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1.

Background

Inconsistent results have been described regarding the part of fetuin-A and testosterone in arterial stiffness in type 2 diabetes mellitus (T2DM).

Aim

To look into the links of serum fetuin-A and testosterone levels with brachial-Ankle pulse wave velocity (baPWV), a marker of arteriosclerosis and common carotid intima media thickness (ccIMT), a marker of early atherosclerosis, in diabetic Saudi men patients.

Subjects and methods

One hundred and fifty adult male patients with T2DM and 60 non-diabetic control subjects were enrolled from different Saudi Arabia Taif hospitals. Biochemical analysis, anthropometric measurements, blood pressure, baPWV and ccIMT were investigated.

Results

Stepwise regression in diabetic patients revealed that the most important predictor of ba-PWV was serum fetuin-A followed by serum glucose and the most important predictor of ccIMT was serum fetuin-A followed by serum HDL then serum triglycerides.

Conclusions

Only fetuin-A levels not testosterone are negatively associated with early markers of atherosclerosis.  相似文献   

2.

Purpose

To evaluate the risk of primary open-angle glaucoma (POAG) development in type 2 diabetes mellitus (T2DM) patients.

Methods

In this 11-year longitudinal study based on the Korean National Health Insurance research database, the data collected comprised 1,025,340 (2.2%) participants who were randomly selected from 46,605,433 Korean residents in 2002. The database was analyzed to identify participants with an initial diagnosis of T2DM in 2003–2004. The control group was composed of participants without T2DM who were propensity-score-matched, five controls per T2DM patient, according to age, gender, household income, residential area and underlying diseases, including hypertension, dyslipidaemia, coronary heart disease, cerebrovascular disease and thyroid disease. Cox proportional-hazards regression was used to calculate the overall hazard ratios (HRs) in participants with and without T2DM for development of POAG before and after adjusting for confounding factors.

Results

There were 12,657 participants with T2DM and 63,285 propensity-score-matched controls without T2DM. POAG developed in 413 (3.3%) and 1188 (1.9%) participants in the T2DM and control groups, respectively. T2DM was associated with an increased risk of POAG development [HR: 1.80; 95% confidence interval (CI): 1.58–2.04] after adjusting for age, gender, household income and other potential confounders.

Conclusion

T2DM was significantly associated with the development of POAG after adjusting for potential confounders in the Korean population.  相似文献   

3.
4.

Introduction

Dementia and type 2 diabetes mellitus (T2DM) are two of the epidemics of our time; in which insulin resistance (IR) is playing the central role. Epidemiological studies found that different types of dementia development may be promoted by the presence of T2DM.

Objectives

We aimed in this review to highlight the role of insulin and the IR in the brain as a pathophysiological factor of dementia development and also to expand our understanding of T2DM as a mediator of IR in the brain and to review the possible mechanisms of action that may explain the association.

Methodology

A critical review of the relevant published English articles up to 2018, using PubMed, Google Scholar, Science Direct, ADI, and WHO database was carried out. Keywords were included insulin resistance, T3DM, T2DM, dementia, brain insulin resistance were used.

Conclusion

The rapidly increased prevalence of dementia concurrently with T2DM and obesity need urgent action to illustrate guidelines for prevention, modifying, and treatment based on mechanistic studies.  相似文献   

5.

Aims

To determine if type 2 diabetes mellitus (T2DM) is associated with the spectrum of uropathogens and antimicrobial resistance in urinary tract infections (UTI) in primary care.

Methods

A cross-sectional study in female outpatients ≥30 years with positive urine cultures. T2DM patients were 1:1 matched to controls by age group and general practitioner (GP). GPs were sent questionnaires for additional data. Uropathogens and resistance patterns were compared between patients with and without T2DM. Multivariable regression analysis was performed to assess the independent association between T2DM and resistance to first line treatments, defined as resistance to nitrofurantoin, trimethoprim, fosfomycin, ciprofloxacin, amoxicillin/clavulanic acid and/or trimethoprim/sulfamethoxazole.

