Journal of Diabetes and Its Complications

2012-03-01

Journal of Diabetes and Its Complications

Vivian Fonseca — 2012-04-11

I am honored and delighted to join the team of Journal of Diabetes and Its Complications as editor in chief. I would also like to welcome two esteemed colleagues, Dr. Steven Kahn and Dr. Stefano Del Prato as associate editors. We should all thank Dr. Philip Raskin for his outstanding stewardship of the Journal over 20years, and to the editorial team at Elsevier for making a smooth transition possible. Over the next few months, we hope to enhance our capabilities further with new editorial board members and the establishment of a journal office in the United States.

Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia

2012-04-11

Abstract: Background: Admission hyperglycemia increases the risk of death in patients with acute stroke. However, the most appropriate cut-off of glucose level indicating an increased risk of short-term mortality remains unknown.Purpose and methods: We aimed at establishing the optimum cut-offs of several variables (including admission blood glucose levels) predicting case-fatality (72hours, 7days) and unfavorable outcome [modified Rankin Scale (mRS) score 5–6 at 7 days] in consecutive first-ever acute ischemic stroke. Receiver operating characteristic (ROC) curves were constructed.Results: Eight hundred eleven consecutive patients were included [median age of 77 (69–83) years; 418 (52%) male; 239 (30%) diabetics; median admission National Institutes of Health Stroke Scale (NIHSS) 7 (4–12), 32 (4%) dead within 72hours; 64 (8%) dead within day 7; 155 (19%) with unfavorable outcome]. Median admission glucose levels were 113 (97–155)mg/dL. Diabetics had significantly higher median glucose levels than non-diabetics [163 (133–214) vs. 107 (92–123) mg/dL, p<0.001]. According to ROC analysis, the only significant predictive value of glycemia was ≥143mg/dL for 72-hour fatality (sensitivity 88% and specificity 70%) especially in non-diabetics (sensitivity 88% and sensitivity 62%). This cut-off point was an independent predictor for 72-hour fatality (overall: OR=4.0, CI=1.6–9.9, p=0.003; non-diabetics: OR=4.9, CI=1.7–14.5, p=0.004). The cut-offs of fasting total cholesterol levels and admission leukocytes had poor predictive values for each outcome, while those of admission NIHSS had good discrimination in predicting short-term outcome measures.Conclusions: Admission hyperglycemia (≥143mg/dL) is a strong and an independent predictor for 72-hour fatality, especially in patients with no prior history of diabetes mellitus.

Angiotensin-converting enzyme gene single polymorphism as a genetic biomarker of diabetic peripheral neuropathy: longitudinal prospective study

J. Jurado, J. Ybarra, J.H. Romeo, M. Garcia, E. Zabaleta-del-Olmo — 2012-04-11

Abstract: Background: Identifying patients at risk of developing diabetic peripheral neuropathy (DPN) is of paramount importance in those with type 2 diabetes mellitus (T2DM) to provide and anticipate secondary prevention measures as well as intensify action on risk factors, particularly so in primary care. Noteworthy, the incidence of DPN remains unknown in our environment.Aims: (i) To analyze a single angiotensin-converting enzyme (ACE) gene polymorphism (D/I) as a genetic marker of risk of developing DPN, and (ii) to determine the incidence of DPN in our environment.Research design and methods: Longitudinal study with annual follow-up for 3years involving a group of T2DM (N=283) randomly selected. ACE gene polymorphism distribution (I=insertion; D=deletion) was determined. DPN was diagnosed using clinical and neurophysiology evaluation.Results: Baseline DPN prevalence was 28.97% (95% CI, 23.65–34.20). ACE polymorphism heterozygous genotype D/I presence was 60.77% (95% CI, 55.05–66.5) and was independently associated with a decreased risk of DPN (RR, 0.51; 95% CI, 0.30–0.86). DPN correlated with age (P<0.001) but not with gender (P=0.466) or time of evolution of T2DM (P=0.555). Regarding end point, DPN prevalence was 36.4% (95% CI, 30.76–42.04), and accumulated incidence was 10.4% 3years thereafter. In the final Poisson regression analysis, the presence of heterozygous genotype remained independently associated with a decreased risk of DPN (RR, 0.71; (95% CI, 0.53–0.96). DPN presence remained correlated with age (P=0.002), but not with gender (P=0.490) or time of evolution (P=0.630).Conclusions: In our series, heterozygous ACE polymorphism (D/I) stands as a protective factor for DPN development. Accumulated incidence of DPN was relevant. Further prospective studies are warranted.

