Motor-evoked potentials in patients with diabetes mellitus type 1

BACKGROUND AND PURPOSE: The aim of the study was to assess the function of the central motor pathway in young patients with diabetes mellitus type 1 by use of transcranial and paravertebral magnetic stimulation. MATERIALS AND METHODS: MEPs were recorded in 68 young patients (25+/-5.69 years), with diabetes mellitus type 1, from muscles: abductor digiti minimi and abductor hallucis (AH). Central motor conduction time (CMCT) was calculated by subtracting cortical latency (CL) after transcranial stimulation from the motor nerve conduction time (MNCT) after paravertebral stimulation. The obtained results were compared with normative data from the group of 36 healthy volunteers, matched for age and height. Statistical comparison of CMCT between diabetic and control groups was performed. RESULTS: There were no significant differences between the diabetics and control means of CMCT. Also, we were unable to elicit the MEPs cortically from AH muscle in 19 (27.9%) of diabetic patients and only in 3 (8.3%) controls. CONCLUSION: CMCT is normal in patients below 40 years of age, in whom the MEPs after transcranial stimulation can be elicited. Lack of MEPs in lower limb muscles following transcranial stimulation in almost 30% of patients in the presence of MEPs in upper limbs may indirectly suggest the dysfunction of central motor conduction in those cases.     

Risk of obstructive sleep apnea in patients with schizophrenia: a nationwide population-based cohort study

Purpose

Patients with schizophrenia (SCZ) have a higher prevalence of known risk factors for obstructive sleep apnea (OSA). This study aims to determine if SCZ patients are at increased risk of incident OSA.

Methods

A total of 5092 newly diagnosed SCZ patients and 5092 non-SCZ controls matched by gender, age, and index year were included between 2000 and 2012 and followed to 2013. Participants newly diagnosed with OSA were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence intervals (CI) of the OSA incidence rate between the two groups studied.

Results

SCZ patients were at increased risk of OSA compared to non-SCZ controls after adjusting for gender, age, comorbidities, and duration of antipsychotic use (2.12 versus 1.01 per 1000 person-years, HR: 1.97, 95% CI: 1.36–2.85). Also, this study confirmed the existence of some known risk factors for OSA, including male gender (HR 1.65, 95% CI 1.14–2.37), obesity (HR 2.62, 95% CI 1.19–5.80), hypertension (HR 1.61, 95% CI 1.06–2.47), hyperlipidemia (HR 1.55, 95% CI 1.04–2.38), diabetes (HR 1.53, 95% CI 1.01–2.38), and antipsychotic use (duration < 1 year (HR 1.57, 95% CI 1.13–2.37), 1–3 years (HR 1.62, 95% CI 1.06–2.82), and 3–5 years (HR 1.45, 95% CI 1.06–2.44)).

Conclusion

This study shows SCZ patients are at increased risk of OSA, and there is still an association with higher risk of OSA after controlling for known risk factors, indicating that it is necessary to develop targeted interventions in SCZ patients to reduce the negative impact of OSA on health.

     

Short-term heart rate complexity is reduced in patients with type 1 diabetes mellitus

OBJECTIVE: The aim of this study was to test whether new heart rate variability (HRV) complexity measures provide diagnostic information regarding early subclinical autonomic dysfunction in diabetes mellitus (DM). METHODS: HRV in DM type 1 patients (n=17, 10f, 7m) aged 12.9-31.5 years (duration of DM 12.4+/-1.2 years) was compared to a control group of 17 healthy matched probands. The length of R-R intervals was measured over 1h using a telemetric ECG system. In addition to linear measures, we assessed HRV complexity measures, including multiscale entropy (MSE), compression entropy and various symbolic dynamic measures (Shannon and Renyi entropies, normalized complexity index (NCI), and pattern classification). RESULTS: HRV magnitude was significantly reduced in patients with DM. Several HRV complexity parameters (MSE at scales 2-4, Renyi entropy, NCI) were also significantly reduced in diabetics. MSE indices and compression entropy did not correlate with linear measures. CONCLUSIONS: The magnitude and complexity of HRV are reduced in young patients with DM, indicating vagal dysfunction. SIGNIFICANCE: The quantification of HRV complexity in combination with its magnitude may provide an improved diagnostic tool for cardiovascular autonomic neuropathy in DM.     

Clinical and molecular findings in multiple sclerosis patients with type 1 diabetes mellitus

The clinical and molecular findings in three patients with multiple sclerosis (MS) and additional type 1 diabetes mellitus are described. These patients all presented with a severe and progressive disease course of MS. Molecular testing for HLA class II genes demonstrated the presence of the haplotype DRB1¹0401, DQB1¹0302 in all patients. This haplotype is closely linked to type 1 diabetes mellitus and is increased among patients with the primary progressive subtype of MS. We conclude that the immunogenetic background in patients with diabetes mellitus may determine the severity and clinical course of MS in these individuals.     

