with diabetes, and particularly those with obesity, have poor glycemic control. They are thus at higher risk of early microvascular complications. Renal tubulointerstitial markers are integral to evaluating diabetic nephropathy. Various biomarkers have been proposed, but their role in the obese pediatric population is uncertain. We investigated renal injury markers in children with diabetes, according to obesity, and determined their role as early predictors of diabetic nephropathy. Fifty-three children and adolescents, diagnosed with either type 1 or 2 diabetes mellitus, and 43 control children, aged 7–18 years, were included. Clinical and laboratory characteristics, including six renal injury markers, were compared among subjects according to body mass index and presence of diabetes mellitus. Urine neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and N-acetyl-β-D-glucosaminidase (NAG) showed significant difference between controls and diabetic children, whereas urine NAG was the only biomarker that was significantly lower either in non-obese or obese controls as compared to diabetic children. Urine NGAL, KIM-1, and NAG showed significant correlations with both HbA1c and urine ACR, whereas only urine NAG was significantly correlated with HbA1c even when groups were subdivided based on the presence of either obesity or diabetes. After adjusting for age, sex, body mass index, duration of known diabetes, and urine albumin-to-creatinine ratio, HbA1c remained a significant risk factor for elevated urine NAG. Urine NAG could be a useful indicator of tubulointerstitial damage in children with diabetes in the pre-albuminuric state. Tighter glycemic control appears to be crucial for avoiding early progression to diabetic nephropathy.

Longitudinal evaluation of gastric emptying in type 2 diabetes

AimsTo evaluate the natural history of gastric emptying in type 2 diabetes. Methods12 patients with type 2 diabetes (7 female; age 65.6 ± 1.2 years; duration of known diabetes 22.9 ± 1.5 years) were invited to return for repeat measurements of gastric emptying using the same dual-labelled solid and liquid meal, a mean of 14.0 ± 0.5 years after their initial study. Blood glucose levels, glycated haemoglobin, upper gastrointestinal symptoms and autonomic nerve function at baseline and follow up were also compared. ResultsGastric emptying of solids was more rapid at follow up than at baseline (period effect P < 0.05), while emptying of liquids was comparable at baseline and follow up (period effect P = 0.2). Gastric emptying of the solid component was abnormally slow (based on T100min) in 6 subjects at baseline and 1 subject at follow up. Liquid emptying was abnormally slow in 6 subjects at baseline, and 5 subjects at follow up. Two patients were insulin treated at baseline, and 6 at follow up. HbA1c was higher at follow up (P < 0.05); however, fasting blood glucose (P = 0.6), postprandial blood glucose excursions (P = 0.07), autonomic nerve function (P > 0.999), and total upper gastrointestinal symptom score (P = 0.1) did not differ. ConclusionsIn patients with long-term type 2 diabetes, gastric emptying of solids and liquids does not usually become more delayed over time, and abnormally slow gastric emptying of solids may improve.

Analysis of the Association between PCSK9 Levels and Plasma Lipid Levels in Cameroonians with Type 2 Diabetes

Studies have shown that intensive LDL-lowering therapy results in a significant reduction in cardiovascular disease (CVD) risk and improved outcomes. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of LDL cholesterol (LDL-C) and an independent CVD risk marker. PCSK9 has additionally been related to CRP which is also a CVD risk marker. The emerging importance of the inhibition of PCSK9 for the treatment of hypercholesterolemia warrants investigations in different populations. This is the first study evaluating the association between PCSK9 and plasma lipid levels in Sub-Saharan Africa. A Cross sectional analysis was conducted at a major hospital in Yaound9, Cameroon in a cohort of 82 participants (53% females) with median age of 51[42-58] years. There were 28 non-obese type 2 diabetes (T2D) patients with median known duration of diabetes of 3.08[1.06-6.50] years, matched for age and sex to 28 obese nondiabetic and 26 lean nondiabetic subjects. Serum PCSK9 levels were measured using sandwich ELISA method. PCSK9 and hs-CRP levels were significantly higher in obese and T2D subjects relative to the lean controls (p&amp;lt;0.001 and p =0.0respectively). BMI was an independent predictor for PCSK9 and hs-CRP levels and this association remained after adjustment for potential confounders. Lean female subjects had significantly higher PCSK9 levels than males (p=0.004) and positive correlation of PCSK9 with LDL-C and total cholesterol (r=0.4, p=0.048 and r=0.5, p=0.039 respectively). An association was not found between PCSK9 and plasma lipid levels in obese and type 2 diabetes subjects nor was it found between PCSK9 and hs-CRP. Obese and type 2 diabetes subjects have higher PCSK9 and hs-CRP levels when compared to lean controls, suggesting that these metabolic states potentially impact PCSK9 levels in Cameroonian patients. Disclosure C.B.M. Mba: None. W.F. Mbacham: None. E. Sobngwi: None. J. Mbanya: Advisory Panel; Self; GlaxoSmithKline plc.. Speaker's Bureau; Self; Novo Nordisk A/S, Sanofi, Servier.

