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1.

Aims

To investigate the prevalence and risk factors for diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese.

Methods

A cross-sectional, hospital-based observational study was conducted. We enrolled 2837 adults with type 2 diabetes mellitus. Diabetic peripheral neuropathy with or without pain were diagnosed using 2 validated screening tools, namely the Michigan Neuropathy Screening Instrument and Douleur Neuropathique 4 questionnaire.

Results

In our sample, 2233 participants had no neuropathy, 476 had diabetic peripheral neuropathy without pain, and 128 had diabetic peripheral neuropathy with neuropathic pain, representing an overall diabetic peripheral neuropathy prevalence of 21.3%, and the prevalence of neuropathic pain in diabetic peripheral neuropathy was 21.2%. Multivariate analysis revealed that older age (P < 0.001), treatment with insulin (P = 0.004), microalbuminuria (P = 0.001) or overt proteinuria (P < 0.001) were independently associated with diabetic peripheral neuropathy, whereas older age (P < 0.001), elevated glycated haemoglobin (P = 0.011), lower high-density lipoprotein cholesterol (P = 0.033), and overt proteinuria (P < 0.001) were independently associated with diabetic peripheral neuropathy with neuropathic pain.

Conclusions

During clinical visits involving biochemical studies, the risk for diabetic peripheral neuropathy with neuropathic pain should be considered for people with older age, elevated glycated haemoglobin, low high-density lipoprotein cholesterol and overt proteinuria, with particular attention given to increased levels of albuminuria while concerning neuropathic pain.  相似文献   

2.

Aim

To evaluate the one-year post effect of the implementation of a diabetes program that includes mHealth interventions on the quality of diabetic care in public primary care centers.

Method

It is a quasi-experimental study with outcome measurements at baseline, 6 and 12 months. The program includes primary care team training, a diabetes registry with a decision support tool in an app. and text messages for patients.

Results

At baseline, 947 patients were included in the registry, 62.3% women with a mean age of 53.6 ± 11.5 years and 92% with type 2 diabetes. Common comorbidities were hypertension (61.3%) and obesity (59%). Only 16.9% had one HbA1c and 48.9% a cholesterol lab in the last year, 61.9% were screened for diabetic peripheral neuropathy, and 29.0% had one eye exam in the previous year. With respect to blood sugar, lipid and blood pressure control: 44.4% of those with HbA1c measurements had levels ≥8%, total cholesterol was over 200 mg/dL in 40.6% and 48.2% had uncontrolled blood pressure values.

Conclusion

Patients with diabetes received a low quality of care at public primary care clinics. A diabetes registry allowed us to draw an epidemiological profile of diabetic patients and determine the quality of care provided.  相似文献   

3.

Introduction

Foot disease is a common complication of type 2 diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot.

Aim

To examine Relationship of Planter Pressure and Glycemic Control in Type 2 Diabetic Patients with and without Neuropathy.

Materials and methods

The study was conducted on 50 type 2 diabetic patients and 30 healthy volunteers. BMI calculation, disease duration, Hemoglobin A1c and presence of neuropathy (by history, foot examination and DN4 questionnaire) were recorded. Plantar pressure was recorded for all patients using the Mat-scan (Tekscan, Inc.vers. 6.34 Boston USA) in static conditions (standing) and dynamic conditions (taking a step on the Mat-scan). Plantar pressures (kPa) were determined at the five metatarsal areas, mid foot area, medial and lateral heel areas and medial three toes.

Results

Static and dynamic plantar pressures in both right and left feet were significantly higher in diabetic with neuropathy group than in control group in measured areas (P < 0.05). Static and dynamic pressures in right and left feet were significantly higher in diabetic with neuropathy group than in diabetic without neuropathy group in measured areas (P < 0.05). On comparison between controls and diabetic without neuropathy group there was a significant difference in plantar pressures especially in metatarsal areas (P < 0.05). No significant correlations were present between the studied variables age, disease duration, BMI and HbA1c and plantar pressures in all studied areas.

