Prevalence Of Diabetic Complications Research Articles

Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study

Cluster analyses have proposed different diabetes phenotypes using age, BMI, glycaemia, homoeostasis model estimates, and islet autoantibodies. We tested whether comprehensive phenotyping validates and further characterises these clusters at diagnosis and whether relevant diabetes-related complications differ among these clusters, during 5-years of follow-up. Patients with newly diagnosed type 1 or type 2 diabetes in the German Diabetes Study underwent comprehensive phenotyping and assessment of laboratory variables. Insulin sensitivity was assessed using hyperinsulinaemic-euglycaemic clamps, hepatocellular lipid content using magnetic resonance spectroscopy, hepatic fibrosis using non-invasive scores, and peripheral and autonomic neuropathy using functional and clinical criteria. Patients were reassessed after 5 years. The German Diabetes Study is registered with ClinicalTrials.gov, number NCT01055093, and is ongoing. 1105 patients were classified at baseline into five clusters, with 386 (35%) assigned to mild age-related diabetes (MARD), 323 (29%) to mild obesity-related diabetes (MOD), 247 (22%) to severe autoimmune diabetes (SAID), 121 (11%) to severe insulin-resistant diabetes (SIRD), and 28 (3%) to severe insulin-deficient diabetes (SIDD). At 5-year follow-up, 367 patients were reassessed, 128 (35%) with MARD, 106 (29%) with MOD, 88 (24%) with SAID, 35 (10%) with SIRD, and ten (3%) with SIDD. Whole-body insulin sensitivity was lowest in patients with SIRD at baseline (mean 4·3 mg/kg per min [SD 2·0]) compared with those with SAID (8·4 mg/kg per min [3·2]; p<0·0001), MARD (7·5 mg/kg per min [2·5]; p<0·0001), MOD (6·6 mg/kg per min [2·6]; p=0·0011), and SIDD (5·5 mg/kg per min [2·4]; p=0·0035). The fasting adipose-tissue insulin resistance index at baseline was highest in patients with SIRD (median 15·6 [IQR 9·3-20·9]) and MOD (11·6 [7·4-17·9]) compared with those with MARD (6·0 [3·9-10·3]; both p<0·0001) and SAID (6·0 [3·0-9·5]; both p<0·0001). In patients with newly diagnosed diabetes, hepatocellular lipid content was highest at baseline in patients assigned to the SIRD cluster (median 19% [IQR 11-22]) compared with all other clusters (7% [2-15] for MOD, p=0·00052; 5% [2-11] for MARD, p<0·0001; 2% [0-13] for SIDD, p=0·0083; and 1% [0-3] for SAID, p<0·0001), even after adjustments for baseline medication. Accordingly, hepatic fibrosis at 5-year follow-up was more prevalent in patients with SIRD (n=7 [26%]) than in patients with SAID (n=5 [7%], p=0·0011), MARD (n=12 [12%], p=0·012), MOD (n=13 [15%], p=0·050), and SIDD (n=0 [0%], p value not available). Confirmed diabetic sensorimotor polyneuropathy was more prevalent at baseline in patients with SIDD (n=9 [36%]) compared with patients with SAID (n=10 [5%], p<0·0001), MARD (n=39 [15%], p=0·00066), MOD (n=26 [11%], p<0·0001), and SIRD (n=10 [17%], p<0·0001). Cluster analysis can characterise cohorts with different degrees of whole-body and adipose-tissue insulin resistance. Specific diabetes clusters show different prevalence of diabetes complications at early stages of non-alcoholic fatty liver disease and diabetic neuropathy. These findings could help improve targeted prevention and treatment and enable precision medicine for diabetes and its comorbidities. German Diabetes Center, German Federal Ministry of Health, Ministry of Culture and Science of the state of North Rhine-Westphalia, German Federal Ministry of Education and Research, German Diabetes Association, German Center for Diabetes Research, Research Network SFB 1116 of the German Research Foundation, and Schmutzler Stiftung.

