Risk Factors In Diabetic Patients Research Articles

The Relationship between Literacy Level and Coronary Risk Factors in Diabetic Patients

Background: Diabetes and illiteracy are common problems in developing countries. In studies on diabetes and cardiac risk factors, literacy level, especially illiteracy, is not adequately addressed. Coronary heart disease (CHD) is a major complication of diabetes and the leading cause of premature death. The purpose of the study was to examine the relationship between literacy level and coronary risk factors in Non-Insulin Dependent Diabetes Mellitus (NIDDM) patients. Methods: A cross-sectional study was conducted in an urban federally funded diabetic’s clinic in Bandar Abbas, Iran. The sample consisted of 256 diabetic patients who were classified into three groups: Illiterates, low-literates and literates. The coronary risk factors were delimited to HbA1C, LDL, HDL, total cholesterol (TC), Triglyceride (TG), Body Mass Index (BMI), and blood pressure. Results: 67.5% of the patients were female, 42.1% illiterates, and 70% were overweight. The measures of TC and BMI were higher among females than males. Differences among the literacy levels based on LDL, TC, HDL, and TG were statistically significant. Conclusion: According to our findings, literacy level does not have a role in glycemic control, but may affect LDL, HDL, TC and TG.

Identification and Progression of Heart Disease Risk Factors in Diabetic Patients from Longitudinal Electronic Health Records

Heart disease is the leading cause of death worldwide. Therefore, assessing the risk of its occurrence is a crucial step in predicting serious cardiac events. Identifying heart disease risk factors and tracking their progression is a preliminary step in heart disease risk assessment. A large number of studies have reported the use of risk factor data collected prospectively. Electronic health record systems are a great resource of the required risk factor data. Unfortunately, most of the valuable information on risk factor data is buried in the form of unstructured clinical notes in electronic health records. In this study, we present an information extraction system to extract related information on heart disease risk factors from unstructured clinical notes using a hybrid approach. The hybrid approach employs both machine learning and rule-based clinical text mining techniques. The developed system achieved an overall microaveraged F-score of 0.8302.

Epidemiology of abnormal glucose metabolism in a country facing its epidemic: SAUDI-DM study.

Saudi Arabia is a community thrilled by sudden social and economical changes, leading to a sharp increase in the prevalence of abnormal glucose metabolism. Age-specific diabetes and impaired fasting glucose prevalence is the focus of this study with the expected risk factors. A nationwide, household, randomized, population based cohort of 18 034 participants aged ≥30 years was selected to test for abnormal glucose metabolism using fasting plasma glucose (FPG) according to American Diabetes Association (ADA) criteria. The prevalence of diabetes was 25.4% with 40.3% being unaware of their disease, while impaired fasting glucose (IFG) affected 25.5% of the total sample. IFG to diabetes ratio was one in this study, decreasing with age and increasing with body weight. Age ≥45 years, hypertension, history of gestational diabetes mellitus (GDM), and high triglycerides are the strongest risk factors in diabetic patients, while history of GDM, dyslipidemia, obesity, and high triglycerides are the most significant risk factors in IFG participants. Abnormal glucose metabolism has reached an epidemic level in this society, where half of adults and older are affected. Risk factors are behind this epidemic and the quick shift from IFG to diabetes in this society.

Carotid Artery Disease in Diabetic Patients

There are two points of view on the interplay between carotid artery disease and diabetes mellitus: Diabetes mellitus has been recognized as one of the main determinants for the presence and progression of asymptomatic and symptomatic carotid artery disease; and carotid intima-media thickness has been defined as a useful tool for risk stratification of this population. Hyperglycaemia, duration of diabetes, arterial hypertension, cholesterol and inflammatory markers have previously been determined as independent factors for carotid atherosclerosis in diabetes, and aging as its predictor in this population by our own results. This paper focuses on the particularities of risk factors in diabetic patients (especially in type 2) and evidence-based guidelines for the management and risk reduction of these patients with stroke and/or carotid artery disease. At present, carotid ultrasound is recommended in diabetic patients with cerebrovascular symptoms. Since the prevalence of diabetes increases constantly, we attempt to address refreshment of criteria for screening of carotid artery disease in the diabetic population. It could be recommended for diabetic patients with at least one more risk factors and for diabetic patients above 60 years of age.

