Prevalence of asymptomatic bacteriuria in type 2 diabetic subjects with and without microalbuminuria

<p>Abstract</p> <p>Background</p> <p>Diabetic subjects, especially women, show high prevalence of asymptomatic bacteriuria (ASB). The aim of the present study was to evaluate the prevalence of ASB in subjects with type 2 diabetes mellitus (T2D) with and without microalbuminuria (MA).</p> <p>Findings</p> <p>A hundred diabetic subjects with MA (53 males/47 females, mean age ± standard deviation: 65.5 ± 11.1 years) and 100 diabetic subjects without MA (52 males/48 females, mean age ± standard deviation: 65.4 ± 11.3 years), consecutively attending the outpatient diabetes clinic of our hospital were recruited in the study. Subjects with overt diabetic nephropathy or nephropathy from other causes were excluded. In addition, subjects with symptoms of urinary track infection or use of antimicrobial drugs in the last 14 days were excluded by the study.</p> <p>Diabetic subjects with MA showed increased prevalence of ASB compared to diabetic subjects without MA (21% versus 8%, P < 0.001, respectively). <it>Escherichia coli </it>was the most prevalent pathogen isolated in diabetic subjects with and without MA (12% versus 3.0%, P = 0.01, respectively) followed by <it>Proteus mirabilis </it>(6% versus 5%, P = 0.75, respectively) and <it>Klebsiella </it>spp (5% versus 1%, P = 0.09, respectively). Univariate logistic analysis showed that ASB was associated with the presence of coronary artery disease [odds ratio (OR): 0.29, 95% Confidence Intervals (95% CI): 0.09-0.95, P = 0.04] and gender (OR: 0.09, 95% CI: 0.02-0.35, P < 0.001) in the diabetic study group with MA.</p> <p>Conclusions</p> <p>ASB is more prevalent among T2D subjects with MA. Screening for ASB is warranted in diabetic patients especially if pyuria is detected in urine analysis since ASB has been found to be a risk factor for developing symptomatic urinary tract infection.</p

In-Hospital Mortality in a Tertiary Referral Hospital: Causes Of Death and Comparison between Patients with and without Diabetes

Introduction: Subjects with type 2 diabetes mellitus (T2DM) have increased morbidity and mortality mainly due to macrovascular complications. In addition, diabetic patients show increased in-hospital admissions in comparison with nondiabetic patients. However, in-hospital mortality data for patients with T2DM are not available in our country. The aim of the present study was to examine mortality rates in diabetic compared to nondiabetic patients admitted to a tertiary hospital during a 10-year period (1998-2007). Material and Methods: We performed a retrospective analysis of mortality rates in patients with and without T2DM hospitalised in a tertiary care hospital during the years 1998-2007. Demographic characteristics, medical history and outcome were collected from the patients’ medical records. Patients with type 1 diabetes were excluded from the analysis. Results: A total of 16 125 patients’ records were studied (14 005 without diabetes and 2 120 with T2DM). In the total sample, 1 467 (9.1%) deaths were recorded. Mortality rates were higher in the diabetic than in the nondiabetic patients (11.2% versus 8.7%, respectively, p &lt; 0.001). Age of death did not differ between diabetic and nondiabetic patients (age +/- SD: 77.1 +/- 9.5 vs. 77.6 +/- 16.3 years, p = 0.73). Median length of hospital stay was higher in the diabetic than in the nondiabetic patients (p = 0.03). Mortality was higher in the diabetic in comparison with the nondiabetic females (59.9% vs. 52.7%, respectively, p = 0.04), while no gender difference was found in males. Cerebrovascular disease was the commonest cause of death in both diabetic and nondiabetic patients (41.6% vs. 30.3%, p = 0.001), followed by infections (23.1% vs. 21.7%, respectively, p = 0.62). Death rates from malignancies were more common in the nondiabetic in comparison with the diabetic patients (18.8% vs. 4.2%, p &lt; 0.001). No significant differences were observed between the two study groups regarding mortality caused by cardiovascular events and chronic renal failure. Conclusion: The present study showed that diabetic patients and especially females had increased in-hospital mortality compared with nondiabetic patients. Cerebrovascular disease and infections were the more common cause of death in both groups

