Presence Of Diabetic Complications Research Articles

Impact of diabetes on the risk of subsequent fractures in 92,600 patients with an incident hip fracture: A Danish nationwide cohort study 2004–2018

PurposeWe investigated the incidence rates of a subsequent hip fracture (HF) and other subsequent fractures than HF after first incident HF, comparing patients with and without diabetes. MethodsUsing Danish medical databases, we identified 92,600 incident HF patients in the period 2004–2018. Diabetes exposure was examined overall, by type of diabetes (T2D and T1D), and by presence of diabetes complications. We estimated cumulative incidence of subsequent HFs and fractures other than HF within two years of the incident HF. Using Cox regression, adjusted hazard ratios (aHRs) with 95 % confidence interval (CI) were calculated. ResultsAmong incident HF patients, 11,469 (12 %) had diabetes, of whom 10,253 (89 %) had T2D and 1216 (11 %) had T1D. The 2-year incidence rates for a new subsequent HF were 4.8 % (95 % CI: 4.6–4.9) for patients without diabetes (reference group), 4.1 % (95 % CI: 3.8–4.6) for T2D, and 4.3 % (95 % CI: 3.3–5.6) for T1D. Corresponding aHRs were 1.01 (95 % CI 0.90–1.14) for T2D and 1.17 (95 % CI 0.87–1.58) for T1D. There was effect modification by sex, as women with T1D had an aHR of 1.52 (95 % CI: 1.09–2.11) for subsequent HF, and by specific diabetes complications (for example, patients with T2D and prior hypoglycemia had an aHR of 1.75 (95 % CI: 1.24–2.42) for subsequent HF, while patients with T1D and neuropathy had an aHR of 1.73 (95 %: 1.09–2.75), when compared with patients without diabetes).For fractures other than HF, the 2-year incidence rates were 7.3 % (95 % CI: 7.2–7.5) for patients without diabetes, 6.6 % (95 % CI: 6.1–7.1) for T2D, and 8.5 % (95 % CI: 7.0–10.1) for T1D, with corresponding aHRs of 1.01 (95 % CI 0.92–1.11) for T2D and 1.43 (95 % CI: 1.16–1.78) for T1D. T2D was only a risk factor for other subsequent fractures among HF patients of high age (age 86–89 years: aHR 1.22 (95 % CI 0.99–1.55), age 90+ years: aHR 1.37 (95 % CI 1.08–1.74)), whereas T1D was robustly associated with increased risk of fractures other than HF in all subgroups. ConclusionAmong HF patients, we found no strong overall association of T2D or T1D with increased risk of subsequent HF, but diabetes patients with prior hypoglycemic events or neuropathy were at increased risk. In contrast, patients with T1D had a clearly increased risk of subsequent fractures other than HF.

Presence of Co-morbid Depression among Diabetics of Less than 5 Years Duration in a Tertiary Care Institution, Chennai, Tamil Nadu, India: A Cross-sectional Study

Introduction: Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. Aim: To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. Materials and Methods: A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years’ duration. The prevalence of depression was calculated using Beck’s Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: The study included 500 participants, of whom the majority (276, 55%) were female, with a mean age of 46.2 years. The prevalence of depression was 55 (11%). It was found that being female, illiterate, and unemployed were significantly associated with depression. Among disease-related factors, diabetes duration of 3-5 years, insulin injection usage, and the presence of diabetic complications were significantly associated with depression. Regarding lifestyle factors, the prevalence of depression was significantly higher among those who were non adherent to dietary modification practices and those with family worries and work-related tension. Multivariable logistic regression analysis revealed that the independent predictors of depression among diabetics were the presence of diabetic complications {Odds Ratio (OR)-2.48 (1.27-4.84)}, family worries {OR-2.54 (1.34-4.80)}, non adherence to follow-up {OR-2.61 (1.37-4.99)}, and non compliance with dietary modifications {OR-2.93 (1.43-5.99)}. Conclusion: The present study revealed that about one in 10 (11%) diabetics with less than five years’ duration have associated depression, with significant independent predictors being non compliant behaviours, the presence of complications, and family issues. Hence, diabetics should be screened simultaneously for depression, giving due attention to those with complications, family issues, and non compliant behaviours.

