Longer Duration Of DM Research Articles

A Narrative Review of Adhesive Capsulitis with Diabetes.

Background/Objectives: To update the perspectives of the association between diabetes (DM) and adhesive capsulitis (AC). Methods: Our findings were summarized in a narrative review. We searched PubMed, Embase, and Consensus databases, using keywords such as "diabetes", "adhesive capsulitis", and "frozen shoulder", for articles published from January 2015 to June 2024, covering both type 1 and type 2 DM. Results: After compiling relevant articles on DM-related AC published since 2015, we found that most studies show an increased prevalence of AC in DM patients, ranging from 3 to 10 times. A longer duration of DM is a risk factor for AC. Whether T1DM or prolonged insulin use will increase the risk of AC is still controversial. Poor blood sugar control seems to increase the risk of AC. Recent studies also show a correlation between blood sugar levels and the prevalence of AC. Cytokines, such as IL-6, IL-8, TNF-α, VEGF, and AGEs, related to inflammation and fibrosis may contribute to the pathophysiological processes of AC. Conclusions: Recent research findings have revealed new perspectives divergent from past notions, while also presenting some topics worthy of exploration. Due the close relationship between DM and AC, clinicians need to be alert to the presence of AC, especially early stage, in DM cases, and control the blood glucose level to reduce the risk of AC. Further research is still needed to provide better prevention and management for DM patients with AC.

Epidemiology and risk factors of diabetic retinopathy in upper Egypt: a 3-year prospective study

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in adult diabetic patients during 3 years. Patients and methods This is a cross-sectional study that was carried out on the adult diabetic population who attended a large private referral ophthalmology center in Assiut City, Upper Egypt for 3 years. All cases were subjected to full history taking, ophthalmological examination, and dilated fundus examination for evidence of DR, and besides, the associated systemic complications were assessed. Results The study included a total of 2178 cases and the prevalence of DR was 18.2%. DR was more prevalent in females than males (67.9% vs. 32.1%). Also, DR was significantly associated with insulin use, moderate and poor control of diabetes mellitus, uncontrolled hypertension (HTN), dyslipidemia, and nephropathy (P<0.01 for all). The risk factors for DR were; older age (adjusted odds ratio (AOR) 1.69; 95% CI =0.91–1.97; P≤0.01), female sex (AOR 1.65; 95% CI =1.21–1.86; P =0.02), smoking (AOR 1.73; 95% CI =1.41–2.11; P =0.02), longer duration of DM (> 15 years) (AOR 2.87; 95% CI =2.48–3.29; P ≤0.01), insulin use (AOR 1.42; 95% CI =0.94–1.65; P=0.03), poor control of DM (AOR 3.98; 95% CI =3.69–5.41; P≤0.01), presence of HTN (AOR 2.62; 95% CI =2.37–2.89; P≤0.01) and dyslipidemia (AOR 1.65; 95% CI =1.42–2.02; P=0.03). Conclusion The prevalence of DR in adult diabetic patients was 18.2% and the significant risk factors for DR (arranged descendingly in power) were; poor control of DM, longer duration of DM (> 15 years), presence of HTN, smoking, high age, dyslipidemia, female sex, and insulin use.

Effect of physical activity on incident atrial fibrillation in individuals with varying duration of diabetes: a nationwide population study

BackgroundDiabetes mellitus (DM) duration affects incident atrial fibrillation (AF) risk; the effect of physical activity on mitigating AF risk related to varying DM duration remains unknown. We assessed the effect of physical activity on incident AF in patients with DM with respect to known DM duration.MethodsPatients with type 2 DM who underwent the Korean National Health Insurance Service health examination in 2015–2016 were grouped by DM duration: new onset and < 5, 5–9, and ≥ 10 years. Physical activity was classified into four levels: 0, < 500, 500–999, 1,000–1,499, and ≥ 1,500 metabolic equivalent task (MET)-min/week, with the primary outcome being new-onset AF.ResultsThe study enrolled 2,392,486 patients (aged 59.3 ± 12.0 years, 39.8% female) with an average follow-up of 3.9 ± 0.8 years and mean DM duration of 5.3 ± 5.1 years. Greater physical activity was associated with a lower AF risk. Lowering of incident AF risk varied with different amounts of physical activity in relation to known DM duration. Among patients with new-onset DM, DM duration < 5 years and 5–9 years and 1,000–1,499 MET-min/week exhibited the lowest AF risk. Physical activity ≥ 1,500 MET-min/week was associated with the lowest incident AF risk in patients with DM duration ≥ 10 years (by 15%), followed DM duration of 5–9 years (12%) and < 5 years (9%) (p-for-interaction = 0.002).ConclusionsLonger DM duration was associated with a high risk of incident AF, while increased physical activity generally reduced AF risk. Engaging in > 1,500 MET-min/week was associated with the greatest AF risk reduction in patients with longer DM duration, highlighting the potential benefits of higher activity levels for AF prevention.

