Longer Duration Of Diabetes Mellitus Research Articles

Ultrasonographic estimation of kidney size in adult Bangladeshi population without known renal disease: a preliminary report

Background: The kidney size of a patient is a valuable diagnostic parameter in clinical practice. Renal size varies with age, gender, body mass index (BMI), pregnancy, race and co-morbid conditions like diabetes mellitus (DM) and hypertension (HTN). Measurements of renal dimensions can be carried out by using different modern techniques like ultrasonography (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI). Out of these modalities USG is choice because of its simplicity, inexpensive, easily available, non-invasive and easy reproducibility. There is no established nomogram for renal size in the Bangladeshi population. Aim of the study was to determine the ultrasonographic renal size in adult Bangladeshi population with no known renal disease and to correlate renal size with age, gender and BMI. In addition, we assess whether hypertension and diabetes mellitus affect renal size. Methods: This cross-sectional study was done in BIRDEM General Hospital and included 55 patients with age >18 years over 6 month period. Study population were not known to have renal disease documented by urine routine microscopy, spot urine for albumin creatinine ratio (ACR), serum creatinine and USG. Their body weight, height and BMI were calculated along with duration of DM and HTN. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters were also done. Results: A total of 55 patients were analyzed. There were 19 (34.5%) male and 36 (65.5%) female. The mean age was 46±.10 years. There mean weight, height and BMI were 61 ± 11 kg, 1.54±.069 meter, 25.7 ± 4.8 kg/m2 respectively. In total population 34.5% (19) were diabetic and 32.5% (18) were hypertensive. The means of length, width and parenchymal thickness (PT) of right kidneys (RK) were 10.1 ± 0.87, 4.2 ± 0.67 and 1.4± 0.32 cm respectively. The means of length, width and PT of left kidneys (LK) were 10.3 ± 0.89, 4.5 ± 0.49 and 1.5 ± 0.32 cm respectively. Measurements were significantly higher in LK than those of RK respectively (p=.003, p<.001 and p=.041). There were significant differences in kidney length and PT between sex and age. There were also significant differences in kidney length and PT between subjects of higher BMI, long duration of DM and HTN. The correlation between renal length and weight showed a positive correlation (r = 0.16, p < 0.023). Conclusion: The variation of parameters of both kidneys varies on gender, age, obesity, comorbidity like DM & HTN and with their duration. Length of both kidneys depends on body weight. Further study needed with large samples. BIRDEM Med J 2024; 14(3): 151-157

Blood Glucose Levels Moderate the Associations Between IGF-1 Levels and Choroidal Metrics in Patients With Diabetes With Acromegaly Without Diabetic Retinopathy.

To examine the effects of serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) on choroidal structures with different blood glucose levels in patients with diabetes mellitus (DM) with acromegaly without diabetic retinopathy. Eighty-eight eyes of 44 patients with acromegaly were divided into a nondiabetic group (23 patients, 46 eyes) and a diabetic group (21 patients, 42 eyes). Forty-four age- and sex-matched healthy controls and 21 patients with type 2 DM without diabetic retinopathy were also included. Linear regression models with a simple slope analysis were used to identify the correlation and interaction between endocrine parameters and choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascular index (CVI). Our study revealed significant increases in the ChT, LA, SA, and TCA in patients with acromegaly compared with healthy controls, with no difference in the CVI. Comparatively, patients with DM with acromegaly had greater ChT than matched patients with type 2 DM, with no significant differences in other choroidal parameters. The enhancement of SA, LA and TCA caused by an acromegalic status disappeared in patients with diabetic status, whereas ChT and CVI were not affected by the interaction. In the diabetic acromegaly, higher IGF-1 (P = 0.006) and GH levels (P = 0.049), longer DM duration (P = 0.007), lower blood glucose (P = 0.001), and the interaction between GH and blood glucose were associated independently with thicker ChT. Higher GH levels (P = 0.016, 0.004 and 0.007), longer DM duration (P = 0.022, 0.013 and 0.013), lower blood glucose (P = 0.034, 0.011 and 0.01), and the interaction of IGF-1 and blood glucose were associated independently with larger SA, LA, and TCA. As blood glucose levels increased, the positive correlation between serum GH level and ChT diminished, and became insignificant when blood glucose was more than 7.35 mM/L. The associations between serum IGF-1 levels and LA, SA, and TCA became increasingly negative, with LA, becoming significantly and negatively associated to the GH levels only when blood glucose levels were more than 8.59 mM/L. Acromegaly-related choroidal enhancements diminish in the presence of DM. In diabetic acromegaly, blood glucose levels are linked negatively with changes in choroidal metrics and their association with GH and IGF-1. We revealed the potential beneficial impacts of IGF-1 and GH on structural measures of the choroid in patients with DM at relatively well-controlled blood glucose level, which could provide a potential treatment target for diabetic retinopathy.

