Risk Factors For Diabetic Complications Research Articles

Serum Magnesium Level Change in Type 2 Diabetic Patients with Cardiovascular Complications

AbstractBackground: Diabetic macrovascular complications remain the main cause of morbidity and mortality in type 2 diabetes patients. Magnesium is a necessary cofactor for several enzymes that play an important role in glucose metabolism.Aim of Study: This work was designed to investigate the relation between serum magnesium and diabetic cardiovascular complications.Patients and Methods: In the present study, 120 patients with type 2 diabetes mellitus were enrolled from Internal Medicine Diabetes and Endocrine Unit Out-patient Clinic, Tanta University Hospitals, Egypt, and 30 individuals as a control within a period of one year. The enrolled individuals were divided into two groups. Group I included 30 healthy non diabetic individuals as control group. Group II included 120 type 2 diabetes patients classified into subgroups;A-30 type 2 diabetic patients without any vascular com-plications.B-30 type 2 diabetic patients with ischemic heart disease.C-30 type 2 diabetic patients with nephropathy.D-30 type 2 diabetic patients with retinopathy.Serum magnesium and other investigations were taken to evaluate the relation between serum magnesium and diabetic macrovascular complications.Result: Serum magnesium level was significantly low in patients with ischemic heart disease 1.28±0.36mg/dl. It was found using recipient characteristic observer curve for mag-nesium as a predictor of diabetic complications that serum magnesium level of 0.9mg/dl was accompanied with 76.4% sensitivity and 72% specificity for prediction of complications. While, HbA1C 7.5% was accompanied with 86.1% sensitivity and 46.2% specificity for prediction of macrovascular com-pilations. Serum magnesium level could be a predictor of occurrence of diabetic complications, but its role in pathogen-esis cannot be well stated as our data did not confirm that hypomagnesaemia is an independent risk factor for diabetes complications.Conclusion: From this study, it can be concluded that that serum magnesium level could be a predictor of occurrence of diabetic complications, but its role in pathogenesis cannot be well stated as our data did not confirm that hypomagnesaemia is an independent risk factor for diabetes complications.

Overall Quality of Care Predicts the Variability of Key Risk Factors for Complications in Type 2 Diabetes: An Observational, Longitudinal Retrospective Study

An association between variability in clinical parameters (HbA1c, blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care. The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters. Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score >25, a score <15 was associated with a significantly larger variation in HbA1c, blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized β coefficients show that the Q-score has a larger impact on the variability of HbA1c (0.34; P < 0.0001), systolic blood pressure (0.21; P < 0.0001), total cholesterol (0.21; P < 0.0001), and LDL cholesterol (0.20; P < 0.0001). The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.