Impact of Empagliflozin on Insulin Use in Patients with Heart Failure with Preserved Ejection Fraction (HFpEF) and Type 2 Diabetes: Sub-Analysis from EMPEROR-Preserved Trial

AimWe assessed the impact of empagliflozin on insulin requirement, and outcomes according to insulin use in patients with heart failure with preserved ejection fraction (HFpEF). MethodsOf 5988 patients randomised to empagliflozin or placebo, 2938 (49%) had type 2 diabetes mellitus (T2DM) and 1980 (33%) preDM at baseline. We analysed the effects of empagliflozin vs. placebo on time-to-first sustained insulin initiation in patients with T2DM or preDM not using insulin at baseline. ResultsAt baseline, 861 patients were using insulin. Patients on insulin were younger, had longer DM duration, lower eGFR, and more co-morbidities such as coronary artery disease and macroalbuminuria. During a median observation time of 26 months, among patients with T2DM or preDM not using insulin at baseline, empagliflozin reduced the risk of sustained initiation of insulin by 31% (HR 0.69 [95% CI 0.49, 0.98], p=0.038). Among patients with T2DM, those using insulin at baseline had higher incidence rates of the primary endpoint (first hospitalisation for HF [HHF] or cardiovascular [CV] death), total HHFs and first HHF that were reduced by empagliflozin but still remained higher than in the placebo arm of those not using insulin. Beneficial effects of empagliflozin on CV outcomes did not differ by baseline insulin use. ConclusionsEmpagliflozin reduced the rate of insulin initiation by 31% in patients with HFpEF and T2DM or preDM. Insulin-users at baseline were at higher risk of adverse CV outcomes; still, the effects of empagliflozin on CV outcomes were consistent in patients with T2DM irrespective of insulin treatment.Figure: The effect of empagliflozin vs placebo on clinical outcomes and mortality in patients with HFpEF and baseline T2DM with or without insulin.

Systolic inter-arm blood pressure difference and estimated glomerular filtration rate in type 2 diabetic patients in Palestine: a cross-sectional study

Objectives This study aimed to investigate the association between systolic inter-arm blood pressure difference (IABPD) and the estimated glomerular filtration rate (eGFR), as well as chronic kidney disease (CKD), in patients with type 2 diabetes mellitus (T2DM). Patients and methods This cross-sectional study included 189 Palestinians diagnosed with T2DM. Data were collected through personal interviews, medical records and three separate blood pressure measurements from both arms. Patients were stratified in two ways: based on systolic IABPD ≥15 mmHg and the presence of CKD, indicated by an eGFR of <60 mL/min/1.73 m2 over a three months period. We used simple and multiple linear regression analyses to clarify the association between systolic IABPD (mmHg) and eGFR and to identify independent predictors for eGFR. Results The mean age was 61.3 years, with a female percentage of 57.7%. The prevalence of systolic IABPD ≥15 mmHg and CKD was 27.5% and 30.2%, respectively. Among patients with eGFR <60 mL/min/1.73 m2, the median systolic IABPD was 12.5 mmHg (interquartile range (IQR), 13.5 mmHg), whereas in patients with eGFR ≥60 mL/min/1.73 m2, it was 7.5 mmHg (IQR, 9.8 mmHg) with a significant difference (p = .021). The results of the multiple linear regression model did not reveal an independent association between systolic IABPD and eGFR, with an unstandardized coefficient (B) of −0.257 (95% confidence interval (CI), −0.623 to 0.109; p = .167). However, older age (B, −0.886; 95% CI, −1.281 to −0.49; p < .001), hypertension (B, −12.715; 95% CI, −22.553 to −2.878; p = .012) and a longer duration of DM (B, −0.642; 95% CI, −1.10 to −0.174; p = .007) were significantly and negatively associated with eGFR. Conclusions Systolic IABPD did not exhibit an independent association with eGFR in T2DM patients. However, older age, a previous history of hypertension, and a longer duration of DM were all significantly associated with lower eGFR.

