Years In Diabetic Patients Research Articles

Implementing a Novel Machine Learning System for Nutrition Education in Diabetes Mellitus Nutritional Clinic: Predicting 1-Year Blood Glucose Control.

(1) Background: Persistent hyperglycemia in diabetes mellitus (DM) increases the risk of death and causes cardiovascular disease (CVD), resulting in significant social and economic costs. This study used a machine learning (ML) technique to build prediction models with the factors of lifestyle, medication compliance, and self-control in eating habits and then implemented a predictive system based on the best model to forecast whether blood glucose can be well-controlled within 1 year in diabetic patients attending a DM nutritional clinic. (2) Methods: Data were collected from outpatients aged 20 years or older with type 2 DM who received nutrition education in Chi Mei Medical Center. Multiple ML algorithms were used to build the predictive models. (3) Results: The predictive models achieved accuracies ranging from 0.611 to 0.690. The XGBoost model with the highest area under the curve (AUC) of 0.738 was regarded as the best and used for the predictive system implementation. SHAP analysis was performed to interpret the feature importance in the best model. The predictive system, evaluated by dietitians, received positive feedback as a beneficial tool for diabetes nutrition consultations. (4) Conclusions: The ML prediction model provides a promising approach for diabetes nutrition consultations to maintain good long-term blood glucose control, reduce diabetes-related complications, and enhance the quality of medical care.

7-year outcomes in diabetic patients after coronary artery bypass graft in a developing country

BackgroundRevascularization in diabetic patients with coronary artery disease remains a challenge in cardiology practice. Although clinical trials have reported the mid-term superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention in these patients, little is known about the long-term outcomes of CABG in diabetic patients compared to non-diabetics, particularly in developing countries.MethodsBetween 2007 and 2016, we recruited all patients who underwent isolated CABG in a tertiary care cardiovascular center in a developing country. The patients were followed at 3–6 months and 12 months after surgery, and then annually. The study endpoints were 7-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE).ResultsOf 23,873 patients (17,529 males, mean age 65.67 years) who underwent CABG, 9227 (38.65%) patients were diagnosed with diabetes. After adjustment for potential confounders, patients with diabetes experienced a 31% increase in MACCE seven years after surgery compared to the non-diabetic patients (HR = 1.31, 95% CI: 1.25–1.38, P-value < 0.0001). Meanwhile, diabetes contributes to a 52% increase in the risk of all-cause mortality after CABG (HR = 1.52, 95% CI: 1.42–1.61, P-value < 0.0001).ConclusionsOur study showed a higher risk of all-cause mortality and MACCE at seven years in diabetic patients undergoing isolated CABG. The outcomes in the studied center in a developing country were comparable to western centers. The high incidence of adverse outcomes in the long term in diabetic patients implies that not only short-term but long-term measures should be taken to improve the CABG outcomes in this challenging patient population.

Nutritional status of children and adolescents with Type 1 Diabetes Mellitus in Baghdad: a case-control study.

Diabetes mellitus (DM) is a major life-long non-communicable illness correlated with obesity and chronic undernutrition. It is particularly important to monitor the nutritional status of children with type 1 diabetes mellitus (T1DM), as they are still growing and may be affected by the disease or associated conditions like celiac disease. This study aimed to evaluate the nutritional status of children and adolescents with T1DM in Baghdad city and identify possible risk factors for undernutrition. A single-center, case-control study was conducted in Central Child's Teaching Hospital, Baghdad, Iraq, over 9 months from November 2021 to July 2022. The study included patients with T1DM and healthy controls. Detailed history, clinical examination, and anthropometric measures were performed for all participants in the study. The mean age of the sample was 10.0 ±3.73 years and 8.68±3.1 years in diabetic patients and controls, respectively. Anthropometric measures in patients with type 1 diabetes were significantly lower than those of controls (P<0.001). All patients within the undernourished group were from large-size families compared with 75.76% of the normally nourished group, with a significant difference. The mean age of disease onset in the normal nourished group was 6.61 ± 2.78 years which was significantly earlier than that of the undernourished group (8.83 ± 2.89). Weight-for-age and BMI z-score had a significant negative correlation with HbA1c (r=-0.312, p=0.004, and r=-0.295, p=0.006, respectively). Patients with T1DM had significantly lower anthropometric measures than the normal population. Older children, female gender, large family size, and disease duration are independent predictors of undernutrition in T1DM. BMI and weight-for-age have a significant negative correlation with metabolic control of diabetes represented by HbA1c.

