Journal of Diabetes and Its Complications

2010-03-01

Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion

2009-04-24

Abstract: Objective: To systematically investigate the effect of lack of adherence to the recommended change in insulin pump infusion line use beyond 48 h and determine whether the type of insulin made a difference.Research design and methods: This was a double-blind, randomized, crossover trial with 20 patients with diabetes mellitus I using insulins aspart and lispro without a line change for up to 100 h. Using retrospective continuous glucose monitoring, we analyzed the average glucose over the day. Changes in serum 1,5-anhydroglucitol, carboxymethyllysine, and free 15-F2t isoprostane were also studied.Results: From Day 2 to Day 5 of the pump line use, the daily average glucose level increased from 122.7 to 163.9 mg/dl (P 180 mg/dl increased from 14.5% to 38.3% (P<.05). Loss of control occurred despite increase in total daily insulin dose from 48.5±11.8 to 55.3±17.9 U (P=.05). There was no difference in loss of control between insulin types, and biomarkers measured did not change significantly.Conclusions: The insulin pump infusion should be changed every 48 h in patients using continuous subcutaneous insulin infusion (CSII), to avoid loss of glycemic control. In the short-term, this loss of glycemic control has no impact on oxidative stress and glycation.

Effects of vildagliptin twice daily vs. sitagliptin once daily on 24-hour acute glucose fluctuations

2009-03-05

Abstract: There is increasing evidence that glycemic disorders such as rapid glucose fluctuations over a daily period might play an important role on diabetic complications. We evaluated the efficacy of sitagliptin 100 mg once daily vs. vildagliptin 50 mg twice daily on daily blood glucose fluctuations in patients with type 2 diabetes that was inadequately controlled by metformin.Forty-eight-hour continuous subcutaneous glucose monitoring (CSGM) was performed in patients treated with metformin plus vildagliptin (n=18) or sitagliptin (n=20) over a period of 3 months. The mean amplitude of glycemic excursions (MAGE) was used for assessing glucose fluctuations during the day. During a standardized meal, glucagon-like peptide-1 (GLP-1), glucagon, and insulin were measured.CSGM shows large MAGE decrements in the vildagliptin group compared with the sitagliptin group (P<.01). A marked increase in GLP-1 occurred during interprandial period in vildagliptin bid-treated toward sitagliptin 100 mg once daily (P<.01). Glucagon was more suppressed during interprandial period in subjects receiving vildagliptin compared to those receiving sitagliptin (P<.01). Since MAGE is associated with an activation of oxidative stress, our data suggest that dipeptidyl peptidase IV inhibition therapy should target not only reducing HbA1c but also flattening acute glucose fluctuations over a daily period.

Factors associated with poor glycemic control among patients with Type 2 diabetes

Maysaa Khattab, Yousef S. Khader, Abdelkarim Al-Khawaldeh, Kamel Ajlouni — 2009-03-12

Abstract: Objectives: Determine factors associated with poor glycemic control among Jordanian patients with Type 2 diabetes.Methods: A systematic random sample of 917 patients was selected from all patients with Type 2 diabetes over a period of 6 months in 2008. A prestructured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviours, medication adherence, barriers to adherence, and attitude towards diabetes. Weight, height, and waist circumferences were measured. All available last readings of hemoglobin A1c (HbA1c), fasting blood sugar measurements and lipid were abstracted from patients' records. Poor glycemic control was defined as HbA1c ≥7%.Results: Of the total 917 patients, 65.1% had HbA1c ≥7%. In the multivariate analysis, increased duration of diabetes (>7 years vs. ≤7years) (OR=1.99, P≤.0005), not following eating plan as recommended by dietitians (OR=2.98, P≤.0005), negative attitude towards diabetes, and increased barriers to adherence scale scores were significantly associated with increased odds of poor glycemic control.Conclusion: The proportion of patients with poor glycemic control was high, which was nearly comparable to that reported from many countries. Longer duration of diabetes and not adherent to diabetes self-care management behaviors were associated with poor glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence to treatment regimen would be of great benefit in glycemic control.