Role of Mediterranean diet in prevention and management of type 2 diabetes

Objective To summarize the importance of Mediterranean diet in the prevention and management of type 2 diabetes. Data sources We searched electronic database on PubMed up to 14 April 2014, we identified these articles with following key words: “Mediterranean diet” and “diabetes”. The initial search resulted in 451 entries. The search strategy had no language and publication date restrictions. The relevance of the studies was assessed based only on the title and abstract. The studies included in our review had to match the following inclusion criteria: (1) randomized clinical trials and meta-analysis or systematic review, and (2) provided strong evidence for the diet as a way to prevent type 2 diabetes, and improve glycemic control and cardiovascular risk factors in diabetic patients. We reviewed 49 manuscripts and only 22 met our inclusion criteria. Study selection Relevant literatures including randomized control trials, meta-analysis or systematic review. Results Based on several studies, Mediterranean diet is inversely related to type 2 diabetes and plays important roles in the management of type 2 diabetes. Based on the evidence gathered and evaluated from various studies, we concluded combination and interaction of Mediterranean diet components, such as fruits, vegetables, nuts, legumes, whole grains, fish and moderate intakes of red wine, which contain essential nutrients and health promoting properties, including high fibers, high magnesium, high anti-oxidant and high monounsaturatal fatty acids (MUFA). Interaction and combination of these essential nutrients and health promoting properties found to lower body weight, hemoglobin A1C (HbA1c), low density lipoprotein (LDL), oxidative-stress and improve high density lipoprotein (HDL) level; which are beneficial for prevention and prognosis improvement of type 2 diabetes. Conclusions In the modern society, poor dietary habits accompanied by inadequate physical activity are associated with the risk of having obesity and type 2 diabetes. Promoting healthy lifestyle and diet are not only beneficial in the prevention and treatment of various diseases but also important in maintaining the overall health. Switching from unhealthy diet to health-friendly diet such as Mediterranean diet represents healthy lifestyle choice.

Grado de control de factores de riesgo cardiovascular en pacientes con diabetes con y sin enfermedad cardiovascular

IntroductionThere is evidence that cardiovascular goals are beneficial in diabetes. ObjectiveTo determine the distribution of cardiovascular risk levels in patients with diabetes and the clinical interventions they have received. DesignDescriptive cross-sectional study. Setting. SERMAS (Madrid) 2010. SubjectsAll patients with diabetes. (n=41,096). Main measurementsPatients in primary or secondary prevention, metabolic and cardiovascular risk factors control, pharmacological and non-pharmacological interventions. Patient and professional variables. ResultsAround one-fifth (21.5%) (95%CI: 21.1% -21.9%) in secondary prevention (very high cardiovascular risk). HbA1c was under control in 31% (95%CI: 30.1%-32%), with 49.9% (95%CI: 48.8%-50.9%) with BP under control, and 39.4% (95% CI: 38.4%-40.4%) with LDL controlled. Only 8.9% (95%CI: 8.3%-9.5%) had a well-controlled HdA1c, BP and LDL, and in 19.8% (95%CI: 19%-20.6%) none of these were under control. Of those with an uncontrolled BP, 23.6% (95% CI: 23.2%-24%) had antihypertensive drugs. There was better control in patients older than 70 years, and those who lived in an urban center, or a lower number of patients per day. ConclusionIn diabetic patients with very high cardiovascular risk (secondary prevention), just half of them had good control of cardiovascular risk factors (BP and LDL). An association was found between better control and older than 70, urban center or lower number of patients per day. This suggests developing strategies to promote a comprehensive control of cardiovascular risk factors in diabetic patients in secondary prevention

