Years Of Diabetes Duration Research Articles

Adherence to Lifestyle Advice and Treatments in Pakistani Patients with Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy are shown to improve blood glucose levels, lipid abnormalities and blood pressure. It is not known how many patients adhere to advice and drugs prescribed. This study aimed to determine adherence to lifestyle and therapeutic advice. Methods: A cross sectional hospital based study was conducted among patients attending the diabetic clinic at the Aga Khan University Hospital, using a structured questionnaire. Adult patients with T2DM and with at least one year duration of diabetes were included in the study. Results: Participants were aged between 32 and 92 years old with a mean age of 55.7 years old (SD ± 10.7). Mean duration of diabetes was 10.7 years old (SD ± 7.7). Majority (94%) of the patients were literate. Around half (47.3%) of the patients have had achieved glycemic target (HbA1c < 7%). Above target glycemic control was more common among patients with ischemic heart disease (68.1%), neuropathy (64.8%) and those on insulin (62.5%). Self-reported non-adherence for blood sugar monitoring (9.5%), physical activity (61.7%), tobacco use (43.4%) and foot care (43.9%) were noted. About 25% of the participants were not fully adherent to dietary advice. None of the patients from our study reported non-adherence to medications. Good adherence to physical activity was found in males with college degree. The highest percentage of tobacco use (33.3%) was reported among businessmen. Conclusion: We noted low adherence to advice for physical activity, tobacco use and SMBG, but a high adherence to prescribed medications and insulin. This was a selected group visiting a teaching hospital. This will need to be studied further in the community and efforts are required to motivate patients.

Effect of Diabetes Mellitus on Survival in Patients with Pancreatic Cancer: A Systematic Review and Meta-analysis.

Concurrent diabetes has been linked with an increased risk of death in many cancers, but findings in pancreatic cancer have been inconsistent. We performed a systematic review and meta-analysis to assess the effect of diabetes on survival in patients with pancreatic cancer. Of 4, 463 original articles, 41 were included in the review; 29 studies with 33 risk estimates were included in the meta-analysis. In the overall comparison of patients with pancreatic cancer and diabetes with their nondiabetic counterparts, the former had significantly higher all-cause mortality (pooled HR: 1.13; 95% CI: 1.04–1.22). Subgroup analyses showed that diabetes was associated with poor survival in patients with resectable disease (HR: 1.37; 95% CI: 1.15–1.63) but not in those with unresectable disease (HR: 1.07; 95% CI: 0.89–1.29). The HR (95% CI) was 1.52 (1.20–1.93) for patients with new-onset diabetes (≤2 years of diabetes duration) and 1.22 (0.83–1.80) for those with longstanding diabetes (>2 years). Diabetes was associated with higher mortality overall in patients with pancreatic cancer. The effect of diabetes on overall survival was associated with the stages of tumor and the duration of diabetes.

Screening for Celiac Disease in Type 1 Diabetes: A Systematic Review.

Prevalence rates of type 1 diabetes (T1D) and celiac disease (CD) vary from 1.6% to 16.4% worldwide. Screening guidelines are variable and not evidence based. Our aim was to conduct a systematic review of CD in T1D. Medline, Embase, and the Cochrane Library were searched. Studies were limited to those in English and in humans. We selected longitudinal cohort studies screening for CD in T1D with at least 5 years of follow-up. Screening rates, characteristics, and prevalence of biopsy-proven CD in people with T1D were extracted. We identified 457 nonduplicate citations; 48 were selected for full-text review. Nine longitudinal cohort studies in 11,157 children and adolescents with 587 cases of biopsy-proven CD met the inclusion criteria. Median follow-up was 10 years (range: 5-18 years). The weighted pooled prevalence of CD was 5.1% (95% confidence interval: 3.1-7.4%). After excluding 41 cases with CD onset before T1D, CD was diagnosed in 218 of 546 (40%) subjects within 1 year, in 55% within 2 years, and in 79% within 5 years of diabetes duration. Two studies (478 cases) reported higher rates of CD in children aged <5 years at T1D diagnosis. The duration of follow-up varied across the included studies. CD screening frequency progressively decreased with increased T1D duration. Because most cases of CD are diagnosed within 5 years of T1D diagnosis, screening should be considered at T1D diagnosis and within 2 and 5 years thereafter. CD screening should be considered at other times in patients with symptoms suggestive of CD. More research is required to determine the screening frequency beyond 5 years of diabetes duration.

