Diabetes Research and Clinical Practice

A systematic review of the association of diabetic retinopathy and cognitive impairment in people with Type 2 diabetes

R. Crosby-Nwaobi, S. Sivaprasad, A. Forbes — 2011-12-12

Abstract: A systematic review of studies reporting data on the relationship between diabetic eye disease and cognitive impairment in Type 2 diabetes was conducted. The increase in cognitive impairment has mirrored the global increase in diabetes. The aim of the systematic review was to determine the level of association between diabetic retinopathy and cognitive impairment. Item selection, data extraction and critical appraisal were undertaken using standard procedures and independently verified by two researchers. 3 out of 10 potentially relevant studies were included. All studies showed a level of association between diabetic retinopathy and cognitive impairment, suggesting a near threefold increased risk of cognitive impairment in patients with diabetic retinopathy compared to those without. An association of cognitive impairment and severity of diabetic retinopathy was found in males. Diabetic retinopathy was more strongly linked to impairment in the cognitive domains of verbal learning and recent memory. An increased risk of cognitive impairment in patients with diabetic retinopathy was found in the reviewed studies. However, the relationship of severity of diabetic retinopathy and cognitive impairment has not been established. Further studies with standardized measurements for cognitive impairment and diabetic retinopathy are required to delineate this relationship and the role of other factors in this relationship.

Usefulness of sum of the thickness of plaque in the carotid artery for predicting the presence and the extent of the coronary artery disease in patients with type 2 diabetes mellitus without known coronary artery disease

2012-02-10

Abstract: Aims: The usefulness of the sum of plaque thickness in the carotid artery (plaque score; PS), as a prediction of coronary artery disease (CAD) was investigated in patients with type 2 diabetes mellitus.Methods: B mode ultrasonographic scanning of the carotid artery and multislice computed tomography (MSCT) coronary angiography were performed in 227 diabetic patients without known cardiac disease.Results: The PS was useful to predict the presence of diseased [nonobstructive and obstructive] CAD (≧3 segments) and obstructive (≧50%) CAD with cut-off value of 3.5mm (area under curve: 0.745 and 0.782, respectively), according to a receiver operating characteristics curve analysis. A multivariate logistic analysis of baseline risk factors showed that the PS was independent risk factor for the prediction of diseased and obstructive coronary artery disease (R2=0.2165, p<0.0001 and R2=0.2265, p<0.0001, respectively). The PS was most significant predictor of the number of diseased and obstructive segments of the coronary artery in a multiple regression analysis (R2=0.2022, p<0.0001 and R2=0.2209, p<0.0001, respectively).Conclusions: The PS in the carotid artery was useful for the prediction of the presence and the extent of CAD, and was most important as a screening test for the identification of a high risk group of asymptomatic diabetic patients.

Predictors of suboptimal glycaemic control in type 2 diabetes patients: The role of medication adherence and body mass index in the relationship between glycaemia and age

2012-01-19

Abstract: Aims: To analyse predictors of glycaemic control including medication adherence and body mass index (BMI) in UK general practice patients with sub-optimally controlled type 2 diabetes.Methods: Baseline demographic, health- and treatment-related measures were evaluated as predictors of one year glycaemic control defined separately as HbA1c≤7.5% and a continuous measure of HbA1c concentration, using multivariate regression models. Significant predictors were adjusted for objectively assessed medication adherence and BMI.Results: One-year HbA1c concentration was associated with baseline HbA1c (p<0.001), BMI (p=0.02), and inversely associated with age (p=0.007) and objectively assessed adherence. Adherent patients had one-year (adjusted) HbA1c concentration 0.65% (95% CI −1.04, −0.25; p=0.001) lower than nonadherent. Odds ratios (95% CI) of HbA1c≤7.5% for 10-year higher age were 1.63 (1.08, 2.45); for adherent compared to non-adherent patients 1.89 (0.84, 4.25); for patients receiving >5 compared to ≤5 medications 0.32 (0.13, 0.76); and for each 1% increment in baseline HbA1c 0.48 (0.31, 0.73).Conclusions: The lower HbA1c achieved from greater adherence to glucose lowering treatment is comparable to that achieved with additional medication. Relationships between older age and better glycaemic control are not explained by better adherence, but may partly relate to lower BMI.

