Progression Of Diabetes-related Complications Research Articles

Diabetic cheiroarthropathy in uncontrolled type 2 diabetes with positive anti-nuclear antibodies: a case report from Sudan

Background: Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 diabetes mellitus (DM). It affects 8–50% of patients with type 1 diabetes and is also seen in type 2 diabetic patients. Consequently, it can mimic many rheumatological diseases and is often underdiagnosed. The authors present a case of a long-standing poorly controlled diabetes with diabetic cheiroarthropathy and diabetic neuropathy, along with positive ANA in the absence of any correlated autoimmune or rheumatological diseases. Case presentation: A 52-year-old female patient with poorly controlled diabetes (her last HbA1c reading was 9.5%) presented to the Rheumatology clinic with flexion deformities of the fingers. The patient has impaired vibration, two-point discrimination, and pinprick sensation in gloves and stock distribution, indicating peripheral neuropathy, entrapment neuropathy in the forms of bilateral carpal tunnel syndrome, and the diagnosis of diabetic cheiroarthropathy was made. Additionally, she has a positive prayer sign and a tabletop sign. Despite the absence of symptoms and signs of autoimmune disorders, this patient has positive anti-nuclear antibodies global (ANA positive by indirect immuno-fluorescence (IIF) 1\320 nucleolar pattern) with a negative: ANA profile, rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (ACPA). Conclusion: Regular and careful hand examination should be part of clinical assessment for diabetic patients as it could be a very simple and useful screening tool for diabetic cheiroarthropathy. Physicians can use this condition as a mirror for microvascular complications of diabetes. This allows for early detection and appropriate interventions to prevent further progression of diabetes-related complications. It is also essential to consider the presence of positive ANA in diabetic cheiroarthropathy despite the absence of any rheumatological and autoimmune diseases.

O172: Donor blood tests and pancreas outcome in simultaneous pancreas kidney transplantation, a national cohort study

Abstract Introduction Simultaneous pancreas-kidney (SPK) transplantation improves quality of life in people with diabetes and end-stage renal disease, and limits the progression of diabetes related complications. Many surgeons are reluctant to accept the pancreas of a donor with raised amylase, due to concern of potentially inferior outcomes. We aim to ascertain whether donor amylase and liver blood tests (a marker of visceral ischaemic injury) predict pancreas transplant outcome. Methods This retrospective cohort study used the NHS registry on adult SPK transplantation (2016-2021). Adjusted regressions models assessed the effect of donor amylase and liver blood tests on pancreas transplant outcome. Results 857 SPK recipients were included (619 following brainstem death, 238 following circulatory death). Peak donor amylase ranged from 8-3300U/L (median=70). Donor peak amylase had no significant impact on pancreas graft survival when adjusting for multiple confounders (aHR=0.944, 95% CI=0.754-1.81). Median peak alanine transaminase and aspartate transaminase was 67U/L and 72U/L (range 8-5930 and 0-7910U/L). Neither of these influenced pancreas graft survival in multivariable models (aHR=0.967, 95% CI=0.848-1.102 and aHR=0.908, 95% CI=0.771-1.070, respectively). Restricted cubic splines were used to assess the relationship between donor blood tests and pancreas graft survival without assuming linear relationships; these confirmed neither amylase, nor transaminases, significantly impact on pancreas transplant outcome. Conclusions Donor amylase and transaminases do not predict transplant outcomes. Therefore, raised donor amylase or transaminases should not be considered a barrier to organ utilisation. The use of pancreas grafts from donors with hyperamylasaemia is a safe, immediate, and simple approach to expand the donor pool.

Changes in trends and patterns of glycaemic control at Ghana's National Diabetes Management and Research Centre during the era of the COVID-19 pandemic.