Efficacy of urinary N-acetyl-β-D-glucosaminidase to evaluate early renal tubular damage as a consequence of type 2 diabetes mellitus: a cross-sectional study

We assessed the prognostic accuracy of urinary N-acetyl-β-D-glucosaminidase (NAG), an early proximal tubular damage marker for the onset of diabetic nephropathy. The study included 491 eligible participants with 76 healthy controls, 194 type 2 diabetes mellitus (T2DM) patients with 0–5, 5–10, 10–15, and 15–20 years of T2DM duration, 71 microalbuminuric patients, 100 diabetic nephropathy patients, and 50 non-diabetic nephropathy patients. Fasting glucose, serum fructosamine, HbA1C, urinary microalbumin, serum creatinine, estimated glomerular filtration rate (eGFR), serum NAG, and urinary NAG were estimated. We compared urinary NAG activity with other well-established markers of diabetic nephropathy like microalbuminuria, eGFR, and serum creatinine. Urinary NAG excretion was increased by 8 and 12 folds in T2DM patients of 10–15 and 15–20 years of diabetes duration (p < 0.0001), respectively, without the appearance of microalbuminuria. The urinary NAG activity increased 16 and 18 fold in moderately increased albuminuria and diabetic nephropathy patients, respectively (p < 0.0001), without any change in non-diabetic nephropathy patients. A cutoff value of 3 U/L of urinary NAG has demonstrated a sensitivity of 96.1 % and a specificity of 100 % discriminating healthy controls from patients with T2DM duration of 10–15 years (AUC 1.000) and 15–20 years (AUC 0.999); microalbuminuria (AUC 0.999), and diabetic nephropathy (AUC 1.000). Urinary NAG excretion gradually increases with the increase in duration of diabetes and appeared much before the microalbuminuria, decreased eGFR, and increased serum creatinine. Thus, the urinary NAG may be considered as a potential site-specific early tubular damage marker leading to diabetic nephropathy.

Determinants of poor glycemic control in Chinese men with type 2 diabetes: a cross-sectional survey of 15,427 men in 77 tertiary hospitals in China

This study aimed to investigate determinants other than drug treatment for poor glycemic control in a large cross-sectional survey of Chinese men with type 2 diabetes (T2D). From March 2011 to June 2011, the Chinese Diabetes Association conducted a survey of patients with T2D who used oral antidiabetes drugs (OADs) in 77 hospitals located in four well-developed cities in China, as part of China’s nationwide surveillance of the rate of poor glycemic control. A total of 29,502 patients were consecutively recruited from the participating tertiary hospitals, and 15,427 male subjects were used in the analysis. Poor glycemic control was defined by glycated hemoglobin <7 %. Multivariate conditional logistic regression was used to identify the determinants of poor glycemic control. Up to 68.5 % (n = 10,600) of the surveyed men with T2D had poor glycemic control. In multivariate analysis, age below 40 years (OR 1.36, 95 % CI 1.19 to 1.65) and overweight/obesity were associated with poor glycemic control. The duration of diabetes was associated with poor glycemic control in a J-shaped manner, whereby being <1 year as well as ≥6 years were associated with increased risk of poor glycemic control. On the other hand, self-monitoring of blood glucose was associated with lower risk of poor glycemic control (OR 0.84, 95 % CI 0.77 to 0.92). Young men aged below 40 years, overweight/obese, newly diagnosed T2D, and 6 years duration of diabetes were associated with increased risk of poor glycemic control.

CorrelationBetween Baseline Characteristics and Clinical Outcomes in a Large Population of Diabetes Patients Treated with Liraglutide in a Real-World Setting in Italy