Results

In 566 urine cultures, 680 uropathogens were found. Resistance to first line treatment antibiotics was present in 62.5% of patients. Frequencies and resistance rates of uropathogens did not differ between both groups of patients. Previous UTI and previous hospital admission were independent risk factors for resistance, but T2DM was not.

Conclusions

In this study T2DM was not an independent risk factor for antimicrobial resistance in UTI in primary care. Previous UTI and hospitalisation are drivers of resistance and should be included in the decision to perform a urine culture to target first line UTI treatment.  相似文献   

6.

Background

Nephropathy is a major complication of type 2 diabetes mellitus (T2DM) and is heralded by the insidious development of microalbuminuria (MA). It is suggested that the serum levels of Intercellular Adhesion Molecule-1 (ICAM-1) is correlated with diabetic nephropathy. In this cross-sectional study, we evaluated serum ICAM-1 level in diabetic patients with and without MA.

Methods

A total of 187 participants were enrolled and were classified into three groups including 40 healthy controls and 2 diabetic groups with (n?=?59) or without MA (n?=?88). Serum levels of ICAM-1, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and C-reactive protein (CRP) were measured in all three groups. Statistical analyses were performed using the SPSS software. A P-value less than 0.05 was considered statistically significant.

Results

Serum levels of ICAM-1 were significantly higher in diabetic patients irrespective of MA. Moreover, ICAM-1 levels in patients with MA were significantly higher than patients without MA. Patients with MA had significantly higher age and blood pressure compared to those without MA (P?=?0.001). Serum levels of ICAM-1 were significantly correlated with age and HbA1c.

Conclusions

Overall, serum ICAM-1 levels were significantly higher in T2DM patients with MA and it may be associated with the severity of diabetic kidney disease.  相似文献   

7.

Background and aim

Individuals with severe mental illness (SMI) who suffer from type 2 diabetes (T2DM) are likely to be sub-optimally treated for their physical condition. This study aimed to review the effect of interventions in this population.

Methods

A systematic search in five databases was conducted in July 2017.

Results

Seven studies on multi-faced interventions were included. These comprised nutrition and exercise counselling, behavioural modelling and increased disease awareness aiming to reduce HbA1c, fasting plasma glucose, body mass index and weight.

Conclusion

Non-pharmacologic interventions in individuals with SMI and T2DM could possibly improve measures of diabetes care, although with limited clinical impact.  相似文献   

8.

Introduction

DM spending in the world is high, and Brazilian studies of public spending caused by DM are scarce.

Objective

To estimate the annual direct cost for the municipal health sphere, related to DM2 treatment, in patients with and without glycemic control.

Method

A cross-sectional study carried out in a city in the interior of Minas Gerais state, with patients with DM2, being municipal PHS users. Data were collected from the computerized system of the municipality and patient records, and analyzed using the IBM SPSS v.19 statistical package. The response variable was categorized into controlled A1c (≤7%) and uncontrolled A1c (>7%).

Results

Glycemic control in 56.6% of the patients was unsatisfactory; the mean cost of pharmacotherapy for DM2 was US$ 3.14 per year for patients in the control group and US$ 45.54 per year for uncontrolled patients.

Conclusion

Patients with unsatisfactory glycemic control are more expensive for the municipal health system.  相似文献   

9.

Objective

Comparative study between the effect of LSG and LMGB on patients with type 2 DM and BMI?≥?35?kg/m2.

Study design

A prospective comparative study which included 40 obese patients with type 2 DM(20 patients were operated for laparoscopic sleeve gastrectomy (LSG) and 20 patients for laparoscopic mini-gastric bypass (LMGB)), with mean age at LSG group 42.95?±?7.63 with range of 31–59 years, at LMGB group was 42.9?±?6.17 with range of 34–58 years.

