non-DM Group Research Articles

Impact of diabetes mellitus on long term clinical outcome in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Background: Few data exist on the long-term clinical impact of diabetes mellitus (DM) in patients with acute myocardial infarction (AMI) undergoing successful percutaneous coronary intervention (PCI). Methods: We retrospectively analyzed a total of 4,754 acute myocardial infarction patients who successfully underwent PCI from January 2004 to December 2009 in COREA-AMI (COnvergent REgistry of cAtholic and chonnAm university for AMI) registry. We compared major adverse cardiac and cerebral events (MACCE) in AMI patients with diabetes mellitus with those without diabetes mellitus. Results: The median follow up period was 39 months (interquartile range 22.8 – 55.3 months). The cumulative rates of all-cause death, cardiac death, target lesion revasculariazion (TLR), and target vessel revascularization (TVR) were signficantly higher in the DM group. After adjusting with multivariable Cox regression analysis, DM group showed worse clinical outcomes than the non-DM group in terms of death (adjusted hazard ration (HR) 1.232, 95% confidence interval (CI) 1.072-1.415 and p=0.003) and a composite of MACCE (adjusted hazard ration (HR) 1.231, 95% confidence interval (CI) 1.101-1.376 and p<0.001). MACCE in patients with and without DM Conclusions: DM is an independent risk factor for higher long-term MACCE in patients with AMI.

Association of Diabetes Mellitus With the Risk of Developing Adhesive Capsulitis of the Shoulder: A Longitudinal Population‐Based Followup Study

Although it has been suggested that diabetes mellitus (DM) is a risk factor for developing adhesive capsulitis of the shoulder (ACS), data on the temporal association between these 2 conditions are sparse. The purpose of this population-based age- and sex-matched cohort study was to investigate the risk of developing ACS in patients with newly diagnosed DM. A total of 78,827 subjects with at least 2 ambulatory care visits with a principal diagnosis of DM in 2001 were recruited for the DM group. The non-DM group comprised 236,481 age- and sex-matched randomly sampled subjects without DM. The 3-year cumulative risk of ACS was calculated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to estimate the crude and adjusted hazard ratio (HR) of developing ACS. During a 3-year followup period, 946 subjects (1.20%) in the DM group and 2,254 subjects (0.95%) in the non-DM group developed ACS. The crude HR of developing ACS for the DM group compared to the non-DM group was 1.333 (95% confidence interval [95% CI] 1.236-1.439, P < 0.0001), whereas the adjusted HR was 1.321 (95% CI 1.224-1.425, P < 0.0001) after adjustment for age, sex, and dyslipidemia. This longitudinal population-based followup study showed that there is a significantly increased risk of developing ACS after developing DM.

Serum uric acid in relation to serum 1,5-anhydroglucitol levels in patients with and without type 2 diabetes mellitus

ObjectivesThe aim of this study was to examine the relationship between serum levels of uric acid (UA) and 1,5-anhydroglucitol (1,5-AG) in elderly subjects (60years or older; mean age, 73.0±7.2years) with and without type 2 diabetes mellitus (DM). MethodsSubjects with DM (n=97) and without DM (n=360) were recruited from among our outpatients (estimated glomerular filtration rate≥45mL min−1 1.73m−2 , and urine protein equivalent to <1.0g/L), and a cross-sectional study was performed with simple linear regression and stepwise multiple linear regression analyses. ResultsThe mean serum UA levels of men were significantly higher than those of women in both groups. The mean serum 1,5-AG levels of men were significantly higher than those of women in the non-DM group. There were positive correlations (indicated by Pearson's correlation coefficients) between serum UA levels and 1,5-anhydroglucitol levels in all patients and in both men and women. Simple linear regression and multiple linear regression analyses showed that the serum 1,5-AG levels were significantly and positively correlated with the serum UA level in both the non-DM group and the DM group. In the non-DM group, HbA1c levels, as well as 1,5-AG levels, were positively correlated with serum UA levels. Furthermore, the correlation between 1,5-AG and UA levels was stronger in subjects with DM than in subjects without DM. ConclusionsThese results suggest that the serum 1,5-AG level is an independent factor associated with serum UA levels in the nondiabetic state, as in DM.

