Longer Duration Of Diabetes Mellitus Research Articles

The effect of the duration of diabetes on dry eye and corneal nerves

PurposeTo investigate the relationship between the duration of type 2 diabetes mellitus (DM) and the ocular surface, and to address the question of why some people with lengthy DM duration are asymptomatic, whereas some people with shorter DM duration have pain or discomfort in their eyes. MethodsEighty-seven eyes of 87 subjects with different durations of DM and 49 eyes of 49 subjects without DM underwent Schirmer I test, tear film break-up time, sodium fluorescein staining and tear meniscus height (TMH) measurement, and completed the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire. Corneal structure and function were assessed with in vivo confocal corneal microscopy and with a corneal sensitivity esthesiometer. Both corneal nerve fiber length and inferior whorl length (IWL) were assessed as indices for neural structure. Age and gender were matched between groups. HbA1c levels >7.8% and proliferative diabetic retinopathy were exclusion criteria. ResultsIn the DM group, compared with the non-DM group, the SPEED score was significantly higher (p = 0.013), and corneal sensitivity and IWL were lower (p < 0.001). Schirmer I test, corneal sensitivity and IWL differed significantly between the group with DM duration >10 years and the non-DM (control) group (p = 0.021, p < 0.001, p < 0.001, respectively). Schirmer I test and IWL were significantly lower in the group with DM >10 years than in the group with DM ≤10 years (p = 0.023, p < 0.001, respectively). Corneal sensitivity was positively correlated with IWL regardless of diabetes status. ConclusionsThe lower SPEED score and asymptomatic feeling in people with a longer DM duration may be explained by the decreased IWL and reduced sensitivity.

Quality of life in patients with diabetes mellitus

Background and objectives: Diabetes mellitus (DM) perpetually affects the quality of life. This non-communicable lifelong disease usually develops micro and macro-vascular complications affecting vital organs. Thus, it reduces the functional capability of health as assessed by the health-related quality of life (HRQOL) measuring tools. It is not known, how much HRQOL of the diabetic population in Bangladesh is affected. Therefore, the objective of the present study was to estimate the levels of HRQOL of cases with DM attending a tertiary care hospital in Dhaka city. The study considered socioeconomic condition, nutritional status, duration of diabetes and treatment modalities while analyzing the HRQOL.&#x0D; Methods: This study was conducted in a tertiary care hospital in Dhaka city from July 2016 to June 2017. Patients with DM were considered eligible and were recruited. Those who were found to have complications like retinopathy, nephropathy, neuropathy, hypertension and stroke were excluded based on previous investigations. Once selected, the study protocol was described to each of the diabetic patients. If agreed, the participant was interviewed. Short Form health survey questionnaire (SF-36) was used for assessment of HRQOL. The assessment of physical health components included physical function, role physical, body pain, and general health. Mental health components were emotion, vitality and social function.&#x0D; Results: A total of 150 diabetic patients (m/f: 80/70) were included in the study. Comparisons of demographic variables between male and female participants showed no significant difference. As regards HRQOL, physical function score was significantly reduced among those who had diabetes for more than 10 years (p=0.049). General health component was significantly impaired among those who had higher BMI (&lt;30kg/m2; p= 0.016) and post-prandial hyperglycemia. Longer duration of DM (&gt;10yrs) and higher BMI significantly reduced components of mental health quality.&#x0D; Conclusion: The study revealed that the overall physical and mental quality of life was significantly affected by longer duration of diabetes, obesity and glycemic status.&#x0D; IMC J Med Sci 2018; 12(2): 73-79

Clinical characteristics and complications of skull base osteomyelitis: A 12-year study in a teaching hospital in South India.

Context:Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality.Aims:The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO.Materials and Methods:This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited.Results:A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, P = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, P = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge (P = 0.001).Conclusions:Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival.