Impact of health professionals’ contact frequency on response to a lifestyle intervention with individuals at high risk for diabetes

2012-01-16

Abstract: Aim: To determine the independent effects of total and each health professional's frequency of contacts, on changes in anthropometric measures and physical capacity following a lifestyle intervention offered by a multi-disciplinary team in adults at high risk for type 2 diabetes.Materials and methods: A 12-month lifestyle intervention was performed in 48 adults with prediabetes. Participants were randomly assigned to either an individual counselling group (every six weeks)+an optional series of 25 group seminars (every week) or to the group seminars only. Physical activity level, energy intake, anthropometric measures, and physical capacity were assessed.Results: Total frequency of contacts with any professional was associated with change in body weight, BMI and, waist circumference (all P≤.05). However, no frequency of contacts with a specific professional was associated with the studied outcomes, except for changes in physical capacity. The latest was significantly improved in participants who attended at least two group sessions with the kinesiologist (P=.02).Discussion: To improve anthropometric measures, total contact frequency seems to be more important than contact frequency with any specific professionals. However, to improve physical capacity, meeting with a kinesiologist for two or more occasions, in group sessions, seems to be an effective strategy.

Musculoskeletal pain in patients with type 2 diabetes

S. Molsted, J. Tribler, O. Snorgaard — 2012-01-16

Abstract: Aims: The aims were to investigate the prevalence of musculoskeletal pain in patients with type 2 diabetes and demonstrate possible associated factors.Methods: Nine hundred fifty-one patients completed a validated questionnaire used in The Danish Health and Morbidity Survey and results were compared to data for 2923 matched subjects from the Danish population. Musculoskeletal pain was self-reported Pain in the shoulder and neck; Low-back pain; and Pain in the arm, hand, knee and/or hip.Results: Compared to the age, gender and region matched controls patients reported musculoskeletal pain 1.7–2.1 times as frequent (p<0.001). Pain was more frequently reported in women (p<0.001). Low-back pain and Pain in the arm, hand, knee and/or hip was associated with body mass index (p<0.005). Low-back pain was associated with a sedentary life style, impaired quality of life and reduced physical function (p<0.05).Conclusions: The prevalence of musculoskeletal pain was seriously increased in patients with type 2 diabetes. It was associated with body mass index, reduced quality of life, low physical function and the ability to be physical active. Focus on musculoskeletal pain in clinical practice is therefore of major importance in lifestyle interventions in type 2 diabetes.

Hypoglycemia is associated with increased worry and lower quality of life among patients with type 2 diabetes treated with oral antihyperglycemic agents in the Asia-Pacific region

2012-01-24

Abstract: Aims: We examined the relationship of hypoglycemic symptoms with health-related quality of life and worry about hypoglycemia among type 2 diabetic patients using oral antihyperglycemic agents (AHA) in the Asia-Pacific region.Methods: A total of 2257 type 2 diabetic patients with at least 6 months of oral AHA were enrolled in China, Korea, Malaysia, Thailand, and Taiwan. Quality of life was measured with the EuroQol Visual Analog Scale (EQ-VAS) and EuroQol-5 Dimensions questionnaire (EQ-5D), and worry about hypoglycemia with the worry subscale of the Hypoglycemic Fear Survey-II (HFS).Results: The mean (SD) age was 58.7 (10.2) years and HbA1c was 7.5% (1.5). The proportion of patients with an HbA1c <6.5% and <7% was 24.9% and 41.8%, respectively. Hypoglycemic symptoms in the prior 6 months were reported by 35.8% of patients. Mean scores on the EQ-VAS and the EQ-5D were significantly lower for patients who had hypoglycemic symptoms compared to those who did not (73.6 vs. 76.9, p<0.001; 0.88 vs. 0.90, p<0.0001, respectively), whereas mean score on the HFS was significantly higher (12.5 vs. 6.3, p<0.001). In multivariate models, hypoglycemic symptoms were independently associated with scores on the EQ-5D, EQ-VAS, and HFS (all p≤0.01–0.001). Symptom severity was positively associated with fear of hypoglycemia (all p≤0.001).Conclusion: Hypoglycemic symptoms were associated with reduced quality of life and increased patient worry in patients with type 2 diabetes treated with AHA.