Health Literacy and Complications in People With Type 2 Diabetes: An Exploratory Study.

A person with diabetes is subject to developing micro and macrovascular complications and prevention requires an active role from the person. So, health literacy should have a preponderant role in the health of people with diabetes but this link is yet not fully understood. The objectiveof this study is to understand the relationship between health literacy and the prevalence of complications in people with diabetes mellitus type 2 (DM2). This is a multicentric transversal observational exploratory study. A survey was conducted with two health literacy instruments, the Medical Term Recognition Test (METER) and Newest Vital Sign (NVS), filled out by people with DM2 coming to consultation in primary health centers in three main regions of Portugal. Results: In this sample (n=141), 50.6% were male, 41 to 88 years old, and 56% earned more than the minimum wage. Using the METER tool, it was found that 57.4% of the diabetic patients had functional literacy.Adequate literacy was found in 24.1%with the NVS tool. Also with the NVStool it was found that 36.2% of the sample subjects had s high probability of limited literacy. Utilizing the METER tool, a statistically significant decrease in health literacy was observed in individuals withdiabetic complications(p=0.001). There was no significant relation between the presence of diabetic complications and present blood pressure values, low-density lipoprotein, and socioeconomic index. In this study, we found a significant relation between lower health literacy and the presence of diagnosed DM2 complications (p=0.001).

Health-Related Quality of Life Assessment in Older Patients with Type 1 and Type 2 Diabetes.

Type 1 (T1D) and type 2 diabetes (T2D) are determinants of health-related outcomes including health-related quality of life (HRQOL). We aimed to determine differences in HRQOL between older adults with T1D and T2D and specific factors influencing HRQOL in this age group. This study used a cross-sectional design with 56 age- and HbA1c-matched T1D and T2D patients (aged 68.9 ± 7.8 years; 55% had T2D). We employed several validated questionnaires (Short Form-36 (SF-36) and the EuroQol-5 Dimensions/Visual Analog Scale (VAS)) to investigate the relationships between HRQOL domains and diabetes type, glycemic control, complications, and comorbidities. T1D was associated with better self-reported general health (assessed with the SF-36 general health domain (p = 0.048) and the EuroQol-5 VAS (p = 0.002), whereas no significant differences in the other SF-36 domains, self-reported diabetes distress, anxiety, or depression were found. Most HRQOL domains were not associated with HbA1c or the presence of diabetes complications. The most significant reduction in HRQOL was experienced by patients with higher BMIs, irrespective of the diabetes type. The obtained HRQOL data could be used in clinical settings for evidence-based patient education focused on specific subgroups of patients, as well as in national healthcare policies, e.g., interventions designed to alleviate obesity.

Is metformin the only culprit for cognitive impairment in diabetes?

Background: As patients with diabetes are conventionally on a long-term prescription for metformin, it is important to identify any increase in their risk for developing cognitive disorders due to metformin. Hence, an attempt was made to study the cognitive impairment by using Montreal Cognitive Assessment test (MoCA) as a possible predictor of development of cognitive impairment in type 2 diabetes patients on metformin therapy. Methods: Four hundred type 2 diabetes patients on metformin were enrolled for this cross-sectional study, and data recorded. Cognitive test MoCA was administered and a score less than 26 was considered abnormal. Results: In this study, the participants on metformin had a statistically significant correlation with age > 65 years, duration of diabetes (>5 years), metformin dose (1 gm and more) and presence of diabetes complications. Ordinal regressions showed significant correlation between abnormal MoCA scores and older age, longer duration of DM, and presence of one of the DM complications. Conclusions: Amongst patients receiving medical therapy for control of type 2 diabetes, participants using metformin showed a very high prevalence rate of abnormal MoCA scores (85%). Increased duration of metformin intake leads to a decline in MoCA performance.