Glycemic control and major depression in patients with type 1 and type 2 diabetes mellitus.

The current study evaluated the association of glycemic control and major depression in 33 type 1 and 39 type 2 diabetes mellitus patients. Type 1 patients with a lifetime history of major depression showed significantly worse glycemic control than patients without a history of psychiatric illness (t = 2.09; df = 31, p < 0.05). Type 2 diabetes patients with a lifetime history of major depression did not have significantly worse control than those with no history of psychiatric illness. Findings from this study indicate different relationships between lifetime major depression and glycemic control for patients with type 1 and type 2 diabetes. Treatment implications for glycemic control in type 1 and type 2 diabetes patients are discussed.     

Postprandial hypotension treated with acarbose in a patient with type 1 diabetes mellitus

Abstract Treatment of postprandial hypotension (PPH) is often unsuccessful. We report a case of a type 1 diabetic patient suffering from severely symptomatic PPH. The patient was treated with acarbose and showed definite improvement of both glycemic control and PPH.     

Cognitive functioning and brain MRI in patients with type 1 and type 2 diabetes mellitus: a comparative study

BACKGROUND/AIMS: Diabetes mellitus (DM) may affect the central nervous system, resulting in cognitive impairments. It has been suggested that cognitive impairments are more pronounced in DM2 than in DM1, but studies that directly compare the effects of these 2 types of DM on cognition are lacking. METHODS: Forty patients with DM1 (mean duration: 34 years) were compared with 40 age- and education-matched patients who were known to have DM2 (mean duration: 7 years). Extensive neuropsychological assessment focussed on abstract reasoning, memory, attention and executive function, visuoconstruction and information processing speed. Psychological well-being was measured and brain MRIs were obtained. RESULTS: No systematic between-group differences were observed in neuropsychological measures or levels of psychological well-being. DM2 patients showed significantly more deep white matter lesions and cortical atrophy on MRI (p < 0.01). CONCLUSION: DM1 patients with more than 30 years of DM have a similar cognitive profile and better MRI ratings than age- and education-matched DM2 patients with only 7 years of DM.     

2型糖尿病患者交感皮肤反应分析

目的探讨交感皮肤反应(SSR)对检测2型糖尿病(T2DM)患者交感神经功能损害的诊断价值。方法选择本院收治的60例2型糖尿病患者进行交感皮肤反应检测,并与40例健康人进行对比。结果60例糖尿病患者交感皮肤反应与对照组比较,起始潜伏时差异有统计学意义(P<0.05),而波幅上下肢差异无统计学意义。结论SSR可以作为评价糖尿病患者交感神经功能的一个显著指标。     

Eating disorders in young women with type 1 diabetes mellitus

Research findings from the past decade regarding the association of type 1 diabetes mellitus and eating disorders are critically reviewed in this paper. Although there has been much debate regarding the specificity of this association, a recent large multisite case-controlled study demonstrated that the prevalence rates of both full syndrome and subthreshold eating disorders among adolescent and young adult women with diabetes are twice as high as in their nondiabetic peers. Further, a 4-year follow-up study showed that disordered eating behavior in young women with diabetes often persists and is associated with a threefold increase in the risk of diabetic retinopathy. These eating disturbances tend to be associated with impaired family functioning and with poor diabetes management. Health care professionals should maintain a high index of suspicion for the presence of an eating disturbance among young women with diabetes, particularly among those with persistently poor metabolic control and/or weight and shape concerns. Screening for such disturbances should begin during the prepubertal period among girls with diabetes. A brief psychoeducational intervention leads to a reduction in disturbed eating attitudes and behavior but is not sufficient to improve metabolic control. More intensive treatment approaches, which should include a family-based component, may be needed to improve metabolic control. The evaluation of these and other treatment approaches is indicated in view of the serious short- and long-term health risks associated with eating disorders in young women with diabetes.     

Vasomotor reflexes in the fingertip skin of patients with type 1 diabetes mellitus and leprosy

Fingertip skin blood flow was measured by laser Doppler flowmetry (as LDflux) under environmental conditions promoting vasodilatation in Scottish patients with diabetes mellitus and Indian patients with leprosy. The reflex control of fingertip blood flow was assessed by measuring the reduction in LDflux induced by deep inspiratory gasp (IG) and cold challenge (CC) of immersing the contralateral hand in cold water.The uncomplicated diabetic patients showed normal vasomotor reflexes and an increased, though non significant, LDflux level (p < 0.06). The patients with diabetic neuropathy had resting LDflux levels significantly less than the uncomplicated group and also had substantial impairment of both IG and CC reflexes. Those with retinopathy (but no clinically apparent neuropathy) had LDflux within the normal range, but they showed minor evidence of impairment of the vasomotor reflexes.The uncomplicated newly registered leprosy patients had reduced LDflux and substantial impairment of CC reflexes. These changes were more marked in newly registered leprosy patients with clinical evidence of neuropathy. Leprosy patients with long-standing neuropathy requiring orthopaedic treatment had LDfluxes so greatly reduced that measurement of vasomotor reflexes was not practicable. The CC reflex was more severely affected than the IG reflex and more frequently absent in leprosy patients, possibly because of associated sensory neuropathy affecting the afferent limb of this response.Thus laser Doppler flowmetry can detect impairment of reflex control of fingertip blood flow in both diabetes mellitus and leprosy, but there are functional differences in the pattern of autonomic impairment between the diseases, suggesting differences in the pathogenesis of nerve damage.     