Improving the perioperative pathway of patients with diabetes undergoing surgery – a quality improvement project

Background: More than 323 000 operations take place in the UK each year in diabetic patients, accounting for 15% of all operative procedures.1 This group continues to have a longer length of stay and higher rates of adverse postoperative outcome.2 As per the 2019 National Diabetes Inpatient Audit (NaDIA), our institution currently operates below the benchmark (staff knowledge and patients’ ability to take control of their diabetes).3 Our length of stay for elective diabetes patients was 0.36 days above the national average.4 Methods: Data were collected prospectively in diabetic patients undergoing elective surgery between 1 and 30 September 2021. Pregnant, paediatric, and non-elective patients were excluded. Patient characteristics and information relevant to perioperative management was collected and analysed against The Centre for Perioperative Care (CPOC) recommendations.4 Results: Our data are shown in Table 1.Table 1Data collected perioperatively in diabetic patients.Characteristics of study subjects. Values are given as mean or n (%). DM, type of diabetes mellitus; CBG, capillary blood glucose.n27Age (yr)69 (49–89)BMI30.4 (18–38.8)ASA 10 214 (51.8%) 312 (44.4%) 41 (0.037%)DM 11 (0.037%) 226 (96.2%)Preop HbA1C <69 mmol L–122 (81.5 %) >69 mmol L–15 (18.5%)Fasting >10 h15 (55.5%)Not first on list20 (74%)WHO Checklist completed27 (100%)Anaesthetic technique GA15 (55.5%) Other12 (44.4%)CBG not measured Intraoperatively12 (44.4%) Postoperatively4 (14.8%)Duration in recovery <1 h20 (74%) >24 h1 (0.037%)Postoperative diabetes management plan As per protocol21 (77.7%) No plan identifiable6 (22.2%)Discharged Day care18 (16.6%) Ward8 (29.6%) HDU1 (0.037%) Open table in a new tab Conclusions: Compliance with CPOC guidelines was variable with some evidence of good practice and some requiring further improvement and education. To improve delivery of care in this group of patients, perioperative interventions were recommended including introduction of individualised perioperative care plans for diabetic patients, flash cards designed for glycaemic management, and development of institutional guidelines for perioperative diabetes management. We emphasise the need for teaching and training of nursing staff and educating patients about their perioperative journey and diabetes management. 1.Rotruck S, Suszan L, Vigersky R, et al. AANA J 2018; 86: 194–2002.Sampson MJ et al. Diabetes Res Clin Pract 2007; 77: 92–83.National Diabetes Inpatient Audit. NHS Digital, 2019. Available from: https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-diabetes-inpatient-audit4.Guidelines for perioperative care for people with diabetes mellitus undergoing elective and emergency surgery. Centre for Perioperative Care, 2021. Available from: https://cpoc.org.uk/guidelines-resources-guidelines-resources/guideline-diabetes

Bilateral vs Single Internal Mammary Artery Grafts for Coronary Artery Bypass in the United States