Anterior capsule contraction and flare intensity in the early stages after cataract surgery in eyes with diabetic retinopathy

To evaluate the changes and relationship in the area of the anterior capsule opening (ACO) and anterior inflammation during the early stages after cataract surgery in diabetic patients with or without diabetic retinopathy (DR). Department of Ophthalmology, University of Fukui, Fukui, Japan. Case-control study. This study comprised diabetic patients without DR (non-DR group), diabetic patients with nonproliferative DR (DR group), and patients without diabetes mellitus (DM) (non-DM group) who had cataract surgery. The ACO area and aqueous flare intensity were measured using the EAS-1000 device and a laser flare-cell meter, respectively, 1 day, 1 week, and 1 and 3 months after surgery. The percentage of anterior capsule contraction (ACC) was significantly higher in the DR group than in the non-DR and non-DM groups 1 week and 1 and 3 months postoperatively (P<.01, Turkey-Kramer test). The aqueous flare intensity was significantly greater in the DR group than in the non-DR and non-DM groups 1 day, 1 week, and 1 and 3 months postoperatively (P<.01). Ordinary least-squares regression analysis showed a significant positive correlation between aqueous flare intensity at 1 week and ACC 3 months after surgery in the non-DR group (P=.0178, R(2) = 0.173) and the DR group (P=.0018, R(2) = 0.308). Greater anterior flare levels 1 week after cataract surgery contributed to the extensive postoperative contraction of the ACO in diabetic patients, particularly those with DR.

Diabetes Influences Peritoneal Morphology in Uremic Patients at the Initiation of Peritoneal Dialysis

The peritoneum begins to undergo morphologic changes before the start of peritoneal dialysis (PD), particularly in diabetic patients. The present study was conducted to investigate the effects of diabetes on the peritoneum. This study involved 17 patients who began receiving PD and had diabetes as an underlying disease (DM group), and 30 patients without diabetes who served as a control group (nonDM group). At the start of PD, the parietal peritoneum was sampled to assess submesothelial connective tissue thickness, number of capillaries and postcapillary venules, and indications of vasculopathy (grades 0 - 3). Submesothelial connective tissue thickness was significantly greater in the DM group than in the nonDM group (p < 0.01). The number of capillaries was significantly greater in the DM group (p < 0.01). Based on multivariate linear regression analysis, diabetes was identified as a significant independent variable of both submesothelial connective tissue thickness and number of capillaries (p < 0.01). In diabetic patients, morphologic changes of the peritoneum are marked at the start of PD.

Detection of periodontal pathogens from saliva of type 2 diabetic patients in urban area of Beijing

To investigate the prevalence of periodontal pathogens from saliva of patients with type 2 diabetes mellitus (T2DM), and to characterize the association between the glucose status and periodontal pathogens in oral cavity. All the subjects were hypertension patients under regular care at Beijing hypertension prevention and management institute. Whole unstimulated saliva samples were collected from 45 non-diabetic subjects (non-DM group), 80 well-controlled diabetic patients (DM-well group) and 100 poor-controlled diabetic patients (DM-poor group). DNA was extracted from the salivary deposition, Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf) and Treponema denticola (Td) were detected by polymerase chain reaction (PCR) method based on 16SrRNA. Prevalence and quantity of the pathogens under different glucose states were compared and logistic regression model was set to analyze the factors related to each bacterium. The prevalence of Tf in DM-well group and DM-poor group was significantly lower than that of non-DM group [81% (65/80), 80% (80/100) vs 91% (41/45), P = 0.048], meanwhile the quantity of Tf was also lower than that of non-DM group [1.9(2.6), 2.1(5.3) vs 3.4(6.4)] (P > 0.05). With the worsening of glucose control, the quantity of Tf was declining (P = 0.032). However, the prevalence and the quantity of Pg, Td in 3 groups had no statistical differences (P > 0.05). After adjusting age, gender, number of missing teeth and other periodontal parameters, OR of having Tf in saliva from DM-well group and DM-poor group was 0.58 and 0.53, respectively. Abnormal blood glucose state may affect the colonization of Tf in oral cavity.