Vitamin D status of tuberculosis patients with diabetes mellitus in different economic areas and associated factors in China

BackgroundVitamin D could be a mediator in the association between tuberculosis (TB) and diabetes mellitus (DM). A large scale multi-center study confirmed that TB patients with DM had significantly lower serum vitamin D level compared with those without DM and reported that DM was a strong independent risk factor for vitamin D deficiency.ObjectivesThis study was undertaken to determine amongst patients with both TB and DM living in different economically defined areas in China: i) their baseline characteristics, ii) their vitamin D status and iii) whether certain baseline characteristics were associated with vitamin D deficiency.MethodsIn DM-TB patients consecutively attending seven clinics or hospitals, we measured 25 hydroxycholecalciferol at the time of registration using electrochemiluminescence in a COBASE 601 Roche analyser by chemiluminescence immunoassay. Data analysis was performed using chi square test and multivariate logistic regression.ResultsThere were 178 DM-TB patients that included 50 from economically well-developed areas, 103 from better-off areas and 25 from a poverty area. Median vitamin D levels in well-developed, better-off and poverty areas were 11.5ng/ml, 12.2ng/ml and 11.5ng/ml respectively. Amongst all patients, 149 (84%) had vitamin D deficiency—91 (51%) with vitamin D deficiency (10–19.9 ng/ml) and 58 (33%) with severe deficiency (< 10 ng/ml). There was a significantly higher proportion with vitamin D deficiency in the poverty area. The adjusted odds of vitamin D deficiency (25-(OH)D3 <20 ng/ml) were significantly higher in those with longer history of DM (P = 0.038) and with HbA1c≥10% (P = 0.003).ConclusionOver 80% of TB patients with DM in China were vitamin D deficient, with risk factors being residence in a poverty area, a long duration of DM and uncontrolled DM. TB programme managers and clinicians need to pay more attention to the vitamin D status of their patients.

Correlation Between Depression and Glycemic Control in Patients with Diabetes Mellitus: A Cross-Sectional Study in a Clinical Setting in India in the Year 2013

Background: Diabetes mellitus is a medical disorder running a chronic course and often co-morbid with depressive disorders. Many physicians do not consider the presence of depressive symptoms per se to be adequate reason for further workup unless they are severe (e.g. suicidal thoughts). Objectives: We aimed to assess depression in adult patients suffering from diabetes mellitus, to study the socio-demographic data associated with depression in patients suffering from diabetes mellitus, and to assess glycemic control in patients with and without co-morbid depression suffering from diabetes mellitus. Methods: This is a cross-sectional hospital-based study. The sample of the study comprised 100 outpatients with diabetes mellitus of either type-1 or type-2. After a semi-structured clinical interview, all patients were administered with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and Becks depression inventory-II. The Chi-square test was utilized for testing the association between variables. To examine the difference between the two or three variables, the Mann-Whitney U test and the Kruskal-Wallis test were used. Results: Among the individuals recruited for the study, 72% had depression and 28% were not affected by depression. The results showed there was a positive correlation between glycemic control, the presence of complications, the type, and duration of diabetes mellitus and depression. Conclusions: The results clearly indicated a high rate of occurrence of depression in diabetes mellitus. Patients with a long duration of diabetes mellitus, poor glycemic control, and the presence of complications of diabetes mellitus were more likely to be severely depressed.

Trends in the epidemiology of chronic kidney disease in Russian Federation according to the Federal Diabetes Register (2013–2016)