Maintaining optimal glycaemic control (GC) delays the onset and progression of diabetes-related complications, especially microvascular complications. We aimed to establish the trend and pattern of GC, and its associated factors in persons living with diabetes (PLWD), and to examine the influence of COVID-19 on GC. A retrospective study involving secondary data from 2,593 patients' physical records from the National Diabetes Management and Research Centre (NDMRC) in Accra, extracted from 2015-2021. Growth rate of GC was assessed, and ordinal logistic and Poisson models weighted with Mahalanobis distance matching within propensity caliper were adopted to assess the impact of COVID-19 pandemic on GC. Stata 16.1 was utilized and the significant value set as p≤0.05. GC pattern indicated a steady deterioration ranging from 38.6% (95%CI = 34.5-42.9) in 2015 to 69.2% (95%CI = 63.5-74.4) in 2021. The overall growth from 2015-2021 was 8.7%. Being a woman and increasing diastolic pressure significantly increase the likelihood of poor glycaemic control (PGC) by 22% and 25%, respectively compared with their respective counterparts [aOR(95%CI = 1.01-1.46 and 1.25(1.10-1.41), respectively]; whilst lower age increased the risk of PGC throughout the years. We found that risk of PGC during the era of COVID-19 was approximately 1.57(95%CI = 1.08-2.30) times significant, whilst the adjusted prevalence ratio (aPR) of PGC during the era of COVID-19 was approximately 64% significantly higher than the era without COVID-19 (aPR = 1.64, 95%CI = 1.10-2.43). GC worsened from 2015-2021, especially during the COVID era. Younger age, uncontrolled blood pressure and/or being a woman were associated with PGC. The NDMRC and other centres that provide specialist healthcare in resource-limited settings, must determine the factors that militate against optimal service delivery in the era of the COVID-19 pandemic, and implement measures that would improve resilience in provision of essential care in the face of shocks.

Synthesis and Potential Antidiabetic Properties of Curcumin-Based Derivatives: An In Vitro and In Silico Study of α-Glucosidase and α-Amylase Inhibition.

Over the past twenty years, the prevalence of diabetes as one of the most common metabolic diseases has become a public health problem worldwide. Blood glucose control is important in delaying the onset and progression of diabetes-related complications. α-Glycosidase (α- Glu) and α-amylase (α-Amy) are important enzymes in glucose metabolism. Diabetic control through the inhibition of carbohydrate hydrolyzing enzymes is established as an effective strategy. In this study, curcumin-based benzaldehyde derivatives with high stability, bioavailability, and favorable efficiency were synthesized. The results showed that L13, L8, and L11 derivatives have the highest inhibitory effect on α-Glu with IC50 values of 18.65, 20.6, and 31.7 μM and, also L11, L13, and L8 derivatives have the highest inhibitory effect on α-Amy with IC50 value of 14.8, 21.8, and 44.9 μM respectively. Furthermore, enzyme inhibitory kinetic characterization was also performed to understand the mechanism of enzyme inhibition. L13, compared to the other compounds, exhibited acceptable inhibitory activity against both enzymes. The L13 derivative could be an appropriate candidate for further study through the rational drug design to the exploration of a new class of powerful anti-diabetic drugs considering the antioxidant properties of the synthesized compounds. The derivative helps reduce the glycemic index and limits the activity of the major reactive oxygen species (ROS) producing pathways.

SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study: Protocol for diabetes medical nutrition therapy randomized clinical trial among African American women

BackgroundAfrican American (AA) women with type 2 diabetes (T2D) carry disproportionate diabetes-related morbidity and mortality burdens. Diabetes medical nutrition therapy (MNT) improves glycemic, blood pressure, and cholesterol control, all critical in preventing and reducing diabetes complications. Yet, MNT does not address low motivation for dietary intake management, which is frequently reported among AA women with T2D living in the Southeastern US. MethodsA randomized controlled trial will be used to test the central hypothesis that diabetes MNT plus culturally-tailored motivational interviewing (MI) (diabetes MNT plus MI) is more effective than diabetes MNT alone (diabetes MNT). Two hundred ninety-one Southeastern AA women who are at risk for development and/or progression of T2D complications will be randomized to diabetes MNT plus MI or diabetes MNT. Both groups will include: 1) a 3-month active intervention period, consisting of group-based, nutritionist-facilitated MNT sessions; 2) a 3-month maintenance intervention period, including one group-based, nutritionist-facilitated maintenance support session; and 3) a 6-month inactive period. Culturally-adapted MI exercises will be integrated into the diabetes MNT plus MI group only. Primary (HbA1c) and secondary (systolic blood pressure, LDL cholesterol) outcomes will be assessed at baseline and 3, 6, and 12 months following the active intervention period. DiscussionThe results from this study, called the SISTER (Sisters Inspiring Sisters to Engage in Relevant Diabetes Self-Care) Diabetes Study, are vital to the adoption and uptake of rigorously-tested MNT interventions that address motivation among AA women with T2D as a way to reduce their risk and/or progression of diabetes-related complications.