Prevalence of Diabetic Retinopathy in Adult Diabetics at National Institute of Diabetes and Endocrinology in Cairo

Background Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes worldwide. The prevalence of type 2 diabetes is high and increasing across all regions worldwide. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. It is one of the leading causes of blindness in the working age population and has a great economic impact on society especially on healthcare systems. Optical coherence tomography (OCT) and fundus photography are noninvasive examinations that help the clinician to observe signs of neurodegenerative changes in the retina and detects neuroretinal changes in the early stages of DR and DME. Aim of the Work The aim of our study was to estimate the prevalence and severity of diabetic retinopathy among patients with diabetes mellitus type 2 over 30 years old they will be screened clinically and by fundus photography and optical coherence topography at national institute of diabetes and endocrinology. Patients and Methods This study included 600 eyes from 300 patients. Diabetics were recruited from patients recruited from National institute of Diabetes and endocrinology in the ophthalmic clinic. It was designed as cross sectional hospital based study. This study conducted to estimate the prevalence and severity of diabetic retinopathy and diabetic macular edema among patients with diabetes mellitus type 2 over 30 years old. Using fundus photography and optical coherence topography (SD-OCT) at National Institute of Diabetes and Endocrinology. Results The findings of our study showed that the prevalence of DR irrespective to type was 34% of studied eyes. Also it revealed that 22.3% of studied eyes had diabetic macular edema. Non-proliferative diabetic retinopathy in our study was more common than proliferative diabetic retinopathy. The prevalence of nonproliferative diabetic retinopathy in DR patients in our study was (72.5%) but proliferative diabetic retinopathy (27.5%) in DR patients. The commonest type was mild NPDR (33.3%). There is a strong relation between duration of DM, control of HbA1c, age, treatment with insulin and DR and DME. The longer duration of DM and high levels of HbA1c considered main risk factors of DR and DME. Conclusion The prevalence of DR and DME were 34%and 22.3%, respectively of studied eyes in ophthalmology clinic in National Institute of Diabetes and Endocrinology. These data highlight the substantial public health burden of DR and DME. Old age, Insulin treatment, poor control and the longest duration of DM patients groups are more liable to develop DR and DME.

Is metformin the only culprit for cognitive impairment in diabetes?

Background: As patients with diabetes are conventionally on a long-term prescription for metformin, it is important to identify any increase in their risk for developing cognitive disorders due to metformin. Hence, an attempt was made to study the cognitive impairment by using Montreal Cognitive Assessment test (MoCA) as a possible predictor of development of cognitive impairment in type 2 diabetes patients on metformin therapy. Methods: Four hundred type 2 diabetes patients on metformin were enrolled for this cross-sectional study, and data recorded. Cognitive test MoCA was administered and a score less than 26 was considered abnormal. Results: In this study, the participants on metformin had a statistically significant correlation with age &gt; 65 years, duration of diabetes (&gt;5 years), metformin dose (1 gm and more) and presence of diabetes complications. Ordinal regressions showed significant correlation between abnormal MoCA scores and older age, longer duration of DM, and presence of one of the DM complications. Conclusions: Amongst patients receiving medical therapy for control of type 2 diabetes, participants using metformin showed a very high prevalence rate of abnormal MoCA scores (85%). Increased duration of metformin intake leads to a decline in MoCA performance.

320-OR: ADA Presidents' Select Abstract: Risk Factors for Distal Symmetrical Polyneuropathy (DSPN) in the Diabetes Prevention Program (DPP) and the DPP Outcomes Study (DPPOS)

