Plasma interleukin-6 is associated with coagulation in poorly controlled patients with Type 2 diabetes.

AIMS: We investigated the relationship between interleukin (IL)-6 and coagulation, i.e. whether changes in the plasma IL-6 are associated with those in coagulation markers (D dimer and fibrinogen) after glycaemic control with sulphonylurea or insulin in poorly controlled patients with Type 2 diabetes. METHODS: We studied 42 patients with Type 2 diabetes, including 19 subsequently treated with sulphonylurea, 23 treated with insulin and 48 control subjects. All patients were in poor glycaemic control and were hospitalized for 3 weeks. At the beginning and end of treatment, we measured plasma concentrations of IL-6, fibrinogen, and D dimer. RESULTS: Plasma concentrations of IL-6 and D dimer were significantly higher in diabetic patients than in controls (P<0.0001 for both). In all patients with diabetes, the plasma concentration of IL-6 decreased significantly (P<0.001) after treatment. Changes in the plasma IL-6 during hospitalization were positively correlated with those in plasma D dimer and fibrinogen (r=0.664, P<0.0001; r=0.472, P=0.0042, respectively). Treatment with sulphonylurea or insulin caused a similar fall in the plasma IL-6 concentration with a concomitant decrease in the BMI and an equal improvement in glycaemia. CONCLUSIONS: In poorly controlled patients with Type 2 diabetes, plasma IL-6 concentrations were reduced significantly even by short-term metabolic control. As changes in the plasma concentrations of D dimer are related to plasma IL-6, plasma IL-6 may reflect a pro-coagulant as well as an inflammatory state in patients with Type 2 diabetes.     

Fatigue and depression in elderly patients with poorly controlled diabetes

In this study, it was aimed to evaluate the severity of depression and fatigue in patients with type 2 diabetes mellitus (T2DM), aged ≥ 60 years, with poor diabetes control. Between December 2018 and June 2019, 310 patients aged ≥ 60 years, with hemoglobin A1C ≥ 10%, followed-up with the diagnosis of T2DM for at least 3 years in the internal medicine outpatient clinics of Bursa Yüksek İhtisas Training and research hospital were included in the study. The geriatric depression scale (GDS) and fatigue severity scale (FSS) questionnaires were administered. Patients were analyzed according to their sociodemographic and clinical characteristics, according to their GDS and FSS scores. The GDS and FSS scores were higher in the female patients than in the male patients, those with diabetes aged ≥ 21 years than those aged < 21 years, those using premixed insulin than those using basal bolus insulin and oral antidiabetic drug for + basal insulin, and those living alone than in those living with their families. The FSS score was higher in patients with vitamin D levels < 20 ng/mL. The factors affecting the GDS score were the FGS and FSS scores in the multivariate analysis. The factors affecting the FSS score were the GDS, diabetes age, hemoglobin level, and vitamin D level in the multivariate analysis. Poorly controlled diabetes affects elderly patients more in terms of their mental and physical health. Therefore, these patients should be considered in terms of psychosocial aspects to increase treatment compliance and effects.     

Medical strategies to reduce amputation in patients with Type 2 diabetes

Lower extremity amputation is a common and disabling complication of Type 2 diabetes. Whilst the introduction of specialist multidisciplinary teams has led to a reduction in the incidence of lower extremity amputation in some centres, the overall prevalence of diabetes‐related amputation has actually increased in recent decades. The aetiology of diabetes‐related amputation is complex, with neuropathy, macrovascular and microvascular disease contributing significantly. Ulceration, previous amputation, increasing diabetes duration and poor long‐term control of glycaemia and lipids are important risk factors for amputation in populations with diabetes. Major randomized intervention trials of blood glucose‐lowering or anti‐hypertensive therapies in populations with diabetes have shown limited reductions in neuropathy and/or macrovascular disease, and no benefit on amputation rates. In contrast, a recent analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study showed a significantly reduced rate of minor, but not major amputations in patients with Type 2 diabetes treated with fenofibrate. Mechanistic studies are clearly needed to understand the basis of this benefit.     

