Long-standing Diabetes Mellitus Research Articles

Inferior ST-Elevation on the ECG

A 62-year-old woman presented to another hospital with a 36-hour history of uninterrupted, nonspecific chest pain. Her medical history included long-standing hypertension and diabetes mellitus for which she took metoprolol, perindopril, felodipine, metformin, and glimepiride. She had stopped smoking 10 years earlier, and did not drink alcohol or use illicit drugs. The ECG on the admission to the other hospital is shown in Figure 1. Laboratory results at the other hospital were all normal, with the exception of mild hyperglycemia; cardiac troponin I was also normal. Based on the ECG in Figure 1, the patient was transferred to our unit for emergency coronary angiography. Clinical examination on admission to our hospital was unremarkable. A repeated ECG on admission in our hospital is disclosed in Figure 2. Based on the history of uninterrupted chest pain in a patient with cardiovascular risk factors and the aspect of the ECG in Figure 1, the on-call cardiology team in our unit agreed with the indication for emergency coronary angiography. This, however, disclosed no significant coronary artery …

Impact of diabetes mellitus on clinical outcomes of pancreatic cancer after surgical resection: A systematic review and meta-analysis.

Background and objectiveDiabetes mellitus (DM) is a risk factor for pancreatic cancer but its impact on postoperative outcomes and long-term survival after cancer resection remains controversial. A meta-analysis of published studies was conducted to address this issue.MethodsAn extensive electronic search of four databases was performed for relevant articles. Data were processed for meta-analysis using Review Manager version 5.1.ResultsSeventeen observational studies involving 5407 patients were subjected to the analysis. Overall morbidity or any type of complications and mortality were comparable between diabetic and non-diabetic subjects. Overall DM has a significant negative impact on survival (risk ratio [RR], 1.24, 95% confidence interval [CI], 1.05–1.45; P = 0.01). Stratification by the type of DM revealed that new-onset DM (<2 years duration, RR, 1.54, 95% CI, 1.24–1.91; P <0.001) but not long-standing DM (≥2 years duration, RR, 1.74, 95% CI, 0.86–3.52; P = 0.12) was associated with reduced survival.ConclusionsDiabetes mellitus does not affect perioperative outcomes in patients undergoing surgery for pancreatic cancer. However, new-onset DM confers a negative impact on survival of pancreatic cancer in patients undergoing surgical resection.

Development of an Autonomous Endoscopically Implantable Submucosal Microdevice Capable of Neurostimulation in the Gastrointestinal Tract.

Gastric dysmotility can be a sign of common diseases such as longstanding diabetes mellitus. It is known that the application of high-frequency low-energetic stimulation can help to effectively moderate and alleviate the symptoms of gastric dysmotility. The goal of our research was the development of a miniature, endoscopically implantable device to a submucosal pocket. The implantable device is a fully customized electronics package which was specifically designed for the purpose of experiments in the submucosa. The device was endoscopically inserted into the submucosal pocket of a pig stomach and partially severed pig side in order to adequately simulate a live animal model. The experiment confirmed that the designed device can be implanted into the submucosa and is capable of the measurement of sensor data and the transmission of this data wirelessly in real time to a computer outside of the body. After proving that the device can be implanted submucosally and transmit data, further experiments can now be performed, primarily with an electrogastrography (EGG) instrument and implantable device with tissue stimulation capability.

Prevalence of glucose intolerance in cirrhotics and risk factors predicting its progression to diabetes mellitus