Disease-Specific Mortality and Secondary Primary Cancer in Well-Differentiated Thyroid Cancer with Type 2 Diabetes Mellitus

BackgroundIncreased body mass index is related to the incidence of thyroid cancer. However, the presentation and therapeutic outcomes of different thyroid cancers and type 2 diabetes mellitus (DM) have not been studied. This study investigated the effect of type 2 DM on the clinical presentations and therapeutic outcome of well-differentiated thyroid cancer.Methods and FindingsA retrospective analysis of adult thyroid cancer patients with or without type 2 DM admitted between January 2001 and December 2010 was performed at an institution. A total of 1,687 well-differentiated thyroid cancer patients with different histological patterns were enrolled. Among these subjects, 122 were type 2 DM patients. Patients with thyroid cancer and type 2 DM were significantly older than non-DM patients. After a mean follow-up period of 5.6±0.1 years, patients with thyroid cancer and type 2 DM showed a higher percentage of disease progression than non-DM patients (24.6% vs. 17.4%). In addition, disease-specific mortality was higher in the type 2 DM group (10.7% vs. 3.8%). Thyroid cancer patients with type 2 DM showed a higher percentage of secondary primary cancers than those without DM (10.7% vs. 4.9%). Thyroid cancer-specific survival rates in the type 2 DM and non-DM groups were 82.2% and 94.9% at 5 years, 72.9% and 91.4% at 10 years, and 36.5% and 61.3% at 20 years, respectively. Multivariate analysis showed that type 2 DM was independent of thyroid cancer-specific mortality.ConclusionPatients with type 2 DM and well-differentiated thyroid cancer had an advanced tumor-node-metastasis stage at the time of diagnosis and an increased disease-specific mortality. Aggressive surgical procedures and close follow-up for well-differentiated thyroid cancer patients with type 2 DM are therefore necessary.

Effect of cardiac rehabilitation on muscle mass, muscle strength, and exercise tolerance in diabetic patients after coronary artery bypass grafting

BackgroundThe effects of cardiac rehabilitation (CR) on muscle mass, muscle strength, and exercise tolerance in patients with diabetes mellitus (DM) who received CR after coronary artery bypass grafting (CABG) have not been fully elucidated. MethodsWe enrolled 78 consecutive patients who completed a supervised CR for 6 months after CABG (DM group, n=37; non-DM group, n=41). We measured mid-upper arm muscle area (MAMA), handgrip power (HGP), muscle strength of the knee extensor (Ext) and flexor (Flex), and exercise tolerance at the beginning and end of CR. ResultsNo significant differences in confounding factors, including age, gender, ejection fraction, or number of CR sessions, were observed between the two groups. At the beginning of CR, the levels of Ext muscle strength and peak VO2 were significantly lower in the DM group than in the non-DM group. At the end of CR, significant improvement in the levels of muscle strength, HGP, and exercise tolerance was observed in both groups. However, the levels of Ext muscle strength, HGP, peak VO2, thigh circumference, and MAMA were significantly lower in the DM group than in the non-DM group. In addition, no significant improvement in thigh circumference and MAMA was observed in the DM group. At the end of CR, the levels of thigh circumference and MAMA correlated with Ext and Flex muscle strength as well as with HGP. Percent changes in the levels of Ext muscle strength were significantly correlated with those of MAMA and hemoglobin A1c. ConclusionsThese data suggest that improvement in muscle strength may be influenced by changes in muscle mass and high glucose levels in DM patients undergoing CR after CABG. A CR program, including muscle mass intervention and blood glucose control, may improve deterioration in exercise tolerance in DM patients after CABG.

Survival difference in NSCLC and SCLC patients with diabetes mellitus according to the first-line therapy

The aim of this study was to examine the survival difference between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients with diabetes mellitus (DM) according to the first-line therapy. All patients with lung cancer diagnosed at our hospitals between April 1999 and March 2011 were retrospectively analyzed. The definition of DM was strictly determined and included fasting plasma glucose and HbA1c levels. The patients were divided into 2 groups: those with DM (DM group) and those without DM (non-DM group). For each treatment type, the survival of these 2 groups was evaluated. For NSCLC patients overall, the difference in survival between the DM group and the non-DM group was not significant (p = 0.112). However, in surgically treated NSCLC patients, the difference in survival between the 2 groups was significant (p = 0.022). In chemotherapy-treated NSCLC patients, the difference in survival between the 2 groups was not significant (p = 0.942). On the other hand, for SCLC patients overall, the difference in survival between the DM group and the non-DM group was significant (p = 0.012). In chemotherapy-treated SCLC patients, the difference in survival between the 2 groups was significant (p = 0.026). The influence of DM may differ between NSCLC and SCLC patients. At the current treatment level for unresectable NSCLC, the influence of DM might not be the same for NSCLC patients treated with surgery as for SCLC patients treated with chemotherapy. Elucidation of the mechanism by which hyperglycemia influences the progression of lung cancer will improve survival in lung cancer patients with DM.