The impact of structured blood glucose testing on attitudes toward self-management among poorly controlled, insulin-naïve patients with type 2 diabetes

2012-01-24

Abstract: Introduction: Patients with T2DM often view self-monitoring of blood glucose (SMBG) as burdensome and pointless, which may affect their broader attitudes toward diabetes management. We examined how a structured SMBG protocol influenced diabetes self-efficacy and autonomous motivation over time, and linked these to changes in glycemic control.Materials and methods: The Structured Testing Program (STeP) is a 12-month, two-arm, cluster-randomized trial that assessed the efficacy of structured SMBG in 483 insulin-naïve T2DM patients. Measures included: Confidence in Diabetes Self-Care for Type 2 patients (CIDS-T2), Diabetes-related Autonomous Motivation (DRAM), self-management behaviors and HbA1c.Results: Intent-to-treat (ITT) and per-protocol (PP) analyses showed significant increases in CIDS-T2 scores over time (main effects p<0.0001). PP analysis showed significant between-group differences (p<0.05), with adherent STG patients displaying greater CIDS-T2 improvement than ACG patients. PP analyses showed main and between-group effects in DRAM with similar findings. Changes in CIDS-T2 were related to HbA1c changes over time; no self-management variable mediated this relationship. CIDS-T2 and HbA1c displayed a significant time-concordant relationship.Discussion: Structured SMBG leads to significant increases in self-confidence and autonomous motivation associated with diabetes self-management. Changes in self-confidence are linked to changes in glycemic control and share a time-concordant relationship.

Health beliefs among individuals at increased familial risk for type 2 diabetes: Implications for prevention

2012-01-18

Abstract: Aim: To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes.Methods: Data analyses were based on the Family Healthware™ Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978).Results: After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups.Conclusions: Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders.

Visceral fat mass is always, but adipokines (adiponectin and resistin) are diversely associated with insulin resistance in Chinese type 2 diabetic and normoglycemic subjects

Jun Bu, Qiong Feng, Jianmin Ran, Qingmei Li, Guangzhong Mei, Yang Zhang — 2012-01-16

Abstract: Aims: The present study investigated alteration of abdominal visceral fat mass (VFM) and its relationship to adipokines and insulin resistance (IR) in obese and non-obese type 2 diabetes and normoglycemic subjects.Methods: Twenty-two diabetic patients and 37 normoglycemic controls were subgrouped into obese and non-obese according to their BMI. VFM was quantified by computed tomography. Plasma adiponectin and resistin, two adipokines exert contrary effects on insulin sensitivity were measured. Insulin sensitivity was evaluated by an established HOMA model.Results: Obese subjects showed remarkably expanded VFM, while non-obese diabetes obtained more abundant VFM than non-obese controls (104±50cm2 vs. 77±26cm2, P<0.05). Plasma adiponectin was only significantly decreased in obese diabetes. Plasma resistin was increased in diabetes, but compared between obese and non-obese subjects. Diabetic patients and obese controls were significantly insulin resistant. HOMA-IR index positively correlated to VFM in both groups (r=0.563, P=0.011 for diabetes and r=0.671, P=0.000 for controls). In diabetes but not controls, plasma adiponectin negatively related to VFM (r=−0.687, P=0.000) and HOMA-IR index (r=−0.659, P=0.002), while resistin had no relation to IR and VFM in both groups.Conclusions: Increased VFM may lead to IR by mechanisms beyond adipokines in Chinese type 2 diabetic and normoglycemic subjects.

The effect of hyperglycemia and hypoglycemia on glucose transport and expression of glucose transporters in human lymphocytes B and T: An in vitro study

Bożenna Oleszczak, Leszek Szablewski, Monika Pliszka — 2012-01-18

Abstract: Glucose transport in lymphocytes is regulated by many agents. It is interesting if only changing glucose concentrations in environment involves the impact on glucose uptake.The aims of this study were to investigate the impact of changing glucose concentrations in medium on deoxy-d-glucose uptake and what these conditions impact on the percent of cells with expression of chosen glucose transporters in human lymphocytes B and T.Isolated lymphocytes B and T obtained from healthy subject were cultivated in different concentrations of glucose. The experiments were carried out using tritium labeled deoxy-d-glucose and flow cytometry.In comparison to normoglycemia, hyperglycemia impairs the uptake of deoxy-d-glucose more than hypoglycemia. Lymphocytes B manifest significantly lower uptake of deoxy-d-glucose than lymphocytes T. Lymphocytes incubated in hyperglycemic and hypoglycemic medium show lower percent cells with expression of GLUT 1 and GLUT 3, and higher percent cells with expression of GLUT 4. The incubation of lymphocytes in hyperglycemic and hypoglycemic medium does not stimulate translocation of glucose transporters 3 and 4 to plasma membrane.Study shows that a change in concentration of glucose in incubation environment influence intracellular expression of glucose transporters in a significant part of lymphocytes B and T.