PurposeTreatment with liraglutide in randomized controlled trials is associated with significant reductions in glycated hemoglobin (HbA1c) and weight loss in type 2 diabetes patients. The aim of this retrospective observational study was to investigate correlations of glycemic control and weight outcomes with baseline characteristics of patients starting liraglutide in outpatient clinics in Italy. MethodsType 2 diabetes patients were followed from baseline to 4, 8, and 12 months. Changes in glycemic parameters, weight, blood pressure, and lipids were assessed. Subanalyses were performed according to baseline characteristics. Multivariate linear and logistic regressions were used to assess correlations between glycemic efficacy, weight reduction, and liraglutide discontinuation after 12 months and baseline characteristics. FindingsFour hundred and eighty-one patients were included. Mean (SD) age at baseline was 57.3 (9.2) years, diabetes duration was 9.5 (6.8) years, weight was 106.7 (20.8) kg, body mass index (BMI; calculated as kg/m2) was 37.1 (6.6), HbA1c was 8.7% (1.3%), fasting plasma glucose was 168.5 (45.3) mg/dL; 38.2% were treated previously with insulin and 52.2% were treated with metformin alone. After 12 months, mean (SD) changes were HbA1c −1.2% (1.4%), fasting plasma glucose −28.3 (41.1) mg/dL, weight −3.5 (5.8) kg, BMI −1.3 (2.1), waist circumference −2.6 (6.7) cm (all, P < 0.001). Drop in weight and HbA1c did not differ between baseline BMI classes ≤30 or >30. Weight loss was unchanged among diabetes duration quartiles, and HbA1c reduction was significantly greater in patients with ≤4 years of diabetes duration (P = 0.01). Non−insulin-treated patients reached HbA1c ≤7% significantly more often than treated patients (44.2% vs 21.2%; odds ratio = 2.94; P < 0.001) and had significantly greater weight loss (−4.5 [8.2] kg vs −2.6 [5.4] kg; P = 0.03). Patients on metformin reached HbA1c target more frequently than others (43.1% vs 29.7%; odds ratio = 1.80; 95% CI, 1.05−3.07). Significant positive determinants for HbA1c reduction after 12 months were baseline HbA1c, age, and prior metformin monotherapy, and weight loss at 12 months was positively correlated with baseline weight, and negatively correlated with prior insulin treatment. Overall, 5.0% of patients interrupted liraglutide before the 12th month due to lack of glycemic control; they were less frequently treated with metformin only before liraglutide (29.2% vs 50.2%; P = 0.04). ImplicationsTreatment with liraglutide in a real-world setting is associated with low therapy failure, good glycemic response, weight loss, and improvement in systolic blood pressure and lipid profile. The HbA1c drop did not differ among baseline BMI classes, indicating that efficacy is maintained in patients with lower BMI. The probability of reaching HbA1c ≤7% was significantly higher in patients previously treated with metformin alone and without any previous insulin. This could reinforce the hypothesis that better results with liraglutide could be achieved in patients after early metformin failure.

Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.

Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established. To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT) cohort. After the DCCT (1983-1993) ended, participants were followed up in a multisite (27 US and Canadian academic clinical centers) observational study (Epidemiology of Diabetes Control and Complications [EDIC]) until December 31, 2012. Participants were 1441 healthy volunteers with diabetes mellitus who, at baseline, were 13 to 39 years of age with 1 to 15 years of diabetes duration and no or early microvascular complications, and without hypertension, preexisting cardiovascular disease, or other potentially life-threatening disease. During the clinical trial, participants were randomly assigned to receive intensive therapy (n = 711) aimed at achieving glycemia as close to the nondiabetic range as safely possible, or conventional therapy (n = 730) with the goal of avoiding symptomatic hypoglycemia and hyperglycemia. At the end of the DCCT, after a mean of 6.5 years, intensive therapy was taught and recommended to all participants and diabetes care was returned to personal physicians. Total and cause-specific mortality was assessed through annual contact with family and friends and through records over 27 years' mean follow-up. Vital status was ascertained for 1429 (99.2%) participants. There were 107 deaths, 64 in the conventional and 43 in the intensive group. The absolute risk difference was -109 per 100,000 patient-years (95% CI, -218 to -1), with lower all-cause mortality risk in the intensive therapy group (hazard ratio [HR] = 0.67 [95% CI, 0.46-0.99]; P = .045). Primary causes of death were cardiovascular disease (24 deaths; 22.4%), cancer (21 deaths; 19.6%), acute diabetes complications (19 deaths; 17.8%), and accidents or suicide (18 deaths; 16.8%). Higher levels of glycated hemoglobin (HbA1c) were associated with all-cause mortality (HR = 1.56 [95% CI, 1.35-1.81 per 10% relative increase in HbA1c]; P < .001), as well as the development of albuminuria (HR = 2.20 [95% CI, 1.46-3.31]; P < .001). After a mean of 27 years' follow-up of patients with type 1 diabetes, 6.5 years of initial intensive diabetes therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy. clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.

