Prospective Study Of Type Research Articles

A Nomogram for Predicting Vision-Threatening Diabetic Retinopathy Among Mild Diabetic Retinopathy Patients: A Case–Control and Prospective Study of Type 2 Diabetes

This study aims to develop a nomogram for predicting vision-threatening diabetic retinopathy (VTDR) in type 2 diabetes mellitus (T2DM) with mild non-proliferative diabetic retinopathy (NPDR) patients. In case-control analysis, 440 patients with mild NPDR or VTDR were enrolled to identify predictors and develop a nomogram. In the prospective cohort, 120 T2DM patients with mild NPDR were enrolled for external validation. Sensitivity, specificity, and area under the receiver operating characteristic (AUC) were calculated to evaluate the predictive performance of the nomogram. In case-control analysis, 2-h C-peptide (OR = 0.85, 95% CI: 0.75 to 0.95, p = 0.006), sural nerve conduction impaired (SNCI) (mildly: OR = 2.18, 95% CI: 1.10 to 4.33, p = 0.026; moderately/severely: 3.66, 95% CI: 1.74 to 7.70, p < 0.001) and UACR (microalbuminuria: OR = 2.37, 95% CI: 1.25 to 4.48, p = 0.008; macroalbuminuria: 4.02, 95% CI: 1.61 to 10.06, p = 0.003) were identified as independent predictors. The concordance index of the prediction nomogram was 0.76 in the training set. In the test set, sensitivity, specificity, and AUC were 84.8%, 60.6%, and 0.73, respectively. In the prospective cohort, median follow-up period was 42 months, and 15 patients (12.5%) developed VTDR. Sensitivity, specificity, and AUC of prediction were 66.7%, 89.5%, and 0.75, respectively. Introducing 2-h C-peptide, UACR, and SNCI, the nomogram demonstrated a good discriminatory power for predicting risk of VTDR in mild NPDR individuals.

Clinical significance of immature reticulocyte fraction (IRF) and reticulocyte maturity indices in differential diagnosis of anemia

Background: Anemia is most common public health problems in developing countries. It is important to know the cause of anemia to treat the patients. The Immature reticulocyte fraction (IRF) value is an early marker for evaluating the regeneration of erythropoiesis. In addition to conventional reticulocyte measurement, the fluorescence method allows the classification of reticulocytes into three maturation stages – LFR, MFR and HFR. Aims: To determine clinical significance of immature reticulocyte fraction (IRF) and reticulocyte maturity indices (LFR, MFR, HFR) in differential diagnosis of anemic patients. Material and Method: IRF and other reticulocyte parameters were measured by automated blood cell analyzer, Horiba Pentra XLR using fluorescence marker that labels RNA and DNA (such as thiazole orange or polymethines), in 124 patients with anemia. The anemia group consist of 50 iron deficiency anemia (IDA) patients, 29 cases of thalassemia trait patients and 45 patients with anemia due to chromic kidney diseases (CKD). In this retrospective and prospective type study, the values of IRF and other parameters were analysed and compared in each group for the duration of one year. Result: Total of 124 cases were evaluated with median age of age of 32.8 years showed that mean value of IRF was low in IDA (0.096±0.058) and in CKD (0.092±0.111) compare to thalassemia (0.116±0.094). The mean values of MFR and HFR were also found to be significantly lower in IDA group and in CKD when compared to the thalassemic group. Values of LFR were higher in IDA and in CKD compare to thalassemia. Conclusions: IRF assesses reticulocyte maturation by the intensity of the staining that reflects the mRNA content. The evaluation of IRF and reticulocyte maturity indices by automated cell counter analyzer seemed to be accurate and clinically useful for the early diagnosis of anemia and the differentiation of IDA and CKD from thalassemia.