Conclusion

Persons with diabetic neuropathy have elevated peak plantar pressure (PPP) compared to patients without neuropathy and control group. HbA1c% as a surrogate for glycemic control had no direct impact on peak planter pressure, yet it indirectly impacts neuropathy evolution through out disease duration eventually leading to the drastic planter pressure and gait biomechanics changes.  相似文献   

4.

Aims

To assess whether an integrated hospital-community diabetes management program could improve major cardiovascular risk factor control among patients with diabetes in real-world clinical settings.

Methods

985 adults with diabetes in the Shanghai Taopu community health service center were enrolled at baseline and 907 subjects completed the follow-up. The follow-up levels of the metabolic profiles were assessed by their averages during the follow up period.

Results

After a mean 7-year follow-up period, heamoglobin A1c, systolic and diastolic blood pressure levels decreased by 0.6%, 5.7 mmHg, and 1.5 mmHg, respectively (all P < 0.001). There was a non-significant difference in low-density lipoprotein cholesterol, while high-density lipoprotein cholesterol increased 1.9 mg/dL and triglycerides decreased 28.3 mg/dL, respectively (all P < 0.001). The percentage of patients with diabetes who met any one of three Chinese Diabetes Society goals (heamoglobin A1c <7.0%, blood pressure <140/80 mmHg, and low-density lipoprotein cholesterol <100 mg/dL) increased from 58.2% to 70.1%. The chronic diabetes complication screening rates (diabetic retinopathy, diabetic neuropathy, diabetic nephropathy) have significantly increased, from almost zero to 12–78%.

Conclusions

This long-term program has increased the proportions of attaining major cardiovascular risk factors control goals and diabetic chronic complication screening rates among patients with diabetes.  相似文献   

5.

Background

The aim of this study was to explore the correlation between obstructive sleep apnea (OSA) and diabetic neuropathy.

Materials and methods

After working out searching strategy, literatures were screened from the electronic databases: PubMed, Embase, and the Cochrane library. R 3.12 was utilized to perform meta-analysis, and odds ratio (OR) and its 95% confidence interval (CI) were used to present effect size. Heterogeneity was assessed by χ2-based Q test and I2 statistics. Publication bias was estimated by Egger’s test and sensitivity was evaluated by leave one out methods.

Results

According to the criteria, a total of 11 studies with 1842 patients were enrolled in this study. With a significant heterogeneity (Q = 31.83, I2 = 68.60%), the random effects model was utilized to assess the effect size of pooled data. A remarkable correlation was identified OSA and diabetic neuropathy (OR = 1.84, 95% CI: 1.18–2.87) without publication bias (t = 1.68, P = 0.13). Meanwhile, the result of leave one out performed a well sensitivity. Moreover, the subgroup analyses presented that OSA was significantly correlated with type 1 diabetic neuropathy (OR = 1.97, 95% CI: 1.19–3.25), but no remarkable correlation was identified between OSA and type 1 (OR = 1.84, 95% CI: 0.86–3.93) or 1 + 2 (OR = 1.30, 95% CI: 0.43–3.92) diabetic neuropathy.

Conclusion

OSA was significantly correlated with neuropathy in type 1 diabetes, but not in type 2 and type 1 + 2 diabetes.  相似文献   

6.

Aim

This study investigates the prevalence of smell and taste impairment in adults with diabetes and potential risk factors for sense deterioration and its influence of daily food intake.

Methods

Data from the NHANES 2013-2014 were analyzed. Smell impairment was defined as failing to identify?≥3 of 8 odors in NHANES Pocket Smell Test. Taste impairment was defined as being unable to identify quinine or NaCl in NHANES Tongue Tip and Whole-mouth Test.