Association of left ventricular diastolic dysfunction with elevated NT-proBNP in type 2 diabetes mellitus patients with preserved ejection fraction: The supplemantary role of tissue doppler imaging parameters and NT-proBNP levels

Sedat Çiftel, Serhat İçağasıoğlu, Gürsel Yıldız, Gonca Tekin, Hüseyin Aydin — 2012-01-12

Abstract: Background: Early diagnosis of cardiovascular disease in diabetic patients may be important to introduce treatment early. Echocardiography is a method used to show the ventricular functions. A ventricular hormone, BNP is used to identify the changes in the ventricular function in early period. NT-proBNP which is a more stable compound with a longer half-life is used in measurement of BNP.Methods: Left ventricular diastolic dysfunction (LVDD) was detected and NT-proBNP levels were measured in forty-four asymptomatic patients with ages of 30–70 and type 2 DM and control group consisted of 40 healthy individuals from the same age group.Results: NT-proBNP levels were found as 566.7±738.5pg/ml in the diabetics with LVDD detected, 166.3±137.1pg/ml in the diabetics without LVDD and 134.5±77.2pg/ml in the control group. Levels of NT-proBNP were significantly higher in the group with left ventricular diastolic dysfunction (p<0.05). However, when the levels of NT-proBNP in the diabetic patients without LVDD were compared with the controls, the difference was not significant (p>0.05). NT-proBNP levels were found significantly higher in LVDD group compared to the controls without a difference between the ejection fractions (p<0.05).Conclusion: High levels of NT-proBNP was correlated tissue Doppler echocardiography findings in type 2 DM patients with preserved ejection fraction.

Metformin alters the expression profiles of microRNAs in human pancreatic cancer cells

Weiguang Li, Yaozong Yuan, Liya Huang, Minmin Qiao, Yongping Zhang — 2012-01-16

Abstract: Aims: To investigate the effect of metformin on the expression profiles of microRNAs in human pancreatic cancer cells.Methods: MicroRNAs real-time PCR Array was applied to investigate differentially expressed miRNAs in Sw1990 cells treated with or without metformin. Stem-loop real time RT-PCR was used to confirm the results of the array assay in Sw1990 and Panc-1 cells. The effects of miR-26a on cell growth, apoptosis, invasion and migration abilities were respectively examined by CCK8 assay, Apoptosis assay, Matrigel invasion and migration assay. HMGA1 was proved to be a target of miR-26a by Luciferase reporter assay, Real-time PCR and Western-blotting.Results: Nine miRNAs were significantly up-regulated in metformin treated cells. Metformin up-regulated the expression of miR-26a, miR-192 and let-7c in a dose-dependent manner. Forced expression of miR-26a significantly inhibited cell proliferation, invasion, migration and increased cell apoptosis, whereas knockdown of miR-26a obtained the opposite effect. Furthermore, we demonstrated that HMGA1, an oncogene, is a direct target of miR-26a. Nude mice xenograft models confirmed that metformin up-regulated the level of miR-26a and surpressed the expression of HMGA1 in vivo.Conclusion: These observations suggested that modulation of miRNA expression may be an important mechanism underlying the biological effects of metformin.

Serum fibroblast growth factor 21 was elevated in subjects with type 2 diabetes mellitus and was associated with the presence of carotid artery plaques

2012-01-31

Abstract: Aims: Fibroblast growth factor 21 (FGF21) is an important regulator of glucose/lipid metabolism. Although there are studies examining the relationship between serum FGF21 levels and glucose homeostasis, the role of FGF21 remains unclear. The objective of this study was to examine whether serum FGF21 levels are associated with metabolic parameters in subjects with varying degrees of obesity and glucose tolerance and with complications in subjects with type2 diabetes mellitus (T2DM).Methods: The study consisted of 213 subjects who were lean and had normal glucose tolerance (lean NGT), were overweight with NGT, had impaired glucose tolerance (IGT) or had T2DM. Serum FGF21 levels and their associations with the parameters of adiposity, glucose tolerance and the presence of diabetic complications were examined.Results: The serum FGF21 levels in T2DM were higher than in lean NGT. Serum FGF21 levels showed a positive correlation with the urine albumin-to-creatinine ratio (ACR) in all subjects except for the T2DM subjects, who showed a correlation after adjustment of age, gender and body mass index. Moreover, the subjects with carotid artery plaque showed higher serum FGF21 levels than those without complications.Conclusion: Serum FGF21 levels were associated with the urine ACR and diabetic complications including carotid artery plaque.