A comparative study of the clinical profile of fibrocalculous pancreatic diabetes and type 2 diabetes mellitus

AimsThe present study aimed to compare the clinical characteristics of patients with fibrocalculous pancreatic diabetes (FCPD) and those with type 2 diabetes mellitus (T2DM) to identify the characteristics distinctive of FCPD. MethodsA total of 133 patients with FCPD were compared with 665 patients with T2DM matched for duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular and macrovascular complications in both groups. ResultsThe mean duration of diabetes was 4.42 ± 5.65 years in the FCPD group and 4.51 ± 3.88 years in the T2DM group. FCPD participants were significantly younger at diagnosis and leaner than patients with T2DM. The FCPD group had higher fasting and postprandial glucose and HbA1c levels than the T2DM group. The FCPD group had significantly lower triglyceride, total cholesterol, low-density lipoprotein cholesterol, serum total calcium, hemoglobin, and serum creatinine values than the T2DM group. The prevalence of coronary artery disease, stroke, and retinopathy was significantly higher in the T2DM patients while the prevalence of distal symmetric polyneuropathy was significantly lower. On multivariate logistic regression analysis, duration of diabetes and HbA1c (OR = 1.17, P = 0 0.04) in FCPD patients and age (OR = 1.04, P < 0 0.001), duration of diabetes (OR = 1.17, P < 0 0.001) and HbA1c (OR = 1.28, P < 0.001) in T2DM patients were associated with microvascular complications. ConclusionsThere are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM. Timely diagnosis may have implications in the follow-up and management of patients.

The Clinical Spectrum of Fibrocalculous Pancreatic Diabetes in Kashmir Valley and Comparative Study of the Clinical Profile of Fibrocalculous Pancreatic Diabetes and Type 2 Diabetes Mellitus.

Background:Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes, described from several tropical countries, including India. We described the existence of this entity in the subtropical region-the Kashmir valley of the Indian subcontinent and compared the clinical characteristics of these patients with type 2 diabetes mellitus (T2DM) patients.Aim:The present study aimed to compare the clinical characteristics of patients with FCPD and those with T2DM to identify the characteristics distinctive of FCPD.Materials and Methods:A total of 124 patients with FCPD were compared with 124 patients with T2DM matched for age and duration of diabetes. Biochemical parameters and microvascular and macrovascular complications were assessed in all patients. Multivariate regression analyses were performed to study the determinants of microvascular complications in both groups.Results:FCPD patients had significantly lower serum cholesterol, serum triglyceride, and serum calcium levels but higher glycosylated hemoglobin levels compared to T2DM patients. FCPD participants were significantly leaner. The prevalence of retinopathy, neuropathy, and nephropathy was similar between the two. Five T2DM patients had documented cardiovascular disease compared to one in FCPD patients (P < 0.05). Multiple logistic regression analysis revealed glycosylated hemoglobin and duration of diabetes to be significantly associated with retinopathy and nephropathy in T2DM. Among FCPD patients, glycosylated hemoglobin showed a strong association with retinopathy as well as nephropathy. BMI showed a significant negative association with nephropathy in FCPD patients. Age and age at onset showed a strong association with neuropathy in FCPD patients while the duration of diabetes showed the association with neuropathy (P = 0.015) in T2DM.Conclusion:There are several differences in the phenotype, biochemical parameters, and prevalence of diabetic complications between patients with FCPD and T2DM.

CLINICAL EVALUATION OF MANAGEMENT AND PREVALENCE OF TYPE TWO DIABETES MELLITUS COMPLICATIONS IN SOUTH INDIAN POPULATION

Objective: The present study was aimed to assess the prevalence of complications and to assess the targets achieved during the management of diabetes mellitus type 2.Methods: The study was prospective and conducted out in a diabetes center, Chennai, ethical approval was obtained from the Institutional Ethics Committee, case records of the 300 patients diagnosed with type 2 diabetes mellitus and its complications were monitored during March 2017–April 2018. Major result actions are body weight, height, body mass index (BMI), blood pressure, fasting blood sugar (FBS), post-prandial blood sugar (PPBS) levels, glycosylated hemoglobin, serum lipids, and presence of complications of diabetes. Comparison of the average of various biochemical parameters was made in patients with and no diabetic complications.Results: The average age of 300 patients was found to be 55.006±13.04. The average BMI was 27.10±12.81 kg/m2. The average duration of diabetes was 10.48±7.53. The average of systolic (SBP) and diastolic blood pressure was 137±20.88 and 79.95±11.81. The mean glycated hemoglobin, FBS, PPBS, low-density lipoprotein, high-density lipoprotein, and triglyceride, and total cholesterol were found to be 8.5±3.99, 148.85±55.64 mg/dl, 200.98±72.63 mg/dl, 88.06±19.46 mg/dl, 36.20±8.27 mg/dl, 141.22±60.15 mg/dl, and 144.45±29.03 mg/dl, respectively. Among the microvascular complications; neuropathy, nephropathy, and retinopathy were documented in 8.33%, 23.66%, and 17.33% of patients, respectively. The prevalence of peripheral artery disease was 20.66%.Conclusion: The prevalence of diabetic complications is significantly increased with patients age, duration, SBP, low-density lipoprotein,total cholesterol, and post-prandial blood sugar levels. Knowledge concerning the supervision of target blood pressure and lipidparameters is need further than the glycemic manage among diabetes patients type two.

