Recent Diagnosis Of Diabetes Research Articles

Diabetic eye disease among adults in Fiji with self‐reported diabetes

To characterize diabetic eye disease and its management among adults aged ≥40 years with self-reported diabetes in Fiji. During a population-based cross-sectional survey using multistage cluster random sampling, participants reported health information, including whether a doctor had diagnosed diabetes. HbA1c and visual acuity were measured. Diabetic eye disease was assessed using 90-dioptre lens dilated funduscopy. Of those enumerated, 1381 (73.0%) participated, with 222 reporting diabetes. Twenty fundi were not examined (19 due to cataract). Of the remaining 424 eyes, 75.5% had no diabetic disease, 1.2% had proliferative retinopathy, 7.5% had active significant maculopathy and 0.7% had burnt-out/treated disease. By person, 27.2% had retinopathy and/or maculopathy in at least one eye. Mean HbA1c (9.9 ± 2.3%) for this group was significantly higher (P = 0.004) than for those without eye disease. Vision-threat occurred in at least one eye of 11.5%. Diabetes (predominantly maculopathy) caused pinhole acuity <6/18, <6/60 and <3/60 for 3.8%, 1.1% and 0.7% of eyes, respectively. No person was bilaterally blind (<6/60) due to diabetes, but 2.3% (all on oral antiglycaemics alone) were 6/60 bilaterally. Compared with recent diabetes diagnosis, diagnosis >10 years ago was predictive of any (odds ratio [OR] 8.13; 95% confidence interval [CI] 3.28-20.21; P < 0.001) and vision-threatening (OR 5.25; 95% CI 1.71-16.12; P = 0.004) eye disease. Although 80.6% claimed regular general diabetes checkups, only 36.5% recalled previous dilated ocular examination. Four eyes had received laser treatment. There was evidence of failure of management of diabetes and its eye complications. Both need to be improved if increasing diabetes-related visual disability is to be avoided.

Prevalence of Symptoms of Anxiety and Depression in German Patients With Cystic Fibrosis

Chronic illness is a significant risk factor for the development of internalizing psychopathology; however, evidence for the prevalence of these symptoms in patients with cystic fibrosis (CF) is limited. We investigated the prevalence of symptoms of anxiety and depression in German-speaking patients with CF and the association of these symptoms to physical health status. A representative sample of German patients with CF (N = 670; age range, 12-64 years; 52.7% men) completed the Hospital Anxiety and Depression Scale. Their medical data were taken from the German CF registry. Data on the study sample were compared with data on a control group from the German general population. Elevated anxiety scores were found in 20.6% of the patients with CF, and 9.6% reported high levels of symptoms of depression. Adult patients with CF reported more elevated symptoms of anxiety than healthy control subjects, whereas no age group of patients was more or less depressed than the general population. Younger patients reported fewer symptoms of anxiety and depression than older patients, and women reported more symptoms of anxiety than men. Recent hemoptysis/pneumothorax and recent diagnosis of diabetes were associated with anxiety, whereas impaired lung function and transplant listing status were associated with depression. Anxiety in particular is an important issue for a large proportion of patients with CF. The risk of depression increased with greater impairment in pulmonary function. Annual screening of symptoms of anxiety and depression as well as appropriate referrals for those in the clinically elevated range are recommended.

Problems of diabetes management in the immigrant population in Germany

Aim To compare prospectively the effect of diabetes management in the immigrant and the native population in Berlin, Germany. Methods Diabetes patients attending a metabolic outpatient clinic in an area with a high immigrant population were studied at the start of the training program and after 12 months of participation. Results 1607 of 2099 patients with at least one post-training visit (76.6%) provided analysable data. Of these 362 (22.5%) were immigrants. Initial hemoglobinA 1c (HbA 1c) was higher in the immigrants. Immigrants were 5 years younger and had a more recent diagnosis of diabetes. HbA 1c fell by 1.4 and 1.5 percentage points in the immigrants and natives, leaving a greater proportion of the immigrants above the target value of 6.5%. Analysis of patients matched according to baseline HbA 1c, sex and age showed a smaller decrease in mean HbA 1c for the immigrants. The percent of patients with hypertension, obesity, dyslipidaemia or diabetic complications was comparable in both groups initially and after 12 months. Conclusion Immigrants had a higher HbA 1c concentration at baseline and after 12 months compared to natives, despite a similar decline in HbA 1c percentage points. More investigations are warranted to identify the causes, such as dietary habits, language difficulties, education and others.

Can we predict future improvement in glycaemic control?

To determine the factors responsible for poor glycaemic control in diabetes and whether any such factors are associated with likely improvement in glycaemic control. A prospective cohort study of 130 diabetic patients with poor glycaemic control (HbA(1c )> or = 10.0%) with 1-year follow-up in a teaching hospital Diabetes Clinic. Changes in HbA(1c) were measured after 1 year. Poor glycaemic control was attributed to one of 15 possible causes. Those cases due to recent diagnosis of diabetes, inadequate treatment with diet, oral glucose-lowering agents or insulin, exacerbation of co-existent medical problems, recent stressful life-events and missed clinic appointments were all associated with significant improvement in HbA(1c) at 12 months. Patients with low mood or alcohol excess, inadequate blood glucose monitoring, poor exercise/sedentary lifestyle, refusal to take tablets or underdosing and refusal to take insulin at all or to increase the dose were all associated with continuing poor glycaemic control at 12 months. The patients were divided almost equally between the two groups. In patients with poor glycaemic control, it is possible by simple features identified at clinic to predict which individuals are likely to show improvement in control and which will not. These findings have not been reported previously and suggest that about half of individuals with poor control will improve within our current diabetes clinic practice. Additional strategies will be required to address those individuals who are not likely to respond.

Diabetes and Endometrial Cancer: An Evaluation of the Modifying Effects of Other Known Risk Factors

To determine whether risk of endometrial cancer among women with type 2 diabetes differs with respect to other endometrial cancer risk factors, the authors used data from a population-based case-control study (1,303 cases and 1,779 controls) conducted in western Washington State during 1985-1999. History of type 2 diabetes was associated with endometrial cancer (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.2, 2.3), more strongly among women with a recent diabetes diagnosis (<5 years) (OR = 2.6, CI: 1.5, 4.7) than among those with a more distant diagnosis (> or =5 years) (OR = 1.3, CI: 0.8, 1.9). Type 2 diabetes was associated with endometrial cancer among women with a body mass index (BMI) (weight (kg)/height (m)(2)) less than 35 but not among women with a BMI of 35 or more. The observed associations persisted after finer adjustment for BMI to control for residual confounding. History of diabetes was associated with a twofold increased risk of endometrial cancer among hypertensive women, but no association was observed among nonhypertensive women. The risk associated with type 2 diabetes appeared not to vary greatly with respect to other endometrial cancer risk factors. These results support the hypothesis that type 2 diabetes is associated with endometrial cancer irrespective of the presence of other risk factors for this disease, except possibly hypertension and extreme obesity.

Central visual field changes using flicker perimetry in type 2 diabetes mellitus

To evaluate the efficacy of flicker perimetry compared with that of static perimetry in determining central visual field losses in participants with type 2 diabetes mellitus. Flicker and static perimetry were performed using the Medmont field analyser on 20 participants with type 2 diabetes mellitus and 24 age-matched control participants. Flicker, but not static, perimetry demonstrated significant reductions in thresholds in those participants who had a recent diagnosis of diabetes or who had no or only minimal diabetic retinopathy compared to the control group at eccentricities close to fixation. Flicker perimetry is recommended for the evaluation of visual field losses in participants with recent onset of diabetes and minimal diabetic retinopathy.