The use of the bilateral internal mammary artery (BIMA) in coronary artery bypass grafting remains controversial. The objective of this study was to investigate the long-term outcomes using the BIMA vs the single internal mammary artery (SIMA) in the United States. Medicare beneficiaries who underwent primary isolated coronary artery bypass surgery using the SIMA or BIMA from 1999 to 2010 were included in this retrospective study, with follow-up through 2014. Greedy matching algorithms were used for 1:4 matching on propensity score based on age, gender, year of surgery, and comorbidities. Kaplan-Meier survival analyses were performed. The primary outcome was death from any cause. A total of 1,156,339 and 25,005 patients who were 72 ± 7.6 years of age and 70.3 ± 7.9 years of age underwent primary isolated coronary artery bypass surgery using SIMA and BIMA, respectively. Matching created comparable groups with 95,780 SIMA and 24,160 BIMA patients. Matched median survival using SIMA vs BIMA was 11.8 vs 12.4 years (P < .001) and 9.6 vs 10 years in diabetic patients (P = .006), respectively. At 10 years of follow-up, the respective survival rates of using SIMA vs BIMA were 58.3% vs 61.1%, respectively. The stratified matched median survival using SIMA vs BIMA with 1, 2, 3, and 4 or more aortocoronary bypasses were 11.8 vs 12.3 years (P= .005), 11.7 vs 12.5 years (P < .001), 11.9 vs 12.3 years (P= .01), and 11.4 vs 12 years (P= .02), respectively. Primary isolated coronary artery bypass surgery using the BIMA rather than the SIMA was associated with improved long-term survival. This survival advantage was independent of aortocoronary bypass grafts or patient diabetes status.

MON-389 Fracture Risk Assessment Models for Patients With T2DM

IntroductionBone mineral density (BMD) measurement, a tool used to diagnose osteoporosis (OP) and to predict fracture risk, has not been found very useful in type 2 diabetic (T2DM) patients. They have a 69% higher fracture risk despite having higher hip and lumbar spine BMD than the non-diabetic population. The aim of this study was to examine the impact of 3 different fracture risk assessment (FRAX) models using surrogate adjustments for T2DM in predicting osteoporotic fracture risk over 10 years.Material and MethodsObservational retrospective study included 98 patients with OP or osteopenia: 94 women and 4 men admitted in the National Institute of Endocrinology between 2011-2019. 50 % (n= 49) of the patients had T2DM, while the other half were non-diabetic patients. BMI, BMD, lipid profile, serum creatinine, calcium, phosphorus, 25(OH)vitamin D, HbA1c were assessed. BMD was measured on a GE Lunar osteodensitometer. The risk of major osteoporotic fracture in 10 years was assessed with FRAX adjusted for Romania. For diabetic patients, FRAX was adjusted by adding 10 years to patients’ age (model 1), by using rheumatoid polyarthritis as a substitute for T2DM (model 2) or by lowering T score with 0.5 DS (model 3).ResultsNon-diabetic patients had a lower BMI (p=0.001) and a lower BMD (p=0.03) than diabetic patients. A higher BMI correlated with a higher hip BMD (p=0.004).For diabetic patients, FRAX risk without adjustment was statistically significant lower than FRAX risk calculated with model 1 and 2 (p< 0.001) for both major and hip fracture risk. Unadjusted FRAX risk was lower than the one calculated with model 3 only for hip fracture risk (p<0.001).Model 1 FRAX adjustment led to a statistically significant risk of both major osteoporotic fracture (p= 0.004) and hip fracture (p=0.04) over 10 years in diabetic patients than non-diabetic patients, though diabetic patients had higher BMD. The same observation was made when FRAX was adjusted by model 2 (p=0.001) or by model 3 (p=0.001).HbA1c correlated inversely with FRAX adjusted with all three models.DiscussionFRAX calculator does not include T2DM among secondary causes of OP and this precludes a proper risk assessment independent of BMD. Trabecular bone assessment (TBS) captures a larger portion of the diabetes-associated fracture risk than BMD, however TBS it is not fully independent of the BMD. We examined 3 models of adjusted FRAX in T2DM patients that showed an important increase in fracture risk prediction when adding BMD - independent risk factors into FRAX calculator.ConclusionT2DM patients have a greater risk of major osteoporotic fracture in 10 years at the same BMD compared with non-diabetic population. New models of FRAX adjusted for T2DM are needed in assessing the intervention threshold for OP/osteopenia of patients with T2DM.