Results

A total of 3204 people (428 patients with diabetes, 2776 controls) were suitable to be included. The prevalence of smell impairment in patients with diabetes was higher compared to the controls: 22% versus 15% (p < 0.001). The difference prevailed after adjustment for age, BMI, alcohol misuse and smoking status. Taste was not impaired in patients with diabetes (p = 0.29). Patients with diabetes and smell impairment had a lower daily calorie intake compared to patients with diabetes and normal smell function. The duration of diabetes, diabetic complications and other potential risk factors were not associated with smell dysfunction.

Conclusions

Smell dysfunction appears with a higher prevalence in patients with diabetes, and this seems to negatively affect daily food intake.  相似文献   

7.

Background

The quality of life is an important indicator of quality of care in chronic diseases such as diabetes and TB. The present research is conducted with an aim to assess the Quality of Life of Diabetic Patients with Smear Positive PTB.

Methods

This cross-sectional study was conducted on 62 diabetic patients with smear positive PTB from January to May 2016 in a diabetes clinic in Zahedan city (southeast of Iran). A simple random sampling method was used in this study. Instrument for data collection was quality of life (SF-36) questioner.

Results

Total quality of life score was 48 that showed an average level of quality of life. Sixty-five patients with diabetes and affected by smear positive pulmonary tuberculosis (PTB) with the average age of 51.30 ± 10.84 years participated in this research. Four patients (0.06%) suffered from type 1 diabetes and 58 (94%) from type 2 diabetes, and all of them were smear positive PTB patients. Study of their quality of life revealed that, in general, the average scores for quality of life in the two main subgroups of physical health and mental health were lower than the average and, among the eight studied dimensions, the highest scores were those for physical activity (60 ± 14.23) and the lowest (31.42 ± 12.14) for general health in the subgroup of physical health.

Conclusion

Results indicated that the patients had a low quality of life although they received the care and treatments that are effective in patients with diabetes and suffering from smear-positive PTB.  相似文献   

8.

Aim

Diabetes is a growing public health problem in India which is soon going to become the ‘diabetes capital’ of the world. It requires regular care and follow up. We aimed to estimate the household out-of-pocket (OOP) expenditure and catastrophic expenditure due to hospitalization and outpatient care as a result of diabetes.

Materials and methods

Secondary analysis of nationally representative data for India collected by National Sample Survey Organization in 2014, reporting on health service utilization and health care related OOP expenditure by income quintiles and by type of health facility (public or private).

Results

The median household OOP expenditure from hospitalization due to diabetes was USD 151, and was 3 times higher among the richest quintile compared to the poorest quintile (p < 0.001). There was a significantly higher prevalence (p < 0.001) of catastrophic expenditure among the poorest quintile (36%) compared to the richest (14%). Median private sector OOP hospitalization expenditure was four times higher than the public sector (p < 0.001). Medicines accounted for 41% and 69% of public sector hospitalization and outpatient care respectively. Concentration indices show gross inequity in hospitalization expenditure, prevalence of catastrophic expenditure and utilization of public health facility.

Conclusion

Households with diabetic patients incur a high risk of catastrophic expenditure, particularly for those in the lowest income quintiles and those seeking care in the private sector. Increased availability and access to essential drugs and strengthening of public facilities will significantly reduce OOP expenditure.  相似文献   

9.

Aim

To evaluate the clinical and microbiological profile of diabetic foot ulcer patients admitted to a tertiary care hospital.

Methodology

This study recruited 120 diabetic foot ulcer patients of all grade. Their medical records were evaluated retrospectively.

Results

We found that median age of patient was 60(52, 67.75) years. 68.3% of patients were males. Median duration of diabetes mellitus was 15(10, 20) years. Mean HbA1C and fasting glucose was 10.3 ± 2.3 and 167.6 ± 52.42 respectively. Neuropathy (35%) and peripheral vascular disease (23.3%) was major micro vascular and macro vascular complication associated. Different locations of ulcers were toe (23.3%), sole (20%), dorsum (18.3%), shin (16.6%), heel (13.3%), and ankle (8.3%). Bacterial infection was seen in 81.66% patients out of which 23.3% had poly microbial infection.

