Performance In Diabetic Patients Research Articles

The promotion of osteointegration under diabetic conditions using chitosan/hydroxyapatite composite coating on porous titanium surfaces

Composited Chitosan/Hydroxyapatite (CS/HA) material coated on titanium surface (cTi) is a promising approach to produce biomaterials with better osseointegration capacity, but its bio-performance under diabetic conditions and the mechanisms involved remain elusive. We propose that the alterations in the Wnt/β-catenin pathway may play a role in mediating the improvement effect of cTi on diabetes-induced impaired implant osteointegration. To confirm the hypothesis, primary rat osteoblasts incubated on Ti and cTi were subjected to normal serum (NS), diabetic serum (DS), DS + Wnt3a (a specific Wnt agonist) and DS + Dkk1 (a specific Wnt antagonist) treatment. In vivo study was performed on diabetic sheep implanted with Ti or cTi into the bone defect on crista iliaca. Results showed that diabetes depressed osteoblast function evidenced by impaired cell adhesion and morphology, decreased cell proliferation and ALP activity, and higher apoptotic rate on Ti. Importantly, both cTi and Wnt3a treatment ameliorated osteoblastic dysfunction and apoptosis under diabetic condition. Implantation with cTi significantly improved osteointegration evidenced by Micro-CT and histological examinations compared with Ti. Moreover, the aforementioned promotive effects afforded by cTi were abolished by blocking Wnt pathway with Dkk1. Our study explicitly demonstrates that CS/HA composite material improves diabetes-induced impaired osteointegration of Ti via the reactivation of Wnt/β-catenin pathway and provides a target point for biomaterial modification to attain better clinical performance in diabetic patients.

Evaluation of cognitive functions and the related factors in 50–80 year type 2 diabetic subjects

To study cognitive functions in 50–80 year aged type 2 diabetic patients. Cognitive performance was evaluated through a mini mental test (MMT) in 131 patients between 50 and 80 years (100 type 2 diabetics and 31 non-diabetics). Relation analysis were carried out for different parameters. Scores in registration and recall were significantly lower in diabetic group. The effect of HbA1c, body mass index (BMI) and age variables on MMT score was statistically significant. A negative linear correlation was estimated between MMT score and age, HbA1c level and BMI value. HbA1c, age and BMI were inversely related to cognitive functions. MMT scores were 24.98 ± 3.10 in diabetic group and 25.35 ± 3.22 in control group and statistically no significant difference was found. No significant difference was between type 2 diabetics and non-diabetics in terms of cognitive functions. But performance of diabetic patients in relation to the registration and recall was lower. Poor glycemic control and obesity in diabetics negatively affect cognitive performance.

Relationship Between Glycosylated Hemoglobin Level and Sciatic Nerve Block Performance in Diabetic Patients

The objective of the present study was to explore the effects of deficiencies in glucose regulation on the onset, regression, and block performance times in a group of patients with diabetes-related foot problems. Forty-eight patients with American Society of Anesthetists physical status 2-4 undergoing foot and ankle surgery with a popliteal fossa block were prospectively studied. Patients were stratified into cohorts based on 3 groups according to their HbA1c levels: group 1 (n = 15), HbA1c 5%-6%; group 2 (n = 16), HbA1c 7%-8%; group 3 (n = 17), HbA1c 9%-10%. A standardized local anesthetic mixture containing 10 mL of 2% prilocaine and 10 mL of 0.5% levobupivacaine was used in all study groups. The primary outcome of the study was the time for regression of the sensory block. The onset times of sensory and motor blocks in group 3 were significantly longer than those in groups 2 and 1. Motor block regression time differed significantly between groups (P = .04), being longer in group 3 compared with group 1. In group 3, the sensory block regression time and the time of first analgesic use were significantly longer than the times in groups 1 and 2. We found that sensory block regression time was longer in diabetic patients with poor glycemic control than in the patients with better glycemic control. Longer block performance time, probably due to reduction in sensory and motor conduction velocity in diabetic patients with poor glycemic control, should be taken into consideration when peripheral nerve blocks are used. Level II, prospective comparative study.

