Insulin-dependent Diabetic Patients Research Articles

Assessment of the Perceived Quality of Life of Non insulin Dependent Diabetic patients attending the Diabetes Clinic in Kenyatta National Hospital

BACKGROUND: Diabetes Mellitus is a common and demanding health related problem that has a wide effect on every day‟s life of the patients. It can have a profound effect on quality of life in terms of social and psychological well-being as well as physical ill-health. It is one of the most psychologically demanding of the chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment.

PS12 - 5. Development and evaluation of a light psycho-educational group intervention with internet for insulin-dependent diabetes patients and problematic hypoglycaemia

Hypoglycaemia poses a major threat to the quality of life of patients with diabetes. The Blood Glucose Awareness Training (BGAT) is effective in improving symptom awareness and reducing hypoglycaemia; however, implementation in Dutch diabetes care has proven to be difficult due to the program’s complexity and time-consuming nature.

KATP vs Purkinje fibers: Which should we shoot first, or should we?

backs. 4 ICDs, which are widely used to prevent arrhythmic SCDs, can also deliver inappropriate shocks that can not only damage the diseased heart but also provoke arrhythmias. In spite of these shortcomings, ICDs are the only available therapy that can effectively terminate VF soon after it initiates. Moreover, select antiarrhythmic medications such as beta-blockers and amiodarone are used to reduce the frequency of ICD shocks but are associated with undesirable side effects. 5 Additionally, ablation of proarrhythmic ventricular tissue can decrease the number of ICD shocks but does not significantly alter mortality rate and potentially can result in multiple complications 6 possibly due to electroporation damage. 7 Therefore, identifying novel mechanisms and therapeutic strategies to effectively treat malignant arrhythmias such as VF is an absolute necessity to improve prognosis for the growing population with cardiac disease. One important approach to achieve this goal is to determine the cellular basis of these fatal arrhythmias. Historically, ion channels that maintain normal electrical homeostasis across the cell membrane are the primary candidates to treat arrhythmias. The ATP-sensitive potassium current IK(ATP) is one such ion current that plays an important role in cardiac repolarization and contraction during both physiologic and especially pathologic conditions. 8 Specifically, KATP channels are known to play a cardioprotective role during myocardial ischemia and hypoxia, wherein the increased potassium efflux causes a reduction in action potential duration. Although beneficial, the anatomically heteterogeneous decrease in action potential duration and hence dispersed refractoriness also can increase the propensity for VF. 9–11 Experimental manipulation of the KATP channels using channel openers (e.g., pinacidil and diazoxide) and inhibitors (e.g., glibenclamide) has clearly established the channel’s role in the induction and maintenance of VF in different animal models, 8,12 explanted human hearts, 9 and in non–insulin-dependent diabetic patients during transient ischemia. 13 Clearly, activation of KATP channels could be one mechanism of ischemia-induced VF, especially in diseased, metabolically challenged hearts. Another important player implicated in VF development is the Purkinje fiber system (PS), where triggered activity has been proposed to initiate as well as maintain VF. 14,15 Premature beats originating in the PS may initiate VF, and ablation focused on these fibers can reduce the arrhythmic burden in patients with idiopathic VF. 14 In the canine heart,

Enhanced Oxygen Supply Improves Islet Viability in a New Bioartificial Pancreas

The current epidemic of diabetes with its overwhelming burden on our healthcare system requires better therapeutic strategies. Here we present a promising novel approach for a curative strategy that may be accessible for all insulin-dependent diabetes patients. We designed a subcutaneous implantable bioartificial pancreas (BAP)-the "β-Air"-that is able to overcome critical challenges in current clinical islet transplantation protocols: adequate oxygen supply to the graft and protection of donor islets against the host immune system. The system consists of islets of Langerhans immobilized in an alginate hydrogel, a gas chamber, a gas permeable membrane, an external membrane, and a mechanical support. The minimally invasive implantable device, refueled with oxygen via subdermally implanted access ports, completely normalized diabetic indicators of glycemic control (blood glucose intravenous glucose tolerance test and HbA1c) in streptozotocin-induced diabetic rats for periods up to 6 months. The functionality of the device was dependent on oxygen supply to the device as the grafts failed when oxygen supply was ceased. In addition, we showed that the device is immuno-protective as it allowed for survival of not only isografts but also of allografts. Histological examination of the explanted devices demonstrated morphologically and functionally intact islets; the surrounding tissue was without signs of inflammation and showed visual evidence of vasculature at the site of implantation. Further increase in islets loading density will justify the translation of the system to clinical trials, opening up the potential for a novel approach in diabetes therapy.