Frequency of Cataract in Diabetic Verses Non-Diabetic Patients

Purpose: To determine the frequency of cataract in diabetic verses non-diabetic patients.&#x0D; Study Design: Descriptive cross-sectional study.&#x0D; Place and Duration of Study: Eye Outpatients Department of Fatima Memorial Hospital Lahore from December to March 2018.&#x0D; Material and Methods: Patients between 20-50 years of age with and without diabetes were included in the study. The diabetic patients included in the study had diabetes for at least 6-7 years. Patients with any other systemic disease and patients &lt;20 years and &gt; 50 years were excluded from the study. All patients underwent a complete eye examination including uncorrected and best corrected visual acuity, refraction, dilated slit lamp and fundus examination.&#x0D; Results: A total of 194 patients were examined. Average duration of diabetes was 6-7 years with age groups 20-35 years (34.02%) and 35-50 years (65.97%). There were 79 (79.79%) patients with diabetes who had cataract while only 13 (13.68%) non- diabetic patients had cataract. Most common type of cataract in diabetic patients was posterior subcapsular cataract (PSCC) 43 (54.43%). This was followed by nuclear cataract in 17 (21.51%) and cortical cataract in 14 (17.72%) patients. While in non-diabetic patients nuclear cataract was seen in 6 (46.15%) patients and cortical and PSCC were the same percentage 3 (23.07%). Cataract frequently developed in the age group of 35-50 years in diabetic patients.&#x0D; Conclusion: Diabetic patients should be screened for cataract early as PSCC can cause significant deterioration of vision between 35-50 years.&#x0D; Keywords: Cataract, Diabetes Mellitus (DM), Posterior Sub Capsular Cataract (PSCC), Nuclear Cataract (NC) and Cortical Cataract (CC).

Probability of a coronary event in the next 10 years in diabetic patients according to the Framingham - REGICOR scale

Introduccion: los pacientes diabeticos tienen un riesgo coronario 2 a 4 veces superior al observado en la poblacion general. Objetivo: estimar la probabilidad de evento coronario en los proximos 10 anos en pacientes diabeticos del Hospital Regional de Coronel Oviedo, Paraguay. Sujetos y metodos: estudio observacional, descriptivo de corte transversal. Muestreo no probabilistico de casos consecutivos con revision de expedientes clinicos de pacientes diabeticos que acudieron al Departamento de diabetes durante el 2013. El instrumento utilizado para la estimacion de evento coronario fue la Escala de Framingham calibrada para Espana, conocida como REGICOR. Resultados: se incluyeron 82 expedientes clinicos de pacientes diabeticos con edades de 30 a 76 anos (media 56,29 ± 11,62 anos). El 61% pertenece al sexo femenino y 97,6% padece diabetes mellitus tipo 2. El 56,1% tiene entre 3 a 4 factores de riesgo coronario, siendo el mas frecuente la hiperglucemia (97,6%). El 46,3% tiene una probabilidad moderada de 5 a 9% de acontecimiento coronario a los 10 anos. Conclusion: los factores de riesgo coronario mas frecuentes fueron hiperglucemia, hipertrigliceridemia y obesidad abdominal. Casi la mitad de los pacientes tiene una probabilidad moderada de acontecimiento coronario a los 10 anos.

Oxidative stress predicts progression of peripheral and cardiac autonomic nerve dysfunction over 6 years in diabetic patients.