Advanced Glycation End Products and Diabetes Mellitus: Mechanisms and Perspectives.

Persistent hyperglycemic state in type 2 diabetes mellitus leads to the initiation and progression of non-enzymatic glycation reaction with proteins and lipids and nucleic acids. Glycation reaction leads to the generation of a heterogeneous group of chemical moieties known as advanced glycated end products (AGEs), which play a central role in the pathophysiology of diabetic complications. The engagement of AGEs with its chief cellular receptor, RAGE, activates a myriad of signaling pathways such as MAPK/ERK, TGF-β, JNK, and NF-κB, leading to enhanced oxidative stress and inflammation. The downstream consequences of the AGEs/RAGE axis involve compromised insulin signaling, perturbation of metabolic homeostasis, RAGE-induced pancreatic beta cell toxicity, and epigenetic modifications. The AGEs/RAGE signaling instigated modulation of gene transcription is profoundly associated with the progression of type 2 diabetes mellitus and pathogenesis of diabetic complications. In this review, we will summarize the exogenous and endogenous sources of AGEs, their role in metabolic dysfunction, and current understandings of AGEs/RAGE signaling cascade. The focus of this review is to recapitulate the role of the AGEs/RAGE axis in the pathogenesis of type 2 diabetes mellitus and its associated complications. Furthermore, we present an overview of future perspectives to offer new therapeutic interventions to intervene with the AGEs/RAGE signaling pathway and to slow down the progression of diabetes-related complications.

Which Aspect of Patient-Provider Relationship Affects Acceptance and Adherence of Insulin Therapy in Type 2 Diabetes Mellitus? A Qualitative Study in Primary Care.

PurposeIn type 2 diabetes mellitus (T2DM), insulin therapy is often recommended to achieve the optimal control of disease, thereby preventing the onset and progression of diabetes-related complications. Despite knowing about the benefits, it has been reported that 71% of patients refuse insulin and the adherence rate ranges from 30 to 80%. Patient–provider relationship (PPR) may affect such insulin-related behaviours, but little is known about which aspect of PPR affects this. This study aimed to explore the key aspect of the patient–provider relationship that affects the initial insulin acceptance and continued adherence.Patients and MethodsWe used the grounded theory approach in this qualitative research. The study was conducted at two primary care clinics between September 2019 and January 2021. Patients with T2DM on basal or premixed insulin were recruited using maximum variation sampling. Data were collected using semi-structured in-depth interviews and transcribed verbatim for analysis using constant comparison and synthesis.ResultsTwenty-one participants with different levels of diabetes control and adherence were recruited. Four themes that emerged were 1) patient–provider interaction, 2) addressing the psychological fears, 3) gaining confidence in handling insulin equipment and 4) follow-up after insulin initiation. Among the subthemes, trust in doctors, provider’s communication skills, patient-centred decision-making and continuity of care positively influenced insulin acceptance and adherence. Conversely, fear of being judged by the provider hindered open communication around non-adherence. Various aspects of interaction with nurses helped in alleviating patient’s fear of injection and gaining confidence with the insulin equipment.ConclusionMany aspects of PPR affect insulin acceptance and adherence. Among these, gaining patients’ trust, effective patient–provider communication, patient-centred decision-making, and ensuring continuity of care improve both insulin acceptance and treatment adherence. Various interactions with nurses help in addressing fears surrounding injection and gaining acceptance towards insulin therapy. Patients’ fear of being blamed or judged by the provider negatively affects open communication around non-adherence.