930-P: Advanced Hybrid Closed-Loop System Is Associated with Increase in Tighter Glycemic Range—One-Year Observational Study

Background and Aims: Advanced hybrid closed loop systems (AHCL) are associated with improvement of HbA1c and time in range (TIR). However AHCL give the possibility to gain even tighter glycemic control. Thus, the aim of this study was to evaluate the efficacy of AHCL to increase time spent in tighter glycemic range (TR, 70-140 mg/dl) and to assess any difference between younger and older subjects. Methods: In an observational retrospective single center study, adults with T1DM using AHCL with predictive integrative derivative (PID) algorithm were enrolled. All participants were recruited at Diabetes Care Unit - Fondazione Policlinico Agostino Gemelli in Rome (IT). Data about TR and standardized metrics have been collected before starting AHCL and 3, 6, 9 and 12 months after AHCL initiation. We compared TR variation over time between younger (age <65 years) and older (≥65 years) subjects. Change in TR over time was evaluated with a linear mixed-effect model including age-group and presence of diabetic complications. Results: We enrolled 75 subjects with T1DM, age 50.5 (14.2) years [mean (standard deviation)], 35 females (46%), duration of disease 24.7 (13.3) years. 17 subjects (23%) were older and 58 (77%) were younger. 39 (52%) subjects were already using an insulin pump before starting AHCL and 36 (48%) were on multiple daily injections. HbA1c before AHCL was 7.6 (0.98) and 12 months after ACHL was 7.2 (0.6) (p=0.03). TR significantly increased over 12 months in the overall populations (TR before AHCL 37.6% (15.3) vs TR 12 months 52.9 % (12.8), p<0.001). Age or presence of complications did not affect the improvement of TR (p=0.38). TR 50% corresponded to mean TIR 76.2% Conclusions: AHCL is associated with significant improvement in tighter glycemic control. This improvement is not different between younger and older subjects. AHCL is an effective and safe system to aim to strict metabolic control in all subjects with T1DM. Disclosure A.Rizzi: None. L.Tartaglione: None. M.Leo: None. L.Lucaccini paoli: None. G.Tosti: None. V.Popolla: None. D.Pitocco: None.

Diet and exercise are a fundamental part of comprehensive care for type 2 diabetes.

Diet and exercise are a fundamental part of comprehensive care for type 2 diabetes.

419-P: Glucose-Induced Cellular Resistance to Methylglyoxal Is Lost in Patients with Diabetes Complications and Further Deteriorated after Caloric Restriction

