Poor Diabetic Control Research Articles

Going Beyond Zip Code: Can a Person's Address Help Us Improve Their Acute Care?

Going Beyond Zip Code: Can a Person's Address Help Us Improve Their Acute Care?

Abstract P318: Neighborhood Environment Characteristics and Control of Cardiovascular Disease Risk Factors in a Primary Care Patient Sample

Introduction: Hypertension and diabetes control are leading modifiable risk factors for cardiovascular disease (CVD) risk. Contemporary epidemiological research suggests that individual and health system characteristics are associated with control. Yet, there is little evidence examining how the neighborhood environment influences hypertension or diabetes control among patients engaged in primary care. Methods: We analyzed data of adult patients (n = 5,711) with hypertension or diabetes who received primary care at 1 of 3 clinics of a statewide health care organization in Baltimore, MD and lived within the Baltimore city limits. The neighborhood environment exposures were tertiles of neighborhood socioeconomic status (SES), crime, and healthy food availability index (HFAI) assessed at the census tract level. Separate multivariate logistic regression models were constructed to estimate the odds ratio (OR) for each of these neighborhood environment characteristics and hypertension and diabetes control, adjusting for patient demographics, and health behaviors; and for physician demographic characteristics. Results: The overall mean age was 57.8 ± 14.3 years, 67.2% were female, and 89.6% were Black. There were 5,325 patients with hypertension and 2,094 patients with diabetes (not mutually exclusive). In bivariate analyses, high neighborhood SES (p= 0.030) and low crime (p= 0.006) were associated with hypertension control, and none of the neighborhood exposures were associated with diabetes control. In fully adjusted analyses, being Black was significantly associated with decreased odds of hypertension control in all models (OR range: 0.63 – 0.65), independent of neighborhood exposures. Among those with hypertension, living in a low or moderate SES neighborhood or a high crime neighborhood was associated with lower odds of hypertension control; however, these associations were attenuated in adjusted models. None of the neighborhood exposures were significantly associated with odds of diabetes control in models that adjusted for patient characteristics. Yet, compared to high SES neighborhoods, living in a low or moderate SES neighborhood (OR=0.74, 95% CI: 0.57 - 0.97 and OR=0.75, 95% CI: 0.57 - 0.98, respectively) was associated with reduced diabetes control after adjusting for both patient and physician characteristics. Conclusion: Exposure to neighborhood disadvantage may contribute to poor diabetes and hypertension control among patients in primary care, independent of patient and physician characteristics. Patient-centered risk assessments including measures of social need and preventive interventions adapted to neighborhood environments could be useful for optimizing hypertension and diabetes control in clinical settings.

Management of Diabetes Mellitus With Glucagonlike Peptide-1 Agonist Liraglutide in Renal Transplant Recipients: A Retrospective Study

BackgroundDiabetes mellitus (DM) is the major cause of end-stage renal disease (ESRD) in Taiwan. Despite the use of steroids and/or calcineurin inhibitors (CNIs) in renal transplantation (RTx), additional challenges occur when a patient displays persisting metabolic disease, carries on an unhealthy lifestyle, or experiences genetic effects. Although RTx recipients could get better glycemic control by oral anti-diabetic drugs (OADs) or several insulin agents, they still need more than two kinds of medication. Liraglutide, a GLP-1 receptor agonist, stimulates insulin secretion and inhibits glucagon secretion and hepatic glucose production in a glucose-dependent manner. In addition, it delays gastric emptying and suppresses appetite through the central pathways. Herein we report on the long-term benefits of liraglutide in the management of DM in RTx recipients. MethodsWe retrospectively retrieved 7 RTx patients in August 2015, who had been prescribed liraglutide due to their poor glycemic control; however, 2 of them discontinued their scheduled doses within 1 month. The mean follow-up period was 19.4 ± 7.6 (range 10.5–27.6) months. ResultsGlycemic control improved fasting blood sugar (FBS) from an initial 228.6 ± 39.1 mg/dL to a final FBS of 166.0 ± 26.6 mg/dL (P = .103), with a significant improvement in nadir glucose control (136.4 ± 5.8 mg/dL, P = .017) and with glycated hemoglobin (HbA1c) from an initial 10.0 ± 1.6% to a final 8.1 ± 0.8% (P = .043). The average body weight was from an initial of 78.0 ± 7.8 kg to a nadir of 75.1 ± 9.1 kg (P = .032). Graft renal function of the estimated glomerular filtration rate (eGFR) significantly improved from an initial 67.7 ± 18.7 to a nadir of eGFR 76.5 ± 18.7 mg/dL (P = .024). There was no significant change in urinary protein:creatinine ratio. ConclusionLiraglutide may be safe and effective for RTx recipients with poor diabetic glycemic control, although there have been incidences of intolerance in some patients, and potential concern regarding absorption of oral medications due to a delay of gastric emptying. Evidence of liraglutide in diabetic RTx recipients is limited, so additional prospective clinical studies should be undertaken in the future.

Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project

BackgroundThe HealthRise initiative seeks to implement and evaluate innovative community-based strategies for diabetes, hypertension and hypercholesterolemia along the entire continuum of care (CoC)-from awareness and diagnosis, through treatment and control. In this study, we present baseline findings from HealthRise South Africa, identifying gaps in the CoC, as well as key barriers to care for non-communicable diseases (NCDs).MethodsThis mixed-methods needs assessment utilized national household data, health facility surveys, focus group discussions, and key informant interviews in Umgungundlovu and Pixley ka Seme districts. Risk factor and disease prevalence were estimated from the South Africa National Health and Nutrition Examination Survey. Health facility surveys were conducted at 86 facilities, focusing on essential intervention, medications and standard treatment guidelines. Quantitative results are presented descriptively, and qualitative data was analyzed using a framework approach.Results46.8% of the population in Umgungundlovu and 51.0% in Pixley ka Seme were hypertensive. Diabetes was present in 11.0% and 9.7% of the population in Umgungundlovu and Pixley ka Seme. Hypercholesterolemia was more common in Pixley ka Seme (17.3% vs. 11.1%). Women and those of Indian descent were more likely to have diabetes. More than half of the population was found to be overweight, and binge drinking, inactivity and smoking were all common. More than half of patients with hypertension were unaware of their disease status (51.6% in Pixley ka Seme and 51.3% in Umgungundlovu), while the largest gap in the diabetes CoC occurred between initiation of treatment and achieving disease control. Demand-side barriers included lack of transportation, concerns about confidentiality, perceived discrimination and long wait times. Supply-side barriers included limited availability of testing equipment, inadequate staffing, and pharmaceutical stock outs.ConclusionIn this baseline assessment of two South African health districts we found high rates of undiagnosed hypercholesterolemia and hypertension, and poor control of hypercholesterolemia, hypertension, and diabetes. The HealthRise Initiative will need to address key supply- and demand-side barriers in an effort to improve important NCD outcomes.

POOR GLYCEMIC CONTROL IS ASSOCIATED WITH INCREASED INTERSTITIAL FIBROSIS IN DIABETIC PATIENTS WITH AND WITHOUT HEART FAILURE WITH PRESERVED EJECTION FRACTION(HFPEF)

Adults with diabetes mellitus demonstrate increased levels of myocardial extracellular volume fraction (ECV), a measure of myocardial interstitial fibrosis. However, whether poor diabetes control is associated with ECV among diabetic patients with and without HFpEF is unknown. We studied 85 adults

Access to Hemoglobin A1c in Rural Africa: A Difficult Reality with Severe Consequences

Sub-Saharan Africa (SSA) continues to have the highest diabetes-related mortality rate in the world. While there exists a multitude of health system barriers driving poor diabetes control, rural facilities particularly in SSA lack access to proper monitoring of glucose and other key biologic tests. At best, most of these diabetes patients receive random blood sugar readings only on the day of their clinic visit. This approach has very limited clinical value in determining dosage adjustments for narrow therapeutic index medications such as insulin. Furthermore, access to other blood tests and physical exam tools for detecting early signs of diabetes complications is limited. We propose that routine access to hemoglobin A1c (HbA1c) testing would not only allow for close monitoring of diabetes control but also provide critical data informing the population level risk for diabetes complications. However, implementing HbA1c testing does have its own barriers at rural facilities, including high costs, refrigeration requirements, and perceived discordance between HbA1c values and mean blood glucose levels for SSA patients. Fortunately, several pilots in rural SSA have illustrated feasibility of HbA1c testing. Further political will, price reduction, and context-specific research are needed. Increasing access to HbA1c testing is a critical step to combat the high diabetes-related mortality rates in rural SSA.

Impact of non-apnea sleep disorders on diabetic control and metabolic outcome - A population-based cohort study.