Development of Mobile Tracking System for Diabetes and Recent Patents on Diabetes Mellitus

In today’s world, the prevalence of insulin dependent patients is increasing worldwide. In light of advancing in technology at biomedical science, the new approach and methods in recent years show the potential to solve the problems. In addition, advances in biomedical instruments have led to new opportunities such as real time patient tracking for mobile healthcare purposes. In this sense, wireless tracking of diabetic patients in home environment has been proposed as an alternative to conventional tracking. It can enhance the performance of processes in terms of reduction of expert person, cost, ease of use, and decrease the compliance of patients. In this study, wireless diabetic tracking system (WDTS) is developed. The application system concerns mainly wireless tracking of diabetic patients from their home environment. It is focused on the insulin dependent Type-2 diabetic patients. Main aim of the system is to facilitate tracking of diabetic patients. Satisfactory results are obtained by applying the system to six patients. Revision and summary of the most important and prominent patents regarding diabetes mellitus management, mobile tracking and treatment are also presented in this study. The patents examined concern a period extending from the years 2000 up to date. The paper ends with a description of the future improvements expected in the subjects covered. Keywords: Diabetes mellitus, mobile, management, patent, tracking, wireless.

A novel ALMS1 splice mutation in a non-obese juvenile-onset insulin-dependent syndromic diabetic patient

Insulin-dependent juvenile-onset diabetes may occur in the context of rare syndromic presentations suggesting monogenic inheritance rather than common multifactorial autoimmune type 1 diabetes. Here, we report the case of a Lebanese patient diagnosed with juvenile-onset insulin-dependent diabetes presenting ketoacidosis, early-onset retinopathy with optic atrophy, hearing loss, diabetes insipidus, epilepsy, and normal weight and stature, who later developed insulin resistance. Despite similarities with Wolfram syndrome, we excluded the WFS1 gene as responsible for this disease. Using combined linkage and candidate gene study, we selected ALMS1, responsible for Alström syndrome, as a candidate gene. We identified a novel splice mutation in intron 18 located 3 bp before the intron-exon junction (IVS18-3T>G), resulting in exon 19 skipping and consequent frameshift generating a truncated protein (V3958fs3964X). The clinical presentation of the patient significantly differed from typical Alström syndrome by the absence of truncal obesity and short stature, and by the presence of ketoacidotic insulin-dependent diabetes, optic atrophy and diabetes insipidus. Our observation broadens the clinical spectrum of Alström syndrome and suggests that ALMS1 mutations may be considered in patients who initially present with an acute onset of insulin-dependent diabetes.

The mean dietary protein intake at different stages of chronic kidney disease is higher than current guidelines

The actual dietary protein intake of adults without and with different stages of chronic kidney disease is not known. To evaluate this we performed cross-sectional analyses of 16,872 adults (20 years of age and older) participating in the National Health and Nutrition Examination Survey 2001-2008 who completed a dietary interview by stage of kidney disease. Dietary protein intake was assessed from 24-h recall systematically collected using the Automated Multiple Pass Method. Complex survey analyses were used to derive population estimates of dietary protein intake at each stage of chronic kidney disease. Using dietary protein intake of adults without chronic kidney disease as the comparator, and after adjusting for age, the mean dietary protein intake was 1.30 g/kg ideal body weight/day (g/kgIBW/d) and was not different from stage 1 or stage 2 (1.28 and 1.25 g/kgIBW/d, respectively), but was significantly different in stage 3 and stage 4 (1.22 and 1.13 g/kgIBW/d, respectively). These mean values appear to be above the Institute of Medicine requirements for healthy adults and the NKF-KDOQI guidelines for stages 3 and 4 chronic kidney disease. Thus, the mean dietary protein intake is higher than current guidelines, even after adjusting for age.

In-hospital Management of Diabetes

In-hospital Management of Diabetes

Anesthetic Management for Resection of Hepatic Paraganglioma Metastatic From the Donor Organ in an Orthotopic Liver Transplant Recipient: A Case Report

This is a case report of the anesthetic management for the hepatic resection of a metastatic paraganglioma in a patient with a history of prior orthotopic liver transplantation. Of interest, the metastatic paraganglioma originated from the donor organ. The patient is an 80-year-old woman with multiple medical problems including a history of cryptogenic cirrhosis who underwent successful orthotopic liver transplantation 9 years prior. She later presented with signs and symptoms of catecholamine excess suggestive of a catecholamine-producing tumor (paraganglioma or pheochromocytoma). Elevated urine catecholamine levels and radiographic evidence of a paraganglioma in the transplanted liver metastatic from the donor organ confirmed the diagnosis. Radiofrequency ablation of the tumor and surgical resection was previously attempted without success. We describe the anesthetic management for the successful resection of the metastatic hepatic paraganglioma, which was complicated by profound intraoperative hypertension and hypotension that necessitated the use of multiple vasoactive infusions, extensive surgical blood loss requiring blood transfusion, and difficult glycemic control in an insulin-dependent diabetic patient. The postoperative course is also described. This unique case presented the anesthesia team with challenges specific to both surgery for hepatic resection as well as for catecholamine-secreting tumors. We are not aware of any reports of paragangliomas of either donor or recipient origin involving a transplanted liver, making this the first such report to the best of our knowledge.