Diabetic retinopathy incidence, predictors and its association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia: joint model.

Diabetes mellitus (DM) is a global public health problem characterized by an elevated blood glucose level. Monitoring blood sugar levels is vital for effective diabetes management and preventing complications. However, the association between longitudinal biomarkers and the incidence of diabetic complications is often overlooked. Therefore, this study aimed to assess the incidence of diabetic retinopathy, predictors, and association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia. A multicenter retrospective follow-up study was carried out in referral hospitals in Amhara region, Ethiopia. A random sample of 462 newly diagnosed DM patients was selected. The proportional hazard assumption was checked for the survival sub-model, and for the longitudinal sub-model, the normality assumption was checked. Then the joint modeling with time-dependent lagged parameterizations was fitted. Model assumptions and comparisons were checked. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value<0.05 was used to identify predictors. In this study, Overall, 54 patients developed DR, and the incidence rate was 2.33 per 1000 person-months over the follow-up period, with a 95% CI of [1.78, 3.05]. Rural residence (AHR = 2.21, 95% CI: [1.21, 4.05]), hypertension co-morbidity (AHR = 3.01, 95% CI: [1.85, 6.53]), and longer duration of DM (>5 years) (AHR = 2.28, 95% CI: [1.91, 5.15]) were important predictors for the incidence of DR. In addition, the incidence of DR was substantially correlated with the time-dependent lagged value of FBS change (AHR = 4.20, 95% CI [1.62, 10.85]). In this study, the incidence of diabetic retinopathy was somewhat high when compared to prior similar studies in Ethiopia. A joint model of longitudinal fasting blood sugar level changes was significantly associated with an increased risk of DR. Besides, being rural residence, hypertension co-morbidity, and a longer duration of DM were significant predictors for the incidence of DR. Therefore, public awareness, an integrated care approach, and prioritizing glycemic control are highly recommended.

Sociodemography, diabetes mellitus clinical parameters, and retinal morphology as predictors of neurodegeneration in preclinical diabetic retinopathy

Abstract PURPOSE: The current prediction of preclinical diabetic retinopathy (DR) in asymptomatic patients with diabetes mellitus (DM) is limited due to a lack of suitable indicators. This study aimed to identify the predictors of neurodegenerative changes in type 2 DM patients during the preclinical stage of DR using sociodemographic and DM clinical parameters and retinal morphology. METHODS: Fifty-six adult DM participants (mean age: 40.41 ± 7.281 years) were classified into three groups: DM without DR, DM with mild nonproliferative DR (NPDR), and DM with moderate-to-severe NPDR. Demographic data, including age, gender, race, DM duration, glycated hemoglobin levels, household income, comorbidities, and insulin dependency, were collected. Retinal morphology, including macular retinal layer thickness, peripapillary retinal nerve fiber layer, and vascular caliber, were analyzed. Multinomial logistic regression models explored these factors’ influence on NPDR prediction. RESULTS: Participants with moderate-to-severe NPDR were less likely to have DM without comorbidities (odds ratio [OR]: 0.048, 95% confidence interval [CI]: 0.003–0.823, P = 0.036). Those with longer DM duration were 27% more likely to develop moderate-to-severe NPDR (OR: 1.272, 95% CI: 1.035–1.564, P = 0.022). Retinal morphology parameters did not predict NPDR risk and severity levels in DM patients, except for mild NPDR, which had a 1.05 times higher risk of wider central retinal arteriolar equivalent (CRAE) (OR: 1.052, 95% CI: 1.002–1.105, P = 0.043). CONCLUSION: DM duration, comorbidity presence, and widened CRAE are critical parameters for assessing neurodegenerative changes in preclinical DR. These parameters could be incorporated into DR screening programs to mitigate NPDR progression and enhance long-term visual outcomes of DM patients.

