Deniz Korkut, Gul Ergor, Gulsah Kaner and Nilgun Seremet Kurklu
Background and Aims: Diabetes is increasing rapidly in Turkey as most countries in the world. The prevention of complications which is the main aim in the treatment of diabetes can be accomplished partly with nutrition education. The aim of this study was to assess the relationship between nutrition knowledge (NK) and complications in patients with type 2 diabetes. Materials and Methods: 280 patients with 8-20 years of diabetes duration who applied to diet outpatient clinic were recruited. The questionnaire was prepared by the investigators to assess the NK. A score was calculated on the scale of 100. The complications were determined based on hospital records and patients’ selfreport. Results: 63.2% of participants were female and 36.8% were male. The most common complications in participants were retinopathy (56.1%) and neuropathy (42.9%). The mean NK score was 80.2±11.7. At least one complication was seen in 85.0% of the participants. There was no significant difference for having any complication in patients with adequate and inadequate NK. However the risk of diabetic foot, and coronary artery disease was significantly higher in women with inadequate NK. Conclusion: NK is quite high in long term diabetic patients. However no effect of the NK on the development of complications could be shown. The difference of effect between men and women could be due to the fact that food is mostly prepared by women thus not much chance of the knowledge of men to be reflected on his eating habits. The knowledge difference among female patients was seen in the results as; in women with inadequate NK, the prevalence of diabetic foot and CAD was significantly higher.
Cristina Muntean, Bogdan Cătălin, Valerica Tudorică and Maria Moţa
Background and Aims: Little data regarding distal symmetric polyneuropathy (DSP) prevalence in Romania is available. The aim of the present study was to assess the prevalence of DSP in our cohort, to characterize it depending on glycemic control, and also to find an easy-to-apply method for DSP screening which could be used in Romania.
Material and Methods: We performed a cross-sectional study enrolling 51 patients followed in the Diabetes, Nutrition and Metabolic Diseases Clinic, Clinical County Hospital of Craiova, Romania. A complete evaluation protocol consisting in clinical examination and Michigan Neuropathy Screening Instrument (MNSI), together with nerve conduction studies were applied for evaluation.
Results: Among the type 2 diabetic patients investigated, 72.54% had DSP. Three-quarters of them had poor glycemic control (HbA1c ≥7%). Mean HbA1c level was 9.17%. Poor glycemic control led to a more severe DSP form as proven by nerve conduction studies and clinical examination. Allodynia and motor deficit were predominantly found with HbA1c ≥7%. Mean MNSI score for the group was 2.55, strongly correlated with nerve conduction studies.
Conclusion: MNSI is a simple and validated diagnostic tool for DSP with a strong correlation to electrophysiological parameters. Therefore, its daily implementation in clinical practice could help identify and follow patients at risk for DSP.
Ciprian Constantin, Aurelian Ranetti, Georgiana Constantin, Cristina Ioniţă, Irina Gal and Dan Mircea Cheţa
Background and Aims: A complete evaluation of complications should be done each time a new case of Type 2 Diabetes Mellitus (T2DM) is diagnosed. A good screening of complications will be the background of an oriented treatment. Our aim was to assess the vibratory and thermal sensitivity using a Computer Aided Sensory Analyzer (CASEIVSystem) in newly diagnosed T2DM patients and to compare it with the threshold determined by classical methods. Material and Methods: We sequentially enrolled 260 patients with newly diagnosed T2DM. The threshold of peripheral vibratory and thermal sensitivity was comparatively assessed using CASEIVSystem and classic tools. Other neurological scores were obtained from patients. Results: The vibratory threshold was abnormal in 56.92% (hand) and respectively 75.00% (foot) of subjects. Altered perception for the thermal threshold was registered in 76.15% and, respectively, 76.92% of subjects for the same sites. The 10g-monofilament exam was positive for 28.46% and the 128Hz-tuning-fork exam was positive for 20.38% of the examined patients. Mean time for a complete CASEIVSystem exam was around 27.23±9.34min vs. 3.21±0.24min (p<0.05) for a classic exam. Conclusions: In our study, CASEIVSystem allowed the assessment of the vibratory and thermal thresholds. The time needed for investigation renders this tool difficult to use in a time effective manner
Background and aims: Recently, large scale studies emphasized the idea of an excess of metabolic and cardiovascular risk in patients currently considered to have normal glucose tolerance but showing an elevated 1 hour glucose (≥155mg/dl) during oral glucose tolerance test (OGTT).
Material and Methods: 75 subjects with normal glucose tolerance or impaired glucose tolerance were completely investigated. We evaluated the clinical and biological markers associated to insulin resistance and we calculated the cardiovascular risk of the subjects using the SCORE charts.
Results and Discussions: Our data found statistically significant correlations between subjects with normal glucose tolerance and elevated 1 hour glucose and the following markers of insulin resistance: triglycerides to HDL-cholesterol ratio (TG/HDL-chol), Homeostatic Model Assessment (HOMA-IR), The Quantitative Insulin Sensitivity Check Index (QUICKI), fasting insulin, fasting glucose to fasting insulin ratio. Also, the subjects with elevated 1 hour glucose had a greater cardiovascular risk compared to subjects with 1 hour glucose <155 mg/dl.