Diabetes, glucose metabolism, and glaucoma: the 2005-2008 National Health and Nutrition Examination Survey.

BackgroundDiabetes may affect vascular autoregulation of the retina and optic nerve and may be associated with an increased risk of glaucoma,but the association of prediabetes, insulin resistance, markers of glucose metabolismwith glaucoma has not beenevaluated in general population samples.ObjectiveTo examine the relation between diabetes, pre-diabetes, metabolic syndrome and its components and the levels of fasting glucose, HbA1c and HOMA-IR with the prevalence of glaucoma in the general U.S. population.MethodsCross-sectional study of 3,299 adult men and women from the 2005–2008 National Health and NutritionExamination Survey (NHANES). The presence of diabetes, prediabetes, the metabolic syndrome and its individual components and biomarkers of glucose metabolisms were based on standardized questionnaire and physical exam data and laboratory tests. The history of glaucoma was assessed through questionnaire during the home interview.ResultsDiabetes was strongly associated with prevalent glaucoma.In fully adjusted models, the odds ratiofor glaucoma comparing participants with diabetes with participants in the reference group with neither pre-diabetes nor diabetes was 2.12 (95% CI: 1.23, 3.67). The corresponding odd ratio comparing participants with pre-diabetes to those in the reference group was 1.01 (95% CI: 0.57, 1.82). Patients with 5 or more years of diabetes duration hadan OR for glaucoma of 3.90 (95% CI: 1.63, 9.32) compared with patients with <5 years of diabetes duration. We also found a hockey-stick shaped associations between biomarkers of glucose metabolisms and the prevalence of glaucoma.ConclusionsDiabetes was associated with higher risk of glaucoma. Participants without diabetes but at the higher levels of fasting glucose, fasting insulin, HbA1c and HOMA-IR spectrum may also be at greater risk of glaucoma.

The risk for diabetic nephropathy is low in young adults in a 17‐year follow‐up from the Diabetes Incidence Study in Sweden (DISS). Older age and higher BMI at diabetes onset can be important risk factors

The main objective of this study was to estimate the occurrence of diabetic nephropathy in a population-based cohort of patients diagnosed with diabetes as young adults (15-34 years). All 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) were invited to a follow-up study 15-19 years after diagnosis, and 468 (58%) participated. Analysis of islet antibodies was used to classify type of diabetes. After median 17 years of diabetes, 15% of all patients, 14% T1DM and 25% T2DM, were diagnosed with diabetic nephropathy. Ninety-one percent had microalbuminuria and 8.6% macroalbuminuria. Older age at diagnosis (HR 1.05; 95% CI 1.01-1.10 per year) was an independent and a higher BMI at diabetes diagnosis (HR 1.04; 95% CI 1.00-1.09 per 1 kg/m²), a near-significant predictor of development of diabetic nephropathy. Age at onset of diabetes (p = 0.041), BMI (p = 0.012) and HbA1c (p < 0.001) were significant predictors of developing diabetic nephropathy between 9 and 17 years of diabetes. At 17 years of diabetes duration, a high HbA1c level (OR 1.06; 95% CI 1.03-1.08 per 1 mmol/mol increase) and systolic blood pressure (OR 1.08; 95% CI 1.05 1.12 per 1 mmHg increase) were associated with DN. Patients with T2DM diagnosed as young adults seem to have an increased risk to develop diabetic nephropathy compared with those with T1DM. Older age and higher BMI at diagnosis of diabetes were risk markers for development of diabetic nephropathy. In addition, poor glycaemic control but not systolic blood pressure at 9 years of follow-up was a risk marker for later development of diabetic nephropathy.

