糖尿病视网膜病变相关因素分析

目的了解糖尿病视网膜病变（DR）的相关因素。方法测定92例代谢综合征（MS）、80例2型糖尿病（DM）患者血糖、糖化血红蛋白（HbA1c）、血脂、C反应蛋白（CRP）、血压、身高、体重,计算体重指数（BMI）。应用免散瞳眼底拍照行眼底筛查。分析DR与年龄、糖尿病及高血压病程、血糖、HbA1c、血脂、BMI的相关性。结果MS组DR发生率高于DM组（P〈0．05）。DR组CRP、餐后2小时血塘、HbA1c、甘油三脂、血压、MS患病率高于非DR组（P均〈0．05）,糖尿病和高血压病程长于非DR组（P均〈0．05）。DR与糖尿病病程和CRP浓度正相关（β=0．250、0．354,P=0．000、0．007）。结论DR与长期高血糖、高血压、脂代谢紊乱及CRP密切相关。     

Clinical factors associated with gait alterations in diabetic patients

Aim To identify clinical factors associated with gait alterations in patients with Type 2 diabetes. Methods A sample of 76 diabetic patients underwent clinical examination and an outdoor gait assessment on tarred and cobblestoned terrains. We calculated respective differences in gait speed (performance measure) and gait variability (fall risk index) on changing terrains. Associations with clinical factors were investigated using correlation coefficients and linear regression analysis. Results The mean walking speed on the tarred pathway was 4.5 ± 0.6 km/h and 3.9 ± 0.8 km/h on the cobblestone pathway (P < 0.001). The CVGCT increased from 2.6 ± 0.9% on the tarred pathway to 5.1 ± 2.8% on the cobblestone pathway (P < 0.001). Regression analysis showed that 36% of the decrease in gait speed was explained proportionally by the mean of maximal isometric lower limb strength (22.2%; P ≤ 0.01), fear of falls (7.4%; P ≤ 0.01) and participants’ perceived vibration threshold (6.4%; P ≤ 0.01). Moreover, mean maximal isometric strength explained 11.8% (P ≤ 0.01) of the increase of the coefficient of variation of the gait cycle time when participants changed from tarred terrain to cobblestones. Conclusion This study indicated that both physiological (strength and proprioception) and cognitive–behavioural factors (fear of falls) should be considered when treating diabetic patients with gait alterations. Therapists should apply these findings when developing specific fall prevention and treatment programmes.     

Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes

Aims

This study was done to assess the risk factors associated with diabetic foot ulcer-free survival in patients with diabetes.

尿白蛋白正常的2型糖尿病患者肾功能下降的影响因素

目的 探讨24 h尿白蛋白排泄率正常的2型糖尿病患者估算的肾小球滤过率(eGFR)及其主要的影响因素.方法 采用中华医学会糖尿病学分会对住院糖尿病患者慢性并发症调查的资料,以改良的肾脏病膳食改良试验(MDRD)公式计算eGFR并进行分析.结果 正常白蛋白尿、微量白蛋白尿和大量白蛋白尿患者中分别有19.7%(149/755)、21.9%(102/466)和45.4%(59/130)出现eGFR的下降.正常白蛋白尿患者中eGFR下降组慢性并发症的发生率较eGFR正常组高.多因素logistic回归分析显示,年龄(OR=1.042,P<0.001)、糖尿病病程(OR=1.038,P=0.045)和收缩压(OR=1.017,P<0.001)是影响eGFR的主要因素,BMI(OR=0.868)及糖化血红蛋白(OR=0.898)亦与eGFR的下降有关.结论 尿白蛋白正常的2型糖尿病患者已有部分出现肾功能损害,结合eGFR有助于更好地评价2型糖尿病患者的肾脏损害情况.     

Predicting the costs of managing patients with chronic obstructive pulmonary disease

The economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD. The medical records of 2116 patients enrolled in one regional health system who had COPD and health-care resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data. All inpatient, outpatient and pharmacy utilisation data for each subject for 1999 were extracted from the database. Total costs for each individual were transformed to a log scale. Potential causes of cost variability (predictor variables) were defined and classified into sets (or domains). Multiple linear regression models were fitted for each domain. The study demonstrated that severity of airflow obstruction, as assessed by FEV(1)% predicted, is a significant but weak predictor of future health-care resource utilisation-prior hospitalisation and home oxygen use, the presence of comorbid conditions and symptoms of dyspnoea are better predictors of costs. Those interested in the economic benefits of new COPD treatments and disease management programs need to carefully account for these factors.     

