Poor Diabetic Control Research Articles

The prevalence of albuminuria among diabetic patients in a primary care setting in Singapore.

Microalbuminuria is an early sign of kidney damage. The prevalence of microalbuminuria in Singapore has been reported to be 36.0%-48.5%. However, the prevalence of microalbuminuria reported in these studies was determined with one urine sample using a qualitative urine test. The aim of this study was to determine the prevalence of micro- and macroalbuminuria using a more stringent criterion of two positive quantitative urine albumin-creatinine ratio (ACR) tests. We conducted a cross-sectional study of patients with type 2 diabetes mellitus (T2DM) who were followed up at a primary care clinic in Singapore. Patients were diagnosed to have albuminuria if they had two positive ACR tests within a seven-month period. A total of 786 patients with T2DM met the study's inclusion criteria. 55.7% were already on an angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB). The prevalence rates of micro- and macroalbuminuria were 14.2% and 5.7%, respectively. Patients with albuminuria were more likely to have hypertension (odds ratio [OR] 3.47, 95% confidence interval [CI] 1.55-7.80). Diabetics with poorer diabetic control (OR 1.88, 95% CI 1.26-2.79), and higher systolic (OR 1.69, 95% CI 1.14-2.49) and diastolic (OR 1.96, 95% CI, 1.20 to 3.22) blood pressures were more likely to have albuminuria. In the present study, the prevalence of microalbuminuria is significantly lower than that previously reported in Singapore. The presence of hypertension, poor diabetic control and suboptimal blood pressure control are possible risk factors for albuminuria in patients with T2DM.

Costs and effects of a telephonic diabetes self-management support intervention using health educators

BackgroundSelf-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness. MethodsCosts of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported. ResultsThe telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators. ConclusionsEffective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.

Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus: Opioid Dose and Health Care Costs.

Diabetes mellitus (DM) has well known costly complications but we hypothesized that costs of care for chronic pain treated with opioid analgesic (OA) medications would also be substantial. In a statewide, privately insured cohort of 29,033 adults aged 18 to 64years with DM and noncancer pain who filled OA prescription(s) from 2008 to 2012, our outcomes were costs for specific health care services and total costs per 6-month intervals after the first filled OA prescription. Average daily OA dose (4 categories) and total dose (quartiles) in morphine-equivalent milligrams were calculated per 6-month interval after the first OA prescription and combined into a novel OA dose measure. Associations of OA measures with costs of care (n=126,854 6-month intervals) were examined using generalized estimating equations adjusted for clinical conditions, psychotherapeutic drugs, and DM treatment. Incremental costs for each type of health care service and total cost of care increased progressively with average daily and total OA dose versus no OAs. The combined OA measure identified the highest incremental total costs per 6-month interval that were increased by $8,389 for 50- to 99-mg average daily dose plus >900mg total dose and, by $9,181 and $9,958 respectively, for ≥100mg average daily dose plus 301- to 900-mg or >900mg total dose. In this statewide DM cohort, total health care costs per 6-month interval increased progressively with higher average daily OA dose and with total OA dose but the greatest increases of >$8,000 were distinguished by combinations of higher average daily and total OA doses. The higher costs of care for opioid-treated patients appeared for all types of services and likely reflects multiple factors including morbidity from the underlying cause of pain, care and complications related to opioid use, and poorer control of diabetes as found in other studies.

A point of view of poor control of diabetes: presence of disease and diagnosis time

Background Developing countries has experienced changes in their profile, as the aging and alterations in lifestyle of population. It has been associated with the high increase in chronic diseases like Diabetes Mellitus Type 2 (DM2), which is connected with increasing prevalence of obesity and aging process. In Brazil, some studies have shown the difficulties of the health care to control diabetes as well as their complications. As a result, low quality of life (QL) is verified in the population with DM2, which may be the starting point to change the possible gaps on the treatment of the disease.

Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial.

Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.