Prevalence and risk factors for diabetic retinopathy in Asian Indians with young onset Type 1 and Type 2 Diabetes

AimTo assess the prevalence and risk factors for diabetic retinopathy (DR) in people with young onset type 1 (T1DM-Y) and type 2 diabetes (T2DM-Y). MethodsT1DM-Y(n=150) and T2DM-Y(n=150) participants, age between 10 and 25 years at diagnosis, had a complete clinical evaluation, biochemical assessment, and four field digital retinal colour photography. The Early Treatment Diabetic Retinopathy Study grading system was used to grade DR. Proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) were considered as sight threatening DR. ResultsThe prevalence of any DR was 53.3% [95% CI 45.3–61.3] in T1DM-Y (duration of diabetes: 12.4±7.4years) and 52.7% [44.7–60.7] in T2DM-Y (11.8±8.3years). The age and gender adjusted prevalence of DR, DME and PDR was 62.5%, 10% and 7.3% in T1DM-Y, whereas it was 65.8%,12.7% and 9.3% in T2DM-Y respectively. In multivariable logistic regression, diabetes duration [Odds ratio (OR) 1.99 per 5years; CI 1.42–2.79], waist circumference [1.28 per 5cm;1.05–1.56] and microalbuminuria [2.39 per 50μg;1.07–5.31] were associated with DR in T1DM-Y, and diabetes duration [2.21 per 5years; 1.61–3.02], diastolic blood pressure [1.54 per 5mmHg;1.18–2.02], Glycated hemoglobin [1.37 per %;1.07–1.75] and lower stimulated C-peptide [1.54 per 0.5pmol/ml;1.15–2.05;] were associated with DR in T2DM-Y. ConclusionOver half of the people with young-onset diabetes, regardless of type, have retinopathy within 10–12years of diabetes duration, emphasizing the need for regular eye screening and aggressive control of glucose and blood pressure to prevent DR.

Treatment of Hyperglycaemia in Type 2 Diabetic Patients in a Primary Care Population Database in a Mediterranean Area (Catalonia, Spain)

Aim: To analyse glycaemic control and antihyperglycaemic treatment in patients with varying duration of type 2 diabetes in a population-based database. Methods: A cross-sectional survey of 286,791 patients with type 2 diabetes registered in the primary care centres of the Catalan Health Institute (Catalonia, Spain) in 2009. We analysed the effects of types of treatment, diabetes duration and renal function on glycaemic control, adjusting for other clinical variables. Results: Twenty-four percent of patients were treated with lifestyle changes only, 35.5% with oral glucoselowering monotherapy, 21% with oral combinations and 17.7% with insulin (alone or in combination). Insulin was more frequently used in patients with longer duration of diabetes or severe renal impairment. Fifty-six percent of patients achieved the optimal target of HbA1c ≤ 7% (≤ 53 mmol/mol), a result more frequently observed in patients older than 65, early in the course of the disease and at the lower steps of treatment (p<0.001). Impaired renal function was present in 18.4% of patients. A significant number of patients with severe renal impairment were taking metformin (16.2%) or sulfonylureas (12.1%), which are contraindicated at this stage. Multivariable analyses confirmed that lower steps of treatment, advanced age and lesser years of diabetes duration were the variables positively related to good glycaemic control. Conclusions: Glycaemic control deteriorates with the progression of the disease despite the treatment intensification. Impaired renal function was frequent and a remarkable proportion of these patients were taking contraindicated drugs.

Assessment of urinary microalbumin levels in type 1 and type 2 diabetic subjects

Abstract: Introduction: Diabetes mellitus is one of the most prevalent metabolic diseases all over the globe, including India. Prolonged diabetes is accompanied with many complications including diabetic nephropathy. Diabetic nephropathy is defined clinically as the presence of microalbuminuria or overt nephropathy in patients with diabetes without the manifestations of renal diseases due to other causes. The earliest sign of diabetic nephropathy leading to an end stage renal disease is microalbuminuria and is estimated as UAE (Urinary Albumin Excretion) in 24 h urine samples and also as UACR (Urinary Albumin Creatinine Ratio) by estimating the albumin/creatinine ratio in spot urine specimens. Indian clinical guidelines strategize the aspects of prevention or prolongation or even reversion of diabetic complications such as diabetic nephropathy at primary, secondary and tertiary stages to yield beneficial effects. With a view of beneficial effect of assessing the onset of nephropathy in diabetic patients we analyzed the microalbumin levels for an early detection of the existence of microalbuminuria and its prevalence in both type-1 and type-2 diabetic patients. Materials and Methods: Morning spot urine samples were collected from diabetic patients. Microalbumin and creatinine were estimated from these urine samples by immuno-turbidometric and alkaline-picrate methods respectively. Microalbumin was expressed in terms of mg/ g creatinine. Lipid profile was also estimated in these patients. Student’s ‘t’ test was applied for significance. Results: A total of 75 samples were analyzed for microalbuminuria, of these 25 were healthy controls and 50 were diabetics (both type-1 and type-2) with 4 to 25 years duration of diabetes. We observed an incidence of 72% microalbuminuria in diabetics (both type-1 and type-2) patients and 65% in type-2 diabetic patients. A good correlation was found between duration of diabetes & incidence of microalbuminuria (p = 0.02) in both types of diabetes. Conclusion: Percentage of subjects with microalbuminuria was significantly high in both the types of diabetes, and it correlates with higher age and longer duration of diabetes. Early and routine screening for microalbuminuria in diabetic patients is desirable for an early detection and prevention of diabetic nephropathy.