Results

In SG cases; complete remission occurred in 11 patients with percentage of 55% and failure of remission occurred in 9 patients with percentage of 45%. No cases developed partial remission in SG cases. In MGB cases; 15 developed diabetic remission with percentage of 75% (11 (55%) patients developed complete remission, 4 (20%) patients developed partial remission). Failure of remission occurs in 5 patients in MGB cases with percentage of 25%.

Conclusion

Based on our results, LSG and LMGB are efficient operations for reducing weight in morbidly obese patients and also in diabetic control in T2DM. LMGB might be superior to LSG in %EWL and T2DM remission after 1.5?year follow up.  相似文献   

10.

Background

Patients of diabetes mellitus experience psychological difficulties associated with their disease which remains unrecognized involving several states related to coping with diabetes. Diabetes distress is a distinct condition which is often mistaken for depression and is related to adverse disease outcomes.

Aims and objective

To study the prevalence and predictors of diabetes distress in patients of Type 2 Diabetes mellitus (T2DM) in a tertiary care centre.

Materials and methods

This cross-sectional study was conducted over a period of one year at Endocrine OPD of Pt. B.D. Sharma PGIMS, Rohtak, a tertiary care centre in northern India. 410 consecutive patients having T2DM attending the endocrine OPD were screened for psychiatric disorders and 189 diabetic patients with no underlying psychiatric disorders were included in the study. Their socio-demographic and relevant clinical variables were recorded. Diabetes Distress Scale (DDS) was used to measure distress due to the disease in these patients.

Results

It was found that the prevalence of diabetes distress was 18.0%; among them 16.1% had emotion related distress, 5.6% regimen related distress, 1.5% interpersonal related distress and 1.2% physician related diabetes distress. The major predictors for high diabetes distress scores among diabetic cases were low education level, retinopathy, neuropathy and hypertension.

Conclusion

The present study suggests that emotion related diabetes distress was more prevalent among diabetic patients. Lower education level and the presence of diabetic complications contribute as risk factors for high diabetes distress.  相似文献   

11.

Objective

The study was performed to evaluate the technique of laproscopic minigastric bypass for metabolic syndrome patients.

Study design

The patients were enrolled in a combined prospective study and had a retrospectively gathered outcome analysis.

Patient and methods

The study includes thirty patients; 24 females and 6 males suffering from metabolic syndrome with a mean age of 33.15?±?10.17?years (range, 20–59), who fulfilled the criteria for bariatric surgery with BMI >35 with associated co-morbidities, all patients underwent laparoscopic mini-gastric bypass.

Results

BMI and WC were significantly reduced post-operatively; also co-morbidities as DM, hypertension and dyslipidemia were resolved or controlled. The mean operative time was 90?±?12.6?min (range, 80–120). No mortality was reported within 30?days of surgery.

Conclusion

Laparoscopic mini gastric bypass is an effective procedure for the treatment of obesity, HTN, type 2 DM and dyslipidemia, technically feasible, safe operation with a low rate of major postoperative complications.  相似文献   

12.

Aim

Glycated albumin (GA) suggested being alternative glycemic marker than haemoglobin A1C (HbA1c) in patients with chronic kidney diseases (CKD). We investigated the association between GA and the progression of diabetic nephropathy (DN) in T2DM subjects.

Methods

We recruited T2DM subjects with different stages of CKD who had regularly measured serum creatinine and estimated glomerular filtration rates (eGFR) according to Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, HbA1c consecutively every 3 months along with GA levels and other anthropometric and demographic measurements. We grouped age and sex matched subjects into the CKD progression, Group I healthy subjects (n?=?100, M: F;50:50). Group II T2DM subjects with eGFR ≥90?mL/min (n?=?167,?M:F; 76:91). Group III of T2DM patients with eGFR 60–89?mL/min (n?=?91,?M:F; 44:47). Group IV T2DM subjects with eGFR 30–59?mL/min (n?=?68,?M:F;31:37). Group V T2DM with eGFR?≤?29?mL/min (n?=?21, M:F; 13:8).