A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease

Secondary prevention can improve outcomes in high risk patients. This study investigated the magnitude of cardiovascular risk reduction associated with consumption of a modified portfolio diet in parallel with medical management. 30 patients with type II diabetes, 6 weeks post bypass surgery received dietary counseling on a Modified Portfolio Diet (MPD) (low fat, 8 g/1000 kcal viscous fibres, 17 g/1000 kcal soy protein and 22 g/1000 kcal almonds). Lipid profiles, endothelial function and markers of glycemic control, oxidative stress and inflammation were measured at baseline and following two and four weeks of intervention. Seven patients with no diet therapy served as time controls. Consumption of the MPD resulted in a 19% relative reduction in LDL (1.9 ± 0.8 vs 1.6 ± 0.6 mmol/L, p < 0.001) with no change in HDL cholesterol. Homocysteine levels dropped significantly (10.1 ± 2.7 vs 7.9 ± 4 μmol/L, p = 0.006) over the study period. Flow mediated dilatation increased significantly in treated patients (3.8 ± 3.8% to 6.5 ± 3.6%, p = 0.004) while remaining constant in controls (p = 0.6). Endothelial progenitor cells numbers (CD34+, CD 133+ and UEA-1+) increased significantly following MPD consumption (p < 0.02) with no difference in migratory capacity. In contrast, time controls showed no significant changes. Dietary intervention in medically managed, high risk patients resulted in important reductions in risk factors. Clinical Trials registry number NCT00462436.

CroDiab NET as a powerfull tool for tracking cardiovascular risk factors in diabetic patients: data from Bjelovar-Bilogora County collected during the period from 2001 to 2012

Diabetes mellitus (DM) and its chronic complications are the major world health problem having an upward trend in the whole world. It is believed that currently 366 millions of people suffer from DM worldwide, and by the year 2030 the number of diabetics will increase to 552 million. The number of patients with DM rises in all countries, and 80% of the world's population suffering from diabetes live in developing countries or newly industrialized countries [1]. The Republic of Croatia and the Bjelovar-Bilogora County are not exempt from this trend and the prevalence of DM in Croatia is 6.1% [2]. The influx of patients in the Center for Diabetes of the Bjelovar-Bilogora County is rising. The values of body mass index (BMI), Hba1c levels and the incidence of hypertension and dyslipidemia are worrisome. Therefore the incidence of modifiable cardiovascular risk factors increases too. Cardiovascular complications are the leading cause of morbidity and mortality among patients with DM, and the risk of coronary artery disease is 2-4 times higher than in the general population [3]. This study has involved 4,408 outpatients whose e-records are maintained by the national register of diabetic persons. CroDiab NET, a computer software designed on the basis of world quality indicators, integrates electronic patient records and generates discharge summaries parallel to collecting data for the national diabetes registry [4]. Type 2 diabetes was recorded in 93% of patients, while type 1 diabetes was recorded in only 3% of patients. Hypertension was present in 51% of patients with upward trend in the last three years. The highest rate of dyslipidemia was 39% in 2004, with downward trend at about 25% in the last 3 years. The frequency of patients with myocardial infarction was stable at around 10%, with the lowest value of 7.4% in 2010. The prevalence of patients with stroke also showed a downward trend from 14.9% to 7.4%. Only 10% of patients had BMI 30 kg/m2. Good disease control was achieved by only 18% of patients, a further 18% of them had borderline disease control. The level of regulation of diabetes, BMI, as well as other observed modifiable cardiovascular disease risk factors (arterial hypertension, dyslipidemia) is not satisfactory. Therefore further efforts for better glycemic control, control of hypertension, and dyslipidaemia are needed. CroDiab NET is a powerfull tool for tracking cardiovascular risk factors in diabetic patients.

Characterization of diabetes risk factors in patients prescribed chronic statin therapy.

Determine the incidence of major diabetes risk factors over time in patients prescribed chronic statin therapy. Retrospective observational chart review of adult patients without diabetes in primary care who initiated statin therapy between 2005 and 2010. Presence of diabetes risk factors were determined 1 year prior to statin initiation and continued up to a maximum of 7 years. Diabetes risk factors included impaired fasting glucose, body mass index (BMI) ≥30 kg/m(2), hemoglobin A1c >6% and metabolic syndrome. Descriptive statistics were used to describe the incidence of diabetes risk factors over time. A total of 98 patients met study criteria; mean age was 57 ± 13 years, 43% were men and 71% self-identified as Caucasian/white. Mean baseline values were A1c of 5.97%, fasting glucose of 104 mg/dl and BMI of 28 kg/m(2). There were zero diabetes risk factors over time in 54% ± 7% of patients. The incidence over time of 1 risk factor was 25 ± 9%, 2 risk factors was 17 ± 5% and 3 risk factors was 3 ± 2%. A total of 12 patients were diagnosed with type 2 diabetes during the course of the study period. The incidence of diabetes risk factors did not change over time in an ambulatory adult population prescribed chronic statin therapy. Larger population studies assessing the incidence of and change in diabetes risk factors in patients on chronic statin therapy may help assess the association between statin therapy and presence of such risk factors.