There has been a growing recognition that obstructive sleep apnea (OSA) could increase the propensity for type 2 diabetes the metabolic syndrome. However, studies concerning about the impact of non-apnea sleep disorders (NSD) on diabetes control and metabolic outcomes are relatively scarce. Our aim is to investigate the impact of non-apnea sleep disorders (NSD) on diabetic control and associated metabolic outcomes in patients with type 2 diabetes. The data were obtained from two nationwide population-based databases for a period 2007 to 2012. A total 66,992 patients with type 2 diabetes were enrolled and divided into two cohorts based on comorbidity with or without a NSD diagnosis, and were followed up four years. The primary outcomes were to compare rate of change in HbA1c and associated metabolic outcomes during follow-up visits between patients with or without NSD. The secondary outcome is to examine whether NSD were associated with poor glycemic control of the last clinical records while controlling for the baseline HbA1c value. Of the 66,992 patients with type 2 diabetes, 14.82% had comorbidity with a NSD. HbA1C decreases were significantly lower by 0.04% in the NSD group (P < 0.05), and triglyceride (TG) decreases remained significantly lower by 2.53% in the NSD group (P < 0.05). Furthermore, patients in the NSD group had an 8% higher risk of poor glycemic control (HbA1C >9) (OR = 1.08; 95%CI, 1.01-1.16). Our findings indicated patients with type 2 diabetes comorbid with NSD had a slower improvement in HbA1c compared with the comparison cohort. It may because there may exist potential floor effect given those with NSD having significantly lower HbA1c values at baseline. On the other hand, the poor diabetic control among those with NSD may be also affected by other confounders such as medical treatment or interventions. Nevertheless, given the rapidly increasing prevalence of metabolic diseases and subsequent complications, the results may highlight the importance of sleep in the clinical management of type 2 diabetes.

Gallbladder Disease in Type-2 Diabetes Mellitus Patients

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Diabetes mellitus is a modern epidemic which leads to various complications over a period of time. Autonomic neuropathy is one such complication which may lead on to gallbladder dysmotility and gallbladder stones.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; To determine the incidence of gallbladder disorders in patients of type 2 diabetes mellitus and to find out the incidence of autonomic dysfunction in type 2 diabetes mellitus and correlate it with presence of gall bladder disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and Methods:&lt;/strong&gt; The present study was conducted in 50 cases of type 2 diabetes mellitus and 25 healthy age and sex matched normal individuals were taken as controls. The cases as well as the controls underwent ultrasonographic examination for gall bladder volume, wall thickness, intraluminal mass and contraction in response to fatty meal. Data thus collected was compared and analysed statistically by using students ‘t’ test and chi- square test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean postprandial gallbladder volume was 20.56±8.87 cm&lt;sup&gt;3&lt;/sup&gt; in diabetics with ANP with gallstones, 26.16±1.24 cm&lt;sup&gt;3&lt;/sup&gt; in diabetics with ANP with dysmotility 13.0±6.26 cm&lt;sup&gt;3&lt;/sup&gt; in diabetics with gallstones without ANP, 12.14±4.88 cm&lt;sup&gt;3&lt;/sup&gt; in normal diabetics and 13.60±5.95 cm&lt;sup&gt;3&lt;/sup&gt; in controls. The percentage contraction post fatty meal was calculated from these values and found to be 24.73±14.64% in diabetics with ANP with dysmotility, 26.38±17 .04% in diabetics with ANP with dysmotility, 43.48±8.45% in diabetics with gallstones without ANP, 56.84±9.02% in normal diabetics and 57 .64±9.92% in controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Incidence of gallbladder disease is much higher in type 2 diabetics (40%) as compared to normal healthy adults (4%). It was concluded that diabetics with ANP had significantly impaired gallbladder emptying. Poor control of diabetes, hypercholesterolemia and diabetic autonomic neuropathy are important risk factors for the development of gallbladder disease.&lt;/p&gt;

Treatment Discontinuation and Clinical Events in Type 2 Diabetes Patients Treated with Dipeptidyl Peptidase-4 Inhibitors or NPH Insulin as Third-Line Therapy.