Relationships Between Daily Acute Glucose Fluctuations and Cognitive Performance Among Aged Type 2 Diabetic Patients

OBJECTIVEThe mean amplitude of glycemic excursions (MAGE) is a significant determinant of overall metabolic control as well as increased risk for diabetes complications. Older individuals with type 2 diabetes are more likely to have moderate cognitive deficits and structural changes in brain tissue. Considering that poor metabolic control is considered a deranging factor for cognitive performance in diabetic patients, we evaluated whether the contributions of MAGE to cognitive status in older patients with type 2 diabetes were independent from the main markers of glycemic control, such as sustained chronic hyperglycemia (A1C), postprandial glycemia (PPG), and fasting plasma glucose (FPG).RESEARCH DESIGN AND METHODSIn 121 older patients with type 2 diabetes, 48-h continuous subcutaneous glucose monitoring (CSGM) were assessed. MAGE and PPG were evaluated during CSGM. The relationship of MAGE to performance on cognitive tests was assessed, with adjustment for age, glycemic control markers, and other determinants of cognitive status. The cognitive tests were a composite score of executive and attention functioning and the Mini Mental Status Examination (MMSE).RESULTSMAGE was significantly correlated with MMSE (r = 0.83; P < 0.001) and with cognition composite score (r = 0.68; P < 0.001). Moreover, MAGE was associated with the MMSE (P < 0.001) and cognition composite score (P < 0.001) independently of age, sex, BMI, waist-to-hip (WHR) ratio, drug intake, physical activity, mean arterial blood pressure, FPG, PPG, and A1C.CONCLUSIONSMAGE during a daily period was associated with an impairment of cognitive functioning independent of A1C, FPG, and PPG. The present data suggest that interventional trials in older patients with type 2 diabetes should target not only A1C, PPG, and FPG but also daily acute glucose swings.

Automated Ankle-Brachial Pressure Index Measurement by Clinical Staff for Peripheral Arterial Disease Diagnosis in Nondiabetic and Diabetic Patients

OBJECTIVEPeripheral arterial disease (PAD) is a prognostic marker in cardiovascular disease. The use of Doppler-measured ankle-brachial pressure index (Dop-ABI) for PAD diagnosis is limited because of time, required training, and costs. We assessed automated oscillometric measurement of the ankle-brachial pressure index (Osc-ABI) by nurses and clinical staff.RESEARCH DESIGN AND METHODSClinical staff obtained Osc-ABI with an automated oscillometric device in 146 patients (83 with diabetes) at the time of Dop-ABI measurement and ultrasound evaluation.RESULTSMeasurements were obtained in most legs (Dop-ABI 98%; Osc-ABI 95.5%). Dop- and Osc-ABI were significantly related in diabetic and nondiabetic patients with good agreement over a wide range of values. When Dop-ABI ≤0.90 was used as the gold standard for PAD, receiver operating characteristic curve analysis showed that PAD was accurately diagnosed with Osc-ABI in diabetic patients. When ultrasound was used to define PAD, Dop-ABI had better diagnostic performance than Osc-ABI in the whole population and in diabetic patients (P = 0.026). Both methods gave similar results in nondiabetic patients. The cutoff values for the highest sensitivity and specificity for PAD screening were between 1.0 and 1.1. Estimation of cost with the French medical care system fees showed a potential reduction by three of the screening procedures.CONCLUSIONSPAD screening could be improved by using Osc-ABI measured by clinical staff with the benefit of greater cost-effectiveness but at the risk of lower diagnostic performance in diabetic patients.