Erythropoietin response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure

2009-03-23

Abstract: Aim: We aim to investigate erythropoietin (EPO) response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure.Methods: A cross-sectional study was conducted on 211 type 2 diabetes mellitus patients without advanced renal failure [estimated glomerular filtration rate (eGFR) >40 ml/min/1.73 m2]. The response of EPO to anemia of type 2 diabetic patients without advanced renal failure was compared with those of nondiabetic control subjects. Autonomic nerve function was assessed using three cardiovascular tests (deep breathing, the Valsalva maneuver, and lying-to-standing). The results of each test were scored as 0 if normal, 1 if borderline, and 2 if abnormal. Autonomic neuropathy was diagnosed when a total score of the tests was 2 or more.Results: Fifty-eight patients were anemic; compared with nonanemic patients, they had a longer duration of diabetes (16.69±10.11 vs. 10.67±8.41 years, P<.001), lower eGFR (66.43±16.30 vs. 81.74±19.49 ml/min/1.73 m2, P<.001), and higher cardiovascular autonomic neuropathy score (3.17±1.95 vs. 1.79±1.72, P<.001). Serum EPO level was weakly correlated with hemoglobin (Hb) level (r=−.085, P<.001). However, the slopes of regression lines between EPO and Hb levels differed significantly between type 2 diabetic patients and nondiabetic control subjects (−0.0085 vs. −0.255, P=.008). Multiple linear regression analysis revealed that cardiovascular autonomic neuropathy score was independently related to Hb (P<.001) or EPO level (P=.052).Conclusions: Autonomic neuropathy is associated with a blunted EPO response to anemia in type 2 diabetic patients without advanced renal failure.

Use of health care services among diabetic Spanish adults: related factors and trends, 1993–2006

2009-02-23

Abstract: Objective: We examined time trends in the use of health care services between diabetic and nondiabetic adults in Spain and their associations with sociodemographics variables.Research Design and Methods: Using data from two national health surveys, we estimated use of health care services, including hospital days per person-year, in the diabetic and nondiabetic populations in 1993 (n=20,880) and 2006 (n=29,478) in Spain.As the dependent variable, we took the answer to the questions, “Has used emergency medical services in the preceding year?” and/or “Have you been admitted to hospital in the preceding year?” Independent variables were age group, gender, educational level, and coexistence of chronic conditions.Results: Use of emergency medical services has been significantly incremented between 1993 and 2006—from 19.6% to 36.6% for the diabetic population and from 13.8% to 29.0% for the nondiabetics. In the diabetic population, with respect to hospital admission, 13.2% of diabetics said that they had been hospitalized in 1993 compared with 18.0% in 2006 (P<.05). The results of multivariate analysis, after controlling for confounders, indicated that diabetics used significantly more health care resources in 2006 than in 1993 [odds ratio (OR)=1.34, 95% confidential interval (CI)=1.01–1.79 for admission in hospital and OR=2.03 95% CI=1.58–2.62]. Also, the length of hospital stay for diabetics increased significantly in 2006 with respect to 1993 (1.38 relative hospital days).Conclusions: Spanish diabetic individuals used health care services (emergency room, admission to hospital) more often than nondiabetics. Furthermore, the length of hospital stay increased among the diabetics surveyed in 2006 compared with that in 1993.

Association of the functional A118G polymorphism of OPRM1 in diabetic patients with foot ulcer pain

Kuang-I Cheng, Shiu-Ru Lin, Lin-Li Chang, Jaw-Yuan Wang, Chung-Sheng Lai — 2009-03-23