PROFILE OF HYPERTENSION IN CHILDREN AGED 3 TO 12 YEARS: EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN NORTH EAST INDIA

Objective: To study the prole of hypertensive children admitted in a tertiary care hospital in the age group of 3 to 12 years. Method: It is a Prospective type Study done over 1 year from June 2019 to May 2020 in the Department of Pediatrics, Silchar Medical College and Hospital (SMCH), a tertiary care Hospital in Assam,India. One twenty six children in the age group of 3 to 12 years meeting the inclusion criteria were admitted with hypertension. Results: During the study period a total of 3214 patients were admitted in the Pediatric Department of Silchar Medical College and Hospital. Out of which 126 patients were found to be hypertensive (3.9%). The number of males were 81(65%) and females 45(56%). The most common affected group was school going children age group (6 to 12 years). 37(29.3%) cases presented with hypertensive emergency. 22(17%) cases presented with congestive cardiac failure and 15(11.9%) cases hypertensive encephalopathy. Renal Cause of hypertension was the leading cause of admission and glomerulonephritis was the leading renal cause (80%). The mortality was 4.7% (6 out of 126 patients) and was due to complication of Glomerulonephritis. Conclusion: Hypertension is a common cause of hospitalization in children. Renal or renovascular etiology of hypertension is the most common cause of hypertension.

The Epidemiology and Genetic Analysis of Children With Idiopathic Type 1 Diabetes in the State of Qatar.

ContextIdiopathic type 1 diabetes is characterized by the absence of autoantibodies and the underlying mechanisms are not clear.ObjectiveWe aimed to study the epidemiology, describe the clinical characteristics, and report results of genetic studies in pediatric patients with idiopathic type 1 diabetes.MethodsThis was a prospective study of type 1 diabetes patients attending Sidra Medicine from 2018 to 2020. Autoantibodies (GAD65, IAA, IA-2A, and ZnT8) were measured and genetic testing was undertaken in patients negative for autoantibodies to rule out monogenic diabetes. Demographic and clinical data of patients with idiopathic type 1 diabetes were compared with patients with autoimmune type 1 diabetes.ResultsOf 1157 patients with type 1 diabetes, 63 were antibody-negative. Upon genome sequencing, 4 had maturity onset diabetes of the young (MODY), 2 had Wolfram syndrome, 1 had H syndrome, and 3 had variants of uncertain significance in MODY genes; 53 patients had idiopathic type 1 diabetes. The most common age of diagnosis was 10 to 14 years. C-peptide level was low but detectable in 30 patients (56.6%) and normal in 23 patients (43.4%) The average body mass index was in the normal range and 33% of the patients had a history of diabetic ketoacidosis (DKA).ConclusionFour percent of the children had idiopathic type 1 diabetes. There were statistically significant differences in the C-peptide level and insulin requirement between the 2 groups. DKA was less common in the idiopathic group. Mutations in MODY genes suggest the importance of autoantibody testing and genetic screening for known causes of monogenic diabetes in idiopathic type 1 diabetes. The mechanism of idiopathic type 1 diabetes is unknown but could be due to defects in antibody production or due to autoantibodies that are not yet detectable or discovered.

A prospective study of type 2 diabetes, metformin use, and risk of breast cancer

Type 2 diabetes (T2D) has been associated with increased breast cancer risk, but commonly prescribed antidiabetic medications such as metformin may reduce risk. Few studies have investigated T2D and medications together in relation to breast cancer. Data came from 44541 Sister Study participants aged 35 to 74 years at enrollment (2003-2009) who satisfied eligibility criteria, followed through 15 September 2017. Information on time-varying, self-reported, physician-diagnosed, prevalent and incident T2D, use of antidiabetic medications, and covariates was obtained from baseline and follow-up questionnaires. Incident breast cancers were confirmed with medical records. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. During follow-up (median, 8.6 years), 2678 breast cancers were diagnosed at least 1 year after enrollment. There were 3227 women (7.2%) with prevalent and 2389 (5.3%) with incident T2D, among whom 61% (n= 3386) were ever treated with metformin. There was no overall association between T2D and breast cancer risk (HR 0.99; 95% CI, 0.87-1.13). However, T2D was associated with increased risk of triple-negative breast cancer (HR 1.40; 95% CI, 0.90-2.16). Compared with not having T2D, T2D with metformin use was not associated with overall breast cancer risk (HR 0.98; 95% CI, 0.83-1.15), but it was associated with decreased risk of estrogen receptor (ER)-positive breast cancer (HR 0.86; 95% CI 0.70-1.05) and increased risk of ER-negative (HR 1.25; 95% CI, 0.84-1.88) and triple-negative breast cancer (HR 1.74; 95% CI, 1.06-2.83). The inverse association with ER-positive cancer was stronger for longer duration (≥10 year) metformin use (HR 0.62; 95% CI, 0.38-1.01; P for trend= 0.09). Results were supported by sensitivity analyses. Our findings suggest that associations between T2D and breast cancer may differ by hormone receptor status and that associations between T2D and ER-positive breast cancer may be reduced by long-term metformin use.

