Longer Duration Of DM Research Articles

Thyroid abnormalities in Egyptian children and adolescents with type 1 diabetes mellitus: A single center study from Upper Egypt.

Background:The aim of this study was to detect the prevalence of thyroid abnormalities among children and adolescents with type 1 diabetes mellitus (T1DM) in Upper Egypt and its relationship with disease-related variables.Design:Cross-sectional controlled study.Patients and Methods:The study included 94 children and adolescents with T1DM (Group 1) attending for regular follow-up in the diabetes clinic of Assiut Children University Hospital, Assiut, Egypt were enrolled in the study and 60 healthy subjects matching in age and sex were taken as a control (Group 2). History taking, clinical examination, measurement of thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine, anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies levels as well as HbA1c were measuredResults:Mean TSH levels were significantly higher in (Group 1) when compared to control (P < 0.01). Six children (6.3%) were found to have subclinical hypothyroidism in Group 1 compared with two children (2.1%) in the control group (P < 0.001) two children (2.1%) were found to have clinical hypothyroidism in Group 1 compared with non in the control group. Positive levels of anti-TPOAb and anti-TgAb were found in 9 (9.5%) and 6 (6.3%) in Group 1 compared with 2 (3.3)% and 1 (1.6%) of controls respectively (P < 0.01). Cases with hypothyroidism were significantly older, had longer duration of DM, higher body mass index and higher HbA1c compared with those without hypothyroidism. TSH had significant positive correlations to age (r = 0.71, P < 0.001), diabetes duration (r = 0.770, P < 0.001), Anti-TPO level (r = 0.678, P < 0.01), HbAIc level (r = −0.644, P < 0.01) and significant negative correlation with FT4 (r = −0.576, P = 0.01).Conclusion:The present study reported high prevalence of thyroid abnormalities in children and in children and adolescents with type 1 diabetes in Upper Egypt. The study recommended yearly evaluation thyroid function tests and thyroid antibodies in all children and adolescents with type 1 diabetes commencing from the onset of diabetes.

Assessment of cardiac autonomic neuropathy in long standing type 2 diabetic women

Patients with long standing DM undergoing surgical interventions are put under great challenge as they may have cardiovascular and/or cardiac autonomic neuropathy (CAN). CAN is serious, often overlooked and under diagnosed, with possible arrhythmias and silent ischemia that threaten life. Assessment of CAN in long standing type 2 diabetic women undergoing major surgery. Cross sectional study. One hundred and six type 2 diabetic women scheduled for major surgery were assessed by the autonomic function tests. Only one hundred cases completed the study. CAN was assessed by analyzing HR variations during three standard tests (deep breathing, lying to standing and valsalva maneuver). Sympathetic functions were assessed by checking orthostatic hypotension. The CAN score of each patient was analyzed. Continuous 24 hour ECG monitoring (Holter) was done to evaluate ischemia, arrhythmia, QTc and QTd. Transthoracic Doppler echocardiography, stressing on LVH, diastolic and systolic dysfunctions were carried out. Cases were classified as mild (with only one abnormal test) or severe CAN when two or more abnormal function tests were present. Exclusion criteria include any systemic illness that can affect the study results or the autonomic functions, smoking and HTN. CAN was detected in 70% of the studied cases, and 70% were severe CAN. Postural hypotension was detected in 34% of the studied cases. QTc prolongation and QT dispersion were frequent. ECG and Doppler echocardiography changes of LVH were more prevalent among patients with CAN. Diabetics with CAN were significantly older had longer duration of DM and higher HbA1-c, higher pulse pressure, triglyceride, uric acid and urinary albumin excretion rate. They also had significant increased LVM index, diastolic dysfunction and myocardial ischemia. Middle aged women with long standing diabetes are vulnerable to CAN with postural hypotension and prolonged QTc intervals, QT dispersion, and increased LVMI and myocardial ischemia. Identification of CAN is crucial to exercise prevention against hazards of CV insults during stressful situation as surgery.