MICROVASCULAR AND MACROVASCULAR DISEASES IN DIABETIC NEPHROPATHY

Introduction: Diabetes mellitus (DM) can be described as a metabolic disorder which is characterized by hyperglycemia which develops as a consequence of defects in insulin secretion or its action, or both. Diabetes is strongly associated with microvascular and macrovascular diseases and its complications, which includes nephropathy, retinopathy, microvascular neuropathy and ischemic heart disease, peripheral vascular disease, and macrovascular cerebrovascular disease which results in organ and tissue damage in about one third to one half of people with diabetes. The early manifestation of DN is microalbuminuria, which eventually progresses to overt albuminuria that is increased albumin levels in the urine, which indicates more severe renal dysfunction, and ultimately leading to renal failure.&#x0D; Material and Methods: Patients were screened and clinically diagnosed accor­ding to World Health Organization (WHO) criteria. Demographic characteristics of the patients were taken, height and weight were recorded, and body mass index (BMI) was calculated in metrics units. Blood investigations were carried out like blood glucose, HbA1C, cholesterol, Triglycerides (TG), serum creatinine, creatinine clearance, and24-hour uri­nary protein were investigated for each patient. Glomerular filtration rate (GFR) was calcu­lated. Rate of change of GFR was calculated. Duration of follow-up, age at onset of diabetes, duration of complications, and time for doubling of serum creatinine were recorded and calculated.&#x0D; Results: A total of 50 patients were included in the study who were diagnosed as DN by the physician. Mean age of the patients with DN was observed as 64.24 ± 13.68. There were 31 (62%) male and 19 (38%) and female. Mean duration of nephro­pathy was 7.2 ± 2.9 years. Family history of DN was shown in 5 (10%). Diabetic complications were recorded and tabulated. Retinopathy was observed in 23 (46%) of the cases, Coronary artery disease in 28 (56%), Angina in 22 (44%), stroke in 6(12%), Diabetic foot in 4 (8%), Hypertension in 43 (86%), blindness in 3 (6%) and end stage renal disease was observed in 12 (24%) of the cases. There were 2 (4%) deaths. The mean time to onset of diabetic com­plications from the diagnosis of diabetes in present study was 9.6 ± 2.9 (Mean± SD) years for coronary artery disease, 15.3 ± 7.3 years, for retinopathy, 11.3 ± 3.4 years for neuropathy, and 6.3 ± 2.9 years for diabetic foot. Patients those who were diagnosed &gt;20 years, end stage renal disease was observed in them. The mean proteinuria was 2.34 ± 1.88 gm/L. Protein excretion &lt; 0.5 was found in 15 (30%) patients, mean HbA1C was 9.7 ± 1.5(Mean± SD).&#x0D; Conclusion: Age, male gender, duration of diabetes, baseline HbA1C, blood pressure, and renal function are risk factors for diabetic complications and nephropathy.&#x0D; Keywords: microvascular, diabetes mellitus, diabetic nephropathy

Glycemic Variability: Risk Factors, Assessment, and Control.

Glycemic variability (GV) a well-established risk factor for hypoglycemia and a suspected risk factor for diabetes complications. GV is also a marker of the instability of a person's metabolic system, expressed as frequent high and low glucose excursions and overall volatile glycemic control. In this review, the author discusses topics related to the assessment, quantification, and optimal control of diabetes, including (1) the notion that optimal control of diabetes, that is, lowering of HbA1c-the commonly accepted gold-standard outcome-can be achieved only if accompanied by simultaneous reduction of GV; (2) assessment and visualization of the two principal dimensions of GV, amplitude and time, which is now possible via continuous glucose monitoring (CGM) and various metrics quantifying GV and the risks associated with hypo- and hyperglycemic excursions; and (3) the evolution of diabetes science and technology beyond quantifying GV and into the realm of GV control via pharmacological agents, for example, GLP-1 receptor agonists and DPP-4 inhibitors, which have pronounced variability-reducing effect, or real-time automated closed-loop systems commonly referred to as the "artificial pancreas." The author concludes that CGM allows close tracking over time, and therefore precise quantification, of glycemic variability in diabetes. The next step-optimal control of glucose fluctuations-is also taken by medications with pronounced GV-lowering effect primarily in type 2 diabetes, and by automated insulin delivery in type 1 diabetes. Contemporary CGM-based artificial pancreas systems use specific GV representations as input signals, and thus their main objective is to minimize GV and, from there, optimize glycemic control.

Self-reported physical activity in community-dwelling adults with diabetes and its association with diabetes complications

AimsTo describe the physical activity levels of an Australian community-based adult population with diabetes, and investigate the interaction between diabetes complications and physical activity. MethodsAnthropometric, demographic, biochemical and self-reported physical activity measures (IPAQ) were performed. Associations and multiple regression analyses were undertaken between physical activity, known risk factors for diabetes complications, and history of cardiovascular disease (CVD), neuropathy and foot ulceration obtained from medical records. Results240 participants were recruited (96% type 2 diabetes; age 68.7 ± 10.5 y; 58% men; diabetes duration 14.3 ± 11.4 y). Sixty seven percent of participants reported undertaking moderate or vigorous intensity exercise to recommended levels, and 29% reported no moderate-vigorous exercise. In addition to being associated with known demographic and biochemical risk factors and other complications, diabetes complications were also associated with different physical activity behaviours. Individuals with a history of CVD were more likely to participate in moderate-vigorous exercise and meet exercise guidelines, individuals with neuropathy undertook less walking and moderate intensity exercise, and those with a history of foot ulceration sat more and participated less in vigorous exercise. ConclusionsIn Australian adults, the presence of diabetes complications may influence physical activity participation, and associate with characteristic physical activity approaches.