Causes of death and associated factors among patients with non-insulin-dependent diabetes mellitus in Taipei, Taiwan

A cohort of 766 patients with non-insulin-dependent diabetes mellitus (NIDDM) from a general teaching hospital in Taipei, Taiwan were followed prospectively to assess survival experience and associated risk factors. Data were abstracted from the medical records and additional information was obtained from patients or their closest relatives using a structured questionnaire. Date and cause of death were determined from death certificates. Standardized mortality ratios were calculated by the direct method. Chi2-Square test and Cox's proportional hazard analysis were used to control for potential confounders. During a median follow-up of 3.5 years (range 1 month to 4.6 years), 131 deaths occurred. Of these, 29.8% were due to cardiopulmonary disease (ICD 401-429), 13.0% due to cerebrovascular disease (ICD 430-438), 13.0% due to acute diabetes metabolic complications (250.1, 250.2), and 11.4% due to nephropathy (580-589). Adjusted for age, people with NIDDM had 2.2 (95% CI 1.6-2.9) times the risk of death than members of the general population, and cause-specific standardized mortality ratios were: CPD 4.6, nephropathy 8.8, cerebrovascular disease 1.9, and neoplasm 0.7. Age, fasting plasma glucose, hypertension, and proteinuria were positively and independently associated with all-cause mortality (P < 0.05 for each). Thus, NIDDM patients have higher mortality rates than the general population in Taiwan, and age, fasting plasma glucose, hypertension, and proteinuria are associated with this excess risk. Proper application of available interventions may control these factors with a consequent reduction in mortality. Particular attention is needed to prevent deaths from the acute metabolic complications of diabetes.     

Additional factors associated with plantar ulcers in diabetic neuropathy

Patients can only examine and handle their own feet if they have adequate visual acuity and joint mobility. We therefore studied the physical capacity of patients with neuropathy to perform the preventive footcare measures previously taught. The study included three groups of diabetic outpatients, comparable for age and duration of diabetes: (1) 38 patients with neuropathic ulcers; (2) 21 patients with neuropathy, but no ulcers; (3) 30 patients without neuropathy. Visual acuity and joint mobility, expressed as minimum eye-metatarsum and heel-buttock distances, did not differ between uncomplicated neuropathic and non-neuropathic patients: visual acuity was sufficient in 95% of neuropathic patients without ulceration and in 87% of non-neuropathic patients; joint mobility was in the normal range in both groups. However, 71% of complicated neuropathic patients had insufficient visual acuity for correct foot examination, and their joint mobility was reduced compared with uncomplicated neuropathic and non-neuropathic patients.     

Potential factors associated with contraceptive intention among adolescent males in Taiwan

This study explored the predictors of contraceptive intention in adolescent males in Taiwan. It used a cross-sectional design and a sample of 1,000 vocational high school male students to determine the potential factors associated with contraceptive intention. Data were collected on an anonymous, self-administered questionnaire, including personal background variables, prior sexual experience, contraceptive knowledge, contraceptive attitude, contraceptive self-efficacy, perception of peers' contraceptive behavior, perception of support from significant others, and parental-adolescent communication about contraception. A total of 230 participants (23%) had prior sexual experience, 13% (30) of whom reported being involved in their girlfriends' pregnancies. Of the participants, 45% recognized the use of condoms as the most favorable contraceptive method for future sexual intercourse. Second to condom use, the combination of the calendar method and condom use was also popular (13.1%). Multiple stepwise regression indicated that better contraceptive attitudes, higher contraceptive self-efficacy, no prior sexual experience, more perception of peers' contraceptive behavior, and higher perception of support from significant others were predictors of higher contraceptive intention. The above predicting factors explained 31.9% of the total variance for contraceptive intention among adolescents. These results provide health professionals with important information to understand the reality adolescents encounter and to design effective contraceptive programs for male adolescents.     