Psychiatric aspects of diabetes mellitus

SummaryDiabetes is an increasingly common health problem, especially in the West, where there is an emerging epidemic of type 2 diabetes, closely related to the epidemic of obesity. Many people with diabetes struggle to optimise their diabetes control, often because they also have mental illnesses or psychological and social problems. Poor diabetes control has significant consequences for the individual, and if not addressed will result in complications that include blindness, kidney failure and even amputations. There are also consequences for health services resulting from increased admissions and emergency department presentations with diabetes-related difficulties. In the long-term, the costs associated with complications such as renal failure and amputation are high. Addressing the psychiatric and psychological barriers to good glucose control can help reduce the burden of diabetes and its complications on both the individual and the health service.

A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States.

Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity.

3 Dimensions of Care for Diabetes: integrating diabetes care into an individual's world

3DFD (3 Dimensions of Care for Diabetes) is an award winning gold-standard model of integrated care, which was developed and evaluated as a sustainable service for improving glycaemic control and reducing diabetes complications in South London's multi-ethnic, socio-economically disadvantaged and growing diabetes population. This service is fully integrated into the diabetes services across Lambeth and Southwark boroughs. It consists of a liaison psychiatrist who provides clinical leadership and psychiatric interventions, psychologists and two third-sector social support workers who provide social care in the community, working directly with the diabetes teams across the sectors. 3DFD has completed two consecutive pilot phases during which the components of the service have been refined and effectiveness demonstrated. We found high levels of mental illness and unmet need, and effected improvements in glycaemic control, psychological status and health service use. We have produced outcomes which compare favourably with new antidiabetic medications to the market and to the outcomes of the local intermediate teams. We believe this provides the best possible model of care for patients with persistent poor diabetes control despite implementing standard pathways. The full economic evaluation is in progress and preliminary analyses indicate that there will be an annual saving of £33 000, based on the reduction in HbA1c from the first pilot. Copyright © 2015 John Wiley & Sons.

The Relationship Between Type 2 Diabetes Mellitus and Proton Pump Inhibitor Failure in Patients With Gastroesophageal Reflux Disease

Introduction: There have been a limited number of studies that evaluated risk factors for proton pump inhibitor (PPI) failure in patients with type 2diabetes mellitus (DM) and concomitant gastroesophageal reflux disease (GERD). The aim of the study was to determine the predictive risk factors for PPI failure among patients diagnosed with type 2 DM and GERD. Methods: Using a population-based study, 398 patients diagnosed with GERD who were treated with a PPI between 2004 and 2014 were included in the study. Patients were divided based on the presence of type 2 DM (diagnosed >1 year prior to enrollment into the study) and were further classified depending on their response to PPI therapy into PPI-responders and PPI-failure. PPI failure was defined as the need to treat with more than once daily PPI or the addition of other anti-reflux agents to ncontrol GERD-related symptoms. Results: A total of 398 patients with GERD were included in the study and of those 65 patients (16.3%) also had the diagnosis of type 2 DM. A total of 30 patients had failed PPI once daily. Between the DM and non DM group, 93 patients (23.4%) had failed PPI therapy and 305 (76.6%) had good response to PPI therapy. Most of the patients were females (61.5%) and mean age of the patients was 53.9 years (range 22-83). Poor diabetic control was measured by HgA1c, and shown to increase the risk of PPI failure by almost 50% (OR 1.47 95% CI 1.03-2.08, p=0.03). Also, in all GERD patients, PPI failure depended on female gender and depression. Males were half as likely to fail PPI therapy (OR 0.56 95% CI 0.34-0.93, p=0.03) and depression carried an odds ratio which was twice that of the normal population (OR 2.00 95% CI 1.19-3.36 p=0.01). Type II diabetes, duration of diabetes, and type of anti-diabetic medication prescribed were not statistically significantly associated with PPI failure.Table 1: Risk factors with P <0.05Conclusion: In GERD patients, female gender and depression were predictive factors of PPI failure. In GERD patients with type 2 DM, poor control of DM as measured by HgA1c was predictive of PPI failure.