ABO blood type, long-standing diabetes, and the risk of pancreatic cancer

To retrospectively study pancreatic cancer patients with respect to their ABO blood type and diabetes. Our analysis included a cohort of 1017 patients with pancreatic ductal cancer diagnosed at our hospital in Tokyo. They were divided into two groups: 114 patients with long-standing type 2 diabetes (DM group, defined as diabetes lasting for at least three years before the diagnosis of pancreatic cancer) and 903 patients without diabetes (non-DM group). Multivariate analysis was performed to identify factors that are associated with long-standing diabetes. The DM group was further divided into three subgroups according to the duration of diabetes (3-5 years, 5.1-14.9 years, and 15 years or more) and univariate analyses were performed. Of the 883 pancreatic cancer patients with serologically assessed ABO blood type, 217 (24.6%) had blood type O. Compared with the non-DM group, the DM group had a higher frequency of blood type B [odds ratio (OR) = 2.61, 95%CI: 1.24-5.47; reference group: blood type A]. Moreover, male (OR = 3.17, 95%CI: 1.67-6.06), older than 70 years of age (OR = 2.19, 95%CI: 1.20-3.98) and presence of a family history of diabetes (OR = 6.21, 95%CI: 3.38-11.36) were associated with long-standing type 2 diabetes. The mean ages were 64.8 ± 9.2 years, 67.1 ± 9.8 years, and 71.7 ± 7.0 years in the subgroups with the duration of diabetes, 3-5 years, 5.1-14.9 years, and 15 years or more, respectively (P = 0.007). A comparison of ABO blood type distribution among the subgroups also showed a significant difference (P = 0.03). The association of pancreatic cancer with blood type and duration of diabetes needs to be further examined in prospective studies.

Comparison of Mean Platelet Volume in Type 2 Diabetics on Insulin Therapy and on Oral Hypoglycaemic Agents

Increased mean platelet volume is a known risk factor for various acute vascular complications, which is commonly associated with patients with diabetes mellitus. This study was aimed to investigate the association of Mean Platelet Volume (MPV) with Type 2 Diabetes Mellitus (DM) and to know the difference of MPV in patients on oral hypoglycaemic drugs and insulin therapy. A total of 150 patients were selected and allocated to three Groups of 50 each, referred to as DM Group on insulin therapy, DM Group on oral hypoglycaemic therapy and non-DM Group (Negative control Group). Investigations like fasting blood glucose, HB A1c and MPV were performed. Difference between the means of age, MPV were calculated by analysis of variance (ANOVA) by using Tukey's Honestly Significant Difference (HSD) test. p-value and Confidence intervals were also calculated (p<0.05). The outcome of study has shown that values of MPV are increased in patients with Type 2 DM, and are significantly higher in those patients on oral hypoglycaemic therapy than patients on insulin therapy. MPV is a simple and cost-effective tool which can be explored for predicting the possibility of acute vascular events in patients suffering from diabetes mellitus. Values of MPV are increased in patients with uncontrolled Type 2 DM, and are significantly higher in diabetic patients treated with oral hypoglycaemic therapy than in those patients on insulin therapy. Early initiation of insulin treatment in confirmed cases of Type 2 diabetics not only helps in controlling blood glucose level but also helps in keeping MPV low and thereby preventing possibility of impending acute vascular events.