Influence of the glucose-lowering rate on left ventricular function in patients with type 2 diabetes and coronary heart disease

2012-04-04

Abstract: Background: The optimal methods for glucose control and reduction in the risk of cardiovascular disease are controversial. Findings from recent clinical trials have shown different viewpoints on the advantages and disadvantages of intensive lowering of glucose. We used echocardiography to explore the influence of the glucose-lowering rate on left ventricular function in patients with type 2 diabetes mellitus (T2DM). We also attempted to discover an effective glucose-lowering rate for patients with type 2 diabetes mellitus and coronary heart disease (T2DM-CHD).Methods: A total of 132 cases of T2DM and 135 cases of T2DM-CHD received intensive glucose therapy. After measuring left ventricular ejection fraction (LVEF) and the E/A ratio, variations and correlation factors were evaluated.Results: LVEF was significantly higher than before intensive therapy in the T2DM group with a glucose-lowering rate of ≤6mmol·L–1·d–1 (P 4mmol·L–1·d–1 (P .05). The E/A ratio increased among all subgroups after intensive therapy (P<.05). The waist–hip ratio, duration of T2DM, and age had a linear regression relationship with variations in LVEF before and after intensive therapy.Conclusions: For patients with T2DM and CHD, an excessively fast glucose-lowering rate could impair left ventricular systolic function. Long-term, good control of blood glucose could restore the impaired left ventricular systolic function caused by an excessively fast glucose-lowering rate. After intensive therapy, left ventricular diastolic function improved among all subgroups regardless of the glucose-lowering rate and CHD.

Prevalence of gastroparesis-related symptoms in an unselected cohort of patients with Type 1 diabetes

Kristoffer Kofod-Andersen, Lise Tarnow — 2012-03-29

Abstract: Background: The prevalence of diabetic gastroparesis is not well defined because of discrepancy between objective measurements, i.e. gastric emptying time, and symptoms experienced by patients. Furthermore most studies have been performed on small selected cohorts.Objective: To determine the prevalence of clinical symptoms of diabetic gastroparesis in a large unselected cohort of out-patients with Type 1 diabetes.Methods: 1028 patients with Type 1 diabetes attending a specialized diabetes clinic were mailed a validated questionnaire; “patient assessment of upper gastrointestinal disorders-symptom severity index”, in which a subset of questions measures symptoms of gastroparesis (GCSI; Gastroparesis Cardinal Symptom Index). Response rate was 74.4% (n=765). All patients were classified according to presence or absence of late diabetic complications and clinical and paraclinical data were obtained.Results: A GCSI Total Score ≥1.90 signified definite symptoms of gastroparesis (n=102) and patient charts were investigated for concomitant illness and/or medication influencing gastric emptying. In 30 patients an alternative etiology was revealed, leaving 72 (9.8%) patients with symptoms related to diabetic gastroparesis. Only 8 patients were previously diagnosed. HbA1c levels were significantly higher in patients with diabetic gastroparesis (8.4±1.3 vs. 8.2±1.2 respectively, p=0.02). Furthermore, patients with diabetic gastroparesis had more retinopathy (p=0.006) and peripheral polyneuropathy (16.7% vs. 6.7%, p<0.001) and there was a trend for diabetic nephropathy being more common (p=0.08).Conclusions: Symptoms of diabetic gastroparesis affect approximately 10% of patients with Type 1 diabetes in a specialized diabetes clinic and are associated with poor glycemic control and other late diabetic complications.

Association of ADIPOQ variants, total and high molecular weight adiponectin levels with coronary artery disease in diabetic and non-diabetic Brazilian subjects

2012-03-29

Abstract: Objective: To investigate the association of ADIPOQ variants, total and high molecular weight adiponectin (HMW) adiponectin levels with the prevalence of diabetes mellitus and coronary artery disease (CAD) diagnosed by coronary angiography in Brazilian subjects with high cardiovascular risk.Methods: 603 subjects undergoing coronary angiography were studied in regard to their glycemic status and presence of CAD (lesions >0%). We evaluated baseline concentrations of total and HMW adiponectin and three ADIPOQ variants: −11391G>A (rs17300539), +45T>G (rs2241766) and+276G>T (rs1501299).Results: The G-allele of rs2241766 was associated with higher levels of total and HMW adiponectin, and the A-allele of rs17300539 was associated with higher levels of HMW adiponectin. Lower levels of total and HMW adiponectin were independently associated with CAD. The G-allele of rs2241766 (OR 2.45, 95% C.I. 1.05–6.04, p=0.04) and the G-allele of rs1501299 (OR 1.89, 95% C.I. 1.04–3.45, p=0.03) were associated with CAD, and these associations were independent of circulating levels of adiponectin.Conclusions: In Brazilian subjects with high cardiovascular risk, CAD was associated with lower total and HMW adiponectin levels. The rs2241766 and rs1501299 polymorphisms were associated with CAD. The rs2241766 variant was associated with total and HMW adiponectin levels, while rs17300539 was associated with HMW adiponectin levels.

