Macroangiopathic Complications Research Articles

Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases

Abstract Introduction: Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes. Methods: We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: ‘insulinoma’, ‘diabetes’, ‘nesidioblastosis’, ‘endogenous hyperinsulinism’, ‘hypoglycaemia’, and ‘hyperglycaemia’ (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods. Results: Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17–96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%–8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma (P = 0.007), micro-angiopathic (P = 0.018) and macro-angiopathic complications (P = 0.039), and other co-morbidities (P = 0.009) were associated with unfavourable prognosis, while being overweight and obese (P = 0.020) at presentation was associated with favourable prognosis. Conclusion: This first systematic review provides insights into the uniqueness of insulinoma in diabetes.

Pituitary Incidentaloma Complicated by Pan Hypopituitarism at the Health Reference Centre of Commune III of the District of Bamako: Case Report

A frequent mode of discovery since the improvement of imaging techniques is the pituitary incidentaloma, defined as the discovery of a pituitary adenoma without clinical signs on a scanner or magnetic resonance imaging (MRI) performed for another reason. We report a case of pituitary macroadenoma complicated by panhypopituitarism, discovered incidentally as part of the macroangiopathic complications of type 2 diabetes at the reference health centre in commune III of the Bamako district. It has poor semiological characteristics but poses a diagnostic problem. In our case, the patient presented with physical asthenia and headaches. On biology, the patient presented with 5 lines of anteropituitary insufficiency. A scan revealed a pituitary adenoma measuring 27x22. Anatomopathological examination of the surgical specimen concluded that it was a pituitary adenoma. The patient received hydrocortisone and thyroid hormones prior to excision. This case highlights the delay in the diagnosis and management of pituitary adenomas.

Endothelial Dysfunction in Type 2 Diabetes Patients and its Association with Microvascular Complications: A Cross-sectional Study

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing worldwide. Microangiopathic and macroangiopathic complications are the main causes of morbidity and mortality in diabetes. Endothelial dysfunction is important in the early pathophysiology of vascular complications. Screening is very important in order to prevent these complications. Aim: To investigate endothelial dysfunction, as measured by Flow Mediated Vasodilation (FMD) of the brachial artery, in diabetic individuals. It also aims to explore the correlation between FMD and Glycated Haemoglobin (HbA1c), as well as the association between FMD and microvascular complications such as diabetic neuropathy, diabetic retinopathy, and albuminuria. Materials and Methods: This cross-sectional study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, between 2020 and 2021 on 160 patients. All patients diagnosed with T2DM, attending the Outpatient Department (OPD) or admitted to the ward, were enrolled in the study using consecutive sampling. FMD was measured for each patient, and Urine Albumin Creatinine Ratio (UACR) was also assessed. Diabetic retinopathy was evaluated through fundus examination, and diabetic neuropathy was screened using the monofilament test. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0 to determine the correlation between FMD and these variables. Results: A total of 160 patients were enrolled in this study, including 104 (65%) males and 56 (35%) females. The median age was 52 years, and the participants had a median Body Mass Index (BMI) of 29.5 kg/m2 . The median HbA1c was 8.7%. The median Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS) levels were 145 mg/dL and 242 mg/dL, respectively. The median FMD among all patients was 5.6%, with an Interquartile Range (IQR) of 4.9% to 6.6%. There was an inverse correlation between HbA1C and FMD values, with a correlation coefficient of -0.718 (p-value <0.01), indicating a strong and significant inverse correlation. Patients with significant macroalbuminuria had a lower median FMD compared to non albuminuric patients, and this difference was statistically significant. The median FMD was also lower in patients with diabetic neuropathy and retinopathy. Conclusion: The study findings suggest that endothelial dysfunction, as measured by FMD, is significantly impaired in patients with elevated HbA1c and microvascular complications of diabetes mellitus.

