Depression and diabetes distress in patients with diabetes

We aimed to identify the prevalence of comorbid depression, diabetes, and diabetes distress and assess glycemic control and rates of diabetes-related complications. While the presence of either depression or distress did not predict the level of glycemic control, certain macro- and microvascular complications were more prevalent with depression.     

Relationship between diabetes control and pulmonary function in insulin-dependent diabetes mellitus

PURPOSE: To evaluate the effect of different levels of glycemic control on the pulmonary function of subjects with type I insulin-dependent diabetes mellitus. PATIENTS AND METHODS: Eighteen subjects with type I insulin-dependent diabetes mellitus with no history or physical findings of respiratory disease. Patients were given insulin therapy with a standard twice-daily insulin injection regimen (standard treatment group) or a subcutaneous insulin infusion device (insulin pump) (intensive treatment group). Glycosylated hemoglobin (HbA1c) levels were determined at quarterly intervals in both groups of patients (standard treatment group, n = 10; intensive treatment group, n = 8). Pulmonary function and diffusing capacity for carbon monoxide (DLCO) were measured after 6 years of continuous follow-up. RESULTS: The average HbA1c in the standard treatment group was significantly higher than that of the intensive treatment group throughout the 6 years of follow-up (p less than 0.001). The forced vital capacity of the standard treatment group was 85 +/- 3% of predicted as compared with 106 +/- 4% of predicted in the intensive treatment group (p less than 0.001). The DLCO was also significantly diminished in the standard treatment group as compared with that in the intensive treatment group (65 +/- 2% versus 87 +/- 4% of predicted) (p less than 0.001). CONCLUSION: These data confirm previous reports of abnormal respiratory function in subjects with insulin-dependent diabetes mellitus and suggest that long-term near-normoglycemia may be beneficial in preventing the deterioration of pulmonary function associated with diabetes mellitus.     

Olfaction and gustation in diabetes

Dysfunction of olfactory and gustatory functions can occur in diabetes. Gustatory dysfunction correlates with specific complications of diabetes. Olfactory dysfunction correlates with diabetic macronagiopathy. Gustatory sweating is the most important olfactory and gustatory dysfunction in diabetes. Pathology of olfaction and gustation can play a role in the pathogenesis of diabetes and its complications. Olfaction and gustation could be also a target of diabetes therapy in the future.     

Coagulation and fibrinolysis in diabetes

The accelerated development of atherothrombotic cardiovascular disease in type 2 diabetes mellitus may be enhanced by the presence of a prothrombotic state. This prothrombotic state includes a diminished fibrinolytic capacity and an increased coagulability. Impaired fibrinolytic capacity appears to be a hallmark of the metabolic syndrome of type 2 diabetes and can be a direct consequence of visceral obesity. In addition, a chronic low inflammatory state with hyperinsulinemia and dyslipidemia may further influence the hemostatic balance. The characteristic dyslipidemia of type 2 diabetes, coined the atherogenic lipoprotein profile, with raised plasma levels of fasting and postprandial triglyceride lipoproteins, atherogenic low-density lipoproteins, and low high-density lipoproteins, is involved in promoting a hypercoagulable state. Lifestyle and pharmacologic interventions that reduce cardiovascular risk in the general population and that may improve the metabolic syndrome may also reduce the prothrombotic state.     

Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus

Aims/hypothesis  

To investigate racial/ethnic disparities in diabetes risk after gestational diabetes mellitus (GDM).     