Diabetic kidney disease in children and adolescents: an update

Diabetic kidney disease (DKD), previously encountered predominantly in adult patients, is rapidly gaining center stage as a childhood morbidity and one that pediatric nephrologists are likely to encounter with increasing frequency. This is in large part due to the obesity epidemic and the consequent rise in type 2 diabetes in children and adolescents, as well as the more aggressive diabetes phenotype in today’s youth with more rapid β-cell decline and faster development and progression of diabetes-related complications along with lower responsiveness to the treatments used in adults. DKD, an end-organ complication of diabetes, is at the very least a marker of, and more likely a predisposing factor for, the development of adverse cardiovascular outcomes and premature mortality in children with diabetes. On an optimistic note, several new therapeutic approaches are now available for the management of diabetes in adults, such as GLP1 receptor agonists, SGLT2 inhibitors, and DPP4 inhibitors, that have also been shown to have a favorable impact on cardiorenal outcomes. Also promising is the success of very low-energy diets in inducing remission of diabetes in adults. However, the addition of these pharmacological and dietary approaches to the management toolbox of diabetes and DKD in children and adolescents awaits thorough assessment of their safety and efficacy in this population. This review outlines the scope of diabetes and DKD, and new developments that may favorably impact the management of children and young adults with diabetes and DKD.

Comparison of Clinical and Social Characteristics of Canadian Youth Living With Type 1 and Type 2 Diabetes

ObjectivesOur aim in this study was to describe the clinical and social characteristics of 2 Canadian cohorts of adolescents with diabetes. MethodsParticipants from the Improving renal Complications in Adolescents with type 2 diabetes through REsearch (iCARE) study (n=322) and the Early Determinants of Cardio-Renal Disease in Youth With Type 1 Diabetes (n=199) study were compared. ResultsAdolescents were 10 to 18 years of age (mean ± standard deviation: 14.8±2.4 years). The T2DM cohort had a shorter duration of diabetes. Both groups had glycated hemoglobin levels above target. The type 2 diabetes (T2D) cohort was comprised of predominantly Indigenous youth. The type 1 diabetes (T1D) cohort was 58.3% European/Caucasian, with a high proportion (41.7%) of visible minority groups (Afro-Caribbean, Asian/Pacific Islander, Hispanic). The prevalence of obesity, hypertension, left ventricular hypertrophy, albuminuria and hyperfiltration was higher in the T2D cohort. The T1D cohort was more socially and economically advantaged in all 4 dimensions of health inequality. ConclusionsThere are significant differences in clinical and social characteristics of adolescents with T2D and T1D in Canada. Both have inadequate glycemic control with evidence of onset and progression of diabetes-related complications.

SYSTEMATIC REVIEW ON MEDICAMENTS USED IN MANAGEMENT OF DIABETES MELLITUS

Diabetes has a global prevalence in developed countries and rapidly flexing its roots in middle-and low-income countries. According to the World Health Organization, it is a major cause of kidney collapse, heart problems, and lower limb amputation. Diabetes mellitus is a metabolic disorder showing an uncontrolled increase in blood glucose levels. To date, no permanent cure has been developed for the complete restoration of impaired glucose haemostasis. With the use of therapeutic agents and nontherapeutic agents, glucose levels can be kept in control for a very long time. The foremost goal of all current ongoing treatments is to control high blood glucose levels, reduction in elevated lipid levels, and delay in the progression of diabetes-related complications. Various therapeutics agents are developed in recent decades, which shown very promising results in the management of diabetes mellitus. These agents prescribed after reviewing the clinical symptoms and situation of an individual patient. This review compiles noteworthy information related to clinically approved medicaments for diabetes mellitus. Review emphasis on categorization, mechanism of action, noted adverse effects along with the physiological responses of used medicines to treat diabetes mellitus.