Risk factors associated with falls among Chinese hospital inpatients in Taiwan

Falls among hospital inpatients were not uncommon and were associated with physical, functional and psychological morbidity for patients and excess cost, bed occupancy, complaints and litigation for hospitals. Risk factors for falls of hospital inpatients have been reported, but rarely in a case-control design. To our best knowledge, there was no case-control study for risk of fall among hospital inpatients in Taiwan, one of the most rapidly aging countries. The main purpose of this study was to determine risk factors for falls among hospital inpatients in Taiwan. A prospective multi-center case-control study was started in 2002. During the study period, all incident falls reported by ward nurses were carefully reviewed by research staff on the next day, and a matched control subject was generated according to the age, sex, diagnosis, and pre-event length of stay. Risk factors of falls, including physical conditions, pharmaceutical agents, and environmental factors were compared between fallers and controls. In total, 202 incident falls (202 fallers, none of them fell twice, mean age: 68.2+/-16.9 years, 73.8% males) were reported and the overall incidence of falls during the study period was 4.4 per 1000 bed days. Leg weakness (odds ratio (OR): 1.88, 95% confidence interval (CI): 1.16-3.05), reported insomnia at admission (OR: 2.28; 95% CI: 1.06-4.89), postural hypotension (OR: 5.57; 95% CI: 1.54-21.46), previous history of fall within 1 year before admissions (OR: 5.05, CI: 2.60-9.78), recent use of hypnotics (within 24h) (OR: 1.86, 95% CI: 1.10-3.14) were all significant risk factors (for all comparisons p<0.05), but family member's company may reduce in-hospital falls (OR: 0.51; 95% CI: 0.33-0.78). In conclusion, the incidence of falls among hospital inpatients was lower than that reported from other countries. Further study is needed to organize a comprehensive fall prevention program according to the risk factors identified in this study to reduce in-hospital falls in Taiwan.     

老年糖尿病伴瘙痒症的相关因素分析

目的探讨老年2型糖尿病患者伴瘙痒症相关因素,为瘙痒症的诊断、治疗、保健和护理提供依据。方法以2003年1月至2006年12月在解放军总医院住院的60岁以上的2型糖尿病患者514人为研究对象,患瘙痒症的143名患者为病例组,无瘙痒的371名患者为对照组,采用回顾性分析。结果病例组年龄、糖尿病病程、空腹血糖、吸烟、血脂异常及糖尿病并发症和对照组比较,差异有统计学意义。结论老年2型糖尿病伴瘙痒症相关危险因素为年龄、糖尿病病程、空腹血糖、吸烟、血脂异常及糖尿病并发症。     

Staphylococcus aureus nasal carriage and associated factors in type 2 diabetic patients

We aimed to compare the rate of nasal carriage of Staphylococcus aureus (NCSA) between type 2 diabetic patients and non-diabetic ones and also to reveal the associated risk factors. Type 2 diabetic subjects were selected from outpatient diabetes clinics and control subjects were selected from outpatient internal medicine clinics in the same hospital. The subjects were divided into 3 groups. Group I included 68 subjects on insulin therapy and dietetic treatment, Group II included 80 subjects on oral anti-diabetic agents and dietetic treatment and Group III included 150 age- and sex-matched non-diabetic subjects. The rates of NCSA for Group I, II and III subjects were found to be 24 (35.3%), 11 (13.8%), and 16 (10.7%), respectively. Whereas there was no significant difference in NCSA positivity between Group II and Group III, a significant difference was found between Groups I and III (P < 0.01). Univariate analysis revealed that the following were significant risk factors for NCSA in our diabetic patients: insulin use, hospital admission within the last 6 months, being diabetic for more than 6 years, fasting glucose level above 111 mg/dl and antibiotic usage within the last 6 months. Furthermore, insulin use (odds ratio 3.32) and antibiotic usage within the last 6 months (odds ratio 5.75) were defined as significant risk factors for NCSA in diabetic subjects by the logistic regression method. Our results suggested that the rate of NCSA was significantly higher in type 2 diabetic patients who used insulin or antibiotics within the last 6 months.     

