Impact of smoking and nicotine addiction on HbA1c levels and diabetic microvascular complications

Introduction. In this study we aimed to determine whether a difference in complications between smok­ers and non-smokers exists in type 2 diabetes mellitus (T2DM) and to evaluate if there is a correlation between microvascular complications and Fagerström test score. Material and methods. Patients with T2DM who at­tended the family medicine outpatient clinics were enrolled in the study. Smokers and non-smokers were compared according to their metabolic outcomes and presence of microvasculer complications. The level of smoking addiction was determined by Fagerström Test for Nicotine Dependence. Results. Fasting blood glucose (FBG), low-density lipoprotein, systolic and diastolic blood pressures were found to be higher in smokers. The presence of neuropathy was significantly higher in smokers. The presence of retinopathy rate increased with increasing level of smoking addiction. The nicotine dependence test score were found to be positively correlated with HbA1c and FBG levels whereas, negatively correlated with body mass index among smokers. Conclusions. Assessing the cigarette smoking status of diabetic patients at the initial clinic visit and indicating the importance of smoking cessation should be the essential part of diabetes follow up program

Unilateral Absence of the Pulmonary Artery Incidentally Found in Adulthood

Unilateral absence of the pulmonary artery (UAPA) or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. UAPA is usually associated with cardiac anomalies and surgically treated in childhood. We report a rare case of a 50-year-old woman who was diagnosed with left pulmonary artery agenesis without any other cardiac anomalies. Clinicians should be aware of the possibility of undiagnosed cases of UAPA in patients through a chest radiograph that suggests the diagnosis. Confirmation of the diagnosis and anatomic details can be discerned by CT scanning

Counselling and knowledge about contraceptive mode of action among married women; a cross-sectional study

BACKGROUND: Family planning counselling which covers knowledge transfer about contraceptive mode of action, by enabling informed choice, improves compliance to and efficiency of contraceptive methods. The objective of this study was to investigate associations between family planning counselling, counsellor and correct knowledge about mode of action of modern contraceptive methods among married women. METHODS: For this cross-sectional study, stratified (according to current modern contraceptive method in use) random sampling was performed from the registries of two primary health care centres. Main outcomes were; prevalence of family planning counselling, professional background of the counsellor and correct knowledge about mode of action. A semi-structured questionnaire developed by the researchers was applied via face-to-face interview. The answers about mode of action were categorized as correct vs. incorrect by consensus rating. RESULTS: Prevalence of counselling and correct knowledge about mode of action was 49.0% and 39.3%, respectively. Higher educated women were significantly more likely to know the mode of action (p < 0.001). Being counselled by a physician (54.1%, n = 120) was not associated with correct knowledge about mode of action (p = 0.79). Non-barrier method users were less educated (p = 0.001), more often counselled (60.8% vs. 8.0%) and less knowledgeable (p < 0.001) about mode of action of their contraceptive method, compared to condom users. Nevertheless, counselled non-barrier method users were significantly more likely to know the correct mode of action of their chosen method (p = 0.021) than counselled condom users. CONCLUSION: The beneficial effect of counselling on knowledge about mode of action of the more complicated, medical (non-barrier) contraceptive methods suggests that the use of family planning counselling services in primary health care should be promoted; furthermore, counselling strategies and content should be re-structured for better efficacy

The Relationship between Thyroid Hormones, Metabolic Syndrome and HOMA-IR in People with Obesity or Overweight

Objective: In the literature the data about the relationship between thyroid hormone (TH) levels and Metabolic Syndrome (MetS) components are conflicting. Our aim was to evaluate the associations between THs and MetS as well as individual components of MetS and homeostatic model assessment of insulin resistance (HOMA-IR) in euthyroid people with obesity and overweight. Materials and methods: Adult patients who presented to Family Medicine Outpatient Clinics of a tertiary hospital between May 2019 and December 2019 with the intention of weight loss were enrolled in this cross-sectional, descriptive study. The data including height, weight, waist circumference, hip circumference, blood pressure (BP), fasting blood glucose (FBG), total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride, thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), insulin, HOMA-IR, and HbA1c were analyzed. Results: A total of 175 patients, 135 (77.1%) female, 40 (22.9%) male (mean age: 40.8 ± 13.1 years), without known thyroid dysfunction were included. A total of 86 were overweight and 89 were obese. Fifty-nine (33.7%) of the study participants were diagnosed with MetS. Subjects with MetS had significantly higher level of fT3 even within the normal range (p = 0.039). When TSH, fT4 and fT3 values were compared with other metabolic components in the group with MetS, a significant positive correlation was found only between fT4 level and HOMA-IR (Rho = 0.316, p = 0.026). Conclusions: MetS was associated with high normal fT3 suggesting differential thyroid hormone metabolism in people with MetS

The Effect of Training About Sleep Hygiene on HbA1c Levels of Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial

Objective: In this study, we aimed to reveal whether training on sleep hygiene have an effect on blood glucose regulation of type 2 diabetes patients. Materials and methods: Those with even protocol numbers were included in the case group and those with odd numbers were included in the control group. Pittsburgh sleep quality index was applied face-to-face to all patients included in the study and at the first admission sleep hygiene training was given to the case group. HbA1c values were noted separately as first and second visit for both groups. Those with known sleep disorders and language or psychiatric problems that would prevent them from answering the questionnaire were excluded from the study. Differences between demographic and clinical features of groups were evaluated using chi-square and Student’s t-tests. Comparisons of the case and control groups before and after sleep hygiene training were evaluated using ANCOVA test adjusted for BMI and DM duration. Results: A total of 347 Type 2 diabetes patients included in this randomized controlled trial (113 case 234 control). Significant difference was observed in the HbA1c values measured before and after the training of the case group. The second mean HbA1c (8.13 ± 2.03 mmol/L) of the control group was significantly higher than the second mean HbA1c (7.51 ± 1.42 mmol/L) values of the case group (p = 0.004). Conclusions: Our study revealed that in addition to classical diabetes treatment, sleep hygiene training also has a positive effect on blood glucose regulation of patients

The Relationship between Thyroid Hormones, Metabolic Syndrome and HOMA-IR in People with Obesity or Overweight

Objective: In the literature the data about the relationship between thyroid hormone (TH) levels and Metabolic Syndrome (MetS) components are conflicting. Our aim was to evaluate the associations between THs and MetS as well as individual components of MetS and homeostatic model assessment of insulin resistance (HOMA-IR) in euthyroid people with obesity and overweight. Materials and methods: Adult patients who presented to Family Medicine Outpatient Clinics of a tertiary hospital between May 2019 and December 2019 with the intention of weight loss were enrolled in this cross-sectional, descriptive study. The data including height, weight, waist circumference, hip circumference, blood pressure (BP), fasting blood glucose (FBG), total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride, thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), insulin, HOMA-IR, and HbA1c were analyzed. Results: A total of 175 patients, 135 (77.1%) female, 40 (22.9%) male (mean age: 40.8 ± 13.1 years), without known thyroid dysfunction were included. A total of 86 were overweight and 89 were obese. Fifty-nine (33.7%) of the study participants were diagnosed with MetS. Subjects with MetS had significantly higher level of fT3 even within the normal range (p = 0.039). When TSH, fT4 and fT3 values were compared with other metabolic components in the group with MetS, a significant positive correlation was found only between fT4 level and HOMA-IR (Rho = 0.316, p = 0.026). Conclusions: MetS was associated with high normal fT3 suggesting differential thyroid hormone metabolism in people with MetS

Wpływ palenia tytoniu i nikotynizmu na odsetek HbA1c oraz mikronaczyniowe powikłania cukrzycy

Wstęp. Cele badania obejmowały ustalenie, czy istnieją różnice w występowaniu powikłań u chorych na cukrzycę typu 2 palących tytoń i niepalących, oraz ocenę, czy zachodzi związek między występowaniem powikłań mikronaczyniowych a wynikiem testu uzależnienia od nikotyny według Fagerströma. Materiał i metody. Do badania włączono chorych na cukrzycę typu 2 pozostających pod opieką ambulatoryjnych poradni medycyny rodzinnej. Porównano osoby palące tytoń i niepalące pod względem wyników metabolicznych oraz obecności powikłań mikronaczyniowych. Stopień uzależnienia od palenia tytoniu oceniono za pomocą testu uzależnienia od nikotyny według Fagerströma. Wyniki. U palaczy zaobserwowano wyższe wartości glikemii na czczo (FBG), stężenia lipoprotein niskiej gęstości (LDL) oraz wartości skurczowego i rozkurczowego ciśnienia tętniczego. Neuropatia występowała w tej grupie znacząco częściej. Odsetek chorych ze stwierdzoną retinopatią zwiększał się wraz z rosnącym poziomem uzależnienia od nikotyny. Wynik testu Fagerströma wykazał dodatnią korelację z wartościami HbA1c oraz FBG, jednocześnie wykazując odwrotną zależność w stosunku do wartości wskaźnika masy ciała (BMI) u palących. Wnioski. Ocena uzależnienia od nikotyny u chorych na cukrzycę dokonana w trakcie pierwszej wizyty oraz nacisk na istotność rzucenia palenia powinny być zasadniczą częścią programu leczenia cukrzycy

The evaluation of the relationship between childhood traumas and smoking addiction

Introduction. Data about the relationship between childhood traumas and cigarette smoking are scarce. In this study, the relationship between childhood abuse and smoking addiction was evaluated in adults.Material and methods. This research was carried out with the participation of 216 individuals (82 [38%] women and 134 [62%] men) over the age of 18 who applied to the Family Medicine Out-patient Clinics of a tertiary hospital. They were asked to answer the socio-demographic questions as well as the questionnaire forms containing the Fagerström Nicotine Addiction Test (FNAT) and Childhood Trauma Questionnaire (CTQ). Results. The median age at which men start smoking was significantly lower than that of women (17 vs. 19 years; p = 0.007). Men have higher rates of physical neglect than women (p = 0.001). No significant difference was found between the exposure of individuals to emotional, physical, sexual neglect and abuse and nicotine addiction levels after adjustment for age, gender and education level. However, a significant negative correlation was found between the FNAT score and the CTQ total score, emotional abuse score, physical neglect score, and emotional neglect score. Conclusion. Contrary to the results in the literature, we did not find a directly proportional relationship between adverse childhood experiences and smoking addiction. This finding suggests that further studies should be done on whether adverse childhood experiences may lead not only to cigarette addiction but also to other serious conditions such as substance abuse, mental and physical health problems. Determinants of child maltreatment are multi-systemic, it therefore, makes sense that in counties with different social, cultural, and economic conditions, the consequences of child maltreatment will also be different