Objective To compare dipeptidyl peptidase-4 (DPP-4) inhibitors with neutral protamine Hagedorn (NPH) insulin, in terms of effectiveness and safety for the management of patients with type 2 diabetes mellitus (DM2) not controlled on metformin and sulfonylureas. Methods A retrospective cohort study of individuals with DM2 newly dispensed with either DPP-4 inhibitors or NPH as third-line therapy, after metformin and sulfonylurea. Treatment discontinuation, macrovascular outcomes, and hypoglycemia were compared using multivariable Cox regression models, adjusted for sex, age, year of cohort entry, place of residence, hypertension, past history of hypoglycemia, diabetic ketoacidosis, comorbidities, and number of visits to emergency departments, outpatient physician, and hospitalizations. Results Treatment discontinuation and hypoglycemia occurred more frequently with NPH than with DPP-4 inhibitor users. In the adjusted Cox model, the use of NPH compared to that of DPP-4 inhibitors was associated with a higher risk of discontinuation (HR: 1.33; 95% CI 1.27–1.40) and hypoglycemia (HR: 2.98; 95% CI 2.72–3.28). Risk of cardiovascular events was similar across groups. Conclusions This real-world analysis suggests that DM2 patients initiating third-line therapy with NPH have poorer control of diabetes when compared to DPP-4 inhibitor initiators.

Peripheral Neuropathy in Children and Adolescents with Insulin-dependent Diabetes Mellitus.

Type 1 diabetes mellitus (T1DM) is a chronic immune-mediated disease. Diabetic peripheral neuropathy (DPN) is an important microvascular complication of T1DM. One of the most important risk factors for the development of DPN is poor glycemic control. We evaluated the prevalence of DPN among T1DM patients and determined the association between DPN and glycated hemoglobin (HbA1c) level. The subjects were recruited prospectively upon initial evaluation at Imam Reza Hospital, Mashhad, Iran from Jan 2013 to Jan 2015. Patients with T1DM were selected based on the inclusion criteria (i.e., age of 6≤yr and absence of other co-morbidities). DPN was assessed through electrodiagnostic studies and neurological examinations, while diabetes control was evaluated by measuring the HbA1c level. Fifty patients with T1DM were enrolled in this study. The mean diabetes duration of patients was 8.38±3.79 yr (mean age16.68±6.68 yr). The mean HbA1c level was 8.6±2.1% in patients without DPN and 10.5±3 in those with DPN (P=0.016). Overall, 24% of the subjects were presented with DPN according to nerve conduction velocity study (NCV) findings. A positive correlation was found between NCV and clinical symptoms with signs (P<0.001, r=0.45 and P<0.001, r=0.644, respectively). Sensitivity and specificity of neurological examination for DPN diagnosis were 91.7% and 63.2%, respectively. Poor diabetes control is associated with DPN. Moreover, HbA1c level was used as an index for glycemic control over the past 3 months. Rigid blood glucose control and periodic neurological examinations were the best strategies to prevent DPN.

Overcoming the Barriers to Insulin Initiation in Type II Diabetic Patients: Clinical Evidence Available to Nurses

The prevalence of diabetes has been on a growing trend worldwide; accordingly, it has increased from 4.5% in 1980 to 8.5% in 2014 (1). The aim of controlling diabetes is to achieve a hemoglobin a1c (HbA1c) level of lower than 7%. However, this target cannot be fulfilled in almost 50% of the diabetic patients. Poor blood glucose control is a risk factor for the complications associated with diabetes mellitus (2, 3). Oral hypoglycemic drugs are typically used to control this disease. In case of failure in achieving the normal blood glucose level, another oral drug or insulin may be required (4(. According to the literature, only 20% of the diabetic patients are interested in insulin initiation. Furthermore, insulin initiation in these patients is challenging for the health care providers (5). The barriers to insulin initiation can be categorized in terms of their relationship with the health care providers and patient. According to the previous studies, the barriers related to the health care providers include the fear of hypoglycemia, lack of sufficient time to educate the patients, patient's low socioeconomic status, lack of sufficient knowledge and experience, absence of a common language with the patients, and poor patient-staff relationship. On the other hand, the barriers related to the patients entail inconvenience and limitation in lifestyle, loss of independence, social embarrassment, poor self-efficacy, needle phobia, depression, failure to receive convincing answers from the health care providers about the benefits and risks of insulin, incomplete conceptualization of diabetes, use of traditional herbal treatments, and fear of weight gain due to using insulin (3, 4, 6-9). Regarding this, delay in insulin initiation is a common practice. Research has shown that around 50% of the patients with poor diabetes control do not initiate insulin therapy timely, and that even insulin initiation is delayed for 3-5 years after receiving no response from oral hypoglycemic drugs. Therefore, this issue requires the direction of special attention because except for a few barriers, including low socioeconomic status, the rest of the aforementioned barriers can be altered and resolved by the health care providers (8). Nurses are among the most important members of the health care providers, who are in contact with patients. They are the ones who should provide the diabetic patients with knowledge and specialized skills to educate and motivate the patients regarding insulin consumption. In this respect, they can contribute to the fulfillment of treatment objectives, which include the reduction of complications and achievement of a suitable HbA1c level (10). In addition, there is a need for evidence-based scientific documents as a basis for delivering essential education to the patients. In order to achieve this evidence, an electronic search was conducted using the international databases, including the web of science (ISI), Pubmed, Scopus, and Google Scholar, with the keywords of “initiate or starting”, type II diabetes”, and “insulin”. The search results indicated that the number of interventional studies investigating the field of nursing and “insulin initiation” was very limited. Accordingly, among the Persian electronic databases, such as SID (Scientific Information Database) and Magiran, only one “descriptive, cross-sectional” study was found (11). Using various studies, the barriers to insulin initiation were listed and investigated. The review was indicative of the implementation of only a few nursing interventions to overcome these barriers. Considering the importance of insulin initiation and the significant role of nurses as the facilitators of this process, there was a gap in the interventional studies targeted toward guiding the nurses in the clinical practice in this regard. Consequently, the researchers are suggested to give more attention to this dimension of diabetes management and take more effective and practical steps to overcome the barriers to insulin initiation in type II diabetic patients.

Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics.

Background:Diabetes mellitus is a metabolic disease leading to abnormal fat, carbohydrate and protein metabolism. Reduced salivary flow rate caused by hyperglycemia is characteristic mainly for periods of poor metabolic control of diabetes, thereby facilitating the growth of aciduric bacteria and caries-lesion development. The objective of our study was to evaluate the effects of diabetes mellitus on dental caries micro-organisms responsible for caries.Materials and Methods:This study was carried out on 60 subjects consisting of 2 groups. The Group A (study group) consisted of 30 subjects with diabetes mellitus and dental caries, and the Group B (control group) consisted of 30 subjects with dental caries but no systemic disease. DFS/dfs index in all subjects was evaluated and compared. Unstimulated salivary flow was collected and levels of Streptococcus mutans were analyzed.Results:It was found that the fasting blood sugar in Group A subjects because of which there was increased streptococcus mutans count and hence high caries index as compared to that of Group B.Conclusion:From our study, we could conclude that with increased age, blood sugar levels, DMFT values, dental caries increases in diabetics than in normal (control) subjects and therefore relationship does exist between diabetis mellitus, oral microbiota and dental caries.

A Case Report of Danon Disease

We present a case of a 21-year-old gentleman with background history of moderate learning disability, Type 1 Diabetes Mellitus and elevated ALT. Due to incidental finding of a double apical impulse and abnormal ECG was referred for cardiology review. His echocardiogram findings triggered a cascade of other investigations which eventually resulted into genetic testing that confirmed Danon disease. He had a high HCM risk-SCD score and therefore had an ICD implant but unfortunately due to poor diabetic control, he was unlisted from heart transplant list. About 5 years after his formal diagnosis, he developed decompensated and congestive heart failure despite optimal medical therapy. He unfortunately passed away due to end-stage heart failure.

Patterns of finger sepsis and predictors of its outcome in patients with diabetic septic hand

The objectives of this study were to determine the different patterns of finger sepsis among diabetic patients, to know its different outcomes, and to detect the predictors of poor functional outcome (using the Sollerman hand function test). One hundred diabetic patients with finger sepsis were assessed using a prospective analytical hospital-based study, conducted in Khartoum Teaching Hospital and Jabir Abu Eliz Diabetic Centre (JADC) from October 2015 to October 2016. The most common pattern of finger sepsis was a superficial abscess (27.9%) followed by necrosis (27.1%), gangrene (14%), ulcers (11.5%), and cellulitis (6.3%). Finger sepsis spread to involve the hand in 39 patients (39%). Eighteen patients (18%) had an amputation of one or more fingers, and four patients (4%) had an amputation of the whole hand. Complete healing was the outcome in 82 (82%) patients. Twelve patients (12%) required reconstructive surgery and grafting. Forty-two patients (42%) presented with late complications such as stiffness, contractures, and deformities. Thirty-three patients (33%) had a Sollerman functional score below 80%. Poor control of diabetes, presence of neuropathy, low educational level, delayed presentation to hospital, and severe necrosis requiring surgical reconstruction were significant predictors of poor functional results of the hand (p value 0.05). The loss of more than one finger or the loss of the thumb resulted markedly in reduced hand function, compared to the loss of the middle or ring finger. Stiffness was an influencing factor in reducing hand function. It developed from severe tissue damage and prolonged periods of immobilization in a dressing which covered the whole hand. Finger sepsis among diabetics has different patterns and different outcomes. Better control of diabetes, early presentation to diabetic centers, and proper management of hand wounds will be in favor of good functional outcomes.

