Presence Of Diabetic Complications Research Articles

A study to assess the Knowledge, expressed Practice and Attitude regarding Diabetic Foot care in patient with Diabetes at Mathura Das Mathur Hospital Jodhpur

This study was to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes “A study to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes at Mathura Das Mathur Hospital Jodhpur” was conducted by Barkha Blossam Francis at Government College of Nursing, Jodhpur. 100 samples were selected using Non – probability convenient sampling technique The knowledge used questionnaire, practice checklist, attitude scale method to assess the knowledge, expressed practice and attitude regarding diabetic foot care in patient with diabetes. The majority of samples 49% had poor knowledge, 39% had good practice score and 46% had favorable attitude in the diabetic foot care in patient with diabetes mellitus. Data showed that that there is no relation found between the knowledge regarding diabetic foot care among patients with diabetes mellitus with the selected demographical variables, in terms of gender, religion, area of living, duration of illness diagnosed, type of diabetes, presence of diabetic complications, with the selected demographical variables. And there is relation found between knowledge regarding diabetic foot care among patients with diabetes mellitus with expressed practice and attitude of diabetic patient. There is positive correlation between knowledge, expressed practice and attitude of diabetes patients.

Depression and Anxiety Screening of Patients With Type II Diabetes Mellitus Attending Primary Healthcare Centers in Saudi Arabia.

Diabetes mellitus is a chronic condition affecting both physical and mental health. High blood sugar levels can lead to serious complications if not managed properly. Individuals with diabetes are also at a higher risk of developing mental health disorders like depression and anxiety. The objective was to assess the prevalence of depression and anxiety among patients with type II diabetes attending primary healthcare centers in Makkah, Saudi Arabia. An analytical cross-sectional study design was employed, targeting adults with type II diabetes attending primary healthcare centers in Makkah. A total sample size of 412 participants was selected through systematic random sampling. Data were collected using validated Arabic versions of the patient health questionnaire (PHQ-9) and the general anxiety disorder (GAD-7) questionnaire, along with demographic information. Statistical analysis was conducted with non-parametric tests used to evaluate the significance of outcome variables. The median age of participants was 47 years, with 237 (57.5%) being male and 373 (90.5%) Saudi nationals. Neuropathy was the most prevalent complication, affecting 181 (43.9%) of participants. The median GAD-7 score was 5, and the median PHQ-9 score was 7. Mild to moderate depression was observed in 224 (54.4%), and 194 (47%) had mild-to-moderate anxiety. Significant associations were found between mental health outcomes and several factors: nationality (non-Saudis showed higher depression and anxiety scores, p = 0.010 and p = 0.020, respectively), marital status (divorced participants had the highest mean ranks for both conditions, p = 0.003 for depression and p < 0.001 for anxiety), and monthly income (p = 0.007 for depression and p = 0.008 for anxiety). Additionally, the presence of diabetes complications was strongly associated with higher depression and anxiety scores (p < 0.001 for both). The findings indicate a high prevalence of depression and anxiety among patients with type II diabetes in Makkah. These mental health issues are significantly associated with socio-demographic factors and diabetes complications. Integrated medical and psychological care is needed to improve the quality of life and treatment outcomes for diabetic patients.

A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus

AimThere is an ongoing search for novel biomarkers of diabetes. We conducted a systematic review and meta-analysis of the serum concentrations of ischemia-modified albumin (IMA), a candidate biomarker of oxidative stress, acidosis, and ischemia, in patients with pre-diabetes, different types of diabetes mellitus (type 1, T1DM, type 2, T2DM, and gestational, GDM), and healthy controls. MethodsWe searched for case-control studies published in PubMed, Web of Science, and Scopus from inception to December 31, 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. ResultsIn 29 studies, T2DM patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 1.83, 95 % CI 1.46 to 2.21, p˂0.001; I2 = 95.7 %, p < 0.001; low certainty of evidence). Significant associations were observed between the SMD and glycated hemoglobin (p = 0.007), creatinine (p = 0.003), triglycerides (p = 0.029), and the presence of diabetes complications (p = 0.003). Similar trends, albeit in a smaller number of studies, were observed in T1DM (two studies; SMD = 1.59, 95 % CI -0.09 to 3.26, p˂0.063; I2 = 95.8 %, p < 0.001), GDM (three studies; SMD = 3.41, 95 % CI 1.14 to 5.67, p = 0.003; I2 = 97.0 %, p < 0.001) and pre-diabetes (three studies; SMD = 15.25, 95 % CI 9.86 to 20.65, p˂0.001; I2 = 99.3 %, p < 0.001). ConclusionOur study suggests that IMA is a promising biomarker for determining the presence of oxidative stress, acidosis, and ischemia in pre-diabetes and T1DM, T2DM, and GDM. However, the utility of measuring circulating IMA warrants confirmation in prospective studies investigating clinical endpoints in pre-diabetes and in different types of diabetes (PROSPERO registration number: CRD42024504690).