Aim: Glucose stress can be protective against dicarbonyl-mediated toxicity. This study aimed to investigate cellular resistance against methylglyoxal (MG) after glucose stress in healthy humans (CON), patients with (T2D+) and without diabetes complications (T2D-) and whether this is affected by caloric restriction. Fibroblast growth factor 21 (FGF21) and β- hydroxybutyrate (β-HB) were analyzed as marker for metabolic adaptation to stress response and ketogenesis. Methods: Peripheral blood mononuclear cells were isolated before and 2h after oGTT and incubated at each time-point with increasing MG-levels for 24hrs. Cell viability was measured with CellTiter-Glo to determine changes of MG-resistance at 2h after oGTT (ΔEC50). Experiments were repeated after a 5-day fasting-mimicking diet (FMD). FGF21 and β-HB were measured in venous blood. Results: Thirty participants (18m/12f, age 64.6 [62.2, 67.0] y, BMI 28.6 [27.2, 30.0] kg/m2) were included. HbA1c was higher in T2D+ (7.4 [6.9, 7.9] %) and T2D- (7.0 [6.2, 7.7] %) compared to CON (5.5 [5.1, 5.8] %, p<0.001), age and BMI were comparable. ΔEC50 of MG increased in CON before and after FMD (12.9% vs. 12.6%), was unaffected in T2D- (1.8% vs. -1.7%) and decreased in T2D+ after FMD (-3.9% vs. -19.0%, p<0.01) and when compared to T2D- and CON (p<0.05). ΔFGF21 increased in CON after FMD (7.7% vs. 115.0%, p<0.05) and tended to be higher compared to T2D- and T2D+ (115.0% vs. 69.3% vs. 47.5%, p=0.5). ΔFGF21 correlated with β-HB (r = 0.48, p<0.01), with strongest correlation for T2D+. Conclusion: Acute glucose stress induces cellular resistance to MG in healthy humans, a response which is lost in T2D with diabetic complications and aggravates after caloric restriction. Our data suggest for an association between loss of capacity for handling dicarbonyl stress and the presence of diabetic complications. FGF21 might play an important role in the metabolic adaptation to dicarbonyl stress and ketosis. Disclosure E.V.Rauchhaupt: None. C.Rodemer: None. E.Kliemank: None. S.Kopf: Advisory Panel; Novo Nordisk, Bayer Inc., Recordati Rare Disease, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim. S.Herzig: Consultant; Novo Nordisk, Actimed, Research Support; Novo Nordisk, Boehringer-Ingelheim, Almac. P.Nawroth: None. J.Szendroedi: None. J.Zemva: None. A.Sulaj: None. Funding DFG; German Research Foundation (236360313-SFB, 1118DZD); German Center for Diabetes Research (82DZD07C2G)

Dengue clinical features and harbingers of severity in the diabetic patient: A retrospective cohort study on Reunion island, 2019

AimDiabetes mellitus is associated with both the risks of severe dengue and dengue-related deaths, however the factors characterizing dengue in the diabetic patient are ill-recognized. The objective of this hospital-based cohort study was to identify the factors characterizing dengue and those able to early identify dengue severity in the diabetic patient. MethodsWe retrospectively analysed demographic, clinical and biological parameters at admission in the cohort of patients who consulted at the university hospital between January and June 2019 with confirmed dengue. Bivariate and multivariate analyses were conducted. ResultsOf 936 patients, 184 patients (20%) were diabetic. One hundred and eighty-eight patients (20%) developed severe dengue according to the WHO 2009 definition. Diabetic patients were older and had more comorbidities than non-diabetics. In an age-adjusted logistic regression model, loss of appetite, altered mental status, high neutrophil to platelet ratios (>14.7), low haematocrit (≤ 38%), upper-range serum creatinine (>100 µmol/l) and high urea to creatinine ratio (>50) were indicative of dengue in the diabetic patient. A modified Poisson regression model identified four key independent harbingers of severe dengue in the diabetic patient: presence of diabetes complications, non-severe bleeding, altered mental status and cough. Among diabetes complications, diabetic retinopathy and neuropathy, but not diabetic nephropathy nor diabetic foot, were associated with severe dengue. ConclusionAt hospital first presentation, dengue in the diabetic patient is characterized by deteriorations in appetite, mental and renal functioning, while severe dengue can be early identified by presence of diabetes complications, dengue-related non-severe haemorrhages, cough, and dengue-related encephalopathy.

The prevalence of diabetes distress among patients with type 2 diabetes in Jordan

