Effects of a 6-month exercise program pilot study on walking economy, peak physiological characteristics, and walking performance in patients with peripheral arterial disease

The purpose of this study was to examine the effects of a 6-month exercise program on submaximal walking economy in individuals with peripheral arterial disease and intermittent claudication (PAD-IC). Participants (n = 16) were randomly allocated to either a control PAD-IC group (CPAD-IC, n = 6) which received standard medical therapy, or a treatment PAD-IC group (TPAD-IC; n = 10) which took part in a supervised exercise program. During a graded treadmill test, physiological responses, including oxygen consumption, were assessed to calculate walking economy during submaximal and maximal walking performance. Differences between groups at baseline and post-intervention were analyzed via Kruskal–Wallis tests. At baseline, CPAD-IC and TPAD-IC groups demonstrated similar walking performance and physiological responses. Postintervention, TPAD-IC patients demonstrated significantly lower oxygen consumption during the graded exercise test, and greater maximal walking performance compared to CPAD-IC. These preliminary results indicate that 6 months of regular exercise improves both submaximal walking economy and maximal walking performance, without significant changes in maximal walking economy. Enhanced walking economy may contribute to physiological efficiency, which in turn may improve walking performance as demonstrated by PAD-IC patients following regular exercise programs

Influence of ethnicity on outcomes of diabetes inpatient hypoglycemia: an Australian perspective

Aims: To evaluate outcomes of diabetic inpatient hypoglycemia among Aboriginal and Torres Strait Islander (ATSI) compared with Australian Caucasian patients. Methods: A retrospective audit of diabetic patients aged > 18 years admitted at a regional hospital general ward between April 1, 2015, and March 31, 2016, was analyzed. The database contains clinical information at the time of admission and initial discharge and readmission within 4 weeks thereafter. Results: A total of 1618 (of 6027) patients were admitted with diabetes representing 23.7% of the total ward admissions, of which 484 (29.9%) had inpatient hypoglycemia. Of the 91 patients with available data analyzed, ATSI origin with inpatient hypoglycemia was associated with longer length of stay (LOS) (hazard ratio [HR], 2.1, 95% confidence interval [CI], 1.2-3.5), whereas severe hypoglycemia (≤ 2.2 mmol/L) in both ATSI and non-ATSI was significantly associated with longer LOS (HR, 2.3; 95% CI, 1.2-4.2). No significant differences in LOS were found for gender, age, and Carlson comorbidity index (CCI). The adjusted model for likelihood of readmission, gender, indigenous status, and CCI were not significant risk factors for readmission to the hospital. Readmitted patients were older (50-59 years vs < 50 years, P = 0.001; 60-69 years vs < 50 years, P = 0.032; 70+ years vs < 50 years, P = 0.031). Conclusion: We reported high rate of inpatient hypoglycemia in our study population. Indigenous Australian diabetic patients with inpatient hypoglycemia had significantly longer LOS compared with non-Indigenous Caucasian counterparts. Further prospective studies on a larger population are needed to confirm our findings

Effects of vildagliptin on wound healing and markers of inflammation in patients with type 2 diabetic foot ulcer: a prospective, randomized, double‑blind, placebo‑controlled, single‑center study

Introduction: Diabetic foot ulcers (DFU) are one of the leading long-term complications experienced by patients with diabetes. Dipeptidyl Peptidase 4 inhibitors (DPP4is) are a class of antihyperglycemic medications prescribed to patients with diabetes to manage glycaemic control. DPP4is may also have a beneficial effect on DFU healing. This study aimed to determine vildagliptin’s effect on inflammatory markers and wound healing. Trial design: Prospective, randomized, double-blind, placebo-controlled, single-center study. Methods: Equal number of participants were randomized into the treatment and placebo groups. The treatment was for 12 weeks, during which the participants had regular visits to the podiatrist, who monitored their DFU sizes using 3D camera, and blood samples were taken at baseline, six weeks, and 12 weeks during the study for measurement of inflammatory markers. In addition, demographic characteristics, co-morbidities, DFU risk factors, and DFU wound parameters were recorded. Results: 50 participants were recruited for the study, with 25 assigned to placebo and 25 to treatment group. Vildagliptin treatment resulted in a statistically significant reduction of HBA1c (p < 0.02) and hematocrit (p < 0.04), total cholesterol (p < 0.02), LDL cholesterol (p < 0.04), and total/HDL cholesterol ratio (P < 0.03) compared to the placebo group. Also, vildagliptin had a protective effect on DFU wound healing, evidenced by the odds ratio (OR) favoring the intervention of 11.2 (95% CI 1.1–113.5; p < 0.04) and the average treatment effect on the treated (ATET) for vildagliptin treatment group showed increased healing by 35% (95%CI; 10–60, p = 0.01) compared to placebo with the model adjusted for microvascular complications, smoking, amputation, dyslipidemia, peripheral vascular disease (PVD) and duration of diabetes