Role of Fetal Cardiac ECHO and Fetal Cardiac MRI in Prediction of Post Natal Hemodynamic Maladaptation in Fetuses of Diabetic Mothers

Background: Maternal diabetes mellitus (DM) is defined as a degree of glucose intolerance with recognition during pregnancy (pregestational or gestational, type 1 or type 2), and it is estimated to be 15% in pregnant females in 2019. The current study aimed to study the role of fetal echocardiography and fetal cardiac magnetic resonance imaging (MRI) in anticipation and diagnosis of hemodynamic maladaptation changes in fetuses of diabetic mothers as predictors for (closure of Patent ductus arteriosus (PDA), persistent pulmonary hypertension and diastolic dysfunction) which were confirmed with post-natal echocardiographic and clinical assessment. Methods: This study was an observational follow-up study that included 80 pregnant diabetic females who were following in the specialized clinics of Ain Shams University Hospitals during the period starting from August 2020 till December 2022. Results: Diabetes affected left ventricle (LV) diastolic function and global cardiac function but did not affect LV systolic function (p-value=0.000). Interventricular septum (IVS) thickness had a significant positive correlation with LV- Myocardial performance index (MPI) and indices of DM such as HbA1c. Diastolic dysfunction was the most affected cardiac parameter in infants of diabetic mothers (p-value=0.002). The hemoglobin A1c (HbA1c) was the most significant predictor for IVS thickness in diabetic mothers' fetuses, especially with a long duration of DM (p-value=0.012). Conclusion: Fetal echocardiography in diabetic mothers is essential and the gold standard modality not only for diagnosing structural abnormalities but also for evaluating the cardiac function of the fetuses. Fetal cardiac MRI could be considered a complementary imaging modality that uses no ionizing radiation, good tissue contrast, and a larger field of view.

High-Frequency Audiovestibular Dysfunction in Long-Standing Diabetes Mellitus: Insights from a Cross-Sectional Study.

This study investigates audiovestibular dysfunction in individuals with long-standing diabetes mellitus (DM). A cross-sectional study was conducted involving 100 patients (DM for ≥ 10years) at the Department of E.N.T. in Prakash Institute of Medical Sciences and Research, Sangli, Maharashtra. A mean age of 43.09years among patients, with 64% male and 36% female participants. Hearing loss was the most common complaint, affecting 46% of subjects, followed by vertigo in 23%. Pure tone audiometry revealed that 34% of patients had sensorineural hearing loss, with varying degrees of severity. Vestibular dysfunction was observed in 10% of cases. Correlation analysis indicated a significant positive relationship between the duration of DM and hearing thresholds at various frequencies, as well as with HbA1c levels. This suggests a worsening of hearing with longer DM duration and higher HbA1c levels. The prevalence of hearing impairment was higher at higher frequencies, with vestibular dysfunction also noted in a subset of patients.

Hypoglycemia in hospitalized patients: A sleeping monster

ABSTRACT Objective: This study describes the incidence and clinical profile of hypoglycemia (including mild, moderate, severe, and recurrent) and its correlation with the time of the day, duration of diabetes mellitus (DM), administration of insulin/oral hypoglycemic agents (OHAs) and diagnosis at admission in hospitalized adult patients. Materials and Methods: This retrospective, observational study analyzed the data of hospitalized patients with episode(s) of hypoglycemia. For each patient, clinical profiles such as age, gender, antidiabetic therapy, timing of hypoglycemic event, duration of diabetes, working diagnosis, place of hypoglycemia, dietary changes, and mode of corrective action were studied. Results: Of 100 patients with a mean ± standard deviation age of 62.72 ± 3.54 years, hypoglycemia was the most common among those aged 61–90 years. There were 134 hypoglycemic events and mild hypoglycemia was the most common (72.39% vs. moderate 21.64% and severe 5.97%). There were 59 (44%) events of recurrent hypoglycemia. Hypoglycemic events were maximum during 4:00 am–7:59 am (34%). Longer duration of DM (&gt;15 years, 42%) and insulin therapy were the high-risk factors. There was a statistically significant association between hypoglycemia and duration of diabetes (P &lt; 0.0133), insulin therapy (P &lt; 0.0001), OHA (P &lt; 0.0192), and a combination of insulin and OHA (P &lt; 0.0059) within 24 h before the event but not with the incidence and dietary changes. Conclusion: Patients above 60 years were the most vulnerable population for hypoglycemia, especially during the early hours of the day. Patients who had diabetes for &gt;15 years, on insulin therapy, and those with pulmonary and renal diseases were the most vulnerable to overall and recurrent hypoglycemic events, respectively.