Abstract: Background: Diabetic foot ulcer (DFU) patients may experience moderate or severe pain. A single-nucleotide polymorphism, at nucleotide 118 for opioid receptor mu 1 (OPRM1), has been reported to alter the opioid effects to relieve acute or chronic pain. The purpose of this study was to elucidate the correlation between nucleotide 118 variants and foot ulcer pain in DFU patients.Methods: Sixty-five DFU patients with Grade 2–5 Wagner–Meggitt classification were enrolled. The occurrence of pain in activities was categorized into five grades. Patients were allocated either into the painless DFU group, with a visual analog scale (VAS) pain score ≦3, or into the painful DFU group, with a VAS pain score ≧4 and Grades 3–5 of occurrence of pain in daily activities. DNA was extracted from blood samples of analyzed patients. Using the polymerase chain reaction–single-strand conformation polymorphism analysis and DNA sequencing of nucleotide 118, we identified the genotype distribution and allelic frequencies in DFU patients. The sequences of the forward and the reverse primer are designed as follows: 5′-TAATACGACTCACTATAGGG-3′ and 5′-ACGCACACGATGGAGTAGAG-3′, respectively.Results: Fifteen patients were classified into the painful DFU group and 50 patients were classified into the painless DFU group. The amplified DNA fragments showed 26 homozygous (AA), 34 heterozygous (AG), and 5 mutant homozygous (GG) genotypes, with overall A and G allelic frequencies of 66.2% and 33.8%, respectively. The painful DFU group included 10 AA subjects, 4 AG subjects, and 1 GG subject, while the painless DFU group had 16 AA, 30 AG, and 4 GG subjects (P=.038).Conclusion: The A118G polymorphism of mu-opioid receptor may be closely associated with DFU pain in 34 out of 50 patients in the painless group and in 5 out of 15 patients in the painful group. This indicates that the nucleotide 118 variant patients may suffer less DFU pain.

Assessment of insulin sensitivity/resistance and their relations with leptin concentrations and anthropometric measures in a pregnant population with and without gestational diabetes mellitus

Ozgur Yilmaz, Mert Kucuk, Aydin Ilgin, Muride Dagdelen — 2009-03-09

Abstract: Fifty-six pregnant women with gestational diabetes mellitus (GDM) and 42 normal glucose tolerant (NGT) pregnant women between 26 and 36 gestational weeks were included in the study prospectively. The body fat percentage (BFP) was calculated using the Siri formula from skinfold thickness (SFT) measurements.Both groups were comparable for gestational age, height, weight, and body mass index (P>.05). Insulin resistance assessed by homeostasis model assessment for insulin resistance (HOMA-IR) method was significantly higher in GDM patients compared to their NGT weight-matched control group. In contrast, the insulin sensitivity calculated from quantitative insulin sensitivity check index (QUICKI-IS) equation was significantly lower in GDM group. Calculated lean body mass was found to be similar in between both groups. Body fat percentage derived from SFT parameters was significantly higher in women with GDM. Women with GDM had significantly higher levels of serum insulin and leptin concentrations when compared with the NGT group. All SFT measurements were higher in GDM group when compared to those in NGT women. We did not find any correlation between leptin levels and insulin resistance; we found negative correlation between leptin levels and insulin sensitivity. Thus, we observed that leptin may contribute development of GDM by decreasing insulin sensitivity but not increasing insulin resistance. Also, we observed that the BFP estimated by the Siri formula from SFT measurements correlated significantly with HOMA-IR and QUICKI-IS and leptin concentrations in pregnant women.We suggest that by simply evaluating SFT, we may hold a view about BFP and leptin concentrations and insulin sensitivity in pregnant women.

Association of genetic variants in the adiponectin encoding gene (ADIPOQ) with type 2 diabetes in Japanese Brazilians