Predictors of chronic kidney disease in type 1 diabetes: a longitudinal study from the AMD Annals initiative

We evaluated 2,656 patients with type 1 diabetes mellitus and preserved renal function from the database of the Italian Association of Clinical Diabetologists network to identify clinical predictors for the development of chronic kidney disease. We measured estimated glomerular filtration rate (eGFR), urinary albumin excretion, HbA1c, lipids, blood pressure. Over a 5-year period 4.3% (n = 115) developed reduced eGFR (<60 ml/min/1.73 m2), 18.0% (n = 477) albuminuria, and 21.0% (n = 559) either one of the renal endpoints (CKD). Odds ratios for eGFR below 90 mL/min/1.73 m2 (1.48, P < 0.001), HbA1c (1.13, P = 0.002), triglycerides (1.04, P = 0.021 by 20 mg/dL), low density lipoprotein cholesterol (LDL-c) (0.95, P = 0.002 by 10 mg/dL) were independently related to the onset of CKD. Known duration of diabetes (1.15, P = 0.014 by 10 years), HbA1c (1.16, P = 0.001), triglycerides (1.05, P = 0.005 by 20 mg/dL), LDL-c (0.95, P = 0.003 by 10 mg/dL), antihypertensive treatment (2.28, P = 0.018) were related to the onset of albuminuria while age and presence of baseline eGFR values between 90 and 60 mL/min/1.73 m2, independently affected the developing of reduced eGFR (OR 1.95, P < 0.001 by 10 years and 2.92, P < 0.001). Patients with type 1 diabetes mellitus and unfavorable CV risk profile are at high risk of developing CKD. The two main traits of CKD share several determinants, although with some specificities.

Visual impairment certification due to diabetic retinopathy in North and Eastern Devon.

To determine certifications of visual impairment (CVIs) due to diabetic retinopathy (DR) in a region that has operated diabetic screening since 1992. A retrospective review of all CVIs due to DR was conducted, with mid-year population estimates and a diabetes prevalence model used to determine the annual incidence of certification from 2010 to 2013. For 2013, CVIs due to DR were also compared to all CVIs in the region. The total number of certifications due to DR was 75; 52 were sight impaired (SI) and 23 severely sight impaired (SSI) certifications; 25% of patients had type 1, and 75% had type 2 diabetes mellitus. The mean age at time of CVI was 65.5years. The mean duration of known diabetes was 22.0years. The incidence of CVI due to DR ranged from 30.8 to 77.4 per million population per year between 2010 and 2013. The incidence of CVI in the diabetic population was estimated at 0.47 to 1.21 per 1000 patients per year with diabetes for 2010-2013. In 2013, DR was a main or contributing cause in 4.3% of all CVIs, but did not contribute to any SSI certifications in the working age population. The incidence of CVI due to DR was comparable to that reported in other regions. Nationwide, DR was the second most common cause of blindness in working age adults, but did not contribute to any SSI certifications in our population. Our results are consistent with the success of a long-standing retinal screening programme.