Comparison of pregnancy mood profiles in gestational diabetes and preexisting diabetes

PURPOSE: This study sought to answer the following questions: How does intensified diabetes management affect the patient's mood profile? Is there a relationship between levels of glycemic control and emotional profile? Which factors distinguish the emotional profile of women with pregestational diabetes from women with newly diagnosed gestational diabetes? METHODS: A secondary analysis was conducted of women with newly diagnosed gestational diabetes (GDM), pregestational diabetes (PGDM), and nondiabetic controls. Those with diabetes were treated with an intensified approach. All participants responded to a questionnaire measuring bipolar subjective mood states. The relation between diabetes types, glucose characteristics during pregnancy, and mood were analyzed. RESULTS: The mood profile was significantly associated with level of glycemic control in GDM women (comparable to controls). PGDM women were not affected by either level of glycemic control or diabetes class categories. The number of glucose determinations, marital status, and maternal age were related to mood profile for GDM women. CONCLUSIONS: Because women with GDM and PGDM present different mood profiles in pregnancy, customized medical/behavioral goals may be needed to enhance compliance and optimize perinatal outcome.     

Cheiroarthropathy and tendinopathy in diabetes

Joint problems commonly occur in people with diabetes. Cheiroarthropathy affects the hands and results in painless limited finger joint extension, appearing to be associated with longer diabetes duration and the presence of microvascular complications. The prevalence of cheiroarthropathy seems to be falling, perhaps as a result of improvements in glycaemic management. Non‐enzymatic glycation of collagen results in abnormally crosslinked protein resistant to degradation with subsequent increased build‐up of collagen in joints. The management of cheiroarthropathy is predominantly conservative, with occupational and hand therapy at the forefront. Tendinopathy is more common in people with diabetes than those without, and is associated with obesity and insulin resistance. As with cheiroarthropathy, the exact causative mechanism of tendinopathy in diabetes is not known, but may be linked to inflammation, apoptosis and increased vascularity of affected tendons, driven by hyperinsulinaemia. Local fat pads have also been suggested to play a role in the pathogenesis of tendinopathy.     

The cost of diabetes and diabetes care

The number of people with diabetes mellitus worldwide is estimated to be 221 million in 2010 compared to about 124 million in 1997. The dominant part of diabetic persons was in 1997 represented by Type 2 (97%). WHO expect the number of adults (20 years and older) with diabetes (i.e. a mix of Type 1 and 2) to rise to 300 millions in 2025 from 135 millions in year 1995. On average people with diabetes are three times more likely to be hospitalized than non-diabetic individuals. The risk for hospitalization is slightly diversified, venous complications being the least risky (1.7 times) and heart-related complications the most risky (3.1 times). The risk of premature death is higher for persons with diabetes compared to those without diabetes, and the life time expectancy is 10-15 times shorter. US data shows that diabetes is the leading cause of blindness and accounts for 40% of the new cases of end-stage renal disease. The risk for leg amputation is 15-40 times higher and the risk for heart disease and stroke is two to four times higher for people with diabetes compared with people without diabetes. Recent studies show that the health care expenditures are as much as five times higher for individuals with diabetes compared to individuals without diabetes. In Sweden in 1994, three times more resources were spent on treating complications compared to what was spent on control of the disease. Studies show that intensive treatments cost more than traditional treatment, but also cut costs substantially for the treatment of late complications. The main message was that early intervention and intensified treatment had a better effect on the late complications. The basic message is quite simple: diagnose more persons with diabetes earlier, introduce and improve treatment.     

Preventing diabetes in women with gestational diabetes

The immediate consequences of gestational diabetes on pregnancy are well known but the complications decades later for the mother and child are just now emerging. This trio of papers discuss the long-term consequences of gestational diabetes, the importance of screening this high risk group of women for type 2 diabetes, and the evidence for lifestyle, medications and breastfeeding for the prevention of type 2 diabetes in these women.     