Background: Liver cirrhosis is a unique clinical entity wherein long-standing diabetes mellitus (DM) can predispose an individual to cirrhosis, and on the other hand, a long-standing cirrhosis liver can predispose a cirrhotic to DM, secondary to deranged glucose and insulin metabolism. Aim of the Study: The aim of this study is to determine the prevalence of impaired glucose tolerance (IGT) in patients with liver cirrhosis and risk factors predicting these patients to progression to DM. Materials and Methods: Adult patients above 18 years of age, with a diagnosis of cirrhosis of liver, irrespective of the diabetic status, the aetiology and severity of liver disease, were enrolled for the prospective cross-sectional study. The American Diabetes Association guidelines were followed for classification of DM. Fasting serum insulin assay was done for calculation of homeostatic model assessment insulin resistance (HOMA-IR) with a cut-off of >2.5. Patients with normal baseline glucose tolerance test (GTT) or IGT were followed up prospectively for 6 months at 3 monthly interval. Appropriate statistical tests were applied. Results: Of the 505 cirrhotic patients screened, 158 patients fulfilled the selection criteria. The overall mean age of these 158 patients was 53.3 ± 11.5 years; majority were men (93.7%). As a significant proportion of patients belonged to Child-Turcotte-Pugh (CTP)-C (51.3%) followed by CTP-B and CTP-A. Seventy-four patients had self-reported diabetes (46.8%) at registration. Post-GTT, the prevalence of impaired IGT was 27.4%, and new-onset diabetes mellitus (NODM) was 11.9%. Patients with CTP-C were at greatest risk for either IGT or NODM (P < 0.05). IGT+NODM patients had high median values of 2-h GTT, fasting serum insulin and HOMA-IR compared to non-diabetic participants at admission with a significant trend increase at 3 and 6 months. Conclusion: The prevalence of glucose intolerance is significantly high in individuals with cirrhosis. A 2-h GGT unmasks a significant number of cirrhosis with normal fasting blood sugar and glycated haemoglobin. A trend towards an increase in glucose intolerance and insulin resistance is noted with increasing duration of illness.

Prevalence of microalbuminuria and its correlates among diabetic patients attending diabetic clinic at National Guard Hospital in Alhasa.

INTRODUCTION:Diabetes mellitus is one of the most common diseases encountered in clinical practice. Diabetic nephropathy is a common consequence of long-standing diabetes mellitus; microalbuminuria (MA) is considered an early stage of diabetic nephropathy.OBJECTIVES:To determine the prevalence of miciroalbuminuria in diabetic patients and factors associated with MA.MATERIALS AND METHODS:This cross-sectional study was conducted in the diabetic clinic of the primary health center of the National Guard Hospital. Diabetes type 2 patients between the ages of 20–60 years who attended the clinic in 2012 were included in this study. Data were collected by reviewing medical records for demographic and disease-related variables. MA was detected by measuring the albumin to creatinine ratio, and MA was diagnosed if this ratio was between 30 and 300 mg/g on two occasions.RESULTS:MA was found in 37.4% of the sample and the rate was significantly higher among females (P < 0.027). MA was positively related to body mass index (BMI) (P < 0.002), the presence of hypertension (P < 0.000), duration of diabetes (P < 0.000), glycated hemoglobin (P < 0.000), fasting plasma glucose (P < 0.000), and low-density lipoprotein (LDL) (P < 0.043). No statistically significant correlation was found between MA and age, creatinine level, high-density lipoprotein, and triglyceride.CONCLUSION:The prevalence of MA in patients with diabetes in this study was high. The study suggests the need to screen for MA early, and the active management of modifiable risk factors, in particular, hyperglycemia, hypertension, LDL, and BMI, to reduce the burden of future end-stage renal disease.

Integrity of central nervous function in diabetes mellitus assessed by resting state EEG frequency analysis and source localization

Diabetes mellitus (DM) is associated with structural and functional changes of the central nervous system. We used electroencephalography (EEG) to assess resting state cortical activity and explored associations to relevant clinical features.Multichannel resting state EEG was recorded in 27 healthy controls and 24 patients with longstanding DM and signs of autonomic dysfunction. The power distribution based on wavelet analysis was summarized into frequency bands with corresponding topographic mapping. Source localization analysis was applied to explore the electrical cortical sources underlying the EEG.Compared to controls, DM patients had an overall decreased EEG power in the delta (1–4Hz) and gamma (30-45Hz) bands. Topographic analysis revealed that these changes were confined to the frontal region for the delta band and to central cortical areas for the gamma band. Source localization analysis identified sources with reduced activity in the left postcentral gyrus for the gamma band and in right superior parietal lobule for the alpha1 (8–10Hz) band.DM patients with clinical signs of autonomic dysfunction and gastrointestinal symptoms had evidence of altered resting state cortical processing. This may reflect metabolic, vascular or neuronal changes associated with diabetes.