Type 2 diabetes mellitus remission after bariatric surgery in Hispanic patients from Costa Rica

Although bariatric surgery is considered a cost-effective technique to treat type 2 diabetes mellitus (T2DM), long-term clinical outcomes of this surgical procedure are unknown in our region. The aim of this study was to report the T2DM remission rate at 3 years in Hispanic patients treated at our referral center. We retrospectively reviewed clinical records from all T2DM patients who underwent bariatric surgery in our center. T2DM remission rate at 3 years was considered if patients had A1c ≤ 5.7% and fasting glucose ≤100 mg/dl in the absence of diabetic medication. Univariate and multivariate analyses were performed to detect prognostic variables of remission. Thirty-three patients were included in this study. Nineteen subjects underwent gastric sleeve and 14 patients Roux-en-Y gastric bypass (RYGB). Mean body mass index at baseline was 51.1 ± 8.8 kg/m2 and mean glycosylated hemoglobin was 7.8 ± 1.8%. After 3 years, the percentage of weight change from baseline was 26.7% ± 10%. T2DM remission was achieved by 22 patients (66.6%). T2DM remission did not vary according to the type of surgery. Nevertheless, patients with T2DM remission had shorter duration of known diabetes (2.0 years vs. 5.5 years; P = 0.047) and larger weight change loss (−29.6% vs. −22.5%; P = 0.04) than patients without remission. After multivariate analysis, only fasting glucose plasma levels were associated with T2DM remission. Bariatric surgery is associated with high T2DM remission rate among Hispanic patients from Costa Rica. Prospective data are needed to determine predictors of T2DM remission.

Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study.

Background:Diabetic retinopathy is a leading cause of visual impairment. Low awareness about the disease and inequitable distribution of care are major challenges in India.Objectives:Assess perception of care and challenges faced in availing care among diabetics.Materials and Methods:The cross-sectional, hospital based survey was conducted in eleven cities. In each city, public and private providers of eye-care were identified. Both multispecialty and standalone facilities were included. Specially designed semi-open ended questionnaires were administered to the clients.Results:376 diabetics were interviewed in the eye clinics, of whom 62.8% (236) were selected from facilities in cities with a population of 7 million or more. The mean duration of known diabetes was 11.1 (±7.7) years. Half the respondents understood the meaning of adequate glycemic control and 45% reported that they had visual loss when they first presented to an eye facility. Facilities in smaller cities and those with higher educational status were found to be statistically significant predictors of self-reported good/adequate control of diabetes. The correct awareness of glycemic control was significantly high among attending privately-funded facilities and higher educational status. Self-monitoring of glycemic status at home was significantly associated with respondents from larger cities, privately-funded facilities, those who were better educated and reported longer duration of diabetes. Duration of diabetes (41%), poor glycemic control (39.4%) and age (20.7%) were identified as the leading causes of DR. The commonest challenges faced were lifestyle/behavior related.Conclusions:The findings have significant implications for the organization of diabetes services in India.

Is Prevalence of Retinopathy Related to the Age of Onset of Diabetes? Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Report No. 5

Aim: To compare the prevalence of diabetic retinopathy (DR) and risk factors in patients with a known onset of diabetes before 40 years and after 40 years of age. Methods: This is a population-based study for which 1,414 diabetics were recruited. The fundi were photographed using 45-degree 4-field stereoscopic digital photography. The diagnosis of DR was based on Klein’s classification of the Early Treatment Diabetic Retinopathy Study scales. Results: The prevalence of DR was 33.3% (95% confidence interval, CI: 26.6–39.9) in known onset of diabetes (≤40 years) compared to 15.6% (95% CI: 13.6–17.6) in those with late onset (>40 years; p < 0.0001). In the group with age of known onset of diabetes ≤40 years, the risk factors, associated with any DR, were poor glycemic control (odds ratio, OR: 1.36 for every g% increase in glycosylated hemoglobin), insulin use (OR: 4.21), increasing known duration of diabetes (OR: 1.10 for increase of every year in known duration of diabetes) and presence of macroalbuminuria (OR: 13.39). In the late onset of diabetes group, besides the above-mentioned risk factors, the presence of microalbuminuria (OR: 2.08), male gender (OR: 1.67), presence of anemia (OR: 1.89) and increased systolic blood pressure (OR: 1.01) were the risk factors for DR. Conclusion: The prevalence of DR was almost twice more in those subjects who developed diabetes before the age of 40 years than those who developed it later.