BACKGROUND: Chronic kidney disease (CKD) is one of the most severe complications of diabetes mellitus (DM), this determines the importance of the study of epidemiological characteristics of the disease.&#x0D; AIMS: To assess the epidemiological characteristics of CKD in adult DM patients with type 1 (T1), 2 (T2) in Russian Federation in 201316.&#x0D; METHODS: We have used the database of the Russian Federal Diabetes register, 81st regions included in online register. Indicators were estimated per 10,000 adult DM patients (18years).&#x0D; RESULTS: In 2016, the CKD frequency registration was T1 23%, T2 6.9% with marked interregional differences 1.5-49.9%, 0.623.5%, respectively. The CKD prevalence in dynamics 20132016 was 2171.42303.0 in T1 and 512.687.2 in T2. The incidence of new CKD cases increased 2 times in T1 (215.5 vs 104.2), and 3.7 times in T2 (190.4 vs 51.8). The analysis of distribution by CKD stages by KDIGO indicates the increase in the proportion of patients with low and moderate cardiovascular risk and end stage renal disease (ESRD) (with the initial stages of CKD, C1/2 A1) - 12.046.8% in T1; 10.050.4% in T2. The proportion of patients with a very high risk (stages C4/5 C3aA3 and C3bA2-3) progressively decreases: 13.46.7% in T1, 11.34.4% in T2. We observed relation between the CKD prevalence and DM duration. CKD develops in 5.1% patients if T15 years and in 48.0% if T130years; in T2 3.5% and 20.3%, respectively. The average age of CKD onset in T1 increased for 4,3yr (36,140,2), in T2 for 2,4yr (64,466,8), DM duration until CKD development increased in T1 11.814.2yr, in T2 7.68.2yr.&#x0D; CONCLUSIONS: There is a significant improvement in the quality of CKD diagnostics at the earlier stages, older age and a longer DM duration before CKD onset in both types while we observed the increasing trends in CKD prevalence in Russian Federation in the dynamics of 2013-2016. Advances in the management of patients with DM in recent years do not reduce the risk of CKD, but give us a delay in its development. The marked interregional differences frequency of registration of CKD might indicate some remaining problems in verification in a number of regions where the standard for mandatory assessment of albuminuria and glomerular filtration rate not implemented.

Prevalence and correlates of erectile dysfunction in type 2 diabetic men: a population-based cross-sectional study in Chinese men.

The aim of this study was to estimate the prevalence and correlates of erectile dysfunction (ED) in a sample of Chinese type 2 diabetic men. Between October 2016 and April 2017, male patients with type 2 diabetes mellitus treated in our diabetes outpatient clinic were recruited in this study. The participants were asked to complete a short version of the International Index of Erectile Function (IIEF-5), which was a validated and self-administered questionnaire for the diagnosis and grading of ED severity. All patients screened for erectile function also underwent detailed physical examination, and interviewed for demographic and medical history. A total of 550 men were recruited in this study, of whom 20 patients were excluded and 35 did not complete all scheduled study procedures, leaving 495 patients in the final analysis. As determined by IIEF-5 score, 318 (64.2%) patients had ED. Among the 318 patients with ED, mild, mild-to-moderate, moderate, and severe were 37 (11.6%), 65 (20.4%), 95 (29.9%), and 121 (38.1%), respectively. The prevalence of ED in patients with high education, secondary education, and less than secondary education were 83.3%, 60.2%, and 35.4%, respectively (P < 0.0001). The prevalence of ED was 64.2% in Chinese type 2 diabetic men. Increased age, longer duration of diabetes mellitus, and worse glycemic control may promote the progression of ED among Chinese type 2 diabetic men. We also found that the higher education levels may increase the risk of ED in men with type 2 diabetes mellitus.

Prevalence of chronic kidney disease using estimated glomerular filtration rate among diabetes patients attending a tertiary clinic in Botswana

ABSTRACTObjectives: Diabetes mellitus (DM) is one of the most common contributors of chronic kidney disease (CKD). The epidemiology of CKD, a concern among patients with DM, has not been studied in Botswana. Consequently, the objective of this study was to estimate its prevalence among these patients in Botswana to provide future guidance to both government personnel and physicians.Methods: Observational cross-sectional study in a leading clinic in Botswana. Demographic and clinical data were obtained from patients through interviews and from their notes using a standard questionnaire. The study was conducted from July to October 2015. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet for Renal Disease equation. CKD was defined as an eGFR < 60 ml/min/1.73 m2. Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors.Results: The mean age and duration of DM among study participants were 54.67 years (range 21–92 years) and 5.0 years, respectively. Over half, i.e. 213/370 (57.6%) and 232/370 (62.7%), had an average blood pressure greater than 140/90 mmHg and poor glycemic control (HbA1c > 7%), respectively. 31/370 patients (8.4%) had CKD. However, only 18/370 (4.9%) had a diagnosis of CKD documented in their charts. Age, level of education, and duration of diabetes were independently associated with CKD.Conclusion: The prevalence of CKD by estimated eGFR was low compared to most previous studies. However, half of patients with CKD are not documented resulting in the potential for prescription errors and drug toxicity. A substantial number of our patients had uncontrolled hypertension and poor glycemic control. Older age, low level of education and longer duration of DM were associated with CKD. There is a need to carry out prospective studies to determine the association and role of glycemic and blood pressure control in CKD causation among patients with DM in Botswana.