Comparison of generalized additive models and generalized linear models for estimating the retinopathy risk factors for diabetic patients in Tehran

زمینه و هدف: یکی از عوارض شناخته شده دیابت، رتینوپاتی دیابتی است که عامل نابینایی افراد در سنین 20 تا 74 سال محسوب می‏شود . تعیین عوامل خطر مرتبط با پیشرفت بیماری می‏تواند در پیشگیری، تشخیص زودهنگام و کاهش رنج ناشی از این عوارض مهم باشد . در این مطالعه سعی شده است با تعیین عوامل موثر بر رتینوپاتی به مقایسه دو مدل خطی تعمیم‏یافته و جمعی تعمیم‏یافته پرداخته شود. مواد و روش کار: در این مطالعه مقطعی، تعداد 367 بیمار دیابتی شرکت داشتند. متغیرهایی همچون سن، طول مدت ابتلا به دیابت، شاخص توده بدنی، هموگلوبین گلیکوزیله ، کلسترول و فشارخون سیستولیک در این افراد اندازه‏گیری شد. با استفاده از معاینات چشم وجود رتینوپاتی در این افراد بررسی شد. در این مطالعه برای برازش مدل خطی تعمیم‏یافته و مدل جمعی تعمیم‏یافته از نرم‏افزار R استفاده شده است. یافته‏ها: در این مطالعه 120 نفر (33%) از بیماران به رتینوپاتی مبتلا بودند و 247 نفر (67%) رتینوپاتی نداشتند. بر اساس نتایج مدل خطی تعمیم‏یافته، اثر خطی متغیرهای طول مدت ابتلا (001/0 > p )، هموگلوبین گلیکوزیله (001/0 > p ) و فشارخون سیستولیک (018/0 = p ) در رتینوپاتی معنی‏دار گزارش شد. این در حالی است که با استفاده از مدل جمعی تعمیم‏یافته علاوه بر معنی‏داری اثر این سه متغیر قادر به کشف رابطه درجه چهار هموگلوبین و رابطه درجه دو فشارخون با رتینوپاتی نیز می‏باشیم. نتیجه‏گیری: برای تعیین عوامل خطر رتینوپاتی، مدل خطی تعمیم‏یافته تنها قادر به کشف روابط خطی بین متغیرهاست. در حالی که مدل جمعی تعمیم‏یافته با ارائه اطلاعات بیشتری از روابط بین متغیرها، کیفیت پیش‏بینی پاسخ را به حداکثر می‏رساند. این کیفیت پیش‏بینی به وسیله کاهش میانگین مربعات خطا و تست هازمرلمشو بیان شده است. واژه‏های کلیدی: مدل جمعی تعمیم‏یافته، مدل خطی تعمیم‏یافته، رتینوپاتی دیابتی

Potential effect of opium consumption on controlling diabetes and some cardiovascular risk factors in diabetic patients.

Due to this belief that opium may have beneficial effects on diabetes or cardiovascular risk factors, the present study aimed to assess the potential and possible effects of opium consumption on diabetes control and some cardiovascular risk factors in diabetic patients. This study enrolled 374 diabetic subjects from diabetes care centers in Kerman, Iran, including opium user group (n = 179) and a non-opium user group (n = 195). The data were collected through a questionnaire completed by interviewing, physical examination and laboratory assessment. Opium did not show any statistically significant effect on blood glucose, glycated hemoglobin (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL) and diastolic blood pressure. However, systolic blood pressure (SBP) and prevalence of high SBP were significantly higher in opium user group (P < 0.050). In addition, lower serum high-density lipoprotein (HDL) and frequency of lower HDL was significantly higher in opium user group (P < 0.001). According to this study, opium does not seem to have beneficial effects on diabetes control or cardiovascular risk factors. Therefore, it would not be advisable to consume opium as an anti-diabetes or cardioprotective agent.

Prevalence of erectile dysfunction and associated factors among diabetic men attending diabetic clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.