Deep surgical site infection in insulin dependent diabetic patients: On-pump or off-pump in isolated coronary bypass surgery?

Aims: This study was performed to evaluate the impact of on-pump (ONCAB) versus off-pump (OPCAB) coronary bypass surgery in insulin depending diabetic patients on deep surgical site infections (SSI).

Application of community periodontal index of treatment need (CPITN) in a group of insulin dependent diabetes mellitus (IDDM) patients

The aim of this study was to assess periodontal status and treatment need of insulin dependent diabetic mellitus patients by using the CPITN system and to shed additional light on the possible effects of the duration of diabetes on the periodontal status in these patients. A comparison was made between 150 diabetic patients and 150 control subjects. The surveys comprised of a self-administered questionnaire, along with medical and dental examinations. The results indicated that prevalence of code 0 was lower and code 1, 2 and 3 were higher in diabetic than control group. Oral hygiene instruction was required for 64.7 % of diabetic group and 47.3 % of control group. Professional scaling was required for 34.7 % of diabetic group and 20 % of control group. Complex treatment required for 2 % of diabetic group and 0.7 % of control group. To conclude, strong association was found between diabetes and periodontal health in the present study. Hence, it is recommended that an oral examination should be one of the components of the initial visit for children and adolescents having diabetes.

Insulin-dependent diabetic patients with macrovascular complications suffer from many geriatric conditions

BackgroundCurrent diabetic care guidelines focus mainly on managing metabolic control and macro- and microvascular comorbidities. This focus may be too narrow given the number of geriatric conditions present in these often aged patients. MethodsWe studied the prevalence of multimorbidity, (undiagnosed) geriatric conditions and disabilities in diabetic patients with macrovascular complications. ResultsOne hundred forty-three community dwelling, insulin-dependent diabetic patients with macrovascular complications, aged 55years and above, who were concurrently enrolled in the diabetes care clinic in a university hospital in the Netherlands, participated. Data on healthcare utilization, activities of daily living, geriatric conditions and quality of life were self-reported using a systematic diagnostic questionnaire. Mean age was 66.9years (8.5years), 62% were male and 22% were of Surinamese-South Asian descent. Loneliness was reported by 47%. The majority rated their quality of life (QoL) from ‘reasonable’ (45%) to ‘good’ (31%). In patients without ADL impairments, 60% were in need of assistance, compared to 95% among those with more than one impairment (p<0.01). In total, 19% had cognitive impairment, and 63% perceived pain. 84% of patients with impairments experienced social problems compared to 32% of patients in the other group. ConclusionsThis study demonstrates that the current focus of diabetes care may be too restricted given the high number of geriatric conditions that these patients present.

Lipoprotein(a), type 2 diabetes and nephropathy; the mystery continues

Lipoprotein(a), type 2 diabetes and nephropathy; the mystery continues

The preparation of a complex of insulin–phospholipids and their interaction mechanism

Subcutaneous injections of insulin remain the standard treatment for insulin-dependent diabetic patients, and noninvasive routes are studied but with little success. One of the reasons is that insulin is a hydrophilic compounds and is difficult to cross the mucosa barrier. In this paper, we developed a novel technique to fabricate the insulin-phospholipids complex by a solvent evaporation method with the aim of improving the lipophilicity of insulin. A systematic study on the preparation conditions of the insulin-phospholipids complex is reported in the present work. The formation mechanism and the physicochemical properties of the complex are studied. The associated efficiency of the phospholipids and insulin can be up to 100% when their mass ratio is 7.5 : 1 or more, and the solubility of the complex is improved more than 40 000 times compared with that of insulin alone in the n-octyl alcohol. The results of the insulin content in the complex and hypoglycemic effects in diabetic mice indicated that insulin was able to withstand the preparation procedure. The stability results showed that the complex was stable for 1 year at -20 °C. The interaction mechanism of this formation is that the peptide bonds of insulin interact with the water-soluble head of phospholipids, forming a reverse micelle-like structure. This novel complex will be of great importance in the drug delivery system for insulin via noninvasive routes. This method is cost effective, scalable, and can be used in many other peptide drugs.