Objective: To evaluate how DSPN differs across the randomized DPP treatment groups and is associated with diabetes (DM) status, DM duration, and cumulative glycemic exposure. Methods: In the DPP, adults ≥25 years of age at high risk for DM (n=3234) were randomized to determine the effects of intensive lifestyle modification (ILS) or metformin (MET) compared to placebo (PLA) on incident diabetes. After DPP ended, participants were invited to join the DPPOS during which metformin was continued in those randomized to receive it. DSPN was rigorously assessed in 1,792 participants at DPPOS year 17 based on both symptoms and signs (pinprick, vibration, and monofilament). Multivariable logistic regression models were used to determine whether DSPN was associated with randomized treatment group, DM status and duration, and cumulative glycemic exposure. Results: At 21 years following DPP randomization, 66% had developed DM with median duration of 15 years. The prevalence of DSPN did not differ by DPP treatment group (21.5%, 21.5% and 21.9% in ILS, MET and PLA, respectively), but was slightly lower for those at risk for DM (19.6%) vs. those with DM (22.7%). There was a significant effect modification by age of the association between DPP treatment group and DSPN (p&amp;lt;0.05): the odds ratio (OR) for DSPN with ILS vs PLA decreased by 3.7% (95% CI 0.6-6.7) with each 1 year increase in age. MET vs. PLA was not associated with DSPN and age did not influence the null association. In models adjusted for treatment group, demographics, cardiometabolic risks, and low vitamin B12 or B12 supplement use, DSPN was associated with DM status (OR 1.40, p&amp;lt;0.001 vs. no DM), greater DM duration (OR 1.04 per 1 year, p&amp;lt;0.001), and higher time-weighted HbA1c (OR 1.85 per 1% increase, p&amp;lt;0.001). Conclusions: The likelihood of DSPN was higher for those with DM, longer DM duration, and higher cumulative glycemic exposure. Although ILS did not prevent DSPN overall, there were ILS benefits with increasing age. Disclosure C.Lee: Employee; Pfizer Inc. N.White: None. W.H.Herman: Advisory Panel; National Committee for Quality Assurance, Consultant; Merck Sharp &amp; Dohme Corp., Other Relationship; National Institutes of Health, American Diabetes Association. D.Research group: None. A.Ciarleglio: None. S.Edelstein: None. J.P.Crandall: Research Support; Abbott Diabetes. D.Dabelea: None. R.B.Goldberg: None. S.E.Kahn: Advisory Panel; Anji Pharmaceuticals, Bayer Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Other Relationship; Novo Nordisk. W.C.Knowler: None. M.Ma: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, UDK048400)

Prevalence of diabetic retinopathy in patients with diabetes in Alexandria and North-West Delta, Egypt

PurposeThe purpose of this research was to estimate the prevalence of DR in Alexandria and the North-West Delta region.MethodsAll diabetic patients attending the general ophthalmology clinics (Group 1), diabetic internal medicine clinics (Group 2), or reached out in the local communities (Group 3) were eligible to participate. Fundus photographs were graded according to the Scottish DR grading system by three independent UK-certified graders. Adjudication by a consultant was done when needed.ResultsOut of 11,033 screened patients, 10,811 had a gradable fundus photograph in at least one eye and were included. The numbers of cases in groups 1, 2 and 3 were 3940, 2826, and 4045, respectively. Males represented 38.35% of the cases. Mean age was 55 ± 12.63. For the whole sample, groups 1, 2 and 3, the DR prevalence was 32.49, 46.4%, 29.13%, and 21.29%, respectively. The prevalence of proliferative DR (grade R4) was 6.16%, 11.83%, 5.02%, and 1.45%, respectively, and of referable maculopathy (Grade M2) was 19.95%, 31.42%, 15.92%, and 11.59%, respectively.In univariate analysis, older age, higher random blood glucose, and longer DM duration were associated with a higher risk of both DR and referable diabetic maculopathy. This association was maintained in multivariate analysis for the high random blood glucose level and the longer duration of DM (but not for the older age).ConclusionA significantly higher prevalence of DR, grades R4 and M2 was found in the hospital-recruited patients than in diabetics from the local communities.

Design and Baseline Data of the Diabetes Registration Study: Guangzhou Diabetic Eye Study

Purpose The incidence and risk factors for diabetic retinopathy (DR) in southern China remain unclear. This project aims to explore the onset and progression of DR and their determinants through a prospective cohort in South China. Methods The Guangzhou Diabetic Eye Study (GDES) recruited patients with type 2 diabetic registered in the community health centers in Guangzhou, China. Comprehensive examinations were performed including visual acuity, refraction, ocular biometry, fundus imaging, blood and urine tests. Results A total of 2305 eligible patients were included in the final analysis. In total, 14.58% of the participants had any DR and 4.25% had vision-threatening DR (VTDR), among which 76 (3.30%), 197 (8.55%), 45 (1.95%) and 17 (0.74%) were classified as mild NPDR, moderate NPDR, severe NPDR and PDR, respectively. There were 93 (4.03%) patients with diabetic macular edema (DME). The presence of any DR was independently associated with a longer duration of DM, higher degree of HbA1c, insulin treatment, higher average arterial pressure, higher concentration of serum creatinine, presence of urinary microalbumin, older age, and lower body mass index (BMI) (all p < 0.001). For VTDR, seven factors were significant: older age, a longer duration of DM, higher concentration of HbA1c, use of insulin, lower BMI, higher concentration of serum creatinine, and high albuminuria (all p < 0.05). These factors were also independently associated with DME (all p < 0.001). Conclusion The GDES is the first large-scale prospective cohort study of the diabetic population in southern China, which will help to identify novel imaging and genetic biomarkers for DR in this population.