Benchmarks of Diabetes Care in Men Living With Treated HIV-Infection: A Tertiary Center Experience.

Treated human immunodeficiency virus (HIV) infection is associated with high rates of type 2 diabetes mellitus (DM), metabolic syndrome and central obesity/body fat partitioning disorders. To our knowledge, there are no available data comparing diabetes care in people with both HIV+DM vs. DM alone (DM-controls) within the same service and evaluating if benchmarked standards of care are being met in people with HIV+DM. This study evaluated the frequency that people with HIV+DM met the benchmarked American Diabetes Association (ADA) standards of care in diabetes (targets for HbA1c, blood pressure, lipid levels, complication screening, and healthy weight), compared to age- and sex- matched controls with diabetes, in an urban teaching hospital. The frequency of diabetes complications and rates of obesity and metabolic syndrome were also examined. All participants were male; individuals with HIV+DM (n = 30) were similar to DM-controls (n = 30) for age, diabetes duration and smoking status, but were more frequently non-obese compared to DM controls (92 vs. 55%, respectively, p = 0.003). Only 41% of HIV+DM met HbA1c targets, compared with 70% of DM-controls (p = 0.037). Blood pressure targets were poorly met in both HIV+DM and DM-controls: 43 vs. 23%, respectively (p = 0.12); LDL cholesterol targets were met in 65 vs. 67% (p = 1.0). Benchmarked complication screening rates were similar between HIV+DM vs. DM-controls for annual foot examination (53 vs. 67%, respectively, p = 0.29); biennial retinal examination (83 vs. 77%, respectively, p = 0.52); and annual urinary albumin measurement (77 vs. 67%, respectively, p = 0.39). The prevalence of diabetes complications was similar between HIV+DM compared to DM-controls: macrovascular complications were present in 23% in both groups (p = 1.0); the prevalence of microvascular complications was 40 vs. 30%, respectively (p = 0.51). Achieving the standard of care benchmarks for diabetes in people with both HIV-infection and diabetes is of particular importance to mitigate against the accelerated cardiometabolic outcomes observed in those with treated HIV infection. HIV+DM were less likely to achieve HbA1c targets than people with diabetes, but without HIV. People with HIV+DM may require specific strategies to ensure care benchmarks are met.

Prevalence of diabetic complications and risk factors among diabetic foot ulcer patients: a retrospective hospital-based study

Background: Diabetic foot ulcer is a painful, demands increased health care utilization, and increases healthcare costs for the patients as well as the health care system. The purpose of this study was to analysis the prevalence of diabetic foot complications and risk factors among diabetic patients at tertiary care Hospital, Karimnagar.Methods: Total 60 sample sizes were included in the study. The study was conducted at General Surgery ward, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from July 2017 to June 2018. Demographic, complications and risk factors were recorded, and outcomes were analyzed using SPSS statistics version 21.0.Results: The Mean age of the study group is 50.31±14.26 years. The male to female distribution is 47 (78.3%) and 13 (21.7%) respectively. The mean duration of illness in days is 96.68±289.21, while mean HbA1C is 9.44±9.02. The mean fasting blood sugar and postprandial blood sugar is 159.78±70.01 and 157.78±86.28 which shown no significance difference (p = 0.87). Odds ratio with 95% confidence interval was computed to the level of significant.Conclusions: There was no significant outcome was found in diabetic foot ulcer. Patient with high risk complications need as early detection, foot care education, moderate physical, exercise, fitted foot wear and diabetic diet should be decrease the risk of diabetic foot ulcers.