Comparison of Two-point Discrimination Perception in Stroke Patients with and without Diabetes Mellitus

[Purpose] The aim of this study was to compare two-point discrimination (TPD) perception in stroke patients with diabetes mellitus (DM) and without diabetes mellitus (non-DM). [Subjects] The subjects were 53 poststroke hemiparetic patients (21 stroke patients with DM; 32 stroke patients without DM). [Methods] TPD was measured on the tips of the first through fifth fingers on both the affected and unaffected sides. [Result] Comparison of TPD between fingers on the unaffected side and affected side fingers showed significantly poorer responses in all five fingers on the affected side. TPD was also significantly poorer in the DM group compared with the non-DM group in all five fingers on the affected side, but no differences were observed for the unaffected side. [Conclusion] These findings suggest that TPD was significantly poorer in the fingers on the affected side vs. the unaffected side in poststroke hemiparetic patients. DM caused a significantly poorer TPD in the fingers on the affected side in poststroke patients but had no significant effect on the fingers on the unaffected side.

Levels of B-type natriuretic peptide in chronic heart failure patients with and without diabetes mellitus

The current study aimed to observe the value of B-type natriuretic peptide (BNP) in chronic heart failure (CHF) patients with and without diabetes mellitus (DM). The study consisted of 559 CHF patients, including 276 patients with coronary heart disease, 234 with hypertensive heart disease and 49 with dilated cardiomyopathy. The subjects were divided into non-DM and DM groups which included 384 and 175 patients, respectively. Their New York Heart Association (NYHA) cardiac function degree and BNP levels were detected following admission. Other blood parameters, including fasting blood glucose and serum creatinine, were also collected. Left ventricular ejection fraction (LVEF) and the average thickness of the left ventricular wall (LVW) were detected by echocardiography. The total score of the heart failure (HF)-related parameters was evaluated for each patient according to age, hypertension, LVEF, LVW and NYHA degree. Additionally, BNP-score relation curves were constructed. The levels of BNP were significantly higher in the DM group compared with the non-DM group (1143.73±94.0 vs. 884.34±57.0 ng/l, P<0.05). Positive BNP-score relation curves were obtained for the DM and non-DM groups, but the curve of the DM group was notably steeper. As the patients with DM have significantly higher BNP levels at a similar HF score, DM history and fasting blood glucose should be taken into consideration when evaluating the value of BNP in HF.

Does diabetes mellitus with or without gallstones increase the risk of gallbladder cancer? Results from a population-based cohort study

Previous studies have suggested that diabetes mellitus (DM) is a risk factor for gallbladder cancer; however, it remains unclear whether DM with or without gallstones increases the risk of gallbladder cancer. The aim of this study was to evaluate the risk factors for gallbladder cancer, including sex, hypertension, hyperlipidemia, gallstones, and DM. The study cohort consisted of 214,179 subjects newly diagnosed with diabetes (cases) collected from the claims data of the Health Insurance Program of Taiwan from 2000 to 2001 who were retrospectively enrolled. The control group consisted of 206,860 subjects without diabetes, matched with the cases for sex, age, and index year. The subjects were followed up until the end of 2008. The effects of the risk factors on the incidence of gallbladder cancer were evaluated with Cox's proportional hazard regression models. The risk of gallbladder cancer was higher in the DM group than in the non-DM group, with a hazard ratio (HR) of 1.53 [95% confidence interval (CI) 1.22-1.90]. Gallstones were also a risk factor for gallbladder cancer, with an HR of 2.52 (95% CI 1.11-5.73). DM and gallstones were synergistic risk factors for gallbladder cancer (p<0.0001), with an HR of 5.37 (95% CI 3.17-9.10) for subjects with both diseases in relation to those with neither of these conditions. In the present long-term cohort study, DM with or without gallstones increased the risk of gallbladder cancer. Gallstones were independently related to gallbladder cancer, and DM and gallstones were synergistic risk factors for gallbladder cancer.