Distinct Patterns of Daily Glucose Variation by Pubertal Stage in Youth with Type 1 Diabetes (T1D)

Background: Glucose variability is an emerging risk factor for diabetes complications. As basal insulin requirements vary in youth with T1D by age and time of day, we analyzed daily patterns of glucose variation by pubertal stage in youth with T1D. Methods: Glucose patterns were assessed using 4 weeks of continuous glucose monitoring (CGM) data from 107 youth ages 8-17 years with T1D for &amp;gt;1 year. Glucose values per hour were expressed as percentages relative to the mean glucose over a 24-hour period. Glucose patterns were compared by pubertal stage (pre-pubertal: Tanner (T) 1, pubertal: T2-4, post-pubertal: T5). Results: The sample had a mean (±SD) age of 13.1±2.6 years, T1D duration of 6.3±3.5 years, A1c of 7.8±0.8; 88% were pump-treated. Pre-pubertal youth had greater mean standard deviation (86.4±12.0, p=.008) and coefficient of variation (0.43±.05, p=.04) compared to pubertal (79.8±13.4; 0.41±.05) and post-pubertal youth (75.8±13.3; 0.40±.05). There was no difference in mean glucose or A1c by pubertal stage (p &amp;gt;.4). Patterns of glucose variation appear in Figure. Conclusion: Pre-pubertal compared with pubertal and post-pubertal youth appear to have greater glucose variability independent of A1c, with a notable dawn-dusk pattern. Thus, A1c alone does not seem to capture the full range of glycemic parameters in youth with T1D, highlighting the added value of CGM data when determining optimal insulin doses. Disclosure J. Zhu: None. L. Volkening: None. M. Katz: None. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson &amp; Johnson Diabetes Institute, LLC..

Diabetes Distress and Glycemic Control: The Buffering Effect of Autonomy Support From Important Family Members and Friends.

To examine whether autonomy support (defined as social support for an individual's personal agency) for diabetes management from informal health supporters (family/friends) reduces the detrimental effects of diabetes distress on glycemic control. Three hundred eight veterans with type 2 diabetes and one or more risk factors for diabetes complications completed a survey that included measures of diabetes distress and perceived autonomy support from their main informal health supporter. Hemoglobin A1c (HbA1c) data from 12 months before and after the survey were extracted from electronic medical records. Linear mixed modeling examined the main effects and interaction of autonomy support and diabetes distress on repeated measures of HbA1c over the 12 months after the survey, controlling for mean prior 12-month HbA1c, time, insulin use, age, and race/ethnicity. Diabetes distress (B = 0.12 [SE 0.05]; P = 0.023) was associated with higher and autonomy support (B = -0.16 [SE 0.07]; P = 0.032) with lower subsequent HbA1c levels. Autonomy support moderated the relationship between diabetes distress and HbA1c (B = -0.13 [SE 0.06]; P = 0.027). Greater diabetes distress was associated with higher HbA1c at low (B = 0.21 [SE 07]; P = 0.002) but not high (B = 0.01 [SE 0.07]; P = 0.890) levels of autonomy support. Autonomy support from main health supporters may contribute to better glycemic control by ameliorating the effects of diabetes distress. Interventions that reduce diabetes distress and enhance the autonomy supportiveness of informal supporters may be effective approaches to improving glycemic control.

Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients.