Associated autoimmunity in Type 1 Diabetes and latent autoimmune diabetes of adults: The role of glutamic-acid decarboxylase autoantibodies

Aims: To determine the prevalence of Associated Autoimmune Diseases (AADs) in Latent Autoimmune Diabetes of Adults (LADA) versus autoimmune Type 1 Diabetes (T1D) and the role of glutamic-acid decarboxylase antibodies (GADA) and other factors. Methods: Adults with autoimmune diabetes mellitus (DM) were recruited from the Diabetes Center of Nikaia-Piraeus Hospital. Demographic and clinical parameters were recorded and anti-pancreatic and organ-specific antibodies were measured. Results: Of 160 patients, 33.75% had one AAD and 24.37% had two or more. Patients with LADA had higher overall prevalence of AADs, mainly autoimmune thyroiditis and gastritis. Celiac disease was present only in T1D. GADA positive patients had higher prevalence of AADs and multiple autoimmunity, especially thyroiditis and gastritis. Patients with LADA had higher rates of positive GADA or islet-cell antibodies (ICA). After controlling for LADA, GADA remained a significant predictor of AADs. Female gender and chronological age were also significant predictors of AADs. Conclusions: AADs were present in 58.13% of patients. Patients with LADA were more prone to a generalized autoimmune disorder than those with T1D. AADs development was significantly associated with female sex, older age and positive GADA, which proved an independent marker of associated autoimmunity. © 202

THE EFFECT OF AN EUCALORIC HIGH-CARBOHYDRATE DIET ON CIRCULATING LEVELS OF GLUCOSE, FRUCTOSE AND NONESTERIFIED FATTY-ACIDS IN PATIENTS WITH CIRRHOSIS

Twelve cirrhotic patients and six controls were fed an eucaloric high carbohydrate (CHO) diet for 3 days. Fasting serum triglyceride (TG), non-esterified fatty acids (NEFA), glucose, insulin and glycerol were estimated daily. On the 3rd day of the study we measured NEFA, glucose, insulin, and fructose every 45 min from 07:45 h until 19:45 h, and then every 4 h until 07:45 h the next day. The patients were divided into two groups of six on the basis of plasma lecithin-cholesterol acyltransferase (LCAT) activity: group A cirrhotics (with good liver function - LCAT activity: 40.6-65.7 nmol . ml-1 . h-1; mean 48.5), and group B (poor liver function - LCAT: 23.7-32.3; mean 27.4). On the high CHO diet there was an increase in the fasting serum TG with a peak after 2 or 3 days. The increase in serum TG in controls was greater (p &lt; 0.01) than in either group of cirrhotics. In the controls and in group A most of the extra TG was carried in VLDL; in group B only 39% of the TG increment was found in VLDL. Fasting NEFA fell with 3 days of CHO feeding in the control group (p &lt; 0.01); they were unchanged in group A, and rose in group B to a significantly higher level than in controls (p &lt; 0.01). During day 3 when a high CHO diet was fed plasma NEFA levels fell in cirrhotics, and for most of the day the mean NEFA concentration in group B patients was significantly (p &lt; 0.05) lower than in normals. On day 3 glucose and fructose levels rose after each meal - much more in cirrhotics than in controls (and more in group B than in group A), and for most of the day they were significantly higher in group B patients as compared to the controls (glucose p &lt; 0.01, fructose p &lt; 0.001). Our results supported the hypothesis that plasma NEFA would be lower following high CHO meals in cirrhotics than in controls. This suggests that a high NEFA utilisation, which occurs in fasting cirrhotics, is not present throughout the day. Following a CHO meal, we suggest that tissues derive energy directly from the dietary sugars which are present in high concentration during the period of absorption and that this reduces the post prandial requirement for NEFA