Microalbuminuria in Type 2 Diabetes and its Relationship with Glycosylated Hemoglobin

Background: Microalbuminuria is the most common aetiology of chronic kidney disease. Optimum glycemic control reduces the development and progression of diabetes-related complications and there is evidence that improved glycemic control improves outcome in diabetic subjects.

Microalbuminuria in Type 2 Diabetes and its Relationship with Glycosylated Hemoglobin

Background: Microalbuminuria is the most common aetiology of chronic kidney disease. Optimum glycemic control reduces the development and progression of diabetes-related complications and there is evidence that improved glycemic control improves outcome in diabetic subjects.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.

Diabetic lower extremity complications, fear of falling and associated HbA1c levels: A cross-sectional study of the East Harlem population

The primary aim of this study was to determine if HbA1c is a positive predictor of the lower extremity complications commonly manifested in diabetes. A secondary objective was to investigate if the progression of diabetes-related complications had any affect on the fear of falling. This was a study of 38 patients enrolled at the Foot Center of New York. Prospective subjects were recruited if they reported an International Classification of Diseases (ICD) code consistent with diabetes using electronic medical records, expressed a desire to participate, conformed with the inclusion and exclusion criteria for the study (they were over 18 years of age and considered alert and thereby able to consent to the study), and provided informed consent. A total of 38 patients were enrolled in the study. Most of the participants were male and African American. The mean number of podiatric manifestations in the group was 4.43 (SD=62.35). The mean HbA1c level for the group was 8.23% (SD=1.94). Several predictors of podiatric manifestations were examined in the study, including mean MFES (Modified Falls Efficiency Scale) score, age, concurrent treatments for neuropathy, and HbA1c levels. Simple correlational analyses revealed that there was no correlation between HbA1c and the number of podiatric manifestations. Several follow-up regression analyses were performed to assess the ability of HbA1c to predict podiatric manifestations when controlling for individual parameters such age and duration of diabetes. HbA1c did not predict number of podiatric manifestations after controlling for age and diabetes duration, age alone or diabetes duration alone. The study did find that patients receiving neuropathy drugs reported lower MFES scores (notably, lower MFES scores are associated with a higher risk of falling). HbA1c levels of patients receiving neuropathy drugs did not differ significantly from the HbA1c levels of patients not receiving neuropathy drugs. The podiatric manifestations of patients with diabetes in East Harlem, where this study was carried out, are wide-ranging and include nail and skin disorders, which are both recognized as common precursors to infections and amputations. Predictive tools could help reduce the economic burden of diabetes. This study assessed the ability of HbA1c to predict the total number of podiatric manifestations in diabetic patients. In the end, HbA1c was not a good predictor of the number of podiatric manifestations. The weak correlation between HbA1c levels and the total number of podiatric manifestations in this study might be due to the small sample size. Future studies, ideally involving a larger sample size, are needed to more accurately assess the potential of HbA1c for predicting lower extremity complications.

Federal Bureau of Prisons clinical pharmacy program improves patient A1C

ObjectiveThe Federal Bureau of Prisons (BOP) currently has over 13,000 patients with diabetes and has placed an emphasis on preventing and delaying the onset or progression of diabetes-related complications. In an ongoing effort to improve patient outcomes, BOP has implemented a nationwide, dynamic system of pharmacist-delivered patient care services via pharmacist clinicians working under the auspices of a physician-pharmacist collaborative practice agreement (CPA). SettingThe BOP Clinical Pharmacy Workgroup targets improved patient outcomes via oversight and support of institution pharmacist clinicians and physicians in establishing and maintaining physician-pharmacist CPAs. A primary emphasis is diabetes and the pharmacist-run clinic clinical outcomes data are presented. Practice innovationSeventy (nearly one-half) of eligible BOP pharmacists at 37 institutions offer pharmacist-delivered patient care services via an approved CPA. In total, BOP has 111 active physician-pharmacist CPAs. Main outcome measuresPharmacist-run diabetes clinic outcomes from 5 institutions have been reported to date. A total of 126 patients were enrolled. Patient's hemoglobin A1C, blood pressure, and LDL cholesterol level are measured before (i.e., when accepted in the diabetes clinic) and after pharmacist-delivered care has been provided. The pharmacist-run diabetes clinics reported an average baseline A1C of 10.6% and produced an average outcome decrease in A1C of 2.3% from baseline. ResultsSpecific pharmacist clinic interventions found to have the greatest impact are: 1) timely medication adjustment when indicated to help patients meet outcome goals; and 2) timely follow-up after a change in therapy is made (often within 1-2 weeks) with continued medication adjustment when indicated until outcome goal is achieved. ConclusionBOP pharmacists have become respected and trusted clinicians within the team medicine model. As demonstrated by the pharmacist-run diabetes clinic outcomes, pharmacist clinicians are a valued link to the improvement of patient outcomes in BOP.

