The prevalence of retinopathy is similar in diabetes mellitus secondary to chronic pancreatitis with or without pancreatectomy and in idiopathic diabetes mellitus

In a retrospective study, we compared the prevalence of retinopathy in two groups of 88 diabetic patients (84 men, 4 women) with either diabetes mellitus secondary to chronic pancreatitis (CP-DM group) or idiopathic diabetes mellitus (I-DM group). The patients of these two groups were pair-matched according to age (48.7 +/- 1.1 versus 48.8 +/- 1.0 yr in CP-DM and I-DM groups, respectively; mean +/- SEM), sex, duration of diabetes (7.96 +/- 0.56 versus 8.08 +/- 0.8 yr) and therapy (80 on insulin and 8 on oral hypoglycemic agents in each group). Retinopathy was assessed by bilateral ophthalmoscopic examination of the fundus after pupillary dilation in all 176 patients and by fluorescein angiography in 47 patients with CP-DM and 35 patients with I-DM. Forty-one percent of patients in the CP-DM group and 45.5% of patients in the I-DM group had diabetic retinopathy (P greater than 0.5). In each group, patients with retinopathy were older than patients without retinopathy (51.6 +/- 1.3 versus 46.7 +/- 1.8 yr in the CP-DM group, P less than 0.01, and 52.1 +/- 1.5 versus 46.0 +/- 1.2 yr in the ID-M group, P less than 0.01). They had diabetes of longer duration (10.9 +/- 1.0 versus 5.9 +/- 0.6 yr in the CP-DM group, P less than 0.001, and 10.5 +/- 1.0 versus 6.0 +/- 0.6 yr in the ID-M group, P less than 0.001). The prevalence of retinopathy increased parallel to the duration of diabetes in a similar way in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus

Background

Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation.

Methods

We conducted a 1-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days.

Results

There were 833 ED visits for hyperglycemia in the 1-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1–5.8), age <25 years (OR 2.6, 95% CI 1.5–4.7), glucose >20 mmol/L (OR 2.2, 95% CI 1.3–3.7), having a family physician (OR 2.2, 95% CI 1.0–4.6), and being on insulin (OR 1.9, 95% CI 1.1–3.1). Having a systolic blood pressure between 90–150 mmHg (OR 0.53, 95% CI 0.30–0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23–0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit.

Conclusions

This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.

     

糖尿病慢性牙周炎与血管病变相关性的研究

目的 通过对2型糖尿病合并慢性牙周炎与无牙周炎相关因素的比较，探讨糖尿病微血管病变与牙周炎的关系。方法 将2型糖尿病牙周炎患者按牙周病变程度分为轻度组（A组）、中度组（B组）、重度组（C组），分别与2型糖尿病无牙周炎患者各亚组（对照组）进行比较。结果 ①2型糖尿病慢性牙周炎组血钙、血磷、甲状旁腺素水平大致正常，骨密度与对照组相比差异无显著性（P〉0.05）。②2型糖尿病牙周炎组血小板最大聚集率、红细胞聚集指数、纤维蛋白原定量、纤溶酶原激活物抑制剂-1（PAI-1）水平、糖化血红蛋白均明显高于对照组（均P〈0．01），且在糖尿病牙周炎3个亚组中随着牙周炎病变程度的加重，各指标也随之增加（P〈0．01）。③牙周炎病变程度加重，则糖尿病伴发微血管并发症的比率也随之明显升高。结论 2型糖尿病患者慢性牙周炎与骨质疏松无明显关系，血糖控制不佳、血浆粘度增加以及微血管病变是导致牙周炎的重要因素。     