Diabetes ketoacidosis and hyperglycemic hyperosmolar state

Diabetes ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS) are the two most serious acute metabolic complications of diabetes mellitus. The diagnosis, epidemiology, clinical features, pathogenesis and management of these disorders in adult patients will be discussed here

Diabetes ketoacidosis and hyperglycemic hyperosmolar state

Diabetes ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS) are the two most serious acute metabolic complications of diabetes mellitus. The diagnosis, epidemiology, clinical features, pathogenesis and management of these disorders in adult patients will be discussed here

Calciphylaxis in a morbidly obese woman with rheumatoid arthritis presenting with severe weight loss and vitamin d deficiency

Objective: o present an unusual case of calciphylaxis in an obese patient with inactive rheumatoid arthritis and normal renal function.\ud \ud Methods: We describe a 46-year-old morbidly obese Caucasian woman who had previously weighed 200 kg and presented with painful leg ulcers following a rapid weight loss of 102 kg in 1 year.\ud \ud Results: The subject was admitted with a 6-week history of painful leg ulcers that progressed to her thighs. Vasculitis and active rheumatoid arthritis were excluded clinically and biochemically. A skin biopsy confirmed calciphylaxis in the context of normal renal function. Serum 25-hydroxyvitamin D was low at 14 ng/mL (reference range, 20 to 200 ng/mL), with an elevated serum parathyroid hormone level of 241 pg/mL (reference range, 10 to 65 pg/mL), but normal serum calcium and phosphorus levels. The skin lesions persisted despite local wound care, daily hyperbaric oxygen, and parenteral sodium thiosulfate therapies. After normalizing the serum vitamin D level through oral supplementation, she responded well to pamidronate infusion with complete healing of the ulcers and regained 13% of her premorbid weight.\ud \ud Conclusion: This is the first case of calciphylaxis preceded by weight loss of greater than 100 kg in a patient with hypovitaminosis D who responded to pamidronate therapy

Use of a standardised diabetic ketoacidosis management protocol improved clinical outcomes

We analysed the clinical outcomes of using a standardised protocol in the management of diabetic ketoacidosis. Of 71 admissions, the protocol group (n = 35) had significantly shorter length of hospitalisation, shorter time to normalise bicarbonate, fewer incidence of hypokalaemia and hypoglycaemia compared with the control group (n = 36)

Extreme hypertriglyceridemia managed with insulin

Extreme hypertriglyceridemia can lead to acute pancreatitis and rapid lowering of serum triglycerides (TG) is necessary for preventing such life-threatening complications. However, there is no established consensus on the acute management of extreme hypertriglyceridemia. We retrospectively reviewed 10 cases of extreme hypertriglyceridemia with mean serum TG on presentation of 101.5 ± 23.4 mmol/L (8982 ± 2070 mg/dL) managed with insulin. Serum TG decreased by 87 ± 4% in 24 hours in those patients managed with intravenous insulin and fasting and 40 ± 8.4% in those managed with intravenous insulin alone (P = .0003). The clinical course was uncomplicated in all except 1 patient who subsequently developed a pancreatic pseudocyst. Thus, combination of intravenous insulin with fasting appears to be an effective, simple, and safe treatment strategy in immediate management of extreme hypertriglyceridemia

Prevalence and risk factors for non-traumatic amputation of lower limbs in subjects with end-stage renal failure on hemodialysis in north Queensland

BACKGROUND: Data from Northern Queensland have shown high rate of diabetes and end stage renal failure (ESRF) 1; both conditions are known to lead to limb amputation2. In spite of these no study has been published that analyses the magnitude and risk factors for amputation in the sub-population.\ud \ud OBJECTIVES: The aims of the study was to document prevalence and identify risk factors of non-traumatic lower limb amputations in subjects treated with renal dialysis for chronic renal failure in North Queensland.\ud \ud METHODS: All subjects diagnosed to have ESRF who attended the Townsville Regional Hospital Dialysis Centre from 01/01/2008 till date, were retrospectively studied. Odds ratio and χ2 tests were performed to identify variables most strongly associated with amputation.\ud \ud RESULTS: We identified 8.8% prevalence of lower limb amputation in 114 subjects with ESRF on dialysis at our centre. The major risk factors of amputations in the cohort were indigenous background (Odds Ratio 0.2 [95% CI 0.03-1.2] P=0.007) and the presence of diabetes (Odds Ratio 1.9 [95% CI 1.62-2.3] P=0.003). Other variables were tested but fell short of statistical significance, these include: smoking history, gender and type of renal dialysis.\ud \ud CONCLUSION: Indigenous Australians with diabetes mellitus on renal dialysis are at risk of having lower limb amputations. Primary prevention of diabetes in the sub-population may help in reducing the limb loss. Further prospective studies on a larger population are needed to confirm our findings