Sensitivity of A1C to diagnose diabetes is decreased in high-risk older Southeast Asians

2012-04-05

Abstract: Objective: To determine the effect of ageing on the performance of glycosylated haemoglobin A1C (A1C) for the diagnosis of diabetes mellitus (DM) in Southeast Asians.Methods: A1C was measured in 511 subjects (mean age of 52.4 years; range 14–93) undergoing the 75-g oral glucose tolerance test (OGTT). Using receiver operating curve (ROC) analysis, the performance of A1C for the diagnosis of diabetes (using different standard criteria) was compared between 4 groups: <45 (n=156), 45–54 (n=132), 55–64 (n=122), ≥65 years (n=101).Results: Subjects aged ≥65 years had the highest false-negative rates with fasting plasma glucose (60.8%) and A1C (35.1%), the smallest area under ROC curve (0.723, 95% CI 0.627–0.820), the lowest sensitivity (58.7%, 95% CI 50.4–65.7) and specificity (71.1%, 95% CI 57.3–82.6) of A1C 6.5%, compared to the younger age groups.Conclusion: OGTT is preferable for diagnosis of DM in older Southeast Asian adults.

Diabetes and cardiovascular risk factor controls in Thai type 2 diabetes with no history of cardiovascular complications; situation and compliance to diabetes management guideline in Thailand

2012-04-04

Abstract: Background: Cardiovascular complication is one of the most important issues causing morbidity and death in diabetic patients. Primary prevention is a key to prevent this complication.Aims: The objective was to study the situations of diabetes and cardiovascular risk factor controls in Thai type 2 diabetic patients who had no history of cardiovascular complication at a university hospital in Thailand after the Thai diabetes management guideline was recently launched.Methods: The study was a cross-sectional survey in type 2 diabetes patients with no history of cardiovascular disease. Seven hundred and fourteen patients were enrolled in the study and 54.3% were females. The data were collected retrospectively from out-patient medical records and an electronic data base for the patients who were followed up at the hospital during January–December 2010. The most recent laboratory values were utilized in the analysis.Results: 70%–90% of all patients were checked for HbA1c and lipid profiles (LDL-C, total cholesterol, triglycerides) at least once a year. It was observed that only 28% of the patients had HbA1c<6.5%. Furthermore, the percentages of the patients who had blood pressure <130/80 mmHg, and who had LDL-C<100 mg/dL were 28% and 41%, respectively.Conclusion: Even though the practice guideline has been launched since 2008, diabetes, hypertension and dyslipidemia were still poorly controlled. Further study is recommended to identify factors influencing these outcomes as well as the policy of diabetic care in Thailand is needed to be seriously implemented.

Stratifying healthcare costs using the Diabetes Complication Severity Index

C.X. Wu, W.S. Tan, M.P.H.S. Toh, B.H. Heng — 2012-04-05

Abstract: Objective: We aim to determine whether healthcare costs for patients diagnosed with Type 2 Diabetes Mellitus (T2DM) are associated with the severity of diabetes complications as measured by the Diabetes Complication Severity Index (DCSI).Methods: Retrospective cohort analysis was performed on a 2007 primary care cohort of T2DM patients. The DCSI is a 13-point scale, which comprises 7 categories of complications and their severity levels. Healthcare cost data from 2008 and 2009 were used as primary outcome. Inpatient and outpatient costs incurred for services consumed by patients within the provider network were included. Generalized linear model with log-link and gamma distribution was used to predict healthcare costs.Results: Of the 59,767 T2DM patients, 2977 (5.0%) deaths occurred and 1336 (2.2%) were lost to follow up. Healthcare cost was strongly associated with increase in DCSI score. Compared to patients without complications, those with more complications (higher DCSI score) had an increased risk of higher healthcare costs. Risk ratio (RR) increased from 1.25 (95%CI: 1.19–1.32) for DCSI=1 to 1.61 (1.51–1.72) for DCSI=2; 2.10 (1.91–2.31) for DCSI=3; 2.52 (2.21–2.87) for DCSI=4 and 3.62 (3.09–4.25) for DCSI≥5. As a continuous score, a one-point increase in the DCSI was associated with a cost increase of 27% (95%CI: 1.25–1.29).Conclusion: The DCSI score is a useful tool for predicting direct healthcare costs. The DCSI can be used to triage high-risk patients for more focused secondary prevention interventions at primary care level, in a bid to lower overall healthcare costs.