Oxidative stress is implicated in the pathogenesis of experimental diabetic neuropathy, but prospective studies in diabetic patients are lacking. We aimed to evaluate whether the plasma levels of various biomarkers of oxidative stress predict the progression of diabetic neuropathy and mortality over 6 years. We followed 89 diabetic patients aged 54 ± 14 years (59 % with polyneuropathy), 72 of whom underwent nerve function reassessment after 6.2 ± 0.8 years, whereas 17 died after 4.2 ± 1.0 years. Plasma markers of oxidative stress at baseline included superoxide anion, hypochlorous acid, peroxynitrite, 8-iso-prostaglandin F2α, vitamin E/lipid ratio, and vitamin C. Neuropathy was assessed by symptoms and deficits, motor and sensory nerve conduction velocity (MNCV, SNCV), vibration perception thresholds (VPT), thermal detection thresholds, and heart rate variability (HRV). Despite a reduction in HbA1c by 1.4 ± 1.6 % (p < 0.001), median SNCV, sural SNCV, peroneal MNCV, malleolar VPT, and warm TDT deteriorated after 6 years (all p < 0.05). In multivariate models, increased superoxide generation was associated with a decline in median SNCV (β = -0.997; p = 0.036) and deterioration in HRV at rest (OR 1.63 [95 % CI 1.09-2.44]; p = 0.017) over 6 years. Low vitamin E/lipid ratio tended to predict a decrease in peroneal MNCV (β = 0.781; p = 0.057) and an increase in malleolar VPT (β = -0.725; p = 0.077). Plasma superoxide generation was associated with an increased risk of mortality (HR 23.2 [95 % CI 1.05-513]; p = 0.047). In conclusion, increased plasma superoxide generation predicted the decline in sensory and cardiac autonomic nerve function and mortality over 6 years in diabetic patients, but larger studies are required for confirmation.

Improved Lipid Profiles are Associated with Reduced Incidence of Coronary Vascular Events in Asymptomatic Patients with Type 2 Diabetes and Impaired Myocardial Perfusion

Individuals with type 2 diabetes are at high risk for cardiovascular events; however, a modality that could reduce risk has not been fully evaluated. We examined the annual incidence rate of cardiovascular events in asymptomatic Japanese diabetic patients who underwent gated myocardial perfusion single-photon computed tomography (SPECT). Asymptomatic patients (n= 485) aged ≥50 years and with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or urinary albumin ≥30 mg/g creatinine, or at least two of abdominal obesity, low HDL cholesterol, high triglyceride levels and hypertension were evaluated at 50 institutions using gated SPECT with the stress-rest protocol and were followed up for three years. In the patients with summed stress scores (SSS) of ≥9, the initial high cardiovascular incidence rate in the first year declined significantly (p<0.001) from 21% to 2% during the second and third year. The incident rate was consistent among diabetics with low SSS during follow-up. Baseline LDL and non-HDL cholesterol levels significantly reduced (123±6.4 to 99±6.1 mg/dL; p<0.05) during the first year in diabetic patients with high SSS, but did not significantly change in diabetic patients with low (<9) SSS. The immediate improvement of lipid levels within one year correlated with the significant reduction in CVD events arising in diabetic patients with moderate or severe myocardial ischemia. Thus, rapidly lowering hyperlipidemia is very effective for patients with type 2 diabetes at high risk for cardiac events.

Pulmonary function over 2 years in diabetic patients treated with prandial inhaled Technosphere Insulin or usual antidiabetes treatment: a randomized trial

Development of inhaled insulin has increased the need to understand its pulmonary safety. This study evaluated pulmonary function changes in diabetes patients receiving inhaled Technosphere Insulin (TI) or usual antidiabetes treatment (usual care). This randomized, open-label study was conducted at 220 sites (25 July 2005 to 29 August 2008). Pulmonary function tests [forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC) and lung diffusion capacity for carbon monoxide (DL(CO))] were prospectively followed over 2 years in patients with type 1 or type 2 diabetes receiving TI (n = 730) or usual care (n = 824), along with a cohort without diabetes not receiving any specific therapy (n = 145). Baseline demographics and pulmonary function were similar between diabetes treatment groups. Lung function declined from baseline in all groups. TI was non-inferior to usual care for mean change in FEV(1) from baseline to month 24 [mean (s.e.m.) 0.037 (0.0119) l; 95% CI 0.014 to 0.060] using mixed-model repeated-measure with a pre-specified non-inferiority margin of 50 ml/year. After a greater initial decline at month 3 with TI, rate of change (slope) in FEV(1), FVC and DL(CO) (months 3-24) was not statistically different between treatment groups. TI was well tolerated; no serious safety concerns emerged. The most common respiratory event associated with TI was mild, transient cough, occurring within minutes of inhalation. Observed changes in lung function with TI were small, occurred early after therapy initiation, remained non-progressive over 2 years and were unlikely to be clinically meaningful.