Diabetic peripheral neuropathy (DPN), a common microvascular complication of diabetes, is linked to glycaemic derangements. Glycaemic variability, as a pattern of glycaemic derangements, is a key risk factor for diabetic complications. We investigated the association of glycaemic variability with DPN in a large-scale sample of type 2 diabetic patients. In this cross-sectional study, we enrolled 982 type 2 diabetic patients who were screened for DPN and monitored by a continuous glucose monitoring (CGM) system between February 2011 and January 2017. Multiple glycaemic variability parameters, including the mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), standard deviation of glucose (SD), and 24-h mean glucose (24-h MG), were calculated from glucose profiles obtained from CGM. Other possible risks for DPN were also examined. Of the recruited type 2 diabetic patients, 20.1% (n = 197) presented with DPN, and these patients also had a higher MAGE, MODD, SD, and 24-h MG than patients without DPN (p < 0.001). Using univariate and multiple logistic regression analyses, MAGE and conventional risks including diabetic duration, HOMA-IR, and hemoglobin A1c (HbA1c) were found to be independent contributors to DPN, and the corresponding odds ratios (95% confidence interval) were 4.57 (3.48-6.01), 1.10 (1.03-1.17), 1.24 (1.09-1.41), and 1.33 (1.15-1.53), respectively. Receiver operating characteristic analysis indicated that the optimal MAGE cutoff value for predicting DPN was 4.60 mmol/L; the corresponding sensitivity was 64.47%, and the specificity was 75.54%. In addition to conventional risks including diabetic duration, HOMA-IR and HbA1c, increased glycaemic variability assessed by MAGE is a significant independent contributor to DPN in type 2 diabetic patients.

The association of long-term glycaemic variability versus sustained chronic hyperglycaemia with heart rate-corrected QT interval in patients with type 2 diabetes.

ObjectivesProlonged heart rate-corrected QT(QTc) interval is related to ventricular arrhythmia and cardiovascular mortality, with considerably high prevalence of type 2 diabetes. Additionally, long-term glycaemic variability could be a significant risk factor for diabetic complications in addition to chronic hyperglycaemia. We compared the associations of long-term glycaemic variability versus sustained chronic hyperglycaemia with the QTc interval among type 2 diabetes patients.MethodsIn this cross-sectional study, 2904 type 2 diabetes patients were recruited who had undergone at least four fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPG) measurements (at least once for every 3 months, respectively) during the preceding year. Long-term glycaemic variabilities of FPG and 2-hour PPG were assessed by their standard deviations (SD-FPG and SD-PPG, respectively), and chronic fasting and postprandial hyperglycaemia were assessed by their means (M-FPG and M-PPG, respectively). HbA1c was also determined upon enrolment to assess current overall glycaemic control. QTc interval was estimated from resting 12-lead electrocardiograms, and more than 440 ms was considered abnormally prolonged.ResultsPatients with prolonged QTc interval (≥440 ms) had greater M-FPG, M-PPG, SD-PPG and HbA1c than those with normal QTc interval but comparable SD-FPG. QTc interval was correlated with M-FPG, M-PPG, SD-PPG and HbA1c (r = 0.133, 0.153, 0.245 and 0.207, respectively, p = 0.000) but not with SD-FPG (r = 0.024, p = 0.189). After adjusting for metabolic risk factors via multiple linear regression analysis, SD-PPG, M-PPG and HbA1c (t = 12.16, 2.69 and 10.16, respectively, p = 0.000) were the major independent contributors to the increased QTc interval. The proportion of prolonged QTc interval increased significantly from 10.9% to 14.2% to 26.6% for the first (T1) to second (T2) to third (T3) tertiles of SD-PPG. After adjusting via multiple logistic regression analysis, the odd ratios of prolonged QTc interval of the T2 and T3 versus the T1 of SD-PPG were 1.15 (95% CI, 0.82–1.60) and 2.62 (1.92–3.57), respectively.ConclusionsIncreased long-term variability of PPG is a strong independent risk factor for prolonged QTc interval in type 2 diabetes patients, in addition to long-term postprandial hyperglycaemia and current HbA1c.