A 5-year prospective study of type 2 diabetes patients in Shanghai Xinjing Community 3.The regression and promoting factors of diabetic retinopathy and diabetic macular edema in Chinese type 2 diabetes patients

Background Long-term study on type 2 diabetes discovered that some patients with diabetic retinopathy (DR) or diabetic macular edema (DME) appear regression of lesions without invasive ocular intervention but only systemic medication.These mechanisms remain unclear. Objective This study was to survey the regression rate and relevant factors of DR and DME in type 2 diabetic patients. Methods A prospectively observational study was performed.Totally 778 patients who met the inclusion criteria participated in this consecutive 5-year survey.The demographic information of the patients was collected, and the systemic and ophthalmological examinations were carried out, and the fundus photography was identified by 2 doctors by blind method.DR was graded into non-, mild-, moderate-, severe-nonproliferation DR and proliferative DR based on international clinical classification, and DME was graded into non-, mild-, moderate-and severe-DME.DR improvement and DME regression were served as the outcome variables and defined as the grading of DR or DME in lateral eyes lowering by at least 1 grade and without development of DR or DME in fellow eyes.The influences of age, gender, education level, diabetes onset age, diabetes course, obesity and serum creatinine, triacylglycerol, total cholesterol and glycosylated hemoglobin levels were evaluated by Logistic regression analysis. Results Four hundred and fifty-six patients appeared DR in the initial examination, of which 139 patients appeared regression of DR severity with the regression rate of 30.48%.Both low blood glucose level and low serum creatinine level at initial examination were independent risk factors associated with DR regression (blood glucose level: odds ratio(OR)=0.53, 95% confidence interval [CI]: 0.45-0.63, P<0.01; serum creatinine level: OR=0.98, 95%CI: 0.97-0.99, P<0.01). One hundred and fifty-eight patients were found to have DME at the initial examination, of which 20 had a regression of DME severity throughout the follow-up duration, with the regression rate 12.66%.High baseline blood glucose level was found to be the only independent risk factor associated with DME regression (OR=1.47, 95%CI: 1.14-1.91, P<0.01). Conclusions Effective control of blood glucose and serum creatinine levels is a favorable factor for the regression of DR, and the rapid drop of blood glucose level is beneficial to the regression of DME. Key words: Diabetes, type 2/complications; Retinopathy, diabetic; Macular edema, diabetic

Prospective study of Type 2 diabetes mellitus, anti-diabetic drugs and risk of prostate cancer.

Type 2 diabetes mellitus (T2DM) has consistently been associated with decreased risk of prostate cancer; however, if this decrease is related to the use of anti‐diabetic drugs is unknown. We prospectively studied men in the comparison cohort in the Prostate Cancer data Base Sweden 3.0, with data on T2DM, use of metformin, sulfonylurea and insulin retrieved from national health care registers and demographic databases. Cox proportional hazards regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) of prostate cancer, adjusted for confounders. The study consisted of 612,846 men, mean age 72 years (standard deviation; SD = 9 years), out of whom 25,882 men were diagnosed with prostate cancer during follow up, mean time of 5 years (SD = 3 years). Men with more than 1 year's duration of T2DM had a decreased risk of prostate cancer compared to men without T2DM (HR = 0.85, 95% CI = 0.82–0.88) but among men with T2DM, those on metformin had no decrease (HR = 0.96, 95% CI = 0.77–1.19), whereas men on insulin (89%) or sulfonylurea (11%) had a decreased risk (HR = 0.73, 95% CI = 0.55–0.98), compared to men with T2DM not on anti‐diabetic drugs. Men with less than 1 year's duration of T2DM had no decrease in prostate cancer risk (HR = 1.11, 95% CI = 0.95–1.31). Our results gave no support to the hypothesis that metformin protects against prostate cancer as recently proposed. However, our data gave some support to an inverse association between T2DM severity and prostate cancer risk.