Stratification of type 2 diabetes based on routine clinical markers

AimsWe hypothesized that patients with dysregulated type 2 diabetes may be stratified based on routine clinical markers. MethodsIn this retrospective cohort study, diabetes related clinical measures including age at onset, diabetes duration, HbA1c, BMI, HOMA2-β, HOMA2-IR and GAD65 autoantibodies, were used for sub-grouping patients by K-means clustering and for adjusting. Probability of diabetes complications (95% confidence interval), were calculated using logistic regression. ResultsBased on baseline data from patients with type 2 diabetes (n = 2290), the cluster analysis suggested up to five sub-groups. These were primarily characterized by autoimmune β-cell failure (3%), insulin resistance with short disease duration (21%), non-autoimmune β-cell failure (22%), insulin resistance with long disease duration (32%), and presence of metabolic syndrome (22%), respectively. Retinopathy was more common in the sub-group characterized by non-autoimmune β-cell failure (52% (47.7–56.8)) compared to other sub-groups (22% (20.1–24.1)), adj. p < 0.001. The prevalence of cardiovascular disease, nephropathy and neuropathy also differed between sub-groups, but significance was lost after adjustment. ConclusionsPatients with type 2 diabetes cluster into clinically relevant sub-groups based on routine clinical markers. The prevalence of diabetes complications seems to be sub-group specific. Our data suggests the need for a tailored strategy for the treatment of type 2 diabetes.

Diabetes mellitus in children and adolescents according to the Federal diabetes registry in the Russian Federation: dynamics of major epidemiological characteristics for 2013–2016

Background: The data of the register is the main source of up-to-date information about patients with diabetes mellitus (DM). Its very important for improving the quality of medical care organization.&#x0D; Aims: to analyze the main epidemiological DM characteristics in Russian Federation (RF) (prevalence, incidence, mortality) in children and adolescents, to assess the dynamics of these parameters for the period 2013 2016, to analyze the status of compensation for carbohydrate metabolism, therapy of DM1, prevalence of diabetic complications and the reasons for hospitalizations in these age groups.&#x0D; Materials and methods: The database of Federal DM registry of 81 regions was included in the online system.&#x0D; Results: The total number of patients under the age of 18 with DM in RF on 31.12.2016 was 33081 people, there were 95,9% (31727 people) with DM1 and 4,1% (1354 patients) with DM2. The prevalence of DM1 in 20132016 in children: 81.0 91.4 / 100 ths., in adolescents 212,8209,5 / 100 ths. The DM1 incidence/100 thousand population in 2016 in children was 14,2/100 ths., in adolescents 10,0/100 ths. HbA1c levels in DM1 was in children: 7,5% in 32%, 7,69,0% in 33%, 9% in 35% of the patients; in adolescents 7,5% in 25%, 7,69,0% in 30%, 9% in 45% of the patients. Among complications in children and adolescents with DM1, diabetic neuropathy is the most often recorded (in 10,9% of cases and 40,8%, respectively); among DM2 patients, diabetic neuropathy is registered in 4,7% and 8,8% in children and adolescents, respectively. There are associated diseases in DM2 patients arterial hypertension and dyslipidemia. 43,8% of children and 49,2% of adolescents were hospitalized in the anamnesis, most hospitalizations in 2016 (children 71,9%, adolescents 67,1%) were due to diabetes.&#x0D; Conclusions: It is established that in the dynamics of 20132016 the prevalence of DM1 in children continues to increase, with relatively stable indicators in adolescents. According to the register, during last two years there has been a decrease in the incidence of DM1 and, on the contrary, an increase in the prevalence/incidence of DM2 in children. Significant interregional differences in the level of incidence/prevalence have been established, especially in regions located in various geographic regions of the RF. The frequency of diabetic complications in children and adolescents with diabetes varies. There is an association of hospitalizations with higher HbA1c level. In the structure of therapy of this age group the ratio of insulin therapy in syringes-pens and pump therapy is 80.9% / 15.1% according to the register.

Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry

Aim. We analysed the main epidemiological characteristics of diabetes mellitus (DM) in the Russian Federation (prevalence, incidence, mortality and mean life span), degree of diabetes control, and prevalence of diabetic complications (retinopathy, nephropathy, and diabetic foot syndrome and macrovascular pathology) according to the federal DM registry.&#x0D; Materials and methods. The database of the federal DM registry of 79 regions was included using the online system until 31.12.2016.&#x0D; Results. TThe total number of patients with DM in the Russian Federation on 31.12.2016 was 4.348 million (2.97% of the population), comprising 4 million patients with DM2 (92%), 255,000 with type 1 diabetes (T1DM) (6%), and 75,000 with other types of DM (2%). DM prevalence per 100,000 population was as follows: T1DM, 164.19/100,000; type 2 diabetes (T2DM), 2637.17/100,000; and other types of DM, 50.62/100. The incidence per 100,000 population was as follows: T1DM, 16.15/100,000; T2DM, 154.9/100,000; and other types of DM, 8.65/100,000. Mortality per 100,000 population was as follows: T1DM, 2.1/100,000; T2DM, 60.29/100,000; and other types of DM, 0.57/100,000. Mortality decreased in patients with T1DM by 6.6% and with T2DM by 3.6%. Mean life span in patients with T1DM was 50.3 years for men and 58.5 years for women. Mean life span in patients with T2DM was 70.1 years for men and 75.5 years for women. Glycated haemoglobin A1c (HbA1c) levels in T1DM was 7% in 33.4%, 7%7.9% in 28.3%, 8%8.9% in 16.2%, and 9.0% in 22.1% of patients. HbA1c levels in T2DM was 7% in 52.1%, 7%7.9% in 29.1%, 8%8.9% in 10%, and 9.0% in 8.7% of patients.&#x0D; Conclusions. This study evaluated the increase in DM prevalence in the Russian Federation in 2016 and in the dynamics of 20132016, which was mainly due to T2DM. An increase in patients with a target HbA1c level 7% and a decrease in the proportion of patients with severe uncontrolled DM was observed; however, the treatment effectiveness of this key indicator was unsatisfactory, i.e. less than a third of the patients with DM. In the dynamics of 20132016, an increase in mean life span for patients with T2DM and mortality reduction in patients with T1DM and T2DM was observed. The frequency of diabetic complications varied widely, which may reflect differences in the quality of specialised care in different regions.

Prevalence of Diabetic Complications and Its Associated Factors Among Diabetes Mellitus Patients Attending Diabetes Mellitus Clinics; Institution Based Cross Sectional Study

Diabetes is a chronic disease, leading to many complications. Therefore the aim of this study was to determine the prevalence ofdiabetic complications and its associated factors. To provide evidence for this conjecture, Institution-based cross-sectional study was conducted. Samples were chosen by systematic sampling technique. Data were collected by pretested questionnaire and document review; data were entered and analyzed by using SPSS version 20. Among 344 type 2 diabetes patients, more than half (53.5%) of participants had major DM complications. Among major DM complications were diabetic retinopathy, diabetic foot ulcer and diabetic nephropathy with a prevalence of 25.5%, 21.2% and 11.4% respectively. In multiple logistic regressions Ages, duration of DM and drug regimen were significantly associated with DM complications. Prevalence of diabetes mellitus complication among the type 2 DM patient is high in study area. Therefore, the health care provider should strength early detection and treatment DM client.

Economic Burden in Chinese Patients with Diabetes Mellitus Using Electronic Insurance Claims Data.

BackgroundThere is a paucity of studies that focus on the economic burden in daily care in China using electronic health data. The aim of this study is to describe the development of the economic burden of diabetic patients in a sample city in China from 2009 to 2011 using electronic data of patients’ claims records.MethodsThis study is a retrospective, longitudinal study in an open cohort of Chinese patients with diabetes. The patient population consisted of people living in a provincial capital city in east China, covered by the provincial urban employee basic medical insurance (UEBMI). We included any patient who had at least one explicit diabetes diagnosis or received blood glucose lowering medication in at least one registered outpatient visit or hospitalization during a calendar year in the years 2009–2011. Cross-sectional descriptions of different types of costs, prevalence of diabetic complications and related diseases, medication use were performed for each year separately and differences between three years were compared using a chi-square test or the non-parametric Kruskal-Wallis H test.ResultsOur results showed an increasing trend in total medical cost (from 2,383 to 2,780 USD, p = 0.032) and diabetes related cost (from 1,655 to 1,857 USD) for those diabetic patients during the study period. The diabetes related economic burden was significantly related to the prevalence of complications and related diseases (p<0.001). The overall medication cost during diabetes related visits also increased (from 1,335 to 1,383 USD, p = 0.021). But the use pattern and cost of diabetes-related medication did not show significant changes during the study period.ConclusionThe economic burden of diabetes increased significantly in urban China. It is important to improve the prevention and treatment of diabetes to contribute to the sustainability of the Chinese health-care system.