Frequency and Risk Factors of Diabetic Complications among Selected Group of Diabetic Patients: Real-life Scenario from a Developing Country, Bangladesh

Background: Diabetes mellitus is a major global public health problem and its complications like coronary artery disease (CAD), stroke, amputations, nephropathy and retinopathy are alarming public health issues. These complications result in significant morbidity, mortality and huge economic burden for the patient and society. This current study aimed to evaluate the frequency of different diabetic complications and their risk factors in a real-life setting.Methods: This cross-sectional study was done in BIRDEM General Hospital from July to December 2015. Diagnosed adult diabetic patients of either sex irrespective of duration and type of diabetes were consecutively and purposively included in this study. Enrolled patients were evaluated clinically and by laboratory investigation.Results: Total patients were 400 with female predominance (57.8%). Mean age was 54.5±10.9 years. Majority (57.5%) were from urban areas, 82% had hypertension and 37.5% had dyslipidaemia. Mean duration of diabetes was 11.6±7.6 years, mean body mass index was 24.6±4.5 kg/m2, mean HbA1c was 9.1±2.0%. Nephopathy (42.5%) was the commonest complication followed by retinopathy (37.8%), neuropathy (29.8%), CAD (25.8%), peripheral vascular disease (14%) and stroke (11%). Long duration (?5 yrs) and poor control of diabetes (HbA1c?7%), family history of diabetes, hypertension, dyslipidaemia and male sex were significant risk factors for diabetic complications.Conclusions: Complications of diabetes are common. Glycaemic control and control of hypertension, dyslipidaemia and weight management may halt or delay the development of complications of diabetes. Patient education is of paramount importance in this regard.Birdem Med J 2017; 7(2): 143-147

The period effect in the prevalence of proliferative diabetic retinopathy, gross proteinuria, and peripheral neuropathy in type 1 diabetes: A longitudinal cohort study.

AimsTo investigate whether, for a specific duration of type 1 diabetes, there is a significant change in the prevalence of proliferative diabetic retinopathy, gross proteinuria and peripheral neuropathy in those more recently diagnosed with diabetes (a period effect), in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Where present, to determine how common risk factors for diabetic complications might be associated with it, and what might be driving it.Materials and methodsLongitudinal cohort study with seven examination phases between 1980 and 2014. Multivariate logistic regression models and ordinal parameterization were used to test for and evaluate any period effect.ResultsThere is a period effect in the prevalence of gross proteinuria and peripheral neuropathy (decreasing), as seen with proliferative diabetic retinopathy (p < 0.001). Adjusting for changing levels of common risk factors attenuates the period effect, particularly for proliferative diabetic retinopathy. For gross proteinuria and peripheral neuropathy, however there is a persistent period effect in spite of adjusting for the major risk factors.ConclusionsThere are period effects in the prevalence of proliferative diabetic retinopathy, gross proteinuria and peripheral neuropathy that cannot be fully explained by changes in common risk factors for complications of type 1 diabetes in this cohort. The role of other potential confounders warrants further exploration.

Elevated serum uric acid and triglycerides level in the patients with Type II Diabetes Mellitus- a Nepalese case control study

Background: Hyperuricemia is associated with type 2 diabetes, which is a metabolic disorder of multiple etiologies resulting from defects in insulin action. The present study wascarried out to look for any association between uric acid and Type II Diabetes Mellitus and also status of triacylglycerol level among those patients.Methods: The blood samples were collected 100 diabetic and 100 non-diabetic individuals in the department of biochemistry and then analyzed for estimation of blood glucose, Uric Acid and Triacylglycerol level.Results: The average level of serum uric acid in diabetic patients was higher (5.706±1.617) in comparison to non diabetic subjects (4.322±0.784) with statistically significant difference (p≤0.05). For female the result indicate there was a positive correlation between (FBS and triglycerides) and (triglycerides and uric acids) which was statistically significant (r =-0.465, n = 41, p = 0.002) and(r =-0.370, n = 41, p = 0.017) respectively.Conclusions: This study documents that hyperuricemia is associated with type 2 diabetes mellitus. Furthermore, the serum triacylglycerol and serum uric acid is also found to be associated risk factors for diabetic complications. Hence, timely diagnosis and management of diabetes is vital to control the complications related to diabetes.Ann. Clin. Chem. Lab. Med. 2016:2(1); 26-34