The effects of non-surgical periodontal treatment on glycemic control, oxidative stress balance and quality of life in patients with type 2 diabetes: A randomized clinical trial.

AimThe purpose of this study was to investigate the effects of non-surgical periodontal treatment on hemoglobinA1c (HbA1c) levels, oxidative stress balance and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM) compared to no periodontal treatment (simple oral hygiene instructions only).MethodsThe design was a 6-month, single-masked, single center, randomized clinical trial. Patients had both T2DM and chronic periodontitis. Forty participants were enrolled between April 2014 and March 2016 at the Nephrology, Diabetology and Endocrinology Department of Okayama University Hospital. The periodontal treatment group (n = 20) received non-surgical periodontal therapy, including scaling and root planing plus oral hygiene instructions, and consecutive supportive periodontal therapy at 3 and 6 months. The control group (n = 17) received only oral hygiene instructions without treatment during the experimental period. The primary study outcome was the change in HbA1c levels from baseline to 3 months. Secondary outcomes included changes in oxidative stress balance (Oxidative-INDEX), the Diabetes Therapy-Related QOL and clinical periodontal parameters from baseline to 3 months and baseline to 6 months.ResultsChanges in HbA1c in the periodontal treatment group were not significantly different with those in the control group at 3 and 6 months. Systemic oxidative stress balance and QOL significantly improved in the periodontal treatment group compared to the control group at 3 months. In the subgroup analysis (moderately poor control of diabetes), the decrease in HbA1c levels in the periodontal treatment group was greater than that in the control group at 3 months but not significant.ConclusionsIn T2DM patients, non-surgical periodontal treatment improved systemic oxidative stress balance and QOL, but did not decrease HbA1c levels at 3 months follow-up.Trial registrationCurrent Controlled Trials UMIN-ICDR UMIN 000013278 (Registered April 1, 2014).

Perception of Stigma is Associated with Poor Diabetes Control Among Adolescents and Young Adults with Type 1 Diabetes

Aim: Stigma related to chronic disease is rejection, judgement, or exclusion related to the chronic disease itself. We aim to determine the prevalence of stigma among youth and young adults with type 1 diabetes (T1D) in Canada and its association with diabetes control.

Evaluation of YKL-40 Serum Level in Patients with Type 1 Diabetes and Its Correlation with Their Metabolic and Renal Conditions

Background: The main indicator of long-term glycemic control in type 1 diabetes and its complications is glycosylated hemoglobin (HbA1c). Considering that there are little studies on the correlation of YKL-40 with HbA1C in type 1 diabetes, we evaluated such correlation to suggest YKL-40 as both diagnostic and prognostic marker of type 1 diabetes poor control and nephropathy. Methods: 49 patients of type 1 diabetes not suffering from any diabetic complications during recent 5 years and 43 sex- and age-matched healthy controls participated in the study. Taking fasting blood and urine samples, we measured CBC, serum levels of YKL-40, HbA1c, creatinine, lipids, and urinary concentration of albumin and creatinine using standard laboratory methods. Results: Serum level of YKL-40 was significantly higher in type 1 diabetes compared to controls (P < 0.001). There was no significant correlation between such levels and HbA1c (P = 0.99) in type 1 diabetic patients. There was a strong positive correlation between YKL-40 and duration of the disease (P < 0.001). We found no significant correlation between serum level of YKL-40 and other factors including urine/albumin creatinine ratio (UACR), blood pressure, lipid profile, and serum and urine creatinine. Conclusions: Although there was a significant increase in serum level of YKL-40 in type 1 diabetic patients, it did not show any correlation with both metabolic and nephropathic states of diabetes.