The practices and outcomes of diabetic patients during ramadan fast: A survey in a specialist clinic

Assessment was made by semi-structured interview of the practices and outcomes of diabetic patients during Ramadan fasting. Data collected included demographic data, diabetes details, medications and HbA1c levels. Patients were questioned about fasting, changes in medications, and outcomes in terms of hypoglycemia, hyperglycemia, and emergency hospital visits. Three hundred and thirteen nonpregnant adult patients were surveyed during the six weeks after Ramadan. Median age was 53 (range 11 to 87) years. One hundred and sixty nine patients (54%) were women and the majority were UAE nationals. The median duration of known diabetes was 10 years (range 1-35). The majority had type 2 diabetes (n=276 or 88%) and 37 patients had type 1 diabetes. The majority of patients with type 1 diabetes (n=30/38) received intensive insulin regimens. Patients with type 2 diabetes were treated with intensive insulin regimen (n=28 or 10%), twice daily insulin regimen (n=40 or 14%) and basal insulin (n=52 or 19%) with or without oral agents. Oral anti-diabetic therapy was used in 156 (57%). The mean HbA1c was 8.7% with a median of 8.1(5.5-17.6%) measured at a median of two months (range 1-12) before Ramadan. Fifteen patients did not fast (4.8%) of whom four did not fast for other medical reasons, and of the total five had type 1 diabetes. Fasting was observed by 258 patients (82%), for &gt; 20 days by 31 patients (10%), between 10-20 days by 7 patients (2.2%) and for &lt;10 days by two patients (0.6%). The total daily dose was unchanged in 209/298 (70%), was reduced by 83 (28%) and stopped completely by 5 patients (2%). Patients took their medication as three doses (6.4%), two doses (81%) or a single dose (12%). No hypoglycemia was reported in 253 patients. However, in 26, 6, and 11 patients hypoglycemia lead to breaking the fast in 1-3, 4-6 and &gt;7 days respectively. Unusually high hyperglycemia was reported by 33 patients with values around 200-400 mg/dL. Admission to hospital was needed by three patients. In conclusion, most patients with diabetes do fast during Ramadan with changes in their medications' total dose and frequency. Hypoglycemia is the most common complication in insulin-dependent diabetic patients.

Biologic Risk Factors Associated with Diabetic Retinopathy: The Los Angeles Latino Eye Study

To identify biologic risk factors associated with having diabetic retinopathy (DR) in Latinos with type 2 diabetes mellitus (T2DM). Population-based cross-sectional study. Six thousand three hundred fifty-seven Latinos ages > or =40 years from 6 census tracts in Los Angeles, California. An in-home interview was administered to all participants in the Los Angeles Latino Eye Study (LALES). All participants diagnosed with T2DM underwent a complete ophthalmologic examination including stereoscopic fundus photography (7 standard Early Treatment Diabetic Retinopathy Study fields). Photographs were graded in a masked manner using a modified Airlie House grading system to assess presence and severity of DR. Univariate and stepwise logistic regression analyses were used to identify independent risk factors. Biologic risk factors associated with any DR and proliferative DR (PDR). Of the 7789 eligible individuals in LALES, 6357 (82%) had a clinical examination. One thousand two hundred sixty-three participants had definite diabetes and 1187 Latinos had T2DM. Of those with T2DM, 46% (544) had DR. Stepwise logistic regression analyses revealed that compared with females, males had a 50% higher risk of having any DR (OR = 1.50; P = 0.006). Factors independently associated with a greater risk of having any DR were longer duration of known diabetes (per year, OR = 1.08, P<0.0001), higher glycosylated hemoglobin levels (per 1%, OR = 1.22, P<0.0001); higher systolic blood pressure (per 20 mmHg, OR = 1.26, P = 0.002); and insulin treatment (OR = 1.60, P = 0.01). Factors independently associated with PDR included longer duration of known diabetes (per year, OR = 1.06, P<0.0001); being on insulin treatment (OR = 3.2, P<0.0001); and a higher systolic blood pressure (per 20 mmHg, OR = 1.44, P = 0.01). The relationship of these variables to the risk of having DR or PDR is not a constant linear function in all cases and varies depending on the variable. Our study showed that the high risk of DR in adult Latinos is independently associated with both nonmodifiable and modifiable risk factors. These findings suggest that controlling hyperglycemia and hypertension in this ethnic group may reduce the high risk of having DR associated with T2DM.