IntroductionThere has been an increase in the prevalence of erectile dysfunction (ED) in the general population especially among Diabetic patients. This seems to be neglected problem in low-income countries. This study aims at establishing the prevalence of ED and associated risk factors in diabetic patients attended at Diabetic Clinic at Muhimbili National Hospital.MethodsA cross-sectional hospital based study was conducted among 312 diabetic patients attending diabetic clinic at Muhimbili National Hospital between May and December 2011.ResultsMore than half (55.1%) of the patients were found to have some form of ED (12.8% had mild dysfunction, 11.5% moderate and 27.9% severe dysfunction). The severity of ED was correlated with increased age. Multivariate logistic regression revealed that ED was significantly predicted by old age (odds ratio (OR) = 7.1, 95% CI 1.2-40.7), evidence of peripheral neuropathy (OR) =5.9, 95% CI 1.6-21.3), and evidence of peripheral vascular disease (OR =2.5, 95% CI 1.2-5.3). Also longer duration of DM was marginally associated with ED (p=0.056). Patients with ED were also more likely to suffer other sexual domains (p<0.001). No lifestyle factor was associated with ED.ConclusionThe prevalence of ED is high among DM patients. Interventions aimed at prevention, early diagnosis and detection of DM and its complications, and adherence to treatment to prevent complications should be implemented. Further studies should emphasize on temporal variation to show true causality of DM on erectile dysfunction.

Overview of cardiovascular risk factors in diabetic patients: focus on hypoglycemia, dyslipidemia, body weight and cardiovascular disease

The incidence of type 2 diabetes mellitus continues to grow rapidly, paralleling the overweight and obesity epidemic. Diabetes has long been related to a significant increase in cardiovascular risk profile. Epidemiological studies have documented a 2 to 4-fold increase in cardiovascular mortality and morbidity. Type 2 diabetes is linked to the metabolic syndrome, a cluster of several metabolic risk factors (such as obesity, hypertension and dyslipidemia). Although improved glycemic control has repeatedly been shown to reduce microvascular diabetic complications, uncertainty remains regarding whether any particular glucose-lowering strategy, or specific therapeutic agent, is safe from a cardiovascular standpoint or can actually lower cardiovascular risk. Thus, there remains a strong clinical need for antihyperglycemic drugs that can improve glycemic control without increasing cardiovascular events, which seems to be strictly related to hypoglycemia. The differences between extra-glycemic effects of antidiabetic drugs currently available should be carefully evaluated, thus improving the achievement of therapeutic goals as suggested by national and international guidelines. An ef fective treatment of the concomitant cardiovascular risk factors through cholesterol- and blood pressure-lowering therapies and a weight-control therapeutic approach should also be considered.

Prevalence and risk factors of five most common upper extremity disorders in diabetics.

In addition to macrovascular and along with other microvascular complications, diabetic patients suffer from some common musculoskeletal complications. The aim of this study was to assess the prevalence of five musculoskeletal disorders of upper extremity including shoulder capsulitis (SC), limited joint mobility (LJM), Dupuytren's contracture (DC), carpal tunnel syndrome (CTS), and trigger finger (TF) as well as identify their related risk factors in diabetic patients. We recruited 432 types 1 or 2 diabetic patients and evaluated them for the presence of musculoskeletal disorders and their-related risk factors in 2012-13. The patients were examined by an endocrinologist and then suspected subjects evaluated by a rheumatologist for defining final diagnosis. The most prevalent musculoskeletal disorder of upper extremity was SC (8.79%), followed by CTS (8.56%), LJM (6.94%), DC (7.4%), and TF (6.71%). Advanced age, female sex, smoking, and duration of diabetes were associated with the appearance of SC; female sex and duration of diabetes with CTS; advanced age and smoking with LJM; advanced age, duration of diabetes and history of foot ulcer with DC; and history of laser photocoagulation was associated with TF. The results show lower prevalence of upper musculoskeletal disorders and different associated risk factors in our diabetic population in comparison with previous studies on other populations.