2型糖尿病住院患者慢性并发症危险因素分析

目的:分析大连地区2型糖尿病住院患者糖尿病慢性并发症的相关危险因素。方法:①收集2005-01/2006-12大连医科大学附属第二医院内分泌科住院2型糖尿病患者579例。符合1999年世界卫生组织糖尿病诊断标准,且对检测项目知情同意。②收集个人资料,测量体脂测量参数(体质量指数、腰围、臀围、股围)以及实验室检查指标(血糖、血脂、24h尿白蛋白、胰岛素敏感相关指标)。根据国际临床分类法,24h尿白蛋白情况,神经肌电图,彩超检查、头部CT、心电图以及酶学诊断糖尿病视网膜病变、糖尿病肾脏病变、糖尿病周围神经病变、糖尿病大血管并发症。③使用Logistic逐步回归分析各危险因子对糖尿病并发症的贡献大小。结果:糖尿病患者579例均进入结果分析,其中42.3%合并糖尿病视网膜病变,其中4.5%为增殖型视网膜病变;63.2%合并糖尿病周围神经病变;37.0%合并糖尿病肾脏病变;56.6%合并糖尿病大血管并发症。多因素Logistic回归分析结果:①糖尿病病程、收缩压、糖化血红蛋白、腰股比为糖尿病肾脏病变独立危险因素(偏回归系数分别为0.005,0.019,0.069,6.693,P<0.05￣0.01)。②糖尿病病程、糖化血红蛋白、空腹血糖、血总胆固醇、24h尿白蛋白为糖尿病视网膜病变独立危险因素(偏回归系数分别为0.014,0.158,0.536,0.039,0.006,P<0.05￣0.01)。③糖尿病病程、年龄、血总胆固醇、空腹血糖为糖尿病周围神经病变独立危险因素(偏回归系数分别为0.016,0.039,0.608,0.433,P<0.05￣0.01)。④年龄、体质量指数、胰岛素抵抗指数、空腹血糖、总胆固醇、24h尿白蛋白为糖尿病大血管并发症独立危险因素(偏回归系数分别为0.085,0.092,0.248,1.153,0.937,0.002,P<0.05￣0.01)。高密度脂蛋白胆固醇为糖尿病大血管并发症独立保护因素(偏回归系数为0.992,P<0.05)。结论:腰股比是糖尿病肾脏病变的主要危险因素,糖化血红蛋白、空腹血糖是糖尿病视网膜病变的主要危险因素,空腹血糖、总胆固醇是糖尿病大血管并发症和糖尿病周围神经病变的主要危险因素。     

Computed tomographic findings in patients with chronic pulmonary obstruction and diabetes mellitus

The study included 40 patients aged 33-71 years with chronic pulmonary obstruction (CPO) and diabetes mellitus (DM). They were examined by multilayer CT with detailed analysis of parenchymal tissues. The main microvascular changes in lung parenchyma included dilation, focal opacity (2-5 mm), and beaded vessels. In patients with isolated CPO, these changes were less pronounced than in those with combined pathology. All patients presented with bronchial deformities, bronchoectasia, emphysema, and cysts. Microvascular pathology in lung parenchyma appears to be a manifestation of universal diabetic microangiopathy responsible for the unfavourable development of CHD in DM patients.     

Hypertension in patients with diabetes mellitus

It is well known that diabetes often induces macrovascular and microvascular complications, and hypertension is also considered to be an important risk factor for macrovascular events. Recent epidemiological studies have proved the possibility that hypertension among patients with diabetes greatly increases the risks of these complications. However, the impact of hypertension on stroke and microvascular complications is considered to be greater than that on coronary heart disease. Co-existent metabolic risk factors such as hyperlipidemia rather than hypertension may affect more coronary heart disease. Antihypertensive treatment among diabetic patients is expected to reduce various complications, but management of metabolic risk factors is also needed to prevent coronary heart disease.     

Fear of progression in patients with cancer,diabetes mellitus and chronic arthritis

Fear of an increasing disease progression (fear of progression) is among the main psychological stresses in patients with cancer, diabetes mellitus (type 1 and type 2) and chronic arthritis. The questions the study seeks to answer are: (1) Which are the main fears of these patients?, (2) How and in which circumstances in life do they occur?, (3) Which are the triggers of the fear? To answer these questions, a sample of 65 patients were researched through interviews. The results indicate that the predominant fears of cancer patients are the fear of dying and the unpredictability of the progression of the disease. Patients with chronic arthritis most frequently fear being physically dependent on someone else. The most common anxiety of diabetes patients are long-term complications. For all three groups of patients job-related fears cause a high amount of distress. These results contribute to the development of a standardised fear of progression questionnaire.     

The presence of retinopathy in patients with secondary diabetes following pancreatectomy or chronic pancreatitis

The incidence of diabetic retinopathy was evaluated by means of fluorescein angiography in 54 patients with diabetes secondary to chronic pancreatitis or to pancreatectomy. Thirty-one percent of the patients had background retinopathy; none had proliferative retinopathy. The percentage of patients with retinopathy was the same in groups with or without a family history of diabetes. There was no correlation between the degree of metabolic control, the levels of C-peptide, glucagon, growth hormone, and the presence of retinopathy. Retinopathy was correlated with the duration of diabetes. In conclusion, diabetes caused by pancreatitis or pancreatectomy has a significant prevalence of retinopathy, which has more benign characteristics and slower evolution than the retinopathy in patients with primary diabetes.