“ SPIROMETRIC EVALUATION IN PATIENTS WITH CHRONIC TYPE 2 DIABETES MELLITUS ”

Background: Chronic hyperglycaemia causes many changes in the lungs such as thickened pulmonary capillary basal lamina and alveolar epithelium causing decreased pulmonary elastic recoil and lung volumes. Aim: of the current study is to know the evidence based signicance of spirometry on type 2 diabetes mellitus. Methods: This was a cross sectional observational study with 90 Type 2DM patients were selected of age more than 35 years and with duration of diabetes &gt; 5 years. spirometry was done for: FVC, FEV1, FEV1/ FVC. Results: Recorded FVC in Type 2 DM is decreased when compared to the predicted values.Recorded FVC of diabetic patients have a mean of 2.14 ± 0.67 with a range of 1.13 – 4.17 compared to predicted values with mean of 2.54 ± 0.63 with a range of 1.72 – 4.03. Recorded FEV1 in Type 2 DM is decreased when compared to the predicted values. Recorded FEV1 of diabetic patients have a mean of 1.93± 0.63 with a range of 0.95 – 3.33 compared to predicted values with mean of 2.10 ± 0.49 with a range of 1.42 – 3.36. 53.3% of the diabetics had mild restriction of pulmonary functions 14.4% of the diabetics had moderate restriction of pulmonary functions. Conclusion: DIABETES MELLITUS causes decrement in the lung functions in the form of Restriction which is more seen in patients with longer duration of DM &amp; patients with uncontrolled glycemic status.

The relationship between vascular endothelial growth factor-A serum level and the severity of diabetic peripheral neuropathy

Background and aimsDiabetic peripheral neuropathy (DPN) is a common microvascular complication in type 2 diabetes mellitus (T2DM). The nerve fibers injury is caused by the interaction between metabolic and vascular factors. Vascular endothelial growth factor (VEGF) is an essential growth factor for vascular endothelial cells. We aimed to investigate the relation between VEGF-A serum level and the degree of DPN.ResultsThis cross-sectional study was conducted on 81 patients with T2DM. Based on the combined clinical and electrophysiological assessment, 67 patients (82.7%) were diagnosed with peripheral neuropathy of which 32 patients (39.5%) had subclinical neuropathy, whereas 35 patients (43.2%) were confirmed cases of DPN. Patients with DPN had longer duration of DM and higher values of glycosylated hemoglobin (HbA1c). Although the mean serum VEGF-A level in diabetic patients without neuropathy was higher than that in diabetic patients with DPN, this difference did not reach statistical significance (P = 0.07). However, patients with subclinical DPN had significantly higher serum VEGF-A level compared to patients with confirmed DPN (P < 0.001).ConclusionDPN was found to be a common finding in the studied sample of T2DM patients. Longer duration of DM and poor glycemic control may be risk factors for development of severe DPN. Low VEGF-A serum levels may lead to more severe DPN in patients with T2DM.

Orthostatic Hypotension and its Relationship with HbA1c Levels in Patients with Diabetes Mellitus

Introduction: For the diagnosis of diabetes mellitus, various tests are available such as FBS (Fasting blood sugar), PPBS ( Post Prandial Blood Sugar), Oral Glucose Tolerance Test, Random Plasma Glucose Test, HBA1c, etc, of which HBA1c is considered to be the most standard test. As diabetes mellitus can be asymptomatic initially, it can lead to important complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, etc if not detected early. Postural blood pressure measurement which diagnoses orthostatic hypotension is a cheap, easy and useful tool to predict HBA1c level even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 100 diabetic patients attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including blood pressure measured with a standard Sphygmomanometer at the end of 3 min after standing and HBA1c as mentioned in the proforma was carried out. Final analysis has been done with the help of Open EPI and SPSS software. Results: 33% of patients of our study population were found with abnormal orthostatic hypotension. Our data shows orthostatic hypotension is directly associated with high HbA1c,longer duration of DM, and higher value of BMI. No correlation was found between age and gender. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal orthostatic hypotension, which can be alarming sign of complications of diabetes mellitus.