A Randomized Comparison of Sirolimus- Versus Paclitaxel-Eluting Stent Implantation in Patients With Diabetes Mellitus: 4-Year Clinical Outcomes of DES-DIABETES (Drug-Eluting Stent in patients with DIABETES mellitus) Trial

We compared 4-year efficacy and safety of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with diabetes mellitus (DM). Four-year comparison of SES with PES in diabetic patients has not been evaluated in a randomized manner. This prospective, multicenter, randomized study compared SES (n = 200) and PES (n = 200) implantation in diabetic patients. We evaluated 4-year major adverse cardiac events (MACE) including death, myocardial infarction (MI), and target lesion revascularization (TLR). The 2 groups had similar baseline characteristics. At 2 years, TLR (3.5% vs. 11.0%, log-rank, p < 0.01) and MACE (3.5% vs. 12.5%, log-rank, p < 0.01) were significantly lower in SES versus PES group with no difference of death or MI. At 4 years there were no differences in death (3.0% vs. 5.0%, p = 0.45) or MI (1.5% vs. 1.0%, p = 0.99) between SES and PES group. The TLR (7.5% vs. 12.0%, log-rank, p = 0.10) and MACE (11.0% vs. 16.0%, log-rank, p = 0.10) were statistically not different between SES and PES group. At multivariate Cox regression, post-procedural minimal lumen diameter (hazard ratio [HR]: 0.44, 95% confidence interval [CI]: 0.24 to 0.81, p < 0.01), hypercholesterolemia (HR: 2.21, 95% CI: 1.29 to 3.79, p < 0.01), and use of intravascular ultrasound (HR: 0.51, 95% CI: 0.26 to 0.99, p = 0.049) were independent predictors of 4-year MACE. Superiority of SES over PES during 2 years was attenuated between 2 years and 4 years in diabetic patients. Use of intravascular ultrasound and larger post-procedural minimal lumen diameter were independent predictors of the improved long-term clinical outcomes.

What is the evidence base for the randomized controlled trial?

What is the evidence base for the randomized controlled trial?

Therapeutic education of diabetic patients

Therapeutic patient education is a patient-centred approach, focussed on patients' needs, resources, values and strategies. It allows patients to improve their knowledge and skills not only concerning their illness but also their treatment. It brings a better quality of life, a greater therapeutic compliance and a reduction in complications. The most difficult part of therapeutic patient education occurs when patients must change their behaviour. Motivational interviewing and cognitive-behavioural approaches contribute greatly here and allow both the preparation and support of patients during progressive 'step by step' change. The work on resistance to change is fundamental, and ambivalence when faced with the choice of a new way of life must be measured, discussed and negotiated. Patients become partners and we become 'coaches'. The negotiation of objectives must allow patients to choose their own strategies, which normally should cost them the least possible, psychologically, and bring them the maximum benefit. The efficiency of therapeutic patient education no longer needs to be proved: 80% less amputations over 10 years in diabetic patients; 50% maintenance of weight loss over 5 years, etc. In conclusion, therapeutic education is part of a humanistic medical approach centred on patients; it allows them to be active participants in their own treatment with the aim of improving their quality of life and therapeutic compliance, as well as reducing potential complications. Thus, health care professionals teach, inform, train, negotiate with, motivate and accompany patients in the long-term follow-up of their illness.