Associations of plasma von Willebrand factor ristocetin cofactor activity and 5-hydroxyindole acetic acid concentrations with blood flow in lower-leg arteries in Japanese type 2 diabetic patients with normal ankle-brachial index

2012-03-29

Abstract: Aims: To evaluate the associations of circulating levels of proinflammatory molecules and endothelial factors with blood flow in lower-leg arteries in diabetic patients with normal ankle-brachial index (ABI>0.9).Methods: We enrolled 123 type 2 diabetic patients with normal ABI and 30 age-matched nondiabetic subjects consecutively admitted to our hospital. Flow volume and resistive index, an index of peripheral vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. An automatic device was used to measure ABI and brachial-ankle pulse-wave velocity (baPWV) for evaluation of arterial stiffness. Plasma soluble intercellular adhesion molecule-1 (sICAM-1) and monocyte chemoattractant protein-1 (MCP-1) concentrations, serum high-sensitivity C-reactive protein (hsCRP) levels, plasma von Willebrand factor ristocetin cofactor activity (VWF), and plasma vasoconstrictor serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) concentrations were measured.Results: Diabetic patients had higher baPWV (P<.0001), resistive index (P<.0001), sICAM-1 (P<.0001), MCP-1 (P=.0224), log hsCRP (P<.0001), VWF (P<.0001), 5-HIAA (P=.0015), and lower blood flow (P<.0001) than nondiabetic subjects. VWF (P=.0019) or 5-HIAA (P=.0011), but not sICAM-1, MCP-1, and log hsCRP, was negatively correlated with blood flow in diabetic patients. A multivariate analysis revealed that the significant independent determinants of blood flow were hypertension, use of renin–angiotensin system inhibitors, VWF and 5-HIAA (r2=0.198, P<.0001) in diabetic patients.Conclusions: Plasma VWF and 5-HIAA concentrations are associated with blood flow and are involved in the pathogenesis of impaired peripheral circulation due to higher arterial stiffness and greater vascular resistance in lower-leg arteries in diabetic patients with normal ABI.

Is silent myocardial infarction more common in women with type 2 diabetes than in men?

2012-03-27

Abstract: Objective: Our aim was to determine if silent myocardial infarction (MI) is more common in women with type 2 diabetes than in men. Our secondary aim was to examine the relationships between silent MI and risk factors for cardiovascular disease.Research design and methods: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) database was used to determine if women had more silent MI on baseline electrocardiograms (ECGs) than did men with a similar unremarkable cardiovascular history. MI was diagnosed using ECG analysis according to the Minnesota code. Multivariable logistic regression analysis was used to compare demographic and clinical associations. Interactive effects of risk factors by gender were tested using a forward selection algorithm.Results: Men were found to have a higher prevalence of silent MI on baseline ECGs than women (6% vs 4%, P = .001). Women had lower odds of silent MI than men after adjusting for other risk factors (OR = 0.80, P = .04). Race and ethnicity were significantly associated with silent MI (P = .02), with Asians having the highest and African Americans and Hispanics having lower odds relative to whites.Conclusions: Our main findings provide no evidence that silent MI, as detected by the Minnesota code, was more common in women than in men in the ACCORD cohort. If, as in the general population, the women in ACCORD are found to have a higher heart disease mortality rate than the men, it seems unlikely that failure to recognize clinically silent heart disease in the years before study enrollment could be a major cause.

Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 27)

2012-03-27

Abstract: Purpose: The aims of this study were to report the prevalence of various microvascular complications and to identify the various clinical and biochemical characteristics related to these complications in subjects with newly diagnosed type II diabetes.Methods: Of the 5999 subjects enumerated, 1414 subjects with diabetes (both known and newly diagnosed) were analyzed for the study. Among the diabetic subjects, 248 (17.5%) were newly diagnosed with diabetes and the remaining had history of diabetes. All subjects underwent a detailed standard evaluation to detect diabetic retinopathy (fundus photography), neuropathy (vibration pressure threshold), and nephropathy (microalbuminuria).Results: The prevalence of any form of microvascular complication was 30.2% (95% confidence interval [CI]=24.5–35.9). The prevalence of diabetic retinopathy was 4.8%, and that of diabetic nephropathy and neuropathy was 10.5%. The risk factors for developing any form of microvascular complication were increasing age (odds ratio [OR]=1.07, 95% CI=1.04–1.11, P<.0001), increasing systolic blood pressure (OR=1.03, 95% CI=1.01–1.06, P=.001), and increasing hemoglobin (OR=1.39, 95% CI=1.09–1.79, P=.011). The risk factors for diabetic retinopathy and diabetic nephropathy were increasing systolic blood pressure (OR=1.06 [P=.001] for retinopathy and OR=1.04 [P=.012] for nephropathy) and increasing hemoglobin (OR=2.20 [P=.007] for retinopathy and OR=1.57 [P=.023] for nephropathy). The risk factor for diabetic neuropathy was increasing age (OR=1.12, P<.0001).Conclusions: Nearly one third of the newly diagnosed type II diabetes subjects had some form of microvascular complication; nephropathy, and neuropathy being commoner than retinopathy.

Assessing the impact of diabetes-related comorbidities and care on the hospitalization costs for patients with diabetes mellitus in Japan

Dulamsuren Lkhagva, Kazuaki Kuwabara, Shinya Matsuda, Yan Gao, Akira Babazono — 2012-03-14

Abstract: Objective: Because diabetes mellitus (DM) has been highlighted in several healthcare sectors, variations in the case mix of DM should be evaluated to promote effective disease management. Using a Japanese administrative database (2003), we investigated the impact of DM-related comorbidities and of their relevant care processes on healthcare costs incurred during hospitalization.Methods: Of 283,771 hospital admissions across 174 acute care hospitals, 27,853 patients with DM were analyzed. The following variables were analyzed according to age (<65 or ≥65 years), the presence of comorbidities, demographic characteristics, procedure-related complications, insulin use, surgical procedures (percutaneous minimally invasive intervention, hemodialysis, ventilation, and rehabilitation), length of stay (LOS), and total charge (TC; US$1=Y90). Multivariate analyses were applied to investigate the effects of DM-related complications and care processes associated with DM on TC.Results: The mortality and procedure-related complication rates were 2.1% and 2.7%, respectively. There were significant differences in the frequencies of comorbidities by age category. Among DM-related comorbidities, peripheral vascular disease had the greatest impact on increasing the LOS or TC. Minimally invasive procedures, hemodialysis, ventilation, and procedure-related complications were significant determinants of TC. Hemodialysis and invasive surgical procedures were independent predictors of procedure-related complications.Conclusions: DM-related comorbidities and care process representative of the DM case mix were responsible for variations in healthcare costs during hospitalization.

Role of peroxisome proliferator-activated receptor β agonist on angiogenesis in hindlimb ischemic diabetic rats

M. Khazaei, E. Salehi, B. Rashidi, S.H. Javanmard, A.R. Fallahzadeh — 2012-03-30

Abstract: Introduction: Studies indicated that PPARβ agonists play a role in modulation of angiogenesis. In this study, we evaluated the effect of specific PPARβ agonist, GW0742, on angiogenesis and serum vascular endothelial growth factor (VEGF), VEGF receptor-2 (VEGFR-2), and nitrite concentrations in hindlimb ischemia in normal and diabetic rats.Methods: Hindlimb ischemic rats were divided into four groups: control, diabetic, control, and diabetic treated with GW0742 (n=7 each). Diabetes was induced by injection of streptozotocin (55mg/kg, ip). GW0742 was injected 1day after surgery (1mg/kg, sc). After 21days, blood samples were taken, and gastrocnemius muscles were harvested for immunohistochemistry.Results: GW0742 significantly increased serum nitrite and VEGFR-2 concentrations and VEGF-to-VEGFR-2 ratio in control and diabetic rats. Capillary density was lower in diabetic animals compared to the control, and GW0742 significantly restored the capillary density in the control and diabetic hindlimb ischemic rats.Conclusion: PPARβ agonists restore skeletal muscle angiogenesis and can be considered for prevention and/or treatment of peripheral vascular complications in diabetic subjects.