Health equity policies: glycaemic control and health services use in insured and uninsured diabetics

Background Socioeconomic disadvantage is associated with risks of poor diabetes control. In Switzerland, some vulnerable groups such as undocumented immigrants face barriers in accessing to health insurance and care. The Geneva University Hospitals facilitates access to best standard care to all patients irrespective of residency and insurance status. We compared glycaemic control and healthcare utilization in diabetics with and without insurance. Methods We retrospectively …

Guillain-Barré syndrome: clinical profile and management.

Introduction: Guillain-Barré syndrome (GBS) is a fulminant polyradiculoneuropathy that is acute, frequently severe and autoimmune in nature. Etiology of GBS is incompletely understood, prognosis is usually good with early detection and prompt treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and electrodiagnostic features of patients with GBS and mode of management, complications and prognostic factors.Methods: Data of 1,166 patients admitted with GBS or presented to outpatient department (previous medical records) with GBS between January 2003 and January 2014 were analyzed. Results: No difference in genders noted. Around 35% of patients are above 50 years of age. Poor control of diabetes with mean HbA1c of 8.1 ± 2.11 is found on analysis. Seasonal occurrence in GBS is prominent in winter 484 (41.50%) and mechanically ventilated were 449 (38.50%) patients. 48 (4.11%) deaths were attributed to GBS. Neurological analysis revealed cranial nerve involvement in 407 (34.90%) patients, facial palsy in 401 (34.39%) and ataxia in 88 (7.54%) patients. Most patients in plasma exchange group belonged to the lower socio-economic status. Mean cerebrospinal fluid (CSF) protein levels was (n=962) 113.8 ± 11.8 mg/dl. Conduction block determined indirectly by absent H-reflex was noted in 891 (90.64%) patients. No difference in complications and outcome is found in treatment regimens of intravenous immunoglobulin (IVIG) and plasma exchange.Conclusion: Seasonal occurrence predominantly in winter is noted. Peak flow test may be a predictor of assessing requirement of mechanical ventilation and prognosis. Conduction block is the major abnormality noted in electrophysiological studies and proximal nerve segment assessing with Erb’s point stimulation has high predictive value. IVIG treatment is more expensive but is associated with less duration of hospital stay.

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

Background and aimsTo study trends of barriers to receiving recommended eye care among subjects with diabetes aged 20–81 years in northeast Germany. Methods and resultsWe analyzed population-based data from two repeated cross-sectional surveys conducted in 1997–2001 and 2008–2012 (Ns of 4308 and 4402). Andersen's Behavioral Model of Health Services Utilization was used to identify individual-level demographic, financial and health-related barriers to annual eye-care utilization in subjects with a self-reported physician's diabetes and to examine population trends in these barriers. The prevalence of diabetes increased from 6.5% to 11.4%. The prevalence of annual eye-care utilization among persons with diabetes decreased from 69.4% to 56.0% (adjusted relative risk = 0.77, p < 0.001). The decline of eye care utilization over the past decade in eye-care use was more pronounced in groups at risk for diabetes-related complications (i.e., lower socio–economic status, >5 years since diagnosis of diabetes, poor glycemic control, obesity, smoking, lack of physical activity, co-existing diseases). We identified relevant predictors of missed annual eye-care use among diabetics. ConclusionThe increase of diabetes prevalence and downward trend of eye-care visits at the recommended level call for development, implementation and evaluation of continued efforts to improve access to eye specialists, particularly among those with poor diabetic control, co-existing diabetic complications, and comorbidities.

Charcot neuroarthropathy after simultaneous pancreas–kidney transplantation: risk factors, prevalence, and outcome