Community based study to assess the prevalence of diabetic foot syndrome and associated risk factors among people with diabetes mellitus

BackgroundDiabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus.MethodsA community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system.ResultsThe overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS.ConclusionThe overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level.

Assessment of Kidney Function Tests in Diabetes Mellitus Patients under Insulin Doses in Arar Region, Kingdom of Saudi Arabia

Objectives: The aim of this work was to assess the kidney function tests in Diabetes Mellitus patients under insulin doses in Arar regionIntroduction: Diabetes Mellitus (D.M) is a prevalent endocrinal disorder in Kingdom of Saudi Arabia. Present study is to highlight the effect of long lasting cases of controlled D.M on Kidney Functions in a local region. Diabetic renal disease in human often requires the better part of two decades to develop the signs and symptoms of advanced/clinical diabetic nephropathy with underlying extensive damage to the various segments of the nephron, thereby causing albuminuria, rising blood pressure, and a progressive decline of glomerular filtration.Materials and Methods: The serum biochemistry investigation for Glucose, Urea and Creatinine.1-Glucose: The fasting serum glucose level was obtained from the laboratory of Clinical Biochemistry using department Autoanalyser (Dimension model RXL MAX) of the Arar Central Hospital, Arar.2-Urea: Urea Kit (Randox) and a spectrophotometer were used to determine the serum urea concentration in the samples.3-Creatinine: Serum creatinine was measured by a Kit (Randox), using the compensated kinetic Jaffe assay.Results & Discussions: It is clear from the result that in almost all patients blood glucose is within normal range but their kidney function test i.e. urea and creatinine lies in high range. Measurements of Blood pressure (SBP &DBP) also found to be in normal range for all patients. So obtained results could be interpreted as: The patients are controlled diabetics under insulin therapy but with very high serum creatinine level indicating severely affected glomerular filtration rate.Conclusion: Based on this study it could be concluded that long duration of diabetes mellitus can affect renal function through destructive effects on vascular bed of renal tissues as a part of general vascular and nervous pathological effects of diabetes mellitus. These patients are advised to go for dialysis regularly and should be under observation of well qualified Nephrologists.

Self Monitoring of Blood Glucose Among Patients with Type 2 Diabetes Mellitus in Eastern Nigeria: Need for Multi-strategic Interventions

Self Monitoring of Blood Glucose (SMBG) is a useful adjunct to lifestyle modification and medications for optimal management of type 2 Diabetes Mellitus (DM). This study was aimed at evaluating the practice, cost and associations of SMBG in subjects with type 2 DM in Enugu, Nigeria. In a cross-sectional survey conducted at the diabetes clinic in three hospitals, 366 type 2 diabetic subjects aged 18-65 years were consecutively interviewed. Socio-demographic and clinical information were documented and glycated hemoglobin was performed for all the participants. A total of 318 subjects with mean age of 49.0 ± 9.4 years completed the study. 304 subjects (95.6%) reported that they were aware of SMBG and 60.7% practiced SMBG at frequencies ranging from ≥ 1/day (7.9%), ≥ 1/week (26.1%) or < 1/week (26.7%). 39.3% of the respondents did not perform any SMBG. Lack of finance was the predominant reason for not performing any SMBG. The median monthly cost of performing SMBG excluding the cost of meters was N2,000 (USD 6.7) per patient, amounting to annual societal cost of N37.8 billion (USD 126 million). Significant associates of performing any SMBG were longer DM duration, previous participation in diabetes education, insulin treatment and infrequent hospitalization. Despite high awareness, SMBG practice is grossly inadequate and is associated with a huge economic burden that may be unsustainable in a resource-poor country like Nigeria. Measures aimed at reducing the cost of glucometers and strips, and improving diabetes education are recommended.