Conclusions: This study identifies a category of subjects currently considered as normal glucose-tolerant individuals but with a special metabolic profile, an increased cardiovascular risk and an increased risk of developing diabetes.
Diabetic neuropathy is a major long term problem allied with diabetes that can cause serious disability and also death. Fifty to seventy five percent of all ulcerations and non trauma amputations are a consequence of diabetic neuropathy. Epalrestat, duloxetine and epalrestat with methylcobalamine are widely used to overcome neuronal damage. This study was designed to evaluate the efficacy of these three drug regimens. Material and methods: Patients included in this study were experiencing pain because of diabetic neuropathy for more than 6 months but not more than 5 years. Results: From 236 subjects with diabetic neuropathy included in the study, 181 patients concluded final analysis. 55 patients dropped from the study (14, 23 and 18 patients from duloxetine, epalrestat+methylcobalamine combination and epalrestat respectively). Mean pain score was reduced from 5.01±1.99 (severe pain) at first visit to 2.86±2.10 (moderate pain) in the epalrestat group, from 6.41±1.73 (severe pain) at first visit to 2.38±1.58 (mild pain) in the duloxetine group and from 5.86±1.76 (severe pain) to 2.88±1.91 (mild pain) in the epalrestat with methylcobalamine group. Conclusion: We conclude that duloxetine was significantly more effective than epalrestat and epalrestat in combination with methylcobalamine in relieving diabetic neuropathic pain.
Background and Aims. The intensive treatment in diabetes mellitus disturbs the common activities of the child, requiring a focus on the disease both from the part of the child and of the family, having an impact on the life quality. Therefore, the general assessment of the life quality of the child with diabetes mellitus becomes important.
Materials and Methods. The study comprised 153 children known with type 1 diabetes mellitus, recorded with the Centers of Diabetes, Nutrition and Metabolic Diseases of Iasi and Suceava, aged between 8 – 18 years old, with a duration of diabetes mellitus of 1 – 10 years. For comparison, we employed a control group of 30 non-diabetic children. Each child and parent filled-in two questionnaires: Pediatric Quality of Life Inventory (PedsQL) and Diabetes Family Conflict Scale.
Results. The direct analysis showed that child life quality decreases slightly in the case of a great number of insulin injections, but not significant. The multivariate analysis regarding PedsQL assessment score highlighted the fact that only the family conflict condition reported to diabetes mellitus of the child and the number of insulin administrations a day, influence in a significant manner their life quality.
Conclusions. Family involvement in the management of diabetes mellitus of the child represents a fertile field for conflict appearance in family and we propose the intensive and correct involvement of the family in the management of diabetes mellitus of the child in order to maintain a high level of child life quality.
Background and aims: Diabetes is considered as the most prevalent disease due to metabolic disorders. This study aimed to determine the effect of an educational on the quality of life) QOL( in patients with type 2 diabetes mellitus (T2DM ). Material and methods: This quasi-experimental study was conducted in the form of a pre-test/post-test with intervention. The statistical sample of this study included 70 patients with type 2 diabetes living in the rural areas in the city of Ilam (west of Iran). The data were analyzed using the SPSS software version 20 via descriptive statistics, paired t-student test, independent samples t-student test, and ANOVA. Results: Except social role functioning, all aspects of QOL significantly increased after intervention (p<0.001). Regardless of age groups, gender, and educational level the QOL scores increased at follow -up (p<0.001). Conclusions: Education to patients with type 2 diabetes leads to increased means of all dimensions of QOL that reflect the effects of educational interventions on each domain.
Mirela Tache, Sandra Milena Tocut and Carmen Dobjanschi
Background and aims: Depression and cognitive disorders were reported more frequently in patients with diabetes mellitus (DM). Our aim was to analyze the association of cognitive disorders and depression association with chronic complications of DM in a group of Romanian patients. Materials and methods: The data was analyzed from 181 patients, with a mean age of 58,3 years to whom we applied the MMSE (Mini- Mental State Examination) and MADRS (Montgomery-Asberg Depression Rating Scale) questionnaires. We also analyzed the presence of chronic DM complications, HbA1c and lipid profile. Results: Most patients with type 2 diabetes mellitus (T2DM) had mild cognitive impairment (92%), more common in the age group 50-59 years. Chronic macrovascular complications were present in 74.58%, while chronic microvascular complications were present in 61.87% of patients with T2DM who associated mild and moderate cognitive impairment (p = 0.013). The most common form of depression was mild depression (90.2%), present in most patients with DM, regardless of progression and type of treatment. MADRS depression test scores were statistically significant correlated with the presence of peripheral artery disease - PAD (p <0.001), ischemic heart disease - IHD (p <0.001) and chronic kidney disease - CKD (p =0.05). We did not find a statistically significant correlation with HbA1c and serum lipid values (p˃0,05). Conclusion: Chronic diabetes macrovascular complications (PAD, IHD) and CKD were more frequently associated with cognitive disorders and depression in patients with T2DM independent of the degree of metabolic control.
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