A 5-year prospective study of type 2 diabetes patients in Shanghai Xinjing Community 2.The risk factors of diabetic retinopathy progression in type 2 diabetic residents with controlled blood glucose

Background Some diabetic patients with well controlled blood glucose still had diabetic retinopathy(DR). The risk factor of DR progression in Mongoloid was not clear. Objective This study was to assess the 5-year incidence and risk factors of DR progression in type 2 diabetic patients with controlled blood glucose. Methods A prospective study was performed under the informed consent of the patients.453 patients with glycosylated hemoglobin A1c (HbA1c)<7.0% in Shanghai xinjing Community from 2007 to 2012 were included in this study.The baseline survey started in 2007 and the final survey ended in 2012.The comprehensive examinations were carried out annually during the follow-up which including general information collection, systemic physical examination, laboratory examination and ophthalmological test.Forward Logistic regression and Cox regression were performed to analysis potential risk factors of DR progression.Kaplan-Meier survival analysis was performed to compare DR progress probability of patients with different HbA1c level.This study was approved by Shanghai First People's Hospital Ethics Committee Results Among the 453 type 2 diabetic patients, 146 developed or progressed DR during the follow-up.The 5-year DR progression rate was 32.23%.Logistic regression showed that baseline HbA1c level was the only independent risk factor of DR progression [P<0.01, odds ratio(OR)=2.84, 95% confidence interval (CI): 2.11-3.82]. Cox regression results showed that the incidence of DR progression in the baseline HbA1c≥5.2% patients was 1.97 times higher than that in the baseline HbA1c<5.2% patients [P<0.01, relative risk(RR)=1.97, 95%CI: 1.32-2.93]. Conclusions The progression rate of DR in type 2 diabetic patients with controlled blood glucose level is still high.In order to reduce DR progression in Chinese type 2 diabetic patients, the targeted HbA1c should be set to a lower level (under 5.2%) under the premise of absent severe side effects. Key words: Diabetes, type 2; Diabetic retinopathy; Hemoglobin A, glycosylated; Risk factor

A 5-year prospective study of type 2 diabetes patients in Shanghai Xinjing Community 1.The incidence and risk factors of diabetic retinopathy and diabetic macular edema in Chinese type 2 diabetes residents

Background Diabetic retinopathy (DR) and diabetic macular edema (DME) are common complications of diabetes.Currently abroad study results of incidence and risk factors of DR and DME in type 2 diabetes population varied largely depending on the ethnical difference.However, relevant epidemiological study is rare in China. Objective This survey was to assess the 5-year incidence and risk factors of DR and DME in Chinese type 2 diabetic patients. Methods A prospective cross-sectional study was performed under the informed consent of the patients.An epidemiological survey for 5-year incidence and risk factors of DR and DME was organized and carried out in 805 type 2 diabetes patients in Shanghai Xinjing Community from 2007 to 2012, and 2007 scheduled as the baseline survey and 2012 scheduled as final survey.The comprehensive examinations were carried out annually during the 5 years, including sociodemographic information, systemic examination and ophthalmological test.DR onset and DME onset grading were performed by OCT and fundus fluorescein angiography (FFA) images based on current international classification.Cumulative incidence of 5 years for DR and DME was determined as the outcome variables, and the associations between potential risk factors and the outcomes were analyzed. Results In the baseline time, non-DR were found in 322 type 2 diabetic patients, of which 151 participants developed DR during the follow-up duration, with the 5-year cumulative incidence rate 46.89%.The independent risk factors for DR occurrence were hyperglycemia (odds ratio[OR]=1.12, 95% confidence interval [CI]: 1.01-1.24, P=0.03) and hypertension (OR=1.80, 95%CI: 1.14-2.86, P=0.01). In the baseline time, 629 type 2 diabetes patients were non-DME, of which 124 participants developed DME during the follow-up duration, with the 5-year cumulative incidence rate 19.71%.Hyperglycemia appeared to be the only independent risk factor of DR onset (OR=1.36, 95%CI: 1.24-1.49, P<0.01). Conclusions Hyperglycemia and hypertension play an important role in the pathogenesis and development of DR and DME in Chinese type 2 diabetic patients, and intensive glycemic control and hypertension control should be emphasized in diabetic patients. Key words: Diabetes mellitus, type 2/complications; Diabetic retinopathy/epidemiology; Diabetic retinopathy/etiology; Incidence; Blood glucose/metabolism; Hypertension; Risk factors; Chinese/epidemiology; Diabetic macular edema