Incidence of Central Involving Macular Oedema After Cataract Surgery in Diabetic Retinopathy Patients – A Prospective Study

Aim: To study the incidence of central macular oedema at 4, 8 and 12 weeks following cataract surgery in diabetic retinopathy eyes. Materials and Methods: A prospective observational study was conducted over a period of 3 months to investigate the presence of centrally involved macular oedema following cataract surgery in diabetic retinopathy patients. Preoperative OCT scans were performed and patients without centrally involved macular oedema were enrolled. Subfield thickness (central, outer and inner) was measured preoperatively and at 4, 8 and 12 weeks postoperatively. The correlation between diabetic macular oedema (DME) and HbA1c, as well as random blood sugar (RBS) levels at the time of surgery, was analysed. Best.corrected visual acuity (BCVA) was assessed preoperatively and postoperatively, and fundus examinations were conducted each visit to evaluate diabetic retinopathy progression. Results: This study included 80 eyes from 44 patients. Postoperatively, central subfield thickness (CSF) increased significantly at first (14.7 μm), second (26.7 μm) and third (30.3 μm) compared to baseline. Inner subfield thickness (ISF) also increased at first (13.3 μm), second (20.6 μm) and third (24.3 μm) months, while the outer subfield thickness (OSF) showed progression from 6.7 μm to 16.6 μm from the first to third month. A statistically significant shift in DME was observed three months post.cataract surgery. There was a significant association between HbA1c levels and the development of DME, but no correlation with RBS levels. BCVA improved remarkably from preoperative mean log MAR of 0.75 to a mean log MAR of 0.1 at 3 months postoperatively. About 30% had mild non-proliferative diabetic retinopathy (NPDR) preoperatively, and in that group, 60% progressed to moderate NPDR. The status of moderate and severe NPDR remained the same postoperatively at 3 months. Of all patients who progressed to moderate NPDR, 3 cases developed non-central macular oedema, and three cases developed both central and non.central macular oedema postoperatively at 3 months. All eyes with severe NPDR resulted in DME, except for one (9.1%) eye. Conclusion: Preoperatively, 57.5% had no macular oedema, while 42.5% had non.central macular oedema. Postoperatively, 4.4% had central oedema, and 10.9% had both central and non.central oedema among those who initially had no macular oedema. Additionally, 38.2% developed oedema in both central and non.central regions among patients initially presenting with non-central macular oedema. There was also a significant statistical difference with longer duration of diabetes mellitus, severity of diabetic retinopathy and elevated HbA1c values with the development of diabetic macular oedema postoperatively. However, larger sample sizes and longer-term follow-up are essential for assessing retinopathy progression and the incidence of DME.

Kvalitet života bolesnika nakon transtibijalne amputacije i različiti periodi nošenja proteze

Introduction. Research into patients with lower limb amputation (LLA) puts strong emphasis on quality of life (QoL) and importance of the research in that regard as a measure for the rehabilitation outcomes. The aim of this study was to show which aspects of QoL are related to the duration of wearing a prosthesis in patients with transtibial amputation (TTA). Methods. The study sample comprised 40 patients who used prosthesis for 1 - 3 years (group A), 4 - 7 years (group B) and &gt; 8 years (group C). All patients completed Trinity Amputation and Prosthesis Experience Scale-Revised (TAPES-R). Results. Prosthesis wearing history was significantly different between the groups: group A (2.2 ± 0.7 years), group B (5.5 ± 1.3 years) and group C (22.9 ± 13.6 years), p&lt;0.001. Patients in group B were significantly (p &lt; 0.05) older compared to patients in group C, displayed a significantly (p &lt; 0.05) lower rate of employment and significantly (p &lt; 0.05) longer duration of diabetes mellitus. Patients in group C displayed a significantly (p = 0.005) lower rate of diabetes mellitus. TAPES-R showed that social adjustment was significantly lower (p &lt; 0.05) in patients in group C compared to patients in group A (3.14 ± 0.46 vs. 3.55 ± 0.41). Conclusion. Although patients with TTA showed good QoL, the group with a long history of wearing a prosthesis differed significantly in social adjustment compared to patients with a short period of wearing a prosthesis. The age and etiology of amputation differed significantly between the groups.

Determinants of diabetic nephropathy among diabetic patients attending in Tikur Anbesa specialized hospital, Addis Abeba, Ethiopia