End-stage renal disease risk equations for Hong Kong Chinese patients with type 2 diabetes: Hong Kong Diabetes Registry

The objective of the study was to investigate risk factors and develop risk equations for end-stage renal disease (ESRD) in Chinese patients with type 2 diabetes. A prospective cohort of 4,438 patients with type 2 diabetes mellitus and without ESRD (median observation period 2.9 years, interquartile range 1.6-4.1 years) was included in the analysis. The end-point (ESRD) was defined by: (1) death due to diabetes with renal manifestations or renal failure; (2) hospitalisation due to renal failure; (3) estimated GFR (eGFR) <15 ml min(-1) 1.73 m(-2). Cox proportional hazards regression was used to develop risk equations. The data were randomly and evenly divided into the training data for development of the risk equations and the test data for validation. The validation was performed using the area under the receiver operating characteristic curve (aROC), which takes into account follow-up time and censoring. During the observation period, 159 patients or 12.45 per 1,000 person-years (95% CI 10.52-14.37 per 1,000 person-years) developed ESRD. Known duration of diabetes, systolic blood pressure, log(10) total cholesterol:HDL cholesterol ratio and retinopathy were significant predictors of ESRD. After further adjusting for eGFR, log(10) spot albumin:creatinine ratio (ACR) and haematocrit, only eGFR, haematocrit and log(10) ACR remained as independent predictors of ESRD. The risk equation derived from these three independent predictors had good discrimination, with an aROC of 0.97. Estimated GFR, haematocrit and ACR were independent predictors of ESRD and the derived risk equation performed well in Chinese patients with type 2 diabetes.

Usefulness of the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) Questionnaire in Patients with Diabetes in a Multi-Ethnic Asian Country

Asia will be at the forefront of the current epidemic of diabetes mellitus. Quality of life (QOL) is an important outcome measure in the assessment of diabetes care. However, few QOL instruments are culturally suitable for use in Asian countries. The Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) questionnaire is a third-generation individualised QOL instrument. Individualised instruments such as the ADDQoL have the potential to be useful and less costly alternatives to computerised adaptive testing (CAT), which may not be practical in developing countries. To evaluate and validate the ADDQoL questionnaire in English-speaking patients with diabetes in Singapore, a multi-ethnic Asian country. The ADDQoL and EQ-5D were administered to English-speaking respondents with type 1 or 2 diabetes (aged > or =18 years) recruited from a tertiary acute-care referral hospital by convenience sampling. The usefulness of the key design features of the ADDQoL were assessed by measuring the number of zero-importance responses, the change in item ranking with and without weighting for importance, and the frequency of utilisation of the 'not applicable' (NA) options. The acceptability, factor structure and internal consistency (Cronbach's alpha) of the ADDQoL were also assessed. Data were subjected to unforced factor analysis with oblimin rotation and then the condition was set to force a one-factor solution. The validity of the ADDQoL was tested with the following hypotheses: those with moderate or severe problems on the EQ-5D would have worse ADDQoL average weighted impact (AWI) scores than those with a perfect health rating on the EQ-5D; those with better Present QOL scores on the ADDQoL would have better EQ-5D utility and visual analogue scale (VAS) scores; on the ADDQoL, AWI scores would correlate better with diabetes-dependent QOL than with Present QOL scores; and female respondents, those who required insulin or had longer duration of known diabetes would have worse ADDQoL AWI scores (known-group validity). We analysed data from 152 respondents (49% Chinese, 34% Indian; 45% female; mean age 52 years, range 18-80; mean duration of known diabetes 10 years, range 0-62). There were few missing data. Weighted scoring and NA options were shown to be necessary, thus supporting the usefulness of individualised health-related QOL measures. Factor structure of the ADDQoL was supported and internal consistency was high (alpha = 0.94). All hypotheses were fulfilled except for one that was partially fulfilled; respondents with longer duration of known diabetes did not report worse ADDQoL AWI scores. The ADDQoL is culturally appropriate, valid, reliable and well accepted among Singaporean patients with diabetes. Individualised measures such as the ADDQoL allow one to obtain precise score estimates and may offer developing countries a useful alternative to CAT.