Tratamiento de la sialorrea en niños con patología neurológica

Drooling is the inability to retain saliva in the mouth and its progression to the digestive tract, being a common problem in pediatric patients with neurological disorders. Three different treatment options are available. To assess the effectiveness and safety of trihexyphenidyl, scopolamine and botulinum toxin infiltration in the treatment of drooling in children with neurological disorders. This is an open and prospective type study. We include patients treated in the Neurology Service that present excessive drooling, affecting their quality of life, between 2009 and 2013. We enrolled 46 patients in the study. The treatment with oral trihexyphenidyl was indicated in 46, obtaining good result in 15 (32.6%), three with temporary effect and the rest with lasting effect. Three patients presented side effects (6.5%). Four out of 11 (36.36%) patients treated with scopolamine patch had beneficial effects. One was withdrawn due to lack of efficacy and six due to side effects. Twenty-five patients were infiltrated with botulinum toxin, with a significant decrease of drooling in 16 patients (64%) after the first injection. We observed no significant changes in nine patients. Only one out of 25 showed side effects (mild dysphagia). Currently there is not a fully effective therapeutic option for drooling. We recommend starting treatment with trihexyphenidyl. A second option could be the scopolamine patch and botulinum toxin as a third option. Botulinum toxin infiltration in salivary glands is shown as an effective and safe alternative in our study.

Behavioral Science Research Informs Bioethical Issues in the Conduct of Large-Scale Studies of Children's Disease Risk

Background: Birth cohort studies of the natural history of pediatric common disease risk raise many bioethical issues, including reconsenting participants over time as children mature and cohort retention. Understanding participants’ study-specific knowledge, attitudes, beliefs, and behavior may offer insights into these issues from a psychological perspective. Methods: We conducted an analysis of factors associated with parent–child communication about minor children's participation in a population-based birth cohort; children's knowledge about their own participation; and parental willingness to be recontacted for future study among Swedish parents (N = 3,605) of children originally enrolled at birth in a prospective study of type 1 diabetes risk. Results: More open parent–child communication about disease risk screening research and greater knowledge among children about their own research participation facilitated greater parent willingness to participate in further study. Parents’ decisions about further study participation were most strongly favorable among those who communicated openly with their child and with high study-specific knowledge. Conclusions: Epidemiologists, bioethicists, and others involved in the design and conduct of large-scale, prospective birth cohorts may consider embedding periodic assessments of participants’ study-specific attitudes and behavior to address long-term retention and willingness to engage in future research.

Decreased Endothelial Progenitor Cells and Increased Serum Glycated Albumin Are Independently Correlated With Plaque-Forming Carotid Artery Atherosclerosis in Type 2 Diabetes Patients Without Documented Ischemic Disease