Osteoarthritis-related difficulty walking and risk for diabetes complications

To examine the effect of Osteoarthritis (OA)-related difficulty walking on risk for diabetes complications in persons with diabetes and OA. A population cohort aged 55+ years with symptomatic hip and knee OA was recruited 1996-98 and followed through provincial administrative data to 2015 (n=2,225). In those with confirmed OA (examination and radiographs) and self-reported diabetes at baseline (n=359), multivariate Cox regression modeling was used to examine the relationship between baseline difficulty walking (Health Assessment Questionnaire (HAQ) difficulty walking score; use of walking aid) and time to first diabetes-specific complication (hospitalization for hypo- or hyperglycemia, infection, amputation, retinopathy, or initiation of chronic renal dialysis) and cardiovascular (CV) events. Participants' mean baseline age was 71.4 years; 66.9% were female, 77.7% had hypertension, 54.0% had pre-existing CV disease, 42.9% were obese and 15.3% were smokers. Median HAQ difficulty walking score was 2/3 indicating moderate to severe walking disability; 54.9% used a walking aid. Over a median 6.1 years, 184 (51.3%) experienced one or more diabetes-specific complications; 191 (53.2%) experienced a CV event over a median 5.7 years. Greater baseline difficulty walking was associated with shorter time to the first diabetes-specific complication (adjusted HR per unit increase in HAQ walking 1.24, 95% CI 1.04-1.47, P=0.02) and CV event (adjusted HR for those using a walking aid 1.35, 95% CI 1.00-1.83, P=0.04). In a population cohort with OA and diabetes, OA-related difficulty walking was a significant - and potentially modifiable - risk factor for diabetes complications.

Abstract P103: Effect of Agents Specific to Triglyceride Lowering, Statins Alone, or a Combination of Both Among Patients with Diabetes and Very High Triglycerides

Background: Severe hypertriglyceridemia is an often-neglected risk factor that is associated with increased risk of cardiovascular disease, pancreatitis and mortality, especially when other comorbidities are present. We investigated the association between triglyceride (TG)-lowering therapy and subsequent reduction in TG levels in patients with diabetes and very high triglycerides (VHTG). Methods: We combined data from the Southern California and Northwest regions of Kaiser Permanente to identify patients with diabetes and a TG measurement &gt; 500 mg/dL with a follow-up measure 6-15 months later. Patients were stratified by whether they received no treatment, pharmacotherapy specific to TG lowering (fibrates, niacin, omega-3 products) only, a statin only or a combination of both between the two TG measures. We compared the characteristics of the four groups of patients and constructed a multivariable logistic regression model to determine the probability of achieving TG &lt;500 mg/dL following therapy, controlling for other characteristics. Results: Of the 3,188 diabetic patients with VHTG, 23% received no therapy, 8% received a TG-specific drug only (72% fibrates, 27% niacin, 1% omega-3), 55% received a statin only, and 14% received both. Compared with no treatment, those receiving a TG-specific agent were not significantly more likely to attain TG &lt;500 mg/dL. However, patients receiving a statin only were more likely to do so (OR 1.79, 95% CI 1.42-2.25), as were patients receiving both a statin and TG-specific agent (1.77, 1.29-2.43). In addition to higher initial TG level, non-Hispanic blacks (1.81, 1.07-3.05), Hispanics (1.26, 1.03-1.54), and men (1.43, 1.16-1.75) were more likely to attain TG level &lt;500 mg/dL. Lower A1C (0.91, 0.87-0.96), systolic blood pressure (0.98, 0.97-0.99), and higher HDL-C (1.02, 1.01-1.04) were also associated with attaining TG &lt;500 mg/dL. Conclusion: Our results suggest that pharmacotherapy is essential for the attainment of TG levels &lt;500 mg/dL in patients with diabetes and VHTG. Because better control of other risk factors was also associated with TG improvement, uncontrolled VHTG may represent an important marker or additional risk factor for diabetes complications that deserves consideration.