Rationale for a metabolic approach in diabetic coronary patients

The incidence of ischaemic heart disease and acute myocardial infarction are greater in people with diabetes than in nondiabetic individuals. Heart disease patients with diabetes have a higher incidence of mortality during and following an acute myocardial infarction and a high risk for progression to heart failure post-infarction. The greater occurrence of ischaemic heart disease is partially due to a poorer coronary artery disease risk factor profile in diabetic patients, and, importantly, due to diabetes-induced abnormalities in the myocardium, termed 'diabetic cardiomyopathy'. The main metabolic abnormalities in the diabetic myocardium are impaired carbohydrate metabolism, specifically reduced pyruvate oxidation in the mitochondria and a greater reliance on fatty acids and ketone bodies as fuels. The healthy heart takes up glucose and lactate and converts them to pyruvate; however, in the diabetic heart there is a reduced capacity to oxidize pyruvate, and thus less glucose and lactate uptake. The defective metabolism is due to high circulating free fatty acids and ketone body concentrations in the plasma, resulting in greater acetyl-Co-enzyme A/Co-enzyme A and reduced nicotinamide adenonine dinucleotide/nicotinamide adenonine dinucleotide+ ratios in the mitochondria, and the subsequent inhibition of pyruvate dehydrogenase. Pharmacological inhibition of fatty acid oxidation during ischaemia increases myocardial pyruvate oxidation and provides clinical benefit to patients with stable angina or ischaemic left ventricular dysfunction. Recent clinical trials with trimetazidine, an inhibitor of the fatty acid beta-oxidation enzyme long chain 3-ketoacylthiolase, showed improvement in cardiac function and exercise performance in diabetic patients with ischaemic heart disease, illustrating the effectiveness of this approach in diabetes.

The Effects of Type 1 Diabetes on Cognitive Performance

To investigate the exact nature and magnitude of cognitive impairments in patients with type 1 diabetes and the possible association with other disease variables, such as recurrent episodes of hypoglycemia and metabolic control. MedLine and PsycLit search engines were used to identify studies on cognitive performance in patients with type 1 diabetes. Effect sizes (Cohen's d), which are the standardized differences between the experimental and the control group, were calculated. In the meta-analysis, a combined d value was calculated, expressing the magnitude of associations across studies. A total of 33 studies were identified that met the inclusion criteria. Compared with nondiabetic control subjects, the type 1 diabetic group demonstrated a significantly lowered performance on the following cognitive domains: intelligence (d = -0.7), speed of information processing (d = -0.3), psychomotor efficiency (d = -0.6), visual (d = -0.4) and sustained attention (d = -0.3), cognitive flexibility (d = -0.5), and visual perception (d = -0.4). Lowered cognitive performance in diabetic patients appeared to be associated with the presence of microvascular complications but not with the occurrence of severe hypoglycemic episodes or with poor metabolic control. In patients with type 1 diabetes, cognitive dysfunction is characterized by a slowing of mental speed and a diminished mental flexibility, whereas learning and memory are spared.The magnitude of the cognitive deficits is mild to moderate, but even mild forms of cognitive dysfunction might hamper everyday activities since they can be expected to present problems in more demanding situations.

Cognitive function in patients with type 2 diabetes mellitus

Patients with type 2 (non-insulin dependent) diabetes mellitus may express moderate degrees of cognitive impairment. The aim of this study was to further characterise these cognitive deficits. Cognitive functions were assessed in 13 patients and 16 controls, matched for age, sex, education and occupational level. In addition, a neurological examination was performed. The performance of diabetic patients was impaired on the neuropsychological examination, in particular in tasks assessing learning and memory. Attention, motor planning and reaction time appeared to be unaffected. Symptoms and/or signs of distal symmetric polyneuropathy were detected in 31% and 56% of the diabetic patients, respectively. The observed deficits are in line with previous neuropsychological studies in type 2 diabetic patients, showing deficits in learning and memory and complex information processing. The fact that these cognitive impairments are reported consistently stresses the need to obtain further insights into pathogenic mechanisms, in order to be able to take adequate preventive measures.

Defective endogenous opioid response to exercise in type I diabetic patients

Plasma β-endorphin (β-E) concentration was determined before, during, and after a standardized incremental exercise test to maximal capacity in eight type I diabetic patients and eight normal control subjects. Diabetic patients were studied under normoglycemic and hyperglycemic conditions in a single-blind random fashion to differentiate between the effects of acute hyperglycemia and of diabetes per se on the β-E response to exercise. The perceived magnitude of leg effort elicited by exercise was evaluated using a category scale. Whereas plasma β-E concentrations increased in control subjects with increasing workload, causing significantly higher β-E levels at the end of exercise than at the beginning ( P < .001), no such increase could be observed in the diabetic patients under normoglycemic and hyperglycemic conditions. In addition, baseline plasma β-E concentrations were significantly lower in normoglycemic ( P < .01) and hyperglycemic ( P < .001) diabetic patients than in control subjects. Even during the recovery period, patients' β-E levels remained significantly lower than those of control subjects. At submaximal levels of power output, the perceived intensity of leg effort was significantly higher in normoglycemic and hyperglycemic diabetic patients than in control subjects. We conclude that in type I diabetic patients, the ability of the endogenous opioid system to respond to exercise-induced stress is impaired under hyperglycemic and even under normoglycemic conditions. Considering the effect of endogenous opioids on stress tolerance, such changes may compromise exercise performance in diabetic patients.