Effect of Diabetes on Survival after Resection of Pancreatic Adenocarcinoma. A Prospective, Observational Study.

AimTo investigate the effect of diabetes mellitus (DM) on disease-free and overall post-resection survival of patients with pancreatic ductal adenocarcinoma (PDAC)MethodsProspective observational study on patients admitted for pancreatic disease from January 2008 to October 2012. DM was classified as recent-onset (<48 months before PDAC diagnosis), longstanding (≥48 months before PDAC) or new onset (after surgery).ResultsOf 296 patients, 140 had a diagnosis of DM prior to surgery (26 longstanding, 99 recent-onset, 15 with unknown duration). Median follow-up time was 5.4 ± 0.22 years. Patients with recent onset DM had poorer postoperative survival than patients without DM: disease-free survival and overall survival were 1.14±0.13 years and 1.52±0.12 years in recent onset DM, versus 1.3±0.15 years and 1.87±0.15 years in non-diabetic patients (p = 0.013 and p = 0.025, respectively). Longstanding DM and postoperative new onset DM had no impact on prognosis. Compared to cases without DM, patients with recent onset DM were more likely to have residual disease after surgery and to develop liver metastases during follow-up. Multivariate analysis confirmed recent onset DM was independently associated with PDAC relapse (hazard ratio 1.45 [1.06–1.99]).ConclusionPreoperative recent onset DM has an impact on survival after the resection of PDAC.

Patient Attitudes Toward Telemedicine for Diabetic Retinopathy.

Diabetic retinopathy (DR) is the leading cause of new-onset blindness in adults. Telemedicine is a validated, cost-effective method to improve monitoring. However, little is known of patients' attitudes toward telemedicine for DR. Our study explores factors that influence patients' attitudes toward participating in telemedicine. Ninety seven participants in a university and the Veterans Administration setting completed a survey. Only people with diabetes mellitus (DM) were included. The main outcome was willingness to participate in telemedicine. The other outcomes were perceived convenience and impact on the patient-physician relationship. Participants reported demographic information, comorbidities, and access to healthcare. Analysis was performed with t-tests and multivariable logistic regression. Demographic factors were not associated with the outcomes (all p > 0.05). Patients had decreased odds of willingness if they valued the patient-physician relationship (adjusted odds ratio [OR] = 0.08, confidence interval [CI] = 0.02-0.35, p = 0.001) or had a longer duration of diabetes (adjusted OR = 0.93, CI = 0.88-0.99, p = 0.02). Patients had increased odds of willingness if they perceived increased convenience (adjusted OR = 8.10, CI = 1.77-36.97, p = 0.01) or had more systemic comorbidities (adjusted OR = 1.85, CI = 1.10-3.11, p = 0.02). It is critical to understand the attitudes of people with DM where telemedicine shows promise for disease management and end-organ damage prevention. Patients' attitudes are influenced by their health and perceptions, but not by their demographics. Receptive patients focus on convenience, whereas unreceptive patients strongly value their patient-physician relationships or have long-standing DM. Telemedicine monitoring should be designed for people who are in need and receptive to telemedicine.