Islet autoantibodies and residual beta cell function in type 1 diabetes children followed for 3–6 years

2012-01-17

Abstract: Aims: To test if islet autoantibodies at diagnosis of type 1 diabetes (T1DM) and after 3–6 years with T1D predict residual beta-cell function (RBF) after 3–6 years with T1D.Methods: T1D children (n=260, median age at diagnosis 9.4, range 0.9–14.7 years) were tested for GAD65, IA-2, ZnT8R, ZnT8W and ZnT8Q autoantibodies (A) at diagnosis, and 3–6 years after diagnosis when also fasting and stimulated RBF were determined.Results: For every 1-year increase in age at diagnosis of TID, the odds of detectable C-peptide increased 1.21 (1.09, 1.34) times for fasting C-peptide and 1.28 (1.15, 1.42) times for stimulated C-peptide. Based on a linear model for subjects with no change in IA-2A levels, the odds of detectable C-peptide were 35% higher than for subjects whose IA-2A levels decreased by half (OR=1.35 (1.09, 1.67), p=0.006); similarly for ZnT8WA (OR=1.39 (1.09, 1.77), p=0.008) and ZnT8QA (OR=1.55 (1.06, 2.26) p=0.024). Such relationship was not detected for GADA or ZnT8RA. All OR adjusted for confounders.Conclusions: Age at diagnosis with T1D was the major predictor of detectable C-peptide 3–6 years post-diagnosis. Decreases in IA-2A, and possibly ZnT8A, levels between diagnosis and post-diagnosis were associated with a reduction in RBF post-diagnosis.

Use of haemoglobin A1c to detect impaired fasting glucose or Type 2 diabetes in a United Kingdom community based population

2012-01-18

Abstract: Aims: To evaluate the diagnostic accuracy of haemoglobin A1c (HbA1c) in screening for impaired fasting glucose and Type 2 diabetes (T2DM).Methods: We screened 3904 adults aged 45–70 (mean age 58.6 [standard deviation (SD) 6.9] years, mean body mass index (BMI) 29.9 [SD 4.7]kg/m2), with fasting plasma glucose (FPG) and HbA1c as part of a large diabetes prevention programme. We assessed the diagnostic accuracy of HbA1c for predicting impaired fasting glucose (IFG), (defined either as FPG 5.6–6.9mmol/l, or 6.1–6.9mmol/l), and T2DM (FPG≥7.0mmol/l).Results: The prevalences of IFG were 13.8% (FPG 5.6–6.9mmol/l) and 4.5% (FPG 6.1–6.9mmol/l) and of T2DM was 2.1%. Using FPG 5.6–6.9mmol/l as the IFG reference standard, HbA1c of 39–47mmol/mol (5.7–6.4%) was 63% sensitive and 81% specific, and HbA1c 43–47mmol/mol (6.1–6.4%) was 21% sensitive and 98% specific, in diagnosing IFG. HbA1c≥48mmol/mol (6.5%) was 61% sensitive and 99% specific in diagnosing T2DM. Having HbA1c 39–47mmol/mol (5.7–6.4%), male sex, and body mass index >29.5 together increased the odds of IFG 6.5-fold (95% confidence interval (CI) 5.5–7.8) compared to the pre-test odds.Conclusion: Defining ‘pre-diabetes’ at a lower HbA1c threshold of 39mmol/mol (5.7%) instead of 47mmol/mol (6.1%) increases its sensitivity in diagnosing IFG, but current American Diabetes Association definitions of ‘pre-diabetes’ based on HbA1c would fail to detect almost 40% of people currently classified as IFG. This has implications for current and future diabetes prevention programmes, for vascular risk management, and for clinical advice given to people with ‘pre-diabetes’ based on fasting glucose data.