Glycemic control of diabetes patients under continuous rocket attacks.

BackgroundEvidence regarding the detrimental effects of exposure to stress on glycemic control among diabetes patients has mainly focused on personal life events or acute trauma. However, the effects of continuous exposure to extreme stress on type 2 diabetes patients have rarely been studied. The aim of the current study was to examine the association of continuous exposure to rocket attacks with glycemic control and with risk factors for diabetes complications among civilian type 2 diabetes patients. We focus on patients residing in the Western Negev in the south of Israel that has been subjected to rocket attacks fired from Gaza since the end of 2001.MethodsA two-arm retrospective cohort study of type 2 diabetes patients, aged 35–70 years, residing in a region with chronic exposure to rocket attacks (N = 1697) and in a non-exposed comparison region in Israel (N = 3000). Data were retrieved from the Health Maintenance Organization (HMO)’s database for four time periods representing exposure: chronic—2008; elevated—2009 (post’Cast Lead’ operation); return to chronic—2010, 2011. Data included socio-demographic variables, HbA1c, BMI, LDL cholesterol, blood pressure. General Linear Models (GLM) were used for analysis.ResultsFor HbA1c, the model yielded a significant main effect for time, a borderline significance main effect for region, and a significant time by region interaction: no differences in HbA1c levels between the regions in 2008 and 2009, followed by significant differences between the regions in 2010 and 2011 when HbA1c continued to increase in the exposed region but decreased in the comparison region. Regarding risk factors, a significant main effect for time for LDL cholesterol only, and significant main effects for region were found in all factors: BMI and LDL cholesterol were higher in the exposed than in the comparison region, but blood pressure values were lower.ConclusionsContinuous exposure to rocket attacks is associated with glycemic control and risk factors in a complex pattern. These preliminary findings require further studies of diverse types of civilian exposure to continuous extreme stress.

Correlates of family involvement before and during medical visits among older adults with high-risk diabetes.

To examine the characteristics of patients with diabetes who regularly receive help from a supporter in preparing for and attending medical visits, and the association between this help and clinical risk factors for diabetes complications. We linked survey data about family involvement for patients in the Veterans Health Administration system with poorly controlled Type 2 diabetes (n = 588; mean 67 years; 97% male) with health record data on blood pressure, glycaemic control and prescription-fill gaps. We used multivariable regression to assess whether supporter presence and, among patients with supporters, supporter role (visit preparation, accompaniment to medical visit or no involvement) were associated with concurrent trends in clinical risk factors over 2 years, adjusting for sociodemographic and health characteristics. Most patients (78%) had a main health supporter; of these, more had regular support for preparing for appointments (69%) than were regularly accompanied to them (45%). Patients with preparation help only were younger and more educated than accompanied patients. Support presence and type was not significantly associated with clinical risk factors. Family help preparing for appointments was common among these patients with high-risk diabetes. In its current form, family support for medical visits may not affect clinical factors in the short term. Supporters helping patients engage in medical visits may need training and assistance to have an impact on the clinical trajectory of patients with diabetes.

Use of Databases for Early Recognition of Risk of Diabetic Complication by Analysis of Liver Enzymes in Type 2 Diabetes Mellitus.