Impact of Diabetes Duration on Clinical Outcome in Patients Receiving Rotational Atherectomy in Calcified Lesions in Korea-Results from ROCK Registry.

There are limited data regarding the clinical impact of diabetes duration for patients with heavy calcified coronary lesions. We sought to determine the clinical impact of diabetes duration on clinical outcomes in patients with heavily calcified lesions who required rotational atherectomy during percutaneous coronary intervention (PCI). A total of 540 diabetic patients (583 lesions) were enrolled between January 2010 and October 2019. Patients were classified into three subgroups: patients with no diabetes mellitus (non-DM), shorter duration (S-DM), and longer duration (L-DM), of which duration was divided at 10 years. During 18 months of follow-up-duration, diabetes duration was significantly associated with the primary outcome. The incidence rate of target-vessel failure (TVF), the primary outcome, was significantly higher in the L-DM group compared with non-DM or S-DM. Among secondary outcomes, any repeat revascularization (RR) was frequently observed in the L-DM compared with other groups. In multivariate analysis, the risk of TVF and any RR was 1.9 times and 2.4 times higher in L-DM than in non-DM, respectively. This study firstly demonstrated that there is an association between a longer DM duration and poor clinical outcomes in patients with severe calcified CAD after PCI. More careful monitoring for recurrence is needed during follow-up in those patients.

A Prospective Cohort Study on Diabetic Foot Infections with Emphasis on Identifiable Risk Factors in Patients Attending Tertiary Care Centre

Background: Foot infections are one of the most commonly observed complications in diabetic patients and are associated with high morbidity and risk of lower extremity amputation. Foot infections account for about 20% of all hospitalizations in people with diabetes and at least 50% of all non-traumatic lower-limb amputations performed annually.&#x0D; Objective: To identify the risk factors in patients with diabetic foot infections attending tertiary care centre.&#x0D; Method: It is a longitudinal prospective study in which patients attending the tertiary care centre with diabetic foot infections meeting the inclusion criteria were enrolled after obtaining the informed consent form.&#x0D; Results and discussion: The results of this study revealed that the overall prevalence of DFI was seen more in males (61.42%) when compared to females (38.57%). The results also showed that the risk of DFI was more with trauma(44.28%) followed by the long duration of DM (28.57%) &gt; wound (15.71%) &gt; uncontrolled DM &amp; prior foot ulcer (5.7%) which indicates a lack of awareness, longer duration of DM, poor glycemic control were the main risk factors causing diabetic foot problems. Conclusion: The results suggest that lack of awareness, poor glycemic control, and long duration of diabetes were the main risk factors causing DFI. Therefore, efforts to prevent infections should be targeted at people with traumatic foot wounds especially those that are chronic and recurrent. Foot care education would be the foremost important way of dealing with this serious problem.&#x0D; Keywords: Morbidity, lower-extremity amputation, trauma, glycemic control.

IDF21-0568 Peripheral Neuropathy and potential risk factors in patients with Diabetes Mellitus in Kano, Northwestern Nigeria

Background: Peripheral Neuropathy is a common complication of DM and a cardinal event in the pathway to foot ulceration in many patients. It may be preventable if detected early and promptly managed. Aim: To determine the prevalence of peripheral neuropathy and its potential risk factors in patients with DM attending two hospitals in Kano, Nigeria. Method: In a cross – sectional descriptive study consenting patients with DM who fulfilled the inclusion criteria were recruited from the diabetes outpatient clinic and wards of two hospitals in Kano. Questionnaires were used to obtain Socio- demographic data and clinical characteristics of the study subjects. Vibration perception threshold using biothesiometer was used to assess for presence of peripheral neuropathy. Results: We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8±12.5years and 7.72±6.65years respectively. Ninety five percent of the study subjects had type 2DM. 149(37.2%) of the study subjects had VPT > 25 volts which is significant for PN. Older age, level of education, longer duration of DM, HTN, PVD, proteinuria, diabetic retinopathy, presence of DFU and foot deformities were significant predictors of PN. The independent risk factors for PN after multivariate regression were older age, longer duration of DM, proteinuria, presence of foot deformities and DFU. Discussion: Peripheral neuropathy still remains one of the most complications of DM which leads to development of DFU and subsequently amputation. Screening with early identification, education and treatment of associated risk factors may go a long way in reducing one of the cardinal event to foot ulceration.