Characteristic MRI findings in hyperglycaemia-induced seizures: diagnostic value of contrast-enhanced fluid-attenuated inversion recovery imaging

To describe characteristic magnetic resonance imaging (MRI) abnormalities in hyperglycaemia-induced seizures, and evaluate the diagnostic value of contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging. Possible underlying mechanisms of this condition are also discussed. Eleven patients with hyperglycaemia-induced seizures and MRI abnormalities were retrospectively studied. Clinical manifestations, laboratory findings, MRI findings, and clinical outcomes were analysed. All patients, except one, presented with focal seizures, simple or complex partial seizures, or negative motor seizures. All patients had long-standing uncontrolled diabetes mellitus. The MRI abnormalities observed acutely were focal subcortical hypointensities on T2-weighted imaging and FLAIR imaging in all patients with overlying cortical gyral T2 hyperintensities in five. Focal overlying cortical or leptomeningeal enhancement on contrast-enhanced T1-weighted imaging or contrast-enhanced FLAIR imaging was observed in all patients. Contrast-enhanced FLAIR imaging was superior to contrast-enhanced T1-weighted imaging for detecting characteristic cortical or leptomeningeal enhancement. Diffusion-weighted imaging showed mildly restricted diffusion in four of five patients with cortical gyral T2 hyperintensity. In nine patients, the lesions were localised in the parietal or parieto-occipital lobes. The other two patients showed localised precentral gyral lesions. After treatment, the neurological symptoms, including the seizures, improved in all patients. On clinical recovery, the subcortical T2 hypointensity, gyral or leptomeningeal enhancement, and overlying cortical T2 hyperintensities resolved. Recognition of these radiological abnormalities in patients with hyperglycaemia-induced seizures is important in restricting unwarranted investigations and initiating early therapy. These patients generally have a good prognosis.

Correction of mineral and bone disorders in a patient with long-standing diabetes mellitus type 1 on hemodialysis therapy

Osteoporosis and diabetes mellitus (DM) – chronic diseases with constantly growing prevalence. Patients with DM have the increased risk of bones fractures. Risk of fracture in the patient with diabetes mellitus type 1 (DM1) is increased by more than 6 times. There are several mechanisms leading to the development of osteoporosis in DM: chronic hyperglycemia, insulin deficiency, genetic factors, and complications of DM. Moreover, the chronic kidney disease in DM impacts not only progression of osteoporosis, but also leads to emergence of other bone disorders, that considerably complicate a choice of antiosteoporotic treatment. This article describes a clinical case of the mineral and bone disorders of a phosphorus-calcium metabolism, which developed in patient with long history of DM1 receiving therapy by a program hemodialysis.

Heart Rate and Systolic Blood Pressure Variability in the Time Domain in Patients with Recent and Long-Standing Diabetes Mellitus.

Diabetes Mellitus (DM) affects the cardiovascular response of patients. To study this effect, interbeat intervals (IBI) and beat-to-beat systolic blood pressure (SBP) variability of patients during supine, standing and controlled breathing tests were analyzed in the time domain. Simultaneous noninvasive measurements of IBI and SBP for 30 recently diagnosed and 15 long-standing DM patients were compared with the results for 30 rigorously screened healthy subjects (control). A statistically significant distinction between control and diabetic subjects was provided by the standard deviation and the higher moments of the distributions (skewness, and kurtosis) with respect to the median. To compare IBI and SBP for different populations, we define a parameter, α, that combines the variability of the heart rate and the blood pressure, as the ratio of the radius of the moments for IBI and the same radius for SBP. As diabetes evolves, α decreases, standard deviation of the IBI detrended signal diminishes (heart rate signal becomes more “rigid”), skewness with respect to the median approaches zero (signal fluctuations gain symmetry), and kurtosis increases (fluctuations concentrate around the median). Diabetes produces not only a rigid heart rate, but also increases symmetry and has leptokurtic distributions. SBP time series exhibit the most variable behavior for recently diagnosed DM with platykurtic distributions. Under controlled breathing, SBP has symmetric distributions for DM patients, while control subjects have non-zero skewness. This may be due to a progressive decrease of parasympathetic and sympathetic activity to the heart and blood vessels as diabetes evolves.

Neurogenic Bladder Repair Using Autologous Mesenchymal Stem Cells.

The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion, the activity of which is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. This report describes a case of neurogenic bladder following laminectomy procedure and long-standing diabetes mellitus with neuropathy treated with autologous cellular therapy. The differentiation potential and paracrine effects of mesenchymal stem cells on bladder function have been highlighted.