Macroangiopathic Complications and Associated Factors in Type 2 Diabetics at CNHU-HKM

Macroangiopathic Complications and Associated Factors in Type 2 Diabetics at CNHU-HKM

Clinical validation of electrochemical biosensor for the detection of methylglyoxal in subjects with type-2 diabetes mellitus

Methylglyoxal (MG), a highly reactive by-product of glycolysis, is involved in the formation of advanced glycation end-products (AGEs). Elevated levels of MG have been correlated with micro-and macro-angiopathic complications in diabetes, including neuropathy, kidney disease, retinopathy, and cardiovascular disease. Therefore, point-of-care devices for detecting MG may be of great use in the screening of diabetes complications. This study was designed to determine the utility of the developed electrochemical biosensor to measure the level of MG in human plasma from type-2 diabetes mellitus patients. Electrochemical studies were carried out with optimized experimental parameters using the modified Platinum-electrode. Subsequently, clinical studies using 350 blood plasma samples were conducted and the results were validated against the ELISA kit, Normal Glucose Tolerance (NGT), and glycosylated haemoglobin (HbA1c). The MG sensor exhibited a linear range of 1.0–7.5 μM concentration with a sensitivity of 1.02 mA µM−1, a limit of detection of 0.21 µM, a limit of quantification of 0.70 µM and a response time less than 10 s. The sensor showed 90% correlation with ELISA data. The developed biosensor showed a significant correlation with HbA1c and fasting plasma glucose suggesting that it can be used as a point-of-care device to screen for diabetes.

Complementary Gene Therapy after Revascularization with the Saphenous Vein in Diabetic Foot Syndrome.

Diabetic foot syndrome (DFS) is one of the most serious macroangiopathic complications of diabetes. The primary treatment option is revascularization, but complementary therapies are still being sought. The study group consisted of 18 patients diagnosed with ischemic ulcerative and necrotic lesions in DFS. Patients underwent revascularization procedures and, due to unsatisfactory healing of the lesions, were randomly allocated to two groups: a group in which bicistronic VEGF165/HGF plasmid was administered and a control group in which saline placebo was administered. Before gene therapy administration and after 7, 30, 90, and 180 days, color duplex ultrasonography (CDU) was performed, the ankle-brachial index (ABI) and transcutaneous oxygen pressure (TcPO2) were measured, and DFS changes were described and documented photographically. In the gene therapy group, four out of eight patients (50%) healed their DFS lesions before 12 weeks. During this time, the ABI increased by an average of 0.25 and TcPO2 by 30.4 mmHg. In the control group, healing of the lesions by week 12 occurred in six out of nine patients (66.67%), and the ABI increased by an average of 0.14 and TcPO2 by 27.1 mmHg. One major amputation occurred in each group. Gene therapy may be an attractive option for complementary treatment in DFS.

Cardiovascular profile of patients with type 2 Diabetes

The diabetic patient is a subject at high cardiovascular risk. Accurate determination of cardiovascular risk requires reliable tools to implement preventive measures. Can risk equations, and in particular the SCORE (Systematic Coronary Risk Evaluation) equation, still be of interest in assessing the risk of the type 2 diabetic patient in the face of new methods such as the coronary calcium score? The objective of the work is to determine the cardiovascular profile of type 2 diabetic patients through Score. Material and methods: Observational and descriptive study involving 176 type 2 diabetic patients conducted during the month of April 2021. All of them benefited from a clinical examination, a metabolic, degenerative and cardiovascular risk calculation according to the Score. Results: The average age is 58.7 years with extremes of 28 to 85 years. A female predominance was noted (74.4%) with a sex ratio of 0.3. The average duration of diabetes evolution is 8.84 years with extremes ranging from 1 month to 44 years. 57.1% of patients were on oral treatment, versus 36.3% on insulin and 6.5% on diabetic diet only. Glycemic imbalance exists in more than 62% (estimated by HbA1c). The other associated risk factors found are: hypertension (56%), obesity and overweight (82.1%), smoking (12%) and sedentary lifestyle (60.7%), dyslipidemia was found in 66 patients (56.5%); 89.6% of women were menopausal. Microangiopathic complications are noted in 60.7% of cases: nephropathy (38.2%), retinopathy (33.3%), neuropathy (59.8%). Macroangiopathic complications affect 23.2%. In our population, 67.3% have a very high cardiovascular risk (> 10%) according to the SCORE. Conclusion: Type 2 diabetic patients are already at high cardiovascular risk. The seriousness of cardiovascular complications in diabetic patients reflects the importance of assessing their cardiovascular risk and of comprehensive management integrating the various risk factors. The Score remains an important and simple tool for estimating cardiovascular risk in patients with type 2 diabetes.