We retrospectively analyzed outcome and risk factors of developing Charcot foot (CF) in 100 patients with type 1 diabetes mellitus who underwent a simultaneous pancreas-kidney (SPK) transplantation. Patients who developed CF after SPK transplantation had significantly higher mortality (56% vs. 18%) and more frequently graft failure (44% vs. 13%). Recipients with CF also experienced acute rejections more frequently (78% vs. 41%). They furthermore had higher pre-transplant values of HbA1c , received cyclosporine and azathioprine more often, and had significantly higher cumulative corticosteroid use. Patients transplanted in an earlier era (1992-1998) received cyclosporine and azathioprine more often and had a significantly higher cumulative corticosteroid use with the higher prevalence of CF. Conversely, patients with diabetes transplanted more recently (1999-2012) received lower doses of corticosteroids as part of their tacrolimus-based immunosuppressive therapy, resulting in fewer CF attacks. In conclusion, development of CF after SPK is associated with poor patient and graft outcome. Poor pre-transplant diabetic control and the use of high-dose corticosteroids are risk factors for the development of CF. We recommend reduction in or even total avoidance of corticosteroids after SPK transplantation. Given the importance of the diagnosis of CF on outcome, a systematic examination of SPK patients' feet is recommended.

PWE-027 Oesophageal candidiasis: does taking a biopsy affect the outcome? a dgh experience

Introduction Oesophageal Candidiasis (OC) is strongly associated with various immunocompromised states. We noted locally that some endoscopists feel confident in their ability to identify the condition visually at OGD, and therefore do not biopsy the oesophagus. The aim of this retrospective study was to analyse the outcomes for a cohort of patients diagnosed with OC at endoscopy to see whether oesophageal biopsy affected outcomes. Method All OGDs performed at DCH over one year (21/03/13–21/03/14) were reviewed. Patients diagnosed with OC at endoscopy were followed up. Three groups were identified: Group 1, Histology proven OC; Group 2, oesophageal histology suggesting alternative diagnosis; and Group 3, patients not biopsied. Diagnoses and patient outcomes were assessed between 10 and 22 months following the initial OGD. Results 3375 OGDs were performed. 103 patients (63 female, 40 male), mean age 72.9 years, (range 34–97 yrs) had endoscopic evidence of possible OC. 49 patients (47.5%) had an oesophageal biopsy. Only 61% of these biopsies confirmed OC (Group 1); of these patients one was subsequently diagnosed with HIV, seven took inhaled steroids, seven had cancer, one had intercurrent sepsis, one was reflux related, one had poor diabetic control, two took continuous antibiotics and ten were on a PPI. Mortality in Group 1 was 10% within one month following OGD (all were related to disseminated malignancy). 39% of biopsied patients had histology negative for candida (Group 2) with the following alternative diagnoses made histologically: 16 had reflux oesophagitis, one had HSV oesophagitis, one had eosinophilic oesophagitis and one had bisophosphonate-related oesophagitis. Mortality in Group 2 was 0%. 52.5% of patients with suspected OC did not receive a biopsy (Group 3). Four patients had contraindications to biopsy: two oesophageal varices, two were over anti-coagulated. 57% of these patients had strong risk factors for OC pre-endoscopy: 12 were on long term inhaled/oral steroid, 11 had cancer, three were acutely malnourished, two had decompensated liver disease, and two were on other immunosuppressant medication. Mortality in Group 3 was high: 42.6% in six months (Range: 0–17 months) with varied causes of death that included fungal pneumonia and colonic adenocarcinoma. Conclusion We suggest all patients with endoscopically suspected OC should be biopsied unless there are compelling reasons not to, as up to 40% of patients will have an alternative diagnosis despite similar endoscopic appearances. Histologically proven OC is often associated with immunocompromise, it is therefore important for endoscopists to advise upon further investigation, particularly in the setting of GP open access endoscopy. Our data suggest a high mortality in this group although treatable diseases may be found. Disclosure of interest None Declared.