Cardiovascular risk stratification in diabetic patients

Several studies, reporting that diabetes is associated with a marked increase in the risk of coronary artery disease (CAD), introduced the concept that diabetes is CAD equivalent, and thereby provided a rationale for treating cardiovascular risk factors in diabetic patients as aggressively as in non-diabetic subjects with prior myocardial infarction. However, the concept of CAD risk equivalence in diabetes has been challenged by other studies. The classification of individuals with diabetes as having a risk level equivalent to that of individuals without diabetes who survived a cardiovascular event is an approach that fails to account for the fact that cardiovascular risk is not uniformly distributed, but follows a gradient from the lowest to the highest risk. Prediction models, based on numbers of risk factors, have been proposed for patients with diabetes. Most cardiovascular prediction models have been developed in general populations, including diabetes as a predictor, while a smaller number of studies have endeavored to construct CAD risk scores primarily in diabetic patients. The detection of occult CAD is the objective of non-invasive of testing diabetic patients for risk stratification purposes. Among the non-invasive imaging modalities, stress myocardial perfusion single-photon emission computed tomography has been widely used in diabetic patients. This review discusses the importance of using clinical prediction models in the diabetic population and the different challenges of non-invasive imaging for risk stratification, considering that the questions of when, how, and which diabetic patients should be studied are still open ones.

The impacts of albuminuria and low eGFR on the risk of cardiovascular death, all-cause mortality, and renal events in diabetic patients: meta-analysis.

BackgroundPrecise effects of albuminuria and low estimated glomerular filtration rate (eGFR) on cardiovascular mortality, all-cause mortality, and renal events in diabetic patients are uncertain.Materials and MethodsA systematic review was conducted of the literature through MEDLINE, EMBASE, and CINHAL from 1950 to December 2010. Cohort studies of diabetic patients providing adjusted relative risk (RR) of albuminuria and eGFR for risks of cardiovascular mortality, all-cause mortality, and renal events were selected. Two reviewers screened abstracts and full papers of each study using standardized protocol.ResultsWe identified 31 studies fulfilling the criteria from 6546 abstracts. With regard to the risk of cardiovascular mortality, microalbuminuria (RR 1.76, 95%CI 1.38–2.25) and macroalbuminuria (RR 2.96 95%CI 2.44–3.60) were significant risk factors compared to normoalbuminuria. The same trends were seen in microalbuminuria (RR 1.60, 95%CI 1.42–1.81), and macroalbuminuria (RR 2.64, 95%CI 2.13–3.27) for the risk of all-cause mortality, and also in microalbuminuria (RR 3.21, 95%CI 2.05–5.02) and macroalbuminuria (RR 11.63, 95%CI 5.68–23.83) for the risk of renal events. The magnitudes of relative risks associated with low eGFR along with albuminuria were almost equal to multiplying each risk rate of low eGFR and albuminuria. No significant factors were found by investigating potential sources of heterogeneity using subgroup analysis.ConclusionsHigh albuminuria and low eGFR are relevant risk factors in diabetic patients. Albuminuria and low eGFR may be independent of each other. To evaluate the effects of low eGFR, intervention, or race, appropriately designed studies are needed.

Changes in all-cause and cardiovascular disease mortality in three different Finnish population cohorts with and without diabetes

BackgroundWe aimed to assess changes in cardiovascular (CVD) and all-cause mortality among diabetic and non-diabetic individuals between three large study cohorts with baseline assessments of 10years apart and followed up for 10years. MethodsSix population surveys were carried out in 1972, 1977, 1982, 1987, 1992 and 1997 in Finland. For the analyses we combined the 1972 and 1977 cohorts (cohort 1), the 1982 and 1987 cohorts (cohort 2) and similarly also the 1992 and 1997 cohorts (cohort 3). ResultsAge-adjusted hazard ratio (HR) of all-cause mortality and CVD in men without diabetes showed that both had a statistically significant decreased risk of all-cause mortality compared to the first cohort. No statistically significant changes in all-cause mortality were observed in men and women with diabetes between the latter two cohorts compared with the first after controlling for several covariates. In both men and women without diabetes, cohort 2 (men, HR=0.65; 95% CI 0.51–0.82; women, HR=0.54; 95% CI 0.32–0.89) and cohort 3 (men, HR=0.32; 95% CI 0.22–0.47; women, HR=0.31; 95% CI 0.14–0.68) showed a statistically significant decreased risk of CVD mortality compared to cohort 1. Age-adjusted HRs in regard to CVD mortality in men (HR=0.22; 95% CI 0.07–0.69) and women (HR=0.22; 95% CI 0.05–0.99) with diabetes of cohort 3 were statistically significantly lower than in cohort 1. ConclusionsThere seems to be a decrease in CVD mortality in people with diabetes indicating that treatment of diabetes and cardiovascular risk factors in diabetes patients may have improved during the last decade.