Mental disorders and diabetes mellitus (Update 2023)

Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is atwofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with ahigher incidence of diabetes are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is achallenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.

PSUN144 Impact of the COVID-19 Pandemic on the Follow-up and Treatment of Patients with Diabetes

Abstract Introduction During the coronavirus disease (COVID-19) pandemic a state of emergency was declared where people were instructed to stay at home to prevent disease transmission, which exerted severe disruptions in the routine care of patients. The aim of this study was to evaluate the impact of the COVID-19 pandemic in the treatment and follow-up of patients with diabetes. Methodology We conducted an observational, descriptive, cross-sectional study in 39 diabetic patients followed by the Endocrinology department at the Hospital de Clínicas during July-September 2021. We compared anthropometric data, blood pressure (BP), HbA1C, lipid profile, changes in eating habits, physical activity, medication access and number of medical care visits before and during the pandemic. Results Mean age was 61.3 ± 13 years, mostly females (56.4%). Type 2 was the most common diabetes form (82.1%). Mean diabetes duration was 12.5 years (range: 5-20). Eighty-four percent had microangiopathic complications; the most frequent was diabetic retinopathy (61.5%). Forty-eight percent had macroangiopathic complications. Most frequent comorbidities were high blood pressure (82.1%) and dyslipidemia (69.2%). Twenty eight percent reported smoking. Eighteen percent had changes in medication access during the pandemic, the main reason was the lack of a medical prescription (12.8%), followed by drug unavailability (10.2%). Thirty-three percent reported changes in eating habits, 30% increased the amount of food consumption, 61.5% decreased fruits and vegetables intake, and 2% increased alcohol drinking. There was a significant decrease in physical exercise (43.6%), medical appointments (4.4 vs. 2.9, p=0.006) and LDL (142±63,6 vs.136,7±96,9, p=0.01) during the pandemic. Forty-one percent and 23% lacked hbA1C testing before and during the pandemic, respectively. Most patients presented with hbA1C values more than 7% before and after the pandemic (65.2% and 70%, respectively). There was a non-significant increase in BMI (31,6±6,3 vs. 32,4±11,7, p=0,668), blood pressure (systolic BP: 132,5±20,2 vs. 136,7±23,5, p=0,32; diastolic BP: 76,7±13,3 vs. 80,5±14,3, p=0,089) and HbA1c (8,1±1,6 vs. 8,2±1,8, p=0,662). Conclusion We found a high percentage of micro and microangiopathic complications in diabetic patients. In addition, many patients had poor metabolic control without HbA1c monitoring. Given the increased risks of COVID-19 complications and death amid patients with uncontrolled diabetes changes in metabolic control may be of great significance. We found a decrease in medical visits, dietary changes, disruption in medication access and a decrease in physical activities during the pandemic. More studies are warranted to understand the indirect effects of the pandemic in patients with diabetes and its long-term effects on micro- and macroangiopathic complications and mortality. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Spatial Reorganization of Liquid Crystalline Domains of Red Blood Cells in Type 2 Diabetic Patients with Peripheral Artery Disease.

In this work, we will investigate if red blood cell (RBC) membrane fluidity, influenced by several hyperglycemia-induced pathways, could provide a complementary index of HbA1c to monitor the development of type 2 diabetes mellitus (T2DM)-related macroangiopathic complications such as Peripheral Artery Disease (PAD). The contextual liquid crystalline (LC) domain spatial organization in the membrane was analysed to investigate the phase dynamics of the transition. Twenty-seven patients with long-duration T2DM were recruited and classified in DM, including 12 non-PAD patients, and DM + PAD, including 15 patients in any stage of PAD. Mean values of RBC generalized polarization (GP), representative of membrane fluidity, together with spatial organization of LC domains were compared between the two groups; p-values < 0.05 were considered statistically significant. Although comparable for anthropometric characteristics, duration of diabetes, and HbA1c, RBC membranes of PAD patients were found to be significantly more fluid (GP: 0.501 ± 0.026) than non-PAD patients (GP: 0.519 ± 0.007). These alterations were shown to be triggered by changes in both LC microdomain composition and distribution. We found a decrease in Feret diameter from 0.245 ± 0.281 μm in DM to 0.183 ± 0.124 μm in DM + PAD, and an increase in circularity. Altered RBC membrane fluidity is correlated to a spatial reconfiguration of LC domains, which, by possibly altering metabolic function, are associated with the development of T2DM-related macroangiopathic complications.

Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville.

Erectile dysfunction (ED) is very common in diabetic males, especially type 2 diabetes mellitus (T2DM). Many factors and complications of diabetes such as macro- and micro-angiopathy are associated with risks leading to ED in male patients. Analysis of factors associated with ED in T2DM. The purpose of this study is to shed light on potential associations between ED, type 2 diabetes, and some risks factors. This was a prospective analytic study of T2DM over 18. The study population consisted of diabetic patients seen at the endocrinology and urology departments of the University Hospital during the study period. Evaluation of ED was made by IIEF 5 score. A total of 333 patients were selected for the study. The mean age was 56.6 ± 9.8 and the prevalence of ED was 82.6% (n=275). In univariate analysis, several associated factors were identified such as micro-angiopathic type complications including diabetic retinopathy (OR 4.88 [2.31-10.33], P < .001), diabetic nephropathy (OR 12.67 [1.71-93.66], P=.002) and macro-angiopathic type including arterial hypertension (OR 3.12 [1.69-5.75], P < .001). In multivariate analysis, duration of diabetes, micro and macroangiopathic complications, and hyperuricemia were independent risk factors for the occurrence of ED (P < .05). The presence of certain complications of diabetes such as micro or macro angiopathy or hyperuricemia should lead to a search for a ED. The presence of these associated factors identified in type 2 diabetic patients should systematically prompt an ED diagnosis which is often moderate or severe. That diagnosis would help design a protocol for the management and improvement of the life quality of these patients. The strength of this work is that it was conducted in the biggest hospital in the country which gives us a good idea of the trend of this ailment in the country. But the limitation of the study is that it only included patients who visited the hospital. This is monocentric hospital study was also transversal which does allow to establish a causal link. ED has a significant prevalence in T2DM. Several associated factors identified in uni and multivariate analyses, including duration of diabetes, micro and macro angiopathic complications, and hyperuricemia, increase ED risk. Therefore, it is essential to investigate the existence of these factors to improve the management of ED, which may allow the patient to regain a better overall health status. SNN Milama, A Mougougou, S G Olagui, et al. Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville. Sex Med 2022;10:100564.

Macroangiopathy In Diabetic Patients. Role Of The Nurse In The Prevention Of Cardiovascular Complications