ObjectivesDiabetes distress (DD) is a state of emotional distress that evolves from living with chronic disease and the burden of daily adjustments of medications and lifestyle. This study investigated the prevalence of DD in patients with type 2 diabetes mellitus (T2DM) in Jordan and the related sociodemographic and medical factors. MethodsWe conducted a cross-sectional study in 608 patients with T2DM in Jordan, ranging from ages 15 to 80 years. The participants filled out a questionnaire where they were asked to self-assess their DD using the Diabetes Distress Scale. In all, 32 participants were excluded according to the exclusion criteria, which resulted in 576 people being included in this study. ResultsThe overall prevalence of DD was 53% (25% had moderate distress and 28% had high distress). Emotional distress had the highest prevalence among the DD subscales, with a total prevalence of 58.8%. The data showed a significant association of DD with different factors including age, the presence of diabetic complications, the type of medication used, and medication adherence. ConclusionThis study showed a high prevalence of DD (53%). This finding should raise awareness to healthcare providers about the importance of screening for DD as part of the treatment guidelines, especially in patients who are on multiple medication regimens for DM; patients who have previous medical complications related to DM; and those who exhibit poor adherence to medications, which was found to be a risk factor of DD in this study.

Psychopathological aspects in patients with diabetes

IntroductionThis paper highlights the mutual influences and the relationships between the variables of type II diabetes, the type of psychiatric conditions, the administered treatment schemes, the imaging examinations and the impact on the functioning and quality of life of the patients.ObjectivesAnalysis of the influences between diabetes and psychiatric disorders, studying the relationships between the variables of type 2 diabetes, the type of psychiatric disorders, treatmentregimens, imaging examinations and the impact on the functioning and quality of life of patients.MethodsPsychiatric interview, Hamilton, Reisberg and Rosenberg scales, laboratory analysysResultsPatients with pre-existing diabetes, psychiatric disorders led to deterioration of its evolution, documented by HbA1c values, treatment schedule, frequency of diabetic emergencies; the increased frequency of psychotic phenomena (hallucinations and delusional ideas) is directly proportional to the number of diabetic emergencies; patients with uncontrolled, long-term diabetes have higher scores on HAM-D and Reisberg scales, while patients with controlled diabetes have higher scores on the self-esteem and quality of life scales; in patients with taste or odor disorders, cortical atrophy may be seen on CT examination, elevated HbA1c levels and the presence of polyneuropathy; alcohol consumption, smoking, high cholesterol levels, determine the advancement of diabetic complications, and these in turn correlate with higher scores on the HAM-D scales, Reisberg; patients who show large variations in blood glucose in the first days after hospitalization are those who exhibit irritability, irritability, nervousness and heteroaggression at the time of hospitalization;Conclusions65% patients with depressive disorders, 10% - with organic personality disorder, 25% - with affective disorders and 30% associated with cognitive impairment. The duration of diabetes mellitus, glycosylated hemoglobin levels and the presence of diabetic complications is directly related to the HAM-D and Reisberg scores; and inversely proportional to quality of life scores and self-esteem.Disclosure of InterestNone Declared

A cukorbetegség szövődményeinek összefüggése a depressziós és szorongásos tünetekkel

The bidirectional relationship between diabetes and depression results in severe disease burden. Co-occurring depression is associated with a higher rate of diabetes complications. These complications impair quality of life, however, their impact on depressive symptoms is controversial. In our cross-sectional study, we aimed to investigate whether the presence of diabetes complications is associated with depressive and anxiety symptoms among patients with type 2 diabetes in general practice. We obtained patient history, anthropometric, socioeconomic, laboratory parameters. For symptom assessment, the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. We collected data between September 2018 and February 2020. We included 338 consecutive patients with type 2 diabetes. The mean age of the sample was 63.98 ± 11.51 (years ± SD), 61.2% of participants were female. We found significant univariate association between diabetes complications and older age, less physical activity, higher body mass index, insulin therapy, higher HbA1c, higher creatinine and carbamide concentrations, worse depressive and anxiety symptoms. In multivariate analysis, diabetes complications and certain socio-demographic factors (female gender, lower education, rural-dwelling) were the determinants of higher BDI and HAM-A scores. Among primary care patients with type 2 diabetes, the prevalence of depressive and anxiety symptoms was higher and more severe in patients with diabetes complications. The recommended screening for affective disorders among patients with diabetes is especially justified if complications are present. Orv Hetil. 2023; 164(3): 79-87.