Vitamin B12 Deficiency in Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a common disease, affecting up to 13.1% of the Portuguese population. In addition to the known micro and macrovascular complications, drug side effects constitute a major concern, leading to changes in the treatment guidelines, which favor safety over efficacy. Metformin is the first-line pharmacological treatment for most patients with type 2 diabetes mellitus; however, it has been associated with vitamin B12 deficiency in up to 30% of treated patients. The authors describe the prevalence of vitamin B12 deficiency in a diabetic population and explore the possible underlying factors. Retrospective, observational study. Clinical and laboratory data of type 2 diabetes mellitus patients whose vitamin B12 status was evaluated in the last decade (2005 - 2016) were analyzed. Patients with known malabsorptive syndromes or having undergone bariatric surgery were excluded from the study. Statistical analysis of the data was done and the results were considered statistically significant at p values < 0.05. The study included a total of 1007 patients (58% women) with a mean age of 66.4 ± 12.2 years and 11 ± 10.4 years of type 2 diabetes mellitus duration. These patients had a high prevalence of complications: diabetic renal disease 47.7%, neuropathy 9.2%, retinopathy 14.9%, coronary artery disease 8.4%, cerebrovascular disease 10.9%, and peripheral arterial disease 5.5%. Vitamin B12 deficiency (< 174 ng / dL) was present in 21.4% of the population and this subgroup was older (68.4 vs 65.8 years, p = 0.006), had a longer type 2 diabetes mellitus duration (13.35 vs 10.36 years; p = 0.001), higher prevalence of retinopathy (20.9% vs 13.3%; p = 0.005) and thyroid dysfunction (34% vs 23.7%; p = 0.002). Vitamin B12 deficiency was also more frequent in patients treated with metformin (24.7% vs 15.8%; p = 0.017), antiplatelet agents (25.4% vs 16.2%, p < 0.001), and calcium channel blockers (26.8% vs 18.2%; p = 0.001). After adjustment for possible confounders, the variables associated with B12 deficiency were: metformin, hypothyroidism, age and type 2 diabetes mellitus duration. Despite the retrospective design, the results report a high prevalence of vitamin B12 deficiency in the type 2 diabetic population. This study also demonstrates that the B12 deficiency risk is higher in older people, with longer diabetes mellitus duration, hypothyroidism and treated with metformin. Further studies are needed to identify the risk factors for the B12 deficit. The recognition of these variables will contribute to optimize the screening and prevention of the B12 deficiency in type 2 diabetes mellitus.

Prevalence and pattern of gastrointestinal symptoms in patients with diabetes mellitus

Background and objectives: Gastrointestinal (GI) disorders are contributor of increased morbidity and poor quality of life in individuals with diabetes mellitus (DM). Racial, nutritional and life style may influence GI disorders to a large extent. Thus, the burden of GI disorders and its determinants warrant investigation in individual population. Therefore, the present study was undertaken to explore the types of GI symptoms in Bangladeshi population with DM for more than 10 years of duration.Methodology: This observational study was conducted on patients with DM for more than 10 years of duration at the outpatient department of BIRDEM general hospital from July 2009 to June 2010. A total of 301 DM patients responded to self-reporting questionnaire (Bengali adaptation of Rome III diagnostic questionnaire). Then 91 participants were further studied for glycemic status, liver function, kidney function and basic defects of diabetes through homeostasis model assessment.Results: The median age of 301 study population was 55 years (range 25 to 84 years) and the male female ratio was 1: 0.74. Out of 301 DM cases, 273 (90.7%) had GI symptoms. Significantly (p&lt;0.05) higher number of males (93.6%) had GI symptoms compared to females (86.7%). Among the clinical conditions, unspecified functional bowel disorder (UFBD) was present in 88.3% cases, followed by cyclic vomiting syndrome (38.1%) and functional fecal incontinence (20.9%). Single GI symptom was present in 123 (45.1%) cases while 32.6%, 12.5% and 9.9% had two, three and more than three GI symptoms respectively. No significant difference was found in any biochemical parameter between cases with and without GI symptoms. Multiple logistic regression analysis revealed sex and residence as poor predictors of UFBD while other variables did not show any significant relation/risk to UFBD.Conclusion: A large proportion of patients with long duration of DM had GI symptoms. A comprehensive management of diabetes requires attention to GI disorders.IMC J Med Sci 2017; 11(2): 56-60