The subject of this paper concerns fundamental aspects of complications, management and education of the diabeticpatient, especially the patient with macroangiopathic complications .The increase in the prevalence of diabetes mellitus is now exponential and its impact on cardiovascular diseases isincreasingly evident.In fact, the patient with diabetes has a significantly increased risk of developing major cardiovascular events.This is due to the particular aggressiveness of atherosclerotic disease at the level of the vessels, favored by endothelialdysfunction linked to the hyperglycemic state.Diabetes is a chronic disease with very widespread diffusion all over the world, destined to increase in the near futurewith the progressive aging of the population and the increasing occurrence of risk conditions that precede its onset.We are in fact in the presence of a real pandemic confirmed by epidemiological data, which indicate that more than300 million people in the world are affected by diabetes.In Italy, the treatment for diabetes absorbs 6.65% of the overall health expenditure, with a cost per patient that is morethan double the national average.Given the significant burden diabetes places on public health, preventing and improving the care of people with diabetes should be a primary goal for most communities and health systems.The consequences for individuals are due to the complications that the person with diabetes can develop, in terms ofa reduction in both the expectation and the quality of life, with significant repercussions, including economic ones.The organizational quality and efficiency of diabetic care 4 are correlated with better disease control, with a betterprognosis of complications, leading to a lower diabetes-related mortality rate.Reducing morbidity and mortality and improving the quality of life of people with diabetes mellitus represent oneof the current challenges for healthcare professionals, healthcare organizations and medical staff working in publichealthcare facilities.The selection and subsequent implementation of therapeutic education interventions, whose efficacy and congruencewith needs have been demonstrated, are essential steps towards improving the conditions of people with diabetes.Diabetes is a chronic disease and as such requires responsible management by those affected. Often people withdiabetes forget to live with a silent disease which, in addition to acute complications, also manifests long-term complications which can become fatal.A structured intervention is therefore necessary that increases the motivation and adherence of patients to the therapeutic plan, thus leading to a good metabolic control, to an acquisition of knowledge that allows them an adequatemanagement of the disease and a consequent better quality of life.The aim of this thesis is to research the results of lifestyle modification among the most important scientific evidence,taking into consideration aspects such as: metabolic control, acquired knowledge, self-management, self-efficacy,quality of life and satisfaction of the subjects.The research was carried out by consulting international databases such as “ Pubmed ” and “ google scholar “.The articles report that education for lifestyle change increases knowledge of one’s illness, self-management skillsand thus 2 an improvement in the quality of life.As a result, there will be a reduction in the incidence of diabetes and an improvement in numerous cardiovascularfactors. Furthermore, the nurse plays a role of fundamental importance both at the educational level through specificstructured interventions, and at the psychological level.

Macroangiopathy In Diabetic Patients. Role Of The Nurse In The Prevention Of Cardiovascular Complications

The subject of this paper concerns fundamental aspects of complications, management and education of the diabetic patient, especially the patient with macroangiopathic complications . The increase in the prevalence of diabetes mellitus is now exponential and its impact on cardiovascular diseases is increasingly evident. In fact, the patient with diabetes has a significantly increased risk of developing major cardiovascular events. This is due to the particular aggressiveness of atherosclerotic disease at the level of the vessels, favored by endothelial dysfunction linked to the hyperglycemic state. Diabetes is a chronic disease with very widespread diffusion all over the world, destined to increase in the near future with the progressive aging of the population and the increasing occurrence of risk conditions that precede its onset. We are in fact in the presence of a real pandemic confirmed by epidemiological data, which indicate that more than 300 million people in the world are affected by diabetes. In Italy, the treatment for diabetes absorbs 6.65% of the overall health expenditure, with a cost per patient that is more than double the national average. Given the significant burden diabetes places on public health, preventing and improving the care of people with diabetes should be a primary goal for most communities and health systems. The consequences for individuals are due to the complications that the person with diabetes can develop, in terms of a reduction in both the expectation and the quality of life, with significant repercussions, including economic ones. The organizational quality and efficiency of diabetic care 4 are correlated with better disease control, with a better prognosis of complications, leading to a lower diabetes-related mortality rate. Reducing morbidity and mortality and improving the quality of life of people with diabetes mellitus represent one of the current challenges for healthcare professionals, healthcare organizations and medical staff working in public healthcare facilities. The selection and subsequent implementation of therapeutic education interventions, whose efficacy and congruence with needs have been demonstrated, are essential steps towards improving the conditions of people with diabetes. Diabetes is a chronic disease and as such requires responsible management by those affected. Often people with diabetes forget to live with a silent disease which, in addition to acute complications, also manifests long-term complications which can become fatal. A structured intervention is therefore necessary that increases the motivation and adherence of patients to the therapeutic plan, thus leading to a good metabolic control, to an acquisition of knowledge that allows them an adequate management of the disease and a consequent better quality of life. The aim of this thesis is to research the results of lifestyle modification among the most important scientific evidence, taking into consideration aspects such as: metabolic control, acquired knowledge, self-management, self-efficacy, quality of life and satisfaction of the subjects. The research was carried out by consulting international databases such as “ Pubmed ” and “ google scholar ". The articles report that education for lifestyle change increases knowledge of one's illness, self-management skills and thus 2 an improvement in the quality of life. As a result, there will be a reduction in the incidence of diabetes and an improvement in numerous cardiovascular factors. Furthermore, the nurse plays a role of fundamental importance both at the educational level through specific structured interventions, and at the psychological level.