Results

Pearson’s correlation analysis between glycated albumin and biochemical parameters were established in all subjects. GA/HbA1c ratio increases with poor glycemic control except for nephrosis state.

Conclusion

Mean GA levels were more closely associated with DN progression than mean HbA1c in subjects with T2DM and can be implemented as an alternative diagnostic marker in nephropathy.  相似文献   

13.

Aims

To investigate how self-reported risk factors (including socioeconomic status) predict undiagnosed, prevalent type 2 diabetes mellitus (T2DM). To externally validate Leicester Risk Assessment Score (LRAS), Finnish Diabetes Risk Score (FINDRISC) and Danish Diabetes Risk Score (DDRS), and to investigate how these predict a European Heart SCORE  5% in a Danish population study.

Methods

We included 21,205 adults from the Danish General Suburban Population Study. We used relative importance calculations of self-reported variables in prediction of undiagnosed T2DM. We externally validated established prediction models reporting ROC-curves for undiagnosed T2DM, pre-diabetes and SCORE.

Results

More than 20% of people with T2DM were undiagnosed. The 7 most important self-rated predictors in sequential order were high BMI, antihypertensive-therapy, age, cardiovascular disease, waist-circumference, fitness compared to peers and family disposition for T2DM. The Area Under the Curve for prediction of undiagnosed T2DM was 77.1 for LRAS; 75.4 for DDRS and 67.9 for FINDRISC. AUCs for SCORE was 75.1 for LRAS; 62.3 for DDRS and 54.3 for FINDRISC.

Conclusions

BMI and self-reported cardiovascular disease are important risk factors for undiagnosed T2DM. LRAS performed better than DDRS and FINDRISC in prediction of undiagnosed T2DM and SCORE  5%. SCORE performed best in predicting pre-diabetes.  相似文献   

14.

Aims

This study aimed to characterize and estimate prevalence and frequency of mild to moderate hypoglycemia and potentially associated factors in a population of type 2 diabetes mellitus (T2DM) patients treated at ambulatory care level.

Methods

HIPOS-PHARMA was a nationwide observational, cross-sectional, multicenter study conducted in community pharmacies, which surveyed T2DM patients treated for at least 3 months.

Results

Overall, 233 pharmacies recruited 1890 patients (males: 50.6%) with mean 67.1 years. On average, participants reported having diabetes for 11.8 years. A total of 86.9% had at least one chronic illness or complication of diabetes, and 76.8% were usually followed in the primary care setting. Fifty eight percent were treated without a secretagogue or insulin. Overall prevalence of mild to moderate hypoglycemic episodes in the 3 months prior to recruitment was 17.8%. A 3.13% prevalence of severe hypoglycemia was observed in the last 12 months. Results suggested that men and patients on antihyperglycemic therapies excluding secretagogues or insulin were less likely to have mild to moderate hypoglycemic episodes.

Conclusions

Mild to moderate hypoglycemic episodes were commonly reported, and factors like type of antihyperglycemic therapy, duration of disease and due complications may contribute. Almost half of episodes were not reported. Such factors should be considered in T2DM management.  相似文献   

15.

Background

Chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2DM) are common comorbidities. COPD is a known risk factor for incident T2DM, however few studies have examined the relationship in reverse. The primary aim of this study was to compare the incidence of COPD in people with and without T2DM.

Materials and methods

We conducted a retrospective case-control study using a long-established English general practice network database (n = 894,646). We matched 29,217 cases of T2DM with controls, adjusting for age, gender, smoking status, BMI and social deprivation, to achieve 1:1 propensity matching and compared the rate of incident COPD over eight years of follow-up. We performed a secondary analysis to investigate the effect of insulin, metformin and sulphonylureas on COPD incidence.