精神分裂症并发糖尿病的相关因素分析

目的了解住院精神分裂症患者并发糖尿病的相关因素。方法回顾性调查符合CCMD-3诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药物的使用情况等相关因素,并观察体重、血糖和血脂的变化。结果在302例精神分裂症患者并发糖尿病者为39例(12.91%),其发生与患者的年龄、病程、体重、血脂和阳性糖尿病家族史以及使用抗精神病药物有相关性。结论精神分裂症患者中糖尿病的发生率远高于普通人群,年龄较大、病程较长以及抗精神病药物的长期使用均可增加糖尿病的发生率。     

A lifestyle intervention for older schizophrenia patients with diabetes mellitus: a randomized controlled trial

PURPOSE: We tested the feasibility and preliminary efficacy of a lifestyle intervention for middle-aged and older patients with schizophrenia and type-2 diabetes mellitus, using a randomized pre-test, post-test control group design. METHOD: Individuals with a diagnosis of schizophrenia or schizoaffective disorder over the age of 40 were randomly assigned to 24-week Diabetes Awareness and Rehabilitation Training (DART; n=32) groups or Usual Care plus Information (UCI; n=32) comparison groups. Participants were recruited from board-and-care facilities and day treatment programs. Fifty-seven patients completed baseline and 6-month assessments consisting of an interview, measures of body mass index, blood pressure, fasting blood chemistry, and accelerometry. A mixed-model analysis of variance was used to analyze the data. RESULTS: A significant group x time interaction was found for body weight, with patients in the DART group losing a mean of 5 lb and those in the UCI gaining a mean 6 lb. Significant group x time interactions were also found for triglycerides, diabetes knowledge, diabetes self-efficacy, and self-reported physical activity, but not for fasting plasma glucose or glycosylated hemoglobin. CONCLUSIONS: Group-based lifestyle interventions are feasible and produce positive health changes in middle-aged and older patients with schizophrenia and diabetes mellitus.     

Study of prevalence of epilepsy in children with type 1 diabetes mellitus

PurposeTo evaluate the prevalence of epilepsy in children (<16 yrs) with type 1 diabetes.MethodsA review of clinical notes and investigations was carried out on all the children with type 1 diabetes who were under follow-up in the Paediatric Diabetes clinic at Alder Hey Children's Hospital in the year 2010.ResultsOf 285 children aged <16 years with type 1 diabetes, six also had epilepsy giving a prevalence of 21/1000. This is approximately six times greater than the prevalence of epilepsy in the general population of children in UK.ConclusionEpilepsy appears to occur more frequently in children with type 1 diabetes than in the general paediatric population.     

米氮平对2型糖尿病患者合并抑郁症的疗效观察

目的 探讨果氮平对2型糖尿病患者合并抑郁症的疗效.方法 将120例合并抑郁症的2型糖尿病患者,随机分为研究组和对照组,每组60例.对照组仅用降糖药治疗,研究组在常规降糖药治疗基础上联用米氮平( 15～45mg/d)治疗,治疗8周.在治疗前和治疗8周末均进行汉密尔顿抑郁量表(HAMD)评定和空腹血糖、餐后2h血糖、糖化血...     

Remission and cognitive ability in a cohort of patients with schizophrenia

INTRODUCTION: Patients with schizophrenia were studied regarding their ability of achieving symptomatic remission. It was found that only approximately one-third of the patients fulfilled the criteria for remission. The importance of cognitive performance was studied to decide whether cognitive ability is a contributing factor for achieving remission. MATERIALS AND METHODS: A homogeneous cohort of 211 patients, of whom 76 patients attained remission (36%), and 135 patients (64%) failed to, was studied. Remission was decided by the use of eight items from the PANSS in which none of these items should have a score above three points. The patients were also tested on a comprehensive battery of cognitive tests including vigilance, working memory, long-term memory, executive functioning, learning performance, visuomotor speed/efficacy, cognitive flexibility and pre-morbid functioning. RESULTS: Marked differences were exhibited in the cognitive abilities in all domains of patients who had attained remission in comparison with those who had not. DISCUSSION: This study highlights the importance of cognitive performance as one possible predictor of remission. Patients without remission had lower cognitive ability and may have more difficulty in benefiting from, or complying with their treatment. As a consequence, various forms of supportive treatment might increase the likelihood of remission.