The aim of the present study was to investigate the serum levels of endothelial progenitor cells (EPCs) in type 2 diabetic patients without documented ischemic disease and the association between EPCs and atherosclerotic plaque formation in the carotid artery. A clinic-based, prospective study of type 2 diabetic patients was conducted. A total of 73 subjects were enrolled in this study after cardiac magnetic resonance imaging and ankle-brachial index measurements to exclude patients with ischemic disease. Plaque formation in the carotid artery was measured on ultrasonography. Circulating EPCs (CD34(+)/CD133(+)/CD309(+) cells) were counted on flow cytometry. Compared to subjects without carotid artery plaques, patients with plaques were significantly older (P=0.006) and had decreased EPC count (P=0.027). Serum glycated albumin (GA) level and the GA/glycated hemoglobin ratio tended to decrease in patients with plaques (P=0.091 and 0.067, respectively). Other cardiovascular disease risk factors were not significantly different between the 2 groups. On binary logistic regression analysis old age, low EPC count, and high serum GA level were independently correlated with carotid artery plaque formation. EPC count and serum GA level appear to be a protective and an aggravating factor for endothelial damage, respectively, and therefore, a reduced EPC count or an increased GA level results in atherosclerotic plaque formation in type 2 diabetic patients.

Prospective Study of Type 1 and Type 2 Diabetes and Risk of Stroke Subtypes: the Nurses’ Health Study

We read the article by Janghorbani et al. (1) and have some observations for the authors. First, why did the authors classify stroke subtypes by Perth criteria (2), when TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification (3) would have been, in our opinion, more suitable? Indeed, this classification, evaluating pathophysiological, instrumental, and anatomical findings following an algorithmic procedure, offers …

Prospective Study of Type 1 and Type 2 Diabetes and Risk of Stroke Subtypes: the Nurses’ Health Study

We thank Tuttolomondo et al. (1) for their interest in our study (2). In response, we would like to clarify several points. First, coding of strokes has been ongoing in the Nurses’ Health Study since 1976. We have not had funding to implement coding by TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification (3) but hope to do so in the future. In an internal comparison of coding …

Stroke in Diabetic Patients: Is It Really a Macrovascular Complication?

To the Editor: We have read with interest the article by Wilcox et al,1 in which they demonstrated the positive effect of pioglitazone on stroke recurrence in patients with type 2 diabetes mellitus (DM). However, we would like to stress a particular concern regarding a basic concept in the difficult question of DM and stroke. In this study, as in other previous studies, stroke is considered a macrovascular event in diabetic patients, but is …

Prospective Study of Type 1 and Type 2 Diabetes and Risk of Stroke Subtypes

The aim of this study was to examine the relationship between type 1 and type 2 diabetes and risk of stroke subtypes in women. We followed 116,316 women aged 30-55 years in 1976 through 2002 for incidence of stroke. At baseline and through biennial follow-up, women were asked about their history and treatment of diabetes and other potential risk factors for stroke. During 2.87 million person-years of follow-up, 3,463 incident strokes occurred. In multivariate analyses, the incidence of total stroke was fourfold higher in women with type 1 diabetes (relative risk [RR] 4.7 [95% CI 3.3-6.6]) and twofold higher among women with type 2 diabetes (1.8 [1.7-2.0]) than for nondiabetic women. The multivariate RR of ischemic stroke was increased sixfold (6.3 [4.0-9.8]) in type 1 diabetes and twofold (2.3 [2.0-2.6]) in type 2 diabetes. Risks for large-artery infarction and lacunar stroke were similar. Type 1 diabetes was also significantly associated with the risk of hemorrhagic stroke (3.8 [1.2-11.8]), but type 2 diabetes was not (1.0 [0.7-1.4]). Both type 1 and type 2 diabetes are associated with substantially increased risks of total and most subtypes of stroke.

Long-term outcome of thyroid function after amiodarone-induced thyrotoxicosis, as compared to subacute thyroiditis

