The Relationship between Diabetes-Related Complications and Obstructive Sleep Apnea in Type 2 Diabetes

This study explored the relationship between obstructive sleep apnea (OSA) and the presence of any diabetes-related complications in type 2 diabetes and whether this was mediated by hypertension. Secondly, the relationship between OSA severity and estimated glomerular filtration rate (eGFR) was investigated. A total of 131 patients participated. OSA was diagnosed using a home monitor, and severity was measured by apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). OSA was found in 75.6% of the participants, 40.5% with moderate-to-severe degree. Any diabetes-related complications (retinopathy, neuropathy, nephropathy, or coronary artery disease) were present in 55.5%, and 70.2% of the participants had hypertension. Mediation analysis indicated that, compared to those with mild or no OSA, those with moderate-to-severe OSA were 3.05 times more likely to have any diabetes-related complications and that this relationship was mediated by the presence of hypertension. After adjusting for confounders, ODI (B = −0.036, p=0.041), but not AHI, was significantly associated with lower eGFR. In conclusion, moderate-to-severe OSA was related to the presence of any diabetes-related complications in type 2 diabetes, and the relationship was mediated by hypertension. The severity of intermittent hypoxia was associated with lower eGFR. Whether OSA treatment will delay or reduce diabetes-related complications should be investigated

Evaluation of Dietary Intakes and Nutritional Knowledge in Thai Patients with Type 2 Diabetes Mellitus

Introduction. Most nutritional guidelines for diabetes management emphasize the importance of having individualized goals, away from a one-size-fits-all approach. However, there is a dearth of information on the dietary intakes and nutritional knowledge of Thai patients with type 2 diabetes mellitus (T2DM). This study is aimed at clarifying dietary intakes in relationship to glycemic control and at examining nutritional knowledge among Thai patients with T2DM. Materials and Methods. A cross-sectional study of outpatients with T2DM at Theptarin Hospital and Ramathibodi Hospital (Bangkok, Thailand) was performed to assess dietary intakes by food records. Diabetes nutritional knowledge and dietary self-care behavior was also evaluated. Results. A total of 304 Thai patients with T2DM (female 52.6%, mean age 57.4 ± 10.9 years, body mass index (BMI) 27.3 ± 4.8 kg/m2, and baseline A1C 7.2 ± 1.3%) participated in the study. The mean daily calorie intake was 1427 ± 425 kcal, and mean intake for each macronutrient was acceptable (carbohydrate 52%, protein 17%, and fat 31%). However, the intake of free sugar was much higher (12.1 ± 5.8% of total daily energy intake) and dietary fiber intake (9 grams per day) was much lower than recommended. There were no correlations between dietary intake and glycemic control. A subset of patients (N=213) completed the diabetes nutritional knowledge survey. There was no association between diabetes nutritional knowledge and the actual dietary self-care behavior. Conclusion. These results indicate that compliance of Thai patients with T2DM to dietary recommendations is not completely satisfactory, especially for free sugar and dietary fiber intakes. Addressing the reality of how patients with T2DM eat in their daily lives and their knowledge gaps would enable them to adhere to medical nutrition therapy

Relationship between depression, sleep quality, and hypoglycemia among persons with type 2 diabetes

Objective: We analyzed two cohorts of people with type 2 diabetes to evaluate the relationships between depression, sleep quality, and history of hypoglycemia. Research design and methods: Two adult cohorts from Chicago (n = 193) and Bangkok, Thailand (n = 282) with type 2 diabetes completed questionnaires to assess sleep quality, depressive symptoms, and hypoglycemia frequency. Proportional odds logistic regression models for each cohort adjusted for duration of therapy, insulin and sulfonylurea management, and other factors. Results: Those with hypoglycemia in both cohorts had a longer duration of diabetes, greater use of insulin, and worse sleep quality. The Chicago cohort used less sulfonylureas but had higher depressive symptom scores. The Thailand cohort had greater sulfonylurea use. In the final Thailand regression model, depressive symptoms were independently associated with hypoglycemia frequency. In both final Chicago and Thailand models, sleep quality was not associated with hypoglycemia frequency. Conclusions: In the Thailand cohort, depressive symptoms were associated with hypoglycemia frequency. Keywords: Diabetes mellitus, Type 2, Hypoglycemia, Depression, Slee