Conclusion

Diabetic foot ulcer patient had poor blood glucose control with elevated HbA1C and fasting blood glucose level. Neuropathy and peripheral vascular disease, hypertension were major complications. Staphylococcus aureus, Pseudomonas aeruginosa were common infecting bacteria.  相似文献   

10.
11.

Aims

The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy.

Methods

This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes.

Results

Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p = 0.587), level of education (p = 0.549) or marital status (p = 0.849) except that the diabetes group was significantly more obese than the group without diabetes (p = 0.002).

Conclusions

Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings.  相似文献   

12.

Aims

The purpose of this study was to investigate whether heat emitted from the feet of patients with type 2 diabetes (DM) and peripheral arterial disease (PAD) differed from those with type 2 diabetes without complications (DM).

Methods

A non-experimental, comparative prospective study design was employed in a tertiary referral hospital. Out of 223 randomly selected participants (430 limbs) who were initially tested, 62 limbs were categorized as DM + PAD and 22 limbs as DM without PAD. Subjects with evidence of peripheral neuropathy were excluded. Participants underwent thermographic imaging. Automatic segmentation of regions of interest extracted the temperature data.

Results

A significant difference in temperature in all the toes between the two groups was found (p = 0.005, p = 0.033, p = 0.015, p = 0.038 and p = 0.02 for toes 1–5 respectively). The mean forefoot temperature in DM + PAD was significantly higher than that in DM (p = .019), with DM + PAD having a higher mean temperature (28.3 °C) compared to DM (26.2 °C). Similarly, the toes of subjects with DM + PAD were significantly warmer than those of subjects with DM only.

Conclusions

Contrary to expectations the mean toe and forefoot temperatures in DM patients with PAD is higher than in those with DM only. This unexpected result could be attributed to disruption of noradrenergic vasoconstrictor thermoregulatory mechanisms with resulting increased flow through cutaneous vessels and subsequent increased heat emissivity. These results demonstrate that thermography may have potential in detecting PAD and associated temperature differences.  相似文献   

13.

Aim

This study investigates the role of muscle strength as a predictive factor for reduced pulmonary function in diabetes.

Methods

Data from the NHANES 2011–2012 were analyzed. Lung function was assessed with spirometry (FEV1, FVC). Diabetes was assessed with an oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), or fasting plasma glucose (FPG). Muscle strength was measured by a grip test using a handgrip dynamometer.

Results

A total of 3521 people were suitable to be included for analysis in this study. Lung function was reduced in diabetes—after adjustment for covariates, the impact of diabetes on FVC was estimated as ?331 mL (SE 48) for known diabetes and ?282 mL (SE 41) for undiagnosed diabetes (P < 0.001). Grip strength was also reduced in diabetes. After adjustment for covariates, the impact of diabetes was estimated as ?5.9 kg (SE 0.8) for known diabetes (P < 0.001). An association between lung capacity and grip strength in people with known diabetes was observed (R = 0.7, P < 0.001). The adjusted impact on FVC from grip strength was estimated as 13.1 mL (SE 3.4) per kg (P < 0.001).

Conclusions

Muscle strength appears to be reduced in people with known diabetes, and this seems to affect the respiratory muscles as an independent factor.  相似文献   

14.
Individuals with diabetes develop lower extremity amputation for several reasons. Investigations into pathways to the development of complications are important both for treatment and prevention.

Aim

To evaluate the relationship between amputation and risk factors in people with diabetes mellitus.

Materials and method

All participants included in this study (n = 165) were recruited from the Diabetic Foot Program, developed in a Brazilian University, over seven years (2007–2014) and all information for this study was extracted from their clinical records.

Results

The prevalence of amputation in patients with diabetes with four risk factors was up to 20% higher when compared to those with only one risk factor. The main predictive risk factors for amputation in this population were the presence of an ulcer and smoking.

Conclusion

The risk factors for amputation can be predicted for people with diabetes mellitus and, in the present study, the main factors were the presence of an ulcer and the smoking habit.  相似文献   

15.