Dyslipidemia and associated factors among diabetic patients attending Durame General Hospital in Southern Nations, Nationalities, and People's Region.

BackgroundDiabetes mellitus is a group of metabolic disorders that are caused by deficiency in insulin secretion or the decreased ability of insulin to act effectively on target tissues, particularly muscle, liver, and fat. As a result of insulin resistance in the target tissues, particularly in the adipocytes, free fatty acid flux is increased, leading to increased lipid synthesis in hepatocytes, which is responsible for diabetic dyslipidemia.ObjectiveThe objective of this study was to determine the prevalence and associated factors of dyslipidemia among diabetic patients in Durame General Hospital in Kembata Tembaro zone.MethodsA cross-sectional study was conducted from September 2015 to April 2016. In total, 224 subjects were involved in the study by using convenient sampling techniques. Face-to-face interview–administered questionnaire was used to collect sociodemographic data and other possible clinical data associated with the prevalence of dyslipidemia. Fasting venous blood specimens were collected to assess serum lipid profiles. Blood pressure (BP), weight, height, and waist circumference were measured.ResultsThe prevalence of dyslipidemia was 65.6%. Individual lipid abnormality of elevated LDL-C, TC, TG, and reduced HDL-C were identified in 43.8%, 23.7%, 40.6%, and 41.9% of study subjects, respectively. The prevalence of dyslipidemia was significantly associated with high BP, high body mass index, aging, and longer duration of diabetes mellitus.ConclusionHigh prevalence of dyslipidemia was found among diabetic patients in the study area. Therefore, a compressive mechanism is required to screen, treat, and prevent dyslipidemia.

Prevalence and risk factors associated with retinopathy in diabetic patients at Parirenyatwa Hospital outpatients’ clinic in Harare, Zimbabwe

Diabetic retinopathy is the fifth leading cause of blindness worldwide accounting for nearly 5% of all blindness. However, most of the prevalence and incidence data is from developed countries, with very limited information from sub-Saharan Africa. The study sought to determine the prevalence of, and factors associated with, retinopathy in diabetic patients. Diabetes mellitus patients attending the outpatients’ clinic at Parirenyatwa Group of Hospitals between October 2013 and July 2014 were recruited into this analytical cross-sectional study. Demographic information was collected. A nurse carried out anthropometric measurements. An ophthalmologist using slit lamp indirect ophthalmoscopy with a 20-diopter and a 90-diopter lens diagnosed retinopathy. Blood samples were collected and analysed for triglycerides, total cholesterol, HDL cholesterol, glycosylated hemoglobin and serum creatinine. A total of 340 patients were enrolled into the study, of whom 73.2% were female. Mean (SD) age was 57.5 (14.9) years and there was no difference in age between females [57.6 (14.1) years] and males [57.2 (16.8) years]. The overall prevalence of diabetic retinopathy was 28.4%. Using multivariate logistic regression analysis retinopathy was associated with longer duration of diabetes mellitus (OR 1.06, 95% CI 1.03-1.09, p value ˂ 0.001) and lower serum creatinine (OR 0.99, 95% CI 0.97-1.00, p value 0.025). The prevalence of diabetic retinopathy was 28.4%. Longer duration of diabetes mellitus and lower serum creatinine, which is a marker of renal damage, were independent risk factors of diabetic retinopathy. Keywords: Diabetes mellitus; Diabetic retinopathy; Complications; Blindness; Prevalence; Risk factor