Impact of diabetes, high triglycerides and low HDL cholesterol on risk for ischemic cardiovascular disease varies by LDL cholesterol level: A 15-year follow-up of the Chinese Multi-provincial Cohort Study

2012-01-13

Abstract: Aims: A large proportion of ischemic cardiovascular disease occur in people without hypercholesterolemia. We aimed to investigate whether risk factors other than low-density lipoprotein cholesterol (LDL-C) have different impacts on cardiovascular risk in people with low verses high LDL-C levels.Methods: A total of 30,378 participants (35–64 years) were followed for 15 years in the Chinese Multi-provincial Cohort Study. Associations of coronary heart disease (CHD) and ischemic stroke with risk factors other than LDL-C were assessed in participants with low (<130mg/dL) and high (≥130mg/dL) LDL-C levels.Results: During the follow-up, 65.5% of CHD and 70.2% of ischemic stroke events occurred in participants with low LDL-C. High triglycerides predicted CHD (HR=1.74, 95% CI 1.25–2.42, P=0.001), and low HDL-C predicted ischemic stroke (HR=1.54, 95% CI 1.18–2.03, P=0.002) only in participants with low LDL-C. Diabetes predicted CHD in participants with high LDL-C (HR=2.38, 95% CI 1.31–4.34, P=0.005), but not in those with low LDL-C. Older age, male, hypertension, central obesity, and smoking had similar effects on the risk in both groups.Conclusions: Triglycerides and low HDL-C should be addressed in the management of dyslipidemia in people with low LDL-C. When LDL-C is high, tighter management of glycemia and LDL-C is warranted.

Strong association of common variants in the IGF2BP2 gene with type 2 diabetes in Lebanese Arabs

2012-01-16

Abstract: Objective: Several genome-wide association studies and replication analyses have identified common variation at the insulin-like binding protein 2 (IGF2BP2) gene to be associated with type 2 diabetes (T2DM). The aim of this study was to replicate in a Lebanese Arab population identified associations of IGF2BP2 variants rs4402960 and rs1470579 with T2DM.Methods: This case–control study involved 544 T2DM patients and 606 control subjects. Genotyping was done by the allelic exclusion method.Results: T allele of rs440960 (P=6.5×10−6) and C allele of rs1470579 (P=5.3×10−4) were significantly associated with T2DM; both SNPs were in strong LD (D′=0.83, r2=0.58). While both IGF2BP2 SNPs were significantly associated with T2DM under additive and recessive models, only rs4402960 remained significantly associated with T2DM under the dominant model. Taking the common rs4402960/rs1470579 GA haplotype as reference, multivariate analysis confirmed the positive association of TC (P=0.009; OR, 1.43; 95%CI, 1.09–1.87), and TA (P<0.001; OR=5.49; 95%CI=2.09–14.39) haplotypes with increased T2DM risk. These differences remained significant after applying the Bonferroni correction for multiple testing.Conclusion: We validate that IGF2BP2 susceptibility variants rs4402960 and rs1470579 associate with T2DM in Lebanese Arabs.

Association between vitamin D status and metabolic syndrome risk among Korean population: Based on the Korean National Health and Nutrition Examination Survey IV-2, 2008

Soyeun Kim, Juwon Lim, Soshin Kye, Hyojee Joung — 2012-02-10

Abstract: Aims: Low serum 25-hydroxyvitamin D (25(OH)D) levels have been linked to metabolic syndrome. However, community-based data for healthy Korean individuals are lacking. We aimed to assess the vitamin D status and the association of 25(OH)D deficiency with metabolic syndrome in the South Korean population (latitude 33–38°N).Methods: In this population-based study, we assessed 5559 South Korean adults selected from the Korean National Health and Nutrition Examination Survey IV-2, 2008. We used multiple logistic regression analysis to assess the association between vitamin D deficiency and metabolic syndrome.Results: The prevalence of vitamin D deficiency (<20ng/mL) was 56.0%. Subjects with vitamin D deficiency were younger and had higher education, lower physical activity, and lower alcohol consumption than those with normal vitamin D levels. The overall risk of metabolic syndrome was not associated with 25(OH)D concentration. The adjusted OR of reduced high density lipoprotein cholesterol (HDL-C) decreased across the quintiles of 25(OH)D concentrations (OR=0.72; 95% confidence interval=0.54–0.95 for comparisons of lowest vs. highest quintile; P for trend=0.003).Conclusions: A high prevalence of vitamin D deficiency was noted in the general South Korean population. Serum 25(OH)D concentration was inversely associated with the risk of having reduced HDL-C.