The worrisome liaison between left ventricular systolic dysfunction and mitral annulus calcification in type 2 diabetes without coronary artery disease: Data from the SHORTWAVE study

Background and AimMitral annulus calcification (MAC) is a marker for coronary artery disease (CAD) and predicts poor outcome in the general population. No data are available on MAC in patients with type 2 diabetes. In these patients we assessed prevalence of MAC and the relation between MAC and left ventricular (LV) systolic function. Methods and ResultsAs many as 386 patients with type 2 diabetes without CAD were studied with Doppler echocardiography. LV systolic dysfunction was defined by analyzing 120 healthy subjects. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (peak S′) were considered as indexes of LV circumferential and longitudinal shortening and classified low if <89% and <8.5 cm/s, respectively (10th percentiles of controls). Patients who had MAC (107 = 28%) were older with longer duration of DM and were receiving more anti-hypertension medications than those who had not. At echocardiographic evaluation patients with MAC showed higher LV mass, larger left atrial volume (LAV), reduced sc-MS (88.4 ± 14.9 vs 92.6 ± 14.3%; p = 0.01) and peak S′ (8.9 ± 2.2 vs 10.0 ± 2.0 cm/s; p < 0.001) than patients without MAC. Multiple logistic regression demonstrated older age (OR 1.03 [IC 1.01–1.06], p = 0.009), larger LAV (OR 1.19 [IC 1.11–1.28], p < 0.001) and combined reduction in sc-MS and peak S′ (OR 3.00 [IC 1.57–5.72], p = 0.001) as independent factors associated with MAC. ConclusionsMAC is detectable in one fourth of patients with type 2 diabetes without CAD and is mostly related to LV systolic dysfunction expressed as combined impairment of LV circumferential and longitudinal fibers, independent of age and LAV.

A pan‐European epidemiologic study of insulin injection technique in patients with diabetes

AbstractAim.A large pan‐European epidemiologic survey of insulin injection techniques was performed in order to determine the epidemiologic profile by centre, country and continent of major issues surrounding insulin injection.Methods.European insulin‐injecting, type 1 or 2 diabetes patients, using insulin for at least 6 months via an insulin pen or syringe; 22 sites in seven countries, 1002 patients in total, 51% female, 58% type 1.Results.Nearly 70% of patients inject using a pinch‐up and this practice is associated with improved HbA1c. Thirty per cent of patients reported having lipohypertrophy. Concurrent nurse evaluation found the prevalence to be 27%. Independent risk factors for lipohypertrophy were found to be failure by the patients to check injection sites regularly, failure to rotate sites and longer duration of DM. Less than 50% of patients reported that they were taught about lipohypertrophy. Needles were used 3.3 times on average in Europe, with wide variation by country. Male sex, type 1 diabetics, a high daily number of injections and the use of the 12.7 mm length needle were factors associated with high needle reuse. Needle reuse, even more than once, increased the risk of lipohypertrophy by 31%. Nearly half of patients dispose of their needles directly into the trash after protecting the needle (recapping or clipping). Alarmingly, 22% dispose directly into the trash without protection.Conclusion.There is a considerable way to go in ensuring optimal insulin injection practices. The issues raised by this study must be addressed by focused and intensive HCP efforts. Copyright © 2002 John Wiley &amp; Sons, Ltd.

Chronic Kidney Disease and Associated Risk Factors Assessment among Diabetes Mellitus Patients at A Tertiary Hospital, Northwest Ethiopia.

The prevalence of chronic kidney disease, particularly in diabetic patients, is increasing rapidly throughout the world. Nowadays, many individuals in developing nations are suffering from diabetes which is one of the primary risk factors of chronic kidney disease. Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 229 study participants were selected using systematic random sampling technique. Urine sample was collected for albumin determination by dipstick. The Simplified Modification of Diet in Renal Disease study equation was used to estimate glomerular filtration rate. Binary logistic regression model was used to identify risk factors. Of the total 229 study participants, 50.2% were females and the mean age was 47±15.7 years. Among study participants, the prevalence of chronic kidney disease (CKD) was found to be 21.8% (95% CI: 16% - 27%). Of all study participants, 9(3.9%) had renal impairment (eGFR < 60 ml/min/ 1.73 m2) and 46 (20.1%) had albuminuria. Older age (AOR: 5.239, 95% CI: 2.255-12.175), systolic blood pressure ≥140mmHg (AOR: 3.633, 95% CI: 1.597-8.265), type 2 diabetes mellitus (AOR: 3.751, 95% CI: 1.507-9.336) and longer duration of diabetes (AOR: 3.380, 95% CI: 1.393-8.197) were independent risk factors of CKD. The study identified high prevalence (21.8%) of CKD among diabetic adults. CKD was significantly associated with older age, systolic blood pressure, type 2 DM and longer duration of DM. Thus, DM patients should be diagnosed for chronic kidney disease and then managed accordingly.