Trends in the management of type 2 diabetes and its prescription drug costs in Greece (1998 &amp; 2006)

Aims Aim of the present study is to compare control of hyperglycaemia and other diabetes-related cardiovascular risk factors during the years 1998 and 2006 and to estimate the change in the cost of medications prescribed for this purpose. Methods We compared the medical records of all patients who were regularly followed in three major diabetes centers located in Athens and Piraeus, Greece, during 1998, with those who were examined at the same centers during 2006. The cost of medications was calculated in Euros per patient-year (PY), using the 2006 official Greek market prices. Results A total of 1743 eligible files were included in the study (805 files from 1998 and 938 from 2006). HbA1c, LDL-cholesterol and blood pressure improved significantly in 2006 as compared to 1998 (7.0% vs. 8.1%, 2.9mmol/l vs. 3.9mmol/l and 134.9/77.6mmHg vs. 139.3/80.9mmHg respectively, p&lt;0.001 for all comparisons). Treatment of hyperglycaemia was more intense and had a different pattern in 2006. The proportion of patients receiving antihypertensive, hypolipidaemic and antiplatelet drugs increased from 48.8% to 74.4%, from 15.2% to 61.2% and from 17.6% to 51.1% respectively (p&lt;0.001 for all comparisons). A highly significant increase in the cost per patient-year was observed for all classes of medications in 2006. The total cost of all diabetes-related medications increased in 2006 by 221.1% (from 341.3±276.0PY to 1095.8±634.1 PY). Conclusions Control of cardiovascular risk factors of patients with T2D, regularly followed by diabetes specialists, improved significantly in 2006 as compared to 1998. This improvement, however, was associated with a considerable increase in the cost of medications prescribed for treatment of these parameters. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart - New York

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM). Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis. Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460–7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546–5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277–5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p &lt; 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU. Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk. © Copyright © 2020 Panagoulias, Eleftheriadou, Papanas, Manes, Kamenov, Tesic, Bousboulas, Tentolouris, Jude and Tentolouris

Twenty-year trends in the prescription costs of Type 2 diabetes: Real world data and empirical analysis in Greece

Aims: To estimate and compare the prescription costs for the management of patients with diabetes over a period of 20 years in Greece, based on real world data. Methods: The records of outpatients with T2D, monitored at three diabetes centres, were examined in four cross-sections (1998, 2006, 2012, 2018). Prescribed medicines per patient, along with a set of clinical indicators were recorded. Annual costs of pharmaceutical treatment per patient were calculated by using each year&apos;s nominal retail prices, as well as by adjusting for 2018 price levels, in order to account for price differences over time. Results: 4066 patients were included in the analysis. Prescription patterns indicate a quick uptake of the new classes of glucose-lowering drugs and a reduction in the proportional use of sulfonylurea and glitazone. Adjusting for 2018 prices, the average total annual prescription cost per patient was 381.54 Euros (s.d. 297.44) in 1998 and 1147.21 Euros (s.d. 814.39) in 2018. Glucose-lowering drug costs per patient increase from 1998 onwards, whereas the costs of antihypertensive, antiplatelet and lipid-lowering treatment declined gradually, especially after 2006. Conclusions: Per patient prescription costs for glucose-lowering drugs present a steep increase, in Greece over the last 20 years. Real-world evidence studies that compare this increase with the changes in patient outcomes are essential in order to examine whether a costs-vs-outcomes balance is optimal. © 2020 Elsevier B.V

The Real-Life Effectiveness and Care Patterns of Type 2 Diabetes Management in Greece