174 Frequency of diabetic keto-acidosis in children with cystic fibrosis related diabetes

Objectives To evaluate the frequency of diabetic keto-acidosis (DKA) in cystic fibrosis related diabetes (CFRD) population and to identify associated risk factors. Methods A retrospective database review of all CF patients with diabetes mellitus (DM) from 1992 to 2014. Data collected included demographics, sweat chloride, sputum culture, evidence of compliance, DM diagnosis parameters, insulin dose and weight profile prior to the diagnosis of DM. CFRD was diagnosed as per American Diabetes Association guidelines. Results Of 392 children with CF, 47 (12%) had DM: CFRD (n = 44), type 1(n = 2, 1 had DKA) and type 2 (n = 1). Only 2/44 patients with CFRD had DKA. Each patient had evidence of poor compliance with CF and DM managements and presented with pulmonary exacerbation and DKA. Both patients had higher HbA1c and insulin dose when compared to the CFRD group (Table). Pseudomonas (56%) and Aspergillus (23%) isolation was higher in CFRD patients when compared to non-CFRD patients. 47% CFRD patients had significant weight loss in 3 months preceding diagnosis – mean 7.4% (range 2–22). TableComparison of the 2 DKA patients with CFRD groupData are expressed as mean(SD) (range).CFRD group (n = 42)CFRD DKA Case 1CFRD DKA Case 2Age at CFRD diagnosis (years)13.8(2) (10–17)1311Sweat Chloride (mmol/L)107(17) (74–165)10385OGTT results (mmol/L) at 0 hrs6.4(2.5) (4–17)Presented in DKA6.5 at 2 hrs12.5(4.8) (4–26)11.8Pulmonary exacerbation at diagnosisNoneYesYesHbA1c (%)7.1(2.5) (5–16.8)10.614Insulin dose (IU/kg/day)0.6(0.8) (0–2.2)3.83.4Number of episodes of DKA03 in total, 1st at diagnosis2 since diagnosisFactors associatedN/APoor compliance high insulin dose & HbA1c (both) Conclusion DKA in CFRD is uncommon (5%) when reviewed over 22 years. Poor compliance with CF therapy and poor diabetic control (high insulin dosage and HbA1c) were common factors. An index of suspicion for keto-acidosis is indicated when those patients present with pulmonary exacerbations. Oral glucose tolerance test is indicated in patients with persistent weight loss and/or new sputum microbiology.

Cost of hospitalizations due to microvascular and macrovascular complications in type 1 and type 2 diabetic patients in Bulgaria

The objective of this study was to evaluate the cost of hospitalizations due to micro- and macrovascular complications in an observed cohort of 433 patients with diabetes. A six-month combined retrospective and prospective observational study was performed. The patients were separated into two groups depending on the type of diabetes and further into subgroups depending on the reason for hospitalization. The total costs for each subgroup were calculated and compared to the total costs of treatment for the observed period. In the type 2 diabetes group (n = 255), there were 128 people with microvascular complications and 215 ones with macrovascular complications, whereas in the type 1 diabetes group, there were only 70 people out of 178 with microvascular complications and 72 ones with macrovascular complications. The total cost of hospitalizations in the type 2 diabetes group was 34 469.76 EUR with the following reported reasons for hospitalizations: poor control of diabetes (45%), microvascular complications (23%) and macrovascular complications (31%). In the type 1 diabetes group, the total hospitalizations cost was equal to 15 319.33 EUR with the following split: 59% due to poor control of diabetes, 22% due to microvascular complications and 19% due to macrovascular complications. Thus, type 2 diabetes is more costly than type 1 when hospitalizations occur. Type 2 diabetes is associated with higher cost of macrovascular complications than of microvascular ones probably due to high hypertension prevalence. Costs are paid by the health insurance fund and the differences need to be systematically revealed.

The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes.

Food insecurity- lack of dependable access to adequate food-may play a role in poor diabetes control. We aimed to determine the relationship between food security status and depression, diabetes distress, medication adherence and glycemic control. Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. Participants had poorly controlled type 2 diabetes (A1c ≥ 8.0 % on eligibility screen), household income < 250 % of the federal poverty level, were 30-70 years old, and were recruited from a large public hospital, a VA medical center and a community-health center in King County, Washington. We measured food insecurity determined by the Department of Agriculture's 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool. Incidence of hypoglycemic episodes was by patient report. Glycemic control was assessed with glycosylated hemoglobin (A1c) values from fingerstick blood sample. The prevalence of food insecurity was 47.4 %. Chi-square tests revealed participants with food insecurity were more likely to be depressed (40.7 % vs. 15.4 %, p < 0.001), report diabetes distress (55.2 % vs. 33.8 %, p < 0.001) and have low medication adherence (52.9 % vs. 37.2 %, p = 0.02). Based on linear regression modeling, those with food insecurity had significantly higher mean A1c levels (β = 0.51; p = 0.02) after adjusting for sex, age, race/ethnicity, language, education, marital status, BMI, insulin use, depression, diabetes distress and low medication adherence. Almost half of participants had food insecurity. Food insecurity was associated with depression, diabetes distress, low medication adherence and worse glycemic control. Even with adjustment, people with food insecurity had higher mean A1c levels than their food-secure counterparts, suggesting there may be other mediating factors, such as diet, that explain the relationship between food security status and diabetes control.