Diabetic cardiomyopathy

Diabetes mellitus is associated with an excessive cardiovascular morbidity and mortality. Although one frequently associates cardiac dysfunction with enhanced coronary atherosclerosis in diabetic patients, evidence has accumulated for the existence of a specific “diabetic” cardiomyopathy. Abundant literature evidence supports the concept of myocardial dysfunction separate from epicardial coronary disease in diabetic individuals. The relationship of myocardial dysfunction to the type, duration, and treatment of diabetes awaits further delineation. The relative pathogenic significance of the multiple factors that may alter myocardial performance in diabetic patients similarly awaits further elucidation.

Psychological adjustment and neuropsychological performance in diabetic patients.

The Faschingbauer Abbreviated MMPI (FAM) was utilized to compare diabetic (N = 39) with non-diabetic chronic illness patients (N = 20) and healthy controls (N = 24). The healthy controls were significantly different from the diabetic and chronic illnesses groups, but the latter two groups were not significantly differentiated. Similarly, in comparison with the healthy groups, both the chronic illnesses group and the diabetic group had significant elevations on the first three clinical subscales of the FAM: Hypochondriasis, Depression, and Hysteria. On the basis of the FAM results, the diabetic patients were divided into a "well" adjusted and a "poorly" adjusted group, and comparisons were made on a variety of neuropsychological measures, including the Wechsler Adult Intelligence Scale, Wechsler Memory Scale, and Halstead-Reitan Neuropsychological Test Battery. Results demonstrated negligible effect of poor adjustment on neuropsychological performance.

Left Ventricular Performance in Diabetic Patients without Clinical Heart Disease: Evaluation by Systolic Time Intervals and Echocardiography

To examine left ventricular performance in diabetic patients without clinical evidence of cardiac involvement, systolic time intervals (pre-ejection period, left ventricular ejection time index and ratio of pre-ejection period to left ventricular ejection time) and echocardiographic measures (percentage changes in minor axis diameter, end-diastolic and end-systolic diameter, end- diastolic volume and end-systolic volumes, stroke volume and ejection fraction), were obtained. There were 89 diabetic patients and 93 control subjects evaluated for systolic time intervals, and 40 diabetic patients and 20 control subjects evaluated by echocardiogram. The diabetic group demonstrated significant (P less than 0.001) differences from the normal control group in each of the noninvasive measures of systolic time intervals. Pre-ejection period/left ventricular ejection time ration was increased by 25 percent and the pre-ejection period was increased by 12 percent in the diabetic patients. Among 40 diabetic patients studied by echocardiography, abnormal percentage change in minor axis diameter, (less than 30 percent) occurred in six individuals. Ejection fraction was decreased by 20 percent as compared to the control group, whereas end-diastolic pressure was not significantly different in the groups.

Preclinical abnormality of left ventricular function in diabetes mellitus

Abnormal cardiac muscle function has been reported in experimental diabetes mellitus from this laboratory. To examine left ventricular performance in diabetic patients without clinical evidence of myocardial ischemia or other cardiovascular disease, a noninvasive measurement of the systolic time intervals was carried out. Simultaneous recordings of the electrocardiogram, heart sounds, and carotid pulse were made in 25 diabetic subjects, 20 to 56 years of age, and compared with 37 normal subjects. The diabetic subjects had a shorter left ventricular ejection time, longer pre-ejection period, and a higher ratio of pre-ejection period/left ventricular ejection time (P < 0.001). The isovolumic time was prolonged (P < 0.001), while heart rate and arterial pressure were within normal limits. Abnormal function was independent of apparent duration and treatment by diet alone, insulin, or hypoglycemic agents. On the basis of available morphologic data in human and canine diabetes, an alteration of the myocardial interstitium may be the basis for this preclinical abnormality in diabetic patients.