Evaluation of glycemic control and related factors among outpatients with type 2 diabetes at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study

BackgroundThe goals of glycemic management for patients with diabetes are to prevent or delay complications and optimize quality of life. However, in clinical practice, the recommended glycemic control target is difficult to achieve. Therefore, it is important to identify factors that influence the outcomes of glycemia to improve the quality of diabetic management.The study aimed to evaluate the level and factors associated with glycemic control among type 2 diabetic outpatients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.MethodsA hospital-based cross-sectional study was conducted among systematically selected 325 patients with type 2 diabetes who attended diabetic clinics at Tikur Anbessa Specialized Hospital. Pretested, structured, and interviewer-administered questionnaires were used to collect sociodemographic and diabetes-related information from March 1 to May 30, 2021. HbA1c was used to assess glycemic control according to the HbA1c target of < 7% (‘good’ control) as recommended by the American Diabetes Association for non-pregnant adults. The HbA1c level in the range of 7–8% was defined as ‘inadequate’ control and ‘poor’ at levels > 8%. Data entry and analysis were performed using SPSS v26. Multivariate logistic regression analysis was used to identify determinants of glycemic control.ResultsThe median level of HbA1c of the participants was 8.4% (IQR 6.8–10.1). And approximately three-quarters (73.8%) of the patients had inadequate and poor glycemic control (HbA1c ≥ 7%). Older age (AOR: 2.46, 95% CI: 1.28–6.01), DM duration of > 10 years (AOR: 3.15, 95% CI: 2.22–6.54), insulin therapy (AOR: 3.07, 95% CI: 2.10–6.12), poor diet compliance (AOR: 1.97, 95% CI: 1.28–3.52) and failure to set goals for glycemic control (AOR: 3.42, 95% CI: 2.17–5.97) were factors associated with inadequate and poor glycemic control.ConclusionsThe study revealed that a significant number of diabetic patients had inadequate and poor glycemic control levels. And this was associated with older age, longer duration of DM, insulin therapy, poor diet compliance, and failure to set control goals. This requires a focus on the associated factors identified and tailored management mechanisms to maintain good glycemic control.

Abstract P155: Differential Incidence Trends In Non-traumatic Lower Limb Amputations In The Province Of Quebec, Canada: Does The Reduction Applies Equally In Both Sexes?

Introduction: Non-traumatic lower limb amputations (LLA) represent an important complication of diabetes (DM) and peripheral arterial disease (PAD). In Quebec, Canada, the latest data between 1996 to 2004 suggested a reduction in the incidence of LLA while other Canadian provinces observed a recent increase between 2010 and 2016. Our objective was to update the incidence trends of LLA in Quebec from fiscal years 2006 to 2019. Methods: Age-standardized incidence of LLA among individuals ≥40 years was assessed using the Quebec Integrated Chronic Disease Surveillance System (n=4,527,533 in 2019). The mean age of incident cases and the presence / duration of DM and/or PAD was collected. Estimations were presented for all, by sexes and by types of LLA (minor: below the knee; major: knee and above), with 99% confidence intervals (CI). Results: Between 2006 and 2019, incident cases of LLA increased from 818 to 1,099 but age-standardized incidence remained stable (Figure 1) for both sexes. Men had a higher age-standardized incidence of LLA then women (32.7 per 100,000 [99% CI: 29.7-35.9] vs 12.9 per 100,000 [11.2-14.9] in 2019). From 2006 to 2019, the age-standardized incidence of major LLA showed a relative decrease of 48% while minor LLA remained stable (Figure 1). Reduction in age-standardized incidence of major LLA was attributable to men (3.8 per 100,000 [2.7-5.3] to 1.7 per 100,000 [1.1-2.6]). The mean age of incident cases went from 68.2 to 69.5 years from 2006 to 2019 (72.4 for women and 68.3 for men in 2019). Ninety-eight percent of LLA had DM, while 95% had PAD and 95% had both in 2019. Between 2006 and 2019, the average time between the first LLA and DM diagnosis increased from 7.0 to 14.7 years and from 2.0 to 2.6 years for PAD. Conclusions: Although the age-standardized incidence of LLA is stable, men remain at higher risk then women. The portrait of incident cases is changing towards an older average age, longer DM duration and a reduction of major LLA. These results emphasize the importance to improve further preventive care of LLA in Quebec.