Association of Glycated Albumin with Glycemic Markers, Lipid Profile and Liver Function Tests for the Assessment Control in Saudi Patients with Long-Standing Type-2 Diabetes Mellitus

This study is an effort to evaluate the association between glycated-albumin and various biochemical parameters in Saudi type-2 diabetic patients. Ninety long-standing (>10 years) type-2 diabetic subjects (51 males, 39 females) serum was analyzed for glycated albumin, fasting blood glucose, hemoglobin1c, cholesterol, triglyceride, albumin, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, aspartate transaminase, alkaline phosphatase, alanine transaminase and total bilirubin. Correlation, principal components analysis, covariance and statistical differences were conducted using SPSS for both male and female participants. The average age (years) of female and male participants was 51.0±10.2 and 51.6±14.1, respectively. Hemoglobin1C was significantly associated with fasting blood glucose (r=0.637,P<0.01). No significant differences between men and women were observed in the glycemic markers, lipid profile and liver function tests. Both men and women showed no significant differences in glycated-albumin irrespective of age and hemoglobin1c covariance. The regression model revealed that low-density lipoprotein, aspartate transaminase and alanine transaminase are significantly associated with glycated-albumin. Men’s glycated-albumin was observed to be significantly associated with hemoglobin1c only, while women’s glycated-albumin is highly associated with low-density lipoprotein only. Glycated-albumin was also co-varied with low-density lipoprotein. Glycated-albumin could be employed for screening high risk diabetic patients for early diagnosis of dyslipidemia and appropriate intervention with lipid-decreasing drugs. Current findings provide novel insights on the use glycated-albumin as clinical chemistry maker.

English

Abstract Atraumatic painful swollen lower extremity has limited differential diagnosis and in patients with risk factors for venous thromboembolism offers little challenge. Poor awareness of rare entities results in misdiagnosis and mismanagement. Diabetic muscle infarction is a rare complication of longstanding uncontrolled diabetes mellitus causing ischaemic skeletal myonecrosis and similar presentation.

DIABETIC HEPATOPATHY

Introduction: Simple steatosis or nonalcoholic steatohepatitis are liver diseases associated with diabetes mellitus (DM). However, a form of diabetic microangiopathy with hepatic sinusoidal fibrosis and basement membrane deposition without cirrhosis has been described and referred as diabetic hepatosclerosis (DH). Objective: To identify scientific studies and to deepen the knowledge on DH, and to evaluate the prevalence of DH in the main published studies in medical literature. Method: Integrative review of the literature conducted in the database PubMed/MEDLINE, and crossed the following descriptors from the Health Science Descriptors (DeCs) and MeSH: liver microangiopathy, hepatosclerosis and diabetes mellitus connected by the Boolean operator AND. Only studies that evaluated the prevalence of DH were selected, summarizing and identifying the limitations of research from 1965 to date. Results: The sample consisted of five studies published that met the inclusion criteria. Studies showed the following aspects: 1. Harrison SA, et al. (2006), described 12 patients identified from hepatic biopsy findings, all had a history of long-standing DM and a noncirrhotic form of hepatic sinusoidal fibrosis not associated with nonalcoholic steatohepatitis. 2. Chen G, et al (2009), reported a prevalence of 12% in 10-year of study. 3. Hudacko RM, et al. (2009) showed that in autopsies from 57 adults with DM, only 1 case (1.7%) of DH was identified. 4. Wang Z et al. (2012), in their study showed that pathological features of 14.2% cases were consistent with the diagnosis of DH. 5. Balakrishnan M, et al. (2015) showed that DH was significantly more prevalent among diabetic patients compared with controls: 45% versus 29%. Conclusion: We identified a small number of studies that addressed the topic, and represent a hepatic form of microvascular disease in DM, in the majority of the cases clinically silent, probably it is common but under-recognized. There is a paucity of literature about DH, and further studies are needed to precisely characterize the DH, to understand mechanisms of pathogenesis and your clinical significance.

Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics.

Whether whole-body MRI can predict occurrence of recurrent events in patients with diabetes mellitus. Whole-body MRI was prospectively applied to 61 diabetics and assessed for arteriosclerosis and ischemic cerebral/myocardial changes. Occurrence of cardiocerebral events and diabetic comorbidites was determined. Patients were stratified whether no, a single or recurrent events arose. As a secondary endpoint, events were stratified into organ system-specific groups. During a median follow-up of 70 months, 26 diabetics developed a total of 39 events; 18 (30%) developed one, 8 (13%) recurrent events. Between diabetics with no, a single and recurrent events, a stepwise higher burden was observed for presence of left ventricular (LV) hypo-/akinesia (3/28/75%, p < 0.0001), myocardial delayed-contrast-enhancement (17/33/63%, p = 0.001), carotid artery stenosis (11/17/63%, p = 0.005), peripheral artery stenosis (26/56/88%, p = 0.0006) and vessel score (1.00/1.30/1.76, p < 0.0001). After adjusting for clinical characteristics, LV hypo-/akinesia (hazard rate ratio = 6.57, p < 0.0001) and vessel score (hazard rate ratio = 12.29, p < 0.0001) remained independently associated. Assessing organ system risk, cardiac and cerebral MR findings predicted more strongly events in their respective organ system. Vessel-score predicted both cardiac and cerebral, but not non-cardiocerebral, events. Whole-body MR findings predict occurrence of recurrent events in diabetics independent of clinical characteristics, and may concurrently provide organ system-specific risk. • Patients with long-standing diabetes mellitus are at high risk for recurrent events. • Whole-body MRI predicts occurrence of recurrent events independently of clinical characteristics. • The vessel score derived from whole-body angiography is a good general risk-marker. • Whole-body MRI may also provide organ-specific risk assessment. • Current findings may indicate benefits of whole-body MRI for risk stratification.

Su1436 Central Versus Peripheral Sites of Action of New Ghrelin Agonists on Gastrointestinal Prokinetic Activity

Background: Gastric dysmotility including delayed gastric emptying and decrease the electrical activity of the stomach is common in patients with long-standing diabetes mellitus (DM). These DM patients, some of them are diagnosed as diabetic gastroparesis, have several upper gastrointestinal (GI) symptoms such as nausea, vomiting, bloating and abdominal pain. However, the relationship between gastric dysmotility and GI symptoms has not been investigated well. Aim: The aim of this study was to identify the relationship between gastric motility measures and upper GI symptoms in patients with long-standing DM. Methods: We enrolled 22 long-standing DM patients (13 females, 9 males; aged 33-80 years) with more than 10 years duration of DM, and 15 matched healthy controls (9 females, 6 males; aged 26-74 years). All DM patients were receiving insulin treatment, and had at least one history of diabetic neuropathy, retinopathy or nephropathy. Gastric motility was evaluated with cutaneous recorded electrogastrography (EGG) and gastric emptying of a semi-solid meal, using 13C-octanoic acid breath testing. Upper GI symptoms were quantified in all patients by questionnaire. Results: Compared with the healthy controls, the DM patients showed a significant lower percentage of normogastria (2to 4 cpm slow wave) in both fasting and postprandial state with a lower power ratio (postprandial peak power / fasting peak power) in EGG. Both half-emptying time and lag time in 13C-acetic acid breath testing were higher in DM patients than in healthy controls, indicating that gastric emptying was significantly delayed in the former in overall analysis. Fifteen patients demonstrated abnormalities of either gastric myoelectric activity or gastric emptying (group A), and 7 had normal gastric motor function (group B). Sixteen of 22 (72.7%) patients had some kind of upper GI symptoms. The number of patients who had some GI symptoms was 13 in group A versus 3 in group B. No significant correlation was observed between gastric emptying parameters and HbA1C values. Conclusion: The patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appear to be an important factor in the generation of upper GI symptoms in patients with long-standing DM. The relationship between gastric motility and upper gastrointestinal symptoms