Clinical practice recommendations for diabetes in pregnancy (Update 2023)

In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in women with diabetes and those with normal glucose tolerance. However, currently women with pre-gestational diabetes still feature ahigher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to apersistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. All women should be experienced in the management of their therapy and on stable glycemic control prior to conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded or treated adequately before pregnancy in order to decrease the risk for aprogression of complications during pregnancy as well as maternal and fetal morbidity. Near normoglycaemia and HbA1c in the normal range are targets for treatment, preferably without the induction of frequent resp. severe hypoglycaemic reactions. Especially in women with type1diabetes mellitus the risk of hypoglycemia is high in early pregnancy, but it decreases with the progression of pregnancy due to hormonal changes causing an increase of insulin resistance. In addition, obesity increases worldwide and contributes to higher numbers of women at childbearing age with type2diabetes mellitus and adverse pregnancy outcomes. Intensified insulin therapy with multiple daily insulin injections and pump treatment are equally effective in reaching good metabolic control during pregnancy. Insulin is the primary treatment option. Continuous glucose monitoring often adds to achieve targets. Oral glucose lowering drugs (Metformin) may be considered in obese women with type2diabetes mellitus to increase insulin sensitivity but need to be prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring (shared decision making). Due to increased risk for preeclampsia in women with diabetes screening needs to be performed. Regular obstetric care as well as an interdisciplinary treatment approach are necessary to improve metabolic control and ensure the healthy development of the offspring.

Health-Related Quality of Life Using EQ-5D-3L Utility Score Among Type 2 Diabetes Patients: Experiences from Tigray Region, Northern Ethiopia.

To assess the health-related quality of life and associated factors among type 2 diabetic patients in Ayder Comprehensive Specialized Hospital, Northern Ethiopia, 2019. A hospital-based cross-sectional study was conducted among 415 type 2 diabetic patients coming to receive their routine outpatient follow-up service during the study period, from January 1, 2019, to March 31, 2019, in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. The EQ-5D-3L instrument was used to assess the patients' self-reported health status and a multivariable ordinal logistic regression model was used to determine the independent factors associated with the health-related quality of life and P-value <0.05 was used to declare statistical significance. The total mean quality of life score was 0.73 ± 0.23 with the total quality-adjusted life year of 2172.60 per life years and an average of 7.4 years of follow-up with type 2 diabetic treatments. Quality of life of type 2 diabetic patients with level two and three anxious patients were 77% and almost three times more likely to be affected than level one anxious patients (AOR = 1.77; 95% CI 1.23-1.86) and (AOR = 2.74; 95% CI 1.24-2.84) respectively. Older age, occupational status, lower monthly income, long waiting time, and presence of diabetic complications were significantly associated with impaired health-related quality of life. The results of this study revealed a relatively low health status among type 2 diabetic patients. Quality of life of type 2 diabetic patients was mostly affected in the anxiety and depression component. It could be worthwhile if hospitals assign psychiatric professionals for the regular and effective counseling of diabetic patients.

Factors Associated With Dietary Behaviour Among Patients With Type 2 Diabetes Mellitus in Rural Indonesia.

Type 2 Diabetes Mellitus (T2DM) is one of the fastest-growing diseases and most serious major health problems worldwide. Few studies have focused on the association of social support with diabetes-related dietary behaviour. To examine the relationship between social support and dietary behaviour among patients with diabetes in a rural area of Indonesia. This was a descriptive cross-sectional study that included 120 physically healthy patients above 18 years old with T2DM for at least 6 months. Data analysis was done using a stepwise regression model. The mean age was 61.97 years (SD = 7.85, range = 52-74); 86.7% of the participants were females. Social support (β = 0.272, p = <0.001), diabetes medications (β = 0.169, p = 0.003), duration of diabetes (β = 0.118, p = 0.0047), and presence of diabetes complications (β = 0.197, p = 0.008) were significant predictors of dietary behaviour and accounted for 34.2% of the variance. Social support, diabetes medications, presence of diabetes complications, and duration of diabetes were associated with improved dietary behaviour. Therefore, social support should be considered when designing dietary interventions for patients with type 2 diabetes mellitus.