BackgroundDiabetic nephropathy (DN) is the consequence of patients with uncontrolled diabetic mellitus and exposed patients to end-stage renal disease. Even though studies conducted to investigate factors associated with DN but still a need to identify what contributes to its occurrence. Therefore, this study aimed to identify determinants of diabetic nephropathy among diabetic patients. MethodsInstitutional-based unmatched case-control study was conducted from April 1st to May 30th, 2023. Systematic random sampling techniques were used. Data were collected using questionnaire. Model fitness was checked by the Hosmer and Lemeshow goodness of model fitness test. In multivariable analysis, a p-value ≤0.05 at a 95% confidence interval was used as declared significant variables. ResultThis study included 540 participants (180 cases and 360 controls) with a response rate of 98%. Poor glycaemic control (AOR: 4.58, 95% CI: 2.22–9.48), Body Mass Index (BMI) being overweight (AOR: 13.05, 95% CI: 5.56–30.62), non-adherence to diet (AOR: 7.52, 95% CI: 3.31–17.05), poor healthcare efficiency system-(AOR: 6.67, 95% CI: 3.43–12.97) and long duration of Diabetes Mellitus (DM) after diagnosis (AOR: 4.45, 95% CI: 2.39–8.28) were the determinants of diabetic nephropathy. ConclusionThe determinants of diabetic nephropathy in this study were poor glycaemic control, obese BMI, poor efficiency of the healthcare system, and long duration of DM after diagnosis. Therefore, diabetic patients better emphasize weight reduction and follow strict dietary recommendations also clinicians should address dietary counseling, ensure effective and efficient healthcare service. This research faced the limitation of dietary adherence questionnaire it might be subjective to recall bias.

Prevalence and risk factors of diabetes foot ulcers in Kano, northwestern Nigeria

BackgroundFoot complications account for more hospital admissions than any other diabetes mellitus (DM) complications with adverse outcomes being foot ulcers and amputation.ObjectiveTo determine the prevalence and risk factors of diabetic foot ulcers in Kano, Northwestern Nigeria.MethodsA descriptive cross-sectional study was conducted in the diabetes outpatient clinics and medical and surgical wards of two hospitals in Kano, Nigeria. Data were collected on socio-demographic characteristics, type, and duration of DM. The study subjects were assessed for the presence of and risk factors for foot ulcers.ResultsWe recruited 394 patients with DM (163 males and 231 females) with a mean (SD) age and duration of DM of 50.8 ± 12.5 years and 7.72 ± 6.65 years respectively. Type 2 DM was present in 95% of the study subjects. Diabetic foot ulcer (DFU) was present in 57 (14.5%) of the patients. Risk factors associated with DFU assessed using univariate analysis were older age, longer duration of DM, presence of peripheral neuropathy (PN), peripheral arterial disease (PAD), diabetic retinopathy, nephropathy, foot deformities, previous DFU, and poor glycemic control. The independent determinants of DFU were previous DFU, foot deformities, retinopathy, PN, PAD, and poor glycemic control.ConclusionDFU can be found in our setting and the predominant risk factors for DFU are common and remain unchanged in our environment. This study, therefore, buttresses the effect of early detection and treatment of DM in preventing the complications that arise from the disease.

Abstract 11425: Association Between Obstructive Coronary Disease and Diabetic Retinopathy: A Cross-Sectional Study of Coronary Angiotomography and Digital Retinal Images

Introduction: Diabetic retinopathy (DR) and obstructive coronary artery disease (OCAD) are the main microvascular and macrovascular complications of diabetes mellitus (DM), respectively. The assessment of DR by means of spectral domain optical coherence tomography (SD-OCT) and angiography (OCTA) conferred a remarkable progress. Objective: investigate if SD-OCT and OCTA can detect DR that is associated with OCAD, determined by coronary angiotomography (CCTA) Hypothesis: DR, assessed by OCTA and OCT-SD, is associated with OCAD, assessed by CCTA Methods: In this single-center, cross-sectional, single-blind study, patients with DM who had undergone CCTA in the previous 3 years (independent indication) were eligible. They were divided according to the presence of OCAD in two groups and underwent SD-OCT and OCTA. The association between OCAD and DR was evaluated through uni and multivariate analysis and another analysis was performed to identify variables independently associated with the presence of DR. Results: We included 171 patients, 87 OCAD and 84 without OCAD. Age (66 vs 64 y,p=0.28), DM duration (12 vs 13 y, p=0.5) and HbA1c (7.5% vs 6,9%,p=0.08) did not differ. Patients with OCAD were more frequently men (74% vs 38%, P&lt;0.01), had a higher prevalence of insulin use (52% vs 38%, p&lt;0.01) and 64% had already undergone some type of revascularization. SD-OCT and OCTA revealed a higher prevalence of DR (48% vs 22%,p=0.01). The main findings were: microaneurysms (25% vs 13%,p=0.04), intraretinal cysts (22% vs 8%, p=0.01) and areas of reduced capillary density in the superficial retinal plexus (46% vs 20%,p&lt;0.01).We also found lower mean vascular density (MVD) (15.7 vs 16.5, p=0.049) and lower circularity of the foveal avascular zone(FAZ) (0.64±0.1 vs 0.69±0.1, p= 0.04).There were significant and negative correlations between Duke coronary score and MVD (r=-0.189; p=0.03) and circularity of the FAZ (r=-0,206; p= 0.02). In an adjusted model, presence of OCAD increased the chance of DR (OR 4.05 [1.4 -11.6], p&lt;0.01). OCAD, DM duration and insulin use were independently associated to DR. Conclusions: OCAD was associated with a greater chance of presenting DR. OCAD, longer DM duration and insulin use were independently associated to the presence of DR.