The local geographic distribution of diabetic complications in New York City: Associated population characteristics and differences by type of complication

AimsTo identify population characteristics associated with local variation in the prevalence of diabetic complications and compare the geographic distribution of different types of complications in New York City. MethodsUsing an all-payer database of emergency visits, we identified the proportion of unique adults with diabetes who also had cardiac, neurologic, renal and lower extremity complications. We performed multivariable regression to identify associations of demographic and socioeconomic factors, and diabetes-specific emergency department use with the prevalence of diabetic complications by Census tract. We also used geospatial analysis to compare local hotspots of diabetic complications. ResultsWe identified 4.6million unique New York City adults, of which 10.5% had diabetes. Adjusting for demographic and socioeconomic factors, diabetes-specific emergency department use was associated with severe microvascular renal and lower extremity complications (p-values<0.001), but not with severe macrovascular cardiac or neurologic complications (p-values of 0.39 and 0.29). Our hotspot analysis demonstrated significant geographic heterogeneity in the prevalence of diabetic complications depending on the type of complication. Notably, the geographic distribution of hotspots of myocardial infarction were inversely correlated with hotspots of end-stage renal disease and lower extremity amputations (coefficients: −0.28 and −0.28). ConclusionsWe found differences in the local geographic distribution of diabetic complications, which highlight the contrasting risk factors for developing macrovascular versus microvascular diabetic complications. Based on our analysis, we also found that high diabetes-specific emergency department use was correlated with poor diabetic outcomes. Emergency department utilization data can help identify the location of specific populations with poor glycemic control.

Improving Diabetes Care in the Latino Population: The Emory Latino Diabetes Education Program

Background: The incidence of diabetes in Latinos is 12.8% compared to 9.3% of the general population. Latinos suffer from a higher prevalence of diabetic complications and mortality than whites yet receive less monitoring tests and education. Purpose: (1) Identify changes in clinical indicators among subjects with type 2 diabetes participating in the Emory Latino Diabetes Education Program (ELDEP), (2) identify changes in risk reduction examinations, and (3) describe the independent contribution of sociodemographic characteristics and biomedical indicators as predictors of class return. Methods: A quasi-experimental study was conducted over 5 years in Latinos with type 2 diabetes mellitus. One hundred forty-two patients receiving culturally appropriate diabetes self-management education and support (DSME/S) were included from 7 primary care clinics in Georgia. Questionnaires and biomedical markers were collected at baseline and 3-month follow-up. Results: Results from this study show that A1C was lowered from 9.1% at baseline to 7.8% at follow-up (P < .001), blood pressure decreased from 135/85 to 128/79 mmHg (P < .001), and home blood glucose monitoring increased from 63% to 85% (P < .001). Risk-reduction examinations increased significantly from baseline to follow-up. Predictors of attendance for DSME/S classes were income, physical activity, and previous class attendance (P < .05). Discussion: ELDEP was effective in providing DSME/S, decreasing biomedical markers, and increasing risk reduction examinations. Translation to Health Education Practice: Exploring culturally appropriate, community-based interventions to foster engagement in follow-up care may be useful in improving diabetes self-management in Latinos.

Liczne przewlekłe powikłania jako rezultat niedostatecznej kontroli glikemii u pacjenta z cukrzycą typu 1 — opis przypadku

We present a case of a 54-year-old patient with type 1 diabetes affected by multiple microvascular and macrovascular complications. Over the course of the disease, he developed diabetic nephropathy that resulted in renal transplant, proliferative retinopathy of both eyes, and sensory polyneuropathy. He also suffered from arterial hypertension and diabetic foot syndrome, complicated by an amputation of fourth left toe. With the implementation of intensive insulin therapy (IIT), a decrease in prevalence of diabetic complications has been observed. Tight metabolic control, especially during early years of the disease, significantly reduces the risk of their development. However, there are patients who suffer from multiple complications, despite receiving IIT. One of the most important aspects of effective diabetes management is patients’ education and their active participation in the treatment.

National register of diabetes mellitus in Russian Federation.