The prevalence of subjective frailty and factors associated with frailty in Taiwan

This study estimated the prevalence of frailty and identified the factors associated with frailty in Taiwan using data from the Survey of Health and Living Status of the Elderly. A nationwide probability sample including 2,238 individuals aged ≥65 years was interviewed in 2003. Based on the Cardiovascular Health Study conducted by Fried, five phenotypes of frailty were selected: poor appetite, exhaustion, low physical activity, poor walking ability, and poor twisting ability of fingers. Participants were classified as nonfrail, prefrail, and frail if they met 0, 1 or 2, and ≥3 criteria. The prevalences of nonfrailty, prefrailty, and frailty were 55.1%, 40.0%, and 4.9%, respectively. The prevalence of frailty increased with age and was greater in women. Frailty was associated with less education, no spouse, disability, higher rates of comorbid chronic diseases, depressive symptoms, and geriatric syndromes. Specific drug use, such as hypnotics, analgesics, herbal drugs, and parenteral fluid supplements was positively associated with frailty. The use of multivitamins, fish oil, and vitamin E was negatively associated with frailty. The prevalence of frailty is lower in Taiwan than in Western countries. Depressive symptoms, geriatric syndromes, and specific medication use are potential fields for frailty prevention in community-dwelling older adults.     

Cardiovascular risk factors in diabetic patients with hypertension

Individuals with diabetes mellitus have cardiovascular disease (CVD) mortality comparable to nondiabetics who have suffered a myocardial infarction or stroke. Aggressive management of risk factors such as hypertension, dyslipidemia, and platelet dysfunction in persons with diabetes has been shown to reduce morbidity and mortality in prospective randomized controlled clinical trials. Accordingly, there are national mandates to lower blood pressure to less than 130/85 mm Hg, reduce low-density lipoprotein cholesterol to less than 100 mg/dL, and institute aspirin therapy in adult patients with diabetes. Although not definitively shown to reduce CVD, there are also recommendations to control the level of glycemia, as well. This article discusses CVD risk factors in the diabetic patient with hypertension.     

The risk factors associated with ultrasonic tissue characterization of carotid plaque in type 2 diabetic patients

AimsLittle is known about the related factors of plaque echogenicity in diabetic subjects.MethodsThis was a single-center, retrospective, study investigating a subgroup of patients of a previously published trial. We enrolled 179 middle-aged and older Japanese type 2 diabetic patients with carotid plaque, and examined the parameters related with echogenicity of carotid plaque evaluated by gray-scale median (GSM).ResultsProportion of males and body mass index (BMI) were significantly higher and HDL-cholesterol was significantly lower in the patients with low GSM (< 48) plaques (n = 89) as compared to those without it (n = 90). A multiple logistic regression analysis with gender, BMI, and HDL-cholesterol as independent variables and the presence of low GSM plaques as an objective variable showed that male (odds ratio (OR) 2.36, 95%CI 1.05–5.31, p = 0.037) and BMI (OR 1.12 [1.01–1.24], p = 0.029) were independently associated with low GSM plaques. Another multiple logistic regression analysis with gender, BMI, and low-HDL–cholesterolemia (HDL-C < 40 mg/dl) as independent variables showed that low-HDL–cholesterolemia (OR 2.30 [1.03–5.13], p = 0.042) and BMI (OR 1.11 [1.00–1.22], p = 0.046) were independently associated with low GSM plaques.ConclusionsOur study suggests that gender, BMI and low-HDL-cholesterol are important determinants of the content of the vascular wall in diabetic subjects.     

Incidence and associated factors of neutralizing anti-interferon antibodies among chronic hepatitis C patients treated with interferon in Taiwan