Background

Albuminuria is an early marker of kidney disease in patients with diabetes and/or hypertension undetected or untreated albuminuria is a leading cause of chronic kidney disease and cardiovascular events, The purpose of the present survey was to assess the prevalence of albuminuria in patients with diabetes and hypertension, treated with a combinations of renin angiotensin aldosterone system inhibitors and dihydropyridine calcium channel blockers.

Methods

The survey was performed in 105 Primary Care Units in Turkey and involved outpatients, routinely visited by either a specialist or a non-specialist physician.Albuminuria was evaluated in a spot morning urine sample, as albumin–creatinine ratio, using the Multistic-Clinitek-device analyzer (Siemens), that has a strong correlation with 24-h urinary albumin excretion. Microalbuminuria was defined as a loss of 3.4–33.9 mg albumin/mmol creatinine and macroalbuminuria as a loss of >33.9 mg albumin/mmol creatinine. Diabetes was assessed through documented blood glucose concentration or use antidiabetic drugs, whereas hypertension through blood pressure measurement and current antihypertensive treatment.

Results

The survey enrolled 1708 subjects with a prevalence of type 2 diabetes (87.6%). Albuminuria was detected in 52.0% of patients. Blood pressure was controlled in 37.0% and diabetes in 56.7%. The risk of albuminuria was significantly high in patients with uncontrolled diabetes (p < 0.001) and blood pressure (p = 0.009).

Conclusions

In a large cohort of treated hypertensive patients with diabetes, albuminuria was present in about 50% and was correlated with poor diabetes and blood pressure control. Systematic screening of albuminuria, particularly in Primary Care, is an important tool for the early diagnosis of nephropathy.  相似文献   

16.

Objectives

To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States.

Methods

Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses.

Results

Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider.

Conclusions

Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.  相似文献   

17.

Background

World Health Organization estimated that people with diabetes (DM) are at 2–3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes.

Objectives

To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB.

Methods

A case–control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG = 152) and without TB were as control group (CG = 299). Exposure status of metformin in both groups were analyzed.

Results

The mean (SD) age of both CG and SG were 55.54 ± 11.82 and 52.80 ± 11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c > 8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR = 0.52 (95% CI 0.29–0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR = 0.256, 0.16–0.40).

Conclusion

Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB.  相似文献   

18.
19.

Objective

The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela.

Methods

During 2006–2010, 1334 subjects ≥20 years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software.

Findings

Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%–10.0%), higher in men than women (11.2% and 7.0% respectively; p = 0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%–9.9%). This figure increased with age, with the lowest prevalence in the 20–29 year old group (1.8% [95% CI, 0.6%–4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%–40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%–2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%–16.7%), and only 48.2% were aware of their diabetes condition.

Conclusion

In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.  相似文献   

20.

Aims

The aims of this study were to assess patients’ non-adherence and associated factors to antidiabetic medication in the primary care setting in the eastern part of Bosnia and Herzegovina (BiH).

Methods

We conducted a retrospective chart review of 323 patients with type 2 diabetes mellitus (T2DM) attending the primary health care center of the Fo?a municipality in eastern part of BiH and measured adherence to antidiabetic medication. Adherence was measured using a pill count method.

Results

The majority of patients were treated with oral therapy (84.21%). Half of the patients (48%) treated pharmacologically were non-adherent and patients on oral and insulin combination therapy showed better adherence than those on oral therapy. Age (B = ?0.749; p = 0.004), copayment (B = 0.549; p = 0.028) and oral therapy (B = 0.827; p = 0.045) were the strongest predictors of poor adherence.

Conclusion

About half of the patients were non-adherent to antidiabetic medication. Interventions oriented towards policy changes regarding availability of antidiabetic medication through copayment reductions, and providing healt education to younger population and patients on oral therapy could lead to better adherence among T2DM patients in eastern part of BiH.  相似文献   

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