Diabetes mellitus is associated with short prostate-specific antigen doubling time after radical prostatectomy

To investigate whether diabetes mellitus (DM) was associated with postoperative outcomes, including prostate-specific antigen doubling time, among men who underwent radical prostatectomy (RP) for clinically localized prostate cancer (PCa). Data of 661 patients who underwent radical prostatectomy for node-negative prostate cancer and were followed up for ≥3 years postoperatively at our institution were analyzed. Associations between diabetes mellitus at surgery and outcomes following radical prostatectomy, such as biochemical recurrence-free survival and prostate-specific antigen doubling time, were examined. Aggressive recurrence was defined as biochemical recurrence with prostate-specific antigen doubling time <9 months. Of the 661 total subjects, DM (n = 67, 10.1 %) and non-DM group (n = 594, 89.9 %) showed no significant differences in various clinicopathologic parameters including age and PSA. DM group had lower postoperative biochemical recurrence-free survival than non-DM group, with observed difference approaching statistical significance (log-rank, p = 0.077). On multivariate analysis, DM at surgery was significantly associated with aggressive recurrence following RP (p = 0.048). Pathologic Gleason score (p = 0.008) and seminal vesicle invasion (p = 0.010) were also significantly associated with aggressive recurrence on multivariate analysis. Our results show that pre-existing DM in men with PCa is associated with more aggressive recurrence, suggesting that DM may affect disease progression following RP. Further investigation would be needed to elucidate exact biologic interaction between DM and PCa and also assess causal relationships that potentially could be modified to improve long-term outcome in patients with the two diseases.

Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China

In China, there are four types of liver abscesses (LAs) that meet the clinical criteria. Pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs) are two of the most common types of abscesses, followed by fungal liver abscesses (FLAs) and hydatid secondary liver abscesses (HsLAs). Diabetes mellitus (DM) is associated with the development of PLAs. However, there is a lack of population-based studies that have evaluated the underlying relationship between LAs (mainly PLAs and FLAs) and DM. We conducted a retrospective study based on a large population to identify the potential differences and factors that affect the mortality of PLA patients in DM and non-DM groups. Our results revealed that the prevalence of DM is 44.3% (158/357) in PLA patients and 35.3% (18/51) in FLA patients. Compared with the non-DM patients, statistically significant differences were found in DM patients according to symptomatology, clinical manifestations, laboratory findings, microbiological characteristics, antimicrobial resistance, clinical treatments and outcomes in relation to mortality. In addition, the status of antibiotic resistance to E. coli and K. pneumoniae, which were isolated from the patient samples, is severe in the area in which the study was conducted. Regarding the treatment of PLAs, our study indicated that broad-spectrum antimicrobial therapy and drug combinations should be recommended and initiated before the pathogens are cultured and identified. In the clinic, therapies that combine percutaneous drainage with antibiotics and surgery with antibiotics are the two most useful strategies for treating an LA. These two combined treatments resulted in satisfactory cure rates. In the DM and non-DM groups, the cure rates for percutaneous drainage with antibiotics were 90.3% and 92.0%, respectively, and the cure rates for surgery with antibiotics were 93.9% and 95.2%, respectively.

Differences in clinical and angiographic outcomes with different drug-eluting stents in Japanese patients with and without diabetes mellitus

BackgroundAlthough percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with worse clinical outcomes, the efficacy of drug-eluting stents (DES) in Japanese patients and differences in effectiveness between different DES types remain unknown. Methods and subjectsFive-hundred and sixty-two consecutive patients (183 with DM, 379 without DM) with 676 lesions were treated with sirolimus-eluting stents (SES, n=531; 160 DM group, 371 non-DM group) or paclitaxel-eluting stents (PES, n=145; 64 and 81, respectively). We assessed the initial and 8-month follow-up clinical and angiographic outcomes. ResultsThere were no significant differences in clinical and lesion characteristics, although the pre-minimum luminal diameter was smaller in the DM group (p=0.016). The risk of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction, congestive heart failure, or recurrent angina pectoris, was higher in the DM group compared with the non-DM group (17.4% vs 9.5%, p=0.007). Among diabetic patients, although SES reduced late loss by 0.45mm (p<0.001) and the binary restenosis rate by 66.4% (7.4% vs 22.0%, p<0.001) compared with PES at 8 months, it did not reduce target lesion revascularization or MACE, as in the non-DM group. ConclusionsDiabetic patients have worse mid-term prognosis than non-diabetic patients undergoing PCI with DES. Although the superiority of SES in terms of late loss or restenosis may not play a clinically meaningful role in the treatment of diabetic patients, this phenomenon was independent of the presence of diabetes.