Machine-Learning-Based Prediction of a Missed Scheduled Clinical Appointment by Patients With Diabetes.

About 10% of patients with diabetes discontinue treatment, resulting in the progression of diabetes-related complications and reduced quality of life. The objective was to predict a missed clinical appointment (MA), which can lead to discontinued treatment for diabetes patients. A machine-learning algorithm was used to build a logistic regression model for MA predictions, with L2-norm regularization used to avoid over-fitting and 10-fold cross validation used to evaluate prediction performance. Data associated with patient MAs were extracted from electronic medical records and classified into two groups: one related to patients' clinical condition (X1) and the other related to previous findings (X2). The records used were those of the University of Tokyo Hospital, and they included the history of 16 026 clinical appointments scheduled by 879 patients whose initial clinical visit had been made after January 1, 2004, who had diagnostic codes indicating diabetes, and whose HbA1c had been tested within 3 months after their initial visit. Records between April 1, 2011, and June 30, 2014, were inspected for a history of MAs. The best predictor of MAs proved to be X1 + X2 (AUC = 0.958); precision and recall rates were, respectively, 0.757 and 0.659. Among all the appointment data, the day of the week when an appointment was made was most strongly associated with MA predictions (weight = 2.22). Our findings may provide information to help clinicians make timely interventions to avoid MAs.

Insulin degludec/insulin aspart is the first co-formulation of basal and prandial insulin analogues

Achievement of glycemic control is the major therapeutic aim to prevent or delay the onset and progression of diabetes related complications. Insulin therapy represents a cornerstone in the treatment of diabetes and has been used widely for achieving glycemic goals. The aim for insulin therapy is to mimic the physiological profile of insulin secretion seen in nondiabetic patients. Development of the insulin analogs has offered new opportunities in the diabetes management to achieve greater safety and tolerability of diabetes treatment. Insulin degludec/insulin aspart(IDegAsp) (Ryzodeg?, Novo Nordisk, Denmark) is the first soluble co-formulation of 70% ultra-long acting insulin degludec and 30% rapid-acting prandial insulin aspart, providing both basal insulin coverage and a prandial insulin bolus in a single injection. This review discusses data regarding the efficacy, safety, tolerability and clinical benefits of IDegAsp. According to the clinical development program IDegAspprovides an achievement of similar glycemic control with superiority in lowering FPG with using less number of injections and lower daily insulin dose, and also associated with numerically lower rates of confirmed and nocturnal confirmed hypoglycaemia in comparison with premixed or basal insulin analogues, as well as a basal component for basal?bolus therapy with supplementary mealtime insulin aspart.Trial results suggest that IDegAspQD or BID maybe an appropriate and reasonable option for initiating insulin therapy in type 1 and type 2 diabetic patients inadequately controlled on maximal doses of oral antidiabetic drugs,and also a simple alternative to basal?bolus treatment in patients who require intensification of insulin therapy, especially when adherence to more complex regimens is challenging.

Health-Economic Comparison of Sensor-Augmented Pump With Low Glucose Suspend Versus Insulin Pump Alone For The Treatment Of Hypo-Prone Type 1 Diabetes In Slovakia.