The 16-year incidence, progression and regression of diabetic retinopathy in a young population-based Danish cohort with type 1 diabetes mellitus: The Danish cohort of pediatric diabetes 1987 (DCPD1987)

The aim was to investigate the long-term incidence of proliferative diabetic retinopathy (PDR), and progression and regression of diabetic retinopathy (DR) and associated risk factors in young Danish patients with Type 1 diabetes mellitus. In 1987-89, a pediatric cohort involving approximately 75% of all children with Type 1 diabetes in Denmark <19years of age was identified (n=720). In 1995, 339 (47.1%) were re-studied with retinopathy graded and all relevant diabetic parameters assessed. Of those, 185 (54.6%) were evaluated again in 2011 for the same clinical parameters. All retinal images were graded using modified early treatment of DR study for 1995 and 2011. In 1995, mean age was 21.0years and mean diabetes duration 13.5years. The 16-year incidence of proliferative retinopathy, 2-step progression and 2-step regression of DR was 31.0, 64.4 and 0.0%, respectively, while the incidence of DR was 95.1%. In a multivariate logistic regression model, progression to PDR was significantly associated with 1995 HbA1c (OR 2.61 per 1% increase, 95% CI 1.85-3.68) and 1995 diastolic blood pressure (OR 1.79 per 10mmHg increase, 95% CI 1.04-3.07). Two-step progression of DR was associated with male gender (OR 2.37 vs. female, 95% CI 1.07-5.27), 1995 HbA1c (OR 3.02 per 1% increase, 95% CI 2.04-4.48) and 1995 vibration perception threshold (OR 1.19 per 1Volt increase, 95% CI 1.02-1.40). In conclusion, one in three progressed to PDR and two in three had 2-step progression despite young age and increased awareness of the importance of metabolic control. After 30years duration of diabetes, the presence of DR is almost universal.

Lietuvos gyventojų II tipo cukrinio diabeto valdymas

Žurnalas „Sveikatos mokslai / Health sciences“ yra recenzuojamas tarptautinis mokslinis žurnalas, skirtas skleisti naujas žinias ir informaciją apie visuomenės sveikatą, sveikatos ugdymą, ligas, klinikinius tyrimus ir klinikinius atvejus, naujas technologijas, slaugą, reabilitaciją, sveikatos ekonomiką ir vadybą. Žurnalas spausdina mokslinius straipsnius lietuvių, anglų ir rusų kalbomis, kasmet išeina 1 tomas (6 numeriai) spausdintiniu ir elektroniniu variantais. Daugiau nei 140 mokslinių straipsnių publikuojami per metus. Žurnalas priklauso Lietuvos mokslo periodikos asociacijai.

Poor glycaemic control in Brazilian patients with type 2 diabetes attending the public healthcare system: a cross-sectional study

ObjectivesTo describe the clinical profile of Brazilian patients with type 2 diabetes attending the public healthcare system and identify factors associated with poor glycaemic control.DesignCross-sectional study.Setting14 centres in five regions...

Direct Diabetes-Related Costs in Young Patients with Early-Onset, Long-Lasting Type 1 Diabetes

ObjectiveTo estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany.Research Design and MethodsData of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors.ResultsMean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs.ConclusionsMain cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting

BackgroundDiabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia.MethodsThe study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics.ResultsThe prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor.ConclusionWe found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.