Results

People with T2DM had a reduced risk of COPD compared to matched controls over the follow-up period (HR 0.89, 95%CI 0.79–0.93). 48.5% of those with T2DM were ex-smokers compared with 27.3% of those without T2DM. Active smoking rates were 20.4% and 23.7% respectively. Insulin, metformin and sulphonylureas were not associated with incident COPD.

Conclusions

People with T2DM are less likely to be diagnosed with COPD than matched controls. This may be due to positive lifestyle changes, such as smoking cessation in those with T2DM.  相似文献   

16.

Aims

Cardiovascular complications are one of main cause of increased mortality and morbidity among Diabetes Mellitus (DM) patients. Altered metabolism of sulphur amino acids in diabetes reflected as increases in concentration of methionine and cysteine/cystine in the blood which known as a markers of Cardiovascular Diseases (CVD). The aim of present study was to determine the effect of Eicosapentaenoic acid (EPA) supplementation on sulfhydryl amino acids and Atherogenic Index of Plasma (AIP) in patients with type 2 DM (T2DM).

Method

A randomized, double-blind, placebo-controlled clinical trial was performed in 36 control and patients with DM. The subjects were randomly assigned to obtain 2?g/d EPA (n?=?18) or placebo (n?=?18) for 8 weeks. Fasting serum level of Cystein and Methionine were measured using HPLC method and atherogenic index of plasma (AIP) as a proxy measure of atherosclerosis was computed.

Results

Eight weeks supplementation with EPA led to significant reductions in Met (p?<?0.002) and Cys (p?<?0.001) compared with the placebo (p?<?0.06). In addition, compared to placebo a significant reduction in AIP were seen after taking EPA (p?<?0.04).

Conclusion

EPA supplementation in patients with T2DM for eight weeks had beneficial effects on Met, Cys and AIP, which may attribute to the prevention of vascular complications in the T2DM patients.  相似文献   

17.

Background and aim

Recently, there has been an increasing interest in the influence of antioxidant vitamins on the efficacy of oral hypoglycemic therapy in type 2 diabetic patients (T2DM). This single-blinded randomized controlled clinical trial aimed to investigate the effect of vitamin C and/or E supplementation on the efficacy of oral hypoglycemic therapy in T2DM Palestinian male patients from the Gaza Strip.

Methods

Forty T2DM male patients aged 40–60 years on metformin treatment were randomly divided into four groups, each group received an additional one of the following daily oral supplements for 90?days: placebo; vitamin C; vitamin E and vitamin C plus vitamin E. After overnight fasting, venous blood specimens were collected from all individuals into K3-EDTA tubes and serum tubes for measuring the biochemical and hematological parameters of the study at baseline and after 90?days of vitamins supplementation.

Results

The results revealed that vitamin C and/or E improve fasting blood sugar (FBS), HbA1c, lipid profile, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), reduced glutathione (GSH); and Quantitative Insulin Sensitivity Check Index (QISCI) compared with diabetic patients group that received placebo.

Conclusion

This study provided additional evidence on the beneficial effects of supplementing antioxidant vitamins in T2DM which could improve the clinical condition and attenuate or prevent diabetic pathogenesis and complications that, secondly to poor glycemic control, could attribute to the imbalance between the decline in the endogenous antioxidants and increasing production of the reactive oxygen species leading to the oxidant-mediated damage present in the diabetic context.  相似文献   

18.

Background

Type 2 diabetes mellitus (T2DM) is a growing pandemic that will lead, if not managed and controlled, to frequent complications, poor quality of life, and high rates of disability and death. Little is known about T2DM complications in Palestine. The aim of this study is to estimate the prevalence of T2DM complications in Ramallah and al-Bireh governorate of Palestine.