CHARACTERIZATION OF TYPE 2 DIABETES MELLITUS IN FIRST GENERATION ITALIAN MIGRANTS TO BELGIUM

Type 2 diabetes mellitus is a major metabolic disease in developed countries, and preferentially affects low-income groups and/or people from Southern extraction. Migrants are especially at risk. In Belgium, a large population of workers emigrated in the 50s and 60s, especially from rural areas of Southern Italy and Sicily. We tested the hypothesis that type 2 diabetes mellitus’ phenotype in these Italian migrants could differ from that observed in autochthonous Belgian subjects. We retrospectively compared the clinical files of 485 patients with type 2 diabetes either of Belgian (n=445) or Italian origin (n=40). Italians were younger at diagnosis (46±14 vs. 52±13 years, P<0.01), shorter, had a lower education and a stronger family record of diabetes (89 vs. 47%, P<0.01). They had similar BMIs (31±6) and similar or slightly worse degree of sedentarity (>75%). We further compared this Italian group to 115 Belgians subjects matched for age, sex, and education. Known duration of diabetes (16 years), smoking and drinking habits, use of oral hypoglycaemic, antihypertensive and hypolipaemic drugs, complications, CRP, estimated glomerular filtration rate, micro-albuminuria prevalence, blood pressure, insulin sensitivity/beta-cell function estimated by HOMA modelling, as well as fat mass indirectly estimated by impedancemetry were not significantly different between the two populations. There was a non significant trend toward higher HbA1c (8.7± 2 vs. 8.2±2%, NS) in Italian subjects whose LDL-cholesterol was however significantly lower (105±31 vs. 120±33 mg.dL-1, P<0.01) as well as folic acid (5±1.7 vs. 6.7±4, P<0.001). Insulin dose was higher (0.77±0.4 vs. 0.48±0.3 IU.day-1, P<0.001) and abdominal obesity less prevalent in males (33 vs. 58%, P<0.01) of this group. Thus, Italian diabetic subjects in Belgium exhibit higher insulin requirements despite similar/better BMI, known duration of diabetes, HOMA indices, use of oral antidiabetic drugs, abdominal obesity and slightly higher HbA1c. This points towards different dietary habits, as do the differences in folic acid and LDL-cholesterol; different patterns of exercise may also play a role. Higher family record of diabetes may be genetic, but may also be biased by tighter family structure in subjects of Italian extraction.

Left ventricular hypertrophy in normoalbuminuric type 2 diabetic patients not taking antihypertensive treatment

Left ventricular hypertrophy (LVH) is an independent risk factor for myocardial ischaemia, cardiac arrhythmia, sudden death, and heart failure, all common findings in patients with type 2 diabetes. To determine the prevalence of, and risk factors for, LVH in normoalbuminuric type 2 diabetic patients not taking antihypertensive treatment. Cross-sectional study. From 1994 to 1998, M-mode echocardiography was performed by one experienced examiner in 262 consecutive, normoalbuminuric Caucasian type 2 diabetic patients, all with blood pressure <160/95 mmHg and not taking antihypertensive medication. Mean +/- SD age was 54 +/- 10 years, 109 were women, and median known duration of diabetes was 4 (range 1-28) years. Body mass index (BMI) was 28 +/- 5 kg/m(2), and blood pressure 134 +/- 13/79 +/- 8 mmHg, all means +/- SD. Median urinary albumin excretion rate was 9 (range 2-30) mg/24 h. The prevalence of LVH indexed to height(2.7) was 43% (95%CI 38-50%), and was similar in men and women. BMI, HbA(1c) and log urinary albumin excretion were significantly associated with left ventricular hypertrophy in a logistic regression model, whereas sex, age, known duration of diabetes and blood pressure were not. Similar results were obtained for left ventricular mass index. LVH was frequent in our normoalbuminuric type 2 diabetic patients not taking antihypertensive treatment. Several potentially modifiable risk factors, such as raised BMI, poor glycaemic control and elevated urinary albumin excretion rate, were associated with LVH.