Congenital Anomalies among the Babies of Diabetic Mothers with Uncontrolled Blood Sugar -A Study in a Tertiary Hospital

Diabetes mellitus is a silent killer which affects at any stage of life. Worldwide incidence of major malformation among the offspring of diabetic mothers ranges from 5-10%. Though 65-75% of birth defects are multifactorial, poor diabetic control in pregnancy predisposes congenital malformation. The aim of this retrospective study is to see the actual picture of congenital anomalies among the babies of uncontrolled diabetic mothers. Cases are taken from the hospital records of the patients who delivered congenitally abnormal babies &amp; were admitted in SCABU of BIRDEM during the period of January, 2006 to December, 2010. After going through all records, patients were divided into DM/GDM/ND groups and different variables are studied. Among the patients (163), 57 (35%) were DM, 38 were (23.3%) GDM and 68 (41.7%) were ND. Major congenital anomalies were found 82.45% in DM and 71.05% in GDM and 83.82% in ND patients. Rests were minor anomalies. Among the anomalies maximum were congenital heart diseases, then CNS anomalies, then renalanomalies and then others. In this study congenital anomalies were found 1.4 times more in DM patients. Among DM and GDM patients maximum had uncontrolled blood sugar. Neonatal mortality was higher in DM and GDM groups. Both cardiac and CNS abnormalities were 1.2 times higher in diabetic groups. Renal anomalies were 2.8 times higher. Limb abnormalities were 7.15 times higher in diabetic groups. So it is concluded that pregnancy with uncontrolled diabetes increases the risk of birth defects, mainly CVS, CNS and Renal system related.Medicine Today 2017 Vol.29(1): 26-31

THE RELATIONSHIP BETWEEN UNCONTROLLED DIABETES AND COGNITION IN MEXICAN AMERICAN ELDERS

Diabetes is considered a modifiable risk factor for Alzheimer's disease and cognitive decline. Mexican Americans are the twice as likely to be diagnosed with diabetes, yet the majority of research examining diabetes and cognition has focused on non-Hispanic populations. The goal of this research is to examine the impact of diabetic control on cognition in Mexican Americans. This study examined differences in cognition among controlled and uncontrolled diabetics without cognitive impairment. Data were analyzed from 171 Mexican American participants with diabetes (61 uncontrolled; 110 controlled) enrolled in the Health and Aging Brain among Latino Elders (HABLE) study. All participants were classified as normal controls. Uncontrolled diabetes was defined as HBA1C levels 9 or greater. Cognition was assessed via performance on multiple neuropsychological tests. Independent t tests were conducted to compare cognition among controlled and uncontrolled diabetics. Uncontrolled diabetics performed worse on WMS digit span t(167)=2.1, p<.05, EXIT 25 t(106)=-2.1, p<.05, and MMSE t(169)=2.9, p<.005. Uncontrolled diabetes was associated with poorer performance in the areas of attention and executive functioning among cognitively normal Mexican Americans. No differences were found in immediate and delayed memory, and visuospatial scores. Ongoing work will determine if these links are associated with neuroimaging and other biomarker signatures that may identify those Mexican Americans at greatest risk for cognitive loss associated with poor diabetic control.

Barriers and enablers to proper diabetic foot care amongst community dwellers in an Asian population: a qualitative study

Diabetic foot complications are common within Asian populations. They arise due to poor diabetic control and foot care. In this study, we aimed to identify the causes for proper and improper diabetic foot care. A qualitative study consisting of key informant interviews with 17 healthcare professionals, including doctors and various allied health workers, was conducted. Participants included had at least five years of caring for diabetic foot patients either in public institutions or private clinics. Data collected was analyzed via thematic analysis. Diabetic patients were generally observed to have a mixture of proper and improper information and beliefs which eventually resulted in the extent of proper foot care. Factors which influenced the extent of proper and improper state of information and beliefs were classified into predisposing and precipitating factors. Predisposing factors were further categorised into modifiable factors (e.g., education level, socioeconomic status, social support) and non-modifiable factors (e.g., age, presence and severity of co-morbidities restricting ability to selfcare, past experiences). Precipitating factors were categorized into patient factors (e.g., degree of reception of information, presence of psychological barriers), provider factors (presence and degree of multi-disciplinary approach to care, presence of administrative inconveniences) and disease factors (presence of diabetic sensory neuropathy, complexity of disease process). The extent of proper foot care amongst diabetic patients is influenced by numerous predisposing and precipitating factors. Further studies can look at further development of the described structure as well as quantitatively defining the various components and factors which make up the described system.