Two main forms of amiodarone- induced thyrotoxicosis (AIT) exist: type 1 AIT is a condition of true hyperthyroidism developing in patients with pre-existing thyroid disorders, and usually requires thyroid ablative treatment. On the other hand, type 2 AIT is a form of destructive thyroiditis occurring in normal thyroids, the management of which usually consists in glucocorticoid treatment. To assess the long-term outcome of thyroid function in a prospective study of type 2 AIT patients, as compared to patients with De Quervain's subacute thyroiditis (SAT). Sixty consecutive patients with type 2 AIT were evaluated during oral glucocorticoid treatment (oral prednisone 30 mg/day, gradually tapered and withdrawn over a 3-month period) and followed for 38+/-4 months (range 6-72) thereafter. Sixty consecutive patients with SAT, referred to our Institutes during the same period and treated with the same therapeutic schedule, served as controls. Type 2 AIT patients were older (p<0.0001) and showed a larger male preponderance (M:F 3.6:1 vs 0.5:1, p<0.0001) than SAT patients. Mean serum free T4 (FT4) and free T3 (FT3) concentrations at diagnosis were increased in both conditions, but higher in type 2 AIT than in SAT (FT4 47.6+/-18.8 and 29.6+/-8.3 pmol/l, respectively, p<0.0001; FT3 15.4+/-7.0 and 11.2+/-3.0 pmol/l, respectively, p<0.001). Correction of thyrotoxicosis was obtained in all patients in both groups, but restoration of euthyroidism occurred earlier in SAT than in type 2 AIT (p=0.006). Ten type 2 AIT patients (17%) and 3 SAT patients (5%, p<0.03) became permanently hypothyroid after glucocorticoid withdrawal and required levothyroxine replacement. A relevant proportion of type 2 AIT patients develop permanent hypothyroidism after correction of thyrotoxicosis. Thus, periodic surveillance of thyroid status is required after type 2 AIT.

Prospective Study of Type 2 Diabetes Mellitus and Risk of Primary Open-Angle Glaucoma in Women

To study the relation between type 2 diabetes mellitus (T2DM) and incident primary open-angle glaucoma (POAG) in women. Prospective cohort analysis. Seventy-six thousand three hundred eighteen women enrolled in the Nurses' Health Study (NHS). Women enrolled in the NHS from 1980 to 2000 were observed. Eligible participants were at least 40 years old, did not have POAG at baseline, and reported receiving eye examinations during follow-up. Potential confounders were assessed on biennial questionnaires, and a diagnosis of T2DM was confirmed on a validated supplemental questionnaire. During follow-up, 429 self-reported POAG cases confirmed by medical chart review were identified. Multivariable rate ratios (RRs) of POAG and associated 95% confidence intervals (CIs) obtained from proportional hazards models. After controlling for age, race, hypertension, body mass index, physical activity, alcohol intake, smoking, and family history of glaucoma, T2DM was positively associated with POAG (RR = 1.82 [95% CI = 1.23-2.70]). Nonetheless, the association did not strengthen with longer duration of diabetes: RR = 2.24 (95% CI = 1.31-3.84) for duration < 5 years versus RR = 1.54 (95% CI = 0.90-2.62) for duration > or = 5 years). In secondary analyses, to evaluate the potential for detection bias we controlled for additional factors such as the number of eye examinations, but T2DM remained positively associated with POAG. Type 2 diabetes mellitus is associated with an increased risk of POAG in women.

A prospective study of Type 2 diabetes and depressive symptoms in the elderly: The Rancho Bernardo Study

The association between Type 2 diabetes and depressive symptoms was examined prospectively to assess possible causal relationships between the two diseases. A cohort of 971 men and women aged 50 and older from the adult population of Rancho Bernardo, California had an oral glucose tolerance test and completed the Beck Depression Inventory (BDI) at two clinic visits, 1984-87 and 1992-96. Depressive symptoms at baseline were associated with higher follow-up levels of non-fasting plasma glucose (P = 0.001) and an increased risk of developing Type 2 diabetes [odds ratio (OR) = 2.50; 95% confidence interval (CI) = 1.29-4.87], independent of sex, age, exercise and body mass index. Conversely, baseline non-fasting plasma glucose was not significantly associated with follow-up depressive symptoms and Type 2 diabetes at baseline was not significantly associated with the onset of BDI scores > or = 11 by the second visit (OR = 0.73; 95% CI = 0.41-1.30). Depressed mood is more likely to be a risk factor for Type 2 diabetes in older adults than the reverse.

Prospective study of type 2 diabetes and cognitive decline in women aged 70–81 years

The following abstracts of articles from leading journals have been selected on the basis of their importance to the practice of obstetrics and gynecology.