Visual impairment and its predictors among people living with type 2 diabetes mellitus at Dessie town hospitals, Northeast Ethiopia: institution-based cross-sectional study

BackgroundVisual impairment is a functional limitation of the eye(s) that results in reduced visual acuity, visual field loss, visual distortion, perceptual difficulties, or any combination of the above. Type 2 diabetes mellitus is one of the common causes of visual impairment. Since there is no study conducted in Ethiopia so far in this regard, the current study aimed to determine the prevalence and predictors of visual impairment among people living with diabetes at Dessie town Hospitals, Northeast Ethiopia.MethodsInstitution based cross-sectional study was carried out from 15 February to 15 March 2020 using simple random sampling to recruit study participants among type 2 diabetes. Visual impairment was measured using visual acuity test. We used Epi Data 3.1 and SPSS version 22 for data entry and statistical analysis, respectively. Bi-variable binary logistic regression was performed to check independent association of each factor with visual impairment. After selecting candidate variables at p < 0.25, we computed multivariable binary logistic regression to identify statistically associated factors of visual impairment. The degree of association was determined using adjusted odds ratio with 95%CI. In the final model, statistical significance was declared at p < 0.05.ResultsThree hundred and twenty-two people living with T2DM participated in this study with 97% response rate. The prevalence of visual impairment was 37.58% (95% CI: 32.3, 42.9). Age (AOR: 1.06, 95% CI: 1.02, 1.09, p < or = 0.001), poor regular exercise (AOR = 2.91, 95%CI: 1.47–5.76, p < or = 0.001), duration of DM above 5 years (AOR = 2.42, 95% CI: 1.25–4.73, p < or = 0.01), insulin treatment (AOR = 14.05, 95% CI: 2.72, 72.35, p < or = 0.01), and poor glycemic control (AOR = 2.17, 95% CI: 1.13–4.14, p < 0.05) were statistically associated with visual impairment.ConclusionThe prevalence of visual impairment in Dessie town hospitals accounted for more than a third of patients living with T2DM. Visual impairment is associated with increased age, poor regular exercise, longer duration of DM, and insulin treatment. Thus, early detection of VI through screening and regular follow-up is recommended to reduce the risk of VI and vision loss.

A multivariate analysis approach on identifying of influencing factors and the chance of development of diabetic eye disease among diabetes in a diabetic Centre of Southwestern Malabar region of India

Background: Diabetic Retinopathy is a non-communicable disease and metabolic disorder. It is a public health problem in Worldwide. In this paper, finding influencing factors and how much probability to development of DR among known T2DM patients. Materials and Methods: This was a hospital-based cross-sectional and observational study among T2DM patients, with and without DR in the diabetes clinic with sample of 150 patients. Statistical analysis used chi-square and binary logistic regression analysis was used to identify correlates of DR after controlling of confounders. Results: In this present study, among 150 patients, 39 (26%) patients had DR. Smoking habit was strongly associated with development of DR (AOR=15.39, p=0.002), patients had history of hypertension was associated with DR (AOR=1.10, p=0.016), medication, in that insulin users were strongly associated with DR (AOR=5.72, p=0.002), duration of diabetes mellitus with &gt;10 years was associated with DR (AOR=1.18, p=0.001), total cholesterol with abnormal was 5-fold more increase in risk with the development of DR (AOR=5.86, p=0.065) but not significant, high hba1c with &gt;6.5% was associated with the progression of DR (AOR=1.34, p=0.035), and fasting blood sugar with abnormal was associated with the progression of DR (AOR=1.01, p=0.027) except age but, showed positive association with DR. Probability of developing DR in a T2DM patient was 98%. Conclusion: From this study, we revealed that influencing variables were hba1c, smoking habit, intake of tablet/insulin, duration of DM, history of hypertension and fasting blood sugar. The chance/probability of developing retinopathy was very high among known diabetes patients those who had longer duration of DM. Hence, we have recommended a periodic eye screening is mandatory in T2DM patients. Keywords: diabetes mellitus, diabetic retinopathy, influencing factors, probability, multivariate analysis