Study of Left Ventricular Dysfunction In Type 2 Diabetes Mellitus Patients Without Known Co-Morbidities

Background: Subclinical left ventricular dysfunction in type 2 diabetes mellitus (DM) patients may precede the development of symptomatic heart failure. Detecting this dysfunction early could potentially prevent its progression. However, there is a scarcity of studies on this topic in Bangladesh. Therefore, this study aimed to explore the left ventricular function status in type 2 DM patients without any known co-morbid conditions in a tertiary care hospital. Methods: A cross-sectional study was conducted at the Department of Internal Medicine in Sir Salimullah Medical College &amp; Mitford Hospital over a one-year period. A total of 100 patients with a diagnosis of type 2 DM, meeting the inclusion-exclusion criteria, were enrolled. Written informed consent was obtained from each participant, followed by the collection of socio-demographic data, detailed clinical history, and routine investigations. Echocardiograms were performed on all participants to assess the presence of systolic and diastolic dysfunction using various modes. Data analysis was conducted using the statistical software SPSS 23.0. Results: The mean age of the study patients was 47.23±9.13 (SD) years, with the majority in the age group of 40-49 years (43%). Female patients accounted for 58% of the sample, while male patients comprised 42%. The frequency of left ventricular diastolic dysfunction (LVDD) was 65%. The presence of LVDD was associated with longer duration of diabetes mellitus, higher HbA1C levels, older age, and increased BMI (p&lt;.05). Conclusion: The majority of type 2 diabetic patients in this study exhibited left ventricular diastolic dysfunction, with a prevalence of 65%. Further larger-scale studies are recommended to validate these findings. Bangladesh J Medicine 2023; 34(3): 229-234

The association of vitamin D level with diabetic peripheral neuropathy: A comparative cross- sectional study

Background &amp; Objective: Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (DM). Vitamin D deficiency has been shown to be prevalent among patients with type 2 DM, particularly in those with DPN. This study aimed to look at the association of serum vitamin D level with peripheral neuropathy in patients with type 2 DM. Methods: This was a comparative cross- sectional study conducted in a tertiary hospital in Malaysia. Fifty diabetic patients with DPN and fifty diabetic patients without DPN were recruited. Serum vitamin D level was determined by measuring 25-hydroxyvitamin D [25(OH)D] level. The patients were clinically assessed and screened with Diabetic Neuropathy Symptoms score. Nerve conduction study was performed for patients with DPN. Results: The serum 25(OH)D level was significantly lower in patients with DPN (11.81 [9.09-18.06] vs 18.63 [11.25-22.63] ng/ml; p=0.006). Multiple logistic regression analysis showed that DPN was significantly associated with higher BMI, longer duration of DM, insulin usage and serum 25(OH)D level. The usage of fibrates had negative association with DPN. Subgroup analysis of the DPN group showed that patients with painful DPN had significant lower serum 25(OH)D level (p&lt;0.001) and the clinical severity of DPN negatively correlated with serum 25(OH)D level (p=0.015). Conclusion: Vitamin D deficiency is associated with DPN in patients with type 2 DM. In addition, patients with painful DPN tend to have significantly lower serum 25(OH)D level.

Magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in Nigeria

Background: Diabetes mellitus (DM) and its complications, continues to pose enormous challenge to health and financial stability. Diabetes has remained a source of national and global economic burden. It has been observed lately that incidence of diabetic foot ulcer (DFU); one of the complications of DM, is on the increase and it is contributing hugely to financial loss, morbidity and mortality among diabetic patients. This is taking a great toll on affected individuals in terms of cost of treatment, deformities sustained, number of working/productive days lost while on admission and its attendant economic implications, and ultimately mortalities recorded. The aim was to determine the magnitude of limb loss or lower extremity amputation attributable to DM over a period of 12 months in tertiary institution and to assess the clinical profile of the patients.&#x0D; Method: This is a retrospective study of the records of all patients that were consecutively booked for lower limb amputation and operated upon in the last 12 months at UNIOSUN Teaching Hospital, Osogbo, South-Western Nigeria. Out of these total, cases of DFU were extracted to form another study group and then studied in detail.&#x0D; Results: Atotal of 38 patients had lower limb amputation from July 2021 to May 2022. Twenty three of the total number of amputations had DFU with a huge proportion of 60.5%, followed by road traffic accident with 28.9% (n=11) Of the 23 diabetic cases , females were 15 with M:F ratio of 1:1.9. Mean age was 63±11.18 years. Mean duration of DM was 8.06±5.64 years. 78.3% had no foot care education and Doppler USS confirmed atherosclerosis in 100% of the patients. The commonest bacteria isolated was Proteus 34.8%. Length of hospital stay ranged between 6 weeks to 16 weeks. Outcome of admission was largely successful with 95.7% discharged and 4.3% mortality. &#x0D; Conclusion: DFU contributes markedly to morbidity and mortality. Long duration of DM, presence of PAD and DPN as well as advancement in age and wound infection with proteus bacterial are observed to be risk factors associated with gangrenous DFU. However, larger studies are needed to establish these factors as predictors of amputation in patient with DFU. Outcome was majorly good as majority of the patients were discharged.

Factors Affecting Intensive Aflibercept Treatment Response in Diabetic Macular Edema: A Real-World Study.

To investigate the systemic and ocular factors that affect the response to intensive aflibercept treatment in diabetic macular edema (DME) in a real-world setting. This retrospective cohort study evaluated 30 eyes of 23 patients with DME who underwent intensive intravitreal aflibercept injections (five monthly loading doses). Treatment response was assessed by central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at each monthly visit. The patients were categorized as good (<300 μm) and suboptimal (≥300 μm) responders based on CRT after the loading phase. Baseline systemic and ocular factors associated with treatment response were investigated. The mean CRT and BCVA significantly improved after five loading injections (486.87 ± 95.46 to 334.90 ± 69.47 μm and 0.51 ± 0.30 to 0.35 ± 0.25 LogMAR, respectively, all p < 0.05). During 12 months of follow-up, 16 eyes (53.33%) maintained CRT without additional treatment. Eyes with diabetes mellitus (DM) for ≥15 years, estimated glomerular filtration rate (eGFR) < 80 mL/min/1.73 m2, serum creatinine ≥ 0.95 mg/dL and potassium ≥ 4.7 mmol/L, and presence of epiretinal membrane (ERM) were more likely to have a suboptimal response to the treatment. Five monthly loading doses of intravitreal aflibercept injection provided significant anatomical and visual improvements in patients with DME. Patients with longer DM duration, lower eGFR, higher serum creatinine or potassium levels, or ERM were predisposed to a suboptimal treatment response. Individual response to intensive aflibercept treatment for DME can be predicted by these systemic and ocular risk factors.

Isolated Systolic Hypertension among Diabetes Mellitus Subjects; a national cross-sectional study in Indonesia

Isolated systolic hypertension (ISH) reflects atherosclerosis. Studies reported hypertension prevalence among diabetes mellitus (DM); however, limited studies provided community prevalence. The present study aimed to explore ISH prevalence among DM in Indonesia. This study obtained data from the 2018 Indonesia Basic Health Survey. The DM category was determined by fasting plasma glucose (PG) level ≥126 mg/dL or 2 hours postprandial and random PG level ≥200 mg/dL or previously diagnosed by a doctor. ISH is categorized if systolic blood pressure is≥140 mmHg and diastolic blood pressure is 90 mmHg. This study also explored the subject’s determinants, i.e., compliance, demography, and lipid profile. A Chi-square and Binary logistic regression were used to determine the association. The study included 3,911 DM individuals and disclosed the prevalence of ISH at 17.5%. ≥65 years old (OR=13.61 95%CI: 3.297-19.365) and 45-64 years old OR=4.59 95%CI: 3.297-6.383)), high HDL-cholesterol (OR=0.77; 95%CI: 0.626-0.936), and longer DM duration (OR=2.89; 95%CI: 2.405-3.474), all together were related to the ISH. Subjects with the oldest age category, i.e., ≥65 years old, had the highest OR. Older DM individuals with low HDL-C and longer DM duration were related to the ISH, suggesting lipid profile treatments, mainly the HDL-C, is a pivotal effort to delay ISH.

Factors Affecting Platelet-Rich Plasma Success in Patients With Diabetic Foot Ulcer.