2型糖尿病及合并大血管病变糖尿病患者C反应蛋白水平观察

目的　观察C反应蛋白 (CRP)在 2型糖尿病 (DM )及DM合并大血管病变时的浓度变化。方法　用ELISA方法测定血清CRP水平。在 2型DM患者 (伴或不伴大血管病变 )、无糖尿病的大血管病变患者、空腹血糖受损 (IFG)者、糖耐量低减 (IGT)者以及正常对照组测定血清CRP水平。结果　IGT者、2型DM以及无糖尿病的大血管病变患者血清CRP水平明显增高 (P <0 .0 5～ <0 .0 0 1) ;2型DM伴有或不伴有大血管病变患者以及无糖尿病的大血管病变患者间血清CRP水平差异无显著性 ;大血管病变患者血清CRP水平较非大血管病变者明显增高 (P <0 .0 5 )。结论　CRP在 2型DM和动脉粥样硬化的发生发展中均具有致病作用 ;就致动脉粥样硬化而言 ,CRP是普通人群 (包括 2型DM )的一般危险因子 ,并非 2型DM的特殊危险因子。     

糖尿病病人的抗高血压治疗及药物对新发糖尿病的影响

糖尿病病人的抗高血压治疗对改善预后至关重要。然而,是否所有抗血压药均可改善预后?糖尿病病人预后的改善主要来自抗高血压药的降压作用抑或是与降压无关的作用?抗高血压药能够预防新发糖尿病吗?噻嗪类利尿药和β受体阻断药导致新发生糖尿病的危险与已知糖尿病是否相同?这些问题仍存在一定的争议。希望本文能够推动上述问题的进一步讨论。     

Late diabetes complications and non-dipping phenomenon in patients with Type 1 diabetes

BACKGROUND: Cardiovascular autonomic neuropathy (CAN) has been thought to underlie the loss of normal nocturnal blood pressure dipping, which is associated with a higher risk for nephropathy in Type 1 diabetes. Previous analyses also suggest however that nephropathy is a major predictor of subsequent CAN. OBJECTIVE: To investigate links between non-dipping phenomenon (NDP) and complications, particularly CAN and nephropathy. METHODS: 24-h ambulatory blood pressure monitoring was performed on 61 consecutively recruited subjects (mean age: 38.5+/-8.1, mean duration: 29.5+/-8.2 years) from the Pittsburgh Epidemiology of Diabetes Complications cohort (658 subjects with childhood onset Type 1 diabetes diagnosed between 1950 and 80). NDP was diagnosed if nocturnal fall of both systolic and diastolic blood pressure was <10% of the average daytime blood pressure. CAN was detected by abnormal (20 microg/min) albumin excretion rate (AER) in at least two of three timed urines. RESULTS: Non-dippers (n=17) had greater LDLc (p=0.012) and AER (p=0.052) and a higher frequency of nephropathy (OR=3.6, 95% CI=1.0-12.6) and proliferative retinopathy (OR=5.1, 95% CI=1.3-20.3) compared to the 44 dippers. CAN and NDP were not associated. In multivariate analyses, adjusting for CAN, proteinuria was significantly related to NDP (OR=3.6, 95% CI=1.0-12.6), an association that further modeling suggests was related to interactions between nephropathy, LDLc and hypertension. CONCLUSIONS: These data suggest a strong link between NDP and proteinuria which is independent of CAN and may be modified by LDLc and hypertension.     

Occurrence of diabetes mellitus in neurogenic diabetes insipidus

Summary The occurrence of a family history of diabetes mellitus, of overt diabetes mellitus and of impaired glucose tolerance was investigated in a group of 43 patients with neurogenic diabetes insipidus. Family history was positive in 16.2% of these, similar to that in control subjects; manifest diabetes mellitus was present in 9.3%, impaired glucose tolerance in 20%. This prevalence appears to be even more significant, considering the patients' mean age, 26.9±2.3 years.     

Study of bladder function in patients with prediabetes,latent diabetes,recent onset diabetes and juvenile diabetes

Summary We have studied the vesical function in 4 prediabetics, 11 latent diabetics, 11 recent onset insulin dependent diabetics and a control group of 6 normal individuals. We found in recent onset diabetics disturbances of cystometric parameters in a statistically significant proportion. This proportion increases with the evolution of diabetes. The difference in sensitivity to cold water that we found between SDB and NBD was statistically significant, so the denomination ‘hyposensitive bladder’ is well applied in this first phase of vesical neuropathy. Prize of the Argentine Society of Urology.