Heart rate variability and plasma norepinephrine concentration in diabetic dogs at rest

Cardiac autonomic neuropathy in dogs with diabetic mellitus (DM) was evaluated using measurement of heart rate variability (HRV) and plasma norepinephrine (NE) concentration. Dogs were divided into 2 groups; the control non-DM group (n = 13) and the diabetic group (n = 22) which was further divided into the well-controlled DM (n = 11) and the poorly-controlled DM subgroups (n = 11) according to their fasting plasma fructosamine concentrations. The electrocardiogram (ECG) was recorded continuously for at least 30 min to yield HRV. The results showed that in the poorly-controlled DM subgroup, the average of normal R-R interval (mean N-N), SD of the mean of all 5-min segments of normal RR intervals (SDANN) were lower than the control group while heart rate was higher (P < 0.05). The NNA, SDNN, SDNN index and pNN50% were significantly lower when compared with the well-controlled DM subgroup (P < 0.05). The high frequency (HF) and total power were significantly lower while the ratio of low to high frequency (LF/HF) was higher (P < 0.05) when compared with the well-controlled DM subgroup. Moreover, in the poorly-controlled DM subgroup, plasma NE concentration was lower than the control group (210 ± 37 vs. 479 ± 74 pg/ml, P < 0.05). There was a significantly negative correlation between plasma NE and plasma fructosamine concentrations. It is concluded that cardiac autonomic neuropathy occurred in poorly-controlled DM dogs. The sympathetic activity was suppressed as shown by decrease in both plasma NE concentration and LF component.

Effect of Supervised Exercise Therapy for Intermittent Claudication in Patients With Diabetes Mellitus

Primary treatment for patients with intermittent claudication is exercise therapy. Diabetes mellitus (DM) is a frequently occurring comorbidity in patients with intermittent claudication, and in these patients, exercise tolerance is decreased. However, there is little literature about the increase in walking distance after supervised exercise therapy (SET) in patients with both intermittent claudication and DM. The objective of this study was to determine the effectiveness of SET for intermittent claudication in patients with DM. Consecutive patients with intermittent claudication who started SET were included. Exclusion criteria were Rutherford stage 4 to 6 and the inability to perform the standardized treadmill test. SET was administered according to the guidelines of the Royal Dutch Society for Physiotherapy. At baseline and at 1, 3, and 6 months of follow-up, a standardized treadmill exercise test was performed. The primary outcome measurement was the absolute claudication distance (ACD). We included 775 patients, of whom 230 had DM (29.7%). At 6 months of follow-up, data of 440 patients were available. Both ACD at baseline and at 6 months of follow-up were significantly lower in patients with DM (P < 0.001). However, increase in ACD after 6 months of SET did not differ significantly (P = 0.48) between the DM group and the non-DM group (270 m and 400 m, respectively). In conclusion, SET for patients with intermittent claudication is equally effective in improving walking distance for both patients with and without DM, although ACD remains lower in patients with DM.

Titanium Fixtures for Bone-Conduction Devices and the Influence of Type 2 Diabetes Mellitus

The aim of this study is to evaluate whether diabetes mellitus (DM) is a risk factor for titanium fixture loss in bone-conduction devices (BCDs) because of osseointegration failure. Retrospective case study. Tertiary referral center. All patients who received a BCD at Nijmegen between January 1, 1988, and December 31, 2007, were analyzed. The analyses were performed on 833 patients (993 implants) and a subpopulation of patients aged 40 years or older consisting of 641 patients (739 implants). Patients received a questionnaire asking about the presence of DM at the time of implantation. Data concerning implant loss were retrieved from medical records and the Nijmegen BCD database. The total survival rate of the BCD implant in this population was 90.6%. The prevalence of DM was 9.3%. In the subpopulation of patients aged 40 years or older, the non-DM group lost 5.1% of their implants versus 14% of Type 2 DM patients, a statistically significantly difference (p = 0.003). Spontaneous loss, loss due to a Grade 4 Holgers skin reaction, and trauma accounted for 2.2% versus 4.7% (p = 0.13), 0.5% versus 2.3% (p = 0.1), and 0.6% versus 4.7% (p = 0.007), respectively, of implant losses in non-DM versus Type 2 DM patients. The prevalence of DM among the Nijmegen BCD population is higher than the general Dutch prevalence. A statistically significantly higher implant loss was observed during the study period for Type 2 DM patients than non-DM BCD wearers.