Introduction Diabetic foot ulcers (DFU) are one of the most common complications of diabetes mellitus (DM). The use of platelet-rich plasma (PRP) in the treatment of DFU has been increasing in recent years. In the current study, we aimed to evaluate the factors affecting the success of PRP in the management of DFU. Methods The present study was planned in a prospective manner, and we enrolled patients with DFU inthe study. Patients' characteristics, DFU properties, and treatment outcomes were recorded. Patients with DFU were classified into two groups according to PRP success: healed DFU patients in Group 1 and non-healed DFU patients in Group 2. Groups were compared according to patient characteristics and treatment outcomes, and multivariate regression analysis was performed to clarify factors that predicted PRP success. Results In total, 182 patients were enrolled in the study, and DFU in 141 (77.5%) patients healed with PRP treatment. The mean body mass index (BMI) was significantly higher in the non-healed patients (p= 0.005). The smoking rate was 58.5% in the non-healed group and 39.7% in the healed group (p= 0.016). The duration of DM (17.9 yearsvs.22.5 years, p= 0.003) was significantly longer, and patients with glomerular filtration rate (GFR) < 60 (44.0%vs.63.4, p= 0.028) were significantly more common in the non-healed group. Multivariate regression analysis demonstrated that BMI ≥30 kg/m2and duration of DM ≥20 years were predictive factors for PRP failure in patients with DFU (p= 0.019 and p= 0.005). Smoking and GFR <60 were significantly associated with PRP failure (p= 0.040 and p= 0.044). Conclusion In our study, it was found that PRP was an effective treatment that improved DFU in 141 out of 182 patients. Moreover, the present study demonstrated for the first time that higher BMI, longer duration of DM, smoking, and lower GFR were significantly related to PRP failure in patients with DFU.

Glycemic variability is associated with diastolic dysfunction in patients with type 2 diabetes

To investigate the relationship between glycemic variability (GV) and diastolic dysfunction in patients with type 2 diabetes mellitus (DM) without coronary artery disease. Seventy-eight patients with type 2 DM without coronary artery disease were enrolled into the study. Diastolic function was assessed by echocardiography (Philips IE33); GV was evaluated by continuous monitoring of glucose (CGM, Guardian™ Connect System, Medtronic). According to the GV all studied patients were divided into two groups: group I - standard deviation (SD) > 2 (high GV), n = 40; group II - SD ≤ 1.9 (normal GV), n = 38. Group I were older (49±9 vs 46±5; p<0.05), with a longer duration of DM (10±9.5 vs 6±5.5; p<0.01). Patients in group I had more severe diastolic dysfunction which was characterized by an increased values of myocardial stiffness index (E/e' ratio), speed of early transmitral flow (E, sm/sec) and peak rate of tricuspid regurgitation (V max TR, m/sec). Multivariate regression analysis revealed that high GV and older age of patients were the only significant independent predictors for diastolic dysfunction. Increased GV is associated with diastolic dysfunction and could predispose to development and progression of heart failure in patients with type 2 DM without coronary arteries disease.

Lower Extremity Amputation Rates in People With Diabetes Mellitus: A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands

Lower extremity amputations are a major complication of diabetes mellitus (DM). In a previous Dutch study, the incident rate of major amputations was 89.2 per 100 000 person years. The primary aim of this study was to describe the lower extremity amputation rates in people with DM in the Zwolle region, where preventive and curative footcare is organised according to the guidelines of the International Working Group of the Diabetic Foot (IWGDF). The secondary aim was to evaluate outcomes and underlying characteristics of these people. This was a retrospective regional population based cohort study. Data from all people with DM treated in primary and secondary care, living in the region Zwolle were collected. All amputations in the period 2017 to 2019 were analysed. Comparisons were made between those with and without an amputation. In the analysis 5 915 people with DM were included, with a mean age of 67.8 (IQR 57.9, 75.9) years. Of those people, 47% were women and the median HbA1c was 53 (IQR 47, 62) mmol/mol. Over the three year study period 68 amputations were performed in 59 people: 46 minor, 22 major. This translated into an average annual crude amputation incidence rate of non-traumatic major and minor amputations of 41.5 and 86.9 per 100 000 person years among people with diabetes. Compared with those not undergoing amputations, those who underwent an amputation were more often men, older, mainly had T2DM, were treated in secondary care, had higher diastolic blood pressure, worse diabetic footcare profile, longer DM duration and higher HbA1c. At the end of the follow up, 111 people died: 96 (1.6%) without and 15 (25.4%) with amputations (p < .001). This retrospective study provides detailed insight into the rate of amputations in Dutch people with diabetes in the region Zwolle. Compared with previous Dutch estimates, these data suggest a considerable decrease in the major amputation incidence rate.