Macroangiopathy In Diabetic Patients. Role Of The Nurse In The Prevention Of Cardiovascular Complications

The subject of this paper concerns fundamental aspects of complications, management and education of the diabetic patient, especially the patient with macroangiopathic complications . The increase in the prevalence of diabetes mellitus is now exponential and its impact on cardiovascular diseases is increasingly evident. In fact, the patient with diabetes has a significantly increased risk of developing major cardiovascular events. This is due to the particular aggressiveness of atherosclerotic disease at the level of the vessels, favored by endothelial dysfunction linked to the hyperglycemic state. Diabetes is a chronic disease with very widespread diffusion all over the world, destined to increase in the near future with the progressive aging of the population and the increasing occurrence of risk conditions that precede its onset. We are in fact in the presence of a real pandemic confirmed by epidemiological data, which indicate that more than 300 million people in the world are affected by diabetes. In Italy, the treatment for diabetes absorbs 6.65% of the overall health expenditure, with a cost per patient that is more than double the national average. Given the significant burden diabetes places on public health, preventing and improving the care of people with diabetes should be a primary goal for most communities and health systems. The consequences for individuals are due to the complications that the person with diabetes can develop, in terms of a reduction in both the expectation and the quality of life, with significant repercussions, including economic ones. The organizational quality and efficiency of diabetic care 4 are correlated with better disease control, with a better prognosis of complications, leading to a lower diabetes-related mortality rate. Reducing morbidity and mortality and improving the quality of life of people with diabetes mellitus represent one of the current challenges for healthcare professionals, healthcare organizations and medical staff working in public healthcare facilities. The selection and subsequent implementation of therapeutic education interventions, whose efficacy and congruence with needs have been demonstrated, are essential steps towards improving the conditions of people with diabetes. Diabetes is a chronic disease and as such requires responsible management by those affected. Often people with diabetes forget to live with a silent disease which, in addition to acute complications, also manifests long-term complications which can become fatal. A structured intervention is therefore necessary that increases the motivation and adherence of patients to the therapeutic plan, thus leading to a good metabolic control, to an acquisition of knowledge that allows them an adequate management of the disease and a consequent better quality of life. The aim of this thesis is to research the results of lifestyle modification among the most important scientific evidence, taking into consideration aspects such as: metabolic control, acquired knowledge, self-management, self-efficacy, quality of life and satisfaction of the subjects. The research was carried out by consulting international databases such as “ Pubmed ” and “ google scholar ". The articles report that education for lifestyle change increases knowledge of one's illness, self-management skills and thus 2 an improvement in the quality of life. As a result, there will be a reduction in the incidence of diabetes and an improvement in numerous cardiovascular factors. Furthermore, the nurse plays a role of fundamental importance both at the educational level through specific structured interventions, and at the psychological level.

Macroangiopathy In Diabetic Patients. Role Of The Nurse In The Prevention Of Cardiovascular Complications