To project the long-term costs and outcomes of sensor-augmented pump (SAP) with low glucose suspend (LGS) versus insulin pump alone (CSII) for the treatment of hypo-prone Type 1 diabetes in Slovakia. The CORE Diabetes Model is a peer-reviewed, validated model, which employs standard Markov/Monte Carlo simulation techniques to describe the long-term incidence and progression of diabetes-related complications. It was used to simulate disease progression in a cohort of patients with baseline characteristics (mean age 18.6 years, duration of diabetes 12 years, mean HbA1c 7.5%) and clinical outcomes (severe hypoglycaemic event rates; Quality of Life; HbA1c) taken from a recent randomised controlled trial (Ly et al, 2013). Local treatment and complication cost data was used. The main scenario considered in this cost-effectiveness analysis was the comparison of sensor-augmented insulin pump (SAP) with low glucose suspend (LGS) versus insulin pump alone (CSII). The target population was type I hypo-prone diabetes patients with the analysis based on a deterministic microsimulation of 1,000 patients, using a 5 year time horizon. Direct costs were calculated from a third-party payer perspective. Discount rates of 3% per annum were applied to both costs and clinical outcomes. The Incremental-Cost-Effectiveness-Ratio (ICER) for SAP+LGS (vs CSII) was €17,893 per Quality-Adjusted-Life-Year gained over a 5 year time horizon. Results were similar across a 1 to 10 year time horizon. Other extensive sensitivity analyses showed the robustness of the results. Using a payer’s perspective, our analysis showed that SAP (w LGS) is cost-effective over a short term (5 year) time horizon in hypo-prone Type 1 Diabetes patients in Slovakia (using a WTP threshold of 1x [€18,000] or 3x [€54,000] Slovakia GDP).

Pancreas transplantation: a treatment option for people with diabetes

Since the first pancreas transplants in the early 1960s, whole-organ pancreas transplantation, either alone or combined with kidney transplantation, has become commonplace in many countries around the world. Whole-organ pancreas transplantation is available in the UK, with ~200 transplants currently carried out per year. Patient survival and pancreas graft outcome rates are now similar to other solid organ transplant programmes, with high rates of long-term insulin independence. In the present review, we will discuss whole-pancreas transplantation as a treatment for diabetes, focusing on indications for transplantation, the nature of the procedure performed, graft survival rates and the consequences of pancreas transplantation on metabolic variables and the progression of diabetes-related complications.

English

Background and objective: Anaemia is often an unrecognized complication of diabetes mellitus that has adverse effect on the progression of diabetes related complications. Contributors to its development include erythropoietin insufficiency and iron deficiency. The aim of this study was to assess the prevalence of iron deficiency anaemia and anaemia of chronic disease among diabetic patients. Methods: Over a period of six month from November 2010 to May 2011, 250 diabetic patients, attending Layla Qasim diabetic center were studied, their age ranged between 18-73 years. Venous blood samples were collected from each of them. A complete blood picture, iron study, HbA1c% and fasting blood glucose were performed. According to the duration of diabetes, patients were divided into three groups: group I patients (duration of diabetes < 5 years), group II (duration of diabetes between 5-9 years) and group III (duration of diabetes ≥10 years). Results: One hundred ten patients (44%) were found to have anaemia. The frequency of anaemia was more among group III (46.6%). Higher prevalence of anaemia was found among female patients (53.9%) than male patient (24.1%). Among anemic patients, 72 patients (65%) considered as having anaemia of chronic disease (ACD), 26 patients (24%) were iron deficiency anemia (IDA), 11 patients (10%) were thalassemia trait and one patient (1%) had autoimmune hemolytic anaemia. ACD was more frequent among group II (80%) and group III (70.4%), while IDA was more frequent among group I (12.6%). both ACD and IDA were more frequent among female patient than male patients (34.7% and 13.8% respectively). There was no significant correlation between HbA1c and Hb, serum iron parameters and S.ferritin. Conclusion: It was concluded that anaemia is common among diabetics and remains unrecognized by both physicians and patients; it is more common among female diabetics. The commonest type of anaemia among diabetic patients is ACD followed by IDA.