Assessing Progress in Retinopathy Outcomes in Type 1 Diabetes

OBJECTIVEThe Wisconsin Diabetes Registry Study (WDRS) cohort consisted of patients diagnosed with type 1 diabetes in the same geographic region as, but 8–34 years later than the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) cohort, providing a unique opportunity to assess changes in complications. We estimated the current prevalence and severity of diabetic retinopathy at 20 years of diabetes duration, compared these between eras, and evaluated the influence of diabetes management.RESEARCH DESIGN AND METHODSTwenty-year examinations, including fundus photographs, were completed on 305 WDRS subjects during 2007–2011. A subgroup of the WESDR cohort participated in one of four study visits during 1980–1996, at similar diabetes duration (n = 583). Adjusted ordinal logistic regression with three retinopathy severity categories was used to estimate odds ratios (ORs) of more severe retinopathy with diagnosis during an earlier era.RESULTSMean hemoglobin A1c (HbA1c) was lower in WDRS than in WESDR (8.0% vs. 9.3% [P < 0.001], and 93.4% vs. 21.3% [P < 0.001]) used ≥3 daily insulin injections or an insulin pump. In WDRS, 18% had vision-threatening levels of retinopathy vs. 43% in WESDR. The adjusted OR of more severe retinopathy in the earlier era (OR 3.0 [95% CI 2.2–4.0]) was reduced by including 20-year HbA1c in the model (OR 2.2 [1.6–3.0]).CONCLUSIONSRetinopathy severity at a diabetes duration of 20 years is lower in the more recent era of type 1 diabetes. Updated projections should be used when informing newly diagnosed individuals of prognosis and for health care cost assessments. Current glycemic control explained a limited amount of the difference.

Revisiting the links between glycaemia, diabetes and cardiovascular disease

Whilst the interplay between type 2 diabetes and cardiovascular disease (CVD) has been recognised for many years, recent analyses of existing studies have helped refine several aspects of this relationship with relevance to clinical practice. First, recent data demonstrate that fasting glucose is not linearly related to CVD risk in those without diabetes; rather, risk levels escalate (modestly at first) only beyond specific glucose thresholds. Consequently, glucose-based measures may not necessarily enhance CVD risk prediction in those without diabetes. Second, other data confirm that new-onset diabetes is not a post-myocardial infarction 'risk equivalent' state and that, on average, several years of diabetes duration is needed to attain this level of risk. Third, meta-analyses and systemic reviews have confirmed that diabetes increases CVD risk by around twofold on average and this risk is subject to wide variation, being lowest in those newly diagnosed and highest in those with existing vascular disease, proteinuria or renal disease. Fourth, meta-analyses of major glucose-lowering trials suggest that, whilst glucose-lowering lessens vascular risk, risk reduction arising from statins and blood pressure-lowering is greater. Fifth, statins increase diabetes risk, albeit modestly, adding to the emerging concept that some agents that primarily target CVD risk may be diabetogenic, and vice versa. Finally, arising in part from the latter observation, as well as an understanding that CVD and diabetes risk overlap in some individuals but not others, the case for combined CVD/diabetes risk screening (generally using non-fasting lipids and HbA1c), has gained strength.

Risk Factors for Thyroid Dysfunction among Type 2 Diabetic Patients in a Highly Diabetes Mellitus Prevalent Society

Diabetes and thyroid dysfunction found to exist simultaneously. In this regard, the present study looked into the prevalence of different forms of thyroid dysfunction and their risk factors among Type 2 diabetic Saudi patients. Methodology. A cross-sectional retrospective randomized hospital-based study of 411 Type 2 diabetic Saudi patients of >25 years of age was conducted to test the prevalence of different types of thyroid dysfunction and their risk factors. Results. The prevalence of different types of thyroid dysfunction is 28.5%, of which 25.3% had hypothyroidism, where 15.3%, 9.5%, and 0.5% are clinical, subclinical, and overt hypothyroidism, respectively. The prevalence of hyperthyroidism is 3.2%, of which subclinical cases accounted for 2.7% and overt hyperthyroidism accounted for 0.5%. Risk factors for thyroid dysfunction among Saudi Type 2 diabetic patients are family history of thyroid disease, female gender, and duration of diabetes of >10 years, while the risk was not significant in patients with history of goiter and patients aged >60 years. Smoking and parity show a nonsignificant reduced risk. Conclusion. Thyroid dysfunction is highly prevalent among Saudi Type 2 diabetic patients, and the most significant risk factors are family history of thyroid disease, female gender, and >10 years duration of diabetes.