Methods

The study was conducted in eleven primary healthcare clinics offering services for persons with T2DM. Macrovascular complications were assessed using the Diabetes complication index. Microvascular complications were measured by physical examinations and laboratory tests. Questionnaires, laboratory tests, and physical examinations were used to assess socio-demographic characteristics, co-morbidities and other risk factors.

Results

517 adult men and nonpregnant women participated in the study (166 men, 351 women). The response rate was 84%. Mean age and mean duration of diabetes were 58.1 and 9.4 years respectively. Prevalence of diagnosed microvascular and macrovascular complications was 67.2% and 28.6% respectively. 78.2% of the participants had poor glycemic control (HbA1c  7.0%).

Conclusion

Significant proportions of persons with T2DM had macro- and microvascular complications and poor metabolic control. These findings are important for policy development and the planning of health services.  相似文献   

19.

Context

Vitamin D supplementation in type 2 diabetes mellitus patients may lead to improved glycemic control by improving insulin secretion and decreasing insulin resistance.

Aims

To investigate effect of oral vitamin D supplementation on glycemic control, in patients with type 2 diabetes mellitus and coexisting hypovitaminosis D.

Settings and design

Randomized, Parallel Group, Placebo Controlled Trial carried out in a tertiary care hospital of Indian Armed Forces.

Methods and material

Sixty patients with coexisting type 2 diabetes mellitus and hypovitaminosis D were randomized into cases and controls and were supplemented with oral Vitamin D and microcrystalline cellulose respectively for six months. Subjects' HbA1c and vitamin D levels were monitored at the beginning and end of the study, fasting plasma glucose (FPG) & post prandial plasma glucose (PPPG) during monthly OPD visits.

Statistical analysis used

Intra-group comparison was made by paired t test & unpaired t test was used for inter-group (A v/s B) comparisons. Repeated measures ANOVA was undertaken to compare values over time.

Results

The two groups were comparable for all parameters at baseline. Case group showed significant decrease in mean HbA1c levels (7.29% to 7.02%; P?=?0.01), mean FPG levels (131.4 to 102.6?mg/dl; P?=?0.04) and mean PPPG levels (196.2 to 135.0?mg/dl; P?<?0.001). Incidentally, significant improvement in systolic as well as diastolic blood pressure and total cholesterol was also noted in the cases, while for LDL cholesterol improvement tended towards significance (p?=?0.05).

Conclusions

We found that oral vitamin D supplementation was associated with improved glycemic control and other metabolic parameters in patients with type 2 diabetes mellitus. Supplementation to achieve normal levels of vitamin D can be a promising adjuvant therapy for T2DM patients & coexisting hypovitaminosis D.  相似文献   

20.

Aims

Type-2 Diabetes Mellitus (T2DM) is one of the most prevalent and progressive metabolic conditions affecting approximately 8.5% of the global population. Individuals with T2DM have a significantly increased risk of developing chronic conditions such as cardiovascular disease (CVD) and its associated complications, therefore, it is of great importance to establish strategies for combatting T2DM and its associated chronic conditions. Current literature has identified several biomarkers that are known to play a key role in the pathogenesis of CVD. Many of these biomarkers affecting CVD are influenced by an increase in oxidative stress as seen in T2DM. The purpose of this review is to analyse and correlate the oxidative stress-related biomarkers that have been identified in the literature to provide an updated summary of their significance in CVD risk factors.

Data synthesis

This review has analysed current research on T2DM, CVD, and oxidative stress. Four key cardiovascular risk factors: thrombosis, inflammation, vascular homeostasis and cellular proliferation were searched to identify potential biomarkers for this review. These biomarkers stem from seven major cellular pathways; NF-κB, Keap1-Nrf2, protein kinase-C, macrophage activation, arachidonic acid mobilisation, endothelial dysfunction and advanced glycation end products.

Conclusions

The pathways and biomarkers were analysed to show their role as contributing factors to CVD development and a summary is made regarding the assessment of cardiovascular risk in T2DM individuals.  相似文献   

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