Feasibility, reliability and validity of the Iranian version of the Diabetes Quality of Life Brief Clinical Inventory (IDQOL-BCI)

2012-02-03

Abstract: Aims: To validate and culturally adapt the Diabetes-specific Quality of Life Brief Clinical Inventory (DQOL-BCI) for the Iranian population.Methods: After translation – back translation, content validity was assessed utilizing a panel of six experts. Based on a sample of 180 diabetic patients referred to two Diabetics Clinic Centers from September to May 2011 in Karaj, Iran, construct validity via detecting the factor structure, and convergent and discriminant validity were evaluated by scale-item correlations and known group analyses. Internal consistency and test–retest reliability were assessed in sample of 30 patients by Cronbach's and intraclass correlation coefficient (ICC).Results: The IDQOL-BCI showed good content validity (CVI values>0.75 and CVR values>0.99), internal consistency (α=0.75) and test–retest reliability (ICC=0.81). A 3-factor solution was found. In addition, high values of item-scale correlations confirmed the convergence validity, and some subscales and total scores differentiate between groups defined by sex, disease duration, income levels, drug using status and physical activity demonstrated the discriminant validity.Conclusions: Our findings demonstrate the initial feasibility, reliability and validity of the Iranian version of the IDQOL-BCI as a measure of diabetic-specific QOL measure in Iranian patients.

Gastrointestinal symptoms in diabetes mellitus, and their relation to anxiety and depression

2012-02-13

Summary: Background: Prevalence of gastrointestinal (GI) symptoms is increased in patients with diabetes mellitus. In general, GI symptoms are influenced by psychological factors such as anxiety and depression, but little is known about this association in diabetic patients.Aim: We tested the hypothesis that anxiety and depression have major impact on GI symptoms in diabetic patients.Methods: 280 diabetic patients and 355 non-diabetic, age and sex matched controls were studied by validated questionnaires: (1) PAGI-SYM and GSRS for common GI symptoms and (2) HADS for anxiety and depression. Data were compared using logistic regression analysis.Results: Patients with diabetes scored significantly (p<0.05) higher on the symptoms diarrhea (OR 1.64, 95% CI 1.05–2.56), early satiety (OR 2.50, 95% CI 1.39–4.49) and bloating (OR 1.58, 95% CI 1.03–2.43), but not on other symptoms. Prevalence of anxiety and depression (HADS scores ≥8) in diabetics and controls was respectively 27.5% and 20.6% for anxiety (p<0.05), and 19.6% and 13.4% for depression (p<0.05). After adjusting for anxiety and depression only the GI symptom “early satiety” remained significantly more prevalent in the patients with diabetes.Conclusions: The prevalence of the gastrointestinal symptoms diarrhea, bloating and early satiety, and of anxiety and depression is significantly increased in our cohort of predominantly patients with longstanding type 2 diabetes mellitus compared to controls. When adjusted for anxiety and depression, only the gastrointestinal symptom “early satiety” remained more prevalent in these diabetic patients, pointing to a somatic based origin. Thus, in our diabetic population psychological factors to a large extent are associated with gastrointestinal symptoms and should be taken into account when considering treatment of the gastrointestinal symptoms.

Six months on from the UN summit: Change is a marathon not a sprint

Ann Keeling — 2012-05-01

March marked the six month anniversary of the UN High-Level Summit on Non-Communicable Diseases (NCDs). WHO Director General Margaret Chan called it a “watershed event” in the opening plenary, and PAHO Director Emeritus Sir George Alleyne heralded it as “the dawn of a new era for NCDs”. But six months on, many Summit skeptics question whether all the effort was worth it and if global political commitments will ever translate into better health and lives for people on the ground.

Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome

2012-02-01

Summary: Twenty-eight diabetics presenting with acute Charcot foot were immobilized and the temperature difference between limbs measured at each month. All patients had monthly follow-up visits for a year and the relapse rate was zero. We found that skin temperature is a good parameter to ensure safe immobilization withdrawal.

Chronic inflammatory demyelinating polyneuropathy mimicking diabetic neuropathy in a young female with type 2 diabetes mellitus

2012-01-31

Abstract: The presentations of chronic inflammatory demyelinating polyneuropathy (CIDP) overlap with those of diabetic peripheral neuropathy (DPN). We described a young girl with CIDP underlying type 2 diabetes mellitus, presenting with progressive numbness and limb weakness, who was initially misdiagnosed to have DPN. Finally immunosuppressive therapy got good response.

Diabetes and life expectancy among Japanese – NIPPON DATA80

2012-02-01

Abstract: Life expectancy (LE) among the Japanese population with or without diabetes mellitus was estimated. LE in 40-year old men and women was 41.1 and 47.5years in those without diabetes and 32.3 and 40.9years in those with diabetes. The LE of 40-year old men and women with diabetes was 8.8 and 6.6years shorter than in those without diabetes. Diabetes mellitus leads to a decrease in LE. The presence of impaired glucose tolerance also affected LE inversely.