2型糖尿病并发抑郁症患者血清同型半胱氨酸水平升高

目的 探讨血清同型半胱氨酸(Hcy)水平与2型糖尿病(T2DM)并发抑郁症的关系.方法 338例T2DM患者中,根据临床表现和汉密尔顿抑郁量表(HRSD)诊断抑郁症患者101例,根据HRSD评分评定其抑郁程度,分为轻、中、重三组.测定血清Hcy、FPG、HbA1c.结果 T2DM患者Hcy水平显著高于对照组;糖尿病并发抑郁症患者血清Hcy水平显著高于非抑郁症组,抑郁症组有更高的HbA1c(P＜0.01),两组FPG水平无统计学差异.糖尿病并发抑郁症的轻、中、重三组比较, HRSD评分与Hcy、HbA1c水平呈显著正相关.结论 高Hcy血症可能是糖尿病患者抑郁症发病的重要危险因素.     

Comparison between vildagliptin and metformin to sustain reductions in HbA1c over 1 year in drug‐naïve patients with Type 2 diabetes

Aims To evaluate the ability of vildagliptin and metformin to sustain reductions in HbA_1c over a 1‐year treatment period in drug‐naïve patients with Type 2 diabetes (Type 2 DM). Methods Double‐blind, randomized, multicentre, active‐controlled, parallel‐group study of 52‐week treatment with vildagliptin (100 mg daily, n = 526) or metformin (titrated to 2000 mg daily, n = 254) in drug‐naïve patients (baseline HbA_1c = 7.5–11.0%). HbA_1c was measured periodically over 1 year. Results Vildagliptin and metformin each rapidly decreased HbA_1c from an equal baseline of 8.7%. Most of the HbA_1c reduction was attained by week 12, and the efficacy was sustained throughout 1‐year treatment with both agents. At the study end, significant HbA_1c reductions from baseline were seen with both vildagliptin (–1.0 ± 0.1%, P < 0.001) and metformin (–1.4 ± 0.1%, P < 0.001); however, statistical non‐inferiority of 50 mg vildagliptin twice daily to 1000 mg metformin twice daily was not established. Body weight did not change during the 1‐year treatment with vildagliptin (0.3 ± 0.2 kg, P = 0.17) and decreased in metformin‐treated patients (–1.9 ± 0.3 kg, P < 0.001). The proportion of patients experiencing an adverse event was 70.1 vs. 75.4% in patients receiving vildagliptin and metformin, respectively. The proportion of patients experiencing a gastrointestinal adverse event was twofold higher in the metformin group, driven by a 3–4‐fold greater incidence of diarrhoea, nausea and abdominal pain. The incidence of hypoglycaemia was similarly low in both groups (< 1%). Conclusions A clinically meaningful decrease in HbA_1c that was sustained throughout a 1‐year treatment in drug‐naïve patients with Type 2 DM was seen with both metformin and vildagliptin monotherapy.     

Effects of improved glycaemic control maintained for 3 months on cognitive function in patients with Type 2 diabetes

Background and aim In a previous study we failed to find beneficial short‐term effects of improved glycaemic control on cognitive functioning in patients with Type 2 diabetes mellitus. A subgroup of the entire sample was tested again to examine the effect of longer‐lasting improvement of metabolic control on cognitive functioning. Methods The cognitive performance of 26 patients with Type 2 diabetes was assessed at baseline and 3 months after discharge. Thirteen controls were tested at the similar time‐points. Attention/concentration, psychomotor speed, verbal fluency, verbal memory and depressive symptoms were assessed. Improved glycaemic control was generally achieved with insulin therapy (20/26). Results At baseline, there was a trend for diabetic patients to perform worse than controls. Both groups improved significantly over 3 months in several measures. However, diabetic patients did not improve more than controls. Conclusions In individuals with long‐standing Type 2 diabetes, previous reports of improved cognitive capacity following restoration and maintenance of near‐normoglycaemia were not confirmed. This might relate to the type of anti‐diabetic therapy.     