Electrocardiographic Left Ventricular Hypertrophy Among Gambian Diabetes Mellitus Patients.

The global prevalence of diabetes and its complications is increasing worldwide. Its role in coronary heart disease has been linked with the presence of left ventricular hypertrophy (LVH). The present study aims to determine the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) in adult diabetic subjects, its epidemiological and clinical correlates. A descriptive cross-sectional study involving 534 patients was conducted at the Edward Francis Small Teaching Hospital (formerly Royal Victoria Teaching Hospital), The Gambia. Four hundred and forty patients were included using a standard questionnaire. Anthropometry, laboratory investigations and electrocardiogram were carried out. We used the Lewis, Cornell, and Sokolow-Lyon Voltage criteria to define ECG-LVH. Minitab™ statistical software version 13.20 was used for analysis. 146 (35.2%) patients had ECG-LVH using all 3 criteria and this prevalence was higher among women being 116 (79.5%). A generally high prevalence of overweight (155/37.4%) and obesity (119/28.6%) was observed among study participants, and both clinic-day systolic and diastolic blood pressure (BP) were significantly higher in those with ECG-LVH. Poor diabetes control was observed in both groups. There was a high prevalence of ECG-LVH and it is especially so with combining multiple criteria, hence the need for screening. Clinic-day hypertension was associated with ECG-LVH hence the need for diagnosing and aggressive treatment of hypertension in patients with diabetes mellitus.

Cardiovascular events and all-cause mortality in a cohort of 57,946 patients with type 2 diabetes: associations with renal function and cardiovascular risk factors.

BackgroundDiabetes and chronic kidney disease (CKD) are independent predictors of death and cardiovascular events and their concomitant prevalence has increased in recent years. The aim of this study was to characterize the effect of the estimated glomerular filtration rate (eGFR) and other factors on the risk of death and cardiovascular events in patients with type 2 diabetes.MethodsA cohort of 57,946 patients with type 2 diabetes who were aged 20–89 years in 2000–2005 was identified from The Health Improvement Network, a UK primary care database. Incidence rates of death, myocardial infarction (MI), and ischemic stroke or transient ischemic attack (IS/TIA) were calculated overall and by eGFR category at baseline. eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) study equation. Death, MI and IS/TIA cases were detected using an automatic computer search and IS/TIA cases were further ascertained by manual review of medical records. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) for death, MI, and IS/TIA associated with eGFR category and other factors were estimated using Cox regression models adjusted for potential confounders.ResultsOverall incidence rates of death (mean follow-up time of 6.76 years), MI (6.64 years) and IS/TIA (6.56 years) were 43.65, 9.26 and 10.39 cases per 1000 person-years, respectively. A low eGFR (15–29 mL/min) was associated with an increased risk of death (HR: 2.79; 95% CI: 2.57–3.03), MI (HR: 2.33; 95% CI: 1.89–2.87) and IS/TIA (HR: 1.77; 95% CI: 1.43–2.18) relative to eGFR ≥ 60 mL/min. Other predictors of death, MI and IS/TIA included age, longer duration of diabetes, poor control of diabetes, hyperlipidemia, smoking and a history of cardiovascular events.ConclusionsIn patients with type 2 diabetes, management of cardiovascular risk factors and careful monitoring of eGFR may represent opportunities to reduce the risks of death, MI and IS/TIA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0204-5) contains supplementary material, which is available to authorized users.

Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation

BackgroundThere is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life. The Child and Adolescent...