Clinical and epidemiological monitoring of diabetes in Russian Federation (RF) is carried out by the National diabetes register, which methodological and organizational reference center is Federal Endocrinology Research Centre. Since 2014 initiated the translation the National diabetes register on online software system in order to increase the effectiveness of the register as a scientific and analytical platform. The article include the analysis of DM prevalence, incidence,DM-related mortality,the prevalence of diabetic complications and analysis of effectiveness of diabetes care (included HbA1c) and according to the data of online register.

Prevalence and clinical profile of metabolic syndrome among type 1 diabetes mellitus patients in southern India

AimTo assess the prevalence of metabolic syndrome (MetS) among patients with type 1 diabetes mellitus(T1DM) and to look at prevalence of diabetes complications in T1DM with and without MetS. MethodsWe studied 451 T1DM patients attending a tertiary diabetes centre in Chennai, South India. T1DM was diagnosed based on absence of beta cell reserve and requirement of insulin from the time of diagnosis. Data on clinical and biochemical characteristics as well as complications details to study the prevalence were also extracted from electronic records. T1DM patients were divided into those with and without MetS[diagnosed according to the harmonizing the metabolic syndrome criteria(IDF/NHLBI/AHA/WHF/IAS/IASO)]. ResultsThe overall prevalence of MetS among T1DM was 22.2%(100/451). Patients with MetS were older, had longer diabetes duration, acanthosis nigricans, and increased serum cholesterol. In the unadjusted logistic regression analysis, retinopathy, nephropathy and neuropathy were associated with MetS. However after adjustment for age, gender, diabetes duration, HbA1C and BMI significant association was seen only between MetS and retinopathy [odds ratio (OR) 2.82, 95% CI 1.18–6.74, p=0.020] and nephropathy [OR 4.92, 95% CI 2.59–9.33, p<0.001]. ConclusionPrevalence of MetS is high among Asian Indian T1DM patients, and its presence is associated with increased risk of diabetic retinopathy and nephropathy.

Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study.

Background. WHO's recommendation of HbA1c ≥ 48 mmol/mol (6.5%) as diagnostic for type 2 diabetes mellitus (T2DM) was adopted by three UK London boroughs in May 2012. The South London Diabetes (SOUL-D) study has recruited people with newly diagnosed T2DM since 2008. We compared participants diagnosed before May 2012 with HbA1c < 48 mmol/mol to those with diagnostic HbA1c ≥ 48 mmol/mol. Methods. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Results. Of 1488 participants, 22.8% had diagnostic HbA1c < 48 mmol/mol. They were older and more likely to be white (p < 0.05). At recruitment and one year, there were no between-group differences in the prevalence of diabetic complications, except that those diagnosed with HbA1c < 48 mmol/mol had more sensory neuropathy at recruitment (p = 0.039) and, at one year, had new myocardial infarction (p = 0.012) but less microalbuminuria (p = 0.012). Conclusions. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes.

Prevalence of Complications and Clinical Audit of Management of Type 2 Diabetes Mellitus: A Prospective Hospital Based Study.

Management of type 2 diabetes mellitus (DM) needs multi factorial risk reduction strategies like weight reduction, blood pressure (BP) control and lipid profile regulation, along with glycaemic control. These strategies should be implemented very early in the course of the disease to prevent both microvascular and macro vascular complications. To find out the prevalence of diabetic complications and to audit the management of glycaemia, blood pressure and serum lipids in the outpatient diabetes clinic in a hospital located in Western U.P. A prospective study conducted in a tertiary referral teaching hospital, on 105 patients with type 2 diabetes mellitus (mean age 52.84 ± 1.02 years) who attended the diabetic clinic during June 2014 to April 2015, who had undergone screening for complications. Weight, height, body mass index (BMI), blood pressure, fasting and post prandial blood sugars, glycated hemoglobin, serum lipids and presence of diabetic microvascular as well as macrovascular complications. Mean of various clinical and biochemical parameters were compared in patients with and without complications. The mean age of patients was estimated as 52.84 ± 1.02 years. Fifty six percent of patients were males. Average BMI was 28.61 ± 0.28 kg/m(2). Most of them had abdominal obesity. The average duration of diabetes was 8.39 ± 0.6 years. The average of systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1C, FBS, PPBS, LDL, HDL and triglyceride were estimated as 129.1 ± 1.49 mm Hg, 84.85 ± 0.94 mm Hg, 6.99 ± 0.08%, 141.33 ± 2.12 mg/dl, 214.51 ± 3.11 mg/dl, 155.66 ± 2.07 mg /dl, 40.07 ± 0.38 mg/dl, 236.53 ± 3.31 mg/dl respectively based on 105 patients. Amongst micro vascular complications; retinopathy, neuropathy and nephropathy were documented in 51.4, 77.14 and 30.47% diabetes patients respectively. The prevalence of coronary artery disease, stroke and gangrene were 42.85, 12.38 and 3.80% respectively. The prevalence and risk of the complications of type 2 DM significantly increased with age of patients, duration of diabetes, fasting blood sugar and LDL levels. The awareness regarding monitoring of target BP and lipid profile is needed beyond the glycaemic control, amongst patients and health care providers.