2009-03-09

Abstract: Aim: The objective of this study is to assess the contribution of ADIPOQ variants to type 2 diabetes in Japanese Brazilians.Methods: We genotyped 200 patients with diabetes mellitus (100 male and 100 female, aged 55.0 years [47.5–64.0 years]) and 200 control subjects with normal glucose tolerant (NGT) (72 male and 128 female, aged 52.0 years [43.5–64.5 years]).Results: Whereas each polymorphism studied (T45G, G276T, and A349G) was not significantly associated with type 2 diabetes mellitus, the haplotype GGA was overrepresented in our diabetic population (9.3% against 3.1% in NGT individuals, P=.0003). Also, this haplotype was associated with decreased levels of adiponectin. We also identified three mutations in exon 3: I164T, R221S, and H241P, but, owing to the low frequencies of them, associations with type 2 diabetes could not be evaluated. The subjects carrying the R221S mutation had plasma adiponectin levels lower than those without the mutation (2.10 μg/ml [1.35–2.55 μg/ml] vs. 6.68 μg/ml [3.90–11.23 μg/ml], P=.015). Similarly, the I164T mutation carriers had mean plasma adiponectin levels lower than those noncarriers (3.73 μg/ml [3.10–4.35 μg/ml] vs. 6.68 μg/ml [3.90–11.23 μg/ml]), but this difference was not significant (P=.17).Conclusions: We identified in the ADIPOQ gene a risk haplotype for type 2 diabetes in the Japanese Brazilian population.

The Starling mechanism of the urinary bladder contractile function and the influence of hyperglycemia on diabetic rats

Xin-min Wang, Mu-xun Zhang, Lei Zhao, Bing Han, Ping Xu, Meng Xue — 2009-08-12

Abstract: Diabetic cystopathy is one of the common complications of diabetes. Bladder dysfunction in diabetes is attributable to diabetic neuropathy that induces sensory and autonomic nerve dysfunction.Materials and Methods: In the present study, the contractile mechanism of the bladder was evaluated both with and without electrical stimulation in normal rats, streptozotocin (STZ)-induced diabetic rats, and diabetic rats with insulin treatment.Results: Both the normal and diabetic rats had optimal capacity of bladder and optimal length of detrusor muscle strips. The peak values of the volume–pressure curves of the bladder and length–tension curves of detrusor muscle strips as well as the enhanced values after electrical stimulation in 6- and 10-week diabetic groups were lower than in the 6- and 10-week normal groups and insulin-treated groups. However, there was no significant difference in peak and enhanced values between normal rats and diabetic rats treated with insulin, indicating that voiding function was improved after insulin treatment.Conclusions: The contractile function of rat's bladder including normal rats, diabetic rats, and diabetic rats treated with insulin is similar to the ‘Starling mechanism.’ It can be impaired by hyperglycemia, and insulin treatment is helpful to restore this function.

The value of self-monitoring of blood glucose: a review of recent evidence

Andrew St John, Wendy A. Davis, Christopher P. Price, Tim M.E. Davis — 2009-02-23

Abstract: Aims: To review the recent literature relating to the role of self-monitoring of blood glucose (SMBG) and glycemic control.Methods: Medline and EMBASE databases were searched between 1996 and June 2008 using terms that included diabetes mellitus, self-care, and blood glucose self monitoring. Both experimental and nonexperimental studies with HbA1c as an outcome measure were included. A meta-analysis was performed on randomized controlled trials (RCTs) in type 2 diabetes which met the inclusion criteria.Results: From 1102 relevant papers, 34 original containing 38 separate studies were identified as being published between 2000 and June 2008. There were 23 studies of type 2 diabetes and, of these, 13 were nonexperimental and 10 experimental, including six RCTs. The results of five of these RCTs in non–insulin-treated type 2 diabetic patients were combined in a meta-analysis with two earlier RCTs which yielded a significant pooled SMBG-related decrease in HbA1c of −0.22 (95% CI −0.34% to −0.11%).Conclusions: The present meta-analysis showed an SMBG-related HbA1c reduction in non–insulin-treated type 2 diabetes patients that was similar to that in previous systematic reviews but in a substantially larger patient sample. This finding is consistent with most observational studies of similarly treated patients.

Sepsis and gas-forming splenic abscess by Clostridium septicum in a patient with type 2 diabetes

2009-03-16

Abstract: Clostridium infections are rare but frequently associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 h. These infections are associated with various medical problems including diabetes mellitus. In this report, we describe a unique case of sepsis and a gas-forming splenic abscess caused by Clostridium septicum in a type 2 diabetes patient which was treatable solely with antibiotics.