Aim To investigate the prevalence of hypoglycaemia during sulfonylurea (SU) treatment of type 2 diabetes mellitus (T2DM) in Greece and its influence on glycaemic control, treatment adherence and quality of life (QoL). Patients and methods This was a retrospective cross-sectional study. We included 383 T2DM patients ≥30 years old on treatment with SU in monotherapy or in combination with metformin for at least 6 months. Patients were requested to fill in retrospective questionnaires on hypoglycaemia experience, adherence, weight gain and lifestyle/behavioural factors along with QoL (EQ-5D-3L), treatment satisfaction (TSQM), and fear of hypoglycaemia (HFS-II Worry scale). Results HbA 1c &amp;lt;7% was found in 161 (42.0%) patients. In total, 165 (43.1%) patients reported hypoglycaemic symptoms during the previous 6 months: 41.6% (67/161) of those with HbA 1c &amp;lt;7% and 44.1% (98/222) of those with HbA 1c ≥7%. Glycaemic control was achieved by 43.1% (94/218) of patients without hypoglycaemia and 50.0% (41/82), 36.8% (25/68) and 6.7% (1/15) of patients with mild, moderate or severe hypoglycaemia, respectively (p=0.013). In multivariate analysis, both occurrence (none vs. mild/moderate/severe) and severity (none vs. mild vs. moderate vs. severe) of hypoglycaemia were significantly associated with impaired global treatment satisfaction (p=0.002 and p&amp;lt;0.0001 respectively) and HFS-II Worry scale scores (both p&amp;lt;0.0001), while lower QoL (EQ-5D (UK) Index) was related to hypoglycaemia severity (p=0.024) only. Finally, treatment adherence was associated with increased (none/mild vs. moderate/severe) hypoglycaemia severity in univariate analysis (p=0.019). Conclusion A high prevalence of patient treated with SU reported hypoglycaemia in Greek healthcare settings with negative effects on treatment satisfaction, patient worry and adherence. Severity of hypoglycaemic symptoms was associated with reduced glycaemic control

Influence of Supervised Disease Understanding and Diabetes Self-Management on Adherence to Oral Glucose-Lowering Treatment in Patients with Type 2 Diabetes

Introduction: Systematic patient education has been reported to improve adherence to treatment, leading to better clinical outcomes. This cluster randomized real-world study investigated the effect of a systematic education program and telephone support on self-reported adherence to oral glucose-lowering treatment in patients with type 2 diabetes mellitus (T2DM). Methods: Centers were randomized (1:1) to provide either standard-of-care (control group) or standard-of-care along with the education program and telephone support (empowerment group). Adherence to treatment and satisfaction with treatment were assessed using the four-item Morisky Medication Adherence Scale (MMAS-4) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). The study population included 457 patients (258/199 male/female) with T2DM and non-optimal glycemic control, on oral antidiabetic treatment (age 62.7 [11.4]; disease duration 8.5 [6.5] years). Results: MMAS-4 high adherence rates for the control and empowerment groups were increased by 3.8% and 16.8% at 4 months (Breslow-Day test p = 0.04) and by 8.5% and 18.8% at 8 months of follow-up, respectively (Breslow-Day test p = 0.09), compared to baseline. Intense physical activity was increased in both control and empowerment groups by 2.3% and 13.9% at 4 months (Breslow-Day test p = 0.082) and by 4.0% and 22.5% at 8 months of follow-up (Breslow-Day test p &lt; 0.001). Baseline mean (SD) HbA1c was significantly lower in the control group compared with the empowerment group [7.7% versus 8.0%, p = 0.001] and decreased in both groups at 4 months by 0.7% and 0.9%, respectively. The change from baseline in the mean DTSQ status score at 4 months was greater in the empowerment group, and the effect was sustained at 8 months (control group: 29.1, 30.5, and 30.9; empowerment group: 25.0, 28.7, and 29.4 at baseline, 4 and 8 months, respectively, p &lt; 0.001). Conclusion: Systematic education combined with telephone support delivered by physicians might be associated with improvement in treatment adherence and treatment satisfaction in patients with T2DM. Funding: MSD, Greece. © 2019, The Author(s)