Anemia and type 2 diabetes mellitus associated with peripheral arterial disease progression in Chinese male patients

ObjectivePeripheral arterial disease (PAD) is a chronic occlusive disease mainly occurred in elderly adults. Arteriosclerosis obliterans (ASO) mainly occurring from small or medium sized arteries of the lower extremities is one of the most common causes of PAD. The gender-related differences of circulating risk factors in diabetic patients with ASO in China remain unknown. The aim of this study is to investigate the gender-related differences in the pattern of several potential risk factors between male and female patients with ASO and type 2 diabetes mellitus (T2D). Design and methodsClinical profiles and risk factors were analyzed in 323 Chinese patients with ASO and 112 patients were confirmed with T2D. Severities of limb ischemia were staged according to Fontaine classification. ResultsThe significant inverse correlation was seen between the increased age and hemoglobin. The significant positive correlation was seen between the increased age, urea and creatinine both in the non-diabetic and diabetic male patients. The expression levels of hemoglobin significantly correlate with the classification of Fontaine clinical symptoms in Chinese male patients with T2D/ASO. ConclusionThe study is the first report indicating that the gender-related differences of circulating risk factors are associated with T2D patients with ASO in China. Anemia in Chinese male patients with T2D/ASO may play an important role in peripheral arterial disease progression.

Predictors of depression among patients with diabetes mellitus in Southern India

ObjectiveDiabetes mellitus and depression are major public health problems and are significantly linked with each other. This research study intends to assess for undiagnosed depression and its predictors among adult diabetic patients. MethodsA cross-sectional study was done among 100 patients with type 2 diabetes mellitus attending the diabetic clinic of a tertiary care hospital. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9). Chi-square test was performed and odds ratios (OR) with 95% confidence interval (95% CI) were obtained. Mann Whitney U and Pearson correlation tests were done. Logistic regression was carried out to determine the predictors of depression and adjusted odds ratios with 95% confidence intervals were obtained. ResultsThe prevalence of depression was 49% (95% CI 39.1–58.9%). The predictors of depression were female gender, elevated fasting blood sugar (FBS) level, physical disability and lack of physician's advice about lifestyle modifications. FBS values were significantly higher in depressed individuals as compared to the non-depressed (p value 0.002). A positive correlation (r=0.38, p value 0.01) was obtained between PHQ-9 scores and the FBS values of the diabetic subjects. ConclusionsSubjects with diabetes are highly prone for comorbid depression. Physicians should be sensitive towards the need for assessing for possible depression and its risk factors in diabetic patients.

Risk factors and follow-up of diabetes patients with hypertension

Objective To analyze the prevalence and risk factors related to the diabetic patients with hypertension in the Kailuan group workers.Methods A total of 9 498 type 2 diabetic patients were followed up for 5 years,regarding myocardial infarction,stroke,and death incident.The cumulative incidence of hypertension in diabetic patients and the evaluated risk factors of hypertension were analyzed.Results The prevalence of hypertension in 9 489 subjects with diabetes was 63.3％,higher than that in subjects without diabetes(42.0％,P＜0.01).Aging,smoking,obesity,high blood levels of triglycerides,total cholesterol,and low-density lipoprotein-cholesterol were the risk factors of diabetic patients with hypertension,in whom the morbidity of myocardial infarction,cerebral infarction,cerebral hemorrhage,and renal dysfunction was 3.3％,6.0％,0.9％,and 18.8％,respectively,all higher than those (2.1％,2.6％,0.3％,and 10.9％) in diabetic patients without hypertension (P＜0.01).By the end of follow-up for 5 years,incidences of cerebral infarction,cerebral hemorrhage,and death in diabetic patients with hypertension were higher than those with normal blood pressure (P＜0.05),but no difference in incidences of myocardial infarction between the 2 groups (P＞0.05).The 5-years cumulative incidence of hypertension in the diabetic population was 40.1％.Male sex,smoking,snoring,obesity,and hypertriglyceridemia were the risk factors of hypertension in diabetic patients (P ＜ 0.05).Conclusion The prevalence and the 5-years cumulative incidence of hypertension in diabetic patients increased significantly.Diabetic patients with hypertension may have higher risk of cerebrovascular events and kidney dysfunction. Key words: Diabetes mellitus ; Hypertension ; Risk factors ; Follow-up; Cardiovascular and cerebrovascular events