BACKGROUND: The administration of interferon (IFN) could be complicated by the development of neutralizing anti-interferon antibodies (NA). This study evaluates the frequency and associated factors of NA among chronic hepatitis C patients treated with different IFNs. METHODS: Ninety-five chronic hepatitis C patients were randomized to be treated with recombinant IFN-alpha2a (n = 28), IFN-alpha2b (n = 39) or lymphoblastoid IFN-alpha1 (n = 28) given intramuscularly, 3-6 million units, thrice weekly for 24 weeks. Serum samples collected before, during and after the cessation of treatment were checked for NA. RESULTS: Three patients were withdrawn from treatment. All patients were negative for NA before treatment and 13 (14%) patients developed neutralizing antibodies. Of the 26 patients treated with IFN-alpha2a, 6 (23.1%) developed NA. whereas NA were detected in only 6 (15.4%) of 39 and 1 (3.7%) of 27 patients treated with IFN-alpha2b and IFN-alphanl, respectively. Age, gender, HCV genotype, ALT level, IFN total dose and liver histology were not associated with the development of NA. By using multivariate logistic regression it was shown that pretreatment HCV RNA level and IFN preparation were the two major factors related to the production of NA. The response of treatment was related to pretreatment viremia but not to the presence of NA. CONCLUSIONS: The frequency of development of NA among Taiwanese patients with chronic hepatitis C might be related to different IFN preparations and pretreatment HCV RNA level. The response of treatment was related to pretreatment HCV RNA level but not to the presence of NA.     

Factors affecting hospitalization costs in Type 2 diabetic patients

ObjectiveTo evaluate Type 2 diabetes hospitalization costs and their determinants by applying a proper methodological approach, taking into account the presence of several observations with zero costs.MethodsA cohort study using per-patient hospital discharge abstracts in a period of 4.5 years of follow-up (from 1/1/1996 to 30/6/2000). Potential cost predictors were age, sex, body max index, hypertension, diabetes duration, hemoglobin A_1c levels, insulin treatment, retinopathy, coronary artery disease, peripheral artery disease, nephropathy, death and presence of comorbidity (cancer, chronic liver disease, chronic obstructive pulmonary disease, and psychiatric disease). Among risk factors, total cholesterol, HDL cholesterol and smoking were considered. A two-part model has been adopted in order to take into account the presence of patients with zero hospital costs: the probability of any hospitalization has been modeled via a standard logit generalized linear model (GLM); the actual level of total costs has been modeled via a GLM, with a gamma cost distribution and a LOG link function.ResultsIn 4.5 years the median total cost per hospitalized person was $4404 (mean $8180). In line with existing evidence, diabetes complications showed a high impact on average costs. In particular, peripheral and coronary artery diseases determined more than $1000 increase in the median costs. Chronic comorbidity were responsible for the highest incremental hospitalization costs ($1771).ConclusionsHospitalization costs were significantly increased by the presence of diabetes complications and chronic conditions. The adoption of a two-part model has allowed to obtain estimates not neglecting the effect of covariates on the probability of having no hospital care.     

Analysis of factors associated with extremity ulceration in diabetic subjects with peripheral neuropathy

Peripheral neuropathy is the main risk factor for foot ulceration in diabetic subjects. This study examined the association of peripheral arterial disease (PAD) with foot ulceration in a sample of diabetic subjects with peripheral neuropathy, and also if inflammatory markers would be associated with this event. We evaluated 32 type 2 diabetic individuals with abnormal 10-g monofilament exam, who were stratified in 2 groups according to history or presence of lower extremities ulcer. The group "with ulcer" (n = 18) included the ones that had active or cicatrized ulcer, or some lower-extremity amputation due to ulcer complications. In addition to the neurological examination and monofilament test, they were submitted to biothesiometry, lower extremity vascular assessment with Doppler, and laboratory determinations. No difference between the groups was found concerning sex distribution, mean age, and duration of diabetes diagnosis. The group with ulcer showed higher mean values of height (1.70 +/- 0.06 vs. 1.63 +/- 0.11 m, p = 0.044), vibration perception threshold measured in medial malleolli (40.9 +/- 13.0 vs. 30.6 +/-12.3 V, p = 0.040) than the group without ulcer. The groups did not differ regarding the mean values of the inflammatory markers. Response to patellae reflex was worse in the group with ulcer (p = 0.047), in which a higher proportion of individuals with abnormal toe-brachial index (p = 0.030) was observed as compared to those without ulcer. We concluded that PAD is associated with the presence of ulcer in neuropathic subjects. The assessment of digital arteries flow in lower limbs (in great toe) contributed to detect such association. Association of diabetic foot ulcers and inflammatory markers was not observed, but cannot be excluded due to limitations of sample size. Prospective studies should examine the sensitivity of the toe-brachial index to identify PAD in diabetic individual at risk of ulceration.