Hypoglycaemia and cardiovascular disease in Type 1 Diabetes. Results from the Catalan National Public Health registry on insulin pump therapy

Marga Giménez, Juan José López, Conxa Castell, Ignacio Conget — 2012-02-03

Abstract: Severe hypoglycaemia has recently been associated with an increased risk for cardiovascular disease (CVD) in diabetes. The retrospective analysis of a national registry on continuous subcutaneous insulin infusion points to a higher prevalence of CVD in Type 1 diabetic subjects with repeated severe hypoglycaemia at the time of starting CSII.

Metabolic syndrome correlates with polyvascular lesions detected by systemic vascular ultrasonography in Japanese people with type 2 diabetes

2012-02-10

Abstract: Atherosclerosis is a systemic disease of blood vessels. We investigated clinical characteristics of Japanese type 2 diabetic patients with polyvascular lesions detected by systemic vascular ultrasonography. The results showed that the metabolic syndrome correlated with polyvascular lesions detected by systemic vascular ultrasonography in Japanese type 2 diabetics.

Glucose sensor excludes hypoglycaemia as cause of death

Signe Schmidt, Kirsten Nørgaard — 2012-02-06

Abstract: The cause of death can be difficult to verify post-mortem in unexpected deaths in patients with Type 1 diabetes. This report describes an unexpected death in a 44-year-old man with Type 1 diabetes treated with sensor-augmented pump therapy. Continuous glucose monitoring data proved useful in determining the cause of death.

Seasonal trends in depressive symptoms in adolescents with type 1 diabetes

2012-02-10

Abstract: Adolescents with type 1 diabetes reported more clinically significant depressive symptoms in the spring/summer months (22% in April–September) than in the fall/winter months (11% in October–March) (χ2=5.67, p=.018). This seasonal pattern was stronger in low-income adolescents than in adolescents from higher-income families.

Clinical assessment of HNF1A and GCK variants and identification of a novel mutation causing MODY2

Ashley H. Shoemaker, Jozef Zienkiewicz, Daniel J. Moore — 2012-02-20

Abstract: A child with impaired fasting glucose was found to be heterozygous for a novel variant at c.659G>A in GCK and a variant at c.1663C>T in HNF1A. Structural modeling and clinical correlation suggests that the GCK variant causes monogenic diabetes while the variant in HNF1A is unlikely to be pathogenic.

Effectiveness of goal-setting on glycemic control in poor outpatients with diabetes

H.L. Guo, Z.M. Wu, D.M. Yu — 2012-02-20

Abstract: The aim was to study the impact of goal-setting on glycemic control in poor outpatients. Participants were provided glucometers for self-monitoring at no cost, while goal-setting on glycemic control was drafted for the experimental group. A reduction in HbA1c of 1.16% indicated that the goal-setting program was feasible and cost-effective.

Missed follow-up opportunities using a two-step screening approach for gestational diabetes

John L. Sievenpiper, Sarah D. McDonald, Vijaylaxmi Grey, Andrew C. Don-Wauchope — 2012-02-20

Abstract: A 1-step approach for gestational diabetes (GDM) screening using a 75g-oral glucose tolerance test (75g-OGTT) has been recommended. We undertook an audit (January 2007–June 2010) to assess adherence to an existing 2-step approach (50g-glucose challenge test followed by a 75g-OGTT). Adherence was sub-optimal. Overall follow-up was missed in 14.5% of those screened. Only 36% of those who met dysglycemia criteria for a follow-up 75g-OGTT received the test as per step 2 of the protocol.

Association of the intronic polymorphism rs891512 (G24943A) of the endothelial nitric oxide synthase gene with hypertension in Chilean type 2 diabetes patients

2012-03-16

Abstract: We investigated two single nucleotide polymorphisms of the NOS3 gene in type 2 diabetic patients (n=93) and healthy non-diabetic controls (n=76) and their relationship with smoking habits, body mass index, hypertension and dyslipidemia. Results showed that eNOS polymorphism rs891512 (G24943A) is associated with hypertension in Chilean individuals (p<0.05).

Influence of fruit juice on fingertips and patient behavior on self-monitoring of blood glucose

Masayuki Arakawa, Chie Ebato — 2012-02-20

Abstract: We examined the influence of fruit juice on fingertips on self-monitoring of blood glucose (SMBG) results and patient behavior regarding SMBG. We found hand washing with tap water after touching the flesh of fruit, rather than using alcohol swabs, to be very important for accurate SMBG.