Introduction:Because of increasing prevalence of T2MD worldwide, it’s very important to recognize risk factors for diabetic complications, as soon as possible. Symptoms of complications appear a few or many years after tissue damage. So, it’s imperative to establish surveillance of diabetics with laboratory and other diagnostic procedures for early recognition of diabetic complications. Follow up of clinical curs of diabetes, by using databases of patients, provide possibility for permanent analysis of important laboratory parameters and any changes could be registered. Although an emerging evidence suggests a strong association of ALT (alanine aminotransferase) and γGT (gamma glutamyl transferase) activity with type 2 diabetes mellitus (T2DM), only a limited number of studies have analyzed the association of AST (aspartate aminotransferase), ALT, γGT, and ALP (alkaline phosphatase) activities in controlled T2DM.Material and Methods:Gender differences are of special interest in trying to follow diabetes progression and development of its complications. Here the activities of ALT, AST, γGT, ALP were analyzed as well as levels of glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in 40 T2DM patients and 40 age-matched healthy subjects. Blood samples were collected from all participants in regular 3-months intervals up to 6 months period. Standard IFCC enzyme protocols were used to determine enzyme activities.Results and discussion:In first measured interval, significantly higher activities of ALT (p= 0,050) and glucose levels (p=0,045) were shown in male. A significant correlation was shown between ALT and AST activity with FPG and HbA1c levels in first and third measured interval. ALT activity was much higher in the group of patients with poor glycemia control. Average levels of activities of enzymes stay nearly in normal limits, but changes of enzymes activities should be recognized as soon as possible, earlier than tissue changes and diabetic complications become irreversible.

Postprandial and basal hyperglycaemia in type 2 diabetes: Contributions to overall glucose exposure and diabetic complications

Both postprandial and fasting (basal) hyperglycaemia contribute to overall hyperglycaemia (ambient hyperglycaemia) in type 2 diabetes (T2D). Postprandial glucose is the main contributor in fairly well controlled individuals, whereas basal hyperglycaemia becomes the preponderant contributor in poorly controlled patients. A more generally acceptable description of the contribution of postprandial glucose is to simply say that the absolute impact of postprandial glucose to HbA1c remains constant at approximately 1% across the entire HbA1c spectrum of non-insulin-treated patients with T2D. While epidemiological and pathophysiological studies seem to indicate that excessive postprandial glucose excursions play a role in or are predictors of cardiovascular diseases, there is still currently a lack of clinical evidence that correcting post-meal hyperglycaemia can improve clinical outcomes. However, even in the absence of consensus, there are many reasons for thinking that excessive postprandial glucose might be an independent risk factor for diabetic complications as it contributes to both overall glucose exposure and glycaemic variability, especially in those who have HbA1c levels < 7.5–8%. Given that excessive glucose fluctuations from peaks to nadirs activate oxidative stress, it seems reasonable to consider that a key player in the pathogenesis of diabetic complications, according to the latest IDF guidelines, is post-meal glucose, thereby warranting its assessment and treatment when found at abnormally elevated levels. Nevertheless, healthcare professionals should bear in mind that targeting both post-meal and basal plasma glucose, giving equal consideration to both of them, is probably the best strategy for achieving optimal glycaemic control and thus preventing or reducing the risk of diabetic complications.

Prescribing of medicines for diabetes in primary care in England

Prescribing of medicines for diabetes in primary care in England

Herbal supplements for type 2 Diabetes Mellitus: A systematic review of clinical results

Type 2 diabetes mellitus is reported to be treated by modern drugs including insulin. However, patient compliance, side effects and cost effectiveness have paved the way to try the complementary and alternative medicine. Diabetes mellitus (DM), a chronic hyperglycaemic disorder, is characterized by an increase in the oxidative stress. The present systematic review aimed to summarize the findings from the published literature focusing on the effect of herbal extract towards the type 2 DM. Databases, including Pubmed, Science direct, Web of Knowledge, and Google scholar were searched using the terms ‘herbs’, type 2 DM’, ‘herbs and type 2 DM’. Only single herb related clinical studies issued in the English language between 2000 and 2013 were included. Data was extracted by two independent investigators, and the references of included studies were thoroughly reviewed. A total of 20 studies met the selected criteria. Few studies showed the comparison with oral hypoglycemic agents. Few (3 out of 20) studies demonstrated the potential effects of herbal extract towards the risk factors of diabetic complications. It was observed that there were less published clinical data on herbal extracts used in the management of type 2 DM. The results of the present systematic review may encourage clinicians and medical researchers to use herbal products for effective management of DM and its complications.