The subject of this paper concerns fundamental aspects of complications, management and education of the diabetic patient, especially the patient with macroangiopathic complications . The increase in the prevalence of diabetes mellitus is now exponential and its impact on cardiovascular diseases is increasingly evident. In fact, the patient with diabetes has a significantly increased risk of developing major cardiovascular events. This is due to the particular aggressiveness of atherosclerotic disease at the level of the vessels, favored by endothelial dysfunction linked to the hyperglycemic state. Diabetes is a chronic disease with very widespread diffusion all over the world, destined to increase in the near future with the progressive aging of the population and the increasing occurrence of risk conditions that precede its onset. We are in fact in the presence of a real pandemic confirmed by epidemiological data, which indicate that more than 300 million people in the world are affected by diabetes. In Italy, the treatment for diabetes absorbs 6.65% of the overall health expenditure, with a cost per patient that is more than double the national average. Given the significant burden diabetes places on public health, preventing and improving the care of people with diabetes should be a primary goal for most communities and health systems. The consequences for individuals are due to the complications that the person with diabetes can develop, in terms of a reduction in both the expectation and the quality of life, with significant repercussions, including economic ones. The organizational quality and efficiency of diabetic care 4 are correlated with better disease control, with a better prognosis of complications, leading to a lower diabetes-related mortality rate. Reducing morbidity and mortality and improving the quality of life of people with diabetes mellitus represent one of the current challenges for healthcare professionals, healthcare organizations and medical staff working in public healthcare facilities. The selection and subsequent implementation of therapeutic education interventions, whose efficacy and congruence with needs have been demonstrated, are essential steps towards improving the conditions of people with diabetes. Diabetes is a chronic disease and as such requires responsible management by those affected. Often people with diabetes forget to live with a silent disease which, in addition to acute complications, also manifests long-term complications which can become fatal. A structured intervention is therefore necessary that increases the motivation and adherence of patients to the therapeutic plan, thus leading to a good metabolic control, to an acquisition of knowledge that allows them an adequate management of the disease and a consequent better quality of life. The aim of this thesis is to research the results of lifestyle modification among the most important scientific evidence, taking into consideration aspects such as: metabolic control, acquired knowledge, self-management, self-efficacy, quality of life and satisfaction of the subjects. The research was carried out by consulting international databases such as “ Pubmed ” and “ google scholar ". The articles report that education for lifestyle change increases knowledge of one's illness, self-management skills and thus 2 an improvement in the quality of life. As a result, there will be a reduction in the incidence of diabetes and an improvement in numerous cardiovascular factors. Furthermore, the nurse plays a role of fundamental importance both at the educational level through specific structured interventions, and at the psychological level.

The particularities of microangiopathic and macroangiopathic complications in type 2 diabetes mellitus patients correlated with the presence or absence of type D personality

IntroductionAccording to our national data based on PREDATORR study, the point prevalence of diabetes mellitus in Romania was 11.6 % in adults between 20 and 79 years old. Unequivocally, type 2 diabetes mellitus is highly correlated with psychological and personality factors.ObjectivesThe objective of our research was to evaluate the frequency of type D personality in patients suffering from type 2 diabetes and its influence on angiopathic complications.MethodsA cross-sectional study was conducted in 173 patients with type 2 diabetes who were self-assessed by using Beck Depression Inventory I, STAI-Y scale and DS 14 scale for detection of type D personality.ResultsBoth depression (p = 0.012) and state and trait anxiety (p = 0.019 and 0.023 respectively) scores were significantly higher in diabetic patients with type D personality compared with non-type D diabetic patients. Lower limb complications were more frequent in non-type D personality diabetics (p = 0.018) while diabetic retinopathy and diabetic polyneuropathy (p = 0.004 and p = 0.010 respectively).ConclusionsThe presence of type D personality has a supplementary negative impact on type 2 diabetic patients’ affectivity and emotions. On the one hand, the more frequent microangiopathic complications in type D personality diabetic patients confirm that diabetes, at least in part, is an endovascular disease. On the other hand, some factors such as pro-inflammatory biomarkers may be more expressed in type 2 diabetic patients with concomitantly type D personality than those without this type of personality, leading to premature microangiopathic complications.

Role of fructosamine-3-kinase in protecting against the onset of microvascular and macrovascular complications in patients with T2DM

IntroductionMicroangiopathic and macroangiopathic complications are the main cause of morbidity and mortality in the diabetic population. Numerous publications have highlighted the role of glycation in the onset of complications of...