The Diabetes-Tuberculosis Co-Epidemic: The Interaction between Individual and Socio-Economic Risk Factors

Abstract Worldwide, tuberculosis (TB) is a major cause of morbi-mortality, about 30% of the population having a Mycobacterium tuberculosis infection. Patients with diabetes mellitus (DM) have a threefold increased risk of developing the disease. The prevalence of DM is rapidly increasing, especially in countries with low and middle income, where TB incidence is also increased, thus baffling the efforts for TB control. The DM-TB co-epidemic is more frequent in married, older men, with reduced level of education, low income, without a steady job, with lifestyle habits such as alcohol consumption, smoking, sedentarism, living in an urban environment, in crowded areas, in insanitary conditions. These patients have a higher body mass index (BMI) compared with those without DM and frequently present family history of TB, family history of DM, longer duration of DM and reduced glycemic control. TB associated with DM is usually asymptomatic, more contagious, multidrug resistant and is significantly associated with an increased risk of therapy failure, relapse and even death. Thus, the DM-TB comorbidity represents a threat to public health and requires the implementation of urgent measures in order to both prevent and manage the two diseases.

Urinary tract infections in Romanian patients with diabetes: prevalence, etiology, and risk factors.

AimPatients with diabetes mellitus (DM) have an increased risk of infections, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence and etiology of UTIs and identify the risk factors for their development in patients with DM.Patients and methodsIn this retrospective, noninterventional study, the medical records of 2,465 adult patients with DM who were hospitalized in a Diabetes Clinic were reviewed. Data regarding the presence of UTI and possible associated risk factors were collected and their possible relation was analyzed. The study protocol and procedures were approved by the Ethics Committee of Timișoara Emergency Hospital. All data were collected and analyzed using SPSS v.17 statistical software.ResultsThe prevalence of UTIs in patients with DM was 12.0% (297 cases), being higher in females than in males and higher in patients with type 2 DM compared with patients with type 1 DM. In univariate logistic regression analysis, risk factors associated with UTIs were female gender, age, type 2 DM, longer duration of DM, and the presence of chronic kidney disease and coronary artery disease. Multivariate analysis identified age, duration of DM, and metabolic control (hemoglobin A1c levels) as independent risk factors for UTIs. The gram-negative bacilli from the Enterobacteriaceae family were predominant, with Escherichia coli being the most frequent of them (70.4%).ConclusionUTIs are a frequent condition associated with DM. It is necessary to improve the care and the screening of UTIs in patients with DM to prevent the occurrence of possible associated severe renal complications.

Advanced glycation end products, fibroblast growth factors and the development of atherosclerosis in patients with diabetes

Introduction. Atherosclerotic processes are more pronounced at diabetes mellitus (DM). Chronic hyperglycemia activated pathological mechanisms of restructuring the connective tissue, including the vascular wall. Fibroblasts are the main cellular components. Activation of the transforming growth factor (TGFß1), basic fibroblast growth factor (ß-FGF), produced by fibroblasts, inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor (α-TNF), advanced glycation endproducts (AGE) and their receptors (rAGE), may have important prognostic value.Objective. To investigate the level AGE, TGFß1 and ß-FGF in patients with severity atherosclerosis coronary artery disease (CAD), to compare with normal blood glucose and DM.Material and methods. The study involved two groups of patients with CAD: 56 patients of the first group had normal blood glucose and 78 patients suffered from DM type 2. The degree of coronary atherosclerosis was determined by coronary angiography (CAG) in all patients. The blood samples were collected from the aorta during CAG and cubital vein simultaneously, immediately centrifuged (15000g*min), supernatants were stored at –70*C until analysis were done. Serum was analyzed by ELISA (IFA). The critical significance level (p) for statistical hypothesis testing was set at &lt;0.05.Results. Average β-FGF, TGF-ß1, AGE, RAGE in the second group was significantly higher than in the first (p&lt;0.005). Increased level of the AGE, RAGE and TGFß1 was positive correlated with low-density lipoprotein and triglycerides (R=0,049, p&lt;0.005). IL-6 was significantly higher in the second group. There was the significant correlative relationship between the levels AGE, RAGE, TGFß1, ß-FGF and IL-6 with DM duration (R=-0,120; p=0.009), direct association with HbA1C (R=0,429; p=0.006). There were significantly higher level of the AGE, TGFß1 and ß-FGF in aortic blood than in peripheral venous blood p&lt;0,005). IL-6 level had opposite features: serum IL-6 was higher in venous than arterial blood. The patients with DM had three-vessel disease often (73%) then the patients without DM (R = 0,021, p&lt;0.005), which was direct correlated with level TGFß1 (R = 0,03, p&lt;0.005). There weren`t any differences in α-TNF level between two groups.Discussion. High AGE, TGFß1 level and positive correlation with atherogenic lipids may indicate the role of the connective tissue remodeling in pathogenesis of the coronary atherosclerosis. As the longer DM duration led to increasing AGE, TGFß1 and IL-6 levels the chronic hyperglycemia can restructure the vascular wall. Higher AGE, TGFß1 and ß-FGF levels in aorta then in peripheral blood may show the involvement of the cardiomyocytes in these growth factors metabolism.Conclusion. DM existence with CAD was characterized by higher AGE, RAGE, TGFß1 and IL-6 levels, which was direct correlated with the atherogenic lipids. Patients with type 2 DM and CAD had more severe coronary artery disease.