The locus of control in patients with Type 1 and Type 2 diabetes managed by individual and group care

Aims The locus of control theory distinguishes people (internals) who attribute events in life to their own control, and those (externals) who attribute events to external circumstances. It is used to assess self‐management behaviour in chronic illnesses. Group care is a model of systemic group education that improves lifestyle behaviour and quality of life in patients with Type 1 and Type 2 diabetes. This study investigated the locus of control in Type 1 and Type 2 diabetes and the possible differences between patients managed by group care and control subjects followed by traditional one‐to‐one care. Methods Cross‐sectional administration of two questionnaires (one specific for diabetes and one generic for chronic diseases) to 83 patients followed for at least 5 years by group care (27 Type 1 and 56 Type 2) and 79 control subjects (28 Type 1 and 51 Type 2) of similar sex, age and diabetes duration. Both tools explore internal control of disease, the role of chance in changing it and reliance upon others (family, friends and health professionals). Results Patients with Type 1 diabetes had lower internal control, greater fatalistic attitudes and less trust in others. Patients with either type of diabetes receiving group care had higher internal control and lower fatalism; the higher trust in others in those with Type 1 diabetes was not statistically significant. The differences associated with group care were independent of sex, age and diabetes duration. Conclusions Patients with Type 1 diabetes may have lower internal control, fatalism and reliance upon others than those with Type 2 diabetes. Receiving group care is associated with higher internal control, reduced fatalism and, in Type 1 diabetes, increased trust in others.     

Factors that influence improvement for patients with poorly controlled type 2 diabetes

ObjectiveAssess reasons for improved control for patients with initially poorly controlled diabetes.Research design and methodsPatients in seven practices with type 2 diabetes were selected if within a 6-month period they had two glycosylated hemoglobin (HbA1c) levels of at least 8.0%. Patient factors that may influence control were compared for patients grouped according to their last two HbA1c levels.ResultsReview of 643 medical records of diabetic patients treated by 29 clinicians identified 69 study patients. After at least 1 year of follow-up 26 patients became well controlled, 14 had intermediate control, and 29 remained in poor control. Becoming controlled was not significantly associated with gender, age, duration of diabetes, BMI, or HbA1c levels prior to baseline. It was inversely associated with greater use of medications (P = 0.04), and positively associated with understanding of diabetes (P = 0.03), adherence to recommendations for meal plan (P = 0.001), and glucose monitoring (P = 0.02). Thirty-one percent of patients who became controlled had a change in life circumstances. Reasons for not advancing medications were probably justified for 69% of patients who remained uncontrolled.ConclusionImproved control depends largely on patient self-care behaviors.     

Subclinical hyponatremia, hyperkalemia and hypomagnesemia in patients with poorly controlled diabetes mellitus

Diabetes mellitus is associated with disturbances in electrolyte metabolism. We studied 68 patients with insulin-requiring diabetes mellitus followed up in the Home Monitoring Clinic in order to assess the relationship between electrolyte disturbances and severity of diabetes. There is a significant correlation of serum sodium (r = -0.323, P less than 0.01), potassium (r = 0.416, P less than 0.001), magnesium (r = -0.292, P less than 0.02) with fasting glucose. Thus, in patients with high fasting blood glucose, sodium and magnesium tend to be lower while potassium is higher. Among the three parameters, only serum magnesium significantly correlates with the level of hemoglobin A1 (r = -0.356, P less than 0.001) and thus may be related to the long-term control of diabetes. On the other hand, the hyponatremia and hyperkalemia are more likely to be related to short-term metabolic control as reflected by fasting blood glucose. To conclude, minor changes in electrolytes have been found in a group of 68 Chinese patients receiving insulin. There is a remote possibility that these electrolyte changes may influence the chemical events responsible for long-term diabetic complications.