Assessment of the work ability related factors in diabetic patients

Diabetes is a common disease all around the world. Diabetes can reduce work and job restrictions. The aim of this study was to assessment of work ability (WA) related factors in diabetic patients. All demographic, occupational, and clinical information of 176 diabetic patients who were referred to the Razi hospital Rasht, Iran, in 2021 was collected. Also, the WA questionnaire for patients with a score from 7 to 49 was completed. The mean score of WA in patients was 28.8. 46.6%, 28.4%, 22.2%, and 2.8% of patients had weak, moderate, good, and excellent WA, respectively. There was a significant association between age, body mass index (BMI), marital status, education, habitat, health insurance status, type of job, job satisfaction status, work shift, underlying disease, history of diabetes, complications of diabetes, fasting blood sugar (FBS), hemoglobin A1c (HbA1C), and WA of patients (P < 0.05). Analysis showed that the variables of job satisfaction and the presence of diabetes complications were significantly associated with the WA. Nearly half of the diabetic patients had weak WA, in which demographic, occupational, and diabetes related factors were associated with weak WA.

Lower Blood Oxygen Saturation is Associated With Microvascular Complications in Individuals With Type 1 Diabetes.

Blood oxygen saturation (SpO2) is lower in type 1 diabetes (T1D) compared with nondiabetic controls. Hypoxia (low tissue oxygenation) is thought to be a risk factor for progression of diabetic complications, but it is unknown whether hypoxemia (low SpO2) is associated with diabetic complications. To test if hypoxemia is associated with presence of diabetic complications in T1D. Cross-sectional study in persons with T1D divided by a previously suggested threshold in low (<96%) and high (≥96%) SpO2, measured in the supine position with pulse oximetry. Complications included albuminuria (2 of 3 consecutive measurements ≥30 mg/g), any diabetic retinopathy, neuropathy, and history of cardiovascular disease (CVD). Odds ratios were adjusted for age, diabetes duration, sex, smoking, physical activity, body mass index, systolic blood pressure, and blood hemoglobin. We included 659 persons, 23 (3.5%) with low and 636 (96.5%) with high SpO2. In total, 151 (23%) had albuminuria, 233 (36%) had retinopathy, 231 (35%) had neuropathy, and 72 (11%) had CVD. The adjusted odds ratio (95% CI, P value) for low vs high SpO2 was 3.4 (1.3-8.7, P = 0.01) for albuminuria, 2.8 (1.0-7.5, P = 0.04) for retinopathy, 5.8 (1.8-18.6, P < 0.01) for neuropathy, and nonsignificant for CVD (0.6 [0.2-2.4, P = 0.51]). SpO2 below 96% was associated with increased presence of albuminuria, retinopathy, and neuropathy in T1D, but not with CVD. Whether hypoxemia could be a target of intervention to prevent progression in microvascular disease in type 1 diabetes should be investigated.

Improved metabolic parameters of people with diabetes attending an Aboriginal health service in regional Victoria.

Aboriginal and Torres Strait Islander people have higher rates of diabetes and its complications than non-Aboriginal people. Rumbalara Aboriginal Co-operative is the major primary healthcare provider for Aboriginal people in the Greater Shepparton region. To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co-operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. Clinical and biochemical characteristics, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro- and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG-CoA reductase inhibitors and antiplatelet agents, were determined. One hundred and twenty-six individuals had diabetes, 121 had type 2 diabetes. One hundred and thirteen identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48-68) years, median HbA1c was 7.8% (6.8-9.6) and median BMI was 33.4 kg/m2 (29-42.3). Compared with other Australian Aboriginal and Torres Strait Islander populations, this population was older and had more obesity, but with better glycaemia management. Compared with specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the past 5 years.