Abstract 3220: Bivalirudin Monotherapy Provides Similar One-Year Survival Compared to Heparin plus GP IIb/IIIa Inhibitors in Diabetic Patients with Acute Coronary Syndromes: Results from the Randomized ACUITY Trial

Background: Among diabetic patients with acute coronary syndromes (ACS) in the ACUITY trial, bivalirudin (Biv) monotherapy (Mono) provided similar survival and protection from ischemic events with significantly less major bleeding compared to heparin (unfractionated or enoxaparin) plus GP IIb/IIIa inhibitors (Hep+GPI) at 30 days. Whether this protection from ischemic events persists to one year is unknown. Methods: In the ACUITY trial, patients with moderate and high risk (ACS) were randomized to Hep+GPI, Biv+gPI, or Biv Mono. We evaluated the impact of treatment group on composite ischemia (death, MI, or unplanned revascularization) and mortality at one year in diabetic patients using Kaplan Meier survival analysis and log rank tests. Results: Of patients enrolled in the ACUITY trial, 3852 were diabetic (28.1%) and 9857 (71.9%) were non-diabetic. Compared with non-diabetics, diabetics had higher rates of mortality at one year (6.1% vs 3.4%, p&lt;0.001). There was no significant difference in the rate of composite ischemia at one year for diabetic patients who received Biv Mono vs Hep+GPI (19.7% vs 18.9%, p=0.39) or Biv+GPI vs Hep+GPI (20.9% vs 18.9%, p=0.16). Mortality rates for diabetic patients by treatment group are shown below. Conclusions: In the ACUITY Trial, diabetic patients had lower survival rates at one year than non-diabetics. Among diabetic patients, treatment with Biv Mono resulted in similar rates of composite ischemia and survival at one year compared to those treated with Hep+GPI. Combined with the early reduction in major bleeding, these findings indicate that Biv Mono is a suitable alternative to Hep + GPI for diabetic patients with moderate and high risk ACS.

Comparison of Coronary Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus

We compared 1-year outcome after drug-eluting stent (DES) implantation with off-pump bypass grafing (OPCABG) in patients with type 2 diabetes mellitus and multivessel coronary artery disease involving the proximal segment of the left anterior descending coronary artery. All consecutive diabetic patients treated by DES (DES group) or OPCABG (CABG group) in our institution from April 2002 to December 2004 because of de novo coronary lesions were included. Patients in the CABG group (n = 149) were older and had a higher rate of 3-vessel disease than those in the DES group (n = 69). At 12 months, major adverse cardiac and cerebrovascular events occurred in 29% of the DES group and 20.5% of the CABG group (unadjusted analysis, odds ratio 1.20, 95% confidence interval [CI] 0.93 to 1.54, p = 0.17). After propensity score analysis, adjusting for baseline differences between the 2 cohorts, DESs increased the risk of 12-month major adverse cardiac and cerebrovascular events (hazard ratio 1.88, 95% CI 1.09 to 3.02, p = 0.020). This was due to the higher rate for repeat revascularization in the DES group (19% vs 5%, odds ratio 2.05, 95% CI 1.12 to 3.75, p = 0.001). In contrast, there was no difference in the rate of the composite end points of death, myocardial infarction, and stroke (DES group 13%, CABG group 12%; adjusted analysis, hazard ratio 0.80, 95% CI 0.80 to 1.35, p = 0.40). In conclusion, at 1 year in diabetic patients with multivessel coronary artery disease involving the proximal left anterior descending coronary artery, the advantage of OPCABG over DES implantation seems to be limited at a lower rate of repeat revascularization. No difference seems to exist in the rate of death, stroke, and myocardial infarction.

Ophthalmologic follow-up of diabetic retinopathy

The mean frequency of ophthalmological check-ups should vary between one year in diabetic patients without fundus changes and six months in patients with background retinopathy. Shorter screening intervals are needed in proliferative stages, during gravidity and adolescence and in cases with loss of vision. Fluorescein angiography is indicated if the treatment modality is based on its results (focal laser treatment in significant macular edema or panretinal photocoagulation in early proliferative or severe pre-proliferative stages). Theory and practice differ markedly. A questionnaire sent 1988 to 146 ophthalmologists and internists revealed that in Switzerland probably no more than one-half of all diabetic patients are regularly seen by an ophthalmologist. An actual questionnaire given to all 58 diabetic patients seen within 3 months in our eye clinic shows that about one quarter of the patients were not aware of the risk of diabetic eye disease.

Auditory Brainstem Response Followed for Two Years in Diabetic Patients

Auditory Brainstem Response Followed for Two Years in Diabetic Patients