PO-0955 Closing The Loop – Successful Implementation Of Audit Recommendations In A Regional Diabetes Centre

Background A previous audit was performed in 2011 by the Paediatric Diabetes department in Sligo Regional Hospital which examined practices, results and key care processes at annual review and compared them to International Standards (1,2). This resulted in several recommendations aimed to improve metabolic control within the cohort. Objectives The objectives of this audit were to compare HbA1c levels in 2013 to those in 2011 and to International Standards (3,4,5), to investigate if the previous recommendations had been implemented and to investigate the proportion of patients with secondary complications. Methods All paediatric patients with diabetes who had an annual review scheduled during 2013 in our centre were included. Exclusion criteria were those who had annual review scheduled at a tertiary centre. Data were collated from retrospective chart review. Results In our cohort of 50 patients, HbA1c results reflected significant improvement from 2011 levels (see Graph 1). The complication rate was found to be comparable to International Standards (5,6) (see Table 1). There was no improvement in the key care processes performed (see Table 2). Conclusion Our improved HbA1c results reflect the increased frequency of appointments and use of basal bolus regimes. References 1 NICE 2009 2 NPDA 2009–2010 3 NPDA 2011–2012 4 IDF/ISPAD 2011 Global Guideline for diabetes in childhood and adolescence 5 Maike C et al . Prevalence of diabetes complications in adolescents with type 2 compared with Type 1 Diabetes . 6 Downie E et al . Continued reduction in the Prevalance of retinopathy in adolescents with type 1 diabetes. Diabetes care , 2011;34

Gender differences and patterns of cardiovascular risk factors in Type 1 and Type 2 diabetes: a population-based analysis from a Scottish region.

To explore the gender differences, along with the relationships between BMI, glycaemic control, cardiovascular risk factors and the prevalence of diabetes complications, in a representative population-based group of people with Type 1 and Type 2 diabetes. Data were obtained from general practices in Ayrshire and Arran, Scotland for 15 351 patients. In the cohort with Type 1 diabetes, after adjustment for age, men had a significantly lower BMI (P = 0.007) and significantly lower total cholesterol (P = 0.005), HDL-cholesterol (P = 2.5*10(-17)) and HbA1c levels (P = 0.003) than women. By contrast, men had higher blood pressure, both systolic (P = 0.034) and diastolic (P = 0.0003), and higher non-fasting triglyceride levels (P = 0.001). Men with Type 1 diabetes had a higher prevalence of neuropathy (P = 0.021). Among people with Type 2 diabetes, men had a significantly lower BMI (P = 4.26*10(-37)), and significantly lower total cholesterol (P = 2.96*10(-62)) and HDL-cholesterol levels (P = 8.25*10(-141)) but higher non-fasting triglyceride levels (P = 0.0002). In Type 2 diabetes, men had a higher prevalence of ischaemic heart disease (P = 1.66*10(-25)), stroke (P = 0.002) and peripheral vascular disease (P = 1.68*10(-12)), while women were older (P = 4.83*10(-23)), heavier and had a higher prevalence of hypertension (P = 5.32*10(-12)). More people with Type 2 diabetes were on lipid-lowering treatment (84.7 vs 52.4%; P = 5.51*10(-8)) than were those with Type 1 diabetes. The prevalence of retinopathy was higher among non-smokers thank smokers in people with both Type 1 and Type 2 diabetes (Type 1, P = 0.016; Type 2, P = 0.001). The study shows gender differences between Type 1 and 2 diabetes that are of clinical significance and require further investigation. Follow-up of the patients included in the present study should give us much greater understanding of the importance of gender in the development of metabolic abnormalities and diabetes complications.