Можливості впливу засобів фізичної терапії на перебіг цукрового діабету та розвиток діабетичних ускладнень

According to the latest data from the World Health Organization experts, the incidence of diabetes mellitus in economically developed countries of the world is up to 6% of the population. Throughout the world and in Ukraine in particular, diabetes mellitus is one of the most common chronic non-infectious diseases. Complications of diabetes mellitus occupy the third place among various causes of death. The use of modern pharmacological agents in the treatment of diabetes mellitus does not solve all the problems of this difficult and multifaceted pathology, therefore the search for non-pharmacological methods of physical therapy and rehabilitation of such patients remains relevant and has been studied insufficiently. In addition, an effective combination of drug and physical treatment methods can accelerate the achievement of diabetes compensation, prevent or cause regression of the development of neurovascular complications. The purpose of the study was to discuss the possibilities of the influence of physical therapy on the course of diabetes mellitus and the development of diabetic complications at the current stage. Results. In accordance with modern requirements, rehabilitation of patients with diabetes mellitus and diabetic complications is carried out in acute, subacute and long-term rehabilitation periods at the inpatient and outpatient stages of treatment. Properly dosed physical activity has a positive effect on all types of metabolism; this may allow to reduce the level of glycemia, increase the number of insulin receptors and their sensitivity, as well as reduce the doses of hypoglycemic drugs. Physical therapy has a positive effect on the condition of the central and peripheral nervous system, the disorders of which are important in the development of diabetic complications. The level of physical exertions should correspond to the patient's state of health, his/her physical capabilities, taking into account the stage and state of compensation of the disease, the presence of diabetic complications. The probability of success in physical therapy for such patients depends on the complex of physical therapy tools in combination with physiotherapeutic methods and massage. The effectiveness and safety of the physical therapy should be monitored by the dynamics of glycemia, glycosuria, and body weight. Conclusion. Therefore, the modern strategy of complex management of diabetic patients from the standpoint of physical and rehabilitation medicine involves a multidisciplinary approach with the inclusion of effective means of physical therapy, rehabilitation technologies, physiotherapeutic methods, as well as ergotherapeutic measures aimed at increasing functional reserves, compensation of impaired vascular and innervation mechanisms, regeneration capabilities, secondary prevention of diabetic complications, social adaptation and restoration of working capacity of patients

A longitudinal assessment of diabetes autoantibodies in the SEARCH for diabetes in youth study.

To assess changes in diabetes autoantibodies (DAs) over time in children and young adults with diabetes and determine whether observed changes were associated with demographic characteristics, clinical parameters and diabetes complications. Participants had DAs measured at baseline (10.3 ± 7.1 months after diabetes diagnosis) and at 12, 24months and ≥5 years after the baseline measurement. At the ≥5-year follow-up, the presence of diabetes complications was assessed. We examined the associations between change in number of positive DAs and changes in individual DA status with the participants' characteristics and clinical parameters over time. Out of 4179 participants, 62% had longitudinal DA data and 51% had complications and longitudinal DA data. In participants with ≥1 baseline positive DA (n=1699), 83.4% remained positive after 7.3 ± 2.3 years duration of diabetes. Decrease in number of positive DAs was associated with longer diabetes duration (p=0.003 for 1 baseline positive DA; p < 0.001 for 2 baseline positive DAs) and younger age at diagnosis (p < 0.001 for 2 baseline positive DAs). No associations were found between change in number of positive DAs in participants with ≥1 baseline positive DA (n=1391) and HbA1c, insulin dose, acute, or chronic complications after 7.7 ± 1.9 years duration of diabetes. DA status likely remains stable in the first 7 years after diabetes diagnosis. Younger age at diabetes diagnosis and longer duration were associated with less persistence of DAs. Measuring DAs after initial presentation may aid in diabetes classification but not likely in predicting the clinical course.