Sharps disposal practices among diabetic patients using insulin

Insulin-dependent diabetic patients are not educated on safe sharps disposal methods, so leading to unsafe disposal of needles. Appropriate education on the correct disposal of sharps should be an integral part of their diabetic counseling. Doctors, nurses and pharmacists should all take responsibility for educating and reinforcing information about correct sharps disposal methods. Patients should be advised to either discard sharps into puncture resistant containers placed into their household refuse, or return them in secure containers for disposal by the dispensing institutions. Patients should also be educated regarding health risks associated with used needles. The South African Metabolic and Endocrine (SEMDSA) Guidelines and the South African Standard Treatment Guidelines (STG) should also give clear guidance on the safe disposal of needles.

The relationship between the dental caries and the blood glucose level among type II non insulin dependent diabetic patients

Background: Diabetes mellitus is one of the most common chronic diseases in the general population that effects the oral cavity so the probability of detecting an increased of dental caries in diabetic patients is more controversial. The aims of this study to compare the dental caries among the diabetic and non diabetic patients and its relation with the blood glucose level, medical history and oral health behaviors among type II non-insulin dependent diabetic mellitus patients. Materials and methods: The samples were composed of 180 subjects of diabetic patients and 180 subjects of non diabetes. Both gender and age range 40 -70 years for both groups. The data were gathered by questionnaire, clinical examination and laboratory investigations included frequency of oral hygiene practices, caries experience using the DMFT Index, blood glucose including the fasting blood glucose level, and random blood glucose level. Independent t-test, Chi-square, correlation coefficient, as well as Z-proportion tests were used for statistical comparisons. Results: It indicated that there was no significant difference in DMFT between the diabetic and non-diabetic groups. In addition to blood glucose level was higher in diabetes than non diabetes with increased dental caries with the increase of blood glucose level either random or fasting blood glucose level. Conclusion: This study indicated that the presence of dental caries is not significantly elevated in most diabetics but the blood glucose level and the age effect on the dental caries as well as diabetic subjects should improve their oral hygiene practices.

Insulin glargine overdose

Insulin glargine is a long acting novel recombinant human insulin analogue indicated to improve glycemic control, in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. The time course of action of insulins including insulin glargine may vary between individuals and/or within the same individual. Insulin glargine is given as a 24-h dosing regimen and has no documented half-life or peak effect. Hypoglycemia is the most common adverse effect of insulin, including insulin glargine. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. We present a case of a 76-year-old male insulin-dependent diabetic patient with refractory hypoglycemia secondary to an intentional overdose of insulin glargine. We would like to highlight the necessity of prolonging IV glucose infusion, for a much longer period than expected from pharmacokinetic properties of these insulin analogues after intentional massive overdose.

당뇨병 환자의 동반상병 점수에 따른 상급종합병원 이용 차이

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

Abstract 8446: Human Fetal Cardiac Ejection Fraction in Normal and Diabetic Pregnancy Assessed by Matrix 3D/4D Echocardiography

Background: Diabetic pregnancy carries higher risk of fetal development abnormality compared to normal pregnancy. Therefore, fetal growth should be monitored during diabetic pregnancy. We used a 4D matrix method to evaluate whether maternal diabetes could affect fetal heart function. Methods: 24 women 18.0-33.1 weeks gestational age (mean 23.6 ± 4.5 weeks) were included: 12 insulin-dependent diabetic pregnant patients and 12 healthy pregnant women with the same gestational ages. A Philips iE33 ultrasound system with an X7-2 matrix array transducer was used. 4D volumes were acquired from the fetuses with an external heart rate simulator. 4D data was analyzed by QLab 6.2 software (Philips). End-systolic and end-diastolic volumes of left and right ventricles (LV, RV) and ejection fraction (EF) derived for each individual were calculated semi-automatically, and maternal blood HbA1C were recorded. Results: Blood HbA1C levels of the diabetic group were 6.99±1.10%, which was higher than the normal level (5.0%). LV EF of the fetuses with diabetic mothers ranged from 52.4% to 85.9% (mean 70.2 ± 11.2%), and 52.3% to 83.3% (mean 71.5 ± 10.5%) for the control group. No significant difference was shown between LV EFs (P = 0.4029). However, RV EF was 55.3% to 85.1% (mean 66.8 ± 9.9%) in the diabetic group, compared to 64.9% to 87.1%(mean 77.2 ± 7.3%) for the control group (P = 0.0108). Conclusions: LV EF of human fetuses of diabetic mothers was normal, but RV EF of the diabetic pregnancy group was lower.

Diabetic mastopathy: Clinical presentation, imaging and histologic findings, and treatment

ObjectiveDiabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. Material and methodsIn an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7years. ResultsThe most common clinical presentation was a palpable nodule (67%). The imaging findings were (a) at mammography: asymmetrical density (50%), (b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and (c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). ConclusionsDiabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings; conservative surgery is the treatment of choice because the condition does not respond to medical treatment.