Orthostatic Hypotension and Heart Rate Variability as Signs of Cardiac Autonomic Neuropathy in Diabetes Mellitus

Aim: The aim of this study was to emphasize two different points in our work: 1) The well known importance of (subclinical) postural hypotension and reduced heart rate variability as (early) markers of autonomic neuropathy; 2) and the more controversial influence of diabetic control in their worsening. Methods: Two standard cardiovascular response tests (heart rate variability by respiration and orthostatic blood pressure changes) were carried out on 93 diabetic patients with prolonged QT interval in order to determine cardiac dysautonomy. QT segment duration was measured on electrocardiography recordings. Patients with HbA1c levels below 7 were considered as wellcontrolled diabetics. A cut off of 5 years was selected for the known duration of diabetes. The relations between cardiac autonomic neuropathy and diabetic control and the known duration of diabetes were determined. Results: The mean values for the known duration of diabetes and HbA1c level were 10±7.23 years and 9.5±2.3 mg/dl respectively. Median QTc differences, postural change in the systolic blood pressure, and changes of heart rate by respiration were 0.62 sec, 20 mmHg, and 6 beat/min, respectively. There was no difference in QTc values with respect to diabetes control but QTc values were significantly different with regard to the known duration of diabetes. Blood pressure variations with standing were significantly related to control as well as the known duration of diabetes. Variability of hearth rate with respiration on the other hand was significantly related to the duration but not to the control of diabetes. QTc showed a significant correlation with the known duration of diabetes, postural blood pressure changes, and heart rate variability with respiration. Conclusion: Clinician’s should be more alert for the signs of autonomic neuropathy, especially in patients with a history of diabetes for more than five years. Special attention should be given to postural blood pressure changes and heart rate variability with respiration.

Microalbumiuria and associated risk factors in type II diabetics.

To determine the frequency of microalbuminuria (MA) and its associated medical risk factors in type II diabetic patients. This cross-sectional analytical study was conducted during Ist half of 2003 at Combined Military Hospital, Lahore. Non-probability purposive sampling was employed. Study population included 150 type II diabetic patients (70 women, 80 men) attending outpatient department of the hospital. Patients having clinical albuminuria and with other causes of proteinuria were excluded. Women and men were of comparable ages. Women (26.4 kg/m2) had higher body mass index (BMI) than men (24.3 kg/m2). The frequency of MA was 46.7%, higher in males (50.6%) than females (41.5%). Fasting plasma glucose and HbA1c levels were significantly higher in patients with MA compared to those with normoalbuminuria (p <0.001). The microalbuminuric patients had significantly decreased HDL-c levels compared to normoalbuminuric subjects (p < 0.001). However, no relation of MA with age, gender, known duration of diabetes, BMI, history of smoking, hypertension and serum: total cholesterol, LDL - c, triglyceride, urea and creatinine was found. There is a strong association of poor glycaemic control and decreased HDL-c levels with the presence of microalbuminuria.

Vascular disease prevalence in diabetic patients in China: standardised comparison with the 14 centres in the WHO multinational study of vascular disease in diabetes

Rates of vascular complications of diabetes in a cohort of mainland Chinese patients with diabetes, ascertained and examined by similar methodology, are compared with those of the WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD). The standardised procedures carried out in the WHO MSVDD were followed in assembling and examining a Chinese cohort of 447 diabetic patients recruited in Beijing and Tianjin [2]. Compared with the WHO MSVDD centres, the Chinese cohort was slightly older, had a shorter duration of known diabetes and had fewer insulin-treated patients. Arterial pressure, total blood cholesterol and body mass index were substantially lower. Large vessel disease rate for age, sex and duration adjusted data (17.9 % ) was about half that of the combined WHO MSVDD centres (33.5 % p < 0.001). However, retinopathy (47.4% vs 35.8% p < 0.001) and proteinuria (57.1 vs 24.9 % p < 0.001) rates were significantly higher. Relatively low arterial pressures and blood cholesterol are likely contributors to the notably low arterial disease rates in this Chinese diabetic cohort; they reflect low rates in the Chinese mainland general population and resemble the Tokyo and Hong Kong centres of the WHO MSVDD. The high rates of retinopathy and proteinuria could relate to later diagnosis, degree of hyperglycaemia and/or increased susceptibiltiy to microangiopathy.