Prevalence of diabetes distress and its correlates among adults with type 2 diabetes mellitus in a primary health center of Bihar - A cross-sectional study.

Diabetes is a chronic disease associated with many complications. Approximately 20% of people living with diabetes suffer from some form of depression. "Diabetes distress" (DD) is used to describe the significant negative psychological reactions related to emotional burdens and worries specific to an individual's experience to manage severe, complicated chronic disease such as diabetes. To determine the proportion having DD and to identify the sociodemographic and morbidity related factors associated with the presence of DD among adults with Type2DM who are being treated at PHC Naubatpur, Bihar. This facility based cross-sectional analytical study was done over 3 months among 260 Type2DM patients attending PHC Naubatpur. Sociodemographic details and morbidity related details were collected followed by PAID questionnaire to assess DD. Around 60% of the participants were of age ≤60 years. Majority (63.8%) of the participants were having diabetes from past 1-10years. One-fourth (24.6%) of them were having score of ≥40, therefore having DD. Alcohol consumption and presence of diabetes complications in the participants were found to be independent predictors of DD. This study showed a high (24.6%) prevalence of DD. It is essential to identify high-risk patients with different mental health needs. Healthcare providers should focus on reducing DD and devise ways to increase self-care practices and coping skills.

Perspective of Continuous Glucose Monitoring-Based Interventions at the Various Stages of Type 2 Diabetes.

Continuous glucose monitoring (CGM) is now advocated for the clinical management of individuals with type 1 diabetes (T1D). However, this glucose monitoring strategy is not routinely used in type 2 diabetes (T2D), given the large population, significant cost implications and relatively limited supporting evidence. T2D is a more heterogenous condition compared with T1D with various glucose lowering therapies that do not necessarily require CGM to ensure within target glucose levels. While all individuals with T2D may benefit from CGM at certain time points, the whole T2D population does not necessarily require this technology continuously, which should be prioritized based on patient benefit and cost effectiveness. In this pragmatic opinion piece, we describe the rationale and evidence for CGM use in different subgroups of individuals with T2d, divided according to the stage of the condition, glycemic therapies, presence of diabetes complications, or associated co-morbidities. We discuss a total of 16 T2D subgroups and provide a clinical view on CGM use in each, based on current evidence while also highlighting areas of knowledge gaps. This work provides health care professionals with a simple guide to CGM use in different T2D groups and gives suggestion for future studies to justify expansion of this technology.

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 &lt;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.

The prevalence of fibromyalgia in patients with diabetes mellitus presenting to primary health care and specialized diabetes clinics in Riyadh, Saudi Arabia

Objective: This study aimed to estimate fibromyalgia Syndrome (FMS) prevalence in diabetes mellitus (DM) patients and explore associated factors. Methods: A cross-sectional study was conducted from June 2023 to February 2024 at King Khalid University Hospital in Riyadh, Saudi Arabia, targeting DM patients aged 18 years and above. A non-probability sampling technique was utilized. Participants were screened for FMS using the Arabic fibromyalgia rapid screening tool. Results: A total of 224 participants were included. The prevalence of FMS was 12.5%. A significant gender disparity was observed to be greater in females (OR = 4.32, 95% CI: 1.63-13.2, p = 0.005). No significant correlation was found between FMS prevalence and HbA1c levels (p = 0.215). Moreover, the presence of diabetic complications, namely diabetic foot, was significantly associated with FMS (OR = 5.68, 95% CI: 1.57-20.5, p = 0.007). Noteworthy, a prior diagnosis with psychiatric illness showed higher odds of fibromyalgia (OR= 7.42, 95% CI: 1.88-31.1, p = 0.004) Conclusion: The study revealed a significant prevalence of FMS among DM patients in Riyadh, underscoring the need for healthcare professionals to incorporate FMS screening into routine diabetic care, particularly for females and those with diabetic complications. This approach would ensure a holistic management strategy for DM patients, potentially improving their quality of life. Further research is warranted to explore the mechanisms linking DM and FMS.

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 &gt; 65 years, duration of diabetes (&gt;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 &amp;lt;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&amp;lt;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&amp;lt;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&amp;lt;0.01) and when compared to T2D- and CON (p&amp;lt;0.05). ΔFGF21 increased in CON after FMD (7.7% vs. 115.0%, p&amp;lt;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&amp;lt;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.