Type 2 diabetes therapy’s quality based on gender. Monographs of AMD Annals 2018

OBJECTIVE OF THE STUDY Evaluate the evolution of the therapy’s quality by gender in type 2 diabetes (DM2) in Italy, from 2011 to 2016, considering the new AMD Indicators in a gender perspective and the possible disparity in the drug treatment. DESIGN AND METHODS For the purpose of this analysis, data from the AMD Annals 2018 were used. They refer to patients with DM2, treated in 2016 in 222 diabetology services. This report is based on the analysis of the new 2015 AMD indicators (Audit 2, January 23rd, 2018). The characteristics of the study population and the analysis of the indicators are reported separately for men and women affected by DM2. RESULTS The data of 242,422 men and 184,696 women with DM2 were evaluated. The patients were treated by 222 diabetology services in 2016. The distribution by gender shows the prevalence of males and the one by age shows a general aging of the population and an increased survival, mainly in women (3.6% of men and 6.6% of women with DM2 have an age &gt;85 years). The average number of visits per treatment group was comparable between sexes. Compared to the 2011 evaluation, an improvement was achieved in all the process indicators in both genders, although still slightly better in males. In particular, the evaluation of metabolic control through the monitoring of glycated hemoglobin affects almost all male and female patients (96.9% vs 97%). The percentage of patients monitored for lipid profile, renal function, retinopathy and foot screening is lower. Some parameters were considered intermediate outcome indicators as they predict cardiovascular (CV) risk: the achievement of targets for the main CV risk factors is systematically unfavorable for women with DM2. In particular, women are more obese, have a worse diabetes compensation (especially a worse lipid profile) and a greater frequency of glomerularfiltrate reduction. The average levels of glycosylated hemoglobin were slightly higher in women than in men (7,3% ± 1,3 vs 7,2% ± 1,2), also the average levels of LDL cholesterol (100,2 mg/dl ± 33,4 vs 92,5 mg/dl ± 32,3) and average BMI levels (30,1 kg/m2 ± 6.1 vs 29,2 kg / m2 ± 4,9). In comparison with 2011 data, is noticeable a slight reduction in smokers among males and a slight increase among women (20,5% vs 21,5% in men, 12,2% vs 11,8% in women). Overall, the quality of the therapy (assessed with Q score) has improved over the years, in a similar way for both sexes. About half of the patients, in both sexes, have a Q score &gt;25, therefore adequate levels of therapy. The use of drugs for the control of glycaemia in both genders is similar also for innovative drugs. The use of statins is high in both sexes, slightly in favor of women. The intensity of the therapy for hypertension has improved in both sexes. Hence, the available data does not highlight a problem of under-treatment of women, despite their worst results. Gender data related to micro and macroangiopathic complications show differences in the two sexes, but the quality of the data recording on final outcomes, especially cardiovascular, is still modest. CONCLUSIONS Data analysis shows a significant improvement in the quality of specialistic health care, with greater attention in monitoring CV risk factors and complications, an increase in the percentage of subjects in target and a more intensive use of drugs in both sexes. However, some gaps are still present. The examined data confirm that the cardiovascular risk profile is decidedly unfavorable for women and that the main cardiovascular risk factors control, although improved over the years, remains sub-optimal in women and men. Greater efforts are needed to optimize CV risk factors management in both sexes and to reduce, or better eliminate, differences between genders. These data offer important insights for research, clinical practice and review of guidelines in a gender perspective, taking into account that various factors related to gender, such as genetic/biological aspects, lifestyle, adherence to therapies, psycho-social aspects, in addition to prescriptive differences, can affect the achievement of the various outcomes. KEYWORDS gender; DM2; AMD indicators.

Mental disorders and diabetes mellitus (Update 2019)

Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is atwofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with ahigher incidence of diabetes mellitus are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes mellitus has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is achallenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.

DIFFERENCES OF LIVER FUNCTION TESTS IN TYPE 2 DIABETES MELLITUS PATIENTS WITH AND WITHOUT CORONARY ARTERY DISEASE

One of the macroangiopathic complications of Diabetes Mellitus (DM) is Coronary Arterial Disease (CAD). Several studies showed that the liver was one of the organs involved in the pathological development of diabetes.The aim of this study was to find the differences of liver function in type 2 DM patients with CAD and without CAD. This was an analytical observational study with cross-sectional design. Forty-four type 2 DM patients with and without CAD at the Adam Malik Hospital Medan who came during June - August 2016 were studied for liver function (total bilirubin, direct bilirubin, AST and ALT). In this study, the average values of total bilirubin and direct bilirubin level in patients with CAD were found to be lower than without CAD. Statistically a significant difference revealed a total bilirubin (p &lt; 0.001) and direct bilirubin (p = 0.001) in type 2 DM patients with and without CAD. There was a significant difference in liver function tests in DM type 2 patients with, and without coronary arterial disease, these data suggested that total billirubin and direct billirubin levels in type 2 DM patients with CAD were found lower than those without CAD.