Prevalence of Diabetic Retinopathy in a Clinic Population from Puerto Rico.

Diabetic retinopathy (DR) is a preventable or treatable cause of blindness in the adult population. The prevalence of diabetes mellitus (DM) in Puerto Ricans is the highest among Hispanics. This study evaluated the prevalence of DR in a screening program of DM subjects in a clinic system in Puerto Rico. A retrospective cross-sectional health records study of DM patients referred by primary care physicians for dilated retinal evaluation to the Inter American University of Puerto Rico School of Optometry Juana Diaz Eye Institute Clinic between 2001 and 2009 was performed. All subjects underwent a complete eye evaluation including fundus photography. Photographs were graded following the Early Treatment Diabetic Retinopathy Study protocols. A total of 411 randomly selected health records of DM subjects older than 30 years were included. The estimated prevalence of DR among all subjects is 37.7%. DR was more common in males (47.2%) than females (33.7%). The age range with higher frequency of DR is among ages 60 to 69 (34.8%) and the lowest between ages 30 and 39 (3.9%). The average number of years since initial DM diagnosis was 12.48. Probability of developing DR increases with longer duration of DM (p < 0.05). The most common stage was mild non-proliferative DR (22.6%). Our data revealed that prevalence of DR was high among Puerto Ricans. Mild stage retinopathy was most prevalent and there exists an increase in probability to develop DR with duration of DM. The prevalence of DR in total population may be different than the findings presented in this paper. Comprehensive studies are needed to understand and estimate the progression and impact of DR in this population.

Calpain and Caspase-12 Expression in Lens Epithelial Cells of Diabetic Cataracts

To compare the expression of calpain and caspase-12 in human lens epithelial cells (LECs) of cataract patients with or without diabetic retinopathy (DR). Prospective, comparative case series. Patients were divided into 4 groups: patients without diabetes mellitus (DM) (Group 1), patients with DM and without diabetic retinopathy (DR) (Group 2), diabetic patients with nonprolifeative DR (NPDR) (Group 3), and diabetic patients with proliferative DR (PDR) (Group 4). Data on DM duration and glycated hemoglobin (HbA1c) level were collected. The LECs were obtained during cataract surgery and immunohistochemical staining was performed for calpain and caspase-12. The reactivity score of each specimen was determined using confocal microscopy. A total of 40 patients (40 eyes) were evaluated, and each group was composed of 10 patients. The expression of calpain and caspase-12 was highest in Group 4, followed by Group 3, Group 2, and Group 1 (P < .001). The expressions were significantly higher with a longer duration of DM, increased HbA1c level, or advanced DR. Endoplasmic reticulum stress may be associated with apoptosis of LECs, resulting in cataract formation in diabetic patients.