Erectile dysfunction and its association with metabolic syndrome and endothelial function among patients with type 2 diabetes mellitus

John G. Ryan, Jason Gajraj — 2012-03-21

Abstract: Context: Evidence suggests that numerous comorbid conditions contribute to erectile dysfunction (ED) among patients with type 2 diabetes mellitus (T2DM).Objective: To review the relationship and mechanism between diabetes, metabolic syndrome, cardiovascular disease (CVD), and ED.Methods: A manual review of authoritative literature from peer-reviewed publications from January 2001 through July 2010 was performed. These publications were further mined to consider the impact of metabolic syndrome as a comorbid condition. Publications from key references were also consulted.Results: The associations between obesity, dyslipidemia, metabolic syndrome, T2DM, CVD, and depression with sexual dysfunction suggest that sexual dysfunction, particularly ED, is a precursor to CVD. Because these conditions share important risk factors with CVD, identifying them and their relationships with the pathogenesis of ED is likely to be critical to the manner in which primary care physicians screen for and manage this condition.Conclusions: Primary care physicians ought to establish trusting relationships with their patients, providing opportunities for them to probe such sensitive issues as sexual activities, as a means of addressing the possibility of ED. When making the new diagnosis of sexual dysfunction in the absence of metabolic disease or CVD, physicians ought to consider the risk for T2DM and CVD. Associations between metabolic disease, heart disease, and sexual dysfunction further suggest that all patients who are obese and have dyslipidemia, T2DM, and/or depression should be further screened for ED.

Cigarette smoking among adolescents with type 1 diabetes: Strategies for behavioral prevention and intervention

2012-04-12

Abstract: Smoking is the leading preventable cause of death in the U.S. and preventing smoking initiation among adolescents is a public health priority and a central element of comprehensive tobacco control. While cigarette smoking is harmful to all youths, those with special healthcare needs are particularly vulnerable to the negative health consequences of smoking, and adolescents with type 1 diabetes (T1D) urgently stand out as a high-risk group. Available literature suggests the prevalence and risk factors for smoking among adolescents with T1D are strikingly similar to the general population. Moreover, smoking negatively affects T1D management and increases risk for and progression of adverse health outcomes related to T1D. Adolescents with T1D are also influenced by disease-related social and behavioral factors that affect decisions about smoking. Pediatric health care providers (HCPs) are optimally-positioned to screen and counsel adolescents with T1D to avoid smoking, as they have well-established relationships with young patients and regularly scheduled visits surrounding T1D management. However, several barriers inhibit HCPs from screening/counseling adolescents with T1D for smoking on a regular basis. Well-established strategies for behavioral counseling for smoking in the healthcare setting may be effective to prevent and reduce smoking among adolescents with T1D. HCPs who care for these young patients can tailor proven counseling approaches to the context of T1D to address smoking alongside other behavioral factors that are central to disease management. Empirical research is also needed to inform the development and deployment of healthcare-based interventions and maximize their impact within this population.

Journal of Diabetes and Its Complications

Contents

Journal of Diabetes and Its Complications

Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia

Angiotensin-converting enzyme gene single polymorphism as a genetic biomarker of diabetic peripheral neuropathy: longitudinal prospective study

Influence of the glucose-lowering rate on left ventricular function in patients with type 2 diabetes and coronary heart disease

Prevalence of gastroparesis-related symptoms in an unselected cohort of patients with Type 1 diabetes

Association of ADIPOQ variants, total and high molecular weight adiponectin levels with coronary artery disease in diabetic and non-diabetic Brazilian subjects

Sensitivity of A1C to diagnose diabetes is decreased in high-risk older Southeast Asians

Diabetes and cardiovascular risk factor controls in Thai type 2 diabetes with no history of cardiovascular complications; situation and compliance to diabetes management guideline in Thailand

Stratifying healthcare costs using the Diabetes Complication Severity Index

Associations of plasma von Willebrand factor ristocetin cofactor activity and 5-hydroxyindole acetic acid concentrations with blood flow in lower-leg arteries in Japanese type 2 diabetic patients with normal ankle-brachial index

Is silent myocardial infarction more common in women with type 2 diabetes than in men?

Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 27)

Assessing the impact of diabetes-related comorbidities and care on the hospitalization costs for patients with diabetes mellitus in Japan

Role of peroxisome proliferator-activated receptor β agonist on angiogenesis in hindlimb ischemic diabetic rats

Erectile dysfunction and its association with metabolic syndrome and endothelial function among patients with type 2 diabetes mellitus

Cigarette smoking among adolescents with type 1 diabetes: Strategies for behavioral prevention and intervention