Su1435 The Role of Insulin and IGF-I Signaling Passway in Renovation of Interstitial Cells of Cajal Promoted by Gastric Electrical Stimulation in Streptozotocin-Induced Diabetic Rats

Background: Gastric dysmotility including delayed gastric emptying and decrease the electrical activity of the stomach is common in patients with long-standing diabetes mellitus (DM). These DM patients, some of them are diagnosed as diabetic gastroparesis, have several upper gastrointestinal (GI) symptoms such as nausea, vomiting, bloating and abdominal pain. However, the relationship between gastric dysmotility and GI symptoms has not been investigated well. Aim: The aim of this study was to identify the relationship between gastric motility measures and upper GI symptoms in patients with long-standing DM. Methods: We enrolled 22 long-standing DM patients (13 females, 9 males; aged 33-80 years) with more than 10 years duration of DM, and 15 matched healthy controls (9 females, 6 males; aged 26-74 years). All DM patients were receiving insulin treatment, and had at least one history of diabetic neuropathy, retinopathy or nephropathy. Gastric motility was evaluated with cutaneous recorded electrogastrography (EGG) and gastric emptying of a semi-solid meal, using 13C-octanoic acid breath testing. Upper GI symptoms were quantified in all patients by questionnaire. Results: Compared with the healthy controls, the DM patients showed a significant lower percentage of normogastria (2to 4 cpm slow wave) in both fasting and postprandial state with a lower power ratio (postprandial peak power / fasting peak power) in EGG. Both half-emptying time and lag time in 13C-acetic acid breath testing were higher in DM patients than in healthy controls, indicating that gastric emptying was significantly delayed in the former in overall analysis. Fifteen patients demonstrated abnormalities of either gastric myoelectric activity or gastric emptying (group A), and 7 had normal gastric motor function (group B). Sixteen of 22 (72.7%) patients had some kind of upper GI symptoms. The number of patients who had some GI symptoms was 13 in group A versus 3 in group B. No significant correlation was observed between gastric emptying parameters and HbA1C values. Conclusion: The patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appear to be an important factor in the generation of upper GI symptoms in patients with long-standing DM. The relationship between gastric motility and upper gastrointestinal symptoms

Su1434 Gastric Dysmotility and Its Relationship to Upper Gastrointestinal Symptoms in Patients With Long-Standing Diabetes Mellitus

Su1434 Gastric Dysmotility and Its Relationship to Upper Gastrointestinal Symptoms in Patients With Long-Standing Diabetes Mellitus

Is type 2 diabetes related to leukoaraiosis? an updated review.

A significantly increased interest has been dedicated to the study of the effects of diabetes mellitus (DM) on the brain. DM is associated with an increased risk of stroke and cognitive decline. In patients with DM, neuroimaging discloses with high-frequency structural changes, such as cerebral atrophy, infarcts and white matter lesions, also called leukoaraiosis (LA), an expression of small vessel disease. A previous review showed a relation between DM and both cerebral atrophy and lacunar infarcts, while the question about the relation between DM and LA remained unanswered. In this review, we provide an update on data on this last association. In the reviewed studies, we examined the presence of DM, other disease characteristics, such as duration and complications, and laboratory markers of the disease such as blood glycated hemoglobin (HbA1c), insulin resistance, insulin concentrations and their association with LA. About 40% of the reviewed studies reported a statistically significant association between DM and LA. Long-standing DM and a poor glycemic control were associated with severe LA. Studies using innovative MRI techniques, such as diffusion tensor imaging (DTI), reported a significant association between microstructural white matter alterations and DM. This review highlights more firmly than previously reported the existence of a relation between DM and both presence and severity of LA. These results are possibly due to more sensitive and advanced imaging techniques recently used to study the extent of LA. However, because of the heterogeneous methodology used in the reviewed studies, a definitive conclusion cannot be drawn.